Dr. Michael Howard of NorthShore University HealthSystem is currently in Haiti assisting with relief efforts following the earthquake there last month. Dr. Howard will be sending periodic updates of his experiences during his time there. (ed. note: Dr. Howard is sending updates via Blackberry. His updates will be published with his shorthand and abbreviations intact)
Monday, March 1st, 7:22 am
Back home to Chicago. There is snow on the ground. I am in need of a shave, shower and a good nights sleep.
Everyone in our group who had been on previous medical mission trips agreed that this was MUCH different than any others they'd taken. What set this one apart was the unpredictability of what we encountered on a daily basis, the extreme disorganization that still remains and the huge gaps in the availability of basic healthcare providers. (Any time a plastic surgeon even thinks about doing a c-section, you know you have a problem...)
I do see "shoots of green", however. People like Craig Hobar and Scott Nelson who have a heart for Haiti and vision for how things can work are where it all begins. They, and others like them, need our support.
The stories behind the volunteers I met this past week are inspiring. Countless numbers of individuals from around the world who dropped everything at home to respond to a need.
For the victims, much care is still needed. It is 7 weeks post quake and there is still an abundance of acute medical needs: wounds, infections, etc. Long term medical needs such as rehab and prosthetics are coming.
Time to plan the next trip!
Saturday February 27th, 11:39 pm
I woke up feeling more than a bit off. My first thought was that I couldn't believe I was going to come down with "Hatian Happiness" during my last 6 hours in Haiti.
I took my first dose of cipro, a couple pepto pills and started drinking. (ed. note: water) Jim had a few gatorade powder packs to add. By the time we got to HCH, I was sure it was just dehydration. The OR at Adventist yesterday was particlarly warm, in part due to the facilities and in part due to the need to keep patients warm during surgery. There are no patient warming machines. There are no blankets. Their street clothes are it.
3 large bottles of water later and I was feeling much better. The med student from KU with the One Five group out of Kansas City was not faring quite as well. After morning report, I convinced him that an IV was in his best interest (personal experience, too). A liter of fluid perked him right up.
Its easy to get behind on fluids here. You're busy, its warm and humid. You give your water away to a patient. Your water bottle experiences a "mysterious dissapearance." And there's a subtle fear of "is this water ok?", even if it comes from an unopened bottle or packet.
Rounds this morning were quick. 2 VAC changes and a trip through the wards and ICU. Everyone was stable. A plan was in place for everyone with Linnea for the next team. They don't know it yet, but they have several cases tomorrow...
We said our goodbyes to the patients, translator staff, and other volunteers. Lots of pictures. Traded email addresses. Unlike summer camp goodbyes, I have a feeling that we will stay in touch.
We then literally bolted for the car past the ER and triage zones before one of the Red Shirts could see us and ask, "Hey Mike, can you look at this patient...?"
Cliff was moving us along. "We should have left 30 minutes ago." He always said that.
The ride to the airport was along a different route, but with similar scenery: Huge fields covered with tent cities. People living on the sidewalks. Flattened and crumbled buildings next to ones that appeared completly untouched.
To me, the most mind-boggling sites of all are the pristine looking buildings, sitting all askew, 5 to 10 feet off its foundation.
Jim said his iphone reports an 8.2 quake in Chile this am. He says he will keep his seismograph ap on for the next few nights; he is as yet undecided about the shoes.
The airpot was hot and humid with no breeze. But, rather effiicient. We were at the gate with plenty of time to spare.
We ran into the St Damien Hospital ortho group from Virginia Mason/Seattle. They've had a great month.
The terminal was filled with lots of other tired-looking-in-need-of-a-shower-and-shave volunteers. Many Haitian families were waiting for the flight to Miami as well.
The incoming AA flight landed and made its u-turn at the end of the runway. Mark Peters, a plastic surgeon from Louisiana, and the rest of the next LEAP team was on that plane. Cliff and Linnea were outside waiting for them. It was Jackson's day off.
I thought I'd be sad to leave. I wasn't. It was actually just feelings of unfinished business.
From 20 feet away, through a glass wall, our team watched the passengers deplane - mostly relief workers. Clean. Well-rested. Wide-eyed with anticipation. We held up a LEAP team sign. A group of 6 recognized it and waved at us excitedly before heading in the opposite direction towards the customs hanger.
The feelings of unfinished business immediately vanished.
Our shoes were filled.
Friday, February 26th, 7:33 pm
During our drive across PAP to Adventist - it was again obvious that the downtown was harder hit; more destruction in the more densly pop areas; or was it the poorer construction? Unconsciously found myself holding my breath as we drove by flattened buildings. The stench of death is still everywhere.
