Project Medishare Research Articles

In situ free-floating craniectomy for traumatic cerebral decompression in an infant: A field hospital solution

Background:Despite refinements in neurotrauma care, the morbidity and mortality of severe traumatic brain injury (TBI) in pediatric patients remains high. We report a novel approach to the surgical management of increased intracranial pressure in severe TBI utilizing an in situ free-floating craniectomy technique, which was originally devised as a creative solution to the unique challenges in a Haitian field hospital following the 2010 earthquake.Case Description:A 13-month-old Haitian boy presented to Project Medishare field hospital in Port-au-Prince with left hemiplegia, a bulging fontanelle, and increasing lethargy following a traumatic head injury 4 days prior. An urgent craniectomy was performed based on clinical grounds (no brain imaging was available). A standard trauma flap incision was made, followed by a hemicraniectomy and expansion duraplasty. A small hematoma was evacuated. Frontal, temporal, and parietal bone flaps were placed on the dura in approximation to their normal anatomical configuration, but not affixed, leaving space for further brain edema, and the scalp was closed. The child experienced favorable peri-operative and early postoperative results.Conclusion:In situ free-floating craniectomy, while devised as a creative solution to limited resources in a natural disaster zone, may offer advantages over more traditional techniques.

Pediatrics in the Community: The Haiti Earthquake

1. Sachin D. Shah, MD* 2. C. Andrew Aligne, MD, MPH† 1. *University of Chicago, Chicago, Ill. 2. †University of Rochester, Rochester, NY Disaster relief appeals to our noblest qualities as health-care professionals and compassionate human beings. The devastation caused by the January 2010 earthquake inspired many pediatricians to travel to Haiti. One of these was Dr Sachin Shah, a veteran of numerous international health experiences, who spent a week in Port-au-Prince helping to staff a field hospital. This facility, run by Project Medishare, (1) was a sophisticated operation boasting a 35-bed pediatrics ward that included a fully equipped …

Two Cases of Restavek-Related Illness: Clinical Implications of Foster Neglect in Haiti

Restaveks, or indentured foster children, are a poorly understood, vulnerable subclass of Haitian society. From 2001 to the present, a partnership between multiple US academic medical centers and Project Medishare for Haiti has held an ongoing series of mobile clinics in rural Haiti. Multiple cases of restavek-related illness were identified. At a recent pair of mobile clinics, the authors identified two restavek cases that were significantly worse off than their communal peer groups and required immediate care. Given the lack of a robust legal support to protect orphaned children in Haiti, clinicians have an important role in advocating for restaveks at the bedside. The plight of Haiti's restaveks is widely reported in the human rights literature but is not publicly recognized as an issue for community health and wellbeing among physicians. To address these health disparities, the health consequences of an entire class of neglected children must be further explored.

Infection Control in Field Hospitals after a Natural Disaster: Lessons Learned after the 2010 Earthquake in Haiti

After the January 12, 2010, earthquake in Haiti, Project Medishare and the University of Miami organized, built, and staffed a 200-bed field hospital (the University of Miami Hospital in Haiti [UMHH]) on the outskirts of Port-au-Prince. We describe the operational challenges of providing a safe environment at the UMHH. Furthermore, we compared how these issues were addressed at this ad hoc hospital with how they were addressed at the field hospital of the Israel Defense Force, a fully deployable hospital with an organization fine-tuned as a result of prior disaster situations, also in Haiti.

An Academic Center's Delivery of Care After the Haitian Earthquake

The Miller School of Medicine of the University of Miami and Project Medishare, an affiliated not-for-profit organization, provided a large-scale relief effort in Haiti after the earthquake of 12 January 2010. Their experience demonstrates that academic medical centers in proximity to natural disasters can help deliver effective medical care through a coordinated process involving mobilization of their own resources, establishment of focused management teams at home and on the ground with formal organizational oversight, and partnership with governmental and nongovernmental relief agencies. Proximity to the disaster area allows for prompt arrival of medical personnel and equipment. The recruitment and organized deployment of large numbers of local and national volunteers are indispensable parts of this effort. Multidisciplinary teams on short rotations can form the core of the medical response.

Rapid Medical Relief — Project Medishare and the Haitian Earthquake

On the evening of January 12, 2010, a few hours after the Haitian earthquake, the leaders of Project Medishare in Miami began contacting Haitian associates, faculty and staff of the Miller School of Medicine at the University of Miami, and owners of small private jets in southern Florida. Project Medishare is a nonprofit nongovernmental organization created in 1995. Given our geographic proximity to Haiti and our 15-year relationship with Haitian physicians through Project Medishare, we were able to offer emergency medical relief and provide medical staff within 20 hours after the earthquake. A five-person team of medical relief workers arrived . . .

Project Medishare: a volunteer program in international health at the University of Miami.

Most U.S. medical schools have programs in international health, but there is a need to find ways to make students (particularly those with little clinical experience) more effective volunteers in international settings. The Department of Family Medicine at the University of Miami School of Medicine developed a program to help prepare students for international work and to ensure that the work they do makes a difference. Over the past four years, this program, Project Medishare, has sent groups of students to Haiti to conduct health fairs. Students prepare all year for their voluntary trips, which take place during the spring and summer breaks; they learn about Haiti's history, culture, language, and health problems. They also raise funds and donations of medicine and supplies. The health fairs, which are one-day events in orphanages and villages, emphasize patient education and preventive medicine. The success of the fairs is evaluated using testimonials from Haitian officials and patients, students' journals, and data collected by the students. Factors critical to Project Medishare's success include (1) having a "critical mass" of culturally and linguistically competent students and faculty; (2) collaboration with local authorities and providers; (3) advance preparation; and (4) using lessons learned from each event to improve the next.