Dispatch from Hôpital Sacré Coeur: Dr. Brian Liddy and the KAPHLUMPHH!!

Dr. Brian Liddy, an anesthesiologist originally from California who now works in York, Maine recently spent a few weeks as a volunteer with Hôpital Sacré Coeur (HSC) after the devastating earthquake struck Port-au-Prince. Dr. Liddy documented his experiences working in Haiti and HSC through his own blog An Anesthesiologist's Journey to Sacre Coeur hospital in Milot, Haiti and the 100 Beds for Haiti Campaign recently caught up with him to ask him more about his experience working on the ground and to get his perspective on why the 100 Beds for Haiti Campaign is important for the short-term benefits and the overall long-term recovery efforts to rebuild Haiti.

100 Beds For Haiti (100 Beds): You're an anesthesiologist working at York Hospital in Southern Maine; what brought you to CRUDEM and Hôpital Sacré Coeur (HSC)?

Dr. Liddy (Dr. L): I have always been interested in travel to developing countries and international medicine. I have travelled extensively in Mexico, Costa Rica and Turkey. I was evaluating several places to go for my next Medical volunteer trip when the Haitian earthquake happened. I knew right away that I had to offer my services to the Haitians. For a disaster of that magnitude to happen to a country with no existing infrastructure? What a catastrophe. I saw all the news clips coming in and the suffering I observed in the Haitian people really affected me on a professional and on a human level.

I was connected with CRUDEM/Hôpital Sacré Coeur through a connection at the American Society of Anesthesiologists (ASA). I felt like my skills would be particularly useful there because they had operating rooms that were up and running. Thus, I could do clinical anesthesia and spread out their workload a little bit. I was able to get 2 weeks off from work thanks to my colleagues and I went down.

100 Beds: Have you ever done humanitarian or disaster relief work before?

Dr. L: I spent 5 weeks traveling around rural Turkey about ten years ago as an ER physician. I helped teach the Turkish residents and Medical Students in eight or so different hospitals. It was a great experience.

I have never done disaster relief on the scale that I found in Haiti. I’m not sure many medical providers have!

100 Beds: What were some of your first impressions when you arrived in Milot and HSC?

Dr. L: Milot was actually much smaller than I expected. It was a very tight-knit, “homey” sort of community. Everyone was very welcoming in Milot. It was much cleaner than Cap Haitien, the city I flew into. Milot actually had some paved streets, a rarity in Haiti.



The first thing that really struck me about HSC when I arrived was how ORGANIZED the place was! I was expecting chaos. After all, they had to expand from a 65 patient bed hospital to treating over 400+ in two weeks! The OR area had been converted from 3 to 5 working OR/procedure areas. I was expecting I would be doing surgeries outside in tents! The tents for patients had already been set up. The volunteer area had been expanded to hold all the extra volunteers. It was very impressive. It was a real, functional hospital in the middle of the poorest country in the Western Hemisphere.

100 Beds: Before you left for Haiti you set up your own blog reporting your own experiences and observations working at HSC. It was really moving to read your different entries starting a few days before you left to your return back to the U.S. You also took quite a few photos of different patients both recovering and during surgery. What was it like to document your own experience on the ground?

Dr. L: Thanks! I really enjoyed writing the blog. It helped me decompress after the long, stressful days away from my family. I wanted to share my own experiences down there to give people a sense about what it was really like to work there. Most of what people see of Haiti on CNN or the other news channels definitely has a “spin” on it. The news networks are in the business of attracting viewers so they are going to find the most shocking or awe-inspiring stories to report on. They aren’t going to talk about the different types of rice and beans the volunteers share with the patients and such... or the roosters that keep the volunteers up all night (laughing).

The kids loved having their pictures taken. Most of the pictures I took of the kids were with cards that my kids’ classes made for them. They LOVED those cards! Even the teens. They were SO
into those cards!




100 Beds: On average, how many patients did you see a day and about how many surgeries were able to be performed each day?

Dr. L: Wow. That’s hard to figure but I would say in an average day I personally did between five and eight cases. The OR was doing at least 30 cases a day. I was there late February and they had done upwards of 800 cases for 2010. Last year they did 1200 cases in the entire year.

100 Beds: As a doctor working in a hospital in the U.S. with access to some pretty advanced technology, how were you able to adapt to the technology available to you at HSC? What were some of the most challenging aspect of diagnosing patients?

Dr. L: In anesthesiology, the main concern was safety. We tried to keep the anesthetics as safe as possible for the patients. Since we did not have access to the most modern anesthesia machines, we tried to do regional anesthesia (spinals and nerve blocks) as much as possible. Regional is pretty “low-tech” : although one of the Duke/Raleigh anesthesiologists that came down brought his own ultrasound for nerve blocks. That was pretty slick! (laughing)


The thing I found the most challenging was not being able to get ( or find) lab results on my patients. I knew they were ordered, but I couldn’t ever, for the life of me, find them. That tends to make things challenging. Your patient is hypotensive and tachycardic. Is it a result of the spinal or is it because their Hemoglobin 4? (Normal is 15)

100 Beds: You mention that Phillips Electronic donated a "fluoroscopy unit for 'real-time' X-rays in the operating room". What did this mean for the OR?

