Wednesday, April 28, 2010

Parting is such sweet sorrow...

Today marks the final day here at HAH. I decided Monday to come home a day early so that I could get home in time for my friend's memorial service on Friday. Since it was just a difference of a day and we had some good teams come in this week who can help with the work load, it was workable so I could leave and get home by Friday. If all flights go well, I'll be able to make it home late tomorrow night.

Leaving will be a mixed bag of emotions. In once sense I am very relieved to be heading home as we have worked day in and day out since arrival, with our easiest days being the first two we were here. We have continued to work 12 hour days or more with little time for breaks in the days. We did get to the hotel again last night for a short dip in the pool and some dinner-- I had the Italian spaghetti in honor of our departing friends, the Italian plastic surgery team. I decided to forgo the ominous dish of hotdog spaghetti. Yikes! It was a nice night to swim and enjoy being outside but not dripping in sweat.

We continue to work hard to save limbs and even a few lives from infection and blood loss. Things here are difficult for even easy tasks and so after two weeks, I am definitely in need of a break and just some time to not have to think about the long list of things we have to do to keep people alive and well. I usually don't sleep well on airplanes, but tomorrow might not be a problem.

Well, I am really exhausted and words are not coming to mind, so I am going to sign off for tonight. I actually plan to continue to write and post pictures over the weekend and possibly into the next weeks as I recall our experiences here. It will be really hard to say goodbye to the people, to our team, to our patients and to the hospital, though the respite is much needed. I'll let you know when I'm home....

Monday, April 26, 2010

Monday, Monday.... Part Deux

Warning.... this is entirely unedited as it's way past my bedtime! I hope it makes even a little sense.

Today was our second Monday of our trip. It came after a very busy weekend with very little rest. As my exhaustion increases, my brainpower for blogging decreases, and I have found myself at the point of having to choose sleep versus updates. Sleep has won out almost every time! I actually took out my camera again to day and took some pictures again, but posting them will have to wait a while. I'll probably not go through them until I'm home.

Things here are continuing to be busy. Saturday we worked till, well, now I can't remember Saturday. I'm sure we worked later than we wanted to. Wow, I really can't remember Saturday now much at all. Sunday we started rounds at 6 and then started cases soon there after. We had on three easier cases and then a bigger case, but because of "island time" it still took us till 5:30 to get done. Things just don't' move with efficiency around here so a potential light day of a few easy cases still took all day, causing us to have a few hours of rest for the entire weekend rather than any substantial amount of time. It took our toll on us, working 9 days straight as today, our 10th day, we were really dragging at times. Things that should be easy, here they take more effort and more time, and just aren't that easy to get done. We can't just write an order in a patient chart for medication. We have to write the order, then find a translator, then find the nurse, then explain the order until she understands, and then check back later to make sure it got done. One of the major jobs this week has been overhauling most of the OR including the supply rooms. Well, that means that where things were on shelves yesterday are not where they are today and not labeled the same, so today I found myself running around looking to where things were moved. While the OR needs the overhaul, it just adds more time and stress to find things when we're in a hurry to grab something needed in a surgery. Yesterday, we were delayed for an hour for maintenance on the generator as we had numerous power outages yesterday. It's great fun to be operating at night and have the power go out. We all have headlights we try to keep around with us so that if the power goes out, we have some light. Of course, the ORs may or may not have functioning lights (one OR just has wiring in the ceiling, but no light) so the only light we ever have is from the fluorescents or our headlamps. I should remember to take a picture of the ceiling in there!

I have actually not been scrubbing in on many cases lately. One of the things I have really been able to help with is getting the supplies and getting the room ready for the surgery. It is certainly not as exciting as performing the surgeries, but we all find ourselves in an environment like this "dividing and conquering" the work to get through things most efficiently, and it's turned out that if I can set up a room to get Terry started on the surgery, I then can get another room ready for another surgeon and try to maximize our efficiency. We now have four Ortho surgeons here, including one resident who is in his 5th year and will graduated in June, so there are a lot of hands to get cases done, but not necessarily enough rooms to keep going at a good pace. And of course, there is only one gurney in the hospital, so we are also limited by the availability of the gurney to transport patients to and from the OR. We do break out the stretcher at times for the smaller patients if we're desperate to get going.

