Academic Emergency Medicine in Rural Haiti: Epilogue

Nahzinine Shakeri, MD

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

PGY-4

      As I look back on the four weeks I spent as a visiting professor of Emergency Medicine at Hôpital Universitaire de Mirebalais (HUM) in Mirebalais, Haiti, I realize how much I gained from the experience.

As an emergency physician, I was challenged. Over the course of the month, I cared for more critically ill children than I had seen in all of residency, helped manage a mass casualty event when a tap-tap crashed, encountered patients with unfamiliar and tremendously advanced disease processes, and made indescribably difficult decisions. I learned to approach even familiar clinical situations in a new way: diagnosing bacterial meningitis clinically and starting antibiotic treatment without the confirmatory cerebrospinal fluid testing I was used to obtaining, for example, or even using a urine dipstick to check cerebrospinal fluid at the bedside for signs of infection, an evidence-based trick I learned from the brilliant and resourceful HUM residents. 

As a leader, I grew tremendously. I had spent the last year in Boston supervising junior residents at MGH and the Brigham, but always with an attending at my side. This was different. Backup was always available by phone if I needed it, but in most cases I was the most senior emergency physician in the department, acting independently and making clinical decisions on my own. While very much out of my comfort zone initially, I grew to be more comfortable in my role. I learned that I love being an attending, and I was more prepared to make this transition than I had imagined.

As a medical educator, I was inspired. During my short time at HUM, I watched the residents grow, watched them apply new skills I had taught them such as gallbladder ultrasound and chest tube placement. On one residency conference day, I collaborated with another visiting professor to create a pseudo-high fidelity simulation experience with the resources we had available to us and watched the residents approach it with excitement and focus, eager to excel and practice their skills. It was a poignant and profound realization for me that the HUM emergency medicine residents, the soon-to-be first residency trained emergency physicians in their country, are the future of emergency medicine in Haiti. They are the future bedside teachers and residency program directors and curriculum designers who will be teaching Haiti’s next generation of emergency physicians how to ultrasound gallbladders and place chest tubes and run simulations. Education, it seemed to me, was a truly sustainable intervention which would have lasting and exponentially-reaching effects, here in Haiti and everywhere.

As a citizen of the earth, I was stirred by the degree of disparity I encountered, my resolve strengthened to use my career to help alleviate suffering in underserved areas at home and abroad.

I look forward to returning to Mirebalais.

“and with that, my last shift is over and i'm off. goodbye Mirebalais. this morning i'm thinking about the amazing emergency medicine residents at HUM, the soon-to-be first emergency physicians in their country, the future of EM in haiti. and i'm thinking about the patients i cared for, a part of their tragedy and grief becoming my own. and all the amazing, dedicated, inspirational people i met here.

goodbye.. for now.”

-journal entry, 4/30