Called to serve the poor: a medical mission
By DR. WILLIAM R. GREENE
Dr. Greene, a parishioner of St. Andrew Church in Myrtle Beach, recently returned from a medical missionary trip to Haiti. The following is his recollection of the experience.
I have returned from my medical mission to Haiti. My journey began two years ago. I increasingly became aware of a sense of frustration with my medical practice; there was a lack of fulfillment and gratification in the mundane functions. In retrospect, I know that there was a very gentle call to search in another direction.
I am reminded of Mary’s gentle call by the angel Gabriel to become the mother of the Lord. Without having any idea of the magnitude of the request, she answered so beautifully and so simply, “Be it done unto me according to your will.”
After a year of prayer, I went to the American Urological Association national meeting in Dallas. I shared a room with a missionary who became my mentor in the journey, Dr. Doug Soderdahl. He closed his urology practice at the age of 58 to travel all over the world to minister to the most needy. His wife is a scrub nurse, and they work together; they are gone the majority of the year to distant lands.
I initially was very hesitant to do similar work. There seemed to be so many uncertainties, so many dangers. During that week of prayer and reflection my confidence and enthusiasm grew. On one very memorable morning, I lay in bed with my arms extended and tears in my eyes. I came to realize that if God calls one to service, he will not let you down. He will take care of all of the details; there is no reason to be fearful. I have since learned that he will also provide peace and gratification, far more generously than the secular world.
My commitment was secure that day, but it took more than a year of prayer and searching to find the right opportunity. I have talents in urological surgery, which require a significant medical facility to utilize. I did not want to become a family doctor in a tropical area; I do not possess those talents. I also wanted to work in a religious environment. I talked with Dr. Joe Jarrett, an orthopedic surgeon in my community, who had been to Haiti twice before. This was the right opportunity for me.
The arrangements for the trip, from Aug. 26 to Sept. 3, required a lot of hard work: documentation, immunizations, etc. I then set out to beg for the people of Haiti, for the medical supplies and equipment that would be needed. I was absolutely overwhelmed with generosity. Not one person or company I solicited refused to participate, and most responded far more generously than I would ever have expected (the Lord was busy).
Indigo Laser and Johnson and Johnson loaned me a $54,000 laser and gave me $12,000 in laser fibers to treat enlarged prostates. Olympus loaned me $20,000 of endoscopic equipment to do telescopic surgery. Valley Lab loaned a $7,000 electrocautery unit. Eli Lilly supplied more than $800 in medication without charge. Interchurch Medical Association, for a fee of $370, provided more than $5,000 in medication. MAP International also offers medication to medical missions. For a fee of $750, they provided $10,000 in medications. The local Rotary Clubs underwrote this expense.
The full list goes on and on.
The most heart-warming experience came from Oregon. Months before the trip I wanted to get some meaningful gifts for people who extended a special effort in helping me. After months of thinking, I realized how valuable my Leatherman tool is to me. This is a wonderfully engineered instrument similar to a Swiss Army Knife; it is like a complete tool box in a single instrument, which I can’t live without. It costs $35. I wrote a letter to the president of the company, Timothy Leatherman. I told him this would be the most unusual letter he would receive that week. I explained my medical mission and asked if I could purchase a half dozen of his valuable tools as gifts, at wholesale price. Three weeks later he wrote back and explained that he could not provide tools at a wholesale price, but he enclosed two dozen of his tools for me to give away.
In order for a trip like this to take place, there are so many details that must fall into place. I am blessed with the skills to do surgery and the desire to share my talents with others. I needed and received the support of my wife and daughter. They probably secretly thought Dad was a bit crazy, but they 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 (the Lord again took care of so many details.)
Although Hurricane Debbie threatened to get in our way, we set out for the journey at 4:15 a.m. on a Saturday: Dr. Joe Jarrett, an orthopedic surgeon; Dr. Cal Cunningham, an otorhinolaryngologist; Donnie Long, an orthopedic operating room technician; and myself. Our first concern was our baggage; we had 14 large boxes and duffle bags to put on the plane — far more than was allowed. When the airline attendant read that we were medical missionaries, he loaded all the bags without a comment. When we got to the Atlanta airport, the attendant learned of our mission and gave us first class accommodations including a delicious breakfast (the last meal we could refer to as delicious). The only frightening part of our journey was our arrival in Haiti. Groups of baggage attendants/gangsters fought to grab our bags, and we had to fight back to avoid losing everything. We learned at our departure that the Haitian airport is the least secure airport in the 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, but in other areas they were washed-out river beds or were covered with football-sized boulders. We saw indescribable poverty. People lived in shanties with a slab of tin as a roof and plywood or branches for walls. Garbage was strewn everywhere. We learned that the per capita yearly income is $500. I have trouble understanding how the average Haitian earns that much. The average life expectancy is 51 years. Haiti has the highest incidence of AIDS in the Western Hemisphere. We had gotten our immunization shots and taken our malaria pills. We were warned not to drink the water, and we took Pepto-Bismol to avoid traveler’s diarrhea.
The hospital is in the village of Bonne Fin (translated means Happy Ending, which is what we experienced on our journey, 16 hours after we set out). It was developed by a general surgeon, a Dr. Nelson from California, and opened in 1973. It is primitive by U.S. standards but took a monumental effort to build in a Third World country. Our quarters were a cinder-block building with nonpotable cold running water and electricity 16 hours a day. Service was interrupted many times each day. We had plenty of roaches and lizards sharing the quarters. I heard only one phone ring in eight days. Food was basic, but satisfying. One 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 tastes like pork but is tougher and less greasy. On a special shelf, we kept $700 of AIDS drugs to use 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 drugs.
