Sunday, January 24, 2010

Haiti Blog by Michael

Our team arrived in Port Au Prince Haiti at approximately 4 am on Monday 1/18. Five days after the 7.0 earthquake devastated the city. Thanks to Stacey we were able to get a slot into the very busy Port Au Prince airport. There were 8 of us on the plane, including two pilots (Mike Cranor and Romer Brown), Huston Hedinger, 2 orthopedic surgeons (Todd Ulmer and Chris Achterman), a doctor (Tom Burry), a pysical trainer (Kathi McCoy), and an EMT (me). From the airport, we made our way to the building that we would be staying in for the next several days. It is fenced, gated and guarded by several trusted Haitians, one of which is a Haitian police officer. We unloaded our bags, met the other team members that had arrived earlier, and waited till daylight to go to the hospital.

Medical Teams International has vertually taken over King’s Hospital in Port Au Prince. Thus relieving the local staff, which has been seriously overworked the last several days, to tend to their own families and needs. It is a brand new hospital that was just getting ready to open. Although many of the walls in the hospital have large cracks, engineers from the UN certified the building as “safe” – whatever that means – the day before we arrived. We immediately set to work to organize the two operating rooms (O.R.s), unpack supplies and equipment and get the O.R.s setup for the surgeons by noon.

We roped off the front of the hospital to control access and triaged patients in the courtyard outside the hospital. Patients with minor injuries were treated and released from outside. Patients with more serious or critical injuries were prioritized and brought inside the hospital for treatment. Inside the hospital we ran 3 exam/ treatment rooms. Each patient came in with a piece of paper with their name, age, and chief complaints listed. We would remove their bandages, clean their wounds, re-examine their injuries and re-splint/ bandage their wounds. Critical patients would be “admited” to the hospital for surgery and the more stable patients would be asked to return in one or two days to have their wounds re-cleaned and dressed or return with an x-ray (if broken bones were suspected – and if the breaks were not obvious), as the hospital had no radiography equipment.

The injuries, in general, were extremely similar from one patient to the next. Crush injuries, multiple fractures, and full-thickness skin loss, paricularly to extremeties. Almost without exception every single patient had a severe infection (pseudomonas or gangrene) of their open injuries. Necrosis (dead skin) was not uncommon. The mechanisms of injury (MOI) were always the same as well. The language barrier (we were working with translators – some more skilled than others) did often make it difficult to determine exactly what happened or to get an adequate description to what exactly caused the injury (which is helpful to rule out other injuries). Out of habit we would ask, but the response was always: “A brick…, a wall…, a house… or something heavy… fell on me.” In some cases, they didn’t know what hit them.

The pain and agony that these people were in was very clear, and every one of them had been waiting patiently for care (for nearly a week or over a week in some cases). The vast majority of them never made even a slight whimper. There was an occasional scream or moan when a bandage was removed, or when an obviously broken bone was moved. But the strength and bravery of these hurting people was an amazing thing to witness. It was the same among young and old, no matter how severe their injuries were. One woman had both a clearly fractured humorous (upper arm) and a clearly fractured femur (upper leg) and yet she never screamed. Two children on the first day were brought to us by their mothers both with femur fractures, neither one even whimpered or cried. Very few had had any medications beyond an ibuprofen or Advil. Antibiotics were limited, but were provided to almost every patient.

I cannot even begin to tell you what it is like to watch a 25 year old man be told that he is going to lose his leg below the knee and then to have him genuinely thank us for being there and helping him. Over and over, everyday that I was there, patients would receive the devastating news that their leg, arm, hand, thumb or toe would have to be amputated. I never heard anyone ask “why me”. The abbreviation BKA was a common phrase used by the nurses and doctors all around the hospital. I learned that this stands for Below Knee Amputation. Once the orthopedics begin to finish their work, there is going to be a huge need in Haiti for prosthetics. It was also clear that the surgeons were doing everything in their power to not amputate unless it was the only option. If there was a possibility that a surgically debridement would clean out the wound sufficiently and that there was still hope of saving the limb, they would always do that first.

