Now you can view all the photos I took in Haiti. Stay tuned for more photo captions in the albums and more stories here on this blog.
I want to thank you all for your interest in and support of my efforts down in Haiti. I give special thanks to my Colville clinic Northeast Washington Medical Group and our CEO Ron Rehm for their offer recently to donate towards covering a small portion of my trip costs. I will continue to be grateful for any more donations anyone desires to give. It means alot to me that people so far away from the suffering are willing to sacrifice to support aid efforts like this. Also, I want to thank Heart To Heart International and its wonderful staff for giving me this opportunity to get to know and serve the Haitian people. HHI really is a great organization to work with and needs more volunteers to help the greatly needed free urgent care clinics go on further in Haiti.
A middle-aged woman took her spot on the beach clinic bench Tuesday and asked me to end her pregnancy because she has nothing and can't stand to give this horrible life to another child. Then she called her five born children over and said that, in fact, she would like me to take all of them away, since she has no food, no water, no father, no home, no future for them. I could hardly keep from crying. All I could do was testify of God's love for her and her family and that I believed things would get better soon for them. I gave her prenatal vitamins and treated her anxiety and insomnia and wished her and her children the best. Once again I felt quite helpless facing the overwhelming needs in Haiti.
Wednesday I came back to Port-au-Prince after running the Leogane clinic site for 6 days. I'll miss the peaceful hospitable Mennonites we stayed with there, but it's nice to have more than a cold trickle for a shower again and not be bitten by malaria-laden mosquitoes every evening. Fortunately it looks like my Malarone worked and I didn't get malaria.
My last clinic work in Haiti was running a mobile clinic from a taptap (covered pickup) Thursday morning with a great ER nurse Anita, one of our best translators Callix, and a helpful med student Alex. We pulled up to a tent city a few blocks from our main Bel Air church/clinic location, and as soon as they saw a doctor, people started swarming to the back in a rough line seeking medical care. We treated the usual problems of gastritis, diarrhea, dehydration, anxiety, insomnia, wound infections, hypertensive emergencies, heart failure, eye/airway irritation, bladder/sexual infections, and musculoskeletal pain from sleeping on the concrete. After seeing 17 patients in two hours, there were still plenty of people wanting to be seen, but it was time to switch out with another doctor so I could go catch the UN flight to Santo Domingo. Crowd control sure was an adventure. I got to the point of conducting about 60% of the interview in Creole, and it was great to connect with these grateful and resilient people in their language. I told every one of them "God bless you" and pray they will be a little better off for my seeing them.
I had a nice free UN humanitarian aid flight to the Dominican Republic, a relaxing night at the bed and breakfast in Santo Domingo, a special time seeing my physician-assistant uncle Bill in Ft. Lauderdale during my layover there, and a good night sleep last night at my parents' place after arriving on a late flight, and now I'm heading back up to Colville to finally be with my wife and kids again. But I'm still having dreams and thoughts about all the people needing help but there being no way to get to them all, and I keep thinking at first that any slight building shaking I feel could be an earthquake. My heart continues to ache for the seemingly unending suffering rampant throughout Haiti. Even more than when I returned from serving in Ukraine as a missionary for two years, I am having some culture shock as I return to see so much frivolousness in our world, and I'm reminded that we in our nicely developed countries have so very much. I hope we will avoid wastefulness and idleness and work for the good of others and share with those who need more. Haiti has left a lasting impression on me and hopefully will change us all for the better forever, though I'm sure we imperfect humans will need plenty of reminders.
Saturday, February 27, 2010
Tuesday, February 23, 2010
Clinic at the Beach
Today a Med-Peds resident and I ran a clinic on the rocky but beautiful beachfront of Gressier, where the resort complex and just about every other building has been leveled. We saw nearly 40 patients and had some more waiting but then a very sick febrile incoherent young man was brought over in a rush, and we gave him a shot of antibiotics, then packed up and rushed him to the Doctor's Without Borders (MSF) hospital, unfortunately not having seen everyone waiting to see us today.
Last night we examined an 11-yr-old Haitian girl with a long-standing heart valve problem who was brought to us from the countryside by some of the Mennonites here. For the last 2 weeks her breathing was getting worse and her legs were swelling up. When we saw her she was breathing 40x/minute and her heart rate was 140, and she couldn't even walk on her own due to her weakness. We gave her some Lasix and loaded her into the Mennonite pickup and brought her into the MSF hospital. I got to carry her in and give report to the Haitian doctor on night shift. She was terrified.
They took care of her overnight but we heard today that she died mid-day today. Apparently she never diuresed, so she was quite far along in congestive heart failure when we saw her, and she probably needed dialysis and heart surgery, which was just not possible here right now. It's so sad so many people are perishing here because they have such horrible access to medical care. I'm glad we're able to improve that somewhat for the time being, but the long-term task in Haiti before the world is overwhelming.
Another strong 4.7 aftershock jolted us all awake this morning at 1:26am, and many couldn't get back to sleep. Today in clinic there were several young men seeking care for numerous symptoms of anxiety and stress. Most people are pretty shaken up by these recent tremors, and I don't blame them. Alot of people in "stable" houses are sleeping outside now for fear of another earthquake. I wonder how long the people will live in this fear. Basically 99% of them sleep outside, even the few that have no significant damage to their homes (rare). The air is stifling from all the burning plastic trash in the streets and the rubble dust and congested traffic. I've been advising lots of people with respiratory irritation to use a mask or handkerchief. At least they don't smoke (because they can't afford it).
