Stephen M. McCollam, MD, provides volunteer care to underserved patients
Haiti is a stunningly beautiful island, but one that is also plagued with violence, political unrest, and severe poverty. Stephen M. McCollam, MD, of Peachtree Orthopedics in Atlanta, knows that about as well as anyone. Dr. McCollam has been providing volunteer orthopaedic care annually at the Hôpital Albert Schweitzer (HAS) in Deschapelles in central Haiti, one of the poorest areas of the island, for more than 28 years. Recently, I spoke with him about his experiences.
Dr. Griffin: How did Peachtree Orthopedics first get involved with HAS?
Dr. McCollam: The hospital's founder, Dr. Larry Mellon, was inspired as a young man to become a physician and provide humanitarian work in underdeveloped countries after meeting Dr. Albert Schweitzer and learning about his work in Africa. In the mid-1950s, when Dr. Mellon finished his medical training, he bought an old banana plantation in Haiti and built HAS, staffing it with both American and Haitian physicians. Shortly thereafter, he met and convinced Peachtree Orthopedics founders Dr. Jim Funk, Dr. Robert Wells, and Dr. Scoot Dimon to join him in orthopaedic rotations at the hospital. Sixty-plus years later, the relationship between HAS and Peachtree Orthopedics is as strong as ever. Peachtree Orthopedic physicians travel to Haiti two to three times a year to provide volunteer treatment to patients living in central Haiti who have little access to care for complex orthopaedic conditions.
Dr. Griffin: What motivates you to return to HAS each year?
Dr. McCollam: I do it as a tribute to the founding partners at Peachtree Orthopedics who, when they began this special relationship, hoped it would continue far into the future. Over time, I have realized that although I can't move mountains I can help people one at a time and that's what motivates me to return to Haiti each year. Changing the lives of the people whose mobility is hindered by a solvable orthopaedic problem is extremely rewarding. In this economically challenged country, helping one individual impacts the entire family unit.
Dr. Griffin: What types of orthopaedic conditions do you generally see?
Dr. McCollam: The types of conditions that the Haitian general surgeons refer to us fall into several broad categories: neglected or complicated trauma, congenital problems, remote infections that have destroyed bones and/or joints, and angular deformity of the lower extremities often caused by vitamin D-resistant rickets.
Dr. Griffin: Do patients have access to follow-up care after you leave the country or do they have to wait for you to return? Does the hospital treat patients who are unable to pay?
Dr. McCollam: After we leave, our patients are followed by the full-time general surgeons or part-time orthopaedic surgeons in HAS in their weekly clinics. We write detailed plans in the patients' charts. The general surgeons follow them and the next orthopaedic team from Peachtree Orthopedics that comes down—perhaps 3 or 4 months later—can follow patients if the surgeons request help to do so. Health care is provided through a reduced fee-for-service model, allowing patients with very little or no income to be treated. Over time, it has been demonstrated that even if patients pay a very small amount, they are more complaint in their care much more than if it was provided for free. These modest fees also help the hospital pay its staff.
Dr. Griffin: What is the biggest challenge a practitioner faces when trying to provide care to an underserved medical population in an economically struggling country like Haiti?
Dr. McCollam: There are several. One is that it's a significant culture shock to go from the richest nation in the world with a per capita income that far exceeds most other countries and land a few hours later in the poorest country in the Western hemisphere with a per capita annual income of no more than $200 a year. Although HAS is one of the best in Haiti, it simply does not have the orthopaedic hardware, anesthetic capabilities, or monitoring capabilities of a tertiary level hospital that we take for granted in the United States. Additionally, there are significant cultural barriers. The hospital employees only speak Creole, which makes it difficult to communicate, especially when wearing surgical masks. It is also very important to plan your surgery ahead of time, pull your own equipment, and make sure it gets sterilized because there is no flash sterilization available.
In Haiti, the air conditioners are marginal so the air temperature and humidity are quite high. There are often flies in the operating room [OR] that we have to kill and the sterility, although quite good, is not as perfect as it is in the United States. Another challenge is having to frequently make compromises. The injuries we see in Haiti are often severe and complicated, and achieving perfection may be impossible, but without our treatment many individuals would not receive any care. I vividly recall a case of Pott's paraplegia in an 8-year-old boy and having to decompress an anterior thoracic paraspinous abscess, approaching it from the posterior chest wall. I am a fellowship-trained hand surgeon, so you can imagine that I had never done spine surgery such as this. I was afraid that I would somehow violate the aorta or pleural cavity and that the boy would bleed out on the table. Fortunately, I found the abscess on the anterior aspect of the spine and was able to help this young boy.
Dr. Griffin: What are some of the personal rewards that come from volunteering in economically challenged countries?
