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Haitian Medical Relief Blog
Written by Lowell General Hospital Team Member Suzanne Forte, BSN, RN, Emergency Department.
Thank God we all arrived safely in Jacmel. We are not with the nuns as planned but instead in a private home, the equivalent of a mansion at home with running water, showers, toilets, etc - not as rustic as we planned for and much appreciated! We have settled in for the night after a delicious Haitian meal specially prepared for us by locals who are trained to cook for Americans so we don't get ill with raw veggies. We are here with another group of docs and nurses from Virginia and we had a planning meeting tonight to figure out how to best serve the people tomorrow. They arrived yesterday and were telling us of today's experience and challenges as they provided medical care. We plan on joining the two teams together and then making smaller specialty specific teams to go to different places tomorrow. We are all very excited for our first clinical day.
It is so strange to see the buildings toppled in real life. It is surreal. But most of the people seem to go about their day, smile and wave to us, and are so resilient. The mission leaders here in Haiti are amazingly organized and dedicated. This is fantastic!
We are working with the Lowell Sun on the blog and will also call into WCAP soon to give more detail. There should be an article in Monday's paper on us which can be accessed via their webpage.
Well I am nestled under my mosquito net right now in bed and will turn in. Will update you tomorrow.
Ok, so maybe I painted too pretty a picture of our accommodations for you, let me clarify. A roach walked across the table in front of me during dinner and the PA from the Virginia team just found a 2+ inch cockroach in his bed. For those of you who know me you are LOLing right now.
Well, every ER nurse knows a little comic relief is very necessary to be able to deal with what we do. Today is no different. We started out this morning driving to the main hospital in Jacmel which was 75% destroyed in the quake and where they lost several staff members. They have been unable to keep up with the demand and have Doctors without Borders (known as MSF which is the French version) and a Cuban team in tents around the premises complete with in patient units and an OR. Then there are the Haitian docs who are always here and then us along with the team from Virginia.
We were told last night they did not think there would be any surgeries today but, as any ER nurse knows, things change in a heartbeat. We started seeing some wound follow-up patients which led to a few surgeries and then had an acute abdomen and peritonsillar abscess come through the ED. Between us and the Virginia team we have partnered with we did 6 surgeries today and we saw 101 patients in the ED from about 8:30AM to 6:00PM.
Some of the things you see are just incredibly difficult to deal with, topping the list was the dead man carried in by his friend who was seen this AM fine and then was found dead. We have no idea why, he appeared to have no injuries or chronic illnesses. This was a bit concerning because a short time earlier two young people were also carried in on their last legs, were febrile to 103 and sick as dogs, possibly with malaria or some virus and it put up the red flag, are we dealing with something else here? The lab and xray were down, we don't speak the language, we have limited supplies, and we were practicing the kind of medicine that in this day and age should never have to be practiced. And we haven't even addressed the constant smell of death in the air. The stroke pt who started to seize we had no meds for, the baby who was barely feeding we had no feeding tube for, and the guy with fever of 103, pallor, and likely acute renal failure by clinical picture who needed 3 liters of fluid to be able to stand up did not meet admission criteria and was sent home.
The perspective is completely different. Everything is different except your desire to treat your patient the best way you know how and the frustration of not being able to do so. My God this is incredibly trying and sometimes it is hard to hold back the tears.
Sometimes it is so surreal, like when you are walking through the hospital and you swear you are watching TV about one of those poor far away countries and then you snap out of it and realize, wow, I am really here. I am really doing the work I was trying to get to do, but it still has not sunken in yet for me. Perhaps it is a protective mechanism, a barrier to really feeling what is going on here, like when you are in the middle of a pedi code and you are in nurse mode and you get the job done without thinking about it. Then it ends and you think did I really just do CPR on a 3 month old? I am glad I am seasoned enough to recognize it and deal with it so I can remain healthy and productive. And I am thrilled to have wonderful colleagues with me to debrief with at night. We are all feeling it in different ways, but all feeling it.
I can not say enough good about the team I came with to Haiti. They are amazing, kindhearted, intelligent, hardworking professionals. We grow closer every day and truly enjoy our time together.