Our route to took us by the harbor. The US Comfort is out there. Pretty cool looking. Rumor has it that the only functional CT scanner in PAP is on the ship. Rumor also has it that they are pulling out soon.
In fact, there are lots of rumors here in Port au Prince. We hear Aristid (sp?) Is coming back. Others swear they will kill him if he does. (That is fact, not rumor). One rumor, broadcast on major radio, blames the French for the quake. ("They got us again." and "It may have been a nuclear bomb from France").
We walked in to Adventist and found a line of patients down the hall waiting to see the plastic surgeon, having been told that they may need surgery. And in fact, most did.
The consistent presence there is by Scott Nelson, an orthopedic surgeon from CURE/loma linda, who's been in Santo Domingo for the several years. He's been doing some monthly work in Cape Haitian, a town a few hours from PaP. They moved their whole operation to PaP shortly after the quake. Having been at Adventist for a few weeks, he is the default International Medical Director there. Overhearing conversations between cases, it appears he too is doing a lot of good, building relations and supporting the existing Haitian admin. The pre-quake relationship between Loma Linda and Adventist has helped tons. They have med students and residents rotating here! Impressive.
A 4th year medical student named Matt took me down the hallway for post-op clinic/wound rounds/pre-op clinic. In a matter of minutes he had my day's OR schedule filled. Matt is awaiting match day, going in to ortho. Here, he has been functioning at much higher of a level than a student. We joked about the 80 hour work week concept here... Internship will be a chip shot for him. Maybe even a buzzkill.
A Canadian fireman then grabbed me and took me out to the hospital's tent city - site of the minor uprising earlier this week. There he had several more surgical cases for me, including a cleft lip and several more wounds for flaps or grafting. We put one more wound on our schedule for the day and gave the rest the name and number of our clinic at HCH. Scott and I coordinated another day of OR time next week for the LEAP team. Easiest OR block time ever negotiated with the OR committee:
Scott, "You guys want a room on Tuesday or Wednesday?"
Mike, " Sure."
Scott: "See you then"
The tents are crazy. There must be over a hundred ranging in size from a Coleman pup tent to a giant white one with a huge red Canadian maple leaf on it. It is almost as magestic looking as the Comfort in the harbor. The tents are packed with cots and matresses. And patients. And family members.
Out in the Canadian tent, between cases, I found my hand patient from earlier this week. I changed his dressing. Several more members of God's Little Cleaning Crew had shown up and been busy over the past 3-4 days. The wound was quite clean. I didn't have time to close him today; hopefully next weeks LEAP team or the ortho guys will be able to do so.
The cases went well. Wendy and Jim did a great job of showing up to a hospital they've never stepped foot in and putting toether an OR room and anaesthsia. Uneventful is good.
All of the patients, save 2, will spend the night in the PACU and then tomorrow get sent outside to the tents.
2 patients with rather complex wounds of an amputation stump and a wrist got VAC'd. Scott had "acquired" 2 VAC machines that were brand new. These were the first VACs placed on patients in this hospital. When they showed up in PACU, the machines created quite a stir. Lots of excited Creole. I told them to trust me, we do this all the time over at HCH (3 times does count as 'all the time', right?). More excited Creole. Then smiles and hugs. Then pictures of Scott, me, a machine and an amp wound vac.
One patient I operated on today really has captured the heart of the Adventist volunteer staff. Scott's wife has written it up in detail and I will forward it when he sends it to me. In short, Rochelle is a 26yo law student who was in class when the quake struck. Her brother, Eddy, dug her out of the school building a day later. Her left arm had to ultimately be amputated below the elbow. Another plastic surgeon had covered the stump with tissue from her groin 3 weeks ago. It had healed well and today she was ready to divide the pedicle connection between her arm and groin. When I get home, I am going to google the surgeon who did her flap to give him some followup on how well she's doing. Tomorrow or Sunday, Matt will discharge her to the tents. Her brother kept hugging everyone.
This case, among many others, really get me thinking about DVT prophylaxis. There is none. All we have is early ambulation and prayer. Have several physical therapy teams here helping with the first. But, as with everything, they need more of both.
A lot of Rochelles story came from a nurse named Brooke. After the quake, she felt a calling to go, so she sold her house and furniture and jumped on Loma Linda train heading south. She's an ER nurse and will be here until May. Maybe longer. She and several others were heading out to a local club tonight for some r&r. "Not everything was destroyed...". Brooke's remaining US possession is a 2009 Subaru outback. Its for sale too. Anyone interested?
