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NIH’s Kristin Collins is a doctor without borders

February 17, 2014

Northern Inyo Hospital Dr. Kristin Collins, second from right, and three of her Hospital Albert Schweitzer colleagues – a doctor, a pediatric resident and a nurse – take a break during a routine 10- to 12-hour day during her month-long visit to Haiti in May 2013. Photo courtesy Dr. Kristin Collins

Northern Inyo Hospital Dr. Kristin Collins has returned from Haiti with a continued passion for the service and rewards she experiences from practicing pediatric medicine abroad.
Like Bishop, Deschapelles, Haiti is a small town nestled in a valley between two mountain ranges. Like Bishop, the wide-spread population depends heavily on its rural hospital. Deschapelles is home to Hospital Albert Schweitzer where Collins spent May 2013 giving of her medical skill set and learning more about how to upgrade medical care in simple but profoundly effective ways.
The doctor of osteopathic medicine is a Chicago native who moved to California in 1998 and joined the NIH pediatrics ward in 2012. She chose to spend her annual one-month vacation at HAS because Haiti is “in dire need of pediatric doctors (and) 60 percent of rural people have no access to medical care,” Collins said. The 100-bed hospital serves the 610-square-mile area where 330,000 largely rural, uneducated, subsistence-farming Haitians live.
Collins arrived at HAS, laden with supplies donated by every NIH department, to find two full-time pediatricians providing “excellent care” in a 30- to 40-bed ward. Children lay suffering from afflictions such as diarrhea, tuberculosis, HIV, pneumonia, meningitis and sepsis – all of which are equally fatal in Haiti and are “things that are often preventable here” in the U.S., Collins said.
In a country with very few immunization programs, Haitian doctors are amazed that some U.S. parents choose to refuse vaccination for their children, Collins said. Another difference between Haitian and U.S. parents is that “here, parents challenge doctors, get intricately involved. There the doctor’s word is gold. Parental involvement isn’t part of the culture.”
With the highest under-5-year-old mortality rate in the western hemisphere, “sadly, Haitian parents are used to losing their children. It is not any easier than here, though; the wailing and crying are hard to hear.”
Collins said that another challenge of her tour in Haiti was seeing children who were unable to get the kind of subspecialty care commonly available in the U.S. “One 14-year-old boy with undiagnosed congenital heart disease, which would have been picked up here at birth, died,” Collin said. HAS had sent him to a cardiology unit at a Port au Prince hospital. “It was just too late,” she explained. “Sometimes you feel helpless as a physician. You learn how to accept the reality of it and leave knowing you did the best you could. These are things that inspire me to go back and try harder.”
The biggest reward comes when “kids come in critically ill, barely breathing or unconscious, and without the medical interventions available (in the U.S.), we see them get better. That shows their resilience,” Collins said. Premature infants, “as young as 27 weeks, have been known to survive without the respiratory support and IV nutrition so commonly available here.”
Another reward of her travels is a change in “one’s life perspective. You learn to appreciate simple things in life. The Haitian people are extremely poor but they are happy with family, enough to eat and shelter.”
Here, Collins quotes John F. Kennedy, paraphrasing the Bible: “‘To those to whom much is given, much is expected.’ That resonates with me, giving back.” Giving back at HAS meant 10- to 12-hour workdays in 100-plus-degree indoor temperatures. Morning rounds, where medical care was decided, were followed by treating patients in clinic. Patients must be referred to HAS by various village clinics, Collins explained, and some families had trudged for hours, hopefully carrying their sick children in their arms.
Patient treatment is augmented by daily morning staff meetings, where cases are discussed and treatment presentations are heard, some of which Collins gave. After-work hours included “taking calls for critically-ill kids and babies born during the night.” In place of stateside cell phone use, nurses would give handwritten notes to security guards who would “knock on my window at night.”
Having paid for her own flight, Collins received room and board from HAS in a cement-block guest house, furnished with “scarce electricity and tenuous running water” and a pool in which she swam laps every day as part of her self-care. While in tropical Haiti, Collins did spend a few weekends at the nearby Recreation Club Med Haiti. “I felt guilty about it but finally realized that to be a good doctor, I needed to decompress, reflect and return refreshed.”
In addition to treating patients, Collins has also implemented triage programs. In Malawi in 2009, medical staff began to “work the lines,” determining which patients were in most serious need, sending them into clinics for immediate care. Before that, patients were helped on a first-come-first-served basis and more patients died as a result.
Collins also implemented a color-coded triage system, with emergency-status patients receiving a red card; a yellow card going to those in serious but “not in imminent danger;” and green indicating low-priority cases. Patients are then directed to clinics by following the appropriately-colored arrows on floors and signs on doors. “This triage system works for people who cannot read.” This triage system has resulted in a decrease of the child mortality rate by 20-25 percent, Collins said. Staff also set up a mini ICU with 12 ICU-designated beds situated closest to the unit.
Collins added that a successful triage system should continue to work long after its creators have left.
Collins began practicing international medicine in developing countries during her 2004-09 Touro University Medical School studies in Vallejo.  “I took off a year and traveled to 18 countries,” spending three months in Guatemala and three more in Spain to learn Spanish, “an invaluable tool in working with the population in California.” It was during her Stanford University residency that Collins first visited Malawi.
A nature-loving rock climber, Collins visited Bishop for about 15 years before relocating here. As someone who appreciates the natural world, Collins said that Haiti is beautiful, a land of “incredible beaches and amazing valleys but it is also sad and devastatingly poor. If more people understood the dire need there, perhaps there would be more willingness to donate and help.” Anyone interested in doing so can visit www.sistercitiesessexhaiti.org/what-do-we-do/support-has for information about donating time and/or money. HAS does “amazing things for the community – free pediatric medical care, a pretty rare thing in the developing world, and help with agriculture and sustainability,” Collins said.
Someday Collins would like to retire to practice medicine abroad full-time. “I’m a doctor because doctors are always needed. I can practice anywhere in the world.” Until then, Collins’ next annual vacation may be spent in Bhutan, or possibly Africa – “my heart is there.”
One of Collins’ greatest inspirations has been Harvard University Dr. Paul Farmer, who started Partners in Health with a main focus on Haiti. Quoting Farmer, Collins said, “‘The idea that some lives matter less is the root of all that is wrong with the world.’”

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