Last night, for our evening of rest, we went over to the hotel again for dinner and a swim in the pool. We got done early enough to catch the 6:15 taptap ride over to the hotel. It is not a far ride at all to get there so takes only about 5 minutes or so. We piled high into the tap tap with the Italian plastics team and enjoyed the ride over until we got up to the top of the hill to enter the hotel driveway and the police truck was coming out. Imagine a "road" up hill only one car width wide and literally you could reach out and touch the US Aid tents lining the street. The road has water draining down the sides and through the ruts in the dirt, and there is a fair amount of garbage lining the street. If someone comes the other direction, it's basically a standoff to see who backs down first. So, we get to the entrance to the hotel drive which is also one lane when the police come driving out. and want to go down the hill, right where we were coming up the hill. They weren't budging, and our tap tap driver wasn't budging! After about 30 seconds of no one moving, the yelling started between the drivers at which point we started ducking for cover and got out of the tap tap and walked around the "traffic jam" into the hotel and got out of the stand off! The police eventually backed up and let the tap tap into the driveway past them. The previous night, (now I am remembering Saturday a little), we also went over to the hotel but we took Scott's landrover and Terry drove us over for the evening. We had a bit of an adventure finding the right street and ended up with quite a tour of the streets around the hotel. We have really not had time to get out of the hospital much and see the area much, so these short forays into the neighborhood were very memorable. LEt's just say it was as close to off roading as I've been in an SUV and certainly would be considered off roading in the US. There is constant water flowing down the hills mixed with garbage and likely sewage. The tents line the streets and people have open fires burning for light and cooking. We ended up having to back down one street when we realized we had gone the wrong way because there was no way to turn around on the narrow road. We ended up on the right street and did get to the hotel safely and home again to the hospital without incident.

Last night, though, we did get to the hotel in time to swim before the pool closed and enjoyed a raucous game in the pool with the Italians and a beach ball. After an attempt to play waterpolo and losing the first ball down the side of the hill when someone scored a goal through the iron fence, we got out a bigger beach ball and tried to keep the ball in the air and count how many hits we could make before it hit the water. Some of the Italians speak some English, but mostly they speak Italian, making it quite entertaining at times. They are quite a rambunctious group making time around them quite entertaining and humorous. So, we enjoyed letting off some steam and playing around a bit until the stern woman at the hotel came and took our ball away. We had accidentally batted it out of the pool just as she walked up to our raucous game, and refused to give the ball back! I guess we were too noisy, but we stayed in the pool anyway and enjoyed a nice swim under the moon and stars. Sometimes when I'm far away from home I look up at the sky and marvel at the same moon and stars that I can see from my own backyard.

Today was another busy day. The added emotions of having lost a friend back at home have compounded the emotions of the trip here. It's been a challenge to stay on task at times and we are constantly pulled in many directions. Tonight, we moved patients around in rooms to create a room of patients without infections and room of those with infections. We don't need our non-infected patients literally in a cot two feet away from someone with a draining wound. So we spent an hour moving people around on their cots being interrupted by people stopping us in the hall and asking us to take care of their family member because we are in scrubs and don't understand that we cannot help every problem that people may have but have to turn them away to get help from the ER or someplace else. It is hard to not be able to help everyone who asks, but it is impossible. We have had some interesting questions asked to us in our Ortho clinic involving body parts we do not deal with and have had to refer them to Urology and General surgery for their.....ummm..... problems. Jeannie today had to keep some man from dropping his drawers right there in the hall to examine what I can only imagine is a testicular hydroceole. Terry got asked about leisure activities after hernia surgery, and I had a man come up to me to inquire about having a hernia examined. When I explained I cannot help with that and he'd have to come back to see the general surgeon, he nodded but then went on to ask me about another problem he had. So I listened and tried not to blush too much when he asked about his erectile dysfunction in layman's terms. I gently deferred the question to the general surgery clinic as well. So, we have had some laughs at times about some of the silly things, at the Italians all singing together silly songs in the OR, and some of our own jokes and occurrences (like the availability of breast implants that were donated by some hospital). Since we had a plastic surgery team, it seemed like an opportune time to joke about the crazy things donated.

Well, I can hardly see straight and rounds start in less than 8 hours. This was a longer post than anticipated. I expect I will actually blog more when I'm home and can post pictures more easily and have time to tell more stories and reflect more on what we've done and seen and experienced. I am thankful for the teams we have here this week and the help they have brought but also the laughter and fun we've had together, even with the language barriers. I have learned that I am not a piece of fig from the Italians. And I can say "piece of fig" in Italian as well! More on that another time....

Sunday, April 25, 2010

Just a minute this morning

quick note

We continue to be very busy each day this week, though thankfully, the nights have not been as late. We were done by 7 on Thursday, 10 Friday, and about 7 last night, too. A group went to the hotel restaurant Thursday night, but I decided to stay back and get to bed early, and I was able to sleep almost 8 hours with only some tossing and turning. I felt pretty good Friday morning and could tell I had some energy back for a few hours that morning. Friday morning, though, I got word that a good friend had lost her battle with cancer and had passed away that morning about 7:30. So, the past 48 hours have been extremely difficult on top of the pain and suffering we are seeing around us here. The few moments I've had for down time have been spent just catching my breath.

