Notes From a Medical Volunteer in Haiti

2-9-2010

On a plane to Miami. Spent yesterday packing with a mid-day ski to allow the mind a rest from too much thinking. It was good to be in the quiet, the snow, amidst the pines. Japhy helped me load up the duffel bags with medical supplies in the eve. I think it was really important for him to take part in a process that has been emotionally charged yet kept under wrap for the 3 of us.

2-10-2010

Spent the day arranging travel for tomorrow and taking it easy. I think we are all a bit nervous. We really are venturing into the unknown. We will take a bus tomorrow at 7am that supposedly will have us arrive in Petion-ville (a suburb of Port-Au-Prince) around 2pm. From there we hope to find transportation for the 9 of us and our 17 bags full of supplies. There is a lot of concern about losing things along the way.

2-11-2010

St. Mark Haiti— today has truly been surreal! Rap music currently blares and the sound of continual traffic and horns completely dominate the air and it’s almost midnight. Sweat sticks to my body along with dust, smog and engine fumes.

I am inside my tent which is pitched on concrete behind concrete walls—it’s been a 19 hour day beginning on the streets of Santo Domingo waiting for our ride to the bus station at 5:30am. Next to our hostel is a museum dedicated to the Revolutionaries who risked and lost their lives to end the brutal dictatorship of Trujillo. Large portraits on the walls outside the museum of Minerva, Patria and Maria Teresa– “Las Mariposas”– revolutionary sisters who gave their lives to end tyranny. For justice. There is another haunting photo of a revolutionary in an electric chair—his eyes are bulging in terror. He was to be an example of those who tried to defy Trujillo. Their incredible bravery gives me courage.

8 hours into our journey and I am trying to navigate myself through the absolute chaos of the Dominican/Haitian border crossing. Thousands trying to leave in a swirl of dust, sun and fumes—like a scene from mad max or something. With the help of a savvy Haitian women we are stamped out of the DR and into Haiti as a team of Medicos.

There was something unnerving about walking around that chaotic scene with 9 passports and hundreds of dollars in my pocket. It was good to have a member of the team along to watch my back.

2 hours later we begin to see signs of collapsed buildings and thousands upon thousands in the streets—-walking, sitting, camped out and just staring at our bus as we drove by. Never have I seen such a concentration of people and vehicles in one area—it’s all a strange dream. Piles of rubble, collapsed buildings, tent cities, blaring horns, vehicles overflowing with people, aid trucks, police, military, motorcycles, bikes—yet there seems to be some sort of flow to this madness. People who have always dealt with the chaotic element.

I’m not really sure how to explain the intensity of landing in an unfamiliar city that is in complete crisis with seventeen bags of supplies and no knowledge of the language or any “real plan” other than you must take a complete leap of faith—which is not to say be naive—just that things will work themselves out in the end. You enter a disaster area you enter chaos! To be swarmed by folks just trying to put food in their and their families’ bellies anyway they can—hopefully by taking this group to where they need to arrive—is a nerve rattling experience. It is beyond description.

You have to believe in the goodness of people I feel in order to overcome the stress of being completely out of your element. You make your choice—and pray that the man who told you that the ones you have chosen will slit your throat and rob you the minute you leave the bus station—has only said that because he lost the opportunity to take this group of extranjeros to their destination.

And so with the help of a young “soon to be Haitian Doctor”(currently finishing his studies through the Cuban free medical school program) I met on our bus ride, we negotiate 400 US dollars for 2 vehicles to drive us and our 17 bags north to St. Mark.

The journey through Port-Au-Prince to St Mark was truly indescribable. I have no words—did I dream the last 3 hours? Did I really see, feel and experience the awesomeness of a city brought to the ground by Earths power! An exodus of people—thousands just walking north,east and south. There were always people walking no matter how far we drove. And the traffic was beyond the scope of reality. I’m not sure it was real.

Yet somehow, 4 hours later—after a nerve racking separation of our 2 vehicles, a complete loss of communication with half our team,after a tire rotation among the rubble on a side walk in the middle of the city, we made it the maybe 60 miles to St. Mark. My head so full I needed Excedrin to stop the pounding. And now 19 hours after waking up I will try to close my eyes and remember the smiles I saw throughout our journey of a resilient people who have known mostly suffering and poverty—yet exude a solidarity and strength seldom seen to me before.

