February 2, 2010

Serena Koenig, M.D., M.P.H., has been providing medical care to the people of Haiti since 2001. She divides her time between Boston and Haiti, working with two non-governmental medical organizations, GHESKIO and Partners In Health. Dr. Koenig is the former medical director of Partners in Health's Haiti programs. She continues to work with the group on medical and economic development projects. At GHESKIO's hospital in Port-au-Prince, she conducts research on HIV/AIDS treatment and supervises a center for the treatment of drug-resistant tuberculosis. Dr. Koenig also is on the staff of Brigham & Women's Hospital in Boston and an instructor in medicine at Harvard Medical School. She serves on the faculties of Social Medicine and Health Inequalities and Infectious Disease. She is a former member of the Aetna InteliHealth board of medical editors at Harvard.

Dr. Koenig had come to Boston for a meeting just two days before the earthquake. She returned right after the quake, and spent the next 10 days providing medical care. InteliHealth news director Lisa Ellis talked with her about the devastation there.

Tell me about your first day back in Haiti after the earthquake.

The Port-au-Prince airport was closed, so I went to Santo Domingo [in the Dominican Republic]. It was a bit tough getting from there into Haiti. I found a Dominican driver who agreed to take us, but his car got stuck on the rocky road in Haiti. Luckily, we were only about 20 kilometers from the town of Lascahobas, where there is a Partners In Health hospital where I used to work. A local man was happy to give us a ride in the back of his pickup truck, and he drove us in to Lascahobas.

Partners In Health has developed a beautiful medical system in Haiti, and it was not damaged in the quake because it's in the countryside. We went from Lascahobas to Cange, the main Partners In Health hospital in rural Haiti. Already the patients had come, just hundreds and hundreds from Port-au-Prince. We set to work immediately to treat them.

Our Haitian colleagues were worried about patients in hospitals in areas that had fewer supplies and resources, so they asked me to assess the situation. I went to a hospital in a major town about a 90-minute drive from Port-au-Prince. The only antibiotic they had was penicillin. A surgeon was conducting amputations with no narcotics for pain relief. We found patients on the floor, really not being properly cared for, and I spent the next day bringing patients by ambulance back to our hospital in Cange.

Were the resources much better there?

Yes, we had a variety of drugs available. We had plastic surgeons and orthopedic surgeons from the United States who are deeply committed and fantastic. We had internal medicine and infectious disease specialists. We had Creole-speaking doctors. We had wonderful resources. The hospital quickly filled up, so the church and the school were converted into wards, with mattresses on the floor for patients. There was a great sense of camaraderie even though so many patients were packed onto these mattresses. It was a beautiful thing to see so many patients getting help, and we were able to provide close to U.S.-level health care.

So many quake injuries required surgery, such as amputations. You're not a surgeon. What was your role?

I provided infectious disease consultations for patients with orthopedic injuries. I came up with antibiotic protocols based on the different levels of fractures. For example, patients with open fractures, where the bone is exposed, have a very high risk of infection. I also treated patients with malaria and other infectious diseases not directly related to the earthquake. Other important medical aspects included preventing blood clots in the lungs after surgery, and monitoring for kidney failure, which is a common complication from crush injuries. We diagnosed six patients that needed dialysis, and we took them to the University Hospital in Port-au-Prince, to the dialysis unit run by Doctors Without Borders and the Ministry of Health.

You also visited the GHESKIO hospital in Port-au-Prince, near the center of the quake. Describe what that's like now.

The GHESKIO buildings suffered severe damage. The hospital is near the palace, which was demolished by the earthquake. However, the GHESKIO clinic never closed. Staff members walked up to 15 miles the day after the earthquake to keep the clinic open. GHESKIO conducts state-of-the-art research. But they have suspended all research to focus on humanitarian relief. They need money and supplies to care for the 5,000 people camped out on their campus, and for the thousands living in the slums across the street. They need tents, sleeping bags, cots, food, water and proper sanitation for the patients.

