HAITI LOG for Tim McCall

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
The team flew to Cap Haitian from Ft Lauderdale on Friday 1/29. Roughly 90 miles from Port-au-Prince, Cap Haitian is a town of 100,000 which is now doubled in size due to refugees arriving from the earthquake zone. From Cap Haitian the road to Milot where the hospital is located was like a three-ring circus, filled with vehicles and stalled traffic. Dirt roads full of potholes, and crowds of people walking in the middle of the road carrying loads on their heads, people on scooters doing 50 mph. Huge white UN trucks inching along stalled in traffic along with rickety cars, vans and buses. It took over an hour to travel 8 miles.

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
The team started working almost as soon as they arrived. On their tour of the hospital compound they got to the OR area and were asked, “Can you do a case now?” The first day the team thought they had no medical supplies. The second day they realized the hospital had lots of supplies but it was so unorganized that it was difficult to find anything. Morphine was sitting in open bins everywhere. You had to hunt for basic supplies and medicines, and OR equipment and supplies were all over the place. Operating rooms were dirty, with flies and mosquitoes everywhere. The Haitians are very stoic, and wait patiently even when in great pain for medical staff to help them. The ORs are mainly doing wound debridement and amputations. The area seems safe, the villagers keeping tabs on outsiders as best they can. A few years ago a camera was stolen from medical staff at the hospital and the villagers hunted down the thief and beat him up. But now they say too many people are coming in from Port-au-Prince and they don’t know who every one is, which makes for more instability. But for now, between the villagers and UN support the place seems very secure.

Sunday 1/31/10
Didn’t get much from Tim but a couple of texts. The mobile hospital has arrived and is being set up. Many chopper trips all day. The pilots can’t radio in when the helicopters come because of the mountain that hangs over the town. When you hear them coming, everybody runs. They land in a soccer field near the hospital compound. 17 new surgical admits today by 2pm, many of them children. Patients are flown from other hospitals in Haiti, they saw at least one patient who was flown in from the Dominican Republic but most come from Port-au Prince or the USS Comfort. The surgical team works 12- 14 hour days in the OR. More tents have gone up as new volunteers have arrived in the past two days, located like Tim’s tent near the field where the helicopter lands. Other medical volunteers are in cement block rooms sleeping on mosquito netting-draped mattresses on the floor, with 8 people side by side.

Monday 2/1/10
Talked for 20 minutes to Tim. They are beginning to move patients into the mobile hospital. It was donated by Caritas in Boston, a consortium of Catholic hospitals, and it costs tens of thousands of dollars to transport and set it up. Similar hospitals have been used in places like Iraq and Afghanistan. The hospital is five large tents parallel to each other, each one about 40 yards long, with 200+ cots supplied for patients. It’s much better for patients than lying on a mat on a concrete floor in the school buildings across the street. The team sees more injured everyday. Most of the injured have infected amputations and badly healed wounds, lots of burns with skin grafts needed, broken bones that aren’t set right, infections and bedsores are very common. Some days they see 10 helicopters land – Army, Navy, Coast Guard, UN, French and other military helicopters. Patients come in on stretchers, there are no carts or wheeled gurneys. The injured are lifted from the ground and carried around the hospital and wards by medical staff and aid workers. International journalist crews come around to take pictures and videos. Someone working for Nightline was there today. Tim heard that 300,000 Haitians were injured in the quake, and 200,000 have died.

HOSPITAL CONDITIONS
There are 3 operating rooms, and 3 procedure rooms which serve as makeshift ORs. A small poorly equipped ICU is adjacent to the operating rooms. There is only one sink in the OR-Intensive Care areas for surgeons to scrub before cases, and for everyone else to wash their hands. One not-at-all clean, barely functional bathroom serves the area, with a toilet that you can’t flush paper down. There are no gowns for patients, so they are in their own clothes. Some have family who can bring them more clothes. Most don’t. One patient had a badly fractured ankle and needed a cast, a young man in his 20s. He was in a lot of pain after surgery, but he was very anxious about his jeans because he could see they didn’t fit over the cast. It was the only pair of jeans he owned. The patient spoke Creole, and when the medical volunteers finally understood what was said, the surgeon rolled up the patient’s jeans neatly and set them under his shirt right next to him. Many patients came in with just the clothes on their back, and the staff took great care to see that no clothes or shoes were misplaced.