My role varied during those four days that I was in country and working in the hospital. Although I was typically only assisting one of the doctors or nurses, organizing medical supplies (which were arriving constantly), or serving as a “gopher” to go get something, I was really fortunate in that I got to experience many different aspects of patient care throughout the hospital. I learned techniques of removing bandages (as EMTs we are trained how apply them, and in experiencing how they are removed I have learned which applications are more humane). I learned how to debride and clean wounds. I assisted the doctors and surgeons in the operating rooms, and I assisted Kathi (the physical trainer) in teaching post-op patients how to walk with a walker or crutches (which were in very short supply – if not non-existent altogether). I was the scribe, writing down the patient’s vital information, as we attempted to develop some sort of patient charting system to document and keep track of the patient records and their care. I did whatever was asked of me and whatever needed to be done.

On Wednesday morning (1/20) our team was awaken at 6am by a significant aftershock. I was asleep at the time, as were many others. I was sleeping on a matress on the floor, but I guarantee you I have never gotten out of bed so fast in my life. When I returned to the room after the quake, I was puzzled that I could not find the sheet that I had been sleeping under. I found my sheet on someone else’s matress over halfway across the room. All I could think about while the building was shaking were the horrible injuries that we had been treating for the last several days caused by collapsing concrete buildings, like the one I was sleeping in. All of the bedrooms were on the second floor, so we all had to go down a flight of stairs to evacuate the building. When we got back to the hospital we found all of the patients outside in the courtyard. On Thursday we had a few more smaller tremors at noon. Ironically, I was in the process of trying to comfort a patient who was trying to flee the hospital because she did not want to be inside.

Post traumatic stress is clearly present in most of the patients, and even those not injured. The injured people are deathly afraid of being indoors or inside of a building that may collapse on them. Many would agree to come inside the hospital for treatment, but refused to remain inside. Those that are not homeless because their house did not collapse are homeless because they are afraid to be indoors.

Please continue to keep the Haitian people in your thoughts and prayers. They have a long road to recovery ahead of them. Thank you for your thoughts and prayers for me and the other medical professionals that I went with. Please continue to pray for them as most of the doctors and nurses are still there and will be for the next several months.

The following video shows a tour of King’s Hospital given by Dr Dan Diamond the leader of our team with Medical Teams International: (If you watch the video closely, you will see me briefly at about 2 minutes and 47 seconds.)
http://www.ustream.tv/recorded/4127362

The following link is Dr Dan’s blog address:
http://www.powerdyme.com/dan-diamond-powerdyme-blog.html

The following link is Andy Davidson’s blog (his Day 1 post uses two pictures that I took). Andy arrived the day before I left:
http://orhospitals.wordpress.com/



Young boy with femur fracture in operating room.

One of many cracks in the hospital walls.

Triaging patients in the courtyard.

Treating patients after triage.

Treating patients after triage.

Thank you for your thoughts, prayers, and support.

Thursday, January 21, 2010

Tonight's Plan

Today (Thursday) the team worked a 12 hour day. They will head back to their place of sleep around sundown tonight (about 7:30 pm Haiti time). The team that Michael is on will try and get some sleep. They will wake up around 3:00 am Haiti time on Friday morning and drive to the airport. This will be the first time that they are out at night. Their flight will be waiting for them at 3:45 am to take them back to Fort Lauderdale. With so many aid flights coming into Haiti, 3:45 am was the only slot left for the plane to take. They are expecting a full day of constant flights in and out of Port Au Prince this weekend.