Tomorrow we have 1 OR case already lined up and may change things up a bit to be able to see more ER patients. There were hundreds lined up for hours and now the community knows we are here and the leaders expect there to be even more people tomorrow. Will let you know. Interested to see what tomorrow brings.....afraid of what tonight might bring!!!
Thanks for your prayers and support. I know you are thinking of us and the people of Haiti. Many of you have asked, and you are free to forward my updates to anyone you wish. I am glad you are enjoying them.
The roaches and I have made friends. They joined us for breakfast AND dinner today, just in case we would miss them. At this point I just brush them away and move on, but very gently so as to not hurt their feelings. How's that for progress, huh?
Well, we made other great progress in medicine in Haiti. Dr. Burke, our prized vascular surgeon and team leader, actually was able to perform a stress test here. For those non-medical folks out there, that is when you place a patient on a treadmill and have them work out to stress their heart while we monitor it to see if there are EKG changes signifying there is trouble in the heart. For those medical folks out there you are wondering how the heck he did that given the circumstances. Well, because he is a flexible guy and dedicated physician, he was seeing patients and doing primary care while not in the OR. A patient arrived complaining of having intermittent chest pain so he said, "OK, let's go take a walk," and so he took her outside, up and down the stairs a few times and low and behold she developed chest pain again! Then he found out we have no nitroglycerin or morphine, just aspirin! So, he gave her aspirin and sent her home to rest, and thus, the first stress test of Haiti has been performed.
That is about where we are now, doing what we think we can to try and help these people. It is so limited as to what we can achieve here it is sickening. I hope these notes inspire some of you to do what we are doing, form a team and come on out here for a week to help. There will be ample opportunity, believe me.
We are still seeing untreated quake victims from rural areas. A man arrived today with a swollen, dead arm which he injured during the quake and was ignoring because he did not want to have it amputated. This is not a good solution and made amputation unavoidable. His case and 5 or so others are planned for the OR tomorrow. We are also talking about venturing out to the rural areas as groups ourselves tomorrow. I am going to be the post-anesthesia nurse tomorrow for starters and then will see what happens. This should be interesting.
Have more to tell you but I am falling asleep as I write this so must stop but will have addendum tomorrow.
Thank you to UMass Lowell who has nominated us for the Hometown Heroes event! That was quite a nice and unexpected surprise! We are glad to be able to do this.
Thank you for all of your prayers and support. Oh yes, before I go, I forgot to mention that we are all fine status post the tremor this evening. (Mom you must have had a heart attack if you heard about it on the news.) In fact, we never even felt it and were told it had happened a few hours later. Will write again soon.
So I was falling asleep while typing last night and gave up. I wanted to share with you the life story of one of our translators. The Reader's Digest version is he was orphaned at a young age and was adopted by one of the missionary doctors and raised here in Haiti by Americans. He works as a teacher and we were discussing with him how he thought life could be improved in Haiti. He had some very interesting things to say.
We also went to the other hospital in Cai-Jacmel which was much nicer than Jacmel's Saint Michel but was still limited. We saw the mobile Swiss OR that may be used for surgeries by us in the future but the anesthesia machine is missing right now. It was like traveling into the country from the city with nicer homes, more spread out much like in America. Interesting.
We also had dinner with the MSF team and some other people instrumental in logistics for the area. Two people we met were just individuals who came to Haiti on their own to help, including a very petite blonde female ER doctor who has been here alone at the airport doing logistics for Jacmel region. I can not believe her bravery to be doing that. I could never do that. I never am separate from our group and am highly aware if I am even just a bit of a distance from them. It is much like that sixth sense of having children in your care and knowing where they are at all times.
The other individual was a 32 year old man who has just some stuff and a tent and will be here for several more months. Small world-- we went to the same grammar school in Yonkers, New York where we both lived as children. Wow. It really is a small world.
These two were just incredible and have become one with the locals and have no fear of being alone down here. I envy their bravery.
