Our plane hits the tarmac at Fort Lauderdale, Florida. We are back in the first world, home from the fourth world.
Where is the fourth world?
For me, the fourth world is a place which may have been third world or even second but has been devastated by the forces of a natural disaster and/or has been reduced to socioeconomic ruin by long standing corruption and internal and external greed.
This place is Haiti.
90 minutes by air away. Driving home from the airport, we cover the 50 miles in 40 minutes on the smooth freeway. I stare out the window at the big cars, the well- constructed buildings, groomed fields. By contrast the ride to the airport in Port au Prince, Haiti, takes over an hour and was around 10 miles. Broken road, broken down cars and trucks, broken homes and broken lives. But not always broken spirits. Beautifully dressed children busy markets, people in survival mode, stunning art works hang for sale, beautiful music coming from groups of clustered musicians.
The air is thick with dust, almost everywhere there is rubble and piled rubbish, seemingly oblivious to it children kick plastic bottles, play, most are helping in the markets, sweeping, sitting with older folks, a few lucky ones walk to school in pressed uniforms.
The wet season is coming, drains are blocked and there is going to be flooding.
UN troops are scattered thinly on the ground, many tent villages are subject to crime and sanitation is non- existent.
Back home I turn on the news. The first item I see touts the fact that life expectancy in the US has reached record highs…
What can Haitian children expect from their lives? 100,000 were orphaned by the quake and thousands more subsequently by disease like cholera. A public health disaster continues to unfold there.
20,000 of these orphaned children are fortunate enough to shelter in orphanages that have set up around Haiti, some have sheltered with other families and some fend for themselves, as young as four or five years old.
5% of children receive education.
We have spent the week seeing patients and operating at the Adventist Hospital. We are hosted in Haiti by Dr Terry Dietrich, orthopaedic surgeon, US trained, and his wife Jeannie, a couple who have, through their faith and their training, dedicated time late in their careers, helping in Haiti. We are joined by Dr Scott Nelson, orthopaedic surgeon, from California, who has chosen to devote a considerable part of his time practising in this country and in adjacent Dominican Republic. Helping him is his current resident Ben Chen.
Our surgical goals this week have been primarily aimed at children and young adults with severe limb deformities. Conditions such as untreated club feet, a case of congenital pseudoarthrosis of the tibia, Blount’s disease where children’s lower limbs gradually become more bowed, fractures that have not healed or have healed in a deformed position, Rickets, an osteo-dystrophy often secondary to Vitamin D deficiency that for several children has left them with severe lower limb angular deformities.
We are lead, from the front, in this directive, by Dr Dror Paley one of, if not the world’s, foremost, surgeons in this field. Dr Nelson has fellowship training from Dr Paley and is already highly experienced. Dr Dietrich has amounted a large number of challenging cases for us through his clinics conducted here over the past six months. We are strongly supported by physician assistants John Robb and Servando Guiterrez and Mark Smith orthopaedic technician
Anaesthesiologist Ann-Maries James from St Mary’s and visiting anaesthesiologists from central California, Steve Mulder and from the Dominican Republic, Dr. Adrien. We have experienced and invaluable equipment and intraoperative support from Smith and Nephew’s Tom Davis and Jeff Reeve from Orthofix. We have photographic, documentary and logistical support from Aviva Paley, daughter of Dr Paley.
This was our team, we are supported by many Haitian and visiting foreign staff of the hospital and the hotel. I am very thankful for their huge efforts.
I will document our surgical cases in another forum, needless to say that this was a phenomenally challenging and educational week. A truly rewarding time in our medical careers.
At the conclusion of our final surgery, I return one last time to our patients to check on them and to say farewell. I am embraced on the ward by old folk who are grateful for our visit. Children who faced already a difficult life made near impossible by debilitating deformities lay recovering from their surgeries, starting to manage a smile again.
I wonder if Haiti can get back on its feet again? If the spirit of these children is any sort of gauge, then yes it can. But it is going to take a much greater commitment. I know that on their own they cannot.
Our work is a mere drop in the bucket. Teams need to return here, again and again .Dr Paley is committed to do this and with the recent establishment of the Paley Foundation this is now a very real probability. Haiti needs anyone. They need skilled labour and unskilled labour. They need teachers, mechanics, plumbers, electricians. There is so much that anyone can do here and there are agencies and avenues in place for people to help.
Most of all, Haiti, the fourth world, an hour and a half way, needs the people of the first world to think of them and do something, no matter how small, to lift them back up.
Dr Chris Fougere.
New Zealand Orthopaedic Surgeon
Fellow to Dr Dror Paley, of the Paley institute,
St Marys Hospital, West Palm Beach