Founder of our St Damien Paediatric Hospital, Fr /Dr Rick Frechette, reflects upon the current Covid19 crisis.
As our good friend Bhavesh (at Mayo Clinic, Phoenix) has correctly said, when it comes to COVID 19, we physicians are all medical students again.
We have had to confront the illness with a challenging learning curve. We constantly learn from the experience of colleagues in Europe and the USA, and from our own experiences.
And all of us are learning new things daily, and having to modify what we thought we just learned.
We started facing Covid patients in Haiti protected by masks made of donated bath robes, and $1 plastic welders glasses.
Worldwide stocks of normal medical protective gear was at a critically low levels because the European and American cases of Covid19 were skyrocketing.
Since then, thankfully, many people have come forward to help us find the correct protective gear that we need to stay safe, as we care directly for people infected by the virus.
At the beginning stages, we learned that COVID would be like a bad flu, affect only the lungs, and mortality might be 2%.
Now, having set up units for respiratory illness both at St Damien and St Luke hospitals, we understand that the focus on the lungs, and organizing everything around respiratory illness, is a very narrow and dangerous focus.
Because many systems of the human body can be damaged by Covid.
Another physician colleague reminded us of the saying, in regards to syphilis (which causes great damage to many body systems, and imitates a wide variety of illnesses) “if you know syphilis inside and out, you know medicine.”
Now the same seems true of the Covid19.
We initially separated St Luke and St Damien hospitals into “THIS WAY FOR CORONA OR SUSPICION OF IT, AND THAT WAY FOR EVERYONE ELSE.
This dual pathway was totally challenged by colleagues at Stony Brook University Hospital (Long Island), who warn that dual thinking invites infection, by lowering one’s guard.
In fact, after two proven positive Covid19 cases in St Luke Hospital (the main hospital, not the Covid wing), we now also have two infected physicians (and other medical staff in quarantine), and we have wisely adopted the SINGLE PATHWAY of prevention.
Another main focus at the beginning of Covid was to be sure there were enough mechanical ventilators to handle all the infectious cases.
In Haiti it would be hard for us to find even 6.
Slowly, however, the statistics have shown very poor survival rates of people needing mechanical ventilation for COVID.
The new focus was how to avoid mechanical ventilation, by studying the so called “cytokine storm”, a very strong reaction of the person’s immune system to the virus, in which the body harms itself.
Since March 16, the date of the official appearance of COVID 19 in Haiti, we have received just over 200 suspicious cases.
Our testing ability has been very limited and is slightly improving, and getting the results has been with disastrous delays, and is also slightly improving.
The people who have come to us range in age from 17 to 92.
They have come mostly from poverty and some from the middle class.
Many are also sick with other illnesses like TB, HIV, diabetes, asthma, hypertension, heart failure, anemia, sickle cell disease, malnutrition, and many other problems.
While the benefits of population testing are limited unless there is widespread testing (testing in Haiti is not widespread), still the only “real” information allowed to be reported are the confirmed positives.
Of our 200 suspicious patients, about 115 were able to go home with simple treatments, and instruction on responsible isolation.
85 people needed to be hospitalized, and of these, about 13 have died.
Of these 85, about 20 were officially Covid positive, through testing.
Of the 13 deaths, 3 were officially Covid postive, through testing.
Here are some facts about our setting in Haiti.
Many people do not believe the disease is real, but a fabrication of the government for money in the form of international aid. Many people do not trust the Government, the Ministry of Health, the media, and do not want to come to centres and be controlled by them. Many people mix spiritual causes with physical causes of illness, and want to leave the hospital for traditional spiritual cures.
For many people Covid19 brings shame and fear. The fear is especially of being attacked or killed by people who blame them for spreading the disease. A majority people who come to us have massive economic and social problems: no where to live, nothing to eat, no work.
These factors lead to a lot of aggression, and disturbed thinking and behavior, that is often directed at us, the caregivers.
This is how things stand with us, two months into this pandemic in Haiti.
We are doing our best, within our circumstances and our means. Yet our best is painfully far from perfect,
On a final note, we will soon release a sung prayer from our young people, high school age. The small choir is made of St Luke and NPH students combined. It is a prayer for Haiti and for the world, as we live through this time of pandemic. We will share this next week.
We so appreciate your help, and we pray for you in song.
Fr Rick Frechette CP
May 9, 2020