With entries by Team Members
TEAM:
• John F Lovejoy Jr MD – ORS Team Leader Jacksonville
• John F Lovejoy III MD – ORS Childrens Medical Center Washington DC
• Edward Fink MD – ORS Childrens Medical Center Washington DC
• Pat Balanky RN – OR Nurse Jacksonville Florida
• Kim O’Brien PA – Childrens Medical Center Washington DC
• Stephanie Gano RN – Childrens Medical Center Washington DC
Tuesday 1-12-10
Haiti suffers a 7.0 Richter earthquake. Center is near PAP and all the major structures are damaged- the Presidential Palace, the docks, the cathedral and most of the homes. Literally thousands of people are buried under the debris.
We called Crudem Foundation and the Hospital Sacred Heart in Milot receives 4.9 r and only sustained minor damage and no loss of life. The pictures of the suffering are heart breaking and we put out the word that our hospital was functioning and could handle some of the trauma patients.
Over the years Crudem has struggled to make the hospital self sufficient. It is a 73 bed hospital with two operating rooms and has its own power and water supply and is now run by Haitians. It has the best lab in the country and is supplied by multiple visiting subspecialty teams who come on a regular basis.
To respond to this emergency the staff cleared the soccer field for helo to land on, opened an annex in the school across the street, set up a dorm for visiting medical teams and tuned their infant feeding station into a cafeteria.
Since most of the hospitals in PAP were destroyed, the word got out and they started air evacing the patients to the hospital. Meanwhile, at home, we were struggling with forming a response team. John 111 called and he had another ortho surgeon, PA and nurse lined up from the Childrens National Hospital in Washington, DC. Pat and I volunteered and Carol worked her heart out to arrange transportation. The government told us no NCO were being transported by the military and the airlines were either booked or not flying. After working on it for several days we were about to give up, when Carol called in the middle of the night Friday or Saturday morning saying she had found transportation. We then began assembling the team. J111 had told his group yes and no so many times he wasn’t certain they could go. After clearing it with his chief and reinstating one team member who we did not think we had room for, he arranged for them to come to Jax Saturday night. I began pulling in chits. I cannot express how generous the people were, St. Vincents, Memorial, and Baptist got us the essentials we needed in half a day; Jacksonville Emergency rescue provided backpacks and fanny packs full of equipment. When I went to buy lunch the owner ask what I was doing; afterwards when I tried to pay he would not let me.
We all rallied at my house and Ellen brought a film crew to record it for a documentary. Channel 12 did a story and we ate, packed, and lightened our load. We were allowed 1000 lbs and had 960 in body weight. Needless to say, we were down to our bare essentials, toiletry and underwear! We finally hit the sack about 11. It was a restless night trying to think of things we might need that we had forgotten.
Up at 3:30 to get off at 4, made it off at 4:15. Whipping these cats in shape! We drove to Orlando and waited to board the plane. Nice plane, Pilatus PC12, made in Switzerland and donated by Andy Laskmann from Jackson Hole, Wy., who is also the pilot. After much fanfare we took off at 8 and flew to Ft Lauderdale to fuel and head south. Jl
(Frenetic Saturday of last minute plans, initially a patchwork of ideas, with time coalesced into the reality of Haiti. Guided by John and Kim, from DC to Jacksonville, greeted therein by Dad Lovejoy. The skill of our nascent team tested by an errant motorcyclist, proceeded to Dad and Mom Lovejoy’s loving abode, meeting effervescent Carole, omniscient Pat, sisterly Ellen. Field tested Stefanie with a pulled pork shoulder, passed with high marks. Witnessing the growing confluence of an ever-expanding number of individuals and their companies, whose incredible largesse in such a time of need has made the relief efforts a reality. Stay tuned for more. EPF)
Thrilled, anxious, exhilarated, humbled, somber. These are all of the first emotions swirling around in my head, as I join an incredibly generous and skillful team of people who have spent the past 48 hours pulling this trip together. When asked by J-Lo (aka Jay-DUB, Fletch, Loverboy) at work Thursday, to come along, I never imagined that we truly could pull off a departure to Haiti by Sunday morning.