The team will then go back to Fort Lauderdale and after customs get some sleep before making the journey back to Portland. They will arrive in Portland late Friday evening.

email from Anne - One of the nurses on Michael's team

"We got to the hospital this morning with every single patient that we operated on yesterday back outside in the hospital courtyard. Multiple repaired horrible injuries were lifted on their families backs and ran to the outside during the earthquake this morning. It was chaos. They were all so scared, as you can imagine. We all cried together - then we got back to work. All in all, it was a very good day. Chris Achterman - one of the pediatric ortho guys, had 2 kids in the OR and did 2 of the most beautiful spica casts I have ever seen, using sticks to support the 2 casted legs apart. What a team effort we have going here, supporting one another."

home?

The team isn't sure when they are coming home. They were going to come home tomorrow (Friday) but now may stay until Saturday. The work that they are doing is making an impact and it's difficult on all of them to leave, so we're trying to figure the best plan of action.

Wednesday, January 20, 2010

The team is doing great!

The earthquake didn't hurt anyone on the MTI team and they keep going strong. YEAH!!

Tuesday, January 19, 2010

update from Kathi McCoy

Kathi is doing triage with Michael for the Medical Teams and she just sent me this update via her IPhone...


"Multiple crush injuries with full thickness skin loss, reeking of pseudomonas and worse, open fractures, partial amputations. No water, crutches or radiology at the hospital. Patients carried in on doors, gates or backs from the street. Haitians brave and grateful. So many lives saved today. Thanks for all of your help..."


It's just her and Michael doing triage for this station.

Dr. Diamond's Blog - You've got to read

The below post is from Dr. Diamond's blog who is leading the MTI team in Haiti. It's amazing!! You can view his blog here or you can read the post below:





It was an unbelievable day! Before I tell you about it, you need to learn about the fine art of cup showering. That is how it gets done around here since there is no running water. You see there is just a five gallon bucket in the bathroom with a bowl floating in it. I'm not sure how water can be colder than air but, just like KY Jelly, it is. So my strategy is to fill the bowl then dip my hand in it and splash the water on a section my body. Then soap. Then I move on to the next part of my body. Then I go back and rinse each part. Now Bill, on the other hand, pours the water over his head while squatting and somehow manages to get his whole body wet. Then soaps. Then he rinses by pouring two cups over his head. Good grief. Three cups total. How does he do it? Mystery.
I spent the majority of the day at our hospital today. We had several breakthroughs. Today our other team arrived in two waves. It was great to see Dr Tom Haggard again. I haven't seen him since we were working at the New Orleans Convention Center after Katrina. He is a great guy with an amazing servants heart. We also added Dr Todd Ulmar (Ortho), Dr Chris Achterman (Ped Ortho), Kathy McCoy (PT), Huston Hedinger (all around good guy) and Michael Graves (EMT and all around good guy). The second wave of folks came as I was heading out so I don't have all of their names yet. Stay tuned.
Today the team worked hard and we were able to get our OR up and running just around noon! We were even able to treat the pastor's wife. The orthopods were able to debride her wound and, using external stabilizers, fix her leg so she can be transported to the United States so she can receive the treatment she needs to save her foot! Bill and I are taking her to the airport where she will be flown to Ft Lauderdale in a private jet. The use of the jet for one week was donated and we are using it to bring in supplies and volunteers. I am excited to see her someday with her foot still attached. I am celebrating today that she is still alive!! God is good.
Today I also worked on organizational structure and figured out department heads etc. This evening I went to the UN field hospital and I was able to find some supplies that we desperately needed. I got some morphine, demerol, antibiotics, disposable surgical gowns, IV solutions and more supplies that were very needed.
The new team is struggling with the fact that we don't have x-ray. For difficult cases we write what x-ray we want on a Rx pad and then the patients family has to go and find someone with a vehicle and painfully place them in the vehicle and take them around to find someplace with an x-ray machine that works. When I close my eyes and imagine transferring into a car (not a cushy ambulance), driving on horrible bumpy roads, transferring out to get the x-rays and then doing the procedure in reverse to get back to the doctor it makes me so grateful that I live where I do. My patients at home often put up with wait times that are embarrassingly long but these people have patience and gratefulness that would make Mother Theresa envious. I have much to learn from them.We are working on getting some intake forms up and running. They are installing a generator that should give us enough power. By the way, we ran out of fuel for the generator in the middle of a surgical case today. They had to finish without power. I was trying to get some forms downloaded from the Internet this evening and to do that in these situations we use a portable satellite link device. The fun thing was the dozen children that were hanging all around me while I was doing it. They sure are curious and full of smiles. I speak very tiny bits of Creole but I do speak fluent "Kid". It was really fun with special handshakes and all that stuff. There were lots of giggles, even in the midst of all of this.
Off to bed. I have to get up early to take pastor's wife to the airport at 5:30 or so. But first I have to get up early for my cup shower. Perhaps I will try Bill's technique. Please keep the prayers up. I could sense His strength throughout the day.

