Living the Dream - Haiti 2010

Dear Friends,

As many of you know, it has been my 'dream' to go to Haiti since their January 12th earthquake. I submitted my name to three different organizations, including Partners in Health and a California based RN volunteer group that received 10,000 names within the first week after the earthquake. I received only general group responses and started to wonder if my not being selected was due to my lack of Disaster Relief nursing experience; or had I submitted my birth date somewhere along the way and was felt to be too old. Yes, this is illegal but a concern, none the less. I had resigned myself to the fact that I would never be selected and just because I wanted something didn't mean that it would come true.

April 21st, I was a guest lecturer for a senior community health nursing class at Arizona State University/ASU. After the class, one of the students came up to me and said, "I want to do what you are doing as a nurse(traveling) because all of my friends are going to Haiti next week." "WHAT?" I said. The student gave me the name and e-mail of Kelly, a physician in Flagstaff, Arizona, 2 hours north of Phoenix, who was organizing a third trip of volunteers to Haiti.

I immediately e-mailed Kelly, introducing myself and expressing my desire to travel. He immediately responded saying that he wanted me to be a part of the team. Within 12 hours I was confirmed to be part of the medical team thru Project Medishare with a confirmed seat from Miami to Port a Prince April 30th, 8 days away. I would be responsible for my own way to Miami. I was NUTS with excitement!

Kelly is the co-founder of the Northern Arizona Volunteer Medical Corps (www.navmc.org) that has become affiliated with Project Medishare thru the U of Miami School of Medicine/Global Health Project. Project Medishare is an organization started by two physicians from the U of Miami Medical School, that has been serving the Haitian people for 17 years. Due to this relationship and Miami's proximity to Haiti, a 90 minute flight, Medishare's doctor's and nurse's were one of the first medical teams that were able to get into Haiti on January 12th.

I don't know if the government said, "do whatever you want" or the docs said, "we'll take this spot" but a large piece of land adjacent to the airport, was taken over by the docs and a hospital created. After cutting down tall weeds and removing the big rocks, four large white tents were erected and the U of Miami Field Hospital/Haiti was born. It became and has remained, the only trauma hospital in Haiti. A MASH unit with UN helicopters, US Army Blackhawk helicopters, C-130's and some non-military airplanes, landing at all hours of the day and night. IT CAN BE VERY LOUD.

The first tent, our sleep tent, houses 150 military style cots with mosquito netting over each cot. The cots are about 24 inches apart and the tent floor is gravel and small rocks. The second tent is the supply tent which sits on dirt. The third tent is the Medical-Surgical units and the Pharmacy which is really just a series of long tables. The fourth tent houses the Pediatric ward, Neonatal, Pediatric and Adult Intensive Care Units, the Operating and Recovery rooms and a very small Lab.

Over the next several days, I received many e-mails from Kelly, filling me in on some basic info that the other 35 members of the Arizona group already had. He was clear that the conditions were primitive and could be harsh. The rainy season was starting and the weather was hot and miserably humid. The sleeping tent has a/c which is very loud and can be cool in the middle of the night. If there is no a/c or electricity, the tent is miserably hot. The tent is not gender segregated and neither are the four outdoor, wooden framed showers which work when there is water. Next to the showers are the porta-potties; bring your own toilet paper and Baby Wipes when the water stops – which is every day. There is ONE water spigot with potable water and bottled water will be provided but always keep personal water bottles filled. Only once did I forget to fill up my water bottles in the evening and when there was no water in the morning and the bottled water had not yet been delivered, I was very thirsty. Not smart!

Do expect to work 12 hours on, 12 hours off for the entire 8 days and possibly be asked to do things that one would not usually do in their own work environments. Be prepared to do anything and everything, leaving ego's at the door and expectations of First World conditions. Be prepared for dehydration, exhaustion and a variety of emotions. Do not expect to save the country of Haiti but do strive to provide dignity, compassion and quality care to those who came to the hospital.

OK, I'll go. Sounds like fun!

I was OK with all of the above conditions but had three concerns of my own: 1. Would I have the stamina to do 7-8 12 hour shifts in a row? I had never worked more than 4 consecutive 12 hour shifts; could I do 7-8 or would I just crump mid-way? 2. Would I be hungry? Really hungry? And would I survive? We were told to bring most of our own food, nothing perishable, and would be provided with some type of meal every day but... 3. What about the bugs, especially the mosquitoes, flying around the porta-potties in the middle of the night? I would be wearing a headlamp to see my way, would be slathered with 90% DEET and was taking my malaria prophylaxis but sitting in a dark porta-pottie at 3am? Hmmmmm. . .
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I say all of this to you because I am assuming that this trip will be unlike any of my other trips, and my words may be different BUT here I go!

Friday, April 30th:

I am flying American Airlines from Phoenix to Miami and Vision Airlines from Miami to Port a Prince. I am allowed 2-50lb suitcases plus two carry-on's without charge. Very generous of the airline gods.

Besides all of my food, I am carrying enough clothes, including scrubs, for 8 days. There are no laundry facilities. I am also bringing mosquito netting, a sleeping bag and sheets, duct tape, bungee cords, medical supplies, headlamps, rubber boots, rain gear, a huge container of hand sanitizer because there is no soap and running water; and anything else that I think might be useful. My intention is to leave most of the items or donate them to some folks. Truth be known, the day after the earthquake, I had created a list of things to take to Haiti, so I had everything organized, labeled and sorted with lists describing everything. A little OCD is good for the soul. You wouldn't want a disorganized nurse now, would you?

I am also carrying a mandatory(and very ugly) fanny pack which must be worn at all times, except when sleeping and showering, that holds all of my important documents: passport, plane tickets, medical insurance cards and money. A ticket out of Haiti is gold! I grew to HATE this thing!

My 5 hour flight to Miami was uneventful and I stayed at the Double Tree Hotel near the airport. I didn't know anyone but it was OK. The shrimp that I had for dinner in the hotel restaurant was possibly the best shrimp I have ever had in my life. I can still taste it.

