Sarah Allen Reflections On Recent Trip To Haiti!

Hey everyone,

Just wanted to write an update about our Haiti project! I just got the opportunity to spend a week down in Haiti last week! My fiance is doing an ortho rotation down there for 3 weeks so I decided to go join at least for a week. It was amazing to see how the hospital has changed since last year when I visited!

Landing in Haiti brought back memories of when I visited exactly one year beforehand. Driving back from the airport to the hospital, I noticed that there were still many tents along the side of the road where people had been living for over a year. They now appeared well inhabited. We drove by the palace, which still stood looked crumbled, identical to how it was 1 year ago. The cathedral was torn to peices, and everything looked as if the earthquake had just happened yesterday. Haiti has been through so much political turmoil in the past year it has been very difficult to get anything accomplished. There has been some progress, however progress in haiti is very slow.

However, driving into the hospital grounds, I did feel like there was a radical change. No longer were there hundreds of tents crowding the campus. It was clean, pristine, and there were very few people walking around. It almost felt empty in comparison to last year. The hospital hallways were clean, the supplies ‘neatly; tucked away in a storage building. There were no longer cots lining the hallways upstairs for volunteers to sleep. Also, for the most part, the haitian doctors and nurses have resumed full care of the hospital. There are still 9-10 long term volunteers that have made a year committment to stay at the hospital to make changes, but they are trying their best to support the haitians to run the hospital. The hospital administrator is Nathan Lindsay along with Emilie Clotaire, and they have a new medical director, Dr. Simeon. Our friend Marc Julmisse who went with us to Haiti on our first trip in 2008 is now down there for a year or more, working as a nurse educator to help raise the standard of care at the nursing level. She has been doing an incredible job, organizing training seminars for the nurses, neonatal resuscitation courses, and sending some employees to the united states for more extensive training. She has a difficult task set before her, given that the nurses don’t all have the same training, very few of them actually have their bachelor’s in nursing.

Also there is an architect there for a year, who is making plans for constructing long term volunteer housing on the campus but not in the hospital building. This will allow more space for inpatients on the wing where they have been staying. Also, in the next few weeks, administration will be moving down to the building near the entrance of the hospital, where the polyclinique is, and pediatrics and maternity will be moving up to where administration currently is. So there are some big changes that will begin to take place soon.

As I mentioned earlier, most all of the departments have returned to being fully run by the haitian staff, except the Orthopedic program. Dr. Terry Dietrich, an orthopedic surgeon who is a graduate of Loma Linda and previously has been living in Wisconsin, has committed to staying at the hospital for 1 year. He and his wife have been working hard to provide free health care for the patients, as orthopedics is the only specialty that is being subsidized right now and is still free for anybody, including surgeries. It is much less chaotic than last year, but still there are many needs. Patients are coming in who have had problems for 10-15 years but have not had the money to have a surgery. Clinics are full every day with people lining the halls waiting to be seen, and they do 7 or 8 surgeries per day as well. Dr. Dietrich has also been working to raise money for long term support for the orthopedic program to become self sustainable and to continue to provide free care in the future.

I’d love to see what they’ve done with the ortho program happen in the other specialties in the hospital. Currently pediatrics is seeing over 800 patients per month. Also, I spent a lot of time working with the Ob/gyn doctors down there. They’ve had an ultrasound machine that was donated last year that they don’t seem to know how to use. I spent some time working with each of them showing them how to use it, which seemed very helpful. Also, there didn’t seem to be nearly the same amount of deliveries as there were last year. Dr. Saint Preux explained to me that when it was free to deliver there, everybody came. But now that it costs money, most people don’t come and instead deliver at home or at the public hospital. Because of that, there is a much higher infant mortality and I would imagine maternal mortality as well. On my last day there a patient came in seizing due to eclampsia. She had waited all throughout the symptoms of pre-eclampsia and didn’t come in until she was actually seizing. We did an emergency c-section on her, and she had beautiful full term twins thankfully! Anyway I’m just saying that the lack of access to health care is obviously causing problems in many areas.

Anyway these are my ramblings, I just wanted to update everyone on how things are going at the hospital. The people seem to be in high spirits and are thankful for all that they have, even when they still are living in tents. There’s still over 1000 people living in tents at the Adventist University down the road. They’re also having elections for a new president this coming Sunday so I’m sure there are some big changes around the corner.

All in all, we’ve chosen an amazing hospital to be committed to. I’m excited about our commitment, and I’m sure that we can make some really positive changes there. I think it will take working with the people that are there long term to really help, cause they’re the ones who know the ins and outs of the hospital. I think God has blessed us to be in the position to make a difference though, and I look forward to what the future has to hold for our class project, and I pray that we can use our endowment to further His work.

