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.

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.

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

We had a pre-eclamptic patient come in today. After watching what happened to the pre-eclamptic last week who abrupted and lost her baby, I was pretty nervous for this one. The nursing care here is sketchy, and sometimes vitals are taken merely once throughout the night….which can be dangerous, especially when her blood pressures were 220/160 this afternoon. We started her on Magnesium Sulfate, and gave her Hydralazine for the bp…it slowly came down but we were monitoring her very closely this afternoon. I’m somewhat concerned about what will happen during the night shift…

Anyway I’m having so much fun with these girls I’ve made friends with! They’ve been too kind to me…they keep bringing me gifts! Yesterday they brought me three, ripe, juicy mangos. I was in heaven! Today they brought me ice cream. And this evening they forced me to sit down, and braided my hair! It was so fun, my head hurts like crazy but its still fun They also keep trying to force other food on me. I try to refuse, but they get very mad when I refuse. I feel like I should be giving them stuff, not taking things from them. But they keep saying its the least they can do to thank me for my friendship. I don’t really feel like my friendship is that important, but it’s nice to know they appreciate it I guess.

I’m loving just hanging out with all of the people here. Looking back in life, one of the best things I ever did was learn french and spanish. It’s been soo useful! I spent a couple of hours this weekend hanging out with a large group of teenagers, just learning Creole. They get so excited when I put a new sentence together! Then during the whole evening, they ask me about California, and what it’s like to live there. They said they heard we have earthquakes too. They were surprised to find out that I’ve experienced multiple earthquakes, and that they don’t scare me. For them, this was their first earthquake ever. Many people had never heard of such a thing, and had no idea what was going on. They said a lot of people got scared and ran into their homes rather than out into the streets.

That evening as my friend Neerla was leaving, I asked her if she was going home. She looked at me and laughed! She was like, ‘Sarah, I don’t have a home! Remember?’ Oops. I can’t even imagine what it’s like to not have a home to go to in the evening. I’m even spoiled here, sleeping in a sleeping bag on a cot in a busy hallway. One of the nurses I’m working with was telling me how when it rains, she stands up all night, hiding under some sort of shelter, and gets no sleep. Then she has to come into work the next morning, without any sleep. And she, just like so many of the patients and other hospital staff, have no idea how long they’ll be without shelter.

But despite the sadness, most often at the end of the day I feel happy. And from what I can tell, so do they. I’m forever in awe of all of the people here, and I feel so thankful to have made so many beautiful friendships in such a short stay.

Martine is another woman we’ve been working with all week. She has one son who is 13 years old, but since then she’s had 5 other pregnancies that she’s lost. Now, at 29 weeks pregnant, she didn’t want to lose this baby again. But with chronic hypertension and superimposed preeclampsia, she was a difficult case. We started her on Magnesium and gave her betamethasone x 2 for fetal lung maturity, but unfortunately her blood pressures remained uncontrolled. This morning, at 5:30, she began to have severe abdominal pain with vaginal bleeding….her placenta was abrupting. She was taken to the OR for a c-section, and a beautiful baby boy was delivered with apgars of 1 and 5, but after bagging him for 2 hours, he was finally left to die at peace. It was an emotional day. We questioned ourselves, what we could have done differently. We questioned the system here, about why things happened the way they did. We organized teaching with the nurses on how to manage hypertension in pregnancy. But it still hurt to see Martine holding her limp baby boy in her arms, sobbing. Nothing we could do now would change that.

I made some friends with some of the young haitian girls today. They’ve kind of latched onto me, craving attention and care. They work here, helping to organize the gynecology clinic and translate. They work for free, it’s completely voluntary. But they do it because they feel safe here. Stephanie, an 18 year old girl, said she likes to come to the hospital because she can forget what it’s like off campus. She can laugh, enjoy her friends, be distracted from what has happened to her world outside. She’s living on the streets, with her mom and 3 younger siblings. She said she was fortunate that none of her family died in the earthquake, but she said it shook her personally so much that the sunday afterwards she gave her life back to God. These Haitians seem to have an amazing faith in God. Each morning, we can hear them singing outside. When the women are in labor, they’re singing songs. It’s like they’ve been through so much tragedy in their lives that God is the only constant thing. It was interesting, they were surprised to find out that I was Adventist, even though we’re working in an Adventist hospital. They thought that no white people were adventist. That might be because a lot of the relief workers here are from all over, very few are actually adventist. But I think it’s also because we have such a different culture. They’re very open about their spirituality, and their faith. I think I have a lot to learn from them.

