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Events, Global Health, Haiti, Medicine and Literature, Patient Care, Stanford News

Physician writers share a “global perspective on healing”

Physician writers share a "global perspective on healing"

6319607736_156bcef31e_zWhen I saw that an event called “Medicine Around the World: Healing from a Global Perspective” was taking place on campus, I thought it would be right up my alley as a medical anthropologist.

The event, sponsored by Stanford’s Medicine and the Muse program and the Pegasus Physician Writers group, was a reading in which physicians shared some beautiful pieces they had written about their experiences providing medical services across the globe, including Haiti, Mexico, Austria, and Vietnam. The musings were less about culture than they were about poverty, conflict, disasters, and war, and what it’s like to seek health and healing in such overwhelming circumstances.

All five physicians’ writings brought to life a difficult scene. Julia Huemer, MD, a child and adolescent psychiatrist, wrote an aching piece about interviewing a young Somalian refugee in an Austrian winter just before Christmas. She conveys the utter incapacity of her survey to capture his experience, and an uneasy awareness that he is the one doing her a favor, indulging her intrusion. Here is a teenager too childlike to carry the weight of adulthood, yet who carries it with more grounded grace than many adults. Her holiday, once marked by stressful emptiness, is not transformed in any heartwarming sense, but at least becomes more heavy, more real.

Ali Tahvildari, MD, a radiologist, composed a “Ghazal for Global Health,” a poetic form used to convey love, loss, and longing, in this case pleading for the privileged to care about foreign suffering. Mali Mann, MD, a psychiatrist, chronicled her experience being one of “los medicos volodores” who fly to Mexico, where she works with orphaned children suffering severe emotional traumas. Henry Ward Trueblood, MD, a trauma surgeon, read an excerpt from his forthcoming book about being a surgeon in Vietnam during the war, where he worked in a tragically understaffed civilian hospital. The extreme environment pushed him to test the limits of his surgical competence, which both challenged him to grow and taught him to respect his own limits when he was way out of his league.

The piece that brought in the most “culture” in a classic anthropological sense was that of William Meffert, MD, a cardiovascular surgeon who read a fictional account of being trapped in a collapsed building in Haiti while on a medical mission after the earthquake. In it, he grappled with how religion – a Haitian mix of voodoo and Catholicism – played a vital role in the life of his assistant. As an atheist, the protagonist vacillated between being baffled, annoyed, and comforted in a way he couldn’t quite grasp; in a way that circled between dream and reality, the supernatural was a means toward healing.

Previously: Stanford doctor-author bring historic figure Jonas Salk to life, Stanford med student chronicles his experiences working in rural Kenya, Surgeon-author: “My intent is to let people know that the person next door could be intersex”, “Write what you know”: Anesthesiologist-author Rick Novak discusses his debut novel, For a group of Stanford doctors, writing helps them “make sense” of their experiences, and Exploring global health through historical literature
Photo by Hanna Sorensson

Emergency Medicine, Global Health, Haiti, Stanford News

A tale of two earthquakes: Stanford doctor discusses responses to the Nepal and Haiti disasters

A tale of two earthquakes: Stanford doctor discusses responses to the Nepal and Haiti disasters

boy in Nepal - 560

Nepal’s 7.8 earthquake in late April killed 8,000 people and displaced thousands more. Paul Auerbach, MD, a professor of emergency medicine at Stanford, spent about a week caring for the people of Kathmandu and recently sat down for a Q&A session with Shana Lynch of Stanford’s Graduate School of Business, where Auerbach earned a master’s degree in 1989.

Auerbach was also part of the medical response team in Haiti after the 2010 earthquake there killed hundreds of thousands. While talking with Lynch, he compares the two earthquakes and the very different medical responses they needed:

When you come in, you need to find the victims. You need to treat them. You need medical supplies. You need adequate personnel in order to manage the life- and limb-threatening injuries in the first few days. From the moment of the earthquake and forward, there’s a need for water and food. In Haiti, the supplies initially weren’t there. Everything needed to be carried in. In Kathmandu, for the most part, the supplies were available. Of course, they needed supplementation, and that happened and will continue to happen. In Kathmandu, they never were in a situation where they had nothing, which was unfortunately the situation in Port-au-Prince.

He also discusses some of the challenges of coordinating an appropriate disaster response plan:

There comes a point when you have enough people and enough supplies. At that point, you need to start storing things and sending people home.

