Messages From Our Colleague in Haiti:
Marie Cordes, RN, BS
Message #1: January 23, 2010
Hi all - our group started with a few of us with experience working in Africa and in disasters who couldn't stand waiting - we knew we could help and tolerate living in austere conditions. In a very short time we put together a great team. We are also coordinating with Paul Farmer and Partners in Health, as well as the Dominican Red Cross (to a lesser extent). Our airfare, telecom, rental vehicles, and strategic support have been provided by the AFT (American Federation of Teachers), the parent union of our local Vermont Federation of Nurses and Health Professionals. We also have continued financial support through donations in our local communities, and vendors providing supplies (Bard, Teleflex, Centurion).
After much effort organizing transport, gathering more supplies and continuing to develop very important infrastructure and network for this and future teams, working with the Cruz Roja in the Dominican Republic, communicating with Partners in Health in Haiti and our own reconnaissance team that struck out ahead of us yesterday, we have joined the rest of our group in a large medical compound in Jimani. Jimani is a border town with Haiti on the Western side of the Dominican Republic.
The compound has been established in an area that appears to belong to a church mission. There is a chapel, a larger 2 story building approximately 4,000 sq ft. for supplies which currently is the command center and kitchen with food for volunteers, and another building about the same size as command center, called the orphanage.
The orphanage and the chapel are being used for patient care and surgical areas - Dr.s Charrash and Greenhouse performed 8 procedures today in the orphanage, including surgical debridements. There is also a large tent for med surg care.
I don't yet know how many patients there are but we think more than 500 just in this compound. There are other ORs set up in Jimani as well, but what our recon team learned yesterday is that they are very chaotic. A major part of the chaos in all of these areas and in parts of Haiti is related to the fact that groups of surgeons from Puerto Rico and other countries flocked in to perform very necessary surgeries, had no nurses to provide post surgical care, and had to leave the patients on their own. There are not enough ORs for all of the surgeons, and they were fighting amongst themselves for control of them (of course not our docs).
One of the co-directors of this outpost is a Nurse Practitioner who with her Family Practice MD husband have lived in this area and provided healthcare to the Haitians for 12 years - said she wouldn't mind if she never saw another surgeon again, the situation was so bad. She said that they were desperate for
nurses.
They are incredibly grateful that our team is here; we've already demonstrated to them a high level of skill and integrity, as well as a commitment to work with them into the future by rotating relief teams into the compound. They are relieved that we are completely self sufficient, and incredibly well organized and supplied with self-care items (e.g. food and water) and telecommunications. They repeatedly called our group "a blessing".
Part of our team is already at work on 12 hour night shifts; the rest of us are resting from the long hard drive with our two rigs across the D.R. (if any of you have driven in a developing country, especially in a border area, you can probably imagine what the roads are like!) - and we'll take the next 12 hour shifts.
Just as we were pulling into the compound and greeting our dear Bill Charrash, David Greenhouse, Jeremiah and Brian, an aftershock occurred - terrifying the Haitians in the buildings, causing an instantaneous mass exodus of patients from the 2 story orphanage including 3 patients jumping off of the balcony causing spinal injury and two fractures. All of the patients have family members with them - were dragging mattresses with patients on them down the stairs. We jumped in and helped move patients out of the chapel as well and under the large tent because everyone was so terrified to be in a building.
Most of the patients have crush injuries and amputations. The patients have external fixation, fasciotomies including children. Nearly 100%, according to one of the coordinators here, have some sort of tissue infection because they did not have post - operative care. We are concerned about bacterial resistance, too, as the antibiotic administration was very irregular until command center was able to begin establishing standard of care routines for patient care. The NP director has me in line for probable PICC placements on patients that will require Vanco, Ampicillin, etc. - she said that patients arms are getting very chewed up from the meds they are getting. I'm also very concerned about sepsis, and am strategizing providing family members with many alcohol prep pads and swab caps and employing them to guard every access of their loved one's line.
Bill and David were instrumental in creating significant order in pre and post surgical care in the orphanage - they created a wound care center out of chaos. They insured that patients had a translator so that the surgeons could describe what they were going to do before they did it (which definitely has not been standard routine, on top of many of the patients having experienced surgical procedures with minimal or no anesthesia.)
We are so incredibly fortunate to have such an amazing amazing team here, and all of you that are supporting us in your own way (prayers I think must be helping, too). All of us are in very good spirits, everyone gets along fantastically, everyone is very honest and respectful to each other, and each of us has important and highly relevant skills and experience to bring to every aspect of this mission. We have succeeded in forming the kind of bond with each other that is absolutely essential in successful disaster management.
But by far - WAY far, the Haitian people are the most amazing of all. They model for us over and over incredible perseverance and hope, even as hell descends upon them again and again. Family members attend to one another so patiently. They are often singing. The children are so beautiful; and yet it is hardest to witness their suffering. Many have a blank look in their eyes that is very painful to see.
It is getting late, and I must sleep and prepare for another long day tomorrow. Know that we feel your love, compassion and support, and it is incredibly important to us, especially because it is helping the Haitians so significantly.
Salud y Solidaridad,
Mari
Message #2: January 25, 2010
Another day....
......but a hard one. Not because it was any different for the Haitians. The mother who lost her two month old when the building fell on them, leaving her to heal from a fractured pelvis and god knows how much of a fractured heart. Gabrielle who has no one with her here, only friends back in Port Au Prince that she would like to get back to but she can't until her amputated thumb heals. Marinich, a 12 year old boy who ambulates with his fractured femur/external fixation with a fierceness I rarely see in patients determined to heal. Soresta who panics at the thought of being in a room on the second floor (even without anyone suggesting she should be), and is a new paraplegic. For them, the days are much the same. We do dressing changes on very painful wounds, sedating many of them, in the hot sun and the sand. They are still without homes and missing many of their loved ones.
No - not much different for them, except that against all odds their bodies are healing. Maybe someday their hearts will heal a bit, too. What was different was that this song from Gabrielle and her refugee friends (attached) cracked my heart open.
David Greenhouse, MD and I talked tonight about how healthcare providers normalize' things when we are responsible day after day for the lives of people in all sorts of disastrous situations, even when there is nothing normal to be found. It is so incongruent with reality we're bound to be slapped upside the head with a glimpse of the magnitude of the suffering, but also of the incredible resilience
and hope of those that are suffering.
Tomorrow is a new day. We'll all get up and do it again, connect a little more with each other, and most likely share whatever beauty we can find in this nightmare.
I pray that we can learn how to care for all of our brothers and sisters without waiting for disaster.
Salud y Solidaridad,
Mari
