This is an official CDC HEALTH ADVISORY: Potential for Dengue Infection Among Relief Workers Returning from Haiti Summary:

The Centers for Disease Control and Prevention (CDC) has received reports of dengue fever among relief workers returning from Haiti, where the disease is endemic. Symptoms of Dengue FeverDengue fever (DF) is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., nose or gum bleed, petechiae, or easy bruising), and leukopenia. The incubation period for DF ranges from 3 to 14 days but is typically about one week; therefore, illness may occur while the workers are stationed in Haiti or after they return to the US. Most dengue fever cases are self-limited and can be treated with bed rest, acetaminophen, and oral fluids. A small proportion of patients develop dengue hemorrhagic fever (DHF), which is characterized by presence of resolving fever or a recent history of fever lasting 2–7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count <100,000/mm3), and abnormal vascular permeability evidenced by hemoconcentration, hypoalbuminemia, or abdominal or pleural effusions. DHF can result in circulatory instability or shock, and the risk for these complications may be increased among persons with prior dengue infection. Adequate management of DHF patients generally requires timely hospitalization and judicious administration of intravascular fluids and close monitoring of vital signs and hemodynamic status.

Dallas Koperski’s note today:

I had an 18 year old boy today with nausea since the earthquake, but no other symptoms. It didn’t add up, so I asked him what happened during the earthquake. He broke down in tears as he lifted up his shirt, showing me the scars where he was impaled by a piece of metal, then told me that his father’s leg had to be amputated and that his mother was killed. I think that’s the first time I have cried with a patient.

Facility Improvements

This post also demonstrates the need for qualified nonmedical volunteers.  Please contact LLU Global Health to determine if HAH could use your services.

Volunteers donated US $1 bills to each of the young boys who filled a trash bag with the loose trash that was strewn around the campus. As the donations begin to run out before all the trash was collected the participants were glad to pick up 2 bags per dollar. Our campus is now clean.

Rooms in the southwest wing were never finished after the initial construction phase 5 years ago.

Plumbing fixtures and painting was completed by Dr Peter Nelson and Arpad Soo from San Luis Obispo, CA. The rooms are now ready for patients. We thank the generous donors of Amistad International for the plumbing hardware that was purchased locally as well as in the US.

One of the biggest challenges in preparing these rooms was fixing the sewer system which had been plumbed to drain the toilets onto the front lawn. Arpad, Jerry and crew worked day and night digging trenches around the raw sewage and placing the appropriate drain pipes. 

Another peculiarity is why the toilet inflow was plumbed into the hot water pipes. Thank you to the expertise of our plumbing crew and their hard work most of these problems are now resolved.

Arpad worked most nights until after midnight repairing leaks and faucets around the hospital. 

This very important sink in which we scrub our hands before surgery now has new foot pedals thanks to a donation from Ferguson Enterprises in Santa Maria, CA. It is important to use high quality materials as the elements are intense and these sinks sustain a high volume of use.

Liz Dickinson, RN, Vice President of Nursing at Loma Linda University Medical Center transformed our operating room with her friend Sylvia. We thank LLUMC and Liz for her hard work and the amazing improvements that were made.

Before this past week, there were still cupboards stuffed with instruments from years past. Liz, Sylvia, and the Haitian nurses sorted through all of them.

Some sterile packaging of unused instruments dated back to 1952.

The "before" shot below of the central sterilization area.

The "after" shot below. The newly painted cupboards are awaiting placement of well organized instruments.

New shelving was placed in the sterilization area after relocating the decontamination sink to a separate room.

In spite of our very low infection rate, measures are being taken to continue to make safety improvements for our OR. This decontamination sink had its faucets and drains replaced this week and it was placed in the decontamination room where instruments will be scrubbed prior to bringing them into the sterilization area for final wrapping.