My roommate for the night, Jill, arrived about 11pm. She is a nurse, originally from Australia, now living in Oregon. She has spent most of her adult life working as a river guide on the Grand Canyon and nursing is a very new career for her. She is excited and scared. Me too!

Saturday, May 1st:

Our flight to Port a Prince is scheduled to leave at 1pm but all 125 of the new team, us, must be at the airport by 10am, to do...a lot of hurrying up and waiting. I met many of the Arizona team, including Kelly and just generally socialized with folks. 125 people with 3-4 bags a piece plus case after case of dried goods, all needing to be processed and loaded by Project Medishare people. Juice, powdered milk, IV bags, tents, mosquito netting, etc. being flown into Haiti 2-3 times a week. That number of flights is down from just a few weeks ago.

We were all dressed in jeans or scrubs because some of the people would be starting work as soon as the plane landed at 2:30pm. Except one man with white hair who was tanned and wearing a Hawaiian shirt and white Bermuda shorts, looking like he had never missed a cruise in his life. I thought, "This man is going on vacation to Haiti? You've got to be kidding!" His name was Harvey Austin, a 74yr old Plastic Surgeon from Maryland; a wild man and a deeply spiritual man and I adored him by the end of the week.

12 noon, we are told that the plane we are supposed to be leaving on at 1pm, must first make a round trip flight to Havana, Cuba before taking us to Haiti. New departure time: 4pm.

2pm, new posted departure time: 6:30pm. Amid the moaning and groaning of all 125 of us who have now settled into two gate areas, is the concern about the staff waiting for us in Port a Prince. They cannot leave until we arrive and when we do arrive, there will be no time for an orientation. It will now be the night shift starting to work on arrival; they will be the first off the plane and thru Customs, will find a cot in the sleep tent, drop their bags and go to the hospital to start their 12 hour shifts. There will be a skeleton staff at the hospital when we arrive who will be whisked to the airport after report, because the plane crew wants to be back to Miami by midnight. OK.

In retrospect, this time in the terminal was a great bonding time. All of the different departments met and planned out assignments. There were 8 physicians in the group who were now in phone contact with the hospital, receiving report from the out-going medical staff and discussing in-coming patient issues including trauma cases that would require surgery that night.

There were spontaneous card games, yoga classes, power walking by the Physical Therapists, soccer games with a small beach ball and napping. We ate at every restaurant in the area and closed down two! The Arizona group met for a picture and Kelly again talked about the ground conditions. We will be exhausted, short-tempered, emotional and dirty and will be there for each other. Am I going to be OK?

5:30pm, department head meeting at the Gate desk, to discuss a 12 yr old boy being brought to the hospital. He is non-responsive with no history to explain it. A Neurosurgeon is needed but we don't have one on our team. "Can anyone else do burr holes if needed?" they discuss. No one is sure.

7:15pm, we finally leave Miami with spontaneous applause from everyone. 8:40pm, 11 hours after walking into the Miami terminal, we landed. Haiti looks to be geographically one hour ahead of the east coast but is time wise, one hour behind. We are now on US Central Time but east of Miami. Strange. The view from the plane is of many street lights but very few moving car lights.

The air is HOT and HUMID. "About 115 degrees today" says Kelly. Large cracks with rocks and upturned concrete in the runway, are visible and the airport is noisy with construction sounds. The Customs area has a roof but no ceiling and the interior walls appear to be partitions. Customs folks look hot and tired but thank us for coming to help them. I want to cry. We are advised to use the toilets because these are the LAST ones we will see for 8 days. OK.

We all walk out to an exterior courtyard and wait for small vans to pick us up. There is a very large gate that we are STRONGLY ADVISED not to cross until we have a seat in a van. There are lines of Haitian men at the fence who yell at us, wanting money, food and cigarettes. I got a seat on a van, at least I think it was a seat, it was hard, that very much reminded me of Africa. I turned to see the frightened wide eyes of one of the nurse's who was saying that she was going to die. We laughed and told her that this was the norm.

A 5 minute ride to the hospital which is literally across the runway from the terminal. The night shift folks go first in line and then there is this flash of movement through the line, "they just brought us a gunshot." And the ER team flies across the compound.
Welcome to Haiti.

Sunday, May 2nd:

I am living in cot A12. Not too close to the "front door flap" to risk having something stolen and not too close to the "back door flap" to be disturbed by people going potty. The a/c was on and it was cold and loud. I generally prefer dark and quiet when I sleep and this is loud and bright. I hope that I get used to sleeping with earplugs, an eye mask and my hooded sweatshirt over my head and face.

At 6:30am, after 5+ hours of sleep, I awoke to "a voice" bellowing in the tent, that it was shift change. OK I say, but I am really shaky. Is today Sunday? When did that happen? Got a 2 minute shower and then stood in line with all of the other blue and green scrubs, brushing my teeth with bottled water and spitting into the dirt. What a great equalizer. Wandered out to the tent covered picnic bench area where all meetings are held only to find out that the person who woken us up (YET to be identified!) was still on Miami time, not Haitian time and that it was really only 5:45am. No coffee or tea because there is no electricity to plug in a water pot and no food other than my trail mix. Have I mentioned that I HATE mornings and hot weather?

Welcome to Haiti.

At 7am, Jill and I started out first day in the ICU. The night nurse's who had not slept in a gazillion hours ago, looked dazed. For the record, the 3 of them are from the U of Washington in Seattle and were outstanding nurse's. A third nurse, Olga, will be arriving this afternoon, with a team from LA to join the Medishare staff.

There are 4 ICU patients: Daphne, an 18 yr old woman with cerebral malaria; Alonse aka Eddie who had a burst bowel; Michel who had been hit by a motorcycle the day before and had several broken bones and a possible head injury; and Pacu, the gunshot victim from the night before. He is a 43 yr old man, never sick a day in his life, who was heading to his job as a security officer when he was attacked, robbed and shot by two teens, in an attempt to steal his cell phone. He had just come out of surgery and was still in the Recovery room. He was my patient. The a/c is on but it is loud and not very cool.

