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July 02, 2009
Health Insurance Exec exposes abuses practices of the Industry against patients, doctors and hospitals

Health Insurance Exec Speaks by Wendell Potter Testimony of Wendell Potter before the U.S. Senate Committee on Commerce, Science and Transportation Mr. Chairman, thank you for the opportunity to be here this afternoon. My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick--all so they can satisfy their Wall Street investors. I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand--or even to obtain--information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted. When I left my job as head of corporate communications for one of the country's largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry's charm offensive--which is the most visible part of duplicitous and well-financed PR and lobbying campaigns-may well shape reform in a way that benefits Wall Street far more than average Americans. A few months after I joined the health insurer CIGNA Corp. in 1993, just as the last national health care reform debate was underway, the president of CIGNA's health care division was one of three industry executives who came here to assure members of Congress that they would help lawmakers pass meaningful reform. While they expressed concerns about some of President Clinton's proposals, they said they enthusiastically supported several specific goals. Those goals included covering all Americans; eliminating underwriting practices like pre-existing condition exclusions and cherry-picking; the use of community rating; and the creation of a standard benefit plan. Had the industry followed through on its commitment to those goals, I wouldn't be here today. The average family doesn't understand how Wall Street's dictates determine whether they will be offered coverage, whether they can keep it, and how much they'll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies' quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits. To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've failed to trim medical costs. I have seen an insurer's stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company's first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later. To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation's largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending.1 The Energy and Commerce Committee's investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims. They also dump small businesses whose employees' medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether--leaving workers uninsured. The practice is known in the industry as purging. The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation. An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust's members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage. The rate increase CIGNA planned to implement, according to USA Today, would have meant that some family-plan premiums would exceed $44,000 a year. CIGNA gave the enrollees less than three months to pay the new premiums or go elsewhere. Purging through pricing games is not limited to letting go of an isolated number of unprofitable accounts. It is endemic in the industry. For instance, between 1996 and 1999, Aetna initiated a series of company acquisitions and became the nation's largest health insurer with 21 million members. The company spent more than $20 million that it received in fees and premiums from customers to revamp its computer systems, enabling the company to--identify and dump unprofitable corporate accounts, as The Wall Street Journal reported in 2004.2 Armed with a stockpile of new information on policyholders, new management and a shift in strategy, in 2000, Aetna sharply raised premiums on less profitable accounts. Within a few years, Aetna lost 8 million covered lives due to strategic and other factors. While strategically initiating these cost hikes, insurers have professed to be the victims of rising health costs while taking no responsibility for their share of America's health care affordability crisis. Yet, all the while, health-plan operating margins have increased as sick people are forced to scramble for insurance. Unless required by state law, insurers often refuse to tell customers how much of their premiums are actually being paid out in claims. A Houston employer could not get that information until the Texas legislature passed a law a few years ago requiring insurers to disclose it. That Houston employer discovered that its insurer was demanding a 22 percent rate increase in 2006 even though it had paid out only 9 percent of the employer's premium dollars for care the year before. It's little wonder that insurers try to hide information like that from its customers. Many people fall victim to these industry tactics, but the Houston employer might have known better--it was the Harris County Medical Society, the county doctors' association. A study conducted last year by PricewaterhouseCoopers revealed just how successful the insurers' expense management and purging actions have been over the last decade in meeting Wall Street's expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008. That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients. Today we are hearing industry executives saying the same things and making the same assurances. This time, though, the industry is bigger, richer and stronger, and it has a much tighter grip on our health care system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers. There are many ways insurers keep their customers in the dark and purposely mislead them--especially now that insurers have started to aggressively market health plans that charge relatively low premiums for a new brand of policies that often offer only the illusion of comprehensive coverage. An estimated 25 million Americans are now underinsured for two principle reasons. First, the high deductible plans many of them have been forced to accept--like I was forced to accept at CIGNA--require them to pay more out of their own pockets for medical care, whether they can afford it or not. The trend toward these high-deductible plans alarms many health care experts and state insurance commissioners. As California Lieutenant Governor John Garamendi told the Associated Press in 2005 when he was serving as the state's insurance commissioner, the movement toward consumer-driven coverage will eventually result in a--death spiral for managed care plans. This will happen, he said, as consumer-driven plans--cherry-pick the youngest, healthiest and richest customers while forcing managed care plans to charge more to cover the sickest patients. The result, he predicted, will be more uninsured people. In selling consumer-driven plans, insurers often try to persuade employers to go--full replacement, which means forcing all of their employees out of their current plans and into a consumer-driven plan. At least two of the biggest insurers have done just that, to the dismay of many employees who would have preferred to stay in their HMOs and PPOs. Those options were abruptly taken away from them. Secondly, the number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance. The industry is insistent on being able to retain so-called--benefit design flexibility so they can continue to market these kinds of often worthless policies. The big insurers have spent millions acquiring companies that specialize in what they call--limited-benefit plans. An example of such a plan is marketed by one of the big insurers under the name of Starbridge Select. Not only are the benefits extremely limited but the underwriting criteria established by the insurer essentially guarantee big profits. Pre-existing conditions are not covered during the first six months, and the employer must have an annual employee turnover rate of 70 percent or more, so most of the workers don't even stay on the payroll long enough to use their benefits. The average age of employees must not be higher than 40, and no more than 65 percent of the workforce can be female. Employers don't pay any of the premiums--the employees pay for everything. As Consumer Reports noted in May, many people who buy limited-benefit policies, which often provide little or no hospitalization, are misled by marketing materials and think they are buying more comprehensive care. In many cases it is not until they actually try to use the policies that they find out they will get little help from the insurer in paying the bills. The lack of candor and transparency is not limited to sales and marketing. Notices that insurers are required to send to policyholders--those explanation-of-benefit documents that are supposed to explain how the insurance company calculated its payments to providers and how much is left for the policyholder to pay--are notoriously incomprehensible. Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that's exactly the point. If they were more understandable, more consumers might realize that they are being ripped off. Thank you, Mr. Chairman, for beginning this conversation on transparency and for making this such a priority. S. 1050, your legislation to require insurance companies to be more honest and transparent in how they communicate with consumers, is essential. So, too, is S. 1278, the Consumers Choice Health Plan, which would create a strong public health insurance option as a benchmark in transparency and quality. Americans need and overwhelmingly support the option of obtaining coverage from a public plan. The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent, publicly-accountable health care option as a--government-run system. But what we have today, Mr. Chairman, is a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.

