Day 5: An Eventful Day!

Today was chock full of activity. We were go, go, go all day, at both work and play. After morning meeting we ran straight to clinic to start seeing patients ... before we could even start today's patients, there were 21 patients whom we couldn't see yesterday because a) we had to run to surgery and b) a storm rolled in last night and everyone left rather than wait for us to get out of surgery. And the thing is, almost every single one came back to be seen! They were that desperate for care, even from a bunch of minor leaguers like us! It was kind of humbling and I made a mental note to do my best and be nice to everyone no matter how tired I got. One of the things that they want in medical volunteers is the ability to roll with things and be flexible, and today proved why they ask you that stuff. Almost right off the bat, one of the translators points out a kid waiting patiently in the hallway, saying something to the effect that I might wanna see this lil' tyke first. He had broken his left arm this morning and was just sitting on a bench with a deformed elbow and wrist. If that weren't enough... he had blood dripping from his wrist which seemed to be coming right from the region of the break - uh-oh! Since it's an open (or what you'd call a "compound") fracture, that warrants an urgent washout of the fracture and usually some sort of fixation, in this case smooth pins through the skin. Back home, we'd send him up to the OR, have whoever was up working in the OR that day take care of him, and then go back to seeing clinic patients. Here, Liz, Tom, and I had to put clinic on hold and run to the OR and take care of it, then come back! We get the flypaper room once again and manage to not have any flies land on the sterile field today. Since it's an open fracture, Liz busies herself mixing up some antibiotics right away to administer to the kid ASAP, and finds another victim -er, recipient- for her pocketful of tetanus vaccines. The little guy has a supacondylar elbow fracture too, so Tom fires in the three pins for the elbow cause I've got my hands full holding the elbow reduced ("located") and there aren't any residents like we have back home. And he actually does a better job than most of them (shh, don't tell them that). We then literally run upstairs to slurp down beans and rice in 5 minutes (everyone stares at us like we were raised by wolves) and then back to clinic, where we step right into a hornet's nest. It seems the translators have lined the remaining patients up in order to be seen. We still have about 5 or 6 patients from yesterday to see, and we haven't even seen the first patient for today yet! The #1 patient for today (they all have numbers, just like when you go to get your tabs or license renewed at the DMV), who's been waiting since 7:30, claims that all these people from yesterday who've been jumping ahead of her are getting preferential treatment cause they obviously must be the translators' friends. To make matters worse, the two translators - we'll call them M. and M. - take opposite sides and join in the fray. I do my best impression of a small speck of dust in the corner and try to look invisible. If the three of us get torn to pieces by an angry mob, would that make the front page of the Star-Tribune? Or would it simply be a short obituary waaaay back by the foreclosure notices? At least Tom and Liz would be listed together because they're both "S"s, but I'd be by myself AND way back cause I'm a "Y." Or would Liz be by herself cause she lives in St. Paul and get published under the Pioneer Press obits? Fortunately all of this turns out to be moot as we opt for the most Minnesotan of all passive-aggressive moves, i.e, "forget" who was waiting from yesterday and see the irate old lady who was #1 today. ("Oh, I'm sorry, you've been waiting all day yesterday, slept outside in the rain last night, and have been waiting all day today? That's just so terrible! Well let me see this nice little old lady and you'll be next! You betcha!") Everyone settles down and the old lady suddenly turns into the sweetest thing in the world once she gets her therapy appointment and free ibuprofen. (ER visits cost $1 but orthopaedic care is free.) We run back to the OR to clean out the amputation stump on the same lady from last Sunday (p.s. - the PC term is "residual limb" but stump is a little more elegant) and it looks a lot better. Now even in the middle of all this hullaballoo we still take time, all three of us, to stop, take a deep breath, and say nice things to each other like "you're doing a great job" and "yeah this is kind a hectic, but think how much better of a story this'll be than if we had nothing to do" and "think how long these poor guys have been waiting." Back to clinic to finish up, and by then all three of us reaaaaallly need a few beers and some pizza which we've been fixating over since last night. We walk back through the local neighborhoods to the hotel where the UFGH folks are staying (there's about 20 of them, mostly from the Boston and NJ areas). These guys are super friendly, open, and inviting and accept us right into their group. They're attendings, residents, pre-med students, nurses, and therapists and they've been to some amazing places like Ghana, India, and Haiti - every year! The walk to their hotel proves to be yet another eye-opening experience. I'd like to save you the trite things people say when they experience the utterly squalid conditions people live in, but I can't. Kids bathing in a drainage ditch - and smiling, cause they really came out cleaner than when they went in. One house standing intact, next to a pile of rubble that used to be the house next door. Houses, piles of rubble, and tents all intermixed, the bricks of a neighborhood held together by the mortar of piles of trash and filth. And again, people living here just normal folks like you or me. Except they have just had some real crappy luck lately. I won't pretend to be an expert on the Haitian people but as far as what I experienced I felt safe, and everyone I saw was super friendly and courteous. We queue up to buy some douces, (sweets you buy in little booths made of figs and coconut) and despite the humble origins and the flies buzzing on the display items it tastes waaaay good. Several of our translators live in the area - this is their neighborhood. Jeanty now lives in Tent City on the hospital grounds, and Claude lives in the very neighorhood we're walking through. Jeanty's a normal 26 year old guy who's got a cute girlfriend and likes to play drums and guitar. Unfortunately his house is now a pile of cinder blocks so it's kinda hard to play music except for when he gets to borrow stuff (Dave, part of the Loma Linda crew managing the hospital supply room, has helped him out there). Fortunately he still has the girlfriend. The hotel is super nice, kind of an interesting contrast with the neighborhood we just walked through, and we have a great time talking with Raja and Richard from Patterson NJ and Boston Medical Center respectively (somehow they've been friends for 10 years). And yes, we do finally get our beer and pizza. Liz has to go back to the hospital early for her English lesson to Michard, the would-be Concordia student ... now that's dedication! As it turns out his knowledge of the rules of English grammar are fairly advanced and is asking about terms that the three of us have no idea about. Tom and I hang out a bit more at the bar with Juliet and Rolando and then get a ride back to the hospital to check in with Jess from Hotlanta about tomorrow's surgery schedule, visit the preop area where the people come to stay before tomorrow's surgeries, hang out in the break room for a bit and talk to Jeanty (his breathing is a lot better after last night's episode) and then hit the sack, thinking about all the different stuff that happened to us today and trying to make sense of it all. For us, since we're here for such a short time, it really comes down to trying to do a tiny bit of good work (9 days of chock-full workdays is still only 9 days after all) and meeting some really cool people. We've met a lot of good people here, Haitians and non-Haitians, and that makes everything else seem to fall into place.