I am thrilled to be part of the “first responders” going down to help. I think there is a small part of me that knows this is why I became a PA. I am thrilled to be part of something bigger. I am thrilled that, for once, I am doing something to help these people; and not just watching events unfold on TV, wishing I were doing something.
I am a bit anxious about arriving in Haiti knowing we will “hit the ground running” and that I may not really rest again until I’m heading back to the States. But my anxiety has been lessened knowing we are going to Milot, just 8 miles from Cape Haitian. They survived without any major damage and the infrastructure is completely in tact. So the dangers fueled by desperation that we have heard about in P-a-P have not made their way to this part of Haiti…yet. Hopefully never.
I am exhilarated at the thought of testing my limits and my skills as a physician assistant, under less than desirable circumstances. My exhilaration is fueled by the knowledge that I am traveling with 3 wonderful and skilled orthopaedic surgeons and two nurses. And that when we arrive in Milot, we will meet a group of people whom, I am told, are equally skilled and professional. They have worked so hard to set up this hospital and seem very grateful we are coming.
I am humbled by the outpouring of support of the American people, the local community of Jacksonville, Florida, my boss at Children’s National Medical Center, my colleagues and traveling companions from Children’s, and all of my friends who worked tirelessly on our behalf Friday night to try to help us find a private plane to make this mission.
Lastly, I am feeling a bit somber, knowing that what I am going to witness and experience during the next few days is not anything I could have prepared for in my lifetime. I am not sure how well I will be prepared for what I am about to face, but I am comforted by all of the support I know I have not only among my new friends I have met 24 hours into this journey, but also my family back at Children’s Hospital and my own family back home. Edward keeps reminding us that this is not about us but all about the people of Haiti. Those are powerful words I think will get me through this week. KO )
We arrived on a sunny day in CAP and were meet by a missionary coordinator who helped expedite our clearance and transportation. There was no difficulty and they were actually efficient and polite. No pushing crowds outside the airport , clean street and grounds. Raymond met us and we headed to the hospital. About the time we were arriving, a helicopter flew over and we raced to the soccer field to meet it. Several severely injured patients were transferred to the hospital. We went to the residency, got scrubs and went to work. The clinic had been turned into a triage area and the ORs were all three running. Our ortho equipment was scattered in the depot at the hospital and residency. We started pulling trays and organizing them. Went to the depot and found several containers of equipment from the last trip and searched until I found my fluro machine. By the end of the day we had found most of our gear. Some of the crew had difficulty with the level of care we could perform with the equipment we had on hand but we worked through it. By dinner time we had done two cases and were partly organized. Dinner was great, chicken, carrots and potatoes, beans, and salad. We had a great cake for desert. Tim told them it was his birthday—the only way to get desert. It was fun and delicious. After dinner we we met and assigned the cases and went back to pull the instruments for the cases today. By nine we were all exhausted after being up about 19 hours. Back for a shot of rum and bed.
1-18-10 Monday
Someone set their alarm to 5:30 so all woke up and heard the rosters crowing and finally, we all got up Breakfast was a little bleak with grapefruit and toast. We then went to surgery and started our cases. We did 16 cases and finished at 11:30 pm, most exhausted but expecting a full day tomorrow.
1-19-10 Tuesday
Up at seven and shower and breakfast. Off to surgery. Same confusion in the OR but managed to get started. Sent desperate message to get the equipment. They had worked so hard on it that it was on the first flight out today and arrived this afternoon. We had received 25 patients by noon and done a dozen cases. I got everyone off to lunch and the helo brought in a load of kids that were so injured the I could not contain myself and just cried. I got it out of my system and after lunch, set up a triage at the school and our gear arrived. Thank God! Stephanie meet the helo and appealed to the pilot for equipment and gave them a list. Next load they brought much needed equipment to continue to operate. We are going to send her more often! Rearranged the hospital so the incoming go to the school, triage, and over to the hospital for x-ray and surgery, recover and back to the school. The school has two sides and a back with a large paved yard between. Perfect for triage on one side and post op on the other.