This afternoon I represented Heart To Heart at the Leogane UN OCHA (Organization for Coordination of Humanitarian Aid) Health Cluster Meeting. (This was the first place I really ran into cigarette smoke, ironically.) It was interesting and very useful to see the latest health care efforts around town and learn better where to send which patients where. Also we are trying to coordinate efforts to provide as much medical care to the surrounding population as possible. Heart To Heart is planning to have a permanent presence of medical volunteer care here and in Port-au-Prince, which is really needed here, especially as alot of international hospitals/groups have already pulled out. I pray Haiti will continue to have the attention of the world, for they will need so much help for so long.
Last night we examined an 11-yr-old Haitian girl with a long-standing heart valve problem who was brought to us from the countryside by some of the Mennonites here. For the last 2 weeks her breathing was getting worse and her legs were swelling up. When we saw her she was breathing 40x/minute and her heart rate was 140, and she couldn't even walk on her own due to her weakness. We gave her some Lasix and loaded her into the Mennonite pickup and brought her into the MSF hospital. I got to carry her in and give report to the Haitian doctor on night shift. She was terrified.
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| From 2010-02-22 |
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| From 2010-02-22 |
They took care of her overnight but we heard today that she died mid-day today. Apparently she never diuresed, so she was quite far along in congestive heart failure when we saw her, and she probably needed dialysis and heart surgery, which was just not possible here right now. It's so sad so many people are perishing here because they have such horrible access to medical care. I'm glad we're able to improve that somewhat for the time being, but the long-term task in Haiti before the world is overwhelming.
Another strong 4.7 aftershock jolted us all awake this morning at 1:26am, and many couldn't get back to sleep. Today in clinic there were several young men seeking care for numerous symptoms of anxiety and stress. Most people are pretty shaken up by these recent tremors, and I don't blame them. Alot of people in "stable" houses are sleeping outside now for fear of another earthquake. I wonder how long the people will live in this fear. Basically 99% of them sleep outside, even the few that have no significant damage to their homes (rare). The air is stifling from all the burning plastic trash in the streets and the rubble dust and congested traffic. I've been advising lots of people with respiratory irritation to use a mask or handkerchief. At least they don't smoke (because they can't afford it).
This afternoon I represented Heart To Heart at the Leogane UN OCHA (Organization for Coordination of Humanitarian Aid) Health Cluster Meeting. (This was the first place I really ran into cigarette smoke, ironically.) It was interesting and very useful to see the latest health care efforts around town and learn better where to send which patients where. Also we are trying to coordinate efforts to provide as much medical care to the surrounding population as possible. Heart To Heart is planning to have a permanent presence of medical volunteer care here and in Port-au-Prince, which is really needed here, especially as alot of international hospitals/groups have already pulled out. I pray Haiti will continue to have the attention of the world, for they will need so much help for so long.
Monday, February 22, 2010
Aftershock this morning
At 4:36am today we were all jolted awake by a few-second-long 4.7-rated aftershock. I stayed in my tent outside. No damage seems to have occurred. I'm sure this was pretty scary for all the people who went through the big one.
Yesterday was a great Sunday. After going to some of the Nazarene service, I walked to the LDS chapel and enjoyed a full service there, packed with many hundred Haitians. A group of 30 American LDS doctors and nurses had arrived there and are running an urgent care clinic and some surgeries out of the church this week. We were able to exchange some supplies and obtain some valuable meds we've been needing, including anti-malarial and anti-scabies medicines. They were happy to share their tetanus vaccines, which is like gold here, with us and store them in our fridge, since they don't have any 24-hour refrigeration at the church.
It was again eye-opening to walk through the city and see how people are living and all the overwhelming destruction everywhere. The Haitians all looked amazingly well-groomed and neat for Sunday despite sleeping on the streets and not having any running water or other modern amenities.
Last night I had a great time harmonizing with the Mennonites singing lots of nice hymns a capella in parts. What wonderful people.
Today I have new partners for the clinic here: an OB/GYN doctor and an RN. Should be great working with them. I'll try to post more soon! Hopefully the internet will cooperate better and I can post more photos.
Yesterday was a great Sunday. After going to some of the Nazarene service, I walked to the LDS chapel and enjoyed a full service there, packed with many hundred Haitians. A group of 30 American LDS doctors and nurses had arrived there and are running an urgent care clinic and some surgeries out of the church this week. We were able to exchange some supplies and obtain some valuable meds we've been needing, including anti-malarial and anti-scabies medicines. They were happy to share their tetanus vaccines, which is like gold here, with us and store them in our fridge, since they don't have any 24-hour refrigeration at the church.
It was again eye-opening to walk through the city and see how people are living and all the overwhelming destruction everywhere. The Haitians all looked amazingly well-groomed and neat for Sunday despite sleeping on the streets and not having any running water or other modern amenities.
Last night I had a great time harmonizing with the Mennonites singing lots of nice hymns a capella in parts. What wonderful people.
Today I have new partners for the clinic here: an OB/GYN doctor and an RN. Should be great working with them. I'll try to post more soon! Hopefully the internet will cooperate better and I can post more photos.
Friday, February 19, 2010
Léogâne - The Epicenter
On Wed I had another gratifying day of clinic in our clinic in PAP, which we revamped that morning with exam tables, dividers, a large wooden medicine cabinet, and new instruments/supplies. See the blog of my friends Aaron and Maryclaire for more details of the work going on in PAP now. Haitians continue their fight for survival on the crowded city streets, improvising with the few supplies and little space available - one long skinny median on the outskirts of PAP is covered completely with makeshift tents people are living in right in the thick diesel fumes.