Day 4: Stressing out and chilling out

Hotter and more humid today. After morning rounds and seeing a few people in clinic we go to the OR and set up for today's surgeries. Tom's already sweated through his first set of scrubs and his pores are busy at work doing their best to saturate his second. We're majorly stressed out cause we have no idea where anything is, equipment is stored in a bajillion different places, and we just had general pandemonium everywhere. We look through the shelves and find a few donated Austin-Moore implants for hip fractures (probably donated because they were expired and even if they weren't, we don't use those much in the States any more). But we make do with what we have, doing a hemiarthroplasty (partial hip replacement) with nothing more than a knife, Weitlander, scissors, curet, army-navy, Key elevator, saw, and a mallet. The overhead lights aren't the greatest so those REI camping headlights come in handy. Again, in the middle of surgery even, we have to stop every now and then and look at each other and say, "Wow, we're in Haiti! We finally got to come down and help! This is so cool." Even after a mosquito lands on the sterile field about two inches from Tom's hand, as we look up and see a huuuge strip of flypaper hanging right over the OR table, we just have to shake our heads and say "Well, we are in Haiti." Dr. Jonathas is a Haitian orthopaedist who's been eager to work with guys from the US, and he scrubs in too. Towards the end of the day we realize that scrub brushes and shoe cover "booties" are running low. Well, actually, we're out of them. Note to self for next time: bring some of those too.

