With Few Supplies, Yale Doctor Tries To Make a Difference in Haiti

When Yale physician Dr. David M. Walker (YC '96) arrived in Haiti three weeks after the earthquake as part of a medical relief team, he and his colleagues did not find scores of critically injured individuals needing life-saving care.

What they did find was hundreds of individuals who were suffering from respiratory problems after days upon days of inhaling concrete dust; patients who had been treated and released from hospitals but who still needed chronic wound care; people who were suffering from psychological trauma or infectious diseases due to overcrowding and poor hygiene; and others who were suffering from "ordinary" medical complaints — children with fevers; adults with headaches, joint pain, sprains or other minor injuries.

In short, they found a population in need of care from a medical system that was as shattered as the surrounding buildings.

"After the quake, people found that their doctor was gone, the medicines in their homes were destroyed — they had nothing. They lost access to what little care existed before the earthquake; they had no place to go," says Walker, an instructor in pediatrics (emergency medicine) at Yale's School of Medicine and clinical instructor at the School of Nursing.

Immediately after the earthquake, Walker began looking for opportunities to join a medical relief team. He learned that — through the efforts of the United Haitian American Society of Norwalk, Connecticut — Old St. Andrews Church in Bloomfield was sending a series of medical teams to a clinic that had been established by Haitian-American Episcopalian priest Jean Elie-Millien. The Connecticut church had long been affiliated with a school run by Millien and his family. Walker became part of the third-wave team, which was composed of health care professionals from across Connecticut, including Yale School of Nursing student Vic Tolentino and Yale-New Haven Hospital nurse Susan Elles.

When the team arrived in Port-au-Prince, they found "the destruction that the rest of the world was seeing," recalls Walker. Their final destination — the Bon Samaritain Clinic — was located in Carrefour, near the quake's epicenter. The clinic was set up in a building that had previously served as a dance school by day and a dance club by night.

"We pitched our tents on the main dance floor. We used the stage to store the food and supplies we'd brought," recalls Walker, acknowledging that, "As volunteers, with access to showers and three meals a day, we had a pretty good deal, compared to others in our situation."

During its week-long stay, the team saw 200 to 250 patients a day, helping them with "what medicine and technology we had," says Walker, who admits he keenly felt the lack of much of the basic equipment available back home. "It was just me and my stethoscope and a language barrier," he notes. "We counted on the locals who served as our translators to help be our eyes and ears."

Walker and the other caregivers offered what treatments they could, given the supplies at hand. "But sometimes," he says, "all we could do was to listen and hand out food or diapers." Of particular concern were patients with chronic ailments, such as high blood pressure, that required special medicines unavailable at the clinic, and those who, prior to the disaster, had been awaiting surgery at hospitals now overcrowded with earthquake victims. When possible, the team members referred these individuals to one of the other medical care facilities that were beginning to be established in the area.

Still, explains Walker, communications on the island were so poor that it was difficult to keep track of the evolving medical landscape. "A local doctor might have re-opened his practice a few blocks away, but there was no way to know about it," he says, noting that the U.S. Marines were helpful in spreading information about newly opened health care facilities.

Since his return to Yale, Walker has made it a point to talk about his experience in Haiti — even giving a Grand Rounds presentation for the Department of Pediatrics on March 3. He feels it is important, he says, to share his experiences so "the interest in Haiti stays fresh" and the community at Yale and beyond does not "get distracted by a million other things."

Walker does, however, express concern that — with the restoration of commercial flights to the island nation — there will be an influx of good Samaritans who will be completely unprepared for what they'll find there.

"A lot of people don't understand what to do in a third-world country when there's less than nothing there," he says. "Even people who travel often to third-world countries don't have this kind of experience."

Walker himself has been working with health care professionals in developing nations in conjunction with his major academic interest — improving the infrastructure of pediatric emergency care in the world's health care facilities.

"Kids are a vulnerable population with special needs," he notes, "And making sure they receive the proper treatment is a core health care issue."

Among the issues he has helped to address are establishing systems for triaging [i.e. prioritizing] the care of patients, approaches for resuscitating the sickest children and even the difficulties of transporting ailing youngsters to the hospital. This work has taken him to the Philippines, India, South Africa, Qatar and Europe — where emergency medicine, let alone pediatric emergency medicine, is a "relatively new concept," he says. Later this year, he will be collaborating with local health care providers to improve pediatric trauma care in Malawi in Africa.

Walker also hopes to apply his expertise in global health care infrastructure to the development of long-term solutions in Haiti.

"The health care needs of the Haitian people are so overwhelming that it is hard to return from Haiti with a sense that one's individual medical skills can make much of a difference," he says."The value of the international response is to provide whatever immediate care is possible and to start the process of reconstruction."

— By LuAnn Bishop