The cases went a little longer than we had planned, so our trip back was after dark. I could sense that Jackson wasn't too pleased. I thought it was a security/safety thing, but midway home realized that probably was not it. Rather, with no streetlights, the driving juju was a bit more tense. Same number, if not more pedestrians and motorcycles. Same agressive Jackson driving.
In fact, driving back through downtown felt very big-city comfortable. In the dark, without street lights, all you could see were the people and tent fronts, illuminated by candles and small lights powered by small generators. Rows and rows of port-a-potties. Plenty of little metal grill carts with delicious smelling barbeque. People everywhere, milling about, smiling and laughing. Tents. We all agreed that it felt like camping out for superbowl tickets in NYC. Or Mardi Gras, minus the beads and parades. Until we passed another illuminated pancacked building front and I found myself holding my breath.
We got back to HCH. They had had a good day. The OB pt was extubated in the ICU. Her skin color looked much more appropriate for a Haitian. Chris was very happy.
We collected the rest of the crew, less Jesse and Liz, who were still in the OR w the Haitian OB doing yet another c-section. Not sure how the case would have gotten done without our anesthesia team here...
Over pizza at a nearby resturaunt, we all swapped stories from the day and began processing the past week.
Liz and Jesse joined us late. Spent an hour talking to Liz. She passed on a very big "thank you" to the rest of the team from the Haitian OB doc for the help last night. "She is alive thanks to your team". Quite interesting to get the Hatian-American perspective and hear about her and her husbands interest in returning to live in Haiti. With her nursing skills, the opportunity is endless. I think her eyes were opened as much, if not more, than mine by the the trip.
As we were getting ready to leave, another American team from 2 tables over came over and asked if there was a general/trauma surgeon in our group? They had just been called about 2 gunshot wound patients brought to their hospital. They don't have a general surgeon there. While we made some calls to help locate a general surgeon, I spoke with a nurse on their team, Julie, who quit her job as a news anchor in Duluth to come down. When she goes back, she is headed to NP school.
The stories from this place are amazing and the craziness just does not stop...
Friday, February 26th, 7:17 am
She made it through the night.
Chris and Susan were amazing.
Heading to Adventist to do a few a few cases. No idea what they are.
Friday, February 26th, 1:05 am
When God talks to you, I suggest that you listen. I also recommend that you do what He says...
I had a dream 4 days before this trip that I needed to learn how to do a c-section. I blew Him off, thinking it was my overactive immagination and pending trip excitement. At 6 this evening, I was convinced that I had made a poor decision.
Our day started as planned- Tim did several cases while I did wound rounds with Vicki, an oncology nurse, and Meredith, a Med/surg nurse. Both are Red Shirts from NC and have been doing wound rounds and working triage for the past week. It took 4 hours to round (18 rooms, peds, and ICU - each with 3-10 patients per room); we are seeing 90% of the hospital census for dressing changes, suture removal, and discussion with the ortho team re: future plans for the patients. We have the service in pretty good shape.
Our minor victory for the day was the successful application of our second and third VACs in the hospital. Not sure how or who, but Craig had someone donate 3 of them for the trip. We could use 15 more. We've been slow to apply them tho, as most of the wounds were rather infected when we got here, requiring multiple debridements. We were also a bit concerned for the functionality and patient acceptance of the device. Our first VAC survived the past 2 nights in the parking lot, so today was full speed ahead!
By 2:30 or 3, Susan was spotted on multiple occasions between the ICU and Labor and Delivery ward. This was not a good sign, as she had a pre-eclamptic patient yesterday and a 28 week premie the day before, both with a bad outcome. She didn't look too worried, tho, as the Hatian Ob/Gyn was coming.
Nina and Scott, the Akron orthopods joined us in our little OR where we took ex fix off of a 4yo boy's tibia. Our last case was a second exfix removal from a 7 yo girl, but we had to cancel as the mom had fed her lunch an hour before. ("But she was hungry..." the interpreter said.) Again, some things here are identical to the US. In the US, we'd look for an intern to blame, but, as I am effectively the intern as well, I just smiled and moved her name to tomorrow's schedule.
Susan was glad that Jim was not doing any more cases and dragged him over to OB. Her patient was bleeding. She was worried.
I spent a bit talking with our team's interpreters/transporters. One, Jersey Joe, has particularly good English. He spent several years in NJ and graduated high school there. He's been back in Haiti for 8 months and is currently working at HCH. He's taken an interest to the wound care. Will have to see if Diversified has a Wound Center in NJ that could "employ" him for a few weeks so he could learn wound care. He's a potential answer to the ongoing HCH wound service needs.
