Today is the 5th of February, and I am on a flight returning from the Dominican Republic, attempting to put into words the emotions and events of the past several days.
When I started out, I had no plan to return to Haiti this year. I had previously taken 7 trips with Holy Spirit medical teams to our twining parish in Sequin. Then, the news on Jan. 12th of a devastating earthquake that struck at 4:53 p.m. changed everything.
Our original team’s plan to go to Sequin the week following the earthquake was radically changed as we heard of the need for trauma and medical teams for treating the injured. Several members graciously gave up their spots to make room for emergency physicians and nurses to go with our team. I was asked to go and made the decision to join them. At the time, many of us had not previously met, but, despite our different faiths, backgrounds, and skills, we became an effective team that did good work in Haiti.
I have traveled in Haiti before and could understand the logistical problems of distributing aid throughout the country. If we wanted to be effective in our mission, we had to be able to bring in our own supplies and get them as well as the team to a designated area of need. We had to make radical changes in a short period of time, and several organizations and people stepped up to make this happen. I am unable to mention them all without failing to recognize someone or some group. Therefore, I will only say that the response was fantastic. Without your support the team and work done could not have materialized and been fruitful. I would like to say that coordinators Tim Ryan and Mary LaPonsie were instrumental in bringing things together and the ground work done by Troy Silvernale and his advance team in Haiti was vital to our success.
The first travel date came quickly, but commercial flights into the Port Au Prince airport were canceled. Our tickets would only get us to Miami. We could not secure a charter flight into Haiti due to the economic restrictions and the daunting logistical problems of distributing aid in Haiti.
The wind was knocked out of my sails when we met and decided we would have to postpone our mission trip. I had second thoughts about staying with the Holy Spirit group versus joining the orthopedic trauma group from Spectrum Health. Dr. Cali, a surgeon from my group, had to drop out due to the change in plans, as did a few other members. Troy and his group made plans to go ahead through the Dominican Republic and arrived in Haiti on Saturday. We continued planning and filled vacancies in the group with qualified people. Then Amway answered our prayers by providing transportation on their corporate jet for both our team and our supplies.
The first group went out on Tuesday, and I was on the second group that left Thursday. This was now 16 days after the quake, and the area had recorded 52 aftershocks. We expected to be sleeping outside in tents like everyone else. We also anticipated that patients who had survived their injuries would now be coming in with secondary infections. The flight down, little more than 3 hours, was the best that I can remember. Saying goodbye to Joan, knowing she was worried, was the most difficult part of the journey. However, having been to Haiti herself, she was supportive and encouraged me to go.
Our arrival at Port Au Prince (PAP) airport was to the frenzy of military personnel ushering materials and planes through the compound. Flying over the port we could see the support ships and the USS Comfort, the US floating hospital. It reportedly could support about a 1,000 patients, but, with estimates of 200,000 killed and over 300,000 injured, all the resources in the area were being strained. It was a relief to see Tim and Troy from our window as we taxied to a stop. We quickly unloaded the plane into nearby trucks, and, following a brief clearance, we were exiting on our way to meet the other team members.
We drove directly to Pastor Ro-Ro’s clinic inside PAP. The pastor was a previous contact from Sequin with whom we have worked in the past. Following a brief hello to other team members already there, we set up stations in a second room and started seeing patients. The rest of the morning and afternoon went by quickly as we saw various patients with medical complaints and infected wounds, which we treated.
That evening we arrived at the Methodist Guest House. This lodging for the team was established by Troy through his contacts. The structure was one of the few buildings not damaged by the quake. We had learned Matthew 25 had sustained damage and had other people staying there that they could not accommodate. It was an unexpected but grateful luxury to be able to sleep on bunk beds rather than in a tent on the ground. The heat and mosquitoes make sleep difficult, but the fear of another aftershock bringing down already weakened buildings had people living in makeshift tents on the street or in open areas such as the soccer field outside Matthew 25 and a park by the Methodist House. In these areas we identified underserved people in desperate need of medical care. The team was split up over the next week, rotating between 4-6 designated areas.
A tent city of 400-500 people was outside the Methodist Guesthouse. I was assigned with others to the clinic we set up in the back. We saw many patients, dispensed medications, and allocated human reassurances as best we could. Those patients that could not get blood pressure or diabetic medication were given a supply from us and told to follow up at a hypertension and diabetic clinic in the area where they could get medication in the future. Others had abdominal complaints or diarrhea, fevers, cold symptoms, muscular aches and pains. We were able to address most of their conditions, but others required referrals like a patient with palpitations and associated thyroid enlargement, breast cancer, and others with chronic medical conditions.
That afternoon, we walked up into the tent city, and a young girl lay on a blanket with a previous incision from a femur repair. It appeared to be healing adequately, but we would need to remove the sutures before we left. An elderly lady nearby had a distal femur leg fracture that was poorly splinted and rotated out of place. She was already developing bed sores due to lying on the ground. We placed her on an army cot and transported her to a hospital where she could be scheduled for surgery the next day. We also found a young man with bilaterally infected shin wounds that required antibiotics as well as incision and drainage, which we performed at the clinic with local anesthesia.
