Doctor's Review: Medicine on the Move

October 20, 2017

Dr Rocco Lombardi (far right) on the ground with the CMAT Team in Haiti.

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Volunteering some advice

An Ontario FM shares his experience working in Haiti

Dr Rocco Lombardi, a family physician who works in emergency rooms in Bowmanville, Port Perry and Scarborough, Ontario, spent two weeks treating patients in Haiti in late February and early March. He worked in a field hospital operated by Canadian Medical Assistance Team and used drugs and supplies sent by Health Partners International Canada. He spoke to Doctor’s Review about what working in Haiti was like and what other doctors need to know to prepare themselves for international medical volunteer work.

DOCTOR’S REVIEW: How did you get involved in the Haiti relief effort?
DR ROCCO LOMBARDI: I’ve been a volunteer with Canadian Medical Assistance Team for five years and I’m also a medical director for Angels of Flight, which is an air medevac company. I got both organizations in touch with each other, and Angels of Flight managed to use its corporate contacts to get a donated flight to bring CMAT’s first team down, because at the beginning it was really rough to get anything into Haiti. After that, CMAT used commercial flights. And as a CMAT member and volunteer, I managed to get onto one of the teams that went down.

DR: Had you volunteered other places before?
RL: Not for disaster relief, but I had done overseas work in South America: Ecuador and Bolivia.

DR: When you first heard about the earthquake, did you immediately know you would be sent?
RL: As a CMAT volunteer, we are all on a mailing list and we all got notification that teams were going to be sent. The way CMAT works is they send an assessment team first and they determine whether the conditions are appropriate for subsequent teams. I gave my availability and I managed to slot a couple of weeks in there. I left February 22 and returned Monday, March 8.

DR: So you touched down about five or six weeks after the earthquake. What was it like when you first arrived?
RL: The CMAT camp was based in Léogâne, and that’s about 35 or 40 kilometres west of Port-au-Prince. When I arrived at the airport, I was met by a driver who was hired by the CMAT team.

DR: Did you arrive on a commercial flight then?
RL: Yeah. I managed to get in on one of the first couple of days that commercial flights were available. I think they started on the 19th. Half my flight was donated by Westjet, down to Miami, and then I paid for the Air France flight down to Port-au-Prince.

DR: What did you take with you?
RL: I had about 100 pounds’ worth of stuff. Some of it was my own clothes and equipment, but I also brought down medications that the team needed, that they had run out of.

DR: What were your first impressions of Haiti?
RL: I guess the most impressive thing was driving through Port-au-Prince itself. It’s a very congested city and it was probably somewhere around 75 percent damaged. So you’ve got complete collapses, partial collapses, and people can’t set up their shops or stores in those buildings nor can they live in them, so a lot of people -- and I think it’s up to about 800,000 total now -- have been displaced into tent cities. You see these along the road, as well as all the rubble. So anywhere you’ve got an area that’s flat and that isn’t part of a road, you usually find a tent city. That was the most overwhelming part.

The town I was in, it’s not as big as the capital city, but it was closer to the epicentre so it was about 90 percent destroyed. It was very difficult to find a building that was untouched.

DR: Where did you work?
RL: We worked at the CMAT field hospital -- essentially two tents that were donated by the Canadian military. We were located right beside the U.N. compound, in a schoolyard.

DR: And did you stay in a tent as well?
RL: Yes, everybody stayed in tents. The military supplied us with water and some food rations, and we also had a local cook we employed as well as five or six local translators, one of whom was a nursing student at one of the nursing schools that was damaged. He helped organized drivers, translators, cooks, etc. for us.

DR: How many people were part of your team?
RL: There were three physicians including myself, two nurse practitioners, two paramedics and two nurses.

DR: You said you’d never done disaster relief work before. Were you at all nervous?
RL: No. I’ve been abroad a few times, so in terms of culture and being in a different place, that helped. In terms of the disaster, I think knowing and seeing pictures and getting feedback from people who were coming back -- that helped prepare for what I was getting into.

DR: What kinds of cases were you dealing with in Haiti?
RL: The first couple of weeks a lot of orthopedic help was needed, so the first CMAT team had an orthopedic surgeon and an anesthetist and they operated out of the field hospital. Over the next two to three weeks, the shift moved from traumatic injuries to post-surgical care, wound care.