We managed to do 24 cases today and I called it. The staff was stressed and the team so worn out that they were getting short and could begin to make errors. We have not lost anyone yet and have a remarkable anesthesia. He is able to run three rooms at once, do spinals, drop gas, conscious sedation and not get ruffled. I can not say enough about our team. They are all turning to, doing their job, never complaining. They are wonderful!
We finished about 8:30, came back, ate and sat around and played with our computers and email.
(PB) (We became a Mash Unit today, Tues. Choppers started coming in and delivering patients and the pace picked up and stayed that way until dark. Our group works well together and everyone has found a niche. The local help are grateful to see us, and have expressed thanks. The reality of the situation is a little odd, in that we are in the middle of all this and yet we don’t get the constant overview that we have at home with the news media. The agonizing reality is becoming profound, that nothing will ever be the same for this country and it’s people. All the loss of extremities means a huge percentage of disabled individuals, plus the creation of more orphans, and the loss of leadership and business in the capital is a fact that is beginning to manifest.
We all seemed to take turns crying today. The experience is exhausting and exhilarating at the same time. I am so grateful to have the knowledge to contribute and participate with such an outstanding group.
The problems have ranged from not enough of critical supplies and staff being so swamped they don’t have time to restock, to not knowing the language and missing communication as a result. Never the less it all came together, and we did 24 cases today and made a difference. We are sharing stories and debriefing and enjoying each others life stories. Time to rest. Pat )
1-20-10 Tuesday continued
Woke up this morning thinking someone was really snoring and shaking the house, but it was another quake, 6.9. Got up and really thought that John had hit my bed going to the bathroom so I went back to sleep and missed it all. After breakfast we went over to get started. Got two rooms going and then reorganized the triage area and open another OR to do minor surgery, such as debridment and minor amputations. We managed to get some of the major cases done and I did an ORIF of a tibia and an amputation after dinner that started out as a debridment, but the bone was dead and we had to convert to a BK. We did l8 major cases and another two teams arrived with lots of equipment. We were overjoyed. At six we had a meeting and tried to fill in all the problems with the help of the new arrivals. The meeting was great. Dr. Previl, the chief of surgery, has worked his heart out and is so patient and helpful. John spoke up and explained the ortho needs. Steve the surgery needs and offer to help ortho. A wonderful cooperative effort. I can’t express how unselfish and giving they are, all wonderful people. It is hard to mention everyone but there are a few notable ones in the first wave. Particularly Rick, an anesthesiologist. We could have never run the rooms without his help. He ran three or four rooms and helped the schedule and fixed everything that was broken.
1-21-10 Thursday
Up early and tried to organize. Ed believes that the kid with chronic osteo has a salvageable limb and wants to send him to the states for treatment. The rest of the team felt that that it should be amputated, It is different from all the acutely infected crush injuries, but I question the use or resources and chance of success. He assured me the he felt it was doable and had emailed the AAOS and POSNA. He wanted to take it on himself . We all disagreed,but he took it on himself to treat it tying up a lot of resources. We had a meeting and discussed other patients that we will be treating. It is now eight days out and almost all the wounds are infected. There is little chance of limb salvage so we need to go ahead with definitive treatment unless there is a good chance of salvage. We also discussed the transition from team to team. The new ortho, David Vittetie and Mathew Dewall are great. They came in and pulled their own instruments and did the cases with little need of assistance. Pat has worked her heart out and is physically exhausted but continues to keep us all with equipment to do the cases. Imagine, one sterilizer, a prep room the size of a bathroom, equipment loose in a storage closet, reusing wraps, looking for equipment but still able to run 4 rooms and keep seven orthos and as many general surgeons happy—what a woman!
Couple of antidotes. What do you do for entertainment in Milot? Go to the soccer field and watch the Helo land. About half of the town comes out to see them and what is coming in. The people of Milot have been wonderful. Putting people up in their homes and the other day I was walking by a lady making a large pot of stew. I mean large and found out she was making it and giving to those who were hungry.