The responses are never perfect because you discover that you need more of something and less of something else. The same holds true for people. For example, the changing nature of medical conditions following an earthquake causes you to need emergency medicine specialists early on, but then orthopedic surgeons and reconstructive surgeons later during the response.

Lynch and Auerbach’s conversation also touches on why community leaders need to plan for disasters, regardless of where they are. It’s an interesting inside look into how medical teams think about and respond to natural disasters.

Previously: “Still many unknowns”: Stanford physician reflects on post-earthquake Nepal, Day 6: Heading for home after treating Nepal earthquake victims, Day 4: Reaching beyond Kathmandu in treating Nepal earthquake victims, Day 2: “We have heard tales of miraculous survival” following Nepal earthquake, Day 1: Arriving in Nepal to aid earthquake victims and Reports from Stanford medical team in Haiti
Photo courtesy of Paul Auerbach

Global Health, Haiti, Infectious Disease, Public Health, Technology

A sanitation solution: Stanford students introduce dry toilets in Haiti

A sanitation solution: Stanford students introduce dry toilets in Haiti

sanitation-toilet-movedIn the United States, we often take for granted the relationship between health and sanitation. Not so in Haiti, where some people dispose of their feces in plastic bags they throw into waterways. As a result, waterborne diseases like cholera are common.

But what’s to be done? Flush toilets guzzle gallons of water and depend on an entire sewage system — an unfeasible option in many developing nations. To fill the gap, a pair of Stanford civil and environmental engineering graduate students have developed a program called re.source, which provides dry household toilets, and empties them for about $5 a month.

From a recent Stanford News story:

Unlike most sanitation solutions that only address one part of a dysfunctional supply chain, container-based sanitation models, such as the re.source service, tackle the whole sanitation chain. The re.source toilets separate solid and liquid waste into sealable containers, and dispense a cover material made of crushed peanut shells and sugarcane fibers that eliminates odors and insect infestations. The solid waste is regularly removed by a service, which takes it to a disposal or processing site to be converted to compost and sold to agricultural businesses.

The re.source students — Kory Russel and Sebastien Tilmans — work under the guidance of Jenna Davis, PhD, an associate professor of civil and environmental engineering. They started small, with a free pilot phase in 130 households in a Haitian slum, but the service has expanded to include 300 additional households with plans to introduce a service in the capital, Port-au-Prince.

The project is part of a larger Stanford focus on water issues ranging from safe drinking water to environmental concerns.

Previously: Waste not, want not, say global sanitation innovators, Stanford pump project makes clean water no longer a pipe dream and Award-winning Stanford documentary to air on PBS tonight
Photo by Rob Jordan

Global Health, Haiti, Research, Stanford News

Health care in Haiti: “At risk of regressing”

Health care in Haiti: "At risk of regressing"

streets of Haiti - smallAs an undergraduate at Duke University, Maxwell Kligerman stumbled into an amazing scientific opportunity. He spent the summer of 2009 collecting data on the availability of health-care facilities in Leogane, Haiti, a coastal city with a population of about 50,000 to support the work of Family Health Ministries, a non-profit founded by Duke reproductive endocrinologist David Walmer, MD.

With a guide, Kligerman walked every street in Leogane, tabulating the location and characteristics of even the most modest doctors’ offices.

His tally was important for local residents and some global health scholars, but certainly not anything with worldwide relevance.

We still need to keep Haiti on our radar. It’s been five years since the earthquake, but now is really the tipping point.

Then, on Jan. 12, 2010, the magnitude 7.0 Haitian earthquake struck, its epicenter just five miles from Leogane. Kligerman had unique, pre-earthquake data that could show the effects of the quake on local health-care opportunities. He could see what happened when the city experienced an influx of foreign aid and how the quake affected the trajectory of its development.

Taking advantage of his rare opportunity, Kligerman returned to Leogane in both 2011 and 2013, collecting information about the availability of health-care facilities.

Now, Kligerman is a third-year medical student at Stanford and recently published his findings in The American Journal of Tropical Medicine and Hygiene, in collaboration with Walmer and Stanford’s Michele Barry, MD, senior associate dean for global health, and Eran Bendavid, MD, assistant professor of medicine.

He has a critical message for those interested in global health: “We still need to keep Leogane and Haiti on our radar. It’s been five years since the earthquake, but now is really the tipping point.”