Dr. McCollam: For starters, it's a delight to go to Haiti and help people turn their lives around so that they have the mobility and function needed to survive in their community. If I were to die tomorrow, I'm certain that other hand surgeons in Atlanta could immediately take over my patients without much fanfare. But in Haiti, if I was not there, those patients would remain impaired and crippled, continuing to be an economic burden to their family, and would never reach their own full potential for happiness. So, knowing that I'm changing people's lives one person at a time is the most important thing to me. In addition, there are no burdensome medical records tasks, and I don't have to worry about malpractice liability, even though I'm stretching and challenging myself in ways I would never think of doing in the United States.
Dr. Griffin: You were in Haiti shortly after the earthquake hit in 2010. What was it like to be a part of that relief effort?
Dr. McCollam: It was life changing in many ways. I've never been in a military or war zone; the earthquake in Haiti is the closest I've ever been to a mass trauma event. Many of the hospitals in and near Port-au-Prince had collapsed and the medical infrastructure was inadequate to treat the hundreds of individuals with crushed extremities, many of which involved gangrene and evolving sepsis. As a result, patients were bused to HAS. Injured victims, many with crushed legs and arms, arrived 50 at a time with no warning. By the time we showed up, the hospital's medical staff was exhausted and relied on us to help them triage patients. They were out of all pain meds and antibiotics. However, one of the hardest things to do was to decide which patients to treat first, knowing that all the crush injuries, many open, needed immediate care. I can remember walking down the halls of the hospital and patients grabbing onto my scrubs, begging me to perform their surgeries next. It was very difficult. Patients were dying of sepsis every day.
Dr. Griffin: Over the years, you have encouraged others to join you in this humanitarian effort. How do you motivate other practitioners who are busy in their practice to take a week off and go to Haiti?
Dr. McCollam: Well, it's pretty simple. I tell them it will be the best week of their year and that they will receive much more than they give. It's an experience that is difficult to articulate but I come home happy, fulfilled, and for the next 3 months, I don't complain at all about the U.S. healthcare system. Once I start to complain again, I know it's time to schedule my next trip to Haiti!
Dr. Griffin: Who accompanies you on these trips?
Dr. McCollam: I usually bring two to three additional dedicated orthopaedic surgeons with me. I treat primarily upper extremity cases, so I try to find someone who is specialized in lower extremity, sports medicine, or pediatric orthopaedics. Often, I'll try to recruit an anesthesiologist and a surgical scrub tech as well. We do have access to the local OR personnel, but again they speak Creole and so it can sometimes be difficult to communicate with them.
Dr. Griffin: What supplies do you bring with you? How do you get implants and other specialized orthopaedic equipment?
Dr. McCollam: We usually communicate with the hospital ahead of time to find out what special supplies they might need so that we can bring them with us. There also is a part-time orthopaedic surgeon now at HAS who can provide continuity when we are not there. We try to bring him recent editions of textbooks to help stock the hospitals' very nice library. Most importantly, we try to teach the general surgeons how to manage some of the problems we see so that patients do not have to wait until we get there to receive treatment.
Dr. Griffin: What impact has this experience had on you as an individual and as an orthopaedic surgeon?
Dr. McCollam: As an individual, it has made me appreciate what I have been given and worked so hard for in this country. When I see the incredible poverty in Haiti, it makes me realize that whatever stresses and troubles I think I have back home are minor compared to those of the Haitians, many of whom are just struggling to survive. The most important thing to keep in mind is that if I don't go to Haiti, people's lives don't change for the better. After all, why do we go to medical school? Isn't it to gain the knowledge and develop the skills that enable us to help those who are impaired because of correctable orthopaedic problems?
Dr. Griffin: Will Peachtree Orthopedics continue to participate in providing orthopaedic care in Haiti? What are your personal plans?
Dr. McCollam: Our future goals are to try to set up Skype or some other kind of internet activity where we can discuss the more complicated cases and perhaps advise the local general and orthopaedic surgeons on individual cases.
I keep going back to Haiti because of its beautiful people and because I want to help give them at least some of what I have in the United States—musculoskeletal health, mobility, and a chance at a good life. HAS is a tribute to Dr. Mellon's efforts to create a better life for the people of Haiti and I want very much to honor his legacy. I also want to honor the legacies of Dr. Jim Funk, Dr. Robert Wells, and Dr. Scoot Dimon by continuing this precious relationship they began with the hospital.
The number of friends I have made from all over the world through volunteering in this effort are very special to me and I love nurturing those relationships. Having patients come up to you years later to tell you that you made all the difference in their lives in turn makes all the difference in my life. All three of my daughters and my wife have been to Haiti multiple times and it is in their hearts as much as it is in mine. Traveling to HAS is the purest expression of why I went to medical school—helping people to make their lives better by using the knowledge and skills I was taught. I encourage others to consider volunteering in humanitarian efforts either here in the United States or in other parts of the world because making a difference for others ends up making a huge impact in one's own life.
Letha Y. Griffin, MD, is a member of the AAOS Now Editorial Board.