Jim returned. "Michael, she's bleeding. A lot. No Haitian should be that white." By now it was 600pm and the other surgical team's bus had come and gone. We were it. We walked over to OB. For a split second, I thought my dream was going to be a nightmare. Fortunately, as I got to the ward, so did the Haitian OB...
Still, it seemed like an eternity getting her back to the OR. Lots of hand waving and excited conversations in Creole. A couple trips to the lab. I could make out "AB plues" in the conversation. By now, Jim and Jesse had found a 3rd set of anaesthsia hands in the form of a CRNA from the Red Shirts, who were still here. (Their bus was still a couple hours a way. It had been used earlier in the day to transport the orphans from our nursery upstairs to a different orphanage and was caught in the rain on the way back.)
She was still bleeding. I assisted the Hatian OB; Tim, Susan and Jessica assisted the Haitian OR circulating team; Craig and Liz (our new team addition, a Hatian born nurse, currently living in Atlanta, that Craig recruited to join us from the camp he visited earlier this week) ran to the lab for blood. More than 1 phone call was made to the hospital medical director and hospital president to ask for permission to give her a blood transfusion. (JP, how would you like that added to your job description?!) (ed. note: JP refers to Evanston Hospital President J.P. Gallagher). We enetually got approval for 4 units. Somehow 6 showed up.
Chris had a very sick patient with pneumonia show up in the ICU earlier today. While I was changing the dressing on our burn patients, I personally watched him mask ventilate the guy for at least 30 minutes. Sue and another Red Shirt nurse took over for a while as he fiddled with the ventilator he had found somewhere. The "vent" was a medium sized plastic box that more closely resembled the old hair dryer at my grandmas house. It now has a large piece of tape on it that said, "THIS WORKS". Fortunately the guy did not ultimately need it and it was available for our OB patient later. In fact he was sitting up, watching us this evening when we brought her in.
The case was very rocky. The baby did not make it. Her placental abruption led to A LOT of bleeding. At one point her BP was 40/20. Kudos to the Hatian OB as he was quite profficient. Hats off again to the anesthesia team for even getting her through the operation. None of the 3 of them had ever stepped foot in that OR room before that case. None of them normally do OB. They had no idea where the drugs and fluids were kept. Wow.
Everybody got the patient to the ICU. I went with the OB and Liz to meet the family. Selfishly, I wanted to hear how the OB would explain things. Still the outsiders, we are trying to make sure we are not intruding or overbearing, rather, making every effort to be welcomed additional support to their system. To be perfectly honest, I did have a small concern that somehow blame for a bad outcome could be slightly shifted our way. Fortunately, it was absolutely not the case.
We prayed with the husband and then took him back to the ICU to see his wife.
Chris and Susan will spend the night at the icu. There are 2 more pre-eclamptic pts in there as well. I did see the Haitian OB examining them, then later, leaving the hospital in his street clothes. Not sure what to make of that.
The rest of us gathered up our stuff and headed out. At the front door, the Haitian Dr on call tonight flagged me down to consult on a possible bowel obstruction.
In the parking lot, I noticed that fewer patients are spending the night outside. The threat of rain is now outways the memory of the quake 3 nights ago.
Tomorrow, half of our team will go back to adventist to do some cases they have lined up for us. Will look for my hand patient.
Thursday, February 25th, 5:13 am
Jim's iphone seismograph was quiet last night. But, at 0515 it unfortunately was again clear that we had not eaten the rooster for dinner. Yet.
Last night as we were leaving the hospital, so were the patients and families for a second night in the courtyard. Quite strange to see an entire hospital evacuate as the sun set. The only 2 patients in the whole place was our postop burn/graft patient and the stroke patient. By the time we got to the hospital this am, most everyone had already returned to their rooms with no issue. With several hundred people coming and going like that, there is substantial concern for looting, theft and mysterious dissapearance. Fortunately, this doesn't seem to have been a problem. In fact, a day ago, I noticed a large basin of medication boxes sitting on a shelf in a hallway. On close inspection, it turned out to be at least a hundred vials of morphine and many more dilaudid and lorazepam to boot. Patients and family had no interest. The water bottles and our Power Bars, on the other hand, did not fare as well this week and have been classified as "mysterious dissapearnce". Linnea and I had a long discussion on this today while recovering our first patient. We agreed that there is a moral distinction between stealing food for survival in Haiti and stealing drugs in America.
