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May 18: Ian Rawson, Managing Director of Hôpital Albert Schweitzer in Haiti, Delivers Carnegie Mellon's 113th Commencement Address

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Ian Rawson, Managing Director of Hôpital Albert Schweitzer in Haiti,
Delivers Carnegie Mellon's 113th Commencement Address

PITTSBURGH—Ian G. Rawson, managing director of Hôpital Albert Schweitzer in Deschapelles, Haiti, delivered the keynote address at Carnegie Mellon University's 113th commencement ceremony on the university campus on Sunday, May 16. The full text of his speech is below.

Carnegie Mellon President Jared L. Cohon: It's my honor to introduce to you, Dr. Ian Rawson.

Rawson: Thank you, President Cohon for that very gracious introduction, and thank you for this opportunity to salute these outstanding graduates. It's a little bit intimidating to look out here, and to see all of you who are graduating, and knowing that when you came here several years ago, probably every one of you was the top student in your class, or knew who was. But every now and then - Leslie [McAhren, this year's student speaker] will recognize this as a Copernican inversion - sometimes it's possible for us, as teachers, to learn from our students, and it's possible for us, as health care providers, to learn from our patients. And that's an experience I would like to share with you today.

As President Cohon said, I have the honor to serve at Hôpital Albert Schweitzer, which is three hours from Port au Prince, far out of the epicenter of the earthquake zone, and not directly affected. We were somewhat dissociated from reality, because all the internal telecommunications in the country collapsed. We had no cell phones, no way of communicating. We didn't know the extent of the problem in Port au Prince. It was late in the evening when the first patients started to come, in the back of pickup trucks, tap-taps that serve as public conveyances. Patients who had been found by family members or neighbors were placed on the door of the ruined building, and put in the back of the pickup truck, and driven out to the hospital, which, at that time, was one of the few hospitals open in Haiti, at least to the area closest to the Capital City. And they came, one and two and three and four, and then many, and still we had no idea of what the extent of the damage was.

You knew more about what was happening in Haiti, than we did. You had the advantage of the helicopters flying over the capital; you had the advantage of Anderson Cooper explaining reality to us, yet one more time, and we didn't know. All we knew was the reality of more and more patients were coming. We have a trauma system, where we can take care of mass casualties, maybe 30 patients at a time, if one of these tap-taps that's fully loaded tips over. We went through that protocol in about an hour. And more and more patients came, with incredible strength, determination and even creativity.

One of the young men who came - we went out to the truck to transfer him to a stretcher to bring him into the hospital - had wrapped around his right leg pieces of cardboard that would hold his leg stable. Pretty good first aid, don't forget that trick. And as we were putting him on the stretcher, it was evident that that wasn't the only place where he had been hurt, but he didn't want to share any of the pain. In Haiti, when you see somebody, you must greet them. <Speaking in Creole> "How are you?" I asked. "I'm not too bad." And here he expressed the strength, the determination. He had no idea where he was; he had no idea what he had actually lost. He knew that he was in pain, and he hoped that this would be better. On balance, he said, it's not too bad.

As we started to move people out of the small triage area into a larger holding area, and started to find out where to put all these people - our 80 beds were used immediately - we went to every house on the campus, and just took beds out of people's rooms, and put them up in the hospital, then sent to town to buy some more. The logistics were astounding. And in the emergency area, the expanded emergency area, we were running almost in Boolean motion to get IV lines, to take people to the laboratory or to the x-ray, and all of a sudden it occurred to me that it was so quiet.

Think about a television program and about a scene in an emergency room. And people are running around and shouting, "Doctor, I need a <inaudible> stat," and "My husband, my husband." Turn off the sound, and that's what it was like for us. We were moving, we were fast, but we weren't making any noise, because the patients were not making any noise. It's almost as though we automatically realized that we must respect the quiet that they had, the reserve and the strength.

We started to sort people around and take them down the halls to be ready to go into the operating room, two operating rooms, operating virtually 24 hours a day. All of our permanent doctors are Haitian, all of our permanent nurses are Haitian and that's who was there when the earthquake hit, and that's who was there for several weeks thereafter. And as I was going down one of the halls, and by somebody I had passed frequently, an older woman, she waved me over.