Olga arrived at 2pm. Pacu is now in the Medical/Surgical tent and I am caring for Michel who was hit by the motorcycle. The a/c is off and the sweat is dripping off of us. We open the tent flaps for air. There is one cardiac monitor for the three patients with a small hand held monitor that can give us some very basic info. There is one suction machine that looks like Florence Nightingale left it. IV's are hanging from bungee cords, off of ropes. There are electrical cords connected to surge protectors everywhere. The small portable ventilators are hanging by ropes from the large oxygen tanks behind each bed.

At 2pm, Michel died and for the life of me, I cannot remember why. His two sons were there, said their goodbyes and left. I wrapped Michel in a white body bag and called the transporters who came in, fully covered in hats, mask, gown and gloves. They put Michel on a litter, just like you would see in MASH and carried him out thru the Pediatric unit, the only door out. People moved and looked and then returned to whatever they were doing.

The morgue is a large white tent across a gravel path from the entrance to our sleep tent. Once a person has died, the family has four hours to either claim the body and move it to be buried or tell us that we can cremate it. If the body is nor claimed or the family cannot afford to claim it and bury it, the body is automatically taken to "a city place" and cremated. The tent is in the sun and many people die...

At 5pm, Pacu is transferred back to ICU because of internal bleeding and deteriorating vital signs. The family is distraught but thankful "for the Americans."

At 5:30pm, our first of many storms start. The power goes out and we are manually breathing for the patients as are the Neonatal and Pediatric ICU nurse's doing. Carlos, our one and only Respiratory Therapist, is dodging lightening bolts, running between tents in an attempt to get the ventilators on emergency power.

The floors of these tents are wooden pallets connected with duct tape. The a/c blows in thru large ducts connected to the outside somewhere. But when it rains, these ducts funnel in the rain which cascades onto the wooden floors, ventilators, us, and everything. We are running around, putting the surge protectors on cardboard to prevent something serious like ELECTROCUTION! I am thankful that I am wearing rubber soled shoes. Try explaining to a family via a translator, that standing at their loved ones bedside, with ankle deep water, might not be the wisest thing for them to do right now. They said that they wanted to pray, I said PLEASE, and mention my name while you are at it! But pray outside the blue tarp tent 'door.' where there is less water.

At 7pm the storm had passed and we changed shifts. There is still water everywhere; the electricity is on but no a/c. At the same time, a minister walks into our large tent which is primarily Pediatrics, along with all of the ICU's and OR, and starts to preach. He then started to sing and all of the families joined him. I felt like I was watching parallel universe's: nurse's quietly changing shift and the people singing to their God. Heavenly!

I am exhausted and fall to sleep by 9pm.

11pm, the tent is awakened to a loud voice, telling us that there have been two electrical fires in the OR and that the hospital is being evacuated to the gravel area next to the tents. We all get up, stumbling outside and just jump in. I later am told that this was the second time that the patients had been moved. The first time was 90 minutes before when smoke was seen coming out of overhead lights in the OR. The ICU's and Peds patients were moved into the general medical/surgical tent. Then smoke was seen coming from an "outlet' of sorts in the Medical tent along with sparks from the overhead lights and the entire hospital was moved outside.

Large lights were moved outside and ventilators were connected to portable oxygen tanks. I helped to write patients names on pieces of paper to be taped to the ends of the cots, to be able to identify who was whom. One of my lasting impressions of that night is of Harvey, the Plastic Surgeon, kneeling at the ends of the cots, wiping dirt off the feet of the patients and family members who had run thru the mud to escape the smoke.

There were approximately 150 patients which meant that there were at least 150 relatives "living" in the hospital. Most of these people are living in tent cities which are crowded and unsafe. We provide a place of safety, cleanliness, food twice a day, toilets and showers and we welcome them. There is no great hurry to discharge people and even less of a hurry to leave because we are discharging them to "the tents."

I spent some time with Pacus' and Daphnes' families, just talking to them and, in very broken French, assuring them that they would be OK. They would just smile and say "Merci."

A 12 yr old boy died during the move. He had been sick for a while and death was the expected outcome. When he was manually moved to the gravel lot, his breathing tube became dislodged and could not be reinserted. His family held him while he died. I remember seeing them sitting on a bench, holding a little boy but I did not know who they were. The staff felt terrible but the family said that it was OK and thanked us for caring for him.

That entire night is a blur to me. I did not realize the magnitude of the events and what the staff's went thru that night, until the next morning, and I feel bad for not being more supportive and productive. I guess I went back to sleep at 1am but I am not sure.

Within an hour of the fires, several members of the US Army arrived and assisted in watching and comforting patients and later, in moving the cots back into the Medical tent. Thank you.

Monday, May 3rd:

I woke up at 4:30am, took off my clothes and stood under the shower head. I was hot and sweaty and barely moving. And there was no water. I put my icky clothes back on and went back to bed.

5:10am, I try again and there is water and it was good. Back to the ICU only to find that it has been relocated to the ER spot because the main big tent does not have power and the source of the fires has not been determined. The ER is outside, under a white tent, sitting on small white stones. There is enough space for our three beds but that is it.

If we are in the ER space, then the ER Dept. is closed to emergencies. But there is a triage area outside the main gate of the compound, under a large mango tree, aptly named Mango Triage. 30-40 patients a day present themselves to Mango Triage for care, some basic, some emergent. Triage remains open but all patients are sent 'elsewhere' if more care is needed. But I am not sure if there is an 'elsewhere.'

Daphne is awake and on a ventilator. Her family is constantly at her bedside, sponging her off to try to bring down her temperature. She has a very high temperature from the malaria and the rapidly heating tent is contributing to her discomfort.

Eddie is starting to wake up but still pretty confused. The patient beds are really just large mattresses placed on the same kinds of cots that we are sleeping on. There are no side rails so preventing patients from falling out of bed is a priority. And Eddie is starting to get restless.

