PROJECT OPEN-HEART SURGERY
CRUDEM HOSPITAL
MILOT, HAITI
Thomas Pezzella, MD
During a trip to the Crudem Medical Center in Milot, Haiti in November 1996, a discussion was held regarding open-heart surgery. Crudem is a regional health facility serving a local population of over 20,000. Patients also come from nearby areas of Northern Haiti, including Cape Haitien, the second largest city Haiti. Over 70% of health care delivery in Haiti is through International non-government organizations (NGO's). Haiti is the poorest country in the Western Hemisphere. With a population greater than 7 million people the economic and political climate is very unsettled and insecure.
The true incidence of heart disease is unknown yet rheumatic and congenital heart disease are common disease in young children. There are only three echocardiography (ECHO) machines in the entire country making an accurate incidence or definitive diagnosis difficult to document.
After considerable discussion and debate the open-heart project at Crudem was formulated. The ultimate goal was to establish a continuum of care ranging from prevention to diagnosis and ultimately curative strategies. It was hoped this would serve as the model for future endeavors in other areas, particularly Port-au-Prince, the capital.
From November 1996 to August 1997, equipment and supplies were gathered and sent to Haiti to bring the operating room and intensive care unit up to standard for open-heart surgery. A team of three went to Crudem in August 1997 to set up the equipment and supply the hospital.
In November 1997, a team of six from the University of Massachusetts Medical Center and St. Vincent Hospital both in Worcester, Massachusetts spent a week at Crudem. The first two successful open-heart operations in Haiti were performed (VSD repair in 7-year-old girl; MVR in 18-year-old male).
In November 1998, a second trip was undertaken. Prior to the trip an ECHO machine was sent. This enabled more precise identification of patients. The team was increased to eight. Four successful operations were performed.
This November 1999, a team of 12 went to Crudem. Two mechanical ventilators were added thus enabling postoperative respiratory care. Three operations were successfully performed (two mitral valve replacements and one pulmonary valvotomy).
During all three trips evaluations of patients were performed. Several screened patients, all children, were sent to the United States for free open-heart surgery. Local medical and non-medical staff was involved in all our endeavors thus assuring continuity of care and allowing for further development and transition to local control.
Future directions include:
