An international collaboration to save a newborn baby

In a late-night email from the general hospital in Port-au-Prince (HUEH), PIH Medical Director Joia Mukherjee reported an inspiring example of lifesaving international collaboration from the night before.

PIH Medical Director Joia Mukherjee at a mobile clinic in Haiti in 2007.
Patients resting under the shade of a tree, for lack of housing at HUEH.

At L’hopital Universite l’etat Haitien (HUEH) last night, the surgical team from Children’s Hospital Boston and I were just wrapping up several cases. The Chief Administer at HUEH and a nurse were rounding by flashlight with two Haitian doctors who had returned from their pediatric residencies in Cuba to help.

On a routine post-operative check on a woman who had undergone a  C-section,  the residents noticed that her baby was pale.  Upon unwrapping the baby, they found that she had a huge amount of blood pouring out of her rectum.  They ran to the operating room asking for a surgeon.  While the team had orthopedic surgeons, a plastic surgeon, four anesthesiologists, six pediatric nurses and me, a pediatrician, we had no general surgeons. 

The baby was profoundly anemic and in shock.  The blood bank that the Haitian Red Cross was to start was a day or two away.

“Ask the American volunteers if any of them have O-negative blood!” I yelled, thinking that if we couldn’t do a formal blood type, the blood that is considered the Universal Donor would be the only way to get blood into this baby. 

An orthopedic trauma surgeon from Grand Rapids, MI, stepped up to the plate and drew 60 cc of his blood into a regular syringe. Meanwhile, as we struggled to get an IV, Plastic surgeon John Meara [from Children’s Hospital] inserted a needle into the baby’s tibial bone marrow (an intraosseus line), and we moved the baby to the operating room, where anesthesiologists from Boston and Grand Rapids went into full code mode, finally securing a line to give the direct whole blood transfusion and nearly one liter of fluid (half the baby’s body weight), as well as provide her with oxygen and antibiotics. 

The cause of the bleeding was likely an intestinal obstruction. When the baby was stabilized, we began trying to transport the baby to one of the U.S. military facilities. Even with the excellent collaboration with U.S. military personnel stationed at the hospital, it took hours to get confirmation of the location. 

By 3 am, the baby had stabilized and was actually sleeping.  Some of us slept on gurneys close by--abruptly jumping up for two aftershock tremors. At 5:30 am, as the sun was rising, I again called the military and finally got confirmation on the location of the hospital.  After waiting 2 hours for military-approved transport, our own PIH/Zanmi Lasante driver took us to the facility.  By 8 am, the baby was stable and in the hands of a competent pediatric surgeon.  We arrived back to our PIH tent city where many new teams of volunteers were waiting in the hot sun to help the people of Haiti. They had traveled from Maryland, Virginia, Michigan, Northern and Southern California, and South Carolina.  I was later relieved by my colleagues from PIH/ Zanmi, Dr. Patrick Almazor and Dr. Louise Ivers.

We don’t yet have an update on the baby; however, we have every hope that she will do very, very well. My brief rest was made more peaceful by this one miraculous example of the collaborative spirit between nurses, doctors, drivers and soldiers, and people from Haiti, Cuba, the United States, and people from around the world on behalf of the life of a tiny baby, shaken into the world by a devastating quake, sleeping under a tree for lack of housing. A baby whose life, like those of all babies, is our collective human responsibility.

In Solidarity,

Joia