Emergency medicine specialist Eugen Salahoru completed his first placement with Médecins Sans Frontières in the only emergency department for more than half a million people in the slums of Port-au-Prince, capital of Haiti. Our emergency and stabilisation centre in Martissant district is a free, around-the-clock service. It treats people experiencing any kind of medical emergency caused by violence, accidents, burns, or obstetric complications. Eugen shares his latest experiences with us.
I had been following Médecins Sans Frontières’ activity in the field and considered applying when I was a junior doctor, but thought I would be able to give more once I gained more experience and skills. I finally sent my application to Médecins Sans Frontières Australia last year, after becoming an emergency medicine specialist. The recruitment process was straightforward, and initially I accepted a mission in Kunduz, Afghanistan. However, the bombing of the hospital there meant that my departure was cancelled. Instead, I was offered a field position in Haiti.
The service in Martissant opened in 2006 but my role, an ongoing one dedicated to teaching and training staff and reorganising the service, was new. It’s a very busy service. On average we saw around 150 patients per day in the ED, cared for by two doctors and three nurses. Consider that my hospital in Perth was making the news with about 300 patients per day, but this was handled by a significantly bigger team—10-12 doctors per shift—and resources. In Martissant the rates for both physical and psychological trauma—direct and indirect—are particularly high, generating 60% of our caseload.
Thanks to my briefings before I departed, I had a good sense of the project, but also about the wider socio-political situation and healthcare needs in Haiti. The main issues were the ongoing violence between the armed groups in the capital, the political instability and the extreme poverty coupled with the destruction caused by the earthquake. You can imagine that life in Martissant is stressful in many ways. Housing is typically cramped and dilapidated, especially after the earthquake in 2010. The district is also home to a number of internally displaced camps since the disaster. The living conditions are complicated by difficult access to most of the neighbourhoods that make up Martissant, due to the mountainous terrain, poor transport network and the bad state of the roads. Not surprisingly we saw many victims of traffic accidents—an average of one in five of those we treated.
"The living conditions are complicated by difficult access to most of the neighbourhoods that make up Martissant, due to the mountainous terrain, poor transport network and the bad state of the roads"
The presence of armed gangs, who largely control the area, also contributes to our caseload. We were treating up to 100 gunshot victims a month. The context is challenging but, despite examples like this, it’s not a conflict zone. I think that Australian emergency doctors are well suited for humanitarian work in difficult situations. We're fortunate to have a very high standard of training. We're prepared to deal with whatever comes through the doors. It helped that I had previous experience with both urban and rural emergency settings, including the Royal Flying Doctor Service. You have to be able to improvise as you won't have all the equipment and facilities that you're used to. We see a large number of patients in our Australian EDs, so we learn not only how to deal with each emergency, but also how to address the administrative issues specific to ED (overcrowding and access block, for instance, which were just as common in Haiti).
I was impressed with the resilience and strength of our national Haitian staff, given the suffering and violence that they are facing on a daily basis. They will be always in my thoughts. I also learned that in MSF our clinical work would not be possible without the skills and expertise of the non-medical team members (logisticians, administrators, coordinators and others). All of us are doing our part, so team work is essential.