2-12-2010

St. Nicholas Hospital—Shama is the name of the little six year old girl whose hand I held as she screamed in pain while they prepped her for surgery. My first face to face encounter with suffering in Haiti.

Somehow she was dragged under a truck that had hit her home and killed 2 others. She is the only one who survived. The driver was never caught—he kept on driving leaving her little body to die. She lost the majority of skin on her belly and some on her thighs. She was laying on a gurney in the pre-op room and I walked in caressed her little hand and looked into her dark eyes—held back my tears and smiled. She started to play with my arm hairs which seemed to calm her down.

I was asked to go into surgery and help in any way I could. The doctors skin grafted from her bum and the back of her thighs. Then sewed the skin onto her belly and legs. I’m not sure how long we were in the operating room—hours! When they were finished she was wrapped from her knees to her chest in gauze and bandages.

The Doctors said she would be in a world of hurt once the anesthesia wore off. I never thought that as an EMT, I would find myself learning the ropes of a surgical nurse assisting Doctors while they performed surgeries in what was described to me as “primitive” at best. I felt lucky to have a nurse feel compelled to show me “the ropes.” To teach as she had once been taught.

Today I saw wounds that I never would have imagined had I not seen them with my own eyes. I spent the entire day in the OR room, eyes wide helping in any way that was needed. This is what our team was doing throughout the hospital. Doing things we never would have imagined—but just jumping right in.

The suffering is incredible yet I still here laughter. It has been one month to the day since the Earthquake. “Misery has been Haiti’s companion for 200 years” is what Odson our host said to us last night. “Yet we still know how to laugh cause we are a strong people.”

2-13-2010

Another day in the O.R. For me. I couldn’t do it! I don’t really know how i’m doing it right now! To humble myself? To face fear? I am 100% out of my element—out of my comfort zone and am not sure how it will all process into my core just yet. I’m just trying to make it through each day as courageously as possible. To endure—like the people of this country have been doing for 500 years—like little Shama—like the young Haitian Dr.s who are doing their year of service after receiving a free education in Cuba.

2-14-2010

Hallmark is not making any money in Haiti today. This is survival here. The emergency department is completely crazy! People just pouring in—wounded–gaped open – its as if there is a perpetual cycle of trauma here. The Surgical team left yesterday and we are left to fend for ourselves for the next 4 days. We will change and clean out bandages Try to prevent any further infection. The post surgery infection rate has been near 100%. Each ward is filled to the brim with patients and their families. People are sleeping on floors. Families taking care of their needs—feeding,cleaning,changing clothes and sheets……helping others as well—a true coming together.

It’s feeling more overwhelming (if that’s possible) without the Boston team here. I think our team is doing exceptionally well but it was real nice to have the guidance of seasoned Doctors and nurses. Today I chose to spend more time focusing on Physical Therapy with Angeline. 11 years old with a broken femur and beautiful smile. More time on children than on gaping wounds and gnarly infections. That is not to say wounds were avoided—impossible!

Today while working with Angeline some young translators asked me to come and help with someone in the Emergency department. I arrived to find a large women with her shirt pulled up and her eyes closed. The family asked if there was something I could do. I checked her pulse—she was dead! They asked me to check again on her other side. I did—nothing….. I pulled down her shirt and told them i was sorry. There was nothing that could be done. They looked at me in a state of shock. I put a hand on someones shoulder and apologized again. Death was a big reality here. The morgue I hear was overflowing.

This morning while walking down the street towards the hospital a man stopped me and asked if I could take his blood pressure. I obliged and quickly a line formed in the street. For the next half hour Aron and I began taking blood pressures and heart rates for folks while Odson translated.

This place is continual noise—non-stop! Horns, voices, music, vehicles, mopeds, roosters, radios, feet continually moving, babies crying, kids screaming—somehow I manage to fall asleep and each time I stir in the middle of the night the noise is still there. Maybe there is a lull while I’m dreaming dreams I can’t remember. We are in a fish bowl here. 9 Americans who come from complete privilege. Something different to take the mind off the reality of their situation. A simple Bon Jour or Bon swa will bring a smile that will feel real good.

