Tuesday, April 20, 2010

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.