My Scope of Practice: A New Director to Foster Hope

Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. — Proverb

  There’s a dirt road in Haiti that leads to a place unlike any other on the small island. It may look like your run-of-the-mill road, but it’s not. Past the street vendors hawking their goods and through the dust clouds kicked up by passing cars lies something extraordinary. Down this dirt road lies hope.

  This is a street John Macdonald, MD, FACS, has driven many times. Just 15 minutes from the small airport in Port-au-Prince along this uneven, pot hole-ridden path, he arrives at his destination — the Project Medishare facilities.   Project Medishare is a nonprofit organization that has been providing the people of Haiti with hope since the 1990s. Under the direction of Dr. Barth Green and Dr. Arthur Fournier, the group’s mission is to provide human and technical resources to the citizens of this small country who are in desperate need of quality healthcare. The organization already has left a lasting impact on the nation. After the devastating earthquake in 2010, Dr. Green organized a team of doctors, including Macdonald (a former President of the AAWC) to travel to Haiti. Within days of the earthquake, Dr. Macdonald had set up a wound program and was caring for the mass amount of people with severe injuries.

  Despite having worked abroad in a number of developing countries, the time Dr. Macdonald spent with the Haitian people in the days following the earthquake left a profound impression. “Every day we experienced despair flowing to hope, chaos flowing to order,” he says. “Death was everywhere in the first days. As more medical support arrived, a euphoria began to set in that told each of us what it truly meant to be our brother and sister’s keeper.”

  In July 2010, Project Medishare (and Dr. Macdonald’s wound program) moved out of the makeshift tent-hospital that had been built after the earthquake and into the Hospital Bernard Mevs, a small 20-bed clinic down a long dirt road. The new facilities allowed Dr. Macdonald to expand the program to include a prosthetic lab, a small clinic room for PT, and two small-wound, behind-the-curtain treatment rooms. They also have two operating rooms, an acute medical ward, a five-bed ICU, a 10-bed spinal injury ward, a pediatric ward with approximately 12 beds, and a triage section.

  Although Hospital Bernard Mevs offers improved conditions over the makeshift tent-hospital, the environment still leaves a lot to be desired. Electricity is shaky at best, shutting down at least once an hour. Luckily, the back-up generator always kicks in, preventing any major complications. The hospital has air conditioning, but it is relatively ineffective against the brutal heat. There is also 24-hour security in place to keep the staff and patients safe.

  In September 2011, Dr. Macdonald became Medical Director of the wound program at the Project Medishare Hospital Bernard Mevs. Dr. Macdonald will travel to Haiti monthly to oversee the wound program. While there, he hopes to accomplish three goals that will guide Haiti toward manageable healthcare. “The first is to establish a sustainable program that addresses the most basic needs of the patients we are able to treat,” Dr. Macdonald says. “The second includes training Haitian clinicians in the fundamentals of wound care. Lastly, we would like to see the program, through the University of Miami School of Medicine, become a global resource for academic clinical training and research.”

  Dr. Macdonald has been in the business for a long time. He knows a point will come when he needs to pass the reigns of the wound program. “My legacy will depend upon my eventually being replaced by those who believe as much as we do that the Haitians and the global wound care world are a match made in heaven,” he said. For now however, Dr. Macdonald is dedicated to gathering support from the academic community through volunteers and the industrial wound care world through financial grants and supplies.

  The wound program and Project Medishare have lofty plans for the future, but there is no doubt the hospital already has provided the Haitian people with both medical care and hope during some of the country’s darkest hours.

   “Haiti is the poorest nation in the Western hemisphere,” Dr. Macdonald says. “Before the earthquake, with a population of 10.5 million people in a nation the size of Maryland, there were fewer than 1,000 designated hospital beds. Poverty is extreme. The government is dysfunctional. Corruption is a constant presence. We must deal with cholera, Dengue fever, malaria, TB, tetanus, trauma, maternal deaths, severe malnutrition, burns, and gun shot wounds. By every standard, this country is at the bottom of every health marker.”

  Despite the sobering realities, Dr. Macdonald remains optimistic about Haiti’s future. “Haiti has the potential to be a beacon for the rest of the developing world,” he says. The road to healthcare equality for all may be long, but Dr. Macdonald is prepared to walk it to change the Haitian scope of practice. This article was not subject to the Ostomy Wound Management peer-review process.