September 23, 2009
NMA position on Health Care Reform, Power point presentation presented in Washington DC

Please share information with local, state and national officials. http://www.nmanet.org/images/uploads/Documents/National_Medical_Association.pdf

September 30, 2009
H1N1 Flu Virus, What you need to Know!

H1N1 ‘Swine Flu’: What You Need to Know What is H1N1 influenza? Like regular, seasonal flu, H1N1 influenza is caused by a virus that infects the nose, throat and lungs. It causes fever and a cough or sore throat that can last a week or more. It can also cause headaches, body aches, chills and tiredness. Some people also get diarrhea and vomiting. How dangerous is it? H1N1 has caused severe illness in some people, but the vast majority recover completely without any medical treatment. How will I know if I have it? Only a laboratory test can tell which type of flu a person has. H1N1 influenza has the same symptoms as regular, seasonal flu, and it responds to the same treatments. Knowing which type of flu you have will not change the way you take care of it. For that reason, the Health Department does not recommend laboratory testing for people with symptoms of influenza. How does the H1N1 flu spread? Infected people can spread the virus when they cough or sneeze into the air. People can get infected by breathing in droplets released when the infected person coughs or sneezes, or by touching something with flu viruses on it, then touching their mouth or nose. Will my seasonal flu vaccination protect me against H1N1 influenza? No. Seasonal flu vaccine will not work against H1N1 flu. To protect against both kinds of flu, people will need 2 different vaccinations: one for seasonal flu, and one for H1N1. A new H1N1 vaccine has just been developed. People will probably need 2 doses of H1N1 vaccine, given 3 or more weeks apart. Call 311 or visit nyc.gov/flu for more information about vaccinations. How can I protect myself and others against the flu? Cover your mouth and nose when you cough or sneeze, using a sleeve or a tissue (not a bare hand). Wash your hands often with soap and water, especially after you cough or sneeze. Or use an alcohol-based hand cleaner. Don’t get too close to people who are sick. If you get sick yourself, avoid close contact with other people. What should I do if I have flu-like symptoms? If you have a fever with a cough or sore throat, stay home from work or school until you have been free of fever for at least a day. You don’t need go to the hospital if your illness is mild. When should I go to the hospital? If your symptoms are bad and getting worse, or you have a medical condition such as heart disease, immune deficiency, diabetes, or severe asthma you should contact or visit a doctor or a hospital right away. If you aren’t sure where to get care, call 311 or visit www.nyc.gov/flu for information. Care is always available if you need it, and no one will check your immigration status. Here are some signs that you may need medical treatment: Adults Trouble breathing or shortness of breath Pain or pressure in the chest or stomach Sudden dizziness Confusion Severe vomiting that won’t stop Children Fast breathing or trouble breathing Bluish skin color Fever with a rash Refusing to drink fluids Vomiting or diarrhea that won’t stop Not waking up or not interacting Being too irritable to be held Having flu symptoms return with fever and worse cough after starting to get better Should I keep my children home to protect them? No. There is no need to keep children home from school or other activities unless they are sick. Teach your children to wash their hands and to cover their mouth and nose with a tissue or sleeve when they cough or sneeze. Hearing so much news about the flu makes me anxious! What can I do? Some anxiety is normal. But if you feel overwhelmed, help is available. Talk to a doctor or a mental health professional, or call LifeNet, a confidential, 24-hour hotline. English LifeNet: 311 or 800-LifeNet (800-543-3638) Spanish LifeNet: 311 or 877-AYUDESE (877-298-33730) Asian LifeNet (Mandarin, Cantonese and Korean): 311 or 877-990-8585 Deaf/Hearing Impaired (TTY): 212-982-5284 or www.mhaofnyc.org. Getting information is healthy, but watching too much news can be upsetting, especially for children. If your child watches the news, you should watch too, and explain what it means. Information may change – stay tuned! For up-to-date information about seasonal flu, H1N1, and where to get a flu vaccine, including free or low-cost vaccines, call 311 or visit www.nyc.gov/flu. 3. From: The Bureau of Communicable Disease’s Influenza Surveillance Team New York City Department of Health and Mental Hygiene September 16, 2009 Influenza viruses, primarily novel influenza A (H1N1), have continued to circulate at low levels in New York City during the summer months. In the Southern Hemisphere and in tropical regions outside the United States, the novel H1N1 influenza virus circulated widely and resulted in clinical, epidemiologic, and virologic patterns that were consistent with what was seen in the Northern Hemisphere during outbreaks occurring in the spring of 2009. During the last 2-3 weeks, increases in influenza-like illness (ILI) activity, coinciding with the advent of the new school year, have been noted in various regions of the United States. With schools and universities now starting the academic year in New York City, and with temperature and humidity falling in the coming weeks, the expectation is that ILI, much of it due to novel influenza A (H1N1), will likely soon increase locally. The influenza season may start early, and may also be prolonged, especially if seasonal influenza viruses circulate simultaneously or later in the season. It is unknown which influenza viruses will predominate during the 2009-10 influenza season. To date, the majority of influenza viruses circulating worldwide since May 2009 have been novel influenza A (H1N1) viruses. Almost all novel influenza A (H1N1) isolates have been sensitive to the neuraminidase inhibitors; only 8 (0.6%) isolates tested by the Centers for Disease Control and Prevention (CDC) have been resistant to oseltamivir to date. DOHMH will actively monitor which subtypes of influenza are circulating throughout the season, as well as levels of ILI occurring citywide. Since in many clinical settings providers will not have access to a sensitive and rapid diagnostic test for influenza, decisions on clinical management of ILI and more severe acute febrile respiratory illness will need to be based on clinical judgment and local surveillance data. Surveillance updates on ILI activity in NYC can be found at www.nyc.gov/flu. Influenza surveillance reports will be updated weekly on the DOHMH website and should be consulted regularly to remain informed regarding which influenza subtypes are circulating and what level of ILI activity NYC is currently experiencing.

