A Place Called Fond-des-Blancs:
The Tourists Don't Come Here

John W. Logue, FACHE, Executive Vice President
and Chief Operating Officer, St. Vincent's

Getting There

It's probably safe to say that most people's geographic knowledge of Haiti is that it's part of an island in the Caribbean. What they may not know is that it's a pretty rugged place. Two thirds of Haiti is mountainous. Consider also that Haiti is one of the poorest countries in the Western Hemisphere. Things we take for granted like telephones, electricity, running water and paved roads are either in short supply or just don't exist at all. That means that just getting to the village of Fond-des-Blancs in the back country mountains of Haiti is always interesting. You learn patience. When we arrive in Haiti's capital, Port-au-Prince, we get into Land Rovers for the 60-mile journey to Fond-des-Blancs. The last time we went was a perfect example of what usually happens. It took four-and-a-half hours. Some of the creeks along the way were flooded, and we had to wait for the water to go down. So, you're patient, and you wait. Eventually, you get there.

A Room With a View

On that first visit 14 years ago, I had what I call "A Room With a View" in Fond-des-Blancs. Let me explain because it's a picture that is one of those that has stayed with me over the years, and I know it always will. When we got there 14 years ago, the clinic at the time was a building with two rooms. Registration for patients was on the porch. There was a waiting room and a doctor's room. There was also a dental clinic out back, and that became my room with a view. The medical personnel at that time consisted of one person — a French male nurse who was working in the dental clinic. My first-ever job in Fond-des-blancs was to assist him in the pulling of teeth for the Haitian people who came to the clinic. Patients sat in a dental chair that was so old, it was held in place with a large rock. There was a window that was wide open to the outside, and families of the patient would rest their arms on the windowsill and lean inside to watch the pulling of their loved one's teeth. That was my room with a view. Among the medical equipment that we took to Fond-des-blancs on our most recent trip was a new dental chair, a symbol of the way so many things have changed since our first trip. But some things have not changed. The need of the people there has not. The last time I saw that old dental chair, it was sitting and waiting to be picked up to go to another clinic in Haiti because it was better than the one they had. I think that's a good kind of monitor for the level of poverty in Haiti.

A Prescription of Collaboration

Over the years, Fond-des-blanc has gotten higher and higher doses of collaboration from the health care community here in Jacksonville. In 1995, my first year at St. Vincent's Medical Center after moving down from Boston, one of our ICU nurses, Judy Bishop, went with us to Haiti. That was the year we opened a 20-bed hospital and an outpatient medical clinic. At that time, we were still making just one trip annually. A few years ago, Dr. Ken Koster, Chief of Cardiovascular Surgery at Baptist Medical Center, heard about our trips and decided he wanted to go to do whatever surgery he could do. Word quickly got around Fond-des-Blancs that he was there, and Haitians who needed different kinds of surgery appeared at our hospital. We did 30 cases. I can still hear Dr. Koster saying, "We have to have an operating room." He's the one who really encouraged us to raise money for an OR at Fond-des-Blancs. It opened in June 2000. We're able to perform procedures that we consider relatively simple here -- nothing requiring blood or lab testing, no surgeries that involve going inside the abdominal or chest cavities. We perform surgery to remove many tumors and hernias. Simple here, but a very big deal in Haiti. Many of the tumors grow to immense sizes and are terrible deformities. The same is true with hernias. We were able to help a Haitian man, for example, whose hernia was the size of a grapefruit between his legs. For another of our patients in Fond-des-blancs, one half of the intestinal tract had migrated into the hernia. It's completely safe to say that, without our hospital and the help we've been able to bring, these people would never get help. In the year 2000, we made four trips to Fond-des-Blancs. Three of those four trips saw a continuation of this wonderful collaboration and something that hadn't happened before. Three anesthesiologists -- all from Baptist Medical Center -- made the trip to Fond-des-Blancs. Dr. Mark Kramp made the trip in April 2000; Dr. Pam Reicheld followed in June; Dr. Tim Besser went in October. This coming year, we'll have six Haiti expeditions. Two of those will be general work trips. The other four will be surgical trips. None of this would have happened without collaboration -- donations of money from St. Vincent's and Baptist, from friends and suppliers -- and donations of time and skill from physicians and nurses from both hospitals.

