One medical missionary's
account of a trip to Hopital Lumiere in Haiti
By Bill Greene '68
On Wednesday night I was alone on rounds when a nurse called,
"Doctor, come quickly to the pediatric ward." A four-year-old
child, who had been admitted for a hernia repair the next morning,
was unconscious in respiratory distress. I went running, but was
inwardly frightened. I have not studied pediatrics in 30 years.
When I arrived the little girl was unconscious. We gave the her
oxygen, but I felt helpless. Our first medical dictum kept running
through my mind: Primum non nocere. I prayed that someone who knew
what to do would soon arrive, but no one did. The lights kept going
off, and we worked by flashlight. Two weeks before my trip, I had
attended a refresher course on advanced cardiac life support. I
clearly remembered that codes generally are called on adults for
cardiovascular disease. Children, however, die more often from respiratory
distress, so I knew that this was a critical situation. I recognized
that the child suffered from bronchospasm. In retrospect, she had
been given intravenous fluids that were probably outdated and contaminated.
Her pulse oximeter dropped to 75. I had not choice but to do something.
Without knowing the pediatric doses, I titrated small amounts of
epinephrine intravenously. Slowly she responded. Later, the internist
arrived; he had nothing further to recommend for the child. The
next morning, when I made my rounds, she was smiling with her mother.
I knew that she was one of the reasons I answered the call to be
My journey to the island of Hispaniola began more than two years
ago. After 23 years in a satisfying urology practice, I began to
feel a sense of frustration and a lack of fulfillment in my daily
routines. In retrospect, I know that was a very gentle call to search
in another direction. After a year of investigation, I read an article
in the Bulletin of the American College of Surgeons by Dr. Doug
Soderdahl. At the age of 56, he retired from his urology practice
to do full-time missionary work. His wife is his scrub nurse, and
they travel the world together, treating the poorest of the poor
and teaching urologic surgery skills to general surgeons. At the
American Urological Association national meeting in Dallas, I shared
a room with this marvelous missionary, who has become my mentor.
Initially I was hesitant to commit to similar work. There seemed
to be so many uncertainties, so many dangers. During that week of
discussion and reflection, my confidence and enthusiasm grew. One
memorable morning while in prayer, I came to the realize that, if
God calls one to service, He will take care of the danger; there
is no reason to be fearful of the unknown. I have since learned
that He also will provide peace and gratification, far more generously
than the secular world.
My commitment was secure that day, but it took another year to
find the right opportunity. I have talents in urology, which cannot
be adequately utilized working out of a tent or the back of a truck.
Dr. Joe Jarrett, an orthopedic surgeon in my community, had been
to Haiti twice. He asked if I would like to join him on his next
trip. After seeing his slide presentation, I knew this was the right
opportunity. Preparing for the trip, set for August 26 through September
3, 2000, required a lot of hard work. Most important, I set out
to beg for the people of Haiti, for the medical supplies and equipment
that would be needed. I was overwhelmed by generosity: Not one person
or company I solicited refused to participate, and most responded
far more generously than I ever would have expected:
Indigo Laser, Johnson & Johnson loaned a $54,000 laser and
donated $12,000 in laser fibers to treat benign prostatic hypertrophy.
Olympus loaned $20,000 worth of endoscopic equipment.
Valley Lab loaned a $7,000 electrocautery unit.
Eli Lilly donated over $800 in medications.
Interchurch Medical Assistance and MAP International provided
$10,000 in medication at a cost of $1,200. The Myrtle BeachRotary
Clubs underwrote these expenses.
My hospital, Grand Strand Regional Medical Center, offered to
give us whatever we requested.
The list of benefactors goes on and on. A heart-warming experience
came from Oregon. Months before the trip I wanted to purchase some
meaningful gifts for people who extended a special effort in helping
me on my mission. I realized how useful my Leatherman Tool is to
me. This is a wonderfully engineered instrument similar to a Swiss
Army Knife; it is a complete tool box in a single instrument that
I can't live without. It retails for $40. I wrote the president
of the company, Timothy Leatherman. I explained my medical mission
and asked if I could purchase a half dozen of his valuable tools
as gifts, at a wholesale price. Three weeks later he wrote back
that he could not provide tools at a wholesale price, but he enclosed
two dozen of his tools for my journey.
In order for a trip like this to take place, there are so many
details that must fall into place. I am blessed with surgical training
and skills, and the desire to share my talents with others. I needed
and received the support of my wife and my daughter. They probably
thought Dad was a bit crazy, but did not object. My practice needed
coverage in my absence; fortunately I have five partners to take
over the workload. I would need to shoulder the expenses for the
trip. This was not a significant problem and, to my surprise, I
received financial support from sources I did not even request.
