Michiana Doctors and Nurses in Haiti

Goshen News Video

2010-02-22T20:12:00.001-05:00

This video highlights the team's return to South Bend, IN and Rick, Doug, and Donna recount our experiences.

Hank Chambers Video

2010-02-22T19:46:00.005-05:00

This video was produced by Hank Chambers, a Pediatric Orthopedic Surgeon who dedicated his time there OUT of the operating room to ensure everyone's wounds were appropriately attended to. He was a role model for us and because of him, we made sure we gave the patients the attention to detail that they deserved, even if it meant rounding until after midnight!

Sinead Cooney's Slide show (CLICK HERE)

2010-02-20T05:32:00.001-05:00

Made by Sinead Cooney, nurse extraordinaire, whom we met during our week in Haiti.

South Bend team video

2010-02-18T06:13:00.005-05:00

CRUDEM Blog

2010-02-17T19:58:00.002-05:00

I encourage all of you who were following this blog during our team's stay in Milot to connect with CRUDEM's blog (site listed here and on the left of the page with the site links). For our team, KDSK is a St. Louis news affiliate and we all met and interacted with reporter Casey Nolen while we were down there. There are also stories and updates on some of the Shriner's kids. All in all, a nice repository that CRUDEM updates. I for one don't want to forget the good we started and seeing that people are still working hard down there keeps it in the forefront of my memories with hopes to return soon!

Michiana Docs arrive in Milot, KDSK.COM St. Louis (Casey Nolen)

2010-02-17T19:53:00.002-05:00

Check out this video feed...you may catch a glimpse of someone you know!

South Bend Team video recap... (CLICK HERE)

2010-02-15T18:59:00.005-05:00

Check out this youtube video I made to chronicle our experiences...

How Long...

2010-02-12T18:05:00.001-05:00

How Long YOUTUBE Video

Check out this video prepared by Dr. Robin Evans, a surgeon from Canada who was in Milot with us...very moving. Thanks, Robin.

The PARADE!

2010-02-11T06:08:00.000-05:00

The kids were such troopers and despite a lot of pain going over the uneven gravel, walkers, crutches, wheelchairs, hopping, or being carried, they were determined to sing and show everyone what they could do. Now the adults SURELY had no excuse to stay in bed.

An experience of a lifetime...

2010-02-11T04:44:00.004-05:00

For those of you who have never done anything like this before, it is an experience you will never forget. We all made friends and developed relationships that will last forever I am sure. We are forever changed by the lives that we have affected, and those that have affected us. From the Brooklyn and Bermuda nurses, to the Caritas group, to the random "angels" that appeared out of nowhere unexpectedly or earlier than expected. These are the friends, experiences and memories we will have for the rest of our lives knowing that we were able to provide some assistance to this disaster ridden country.

The icing on the cake

2010-02-10T23:27:00.001-05:00

So the icing on the cake today was after weeks of hard work, multiple telephone calls and hours of paperwork and contacting of the UN and government, we were able to send 8 children to US hospitals. Remember these kids from a previous post with her having 30% burns on her back, and he having 60% burns on his body? These two cuties were in the ICU the entire week. While they had been improving, being in the less sanitary conditions there may not be the best suited for them and, with this and prior teams' efforts, today they are moving on to more definiive care at a location that is suitable to their needs.

The creative will propser...

2010-02-10T23:05:00.001-05:00

So the improvisations never cease..

The weather and work and the work take its toll

2010-02-10T22:55:00.000-05:00

The weather and the work weren't always the most cooperative but we made do with what we had...even sleeping after a long day in the hot sun or walking in the rain and mud, Fred has a smile on his face. This was one of the longer OR days of about 33 operations/procedures in one day and rounds for the Ward teams went on until 5-6pm. Definitely a well deserved break.

Our various roles...

2010-02-10T22:32:00.000-05:00

As you can see, we all had to multi-task and that was the strength of this group. All were able to flex up or down. Whether it was working in preop, as a CRNA, ICU nurse, ortho tech, transporters, sedation, ward staff, wound care team, housekeeper, engineer, there was no shortage of work to be passed around that's for sure!

The long-awaited PARADE!