Side Effects

When you talk about our work in Fond-des-Blancs, you have to talk about the side effects. Each time I go back, I see more and more of what I consider an economic engine, and it's happening because the hospital is there and continues to grow. Remember that, when we started 14 years ago, there was really no health care for the people in and around the village. Today, the hospital has a staff of 40 people including three fulltime Haitian doctors, 8 nurses plus lab and pharmaceutical technicians. The facility includes the phase one areas of a waiting room, registration room, two physician consultation rooms, emergency treatment room, laboratory, pharmacy, delivery room, rooms for twenty patients, rooms used by the staff and visiting physicians, and a place to cook for patients. That last item is very unusual in Haiti where families usually have to cook for their loved ones and carry the food into hospitals. The second phase of our hospital includes the operating room, reception area, physician examination area, room for patient preparation and our OR recovery room. We also have guestrooms for visiting physicians and nurses, nutrition center, education classrooms, storerooms for food and pharmaceuticals and a dental clinic. That kind of improvement brings another kind of change. The market, such as it is in Fond-des-Blancs, is definitely growing. There's no doubt about it. The small stalls with their tops of cloth or thatch are increasing in number. That's because more and more people come there for the care they can get at the hospital. Their families come with them and are staying there, rather than remaining in the slums of the cities. Fond-des-Blancs has gone from no health care to having a hospital that sees 120 patients each day. There are still no telephones in Fond-des-Blancs, but the economic engine has changed communications, too. Yes, there's e-mail! Communications from Fond-des-Blancs can go over short-wave radio to Port-au-Prince where a missionary group sends the messages by satellite to its contacts in San Francisco, and the messages are put on the Internet. A hospital brings change, and it's good change.

A Whole New Meaning to Triage

Since we started surgery, we're finding patients with conditions that are too difficult for us to handle in Fond-des-Blancs. For some time now, we've been bringing those patients back to Jacksonville for treatment. The first five patients all had very large face and neck tumors. Last summer, we began to help a Haitian with a large tumor of the jawbone. Treatment will involve several trips to Jacksonville. The first -- for removal of the jawbone and implanting of a plate _ has already happened. The next trip will be for physicians to remove some of the bone around the hip so that it can be fashioned into a new jawbone. Three or four months after that, our patient will return so physicians can implant the new jawbone. Jacksonville oral surgeon Dr. Pairot Tayapongsak has been so very gracious with his time and skills in performing surgery on these patients. As I'm writing this, there are patients from Haiti here in Jacksonville for surgeries and treatment we could not do in Fond-des-Blancs. Often, we invite the patients to stay with us in our home. That's always so interesting for a couple of reasons. First, they speak only Creole. We've picked up a bit of the language, but we are by no means fluent. We keep a Creole Dictionary in the house, and somehow we manage to communicate. And it's just interesting to watch them in our world. For example, the Haitian woman staying with us in our home now is absolutely fascinated with the vacuum cleaner. She asks constantly if she can vacuum because -- for her -- it's great fun. One thing's for sure; there's not a speck of dust anywhere in the house right now!

Now What?

At this point, we want to do as much education of Haitian medical personnel as possible. I believe our efforts to upgrade the level of medicine practiced in Fond-des-Blancs will have even more long-lasting impact if we can teach the people there how best to care for themselves. This will allow the work we do to spread much further. Now, that sounds very simple, doesn't it? It's not simple, even though the people we get to work with in Haiti are quite intelligent. I know the literacy rate in Haiti is low -- less than half of people 15 years and older can read and write -- but the people we work with are smart. They're eager to learn and catch on very rapidly. We show them how to do something, and they catch on and go with it. The trouble is that they don't have the resources for us to teach them -- equipment and supplies. So, like everything else in Haiti, this new focus of ours will take time. We've started, though. Last June, we delivered the first automated piece of lab equipment to Fond-des-Blancs -- a 7-channel lab chemistry analyzer. We had an interpreter, and we were able to train our Haitian lab technicians how to use it. Sherry Updyke, a lab technician for St. Vincent's, spent a week in June and another in September conducting training in Fond-des-Blancs. Next on our list will be x-ray training. We're sending detailed instructions on how to construct the x-ray facility there. About a month from now, we're bringing a physician from Haiti here to learn how the equipment works and how to use the information it offers. After that, we'll ship x-ray equipment to Fond-des-Blancs. All good things take time -- especially in Haiti. When you ship things, only God knows how long it will take to get there. We shipped all of our equipment for the operating room one November; we got it out the following July. So, x-rays are coming to Fond-des-Blancs. The exact date is….flexible. At the same time the physician from Haiti arrives here for x-ray training, a very special lady will be leaving Jacksonville to go to Fond-des-Blancs. It's Elyse Baird, a nurse who's decided to leave her position at Baptist Medical Center to work in Fond-des-Blancs for one full year. Baptist is paying her full salary during three months of intense training in the operating room before she leaves for Haiti. We're all impressed about her decision, Sandy especially. Sandy says that she's stayed as long as one month at a time herself, and she acknowledges that _ as kind as the people there are to her -- it gets lonely. Elyse's decision to stay for a year is critical to future progress at our facility. She'll be teaching more modern nursing techniques to our Haitian nurses. One of the reasons we haven't been able to increase the kinds of surgeries we do there is that the nurses are not trained in post-operative surgery care. Elise will concentrate on that, and her presence will give us a kind of continuity we haven't had before. Her work will make an enormous difference.

