Updates from Haiti (web journal)

For the most part I haul stuff, including patients. Yesterday, I was an electrician and rewired a tent and put in more fans.

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

February 4

We arrive to the University Hospital around 7:15 a.m. We have a short debriefing and then we are off to our units. There is no way to know what we are in for each day. I meet with my interpreter and we chat about our previous night. I ask about his family, how his wife and kids are? He always says they are good. It's hard for me to comprehend they are "good" with their home destroyed and having to live in a small tent, meant for two but accommodating five. He says his kids love not going to school. I think to myself that perhaps his children have not yet realized their schools are destroyed and the devastation of the earthquake has taken the lives of their classmates and teachers. After the brief conversation we are ready for our day, both of us know it's going to be long and hot. We don't give the conditions a second thought as we are immediately focused on making a difference--bringing light to the darkness that surrounds so many here.

Arriving at the unit, I take inventory to see what supplies we have for the day. I have learned that many of our supplies are missing. Already patients are waiting for care. The long lines twist down the street. American care is here and the Haitians have welcomed it with open arms. They have a robust confidence in the work we do--often expecting a cure for the incurable. As the chaos begins, there are doctors and nurse swarming the tents. Novice nurses work side-by-side the seasoned healthcare providers. The newest additions to our ER flounder briefly asking questions like "where is this antibiotic, where is this narcotic, will you start this IV, can you figure out what is wrong with patient, I am new here can you help with what I should do, etc." The intensity drives all of us to push our limits and immediately adjust to the demands from all sides.

After 10 hours of craziness in 100 degree heat, we finally come to a day's end and take time to reflect. Have I made the right calls? Have we truly done our best to make a difference? The realization that our Hopkins group will have worked over 1,000 hours within 10 days, does not ease the demands I have for myself and the short-comings I have identified within myself. It's two weeks out of my life--a short time to do the good I set out to do.

Pierre, my translator, has stood by my side all day. He's held my supplies at my side, tidied my workspace, and spoken every one of my words. He comes here every day to make a difference of his own. Knowing his family awaits him, he sets off back to his "home."

Despite leaving the ER for the evening, my mind is continuously rewinding through the day. How will I be better tomorrow? Am I good enough for these people who depend on us so much? I think of each face of each patient, of each heart I have touched. The strain and stress can be overwhelming but I find a strength in those who depend on me. I will return tomorrow with a smile on my face, a soothing touch to my medicine, and shoulders to carry the burden of a broken country.

-Rocky Cagle
(Johns Hopkins Disaster Response Team Nurse, Port-au-Prince, Haiti)

February 4

Day 6 six in Port-au-Prince. Already half-way through our stint here. I can't believe it was only one week ago that we were first flying here. It feels like so many more.

I hit a brick wall yesterday as we have all been working almost non-stop since arrival--some since the minute we stepped off the bus from the Dominican Republic into the hospital. It's the long hard hours in the sweltering heat of the tent, the relentless flow of patients desperate for miracles we can't provide, the lack of sleep, and continuous failed efforts to stay hydrated and nourished. At least one volunteer has succumbed to the pressures every day since we've been here, to the point of being unable to walk and needing IV hydration. I came dangerously close to that point multiple times about every 2 hours yesterday, needing to find shade outside of the tents, and force down some ORS (oral rehydration salts). I had at least 3 liters of ORS plus more water and still couldn't last more than 2 hours in the tent without feeling like I was going to vomit and pass out. I realized I had to take more than the time it took to down a liter of ORS away from this work. Thankfully everyone else realized it yesterday as well and time off is now not only being more welcomed, but mandated. I quickly stepped up to the plate to take the first day off. I finally slept better, I think knowing I wouldn't face the pressures of not only caring for others this morning but caring for myself in this condition. That alone was a huge weight lifted for the night. And I still awoke nauseous and still feel so now. With being awake through the night not only because of the heat and stress and mosquitoes, but because of having multiple trips to the bathroom with vomiting and diarrhea.