Pacu has had an uncomfortable night but it is hard to know if it is because of post-op issues or two evacuations with little sleep. At 7:55, I look over at him and he has stopped breathing. We immediately start CPR and code him for 15 minutes but we never get a pulse. Pacu has died. I am stunned! I had just given him some pain medication; did I kill him? We find his wife who has backed out of the tent and she immediately passes out onto the stones. This is a very common hysterical reaction and within 2-3 minutes she awakens, only to start screaming and throwing herself on his body. Two Haitian born Psychologists, who are part of the Medishare team, assist the wife to another tent so we can clean up Pacus' body and she can scream and wail.

After 20 minutes, I find the wife in the small Orthopedic/Physical Therapy tent. She is laying on her stomach and her hands and feet are being held down by Greg and Frandy, the two Psychologists. She is arching her head up, attempting to spit on them. If they let her go, she will hit them and possibly herself. She is out of her mind right now. After another 15 minutes, she is able to walk back to the ICU area where she just throws herself on her husband's body. It is gut wrenching to see.

Eventually, the wife and other relatives leave and I wrap up Pacu's body, call the transport team and watch them carry him away.

By noon, the heat in the tent is unbearable and we cannot cool down Eddie and Daphne. Olga, Jill and I are OK but slowing down. Michaela, the Charge Nurse of the ICU and ER says that we must move so we pack up the ICU, and Eddie and Daphne and move down the walkway, to the Ortho/Physical Therapy tent which has a/c. Pretty wonderful I say.

We are able to cool down Daphne and Eddie but Daphne is starting to have "the look." The "look" of someone who might not survive. Several members of the Tennessee based Southern Baptist Church, who are here attempting to organize our Supply Tent, come in and offer to pray with Daphne's parents. Daphne's parents are kneeling on the floor on one side of her bed, the three church member's on their knees on the other side of the bed and the translator is kneeling at the foot of the bed, translating southern accented English prayers into Creole and back again. Amazing!

The heat and humidity are starting to affect the staff. The a/c is intermittent, making sleeping nearly impossible for the night shift staff. Three staff members are now in our ICU tent, requiring IV fluids due to dehydration. We are constantly told to drink enough water and fluid to cause us to pee every 2 hours. I am at once in a 12 hour shift but feeling OK.

Tonight, the UN food canteen will come to us. They can barbecue hamburgers and even add cheese. And they have really cold adult beverages but I am very tired and going to bed.

Tuesday, May 4th:

Daphne is looking worse and there is now a question about brain damage from the high temperatures. By some act of God, Pete, a Neurosurgeon from Montana, has arrived and is evaluating her for brain activity. We have no MRI or ability to do major neurological testing but Pete is doing what he can to diagnose her. Jill is caring for her and I am the runner for everyone.

Eddie, on the other hand, has woken up and is requiring Olga's constant attention to keep from pulling off his colostomy bag and falling out of bed. He seems to be hallucinating but clears enough to count and name all 14 of his children, in Spanish. He worked for many years in the Dominican Republic, as have many Haitians, so speaks fluent Spanish. But when Olga, who is from Mexico, speaks Spanish to him, he answers her in Creole. She is becoming exasperated by him and occasionally swears in Spanish, I think.

It remains unbearably hot and humid and there are now 15 staff members requiring IV hydration. We are also receiving relief workers from other agencies who require IV's. The a/c remains spotty and several night shift staff are now sleeping on cots in the evacuated Pediatric tent. It is noisy but cool. The staff are now wearing shorts or rolling up their pants legs to make shorts. Several staff have just cut off their pants legs and used them for wet cloths to cool down. There are no mirrors around here which I am thinking is a really good thing. I am so hot and sweaty and have never felt so dirty in all of my life. My fingernails are filthy! I have started to wear a bandanna on my head, to catch the sweat. And in order to roll up my pants legs, I have shaved my legs with DEET! So I KNOW that I am a true vision of loveliness!

Along with acute care, rehabilitation is the main focus in the hospital. There are thousands of people with amputated limbs who must be trained on a prosthesis if they are going to be able to work and survive in Haiti. Previous to the earthquake, anyone with a physical deformity was an outcast but since the earthquake, people have become more accepting of deformities and missing limbs. They are probably thinking that they are just lucky to be alive.

There are several Physical and Occupational Therapists on the Medishare team that work tirelessly with hundreds of children and adults, to get them back on their feet, literally. There is a rehab tent and an outdoor but covered rehab area with walking bars, etc. Because we, the ICU folks, have taken over the rehab tent, all of the therapy is being done outside in the heat. It is miserable. But I see that the cut off legs of the scrub pants are now taped in place over the walking bars, to prevent the patients and therapists from burning their hands during the therapeutic exercises. Necessity being the mother of invention...

The hospital is right next to the United Nations compound and taking a trip to the UN Bar and Grill is on the 'to do' list at least once during the volunteer week. The UN provides transportation for the staff even thought the compound is technically within walking distance. It is not safe at night so we jump in little vans and are deposited at the UN gate. The compound has many small fruit and flower trees and seems quite pleasant and cool compared to our little corner of heaven next door. The Grill has:(drum roll please)-running water, flushing toilets, shrimps on little sticks, really cold beverages and CNN. Who knew someone was trying to blow up Times Square? I have lost all sense of time here.

There was dancing in the aisles with some Red Cross staff and flirting with some really bad boys from the Tahitian UNICEF group. What a blast! And very much needed by the staff.

Wednesday, May 5th:

Daphne is dying. Pete has determined that there is irreparable brain damage and that she will not survive. Her mother was at her bedside praying as Pete removed Daphne from the ventilator. Daphne did not breathe, on her own, and her mother collapsed, wailing and screaming that can be heard across the camp. Daphne's father is 2 hours away at his home in the mountains and must make it to the hospital in the next four hours if he is to see her.

