Comfort On A Deadline

A Haitian girl's case illustrates the problems and hopes of the doctors and patients aboard the Navy hospital ship


PORT-AU-PRINCE, Haiti -- Christelle-Melenchy Fortius' first chance at a reasonably normal life ended badly, with the surgery on her mouth aborted before it began and a Haitian doctor apologizing that the anesthesia didn't work. Her father, Dieumaitre Fortius, said he tried to earn money to pay for another doctor but never got far, and some days he couldn't even afford food.

Last month, Christelle's second chance came unexpectedly, from the United States. The USNS Comfort, a Navy hospital ship, appeared one morning in Port-au-Prince harbor, and three days later 4-year-old Christelle was asleep on an operating table inside, with an oral surgeon and a plastic surgeon taking turns making the tiny cuts and stitches to repair her double cleft lip.

"That ship was like a benediction for me," Fortius said. "There was no hope for my daughter without the Americans. No hope."

But Christelle still needs another miracle.

The Comfort's tightly choreographed 12-nation tour of Latin America didn't allow time to fix Christelle's cleft palate, which prevents her from talking and eating normally. And after surgery on her lip, the ship dropped Christelle off in Port-au-Prince without any provision for follow-up care - neither a check to monitor for infection nor the type of long-term dental work and therapy generally provided by international aid groups such as Interplast or Operation Smile.

Now Fortius is looking to doctors in Cuba to provide the next level of Christelle's care.

Her U.S. Navy doctors said they did the most they could, given the Comfort's limited time in Haiti.

"It's always a concern on humanitarian missions, that you might not get any follow-up," said Cmdr. Craig Salt, the Navy plastic surgeon who fixed Christelle's lip. He weighed the profound effect of surgery against the relatively low risk of complications and decided to do what he could, Salt said. "We had the chance to really change her life, or to do nothing," he said.

But some surgeons in the United States are questioning the depth of the Comfort's commitment to providing humanitarian medical assistance.

"The Americans come in there with all that technology and then they just sail away? Who's taking care of the kid?" asked Dr. John B. Mulliken, a cleft lip and palate specialist at Children's Hospital in Boston.

"I don't want to bash the Navy, but I don't think anyone would say that no follow-up on a 4-year-old surgical patient with a residual cleft palate is responsible care," said Dr. Evan S. Garfein, a New York University plastic surgeon and veteran of several humanitarian missions to Haiti.

`Medical diplomacy'

Christelle's is the story of the United States' "medical diplomacy" in Latin America - the Bush administration initiative to gain public support in the region by deploying American medicine as a tool of good will. From June to October, the Comfort and its crew of 700 military and civilian workers dispensed medical care to 98,000 patients in the region, improving lives even as it left thousands of would-be patients asking for more.

When the Navy's floating hospital anchored off Christelle's hometown, then employed its skills and resources to treat her, it revealed how easily and willingly the United States can brighten the future of the poor communities within a short sail of the nation's coast.

Then, when the ship sailed away the next day and left Christelle to recover in the grubby corners of Port-au-Prince without follow-up care, it exposed the shortcomings of a campaign designed more for symbolism than substance.

And with her parents looking to Cuba for more help, the tiny girl with the colored beads in her hair and the new smile is an unwitting metaphor for the diplomatic grandstanding that some believe the ship's campaign reveals. The Americans proved they have the resources to change lives in Latin America, but Cuban doctors working in Haiti are better positioned to help Haitians get the treatment they need long term.

"Having your cleft lip repaired and not your cleft palate is not a solution to your problems," said Dr. Gilbert M. Burnham, a professor at the Johns Hopkins Bloomberg School of Public Health who specializes in humanitarian medicine.

"You can make a huge impact in a place like Haiti by providing a service that the local health system is incapable of providing," he said. "But you also need a clear goal and good coordination with local doctors, to make the most of your time and resources."

Christelle was born with a double cleft lip, which means she was born with scarcely any upper lip. The skin between her mouth and nose looked as though it had been sucked up into each nostril, leaving a flap of skin and gum the size of a penny protruding just above her front teeth.

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