Monday, January 18, 2010

I heard from Michael!!

Michael just called me (around 3:30 pm). It was really great to hear his voice. He was calling from a satellite phone and mentioned his cell phone doesn't work in Haiti. He didn't sound too tired, but said he was exhausted. He has been doing triage all day long for the 3 orthopedic surgeons. He is working with veteran natural disaster responders and is learning a lot. (I didn't know what triage was before I married Michael, it' a french word for sorting, which means he has been deciding who gets to go to surgery and who has to wait.) The phone line was cut off and I haven't heard back from him, but I know that the satellite phones haven't been working perfectly so it doesn't make me worry. I'm sure other team members needed to call their families as well. It's 7:30 pm at night there and he said that they would not be working in the dark, that they were all going back to the guesthouse to get some sleep and to be ready for a full day tomorrow.

update 2

I heard from the pilots this morning. They landed safely in Port Au Prince this morning. They were greeted on the ground by MTI personal and were escorted to the make shift hospital that they will be working out of all day today.

The only trouble they had was that Fort Lauderdale customs wasn't open yet, so they had to detour to another US airport to go thru customs and then head off to Haiti. It took extra time that was a little frustrating but all in all, wasn't so bad.

The pilot said that they were doing some "really cool" work down there, so I'm sure that the team will be very tired tonight. Hopefully I will hear from Michael but I'm not sure yet. I haven't heard from anyone in Haiti yet (the pilots called after they had returned to the US, every plane only has 1 hour on the ground in Haiti, so that the airport doesn't get backed up, so the pilots could not stay there).

Sunday, January 17, 2010

good night

It's been a really long day. I'm headed for bed. Michael and the team will get a 4/5 hour sleep tonight and then are to be up again around 10:30 pm our time. They will then take a 90 minute flight out to Haiti and land in Port Au Prince around 6:00 am local Haiti time. They will work constantly all day long. I don't know if I'll hear from him again until Thursday night. If I do, I'll post it.

MTI blog

The MTI team who is already stationed in Haiti, their leader, has a blog. This is medical team that Michael will be a part of when he lands tomorrow morning.

Update 1

I was able to secure an arrival time in Port Au Prince for tomorrow morning at 09 40 z, which translates to 1:40 am PST. It'll be early for the team, but I am very grateful they are now have a landing code and will be landing in Port Au Prince. That will allow Michael to work for four days on the ground with the team.

Medical Teams International has been an incredible organization to work with. They have had good communication with the team and me and are organized within a chaotic situation. If you are still wanting to help Haitians financially, they are a good one to donate to. There disaster response to this situation is going to be expensive. Already, I'm helping coordinate what the current MTI teams in Haiti need to be bought and brought into country for them to continue providing medical aid. The list is very long and has very expensive items on it. Click here for the link to their donation site.

Michael's Take Off to Haiti this morning

It's been a really busy 48 hours! I finally got to send Michael off this morning with a kiss and he is currently in the air traveling to Fort Lauderdale. He will spend the night tonight in Fort Lauderdale and the head to Haiti tomorrow morning. The hope is that they can land in Port Au Prince, but so far I have not been able to secure a landing spot in Port Au Prince for early tomorrow morning. If I cannot get them a spot they will land in Cape Haitian, normally a 3 hour drive from Port Au Prince, but currently an 8 hour drive with the only option of driving in daylight (meaning if they don't have 8 hours of day light of ahead of them, they don't get to leave Cape Haitian) so we are working around the clock to get them a spot to land in Port Au Prince.

