What does it take to fix a broken neck?
Staff at University Hospital in Mirebalais, Haiti, had to learn when two patients with that same injury arrived at the emergency room days apart.
One was a 48-year-old farmer who fell out of a tree while he was cutting a branch to sell as firewood. The other was a high school senior who broke his neck in a traffic accident when the brakes of his bus gave out on the winding highway from Mirebalais to Port-au-Prince.
A broken neck—in this case, a fracture of the second vertebrae of the cervical spine—is a dangerous injury. If not handled, diagnosed, and treated properly, it can result in permanent paralysis—a grim fate especially in a poor country like Haiti, where disabilities sink families even deeper in poverty.
So when Marcenne Desanm, the first patient, showed up at the emergency room entrance of the hospital, clinicians handled his neck with care. They were able to quickly diagnose the injury with the CT scanner at the hospital, which showed the fracture in the spine. Then they realized they would need a device called a halo collar to heal the injury.
A halo collar is a type of brace that holds the neck still, allowing the fracture to heal. A metal band runs around the head like a halo and screws into the scull. The metal band then connects to a brace around the torso and waist to keep the neck from bending or turning.
“It’s not the most pleasant experience to be in a halo collar,” said Dr. Luther Ward, a Paul Farmer global surgery fellow who is training Haitian surgical residents at University Hospital. “But it’s a matter of being permanently disabled compared to being able to be back in society.”
But the team didn’t have a halo collar. So they made Desanm comfortable as he waited, and called Boston, where a PIH-affiliated surgeon at Boston Children’s Hospital arranged for two halo collars, a donation from the manufacturer, to be sent to Haiti with the help of PIH Boston’s procurement team.
“For 14 days, I told Desanm not to move—just lie on his back and wait—because we were searching for the halo collar for him,” said Dr. Regan Marsh, director of the emergency department at University Hospital and attending physician at Brigham and Women’s Hospital. “He never complained and is incredibly strong and kind.”
It was a lucky coincidence that they managed to send two, because by the time the collars arrived, so too had the second patient, Guerrier Wilcliphe, 21.
The surgical team still needed help to place the collars. In the United States, this procedure is done by a neurosurgeon, and the hospital’s surgery team didn't have that skill set. So the team reached out to a partner institution, Port-au-Prince’s Hospital Bernard Mevs, operated in conjunction with Project Medishare.
A Haitian neurosurgeon at Bernard Mevs was available to help, and so Ward and another surgical fellow, Dr. Jacky Fils, who is Haitian-American, traveled with the two patients to Port-au-Prince. The neurosurgeon there taught them how to properly place the collars. The surgical team and the patients returned to Mirebalais, where the patients received follow-up care and then were discharged home.
Guerrier Wilcliphe, 21, broke his neck in a bus crash in Haiti. After three months in a brace called a halo collar, he should be able to resume living as before. Jacky Fils/Partners In Health
Desanm and Wilcliphe will continue receiving follow-up care in Mirebalais over three months, at which point doctors hope their fractures will be healed, the collars removed, and they can resume living normally. Desanm’s fracture is more complicated, and he may require further care.
“God put me here with these doctors,” Desanm said. “I hope to return to work after the collar is taken off, but I will follow whatever instructions the doctors give me. I have so much hope in life now. I just hope that I will be able to continue working so that I can provide for my family.”
The halo collars can be reused, so future similar injuries can also be treated, with the new skills of the University Hospital surgical team, the right equipment, and a team of specialists to handle complex cases.
“This is the amazing thing about this hospital,” Ward said. “You have to have a CT scanner to make the diagnosis. You have to have an ER that is keen enough to handle these patients. The fact that we can diagnose the problem opens up a whole new world, because we can treat the injury. Putting on the halo collar is probably the smallest part of the whole thing.”
Desanm and Wilcliphe told their stories to hospital staff. Below is what happened in their own words, translated from Haitian Creole.
Guerrier Wilcliphe, 21, from Mirebalais
I was in a tap-tap on the way to Port-au-Prince, about 25 minutes from Mirebalais on Route Nationale 3, when the brakes stopped working. The car flipped on its side and during the crash I broke my neck. An ambulance arrived and brought me to the emergency room at University Hospital in Mirebalais. I was in the ER from Thursday to Monday. On Monday afternoon I went down to Port-au-Prince in an ambulance with Dr. Luther Ward and Dr. Jacky. They put the collar on me and I returned to HUM the same day. I was able to return to my house the next day.
Now I sometimes get headaches on my right forehead but overall I don't have too much pain. I come for a consultation once a month and will take the collar off after three months, or earlier, if Dr. Luther says it is okay.
You never expect an accident like that to happen. I found really good care here, and I think this collar will help me return to the way I was before the accident. I'm in my last year of high school and hoping to go to university next year. I also love to play soccer and am hoping that one day I'll be able to play again.
Marcenne Desanm, 48, from Savanette Cabral
I am a farmer who lives in Savanette Cabral. I have a wife and eight kids—seven are in primary school and one is in secondary school. I grow grain, corn, and plantains, and sell wood.
The accident occurred when I climbed a tree to cut off a branch to sell the wood. I stood on a lower branch and was sawing a branch above me. When the branch broke, it didn't fall on the ground; instead, it fell on me and crushed me in between the two branches. My stomach was bleeding and I was completely stuck. My wife saw me and cried for help; my neighbors then rushed to my assistance. They climbed the tree and pulled the branch off of me, but when they did this I fell backward onto the ground and broke my neck. I lost consciousness.
I live a two-hour walk from the closest road, so my neighbors had to put me on a stretcher and carry me to the road where the ambulance could meet them. I came to HUM and spent 13 days in the emergency room. They put a catheter in me and took care of my wounds where the branch had crushed me.
I went down to Bernard Mevs with Luther and Jacky and had the collar placed on my neck. I came back to the hospital and stayed for four more days. For the next few months while I am recovering I am renting a house in Cange, because my house in Savanette is too far from the road for me to walk to return for consultations. An ambulance now comes to pick me up at my rented house whenever I have an appointment and takes me home afterward. Two of my kids and my wife are staying with me too.
They took great care of me from the moment I arrived. God put me here with these doctors. I don't feel too bad anymore. I used to have problems sleeping, but now I just sleep sitting up or leaning on my hand, and it doesn't feel too bad. I can also now stand up from a chair by myself! I hope to return to work after the collar is taken off, but I will follow whatever instructions the doctors give me. I have so much hope in life now. I just hope that I will be able to continue working so that I can provide for my family.