January 04, 2010
ESMA President's Letter

January 1, 2010 Dear Colleagues, I would like to wish you a Healthy and Happy New Year. At the Empire State Medical Association we have made a lot progress during the past year with the following events: - Advocated to stop increases in Medical Malpractice rates in New York - Advocated for healthcare reform both Nationally and in New York State - Continue to advocate to address healthcare disparities and workforce diversity - Expanded our annual NYS conference with physician CME education - Expanded our student research competition/mentoring - Expanded our website to serve as a networking resource for physicians and patients - Expanding our physician list serve - National Medical Association Annual Convention - National Medical Association Annual Colloquim - NMA Regional meeting The Empire State Medical Association promotes the collective interests of physicians and patients of African descent. We carry out this mission by serving as the collective voice of physicians of African descent and a leading force for parity in medicine, elimination of health disparities and promotion of optimal health. The organization's focus includes, health policy advocacy, elimination of health disparities, maximizing excellent health outcomes, health education, research and clinical trials, physicians continuing medical education, health professions student mentoring and recruiting, cultural competency and health literacy. We at the Empire State Medical Association and NMA give great importance to the reduction of health inequality. Reducing health inequalities, improving health status, enhancing the responsiveness of the health system to the legitimate expectations of the population, and protecting people in a fair manner from the financial consequences of caring for health are our main goals. If you would like to participate on the 2010 ESMA health policy committee, and or conference planning committee please let me know. Thanks for your continued ongoing support as we continue to move forward and reach back. Please complete the 2010 application to update your address on our website, participate on our listserve, and review our ongoing programs as well. Sincerely, Daniel Laroche MD President, Empire State Medical Association

February 09, 2010
ESMA Support of AMHE medical relief update

The Empire State Medical Association is working with the Association of Haitian Physicians Abroad (AMHE, www.amhe.org) to deploy physicians, nurses and medical personnel to provide medical relief to Haiti. AMHE has deployed nearly 200 physicians and nurses to Haiti thus far. The current updated needs are as follows: (updated 2-7-10) 1)”Federal, State and local officials inform us that the United States Agency for International Development (USAID), the lead agency for the nation’s response to Haiti’s needs, is not planning to deploy medical volunteers at this time.” The Empire State Medical Association disagrees that there is no need for medical personnel to be deployed to Haiti and will continue to send Volunteer medical personnel, particularly nursing staff. This past weekend the AMHE has deployed another team of physicians and Nurses to Haiti. 2) Please see this recent article about the current situation in Haiti. Haitian Newborns Get Harsh Start at Life by Meredith Mandell (Feb. 6) - The first day of Allens Neptune's life was spent in a mosquito-swarmed, 10x10 tent made of bed sheets. He was born at 5 a.m. Thursday at Hopital de l'Universite d'Etat d'Haiti, the main hospital in Port -au-Prince. Two hours later, he and his mother were whisked out of the hospital. They ended up among several hundred homeless families two blocks away who have set up a tent city in Jean Jacques Dessaline park, where the stink of urine lingers, and the earthquake survivors sleep alongside trash and dirty pots and pans. Born Amid the Rubble: Lanette Joseph has more worries than the average new mother. The 24-year-old gave birth to a son, Allens Neptune, on Thursday in a Port-au-Prince, Haiti, hospital. Two hours later, mother and son were back in the tent city where Joseph has lived since the Jan. 12 earthquake ravaged much of Haiti. "I don't have anything for my child," Lanette Joseph, 24, said in French Creole, as she breast-fed her firstborn. She worried that her own diet of rice and beans would not give her baby good milk. And she said, if it were not for some neighbors, who pooled together money on her behalf, she would have no clothing or baby wipes for Allens. Little Allens is among thousands of newborn infants winding up in the unsanitary makeshift tent cities that are dotting the Haitian landscape. They are exposed to crowds of coughing children and babies with bloated stomachs from malnutrition like six-month-old Jamal, who lives in a tent a few yards away from Allens. Jamal's mother, Alenise, 28, said she doesn't have the money to take him to a doctor. She said neither international aid organizations on the ground nor the government has eased their plight. "The government won't even give us a bottle of water," she said. People complain they aren't getting medical attention in tent cities. Grace Deumedjian, a volunteer and pediatric medicine student, said many of the babies were at risk of death because of their unsanitary living conditions. "The problem is the cramped quarters and the high risk of getting diseases like Diphtheria. The risk of infection is out of control," she said. Deumedjian said she's also seen a large number of babies lacking breast milk and formula, critical to their survival. As for the fate of little Allens, his father, Necker Neptune, 33, said he doesn't think the family will leave the tent anytime soon. Neptune was a carpenter's apprentice, but lost his job when his place of work was toppled by the earthquake, and he has not been able to find a job since. Allens' mother smiled and caressed his full head of hair. But then, swatting mosquitoes, she gloomily added, "The world is so hard; I don't want to have children again." 3) Below please see a letter from the American Academy of Ophthalmology to its Ophthalmic Business Council: Dear Ophthalmic Business Council Member, We are writing to inform you of the Academy’s initiatives surrounding the Haiti earthquake response. The Academy has formed the Task Force on Haiti Recovery to coordinate our ophthalmic recovery efforts in Haiti. The task force is led by former Academy president Michael W. Brennan, MD, a military veteran with unique humanitarian experience in Iraq and Afghanistan. It is comprised of Academy members with direct connections and experience in Haiti or with strategic partners in humanitarian relief. The task force is working in close collaboration with the Pan-American Association of Ophthalmology (PAAO), the Bascom Palmer Eye Institute and the Association of Haitian Physicians Abroad.Reports from Haitian ophthalmologists tell of practices destroyed, a shortage of supplies and equipment, and an increased demand for ophthalmic care. In the coming months, the task force will work closely with Haitian leadership – the Haitian Society of Ophthalmology and the University of Haiti Eye Hospital -- in a cooperative effort to facilitate the recovery of ophthalmic practice and delivery of eye care. In a direct response, the Academy is undertaking a campaign, in conjunction with PAAO, to provide five portable eye units to ophthalmologists in Haiti. Portable eye units can be carried by an individual ophthalmologist and will facilitate microscopic evaluations of the eye, treatment of lacerations, removal of foreign bodies, injections and other severe eye conditions, outside of a clinic or university setting. To support the campaign Academy will be seeking