Haiti Medical Mission

Hi everyone. I just returned from Haiti early this morning (wed jan 20). I was in Haiti, Port au Prince on a medical mission as you all know. Many people have already asked me about my experience and I would like to get it all down while it is fresh in my mind. Excuse mistakes in grammer/spelling, I am operating on minimal sleep.

I had been planning to go to Haiti with a group of pediatric residents for 6 months to provide medical care to children. We were scheduled to leave Wed morning, the morning after the earthquake, so of course our flight was cancelled. We scrambled and were able to find flights to Miami. After waiting in many airports and multiple flights being cancelled we finally found a group called Medishare through University of Miami who had a makeshift hospital set up in the UN compound next to the airport.

Friday night they were able to take 3 of our group of 8 (my attending Dr. Schneider, a nurse and me) and the rest were scheduled to leave the following day. We waited in a private airport from 7pm on and at midnight we boarded a private Lear jet ( james bond style!) with as many medical supplies/food/water as the plance could handle and set off.

We arrived at the airport around 2am and got in trucks which brought us to the 'hospital'. On arrival we saw 2 big tents up on a piece of land. A fold up table was sitting outside one of the tents and I was told, that is the operating room. I knew then things would be very different from anything I'd ever known.

We unpacked the truck and then by 3am got to work. We were told there were 4 basic things we could do at that time 1) provide pain medications (morphine, motrin, etc) 2) give antibiotics 3) do dressing changes on the wounds 4) place IV's and provide IV fluids.

This hospital was set up by 3 doctors from Medishare who arrived Wed and they were the only ones for the first day. Thursday more doctors and nurses were able to come in and we relieved them to 'sleep' when we started at 3am early sat am. I was lucky as I speak french fluently and so was able to communicate what was necessary to the majority of patients and families.

I was placed in 'tent 1' with 3 other doctors who had just arrived. There were approximately 150 patients in cots with a few inches between them in this tent. There were family members at many of the bedsides. If we were lucky we were able to find a piece of paper with their injury and perhaps what meds they had been given. It was remarkably overwhelming.

We began going down the aisles of patients trying to give antibiotics, pain medication, place IV's and change dressings. The vast majority had multiple fractures, many of the open (bones protruding throught the skin) and crush injuries.

That night one patient I met was a 9 yo little boy. Marc had a bad crush injury to his right foot and gangrene had already set in. (Even in the patient's with wrapped wounds the smell and the quantity of flys on the patient would indicate which patients had gangrene). His mother was distraught, we gave him anitbiotics and pain medication and hoped for the best.

The following morning several boys were brought in on a truck who had been found in the rubble. One, Jean Wesley (who's nickname is Pushant) arrived with an open tib fib fracture to his right lower leg. He was one of the sweetest boys I have met. 12 years old and there with his uncle. He spoke french well and despite his pain always had a smile for me and wanted to chat. The surgeons dressed his leg. Like most of the patients, we were trying to keep him alive until we had the surgical capability to fix his leg, or amputate.

Around 1pm sat my attending and I were finally able to catch a nap. That brings me to sleeping conditions. There were no beds for doctors or nurses. We would sleep where we could find a spot on the ground in the tent. Lights are on, the sounds of patients screaming is all around, and people are stepping over you to get around.

At 2pm one of the doctors shakes me awake. I'm so sorry, she says, I know this is the first time you have slept but a baby just arrived pulled from the rubble and you are the only 2 pediatricians. We got right up and went to the child. She was found by reporters (now 5 days post earthquake) alone in the rubble. She was limp, with a low heart rate, would occasionally moan, and had a flail chest (multiple broken ribs which causes a deformity to the chest, buts pressure on the lungs and is life threatening) She looked about 2-3 months old. She was so dehydrated IV's could not be placed so an IO (intraosseous needle) was placed in her lower leg and we pushed fluids. She slowly began to show more life. Her lungs did not sound good and we were debating whether we should place a needle in her chest to see if we could get either air or fluid out (remember there are no x-rays or other ways to tell what is going on, just the clinical picture). Miraculously someone was able to find a private plane going back to Miami and the hospital accepted her. My attending and I ran to a jeep, jumping in holding her IV bags up and put her on the plane. The last update I heard she was doing well. SHE WAS ONE OF THE LUCKY ONES. WE ARE DESPERATELY TRYING TO GET PATIENTS OUT TO HOSPITALS IN THE US AND ELSEWHERE WITH THE CAPABILITY TO OPERATE/TREAT THESE PATIENTS.