Yesterday two nurses and I came to Léogâne (right by the epicenter, so the destruction here is profound, rated at 90% by the UN) with two nurses to replace a team that left that day (a PA, an FP, and two nurses), and now I'm the Heart To Heart provider coordinating the urgent care clinic at the Nazarene Church here. We'll get another doctor or two and another nurse or two as reinforcements in the next couple days.
The ICU nurse and I were the main providers in clinic today, and between the two of us we saw 62 patients. She consulted me alot, but actually she's been a provider like this on mission trips before, which experience is very helpful. The pastor's wife (Haitian) helped with wound care and the other nurse ran our pharmacy, which turns out to be a bit better supplied than the PAP clinic. The church we worked in has a tin roof on steel supports, so it feels a bit like an oven inside. Again we saw numerous patients complaining of gastritis, respiratory irritation, back aches, diarrhea, UTIs, wound infections, scratchy eyes, and most frustrating, lack of food and water. We are giving every patient a single dose of anti-parasitic medicine to free them of the worms that inevitably suck away over 30% of their already pitiful nutrition. Most people here suffer from physical manifestations of the intense psychological trauma they have gone through, including anxiety, despair, sleeping disruption, and even anger. The Doctors Without Borders website has an excellent article explaining the current state of international medical care here in Haiti.
One of my afternoon patients was a 50-year-old 9-mo-pregnant woman with headache and visual problems who turned out to have a BP of 220/120 (glad I checked!) so I diagnosed her with preeclampsia. Her first baby died at 1.5yrs, her second pregnancy ended in miscarriage at 6mo, so I hope for her that this child (probably her last) will be the one she'll raise to maturity, despite the odds being stacked against them both. Her cervix was not open yet, but for her safety she needed to deliver the baby, so I saw the last few patients then together with our driver brought her to the local Doctors Without Borders (MSF) hospital for induction or C-section. The American Seattle-trained FP doc in admitting there graciously accepted her promptly into the maternity ward and gave me a quick tour of the 100-bed full tent hospital on the way. Pretty busy and quite amazing. They have 10 deliveries a day there, including a couple C-sections, and the ortho doc there is apparently tiring of assisting the general surgeon on C-sections there, so now they may call me if they need a C-section assist this week that I'm in town, which would be pretty exciting.
We are staying in tents at a safe Mennonite compound nearby the clinic where for 25 years this group of Mennonites has been educating and sheltering 30 or so Haitian girls here from impoverished or abusive backgrounds. With various volunteers they make doilies, baskets and other crafts for sale, which proceeds help fund their school. The Mennonites here are all wonderful, kind-hearted people, and we are provided with three superb hot meals a day. The stars here are beautiful. The wash water is not that reliable, but now that we have tents to stay in the conditions are much better than the last "extreme team" endured. I've seen a gecko and plenty of mosquitos, probably malaria-ridden, but I haven't seen any of the infamous tarantulas or bats here yet. Wireless finally started working today since one of the Mennonite men spent hours fixing the satellite transmitter.
I just felt my first aftershock (a brief mild rumble), so I think I'll head to bed now. :) Many thanks to all of you who are listening in on my story here and showing me your support during this rough but amazing experience. God bless!
Yesterday two nurses and I came to Léogâne (right by the epicenter, so the destruction here is profound, rated at 90% by the UN) with two nurses to replace a team that left that day (a PA, an FP, and two nurses), and now I'm the Heart To Heart provider coordinating the urgent care clinic at the Nazarene Church here. We'll get another doctor or two and another nurse or two as reinforcements in the next couple days.
The ICU nurse and I were the main providers in clinic today, and between the two of us we saw 62 patients. She consulted me alot, but actually she's been a provider like this on mission trips before, which experience is very helpful. The pastor's wife (Haitian) helped with wound care and the other nurse ran our pharmacy, which turns out to be a bit better supplied than the PAP clinic. The church we worked in has a tin roof on steel supports, so it feels a bit like an oven inside. Again we saw numerous patients complaining of gastritis, respiratory irritation, back aches, diarrhea, UTIs, wound infections, scratchy eyes, and most frustrating, lack of food and water. We are giving every patient a single dose of anti-parasitic medicine to free them of the worms that inevitably suck away over 30% of their already pitiful nutrition. Most people here suffer from physical manifestations of the intense psychological trauma they have gone through, including anxiety, despair, sleeping disruption, and even anger. The Doctors Without Borders website has an excellent article explaining the current state of international medical care here in Haiti.
One of my afternoon patients was a 50-year-old 9-mo-pregnant woman with headache and visual problems who turned out to have a BP of 220/120 (glad I checked!) so I diagnosed her with preeclampsia. Her first baby died at 1.5yrs, her second pregnancy ended in miscarriage at 6mo, so I hope for her that this child (probably her last) will be the one she'll raise to maturity, despite the odds being stacked against them both. Her cervix was not open yet, but for her safety she needed to deliver the baby, so I saw the last few patients then together with our driver brought her to the local Doctors Without Borders (MSF) hospital for induction or C-section. The American Seattle-trained FP doc in admitting there graciously accepted her promptly into the maternity ward and gave me a quick tour of the 100-bed full tent hospital on the way. Pretty busy and quite amazing. They have 10 deliveries a day there, including a couple C-sections, and the ortho doc there is apparently tiring of assisting the general surgeon on C-sections there, so now they may call me if they need a C-section assist this week that I'm in town, which would be pretty exciting.