But I'll get through it. All of us will (with a few exceptions of early flights home for fear of serious illness). The bonus of doing medical relief is that we all have easy access to medicines and IV fluids with the know-how to provide it to each other. I started an IV on another nurse that went down in the middle of the day yesterday. I have been offered IV fluids and Zofran and Cipro by many of my fellow volunteers. Everyone cares and everyone understands. It's great camaraderie and great inspiration to see what we are all going through to try and make some difference here. And I like to believe it's in the small ways that we are. We are so limited in what we can do for the severely sick and without social work it feels so wrong to discharge those without a home to go to, but that is nearly everyone. I don't know how these people are surviving, but they are. Not only that, they smile and thank for the simplest things--some Tylenol, a little cleaning and fresh gauze on a horrendous wound that covers half their leg which they will have to limp out of here on. And to where? A two-tarp tent, waiting for the next food and water drop off. We pass by their lives, sheltered by the walls of the bus and the walls of hospital, see them cooking and bathing on the sidewalks, bustling to and fro. Life goes on in unexpected ways.

-Alicia Hernandez
(Johns Hopkins Disaster Response Team Nurse, Port-au-Prince, Haiti)

Wednesday, February 3

The day starts about 5:30 a.m. when the hotel turns back on the power. The fans come back on at least. People begin stirring, snores fade away, backpacks rustle and feet pad around. The lights usually burst on at 6 a.m. and then the activity intensifies except for the few still trying to squeeze out a few more minutes of sleep. People dress, food and supplies are gathered.

The bus leaves at 7 a.m. driving less than a mile past normal buildings and lives and crumbled ones and tent camps. Vendors have already lined the streets past the ramshackled tents in the city’s main plaza--food stalls, haircuts, a Gno Kozes (snow cones). Most interestingly the guy with the truck well lit by fluorescent lights and a rack of blenders on the back is making smoothies. At the gate of the hospital there is already a half-block long line of patients waiting to get in.

By 7:15am we have completed our briefing and are pulling supplies. The little triage tent is bursting with people. Report is given by the night team- there are always patients leftover – usually very sick. They bring the sick ones from the rest of the compound back to the ED if they go bad at night, and only the really sick come in after midnight. Patients start pouring in.

Our tents are hot, probably 10 to 20 degrees hotter that the ambient 95F air outside. They have few windows and the power only runs occasionally to run the fans. We lose at least one staff member a day to heat exhaustion. Yesterday it was the 6’2” Amazon nurse from Utah--dizzy and pale then down and vomiting. We run IV fluids and bring them to a cooler area. We have started mandatory fluid requirements and push people to take breaks. We now will have a mandatory ½ day off every five days minimum. The army guys might hook us up to one of their generators so we can at least run the fans. I got pizzas and cold Cokes delivered from the outside yesterday. A strange, and strangely comforting little piece of normality.

The buses head back between 5:30-6 p.m. and it is always a scramble to tuck things away, restock and sign out to the night people. We usually miss the bus and bet the late one.

Debriefing 6-6:30 or 6:45 p.m. (although I usually miss the first few minutes, preferring to sit with my sore feet dangling in the cold pool water and drinking a beer.) Dinner--cafeteria style--is at 8 p.m. Most people start fading out around 9 p.m. The few hardy (stupid? gregarious? insomniacs?) sit on the patio late talking and drinking $4 beers or soda until late surrounded by the reporters furiously working on stories and hogging all the wireless bandwidth.

Finally sleep in the dark conference room with 40 to 50 people scattered around in various odd sleeping arrangements--bed mattresses, inflatable ones, cots, even tents pitched indoors. The stirring, rustling backpack and padding feet gradually fade away and a low-grade background hum of stores rise up and the day ends.