2010-02-10T19:34:00.004-05:00

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The 50+children in the peds ward rehearsed long and long and hard and were excited to motivate their adult counterparts get up and do their physical therapy. Morale was surely boosted both for the patients as well as the staff. It brought tears to many eyes who have for the first time seen the fruits of their arduous labor and see that we truly are doing good

Our crew and the trip

2010-02-10T19:33:00.001-05:00

Sorry there were no posts for the past couple of days...I think rain or something slowed the internet to a crawl. Finally I'm in a hotel in FL and can fill you in on more details.

Let's start with the Surgery Crew:

Mike, Fred, Henry, Randy, George and Dana along with Dr. Bernard, the local Haitian surgeon performed over 120 procedures including skin grafts, amputations, ORIFs, dressing changes, and washouts in addition to roaming the tents filled with the 420+ patients here. This eval allowed them to identify patients that urgently needed attention to. Jeff and Rick had to keep up with the anesthesia, but with such a volume, they recruited Doug to assist with procedural sedation. There were probably more patients with external fixators here in one location than most US physicians would see in their lifetime.

All this was done without the use of fluoro/C-arm, so you can truly see they have to be experts at their jobs!

The Parade

2010-02-10T18:56:00.000-05:00

Can't wait for the parade

2010-02-09T01:32:00.004-05:00

Karen, one of the pediatric Physicians shared with us the touching story of this "baby boy". He was orphaned, no known name with an amputation of his L leg. I saw him when he presented to the ER tent as Heather, Mike, and Catch assessed him. He was calm, no crying, smiled, and the minute Karen picked him up, he gave her a hug as she carried him to the Peds ward. She named him Jean Pierre. The neighboring family adopted him and the mother, whose son was also injured in the quake, cares for him as her own. In the 2 days he has been there, he now responds to his new name, is quite protective of his "mother" and even gets along with his older "brother". Stories like this are countless and make the long and tiring days worth it.

Tomorrow, the pediatric patients (who are housed in the Nutrition Center) ave been practicing french songs like Frere Jacques and others to raise the morale of the adults. They will tramp through the wards and tents on their crutches singing and dancing as best as they can. I just may have to take a break so I can see it.

A better day so far-except for the rain...

2010-02-08T14:03:00.002-05:00

Rain all day...how miserable to care for patients. Our scrubs are covered in mud, we are sweating under the ponchos (for those that have them), and then freezing in the ICU and OR. All not as bad as my little friend here...he has 60% BSA burns, goes to the OR every other day for a dressing change. He came back 94 degrees after the OR! I should have NOTHING to complain about! George has been operating on him every time since he's been here and we are at the end of our rope with what we can do with his grafts, and we just heard word that he is accepted state-side soon!

As for my ventilated patient, Dr. Previl was ecstatic that this was the first successfully ventilated then extubated patient they have had here at Sacre Coeur! As you may recall, when I got here my 1st day, she was intubated with a heart rate of 140 and breathing 55 times/minute, completely lethargic. Her brother was here today, she is all smiles, using her incentive spirometer.

Day 5...a trying day

2010-02-08T06:01:00.004-05:00

To get away from it all, I took a sunrise walk before the start of the day to head to the "palace". Built in the early 1800s it was a time of solace for me at the start of a very trying day. I ran into Jean Jerome, an 18 year old boy who was studying geology and instantly became my tour guide (for a couple of dollars...).

It's tough being in charge of the medical operations, but I rely on Mark Walsh to handle the daily rounds with the ER docs/internists, wound care and RNs and Barry the the designee on the Nursing side and both have been God-sends. I handle the ICU in addition to the med ops, and today took its toll on me a bit emotionally. I stayed to take care of a couple of kids in the ICU for severe burns. Myerlene (i'll get a pic later) has burns on her back suffered in the earthquake, she sleeps in the wards, and comes to the OR for her dressing changes. Today, her wound was full of bugs, got washed out by Dr. Friend, and she has only a tiny glimmer of hope to get to Shriner's. Her meds and antibioitcs were inadequate, her IV came out, and I didn't know what else to do. Her neighbor, Lucson has 60% burns all over his body and is constantly in pain.