Linnea is a nurse practicioner from San Diego. She joined the team as she is between jobs. Her last job was as the single healthcare provider for the US contingent of Stark Treaty observers of a nuclear warhead factory in Siberia. Technically it was still Russia, but 500 miles east of Moscow counts as Siberia in my book. She and 20 Americans counted railcars coming out of the factory as a proxy for warhead production volume. Evidently, the Stark treaty expired and no one got arround to renewing it. Who knew. The expiration occured at the same time as Michael Jacksons death. So, while the world became obsessed with propofol, Russia became free to churn out railcars at will.
With all the US-Russian nuke observers now unemployed, Linnea is contemplating staying for a few weeks to bridge future LEAP teams as they cycle through. This consistent presence and patient care is key. Her second week here will qualify her as the default hospital medical director.
She, Tim and I went to hospital morning report, currently organized by Cord, a future psychiatry resident from Kansas City. He introduced 2 new teams, a couple of orthopods from Akron, Ohio and a group of 4 high school guys and their dads. Cord put the 8 of them in charge of sorting thru and organizing the hundreds of yet-unopend boxes of donated supplies. He sent the rest of us off to our respective posts.
We spent the morning doing wound rounds, seeing patients with the new ortho team and several cases. They consisted of a few skin grafts, amputation stump revisions and a foot avulsion flap revision. Jessica, our team's scrub, also from Dallas Childrens, had her A game on. We've only worked together for a few days, but she had me and and the system figured out. (Better: she has us on her system). The instruments were scrubbed and soaking in Cidex, room cleaned, and tables ready for the next patient in 7 minutes flat. I bet our room might even pass a JCHO inspection!
Looking at the historical course of cases here has been quite interesting. The quake occured on 12 January. Most amputees relate their first operation was not until 19, 20 or 21 January. Most ex-fixes went on between 22 Jan and 3 Feb. There will be a huge need here in 3-4 weeks just taking off exfixes. The scene is bad now 6 weeks out; I cant imagine the traumatic, mangled extremity scene the first week post quake. Thousands of crushes untreated for days.
Many of our current surgical cases are dealing with complications of prior surgeries. It is at first tempting to say "what were they thinking, doing that?" But, stepping back, imagining the scene and realizing that there was no way of knowing if they or the patient would ever get another chance. It was essentially 4 weeks of damage control surgery. It is amazing that the first groups in, did so much, so well. For the most part.
Case in point: one of my wound patients was admitted, seizing, 4 weeks ago (about 14 days post quake). In the ER, Dr. Ken was about to give him some ativan when a nurse injected the contents of another syringe into the patient. Penicillin. The guy survived his full blown tetnus episode and looks great.
Between cases, Wendy had time to unpack the box that I brought down with me. Wendy is an OR nurse from Childrens in Dallas and has our little OR wing fairly well organized. She was ecstatic with the "trash" from my hospital! It will be well used. Will have to thank all the OR nurses back home.
Our cases were set to finish on the early side and we made the fatal mistake of saying we're done early, when the ER called us over for a pediatric case. Tim took the boy to the OR and extracted a rather large black bean from his ear while I tended to yet another young boy from the ER with a deep buttock laceration. By the time we had finished, everyone was gone from the ER, except for the boy, his mother and I. I left them there, ran upstairs to pharmacy and found the tetnus toxoid for him. No lie, just as I finished the injection and pulled the syringe out, a mother ran arround the corner with her 2 yo daughter in her arms. She looked at me and yelled "are you the ER dr?". I looked over my left and right shoulders. Nada. "Yes" was all I could say.
The girl had fallen off the stairs at home, onto the stove, where mom was cooking dinner. We took her to the OR, cleaned her burns up and got her back to the ICU. Chris was just back from his 2 day adventure, tending to yet another pediatric asthmatic. His iphone churned out the Parkland formula for her IV fluid rate. Haven't seen a scale here, in my arms, she weighed about the same as Nolan, so we went with that.
All the patients and their families had left the hospital for the parking lot hours ago. I was leaving the front door when Susan found me and dragged me back to the icu. "We can't find your postop orders.". I swore I'd done them, but they were nowhere to be found. Some things are still the same as the US!
Hats off to Jesse and Jim, our team's anesthesiologists. Between the ICU, our full surgical load and the ER, they were incredible. Given the sick patients, the communication barriers and the sketchy histories, I do think their job is the toughest of all. Our hospital is situated at the top of a very long, steep hill. Driving up it, Jim and I joked that the only 2 preop questions we really need answered is "when did you eat last" and did you walk to the hospital?". The walk up the hill is the definitive cardiac stress test.
