Reflections on my trip to Haiti

I started having flash backs to the patients I saw in Haiti today. It all came so fast, like one of those movies that jerk around in some action sequence. I rarely in Haiti had time to reflect. My time to process comes now.
I am so thankful for all the support I have received from my friends and family, all of your prayers, your monitary support of both my trip and the hospital in general. I was able to experience success in patient care for those who came to our hospital.
When my two classmates Alfonso Duran and Daniel Patton left to Haiti on a Saturday night, I went with two days without sleep (red-eye flight on Saturday and about 10 inturuptions on Sunday night). Monday at 4AM we went and picked up others in our group and started toward the Dominican-Haiti border. The ride to the border was smooth sailing. There was no border; we just went straight from paved road to bumpy gravel and dirt. On my previous trips across the border, the process took 2-4 hours, due to corruption and the need for various bribes. They would threaten to take apart all your suitcases if you don’t pay them. This time however there was no stamping of passports, we just drove straight through. We slowly transitioned into Port-Au-Prince. I had been there before but there was a different feel about it. First of all, tents were everywhere. But surprisingly it appeared as if the majority of Haitians were going about business as usual. Occasionally you would see some foreign vehicle, but nothing like I imagined. Occasionally I saw groups of Haitians working to dismantle fallen buildings. Not every building was destroyed as you see on the news. But as we drove closer to the Hospital, more and more buildings seemed broken. A couple times our van overheated and we were forced to pull over. Groups of Haitians eagerly gathered around trying to help. I felt safe, they were only trying to contribute and if possible provide something of value so that we might give them something in return.
Arriving at the hospital was not a grand entrance. Everyone was too busy to notice us. All I remember was dropping off my bags upstairs and being introduced to the only doctor working in the ER. She was absolutely overwhelmed with 20 sick patients in the triage area and about 15 in the ER who were sick. Alfonso and I quickly put ourselves to work. We were also low on nursing staff at the time, but those who were working were overjoyed to follow orders, “we need vitals on that patient”, “can you get an IV started on that one”… at that time there was no charting system, so we just wrote and stuck it to the wall near the patient, so that all could see what was going on. The medications were hard to find, most in boxes pilled up in the pharmacy. Sometimes it would take 10 min to find something that would work for what you were looking for. Before long it was night, and things had quieted down considerably. We had the time to set up our tent on the Hospital roof, take a shower, get a quick meal and go to bed. I did not leave the hospital for 10 days. I awoke sometime in the middle of the night in a sweat due to the heat. But at this point too tired to care about much I slept soundly though the night.
A typical day started at around 6 AM for me and end at about 9 PM. I would have a quick devotion time, pray for strength to be a loving force to the patients, translators, and other workers. There was a lot of natural tension that existed throughout the day. The patients were not seen as fast as they wanted, the translators were thirsty and not paid. The internationals were from France, Canada, USA, and the Dominican Republic and had different ideas on how to operate in a third world. The Haitian nurses did not understand our notes and so naturally felt not as integrated—at first. Medications and supplies were usually present but hard to find when you needed them. The hospital was constantly fighting entropy, and to add any organization took extra effort, but when you were simply just trying to put out fires how could you also add organization to chaos? I am actually amazed at how well we all worked together under such conditions. Every patient who could have been saved was brought out from the brink of death.