In between cases we manage to run up and grab some food. Volunteers here get one free meal a day which gets delivered in styrofoam containers. Every meal is vegetarian - perhaps because the shipments end up sitting out for a long time waiting for people to eat them whenever they can spare 5 minutes to wolf down food and they don't want it to go bad, or because there seems to be an overlap in the Venn diagram between the circles representing relief workers and vegetarians. Today it's vegetables, rice and beans, and a plantain. As a bonus today there's a small sliver of avocado! Tom also takes the opportunity to refill his water bottles. He sweats so much that he has to replentish 3 liters of water a day! I just don't have the heart to tell him that all that water is just encouraging his pores. It's like buying an alcoholic a drink.

Needless to say by dinnertime Liz is hankering for a slice of pizza. (Somehow, despite eating the least of the 3 of us, Liz seems to be getting taller and taller every day. I swear we were pretty much all the same height when we started!) Tom has opted for the beef jerky and is happily munching away on good ole' USDA Grade A. Ironically the look on his face as he blissfully devours his dead animal is the same look that cows get when they contentedly chew their cud. He's just thankful he doesn't have to worry about sharing it with me. Kristi from Loma Linda explains the intricacies of heating up an MRE while Liz is off giving a free English lesson... Normal everyday people who lot their houses in the quake are trying to get back to living normal lives, and that does include kids studying and going to school. There's this one kid who says Concordia College has offered him a scholarship if he just passes this English test, so needless to say he's quite motivated. So good for Liz for helping him out!

Staying here at the hospital makes it super easy to check in on patients and kind of makes you feel like a resident again. Transfers come in at night from other hospitals and you just run downstairs and see them. Tonight Kristi as our in-house pediatrician has a transfer, a 31-week old preemie. Hope the kid is going to be ok. No time to gloat about it being Kristi's turn and not mine this time, as a few moments later one of the translators gets an asthma exacerbation and we go downstairs to the ER to give him some steroids and nebulizer treatments.

Unfortunately the incoming storm upsets our plans for pizza but then again reconstituted stew, powerade and s'mores trail mix taste almost as good when you're this hungry. It may as well be a yummy margherita Punch Pizza when you're so tired you fall asleep sitting up. Plus it's always fun watching Liz eating a dinner made of reconstituted milk, grapenuts, and craisins ... or Kenny hitting the jackpot when, as he rummages around the food bin, finds an MRE of ravioli with beef sauce! Tom, as usual, is cracking himself up about something, who knows what!

Day 3: Stuff hits the fan!

A lot of the Loma Linda young men and women leave today which is sad cause they were fun to hang out with, and we did have some good conversations (Hey Mike! -Good luck with pharmacy school!), but also happy because they were kind enough to leave behind a lot of yummy vegan camping food. Tom and Liz fight over the choiciest treats which is OK cause they'll need the energy ...

Now I wouldn't say we were exactly dreading today, because we came here expecting to work hard, but let's just say that Monday is always busy in a clinic. And not just at HCMC or Haiti but a lot of places. If you or I get hurt over the weekend, why waste your weekend sitting in a waiting room for 3 hours when you can waste time during the workweek? So everyone who gets hurt any less grievously than getting mauled by a rabid chimp over the weekend tend to all come in on Mondays. We'd even mentally psyched ourselves up for it yesterday: "OK there are gunna be times Monday when we'll be overwhelmed by the workload and ready to bash our heads against the wall in frustration with adjusting to a very different way of doing things locally. So when (not if) that happens, just remember, this is what we wanted. This is what we signed up for. We've been trying for 6 months to do exactly what we're doing ... which is to be totally busy helping out with taking care of people who got hurt by an earthquake."

Of course that did help a little bit ... kind of like how if Tom hasn't eaten in three days, one peanut might help his hunger a little bit. There were a lot of people who came in. The usual orthopod here at Adventist, Scott Nelson, who'd been here since the quake, had to leave a few weeks ago, so a lot of outlying hospitals around the country sent stuff down here to Aventist knowing that we had an orthopod this week, and a lot of local patients who needed help waited to come in this week. Fortunately Matt and Ronaldo, ED residents from the east coast, see lot of people. Tom and Liz jump right into things and get their hands bloody ... external fixators need to be removed, pins need to be pulled, casts put on ... and oh yeah, there's a bunch of tentaus shots that are going to expire this month that Liz is so happy to use up! Translators help us all out, even though my high school/college French is just starting to come back, and this does help with a lot of patients, even if they are mainly Creole speakers.

