Ophthalmology & Urology June 2013: Daughter’s Perspective

By Erica Bromberg

I returned from my second mission to Haiti this past weekend and it was just as good as the first trip, if not better. This trip was very different for a few reasons. First, there were twelve of us, making the group a lot larger than the December mission. We also had many more guys (great for travel purposes in terms of carrying and lifting bags and staying safe, not so great when the guys claimed the larger room for sleeping accommodations at Open Door!). Second, my Dad came on this trip, spearheading Hands Up for Haiti’s Urology team.  Lastly, the group performed both ophthalmology and urology surgeries, which I was able to observe.

Although there was only one other person under the age of 30 (I think it would be safe to say 40 or even 50…), I enjoyed working with every person on the team. As with the December trip, my mom was the trip organizer and leader. Mom did not stop thinking, organizing, teaching, leading, and caring for patients all week; she truly was an amazing leader.

Mitch, Mom’s co-leader and Dad’s “twin”, returned on this trip as well. This time I was able to observe a few of the eye operations Mitch performed.

After Dad saw how much I enjoyed my first trip, he decided to join us on this mission, in essence forming the organization’s urology team.

Dad was accompanied by Joanne, an [amazing] RN who works with Dad at home. Joanne helped Dad examine patients at the clinic by checking blood pressures, collecting urine samples, etc., and she assisted Dad and the Haitian surgeons in the OR at Justinien Hospital.

John, an ophthalmologist whom we have known since we moved to Armonk twenty one years ago, joined my mom and Mitch as the third ophthalmologist on the trip. I was also able to observe John perform surgeries.

Michael is an OD (optometrist) in Westchester who joined the eye team on this mission, doing complete eye examinations as well as teaching the optometrists at the clinic in Cap Haitian.

Wendy, an ophthalmic technician, was a crucial member of the team, performing auto-refractions on every single patient as well as assisting with other eye exam procedures.

Charlotte, an OR nurse, performed vision exams at the clinic and assisted the eye surgeons in the OR at Vision Plus Clinique.

Charlotte’s husband, Dwight, was a key member of the team, registering patients at the Open Door clinic and documenting our trip through photographs.

Mike, a pre-med post-bac student at Columbia, came on the trip with the same intentions as me – to learn as much as possible. It was great having another pre-med student on the trip (and someone relatively close to my age!).

Lastly, Geral (also known as Jean), returned to his birthplace of Haiti for the first time in thirty years. Not only was it great having a member of the team who could speak Creole, but Geral is possibly one of the friendliest people I have ever met. Geral works for Propper Manufacturing and came on the mission to repair instruments as well as teach the Haitians how to do so.


Upon returning to Open Door where we were staying for the first few days, I had the sensation one feels when returning home after being away for a long time. This feeling was pleasantly surprising, as it confirmed that I was excited to be doing another medical mission. I also noticed some progress. The clinic had the beginnings of a second story and there was an additional building in front of the school.