Although Hurricane Debbie threatened our travel plans, we set
out at 4:15 a.m. on the most miserable journey I have ever made.
I was accompanied by Dr. Jarrett, Dr. Cal Cunningham, an otorhinolaryngologist,
and Donnie Long, an orthopedic operating room technician. Our first
concern was our baggage; we had 14 large boxes and duffle bags,
far more than the airlines allowed. When the attendant read we were
medical missionaries, he loaded all the bags without comment. When
we arrived in Atlanta, the agent learned of our mission and gave
us first class accommodations, including a delicious breakfast (the
last meal we could refer to as delicious).
In preparation for the journey, I brushed up on French, which
I had studied 30 years earlier in college. Although Creole is the
language of the people of Haiti, French is the second tongue of
the educated. On the flight from Miami, I had the opportunity to
talk with a native Haitian school teacher who did not speak English.
I learned from her that Haiti is an extremely poor country; due
to decades of political corruption, no significant industry has
survived, and infrastructure has deteriorated. Per capita income
is $500 per year. Life expectancy is 51 years. Haiti has the highest
HIV rate in the western hemisphere. Two-thirds of the people are
illiterate and 60% go to bed hungry each night. Medical care is
primitive, relying upon itinerant specialists to support the work
of Haitian-trained primary care physicians and missionaries.
The frightening part of the journey awaited us at the airport
in Port au Prince. Groups of baggage attendants/gangsters fought
to grab our bags. It was customary to expect one American dollar
each time an attendant touched a travel bag. We could see our valuable
cargo going off in many different directions. We had to fight back
to avoid losing everything. We learned on our departure that the
Haitian airport is the least secure airport in the entire world.
It took six hours in a truck with a very aggressive driver, to
travel 120 miles to the village of Bonne Fin and Hopital Lumiere.
The roads in some areas were paved; in many areas they were washed-out
river beds with deep ditches and football-size rocks. Our driver
would weave from one side of the road to the other; he took us down
paths that were never meant for motorized vehicles. We barely missed
hitting pedestrians, bicycles, and animals along the path. We witnessed
almost indescribable poverty. People lived in shanties with slabs
of tin as roofs and plywood or branches for walls. Each village
had a central well; water was carried on the top of the women's
heads to the homes. Garbage covered the island, and the air had
the stench of charcoal burning everywhere we went. We had taken
our immunizations and malaria pills. We were warned not to drink
the water, and we took Pepto-Bismol to avoid traveler's diarrhea.
The hospital was in the village of Bonne Fin (translated this
means "Happy Ending," which was what we experienced in
our journey, 16 hours after we set out). It was developed by a general
surgeon, Dr. Nelson from California in 1973. It would be considered
outdated by U.S. standards, but was a monumental effort to build
in a Third World country. The compound was protected by a tall brick
wall and guards armed with rifles. Our residence was a cinder block
building with non-potable, cold running water and electricity during
daylight hours. The utilities in the compound were interrupted many
times each day. We had plenty of roaches and lizards sharing the
quarters. Food was basic but satisfying. My most memorable meal
consisted of mashed potatoes, rice, French fries, and bread. We
had chicken a few times, and I really developed a liking for goat
meat. It tasted like barbecued pork, but was tougher and less greasy.
Our most valuable possessions were vinyl 5-gallon water bags. We
would fill them from a slowly dripping faucet in the morning and
hang them in the sun all day. When we returned late at night, the
water and electricity were off, but we were assured of a marvelous
shower before retiring. On a special shelf, we kept $700 of AIDS
drugs donated by our hospital back home, to use as prophylaxis if
we were cut or stabbed with a needle during surgery. This reminded
us that we were playing for keeps: thankfully, no one needed the
The day began with breakfast at 7 a.m., followed by chapel service
at 7:30 for the hospital staff. Doctors and nurses usually presented
testimony or Bible readings. The U.S. doctors sat in the back, and
a member of the congregation would always come to sit behind us
and translate from the native Creole into English. On the last day
we were there, I mustered the courage to offer witness with translation
by my friend, Dr. Jean Luis, the general surgeon.
Ninety percent of the people were nominal Catholics who also practiced
Voodoo; a form of African animism. Before surgery, the Catholics
would offer prayers to the Christian God, and also Voodoo prayers
to be certain all bases were covered. Unfortunately, the Voodoo
doctors frequently were the first line of health care; patients
who failed to recover from their potions and rituals were then brought
to the hospital, in more serious condition. In the case of high
risk pregnancy, the baby often was dead by the time a medical doctor
was seen. There were many Baptist churches on the island, and Baptist
missionaries ran the hospital compound. During the services we attended,
I was impressed with the sincerity of the peoples' prayers and hymns
and the depth of their faith. They offered thanks to God for the
gifts He had bestowed upon them, meager as they were. "Amazing
Grace" was easily recognized in Creole. The pastor introduced
us to the congregation as the visiting American surgeons, and we
received a hearty round of applause.
