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Haiti quake patients test medical, cultural expertise at Tampa General Hospital

TAMPA

A 23-year-old man, abandoned in a Haitian morgue for three days, doesn't know if he will walk again, but wishes he spoke the same language as his nurses so he could crack jokes.

A toddler, her head scraped bare after she was buried for five days under the rubble of a Port-au-Prince home, races toy cars across her hospital room with her remaining arm.

A young man was unconscious and in intensive care for several weeks. On Monday, hospital workers finally were able to contact his relatives in Haiti to tell them he's alive.

The 67 Haitians airlifted to the Tampa Bay region for medical care after the Jan. 12 earthquake aren't typical hospital patients. Gravely injured and mostly unable to speak English, they arrived malnourished, some fighting infections rarely seen here anymore.

Healing them has tested more than medical expertise at local institutions like Tampa General Hospital, which has treated 36 of the Haitian patients.

"It's been a cultural education," said Dr. David J. Smith Jr., chair of surgery and director of plastic surgery for the University of South Florida and Tampa General, where he also directs the burn unit.

• • •

Assessed at a makeshift triage unit at Tampa International Airport, the injured needed specialized care for multiple burn wounds, exposed bone and all manner of crushing injuries.

One patient had been trapped in the rubble for 28 days, kept alive with what little food and water bystanders could get to him. He lost 60 pounds.

Dr. Joe Lezama, chief of medicine at James A. Haley Veterans' Hospital in Tampa, directed the federally coordinated relief effort locally, placing patients in hospitals around west-central Florida.

Lezama received only bare details on each patient, just hours before they landed. He was alerted to watch for infectious diseases that are rare here, such as tuberculosis, malaria and measles. One patient turned up with tetanus, something most Florida doctors never see.

But one of the things that has made the patients from Haiti stand out most is what they don't do: complain about pain.

"We could tell from their vital signs that they were probably in pain, but they were relaying no pain to us," Lezama said.

"Many times we asked over and over, 'Are you sure you're not in pain?' "

• • •

Ylfauker Viellard, 23, marvels at how often nurses and doctors at Tampa General check on him, a level of attention he would never expect at home.

One nurse discovered he likes vanilla ice cream, so he got a big bowl one recent morning, followed by a hearty lunch of rice, beans and plantains.

This, too, has taken getting used to. When you're hospitalized in Haiti, Viellard said, your relatives often bring you meals.

Viellard, who liked playing soccer, was lifting weights when the earthquake struck, and a building fell around him. He was taken to a morgue and left for dead.

For three days, he lay unconscious among the decomposing bodies. On the fourth day, a cousin came looking for his body to bury him. Covered in blood, Viellard was mumbling an endearment for his young daughter, "madame, madame."

Today, Viellard recounts the story through a translator, the Rev. Celillon Alteme, a Haitian native who works in pastoral care at Tampa General.

He can move his upper body, but he still can't feel his legs. He says he will know in time whether he will ever walk again.

Without visitors, Viellard has lots of time to ponder an uncertain future: When will he see his wife and daughter, now living on the streets in Haiti? How will he provide for them?

Such questions remain unanswered for many of the Haitian patients, even as they are entering long-term rehabilitative care. For now, their medical costs are being covered by U.S. taxpayers, but many do not know how long they can stay here; and if they go home, how they will survive.

So Viellard pushes aside his own fears and focuses on an immediate frustration: He wishes he could talk with the nurses. Then he thinks perhaps it's just as well that he can't. If he could speak their language, he'd joke so much that "they'd be laughing all day."

• • •

Smith, the head of surgery at TGH, recently went to the hospital kitchen for a consult.

He was concerned that, malnourished as his Haitian patients were, they weren't eating enough. The answer came from a Haitian cook: a taste of home. The regular fare was replaced with more familiar flavors.

Food is only one of the cultural issues patients and doctors have faced. One man became hysterical when a feeding tube was inserted through his nose. Common here, but to this patient, a sign that he would soon die.

And the language barrier makes it difficult for doctors to assess their patients' mental states. "The posttraumatic stress disorder, we don't quite have a good handle on," said Dr. Mark Vaaler, vice president of medical affairs at St. Joseph's Hospital in Tampa, which treated more than a dozen Haitians. "They are coming from devastation that most of us have never had to deal with."

• • •

Just shy of her second birthday, Fritzcar Pierre is a survivor.

She was inside a two-story house when it collapsed. Her father raced there from work but found no signs of life.

Five days later, an uncle, looking for clothes, saw a tiny shoe moving. Fritzcar was alive.

Today, she plays with donated toys at TGH. Her father sleeps on a makeshift bed next to her crib.

Fritzcar doesn't seem to realize her right arm is gone. The bandage on her head guards a skin graft covering her once exposed skull. One eye is an inflamed ball; doctors don't yet know if they can preserve vision in it.

Her father says quietly through the chaplain, his translator, that he's coping with losing so many loved ones, including Fritzcar's mother.

Fritzcar perks up at a familiar word. "Mama! Mama! Mama!"

He keeps telling her that mama is at work. There will be time for the truth.

For now, he prays his daughter grows up enough to understand.

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.

Haiti quake patients test medical, cultural expertise at Tampa General Hospital 03/08/10 [Last modified: Tuesday, March 9, 2010 10:01am]
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