The “Hopital Albert Schweitzer,” in central Haiti, that serves 345,000 impoverished people in the region, is a place that provides ample opportunity for Dr. Roland to carry out his mission in Haiti.

“Yesterday I took a second year Haitian resident through an amputation. The case went well but took too long. He did not know his anatomy,” he writes in an email message to his wife, Jola, and to his two sons, Peter and Tristan. “The second case was a groin hernia. The scrub nurses wouldn’t let the resident scrub. They said there is not enough sterile gowns for the day. The case went well until I got into an artery. The suction doesn’t work so I could not see in the wound as the blood was welling up. I actually began to develop a tremor as the situation was getting a bit dicey. I did get control of the bleeder.”

He then describes the atmosphere in the operating room. “My second scrub nurse is the same type of person I have experienced in every hospital. She is skeptical of the surgeon, surly, and totally experienced. You know as a surgeon what you are dealing with when the nurse forcefully slaps the requested instrument into your hand. I could tell she was assessing my skills. She was one step ahead of me during the case.”

The last case he handled that day was of a young man with colon obstruction due to twisting of the colon. This happens in countries where people eat roughage.

“Dr. Exe, the Haitian chief surgeon, was doing the case. But as he opened, the massive colon was dead. It looked like a green boa constrictor arising out of the abdominal incision. It already stank of death. I scrubbed to help him. This is the best way for surgeons to bond, to help each other difficult cases.”

Yet, there was no assurance that the patient will live. “In the States, he would go to the ICU, here he just goes into the corridor. If a patient cannot breathe after surgery, he or she is simply extudated, and left to die. They have no ventilators.”

In a follow up email message, Dr. Roland writes, “I am feeling a bit overwhelmed…Tomorrow I have an amputation, hand infection drainage, and circumcisions scheduled… Yesterday’s patients would have been screaming in pain in the States, they receive no narcotics here. But here they just smile at me. I am talking about bowel case with long incision, amputation, hernia… They just have a very different expectation of pain control here.”

Than, he describes the fate of a twelve year old girl, who is dying a horrible death of heart failure. “She is struggling to breathe, cannot lie down. No one knows the diagnosis, nor is there a real attempt to cure her. There is a Swiss cardiologist who will do an echocardiogram, but there are no medications for her. Two American physical therapists are paying for someone to care for her as she suffers. The girl’s family has abandoned her. I gave some money to help out. We are all hoping she dies soon.”

But there are brighter moments, too. “I just did a circumcision on a tiny penis. I was thinking how I would be in big trouble if I ruin a Haitian boy’s penis. I knew I was doing OK when half way through the procedure my unsmiling scrub nurse started talking about her personal life with other women in the room.”

Although the Hopital Albert Schweitzer apparently doesn’t live up to the expectations of the American public, it plays a vital role in the Haitian health care system. The hospital was started in 1947 in tribute to Dr. Schweitzer, by Larry and Gwen Mellon, a scion of the Mellon family. But the Foundation, based in Pittsburgh, supporting the hospital, is running out of money. The facility now is entirely dependent on contributions.

Indicative of the need for financial support is the fact, Dr. Ronald said, that the cost of fuel to operate the diesel generators is just under $1 million per annum. It takes $5 million to run the hospital. And the Haitian physicians work for a pittance compared to what US physicians earn.

Frank Shatz lives in Williamsburg, Va. and Lake Placid. His column was reprinted with permission from The Virginia Gazette.