Medical Volunteer, Anesthesiologist at Crouse Hospital, Syracuse, NY
1/29/10 – 2/5/10 – as transcribed to Cindy McCall
Background: On January 12 a devastating 7.0 magnitude earthquake struck Port-au-Prince, destroying hospitals and infrastructure throughout the area. The following is a journal of a week I spent working as an anesthesiologist with a surgical team at Sacre Coeur Hospital in the north of Haiti close to Cap Haitian and outside of the quake zone. I arrived just as relief efforts had begun a series of helicopter airlifts to bring the severely injured from the earthquake zone to Sacre Coeur, which had organized surgical, medical and nursing teams to treat these patients. With limited access to computers and inconsistent phone coverage I relayed this journal to my wife through texts and cell phone calls. Since the horrific images of the earthquake victims appeared in the media two weeks ago, it seems there has been little or no attention paid to the continuing suffering of the injured, and to the challenging, long-term work necessary for their recovery and rehabilitation. It’s been reported that over 40,000 Haitians are amputees due to earthquake injuries. The scope and the gravity of the physical injuries suffered by the Haitians, an overwhelming number of whom have not only lost limbs but are paralyzed or maimed, is staggering.
This is an account of a surgical team’s experience but the huge need for volunteers in all areas at Sacre Coeur cannot be overemphasized. Medical training is not required. Anyone with some organizational skills and a desire to help others would be an asset to the hospital, as patients face the daunting challenges of recovery and rehabilitation. The really hard work has just begun.
Saturday 1/30/10
A text Friday night (last night) confirmed the medical team had arrived. Couldn’t get a call through but Tim called Saturday around 2:30 pm.
Texts take up less bandwidth and can get through easily when over-whelmed phone lines open up even for a moment, so it’s easier to text than call. Cell phone communication in Haiti is pretty good once you’re able to get through.
INITIAL IMPRESSIONS
The first impression the medical team had was that the situation was like being in a war zone, helicopters from Port-au-Prince landing all day to drop off the injured. The helicopters were also transferring patients from the USS Comfort, a 1,000 naval bed hospital offshore of Port-au-Prince that had no more room for the injured.
When the patients came in, some had elastic cords around their necks with tags hanging on them. Sometimes the name of a patient was listed, sometimes not. The tags had triage picto-graphs. One was a cross which means nothing can be done, the patient was going to die. Two was a rabbit, which meant get to the patient immediately. Three was a turtle, which meant the patient was not at immediate risk of dying.
Helicopters landed and delivered wounded people on stretchers. Patients were transported to Sacre Coure’s make-shift ER, where the injured lay on the floor until the hospital staff could get to them. MILOT and SACRE COEUR Milot is a pretty village surrounded by mountains covered in forests. The villagers are devoted to the hospital. Many patients are being fed by the villagers who walk up every day with food they’ve cooked at home. Sacre Coeur is a 73 bed hospital, one of only three hospitals open in Haiti, which is now accommodating close to 400 patients. Since the quake decimated Port-au-Prince hospitals, UN inspectors consider Sacre Coeur the most modern and best equipped hospital in Haiti, the only one currently capable of handling complex surgical cases. Some of the injured arrive at Sacre Coeur by vehicle with family or UN help, but most are being airlifted from Port-au-Prince and the earthquake zone. Patients are reluctant to be discharged as they have nowhere to go, and know no one in the area, and many are not well enough to get home, if they have a home still. Some patients are there with family members, many are there alone. Orphaned kids come in with an adult they don’t know who brought them there, kids with traumatic amputations and broken bones who are so little they can barely tell you their names, 3 year-olds, 4 year-olds. Tim speaks fairly good French and it helps, although most Haitians speak Creole rather than French. Across the street is a school compound that has become a hospital ward. Patients are on concrete floors with a mat underneath them and family members all around. On Sunday (tomorrow) a mobile 200 bed hospital is arriving, donated through Caritas of Boston, and they’ll move patients out of the school and into the tent hospital. It’s a big logistical problem housing and feeding the medical volunteers. CRUDEM, the nonprofit that runs Sacre Coeur, and Catholic nuns from a British order stationed in Milot are running the show. The hospital usually accommodates about 12 medical volunteers at a time but over the course of this past week the number went from 50 to 90. Tim is housed in a mosquito-proof tent with 2 other guys. He’s got a cot and it’s pretty comfortable. There are also Haitian teenagers from the Boy Scouts and the Red Cross, who work with the nuns and the hospital staff, and are a huge help. Other medical volunteers are mostly Americans or Canadians. Three volunteers with Tim’s team are American Haitian and speak Creole. Some volunteers are at Sacre Coeur for a week, and others have come for a month. One orthopedic surgeon in the team has volunteered in Haiti every year for 20 years. The nuns are Irish, British and American, and are in Haiti for a five year stretch. CONDITIONS at SACRE COEUR Sunday 1/31/10 Monday 2/1/10 HOSPITAL CONDITIONS The medical team was seeing some of the most complicated cases they’d ever encountered. There is little or no lab work, and most patients are anemic and malnourished. There is very little blood available. A big deal to get any blood at all. Patients do not have adequate nursing care, and the hospital doesn’t provide food for them. If they have family, the family bathes and feeds them, changes