equipment donations and may contact you with a specific request. The Academy and its partners in the recovery effort will manage the collection, transport and distribution of the portable eye units, ensuring that the packages reach the appropriate parties with ease and alacrity. In addition, the Foundation of the AAO has established a Disaster Relief Fund to provide ophthalmic resources and facilitate much-needed patient care. All of the funds collected will be used for Haitian recovery efforts. In addition to portable eye units, the Academy will continue to direct interested ophthalmologists to relevant relief efforts and firsthand member reports via our web site. The task force will also be working to coordinate the deployment of ophthalmologists interested in volunteering with federal and private sector organizations responding to the earthquake. Above all, the Academy hopes to serve as a conduit of information and support between our Haitian colleagues, our membership and ophthalmic partners. If you have any recommendations or questions, contact Jane Aguirre, vice president of global alliances at jaguirre@aao.org Sincerely, David W. Parke II, MD B. Thomas Hutchinson, MD Executive Vice President and CEO Chair American Academy of Ophthalmology FAAO Advisory Board 4) Currently our ophthalmology contacts in Haiti are Bridgette Hudicourt MD at bhudicourt7@yahoo.com Telephone number: 509-3446 1777 or 509- 3701 1889 Ophthalmology equipment and supplies can be shipped to Dr. Hudicourt’s attention to: Caritas Haiti: 31, Delmas 65, Port-au-Prince, Haïti Tél(s) : (509) 22461690 / 28131690 Fax : (509) 22490128 Boite Postale 13191 – Delmas secretaria@caritashaiti.org http://www.caritashaiti.org Dr. Frantz Large MD is President of the Haitian Society of Ophthalmology: Telephone: 011 509 3-7135081, email: franzlarge@yahoo.fr The following National Medical Association Members are directly involved on the American Academy of Ophthalmology Task force: Claude Cowan Jr. MD, ccowanjr@aol.com Stephanie Marioneaux MD, marioneaux2@cox.net Mildred Olivier MD, molivier@midwestglaucoma.com Dr. Mike Brennan MD is the head of the American Academy of Ophthalmology Task Force: mbrennan43@gmail.com For shipping Large items such as medical equipment to Haiti, Dr. Marioneaux has shipping contacts. Please contact her at marioneaux2@cox.net There is a great need for exam lanes, ophthalmoscopes. Retinoscopes, autorefractors, computers, lensometers, glasses, sutures, cataract, glaucoma surgical trays, FDT visual fields, eye medications of all classes, computers, electrical generators, tents, among many other items. 5)We recommend at all subspecialties of medicine and surgery, etc. work with Association of Haitian Physicians In Haiti, Association of Haitian Physicians abroad www.amhe.org , the National Medical Association Subspecialty sections www.nmanet.org, and National Subspecialty Academies. This collaboration will help provide the manpower to assist Haiti in its recovery and will all the private business community to assist with much need supplies and equipment. The above collaborations will hopefully help direct the efficient flow of supplies and manpower to the needed areas. 6)Here is a report from Dr. Mesaros who just returned from Haiti “Dear Dr. LaRoche…I worked at St. Damien's Children's Hospital (which treated all age patients) and General/University Hospital in PAP as an anesthesiologist. Yes, there is ongoing need for doctors and nurses, especially those who can speak Creole, if not French. There is a need for internists, pediatricians, ob-gyn, especially high risk OB, and mental health. I also went to villages with a medical team to treat wounds, dressing changes and treat ongoing medical problems. Post-traumatic stress was very prevalent and depression among the older. Hypertension, diabetes and GI related disorders were common..I suggest: bug spray, insect repellent to keep OR relatively free of insects, large mesh tents to do same. Local anesthetic sprays, like cetacaine, bactine or EMLA cream would be great. all types of medical equipment, including stretchers, guerneys in OR, I never felt unsafe but was greeted with smiles, hugs and sincere appreciation.” Marie Antoinette Mesaros, M.D. 7) AMHE works closely with AMHE national and AMH (Association Medicine Haitian in Haiti) headed by Dr. Claude Surena MD. The contacts to go with AMHE are Dr. Paul Nacier (pnacier@aol.com) and Dr. Eric Jerome (eljerome@pol.net) . To sign up please visit www.amhe.org and fill out the volunteer form in the middle of the page and follow the instructions. Please bring a tent, sleeping bag, personal supplies, medical supplies, antibiotics, additional information is listed below. Anything you do not use please leave for the people in Haiti. 8) If you plan to travel to Haiti Please visit the CDC link below to prepare for your trip. MUST READ http://wwwnc.cdc.gov/travel/content/news-announcements/relief-workers-haiti.aspx 9) The ESMA will be collecting financial donations for shipping medical supplies for healthcare in Haiti working with Please continue to give contributions to: Empire State Medical Association, Haiti medical relief, 49 West 127th Street, NY, NY 10027 All contributions go directly to earthquake relief with no administrative fees deducted from your contribution. All of the officers and members and supporters are Physicians, nurses and supporting medical personnel and supporters whom are not compensated and volunteer their time to improve the health of the Haitian people. 10) All persons whom would like to participate are asked to make collection boxes designated as Haiti earthquake relief to collect financial contributions and have these boxed placed at the front desk of our offices and workplaces to solicit donations from those whom would like to make a voluntary contribution to send to the red cross and University Hospital in Haiti. There will be an ongoing need over the next several weeks. Please send in contributions to the address above. 11) Medical Supplies Needed Manual OR Tables Exam Table IV Poles Wheelchairs Sterile as well as regular gloves Antibiotics (cephalosporins, cillins, cleocin, etc.) Skin-graft equipment (dermatome, blades, mesh.) Oxygen Surgical packs Surgical drapes Surgical blades Iodine Alcohol antiseptic Hand sanitizer Respiratory masks Iv starter kits Ringers Topical antiseptic Casting materials Cotton Betadine Gauze Bandage Tape Topical wound care (Silvadene, bactitracin, or Neosporin, ointments, xeroform, etc.) Sterilizing equipments Cauterizing equipment Staples Staple removers Sutures (all sizes and types… nylon (ethilon) 2-0 3-0 4-0… Vicryl 2-0 3-0 4-0…. Chromic 3-0 4-0 2-0; Prolene 6-0 4-0 3-0 2-0 , etc Instruments Trays Plastic trays Pain meds Local anesthetics Syringes Needles Fiberglass splint materials Cast materials Cast cutter tools IV fluids IV lines/starter kits Tapes Chest tubes Tents, bedding, pillow, cidex, garbage bags Attn Bridgette Hudicourt MD Caritas Haiti: 31, Delmas 65, Port-au-Prince, Haïti Tél(s) : (509) 22461690 / 28131690 You may also ship items directly to Port au Prince with A and T Transport Cargo Inc. 96-09 Springfield Blvd, Suite 210a, Queens Village NY 11429. They will come to your office to pick up boxes to bring to Haiti door to door. There telephone numbers are 718-217-1618.646-296-0882, 917-586-8244. Ask for Alix and Smith. Depending on the size and weight they will give your cost of shipment. 