Dr. Linda Théodor, a visiting doctor from Port-au-Prince, Haiti, with Drs. Jordan Bonomo, left, and John M. Tew in the Neuroscience Intensive Care Unit at UC Health University Hospital. Photo by Cindy Starr / Mayfield Clinic.
The commitment by UC Health Team Haiti to Bernard Mevs Hospital/Project Medishare, Haiti’s only hospital dedicated to intensive care and trauma, continued this week not with another visit to Haiti but with a special visit to Cincinnati. Dr. Linda Théodor, one of two full-time physicians at the Port-au-Prince hospital, came to UC Health University Hospital to, in her words, “see how an ICU really works.” She is also learning to use technologies that could help her save more lives at Bernard Mevs.
The intensive care unit at Bernard Mevs, the only one in Haiti, has only four beds. It also lacks many amenities that are standard in the United States, including continuous cardiac monitoring equipment, ultrasound machines and a sufficient number of experienced clinical staff members. When foreign volunteers are not at the hospital helping out, Dr. Théodor finds herself working up to 90 hours a week, caring for babies, children and adults in the ICU and 12-bed general ward. The medical landscape she covers is almost infinite, challenging her with everything from neurotrauma to abdominal typhoid. She also instructs Haitian medical students in their clinical rotations.
Jordan Bonomo, MD, a specialist in emergency medicine and neurocritical care at the UC Neuroscience Institute and Mission Director for UC Health Team Haiti,* is helping to equip Dr. Théodor with new knowledge during her two-week visit as an academic guest of the UC Department of Emergency Medicine. He also hopes to help Bernard Mevs acquire some important equipment during the team’s third annual visit to Haiti in early 2013.
The first big news came this Tuesday. Turning to Dr. Théodor during a break, Dr. Bonomo announced that he had just received word that Cheetah Medical, manufacturer of an advanced, non-invasive cardiac output monitor, will be donating a machine to Bernard Mevs. Cheetah Medical sent a portable loaner with UC Health Team Haiti last year and has increased its commitment to the team as a result of its developing relationship with University Hospital. “They’re giving us a machine that we can take to Haiti and leave there,” Dr. Bonomo said. “They’re also donating enough pads (sensors) to take care of patients for a year.”
Dr. Bonomo said that the heart monitor made a difference during the team’s visit in 2012 and that Dr. Théodor has learned how to use it.
His goal for the remainder of her visit, he said, is to ensure that when she goes back she can not only practice what she does now but also teach the technology and some of the fundamental concepts of resuscitation, such as volume-loading in the management of critically ill patients.
The concept is a vital component of emergency medicine and critical care, Dr. Bonomo continued. “When people come in to the emergency department with low blood pressure (hypotension), it’s usually because of one of two things: either they need more fluid, or their heart needs to squeeze harder. The two problems are managed in vastly different ways, and the Cheetah machine makes it a lot easier to determine which of those two problems you’re dealing with. The hope is that with the change in management, so comes a change in mortality and morbidity. When you augment that with the ability to look at a heart with ultrasound, the next big step in Dr. Théodor’s training, then she can answer all the questions.”
UC Health Team Haiti again hopes to take ultrasound equipment to Bernard Mevs next year, and Sarah Winston, MD, a fourth-year resident in the Department of Emergency Medicine, is working with Sonosite to make a permanent donation of an ultrasound machine to the hospital. The team is also hoping to connect UC Health’s emerging telemedicine program to a telemedicine robot that another institution recently donated to Bernard Mevs, allowing for remote ICU rounding, telemedicine conferencing and the ability to remain engaged even from a distance.
Dr. Théodor’s visit has been enriched by the behind-the-scenes contributions of Jessica Wiles, RN, BSN, Clinical Education Program Developer in the Emergency Department and Team Coordinator for UC Health Team Haiti. Ms. Wiles has enabled Dr. Théodor to spend time in the operating room, on the helicopter with AirCare & Mobile Care and at social events in her honor.
Although Dr. Théodor’s native language is French, she communicates effectively in English. She has been a doctor for seven years, the fulfillment of a childhood dream. “It is difficult in my country to have a dream, because after high school it is difficult to enter to the university,” she said.
A strong, slim young woman, she appears more determined than daunted by the chasm between her resources in Haiti and those she sees at University Hospital. “The first thing I learned is there is a big difference between their ICU and ours,” she said, laughing. “I can’t find the words to say the difference between my country and here: the size, the structure, the equipment. I learned that there are many things to do in Haiti.”
“When Linda came here, she said something on rounds that everybody in the hospital has heard now,” Dr. Bonomo said. “When we started ordering labs every four hours, she said, ‘What? Why? Can’t you just examine the patient?’ It gave us a chance to see our own practice through different eyes as well.”
At Bernard Mevs, some labs are done twice a day, others not at all.
Dr. Bonomo said that Dr. Théodor “will take some of this” experience back to Haiti, and Dr. Théodor is determined to make it so.
“I take care of patients and I want to have the competence,” she said. “Coming here was a surprise for me. I thought at first that Jordan was maybe joking. But it’s really real. Some people before Jordan told me that they would like me to see their ICU in their country. But Jordan and the Emergency Department, they really did it. I realize it when I arrive here, that it’s really true. I’m really here, and I saw a real-life ICU. I think it’s giant. I don’t know how to say thank you.”
– Cindy Starr
*UC Health Team Haiti includes doctors, nurses and paramedics from UC Health, Cincinnati Children’s Hospital Medical Center and Good Samaritan Hospital. About 100 volunteers will serve at Bernard Mevs in Port-au-Prince from January late January through mid-February.
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