What helps more is remembering that these are people, human beings, no better or worse than you or me, whose idea of a crappy day isn't having to work 16 hours, or having your heart broken. It's having your house fall on you, being pinned under a piece of rubble for 7 hours before someone pulls you out, having your hand or arm or foot or leg ampuated cause it was becoming infected enough that you might die from sepsis, and then realizing you were the only one in your building, or your family, who survived. This, or a variant of this, is a fairly commonly heard story here. So every time the 3 of us meet someone new today we remind ourselves to try and chill out and smile. Most of the time people smile back. And for people who lately haven't had a whole lot to smile about, you know it's genuine.

There are a lot of complex problems today - nonunions (bone didn't heal), malunions (bone healed but healed crooked), infected nonunions (bone both not healed and infected), and infected nonunions with huge bone defects (uh, sorry, you're SOL). So we spend a lot of time thinking about treatment plans and giving people their options. They have tough choices, and a lot of people go back home and just think about their choices for awhile. Not everyone opts for surgery. A lot do. Today off the top of my head we scheduled surgery for 2 people with distal radial malunions, 1 chronically dislocated ankle, 2 hip fractures, 1 humeral shaft nonunion, a repeat I&D for the lady with the infected AKA stump, the humerus fracture on the guy whose shoulder we reduced Saturday night, and a tendon transfer for a woman with a wrist drop. A lot of this stuff was still due to the January 12th quake, even after all this time just cause it hadn't healed up yet, or got infected which delayed definitive care. (Kinda answers the question, "Haiti? Wasn't the quake like 6 months ago? Are you guys gunna have anything to do?") We estimated over half the patients we saw today in clinic were injured January 12th.

When the last patient, who's been patiently waiting all afternoon, has been seen (she needed surgery), we sit down and take a breath!

After all that we're still getting along great. The 3 of us couldn't have picked a better couple of travel parners, or a better group of people to work with here at Adventist. After a fancy schmancy meal of peanuts and melted Hershey bars (have I mentioned it's hot here?), Tom, Liz, and I join Kenny (our de facto social ringleader), Brooke (our actual ringleader), Kristi (new arrival, a peds resident from Loma Linda), Jess (fearless nurse from Hotlanta), and Franz (translator emeritus now residing in Tent City) for a few Prestige's at the outdoor patio bar down the street. Let's just say the first 2 beers we've each had in Haiti taste reeeaal good. And what better way to complement this with a DJ bobbing up and down punctuating songs with a few randomly placed "Yeah"s, looking like he's spinning tunes ... especially when the music stops and he's still bobbing and forgets to stop pretending. ;p

Day 2

Awoke this morning to the usual hum of people all around us at 6:30. With patients sleeping in hallways, and a veritable tent city of patients, families, and people with no where else to go sprawled outside on the hospital grounds, there's always a buzz of activity. Liz, Tom, & I share a ward full of cots with the Loma Linda students also volunteering here at Hopital Adventiste d'Haiti ("HAH"!). Today is their last full day so even though we didnt overlap all that much we'll miss Kevin, Sarah, Julie, Mike, David, and the other cool ones whom I remember but whose names I forgot! We all head downstairs to morning roll call slash prayer meeting and meet the other groups working here. There's a bunch of docs and nurses from various East Coast places like Khaled from New York, and the trio of nurses from Boston City Hospital and MGH with their thick (yet somehow, oddly enough, endearing) Boston accents. The weather as usual is hot, humid, and intermittently rainy. Rain is good because it cools down a bit until you remember everyone living outside in tents. Sad face. The views from the hospital (most of the hallways are open air) are very nice. You can walk out onto the roof and dry clothes and hang out.

We go on morning rounds with about 45 people on the list to see. The signout census list we use here is just like any other intern-generated list back at home, except half the patients dont have room numbers - instead they have places like "tent," "hallway," and "postop area" listed. The biggest tent on the premises was donated by a medical group from Quebec, with a big maple leaf, so we had one patient whose discharge plan was "d/c to Canadian tent."