Peter Nelson, DDS (on the right below) poses with Kyle Fiess of Maranatha. He used this hammer drill to make approximately 60 holes in the 10 inch walls of the southeast wing through which the entire plumbing system will be replaced. Prior to the earthquake the low pressure partially functioning water system delivered water to various plumbing fixtures, many of which were in disrepair. With the installation of a high volume inflow system and increased water pressure many leaks became apparent. This was causing a loss of approximately 7000 gallons of water per day into the walls, foundation, and electrical system of the hospital. 

Chapel Presentation Today

In chapel today at Loma Linda, Daniel Westerdale, David Puder, Marc Julisse and DJ Patton presented the Haiti project to the Loma Linda campus. A movie about the project as also shown. Daniel talked about how as a Christian community we all have various gifts which we contribute. DJ talked about how the transformation of one life needs to be the emphasis of any missional effort. Marc talked about how people just needed to get activated to help. My closing remarks was that all of life is a gift, being born is a gift, being saved is a gift, being given a new heart is a gift, and the chance to serve is also a gift.

LLU Strategy For Hopital Adventiste d’Haiti

• The need for additional medical teams continues, but as we move forward the composition of these teams will change to reflect current needs at the hospital.  Keep in mind the needs change almost daily.
• As of April 20, 2010, the "Dream Team" includes:
  
  
  • 1-2 Orthopaedic Surgeons
  • 1 General Surgeon
  • 1-2 Anesthesiologists (MDs and CRNAs)
  • 1-2 ER Physicians
  • 1-2 Pediatricians
  • 4-8 RNs of whom 2-4 with OR and ER experience
  • 1-2 Physical Therapists and/or Occupational Therapists 
  • 2 Pharmacists
  • 2+ Central Supply Personnel
  • 2 Utilities and Maintenance Personnel
• We also welcome applications from OB-GYNs, PAs,NPs and other health care professionals.  We would like to keep the number of our teams to about 25-30 people on any given week. 
• The teams will work at the Adventist Hospital.
• The current strategy is to send in teams for at least a 9 day cycle (Teams arrive on Friday and leave on Sunday.)  A longer term of service is preferred.     
• LLU will maintain and manage the schedule of the various teams and provide them with information about their trip and tips about what to bring, etc. 
• Selection and composition of the particular teams will be done with input from all the partners mentioned above in close consultation with the administration at the Adventist Hospital of Haiti.  It is very important that we send essential personnel in an organized manner so as to not strain already limited support resources.
• LLU and our partners are committed to support our hospital in the months to come.  These efforts will build on local available resources under the leadership of Lesly Archer, MD, Medical Director for the Adventist Hospital and supported by Orthopedic Surgeon, Scott Nelson, MD.
  
  Reposted from haitibones.org - thanks Jim

Jessica Eddlemon Claridge Reports on Haiti:

“Pa bwe, pa mange a minwit.” If I learn nothing else in Creole, I will at least know how to tell people not to eat or drink anything after midnight because they have “operation deme” (tomorrow). Ha ha, I love my patients though even though we can barely communicate. I have a lot of young girls with broken legs from the earthquake (working on the ortho service). One of them shared her salsa music with me. Another confided how she had a crush on one of the “white men” ha ha. Another keeps begging to braid my hair. It makes it fun when there’s lots to do.

There are some crazy things that walk our halls. A woman comes to the ER for daily dressing changes of the mass that protrudes from the left side of her head – maggots and all. The med students got pimped on the differential diagnosis of a groin mass as we were shown a woman with a baby-head sized ulcerating mass with black material in the middle. The large black spot on her heel gave it away, malignant melanoma. I was stuck down in the OR draining one of the wound vacs. Alex had spent forever assisting in an exploratory laparotomy…why was this little boy’s bowel so infected and destroyed? They patched him up, closed him up, and it wasn’t until anesthesia was waking him up, that I heard an extra loud gurgle from the suction. “Hey Jess, come here.” There Alex stood next to his attending who was holding a very long white wiggling worm with a pair of tweezers. They found nothing during the surgery, but afterward, the worm was sucked out of his throat. Ha, emptying the wound vac was so worth it that night.