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

Tuesday, February 2

Today we saw 470 patients, with 10 hours of clinical care (and 2 hours of other stuff) that's almost 1 patient a minute. It's hot, it's chaotic, and it is repetitively, achingly sad. We have created a system and teamwork that is so efficient it's scary. Of course that means that I am mostly a runner, appropriator-of-supplies, communicator and patient transporter.

We have truly transited into replacing the primary health care systems with people pouring in to get horrible chronic illnesses addressed--horrible, ulcerated cancers, severe hypertension and chronic heart failure, children devastated with cerebral palsy. Mixed in though, are patients dying from untreated illnesses--severe heart failure and asthma, and many with serious infectious diseases that are difficult to diagnose, so we just pour in antibiotics and hope for the best.

The first photo is of the triage area where everyone lines up for care. It is late in the afternoon, after we have cleared things out, when the other clinics, hospitals and field hospitals send truckloads of patients to us...because we're better I guess (laugh out loud)?. It reminds me of the Hopkins Emergency Department.

The second photo is of the entrance to the main hospital building. It still has no power so at night, when it is jammed with close to 100 patients and their families, it is pitch black with flickers of flashlights and low murmurs and moans.

This last photo is of  Rocky Cagle. He is a Cardiac Surgery Intensive Care nurse. However in Haiti, he is an all around care-giver, organizer and nursing leader. Rocky is pictured with two of our interpreters--James and Pierre. Both have lost their homes and are living in tents, but still come to work every day and help immensely.

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

Tuesday, February 2

We work out of big, cream-colored tents, maybe 30 feet long by 15 feet wide. There are tents scattered all over the compound, from many different countries, but all with slight variations on the same design with a color range of white to tan.  I guess they are the international standard disaster tent.  We have three tents for our "Triage Emergency Department."  Two tents stand out--the ‘Jiffy Pop’ (look that up those of you born into the microwave era), and the Blue Tent.  The Blue Tent is the infectious disease tent with 6 places for the emaciated people coughing blood that we think have advanced TB. There is an exceptionally brave and unassuming Infectious Disease fellow from California who works there, pretty much alone it seems.  She is quiet and unassuming with dark hair and a serious look about her. And she risks her health and maybe even life every time she steps in there. She works 10-11 hour shifts. At night the patients are alone to cough and gasp for breath.

The patient I sent there yesterday was a 19 year old with what appeared to be advanced AIDS. He looked like one of those classic "refugees" in a starvation area with racks of ribs cascading down his chest, sunken eyes and limp, lean arms and legs. By the time he got to us he was already breathing so hard that he had to sit upright and could only gasp out one or two word sentences. He was sweating and you could see every muscle in his torso working to drag in each breath. We poured antibiotics, anti-malarials, and fluids into him immediately, but because he reported coughing blood we moved him to our "isolation area"--the open space between our two tents under the shade of some trees.

I moved him to the Blue Tent in the late afternoon knowing there was not much to do, but hoping the California ID doc could work some miracle. The next morning I went by and was somewhat surprised to see him from under the tent flap still sitting in his bed. After donning an N-95 mask I went into to the dark cramped tent among the shrunken, slightly stirring bodies to get a better look. He sat exhausted and glassy-eyed, sweat streaming off of him and making small grunts with each breath. It took him all his remaining strength to keep himself breathing through the night and now he had no reserves left. I just tuned and left. He died 2 hours later.

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

Monday, February 1

“I Watched 3 People Die Today”: Letter from Alicia Hernandez Nurse, Johns Hopkins Disaster Response Team

Expectations have so drastically changed every hour along the way here that I can't even compare the reality to expectations. We had heard earthquake-related medical needs are over and yet one of the patients we received today was a little girl who had bricks fall on her legs during the earthquake and only came in today for it. She had bilateral femur fractures. I'm not sure how things will turn out for her. The day was filled with the questions "What can we really do for this patient?” and How many resources should we really use?" considering every bag of saline and every glucose meter strip when we were down to 4 of each for the day by noon.

