A Promise Made is a Promise Kept

Thank you to all of those that followed us this past month on the blog!  This will be our last post of the 2018 trip, so please follow along with us next year.  And if what we have written about this summer resonated with you, please consider donating to our trip.  We always have unexpected costs to reconcile when we come home, and we start planning for the next year's trip the day we come back!  Absolutely any amount helps.

A contribution from MS4 Beth Carpenter:
A summer thunderstorm is rolling in when Dr. Pettitt, MS4 Uday Betarbet, and I make our slow progress up the long, steep driveway from our house to that of Dr. Guy Theodore, the founder and father of Hospital Bienfaisance de Pignon.  The road is heavily shaded by the Caribbean jacardanda trees and palms, and as we approach the house we begin to see Dr. Theodore’s beloved birds wandering around: chickens, turkeys, ducks with chicks, geese (who have taken a nip at more than one of us), and his gorgeous peacocks.  When he’s nowhere to be found, we start the descent down thinking we misunderstood and we must be meeting him at the hospital—corrected when we see his early 2000’s land cruiser headed our way.
 
“Our meeting is not until 1pm, no?” he cheekily asks.  It is 1pm on the dot.  We all climb in and head to his house, where he seats us on a beautiful cantaloupe-colored veranda overlooking the trees on his property.  We are rather humorously joined by at least five different kinds of birds, who clearly follow Dr. Theodore.
 
To meet Dr. Theodore is to meet the soul of Hospital Bienfaisance, a dream since eleven years old in the 1950s when he lost a close friend.  There was no medical provider at all in Pignon to come take care of his friend who fell sick and soon after died, and Dr. Theodore promised himself that if he could become a doctor he would come back to Pignon to serve.
 
He did well in primary and secondary school with high expectations from his family, who raised him to believe that intelligence is a gift from God and one must give to their country. 
 
He went to medical school and completed his internship in New Jersey and surgical residency in New York at Kings County Hospital, afterwards serving in the US Air Force for seven years starting in 1977.
 
Every year during his vacation time, Dr. Theodore would come back to Pignon to help in the Catholic and Baptist clinics.  During this time, he created a leadership group to whom he presented in 1978 his vision for a hospital. 
 
“When you get the acceptance from the community, that is the biggest thing,” he told us.  Because while the majority of the money to build the hospital was sent by Dr. Theodore (for the most part earned by moonlighting as a surgical resident in Arkansas), the community banded together to assist.  In 1978, only one truck a week made the journey through Pignon on the way from Hinche to Cap Haitien and thus a truck was unavailable to assist in construction.

---

Right: Pignon marked in red on a map of Haiti, with Hinche to the south of the Central Plateau and Cap Haitien on the coast to the north.

From left: Des (translator extraordinaire) MS4 Corinne, Dr. Painson (local general surgeon), MS4 Beth, Dr. Theodore, MS4 Lindsey, MS4 Danielle, MS4 Uday

Hillary Clinton visits Dr. Theodore at the hospital

The community of Pignon organized a rotation among the different schools of the town to haul sand, water, and rock from the mountain themselves.  “It is their hospital—they have the sweat in it, the contribution in it.  The hospital of Pignon is not like the common missionary hospital where outsiders came.  They did the whole thing, and then others joined,” Dr. Theodore explained. 
 
The hospital was completed in 1981, and Dr. Theodore sought out a partner in the United States.  He founded the Christian Mission of Pignon in Arkansas, but a name change was soon in order.
 
“It was a commitment that you made at eleven years old, and--they said—a promise made is a promise kept,” Dr. Theodore recalls.  The organization Promise for Haiti continues to be the main partner of the hospital to this day. 
 
Dr. Theodore retired from the USAF as a full-bird colonel in 1983.  He could not advance any further without giving up his Haitian nationality, which he refused to do.  Instead, he returned home to Pignon.  The structure was there, but now he needed to build a hospital.
 