We also went to tent city, which is a soccer stadium full of 6000 refugees in tents, much like what we saw during Katrina. I have to be honest that when we jumped out of the van to take a quick closer look I felt very uncomfortable and unsafe. I don't know why but my internal alarms were blaring and I jumped back in the van very quickly. Not sure about that experience as no one else felt it. Hmmm.
Well Angelina Jolie is supposed to be here today. Will talk again later.
I think I may have insulted the roaches....I haven't seen one all day. But that is ok I guess. I never saw Angelina either. I wonder why. We were at the main hospital of Jacmel all day. I guess she just stayed at the Save the Children offices but she would have seen many children if she had joined us today.
The urgent care area was pretty busy today and saw a lot of children. I was in the OR (the building it is in is mostly destroyed- see attached picture) for part of the day instead and watched a skin graft of a foot injured in a moped accident yesterday evening and then was her recovery nurse. In America she would have been in a Post Anesthesia Care Unit and I would have had to take a blood pressure every 5 minutes, document her mental status and vital signs and make sure she did not drop her oxygen level by monitoring it with a SpO2 probe as well as do many other things. The difference with today is that there is no PACU, instead she was carried by the Scouts on a gurney to "the inpatient unit" which is an outdoor tent filled with flies and about 9 other patients with no curtains between them, no privacy, and no equipment. I got to take one blood pressure before the cuff was wisked away to another tent for a girl with trouble breathing. I felt like Florence Nightingale, only able to use clinical signs that she was ok, especially given the language barrier. I just needed to trust my instincts and go back to the basics.
We were all just talking about how an orthopedist would be very busy at Saint Michel Hospital if they were to go work there in urgent care. That has been a huge part of our patient load. You can always count on a moped injury involving a moderate to severe injury to the leg to arrive during the later part of the day. I laugh because these patients have no idea that they get faster care in Haiti for their fractures than they would in America. Every day they have come through the hospital door directly into the hands of a world class orthopedic surgeon with no wait, no triage, no waiting to call in the specialist and are immediately treated and casted and either sent to the OR or home. The only difference is they get no xray! However, because Dr. Roman is so skilled and experienced he feels the bones and tissue and can pretty much tell what is there and treats it without the xray. It has been very interesting to watch. Today a girl went to Cai-Jacmel to get an xray after he fixed her leg without an xray (because we don't have one) using sedation by mouth and the realignment was fine requiring no further correction. It was impressive. See, back to the basics and things are still done well.
I mentioned the Scouts earlier; they deserve an explanation. They are "Boy" Scouts, in full dress uniform and everything who help out around the hospital. Their uniforms are clean and pressed, they are polite and kind and always willing to help and seem to be role model citizens of Haiti. We just love them! And they range in age from teen to probably 60's! Anytime we need a patient moved we just call them and they carry the patient out. It is pronounced here like "scoot". If you are ever in Haiti and see one be sure to say hello.
We will see what tomorrow brings. It will be our last full day in Haiti and we hope to accomplish a lot. As a little aside, yes, my friends in the ED, you were right and I am suffering from coffee withdrawal. I forgot to bring it and they don't drink coffee in Haiti-go figure! Brian, please pick me up at the airport with a large regular Dunkins in your hand!
Well, if history repeats itself as in these emails it seems to, I should be saying something funny about the roaches right now but I can't. I am too sad and must tell you that I am feeling down right now that I will be leaving Haiti and the roaches in just a few short hours. I cried as I was saying goodbye to my new Haitian friends, especially Ephesian, the one I told you was raised by the American doctor. He is a beautiful person, full of wisdom. I really hope I will see him again someday.
Today overall was sad for us as we lost one of our patients - the one they took the BP cuff for when I was recovering the skin graft patient. She was only 15 years old and had complications from typhoid and died today. The thing that made it so difficult is that we could have saved her if we could have done what we wanted to and not been dealing with outdated medical practices and the political games here between the non-governmental organizations. I know you have to think in disaster terms and limitations to treatment based on that but there were more things that could have been done for this patient that were not allowed which we believe led to her death. As you can imagine this has been the talk of the evening.