A team from Texas, disaster specialists, under the authority of Loma Linda, implemented an organizational structure. This group had worked on various disasters such as Hurricane Katrina, and some were the big shots. As the days went on Andrew Haglund, a public health professor from Loma Linda, the “incident commander” or “IC”, had some weight taken off of his shoulders. Now if someone needed a supply, they would go to the supply chief. If a new medical team showed up, it would be taken care of by the Medical Director Christa. It was a blessing to have them around. They developed a system where every 12 and 24 hours we had specific goals, and at each 7:30 AM and PM meetings these goals would be repeated and judged successful or not. This group came to Haiti originally to work at an orphanage, but ended up stopping by the hospital to see if they could help. Dr. David Marks was among them, an internal medicine critical care doctor. He was also well-trained in disaster medicine, and whenever he commanded the ER, things were different. He instituted our crash bed, organized the needed supplies around the bed, and ended up turning the ER into a small ICU with a patient on a ventilator. As he took the night shifts, structure was lost to the day shifts, as many doctors would trickle in trying to help, at first it was chaotic, doctors doing the job of nurses, nurses doing the job of doctors, everyone running around putting out fires, no one accountable for any one patient, but feeling accountable to all of them.
About day five I working ER triage and I realized how the system was not working. I talked and examined patients their spot in line. I had seen maybe 20 patients, it was around 11 AM, and I felt mobbed. My translator was getting distracted by the masses around him, and I was getting frustrated. I had passed out numbers, so that I knew who was next. My triage nurse had disappeared and I had no one to take vitals or organize the patients for me. It was seeming to me that the majority of the patients I was seeing were not emergencies, and I realized that some of them had gone through the gate triage system, and some had not. At the gate there is a group outfitted for small headaches and able to give out vitamins very quickly. I walked out to see what was going on. Patients were just not going through the system and were passing directly to the ER. I was swamped with minor issues and not seeing patients that needed to be admitted to the ER. I was seeing gynecology issues that could have been sent to the OBGYN and pediatric issues that could have been sent to the pediatrics triage. In general many of the issues I witnessed were either from the poor living conditions (malaria, typhoid, scabes), from not seeing a doctor since the earthquake (hypertensive crisis, uncontrolled diabetes, seizures), or from stress from the earthquake (tension headaches, stomach ulcers, PTSD). Feeling overwhelmed, I had my translator explain that if they did not have the paper that the gate triage filled out, they needed to go back out. Some of them were very disappointed, as they had been waiting hours already. I continued to see patients and the crowd seemed to gather around me very tightly. This went on for some time and I was feeling drained, dehydrated, and like a zombie.
At about 1 PM I was called upstairs, a new group had come and I was to meet them at the steps. I went out there and greeted them. It was a team of doctors and nurses from California looking to help out till 7PM. They were eager to get plugged in, so I was somewhat relived. You must understand our ER was on a 12-hour shift changing at 8, and one semi-frustrating thing was groups that would come in for a 7-hour mid-day shift. They split into two groups, one to help me, the other to help at the front gate. I oriented my group, but then was told that the wrong group had been given me. So I was left with the other group. I got them plugged into the system, showed them where the supplies were, and Christa came back and relieved me for a break. I went up stairs and shed a few tears. I was so emotionally on the edge, was residually tired, I had seen patients on the brink of death, I was giving it everything I had, but it was at times not enough. Somehow right when I could not take it anymore a group showed up and took my place. They took the weight I was carrying. This was the trend I witnessed over and over—right when I almost was at my limit, God would send rain.
The next morning I woke up on a mission to implement order into the chaos I was witnessing. The system changed in the next couple days. I put the newer doctors up in the triage area, as they did not need to know the story of the patients who had been in the ER for a few days with cerebral malaria or typhoid fever with seizures. When we had enough staff, I implemented a nurse and doctor per area, giving them responsibility for one area, not the whole ER. I enforced Dr. Dave’s charting system. Orders were written by doctors and carried out by the nurses. I worked with a Haitian to implement a bilingual pharmacy layout and once signs were put up, things naturally started to be placed in an organized fashion. A new security leader fully enforced the triage system so the patients that showed up to the ER actually had gone through the screening process. He also regulated how many could be in the waiting area at one time, so that the triage person would not feel swarmed.
For the past several years, I have been asking myself the question, what does it mean to be a Christian? During my time in Haiti, I felt like I was given some clarity. True Christianity, leads to full—hearted service to others. In chapter 25 of Matthew, Jesus tells us what we will be judged by:

“But when the Son of Man comes in His glory, and all the angels with Him, then He will sit on His glorious throne. All the nations will be gathered before Him; and He will separate them from one another, as the shepherd separates sheep from goats; and he will put the sheep on His right, and the goats on the left. Then the King will say to those on His right, ‘Come, you who are blessed of My Father, inherit the kingdom prepared for you from the foundation of the world. For I was hungry, and you gave Me something to eat; I was thirsty, and you gave Me something to drink; I was a stranger, and you invited Me in; naked, and you clothed Me; I was sick, and you visited Me; I was in prison, and you came to Me.’ Then the righteous will answer Him, ‘Lord, when did we see You hungry, and feed You, or thirsty, and give You something to drink? And when did we see You a stranger, and invite You in, or naked, and clothe You? The King will answer and say to them, ‘Truly I say to you, to the extent that you did it to one of these brothers of Mine, even the least of them, you did it to Me.’”

This verse along with others like James 2 “the royal law according to Scripture “You Shall Love Your Neighbor As Yourself”…”faith, if it has no works, is dead” leads me to think that as our faith grows, as the law is written on our hearts, from our hearts we will help “the least of these”. I very much dislike pew Christianity—the type that only happens once a week on a church pew. True Christianity is something that transforms the heart, the soul, and the mind. At first it is a war of our selfishness coming up against God’s love (the war of the flesh and the spirit), but then through continual submission the spirit overcomes the flesh. “You, however, are controlled not by the sinful nature but by the Spirit, if the Spirit of God lives in you” (Rom 8:9). In conclusion, ideally, by walking in the Spirit, adopted as Sons and Daughters of Christ, allowing our hearts to be more and more conformed to His, we experience the inward motivation to help the “least of these”.
I myself make no concession that I have arrived at this place, but present it as an ideal, something to move towards. At times I feel more like a Romans 7 Christian, doing what I don’t want to do, living more by the flesh then the Spirit, but at these times I need to re-submit my life to Christ, and try to re-align my heart.
As I went through a supermarket yesterday I was newly aware of the organization we have in America. The products are almost perfectly arranged and in a logical order. Ideally this is our plan in Haiti at our hospital. To find out what order makes sense, what works, and then slowly integrate more and more Haitians back into the spots that we are currently filling will take time. Because I have had the opportunity to be at the hospital before and after, I know the hospital is operating at a level never seen, but still far from what I would envision ideally. The lab still needs a cell counter, non-broken microscopes, and other supplies so that trustworthy results can be given. More shelves are needed almost everywhere, and with shelves comes more organization. Good Haitian Doctors need to be interviewed and integrated into the system. Ideally I envision this being a training center for the local medical and nursing school. Integrating a sliding scale payment system would allow for care of both the rich and poor (right now everything is free). New challenges daily develop; as many foreign groups are disappearing (during my time there it was difficult to get an American on the USNS comfort and the Miami field hospital was shutting down) more patients will come to our hospital instead!
God led our class to adopt this hospital 3 years ago. It is developing into one of the best in Port-au-Prince. I feel blessed to be a small part in this effort. Please pray for Hopital Adventiste d’Haiti. As we serve, as we give our time, our money, and our lives, God is glorified.

Update from David Puder

Day 3 in Haiti: a long day.  ER had a never ending line of both the very sick and also the emotionally sick. Pray for a girl who came in tonight with sepsis from a scabes skin infection gone bad. Pray for rest For our team. Alfonso just said “I have seen more and done more in these three days then in my whole 4th year”.

Scabes? Then infected with staph... Now in respiratory failure

Allen in Haiti

Hey everyone,

It has been such a blessing to be able to help the Haitian people in their time of need. On Wednesday and Thursday I went out with a mobile clinic. Each day I saw over sixty patients! They range from newborns to the elderly, very sick to doing pretty well. Most patients are coming in with a variety of infections, many of which are likely to the poor living conditions. Over one million Haitians are now homeless. Many don’t even have tents to sleep in yet. It has been very sad to see some patients complaining of hunger pain because they are unable to afford food. There is no pill we can prescribe to fix this. The locals are extremely grateful for the help that we are providing. The Haitian children are beautiful and are very eager to smile if you wave or show them even the smallest smile. There is so much work to be done here both now and for years to come. I can’t urge you all, my classmates, enough to continue helping.