“If I’m being honest with you—I’m a surgeon, not a hospital administrator.  That’s the reality!  So I came and I made something kind of like a hospital,” he joked.  He recruited nurses and techs from around Haiti.  International groups such as ours from Emory soon started coming to assist in 1983, with the first group from Arkansas.  But Dr. Theodore understood that sustainability was at stake with these strategies. 
 
“Just like in the States, when you’re in a small community like Pignon it is hard to retain!  But I want a system which will sustain itself.”  He created a scholarship for the poor, sending children of Pignon to primary and secondary school to become nurses and lab technicians and doctors.  Without naming any names, he told us that many of the faces we see in the hospital every day were once children in his scholarship program. 
 
His life’s work is recognized internationally.  Pignon was the site of the first rural rotary club in Haiti, and as the president of the rotary club of Pignon and later Governor of the districts of the Caribbean, Dr. Theodore traveled throughout the region.  He was chosen in 1999 as “Man of the Week” by ABC news in the United States.  He was honored by the American College of Surgeons in 2000 with the Humanitarian Award, and shortly after by USAID as an international leader.  He will be celebrated at his upcoming 50-year medical school reunion this year in New York City.
 
Throughout our meeting, Dr. Theodore fondly recalls the evolution of medicine over the span of his career, citing the birth of the nurse practitioner and physician assistant.  He experienced the development of surgical operations commonly performed today, such as the carotid endarterectomy, and the dawn of surgical specialties such as head and neck surgery and pediatric surgery.  “When people talk about novelty in medicine today, sometimes I laugh!” he chuckled.
 
His sense of humor entertains us for the entirety of the meeting.  When asked if there is a video tape of his 1999 interview by ABC, he quips that the footage is better found on YouTube.  When a rooster begins getting a little too feisty, he yells as him to be nice and eventually expels the rooster from his presence for being too loud. 

---

Dr. Theodore’s anecdotes are also ripe with wisdom gained from a long life working in a rural Haitian hospital where resources are limited and medical need is boundless.  He tells a story of a young housewife who visited the hospital many years ago—many derided her being there, stating that she should have just sent money or someone else who had medical skills.  She insisted that she felt called to come, and Dr. Theodore defended her.  After she witnessed Dr. Theodore perform an emergency oophorectomy and salpingectomy for a ruptured ectopic pregnancy under local anesthesia, she called her brother in law who was an anesthesiologist in the States.  Thus the hospital’s anesthesiology department was established, and he made his point that everyone has something to contribute.

He explains that the hospital requires over $40,000 a month to run, and Promise for Haiti contributes only about $10,000 a month—so where must the rest of the money come from to keep the lights on if we don’t ask patients to contribute what they can for their medical care?  Many of his words carry an undertone of the ethical principle of justice, which describes fair distribution amongst the many.  In a world where it feels like we characterize the success of a surgical trip like ours by the sheer number of operative cases and the complexity of the care we deliver, can we truly state that we are helping the region when our case load may place the hospital generator and/or available hospital resources at risk?  And as we've discussed before, our most valuable surgery to offer in Haiti may be the humble hernia repair, which can give a patient back his or her chance to provide for their family.   
 
Perhaps we can redefine our idea of a job well done not by the number of cases, but rather by the strength of the partnership we build with our host institution, which will hopefully translate into many more lives and livelihoods saved.
 
On the very first day of our first week of operating this summer, Dr. Sharma stated rather colorfully that he didn’t care how many cases we did this year because that wasn’t how he wanted us to characterize the success of our mission here. 
 
“Many come, but few return,” he stated one morning as we walked to the hospital. 

We look forward to be among those that return.

"Core M4s"

P.S.  We're not the only ones going home from the hospital!  I'd be remiss if I didn't share that our patient who suffered a trauma to the neck and underwent an emergency tracheostomy and neck exploration at the end of our first week in Pignon went home after successful decannulation at the end of last week.   In a streak of irony, our patient who couldn't talk for over a week ended up speaking beautiful English!  He expressed his thanks to our crew before heading home  with his beautiful wife.  (But not before I snagged a picture with them day of discharge!)