On our way back, Chris told us about his past 48 hour adventure, which is great subject matter for another email. Not sure which name is most appropriate: MacGyver, House or Jack Bauer.
Hard to believe the week is half over.
Wednesday, February 24th, 8:22 am
Got an email last pm from a friend saying, "wow, it must be depressing."
Quite the opposite.
Yes, there is an amazing amt of destruction. The death toll is staggering. The poverty is everywhere. People living in the streets with nowhere to go or tents in front of their houses, afraid to go back inside. Corruption rivaling that of Chicago - maybe worse. The trauma fresh on the peoples faces and bodies. A generation of amputees in a country with zero handicap accessibility.
But, in the midst of all that, the sun is shining beautifully, the orphans at our hospital are truely smiling. The Haitian people are so friendly and appreciative. The volunteers are coming from everywhere, some alone, some by the bus load.
Currently our hospital is effectively being run by a photographer from Arizona (he used to work materials mangement in a hospital) and a PM&R doc from Dallas. Each just dropped everything and came for a month, fortuitously ending up at HCH. Add to that cooks from NC, a 30yo contractor from MA and a 29 yo leading a team from the USVI, who also just found themselves here. I've mentioned the Basque nurses and the Tyler, TX surgical team. The Red Shirts. LEAP team. Ortho from Seattle. Its amazing. Crazy. But beautifully so.
Two other recent emails asked what can I do there in Haiti? And, What can I do here at home?
To #1, in short, I now firmly believe that everyone in the US has some talent, gift or skill they can use here. Whether it be doing surgery, building shelves, nursing, opening boxes, changing dressings, cooking rice, organizing patient transfers/politically working with the local administration, counseling, making coffee or changing a diaper - everyone could do something. Find an organization and sign up. Even if its a year from now, the need will be there.
To #2, even those who can't go can do something back home. Will spend some time thinking about/sorting out specifics to this over the next days and weeks.
Stay tuned.
M
Tuesday, February 23rd, 9:36 pm
The morning started at 0130 with another quake that knocked me off my air mattress. Internet said it was a 4.7. Definitely felt stronger than yesterday. 15 min later, a second minor shock lasting 5 seconds, had most standing in the living room eyeing the front door.
Beautiful sunny morning here. Everyone was up and out early due to the quake. Prior to our ride to the hospital, I took a walk thru the neighbohood and talked with a few of the neighbors. One is a Palestinian, born here in Haiti and educated in the US. He owns a construction company. Ironic. Spent a while talking w him re the construction techniques that led to the disaster. Many of the houses just pancacked down. Basically, he summed it up as "cheap construction". The engineer in me was intrigued by his further explanation: The re-bar in the pillars between floors was scant, only 4 pieces or so. That rebar was wired, not welded, to the rebar in the floor. Within 3 months, the fresh concrete dissolves the wire, leaving virtually no support to the structure and rendering the builing a house of cards. During the quake, the top and bottom of the pillars crumbled and the floors crushed down one on another. There are hundreds of homes and apts like this. Who knows how many victims are still in them.
When we arrived at the hospital, the place was in chaos. People everywhere. The entire grounds covered with beds, stretchers, IV poles, patients, and family. It was as if everyone in the hospital, patient, family member and staff, had moved outside. In fact, they had.
The staff said that the mid night quake had sent every one running for the doors, carrying their family member/patient on their mattress. It proved what I had suspected since landing - there is immense psychologic trauma here. Most everyone has a hollow look, deep in their eyes. Most people still prefer to sleep outside.
We spent the next 2 hours coordinating the return of the patients back inside. Our team spearheaded the ICU pt location, eval, and transport. I found our entire ICU census in the driveway... We got them back in and tucked away. All except for the 3 month old asthmatic that Chris Winslow had saved yesterday. She and mom were nowhere to be found. We all feared the worse.
Early this am, Chris left with Craig Hobar (a plastic surgeon in Dallas, LEAP founder and our team leader) for a remote hospital 5 hours away that has not had a doctor in weeks. We texted them updates. 2 hrs later we were happy to let him know that the baby and mother had reappeared in quite good shape. Chris' replacement was Susan, a nurse on our team. She was amazing. An ICU nurse at Childrens in Dallas, she picked right up where Chris left off and didn't look back. She was the only one in the unit for the next 12 hrs. She tuned up the baby and discharged her (at the mothers request) with some steroids, amoxicillin and instructions to return "imediamont!" If the wheezing resumed. She later admitted an 83 yo lady with a fever of 103, blood glucose 600, BP 200/130 who had siezed in the triage. No CT scan to confirm our neuro exam, but Susan was pretty sure she'd had a big stroke. Between cases I checked on one of our postops and took a look at her as well. Through the translator we talked with the family, asuring them we'd keep her comfortable. They were satisfied. "She has Jesus in her heart. Her heart is strong," they said. The family gave Susan 6 tangerines as she left tonight. There were no dry eyes on the way home.
