sutures newsletter


On the beaten path

By Harry C. Sax, MD, MHCM, FACS
Professor and Vice Chair, Department of Surgery

Surgeons at Cedars-Sinai are involved in humanitarian work throughout the world. Although we often recount our cases as a measure of our experience, it is often when we get away from the hospital that we truly learn about those we serve. I have been returning to Hospital Sacre Coeur, in Milot, Haiti, on multiple occasions since the 2010 earthquake. For this issue of Sutures, I'd like to show you the area surrounding the hospital. This is an excerpt from

As a child in West Virginia and Ohio, I remember driving on National Pike, which was subsequently to become parts of Interstate 70. It followed a Native American trail several hundred years old. Post Road, from Boston to New York, now Route 1, was originally a trail, and with continued use, became a dirt road through the forests and along streams. Inns, post offices, and cities sprang up as human and vehicle traffic beat down any vegetation and created an enduring path. We speak of getting off the beaten trail, in an attempt to get away from society. Yet in Haiti and other less-developed countries, a trip along the beaten path reveals much about the people that live there and their interaction with geography and each other.

The road from Cap Haitien to Milot continues up the mountain, past San Souci to the Citadel. During the period of the war with the French, it served to move supplies inland, and gain strategic advantage. It has recently been paved, and the previous rattling ride from the airport is now 20 minutes, instead of an hour. About 300 yards before the entrance to the CRUDEM compound, a dirt road heads west and winds its way out of the valley, then back to Milot, well below the Palace. Its path reveals much about human nature.

Let's take a run and see what we can learn.

Turning left from the compound, we dodge tap taps, motorcycles and people walking to the hospital. A well marks the entrance to the path. Immediately, it becomes quiet. There are a few dwellings, and the banana trees, cocoa bushes, grapefruit and aloe grow to the edge. You can see perhaps 15 feet into the forest. A second path cuts to the right. I don't see where it's going, until a man with a machete and bunch of bananas emerges from the woods – that path led to economic support for his family.

About a half mile in, I see bags with USAID markings and a large pit near a river. Previously I would assume this was rice, but in fact it is limestone, which, when mixed with nearby water, forms plaster for homes. The road jogs back to the right and it is again quiet. A motorcycle overtakes me, and as I follow the dust cloud, it stops at a junction. There is a great deal of activity, and children begin to run with me. A new well, beautifully constructed after the cholera epidemic, draws local town folk and numerous homes are seen. A concrete bridge forges the river, yet in its shadow, women are doing laundry, the soap suds mixing with the shallow, muddy water.

We begin an uphill climb, and to the left, open-air stalls offer drinks, vegetables, cigarettes and canned goods. A grandmother sits on a stool as her granddaughter braids her hair. "Bon soir," they call out as they shake their heads at the concept of anybody running just for the sake of it. The road at this point is wide enough that a truck could get by, but soon it gets very rutted and I need to be careful to keep from twisting an ankle. As we move farther from water, dwellings again thin out, but there are areas of the forest that have been recently harvested. Piles of stone are in place for community use in building shelter.

The road comes to a T. To the right is the "short cut" to Cap; to the left the road to Milot. As is normal at crossroads of commerce, the Haitian equivalent of an ATM springs up (pictured at top). Trading dollars and gourds is big business.

As I climb above a ridge, the view back to the valley is spectacular, with the mountains behind. Few people are around.

Cresting the hill, I hear the noise of young men playing soccer, and the one flat area has become a makeshift field. The goals are sticks, and they play a tight game – goal width is about two ball diameters. I move to the side so as not to interrupt.

I must be getting closer to town as I start back down the hill. School children in their uniforms are walking up. A young man and his girlfriend hold hands. The homes now have rudimentary electricity, and the road is less dirt and more stone. It curves around a large tree that was never beaten down as a sapling.

The entry to the city is first heralded by the cellphone tower, then the river, and buildings tight together. People are everywhere, and there is a more frenetic feel. A left turn takes me past the music school, and I hear the sound of a band, but the location does jibe. A short block to the right is the main street to the hospital, and next to it, the cemetery. The road is packed as the funeral band, playing "Auld Lang Syne," marches past. Everyone is in their best clothes, and I feel embarrassed that I am sweating and in shorts. I stand well behind the masses, then when the procession passes, I turn to the left, and again compete with buses, vendors and the normal crowd by the hospital.

As things thin out, I am able to sprint the last 200 yards to finish the loop.

I sit outside to cool down. How often do we move through life, take the road prescribed by the GPS, and never notice the changes around us?

We often speak of standing on the shoulders of giants, yet as surgeons, perhaps we should also reflect that we are walking in the footsteps of those who first blazed the trail, and owe them thanks for beating out the path.