Update from Nathan Lindsey, MPH at the hospital:

Post election results were released last night in Haiti. Not a good situation. Lots of rioting, fires, violence, etc. We are safe at the hospital but please continue to pray for everyone here. Many of our local staff risked their lives just to come to work today.

Update on the general situation by on of my friends Nadjy Joseph, MD

Haiti feared further catastrophe from Hurricane Thomas but was mostly spared as a current review shows six people dead from the tropical storm. Many more lives have been saved, but cities like Léogâne and Aux Anglais have been flooded. Roads also are cut, isolating departments across the country. Thomas leaves Haiti under several feet of water particularly in the Artibonite department where the cholera epidemic has started.
Good public information and other prevention measures have made the difference Haitian authorities say. In Port-au-Prince, this is a huge relief because many earthquake victims live in precarious camps of tents and plastic sheeting. When I talked to my parents this week, they told me that God listened to Haitian’s prayers because the country couldn’t face another big catastrophe 10 months after January 12 earthquake.
Efforts are now mobilizing to limit the cholera outbreak. Since this cholera epidemic hit the country in mid-October, the Health Ministry has recorded nearly 900 deaths and more than 10000 hospitalizations. The post-Hurricane Thomas floods are likely to increase these figures in the coming days.
According to WHO’s, Pan American Health Organization, action is essential to keep cholera from quickly spreading across the country. This week 73 cases of cholera were reported in Port-au-Prince, the capital where 1 million homeless live in overcrowded conditions where the disease can easily spread. Dan Epstein, a PAHO spokesman, has warned that there is a real risk of the epidemic crossing the border into the neighboring Dominican Republic. According to Haitilibre.com, three Dominicans have been admitted to hospitals due to cholera symptoms.
One of the cases was in Bernard Mews Hospital, where one of my physician friends encountered people with cholera symptoms who had moved from the Artibonite department, where contaminated river water spreads the disease. Last Monday, a three-year-old child who never left the neighborhood of Cité Soleil was treated for the disease. Already one person has died of cholera in this slum with 800000 inhabitants, and a hundred others were hospitalized with severe diarrhea. Hygiene conditions in Cité Soleil are catastrophic, so the disease can spread quickly there and remain persistently. The situation is now beyond control with local resources; health authorities and NGOs are talking about cholera becoming a national security issue. The water-borne disease has already spread to half of Haiti’s 10 regions. Flooding caused by Thomas Hurricane has exacerbated conditions and help the disease spread further. At the end of last week, the storm left 20 deaths with 36 injuries and 11 people missing. All state actors must be mobilized and concern is growing in Haiti but also in the international community.
Thanks to God, Hurricane Thomas left Haiti, but my country faces many other threats right now. This makes me wonder when Haiti will have a brighter future. However, Taiwan has pledged to support Haiti in reconstruction. Although this support has been slow to arrive (like that of many other donor nations), it is needed more than ever now.
Taiwan has been able to support Haiti with health services, including sending short-term medical missions to Haiti’s rural villages and helping to establish a national laboratory for HIV. I can only hope that this cholera epidemic will receive the same compassionate attention from Taiwan’s leaders and people
Nadjy Joseph, MD
School of Health Care Administration, Taipei Medical University

Dallas Koperski: The Good Haitian

Last night a man was brought in to the hospital by a Haitian hospital volunteer. The man had been brutally beaten and left on the side of the street. Upon arrival to the hospital he was taken outside to be cleaned before being taken into the ER. When I found him out in the gravel behind the hospital, he was completely naked, emaciated, delirious, unable to communicate, drool and snot running down his face, jagged wounds all over his body, a ligature scar around his neck where he had been hung, a broken jaw, and maggots crawling out of deep lacerations on his head. The scene was shocking. I have never seen someone so completely stripped of their humanity. The staff did their best to wash him, then gave him clothes and brought him into the hospital for more treatment. Thinking about the whole situation afterwards, I realized that the Haitian volunteer that brought him in to the hospital was the Good Samaritan. He found the man, a stranger half dead on the side of the road, likely passed over by hundreds of other people, and had compassion on him. That realization made me question whether I would have done the same. It is easy to listen to the story of the Good Samaritan and look down on the priest and Levite who passed the traveler by. We automatically assume that they must have been inherently bad people, and that ourselves being so Christ-like, would have stopped and helped the traveler. To be honest, I don’t think many Christians would have stopped to help this man. He was delirious, appeared to be almost dead, and was not asking for help. It would have been much easier to pass him by and think, “wow, what an unfortunate situation, I feel so sorry for these Haitian people,” then keep walking. In the end, I can only pray that someday I will be as Christ-like as the Haitian volunteer.

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.

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.

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.

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