By the time I arrived, a month and a half to a month and three-quarters afterwards, it was getting into primary care. So were starting to see people exhibiting signs of post-traumatic stress, so a lot of locals exhibited this as headaches, upset stomachs, generalized aches and pains. They didn’t really vocalize the stress they were going through.

Almost everybody had at least one family member killed. I met one lady who was quite depressed and didn’t talk very much. She lost her two children and all the rest of her family, so she was the only one left. There were a couple of people with panic disorder symptoms but, for the most part, they were exhibiting headaches, upset stomachs and generalized pain.

And we were dealing with infectious diseases. Malaria was the most prevalent. Leptospirosis cases came up in the first week I was there. Typhoid, dengue, as well as multiple fungal infections because of the humidity and heat and poor hygiene.

DR: Did you feel you were well prepared for the clinical work, not just in terms of your medical experience but also in terms of the facilities and supplies?
RL: Yep. For the field hospital, primary care is well adapted for that. For the traumatic stuff at the beginning, you deal with what you’ve got because there’s no hospital available. For primary care, we were quite adept at doing all that and we had all the appropriate supplies we needed for the most part.

DR: It sounds like part of what you were doing was psychiatric care.
RL: There is very little we can really do in a field hospital setting in terms of counselling. Most of it was dealing with symptoms and helping them along symptomatically with the medications we had donated. There are other teams with psychologists and psychiatrists coming down now, and they are now doing surveys to see what the need is and that’s going to be the next step, in addition to the rehabilitation of the people who have had amputations or traumatic injuries.

DR: What was the most difficult case you saw?
RL: We were still seeing people who hadn’t even seen a doctor yet. They had injuries that may not have been life-threatening but hadn’t been treated, so we had them referred off to the larger centres in Port-au-Prince. There were even some that were initially treated but needed open surgery that wasn’t available at the time because of infection risk. We did see some children suffering from significant infectious disease, to the point where they were dehydrated and required hospitalization and intravenous fluids.

But I think the most serious one we saw was a young man who was pretty much unconcscious due to a malaria infection that was so severe that it was affecting his brain as well. Those are quite commonly fatal at that point, so he was referred to the MSF hospital for IV therapy.

DR: Would you consider going again to Haiti?
RL: It puts a lot of stress on work and family, so those will have to be considered first. And my wife, who’s a nurse, is also interested in going so we’ll have to see when the opportunity arises. Possibly I’ll go when the kids are off school.

CMAT is collaborating with the Sean Penn Foundation on a rotating hospital clinic service in Pétionville. Apparently the tent camp area is on a golf course. That project will be going for about a year’s time. But there are other organizations I am in touch with. MSF and Red Cross are the major players at the moment but they require long-term commitments.

One of the organizations I am in touch with is Feed the Children, which had medical operations there before the earthquake. We helped them get some of their teams down there with Angels of Flight.

DR: What advice can you give to physicians who are interested in international relief work?
RL: Anytime you are dealing with international work, you want to familiarize yourself with the cultures you may potentially be working with. With disaster relief it’s pretty hard to familiarize yourself with the culture because it’s a last-minute thing, but if you’re doing primary care or other work that’s scheduled ahead of time, then you do have time to learn about the people as best you can before you go down.

When it comes to disaster relief, you have to be a person who’s accustomed to adapting to whatever situation you get thrown into, and you have to be quite flexible. Those are the kind of people groups like CMAT look for.

They're also looking for open-mindedness. You are going to be working in a difficult environment with other people as well as interacting with patients of a different culture. You need patience, understanding and you need to be a team player since you are working quite often in a team and under duress. You don’t have supplies with you, so you need a bit of ingenuity.

DR: I assume that part of the reason you say doctors need to be flexible and adaptable is because of logistical challenges you’re likely to face.
RL: There are logistical challenges. You may get down there are find out the living conditions aren’t what you thought they were going to be and you have to adapt to what’s there.

For me, I was quite surprised that the conditions in Haiti were better than I had anticipated. That’s probably the best way to approach it. Anticipate the worst. Expect you’ll have absolutely nothing, that you’ll have to live off nothing. Then anything else is a bonus.

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