We have gotten a new team in this weekend, and along with the surgeons came a couple of Physical Therapists, a wound care nurse, and some other people who can help with our patient load. That is a huge answer to prayer. OR experienced people continue to be in short supply, though. We have settled in to many things here and have gotten familiar with a few translators who are eager to help us and seem like they want to learn. IF we can teach them some skills, it will really help this place run in the future when the "Americans" are not coming so regularly.

Friday, the Italian Plastic Surgery team arrived and they have started to work in the OR as well. Now we have 5 languages being spoken and another language barrier, but we enjoy listening to them speak and picking up phrases in all languages. We also have a psychologist from Switzerland and a number of new Americans, some from the Chicago area.

Well, rounds are about a minute away, so I should post and get ready to go. I haven't seen the rest of the team assembling yet, so I hope I didn't get up at 5:30 for naught. I hope to ahve more time today even to write more and catch up with much needed rest. We are at t-minus five days, 7 hours till departure. The first week has gone fast and slow at the same time and it feels like we've been here much longer than just a week.

Thursday, April 22, 2010

92 degrees.

Someone hung a thermometer on the clothes line today and tonight at 7:30pm it read 92 degrees. Although right now, I'm actually quite comfortable after a long cold shower and a fan blowing around our section. The heat and humidty though cause us all to feel hot and sticky and sweaty all the time. The ORs have air conditioning, but only in the rooms themselves, not in the hall, so with all the people in and out, we not only have a fly nad mosquito problem, the rooms get a bit warm. Wear a lead apron and a cheap surgical gown, and one easily soaks through scrubs and drips with sweat the entire case.

The last three days have been absolutely crazy. I have lost track of days and of time. Morning runs into afternoon which runs into night and night runs into la madrugada (spanish for the wee hours of the morning). We have been operating past midnight the past two nights, Wednesday morning it was 1:30 and today was 12:30 or so. We get up for rounds which start at 6 and the day just continues from there at a relatively nonstop pace. We have morning report at 7:30 on the front steps which is a time for a short devotion and prayer, then a chance for the head of each division to make announcements. It's a chance to stop and smell the roses so to speak, and today, it wast just wonderful to sit down for 17 minutes. I was sad to see the brief reprieve come to an end and to be back on my feet. I have been very foggy in the head today and have had a hard time concentrating and moving. My feet are so sore they hurt even when I'm lying in bed. While I have a great pair of shoes, no shoes can make your feet not hurt after being on them for roughly 51/60 hours. I have had a chance to take a brief nap yesterday and today, so that has helped. I would have slept longer yesterday if I'd known how late we'd be up last night. Tonight, Terry and Jeannie went out for dinner with some of the other volunteers. I finally had to say that I just didn't feel up to it and needed to get to bed so I could function tomorrow. Terry has been very appreciative of my work this week and long hours and has also been gracious to let me rest. I just always feel pretty guilty about resting when he's working so it's hard to rest when I know they are operating and have little help if I'm not there.

I am certainly not thinking straight and cannot even think to recap the past two days. We continue to washout a lot of pus in wounds and have now done a few ORIFs of limbs that have healed from their infections. (ORIF is open reduction and internal fixation where we make an incision, realign the bone, and hold it in place with plates and screws). Actually, we have done three IM nails to be more precise which means we've fixed a tibia (shin bone) and femur (thigh bone) with a long rod that goes down the medullary canal of the bone and is held in place by a few locking screws. to keep it from rotating in the bone. We have also continued to work at saving limbs or stumps that have horrible infections and need continued surgeries help clear infections. I can't even count the people we have on our service (inpatients). We have a very busy service and the hospital is beyond full. We have patients in the halls because there is no room in the units. The units are hardly much larger than a standard double hospital room but house 6-7 patients on cots rather than two. In many developing countries, family members act as the primary caregivers in the hospitals,. The patients bring their own sheets, the families bring the patients food each day, they do the bathing, run blood and surgical specimens to the lab, and keep watch over their family member. There is often one nurse for 10 patients or more. They take vitals, give medications, and start IVs, but much of the other care falls to the family. The family members do not get beds to sleep on. Some will bring sleeping pads but some sleep on the floor next to the patient''s cot on cardboard. Even when I feel like I'm "roughing it," there are people all around me with much less. I have access to a shower, running water (though sometimes the water is turned off and we always have to drink filtered water not out of the tap), a cot, nutrition from the food we brought along. These people have a cardboard box they have cut open, a bedpan, a bucket for bathing. The patients are to get one meal from the hospital a day but the family brings the rest and has to bring their own food to feed themselves. There are a few people who volunteer every day to take the lunches around to the patients and have to turn away from hungry people who are not on the list to receive meals. There are still hundreds of people living in tents on the hospital property. I have not had a chance to get a tour of the tent city here at HAH, but some of our team was taken out by their interpreter to see his tent and see the grounds. He apparently lives in the tent with 10 family members and was very excited to be promised a flashlight and sleeping bag when our nurse departs tomorrow. We are personally not making a dent in the tremendous illness and poverty here, but maybe collectively, with all the people who have come already and are yet to come, maybe we can make a difference for the people of Haiti. The long term goals are huge and seem insurmountable at times, but in one perspective, there was great need in Haiti for years prior to the earthquake, and maybe the quake was a means to get people interested in coming to help who would have never otherwise considered it.