So I didn't blog yesterday because emotionally it was a very tough day...sick patients, sick kids, constant running around. Finding ICU coverage has been particularly challenging but I awoke this morning refreshed I have to say this is a tough environment to work in and we are all here volunteering our time to the Haitian people, and we all have to realize each of us can only do so much. It sure makes residency look easy!

Well, last night I had a great night's sleep, will extubate my patient, Elie, today, and will try to get more pictures for you all! (no promises...)

The team at work...

2010-02-08T05:45:00.002-05:00

Everyone is keeping busy with the daily "routine"

Trail Angels

2010-02-08T05:33:00.005-05:00

I hiked part of the Appalachian Trail last year and they call them trail angel. Basically when the most appropriate item/person shows up at the most opportune time to leave you a small piece of heaven to maintain your sanity or survival, it was left by a "trail angel". This trip has been full of them. The last couple of days have been the most trying. I have been in charge of the medical operations on the Physician side as well as responsible for the ICU. At a trying time when temperatures were extremely hot, tempers (and staffing) were running short, out of the "sky" appeared a team from Utah. A surgeon, a translator, and a medic just happened to hop a helicopter from PAP to see if we needed help, and indeed we did! We put them to work and it allowed both the medical teams and surgeons to benefit from their expertise and experience.

Whether it's the military, that shows up to bring us much needed food and supplies, or the 2 pediatric nurses that appeared just when I was ready to throw in the towel when we had no overnight coverage in the ICU for our sickest pediatric burn patients or the UN just when we need them to beef up security....it is truly unexplainable.

Hey You! Photo!

2010-02-06T12:59:00.002-05:00

These kids, too, love getting their picture taken and the minute anyone walks in with a camera...a slew of "Hey Photo!" is yelled out, despite the fact that none speak english.

The pediatrics ward brings another whole set of challenges. The kids are great at doing therapy, have been dealing with their injuries and amputations in stride and really do so with a smile on their face.

Families really provide most of the routine care for the patients. Rehab, bathing, feeding, play therapy. Today, Dr. Mike brought them stuffed animals, some used as pillows, all brought smiles to the kids faces.

Day 4...

2010-02-06T06:36:00.003-05:00

So I realized I never introduced who we are. I'll try to get pictures of everyone today and post them to give you a look at what each of us is doing, but in the meantime, here's a list of the people in our group:

Mark Walsh ER
George Friend General Surgery
Rick Skupski Anesthesia
Michelle Crawford OR Nurse
Donna Dickens OR Nurse
Kyonna Charlston Critical Care Nurse
Meredith Wierman Infectious Disease
Jeff Lindquist Anesthesia
Doug Gibson Critical care RN
Mike Yergler Ortho
Fred Ferlic Ortho
Randy Ferlic Ortho
Henry DeLeeuw Ortho
Dana Brackett Ortho NP
James Wierman Critical Care Internist
Joey Garcia ER/Critical Care

People come and go just about every day. A sad but necessary part of the turnover of care as the duration of committment ranges from 1 week to several months. It's difficult because we are constantly orienting new arrivals every day and there is really no "routine". Most of us relocated to rooms last night (and some even had real beds!). That meant no mosquito netting, a better and more comfortable nights sleep.

Lastly, I just found out I will be the new Medical Operations leader for the next few days until I leave on Wednesday... This means I have to direct the ever-changing climate here. The past few days we found ourselves moving out of the school which we were using temporarily into the "tent city". We are trying to discharge our paraplegics to a local hospital that can provide them better accommodations than military cots in a tent to as to prevent decubitus ulcers. We also find ourselves becoming dedicated to wound care. The rumor is there will be no new patients coming or redistributing, but that is an ever-changing target and at the whim of the military since 2 days ago we heard we would be getting 100 new patients and we were ramping up to prepare for that.

I have better internet now, so will try to let you know more about our group, what life is like down here for the local people here and our patients who have been displaced from their homes.

PLEASE keep the comments and the prayers coming. The group is able to see your posts and it provides us a boost in moral at the end of our exhausting days.

-Joey

Rick is feeling better!

