Academic Emergency Medicine in Rural Haiti: Prologue

Nahzinine Shakeri, MD

Resident in Emergency Medicine, Brigham and Women’s Hospital and Massachusetts General Hospital

PGY-4

From my vantage point in the back seat of the old Land Rover, bouncing and jolting this way and that down the uneven dirt roads of Port au Prince on the way to Mirebalais, Haiti, things looked bleak. I’d just arrived from Boston, and it didn’t take long to recognize poverty more grim than I’d ever seen it, road traffic conditions primed for trauma, and a paucity of basic fundamentals necessary for the population to stave off disease – clean water, food, sanitation, durable housing.

 Haiti is the poorest country in the Americas and, despite the relatively high burden of disease facing its people, has severely limited healthcare infrastructure and limited access to medical care for most.

I’d traveled to Haiti to learn more about how these seemingly insurmountable problems were being addressed and to see if, in the span of four weeks, I could apply my skills as an emergency physician and aspiring medical educator to contribute in some tiny way.

Outside the window, the terrain became much more rural, more mountainous. Embedded among the rolling green hills and mountains of Haiti’s Central Plateau and the community of Mirebalais was a beautiful white and iron structure - Hôpital Universitaire de Mirebalais (HUM). HUM is a 300-bed tertiary, public teaching hospital which opened its doors in 2013 and is funded by Partners in Health, grants and the Haitian government. The hospital is the first of its kind in Haiti, providing cutting edge care to the community without the traditional fee-for-service payment model. Residency training programs in a number of medical specialties at HUM draw medical school graduates from all over the country, including Haiti’s first emergency medicine residency which was founded in 2014 and which will graduate the country’s very first class of residency-trained emergency physicians in 2017.

Over the next four weeks, I would be living in Mirebalais and working as a visiting professor of emergency medicine at HUM. This would provide me with the opportunity to teach the emergency medicine residents both at the bedside and in the classroom, to care for patients, to learn about what it takes to build, develop and sustain an emergency medicine residency in this setting, and more than I understood at the time, to think about medical education in a new way.