We are staying in tents at a safe Mennonite compound nearby the clinic where for 25 years this group of Mennonites has been educating and sheltering 30 or so Haitian girls here from impoverished or abusive backgrounds. With various volunteers they make doilies, baskets and other crafts for sale, which proceeds help fund their school. The Mennonites here are all wonderful, kind-hearted people, and we are provided with three superb hot meals a day. The stars here are beautiful. The wash water is not that reliable, but now that we have tents to stay in the conditions are much better than the last "extreme team" endured. I've seen a gecko and plenty of mosquitos, probably malaria-ridden, but I haven't seen any of the infamous tarantulas or bats here yet. Wireless finally started working today since one of the Mennonite men spent hours fixing the satellite transmitter.
I just felt my first aftershock (a brief mild rumble), so I think I'll head to bed now. :) Many thanks to all of you who are listening in on my story here and showing me your support during this rough but amazing experience. God bless!
Monday, February 15, 2010
First Day in Clinic in Port-au-Prince
Today we finally got to see patients in clinic in the very poor Bel Air area of Port-au-Prince. See my latest photo album. We are using the top floor of a Nazarene church with no structural damage, neighbored by two huge piles of unidentifiable rubble from two collapsed buildings - a school and an apartment building. The days and hours before clinic we gathered and arranged our medicines and supplies and planned how we would treat the prevalent diseases with our very limited current supply.
Around 9:30am (later than planned) we climbed aboard a rented "taptap" (named that since you tap the side to request a stop), the main form of public transportation in Haiti. It is a small pickup truck with its bed covered by a partial camper top with view-holes up front, windows on the side, and a wide open back (no tailgate) with a rail with grating on the sides. You sit on 2x8-board benches on the sides of the bed, and all your have to rest your back against is a jagged metal ledge jutting out. The roads are of course the craziest bumpiest obstacle course ever, and there is not much to hold onto, but you have to be careful not to bruise your arms, break a rib, knock your head on the roof, or fall out the back. Most taptaps are painted in unique colorful and beautiful Christian Haitian cultural murals, but ours is a bland unmarked one, though just as run-down and shock-less. The 45-minute ride into downtown Port-au-Prince is the craziest dustiest stinkiest bumpiest route I've ridden, and now I understand why I was advised to just not look while the laid-back drivers weave across the entire road to avoid 2ft-deep potholes and pass all traffic possible without more than an inch or so margin. They honk for everything, and pedestrians including kids are barely jumping out of their way. There are a few traffic lights working, but they just create more rules to be broken.
The concrete dust and diesel/gas smog (and occasional stench of corpses) are all quite overpowering, though a bit better with sunglasses and a mask I wear sometimes. The destruction is simply everywhere and is just overwhelming. Rubble is still overflowing into most of the streets, even though Canadian crews have already hauled miles of rubble to the outskirts of the city, on top of which incidentally people are already staking out tent space, since any space is such a premium. The bustling population is so amazing to watch constantly doing everything they can to survive in this disaster and chaos, and so many emotions are etched in all their faces.
Today was the first time to use this facility for clinic. Until the three days of mourning, Heart To Heart served in the large bowl-shaped Stadium where thousands have been camping out since the earthquake. They decided to move the clinic out because the with no sanitation or ventilation and with tense crowds. When we arrived at the church there were already 50 people lined up on the benches inside to see us. We have our clinic area in the rear loft of the church, overlooking the chapel on one side and the destroyed city and the seaport on the other. To get there you have to climb three flights of stairs, the last with no railings or sides. (Like a cardiac stress test on the way in!) We have someone assist elderly up and down those last stairs. The loft floor is rough dusty concrete, and rebar and blocks are sitll lying in one area from the fallen little tower that was on the roof, but the space has lots of great natural light and ventilation through the windowless concrete frames. We set up three provider stations and one wound care and one pharmacy station. We frequently help out with each other's patients. It runs pretty smoothly. We work well as a team, and our translators help keep things moving. They are all pretty decent and kindly are helping me to learn Creole. The translators and our drivers are young men whose studies or jobs were derailed and now they have scrambled to get these very nice jobs at $20/day, and numerous friends of theirs are always trying to volunteer with hopes of them getting paid too. Any job is a Godsend right now, especially considering that PRE-earthquake Haiti's legitimate employment rate (not UNemployment) was a mere 7% and median income was less than $2 a day.
We saw 115 patients today, with the doors apparently having been closed at 4pm for a few more non-urgent cases to come the next day. We had a small lunch break in the middle, where we shared powerbars with our translators. I saw 25 of my own patients personally, similar to the others' numbers. The statistics I was quoted before of 60-100 patients per day per provider turned out to be an exaggeration, but 6 patients an hour is already alot faster pace than I've ever had in clinic in the States (the barebones charting helps!).
With a slower pace than I had imagined, I enjoyed taking a moment to learn about their homes and families and sleeping conditions and express my condolences for their great losses. About 90% reported sleeping on the loud rocky street under occasional rain in front of their destroyed home (Bel Air was hit hard), hence understandable the myriad complaints of back pain and insomnia! Everyone lost someone close to them in the quake, some lost many family members. The prime minister of Haiti announced that 270,000 people have been buried in the mass graves alone. We gave out lots of Benadryl for itching scabies (no ivermectin cure pills yet) and insomnia. What they really need is tents and sleeping mats and a safe place to camp. Of course when hurricane season comes the tents won't help much though. Also, the UN-run food an water distribution is really not enough and not reaching anywhere near everyone who needs it (everyone).
My first patient was a tough young man in flip flops (his only shoes, just like most people here) with a large abscess on his heel from an injury from climbing on rubble a week ago. He asked for gauze to bite while a friend held his head and hand. Our smallest needle at the moment was a large 21-guage, so that part was not comfortable, but he got a decent block and was feeling better after I incised it and drained a bunch of foul pus. For antibiotics I gave him the last of our Omnicef solution; now it turns out we have tons of Omnicef tabs too, our main antibiotic in store currently. He'll be back in 2-3 days for recheck and to get more Omnicef, this time in tabs.