2-15-2010

Shama is beginning to have a systemic infection. We changed her bandages today and thank-God for narcotics—for the ability of Stacey on our team. She screamed quite a bit until the sedation started to kick in. Her goofiness towards the end of us working on her was enuff to make me laugh—so as not to cry.

As a team I felt we rocked today! We got done what needed to be done. What would have happened had we not been here to follow up on all the surgeries? What is to happen in the long run? How does this level of care, transfer over? I have no idea! What is happening, what has been happening, what will continue to happen is beyond overwhelming.

All day we worked on Earthquake victims and their wounds. Another woman died today. And I think it was for the best, yet who the hell am I to even think that? As I watched her family running around and screaming, wailing, throwing themselves to the ground, convulsing. Grieving for the last 500 years of sorrow. Somehow I feel that that is the gift of death here. To allow these incredibly resilient people to fully grieve for all they have had to endure and will continue to. This is a country that knows mourning.

I can barely keep my eyes open despite the chaos of noise around me. I think I will just have to plow through cause stopping might give me to much time to think about the enormity of this situation.

2-16-2010

Another day of wounds and screaming. beginning to feel less chaotic—are we getting used to this madness? We have been going all day non-stop for the past five. The last three have been just us working with the Haitian staff. I have become somewhat numb to the awesomeness of the wounds we are seeing.

The surgeons arrived this afternoon—and we are feeling relieved that these extreme trauma cases will be handled by Doctors. We are thinking of heading to the outlying communities.

Shama is febrile today—she needs more care than can be offered here. Angeline continues to improve. I am toast!

2-17-2010

The new team helped us clean up Shama today—she was a mess of urine and feces. We re bandaged her and left a bigger opening in her bandages to make it easier for her family to clean her. I spent the rest of the day helping orientate the new team to the way the O.R. works here. Nothing like the states as I could tell by their expressions. I was marveling to myself that here I am “showing the ropes” to experienced surgeons. They were thankful and I felt good “to teach as I had been taught.”

I was in the O.R. for an attempt at a skin graph when the electricity went out again. They put a plate into a young girls arm who had broken both bones in the earthquake and finished the day with a re-amputation of a leg wound that had become completely infected.—-to tired to write—lots of blood today

3:30 am if it wasn’t for some group snoring it would almost be quiet. Someone somewhere close by has a radio playing—i can actually hear the sound of insects humming. The road is actually quiet of vehicles, horns and motorcycles. I can hear roosters crowing all over the place. It turned out to be a long day yesterday with really no break. I missed working with Angeline and hope to see her today. An eleven year old smile goes a long way in this crazy place. I’m not really sure I should be in the O.R. today—but we will see what the universe has in store.

2-18-2010

It was only a 5 hour day because we left around 1ish. It got a bit hectic with the St. Louis team and I think the Haitian staff had it. I feel it was for the best because we are toast—spent. I think they need to integrate a bit more and use this as a teaching opportunity for the local staff.

7 days non-stop! it’s hard to believe the work we have been doing. Today I was asked to pack an open amputation! Solo! Just stuff gauze into that fish mouth—wet to dry OK” I’m so glad Leah showed up to land a hand.

So in the last week I have been in on operations, amputations, skin grafts, plates put into arms and legs, cleaned wounds as big as craters, done Physical therapy, watched people die and families mourn, heard women, men and children screaming in pain and have just plodded along like I am in some waking dream. Wake, eat, head to the hospital, come home, wash-off the day, wash my scrubs, eat, sleep, get up and do it again.

2-19-2010

7 am—the heat is in full force—been up off and on since 3:30 am. Sleep has become quite challenging-the first few nights it was easy to just pass out. Now i find myself waking—mind spinning and unable to fully fall back asleep. I’ve been watching two little girls playing happily in their dirt/rock yard. A mother hen with her chicks in tow following behind peeping and looking for anything amidst the piles of trash. The children continue to play tag. Every now and then one of them stops to love on the scrawny little puppy wagging its tail as they chase each other. Buckets of water are hauled in for baths.