While scrubbed, I ask the nurse for something and said pass me the instrument babe. She said her mane was Carol, not babe. Next time I asked, I said Carol babe. We all started laughing and she now has a name tag that says Carol Babe. She is from Philie and I’m from the south and we enjoyed pulling each others chains.
Its 2:30 pm and I just got to lunch and am taking a sanity break. This morning after getting the cases started, we made rounds on all the surgical patients, changing dressings, scheduling wash out for open wounds, and evaluating others for surgery. Other teams arrived, ortho, general surgery, anesthesia and nurses. We are pretty well organized and put them to work. Now we have someone to organize equipment and relieve those who are worn out. Our triage was not getting the patients to surgery so we changed the system so they would go to triage, x-ray, be seen by ortho again with their x-rays when a decision would be made whether they go to surgery immediately or to holding. Then I began to organize the depot so we could find things. One ortho and tech to the ortho closet and the other to organize that equipment. We just heard they were evacuating up to 100 more patients today so I got to go. I heard two or three helos landing.
Managed to get 29 cases done and finished by 10:30 pm. I think that I finally got the system down. I converted the clinic into a mash unit. Two rows of beds and cots, eight cots and 6 beds. That way we can evaluate the patients in triage and send them to x-ray or the mash unit and those in x-ray get seen and those needing surgery go to the mash unit. Thus we have those ready for surgery ready in the room next to the OR. It is working! Everyone is trying to work in the system and I am proud of them. We now have nine orthos and everyone is great. Observation—the people who come here are easy to work with, want to help and support the others. Pat and I and maybe Stephanie feel that if we can stay until Monday to perfect system and train some others it might continue. We are working on it.
(Friday (Pat’s entry)
Up at 5:30, a nice hot shower (thanks to engineer Tim Traynor) and all of us went to Mass in the little Chapel, at 7:00. The setting is a lovely Haitian concept, with a rock wall behind the altar, which is a large tree stump with a solid mahogany slab. Two small candles set a tranquil mood. Father James, RN, spoke about the need to maintain hope and pointed out the fact that we individually cannot “do it all”. We need to trust and turn the work over to others when that time comes. I feel such grief for the children. Once of my saddest mental images is a small child, about 2 yrs. old, who was not injured, but was transported to us along with patients because his family was killed. He was placed on a bed and sat quietly watching the staff and patients, coming and going looking up at faces, waiting for one he recognized. Abandoned by circumstance. The local people have been wonderful at coming and supporting those individuals who now have no one. The days are all running together, with the seemingly impossible becoming doable. I would never have thought this little hospital could have managed to accomplish what it has. The Haitian Staff have been magnificent. I am feeling blessed to have been here. PB )
1-22-10 Friday
Short nights rest, but no tremors. After going to Mass, began organizing 8 o’clock surgeries and then the trip to the Citadel and beach for those who had been working day and night for a week. It was like herding cats, first getting the docs and staff together and then the transportation. In the process they could not find the keys to the vehicle. After that went to hospital where John was rocking and rolling with all the new surgeons that had come in. He got twenty cases done in the morning. I was running around putting out fires, finding equipment, evaluating patients and keeping ahead of the schedule. Watched the hellos bring in more patients. Received multiple helos, sometimes three at a time. Don’t even know how many or how many patients. At about 1pm I noted that the OR staff was decompensating and could not handle it. There were over 20 cases and Natile was exhausted. I called it and stopped surgery for an hour and told her to give each person a 30 minute rest in shifts. I got the nicest smile and they took a box and propped up their feet. I waited for my son to return to take over the board and begin surgery at 2. Then I went to lunch and back to the cast room. A boy had fallen off a roof and broken both wrists and had a head contusion. He was in a lot of pain so I decided to do him emergently. He had eaten a full lunch so we could not put him to sleep. We gave him morphine and sedation and did a hematoma block. I asked another orthopaedic doctor to help and he said yes. I did my block and he looked up and I offered to block his side and ask him to get supplies. He left the room and said he could not take the screaming and left. Fortunately Dr Beth Moran stepped in and helped. She is amazing, she is competent in adults and peds and pitches in to help everyone, When the blocks set, the patient calmed down and we reduced both radial epiphysis fractures. He was so happy but we kept him overnight to observe him because he soft tissue swelling in head.