Thank you for your continued prayers,

Allen Patee

Update from Allen Patee

I just received this from my classmate Allen Patee:

I’ve been in Haiti for the past 2.5 days and the experiences here have been amazing. There is so much opportunity to help so many people in so many ways. I spent 13 hours yesterday in the OR helping out with ortho cases. There was no OR nurse or tech present so I was helping out with those types of things. I would also periodically scrub and help hold limbs in various positions. When we were done with our cases for the day we built ortho trays and continued to organize the OR. Today I stayed extremely busy in a clinic/urgent care/ ER. There were literally hundreds of Haitians lined up since early this am. There was one Pediatrician, several RN’s, and me. I ended up seeing 42 patients on my own!! I saw lots of infections, asthma exacerbations, hypertensive urgencies, musculo-skeletal injuries, peds, peds, and more peds! I did have a Haitian translator to translate and document for me. Apparently this is how it has been every day. There is a good supply of antibiotics, and we provide full care. They have also been begging for people to work overnight shifts in the ED and in L&D. There is a couple of midwives and one OB GYN intern. Yesterday there were several deliveries, 3 C sections, and 2 patients in eclampsia (not Pre-eclampsia—these patients were actually having seizures)! The people here are all so grateful for the help that we provide. It is such a blessing to be here and to be able to help. There is definitely more than enough to do for all of our classmates, and I know that you would feel tremendously blessed if you are able to come.

Thank you for your continued prayers,

Allen

Joe Kim’s Update from Haiti

“The quakes keep rolling. Well they are more like little tremors that shiver more than shake, but the reaction everyone has is a reminder of how traumatic the memories are. Last nights’ late shift was fortunately calm without incident. That was in strong contrast to the earlier night shift in which we had 4 codes and so much of the group was pushed to emotional and physical limits. So far a more systematic approach to patient care and rounding has led to earlier identification of sicker patients, and the leadership is working hard to address some of the resource limitations that prevented us from being able to save lives earlier.

In other news, our little global village compound has been quite the press joint today, the Hope Channel was here. About half way through the day, a large convoy of trucks complete with VIP blinkers and bodyguards on foot made their way into the hospital and an American and French ambassador stepped out with a small press corp. Apparently we have all been working so well with the French that it has been reminiscent of those old guys, Lafayette and Washington. I don’t want to start any rumors, but we might be getting back together after that whole Iraq quarrel thing. I’ve already started calling freedom fries French fries again in anticipation.

I ended up sleeping away the afternoon after the late shift, but the exciting word for the collaborative operations is that a tent went up for the clinic at the Refugee camp at the University and the set-up for the satellite clinic is complete. There are big plans to continue the outreach spreading out from the hospital, and while there seems to be a steady flux of medical personnel to staff the hospital, with the expanding vision, new places to plug into the patient care are always coming into need. Just the other day as I was helping the team from Texas set up the clinic across from the hospital, we went out to spread the word and found that there were over 50 patients waiting at a refugee camp being seen by a few local nurses who were not capable of handling the suturing, and diagnosis necessary to treat the large gathering crowd. There is definitely a sense of excitement in being able to directly fill a clear need, and the opportunity to do that has only been growing with what to this point has been a great collaboration between Loma Linda, ACTS, the French Pompiers, the hospital administration, and the number of many other sincere volunteers who have been coming to the hospital. I can’t wait to see how our class will fit into this growing aid work, and am sure that we can make a contribution that will have a lasting impact.”

Joseph Kim Update from Haiti

Hopital Adventiste d’Haiti Needs Your Support!!!

Loma Linda University has established a fund to facilitate donations to the Hopital Adventiste d’Haiti. The hospital is in need of many resources in order to function around-the-clock during this critical period. Donations may be made as follows:

• On-line: support Hopital Adventiste d’Haiti
• Telephone: (909) 558-5010
• Mail checks: Loma Linda University – Haiti Earthquake Office of Philanthropy
  24519 Redlands Boulevard, Suite A
  Loma Linda, CA 92354

Loma Linda wishes to thank all who are taking time to remember in prayer the desperate needs of the people of Haiti. We hope that many will be motivated to provide the means through which needed health care can be sustained at this time.