Jill is really struggling with Daphne's death, the heat, me and Olga. We help her clean up Daphne and put her into the white body bag. Jill has never done this before and walks out of the ICU. She will not return.

Again, the transporter's come and take the body to the morgue. Daphne's father arrives 3 hours and 55 minutes after her death. When he sees his wife, you can hear the wailing across the camp.

Within 30 minutes, a decorated bus arrives, along with a church choir and Daphne's body is put into a coffin. The coffin is hoisted to the top of the bus and the choir sings and processes the family down the gravel path and out of the hospital compound.

So now there is just me and Olga and Eddie in our little ICU heaven, and several staff members requiring IV hydration. But then we loose our a/c and within an hour, the tent is unbearable and Olga and I can only sit there with Eddie, placing cold packs on each other. He wants something cold to drink, us too, but we can only give him warm water. My Creole is a bit rusty but I suspect Eddie is expressing his displeasure with the tent accommodations, warm water and lack of access to beer and cigarettes based on the fire in his eyes and the verbal spewing of words in Creole.

If Eddie were in the US, he would have already been transferred out of the ICU, to a step-down unit of sorts, because he is still requiring a small amount of continuous oxygen to breathe comfortably. But with 150 patients and 150 relatives and staff on top of each other and...all in one tent, it is decided that Eddie should stay with us so we can keep an eye on him. We are his only socialization and he is starting to get "a bit buggy." We would call it "ICU psychosis" in the States; here, I don't know, but Eddie needs a pal to entertain him and we are obviously not fitting the bill.

At some point, one of the physicians walks in to talk about transferring a patient to us and asks how we are. I say, "Living the Dream." The doctor says, "This is a deathtrap in here, we have got to get you out of here NOW!" OK. We knew that it was getting hot in there but just thought that it was part of being in Haiti. So again we pack up the ICU and Eddie and move back to our original spot, in the Pediatric tent, which now has a/c! But because of limited electricity, or whatever, I've stopped asking questions, we can only use our suction machine if the lights are off! OK. Turn off the one big light that we have, open the tent flap and suction away!

At 2pm, I receive an admission of a 24yr old woman, Maxi, who is in Sickle Cell Crisis. She is Haitian born but has lived in New York City for 6 years. She had just returned to NY in January, after a US military tour of duty in Iraq, when the earthquake occurred and she returned home. She is awake and talking but her breathing is a bit labored. She is not visibly bleeding from anywhere but her 'iron number' is very low. To my physician friends, her Hgb was 2.3!!!!!

At 4:30pm, I am drawing blood from one of Maxi's main IV sites and she became agitated, pulled off her oxygen and let out a blood curdling, gutterall sound that scared the crap out of me. I yelled, "I NEED A DOCTOR IN HERE NOW" as Maxi has a Grand Mal seizure, vomits and passes out. And then loses her blood pressure and tries to die. Her repeat 'iron number' is 1.8, incompatible with life.

Maxi is resuscitated and put on a ventilator and the family reluctantly consents to a blood transfusion for her. She has never been this sick before and the family does not understand the need for the transfusion. We tell them that she will die without the transfusion. Within 30 minutes, a unit of blood shows up and is given to Maxi. Miraculously, the International Red Cross finds another 2 units of blood during the night which are transfused into Maxi and her 'iron number' stabilizes at 7.1.

During all of this commotion, Eddie has been laying in his bed, having animated conversations with people that I am unable to see. Someone brings him Styrofoamam container of rice, beans and small pieces ohot dogog which he eats while we are trying to save Maxi's life. At some point I turned around and saw that Eddie has spilled/tossed/thrown his food on himself, the bed and the floor. EDDIE!!!!!!!!!!!! I thought Olga was going to kill him!

Kat, Jessica and Laura, the night shift nurse's come in for report and discuss the possibility that Eddie will need to be transferred to the Medical tent because there is a possibility of 2 more admissions to the ICU. But first, we must find a broom and dust pan, to clean up Eddie's mess. HOUSEKEEPING! (That would be spelled N*U*R*S*E!)

Tonight, I decided to join the spontaneous gathering of staff that occurs on the picnic benches after change of shift. The UN truck is here and Olga and I share a rather crispy, hard hamburger but it beats peanut butter for dinner. There are also the local beers of Prestige and Presidente in pretty green bottles.

Several of the Black Hawk helicopter pilots are around and join us. I am told that they frequent the hospital, to play with the kids and show movies on the tent ceiling. The kids adore the pilots, all men, and climb all over them as if they are their own personal gyms. The men love it!

I think that the pilots also enjoy meeting some of the young, pretty nurse's based on how many spontaneous 'classes' occur, teaching the nurse's how to properly salute, etc. There is a lot of laughter around those benches.

And then it starts to rain. And rain. And rain. And after an hour, the entire camp has flooded! We are running into the sleep tent to pull all of the luggage off the gravel ground, onto the bunks, because the water is visibly rising over the gravel. The ICU is again being pounded by water and the Medical tent, which holds the entire hospital, now has an inch of water on top of the wooden pallets.

And God bless those army pilots. They immediately found some shovels and started to dig and expand the already existing trenches that surrounded the tents and added more as needed. "We are good for something, Ma'am."

We all finally got to bed at midnight but I frequently woke up during the night, to hear the "squish, squish" of someone getting up to go to the bathroom.
Fires, floods, are the Locusts next?

Thursday, May 6th:

Awake at 4:30am. I didn't hear any wailing during the night; does this mean that Maxi survived the night? God, I hope so.

6am, joined the early morning group of staff who are sitting at the picnic tables drinking instant coffee and contemplating the world. And out walks Harvey in a short, black silk robe/smoking jacket, brushing his teeth! What can I say? Many words were spoken, none of which are repeatable here and photos taken. Hurricane relief work, in a MASH unit, in miserably hot and humid weather, does bring out the best in us!