It was great seeing Pastor, Ma Pas and all of the young translators again. All of the Haitians agreed that Dad and Mitch look identical – when Mom introduced Dad as her husband everyone said “No, that’s Dr. Mitch!”
Since we didn’t arrive until late in the afternoon on Saturday, we spent the rest of the day unpacking the medical supplies from our suitcases, ate Ma Pas’ home-cooked dinner (I missed those chicken legs!), and went to bed.
Day One
Our first day in Haiti was a Sunday, so we went to Church in the morning. Since the service did not start until 10am, we spent the morning organizing the supplies in the clinic so that we would be ready to see patients the next morning.
The church service was full of songs, shouting, and a lot of hands in the air.
Pastor had Mom announce our team to everyone and Geral translated into Creole. I received a shout out for convincing Dad to come to Open Door. Pastor was very excited to offer urology examinations to his community.
When we left church there were a bunch of kids waiting outside so we handed out stickers. The kids absolutely loved the stickers. They would hold out their hands (most would also grab our arms or even try to grab the stickers) and say “Blan! Blan!” This is the word for “foreign white person.” The teenage girls were very interested in asking what my name was.
In the afternoon we went over to the orphanage. Propper gave us a bunch of shirts to give to the children. I was very happy to recognize a bunch of the orphans from the last time I was there. It was reassuring to see that they are still being taken care of.
After the orphanage we went back to the Mission to finish setting up clinic for the next day. Dad and Joanne gave a community education talk, which Geral translated. The talk was extremely successful; the Haitians were very interested in what Dad and Joanne had to say and were asking a lot of questions.  Dad and Joanne covered male and female anatomy and a lot of the questions dealt with menstruation and sex. The level of education appeared to be much higher than what was anticipated.
Day Two
Monday was a full day in the clinic. I spent most of the day checking visions after Wendy auto-refracted patients.
I got to watch Dad and Joanne doing the urology exams (such as prostate checks) – something I definitely don’t get to see at home! One man had a hydrocele on one side and a testicular mass on the other.
Dad and Joanne taught me and Mike how to check blood pressures. We practiced on one of our favorite translators, Tiroro:
Day Three
We spent Tuesday morning at the clinic again.
Geral and Dwight registering patients:
Mitch examining a patient at the slit lamp:
John prescribing glasses:
Mom and John performing exams:
Charlotte checking visions:
Me and Mike with our stickered friend:
In the afternoon, Mike, Dad, Joanne and I drove into Cap Haitien to begin working at Justinien Hospital. We met Dr. Desir, the head urologist at the hospital with whom we would be working all week. The company Karl Storz donated a lot of instruments for us to bring to Haiti so we gave those to Dr. Desir first thing. He was so appreciative.
Next we got a tour of the hospital. In the recovery rooms were rows of beds with people, windows were open and flies were all over the patients, nurses were dressed in white caps and stockings, and there were bathing bins next to each bed. There was no air conditioning except for in the two operating rooms. We saw a few mice running the length of the hall outside of the OR… It was truly medicine from the 1920’s. After operations, patients are wheeled from the OR, outside, and up the street to the recovery room. This happens rain or shine.
Patient being taken to the OR
Operating room entrance
Scrub station (no running water)
Operating room
Dad and Joanne at the urology entrance
The urology section of the hospital
Day Four
Mike and I spent Wednesday with Dad and Joanne at the hospital. We watched a cystoscope in the morning (looking inside the urethra and bladder with a probe) and then observed three operations – two supra-pubic prostatectomies and a hydrocelectomy. Dr. Desir and Dad let us all peek inside to see where the bladder was cut open. The only complication of the surgery was when the peritoneum was accidentally cut into when opening the bladder, and as a result part of the intestine started poking through. Apparently this is very common since the peritoneum is so thin. The craziest part of the surgery was the contraption that was set up at the end in order to keep pressure on the cavity where the prostate once was. A catheter with a balloon was inserted into the patient and a rope leading down the patient’s leg to his foot was tied to the end of the catheter in order to create a stirrup. Talk about primitive medicine! The third operation (hydrocelectomy) was the most “fun” to watch. The scrotum was cut open and 2,500 mL of fluid was drained from one side of the hydrocele and 500 mL from the other side. Each surgery took about an hour and a half.
Dr. Desir and Dad
Joanne, Dad and Dr. Desir
Dr. Desir digging for the prostate!
Joanne and Dad showing me the bladder during surgery
Me, Dr. Desir, Joanne and Dad
Translator Guindy spent the day with us and it was perfect for him because he wants to work in the medical field. It was his first time seeing surgery and he had a blast.
Day Five
Thursday I spent the day with the eye team at the clinic. We saw a lot of pathology as usual. Sandra’s cousin came in to have her eyes checked – she is completely blind in one eye and has nodules on the other eye. A doctor told her to have surgery in the Dominican Republic to fix the blind eye, which would have been a complete waste of time and money. A fifteen month old baby had crossing eyes but both were functioning separately (called alternating esotropia), which is a good sign. This means that the brain is still using both eyes so if we can get a pediatric surgeon to come on the next trip they will be able to operate on the baby.
Vision Plus Clinique
Teaching moment
Mom examining a patient
Baby loving the light (until it was in his eyes)
Mom examining the baby with alternating esotropia
Charlotte and a patient
Michael examining a patient with translator Sandra
I watched a few phacoemulsifications (cataract surgeries) in the afternoon. I had never seen eye surgery before and it was fascinating. I couldn’t believe that the patient was not sedated during surgery, only the eye was numbed. The surgeries took close to an hour each, but at home Mitch and John are able to do them in about half hour or less. These took more time because the Hatian doctor is relatively new at performing the procedure and Mitch and John did a lot of teaching. Mike and I were allowed to look into the oculars of the microscope from time to time to see what was being done.
The eye surgeons and nurses in the OR at the eye clinic
Mitch and the Haitian doctor performing cataract surgery
Wendy checking a patient’s vision
Michael teaching the Haitian optometrist
Charlotte in the OR
Geral spent each day at the clinic teaching Tiroro how to fix machines, since Tiroro hopes to come to the US and go to school to be a mechanic. Geral became a hero when the machine used for performing eye surgery broke and having never seen the machine he was still able to open it up and completely fix it.
Geral and Tiroro
Geral fixing things!
Day Six
I spent the morning of our last day with the urology team and the afternoon with the eye team. I observed a few more surgeries more surgeries and while with the urology team I saw bladder tumors being removed.The last night we had the usual big dinner back at the hotel with all of the translators and the Haitian doctors. I was sad to part with the Haitian doctors and translators; I felt as if they had become my friends. I really hope to return on the next mission.