dressings, turns them over. For those who don’t, sometimes they find angels in fellow patients lucky enough to have less serious injuries, who take care of strangers who are in worse shape than they are. There are also medical volunteers who at the end of the day bring food for patients who haven’t eaten. The villagers are providing food as best they can to patients with no families, and they’re trying to take in those people discharged from Sacre Coeur who are ill and alone. The situation seems so overwhelming it’s hard to feel as if you make any difference. But in the face of a disaster of such catastrophic proportions the medical volunteers do as the Haitians, just go on and do their best every day to help others. You take care of what’s in front of you and keep going. Wednesday 2/3/10 MOBILE HOSPITAL One of the tents has become the ER where new patients are stabilized. The four-man Haitian transport team who deliver patients to the OR are extremely hard working and really keep the ORs functioning efficiently. Helicopters continue to come in daily with more wounded but patients are not as injured or as critically ill. The triage picto-graphs are gone. Everything is better organized. Patients come in from field hospitals in Port-au-Prince with signs taped to them indicating their injuries. Lots of new patients every day but less trauma and less critical injury. PATIENT CARE In the halls you see patients moaning in pain. The best you can do is give out morphine on the spot. No sign outs or protocol with morphine or other pain meds – the anesthesiologists all keep morphine with them, and administer it right away to those who need it. Many patients are in terrible pain. The hospital did 30 cases in the 3 ORs and 3 procedure rooms yesterday. Still doing mostly amputations and cleaning out infected injuries, or fractures that haven’t healed well. Many children and teenagers have required amputations. They are often reluctant to have surgery, terrified that they will wake up without a limb. 2 of the ORs are air-conditioned. The 3 additional procedure rooms where surgery is done, are make-shift spaces but they’re set up pretty well now, and it works. The doctors change dressings in there whenever possible, as you can have some privacy and give patients some pain meds. It’s very painful for patients to have dressings changed on the wards, especially with burns. Without enough nursing staff to change dressings or turn people over, bedsores and infections are a serious problem. Many people are paralyzed due to injuries from the quake. You see young paralyzed patients with extensive, severe bedsores that will end up causing fatal infections – a terrible heart-breaker. Other problems that come from inadequate nursing care are that essential medications are not being given. Too many patients weren’t getting antibiotics regularly, or at all. Now it’s written right on the patient’s dressing when it should be changed next and when the next dose of antibiotics should be administered. Medications are taped to a patent’s dressing so they will be given at the correct time. This has really helped cut down on the chaos. It was overwhelming at first for the medical team to be in the middle of such a medical catastrophe. They were rocked the first day when a 4-year-old boy in a diabetic coma died of cardiac arrest due to inadequate lab monitoring and lack of basic medication. At the staff meeting that evening tears, second-guessing and guilt gave way to an understanding that all present did their best to save the boy. From then on the team realized that the only thing you could do was try your best with what you had. As the hospital situation became more organized, Tim became used to the working conditions. You learn to trust your ability to fly by the seat of your pants. The medical team and the surgeons were what made it work. Many were military docs who had experience working in combat zones in Iraq and Afghanistan. They already knew what it was like to operate in the field, and nothing upset them. Most importantly they could make do with what was at hand in the OR. They were calm, great with people, they gave everyone the same excellent care, and they were top-notch surgeons. TIM’S TENT Thursday Feb 4 Besides the stray dogs there is a new crowd of people around the outskirts of the hospital compound, as now only 2 people are allowed to stay in the wards with a family member. Hundreds of family members and others congregate at the hospital gates, hanging out all day waiting. Some go down to buy food in town and bring it back to share with others. You hear rumors that troublemakers are here, that Port-au-Prince jails collapsed and let out all the criminals. The Milot villagers worry about that, but again, it seems very safe here. An armored UN vehicle is parked in front of the hospital every night. This really wonderful thing is happening in the evenings now. A group of Haitian ladies in colorful clothing come up from the town and sing every night to the patients. They go through the wards and sing in Creole. The songs are beautiful, sung in several parts, and they have amazing voices. They sing for about an hour and 1/2. It’s peaceful and soothing, and the patients love it. WHAT’S NEXT So many problems and so much sadness. Tim has talked to patients every day who tell him about the family members they lost in the earthquake. They point to the sky and say their lost family is in heaven. Ciel in French. So many orphans. More every day. It breaks your heart. Leaving tomorrow but you feel as if part of your heart stays here. It’s been an amazing week. It will be hard to say goodbye. Expanding the Concept of Comprehensive Healthcare Through the Eyes of a Haitian Child… A Year of Profound Grace for Hôpital Sacré Coeur We are concerned …For the children. We are concerned … For the children. For the elderly. For the disabled. For... Read More Hôpital Sacré Coeur’s Amazing Staff Hôpital Sacré Coeur continually defies the odds and makes noteworthy progress no matter the... Read More Thank you!! 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