Surgical Department at Saint Barnabas Medical Center

Missionary Surgery

CRUDEM stands for the Center for Rural Development in Milot (Haiti). It is typical of many such projects founded by various religious or international organizations to help poor countries with their medical needs. While not on a scale of Medicines Sans Frontiers ( Doctors Without Borders) or Operation Smile it nevertheless requires a great deal of organization by many people. The medical need is enormous. It far outstrips any one organization or even country's ability to solve. Haiti is the poorest country in our hemisphere. The average annual income per family is $250.00. There is now an elected government with an elected President, but there remains no infrastructure. The roads are bad, there is no sewer system, sanitary conditions are very poor and malnutrition is common especially among the children.

Milot is a town if 25,000 people in the mountainous northwest corner of Haiti. It sits twelve miles away from Cap-Haitian which is the second largest city in the country. It has no electricity. Crudem was founded by the Brothers of the Sacred Heart and is now supported by major grants from the Knights of Malta and other sources. The hospital, Sacre Cour, was built from the original clinic in 1986 by Brother Yves Beausejour. In 1986 the operating room was outfitted by Dr. Theodore Debuque a surgeon from St. Louis who also performed the first operation that year. It has been continually expanded to its current capacity of 40 beds, 2 operating rooms, a one room delivery suite, a pediatric ward and various clinics. It has its own generator for electrical power. The hospital now has four permanent staff Haitian physicians ( 2 internists, a pediatrician and a gynecologist ). They are supported by over 140 visiting medical personnel from the U.S. each year including many from New Jersey.

For the past two years I have had the privilege of spending a week at Crudem with a medical team. A team typically consists of a gynecologist, a general surgeon and at least one internist plus occasional nurses and residents. A typical day consists of continuous surgical clinics in between operations and lasts from eight in the morning to six or seven at night with a break for lunch. There is always plenty of work. I have done 30 or more operations on both of my visits. The gynecologists have done at least as many.

Those cases we were unable to get to we set up for the next team. Last year there were over 700 cases done by visiting surgeons. The surgical experience runs the entire gamut of general surgery and there is even a team that does cardiac surgery once a year. Hernias and hydrocoels and fibroids of the uterus are very common and very large. Many of the hydrocoels are caused by Filariasis, a worm that is ingested with contaminated water and blocks the lymphatic system. Ulcer disease is also common since there is no wide availability of antacids or other more effective acid blocking medicines. It is not unusual to see gastric outlet obstruction because of chronic ulcer disease. On the other hand, since the diet is low in fats, gall bladder disease is not common. AIDs is said to infect 20 % of the population but there is no way to be sure because they do not routinely test for it. One does not see many patients with AIDS since these unfortunate people rarely can afford the medications needed and die quickly of their disease. Fortunately, there is progress being made in the area of educating the population in the use of condoms. Malaria and other tropical diseases such as typhoid are also common.

The rewards of missionary surgery are many. It is the opportunity to really help make a difference. The hours are long but the satisfaction is unequaled. The patients ( who actually pay the equivalent of a few dollars for their care) are very appreciative of our efforts on their behalf. I plan to return for at least a week every year for as long as I can. Next year I will hopefully be joined by some of my St. Barnabas colleagues.

H. Stephen Fletcher, M.D., F.A.C.S.
Phone: (973) 533-9494

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