The faces and injuries can fade with time, while others more grotesque are not as easily forgotten. By faith and the conviction that you are serving God and your fellow man you keep going. That night, we had more fellowship. Each evening meal and morning before departing for clinic, we would hold hands and pray for strength, guidance, and God’s healing presence.
This day, I was assigned to Grace Children’s Hospital. The prior day, we had a 17-year-old boy walk into clinic with bone sticking out of his lower leg. Ron, an orthopedic surgeon with our group, evaluated him. He apparently had a chronic osteomyelitis(infection of the bone) in his tibia for over 8 months. The body was trying to push the dead bone out through the skin. Beneath, the bone had remodeled, so it was still structurally sound and able to support his weight so that he could walk. We scheduled him for surgery to remove the bone and clean his wound.
Jeff Link, a maxillary-facial surgeon from Traverse City performed conscious sedation with Ketamine and Versed. I rigged a fitting onto an O2 tank that didn’t have a regulator connecting it to a mask. We had a battery operated finger oximeter to follow his O2 saturation and an earpiece to continually listen for heart tones. Beryl, Troy’s mother, interpreted and was our circulating nurse, and I assisted Ron with the procedure. All went well, and we extracted a bone shard, approximately 10 cm, from the wound.
That morning, a nurse brought a patient that had a fracture of the jawbone. Jeff evaluated the patient, scheduled her for x-rays on Monday, and wired her jaw back into place. We cleaned up from that morning and then drove over to Matthew 25 to help out other team members working in the over 1,500 person tent city. Initially, we saw a lot of patients with amputations of arms and legs presenting with secondary infections. Luckily, these were superficial at the time and could be treated with local wound care. The amputations themselves were not cosmetic, but, given the circumstances, they had to be performed to save the person’s life. If you had the opportunity to watch the Today Show, there was a documentary of the conditions at Matthew 25 on a segment of their program. Despite the Haitian people’s situation, most were thankful for the medical attention and our presence. Traveling on the road in open vehicles, bystanders would shout out, “Thank you for your help to our country.” The Haitian people’s faith in God is strong, and I am amazed at their endurance under such conditions. Their rising up, praising, and singing His name despite such hardship was, to say the least, inspiring.
The clinics were closed for services today. Therefore, we made a trip into the city to observe firsthand the damage. We stopped at Mother Teresa’s orphanage. The priest gave us a communion service. We then visited with the children in their outside temporary shelter. We helped feed the younger orphans who enjoy just the comfort of being held. They took a special interest in my sunglasses. I played keep away with one of the girls and bribed her with a bag of cookies to get my glasses back. To my joy, she took the treat and started sharing them with her other playmates. It weighs heavily on your emotions to see these children. We took up a collection to give to sister before leaving. She thanked us and extended her heartfelt appreciation to Holy Spirit and the diocese for their contributions to Haiti.
The downtown section of PAP has even more evident damage from the quake. Buildings all around are reduced to rubble or left cracked and tilted off their foundation. The pungent smell of dead and decaying bodies emanates from the ruins. It is the closest I will come to viewing what the aftermath of war must be like. In a pile of rubbish, I can make out the spine and skeletal remains of a cremated body. No identification or ceremony marked his passing into the next world. Talking to most Haitian’s we encounter, they have some relative or friend that was lost in the quake. I was relieved that many of our interpreters with whom I have created friendships in the past have survived.
We stopped by the Cathedral of PAP. A backhoe is digging through the debris and unearths some bodies. Relatives race forward to see if they can identify a loved one. They are driven back by the smell of decomposed flesh. In the corner, the cross with Christ upon it looking up to God still stands unscathed. At St. Mary’s church we also find the intact cross outside the disheveled remains of the building. Haitians stop. On their knees, they give thanks to God and ask for his saving grace.
Next, we travel up to the Seminary of Notre Dame. Upon entering, the unmistakable odor of dead bodies assaults our nostrils. An open pit with a body lays close by where we park. No words are spoken, just a silent prayer is offered for the broken body laid unceremoniously in the earth. As we stroll around the grounds, personal artifacts are scattered about: pictures of seminarians, religious books, rosaries, and a burnt, damaged chalice. This leaves a penetrating memory of the nine priests who lost their lives here during the quake. No words can adequately describe the emotions that I felt or the horrific sights and smells I encountered during this mission trip. I can only pray that God’s strength and peace be with the Haitian people and that we do not forget them in their time of need.
The mornings always start early around 6 a.m., and clinics are running before 9 a.m. I arrive at Pastor Ro-Ro’s clinic, and a line of people are already waiting to be seen. We are busy seeing patients when an interpreter comes in saying Tim wants to talk to me. He has transported a child with Hydrocephalus (an enlarged head from a blockage of fluid between the brain and spinal canal) to the University of Miami Hospital at the airport. He finds they are in need of personnel while in transition of teams. I arrive and go through a short process to review my license. The next thing I know, I am in their pediatric unit working with their wound care unit.