12) To purchase medical supplies at a lower price you can use doctodock.org website. DoctoDock Address: 300 Douglass Street, Brooklyn, NY 11217, phone 718-852-0655. Dr. Brenda Aiken is coordinating this effort and can be reached at: ba220@columbia.eduAntibiotics can also be purchased at Map International MAP INTERNATIONAL Telephone: 800-225-8550 / Fax: 912-280-6638 4700 Glynco Parkway, Brunswick, GA 31525. Dr. Karen Aletha Maybank is coordinating this effort: karenmaybank@yahoo.com Web link is: http://www.map.org/site/PageServer?pagename=travel_Map_Travel_Pack 13) Please encourage community groups and churches to collect, bottled water and clothing, and first aid supplies and SEND relief in BARRELS to: Tents, Water, Rubbing Alcohol, shoes, PERSONAL HYGIENE GOODS: • Toothpaste and tooth brushes • soap and deodorant • sanitary napkins • brand new underwear - adult (small & med.) and children sizes DRY FOODS & OTHER ITEMS: • Nutritional bars, fruit & nut bars, cereal bars • Tea Light candles & quality batteries (AA & D) Paying for the shipping will ensure it gets there. Try to avoid canned food due to increased weight and disposal difficulties, and difficulty opening cans in the current environment (this is a change from our previous recommendation. All donated material can be mailed to : Attn Bridgette Hudicourt MD Caritas Haiti: 31, Delmas 65, Port-au-Prince, Haïti Tél(s) : (509) 22461690 / 28131690 You may also ship items directly to Port au Prince with A and T Transport Cargo Inc. 96-09 Springfield Blvd, Suite 210a, Queens Village NY 11429. They will come to your office to pick up boxes. Thanks in advance for all whom have supported and continue to support. Please forward to other supporter and enablers. Daniel Laroche MD President, Empire State Medical Association www.nyesma.org, NYS affiliate of the National Medical Association www.nmanet.org Member, AMHE www.amhe.org Director, Glaucoma Section, National Medical Association Member, American Academy of Ophthalmology Member, American Glaucoma Society

February 22, 2010
ESMA supporting AMHE Medical Relief: Report of Dr Daniel Laroche MD

Medical Relief Trip to Haiti University General Hospital- Eye Center On Sunday Feb 14 I left JFK airport to Santo Domingo with a 12 person healthcare team with the Association of Haitian Physicians Abroad (www.ahmhe.org). In our group were: Daniel Laroche MD, Ophthalmology , Team Leader Francois Dufresne MD, Internal Medicine Team Leader Mario Nelson MD, Physical Medicine and Rehab Daniel Hirsch MD, Pediatrics Wesner Thenor Louis MD, Ob-Gyn Duplan Auguste MD, Psychiatrist Edgar Mandeville MD, Ob-Gyn Martine Dufresne RN, Betsy Pierre Louis RN, Valincia Thomas RN, Marie St Urbain RN Marc Saget LPN Margaline Lazarre RN The following is a summary of my observations during the trip. I have asked all of the above team members to share their observations to pass on to the group. The plane will only take up to two bags weighing 50 lbs. I brought as many eye supplies instruments that I could carefully place in my bag that I would use for the trip, in addition to following the recommendations that were made for personal items to bring. The trip through Santo Domingo was straight forward but long (about 10 hours due to 1 flat tire that had to be repaired). As of the time I am writing this there a currently direct flights landing into Port au Prince. Once we were nearing the Haitian border we saw checkpoints on the other side of the road that were set up to stop any Haitians from crossing the border into the Dominican Republic. Once we got close to the border it became very congested with traffic secondary to many Dominican business selling goods to Haitians coming to the border to purchase food, water and supplies. Traffic at the border was about 1 hour. Once we got to immigration, the officials were so overwhelmed they just stopped our bus and once they saw we were medical professionals coming to assist they waved us in without processing us or stamping our passports. As were drove into Haiti you see a stark difference. At the border the roads were not paved with exposed marl on the road leaving clouds of white dust as vehicles go by. The nearby trees on the road were all white from the white dust. As we got away from the border the road became more paved, villages were seen with small business activity taking place with many supply buses loading materials to be brought towards the inner areas of the country. As we came closer to Port au Prince we started to notice many cracks in large buildings and some small buildings collapsed. When we got to Port-au Prince many buildings were collapsed, damaged on nearly every block. When we got to downtown Port au Prince nearly the whole down town area was destroyed. The people were remarkably resilient, some breaking down large rocks with hammers, removing large rocks by hand to remove the rubble to rebuild. There were some people struggling to survive looking through the rubble for anything that would help them survive. Many street vendors were setting up their shops and doing business in front the rubble. Many tent cities were seen in all of the public parks. There was only 1 crew of heavy machinery removing rubble from the streets that was from the US military. Clearly there will need to be additional international assistance to remove rubble and debris and begin reconstruction in such a way that it is safer and less congested. There continues to be a struggle for day to day survival on the streets of Port au Prince with the people still rummaging through to rubble for various items. We finally arrived at the General University Hospital . There we went to meet Dr. Lassegue the Director the Hospital whom warmly greeted us as the 5th medical team from AMHE that arrived and based on our specialties sent us to work with various specialists at the Hospital. I was introduced by the Medical Director, Dr. Pierre Pierre to Dr. Jean Claude Cadet the chair of Ophthalmology at the University. Dr. Cadet then gave me a tour of the eye department and pointed out the structural damage the hospital and clinic suffered a broken slit lamp that fell. I had been scheduled to have a meeting with the Haitian Society of Ophthalmology the following day to assess damage, short term and long term needs, see glaucoma patients the following day and give lectures on glaucoma, operate and teach residents the following two days. We stayed at the Quesquya Earthquake relief center run by Christian Relief International. We were warmly greeted, well treated, provided with safe housing in a classroom, shower and bathroom facilities, 2 meals a day, and free medical supplies that we could bring to the University Hospital. Meeting with The Haitian Society of Ophthalmology 2-11-2010 Present Frantz Large MD, President Haitian Society of Ophthalmology(HSO), Bridgette Hudicourt MD Vice President, Pascal Pellisier Auguste, Carol Day MD, Jean Claude Cadet MD, Chuck Slomin MD (oculoplastic guest), Ritza Eugene MD, Francois Romain MD president of prevention of blindness committee, Florence Burr Raynaud MD. Dr. Frantz Presented the Agenda. Dr. Hudicourt made a presentation on what supplies were received by the HSO and from whom. They are still awaiting the mobile units from the American Academy of Ophthalmology and still assessing the damage from the earthquake. Mike Maingrette MD is to submit is separate report. As of February, 14 SHO supplies received reported by Dr. Hudicourt were as follows: Supplies from Dr Brennam and supply found in a piece of Luggage from DR LEE given by DR Slonim Materiel trouvé dans une malle remise par Dr Slonim de la part du Dr Lee 2 PSL by Reichert slit lamp portables dans des boites 5 Zeiss loupes chirurgicales dans leurs boites 2 nidek portable indirect ophthalmoscopes 1 nidek portable indirect ophthalmoscope case 1 set of three lenses for the indirect ophthalmoscope 14 pairs of sun glasses 2 sciseaux vannas jetables (disposable)sterile 1 forcep Bonn jetable sterile Une boite de fils 4-0 vicryl Une boite de fisl 5-0 vicryl