Well, my stream of consciousness post is coming to an end. I need to wind down and try to fall asleep here soon. Most of the people in my section are leaving in the morning, some very early, so there will be no sleeping till the last moment before rounds tomorrow. I have to walk down the hall and hope to reconnect to the internet there so I can get my email and hopefully get this posted. Evening time connections are hard because everyone is trying to connect and the little wifi server is overloaded. 1:30 AM i can connect from my cot without a problem, though!

I hope tomorrow also ends at a reasonable time and that my rest tonight will help me focus and have more energy for cases, clinic, and managing patients. Most of our team leaves tomorrow and we more volunteers this weekend. We can hope and pray that we get some good hands who can help with our busy Ortho service. We'll see what God provides. I am seeing that I cannot make it through each day on my own strength and need His help to get through. Looking through the halls, though, makes us realize that each day of health and of having four working limbs and food to fill my belly are all gifts and much to be thankful for.

Wednesday, April 21, 2010

32%

My computer battery is currently at 32%. I think my personal battery is much lower. Yesterday was a long, tiring, busy day. The disaster relief effort is past the battlefield medicine of the initial weeks after the quake, but we are in the midst of our own battle at HAH. Everyday, the clinic lines are long, the operating room schedule is beyond capacity, and people are transferred and flown in from field hospitals and local hospitals needed "definitive" orthopedic care. Definitive meaning more than just a temporary solution until the patient can get to someplace more sophisticated. We are that more sophisticated place. We have the honor of having the best Orthopedic care in the country and being a tertiary referral center for the county. We are the end point. If we can't take care of them, no one can. We don't turn people away and we do all we can for them.

Yesterday started out with the news of an emergency C-section for a baby who did not survive. Sometime mid-day, there was a C-section done for a beautiful baby girl who was crying and moving and giving "the eye" all of us oolgers with cameras. I marveled at life and death and the spectrum we see. The day yesterday was full of Ortho cases. We did at least 11 surgeries, and a Plastic surgery team who came to HAH for the day did 4 cases that were on our schedule as well. About 7 last night, as we were plowing through our last 5 cases, we got a call that an American relief worker had had an injury to her left arm with a possible severed artery. They were 20 minutes away and wanted to come into the OR we were in. Scrub technicians (the people who really know the instruments and are responsible for handing instruments, setting up and taking down cases, well, we really don't have any. We have a two nurses who used to scrub cases years ago, and well, that's about it. So, I was acting as scrub tech and 1st assist for our Ortho case last night when this woman came in. The general surgeon asked who he had to tech and I said, well, I'm an Ortho PA with no vascular tech experience, but I can try. When he asked who we had just had as our tech, I said, "Me!" I was very thankfully that one of our nurses/previous scrub nurse was able to step in and take over and I was relegated to running and finding supplies for them. THankfully, the artery was not damaged but it was a large vein that bled badly. The people in the field had put on a tourniquet so tightly there was no pulse in the wrist and her hand was blue. It ended up being a simple procedure and over quickly, and she was on her way. The remarkable thing was seeing everyone come together for an emergency, make the most of the situation and the supplies we have, and get something accomplished. The whole night was like that, though less emergent. We worked till past 1 am this morning. I got to bed about 1:30 after a much overdue albeit quick shower and slept soundly till 6 when rounds started. It was even cool enough to need to pull on the sheet last night.

We did wash out a TON of pus yesterday, and will have more today, and more tomorrow, and more the next day. The major things we are dealing with post earthquake are all the infections. Imagine having your family killed in the quake, living in a tent in a field with no clean water, and having a wound from surgery. Even some of the "clean wounds" have been infected. Also, initial treatments for some open fractures (bones that protrude through skin) was to fix the break with metal hardware. One principle of Ortho is to NEVER implant metal in an open fracture. It 99.9% of the time gets infected, but people here don't know that. So, we are still cleaning out wounds of people with horrible infections. Last night, at midnight, we were debriding the stump of a 40 year old woman whose stump form her above knee amputation was infected. She was sent from another hospital because they didn't feel they could care for her. We did extensive debridements for necrotizing fasciitis, or flesh eating bacteria. It was ugly with lots of dead tissue. She could potentially die from this infection if we don't keep it under control. She could certainly lose the rest of her leg which is highly likely. We will take her back to the OR today for another cleanout surgery.

