Haiti Mission Project

Update from Sarah Allen in Haiti: Day 3 and 4

I spent all afternoon treating vaginal infections. Let me tell you, even though I’m going into Ob/Gyn, doing the whiff test is still not my favorite activity. But these vaginal infections are a sign of what kind of conditions the people of Haiti are living in right now. I’m not sure how often they have a chance to bathe themselves, or where they would anyway. If they’re lucky, they’re living in a tent. If they’re lucky. If not, they’re outside, under a tree, by a wall, next to the road, or wherever they can find shelter from the rain. That’s why its impossible to discharge them sometimes, because here at the hospital they have shelter, safety, and food. Who would want to leave?

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.

Sarah Allen MS IV: Juliette – Day 2 in haiti

Her name is Juliette. She’s 38, in her 7th pregnancy, but delivering her 3rd child. She has two older boys at home, 7 and 3. Her husband died in January in the earthquake. She says they were at home, and a wall fell on him. So she’s raising 2 kids on her own, and now with another one on its way. We examine her, and she’s 7 cm dilated. We take her to the delivery room, prepare for a fast delivery since she’s a multiparous woman, and sit there and wait. 15 minutes, 30, an hour, and soon 3 hours go by. She’s not making any progress. We repeatedly check her, and the exam is difficult. Its hard to tell what’s vaginal wall, what’s cervix, and what’s the baby’s head. Thats when we realize….it wasn’t the baby’s head. The ’suture’ line, was the baby’s bottom. The fontanelle was the baby’s rectum. We had a breech position on our hands.

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…

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.

The C-Arm arrives

A Sabbath Days Rest

 

 

 

 

  

 

  

 

 

 

 

Update from Dr. Patton

Tuesday AM
Another quake. 4.7 at 1:27 am. I didn’t get out of bed. It wasn’t bad enough. I have the Haitian trots this AM. Not good.

Wednesday PM
I have been working part time since I got the trots. I wish I could work more but I feel weak as the day wears on.
Today I removed 6 casts. I taught my friend and Haitian interpreter, Jean, to remove them. He learns quickly. One young lady had a cast that ended at the fracture site on her humerus. Of course it had not healed. There is so much work yet to be done.

A young boy burned his foot. It had been dressed but that dressing had not been changed in days. Pus dripped from the wound. It needed cleaning in the OR. The family could not be persuaded that the surgeon would not cut his foot completely off. They left without allowing any intervention. I hope they come back before the child becomes septic and loses his life or at best now his limb.

I so enjoy Scott Nelson’s vision.

Feeling feverish and weak. I hope tonight passes quickly.

H2O traction in a tent. “Welcome to Haiti.”

My buddy, Jaunty, brought me a protein milk shake. What a great guy!

The owner of these cute, dimpled hands can count to twelve!

I am impressed at the older and cleanliness of many of the people despite the surrounding chaos and filth.

This little boys spine is protruding because it has been destroyed by tuberculosis.

This is a common sight.

...a lot of metal to hold together a destroyed pelvis.

Without C-arm there was no way to know if this fixator was on straight in the OR.

Everybody’s leaving but we’re still here

Puder the Tall Checking In

Today I woke up feverish in a sweat to the shaking of the earth. I am on doxy malaria prophylaxis but added chloroquine today. The residual fatigue is getting to me, but as the day went on I felt stronger. I had a new doctor who worked ER triage so I slowly made my rounds making sure things in the ER were moving forward and people getting meds, improving, etc. One of my big projects today was using a translator to make sure the Haitian nurses knew how we were writting orders. Dr. Nelson arrived today.  Good to see the doc that got me excited about Haiti!

News from Dr. Patton

This afternoon I made rounds through the tents with a general surgeon from Martinique. He is an angel! His goal is to help motivate the patients to return to there homes and begin to rebuild rather than remain in a tent on the hospital lawn. Every family and widow responded, “we need a tent to set up on the street outside our house”. They have nowhere to go. Dozens of families. I heard the exact story repeatedly.

The mobile dressing and casting cases I made were wheeled through the camp today to care fore those in the tents.

The surgeon amputated an infected foot.

The Ortho team rode to the hotel where CNN reporters and other VIPs stay in a “top-top”. It’s a pick up with a topper raised by metal bars to allow the passengers to ride in the bed of the pickup, sitting on parallel facing benches yet covered with truck bed topper: top-top. We survived.

I had a wonderful conversation with Andrew Hagland about the story of the first few days of establishing this hospital as the premier medical faciltiy in Haiti post quake.

Scott Nelson arrives tomorrow.

Tough Day

Today’s events:

• ER triage;
• a cardiologist helped me diagnose a girl who looks pregnant with (per echo) biventricular heart failure with a 20% ef;
• called a code as a woman came in vomiting up blood;
• worked with Haitians on organizing the er pharmacy;
• packed a gun shot wound;
• took a pregnancy test to make sure it works (I’m not pregnant);
• made difficult decisions;
• prayed to God for help;
• worked dirrectly in consults with surgeons and ortho;
• treated a severe asthma exacerbation;
• drained some abscesses;
• delt with stress related psychosomatic issues;
• worked with some excellent nurses;
• got to know some translators;
• and loving it!