double aiguilles(needle) 5 fils de chromic 6-0 double aiguilles 17 disposables drapes with pouch ( champ chirurgical jetable) 4 flacons de vigamox 6 bouteilles d’ofloxacine Falcon 3 bouteilles de zymars 1 bouteille Iquix (levofloxacin) 3 Besivance (besifloxacin) Plusieurs bouteilles d’anesthsie locales injectables expire en nov 2009 Dans deux sachets de plastic donner avec la malette; In two plastic bags received with piece of luggage : 12 alcaines preopened 8 preopened dilating drops 6 Azasite ( azythromycin ophthalmic) 4 gentak ( gentamicine) ointment 2 polymicyn +neomycin and dexa ointment 4 open fluo drop open Several small open tetracaine drops 4 7-0 chromic suture 8 4-0 silk double armed 3 5-0 prplene suture 20 drape holding 5 suture scissors 6 small tissue forceps 1 pack of 200 non sterile sponges Febuary 16 th from Dr Laroche Donation by Khoshla 2 iris spatula 1 chopper 1 y shape nucleus manipulator 6 mcpherson son forceps 6 rotators 10 canula 4 simco canula 10 jewelers forceps 5 needle holders 1 pairs of curve scissors 2 blepharostates 5 utrata 10 baraquer blepharostats 3 boxes of scalpel blades Hundreds of eyedrops for washing out eyes, tears, some antibiotics, glaucoma medications, anesthestics donated by Dr. Laroche via donation of samples and a small supply from Alcon. They are awaiting larger contributions of medication from pharmaceutical companies and have yet to receive any. The group then reported the damage to eye care facilities in Port au Prince from the earthquake and they are as follows: 1) St. Vincent’s Eyecare Clinic, located at Rue des Casernes, Building was damaged but is still present. The patient area and exam area destroyed. The OR room was OK. All of the equipment including complete exam lane, supplies and OR equipment were stolen. 2) University Hospital in Port au Prince, 2 slit lamp damages, zeiss video camera damaged and non functional, eye clinic has extensive structural damage in the corners in nearly all exam rooms will need to be rebuild. There is a large that cannot be used for patient care and currently stores beds, due to structural damage. The eye ER area cannot be used due to a large tent for orthopedic rehab that was been placed in front of it. There is a functional conference room present that can seat approximately 50 people. Computers and Av equipment are several years old limiting internet communication and presentations with update video technology. 3) Dispensaire La Providence Catholic NGO, eye clinic completely destroyed, lost 2 slit lamps, exam lanes, tonometers, autorefractor, indirect ophthalmoscope, eyechart projector, direct ophthalmolscopes, trial lenses. 4) Grace Children Eye clinic located at Delmas 31, lost 2 slit lamps 5) Adventist Hospital, the eye clinic has been turned into a storage room for medicines for orthopedic injuries due to the high number of trauma injuries. Dr. Kerolle is in charge with Dr. Figaro. 6) Gressier Mission, optometrist, 4 lanes , an edging lab, with lenses and showroom not being used since the building is cracked not safe for evaluation, waiting for structural reinforcement of the walls before evaluation . 7) St. Croix Hospital, Leogane-1 exam lane not being used, room being used for quake rehab victims. 8) Siloe Eye Clinic in Petit Goave- Building destroyed, all eye equipment stolen including 2 exam lanes, 2 slit lamps, 1 autorefractor, lost of operating room and operating microscopes. 9) No information has been received yet from Jacmel 10) Frantz Large MD- Private practice, complete loss of eye private office including 1 exam lane, slip, tonometer, visual field. 11) Other private physicians have not been heard from and ongoing damage are being assessed. Intermediate needs were also discussed due to the death of 1 ophthalmologist, the departure of at least 2-4 others from the island, and two ophthalmology residents left the country with no plans to return. The destruction of eye clinics and damage there will increase the needs to the other existing facilities. Currently the General Hospital eye clinic sees about 80 patients a day. The HSO recommends seeking donations to replace the above damaged equipment. The existing eye clinics currently have very old equipment. To assist with the shortage of manpower and increased eye needs of the nation the following recommendations were made: 1) Ophthalmologists will agree to spend a percentage of time seeing non private service patients. They need donations of equipment to replace the above lost and damaged equipment. Before the earthquake ophthalmologists spend about 10-25% of their time seeing non paying patients. 2) Public patients would be seen in mobile clinics visiting tent cities and/or spending some time seeing patients at a public hospital. 3) They will seek donations for the equipment below: B-scan, Fundus Camera, VF, SLT, Argon Laser. This will be placed in a location that all can share for private and public patients. By having limited expensive equipment at the university general hospital that would allow residents in training to learn the equipment, allow public patients to receive treatment, and all private attending to bring private patients to be serviced with the equipment. Mildred Olivier had previously donated a diode laser several years ago however no one was up to date as to the location and status of the Laser and maintenance record. A concern of security of new equipment was mentioned at the general hospital due to politics. A consideration was given to place some new equipment at another location (ie such as Dr. Frederique’s old practice to be used by all physicians for both private and public patients). (In my personal opinion, I think that the General Hospital Eye Center has many room s to secure equipment and that it is vital to have resident access to learn and train with the equipment, and allow private attending the opportunity to bring their patients to use the equipment as well.) 4) Most ophthalmologists perform extracapsular cataract extraction and are learning small incision ECCE and NOT phaco due to the expense of supplies to maintain the machines. Additional ongoing supplies of ECCE instruments and modern instruments would be helpful and educational materials, surgical training videos, and supplies to support the need for care of the public patients. 5) Donations of updated cataract and glaucoma surgical instruments would be helpful for all of the active surgical centers in Port au prince to treat both private and public patients. 6) Preferred practice patterns of same chart documentation to keep records and record a complete eye exam would be helpful to update all of the ophthalmologists whom have not been able to keep up to date with CME and outside travel to AAO or PAAO to the poor economy in Haiti for the past several years worsened by the earthquake. 7) Documentation of care to private and public patients will be performed. 