The hospital normally had 60 beds. For two weeks before our trip,
the local radio channels announced the anticipated arrival of surgeons
from the U.S. Patients walked for miles to be seen; Hopital Lumiere
was overflowing with dozens of patients sleeping in the halls and
in the clinics. Our day ran from 8 a.m. until 5 p.m. in the operating
room, a surgeon's dream. I would go for dinner at 6, and return
for rounds and pre-op evaluations until 10:30 or 11 p.m. I had a
group of six sixth-year medical students from Port au Prince who
worked with me. They were hungry for medical education: I would
teach as much as possible, especially from 10-11 p.m. One student,
Rolf, spoke beautiful English and served as my translator with patients.
He received one of my Leatherman Tools.
The hospital had one general surgeon, two internists, a pediatrician,
an obstetrician-gynecologist and several nurse anesthetists, who
were excellent. They gave us unrestricted use of the four operating
rooms. I had the opportunity to perform 27 urologic operations.
Each day, the nurses reminded us to pray with our patients. This
was not difficult, because I have been praying with my patients
in Myrtle Beach for the past four years. My prayer is always very
simple: "Blessed Lord, we know that you are the healer and
we are the instruments of your hands. Please make the surgery go
safely and smoothly for this patient. Please allow him to have a
good result from what we do, and grant him the grace to accept your
will. In Christ's name we pray. Amen."
Surgical experiences in a Third World operating room presented
unusual challenges. The temperature averaged 90 degrees. At the
end of every case, we would be drenched in perspiration from the
neck to the ankles. There was no reason to change scrubs, because
we would be drenched again after the following case. Open windows
were the only source of ventilation; the screens had holes and flies
in the operating theater were common. We always irrigated well at
the end of each case. The combination of patients with hearty lifestyles
and few antibiotic-resistant organisms protected us from serious
infections. In the States, Central Sterile Supply is always neat
and well-organized; in Haiti there was chaos. Instead of instruments
arranged on shelves in cabinets, there was a "central mound"
two feet high and four feet wide with all of the surgical instruments.
We would rummage through the inventory to find what we would need
for each case. A gyn colleague, Ben Martin, had worked at Lumiere
the preceding year; he donated an O'Connor-O'Sullivan retractor,
which was sorely needed. By our fourth day in-country, pieces had
been lost, and it was no longer functional. The hospital pharmacy
was limited and disorganized; they did not have a formulary and
were unsure of what medications they had available. Post-operative
analgesics were almost non-existent; fortunately we brought our
own supply of IV Toradol. Attempts have been made to educate the
Haitians on organization and planning. Unfortunately, the culture
and level of education are not conducive to outside influence, so
life goes on with little change.
There are so many personal stories I can relate. I was presented
with a patient with kidney cancer diagnosed only by ultrasound.
We performed a radical nephrectomy under the most difficult conditions.
This was truly a leap in faith. There was very poor lighting in
the operating room, and we had limited instruments. We fashioned
a gall stone scoop to serve as a vein retractor when we had trouble
identifying the renal artery. At one frustrating point in the surgery,
I stepped back and prayed, "Lord, You asked me to come here
to take care of your people; please guide me in this very difficult
surgery." He did not let me down (I remembered the story of
"Footprints" and one set of tracks in the sand). The patient
did remarkably well, and I am confident he is now cured.
Two women had Vesicovaginal Fistulas repaired trans-abdominally.
An older man was in kidney failure with advanced prostate cancer.
Most Haitians do not live long enough to develop prostate cancer.
I removed his testicles and reversed his renal failure (at least
temporarily). Another man had a giant hydrocele. I drained five
liters of fluid from his scrotum. It is hard to imagine that he
had been carrying 10 pounds of fluid between his legs for years.
Benign prostatic hypertrophy was a common malady in a Third World
country with few urologists. I did 14 operations on men who had
been in urinary retention and wore catheters for months. These patients
had very large prostate glands and usually required a TURP, a major
undertaking in Haiti. Most patients were anemic and would likely
require transfusion from a blood bank tainted with the threat of
AIDS. Fortunately, I made use of the Indigo Laser and was able to
do the surgery very safely with the newest technology. Instead of
cutting away the tissue, the laser fiber was inserted into the adenoma
and heat destroyed the obstructing tissue. No patients were transfused.
Although the hospital staff was accustomed to postoperative hemorrhage
and clot retention, they were pleasantly surprised with interstitial
laser prostatectomy. The students asked if this blue box was American
magic. I told them, "No, this is American Voodoo."