Eddie was transferred to the Medical tent but resisted going, telling the translator, "My nurse's will miss me!" His nurse's laughed and said that they would miss him and would visit him. A few hours later, they did visit him and heard him attempting to bribe some nurse to buy him some cigarettes, with his oxygen tubing dangling from his neck. Gotta love it!

There have been 2 new ICU admissions during the night: Yves and Clisence, a woman. Yves is a 30yr old man who is a driver for Catholic Relief Services. Say what you want or don't want, about the Catholic Church, the Catholic Relief Services(CRS) organization does some wonderful work here in Haiti and in many other countries around the world.

Yves had just dropped a group of doctor's off at their residence last evening, in the rain. As he drove away, his car skidded and over turned into a ditch. The doctor's immediately ran to the carextricateded him and brought him to us. Yves was unresponsive and the doc's were sure that there was head trauma, broken bones and internal bleeding.

But there were no injuries other than a mild concussion. Nothing short of a miracle! This group of doctor's came to see Yves this morning and were shocked that he was alive, let alone OK. As it turned out, these doc's were Shock Trauma surgeon's from the U of Maryland, the #1 Shock Trauma program in the country. These people had saved Yves life. Had any of the circumstances been any different, Yves would have died.

Clisence is a 62yr old woman who came to us with a 6 month history of headaches and Right sided weakness. 6 months ago when the symptoms first started, Jean-Pierre, the daughter, took her mom to a Doctor who did a CAT scan, or something, diagnosed a brain tumor and sent Clisence home.

Symptoms continue; the earthquake occurs and Clisence and her family loose their house and car and move into a tent. Jean-Pierre hears about us and brings her mother here. Pete, our beloved neurosurgeon, re-scans her and finds a "simple" clot(subdural hematoma). He takes her to surgery and removes the clot, making two incisions between her braids so as not to cause any "hair problems." Today, 8 hours post-op, she feels good with diminishing symptoms and can only say "Merci."

Maxi is better but not out of the woods. Several friends come into see her, besides the large family contingent that has spent the night. These friends have just visited Maxi's mother who is too distraught to visit her daughter, convinced that Maxi is dying. After seeing Maxi and getting an update, these friends leave and within an hour, bring the mother to see me and Maxi. Maxi is still on a ventilator but opens her eyes when her mom calls her name and everybody cries.

A 62yr old American volunteer has just been brought to us because he has had a heart attack. He was stabilized in another hospital but sent to us in hopes that we have a Cardiologist who can treat the man. But we don't have a Cardiologist so plans are made to evacuate the man to Miami in the next few hours. AND THEN, this man walks in the door, says, "I am a Cardiologist, do you guys need any help?" Swear to God. Wherever he had been, they did not need him, so he came to us. The gentleman was flown to Miami that night, in stable condition.

Several staff have been able to take city tours during the day. Most are night shift folks who can't sleep anyway; or other department staff who can alternate with each other. For those of us on day shift, there is no possibility to leave. When the people return from the tours, I ask them how it is out there and they can only say, "It is total and utter destruction out there. Now I am really depressed."

Today, Tom, the Orthopedic surgeon from LA, brought me a COLD bottle of water! "Where did he get this?" I ask. He smiles and walks away. This is the first bottle of cold water I have had since Miami. Wonderful!

Again, I join the staff at the picnic benches after change of shift. There is no rain in the air and little kid's are running around us. Some of the nurse's are sitting and feeding babies. And I am invited to join the 'grown-ups' for some adult beverages. "O'Leary, come and drink with us" says the Neurosurgeons, Orthopods, Plastic Surgeons, and Anesthesiologists. Who am I to pass up a medical meeting?

I am first given a shot of Crown Royal that is poured from an almost empty, but very large, bottle. And then a cooler of beer is delivered from the UN, courtesy of the LA Medishare group. Thanks Olga, Tom and Jack. A few beers later, I start to take group pics which seemed quite clear at the time, but on review, are blurred, green underwater looking images of beer bottles. Perhaps I had the wrong settings.

I need to go to bed.

Friday, May 7th:

Maxi continues to improve and my be able to come off of the ventilator today. Yves has been transferred to the Medical tent with no memory of his accident and feeling a little 'beat up', but he is alive. Clisence is able to get out of bed enough to squat down and use a bedpan and wash herself up. Some American patients could take lessons on strength anresiliencece from these Haitian people. And their total lack of whining! Clisence lays in bed with a flowered scarf around her head, wearing a lacy nightgown that her daughter has bought her in the market.

At 2pm, a 23 yr old man is brought in via ambulance. A "real" ambulance which means that it is serious. Most people come in via back seats of cars or flatbeds of trucks.

This man has been hit by a car and is bleeding from both of his legs, one of which is dangling and will need to be amputated. He is also unresponsive and has sustained head trauma. For the next 2+ hours, several surgeons will attempt to save the remaining leg and repair other injuries.
The man is brought to us at 4:30pm with barely a blood pressure, despite IV medication to raise it. One of the volunteers 'flies' in the door with 2 units of blood, originally meant for Maxi but now potentially useful for this man.

In most hospitals in the States, an Ethics Committee exists to discuss complicated medical situations with hopes of a resolution that is "the right thing to do." A few minutes after the blood was brought for this man, a spontaneous Ethics Committee formed at the foot of his bed. Should these 2 units of blood be given to this gentleman who will probably die despite the transfusions? Should we give just 1 unit of blood to show the family that we are doing all that we can? Are we doing this for ourselves? What if someone comes into the ER during the night, needs the blood and would survive if we gave the blood? How would we feel if we didn't have the blood to give the patient, knowing that we had given it to someone who will not survive anyway? What is the right thing to do?

I was sitting in a chair in the ICU as this conversation occurred about 10ft away from me and was struck by the angst of these physicians to 'do the right thing.' Most people never see this angst or hear these discussions and may just think that physicians don't care, want money, etc. I have seen these types of meetings and heard these conversations way too often, to know that physicians agonize over making the right decisions in caring for their patients.