The usual day began with breakfast at 7 a.m. followed by chapel service at 7:30 for the hospital staff. Staff members gave testimony or Bible readings. The U.S. doctors sat in the back, and a member of the congregation would come to sit behind us and translate from the native Creole language to English. On the last day we were there, I mustered the courage to offer witness with translation by my friend, Dr. Jean Luis, the Haitian general surgeon.
Seventy percent of the people are illiterate. Most speak Creole, which is a mixture of French and African dialect. The educated people speak French. I studied French in high school and college 30 years ago and never used it. I began to study it four weeks before the journey and was able to easily converse with the nurses and staff. Ninety percent of the population are nominal Catholics. They also practice voodoo, which is a form of African animism. Before surgery, the Catholics would offer prayers to the Christian God and voodoo prayers to be certain all bases were covered. Unfortunately, the voodoo doctors often got first shot at patients, who were then brought to the hospital much later, in much more serious condition. There are many Baptist churches on the island, and Baptists ran the hospital compound. Before leaving for Haiti, I anticipated the opportunity to meet and work among living saints, and I was not disappointed. I met many spiritual giants.
Our day ran from 8 a.m. to 5 p.m. in the operating room Monday through Friday (a surgeon’s dream). I would go for dinner at 6 p.m. and return for rounds and pre-op evaluations until 10:30 or 11 p.m. I had a group of six sixth-year Haitian medical students who worked with me. I would teach as much as possible, especially from 10 to 11 p.m. One student, Rolf, spoke beautiful English and served as my translator with patients. He received one of my Leatherman tools. The students were very hungry for medical information. The hospital has two general surgeons, two internists, one pediatrician and several nurse anesthetists who were excellent. They gave us unrestricted use of the four operating rooms. We did a total of 52 operations. I did 27. Many patients had been in the hospital for weeks awaiting the doctors from the United States.
There are so many stories I could relate to you that would bring tears to your eyes. Each day the nurses reminded me to pray with my patients. This was not difficult because I have been praying with my patients in the United States 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.”
On a patient with kidney cancer, I performed a radical nephrectomy under the most primitive conditions. This was truly a leap of faith. There was very poor light in the operating room, and at one frustrating point in the surgery, I prayed, “God, 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 (remember of the story of “Footprints”). The patient did remarkably well, and I am confident he is now cured. One man had a fluid accumulation called a hydrocele for many years in his scrotum. I operated and drained five quarts of fluid. If you can image, he had been carrying 10 pounds of fluid between his legs for years.
I did 14 operations on men with prostate enlargement. Almost all had been unable to urinate for months and wore catheters to drain their bladders. Fortunately, I brought the Indigo Laser and was able to do the surgery very safely with the newest technology.
No patients required a blood transfusion (blood is available, but the risk of AIDS if high). No patients developed infection, and all recovered without difficulty. Although the staff was accustomed to problems with these patients, they were pleasantly surprised with laser prostatectomy. The students asked if this black box was American magic. I told them, “No, this is American voodoo.”
The “poster boy” of our trip was about 10 years old, and we believed he had rickets. He suffered with bowed legs: his upper leg bones formed a 90 degree angle with the lower leg at the knee. He walked with extreme difficulty on his toes. Dr. Jarrett cut four bones in his lower legs, straightened them and applied external pins to hold them in place. The boy will remain in the hospital for three months until the next orthopedic surgeon arrives to complete his care. He did well.
On Wednesday night on rounds at 10 p.m., a nurse called for me to come quickly to the pediatric ward. A 3-year-old child, who was admitted for hernia repair the next day, was unconscious in severe respiratory distress. I went running, but was inwardly frightened. I do not do pediatrics and know very little about it. When I arrived the child was close to dying. We gave the little girl oxygen, but I felt helpless. The first medical dictum kept running through my mind: Primum non nocere — First do no harm. 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 took a refresher course on Advanced Cardiac Life Support. I was reminded that children die more often from respiratory failure, so I recognized that this was a critical situation. I realized that the child suffered from bronchospasm (a spastic closure of the upper respiratory passages). In retrospect, she had been given intravenous fluids which were probably contaminated. We obtained a pulse oximeter reading of 75 percent, which indicated dangerously low blood oxygen. I had no choice but to do something. I gave her small doses of epinephrine intravenously, and slowly she responded. When the internist arrived, he had nothing further to recommend for the child. She was smiling with her mother when I made rounds the next day. I knew that she was one of the reasons I was called to be in Haiti.
On a very late Thursday night with my entourage, I again heard the question, “Doctor, would you see just one more patient?” (How can I say no?) They brought me a beautiful 8-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 come together; the bladder does not close and lays open on the lower abdominal wall pouring urine. The penis and scrotum were split, and the urethral tube, which normally carries urine during voiding, was also split. 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 received extremely sophisticated surgical correction when I returned home. I have been in contact with the surgical staff in Norfolk, Va. They are anxious to make arrangements for him to be transported there for some very major surgery.
On Saturday morning at 5 a.m., we left on the journey home, entirely drained. I told one of the surgeons earlier that I expected to be abused on this trip, and I did not leave disappointed. But what a marvelous feeling of satisfaction and inner peace. We had succeeded in clearing the hospital of all the surgical patients who required our attention. Miraculously, no patients died, in spite of some very serious diseases; I cannot recall a single complication. But then again, why should I be surprised. We did the work that he called us to do.
Since I have been home, 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 the following: 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 give, but because this opportunity has given me so very much. 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.”