Back from Haiti: Sidney Coupet, DO, MPH

Long before Haiti captured the world’s attention three weeks ago, Sidney Coupet, DO, MPH, held the poor, tiny Caribbean nation close to his heart.

“I am going to save Haiti,” he told a university magazine in 2006. “My ultimate goal in life is to help save Haiti,” Dr. Coupet told another in 2005. A few years ago, he dedicated a policy paper to “the people of Haiti, for their contributions to society since 1804!”

Born in Brooklyn, N.Y., to Haitian immigrants, Dr. Coupet has Haiti in his blood. Fluent in Creole and French, he has the country on his tongue.

Now, having just returned from treating hundreds of earthquake victims in Port-au-Prince, the country is branded in Dr. Coupet’s psyche.

“What I saw brought back the many stories my colleagues tell me about battlefield medicine, war medicine,” Dr. Coupet said last week. “That’s what it’s like. The only difference is there’s not a war—there was an earthquake. Yet people are being taken care of as they are on the battlefield.”

The 10-day trip to Haiti was not the first for Dr. Coupet, a second-year general internal medicine resident at Geisinger Medical Center in Danville, Pa. As a student at the Lake Erie College of Medicine in Erie, Pa., he spent three weeks honing his clinical skills at Hôpital Albert Schweitzer in central Haiti. Dr. Coupet cast the experience into a paper he wrote as an Osteopathic Health Policy Intern in Washington, D.C.

Last year, Dr. Coupet founded Doctors United For Haiti to improve health care in the Western Hemisphere’s poorest nation. One day, he wants to open a hospital in Haiti.

Less than 48 hours after the earthquake struck on Jan. 12, Dr. Coupet thumbed a message into his Blackberry: “I am currently in the Dominican Republic. … I could no longer bare to see my Haitian brothers and sisters left to die. … I plan to be in Haiti in one hour.”

During an interview with The DO last week, Dr. Coupet told what happened next.

What did you see when you moved into Haiti?
The people at the border were business as usual, almost as if there was no natural disaster.

When I got deeper into Haiti, to Port-au-Prince, I saw a lot of people in the streets. People were living in the streets. People were sleeping in the streets—they were terrified to go back into their homes. But there was a sense of order, and people were still trying to make a life within the circumstances. That was remarkable. They were trying to help each other and trying to work their way through all this.

There was a sense of camaraderie among the Haitian people. As an example that sticks in my mind, there were roadblocks diverting traffic away from where people were sleeping in the street. Everyone was really trying to help each other. I immediately felt safe.

Where did you practice?
I went down with the Overseas Medical Assistant Team. We had three surgeons, a pediatric intensivist, a nurse and myself as the internist.

We flew commercial into the Dominican Republic. We had a contact on the ground who picked us up and drove us to Haiti.

The first hospital we went to was outside of Cap-Haïtien in northern Haiti—Hôpital Sacré Coeur in Milot.

When we stopped there, we didn’t find one earthquake victim. The hospital had two fully functional operating rooms. It had a full staff taking care of patients, people in need in the area.

Our team discussed relief efforts with the staff of Hôpital Sacré Coeur, including the possibility of having patients life-flighted from Port-au-Prince to Milot to get help. You have to consider the roads in Haiti are horrible and almost impossible sometimes. It took us eight or nine hours when we drove from Milot to Port-au-Prince, which is about 75 miles.

We thought if we could get some casualties diverted to Milot, that would alleviate some of the stress.

Then we drove down to Port-au-Prince, to Adventist Hospital in the Diquini neighborhood. Remarkably, that hospital is still standing. There were a lot of cracks in it after the quake, but it is still standing.

When we got to the entrance to the hospital, it was immense with people. We went through the gates. We saw a lot of people on the grass, in the parking lot, just lying there. These were casualties, victims of the earthquake, with their family members, waiting to be seen.

We continued walking toward the hospital, and we noticed that the physicians and nurses were taking care of the patients in the parking lot. Medicine was being practiced outside of the hospital—no one was allowed in the hospital because of possible aftershocks. Doctors were seeing patients and performing operations under a tent in front of the hospital.

That scene took me aback. I was awed by that. I had never seen anything like that in my life.

How did you and your team help at the hospital?
Immediately we had to develop a system in which we all worked together.

Our team’s nurse and I took care of pre-op and post-op patients. I started IV fluids and administered whatever antibiotics we had.

I triaged patients, as well. With the surgeons, I went around identifying patients who needed surgery urgently—those who had gangrenous, infected limbs that could’ve killed them any moment.

By the time we arrived, people had been lying there with open wound fractures for three or four days. Many, many patients needed an amputation to save their lives.

Once patients got out of the OR, our team’s nurse and I continued to care for them by administering fluids and antibiotics as needed.

For the first several days, we basically had no pain medication. Patients were screaming in pain. We couldn’t do much about it until the fourth day, when international organizations began delivering pain medications.

So those were the bulk of my duties. The rest of my team stayed in the OR, including the pediatric intensivist. Because of his extensive training, he was able to administer anesthesia to patients undergoing surgery.