Tim and I tag teamed the surgical cases today. Mainly debridements and skin grafts. Last night, Chris had given us the ok to operate on the large 3rd degree burn pt in the ICU (make that "driveway" this am). It took him 8 hours to figure out how to get a CBC, but his efforts paid off, his hgb was 11. Tim and I skin grafted his entire left back, flank and hip. Thanks to 2 liters of tumescence, an otherwise very bloody procedure was quite manageable. (We were also told yesterday, "there is a way to get a blood transfusion", they just forgot to mention, exactly what "that way" was...). The only hitch was that the hospitals power went out about 1/3rd of the way through the case. Our skin graft harvesting machine is electric. We finished what we could, but before deciding about Plan B, the lights flickered back on and we were back in business.
While Tim did the next couple cases, I went on wound rounds in the hospital, which means seeing just about every patient in the place, less the nursery and the OB wards. I use the term "ward" loosely. Its actually a larger room that houses more than 3 patients. And all their family. And all their earthly possessions. And a cell phone charging in every available electric socket.
Each patient has 2 or 3 family members caring for him or her in the room. Their bed and sheets from home are spotless. The patients hygiene is perfect. When you go into a room to see a patient, at least 15 people are watching the dressing change. HIPPA does not play well here. In fact, the onlookers are great to have - they erupt in cheers when you and the translator pronounce "the graft has taken"; they also give great support when the news is not so good. Privacy is sometimes not a good thing.
A Baptist group out of North Carolina, affiliated with Samaritans Purse, wearing red team shirts, known collectively as "The Red Shirts", is providing a substantial amount of the hospital's daily infrastructure. Several Red Shirt guys are the construction detail- they have built an entire hospital wing of shelving, including a wall full in our OR stockroom. (Their Dewalt Power tool chargers trump the patient cellphone chargers in the HCH electrical heirarchy. 2 days ago they made a Home Depot run. Seriously.). At lunch the same guys pull out massive kettles and cook a meal for the entire hospital. The Red Shirts have a team led by an EMT and a retired physical therapist that do daily wound dressing changes. They are trying to train a Haitian team to take over for the long term, but that has not gone so well... Late last week, the wounds started looking much worse after 3 days of Haitian Team changes, so the Red Shirts stepped back in. The Red Shirts also staff the ER/Triage in front of the hospital. If anyone in the US knows a Samaritan-Purse-Sponsored-Red-Shirt-Wearing-Baptist-in-North Carolina, tell them "thank you".
I mentioned the nursery. Here at HCH, for security purposes, its located in the back of the hospital on the second floor in an unfinished section of the hospital. 4 cinder block walls and a tarp roof house 2 saintly nusres from Basque region Spain and 10 pack & plays. Each has at least 3 or 4 toddlers in it, peering over the edge and bouncing happy as can be. It is the cutest damn thing you'll ever see. Most of this dehydrated and malnurished group were rescued last week from an orphanage that was in deplorable condition. Through a US Virgin Island volunteer's local Hatian contacts, a team "visited" the orphanage, found one of the infants who coughed once, declared "a suspected tuberculosis outbreak" and rounded up all the kids. The orphanage is calling to get the kids back. Not sure how this will sort itself out.
Back home for dinner - supposedly turkey, but birds don't have that big of bones or solid of marrow, and a bite of tangerine.
Jim found an seismograph app for his iphone and set it up in our room. He spent 30 minutes calibrating the alarm sensitivity. Its currently set at 2.0 on the Richter scale. He's wearing his shoes to bed. "If this baby goes off, the house will have one less anesthesiologist in it."
Wonder if Idoxy will show tomorrow?
Tuesday, February 23rd, 3:25 pm
I was wide awake at 0430 today, lying in bed listening to the dog bark next door and planning Wednesdays surgery on Idoxy's arm.
The ground shook.
It only lasted 2 seconds. Cliff later said it was a 4.2. But it was enough to wake the rest of the team, set off all the car alarms in the neighborhood, and start every dog barking for the next hour. Which then set off the rooster. No one had much to say, but everyone was eyeing the best route to the front door.
An incredibly busy day. Highlights:
- All our patients survived the night.
