Late summer is avocado season in Haiti, and people lucky enough to have a tree on their property gather the fruit to eat and sell.

Roseline Bernard, 17, lives with her grandmother and her aunt in Lascahobas, a small community in Haiti’s Central Plateau. Her mother died when she was young, and her father hasn’t been around, so Roseline’s work harvesting avocadoes is a big contribution to the household.

On Aug. 8, Roseline climbed high into her family’s avocado tree to collect the fruit before it ripened and dropped to the ground. She was nearly three stories high when she fell.

A year ago, Partners In Health could have treated her, but her odds of recovering from such a fall would have been slim. A year ago, there would have been no emergency room to receive her, no modern surgery suite to repair her damaged abdomen, no CT scanner to identify her most complex injury.

A lot of people didn’t feel there was much hope for recovery. We saw this young girl come to life.

Hôpital Universitaire de Mirebalais was designed to handle cases like Roseline’s—complex, urgent, inter-connected—that a community clinic or district hospital isn’t equipped to manage. With Roseline in tremendous pain, her family took her on the two-hour journey to University Hospital, first carrying her on a wooden board for the 45-minute hike from her home to Lascahobas and then taking a motorcycle to the hospital in Mirebalais.

There, staff stabilized her and began to diagnose and treat her injuries. Using X-ray and other diagnostics, they found she had shattered both wrists, broken her face, and had an internal abdominal injury.

The surgery team wheeled her into the operating room to repair her abdominal injury, and other clinicians set her broken bones. After the operation, she began healing in the inpatient ward. But Roseline was agitated and restless. She couldn’t walk. For the first week, she couldn’t even speak.

Doctors began to piece together the problem. She had lost consciousness for hours after the fall. A CT scan revealed that she had suffered a traumatic brain injury—a diagnosis that’s rarely made in Haiti, despite countless cases from injuries in traffic accidents and falls.

“Traumatic brain injury often goes under-recognized in Haiti,” said Dr. Andree LeRoy, director of rehab at University Hospital. “Sometimes clinicians make the assumption she was always like that, or they might not be able to do anything about it.”

University Hospital rehab technician St. Lot Odeus worked with Roseline Bernard, 17, and her aunt, to provide cognitive stimulation and help her recover.

For traumatic injuries like Roseline’s, surgery and emergency care are just the beginning of a long road to recovery. Suffering from malnutrition in addition to physical and cognitive injuries, Roseline would need cognitive and physical rehabilitation to function normally again.

Partners In Health has been working to strengthen rehab care in Haiti, especially in referral facilities like University Hospital. LeRoy, who is Haitian-American, has led this work as director of rehab for PIH, while juggling her day job as a rehabilitation doctor at Spaulding Hospital, a teaching hospital of Harvard Medical School. (Read more about Dr. LeRoy and how the 2010 earthquake led her to Haiti.)

This summer, the rehab program based in Cange moved to University Hospital, where it could be better integrated with the other critical care services that depend on rehab to help patients recover from disability, such as surgery, the emergency department, and mental health.

Between June and August, the rehab team evaluated 123 patients for care, including 14 patients who suffered traumatic injuries in a July bus crash. The team has also provided mobility devices, including crutches, canes, walkers, and wheelchairs, for 50 patients to use at home once they’re discharged from the hospital.

University Hospital, in addition to PIH-supported Hôpital St. Nicolas in St. Marc, also offers community-based rehab services. After patients return home, community rehab educators support patients during the transition, helping them use their mobility devices, take their medicines, complete their physical therapy exercises, and return to the hospital for follow-up care.

During their home visits with existing patients, staff members also identify patients in need of rehab care in the community.

The system worked for Roseline.

“She had every kind of injury,” LeRoy said. “Rehab requires care from many different fields—nurses, physicians, physical therapists, rehab technicians, nurse auxiliaries, and psychologists all work together to maximize the function of an individual. It’s a beautiful thing.”

For a chance to recover, Roseline needed cognitive stimulation—quickly. With training from LeRoy and others, St. Lot Odeus, a rehab technician with Zanmi Lasante—PIH’s sister organization in Haiti—began working with Roseline even when she was too weak to leave her bed. He helped her family understand that they needed to speak to her to help her brain heal.

At first, Odeus helped her do exercises lying down, then sitting at the edge of the bed. Roseline’s constant bed rest and inability to eat after the injury had left her very weak. Slowly, she began to stand with the help of a walker. Then, she took her first few steps. With her caretakers’ help, she explored the courtyards at the center of University Hospital, and watched koi fish in the ponds designed to create a sense of beauty, calm, and healing for patients.

“I am very happy because I can walk again,” Roseline said. “That was my first time going outside in a long time and it felt really good.”

University Hospital rehab staff accompanied Roseline Bernard on a walk through the hospital’s courtyard this fall.

With hospital nutrition staff providing healthy meals, her malnutrition also improved. Two weeks later, Roseline was able to take a few steps on her own. Just before she was discharged home, she could walk more than the length of a football field on her own. When she was ready for discharge on Oct. 5, she had grown two inches taller during her stay.

Today, she is doing well, although she’s still unable to walk through the mountainous terrain of her home to reach school.

"A lot of people didn’t feel there was much hope for recovery," LeRoy said. "We saw this young girl come to life."

 

Roseline returned home from the hospital recovered and two inches taller. Photo: Jonah Feldman/Partners In Health

Roseline fell about 30 feet from this avocado tree near her house. Photo: Jonah Feldman/Partners In Health

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