The End of the Beginning

Our story with the Haiti Hospital Appeal (HHA) in Cap Haitien began eight weeks ago tomorrow.  But before that, a series of extraordinary events occurred to set the stage for our arrival: an earthquake; an unprecedented number of people sustain spinal cord injuries (SCI) and, more importantly, survive; a caring group at the HHA recognize the need for SCI rehab and take in 19 individuals; Toronto Rehabilitation Institute (TRI) gets involved and makes a generous donation to advance SCI rehab in Haiti by sending its most precious cargo – us, its human resources.  Our mission is one of education.  As the proverb goes, you can give a man a fish and feed him for a day, or you can teach a man to fish and feed him for a lifetime.  We’ve started the latter process.

Tess (occupational therapist) and I have a special vantage, since we’ve been part of the teams bookending this time at the HHA.  It’s hard to describe what we, Tony (physiatrist) and Jackie (registered nurse) walked into when we first arrived.  All I can say is that the concept of SCI and SCI rehab were quite foreign to everyone, including the Hatian staff we were educating, and to the patients especially.

I could fill volumes telling you all that wasn’t known.  There was much gnashing of teeth, banging of heads and testing of patience as we tried to implement strategies of care and to educate everyone (including nursing staff, doctors, rehab assistants and the patients themselves).  Bowel and bladder care…what’s that?  Flexion and extension of joints?  Promotion of mobility and independence?  Prognosis?  It was a lot of information that we had taken years to integrate into our practice and culture that we were now asking people to adopt and learn in a matter of weeks.  The learning curve was more like a vertical line.

Flash forward to now.  We’re here with Anita (registered nurse).  What can I tell you about the accomplishments of the four TRI teams and the impact we’ve had on the staff, the patients and their families, and the greater community?  I could start by saying that the HHA now looks and feels more like a rehab centre and that there is no better place in Haiti to be for SCI care.  We’ve had 5 people discharged (all ambulators) who are now examples to their communities that life after an SCI is possible.  More patients are now doing self catheterization and independently doing their bowel routines.  Every patient has been getting up into their wheelchairs and are learning the nuances of wheelchair skills.  Sam, our lone tetraplegic patient, now drinks from a cup independently while up in his chair, and can push independently with an upside down obusform back rest for support.  The two rehab assistants led a transfer training session for the nursing staff and students (about 15 people), using a real patient, safely and competently.  A new patient was admitted last week, and seeds of interprofessionalism were planted as the assistants and nurses collaborated to share information about him.  It has been an inspiring and fulfilling two weeks for us.

I know that these accomplishments are par for the course in established SCI rehab cantres, but they represent leaps forward from the absence of rehab that existed in Haiti before.  You have probably noted that no full-time wheelchair users have been discharged yet.  A tent in a tent city would be the “housing” that these patients would realistically return to in Port-au-prince if they were to be discharged.  This scenario would pose monumental challenges for them and potentially put their health and safety at risk.

There is much yet to be done to find solutions needed to help these individuals reintegrate back into a community setting.  I don’t know if TRI will be involved then, but I am proud to say that TRI has been here for the past eight weeks.  We hope that our presence has helped to initiate the laying of a foundation for SCI rehab in Haiti, and that momentum to advance this field will be continued through the skills aquired by all the people we’ve touched.

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