That afternoon I went to check on Marc (the 9yo with gangrene in his foot). He was now febrile, meaning the infection had likely spread to his blood. We pushed harder to get him to a facility which could amputate his right foot as we knew he would die without this, but without luck. Around 6pm he became less responsive and had rigors (body shaking from sepsis). By 8pm he was no longer responsive. We rushed him into the back behind the tent on his stretcher. I was sent, running, to the other tent to find scalpels. The rest of the team had just arrived and one of them saw me and yelled hello. I couldnt stop to talk as I had to get the surgeons the tools. With a scalpel and a small saw his foot was amputated, without anesthesia, in the back, oustside, behind the tent. It was dark so I had to hold my headlamp up for the surgeons to see what they were doing. Fortunately at this point he was no longer conscious. Sadly Marc died about an hour later. I had to tell his mother, she had already lost her 2 other children in the earthquake. She sang, she prayed, and she fell asleep. I did not see her again.

We had to continue with the rest of the patients and, thank goodness, 5 other pediatric residents as well as others from Miami hospital had arrived, ready to work. And they are amazing, amazing doctors. We set out to try and get organized and got all the antibiotics together for tent 1 and began to distribute them. My fellow pediatricians sent me to rest for a few hours and they worked through the night.

Sunday we began to get more organized. We went to each bedside and taped a piece of paper with patient name, problems, and 'plan' consisiting mostly of which antibiotic to give. We would then write which medications were given and the time on the sheet so 1) we could get at least 2 doses of antibiotics in each patient 2) so we knew the last time they got morphine so we did not overdose (no capability to intubate if they stopped breathing from too much narcotic) 3) to know if their dressings were changed. Surgeons would also mark who most urgently needed operations so we knew who to prioritize and try to get out. Teams were also devised, we were the pediatric team and so were in charge of all patients under the age of 16.

Sunday a group of anesthesiologists also arrived meaning they had some drugs to start doing amputations. There was no ability to intubate so drugs which would make people not know what was going on (ketamine) or would make them fall asleep but still breathe (propofol) and nerve blocks were used. The operating room was now a section of one of the tents that had sheets and makeshift walls. There were 3 tables a few feet apart and amputations and wound debridements would occur side by side. They started doing 10-12 amputations a day on patients who had gangrene and would not survive another 12-24 hours without it.

Remember 12yo Jean Wesley with the open tib fib fracture? He had developed fevers and gangrene. We told him he needed an amputation. He was devestated, but this boy is so incredibly strong. He wanted to know if he would still be able to go to school, how would he get there. He wants to go to University and be a doctor one day. I went with him into the OR, he was shaking from fear but did not cry, just held my hand until the medication put him to sleep. His BKA (below the knee amputation) was a success, he survived the operation.

Let me tell you about another young man, Charles. Also a 12yo little boy, very sweet, suffered bilateral lower extremity crush injury. He had lost sensation in both legs below the knee. His lower legs were tense they were so swollen, cold, and blistering and the tissue was dead. He also lost the ability to urinate, meaning likely spinal injury, and needed a foley (tube throught the penis to the bladder to drain the urine). He needed an operation to amputate his legs. He developed fever on Sun and was supposed to go to another facility where they had a higher tech operating room but the truck never came. Overnight he developed rigors, it was Marc all over again. Monday a truck finally came to bring him to the other hospital. Mom and I hugged, he might make it. A few hours later I was shocked when Mom came up to me in huge distress...they were sent back. He was too sick to be treated at the other facility in Haiti. For the first time I lost it. I went outside and sobbed. Miraculously a pilot had come to our makeshift hospital and was looking for patients to transport. He came up to me and said, I will take him, I'll get him to Miami.

As always, things almost did not work. A 1yo little girl, very sweet with a loving and doting mother, was supposed to go with him. She had severe burns over her back and chest as a pot of boiling water fell on her during the earthquake. She got in a van to the airport but Charles had not been accepted by the outside hospital so they could not take him too. At this point we were sitting outside, he was on a stretcher, waiting to be loaded to the van but instead we watched it go without him. The doctors at our hospital did not give up, phone calls were made and an hour later he too was boarded on a truck to go to Miami. Mom could not go with him. Fortunately his father lives in Florida and his contact information was given to the driver.