Well, I know there is more to tell, but no time or brainpower to tell it right now. I'm going to check my email with my feet up for a few more minutes and then get down to clinic. Terry was gracious and suggested I take a break while he gets things rolling downstairs. He thrives on this kind of medicine and schedule and can operate, literally and figuratively, on 4 hours of sleep night after night. I do not. Also, our medical student leaves this Friday morning, and Jeannie and I will be trying to take the job of three people. Also, our wound care nurses will leave on Friday as well, taking most of our team. You can pray that some people come who could join our team and really help shoulder the load. We do have some nice size teams coming from CURE this week, so we can hope and pray for some more hands. Also, our amazing Scott leaves this weekend for some much needed respite time in the US with his family, leaving Terry as the head of Ortho. We will be getting another Ortho surgeon as well, so we'll have his help, too. Terry has a wealth of knowledge and experience in this kind of medicine, but we are still figuring out the logistics around the hospital and with teams coming and going constantly, Scott does a lot to coordinate the entire effort. We will need to all work hard at communication and working as teams to care for these people. We are all tired and all working on little sleep, and what we do get is restless from heat and humidity and from having 40 people stuffed into one area and another 20 down the hall. It is noisy and cramped and crowded, but we are making a difference for people one at a time.

Tuesday, April 20, 2010

The view from the veranda

The view from my cot

A boy in town selling bags of water, looks like what the relief teams handed out a few months ago. He kept asking me "Hey you.... got money?"

Waiting for the chopper to come in:

A young girl at the "helipad"

Walk thru the streets

The hospital from the main drive

The electric fly swatter

15 minutes before rounds

Not much time today before rounds start. I might have a few minutes if rounds go quickly to hammer out some more on yesterday. Quick summation: it was a very busy clinic day. Scott (the chief physician for the Americans/volunteers and head of Ortho) said it was the worst clinic day yet. If that was the worst, we can handle it. While it was busy and chaotic, it was not frustrating or enfuriating in any way, just very very busy. So, I am thankful for that. Of course, things can always go South here quickly.

We did three cases yesterday on top of seeing 39 clinic patients. Our day was from 6 AM rounds to after 6 PM. Terry's wife Jeannie has been a huge blessing to our work here and yesterday her strengths in organizing Terry's schedule and coordinating were very apparent. Her birthday is Thursday so we may go out to the hotel for dinner that night. I'm saving my shower for after surgery today. Yesterday, I was filthy and literally soaked my scrubs in sweat, pants and shirt, before 10 am. The facilities guys were working on plumbing yesterday, so there was limited running water. It might have been a blessing because with limited water, limited internet, I was in bed about 8 and asleep shortly there after. I slept fairly well till 5 this am. I am not "rearin' to go" but at least not a complete zombie.

I was going to try to post pictures, but I fear my internet service just went down again, so I'll post what I can when I can. Thanks for prayers and emails. They do help me feel closer to home. I've only been here four days, but already feels like it's been much longer.

Monday, Monday....

This post was written Monday morning, 4/19, but due to spotty internet access, I haven't been able to post till this morning.
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Last night was an extremely hot and humid night on the third floor veranda. Ithink sleeping in a tent in the roof would be nicer as long as it's not raining. It hasn't rained since we've been here and the air feels like it's about 150% humidity. Actually, outside feels better than inside. We have morning report and worship in a half hour then startsthe craziness for today. I only slept about 5 hours last night I think so today will be tough. Thankfully someone has some starbucks instant coffee packs that are helping me out. It will be a challenge to stay interested and keep the right mindset towards everyone when I'm so tired.

There is a lot of pain here, phsyical, emotional, spiritual. The people come to us with physical wounds from the earthquake that were not appropriately treated initially by the healthcare system and are now infected and full of pus. The 11 year old girl screams and night and seems to have nightmares. I'm sure it's related to the quake and the trauma. When half asleep we just want herto stop screaming, but the truth is that the wounds in her heart are much greater than her physical wounds and are hard to even imagine. Another woman had to have both her legs amputated at the hips and has wound healing problems. She has no family to care for her and cannot get into her wheelchair by herself. I don't know where she could even go.

Over 200,000 people died here. Bodies are still buried in rubble in places. There is no where to put the rubble so it sits in the streets alon withte garbage and the tents that house people. People try to carve out a living with roadside stands and eat over open fires. Raw sewage empties into an open area next to the hospital. There is more pain here than I can help, but maybe we can help a few and by saving their limbs help them be functional and live with less phsyical pain. The spiritual pain we can only pray for and try to show Gods love for us through Christ by being here and caring for each person we come in contatc with.