2010-02-05T20:27:00.002-05:00

Rick's sodium is back to normal...now 138. He feels back to normal and has been sleeping in the fully air-conditioned storage room (you actually need a blanket there..). Gatorade is his friend, and, despite our recommendations, he is determined to stick it out here.

Gangrene is not your friend...

2010-02-05T20:21:00.003-05:00

So this is our approach to the "time out". No mistaking which side needs to be done here...this woman now resides in my ICU. We have found ALL of our patients to be profoundly anemic and this one had a hemoglobin of 7. This likely reflects the poor nutritional status of the Haitian population. We transfused WHOLE blood also...not done too often at home. She did fine, source control helped her out and hopefully she will be fine tomorrow now that we have removed her the Randy and Fred have removed her gangrenous leg.

Day 3 begins!

2010-02-05T18:43:00.003-05:00

Really, just our 2nd full day...the camp is the same, sunny out, though threatening to rain. Still HOT and standing water means more mosquitos after the rains yesterday. There is plenty of Deet to go around for us, but work...work...work. The patients still need a lot of attention...

Helps to be a boy scout...

2010-02-05T18:39:00.005-05:00

So a boy scout I never was, but we do have "MacGyver" things on a daily basis. From crutches to wound vacs to splints to tourniquets to saline locks...camping mattresses used for the para/quadraplegics to prevent decubitus ulcers. These are just some examples

Some of our patients

2010-02-05T12:35:00.003-05:00

This is just a small sampling of the kinds of cases we see here, some sad, but the occasional heartwarming ones too:

(From the bottom to the top)
1. Sepsis (our vent patient is doing well, possibly extubated tomorrow)
2. Cast changes
3. Extremity amputations, in this case 6 year old boy had an above elbow amputation
4. Infected wounds get washed out.
5. For the first time, I was able to show this woman that her baby was alive and doing fine. She, I, and her neighbors were cheering and crying. Truly one of the most heartwarming moments of my life...

Our first official day

2010-02-05T12:33:00.003-05:00

The gang is bright eyed, bushy-tailed, and Fred is ready to work on his tan.

2010-02-05T12:33:00.001-05:00

The "ER"

2010-02-05T12:31:00.001-05:00

This is what can happen in the ER after just 1 or 2 helo landings...surge capacity is our motto

ROAD TO RECOVERY!

2010-02-05T12:20:00.003-05:00

CASE: 52 yo male in Haiti drank 3 beers the night before, awoke and drank 3 liters of water. During the AM, he continued to drink another 4-5 liters of water, had a late lunch. By Dinner time, he feels nauseated, gets `2L ringers lactate. He is checked on but shows worsening with facial and peripheral edema. VS: 150/80 HR 80, RR 16, SaO2=86%. He is treated presumptively with a drug that completely reverses his condition within a few hours.

Diagnosis???

SEVERE HYPONATREMIA.

NA=117!!!

This was our friend, Rick's, condition last night. We gave him 40mg lasix (no 3% saline here....), with IVF, Na corrected to 121 after 6L of urine output in the next several hours. With diligent care by Kyonna, our ICU nurse, who replaced his urine output cc for cc, titrated his IVF drips per my orders, emptied his catheter (yes, he got a foley catheter), by morning, his sodium is corrected. He is raring to go back to work , but we are encouraging him to take it easy. Thanks everyone for your prayers and giving us the ability to treat him in the most sublime of conditions.

A rough 1st day!

2010-02-05T04:48:00.002-05:00

Yes, it's 5am and I haven't been to bed in almost 24hrs. No helos today, thankfully, and the ER is emptied out. We are consolidating patients to the central "new hospital" tent area. Just when we had everything squared away, we were met with a TORRENTIAL downpour...flooding, leaking tents. And to top it all off, one of our team members, Rick, fell extremely ill. I have been up with him all night in the hospital ICU. The team really pulled together to care for him...carrying equipment down the muddy street on their backs, oxygen tanks, cardiac monitors, drugs, IV fluids. He is out of the woods and will be just fine.

After a day/night like this, I can honestly say it is a privilege to be here with such a committed and caring group of doctors and nurses, most of whom I have met just 2 days ago. Well, given I haven't slept a wink, you'll have to wait until later for more pics of today's events, etc...