This is the closest thing to a MASH unit that I can describe. Patients are on cots identified by alphabetical row and number that run the length of a huge tent. Several have large wounds with VAC dressings (A type of sponge on suction used in an open wound to promote healing). To the relief of the eye doctor working in the area, I have some experience applying these. We have a nurse anesthetist using Ketamine and Versed for sedation. I debrided and redressed an arm amputation and then saw an old gunshot wound to the right leg. X-rays show a fracture of the tibia and that the bullet is still present. We consult the orthopedic surgeon who doesn’t recommend surgery but placing in a knee immobilizer with no weight bearing for six weeks on crutches as well as follow up x-rays.
Bruce and Sarah arrive, an experienced ER physician and a nurse, respectively. The makeshift ER outside was getting overrun so we started helping out evaluating and treating patients. One patient had a swollen, painful left leg following previous orthopedic surgery. We had orthopedics see him, and he was taken to surgery for exploration and wash out of a likely infected wound. Then a 3-year-old came in with a chord injury from a T8 vertebral fracture. This was stabilized, and the child was transferred out for surgery. The pediatric doctor in charge of the unit came over to our area upset we were interfering with her pediatric patients. We could do nothing but apologize and finish up since things were quieting down.
The ride back was quit an adventure. We had to wait an hour for Junior to get to the airport to pick us up. A short time later on the drive back, his truck started spewing smoke from its vents. We got out quickly thinking it might start on fire, but it appeared to be an electrical problem and was not drivable. A Tap-Tap (local open vehicle transport) stopped, and we climbed in for a smokey, dusty ride back to the Guesthouse. Despite the mask I was wearing my lungs took a hit and that night aggravated my cold symptoms. I had trouble with wheezing and coughing and did not have a restful night.
The action and acuity of patients at U of Miami was more what I was expecting to see in Haiti but we were not being utilized efficiently in that setting. The chaotic atmosphere also made it difficult to work effectively. We had a meeting that night and felt we could have more of an impact and see more patients by going out into the tent cities with a mobile unit. We repacked that night for this type of work on Tuesday.
A group of us went today to Hospice of St. Joseph. They had a small clinic set up outside and said a tent city nearby needed medical care. Bob, a primary care physician, and Sarah, a nurse, stayed at the clinic while Kelly, an ER physician, Rita, a nurse, and I went on to a tent city close to the slums. The tent city was not well organized and, judging from the smell, did not have any sanitation plan in place. We met the priest, Father Patrick, at the courtyard to the church and set up clinic near a tree. A tarp was our cover and table with some chairs our exam area. We had several mothers show up with their children. I treated a burn on a small child from spilled bean soup. Kelly worked on a revolting foot infection. The patients were not as memorable as the conditions we worked in that day. We dubbed the spot fly city. The site became infested with flies attracted to our supplies and meds. They soiled our clothes and equipment. The conditions were deplorable but we finished seeing patients that day hoping we provided some comfort. We left behind the fecal spattered tarp that quickly was taken down and used as someone’s temporary shelter.
The past few days had taken a toll on my respiratory system. The dust and fumes are hard to describe unless you have experienced a ride in the back of a truck through this congested city. This morning, I asked to stay at the Guesthouse in case I needed to use the nebulizer we had for a respiratory treatment. Luckily, when we came to Haiti we had on hand all the things we needed to treat ourselves as well as our patients. Two of our group had already had IVs placed for GI problems and rehydration. Several were also on antibiotics. One of our group got upper respiratory symptoms similar to mine. Luckily no one became seriously ill.
We spent the day treating several medical issues and minor wounds. The dressing changes were a daily event. A 3-year-old girl came in unable to walk on her left leg due to pain. She didn’t seem to have a deformity but we sent her for x-rays that showed a facture, which was casted. We made rounds in the tent city, removing sutures and a super pubic catheter in a patient with prostate cancer.
The need for further teams to come in and provide continuing care is self-evident. When possible, we tried to establish continuity of care by notifying other teams of the areas visited or telling patients where they might get help, but resources are limited. We saw thousands of patients, transferred 25 to other facilities for care, and Dr. Link performed 60 tooth extractions.
When asked if we made a difference, we thought of ourselves as the person in the starfish story. After a storm when several starfish were washed ashore over miles of beach and dying in the sun, a person started throwing them back into the ocean one by one. Another person asked him what difference he thought he could make. His simple response was, “It made a difference to that one.”
The need in Haiti will continue for weeks, months and surely years to come. It will shift from immediate adequate food, water and medical care to shelter and a rebuilding program. There will be many challenges ahead but with support from us, the Haitian people have the resolve to rise up from this catastrophe. We need to remember them in our prayers and with our time, talents, and treasures, even after the cameras and news people leave the country.
Remember Haiti needs you and you can make a difference.