One unfortunate patient I saw was a 1 or 2-yr-old baby (the mom didn't know her child's age exactly, which is very common!) with diarrhea, vomiting, and weakness. We perked her up with some oral rehydration therapy, which we're using on alot of people of all ages. I did see a couple people with probable typhoid and malaria, but I had to refer them to the nearby Cuban field hospital because we still don't have Cipro or chloroquine available for respective treatment.
We send people there for chest x-rays with bad chronic coughs (some report coughing up blood) or for lab tests if they look severely anemic (everyone looks at least somewhat anemic) or need other tests or surgery. Referrals can be messy though. I sent the Cubans an elderly lady with what I feel is osteomyelitis of the tibia that has developed from a wound from rubble a week ago, but they apparently sent her away with nothing more than a prescription for hypertension medicine to be filled at our "pharmacy," so I'll have to somehow find her again and make sure she gets adequate IV/IM antibiotic use for the bone infection.
We are seeing alot of patients who are seeing a doctor for their first time ever or in many years. The most common complaints are irritated eyes and insomnia/back pain, but some have fevers, diarrhea, wound infections. I've seen lorger goiters here than I'd seen before in person. Many also have thrush and yeast pharyngitis, so I wonder if they have HIV and am hoping the Cubans will check for that as requested. This experience is really teaching some reliance on a good history (difficult with the language/cultural barriers) and physical exam.
So it was a great day, and I'm very excited to finally be out serving the people of Haiti! How grateful and humble they are! People here have so much endurance and a positive attitude to boot! This trip is really giving me some amazing perspective. I hope you are able to experience some of this through this blog. Thanks & take care!
Around 9:30am (later than planned) we climbed aboard a rented "taptap" (named that since you tap the side to request a stop), the main form of public transportation in Haiti. It is a small pickup truck with its bed covered by a partial camper top with view-holes up front, windows on the side, and a wide open back (no tailgate) with a rail with grating on the sides. You sit on 2x8-board benches on the sides of the bed, and all your have to rest your back against is a jagged metal ledge jutting out. The roads are of course the craziest bumpiest obstacle course ever, and there is not much to hold onto, but you have to be careful not to bruise your arms, break a rib, knock your head on the roof, or fall out the back. Most taptaps are painted in unique colorful and beautiful Christian Haitian cultural murals, but ours is a bland unmarked one, though just as run-down and shock-less. The 45-minute ride into downtown Port-au-Prince is the craziest dustiest stinkiest bumpiest route I've ridden, and now I understand why I was advised to just not look while the laid-back drivers weave across the entire road to avoid 2ft-deep potholes and pass all traffic possible without more than an inch or so margin. They honk for everything, and pedestrians including kids are barely jumping out of their way. There are a few traffic lights working, but they just create more rules to be broken.
The concrete dust and diesel/gas smog (and occasional stench of corpses) are all quite overpowering, though a bit better with sunglasses and a mask I wear sometimes. The destruction is simply everywhere and is just overwhelming. Rubble is still overflowing into most of the streets, even though Canadian crews have already hauled miles of rubble to the outskirts of the city, on top of which incidentally people are already staking out tent space, since any space is such a premium. The bustling population is so amazing to watch constantly doing everything they can to survive in this disaster and chaos, and so many emotions are etched in all their faces.
Today was the first time to use this facility for clinic. Until the three days of mourning, Heart To Heart served in the large bowl-shaped Stadium where thousands have been camping out since the earthquake. They decided to move the clinic out because the with no sanitation or ventilation and with tense crowds. When we arrived at the church there were already 50 people lined up on the benches inside to see us. We have our clinic area in the rear loft of the church, overlooking the chapel on one side and the destroyed city and the seaport on the other. To get there you have to climb three flights of stairs, the last with no railings or sides. (Like a cardiac stress test on the way in!) We have someone assist elderly up and down those last stairs. The loft floor is rough dusty concrete, and rebar and blocks are sitll lying in one area from the fallen little tower that was on the roof, but the space has lots of great natural light and ventilation through the windowless concrete frames. We set up three provider stations and one wound care and one pharmacy station. We frequently help out with each other's patients. It runs pretty smoothly. We work well as a team, and our translators help keep things moving. They are all pretty decent and kindly are helping me to learn Creole. The translators and our drivers are young men whose studies or jobs were derailed and now they have scrambled to get these very nice jobs at $20/day, and numerous friends of theirs are always trying to volunteer with hopes of them getting paid too. Any job is a Godsend right now, especially considering that PRE-earthquake Haiti's legitimate employment rate (not UNemployment) was a mere 7% and median income was less than $2 a day.
We saw 115 patients today, with the doors apparently having been closed at 4pm for a few more non-urgent cases to come the next day. We had a small lunch break in the middle, where we shared powerbars with our translators. I saw 25 of my own patients personally, similar to the others' numbers. The statistics I was quoted before of 60-100 patients per day per provider turned out to be an exaggeration, but 6 patients an hour is already alot faster pace than I've ever had in clinic in the States (the barebones charting helps!).
With a slower pace than I had imagined, I enjoyed taking a moment to learn about their homes and families and sleeping conditions and express my condolences for their great losses. About 90% reported sleeping on the loud rocky street under occasional rain in front of their destroyed home (Bel Air was hit hard), hence understandable the myriad complaints of back pain and insomnia! Everyone lost someone close to them in the quake, some lost many family members. The prime minister of Haiti announced that 270,000 people have been buried in the mass graves alone. We gave out lots of Benadryl for itching scabies (no ivermectin cure pills yet) and insomnia. What they really need is tents and sleeping mats and a safe place to camp. Of course when hurricane season comes the tents won't help much though. Also, the UN-run food an water distribution is really not enough and not reaching anywhere near everyone who needs it (everyone).