Tuesday morning while rounding on patients Mom ran up to me, gave me a huge hug and said she had just spoken to Charles. He was still alive and his father had found him at the hospital. Mom had 4 children all of whom were in their house when it collapsed. Charles was pulled from the rubble, the other 3 were never found and are presumed dead. He is Mom's last child.

I also want you to understand the strength and the kindness that lives within these people. Sadly there were many orphans. It was days before we even came to the realization that some of these children were orphans. Families of patients in the cots surrounding these children would give them food and water, despite the fact that both were incredibly scarce. Over my last 2 days in Haiti we saw many of these children come to life as some of the shock began to wear off. We placed them together in an area near 'the stage' where we placed our bags and we slept. Those who were able to get up played and smiled. They are absolutely beautiful.

There are so, so, so many others I could tell you about. Many with good outcomes, who's wounds were cleaned and dressed and who faired very well and left. When I left we were working on trying to find a place for a 15yo girl ( I'm afraid I cannot even remember her name). She was there with her father. Her father was not at home when the earthquake occured. Her mother and 1mo old sister were trapped in rubble and so she alone went to dig them out. They came out of the rubble, miraculously, without serious injury. As she got them out, a neighboring house collapsed and part of it fell directly on her face. She has what is known as a LeFort fracture where the middle of her face is basically broken and pushed in ( over her eyes, her nose, her two front teeth are a few centimeters behind the rest as the middle of her face is depressed in). He also cannot eat as her jaw appears to be broken. This can be fixed but she needs a oral maxillary surgeon. We need to get her to a hospital in the US.

We had initially planned to stay until the weekend but the conditions for the doctors and nurses were difficult and I soon realized that I could not last much longer than 5-6 days. We had planned to all leave (our group of 8, 6 pediatric residents, 1 attending and a nurse) on Wednesday however Tuesday morning we were told that there may only be 3 spots to leave that day. There was a flight leaving that afternoon, perhaps a few spots Wed, and hopefully Thursday and Friday. 2 other residents and I said we would take the flight that afternoon, and the others (hungry and sleep deprived) said they would stay and get the next available flight. Talk about selfless.

It was time to say goodbye. I could not bring myself to say goodbye to all the patients and families I had come to love very quickly, but I had to say goodbye to Pushant (jean wesley) my 12yo with the BKA. We both cried as I said goodbye. I kissed him on the cheek and he held my hands tightly and kissed me on the had and gave me a big smile. He wants to come to the US to see me. I gave him my phone number and email and pray that he will find a way to contact me one day.

This was an incredibly emotional trip. I am not a 'crier' but have not stopped while writing this blog. My hope is that those of you reading will try to help. We need so many things, in the immediate 1) more nurses, there were many more doctors than nurses at our facility and they were more overworked than most of the doctors 2) food for the patients, my last day I could only offer water, pedialyte and whatever food bars I had brought from the states 3) THEY NEED TO GET TO HOSPITALS, if you work in a hospital advocate to sponser a child 4) We need CRUTHCES FOR CHILDREN AND ADULTS NOW, in future they will all need PROSTHETIC LIMBS to be able to survive. They need to work and walk and without this will die.

This is my account, I did not want to speak for the other pediatric residents as well as adult medicine doctors, surgeons (trauma, orthopedic, cardiothoracic), anesthesiologists, nurses etc who all worked with almost no sleep or food to take the best possible care of these patients. They were all so selfless, loving and worked harder than I have ever seen people work. And they did it with love for these people.

I did not have a camera with me but others, including those who are still there did. I will post pictures when I am able. I want people to see their faces, to reach out to help them. We also have a paypal account to which we have now raised over $16 thousand dollars (set up by our pediatric group). We plan to use this to help transport patients to hospitals where they can get the care they need as well as for food and whatever else is most necessary. Thank you so much to all of you who donated.

I would also like to add that for anyone mentioned by name I had explicit permission from patient and family mentioned here to tell their story. They wanted to do whatever they could to get the help their country needs.

I am not sure I can post the paypal account at this time until we get it arranged so it is under the correct tax etc heading. I will as soon as I am able. Thank you all again, all my love. Delphine
my email: delphine.robotham@gmail.com please email me with questions, offers to help, etc.