By Dr. Jill Ratner
Four months after Dr. Michael Shaw returned from his first trip to Haiti and his first experience delivering health care in a resource limited country, we sat down to talk. Even though Dr. Shaw is a seasoned Obstetrician/Gynecologist and has done extensive volunteer work with Planned Parenthood, he admitted that nothing had prepared him for what he saw in Haiti. And as with many of our volunteers, sometimes you need some time to process the experience.
He spent his week working in the clinic at Open Door Ministry alongside trip leader and pediatrician, Dr. Allison Platt, and then focusing on his core mission: teaching life saving colposcopy and cervical cancer screening at the Justinien Hospital, the main teaching hospital in Cap Haitien. To do this he would conduct training classes and make rounds on patients with Ob/Gyn Attending, Dr. LeConte and his house staff.
Cervical Cancer is the leading cause of cancer death for women in Haiti and it strikes them in their 30’s and 40’s.
This program was first brought to Cap Haitien by another Hands Up for Haiti volunteer, Dr. Sue Malley who managed to get the first cryoprecipitate machine and screening done two years ago. (link to previous blog)
“There is no comparison with working in a clinic or office in the United States and the conditions in which you see patients in Haiti- the heat, the lack of equipment, nothing is clean despite all efforts- you can’t be ready for that”. Despite that, he commented that the cases he saw in the hospital were extremely well managed, and the outcomes were going to be good. The patients were suffering from complicated medical problems such as uterine perforation after an abortion and severe pre-eclampsia of pregnancy. Despite the environment of crowding, lack of basic hygiene control, and incessant flies in the hospital, patients were receiving good care.
Dr. Shaw felt that cervical cancer screening with colposcopy and “see and treat” protocol was definitely the “way to go” in this setting, especially since obtaining routine Pap smears is not possible for the millions of women at risk. He felt that there were women with pre -cancerous or cancerous lesions that he treated and he was sure that they will have good outcomes because of this. “The equipment is old, difficult to focus and needs upgrading”. One of Dr. Shaw’s goals will be to try to obtain a new culposcope and cryoprecipitate machine for the program.
Although Dr. Shaw recognized that doctors were trying their best to deliver good care, he did feel there was much need for increased sensitivity to the rights of patients for respect and privacy even in this setting. It is a different culture and “The lack of drapes during exams, the lack of privacy was really hard for me to see.”
As far as Hands Up for Haiti was concerned, Dr. Shaw had nothing but superlatives. “I always felt safe and the trip leader was “tremendous”. “From the moment I stepped off the plane, until returning home, our Haitian team was always there and escorting us through sometimes tricky situations”.
As for most of our medical volunteers, the first trip is always the hardest. “It was difficult being without the support of my family and other Ob-GYN colleagues. I am not ready to go back…..yet. When I do go back, I think the way to go will be with an experienced operating nurse, and maybe even an anesthesiologist. I would be willing to continue to work on the cervical cancer screening and on the operating room protocols and techniques with the Haitian doctors and nurses.”
There were bright moments as well. “One of the highlights of the trip for me was watching Allison treat the children from the orphanage. The children were so grateful for the attention and care. It was emotional and heartbreaking all at the same time”.
In the meantime, Dr. Shaw is continuing to support Hands Up for Haiti and its work, and will be actively seeking improved equipment that will make treatment options even better.