Dr. Jean Luis was an inspiring figure. He was a tall, handsome
Haitian-trained general surgeon, a compassionate physician and skilled
technician who worked tirelessly for his people. In the absence
of visiting specialists, he was responsible for all surgical cases
that arrived at Hopital Lumiere. He was a classic general surgeon,
with expertise in all surgical specialties. If he could not handle
a critical case, the patient would die. When I visited, the ob-gyn
surgeon was on vacation, so he was busy with Caesarian sections
and vaginal deliveries. He knew details on each of the inpatients,
and worked unending hours in the hospital.
One morning, in chapel, we had three visiting dignitaries - ministers
from surrounding provinces who came in to give sermons. I was asked
to delay my surgery that morning, to attend to their urologic needs.
I saw each individually in the clinic; two had come to have their
Viagra prescriptions refilled.
The "poster boy" of our trip was a child about 10 years
old, who suffered from rickets. His femurs met the tibias at the
knees at 90-degree angles. He walked with extreme difficulty on
his toes. Dr. Jarrett performed rotational osteotomies on the tibia
and fibula bilaterally, straightened the legs and applied external
fixation, without the use of intra-operative x-ray. The boy would
remain in the hospital for three months until the next orthopedic
surgeon arrived, to remove the fixation and begin rehab.
On a late Thursday night with my entourage, I again heard the
question, "Doctor, would you see just one more patient?"
They brought in a beautiful eight-month-old child with his mother.
As they undressed the boy, I was the only one in the room who recognized
that he suffered from the most devastating urological birth defect:
exstrophy of the bladder. In this condition the bones of the pelvis
fail to close and the pubic bones remain widely separated. The bladder
lays open on the lower abdominal wall pouring urine. The penis and
scrotum are split; epispadius leaves the urethra open on the dorsum
of the penis. The testicles do not descend to the normal position.
After explaining the condition to my students, I reassured Dr. Jean
Luis that there was no immediate emergency. I would make sure that
he would receive sophisticated surgical correction, when I returned
home. I have been in contact with Dr. Charles Horton, the founder
of Physicians for Peace in Norfolk, Virginia. We have now made arrangements
for a department chairman of urology, who has an upcoming trip scheduled
for Haiti, to perform the major reconstructive surgery in-country.
On Saturday morning at 5 a.m., the four of us left for the trip
home. I told Dr. Jean Luis earlier that I had expected to work very
hard; I left totally drained. But what a marvelous feeling of satisfaction
and inner peace. We performed 52 operations; we succeeded in clearing
the hospital of all of the surgical patients who required our attention.
Miraculously, no patients died, in spite of very serious diseases;
we experienced no sepsis, no transfusions, no infections. I cannot
recall a single complication. But then, why should I be surprised?
We did the work that He called us to do. "Blessed Lord, we
know that you are the healer and we are the instrument of your hands..."
We returned home with many new friends and many treasured memories.
I will never forget the kiss I received from the woman with urinary
incontinence, or the smile on the boy with the bow legs now straight.
I developed immense respect for those who devoted their entire lives
to helping these less-fortunate. The Haitian people proved to be
a humble but proud people, who endured the degradation of poverty
and illness with grace and acceptance.
Many have asked if I plan to return to Haiti. On the flight home,
at a quiet time, this thought came to mind. If I am given the opportunity,
as my own death is imminent, to think back on perhaps five of the
most meaningful times in my life, they would be my marriage to MaryEllen,
the birth of my daughter, Erin, my graduation from medical school
and surgical training, and my trip to Haiti. I have no choice but
to return again and again. Not because I have so much to offer,
but because this opportunity has given so very much to me. I was
able to see the Lord through the faces of my Haitian patients. I
was given the opportunity to operate on so many desperately poor,
suffering people. Remember, He told us, "As long as you do
it for one of these, the least of your brethren, you do it for Me"
The call to care for patients in Haiti and the Third World in general,
will never be fully satisfied. All specialties are in demand. If
one responds to this gentle call, the following organizations may
be helpful: World Medical Mission 828-262-1980 United Methodist
Volunteers In Mission sejumvim.compuserve.com Mercy Ships mercyships.org
International Volunteers in Urology ivumed.org Physicians for Peace
physiciansforpeace.org AmeriCares 203-966-5195 International Medical
Corps 310-826-7800 Northwest Medical Teams 503-624-1000 Catholic
Medical Association firstname.lastname@example.org
You can reach William R. Greene, M.D., FACS at GUDOC96@HOTMAIL.COM,
or by snail mail at 823 82 Pkwy. Myrtle Beach, S.C. 29572; 843 449
1010 ext. 239.