Our translators are amazing. They work SO HARD and just get paid with lunch; that’s it as I understand it. I gave the offering call last Sabbath. Cliched, but I talked about being thankful for things we don’t even realize we need to be thankful for…like being able to communicate with each other (very difficult to give discharge instructions to a patient without a translator). As I put $5 in the offering plate, I thought to myself how thankful I was that I even had offering to give. Then I saw one of the translators also put in $5. Oh.

Everyone is pretty open about what happened on January 12. I haven’t met anyone yet that hasn’t lost someone. “Oh yes, I lost 7 family members.” “I have to go home to be with my mom every night because she gets scared to sleep alone.” “Our house is still standing, but we still sleep outside in the tent because it’s too scary.” Most of our translators are highschool or college age boys who would be in school, except for the fact that there is no longer a building. “Oh me? I study economics.” “I study linguistics.” “We were supposed to go back to school today, but people were sleeping in the school tent.” Many of them sleep at the hospital, in the OR, in exam rooms, on the benches. A very sweet nurse took me all around the hospital tonight to look for more prescription pads. She pounded on all the locked clinic and office doors and groggy people would eventually emerge from inside where they had been sleeping. We finally found some in the urology clinic where a very sleepy man had been curled up.

I spent forever developing a pain regimen for my 11 y/o girl that wakes up screaming every night. Nothing seemed to work. Upon further exploration, turns out everyone in her family except her mom died in the earthquake and now she has night terrors.

It’s really hard to discharge patients from the hospital when they have nowhere to go. And those who come from farther away have difficulty getting home because of the gas crisis. We have a few tents left that are able to go to people who meet certain criteria, but that’s not everyone. All the patients and families are friends, which also makes it hard. Why would you want to leave a place that gave you a bed, fellowship, and a free meal every day?

Haitians can sing, and it’s beautiful. I have one girl who hums to herself when she hurts. That’s how I know she needs pain medicine. Another lady wasn’t doing well in the ER and Jen said everyone else in there started singing to her. It’s beautiful.

Connections are being made little by little and it’s very exciting to watch the local staff be proud about various improvements and possibilities. The longer I’m here, the more I see parallels with home. I felt right at home when one of the Haitian doctors started discussing the pros and cons of using a B-blocker in one of my diabetic patients with migraines and hypertension the other night. And at first I was amazed that I didn’t feel tired here, but yup, even here things catch up with you

Food is short, but there is always enough. Not sick yet. Life is good.

Jessica Reports From Haiti!

I agree with Sarah. I do feel like I’m running around all day. One hour to make sure blood gets drawn for a CBC (finding the people to get the materials, finding others to translate, attempting to draw it myself, failing miserably and being concerned my patient would leak like a sieve after many unsuccessful attempts, getting a translator to help me ask a Haitian nurse for help, watching as she attempted to collect the drops of blood on the patient’s skin in a vial for the lab when she too was unsuccessful) – check. Someone did eventually succeed, the blood was sent, and now I’m staring at a hemoglobin of 6 that I’m not entirely sure is accurate. If we do decide to transfuse him, his family (who don’t come often) will have to take a prescription to the general hospital, pick up the blood and bring it back, which, as you can imagine is not a fast process, nor is it one that will be happening tonight.

1.5 hours to follow up on someone getting their pain meds (finding the nurse, finding the other nurse, attempting to communicate, finding a translator, finding a better translator, talking with the nurse, talking with the patient, talking with the sister of the patient who insists the patient already received pain meds and is worried about giving her more…etc.) – check.

I think some education and motivation might be helpful for the Haitian nurses, but honestly, I don’t know how much I would get done either with as many patients as each carries and the whole ordeal one has to go through just to get the medicine from the pharmacy, mix it up and give it. Nevermind the fact that orders are written in English and the doctors aren’t always used to going over every order with the nurse to ensure it gets done. Some nurses are wonderful to work with, but then there are the ones who fall asleep when taking watch in the ER or who don’t give any of the night-time antibiotics on any of the patients with osteomyelitis. It’s a systems issue just as much as anything. Either way, little by little, and people are getting better.