The crew that went to the Citadel and beach came back relaxed and had a great time so I put them back to work. We did about as many cases in the pm but not as severe. We did 39 cases today and it is 1145 pm and time to call it a day. All the staff and visiting teams are fatigued. Tired in body but strong in spirit.
It is time to adjust my five star titer and go to bed—(to my son)good night John Boy! it didn’t work. They are all up talking and smoking cigars. John is holding court. Everyone likes him and interacts well with him. It makes me proud as a parent. He has done a wonder job. It has been an incredible father son experience, I respect his judgment and he mine.
We may differ in opinion but work it out amicable. We have laughed and cried together and shared an experience that few father and sons ever get.
(It has been a wonderful experience in Haiti . There are so many people here willing to pitch in. It is truly a big team. There is no hierarchy between Doctor, Nurse, Scrub Tech, etc.
Everyone is pulling together for one cause. We are all trying to help the Haitians. We have done great cases here. The transformation and organization that has occurred in just a few days is awesome. I look forward to the rest of my time here. Jk )
(We each have been challenged to embrace these wonderful Haitian people. I was here when the earthquake happened, everyone reached out the strangers & became friends.
My day today started a little differently. I got a chance to go to the Citadel built by King Henri Cristophe. It was beautiful Kim )
1-23-10 Saturday
It is 6 am and the rooster is crowing. Had to get up to get my team off. It sure will not be the same without them. At this time in the morning there is time to think with a clear head and wonder what it is all about and why you are here. You see all sorts of motivation. Some are here for their personal reasons but most are here to help the Haitian unselfishly—-got to go emergency; back, John went to make rounds at 6 am and there was a child in respiratory distress. He took it took it to the OR and sent out an emergency call, man everyone was up half dressed and running. The patient was a little girl who had tetanus, a disease rarely seen where the toxins caused by a bug goes to the nervous system and the patient becomes stiff, she responded to the resuscitation after arresting but needed positive ventilation so we are trying to get her to the hospital ship. What a long sentence! Sort of like the days.
Ed Fink refused to leave on the flight he was booked on despite being ask to, so we will put him in triage, it is going to be a long day. A lot of old trauma came in and one new one hit by a car with a head injury. I was running the rooms and when I got there someone had moved the x-rays and we had to begin searching to get the cases started. It maybe a local trick to slow things down To top if off there were two C-sections so we lost one room. We managed to get the other rooms started and the cast room. By lunch we had done 12 cases and 13 in the afternoon. We were planning another after dinner but anesthesia called it. Everyone was exhausted. During the afternoon we received a kid hit by a car and was on a respirator so we lost one room because the only way to keep him going was by hand ventilation or an anesthesia machine. I need to stop and recognize Phillips. They have donated monitors at 30g a copy and ventilators, about a dozen of each and sent 2 techs to install them. What a gift, it has made everyone’s job easier. Anyway, we arranged to transfer the patient to the USS Comfort and they sent a helo. We also had a patient in renal failure that we needed to transfer and they are working on it. We had a meeting scheduled at 8 pm and about then two helos came in with more patients so we meet after receiving them Peter is going to divide us into groups and try to meet daily. We now have about 50 volunteers, have received about 300 patient and done over 160 surgeries. It is a bit staggering considering that we have been here about a week. Every new group is so enthusiastic they want to change forward. We have to remember we are guest at their hospital and they have been working 16 or more hours a day since the earthquake and are physically and emotionally stressed. Just try to think about your family and where they may be and try to work constantly seeing the victims. It is overwhelming and they are handling so well. We went back to get the preops ready for tomorrow and finally headed home about 11 pm Tried to call my wife twice and loved hearing her voice on the answering machine. I hope John and crew made it. Got to hit the sack, full day tomorrow. Will try the phone again, wouldn’t you know it, I got her on her cell phone. It was wonderful to hear her voice. She and Ellen have been real troopers.
