denise luxe

There is a post from February 8th with a photo of Denise Luxe (or rather her thighs, both with external fixators). She was one of the first patients I taught to do her own pin care. On this trip, she had both the ex fixes removed, and this is a photo of her walking the next morning. I never saw her without a smile on her face. I'm also posting a photo of the Operation Smile team (although a few are missing -sorry).

I returned home from Haiti on April 21st, but am now only able to write about the rest of my experiences. I sat down to try and write more of the experiences I had while there, but anything I wrote just seemed to so inadequately describe my feelings. I imagine that's still the case, but I've been able to gather a few thoughts since then, and will at least share those.
I'm also posting a photo of my fantastic translator, Edner. I worry about him everyday. The sad fact is that right now in Haiti, even those with some kind of skill are unable to find employment. Edner worried everyday about the day that the field hospital would close (last I heard, the end of May). and he would be unable to feed his young son and wife.
I've been to Haiti a total of 7 times since 2004, two of those times since the earthquake. It seemed like every year I went, there were small sign of progress - some functioning traffic lights, more police presence, improving conditions in many of the orphanages, a youth group picking up litter - I know it may sound inconsequential, but those small things are big in Haiti. But I honestly don't know if Haiti will ever recover from the blow dealt by the earthquake. We visited Port-au-Prince and I didn't see any sign of the billions of dollars that have been raised/promised to Haiti. And since there is really no functioning government, and no one else to take the lead, I doubt the Haitian people will ever benefit from that money. I truly hope I'm wrong, but as we drove through the streets, there was a sinking feeling that has not left me. On the Miami to Dallas leg of my trip home, I was in the very back of the plane, and everything I saw just seemed to come crushing down on me. I started crying, and didn't stop until just before we landed. I think the flight attendants thought I was crazy.
The field hospital in Fond Parisien was still very busy, but there wasn't as many acute medical issues on this trip (except for the multiple patients from the community with motor vehicle/motorcycle accidents, burns, incarcerated hernias - a mixed bag of everything). Our orthopedic surgeons removed a total of about 40 external fixators, which was great, because then those patients could finally get up and move around. One of my responsibilities was to help the patients who were ready to be "discharged" - but how do you discharge someone who is living in a tent? A few of the patients had relatives who they planned to move in with, but most had nowhere to go. It became a real emotional drain when I would get the discharge paper with the patient's name who was medically cleared to leave the hospital. On one occasion, I found the patient - a 9 year old with now healed skin grafts - in his tent with his 3 other younger siblings, and their grandmother who was their caregiver. I found out that both the parents had been killed in the earthquake, and the emaciated grandmother, who looked like she could barely stand up, was trying to care for these children. All I could think of was that these kids will soon lose their grandmother, adding to the already staggering number of orphans living in Haiti. I gathered as many supplies as I could for her - a couple of tents, cots, clothing, food, and a cooking kit to give her before she re-located to the refugee camp down the road. My heart sank as I watched the tap tap pull away with her, the kids and all the supplies. It felt so hopeless.
There was one night where I had found a secluded place on the veranda of one of the classrooms so I could skype with my kids. Some of the young boys from the "unaccompanied minor" tents walked by and came up to listen and watch out of curiosity. Most of them have spent much of their lives in orphanages, and consequently speak English since most of the orphanage caretakers speak English. They started talking to my kids and teaching them some Creole words. My son Ian, talked to several of the boys and answered many of their questions. After almost 20 minutes of this, we said goodbye and they then wanted to see the photos on my computer. My screensaver photos kept coming up - vacation photos, birthday parties, holidays, sporting events, etc... They were all fascinated, but I have to say that I felt a bit ashamed at seeing the obvious disparity in our lives. After a few minutes, I quickly shut down my computer. The next morning, I emerged from my tent to find one of the boys - he had to be about 7 years old - waiting for me. He ran up to me, grabbed my hand and asked me in the most serious way if I could take him home with me when I leave. I leaned down and gave him a hug, and could hardly get the words out to tell him why that would be impossible. I returned to my tent to cry and skipped breakfast that morning.
It was experiences like those, and seeing the continuous stream of people being discharged to a refugee camp with no running water and no electricity that made me unable to keep writing. There were so many other heartbreaking stories, but they're so personal and painful, that I haven't been able to talk or write about them. I just fear for the people of Haiti and the second wave of death that will come from disease, malnutrition and the complete lack of action to help Haiti rebuild. The Haitian people have always been resourceful and resilient, but they need the world's help more now than ever. I hope they won't be forgotten.