Haiti Update – Supplies

Dear Friends,

Fantastic news, the autoclave that Howie Guan and Patrick Hu drove down to San Francisco arrived to our hospital in Haiti today! I received a message from Joe Kim asking how to set it up when I was on rounds! I had Jerry Daly email him instructions…. they subsequently installed it and it works!!!! They also praised God for the granola bars that classmates David Penner and Oliver packed inside! Praise God! One hundred thousand dollars has been raised for our hospital’s Earthquake fund, but more is needed! Why? Because we are paying the gas for the generator, and likely no patients are paying for treatment right now… and we are running 3 Operating rooms… and patients are still waiting for much needed treatments. I was looking at the audit of books we did while at the hospital and it takes roughly one million dollars to run the hospital for a year. Likely our fund raising for the acute needs, along with all the materials we will be bringing in will bridge the gap until Haitians can start to work again and help pay for their treatment. About two thirds of the money usually came from patients with insurance, which the minority of patients had, however I am sure no one will be making insurance claims any time soon. The supplies we itemized from Marc, Christine and Sarah’s public health assessment that we made a year ago are being brought into our hospital at a record rate! We are currently looking to acquire a good C-Arm for orthopedic cases (it is a machine that has a rotating X-ray for intra-op adjustments) along with 2 quality anesthesia machines. Let me know if you have ascertained these tools for donation, some students are taking on this challenge to find these expensive but essential things. Currently they are trying to open up a 4th OR. Likely one of the OR’s will have to be expanded as soon as we can get a C-Arm into the hospital for some serious ortho procedures. One more thing, the generator was having some issues but they have gotten both functional. There has been talk about moving them out of under the building structure, and possibly bringing in another generator for back up.
There have been continued smaller earthquakes (a 6.1 today and a 6 a few days ago) but the hospital is sound other then some new small cracks.
Also of interest some of the American volunteers were woken up this morning at 4AM by “What a friend we have in Jesus”… despite all the hardship those living still praise God.

Continue to pray for these things:
1. That more money will continue to be raised for the hospital earthquake fund
2. For the safety of the teams over there, especially our classmate Joe Kim, in terms of being overworked, poor sanitary conditions, and ongoing earthquakes
3. That the materials we boxed up today will arrive there safely
4. That we can get a C-Arm and anesthesia machines moved into the hospital
5. That those who are stealing medical supplies, food and water and selling them on the Haitian black market would get caught (I heard from my Haitian friend that this is a big deal right now!)
6. Pray for unity among those working on the ground in Haiti and in the US

For more updates follow posts being made from Haiti at: http://lluinhaiti.blogspot.com/

Sincerely,
David Puder

Haiti Updates

***For Further Updates, please check the “Earthquake Relief Effort” section***

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As most of you know, the earthquake in Haiti has brought great destruction to the area around our adopted hospital.   50,000 people were killed.  Dr. Archer, our main contact, is safe along with his family.  From the news I have learned, most of the hospitals around Port au Prince are deeply damaged.  Dr. Nelson, an orthopedic surgeon, will be arriving Thursday to assess and work out of our hospital if possible.  Everyone is invited to my house for a time of prayer Friday night at 6:30.  Bring a snack, fruit or desert and join us!  It would be great to mobilize our class to help!

David, Doug and Dan’s house: Friday, 6:30 pm @ 25466 Sonora Loop, Loma Linda CA

Sincerely,
David Puder

Major Earthquake Hits Haiti

“Major quake rocks Haiti causing damage and casualties. A powerful 7.3-magnitude earthquake has struck off the coast of Haiti, rocking the capital and sparking a tsunami alert for neighboring states.” Compliments of the BBC

Reports say a hospital has collapsed, though they haven’t stated which one. It sounds like it was in Petionville which is not where Hopital Adventiste d’Haiti is located, but it may be close to where Dr. Archer, our main contact physician, lives.

Please be sending prayers and we will keep this site updated as more info becomes available.  We are not sure yet how we can help, but if you are interested in getting involved, please contact Jessica Claridge from the Contact page.

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