- Chris Winslow's (my colleague from Evanston) ICU census continued to increase. The people hear there is a critical care doc and they come. He is amazing. He took a single 18x25 room with 8 sick patients in it and converted it to a reasonable unit. He labored most of today on a 3 month old girl having a severe asthma attack. Without him, there's no way...
- We rounded on our patients, did dressing changes, and planned for the OR today. Phil, a plastic surgeon in Dallas took 2 of them to the OR while Tim, Craig and I went to Adventist Hospital to connect with the teams there.
We went thru downtown Port au Prince on the way - destruction everywhere. The capital building was down and supreme court was completely destroyed. People in the streets. Miles of tent cities. Not sure where to begin fixing the issues here.
We walked into Adventist Hospital, introduced ourselves to the staff. After a handshake, they immediately handed us IDs and pointed us to the OR. (The easiest hospital professional staff application I've ever filled out). On the way to the OR, we were met by the AZ ortho team who pointed to a kid with a crushed hand and asked if I could take care of it. 5 min later I was putting in a wrist block and away we went. Best guess, time from entering the hospital to PACU = 65 minutes.
The kid's hand was a mess. He had rings on all the fingers which had acted as tourniquettes for who knows how long. The 5th finger was dead which I amputated. The 3rd was partly dead and was amputated midfinger. The other fingers were cleaned out. Tim and I debated on whether to leave Gods "little wound cleaning crew" in place or not. Ultimately we elected to remove the maggots too. We coordinated with the ortho team to come back on Thursday to operate with them again. They will collect cases for us over the next 3 days - good collaboration is key.
Leaving the hospital turned into a challenge. As I finished the case, word came that the hospital was on lockdown and UN troops were outside. Turns out that the hospital admin had tried to clear the people from the hospital yard tent city to make room for more patients. This turned into a minor riot. Things settled and soon Jackson had us on our way back.
Back at HCH things were highlighted by 2 ortho patients - 1 quake tib/fib fx had been casted 3 weeks ago in poor allignment and a second bus v. pedestrian w/ a crushed lower leg and an ob/gyn pt (pill-induced abortion) who needed a d&c. Both the ortho patients got transfered to St. Damien - a peds hospital next door to the US embassy doing. They are staffed by a big team from Seattle and we've been looking forward to connecting with them. So I hopped in the ambulance w them. The hospital is very well run with a lot of italian military support. After a quick 30 min tour and introductions, I headed back out. My ambulance ride and the Estonian driver were no where to be found... After a few laughs, "arrangements" were made.
Back to HCH for evening rounds where we irrigated the thigh/femur wound patient using my home made, implanted irrigation system. (CT, you'd love this one). It looks clean - may try closing it on wedneday.
Another 30 min conversation with some other volunteer groups re: our hospital administration and how to plan for the future as more groups start pulling out.
Got a great call from Melissa - she talked to AT&T - through a very broken connection I understood that they have a "disaster responder plan" that will make phone and texts reasonably affordable. Good to hear as text, email and cell are imperative to relief efforts here.
Back home for a quick dinner w host family.
At dinner Jim suggested we eat the rooster. No one disagreed.
M
Monday, February 22nd, 11:21 am
So, Jackson does exist.
A good nights sleep on the tile floor of an an open air house with an incessant dog barking outside and an early rising rooster. Haitian coffee for breakfast - an espresso, but smoother.
Jackson rolled in at about 0730 and stuffed the 7 of us in an Izuzu trooper for a quick trip to HCH (Hatian Community Hospital).
We made rounds with the various teams there and spent time getting to know the patients and staff.
Amazing volunteers from all over.
We found 4 pts who needed surgery. Spent a few hours getting the OR ready and then did the cases. 4 debridements. Hand, 2 legs (open fractures) and a butt.
After wrapping up, the entire group went to our little town for dinner. Jackson pulled some driving manuvers that were absolutely amazing to avoid a trafic jam from a jack knifed tractor trailer. He got a round af applause.
We all will sleep well.
Love to all.
Saturday, February 20th, 10:45 am
On our way. In ft lauderdale w flt out to PAP in a couple hrs. Rdvz w Dallas team in a few minutes.
Exciting develpment - Thursday am the folks on the ground in PAP called with urgent request for ICU help as there are evidently a lot of very sick people at our hospital. I walked in to the Evanston ICU a few minutes later and the first person I saw was Chris Winslow (ICU medical director) and said, "wanna go to Haiti on Saturday?". He said "seriously? I'm in." Special thanks to his colleague Dan Ray for picking up his call this weekend and Karol Gutowski/Mark Sisco/Jeremy Warner for covering me.
It has been great to see the fellow staff at NS step up to assist making this happen.