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
I only got a couple of texts from Tim on Tuesday.
Today we talked for a while. Things are going much smoother now. The team had time to organize the ORs and the wards, and get medical supplies and medicines sorted out or put away. Med staff meetings are held every night at 8:30 – the surgery team can’t always make them as they often operate until 9:00 – and the hospital staff is making great progress at cutting down the chaos and getting things under control. There is an air-conditioned storeroom that is overflowing but that’s a good thing. More medical supplies and medicines come in every day. UN and UNESCO personal overseeing the hospital are very encouraging and appreciative of the work going on at Sacre Coeur. They tell the staff they’re doing great. US Air Force and Army soldiers have been around a lot, great guys who are helping the medical staff do all sorts of stuff, from carrying what needs to be moved into the mobile hospital to bringing in supplies and sorting them for the main hospital. It’s a lot of work to set up the mobile hospital. There are still hundreds of boxes everywhere.

MOBILE HOSPITAL
The work of carrying patients and moving in equipment into the tents is underway. The Haitian Boy Scouts and Red Cross teenagers are very helpful, willing to do whatever is needed. Some patients are out of the school and in cots in the mobile hospital although it’s not fully up and running. It has no floor yet – the floor is coming on Saturday. Right now plastic tarps are laid over the ground. The tents are powered by a super loud generator that makes it hard to hear anything. Hey, at least there’s power. One tent will be for men and another for women. This makes sense as there is no privacy and no bathroom facilities. Patients use bed pans, the contents of which are thrown into 10-gallon buckets that are carried outside and disposed of somehow.

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
There was a 2-month old baby girl that came in yesterday. She was discovered under the rubble beneath 6 dead adults, but she was fine. She had a crush wound on one buttock. Her mother was with her, which was good to see as there are so many orphans. The baby was wearing a beautiful, purple lace-trimmed dress the next day and was doing very well. There’s also a 30-year old lady, Nathalie, who is full of spirit and helps others as much as she can although she has one arm amputated above the elbow and the other arm is severely wounded. Her husband is with her, and she has a godmother in Brooklyn Tim has promised to call when he gets back.

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
A rooster has settled in to live next to the tent. He’s there every day, you have to shoo him out of the way to get by. He starts to crow around midnight. After the first night, you sleep right through it. Nothing happens early in the morning here. The medical volunteers get up at 6:00 but the Haitians don’t get going until much later. It’s after 8:00 by the time they have breakfast and start surgery. So, this morning Tim took a walk with other medical volunteers to a famous sight in the area, a palace called Sans Soucy or the Christophe palace. It was built by Henri Christophe who after the slave revolt declared himself king of Haiti in 1811. It was toppled by an earthquake in 1842. It was beautiful, only about a 15 minute walk away. It was the first time Tim was able to see the town of Milot. It’s very small but there are several nice churches, one really imposing -looking one with a kind of onion dome roof, a basilica that’s connected to the palace. The onion dome church was full of people attending 7 am daily mass. Vendors came out of the blue to sell things, but were very polite and respectful. On the way they walked by a filthy river, full of trash with pigs rooting around in the water. Haitians came roaring past on scooters carrying all kinds of stuff. Many women were walking with big jugs of water on their heads. They say Haitian women spend 75% of their time carrying water.

Thursday Feb 4
24 OR cases today. Stray dogs are all around and last night a big gang of them had a fight right by the tent. It sounded like they were coming inside. Lots of action by the tent, between the dogs and the rooster. The rooster calls to all his friends and starts up the chorus every night. Chickens are numerous around the compound too, and some end up on your plate at night. By the way, the food is great. Rice and beans and different stews. Very flavorful and satisfying. Goat stew last night, with some curried vegetables. You had to watch for bones but it tasted great.

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
They say things will slow down more in terms of surgery. The next step is to get more nurses, physical therapists and rehab people to help patients recover. The tent hospital may only be needed for a month or so, as people recover and are discharged. It’s unclear where they will go, as so many of their homes were destroyed. Medical issues are compounded by social and political problems. For example, a young boy was diagnosed with leukemia early in the week at Sacre Coeur. Attempts made to transfer him out of the country for chemotherapy in an American hospital were unsuccessful as the hospital was unable to contact the boy’s family. This may have been due to the high profile case currently in the news of the American missionaries who attempted to take a group of orphans out of the country without authorization from Haitian officials.

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.

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