8) They also request that a ophthalmic equipment repair specialist come to repair broken slit lamps and equipment. Some may not need to be thrown away. 9) The University General Hospital needs assistance with rebuilding the eye clinic damaged from the earthquake, equipment replacement/repair, file cabinets to assist with filing medical records that are currently in piles. Currently there are 5 locations in the Port au Prince area where anterior eye surgery can take place. They are as follows: University Hospital HUEH) : government run university hospital Grace Children’s Hospital: NGO Hopital de la Communauté Haitienne ( Haitian Community Hospital) : NGO Dr. Taverne clinic, Private ASC ORLO CLINIQUE 2 Or, private group of 5 ophthalmologists: 1- for non general anesthesia plastics/ pterygion’ OR in the hospital) 2- One set in Hopital du Canape Vert for cataracts/ Glaucoma A continuous donation of ongoing supplies will be needed by industry to the support the eyecare of public patients whom cannot afford to pay for surgery. These patients will be identified by: 1) Patients seen at the General Hospital and other public hospitals whom cannot afford care. 2) Patients seen by private practitioners office whom cannot pay 3) Tent city screenings and referrals for eye exam Dr. Florence Burr Reynaud will seek shipping abilities via Dr. Jean Robert Brutus 35588385. The Haitian Society of Ophthalmology is seeking funds for website development, transport of supplies and shipping, customs cost in transfer of equipment. The Haitian Society of Ophthalmology will be setting up a website to display pictures of destroyed offices, and equipment and demonstrate their role in patient care. Jacques Arpin came recommended to set up the website, he setup the website for AMHE (www.amhe.org) The HSO would like physicians from the AAO and PAAO to rotate to Haiti for 1 week rotations to perform surgeries and give lectures and participate in teaching. There are two operating microscopes that are functional at the University Hospital General in Port au Prince. Transportation from Port au Prince Airport and housing will be provided by: Jean Claude Cadet MD 509-342-11106 Carol Cadet MD 509-3411129 Florence Burr Reynaud MD, 509-37431912 The HSO is considering having fundraisers at the AAO, ASCRS, Vision Expo. They would have a fundraiser with a presentation updating the current needs in Haiti and thanking contributors. Gary Nader an artist from Miami has worked with the HSO in the past using art auctions to assist with fundraising. The name of Cheryl Coley was given to consider assisting. Cheryl Coley is an event planner in NY. For CME the ophthalmologists will seek to register the ophthalmologists and residents for the ONE network with the AAO however some have been having problems doing this with password issues. There is a shortage of current text books and educational materials at the medical school and university Hospital. Educational items for those two facilities should be mailed to: Service d’Ophtalmologie (Eye Department), Hopital de l’Universite d’Etat d’Haiti, Rue Monseigneur Guilloux, Port-au-Prince, Haiti, West Indies. Societe Haitienne d’Ophtalmologie ,C/O Dr Claude Surena , Association Medicale Haitienne(Haitian Medical Association), 1 ere avenue du Travail, Port au Prince, Haiti Experience of Dr. Laroche working at the University General Hospital: On Wed Feb 17, I worked in the general eye clinic with 1 first year resident, 2nd year resident, 2 attendings. They saw approximately 80 patients. The equipment was quite outdated but functional. Some equipment was not available such as, occluders to check visual acuity, space for patient privacy, eye projectors were not functional, 1 slit lamp was functional, 2 were broken after falling from the earthquake, anterior segment exams were done with ophthalmoscopes in many cases, 1 tonometer was functional, no 4 mirror lenses were present except for the one I brought and taught the attending and residents how to use. No goniosol was available to evaluate glaucoma patients with a 3 mirror lens. I retrived some from my bag of supplies that I had brought with me. There was one 90 Diopter and 2.2 lens that was shared by the all of the staff. There were 3 direct ophthalmolscopes. There is one autorefractor present and functional. Visual fields were performed with a matrix visual field machine that was present and functional. 6 patients were identified and referred with severe glaucoma that were not adequately controlled with medical therapy with high IOP’s and without access to laser treatment, that were recommended to have glaucoma filtering surgery the following day. (I brought my surgical instruments, sutures, cannulas, blades, for glaucoma surgery and brought 10 Ahmed valves that were donated from New World Medical). Dr. Terry McGhee MD, the Director of Ophthalmology on the US Comfort came to the eye clinic and we greeted each other. We did not have much time to talk due the busy number of patients that were present. He did inform me that the US comfort would be leaving the following week and assured me that he would continue to work to help restore and strengthen eyecare Haiti. After the day clinic was complete a 2 hour lecture with surgical video was given in a conference room on “Fine Tuning the Diagnosis and Management of Glaucoma” . There were 15 ophthalmologists and residents present from the Port au Prince Area. The lecture was well received with several questions and answers about the difficult management of glaucoma in Haiti. Later that day I meet with Dr. Eric Jerome MD and Dr. Lassegue about how to best assist with the future needs of the hospital. It was clear that the needs continue to be great due to the shortage of physicians and nurses and needs of the patients and resident teaching. Dr. Lassegue welcomed additional medical teams coming down to working at the University General Hospital and recommended working through the AMHE whom he has had a long standing relationship with to simplify logistics of dealing with multiple organizations and leaders. I also met with Dr. Edgar Mandeville and Wes Thenor, both Ob-GYN whom performed surgery in the main operating room and reported that there were challenges with flies in the OR (lack of closed room), no AC, malfunction of lighting, shortage of surgical supplies making surgery very difficult. On Thursday February 18, there were some nurses and staff that did not show up or came late to work because it had rained very hard the night before. Many were homeless and or their tents and supplies became drenched. I went to the OR and began preparing for surgery with Dr. Eugene, Dr. Pascal and the residents. There were two microscopes. We used a Zeiss Microscope with teaching scope. Only one aspect of the microscope up-down focusing had to be done manually since the foot pedal focus did not work. The OR table was outdated with no ability to manipulate head or body position but we managed. We performed six surgeries that day, all trabeculectomies with 5-FU on patients referred by Dr. Ritza Eugenne, Dr. Pascal, and from the HUEH General Hospital. I performed the first one and Dr. Ritza Eugene performed the next 4 as I was teaching her to do the procedures. I performed the 6th Trabeculectomy and Dr. Pascal assisted observing the technique. The instruments were limited and supplemented by mine including the Kelly punch I had brought with me. Dr. Eugene was a quick learner with good hands and learned the technique well. Various attending physicians and residents were in and out throughout the day observing the surgery and asking questions. The OR staff can use additional up to date training with sterilization techniques. There is a shortage of sutures and canulas. There is no posterior segment surgery machine, no eraser electro cautery, or anterior vitrectomy machine. Later that evening I met with approximately 20 members of the Haitian Society of Ophthalmology in Petionville. This town north of Port au Prince that did not sustain much damage and we ate at a nice restaurant called Papaye. This was the first time since the earthquake the ophthalmologists had come together. Some were so traumatized from personal and family loss that they still could not come. Many of the group shared their stories of loss and struggle to survive the deal with the challenges, trauma, and emotions. They were grateful for my providing an opportunity to get together for dinner to meet. They looked forward to receiving assistance to help rebuild eye care in Haiti. They have lost many patients whom died and family members