The group decided to not give the blood and to let the man die peacefully and pain free.

Dave, the surgeon who did most of the surgery on this man's leg, would not leave the foot of the man's bed. He just kept standing there, looking and shaking his head. Dave was covered in sweat and blood and I looked at him and said, "Dave, you did good." He came over and sat next to me and said, "I don't know." I reminded him that in the States, the family would have been less gracious about the situation and possibly sued him for "not doing enough." "I know" he said. "And what I got here was a kiss and a Thank You from the boy's mother. Amazing."

The patient died an hour later and Dave stayed and helped the nurse's clean and wrap up the body. Now that's amazing!

Final night at the picnic benches with the UN truck in attendance. One of the men at the bench was Tom, the COO of Project Medishare. He looks a bit like Indiana Jones. I jokingly told him that I wanted to speak to him about the working conditions in his establishment! We laughed, had a beer and then he said that he wanted to show me something. We walked across the gravel to a huge mango tree surrounded by a fence. We walked thru the gate and there was a group of 20 or so people, all of the 'Senior Management' of the camp, having a party! In the center of the area was a large white tent, donated by the Shelter Box folks, that houses the man who is head of maintenance for the camp. He and his family live in the tent.

I felt like I had been admitted to the inner sanctum.

There was a large grill with REAL FOOD: chicken, sausages, beef. And mixed drinks! I couldn't believe it! The area is unofficially called 'Mango Mango.' After one drink and many discussions on the meaning of life, I wandered back to my little cot to prepare to pack.

Saturday, May 8th:

I am going home today! It's OK to leave but if I was told that I had to stay another week, that would be OK too. Up at 4:30am but went back to bed when I realized that there was no water and the sun wasn't even up. Up again at 5am to find a line for the shower's! That's crazy! Someone said that it felt like Christmas morning when you wake up early but know that it is too early to get out of bed to open the presents. But there is something beautiful and reaffirming about showering outdoors to the sunrise.

Throughout the week, we have been told that we may donate any of our belongings to whomever we want just so we fill out a form with the recipients name so the hospital exit guards will know that the items were not stolen. We were told not to be ashamed to even give people our dirty socks and underwear because they have nothing and will gladly wash out the clothes and wear them. Ewe!!! Neither Olga nor myself can bring ourselves to do this but we have decided to give our sleeping bags, mosquito netting, and extra clothes and food, to Maxi and her family and Jean Pierre and her family. The families are thrilled and at 6am Olga and I drag our suitcases down to the ICU, to give to the families. As usual, most of the family members have slept outside the blue tarp 'door' of the ICU, some sitting up in dilapidated chairs all night. There are 11 people living in Jean Pierre's tent but ONLY 7 in Maxi's tent. Amazing.

Olga is leaving at 6:30am, with the LA team so I am on my own in the ICU. Just so we do not get a third patient, I am OK.

A new group of physicians arrived last night. There are 13 of them, all East Indian descent, some of the women are in sari's, and they are just wandering about. Dr. Shah, a member of the group, wandered into the ICU and I essentially asked him, where had they all come from?
They are all members of the Jain sect, living in LA and New York, and had flown to Haiti to assist Sean Penn at his orphanage outside of the city. When the group realized that the 'hospital' that is at the orphanage did not have an Operating Room, the 13, all surgeons and anesthesiologists, found us and asked if they could help. Once the 125 of us leave today, this group will be sleeping on cots across from the 6 Tennessee based Southern Baptist folks who have been organizing the supply tent. Gotta love it!

Maxi is doing much better and is able to sit up in bed with assistance. At 1:40pm, two Ministers come in to visit the family and pray over Maxi. As the Ministers and family members were gathered around her bed, a newborn baby started to cry on the other side of the blue tarp. The group started to sing softly in French/Creole but gradually grew louder and the baby stopped crying. Breathtaking! Maxi and her family cry about my leaving and pray for me in Creole to have a safe and happy life. I just shake my head in amazement that any of this is happening to me and I can only say Merci Beaucoup.

At 3pm, the 6 new ICU nurse's come in. They look so clean and fresh and smell good and have make-up on and...wait til next Saturday when they are leaving! They also look stunned!

Every 7 days, this hospital turns over approximately 90% of its staff in a 30-60 minute time period without, hopefully, compromising patient care. Pretty amazing. I oriented the nurse's to the unit, gave them report on Maxi and Jean Pierre, hugged the patients and families good-bye, picked up my carry on bag and walked out the door to the waiting airport van. I hope that they will all be OK.

Because we had arrived in the dark a week ago and I had not been out of the compound during the day, I had not seen any of the neighborhood. In the light of day, I could now see the tent cities in the near distance; groups of people milling about on the street; a man walking his 3 goats down the street and numerous women and children just staring at us. They looked very tired.

The airport is old and worn and still partially destroyed. There are many people milling about outside; some have nothing else to do with their time; others are waiting to see people off but they are all staring at us. What are they thinking?

There is airport security, more or less, and thank God, they did not ask us to remove our shoes. Half of us, myself included, were still in our sweaty, nasty scrubs that we had worked in all day and WE SMELLED! Taking off our shoes was beyond comprehension! My God, we were nasty!

We flew Vision Airlines to Miami, the same airline that flew us down and 2 of the 3 flight attendants on this flight had been on our flight a week ago. There were also 20+ members of the Miami Dolpins football team, mostly execs and PR folks, on our plane. They had spent a few hours at our hospital, donating more large, white tents from the Shelter Box organization, to several families with kid's, so the families would have a place to live when the child wad discharged from the hospital. They sat in the front of the plane probably to be up-wind of us.

After take-off, the Flight Attendants announced that because the plane had sat for 4 hours on the airport tarmac, all of the ice had melted and there would be no cold drinks available and ALL of the beer was gone! We were hysterical! After 8 days without anything cold to drink, what was another 90 minutes? It just didn't matter.