Yesterday afternoon we went to a small orphanage nearby, and gave hundreds of tetanus and typhoid vaccines. The children lined up nervously, waiting to be shot. We rewarded them with stuffed animals after braving the two shots. After finishing with all of the orphans, people from the street started showing up, asking to receive vaccines. We gave out as many vaccines as we had syringes, but there were still more people waiting. We’re continuing the vaccine campaign each day.

Today at lunch I walked around the tent camps here on the hospital campus, taking pictures. At first I felt somewhat bad, because I didn’t want to just take pictures of their suffering. But these people were so joyful to have their pictures taken, I didn’t feel like I was documenting any suffering at all! One woman had just had surgery on her leg, and she laid on her bed with arms wide open and the biggest smile on her face. I can’t wait to post her picture up. Other amputees gladly had their picture taken. I saw countless young children running around very skillfully on crutches, with big smiles on their faces. Life here goes on, day by day.

I have so much to learn from the people here. I only hope I can give them back a piece of what they’re giving to me.

So in the states, to begin with, most people would have some sort of prenatal care, with an ultrasound (there isn’t a single ultrasound around), and the breech position would be known about far in advance. And then, some people are comfortable with breech deliveries, but most prefer to do c-section. The doctor I was working with said she ‘doesn’t do’ breech deliveries. But at the same time this was going on, there was a lady who had hemoperitoneum needing to go straight to the OR, since 2 weeks ago she had had surgery for an ectopic pregnancy, and somehow a sponge was left in her abdomen. All of the other OR rooms were full, so we were left with this breech on our hands. Thankfully, there was a midwife, Terry, around who felt comfortable doing breech deliveries, and she came just at the exact moment that Juliette let out that final scream, meaning it was imminent. Terry delivered the baby’s bottom, then the legs, the torso, the arms, but the head had a hard time coming out. It hadn’t had the time to reshape to the form of the mother’s pelvis since he was breech. But Terry reached up under the baby’s chin, put two fingers in his mouth, and pulled the baby down and out. We laid him on Juliette’s stomach, and she shrieked that sigh of relief, realizing that her agony was over. The baby was limp, and didn’t seem to be breathing however. We bagged him with some oxygen, and soon after he came to. Apgars were 3 and 9.

I sat down and delivered the placenta, which didn’t need much help whatsoever. But since Juliette had been in labor for so long, the uterus was having a hard time clamping down, and kept bleeding. I gave some extra Pitocin, and we also gave some Cytotec to help her. She kept bleeding for quite awhile. I kept checking her vitals to make sure her blood pressure was stable. We had her feed her baby to get the natural pitocin going. And soon there after, her uterus was feeling much more firm, and she was bleeding a lot less.

Then next to her, we had a pre-eclamptic patient whose blood pressures had been 190/110 all afternoon. And in the other room a 7 month pregnant woman with malaria, a woman with a fetal demise of 4 months, and a woman progressing in labor at 6 cm. Waiting in the hallway we had a woman with cellulitis of the breast, being treated with IV antibiotics, and a group of women waiting to be triaged.

So that was my second day in L&D. I have so many other thoughts about being here, about the people, the hospital, the needs, the problems, the beauty etc. But basically what I’ve seen so far, each and every person is a victim of the earthquake. They’re all struggling. We’re having a hard time discharging patients, because they have nowhere to go. The ortho patients especially, since many of them are newly amputees. Haiti isn’t wheelchair accessible. Many are living in the tents here on campus. Others don’t have anywhere to go. And even if they do have a tent, their hygiene is way sub-par. Yesterday in gyn clinic we treated at least 20 vaginal infections. We figure they just don’t have the means to clean themselves properly.

Ok enough for today, I’m sure there will be more to come…