I think of Japhy—think of kids in the U.S.–think of how simple we tried to keep it—how hard it gets with each passing year to keep it that way with the suffocating influence of modern society. Here among all this poverty and tragedy to see children happy—joyful, is humbling.

I’m realizing the only time I have really felt afraid for my life has been in vehicles driving on these chaotic roads. No longer do I have the carefree attitude that I had while hitch-hiking during my Peace Corps years. Here it feels as if every corner we round is a close call.

We headed out to the country today—to the village where Odson grew up. We drove a battered pot-hole filled road to a dirt one and in about an hour arrived to a cluster of mud and stone huts in the blistering heat and dust. It wasn’t long b/f we were completely surrounded. Wide eyes of all ages staring at the group of gringos before them. It was good to watch as Odson reunited with his 80 something year old grandmother, his nieces and nephews and cousins. He announced that we would be checking blood pressures and tending to wounds. Word spread fast and soon we were surrounded by hundreds of folks from the surrounding areas.

I never felt so closed in—I had to ask a man who spoke Spanish and was helping me translate—to please ask the people to allow me a little space. They would back up a bit and before I even finished with one person I would be completely enveloped in people. To feel this intensity while a language I don’t understand is being spoken emotionally around me as people wrestle to be the next in line is an experience in and of itself. For the next 3 hours or so we checked blood pressures, cleaned wounds and consulted people who had various health concerns.

In the EMS world the phrase “sudden onset” is used to explain how one might be feeling. And that is exactly how I felt has a dizziness came over me and the feeling as if an all out brawl was beginning in my stomach. I was done and only wanted to escape the constant eyes. I was relieved to finally head out and tried my hardest not to lose it on the bumpy ride back. At one point I heard Leah scream as we got awfully close to a large truck heading straight for us. Back at the compound I got quite sick. It is good to be traveling with paramedics and a nurse as 2 bags of I.V. and some meds had me feeling much better. I crashed early for another fitful night of sleep.

2-20-2010

It is hard to believe it was our last day at the hospital. The St. Louis team was definitely glad to see us back and it seems as if they have gotten into a routine of their own. I went to check on Shama and Angeline and was pleasantly surprised to see Shama sitting up and smiling with her Aunt. It seems as if she is on the road to recovery. I only pray that there is follow up on her dressing changes after the St. Louis team leaves, which is only a day after us.

I changed out Angeline’s Ace bandage and cleaned over her wound, the stitches have been removed and her leg is healing nicely. We did a loop around the ward on her crutches and some more leg stretches.

Afterwards I went back to the pre-surgery room and spent the rest of my time helping with patient care as they were being sedated in order to take of bandages and clean out wounds. Our time to leave had arrived and we made our rounds saying good bye t the many people we had formed bonds with—translators, doctors, nurses and most of all the patients.

It was truly bittersweet in that I am ready to be home—I miss my family and community—I am tired! Yet I know that this is only the beginning of a very long road for the Haitian people. A journey they have been on long before the earthquake occurred. It has been and honor for me to walk a small part of this journey with them—they truly are a people that embody courage and perseverance and they do it with grace and humility.

2-21-2010

Last night we played music and sang and danced and laughed with Odson and his family and community. We spent the late afternoon swimming in the beautiful Caribbean waters of Haiti—invited by a Haitian Doctor and his wife. And it was glorious! A perfect way to end an incredibly intense 10 days. To sing and dance—to laugh with with the people…….

We spent 11 hours on a bus driving back to Santo Domingo. We skirted around Port Au Prince and all sat staring out our windows looking at buildings that once were—tent cities, lost in our own thoughts. Horns continue to blare the air thick with dust and exhaust—people everywhere. I know we all leave Haiti changed—how could we not? I look forward to the quiet of 9000 feet. Of pine forests and aspen meadows. To the voices and feel of my family. Of some time to reflect on what has been an incredible journey .

Community Connection

For a perspective on how Matador’s Julie Schwietert organized a response to the earthquake, please read Organizing Matador’s Haiti relief effort.