I'm writing at 7:15. Morning report starts soon. Not sure when I'll get this posted.

Sunday, April 18, 2010

First "Kill"

I've heard from soldiers that you always remember your first kill. Today, mine came in the form of a Haitian housefly with the electric flyswatter. See picture below. We operated today, and a window was left open in the operating breakroom without a screen, so with all the doors that are left open and even when closed, don't seal tightly, we had FLIES and MOSQUITOS GALORE in the ORs today! We are all quickly becoming proficient with the electric fly swatter which resembles a tennis raquet. We all have double duty as health professionals and fly killers. The zap of the bug killer is music to our ears!

It is Sunday, and supposed to be a light day as most locals are in church. Since we celebrated Sabbath yesterday, the traditional Jewish and Adventist day of rest, we worked today. Our teams got some GREAT stuff done in the OR suites. The sterile processing room was doubling as a dirty instrument processing room. Not a good idea to have clean and dirty instruments in the same room for obvious reasons. So, a group of nurses and staff cleaned out a huge scrub sink of instruments and sorted them, then the facilities men moved the sink into another room that was emptied and cleaned top to bottom, and now they are working on moving all the supplies back. HUGE project. Having done a major organization project in the DR last May, I understand the overwhelming feeling when getting started, and its amazing to see such a big job accomplished. It will make a huge difference for instrument processing and huge leap forward for cleanliness and disease transmission.

From the Ortho standpoint, we did three cases today. Our first case was an 18 year old woman with an open tibia fracture who now has an external fixator on her tibia. Her bone is infected and we needed to clean out the bone, cut the bone ends off to get down to clean healthy bone, and reduce the bone back into alignment and tighten up the fixator. After that case, we cleaned out a few other open wounds with infection and pus. In between, we helped to sort screws and instruments. It seems like any trip Jeannie and I are on, we end up sorting screws together! It's just one of those jobs....

We did enjoy dinner out last night. We went to the hotel down the road a ways via Tap-Tap hired by the hospital. The service is notoriously slow, so we enjoyed a night out in a nice atmosphere and just visiting together. The hotel had a nice 2nd floor open veranda with large fans running, so there was a nice cool breeze. It took about 2 hours to get our two cheese pizzas (probably had to age the mozzarella first) but it was pretty good and certainly edible. I was so tired by the end of the night, I was seeing double almost. The hospital sent an ambulance to pick us up and take us back to the grounds. It was a good night out.

Before our first case today, I tagged along as Terry and Scott walked through town up to the "heliport" to greet an incoming helicopter from Santo Domingo with a friend of his on board coming to help and deliver some supplies. It was great to walk a bit through the streets, see some people, meet some children and catch a few pictures. The children are friendly and often want to have their picture taken and see their picture on the screen on camera. One boy, probably 10 or 12 years old kept saying, "Hey you, hey you" so we would try to exchange a few phrases. One of the first things he asked was if I had any money. I was carrying a shoulder bag that had some supplies from the hospital in it and he kept wanting some of what was in the bag, even after I explained it was hospital supplies. Even patients' family members may ask for money after greeting and smiling at them. It is hard to say no, but there is more need here than we can ever meet. There was some rebuilding going on of a wall along the road with new ditches and supports going up. There are many street-side stands selling all sorts of goods from clothes to toiletries and everything in between. One has to remember that pedestrians do not have the right away in this country and to get out of the way of the motorbikes, tap taps, and other vehicles driving through the streets.

Today, we did get some hot lunch. I'm not really sure what it was, I think some tofu (though Terry now clarifies that he thinks it was gluten) in some sort of sauce, a vegetable, and some rice with some sort of cheesy tasting potatoes (I think they were potatoes). The rice and cheesy potatoes were very tasty and so was the gluten. It was certainly food and filled my belly which was good. Dinner tonight will be more power bars and trail mix, which is good too.

Tomorrow will be an extremely busy day. Manic Monday, so i'm told, and the guards will have to hold the crowd back at the gate. We will have a full day of clinic and some surgery. At this time, it's a lot of washing of infected wounds and while we could do some "clean" cases of non infected extremities, we are just trying to help a lot of infections so they can hopefully heal. It's hard to see the pain and suffering these people are and have endured with their injuries, but the alternative would be that they would all have amputations and live a very crippled life. There is some amazing work being done here and helping so many people. There are still great needs for the people here, one of which is training for the local hospital staff-- things as simple it seems sometimes as keeping doors shut to keep the flies out of the ORs.

Another interesting occurrence for me today: a large group of volunteers came last night as part of the Cure International group. Today, there was a physician in one of the ORs whose name was familiar to me. I was trying to place him when I realized who he was. I asked him where he was from and he confirmed my suspicion that he was in fact from Philadelphia and was one of the Emergency Medicine physicians who lectured to my PA class back in January of 2001. We chatted for a few minutes and when he saw me operating the electric fly swatter, he was very proud of his teaching back in the day. Apparently he still lectures at my alma mater in Philly.