Uneventful landing and the march thru Customs. God bless 'em. Here are 125 of us in line, still in scrubs and after the first few folks got thru the questioning, the Immigrations folks just started to say, "Are you part of the group? Thank you for your service, move on." The TSA guys just stood there and laughed.

Shuttle to the hotel with 4 other nurse's. We are giddy with anticipation of EVERYTHING! I am asked for a credit card for my room and I can't find it. I am asked for a photo ID and can only show my Passport which, for some reason, was not sufficient. And it was at this point that I almost lost it. I wanted to scream and cry but could not even formulate the words, none of which would have been appropriate. I just stood there with my mouth open and started to cry. I am scared because I fear I have lost my credit card and scared that I have no place to sleep. It is 11pm.

Heather, one of the nurse's, immediately pulls out her credit card and gives it to the clerk who is now saying, "it's OK, it's OK." Heather is one of the nicest people that I have ever met so I was not surprised that she would do this but I am wondering if she saw the look of total decomposition on my face.

I went to my room and frantically dumped my carry-on bag and there was my credit card where I had safely put it 8 days and a lifetime ago. I just cried.

Sunday, May 9th:

Let us all say "Amen" for the gloriousness of running water, flushing toilets and King sized pillow-topped mattresses! I feel wonderful!

I am mentally still in Haiti and wondering how the new ICU nurse's are doing. How is Maxi? I am so afraid that she is going to do something "dumb" like die.

As I said at the beginning of this week, one of my concerns was that I might be hungry in Haiti and I am ashamed to even admit that it was a concern. What is it like to be 'really' hungry and not know where your next meal is coming from; or wonder if you might eventually die from malnutrition? What a terribly painful way to die.

I went to the hotel dining room and felt so hungry. I had not been hungry all week but now...I was starving and had two helpings of their buffet! There was a family enjoying a Mother's Day dinner and their 4 yr old little girl was running around carrying her dolly, and she looked so nourished! "Meat" on her bones. It had been so many days since I had seen a well nourished child and I just kept staring at her and her family. Based on the accent of the grandmother, they sounded like they were from Cuba. They had "made it out' but what about all of the other's who are left behind? And they left food on their plates! What a waste; don't they know that people are starving?

My return 5 hour flight from Miami to Phoenix left at 5pm which I had deliberately scheduled to give myself time to get some sleep. Also, I still needed to get a seat for the flight. On-line check in was not an option: there is no "on" or "line" in Haiti so I did it the "old fashioned" way, at the gate. I got one of the last 3 remaining seats, all middle ones. Good thing that I am small.

I sat between two brother's, big boys, who were just returning from 3 months in Haiti, working as welder's for a company called Emergency Medical Kitchens. They were tasked with building large, portable kitchens that can be used for food preparation in the tent cities. They regaled me with stories of "doing business" in Haiti(very difficult), most especially their trips to Home Depot in Miami to get parts and equipment. There is no Home Depot, or anything like it in Haiti, so an entire day would be spent on excursion, in and out of airports, immigration, and taxi rides, to buy fairly simple items. They were quite the comedy team and at times I felt like I was the "adult supervision" between squabbling siblings. But they were quite funny, bought me a drink, and were quick to tell me that they had gotten up at 5am to call their mom on Mother's Day. Mom lives in Seattle and it was 3am her time but it was the thought that counted, they hoped.

I have now been home a week and continue to feel energized from my trip. I have heard that the new ICU nurse's are OK and doing well but that our team is missed. And Maxi is well. It has been determined that her main problem was her Gall Bladder and she will return to New York for surgery. Thank God.

Some of you have asked me questions about what is happening in Haiti right now and this is what I know:
1. Is the government in charge and what are they doing?
I am told that they are in charge but that it is really the Volunteer/NGO organizations, that are keeping Haiti alive. The government was questionably in charge before the quake and has struggled since.
2. What about all of the money that has been donated?
Good question. Several of the organizations are looking at short and long term projects. Habitat For Humanity is building some temporary small houses to get people thru the present rainy season and impending Hurricane season, and will start building permanent structures in 2011.
There were 3 million people living in Port a Prince before the earthquake, 80% in poverty. 1 million were made homeless by the quake, 250,000 died, 300,000 injured. It is projected that it will take 3-5 years to even clear up the rubble due to lack of trucks and space to put the tons of rubble. 70,000 buildings are eligible for repair at this time. These are staggering numbers.
3. Have there been any improvements at all?
There are tent cities all over the place which is better than living on the streets. Safety has improved 'a bit.' Immediately post-quake, looting, robbery, and assaults were so prevalent and malicious, that carrying a gun, in the light of day, was required. Now, a gun is only 'required' at night due to carjacking, robberies and assaults.

There continues to be gang rapes and sexual assaults. A 14 yr old girl was brought to our hospital after a gang rape but would not stay because
'she did not feel safe anywhere.' The staff convinced her to return the next day for follow-up and believe that she will return when she realizes that we are a place of safety.

Here are some websites that may be of interest to you:
1. www.projectmedishare.org. The site talks about the hospital program and how to volunteer. There is a line about CBS News and a segment that Katie Couric filmed at the hospital the week before I arrived. It captures a lot of what i have been talking about. I love watching it.
2. www.navmc.org. This is the Northern Arizona Volunteer Medical Corps, based in Flagstaff. There are some blogs about our trip.
3. www.azdailysun.com. This is the website for the Daily Sun, the Flagstaff newspaper which has just published an article with photos, about our trip. Their photographer, Josh, was on our trip and recorded a video diary of the week.

Most of us enter the medical field because we truly just want to take care of of people who are suffering and need care. To do this, we unfortunately get entangled in stuff: politics, ego's, etc. During my week in the hospital, these issues were not even thought of. What would take me 1-2 hours to accomplish in an American hospital, took me 10-15 minutes here, because there were no barriers to care and the communication was clear and present. We were truly able to care for people without the 'stuff.'

I have never, ever been so proud to be part of a medical team as I was with this group of people, and I am a better person and nurse because of them. Thank You.

Kathleen