My first patient was a tough young man in flip flops (his only shoes, just like most people here) with a large abscess on his heel from an injury from climbing on rubble a week ago. He asked for gauze to bite while a friend held his head and hand. Our smallest needle at the moment was a large 21-guage, so that part was not comfortable, but he got a decent block and was feeling better after I incised it and drained a bunch of foul pus. For antibiotics I gave him the last of our Omnicef solution; now it turns out we have tons of Omnicef tabs too, our main antibiotic in store currently. He'll be back in 2-3 days for recheck and to get more Omnicef, this time in tabs.
One unfortunate patient I saw was a 1 or 2-yr-old baby (the mom didn't know her child's age exactly, which is very common!) with diarrhea, vomiting, and weakness. We perked her up with some oral rehydration therapy, which we're using on alot of people of all ages. I did see a couple people with probable typhoid and malaria, but I had to refer them to the nearby Cuban field hospital because we still don't have Cipro or chloroquine available for respective treatment.
We send people there for chest x-rays with bad chronic coughs (some report coughing up blood) or for lab tests if they look severely anemic (everyone looks at least somewhat anemic) or need other tests or surgery. Referrals can be messy though. I sent the Cubans an elderly lady with what I feel is osteomyelitis of the tibia that has developed from a wound from rubble a week ago, but they apparently sent her away with nothing more than a prescription for hypertension medicine to be filled at our "pharmacy," so I'll have to somehow find her again and make sure she gets adequate IV/IM antibiotic use for the bone infection.
We are seeing alot of patients who are seeing a doctor for their first time ever or in many years. The most common complaints are irritated eyes and insomnia/back pain, but some have fevers, diarrhea, wound infections. I've seen lorger goiters here than I'd seen before in person. Many also have thrush and yeast pharyngitis, so I wonder if they have HIV and am hoping the Cubans will check for that as requested. This experience is really teaching some reliance on a good history (difficult with the language/cultural barriers) and physical exam.
So it was a great day, and I'm very excited to finally be out serving the people of Haiti! How grateful and humble they are! People here have so much endurance and a positive attitude to boot! This trip is really giving me some amazing perspective. I hope you are able to experience some of this through this blog. Thanks & take care!
Days of Mourning
Saturday and Sunday (click day for photos) were extended days of mourning mandated by the Haitian president, and I did not end up finding work to do at a field hospital, but we made major progress organizing our clinic plans and the application of our currently limited medications. Also, we were able to tour the Port-au-Prince metropolitan area, and the widespread destruction made my soul ache for this nation. On Saturday we got to go to a large worship/mourning service downtown at the square by the destroyed Presidential Palace, and everyone we saw was very welcoming and friendly. What especially moved me was the amazing Sunday worship service we attended at the Nazarene church in the Port-au-Prince downtown area Bel Air. Despite the church being undamaged, this was the first church meeting being held inside this building since the earthquake a month ago. There were probably 1000 Haitians present, most completely homeless, and I was amazed at the intense gratitude and praise expressed by the people's singing and dancing and praying, despite what they had been through. Every once in a while I noticed a Haitian spontaneously lay head in hands and just start bawling. I could only imagine the horrific losses that weighed on their souls, and I could not help but just cry with them in compassion. It was an honor to be there with these precious people and worship Jesus and pray for God's blessings upon them together.
Friday, February 12, 2010
On the Ground in Port-au-Prince, Haiti
Bonjou fanmi ak zanmi! (Hello family and friends! in Haitian Creole)
As some of you already heard, I have been granted the privilege to volunteer for two straight weeks as a field clinic physician for Heart To Heart International as part of an elective rotation for my Rural Family Medicine residency training. It's exciting to be here! I am now settling in at the Nazarene Seminary compound in Port-au-Prince, Haiti after arriving here yesterday evening. It took 2 days of flying and a long minibus journey from Santo Domingo through a very porous and crazy/congested border to get here. Check out the photos from the 8-hour bus trip over. The surrounding mountains are beautiful. The city here is busy and filthy. I have yet to see the major destruction of downtown (tomorrow I will), but the people look exhausted, dirty and hungry.
Today is exactly one month after the earthquake that devastated the Port-au-Prince area of Haiti, killing over 230,000, injuring over 300,000, creating over a million homeless, forever disrupting and traumatizing the already impoverished nation. As we found out last night, the Haitian president designated today a national Day of Mourning. Everything was basically shut down today and the Haitians have been in white & black (if they have the clothes) and singing/praying/mourning in streets, shelters and churches. Initially I thought we'd be out seeing patients today, but last night we were advised to stay in our compound today to avoid running into any possible riots and disrespecting the Day of Mourning by being out and about. So today we spent time planning and organizing our work and medications/supplies for the coming days and weeks. Throughout the day we've been able to hear a distant but haunting sound of people singing hymns in the churches and streets.
Since the president has also requested the country continue mourning for the rest of the weekend, the Heart To Heart advisors here feel we should wait until Sunday afternoon to open up our little clinics again. So we providers are feeling quite antsy, wanting to just go out there and help people anywhere. Tomorrow morning we will go into downtown Port-au-Prince and see what help we can offer at some of the larger field hospitals that are still having an influx of patients despite the continued days of mourning. Sunday the plan is to run a clinic at the front of our compound after announcing it at church, which brought over 250 patients to be seen when they did it like this last Sunday.