Dr. L: That was huge. We had the only fluoroscopy machine in all of Haiti! A fluoroscopy machine lets the surgeon see immediate X-ray images intra-operatively. When all the original, emergency repairs took place this was not available to the surgeons. As a result, the orthopedists were taking their “best educated guesses” as to how the bones would line up best.

Once they got the fluoro machine they could re-do the repairs with much better fixation and alignment for long term recovery. We were getting 4-5 patients flown in daily from all over Haiti to have their fracture fixations revised. The orthopedic team was absolutely pummeled when I was there.

100 Beds: You describe one patient, a 17-year old boy who among other injuries had a fractured skull with parts of the skull effectively dead from infection, and needed to be removed to prevent an even more serious infection like meningitis. The decision to operate was a complicated one because this particular piece of the skull rested over a large vein that drains blood from the brain (so any sort of tear could cause immediate death) and you had only one unit of blood that you were unable to test for HIV. How did you and your team evaluate this case, including the mitigating circumstances, and chose to operate?

Dr. L: Yeah, that was a tough one. He was the nicest kid too. He was an orphan but had such a great attitude about everything.


With him it came down to: without the surgery, he was certainly going to die from an extension on the infection intra-cerebrally. There was a much smaller risk of tearing his sagittal sinus and an even smaller risk of contracting HIV from the blood transfusion. So, even though the surgery and transfusion would entail some risk, “gonna die” trumps “slight risk of dying” to put it bluntly. So we elected to proceed. Luckily, he did fine and there were no complications.

100 Beds: Haiti has one of the world's highest HIV rates, did you find this to be an added challenge when treating patients?

Dr. L: We practice universal precautions with all our patients and assume “everyone could have HIV” in the US. So it didn’t feel any different in Haiti, although I must confess I was I bit more wary down there. The diseases I was more concerned about were malaria and tuberculosis (TB). Several volunteers I talked with contracted malaria on previous visits. That didn’t sound the least bit fun.

TB runs rampant in Haiti and it is, in fact, one of the leading infectious causes of death in Haiti. We took care of numerous patients with TB and probably many more that are undiagnosed. HIV is relatively hard to catch, TB is relatively easy to catch.

100 Beds: One passage from your blog struck me as particularly moving and in keeping with our 100 Beds for Haiti Campaign, I found extremely relevant:

“It is now 10 PM and having just transported our last patient of the day on an army stretcher, across the dirt road, in the rain, to his current home in Tent #5 where he will spend the night with 50 other patients, I’m going to pass out on my own cot. zzzzzzzzzzzzz”

HSC has about 73 patient hospital beds, and is treating well over 300 patients. Many of these patients are recovering in the Tent City set up across the road from the hospital, sleeping on cots; and, even you were sleeping on your own cot! Can you describe your response to the condition you were working and living in?

Dr. L: Ha ha. Yeah, I was pretty tired when I wrote that. We all realized that when we were heading down there, it was not going to be “Club-Med” and our accommodations were going to be somewhat spartan. We weren’t getting the best sleep in the world but none of us were complaining. We knew it was as bad if not worse for the patients. That patient that I described just had a revision of his lower leg external fixation device. So Sam, a medical student and I carried him across the street in the pouring rain and we were all soaked. The patient plopped himself down on his cot, KAPHLUMPHH!! He and his family thanked us profusely. All the other patients were peering out from their sheets to see what all the commotion was. I couldn’t help think, “I have absolutely nothing to complain about”. But, I really think he would have benefited from a real hospital bed. The cots are far from the least comfortable thing to sleep on (that prize goes to the luggage compartment floor in a Czech second class train) but post fracture fixation patients do require a bit of malleability in their resting quarters. They really need their fractures elevated and such.

100 Beds: Haiti has a long way to go on its own road to recovery but from your own experience and observations what does an increase in support and donations from professionals volunteering their time and skills to monetary donations mean in terms of immediate positive changes?

Dr. L: Haiti is totally dependent, at this point, on foreign aid and organizations. Sadly, the Haitian government has not figured out how to truly help the people of Haiti themselves yet. If there is a silver lining to this earthquake, I hope it is that the Haitian government can begin to honestly work with foreign governments and aid organizations to re-invent Haiti’s infrastructure, schooling system and health care delivery. The will to help in Haiti is definitely there! In the meantime, Haiti will continue to benefit from people generous enough to donate their time and resources to help them rebuild their country. Aid is the only way things are going to improve at this point. The people of Haiti are phenomenal; kind, generous, friendly, caring. I’m already planning my next trip back there! I love it!

*All photos courtesy of Dr. Brian Liddy*