Emergency Care at HUM

The Emergency Department is one of University Hospital of Mirebalais' (HUM) primary entry points; more than half of hospitalization cases go through this department, that operates 24 hours per day, every day, since it opened on June 14th, 2013.

Currently, its medical team is made up of 11 doctors, 9 of whom specialize in Emergency Medicine. The Nursing team is made up of 13 auxiliaries and 19 nurses who are also specialized, for the majority of them, in Intensive Care and Urgent Medical Aid. 19 residents of HUM's Emergency Medicine program are currently in Emergency Training. This program has been headed for 6 months by Dr. Cassandre Edmond, who is an emergency doctor, family doctor, training officer and department head.

More than 40 patients are seen every day at the Emergency Department of HUM. Very often, these are cases of trauma: head trauma, limb fractures, etc. The service also receives people with heart disease, hypertension and patients infected with tuberculosis and COVID.

HUM Uses a South-African Triage System

To give priority to more serious cases, the service uses an automatic South-African triage system, which indicates the order of severity of the patient's case according to the colors: red, yellow, orange, green, blue.

Red denotes urgent and unstable patients who cannot wait more than 5 minutes, yellow, patients who can wait a long time, orange, patients who cannot wait more than ten minutes and green, patients who can wait 4 hours. Blue signals that it is already too late, and that the patient is dying.

"It's always a matter of seconds in the emergency department," says Dr. Cassandre Edmond. "Sometimes we don't even have time to sort it out. A second can make the difference between life and death,” she says.

Patient Care at HUM

Upon arrival at the Emergency Department, the patient is greeted by a nurse. After an initial medical examination, the medical staff may be required to carry out additional technical examinations (blood test, electrocardiogram, X-ray, scanner). After this first examination and in possession of the results, the emergency doctor calls on various specialists from the hospital who come to complete his assessment.

At the conclusion of the process, three alternatives are possible: either, hospitalization for adequate treatment and additional assessment, or a more prolonged monitoring in the Emergency Department before returning home, or a simple return home with, if indicated, an appointment with a medical specialist or the patient's doctor.

HUM receives patients from all ten (10) departments of the country. As a result, the Emergency Department is always overloaded and often finds itself short of personnel, medicine and emergency equipment. The HUM Emergency Department only has 41 beds while they often treat on average 71 patients.

“We are always juggling with other services and subdividing our team to be able to provide care to our patients quickly and welcome as many people as possible,” says Dr. Edmond. ERs need more nurses and emergency physicians. “We sometimes have only one nurse for about twenty (20) patients. It's not normal," she said.

Like all hospitals in the country, HUM also has needs. The 3 fans in the Emergency Department no longer work. We need at least 4 ventilators to function, 2 defibrillators, 10 monitors to check blood pressure, 2 sonography machines with a stand, emergency carts, medicines and more beds and chairs to accommodate patients," says Dr. Cassandre Edmond.

Despite everything, the HUM Emergency Department makes a difference. There is always a doctor on site night and day, its doors are always open to receive any patient. In a country like Haiti where insecurity is in full swing, where armed gangs still fight with one another, and where natural disasters claim victims, it is always important to have emergency services open 24/24, 7 days a week, in order to care for the sick and injured.

In addition, the ED also serves as a bridge between patients and doctors. During her many years in the emergency room, Dr. Cassandre Edmond realized that, even in need, some patients retain their pride and honesty. She remembers that a man, accompanied by his son, came one day to the emergency room to have the son's infected wound treated. Following the medical examinations, the doctors declared that the child had tetanus, and that he needed to take medication that the hospital did not have in stock at the time. The doctors referred him to another hospital. Unfortunately the father did not have the 200 gourdes, (or 2 US dollars), to pay the transportation costs. Thankfully Dr. Edmond was happy to help out.

A few months later, the man returned to the hospital to reimburse Dr. Edmond. He insisted she accept the reimbursement, though she did not want to. It was there that she learned that his son had died of tetanus a few days after his first visit. “I was very moved. Despite his pain, he insisted on giving back the money. I will never forget this man,” she said.

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