Giving a Haitian a leg up on health—and life
John Laguerre knew he needed help. The victim of a drive-by shooting, he had simply been standing outside his home in Montrouis, Haiti, one day when he was shot in the leg.
It was now months later, and his thigh was still swollen. The 18-year-old had traveled numerous times to Zanmi Lasante in Cange, one of 12 Haitian hospitals operated by Partners in Health (PIH), a nonprofit organization dedicated to providing medical care to those who would otherwise not have access to it. Laguerre kept hoping to meet with a physician who would be able to help him.
Finally, in February of 2011, he saw Dr. Michael Beach, an anesthesiologist at Dartmouth-Hitchcock Medical Center who had traveled to Haiti with other Dartmouth physicians to treat patients at Zanmi Lasante.
"It was immediately clear that there was something very wrong," says Beach. Laguerre had two problems with his leg: an arteriovenous fistula (an abnormal flow of blood between an artery and a vein) and a pseudoaneurysm (a leakage of blood from an artery into the surrounding tissues).
Fistula: Dr. John Butterly, the executive medical director of DHMC and the individual who is responsible for coordinating the DH medical teams that travel regularly to Haiti, says that both conditions are serious. "Chronically, the fistula can be very debilitating, but the pseudoaneurysm was acutely dangerous. Although we had several very capable specialists in Haiti at the time, they conferred with vascular surgeons here at Dartmouth and did not feel it was safe to try to fix the leg there."
The team decided to bring Laguerre to DHMC for surgery and recovery. "It took about a month for us to get the paperwork to bring him to the United States," explains Owen Robinson, the operations manager for a future PIH-Zanmi Lasante hospital in Mirebalais. Once Laguerre's passport and visa were set, Robinson flew with him to the U.S. To finance the trip, Dartmouth used funds from a budget set aside just for international patients who are in danger and unable to otherwise receive appropriate care.
Cast: The surgery went fairly smoothly. "A cast of hundreds of people . . . helped with arrangements, appropriately evaluating him, doing the operation itself, and providing postoperative care," says Butterly.
"It was . . . clear that there was something very wrong," says Beach.
During Laguerre's recovery, which was more complicated than anticipated due to problems with clotting, the Haitian teen stayed with Beach, who has two teenage children. Laguerre even accompanied them to Hanover High School and on some social outings, and he started to learn some English, says Beach. "What was most striking was how different living in Hanover was compared to his life in Haiti. He and his sister run a food stand to support his six siblings. His father is quite ill, due to complications related to high blood pressure, and his mother died several years ago.
Abundance: "He was completely awestruck by the abundance of food here," adds Beach, "and the luxuries we take for granted every day, like a bed to sleep in and flush toilets."
Six weeks after his surgery, Laguerre returned to Haiti and his family. Beach, Butterly, and the other Dartmouth physicians who helped care for him were so moved by his struggles that they started a fund for his education. Laguerre wants to be an auto mechanic, and Robinson, who is orchestrating follow-up psychological and social support for Laguerre and his family, says the plan is to enroll him in a vocational school where he can pursue his dream. But it's not as simple as just paying his school tuition. Laguerre's family can't survive without his support, so PIH is working out a plan to see that some of the money goes to helping his family so he can stay in school. (Information on helping support Laguerre's education is available from Molly.R.Bode@ Dartmouth.edu.)
Poverty: "I'm optimistic that he'll do better in the long run if he can get into school," says Beach. "Still, his problem now isn't his leg at all. It's surviving in a country where poverty is a real issue on a daily basis."
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