On Monday we start back full-force running the multiple urgent care field clinics that Heart To Heart has been running for weeks now in the Bel Air neighborhood of Port-au-Prince and a couple somewhat outlying cities including Léogâne, the epicenter where mild tremors can still be felt on a daily basis. There is one town the group serves, Grossier, where the only building left standing is the Voodoo temple. Another two towns, Jacmel and Fondwa, will no longer be part of this project for a while because the only road out there is frequently impassable due to ongoing landslides.
In these field clinics, each provider (doc/nurse/PA/paramedic) is seeing 60-100 patients a day, functioning as doctor, nurse, pharmacist, and counselor all at once. Cases include wound infections, sepsis, dysentery, fractures, stomach pain, dehydration, asthma, anxiety, abscesses, hypertensive crisis, STDs, etc. Diarrhea and respiratory infections are really starting to mount. The dust is a major irritant. Malaria, TB, HIV, scabies, worms, and other 3rd-world diseases are quite prominent. Typhoid, dengue fever, measles, meningococcal meningitis, and H1N1 influenza are all starting to spread. Tetanus is starting to show up, not surprising with the hundreds of thousands of dirty injuries and lack of immunizations here. Our charting consists of one line for each patient: age, sex, diagnosis and treatment, which we report to the UN for biosurveillance. There are daily UN Health Cluster meetings/forums that one of us attends downtown, which minutes are posted among lots of other various information that agencies are sharing with each other online.
At a debriefing with the 8 providers who just left here, I heard amazing stories. Some have experience helping in Africa, Katrina, 9/11, and the Asian tsunami, and they say they've never seen anything like this and are seeing cases they've never seen before exc. And they say the people are incredibly resilient and determined to survive and recover.
The providers here have some amazing photos and stories. I look forward to accumulating and sharing my own with you, but here's a sample story from one of the doctors who just finished here last night. A high school girl came up complaining of stomach pains and inability to sleep. She was on her high school roof terrace when the quake hit. Its several floors collapsed like pancakes, dropping her and catching her repeatedly on the way down as each floor broke through, while her classmates and teachers were crushed below her, left screaming and dying. She and millions here now have PTSD (since their stress reaction has lasted a month now), and their anxiety is literally wrenching their stomachs in pain. She got an acid blocker for her belly, debridement and antibiotics for a couple infected wounds, and Benadryl to help her fall asleep on the hard street. (Hopefully soon they will get mats and tents too, which they did protest for downtown yesterday!) These sort of things are very common here right now. We have tons of certain meds and supplies, but we still need many others, which we expect to be able to get soon from some cooperating sources here, plus the group I'm with, Heart To Heart is one of the most efficient aid agencies I've researched and has brought in 3 jumbo jets full of supplies already and will be bringing more.
There are seven of us providers here at the moment (9 just went home in the last few days, so the need these next couple weeks is great), and 8 more arrive over the next 3 days, but there is still so much need. I'm thrilled to hear my dear med school friends Aaron and Maryclaire (also broad-scope family medicine residents) will be joining me in this great work in a few days. My on-site Heart To Heart field director says we could accommodate 50 providers here, and the international agencies say the medical needs are only growing, so hopefully more providers will come soon. The two main physician attendings I will be working with are Dr. James Dickie, an FP/ER doc from near Kansas City, and Dr. Duane Spalding, a retired internist/hospitalist from Colorado Springs, both very experienced and quite interesting and nice, as are the nurses, paramedic, and logistics staff who are here.
The facility I'm at currently is a very sturdy and nice home complete with electricity, wireless, cell reception (for certain phones, not mine), and hot showers, though all are spotty. The men and women volunteers sleep separately, each with 9 cots to a room. The water is filtered, the toilets and washer work great. We have a motherly woman cook/helper Elise who speaks English and makes the most delicious breakfasts & dinners, complete with fresh papayas, bananas and breadfruit grown here on the compound. She lost her home and in staying in a tent in our driveway.
When we go out on field clinic trips to outlying communities the conditions aren't as nice but are still secure. For instance, we get to camp in a secure Mennonite compound in Léogâne with a few hours of water and electricity a day and eat great breakfasts and dinners with very good people, but the surroundings are infested with tarantulas, centipedes, fleas, scabies, bats, and of course mosquitoes. Especially there our DEET, Malarone, tents, mats and mosquito netting will be our great friends.
I'm excited finally to start seeing patients soon and feel honored to be a part of this amazing relief effort. Please do send your thoughts, prayers, and support to these suffering people, to those of us trying to do what we can for them at ground zero, and to our own dear families back home. Thank you/Mèsi/Merci!
God bless and much love,
Lincoln :)
As some of you already heard, I have been granted the privilege to volunteer for two straight weeks as a field clinic physician for Heart To Heart International as part of an elective rotation for my Rural Family Medicine residency training. It's exciting to be here! I am now settling in at the Nazarene Seminary compound in Port-au-Prince, Haiti after arriving here yesterday evening. It took 2 days of flying and a long minibus journey from Santo Domingo through a very porous and crazy/congested border to get here. Check out the photos from the 8-hour bus trip over. The surrounding mountains are beautiful. The city here is busy and filthy. I have yet to see the major destruction of downtown (tomorrow I will), but the people look exhausted, dirty and hungry.