How long is this crisis phase likely to last before the medical system in Haiti can work on making things better again?

I think the crisis is going to last for months to years, and we will at the same time work to make things better again. I am deeply concerned that the world's attention span is not long enough, so we look ahead to very difficult times and very hard work.

What will be the next stage? Will there be new or worse medical problems for a long time because of the earthquake?

It depends on how we handle the crisis. Right now, it is obvious that we will have epidemic disease such as typhoid fever if we do not properly protect the patients, and that will be on our heads. We need to ensure adequate sanitation, potentially typhoid vaccine, and make sure we are stockpiling antibiotics and providing clean drinking water. Those are all critical. Patients are malnourished and this is going to make them more susceptible to epidemic infections. International aid organizations are working on this, but relief is coming far too slowly. It would be a travesty if patients died of typhoid fever because they lacked proper medical care. Unfortunately, patients die of typhoid fever every year in Haiti.

As a result of the quake, will there be new medical needs, such as prostheses and rehabilitation for people with amputated limbs?

There will be extraordinary needs. I've seen patients who had both feet amputated and patients with broken spines who were paralyzed. There are patients with one foot amputated. Some of them had jobs that required them to stand on their feet, so it will be very difficult for them to find work. So I think it's going to be extremely important that we do everything we can. I think physical therapists will be very important, and prostheses as well.

It's hard to be disabled in the United States. Just imagine Haiti, where roads are not paved, there are no elevators. Now you see people with those types of disabilities begging on the streets. If they have families, they're probably cared for in the home. But ideally we would be able to provide the resources to allow people to be as independent as possible. It's very difficult, particularly for the patients with spinal cord injuries. How do you get around in a wheelchair in a town without pavement?

What have you been doing back in the United States in the last week?

I have been working on fundraising and logistics for GHESKIO and Partners in Health. I'm speaking to companies, churches. We need to raise money and that's easier to do from here. It was very helpful when I was there, but right now there are a lot of volunteers that are willing to go. I plan to head back to Haiti shortly, and will stay for several months. It's going to be a long road, a long road.

Your apartment and all of your possessions in Haiti were destroyed in the earthquake. How have you dealt with that?

I have other stuff in Boston. Let's say it's a great reminder about the temporary nature of life as we know it. When I left my apartment a couple of days before the quake I put some important documents in a drawer in my apartment. I figured that was a very safe place for them to be. I lined up my shoes and my clothes. It was a very solid apartment connected to the Montana Hotel, which is a very substantial hotel. I thought I'd return in a few days. I never imagined it would be demolished in an earthquake a couple of days later.

What do you think of the public and foreign government response to this crisis? Do you think this attention will help Haiti in the long run?

I am an optimist. I think this has called the world's attention to the fact that one of the poorest countries in the world is just a 90-minute plane ride from Miami. There was great human suffering before the earthquake. It has dramatically increased after the earthquake, and I think people have come together and done the best they can. We have tremendous economic pressures in the United States right now. But people have been very generous with Haiti. I hope this momentum can move us forward under the guidance of the Haitian government to rebuild Haiti stronger than it was before.

For people who want to help, what's the best thing to do?

If people want to help, what they can do that is desperately needed is to give money. I can personally vouch for both Partners In Health and GHESKIO, that every dollar will go directly to immediate aid. That's 100% of every dollar. The problem with giving supplies is the logistical nightmare of getting supplies out of the Port-au-Prince airport and into the clinics. By giving direct funds right now what is needed can be purchased.

What would you like to see happen in the future?

I would like to see a long-term plan to work with the Haitians, under the guidance of the Haitians, in solidarity with the Haitians, to help them rebuild their country. This should be undertaken with the humility of understanding that Haiti has been treated dismally, historically, by many of the surrounding countries, actually by many of the world's leading powers. And I think with that humility in mind we could realize a shared responsibility for how the situation in Haiti became as bad as it is and also a shared responsibility to build Haiti back up together.