So much of this care involves deciding who to let die. The hard part means watching them die and watching their loved ones deal with their deaths. In these places, you'll see a brother, who's 40-something previously healthy sister just died, say "OK" with a non-chalant shrug when informed that she's gone. Like, "just thought I'd ask". And it seems like they are so hardened to this because they are dealing with is regularly, and with so much worse. But with this particular individual, we had the privilege of treating his father in the same day and keeping his company throughout the majority of the day. Even after his sister died, and worrying about his father's treatment in the same place, he was cheerful and thankful. There was a moment, however, where the hardening softened, and he collapsed down onto the stretcher next to his father that was finally briefly freed of another patient, and sobbed, when he thought no one was looking, for a brief moment.

Each death was different, each patient was different, from gunshot wounds from a riot setting to chronic illnesses sent from other hospitals drowning in the situation, to a women with nothing left we could do, no family, no identity, and who still hung on for hours. There is so much need, and so many people who want to provide, and so many obstacles. And this is just our day 1. We will make a difference. I am determined. I don't know how. I know even less so how than I thought I did 3 days ago. But with the good will and determination I sensed today, it will happen, no matter how slowly.

-Alicia Hernandez
(Nurse, Johns Hopkins Disaster Response Team, Port-au-Prince, Haiti)

Monday, February 1

Work here is hard--12 hour days, essentially on your feet constantly in boiling hot tents with limited electricity. We have truly transited to the primary care phase, although occasional people come in with untreated wounds and fractures from almost 3 weeks ago. There is so little that we can do it seems, with the limited resources we have, and even less to do for an essentially non-existent Haitian healthcare system. We can treat acute infections, but pretty much anything else is almost impossible. People are pouring into us because they think that we can give them the care they can never get in Haiti--horrible and massive cancers, HIV and AIDS, chronic abdominal problems, diabetes, whatever. But all we can do is bandage, fix the acute problem and give a few pills to go and hope that maybe at some point they may get the long term health care they deserve. Still, we see 250 to 350 people a day and give the absolute best care we can considering the resources.

The team has been amazing and has taken over the management of the emergency department. Everyone is pulling their weight (and then some) and using their intelligence, wit and grace to make this place better every day (despite the ongoing chaos).

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

Thursday, January 28

The Hopkins Disaster Team finally arrived in Port-au-Prince last night at 5:30pm after two days of travelling. We arrived at the University Hospital just in time because a large group of providers is leaving tomorrow morning. The staffing is so short that our pediatrician and our Creole-speaking physician are working the night shift tonight to staff the pediatric ward, which otherwise would have been left only to the patients and their families. The first group has been working non-stop for two weeks and is exhausted.

Port-au-Prince has an odd look about it with scattered areas of devastation next to completely functioning businesses. Camps of the homeless are scattered throughout the city. The University Hospital is a strange mix of functioning wards, collapsed buildings and tents from NGOs scattered across most open spaces.

The Hopkins Team is sleeping in a giant conference room at a local hotel, but it is safe and relatively cool and clean. Tomorrow the real work starts.

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

Wednesday, January 27

"We landed in the Dominican Republic and took a truck ride from Santa Domingo to the border of Haiti through lush rain forest and a field of cacti and yucca. We were stuck at the border for a while, but now finally getting through the border crossing. It’s actually a good sign. There is so much chaos and a massive traffic jam at the border because a ton of supplies and equipment are pouring into the country."

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

Wednesday, January 27

"We are off. Our Hopkins Team is composed of physicians, nurses and mid-level providers. We carry supplies donated by the Hopkins hospital and a local pharmacy (Harrison's). We are prepared to sleep in tents, but there may be a conference room at a hotel we can sleep in. Frankly, I think I'll sleep outside. But there will be electricity available"

-Tom Kirsch
(Johns Hopkins Disaster Response Team Leader, Port-au-Prince, Haiti)

Return to main Haiti page