Mount Sinai Student’s Scholarly Year in Haiti

On January 12th, 2010 when a catastrophic magnitude 7.0 earthquake hit Haiti, Ernest Barthelemy was half way through his second of medical school at the Icahn School of Medicine at Mount Sinai. The earthquake that devastated Haiti hit Ernest in every way, from the personal casualties within his family to its spiritual implications for his cultural identity to an eventual redefinition of his professional medical career.

Ernest got on the first plane he could to Haiti and spent two months volunteering as a surgical coordinator with Partners in Health in Haiti. Ernest was shocked by the amount of young patients with severe head trauma that was not earthquake-related who could not be treated due to a lack of resources. Upon return to Medical School, Ernest knew his work in Haiti was not done and set out to create a new research program with Mount Sinai in Haiti.

Ernest spent the next year developing a research proposal to study neurosurgical disease trends and needs in Haiti, under the mentorship of Dr. Isabelle Germano and co-mentorship of Drs. Ernest Benjamin and Irene Osborn. In April 2012, Ernest applied for and was awarded the first ever Scholarly Year in Neurosurgery Award from the Department of Neurosurgery at Mount Sinai.

Ernest spent his scholarly year in Haiti at three different hospitals where he surveyed all hospital admissions through the emergency rooms in order to identify patterns of neurosurgical and neurological care in Haiti, and to document the current state of health care for patients with neurological or neurosurgical diseases. This study was the first of its kind to document neurosurgical or neurological diseases and needs in Haiti. The goal was to determine which diseases are the most common in order to guide efforts to improve Haitian health care.

Ernest and his team looked at number of emergency room admissions, the types of neurological diseases the patients had, were they male or female and their age. Of the three hospitals, two were in an urban area (one, a private facility and the other, a public facility) and the third was in a rural area (a private facility). He found that the public hospital, which provided the largest number of patients studied, had a higher number of patients coming in with cerebrovascular diseases than the other two hospitals; most of these patients middle-aged females. On the other hand, both of the private hospitals had more young, male brain trauma patients than cerebrovascular patients. He also found that overall, 1/3 of the hospital admissions that he documented were due to stroke or other cerebrovascular disease. Of those who were having a stroke, the median time the patients had been having symptoms before they got to the hospital and saw a doctor was 24 hours. The high number of trauma cases in the private hospitals appeared to be related to men riding on motorcycle taxis without a helmet. Of the trauma cases he documented, 59% were caused by motor vehicle accidents, 20% by a slip or fall, and only 5% assault with a firearm. Overall, neurotrauma was found to be the most common neurosurgical disorder in the study, while cerebrovascular disease was found to be the most common neurological disorder.

After 3 hospitals and 9 months researching the current state of neurological and neurosurgical care in Haiti, Ernest and his team came to the following conclusions:

  • Patient education about stroke risk factors, such as controlling hypertension, could help to reduce stroke incidence, morbidity and mortality in Haiti.
  • Public health efforts to encourage wearing motorcycle helmets could significantly reduce the Haitian burden of disease caused by head trauma.
  • Expansion of neurological and neurosurgical training efforts and resources focused on addressing the disease priorities identified in this study may significantly improve Haitian health care.
  • Further research is indicated to confirm and build upon the findings of this study.

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Neurosurgery in Haiti

  • No Neurosurgical training program – neurosurgeons have to leave the country to be trained.
  • 4 practicing neurosurgeons in Haiti. One is planning to retire soon.
  • All neurosurgeons practice in the capital city, leaving >70% of the population with no access to a neurosurgeon.
  • Three private CT scan machines in the country, all in the capital city. Only one of them is made affordably available to most Haitian patients. A fourth CT scan machine has recently been installed in a new, rural hospital; it is the first to be installed in a public facility.
  • There were no full time practicing neurologists in Haiti when Ernest arrived in late 2012. There is now one practicing neurologist who sees patients in the whole country.

Ernest graduates from the Icahn School of Medicine in May 2014 with distinction in research.

In July he begins his Neurosurgery Residency at Mount Sinai, where he is determined to become a leader in the young but growing field of global Neurosurgery.

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