We then made "tent city" rounds, complete with chickens (bawk bawk!), a soccer game, and lots of people chillin' outside with external fixators and casts on.

Rounds are interrupted by a few consults from the ER, which gets a lot of ortho referrals. One's a woman who was selling fish, didn't see a hole in the ground, and fell in sustaining a distal radius fracture and a deep forehead lac. Liz gets her Ketamineized again while I supervise Tom & Jessica (a nurse from Macon, just south of Hotlanta) repair her forehead lac and Kevin, a med student from Loma Linda, reduces and splints her distal radius. And then in the middle of all this, I stopped and realize that people selling stuff carrying stuff on their foreheads can't look down to see where they're walking. We see a kid with a supracondylar humerus fracture, go up to the ward to change a VAC (vacuum assisted closure dressing) for an open tibia fracture, and then to the OR for an I&D for a badly infected AKA (above knee amputation) wound with lots of pus gurgling out. Fortunately there's some strawberry oil we find in a drawer that we can put inside our masks! After one more consult, a late night tibia fracture transferred from the U of Miami-run hospital group, we're all pooped! Time to bone up on Creole, keep in touch with people, and crash!

Day 1

After spending the morning traveling we landed in Port-au-Prince, Haiti early this afternoon. Most of the flight appeared to be non-Haitian relief workers. It was hot in the 90's, and humid. Tom's head immediately sprung to life, gushed forth geysers of liquid, and started working overtime salivating like Corky ogling a dish of ice cream. Problem solved with the first of a long series of bandanas he would don today. The bumpy van ride to the hospital was an eye opener. 98% of the rubble from the quake is still not cleared, but life goes on with people buying and selling at markets, fixing trucks by the roadside, and hawking frozen bottles of pop on the street amid the rubble.

Late in the afternoon we arrive at Hopital Adventiste d'Haiti and meet Nathan and Amy Lindsey as well as Dave, Mike, Sarah, Julie, Kevin, and the rest of the crew (mostly undergrads and grad students at Loma Linda University) who serve as the expatriate staff here. Now these guys sure know how to run a tight ship. They're careful to work in support of the local staff and not patronize. They know everyone's name. They have good relationships with surrounding hospitals outside Port-au-Prince to coordinate transfers. Best of all, they're all really cool people! The supply rooms are well organized, there are security people at the entrance to the hospital and to the ward, and the hallways are clear. In the OR, there's a functional C-arm for intraoperative x-ray imaging, and the supply rooms are well stocked with everything you could need to fix a broken bone with, from Ilizarov fixators to SIGN nails. One supply room we entered seemed to go on and on forever, packed high to the ceiling with sutures, dressings, hand sanitizers, bottles of peroxide, etc ... reminiscent of the scene at the end of Raiders of the Lost Ark when they stick the Ark of the Covenant in the basement of the Smithsonian. Best of all the OR's are air-conditioned and I can read Tom's mind ... "forget the open air wards and mosquito netting sweating it out on my cot ... I'm coming down here to sleep!"

No wonder this place does more orthopaedics than anywhere else in Port-au-Prince. Although our trip at once seemed doomed, being bounced around from group to group over the past several months, it looks like we hit the jackpot with Adventiste and these awesome young Loma Linda folks and we made the right choice.

Almost as soon as we arrive however, an unfortunate gentleman gets admitted to the ortho ward who fell off a truck 2 days ago. Xrays show he's got a right shoulder dislocation and a right calcaneus fracture. Yeah his shoulder's been out for 2 days, but we have to give it a try. At 5pm on Saturday there's no anesthesia staff here, so we go online to Micromedix and check proper dosing, hunt down some Ketamine in the anesthesia cart downstairs, get a pulse ox on his finger and have O2 standng by, Liz pushes 100mg of it slowly over a minute, we get him totally sedated, and the three of us get his shoulder reduced with a nice satisfying ka-chunk! Nothing like hitting the ground running! After putting a shoulder immobilizer on, checking his post-reduction films, and making sure he's doing OK (his pain is much better than it was the last 2 days!), this was followed by a quiet evening in the staff room with snacks, AC, a video about the hospital produced by Adventiste Health International, and of course taking advantage of the wi-fi!