1-24-10 Sunday
Got to sleep until 630 am and really needed it. There seem to be less roosters crowing in the am, could it because we are eating a lot of chicken? Just a thought. Headed the OR and they were getting the cases started. I really feel good about the system we set up. It allows patients to be there the night before and ready to go in the am. What I did is set up a pre-op area in the old clinic in the front of the hospital and numbered the spaces, then drew a picture on exam paper and taped it to the wall. I made a similar one next to the posting board and a list below. When the patients come in they are put in a slot, their name on the board and a slip on the schedule. The visuals help because of the difficulty communicating in another language. It took several reminders to change the workers way of doing things but it works. We use the walkie talkies to talk to the other areas and find patients and send them to the OR. By the end of the day it was running pretty smoothly and we were able to post the cases for tomorrow. I also got to do my last case. There was a little old lady in pre-op that had a broken hip and no one felt comfortable doing the surgery. Since I was running board I walked by her all day. Each time she lifted her finger and beckoned me. By today, the fourth for her on the stretcher, I was so moved that I insisted on doing the case over some resistance from others who wanted to do theirs. I sort of insisted.they agreed, and Jeff and I did a open Richards screw. Posterior lateral approach, remove the hematoma, drill the femur, place the side plate, reduce, place guide wire, remove side plate and put compression screw on side plate, reapply and screw the plate to the femurs and screw the compression screw into the head. Looked good and was stable on range of motion—done in one and a half hours no x-ray. Really felt good about it. Jeff Keen, a senior resident in the UF Shands program gave up his vacation to come and has been a valuable team member. He pitches in everywhere and does any surgery he is asked to do and asked for help when he needs it which is not very often. It is so important for all of us to recognize our limitation and look for help when necessary.
The best part or my day was at lunch. We got to lunch early between cases ,and were talking when a helo came in and they ask for help unloading it. We ran over, it landed and they signaled us to come. We ran over to the Navy chopper and I spotted a infant in the crew’s arms and pointed that I wanted if. She passed if off to me and I took it to a nurse anesthetist, Marty, who got in the front seat of the ambulance and I passed her the child. The child was listless and eyes rolling back. After surgery I checked on her and she was better hydrated and stable. The story I got was that she was just found in the rubble. I really find it hard to believe but want to, maybe the ruble was from the aftershock. To be apart of this experience with my son and support from my daughter and wife is what life is all in all about. John Lovejoy
One cannot conclude a journal such as this without recognizing some of the key players and thanking all who helped. First, Tim Traynor and John Gilbertie who were at the Sacred Heart hospital at the time of the earthquake and set up a command center and organized the effort using every resource they could, phones and internet when working and being everywhere to coordinate the response. Sister Marilee who was our personal angel. She looked over us all like mother hen, giving us a hug when we need it and quietly supporting us with coffee and clean clothes which comforted us all. Santana, who came down to film and document the experience ended up helping everywhere and being one of the key go-to people. A Haitian American orthopaedic equipment rep, Ryan Gardere who spoke the language and understood the peoples needs and was everywhere translating and communicating. And Dr Peter Kelly who arrived with his calm personality, gentle authority and commanding presence. He is a diplomat and works so well with the Haitians and brought so many up to a higher level of competence. I know I have forgot many, like Carol, Joni, Deb and Denise, who have all put their lives on hold to help Haiti but with out them this effort would not be a success.
SUMMARY
Patient List
That’s was a joke, difficult at first, but Anthony did set up a computer to enter each patient as they came thru Triage. I think we accepted over 300 approaching 400
Surgery List
We figure around 180 cases in surgery. The info was left for the OR to log but we do not have an official count
Total dollars donate–to high to figure
Feelings–job well done and feeling good about being able to participate
Final observations: we are all ok, our bodies are fatigued but our spirits are high with the knowledge that we have given our best effort to make a difference in others lives and that helps to ease the anguish of this experience.