aftershock

2 nights ago while drifting into sleep, I felt my cot sway back and forth. I wondered if I was dreaming, but the next morning several people were talking and saying that they had also felt it. It's no wonder the Haitians almost refuse to sleep or even enter into the buildings here.
A group (H.A.R.T.) came in for the last couple of days and fitted many of our leg amputees for prosthetics. Many of them have been waiting for weeks and it was so exciting to see them walking for the first time since the earthquake. As soon as they were fitted for their new leg, a physical therapist would work with them on how to get up and down steps. These people adapt so well, and most were walking around the camp by the afternoon. Really heartwarming.
I can't believe that I only have 2 more days before I leave on Wednesday morning. Haiti is the kind of place that after you've been here a day, it feels like a million years. But when it's time to leave, you wonder how the time went so fast.
It's very late here and I'll be getting up with the sun, so I'll make this short. I'll post photos tomorrow if time allows.

crutch races

Today the surgical team began removing external fixators. They were able to get 16 of them off, and it looks like they'll be able to get all of them off by next Monday. We continue to get patients from the community. Today we had to transferred out 3 patients - an infant with seizures, a man with severe burn injuries and a young boy who needed specialized surgery in Miami. We're slowly discharging patients and decreasing the size of the hospital. We also held an immunization clinic today for most of the kids in the camp. Me and another nurse, Sarah, along with the pharmacist here gave about 100 immunizations. It was a great experience and very rewarding. Even though most of the kids cried when they recieved their shot, the parents all thanked us. The kids then all received a toy afterwards, so they quickly forgot about the pain of the shot.
It hasn't rained for the last 2 nights, so the camp has finally dried out. And it's as hot as ever during the day. I've always loved being in the sun, but I have to say that I've had my fill of it at this point. It seems like when it hits about 2pm, there is nowhere to escape from the searing heat.
There are two huge white tents that have been built to house certain patients - unaccompanied minors, those with non-healing wounds and other patients who are at high risk for infection. It's the only totally waterproof tent in the camp, as well as being very open and airy. So the other patients have a bit of tent envy going on. They also hold a big group physical therapy session in the white tent everyday. I went to watch it yesterday and found 2 cute girls - both of who have had amputations. They were racing each other back and forth and laughing so hard that everyone was watching and cheering them on (see photo). It's those kind of heartwarming moments that make it totally worth being here, and they're images I'll never forget.
I continue to help discharge patients. I'm averaging about 3-4 discharges a day. We always give everyone who leaves a tent, cooking kit and soap and other essential supplies. I also give them money for transportation for wherever they're going. Many are returning to Port-au-Prince, and others choose just to relocate just down the road at the refugee camp. It makes me so thankful for what I have to see how many people truly have nothing. I'm also glad that the camp is able to at least help them make a start. The camp also employs many local Haitians to cook, help manage the warehouse and translate. They have also trained one of the locals to be an x-ray tech, and he works independently without needing any help from the international staff. We also have the local Haitian nurses helping us staff the triage area.
The group of nurses that I'm in charge of are awesome. They are so willing to do anything I ask. Of course as always in Haiti, the only sure thing is that nothing is predictable, and so we very often have to change assignments or pick up new duties as the day wears on. They never complain and are doing such an amazing job with all of the patients. It makes me proud to be nurse. There are times when I've wondered if I should have done something else with my life - but right now I wouldn't want to be anything else but a nurse. Oh - did I mention that the rats are the size of small cats here?

rainy season

I decided that I prefer the dust that was here in early February to the mud that is now here. It's rained every night - except tonight - and the ground just doesn't get a chance to dry out. Many of the patients tents flood every time it rains. We've tried to give all of them cots so their mattresses aren't soaking up the water, but it's still is a miserable situation.
As part of my "charge nurse" duties here, all of the camp discharges go through me. I make sure that everyone who leaves has some supplies - tent, cooking oil, rice, soap, etc.. and any other things I can pillage out of the supply warehouse. Most of the patients are going down the road to the ARC (American Refugee Camp) and some are choosing to return to Port-au-Prince. There aren't many good options for most of them. We're averaging about 4-5 discharges per day, and the plan is not to admit any more patients so they can shut the hospital down in the next couple of months.
The rest of the Operation Smile team arrived today. The plan is to remove every external fixator that's in the camp - about 40 patients. So it will be busy. Those patients should be able to be discharged about a week afterwards if there are no complications.
There are 4 Mennonite nurses who come in every day from a center a few miles down the road. They have been so helpful with staffing the rows of tents and taking care of the patients. Today we had a young girl (about 6 years old) who fell off of a motorcycle and hit her head. She was unconscious and we arranged emergent transport to Miami for her. The triage nurse had to accompany her on the transport and one of the Mennonite nurses stepped in to cover triage, even though she really didn't have much experience in that area. She did an awesome job, and saved the day. It's easy to be in charge when you have such remarkable, inspiring nurses to work with!
I was able to talk with my family via Skype tonight, and my translators all got a kick out of seeing them on the computer. And it makes me a little less homesick.
Better get to bed and pray for no rain tonight.