In addition, once we got Port-au-Prince, our team went to the U.S. Embassy with a letter from the CEO of Hôpital Sacré Coeur indicating that the hospital is willing to take earthquake victims.

Because of the hospital’s actions and our actions, the U.S. military began airlifting casualties to Milot. Last we were told, about 140 patients had been airlifted to Milot. There they were taken care of more effectively because, again, that area in Haiti wasn’t as affected by the quake.

What would patients say when they talked to you?
I was being pulled left and right by family members. I was unable to spend five minutes without a family member trying to get my attention because a loved one was either dying or in extreme pain.

The family members were really concerned. They were asking me, “Doctor, is there anything you can do? My loved one has been sitting here for three days, four days, and no one has seen him.” Or “My loved one is not talking, not speaking to us.” The Haitian people were in such a state of shock that some did not notice that their loved ones had expired.

There was one particular family that asked me to assess the mother after being told that she was dead. Of course, by the time I got to her, she was already cold. I don’t know how long she had been lying there. But her family was in disbelief. I spent about 20 minutes explaining that she was indeed dead. But the family persisted, asking, “Can we do anything for her?”

So it was very hard.

A lot of my conversations with patients and their family members were to explain, “There’s nothing more I can do” and “Leave it up to God,” which is an expression that Haitians are very familiar with.

There was one young man who lost his mother and his father, and he rushed his little brother to the hospital. With his brother in his arms, he asked me, “Can I do anything for him?”

After examining his little brother, I noticed he was not breathing. He had no heartbeat. He would not respond to any stimuli. I knew what that meant, and I had to tell the young man that the only loved one he thought he was going to save had passed away.

But a day later, the young man came back. He told me, “Thank you for trying your best. Now what can I do for you?”

He came back and he worked with me. He became part of my transport team. The rest of the time I was there, he helped me take patients to and from the OR tent. He knew the only way to overcome the stress and the impact of losing his whole family was by helping others. He understood that. That was remarkable for me. That inspired me. He was only 16 years old, and he inspired me.

Where did you stay and how much did you sleep?
We stayed about a 20-minute drive from the hospital, at the home of the parents of one of our surgeons. Every night we left the hospital to at least try to get two or three hours of sleep so we could be effective the next day.

At first, we recognized that when we left, we were leaving the hospital staff to handle an overwhelming patient load. Patients could succumb to their disease—they could die because we left.

We couldn’t save everyone. That reality that didn’t come to me until probably the third day at the hospital. Before, I would say, “We can’t leave now. These people need us.”

Fortunately, other surgeons arrived from Mexico, and they were able to switch with us.

How did patients manage with so little pain medication?
I was there for 10 days, and we were doing eight to 10 amputations a day. When patients came out of general anesthesia, they had excruciating pain. And the only way I was taught to address that is with pain medication.

Here in the states, we have morphine at our disposal. We have other narcotics at our disposal. And sometimes even those aren’t even enough.

But we didn’t have morphine. We didn’t have any narcotics. For three days, we essentially didn’t have any pain medication at all.

So if you can imagine the people screaming at the top of their lungs, people crying at the top of their lungs because they were in pain. And you had to work within that environment. You had to work with family members, every minute, coming to you: “Please help my loved one,” “Please help my dad,” “Please help my son,” “Please help my brother.”

What was most positive about your experience in Haiti?
From a personal standpoint, I’m glad that my family members are OK and safe. They were not harmed by this earthquake. I didn’t learn of their safety until my fifth day. That was probably my most emotional moment.

But I’m saddened because I wish I could’ve done more. I wish I could stay. But if I had stayed for six months, I still would’ve felt that I was leaving too soon.

Which of your experiences in Haiti do you keep thinking about since you’ve returned?
The image that I’ve had in my head is that of a young man, probably 13 years old.

I was leaving the hospital, exhausted, tired. Then I saw him. I looked at him. He looked at me—and he smiled.

I have to tell you, it wasn’t your typical smile. His was a smile that showed, “We will be OK.” That young man’s smile? Every time I close my eyes I see his smile.

How can osteopathic physicians best help in Haiti?
My colleagues in the osteopathic medical community can contribute to organizations like mine, Doctors United For Haiti, or to other organizations. My colleagues can contribute money, contribute time, contribute medication—anything that will not only help save the earthquake victims but also address the health care problem that Haiti has been dealing with for decades.

I tell you this: Haiti has access issues. Haiti has cost issues. Haiti has people dying from preventable diseases.

Knowing that, I ask the osteopathic medical community to join with me in giving the Haitian people support in addressing their health care issues.

Since the earthquake, my organization has been getting physicians down to Haiti, getting medical equipment down to Haiti, getting medications to Haiti.

We’ve developed contacts on the ground. Now physician organizations are contacting us, and we’re sending their doctors down.

In fact, John Parenti, MD, the director of orthopedics at my hospital, Geisinger Medical Center, is getting ready to go to Haiti. My organization is working through the logistics for him to get down there.

He volunteered at the last minute to take a flight down to Florida. A charter plane is going to take him down to Jacmel, Haiti. And he’ll start helping.