Before the earthquake, Leogane had 25 health-care facilities, ranging from a small doctors’ offices to large hospitals. Eleven of those buildings collapsed during the earthquake.

But soon, the international community swooped in, upping the number to 28. By 2013, Leogane had 34 healthcare facilities, many offering free care. Yet although the numbers look rosy, change is on the horizon.

Doctors without Borders, which operates the only full-service hospital, has announced plans to close the facility in 2015. That alone will dramatically reduce the availability of health care to Leogane residents, Kligerman said.

Continue Reading »

Emergency Medicine, Global Health, Haiti, Stanford News, Videos

New Stanford Hospital team ready to mobilize for disaster relief

New Stanford Hospital team ready to mobilize for disaster relief

When Stanford Hospital staff members volunteered to participate in a relief mission to post-earthquake Haiti last year, they were stunned over the number of deaths that could have been prevented had emergency medical services been available just a few days sooner. As highlighted in the video above, their initial shock led to the creation of the Stanford Emergency Medicine Program for Emergency Response, a team that will be able to mobilize immediately in response to a global disaster.

Previously: Treating the injured amid the apocalypse of Haiti, Reports from Stanford medical team in Haiti and Stanford sends medical team to Haiti

Emergency Medicine, Haiti, Infectious Disease, Medicine and Society

Haiti, a year after the quake

At Hospital Albert Schweitzer (where I traveled last February to write about the hospital’s struggle to care for the wounded in the quake’s aftermath), the staff paused today to “honor what Haitians have lost,” according to Ian Rawson, managing director of the hospital in Deschapelles.

In the past year, the hospital has treated thousands struck by the cholera epidemic, and served tens of thousands of displaced persons in addition to their daily work of caring for some of the poorest patients in the Western Hemisphere. Rawson writes on the hospital blog:

Despite all this, the Haitians never give up. Therefore never can we. We draw strength from their forbearance and resilience. Everyday we learn again about the reservoirs of strength which come from hope.

The hospital has planned a prayer of remembrance, followed by presentations from caregivers who were on the front lines treating the victims of the quake. The hospital will also pause to celebrate Hanger Klinik, the clinic built virtually over night and where new limbs for more than 800 earthquake victims have been built and fitted.

Photos will be posted on Flickr throughout the day.

Previously: Haiti day 4: Life after the quake, Haiti: In pictures, Haiti day 3: Amputees, Haiti day 2: At the hospital, and Haiti day 1: Arrival
More entries can also be found in the Haiti category.

Global Health, Haiti, Videos

MIT students test low-cost wound-healing device in Haiti

From plug-and-play hospital tents to the water-disinfecting SteriPEN, physicians and aid workers have used a number of simple yet innovative technologies in treating earthquake survivors in Haiti.

Another such interesting tool, which I learned about today, is a $3 wound-therapy device designed to speed up the healing process.

The device was designed by MIT mechanical engineering students and originally scheduled to be field tested in Rwanda. But Partners in Health requested prototypes of the tool be brought to Haiti, according to a release.

MIT doctoral student Danielle Zurovcik demonstrates how the device is applied to wounds in the above video.

Global Health, Haiti, Media, Technology

On crowdsourced relief efforts in Haiti

Lukas Biewald discusses the crowdsourced relief efforts in Haiti:

The advantages of a flexible crowdsourcing workflow to managing disaster relief are huge. Businesses like crowdsourced work because they don’t have to plan unknown work capacity in advance, and managing a crisis is an extreme version of this problem. There would be no practical way to have thousands of trained Kreyol speakers ready to handle emergency text messages, but through viral channels and a microtask framework it was possible to have thousands of people around the world doing mission-critical work within days.

Of note, FrontlineSMS: Medic is mentioned in the piece, which was co-founded by Stanford medical student Nadim Mahmud.

Previously: Using cell phones to save lives

Global Health, Haiti, Stanford News

Haiti day 4: Life after the quake


On a workbench in the backroom at the new rehabilitation facility is a brown plastic foot, about a woman’s size 6, with a carefully carved notch between the big toe and its neighbor.

It’s about 7 p.m. on March 1. Ania Antoine, a pretty 15-year-old in a short denim skirt, who is waiting for her turn with the physical therapist, likes to wear flip-flops. Right now, she’s only wearing one.

She smiles when she hears the new foot will fit nicely into a flip-flop. And has toenails to paint as well.

