Trauma consults on humanitarian surgery trips: A perspective on the Haitian trauma system and the humanitarian’s role

Abstract

Ubiquitous access to surgical care, especially trauma surgery, is recognized as an essential component of public health. We present two trauma cases—an upper arm machete laceration and a penetrating chest wound—that highlight barriers facing trauma patients in Haiti and describe how it relates to humanitarian surgery trips. An Emory University student–faculty collaborative, partnering with the non-profit Project Medishare (PM) for Haiti since 2008, provides elective and urgent surgical care to the underserved population of the Haitian Central Plateau. This partnership collaborates with a main referral center known for providing quality surgical care at little or no cost. Elective urological and general surgical cases comprise the bulk of the case load but urgent trauma services have been provided when required. Future trauma system initiatives must focus on increasing access to vehicles, telecommunications, and first responders. Our recommendations are reinforced by preliminary results from a trauma needs assessment performed in the Central Plateau and surrounding departments during July 2013. Humanitarian teams can contribute by preparing for emergencies prior to departure and sharing new procedural knowledge with local providers. Supplementing the ability to intercede in emergency surgical situations furthers the goal of short-term surgical trips to diminish indigenous patient morbidity and mortality. We advocate extensive preparation for such situations and increased bidirectional knowledge sharing with local staff.