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“In Tabarre, the stream of admitted and treated patients is exceptional”

Fernand Marxen - MSF Surgeon
For his third mission abroad, Fernand Marxen, a Luxembourgish surgeon, went to Haiti, in the MSF hospital of Tabarre, which is specialised in traumatology. He discusses his experience from May to July 2017.

    What is the current situation in Haiti?

    The “N'ap Kenbé” hospital of Tabarre, a building made out of containers in Port-au-Prince, was set up by MSF in 2011, shortly after the earthquake of 12 January 2010. This tragedy killed more than 200,000 people and wounded over 300,000, destroyed 90% of the schools in Port-au-Prince, 60% of the hospitals and 60% of the public buildings as well as causing a total of 1.3 million internal refugees.

    Port-au-Prince is back to being a lively city of three million inhabitants, even though public buildings have not yet been rebuilt. However, there is still great poverty, violence, illiteracy, unemployment, a strong brain drain (80% of graduates are leaving the country) and a sense of deep insecurity affecting the majority of the population. Health infrastructures are largely inadequate, hospitals are poorly equipped and the medical workers are poorly paid and unmotivated, except in a few private structures that are not affordable for ordinary citizens.

    What are the local needs? How does MSF organise itself to respond to them?

    In the medical field, Haiti lacks everything. MSF has set up polyclinics and treatment centres in several places across the country: a polyclinic in the very poor neighbourhood of Martissant, a Cholera Treatment Centre (CTC) in Port-à-Piment, a centre for obstetric emergencies in Delmas, and the Tabarre surgical centre (named after the neighbourhood where it is located), dedicated exclusively to surgical emergencies, both traumatic and non-traumatic.

    What role did you play there?

    Tabarre hospital is always open 24 hours a day. The stream of admitted and treated patients is exceptional, not just in numbers but mostly because of the great complexity of the lesions. The 27 surgeons and 6 assistants have all received excellent training (in Haiti, Cuba and Venezuela), are fully autonomous, highly skilled, used to a heavy workload and have demonstrated cohesion, solidarity and loyalty to each other.

    Despite the high technical level, resources are limited.

    Therefore, my role was not to teach surgical techniques, except for a few exceptional procedures. Instead, my experience helped to initiate and animate discussions on the methodology, approaches and alternatives treatments as well as and the feasibility and justification of certain procedures. Despite the high technical level, resources remain limited compared to the standards of western countries, so certain procedures were impossible or not cost effective. I also helped by highlighting the importance of rigorous surgical follow-up, flawless documentation, perfect traceability and, in short, perfect discipline and rigour in the management of treatments and follow-ups.

    How is this experience different from your previous experience in Bili, Democratic Republic of Congo?

    In Bili, I worked in a camp hospital located deep in the woods, without infrastructure, running water, electricity, trained personnel, surgeons or obstetricians. Port-au-Prince is a city of 3 million inhabitants, the hospital is well-equipped (in line with local regulations) and the medical and paramedical personnel are well-trained. In Bili my work consisted mainly of basic surgery while in Haiti I often worked on highly complex procedures. In short, I had vastly different experiences, but both were extremely rewording.

    What are your personal impressions?

    I have greatly appreciated the opportunity to learn to look at the world with different eyes. I have great respect and admiration for the local staff that does incredible work with very limited resources, both in Bili and Haiti.

    I have great respect and admiration for the local staff that does incredible work with very limited resources.

    And what a privilege it was to be part of such a multinational team. In Haiti, during my stay, the team was made, aside from the locals, of surgeons from China, New Zealand, Mexico, Congo, Italy, Germany and Luxembourg. The notion of universality is really astonishing once you are in the field!