Ania (pictured above) lost her right leg – and most of her family – in the Jan. 12 earthquake that nearly leveled the capital city of Port-au-Prince and killed more than 200,000 people. She and her father alone survived.

Sitting along the walls of the rehab room in white plastic chairs are five young adult amputees, all healthy enough to leave the hospital but housed near the Hospital Albert Schweitzer at L’Escale, a former tuberculosis village, a short walk from the rehab facility. They are among the first of Haiti’s estimated 4,000 amputees to get prosthetic legs and begin the difficult process of learning to walk all over again.

They need a week or two of practice before they go off on their own, navigating the difficult Haitian terrain. Most are from Port-au-Prince and have lost their homes or schools and don’t know where they’ll go from here.


“Two people were dead next to me in the rubble,” Ania (shown again, right) explained earlier in the afternoon, speaking through a Creole interpreter. She was walking around on crutches in L’Escale, a desolate place of scattered cinderblock homes housing about eight amputees. The grounds are dirt, the residents wash laundry in a pump at the center of the village. The smell of burning piles of garbage drift through the air. A Haitian community group, led by Luquece Belizire along with the help of the hospital, provides bottled water, and members come by to cook meals at an outdoor barbecue. Belizire’s mother and sister often cook the meals. Belizire drives the amputees back and forth to the hospital for rehab where the physical therapists work long days that continue late into the night.

Despite the desolate surroundings, the young people find comfort with each other. They flirt and answer cell phones and laugh and joke.

Denise Jacques, 16, said it’s not very difficult learning to walk on the new leg. She described the horrible pain of suffering with a crushed leg for four days before a team of foreign doctors set up a tent at a nearby town where she finally had it amputated. She lives in one of the cinderblock homes with her brother. Jean McKinley, 19, lost his leg and four fingers in the earthquake. He also lost his school where he was learning to be a mechanic.

“He’s really good,” said Cynthia Racine, MD, a Haitian-born physiatrist from the United States who came to Hospital Albert Schweitzer to volunteer after the earthquake. She points out that McKinley can’t use one of his hands because of the amputated fingers where skin grafts are healing. “He’s trained as a mechanic and understands when we talk about center of gravity and vectors.”

At the end of the day about 10 p.m., the young amputees finish their 40-minute rehab by kicking a soccer ball with their new legs, and even attempt to dance with each other.

It’s just one small room in one small town way out in the Haitian countryside, but it’s an amazing sight and a sign of hope for the future of Haiti.

On March 2, I headed back to the airport in Port-au-Prince from the hospital in Deschapelles, driving 80 miles through some of the poorest communities in the Western Hemisphere. Trucks overloaded with Haitian passengers and piled high with mattresses rumble past, heading away from the tent cities and destruction of the capital, looking for new homes in the country.

My traveling companion, an American hydrologist who has worked and lived at the hospital for more than a decade, describes how the Haitian people have organized themselves to survive this earthquake. In the tent cities they provide community patrols to keep the women safe. They share whatever food they can find.

She says there are rumblings among the Haitians about how the much-stronger 8.0 earthquake in Chile on Feb. 27 caused fewer deaths and less destruction than the 7.0 earthquake here. And she talks about a fierce determination to rebuild the country better than before.

“It’s not, ‘We have to rebuild Haiti,'” said Ian Rawson, the heart and soul behind this hospital, whose mother and stepfather, Larimer and Gwen Mellon of Pittsburgh, founded it more than 50 years ago. “We have to build Haiti. Together, with the Haitian people.”

Tracie White is a Scope contributor and writer in the medical school’s communication office. She just returned from Haiti, where she wrote about the situation there. You can see all of her updates in our Global Health category. More details on Stanford’s Haiti relief effort are available here.

Global Health, Haiti, Stanford News

Haiti: In pictures


This is David Charles, one of just a dozen Haitian physical therapists in the entire country. David works at Hospital Albert Schweitzer. He trained in the Dominican Republic.


This child is one of 132 people staying at a refugee center near the hospital. The center is a half-built hotel.


This is Ania Antoine, age 15, an amputee who was one of the first refugees to get a new leg.


These are Deschapelles schoolgirls walking past the hospital.


This is a girl collecting water from a stream that runs between the hospital and L’Escale, a former tuberculosis village.

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Global Health category. More details on Stanford’s Haiti relief effort are available here.

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