Tomorrow will be another test for us all as the local staff comes back in full force and as we learn to work together more and struggle with the language barrier. Scott brought one of his scrub techs with him to help for a few weeks from the DR, so we have been speaking Spanish, a few words in French, and also of course English. My french lessons have come in handy a little bit so far and I have actually taught a few words to people throughout the days. I need to refresh even more with some phrases and vocabulary. I have also asked the translators a few words as well. I do find myself thinking in Spanish more since that is my foreign language of familiarity. The language barrier is hard and frustrates us all at times. There is a translator staff to help-- locals who started as volunteers and then were hired on by the hospital a few weeks after the quake when they said they needed to get to productive work and making money. Their English knowledge varies but they are a great asset to medical care for these people.

Well, I am going to get some pictures posted here hopefully (when the internet is back working again) and hopefully get some rest tonight. I for one am hoping for a quieter night tonight than it was last night so I can get some better sleep before 11. Pictures to follow another time:

Saturday, April 17, 2010

Our luggage arrived today and we are grateful! We got a call from the airline saying it had made it and it was brought to the hospital about 3 when the next group of volunteers came. So, I spent an hour sorting supplies, food, and my extra personal things like my headlamp and extra bug spray.

I don't think there will be time to write about all we've done and seen throughout the next two weeks but I'll do the best I can. We arrived in PAP (Port Au Prince) yesterday about 3. After waiting for our luggage which didn't arrive and collecting the entire group of volunteers on our flight (there were also 7 volunteers through Cure International and 2 other women through Loma Linda University) we finally got in the bus to take a group to the hotel and the rest of us to the hospital. It was about 7 or so by the time we got to the hospital and then proceeded to unload and try to settle in a bit with cots and mosquito nets. The drive through town was a brief tour of the destruction in the area and a brief view of some of the tent cities. We drove past the Presidential Palace which was just completely toppled as well as many other buildings and piles of rubble, garbage, water backing up in streets. By the time we got to the hotel and then hospital, it was dark (we are on eastern standard time, so it's the same time as central daylight savings, but we're much further east of Miami, so it gets dark early and the sunrise is early). We saw families living in the tents with their little grills cooking dinner over open fires. Some people were in buildings. Some had electricity. Some tents were set up on the islands in the streets between the two directions of traffic. Apparently they set up far away from any walls as they are terrified of walls falling on them. WE passed by tent cities of tents stretched as far as we could see. There is rubble EVERYWHERE, and garbage all mixed in. Someone said they heard a statistic that all the rubble from the 60,000 destroyed buildings would fill the Houston Astrodome 23 times. Where do you even begin? In someways, it si cleaner here than before the earthquake as there have been groups employing locals to help clear streets. The buildings sit very close to the street and people are living outside of the buildings in tents, so the narrow streets are even more narrow and dangerous. They are a generous single lane, but lanes don't matter and it's pretty common to see large trucks coming straight towards you in the bus. It's a lot like the DR in some ways

We had a brief meeting to do introductions and get a tour of the hospital. I got to bed about 10 last night and fell asleep soon after only to wake up at 11 to the cries of a girl in pain (my bed is up a few steps and just behind a wall from the 2nd floor ward). She settled down soon and I slept till about 5:15 when people started moving around. We started rounds about 6am and then had a worship service at 7:30. We had patients lined up for Ortho clinic afterwards already, so saw a few patients before heading into surgery to do a partial hip replacement for a broken hip and then washout an infected wound/fracture on the 11 year old girl crying last night. In clinic, we also saw two people who had broken their arms today and we were able to do closed reductions on them and put them in splints. So, we are still cleaning up injuries from the earthquake as well as problems and injuries that are everyday type occurrences. There are still babies being born, C-sections, and traumas. A girl in the ER had been hit by a car but thankfully had no significant injuries. A baby came in to the ER early this morning and was hemorrhaging (from what I don't know) and did not survive. I was not involved in taking car of her, but it is hard to hear about regardless.

Apparently there was some lunch served today, but we were operating and there wasn't any left by the time we got done. So, we ate some more bars and snacks. I have thus far avoided the Humanitarian Daily Ration (HDR) and we'll see how long I hold out. I weighed in on the scale in one of the bathrooms and will compare it to my weight when we leave in two weeks. We'll see. I just have to remember to drink enough water.

Here are some pictures from the past 24 hours so far. They are all completely unedited and will be till I get home, but wanted to share some right away. I am being inundated with the singing of How Great Thou Art in Creole. It's lovely to hear it echoing through the veranda. We're off to dinner soon. Have to catch the tap-tap soon! Have a good night!