<Speaking in Creole> "Come, I want to talk to you," she said. I said, "Okay, me?" <Speaking in Creole> "This hurts me," and she points to her leg. And on her leg was an x-ray, because she was one of the ones next in line for the operating room. So I looked at the x-ray, and then I had to turn it so it was between me and her face, because I didn't want her to see what my reaction to the x-ray was. And I put it down, and I said, <Speaking in Creole> "Yes, I know that hurts you, and Madam, we don't have anything."

We ran out of all of our antibiotics, we ran out of all of our analgesics within five days. We keep a 30-day supply. That's how big the demand was. And she looked up to me with a smile, and almost as though she was comforting me, because she'd seen me going by hundreds of times in the several days. And she said, <Speaking in Creole> "I know. Persévérance." Perseverance. That's what it's going to take to get through this. That's what it's going to take her to get through this terrible injury she has, to wait until it's her turn to go to the operating room. That's what it's going to take all of us to get through this.

People in Haiti have had a tough life. They've had to persevere. It's only with persévérance, that they're able to continue and to thrive. In the mornings, when we would go around the hospital and see how people were overnight, people had recognized that they were going to be there at the hospital for several days, and family members had brought them radios. So in the morning, there's a popular program where they play hymns at seven o'clock in the morning. And somebody in this large waiting room area that we had, had put on the radio, and had the hymns on. And very quietly, so as not to disturb anybody, the woman who had the radio was singing with it, and other people were singing, and then other people were singing. And all around the room, they were singing quietly, again, not to disturb people who had yet woken up.

Not everybody in Haiti is Christian, but everybody was singing, because everyone recognized the power of song to raise your voice to an unknown spirit. Perhaps in supplication, perhaps in thanks, but communing together from many faiths at the same time, seeking and finding strength in the possibility of communing together with some higher force that might help them through this, to join their persévérance with hope.

After several weeks, we began to see the tide recede. We were able to transfer patients out of the hospital to an uncertain future. In an American hospital, we write on a chart, "transfer home." We just wrote, "transfer," because we didn't know whether these people had homes, and many of them did not have homes to go back to. But we began to see the patterns emerging, and we began to notice in the few moments we had to talk together, the large number of patients who had come out to us with traumatic amputation and the several that we had had to perform amputations on, either due to the trauma or because of the possibility of infections. And a wonderful thing happened. We had the opportunity to start a prosthetic service, to be able to give people who had lost an arm or a leg, some new mechanism to be mobile, to be active.

After several weeks, we had collected a large number of patients, and we had arranged some houses in a village where they could live as they were waiting. The technicians would go over, and they would explain the mechanism of the complex knee, and the complex foot. The feet are wonderfully designed. They have a metal plate, a narrow metal plate under them, and it's an energy transferring plate, so think, as you put your foot down and roll forward, as you're walking forward, your toes kick up to carry you forward. Don't try that now, your time is coming. That's what magically propels you forward.

We were explaining this to people, and two of the people we enjoy talking to so much, a young girl with a beatific smile, and her good friend, they had met at the hospital, and they had bonded almost as sisters. And we were explaining this, and she had taken a few dance lessons, and they were always moving gracefully whenever the radio was playing in the small village, and she said, "Yes, that looks good to me. That's a great idea."

The next day she and her friend came, and they were the first ones to receive their new legs. And she was first. And they fitted the leg, and she walked on the parallel bars, and because she was graceful, we said, "Now, later you can walk outside the bars." She said, "That's okay, I can do it," and she turned around and walked around. And all the doctors, the nurses, the physical therapists were there, taking her picture and cheering her on, and she got to the end, and gave us all her patent and beautiful smile.

Then her friend was getting her leg, so everybody else went down to be with her, and to cheer her on, and to take her picture. So she went back to the parallel bars, and she walked out, she held on with her left hand, and stood there for a moment. Then rose up on tiptoe, and struck a pose. Again, with her most beatific smile.

Only a few of us saw that, but those who did learned from her, the power of perseverance, and the power of hope. A young girl had lost almost everything, her family, her home, her leg, but she knew where she was going, and she knew how she could carry forward.

So from our patients at our hospital in Haiti, who are our teachers, and me, I congratulate all of you for what you've learned from your teachers, and wish you God speed, bon chance, good luck. <Speaking in Creole> Thank you very much.


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