On a positive note, we all agree that we could stay another week and help. We just got in the groove and knew our roles and now are leaving too early it seems. Even 10 days would at least give you several days of being up to speed. I hope future groups will use that advice and plan their trips accordingly.
I was the triage nurse in the urgent care area today which saw 100 patients. It was busy but worse, I was tired and falling asleep. Not much sleep last night and so was having trouble staying awake to work, much like I am right now. So, I will turn over in my mosquito netting and will write again tomorrow.
So the roaches have deserted me. They didn't even come to say goodbye!
I am a little jealous because they seem to like Dr. Burke better than the rest of us. The night before last one of them tried to spoon with Dr. Burke at around 3AM and he wasn't going along with that plan! It was very persistent too, I understand, and kept coming back to try to win him over, snuggling up to the nape of his neck and whispering sweet nothings in his ear. However, after several battles, Dr. Burke won the war, and in the morning I woke to find the remains on the battlefield. I tell this story as it was told to me by those woken in the night by the cries on the battlefield. I understand there were words never uttered before. I, as Brian knows, can sleep through anything, and missed the excitement. There was no funeral in case you were wondering.
I write this as I sit at Jacmel airport, waiting for what I hope will be a helicopter to fly us out. I have always wanted to fly in a helicopter so this would be sweet buttercream frosting if in fact it happens.
We have been here for several hours as plans have fallen through and now we just wait to see what will happen. I feel like Brian when he was to return from Iraq. "Until the boots are in the ground" is the expression, meaning until you actually arrive home you may not in the time you expect it to happen. So babe, how does it feel to change places? I bet your arms are waiting for me as mine were for you.
I had to write again because I felt badly that my last message was such a downer. A good night's sleep is always very healing. Wow, as I type a chopper just arrived. Gotta go!
Final Blog: On the Way Home
As I for dressed this morning at 0400 to head to the Dominican Republic airport bound for home, I was putting on my socks that I had paid a Haitian woman to wash with my laundry. (God only knows exactly how that was accomplished with no running water and filth everywhere but whatever.) Anyway, I put my sock on and felt something hard as a rock and sharp. When I turned it inside out there was a small burr in my sock. It made me remember seeing an elderly woman sitting on the ground by the side of the road with a basin in which she was washing clothes. It also made me think of that great song from Jesus Christ Superstar that sings, "I'll put a pebble in my shoe, and watch me walk, I can walk" and of course the Bible verse it is based upon. It was quite appropriate given our activities this week. It made me think that I should keep this burr in my sock so that with every step I take for the rest of my life I will remember this experience and all that I have learned.
That people survive without material things, that we as humans need to care for each other, that speaking in different languages is an opportunity and not a barrier, that going back to the basics in nursing and medicine can be a good thing, and so many other things too numerous to mention but most of all that when connections are made between humans, no matter how far apart, you will always remember them in your heart and soul.
I had never been to Haiti or thought of it before the quake. Haiti was just a poor little country to me, without any connections, that I heard about in the news. It made no difference whatsoever in my daily life. It never occurred to me that I would ever travel there or learn about their culture or even befriend a Haitian. Sure I have worked with Haitians before but never really thought much about their lives in Haiti because to me they were working and living here so they were more like Americans - I just never really thought about it.
The definition of Haiti has changed for me. Now it means my friends, those who embraced me and my teammates without knowing us at all, who picked us up at the airport and drove us around safely, who translated for us and brought us food and water and cooked for us when their fellow Haitians were starving directly across the street. It means people who are eternally grateful for the care we gave them and their families, who waved and smiled at us when we were being driven back and forth to the hospital, who after they saw what we were doing trusted us enough to bring their family members to us to be treated medically. They are beautiful people. Haiti now means a place I intend to return to, hopefully soon.
As I return home, I am very glad to be home but I am very sad to leave Haiti. I find comfort in knowing we made a huge difference in the lives of hundreds of people, but am eager to do more. I hope that you are too. There is so much we can do - donate money or supplies, travel there to help, but even to just recognize that they are more than just people that we hear about on TV, that they are our friends.
I did remove the burr from my sock, but I will never remove Haiti from my heart.