Today is exactly one month after the earthquake that devastated the Port-au-Prince area of Haiti, killing over 230,000, injuring over 300,000, creating over a million homeless, forever disrupting and traumatizing the already impoverished nation. As we found out last night, the Haitian president designated today a national Day of Mourning. Everything was basically shut down today and the Haitians have been in white & black (if they have the clothes) and singing/praying/mourning in streets, shelters and churches. Initially I thought we'd be out seeing patients today, but last night we were advised to stay in our compound today to avoid running into any possible riots and disrespecting the Day of Mourning by being out and about. So today we spent time planning and organizing our work and medications/supplies for the coming days and weeks. Throughout the day we've been able to hear a distant but haunting sound of people singing hymns in the churches and streets.
Since the president has also requested the country continue mourning for the rest of the weekend, the Heart To Heart advisors here feel we should wait until Sunday afternoon to open up our little clinics again. So we providers are feeling quite antsy, wanting to just go out there and help people anywhere. Tomorrow morning we will go into downtown Port-au-Prince and see what help we can offer at some of the larger field hospitals that are still having an influx of patients despite the continued days of mourning. Sunday the plan is to run a clinic at the front of our compound after announcing it at church, which brought over 250 patients to be seen when they did it like this last Sunday.
On Monday we start back full-force running the multiple urgent care field clinics that Heart To Heart has been running for weeks now in the Bel Air neighborhood of Port-au-Prince and a couple somewhat outlying cities including Léogâne, the epicenter where mild tremors can still be felt on a daily basis. There is one town the group serves, Grossier, where the only building left standing is the Voodoo temple. Another two towns, Jacmel and Fondwa, will no longer be part of this project for a while because the only road out there is frequently impassable due to ongoing landslides.
In these field clinics, each provider (doc/nurse/PA/paramedic) is seeing 60-100 patients a day, functioning as doctor, nurse, pharmacist, and counselor all at once. Cases include wound infections, sepsis, dysentery, fractures, stomach pain, dehydration, asthma, anxiety, abscesses, hypertensive crisis, STDs, etc. Diarrhea and respiratory infections are really starting to mount. The dust is a major irritant. Malaria, TB, HIV, scabies, worms, and other 3rd-world diseases are quite prominent. Typhoid, dengue fever, measles, meningococcal meningitis, and H1N1 influenza are all starting to spread. Tetanus is starting to show up, not surprising with the hundreds of thousands of dirty injuries and lack of immunizations here. Our charting consists of one line for each patient: age, sex, diagnosis and treatment, which we report to the UN for biosurveillance. There are daily UN Health Cluster meetings/forums that one of us attends downtown, which minutes are posted among lots of other various information that agencies are sharing with each other online.
At a debriefing with the 8 providers who just left here, I heard amazing stories. Some have experience helping in Africa, Katrina, 9/11, and the Asian tsunami, and they say they've never seen anything like this and are seeing cases they've never seen before exc. And they say the people are incredibly resilient and determined to survive and recover.
The providers here have some amazing photos and stories. I look forward to accumulating and sharing my own with you, but here's a sample story from one of the doctors who just finished here last night. A high school girl came up complaining of stomach pains and inability to sleep. She was on her high school roof terrace when the quake hit. Its several floors collapsed like pancakes, dropping her and catching her repeatedly on the way down as each floor broke through, while her classmates and teachers were crushed below her, left screaming and dying. She and millions here now have PTSD (since their stress reaction has lasted a month now), and their anxiety is literally wrenching their stomachs in pain. She got an acid blocker for her belly, debridement and antibiotics for a couple infected wounds, and Benadryl to help her fall asleep on the hard street. (Hopefully soon they will get mats and tents too, which they did protest for downtown yesterday!) These sort of things are very common here right now. We have tons of certain meds and supplies, but we still need many others, which we expect to be able to get soon from some cooperating sources here, plus the group I'm with, Heart To Heart is one of the most efficient aid agencies I've researched and has brought in 3 jumbo jets full of supplies already and will be bringing more.
There are seven of us providers here at the moment (9 just went home in the last few days, so the need these next couple weeks is great), and 8 more arrive over the next 3 days, but there is still so much need. I'm thrilled to hear my dear med school friends Aaron and Maryclaire (also broad-scope family medicine residents) will be joining me in this great work in a few days. My on-site Heart To Heart field director says we could accommodate 50 providers here, and the international agencies say the medical needs are only growing, so hopefully more providers will come soon. The two main physician attendings I will be working with are Dr. James Dickie, an FP/ER doc from near Kansas City, and Dr. Duane Spalding, a retired internist/hospitalist from Colorado Springs, both very experienced and quite interesting and nice, as are the nurses, paramedic, and logistics staff who are here.
The facility I'm at currently is a very sturdy and nice home complete with electricity, wireless, cell reception (for certain phones, not mine), and hot showers, though all are spotty. The men and women volunteers sleep separately, each with 9 cots to a room. The water is filtered, the toilets and washer work great. We have a motherly woman cook/helper Elise who speaks English and makes the most delicious breakfasts & dinners, complete with fresh papayas, bananas and breadfruit grown here on the compound. She lost her home and in staying in a tent in our driveway.
When we go out on field clinic trips to outlying communities the conditions aren't as nice but are still secure. For instance, we get to camp in a secure Mennonite compound in Léogâne with a few hours of water and electricity a day and eat great breakfasts and dinners with very good people, but the surroundings are infested with tarantulas, centipedes, fleas, scabies, bats, and of course mosquitoes. Especially there our DEET, Malarone, tents, mats and mosquito netting will be our great friends.
I'm excited finally to start seeing patients soon and feel honored to be a part of this amazing relief effort. Please do send your thoughts, prayers, and support to these suffering people, to those of us trying to do what we can for them at ground zero, and to our own dear families back home. Thank you/Mèsi/Merci!
God bless and much love,
Lincoln :)
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