The people who have been making our food are called the Supreme Masters of Chang Hai. They are vegan, have been here for a long time since the quake and have cranked out 2-3 meals a day for 1000 plus people (the volunteers, Haitian staff, patients, and people in the surrounding community). They have been amazing, but the last meal they made was last night.

Today, the Haitian staff began cooking again. They can’t crank out quite the volume, but it certainly it is tasty and it’s important to start turning things back over. No dinner tonight though and there aren’t enough meals to feed both volunteers and patients, so they’re coming up with a system to either split the meals or rotate them. I say, patients first and we can buy ours down the road from the grocery store. All the Haitians who know me from when we came in 2008 keep telling me how much weight I’ve gained. I think I look fine, but maybe by the end of this trip I’ll be back to an “acceptable” size – ha.

Supplies are in both great supply and demand, but not necessarily in a way that matches up conveniently. An example, we actually have wound vacs, but not so many cartridges that can be changed out. Solution: drilling holes in the “disposable” portion of the wound vacs, draining out the rancid smelling liquid with a syringe (whatever is being sucked out of the wound – blood, pus, etc.), then covering the holes with tegaderm…daily. Any guesses as to whose job that might be

It is highly likely that many of the supplies needed are here but just haven’t been reached in the unpacking and organization process. Some of the hallways are literally piled from floor to ceiling. Some of the volunteers are working full time to get the situation under control.

Engineers from Project Hope have been here all day working with some of the Haitian staff and many of the representatives from Loma Linda to help assess and make recommendations for the hospital. Tomorrow there will be a meeting to discuss some of the future plans for the hospital – much prayer needed!

Sleeping on the roof – a little scary in the rain, but we have a tarp (set up in the rain), and the best view of everyone (a little ocean, lush mountains, beautiful sunsets). A great place to escape from it all for a few minutes.

Stateside

Corey, Donald, Alex holding down the fort!

LLU Med Students Hold Down The Fort
There was a mass exodus of medical personnel from Hopital Adventiste d’Haiti last Friday. The ortho team consisting of 2 attendings, 2 residents, and 1 anesthesiologist along with General Surgeon Tom Kramer vacated their posts. One of the obstetricians left as well.
Fortunately, we left our patients in the capable hands of Corey Fuller, member of the Loma Linda School of Medicine Class of 2010. As mentioned in a prior post, Corey has been accepted into the Orthopaedics Surgery Residency Program at Loma Linda and had scrubbed with us on numerous occasions over the past week so he knew our patients well and functioned with an “ortho mindset.”
Corey sent me the following email early this morning:
“Things have been going great here. I’ve done all the dressing changes without any problems. We have had some patients show up for ortho issues in the ER and clinic over the weekend. A sprained ankle, some followups for fractures, suture removals…but nothing too big for me to handle. It has been a lot of fun, I’m looking forward to starting residency so I can be of greater use next trip!”

In the image above, Corey performs a dressing change under the supervision of the Interim Medical Director Dr Robert Soderblom.
In comparison to the orthopaedic team, the General Surgery Department has been relatively understaffed over the past couple of weeks with only one attending Dr Tom Kramer. He greatly appreciated the addition of LLU Senior Medical Student Alex Coutsoumpos to his service. Alex, pictured below on the right, was a natural for the job as he has been accepted into a General Surgery Residency at Loma Linda starting this summer.

We were also grateful to have 3 additional LLU medical students join us during our stay. Pictured below from L to R are Donald Whang, Jonathan Lio, and Jason Horinouchi.

When Donald and Jason arrived, the pediatricians had left leaving them as the primary caretakers of that department. Dr Bob reports that they have done an outstanding job.
When Dr Dan left early last week, Jonathan assumed the role of managing our storeroom as well as organizing communications and transportation. He also has performed in an exemplary fashion. We were constantly bombarding him with requests for obscure equipment and supplies. We were especially grateful that he got us all to the airport on time!

http://www.haitibones.org/2010/04/llu-med-students-hold-down-fort.html