whom died. They have provided care to many patients whom lost everything materially. Previously the average private patient paid $40 US for an ophthalmology consult. This was only obtained by about 50% of the patients. Another 25% paid less and another 25% were seen free. After the earthquake patients stopped coming to the eye MDS due to other survival needs. The number of patients that can pay for eyecare has diminished even more to 10-20%. At the University General Hospital the average fee for an eye exam is 50 cents US. Some ophthalmologists have left Haiti feeling that they can no longer even make a living under these circumstances. The financial resources are extremely limited. They hope the international community will assist them to deliver eyecare to all in Haiti. They all paid a tribute to Dr. Laguerre an ophthalmologist who died in the earthquake. On Friday, February 19, I saw are post-op patients with Dr. Eugene and the residents and discussed post op care. I then operated on another patient with advanced glaucoma uncontrolled on meds with the residents. I then gave a talk on Ahmed valves in glaucoma management, Gonioscopy in Glaucoma and Glaucoma and Cataract Surgical Videos for the residents and attending. In the afternoon, I asked Dr. Cadet if it would be ok to give a financial contribution directly to the support staff of the eye clinic, understanding that they do not make much money and many are living on the street and have been through a lot. He stated it would be OK. I gave Dr. Cadet $1500 cash to distribute equally $50 to each of 30 nurses, techs and staff. They were extremely grateful, all coming into the conference room as a group to express their gratitude, singing a popular religious thank you song in the native language Creole, and all signed their names on a piece of paper with the HUEH hospital eye clinic stamp to give to me as a momento of the gift. I observed that what makes the Haitian people unique is not what they materially do not have but that they have preserved their culture, language, art, and identity despite the challenges over 200 years and demonstrate an unparalleled will, resilience and ability to survive extraordinary challenges. Saturday we left Port au Prince for Santo Domingo to return home to NY. The bus ride was 7 hours from PAP to Santo Domingo. I believe that direct flights are now available from NY to PAP, Haiti. Overall, there continues to be an overwhelming amount of medical pathology present that is both earthquake related and non earthquake related that requires medical attention due to the shortage of physicians and nurses. In addition to the shortage of physician and nurses, many have been emotionally devastated from personal tragedies, making it difficult to deliver care at times. The patients, physicians and nurses are EXTREMELY grateful for the concern shown by the international community and the assistance provided by those visiting physicians and nurses. The residents are grateful for all the teaching. Implementation o f the above recommendations would go a long way to restore and improve eyecare in Haiti. I also recommend that specialty specific recommendations and interventions take place to restore and improve all medical care in Haiti. I also personally believe that the University Hospital in Port au Prince should be the flag ship location to rebuild, reequip, and support and teach from while also supporting other hospitals and private physicians whom also meet the needs of those unable to pay for care. Some political solutions will also be required. In the streets of Port au Prince, if someone steals, this is crime that can punishable by death via vigilante. I never felt unsafe while I was in Haiti. There has to be political accountability at the level of government to not steal from the people. This should be punishable with severe consequences. There is also a centralization of wealth among a small group of families in Haiti not originally from Haiti that appears to have a strong hold on the economy not supporting competitive free trade. The business practices of these families should be transparent to ensure that they are fair and supportive of reconstructive efforts and not subverting reconstructive efforts. Daniel Laroche MD President, Empire State Medical Association Director, Glaucoma Section, National Medical Association Ophthalmology Section Member, American Academy of Ophthalmology Member, American Glaucoma Society

March 31, 2010 to April 04, 2010
SNMA Annual Conference, Sheraton Hotel, Chicago Illinois

ABOUT THE 2010 ANNUAL MEDICAL EDUCATION CONFERENCE The SNMA Annual Medical Education Conference (AMEC) has emerged as a cornerstone activity for the SNMA, an event in which both students and professionals have gathered with high anticipation to attend a wide range of educational and networking events. The AMEC is held each spring in locations around the country and serves to enhance our members’ career development, provide continuing education, facilitate networking among minority medical students, bolster the effectiveness of our local community service programs and recognize the achievements of our members. In short, our conference is designed to nurture future leaders in the field of medicine. The AMEC attracts students from all levels of medical education and is consistently the largest gathering of underrepresented minority medical students at any time in any place in the country. We heartily welcome your participation with us in fabulous Chicago, one of our nation’s most exciting and vibrant, and historic meeting venues. Our conference program will include all of these traditional annual events, plus some other special features, the plans for which are still developing: • House of Delegates sessions and election of national officers • A dynamic exhibit hall for peer and professional networking • Insightful and provocative workshops • Alumni Resident Educational Track • Physician-Researcher Initiative (PRI) Educational Track, focusing on paths of success for future scientists • Opportunity to take mock USMLE and COMLEX exams • Annual Dr. Wilbert C. Jordan Research Forum, displaying the academic and service excellence of our members • Pre-medical Forum (PmF), designed just for our pre-medical members • The new SNMA President’s Installation Ceremony and the Board of Directors Banquet and Ball, where we will celebrate the hard work and achievements of the SNMA nationwide. • A Community Service event, designed to serve the local community, ‘giving back’ while we are in their city • The SNMA Commencement and Pinning Ceremony, our newest tradition, held to recognize and applaud our emerging physicians • Inspirational and informative speakers in plenary sessions and our workshop program • The singular sights and sounds of fantastic Chicago. Watch the SNMA website for program and schedule details! Exciting offerings are ever present in sensational Chicago and many are just minutes away from our host hotel, the Sheraton Chicago Hotel & Towers, located minutes away from awesome Lake Michigan. The famed Miracle Mile, Navy Pier and Grant Park are within walking distance and other cultural and historic sites are easily reached by Chicago’s famous “L” (elevated) commuter rail system. Numerous restaurants, popular clubs and specialty shops located in the downtown Loop area make Chicago one of the nation’s foremost destinations and a great location for the 2010 AMEC. The SNMA’s Annual Medical Education Conference held anywhere is a program that it is hard to pass-up and Chicago is sure to become a favorite venue for those choosing to attend the 2010. So, put the dates on your calendar and plan ahead. Come and see what our President’s chosen home town is all about!