I realize some of you may not know what's going on, so here's a little back ground: I work for a company that works with NGO's. One of those NGO's is Medical Team International. The company I work for is sending the company plane to Haiti with 7 personal on board: 3 orthopedic surgeons, a physical therapist, a company representative, and my husband (serving as an EMT). It's my job to handle the logistics of the flight, communication for the team, and to assist with Medical Teams International with anything that they need. While putting this together on Friday, it grow more and more obvious that they needed someone who had the Michael's skill set and could leave Sunday morning for a week so the team asked Michael to join them and both of us thought it was absolutely something that he could do. MTI currently has 2 teams already on the ground and this team and another team from Seattle will arrive tomorrow making 4 MTI teams serving in Port Au Prince.

Here is Bas explaining the team situation which is currently that everything changes every hour in disaster response. We make decisions with what we know at the time and then change them as needed.

Michael and Bas before take-off.

Me and Michael. :)

The medical response team taking one last photo before take-off. Good luck!!! We will keep you in our thoughts and prayers.




Sunday, January 10, 2010

our new bedroom furniture

Michael and I have been using his old dressers in our bedroom for the last few years and we recently moved them into the kids room (we're only having 1 baby, but we already have 2 kids rooms...). We found what we were looking for at IKEA and Michael worked hard to put it up. They look great!





Hester was a very important part of this process. She wanted to be in everything and know exactly what we were doing. It was pretty darn cute.

Wednesday, January 6, 2010

22 Weeks and Counting

I’m thrilled to be 22 weeks along and over half way there. We’re getting more and more excited every day. Michael and I have started to ‘ready the house’ for the baby. We’re putting in a much larger dresser/bookshelf/storage thing in our bedroom that will hopefully allow us to use our space better. After that, we’re concentrating our focus on the baby girls room. Her room is painted a soft green and I am thinking that the theme I would like for the room will be butterflies, but haven’t decided yet. I can imagine pink and purple butterflies on the drapes and dresser and for the bedding, but I’m still thinking about it. I haven’t found this design on any children’s websites yet and am trying to figure out if I want to create and paint all these things or if buying them would be the better option (hopefully I can find them somewhere because right now I don’t have the option to buy them).

We’re also starting to collect the baby items. We have had incredible generous friends who have given us already so many things. We’re making a list of all the things that we need to get and the list is getting longer and longer. Honestly in a house that is already completely furnished, it’s a little overwhelming to think of where we’re going to put this stuff. I’ve been taking several trips to the Goodwill lately to try to empty some of the space, so that I can put some new things in. We’ve also rearranged our living room so that a glider rocking chair can fit into it better.

Mom got a new dog last week and he is only 2 pounds and SO darn cute. We’re excited because we know that a baby/little kid will love dogs and will now be able to play with one. Michael is excited because our baby can enjoy a dog and he doesn’t have to have it (the dog) in his house all the time. Harley (the little dog) runs around my mom’s house and when she brings him over, Harley likes to chase our cats. It’s pretty hysterical to watch a 2 pound dog chase a 10 pound cat, although I don’t think that Hester or Jaguar appreciate it very much. We’re trying to get them to be friends so that we when one of us is out of town, the other can watch the animals. We’ll see how it goes.

There is so much to do in preparing for your first baby and even more to think about. I think that’s why I haven’t been blogging as much. When I’m not getting something done around the house, I’m resting (Michael is very encouraging about the resting thing for me). So, it leaves little time to blog, but I know I’ll be back on here more and more soon, especially with pictures. Many people have asked me to show them a picture of my pregnant belly and it’s coming soon, I promise.