My cot and mosquito net. I have a wall behind me, so i can put stuff on it.


Section 1 of the veranda

Stairs to the veranda in the volunteer area

A boy outside this morning by the front door. They love seeing their pictures on the camera screen.

Worship this morning. Great singing.

Collapsed buildings along the drive to the hospital

The Presidential Palace

Large piles of rubble in the streets

Tent Cities
A Tap-tap (a sort of cab)

Friday, April 16, 2010

D-Day

Today is our D-Day. We have arrived in Haiti, in Port Au Prince, and now am at the hospital. Our travel today was largely uneventful other than our bags have not arrived. Thankfully, we were aware that this could happen and packed our necessities in carry ons.

This will be a quick post as it is 9:40 and the roosters start crowing at 3, the sun rises at 5, and rounds start at 6. Tomorrow is Sabbath, a day of rest, so we will have a church service in the morning (in English, I'm told), then do a few cases and then some rest. Sunday starts up full schedule again.

Food here is short. We're told the some of US volunteers are not eating a lot of the one daily provided hot meal to allow the patients to have more food. As some of you heard, the chefs left last Sunday and things have been a bit different. I think they were from China somewhere, possibly with the group Chefs WIthout Borders.

We got a tour tonight from the nurses who arrived this morning. This is true "see one, do one, teach one" apparently! There is plenty of fresh water. I am thirsty and pretty sweaty already. The volunteer breakroom has wireless internet and an A/C unit, so it's somewhat cool and I put on some dry scrubs, so I'm fairly comfortable right now. I hung my mosquito netting around an empty cot and we'll see how sleep goes tonight. This is definitely still disaster relief medicine, but still some luxuries like a room with A/C and clean water in a 5 gallon bottle dispenser. We do have some flush toilets, and some cold showers. We'll see when I decide to brave the cold water, thought it'll probably feel good after working in the heat.

Pray that our bags with all the supplies do arrive tomorrow, and that we get some sleep, stay healthy, and that God provides our strength. I for one know that He is the only way I will get through these next two weeks.

Have a good night. Hopefully there will be some time tomorrow to post some pictures and write more about what we've seen and done so far including the drive through the city and the destruction but also the smiles we can bring to the children just by waving and smiling at them.

Oh, we are on central daylight time for anyone that wants to know what time it is here. At least I think that's what time it is. I think technically they are on Eastern Standard and don't change clocks ahead for the summer like we do in the US.

Thanks for prayers already.

Thursday, April 15, 2010

A Video from Hospital Adventise d'Haiti

Just a quick post this morning to share a video by the group working at the hospital we'll be at tomorrow. It's less than 5 minutes and will bring some tears to your eyes. At least it does mine.

http://www.youtube.com/watch?v=_n8sgreJ15M

I am heading back out to the store to get some last minute items that Scott, the surgeon in Haiti requested. Right now, I have a small suitcase to carryon half full of scrubs, half full of food, and a large suitcase to check that is full of supplies. This is the smallest clothes to days traveling ratio I think I have ever packed with the exception of our La Vida backpacking trip in high school.

We leave this afternoon. Until then, last minute packing and a run with the Maddog. I miss my family dearly already and have been for 3 months since we first started planning to go.

For more detailed information of the situation at the hospital, visit:
http://www.haitibones.org

Monday, April 12, 2010

I have taken a very long hiatus from this blog over the winter, and really have picked up my camera very little lately. Over the next few weeks, I plan to blog more and hopefully post some photos of my upcoming trip to Haiti to work at Hospital Adventiste d'Haiti. I took my first Chloroquine tablet last Friday night (anti-malarial medication that is started one week before arrival in the country), and the countdown is currently at 3 days and 40 minutes till push back at the airport for the first leg of our trip. It will take us about 24 hours of travel to get down there with layovers. We are scheduled to arrive Friday afternoon if all goes as planned.

I am working today on packing and making sure I have my own personal pharmacy ready-- antibiotics for diarrhea, chloroquine, bug spray, and mosquito nets for malaria prevention, iodine tablets to treat the water just in case, sunscreen, nutrition bars and snacks to supplement the food the hospital can provide, gatorade packets for electrolyte replacement. The list goes on. The temperatures are about 90+ in the daytime and 80+ at night. The rainy season has begun officially as well, making life for the people living in tents even more difficult. The hospital there continues to be very busy, but is doing amazing work. For more on the happenings there, visit http://www.curecaribe.blogspot.com/

Since I do not yet have pictures from Haiiti to share, I wanted to share a few portraits from the Domincan Republic, which borders Haiti and shares the Island of Hispanola. These are some of the people I met last year while on trips to the DR. Thank you for all your prayers that have been prayed for us in advance and for those while we are there and for the teams there already.