Dollars for Donkies

If you live in Jacksonville and you want to go to the hospital, you usually just get in a car and go. If you live in Haiti, you walk or -- if you're lucky -- you get on your donkey. For a Haitian family, the donkey is a very valuable part of everyday life -- just like our cars are to us. Not long ago, we brought a girl from Haiti to Jacksonville for surgery. She stayed with Sandy and me in our home. While she was here, we learned that her mother had sold the family donkey in order to pay for the girl's passport. Sandy got busy and started a project that she calls "Dollars for Donkeys." She used our personal e-mail address and began asking people we know to contribute a small amount to "Dollars for Donkeys." Sandy has received enough to buy a donkey for that family and more. That's a good thing because we've learned that the families of other patients have sold their donkeys to pay expenses connected to their medical needs. She'll take the "Dollars for Donkeys" when we go back to Haiti next time. There are so many great side stories like that one because — while delivering better medicine there takes physicians, nurses, technicians, equipment and supplies -- it also requires something else. You have to care about the people very much. What I've found is that care winds up being returned in a very big way. When we began building there, for example, all of us wanted the people of Fond-des-Blancs to be involved. Many of them ground up stones by hand and delivered the gravel so that it could become cement blocks. That whole hospital is made from hand-formed concrete blocks. In a way, you could say the people of Fond-des-Blancs built their own hospital. I hope that, as the years go by, it might be part of longer, healthier lives for the people of a country where the average life span is now less than 50 years.

My Number One Fondest Memory

Someone asked me the other day what my number one fondest memory is of all the years of trips to Haiti. For me, that was an easy question to answer. As I already mentioned, we knew it was important for the people of Fond-des-Blancs to feel that the hospital is theirs. When it was time to celebrate the operating room's official opening, we asked that they help prepare for the big day, and they did so in a very simple way. As the dedication time neard, at least 100 of them came and got down on their hands and knees in the hallways and rooms. They began to scrub away. While they cleaned, they sang in Creole at the top of their voices. They were singing the old hymn "How Great Though Art." I can still see that picture and hear those sounds. And that is my number one fondest memory from Fond-Des-Blancs. Of course, as the years go by, I may have a new memory that tops that. Ask me again, I told this person, in a few years about my number one fondest memory from Fond-des-Blancs because Sandy and I will keep going back. Six Haiti expeditions in 2002. Perhaps more the year after that. We have to keep going back, and we can't wait to get there. I am deeply grateful to all the nurses and doctors who have helped us by going with us to Haiti or by caring for our patients in Jacksonville. St. Vincent's Medical Center, Baptist Medical Center and Wolfson Children's Hospital have been wonderful in providing care to the many patients who've come with us to receive care here in Jacksonville. We believe in what we do, and we have learned to love the Haitian people. I don't know another place in the world where you can go and see that the things you do truly make a difference. Truly.

A Place Called Fond-des-Blancs

St. Boniface Haiti Foundation 2002 Expeditions

• Work Retreats: January 28 - February 6
• July 8 - July 17
  
• Surgical Trips: January 23 - January 27
• April 3 - April 7
• July 10 - July 14
• October 9 - October 13
  

For more information, call the St. Vincent's Community Relations Dept. at 904-308-7437.

Jacksonville Medicine / January, 2002

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