A team of burn and plastic surgery specialists from Sheba Medical Center in Tel Hashomer, Israel, traveled to Haiti in January, where they delivered and operated the country’s first medical laser. The laser, donated by the New Jersey-based nonprofit Burn Advocates Network, is primarily used to treat pediatric patients suffering from catastrophic burns, a major health crisis in the Caribbean nation.
Sheba National Burn Center director Prof. Josef Haik and two Israeli colleagues mentored 30 surgeons, nurses, and therapists from six hospitals in Haiti and the Dominican Republic on how to use the laser and carry out other state-of-the-art care to reduce and alleviate disfiguring, painful and motion-restricting scarring.
The introduction of the Lumenis UltraPulse CO2 fractional laser to the Sacre Coeur Hospital in Milot constituted the first international satellite project of I-PEARLS (Israel Pediatric and Aesthetic Reconstructive Laser Surgery Center of Excellence), a recent partnership between Sheba and BAN creating the first laser treatment and research center in the Middle East focusing on healing pediatric burn survivors.
BAN provided the funding to renovate existing space in Sheba’s advanced technology wing and outfit it with an array of lasers and other equipment necessary to make it a center of excellence.
According to Haik, the I-PEARLS center at Sheba has conducted 1,000 procedures annually in the last three years, with around half of the patients coming from the Palestinian territories. Unlike procedures carried out on adults that can often be performed with local anesthesia, those done on children require full anesthesia.
However, the drugs and consumable surgical supplies readily available in Israel are in short supply in Haiti and the Dominican Republic, where approximately 60 percent of burn victims are under age 12. The majority of their injuries are caused by unsafe cooking practices, faulty electrical wiring, and dangerous storage and handling of gasoline. The devastating 7.0 earthquake in January 2010 also caused widespread burns.
“There was a lack of anesthesia and drugs, and they were afraid to use the supplies they had,” Haik said of what he found upon arrival at the hospital in Milot.
While the Israeli surgeons found the situation overwhelming at times, they were impressed by how their Haitian counterparts found ways to compensate for what they didn’t have.
“Our Sheba surgical team connected with the Haitians on a deep and almost spiritual level. They took on both their teaching and clinical assignments with a down to earth attitude and humility. They made it clear that they had not come to change the way they practice medicine, just to support them as they tackled some of the most difficult trauma cases imaginable,” said BAN founder, attorney Samuel Davis.
With riots, crippling fuel shortages, and impassable roads due to burning tire barricades just two weeks before the January 5-7 mission, Davis said it was “miraculous” that the I-PEARLS training’s educational and clinical goals were met.
“The communication grid was disabled and there wasn’t enough petrol to keep cars on the road. Our laser, which had been delivered to the Sacre Coeur Hospital in September, was carefully uncrated and functioned flawlessly using transformer-generated electricity,” he said.
The Israeli team demonstrated the use of the laser on 12 patients and guided the local surgeons as they tried it for the first time. They also conducted lectures and presentations on a variety of subjects related to burn care, such as the necessity of early skin grafting and physical therapy as a follow up to surgery to prevent contractures (permanent tightening of tissues).
“The laser is a good initiative,” said Haitian burn surgeon Dr. Rolph Richeme, founder of Fondation Haïtienne D’Aide Aux Brûlés (FONHAB), the Haitian burn foundation. “I think if patients have hypertrophy or keloids then with this technology they will look and feel much better.”
“If burn patients, especially children, are more comfortable with the way their scars look and feel, then they will find it much easier to adjust to their new reality, and they will be more optimistic about the future,” Richeme said.
While providing hands-on instruction on how to use the laser was the reason for the Israelis’ visit, they ended up also educating about infection control, cleaning, bandaging, and nutrition. They also performed unplanned complicated surgeries.
In the course of doing rounds, Haik and his colleague Dr. Moti Harats encountered two patients who were critically ill — quite literally on the verge of dying from their burn injuries, according to Davis.
“There was one small child who was so infected, yet he was about to be sent home!” Haik reported.
After examining the boy in an isolation room, the Israeli doctors determined that the virulent infection required immediate surgical intervention. The team performed a deep debridement and found that the infection had spread to a lymph node. Had the procedure been delayed by a few days, it was likely that the boy would have died from the spreading of the infection to his blood.
The second case involved a 27-year-old woman had been burned six months earlier when she fell face-first into a réchaud, or traditional Haitian stove. Her face and neck had deep second-degree burns, but there was no ability to do a skin graft. By the time the Israelis arrived, the woman had formed keloidal scars that resulted in her mouth fusing almost completely shut. Barely able to put a straw into her mouth for nourishment, she was starving to death. To complicate matters, the woman was seven months pregnant.
“The Israeli team had an excruciatingly difficult decision to make. To save both this woman and her unborn child they would have to perform a major procedure under local anesthesia. If they did not attempt to free up her mouth, a slow death for this young woman and her child was a certainty,” Davis said.
The visiting team even brought food from the dining hall to patients, as Haitian hospitals do not provide meals and patients must rely on what family members can bring them to eat. The doctors’ gesture was merely a stopgap measure in providing the proper amounts of protein needed by burn victims to heal.
Haik, who has served on medical missions to many countries around the world and represents Israel at the World Health Organization, is positive about the Haiti mission’s outcome. He and his colleagues stay in touch with the surgeons from Hispaniola on social media and are available for long distance consultations. But most importantly, the Haitian and Dominican physicians can now support one another in using the technology.
“The multiplier effect of the mission is the biggest treasure,” Haik said.
Davis started his work on behalf of burn victims with “burn camps” in Israel, India, and Brazil aimed at helping children and adolescents deal with their physical disfigurement and emotional scars. However, with clinical advancement in the last five years due to the introduction of lasers, Davis decided that BAN’s focus should be as much on technology as on psycho-social healing.
“I am confident that the future of pediatric burn care even in resource-challenged countries will include both burn camps to restore the spirit and laser therapy to heal the scars,” Davis said.