Our Tent

2010-02-04T06:08:00.003-05:00

Our sleeping quarters...one big tent complete with mosquito netting for the 16 of us. No one was a big snorer, thank goodness, and we were lulled to sleep by the dogs barking, roosters crowing. Quite peaceful and restful, actually, but maybe we were just EXHAUSTED!

Daily Debriefing

2010-02-04T06:02:00.003-05:00

Our daily debriefing happens every day at 8:30 pm where we discuss what transpired that day. Todays events focused on moving to the new "Wards", decompressing our current situation in anticipation of a "surge" delivery of patients. The military is planning on getting everyone out of the other temporary facilities to more "permanent" ones such as ours

The first intubation

2010-02-04T05:58:00.003-05:00

A very FIRST for Hopital Sacre Coeur...So I Intubated the very first patient here...a woman we discovered now has pneumonia who was breathing 60 times a minute, obtunded, HR of 160s. She is doing well on our new ventilators! We were able to "rig" it to use very minimal oxygen as the vents have their own compressor. Let's pray the she does ok!

The "Board"

2010-02-04T05:52:00.003-05:00

~25-30 surgeries are performed here on a daily basis, mostly orthopedic on the Earthquake victims from PAP (Port-au-Prince). Some require washouts, external fixators, skin grafting, but even some general surgical procedures.

H1/N1

2010-02-04T05:49:00.001-05:00

Even in Haiti, gotta prevent H1/N1! This hospital usually serves as a site for excellent outpatient care, preventive health, and specialty surgery, depending on what volunteers come here for mission work.

"Old Hospital"

2010-02-04T05:46:00.002-05:00

Across the street from the "WARDS", the "OLD HOSPITAL" still functions to service as the local ER and inpatient facility, but the operating rooms and ICU now comprise the bulk of activity here. We do have xray facilities and a lab!

The WARDS

2010-02-04T05:44:00.000-05:00

5 tents, 1 (ER) and 4 inpatient where we do our assessments and daily care of the patients

The walk

2010-02-04T05:42:00.001-05:00

It's a short jaunt (~1 block) from the compound to the neighboring "tent" hospital (ER and Wards) and "old hospital" (Operating rooms, PACU, Recovery, ICU)

Helicopter Landing

2010-02-04T05:37:00.002-05:00

Helos land on the neighboring soccer field....here we received a man and woman from USS Comfort

Orientation

2010-02-04T05:32:00.006-05:00

Just out of our transport, Dr. Mike, from Boston, gives our team our first look at the reality of the environment. Nearly 400 patients depend on the volunteers and staff medical teams to provide top notch care in suboptimal conditions. Patients were moved yesterday from the schools (schools back in session come next week, which is a great thing!) to newly set up tents. The problems of sanitation, room, and board will soon become a focus as these are entities that the older faciiities (a previously 73 bed hospital) were not anticipating.

Well supplied

2010-02-04T05:32:00.003-05:00

Well supplied

2010-02-04T05:32:00.001-05:00

2010-02-04T05:29:00.002-05:00

Arriving at CRUDEM. This facility as you will see from the upcoming pages, is quite safe and secure and, most importantly, is replete with medical supplies and dedicated volunteers and staff!

Long day....

2010-02-04T00:12:00.000-05:00

So, our first day is over. 400+ patients moved into brand new tents. Just got our ventilators here today and I already had to intubate someone in respiratory failure from pneumonia. Limited labs, no xrays, plenty of docs, excellent nurses, PTs, staff. Food is excellent, accomodations more than adequate with mosquito netting. It should be busy...more helos expected tomorrow... Tomorrow brings another day full of surgeries, wound checks, rounds, and who knows what else.

At CRUDEM, Milot, Haiti

2010-02-03T14:11:00.000-05:00

Getting a tour from Dr. Mike the ER doc here. Hospital moved to tent city near school. Many many many patients...>400??!! Pictures to come. Staying in a tent tonight.

At the airport waiting to go to Haiti

2010-02-03T06:26:00.000-05:00

So 16 docs and nurses are here ready to go. 3 ventilators, 800 lbs of equipment, unaware of what we are to encounter...will blog more Haiti-side.