return to haiti!!

After overnighting in Miami, I arrived yesterday with 2 other members of the Op Smile team. The rest arrive tomorrow. Let me first say that when the news talks about it being rainy season in Haiti, they really aren't kidding. It has rained both nights - and when I say rain, I mean torrential downpour. It's the kind of rain that's so loud that you can't hear someone talking who is a foot away. The camp has tried and put gravel down in as many places as possible, but it's impossible to avoid the mud. Enough about weather.
It was awesome to see almost all my patients again. When I walked into camp, some of them saw me and came running over to hug me. Which was great, because most of them couldn't even walk when I left last time. It's so great to see how much progress they've made. A couple of them still have their external fixators. One of our team's goals is to remove all the remaining fixators in the camp.
I've been told that I'm taking over as "charge nurse" for the camp. The current charge nurse, Lisa Friesen (we were together on the first Op Smile team here) spent the day going over everything and introducing me to everyone. So, I'll be responsible to make sure all the tents have nursing coverage, as well as the ARC (American Refuge Camp - about a mile away from us) clinic is staffed with a nurse and MD. I also do all of the "discharges" - which involves making sure people who are well enough to leave the camp have a place to go, and supplies so we don't just kick them out on the street. We've been giving tents, cooking oil, rice and clothing to everyone who is returning to Port-au-Prince. So it will be a busy week.
I had a chicken and dumpling MRE for dinner last night and was pleasantly suprised at how good it was.
It was fun to be able to talk to Ken, Ian and Madison via Skype last night(Haeli wasn't home). It's amazing how quickly I start missing my family. Love you guys!!
Despite it being only 9pm, I'm exhausted and better get to bed. It's great to be back.

follow up

I've been getting follow up emails from some of the doctors and nurses that have been returning home from Fond Parisien. One of the doctors I worked with, Keegan Checkett from Chicago sent me an email which included the following (first let me say that it was of course a huge collective effort on the part of all of the nurses there):

On a happy note, for which I think you deserve a lot of credit: the Navy is so impressed by the excellent wound care provided for the patients in ex-fixes, that they're thinking about writing an article/doing a study! Seriously. Usually, ex-fixes are so nasty, they have to be taken out & the pt treated with abx for a few weeks, before definitive surgery can take place. We transferred ~30 pts with ex-fixes to the Comfort....and all of them were able to get immediate surgery, since their wounds looked so awesome ;-)

It's great to hear that we may have made a difference for the patients we took care of. I think it's rare in life when a person is lucky enough to be in the one place in the world at a moment where they're needed more than anywhere else - and all of the nurses were able to experience that with our patients in Haiti. I will always be thankful for my time there, and for the awesome nurses I worked with.
Keegan also mentioned that Vanessa, our patient (I've included a photos of Vanessa above, she's pictured with Dr. Dianne Sampson) with the pelvic external fixator had been able to have it removed and had been discharged. So it was great to get that news. Another nurse, Tracy Jarden emailed me from Haiti last week, and said that she had visited Port-au-Prince and saw virtually no sign of anyone trying to clean up the rubble or re-build the city. That's so discouraging - where is all the money that has been raised? I can only hope that the Haitians will actually see some of that money used to rebuild their country.
While writing this, I realized that I never thanked my co-workers at Alta View and Intermountain Medical Center for covering my shifts while I was in Haiti. I literally recieved my e-ticket from Operation Smile at 8pm the night before my flight which departed at 7am the next morning. So there was not a lot of time to find coverage, and everyone was more than willing to help me. So a big thank you/shout out to all my co-workers!

my fantastic translator, Carlyle

final days in haiti

Things were so hectic the last few days in Haiti that I am now only getting a chance to write now as I sit at home. I had such mixed feelings about leaving. As our bus was pulling out Saturday evening from the camp, I was looking forward to returning to civilization (and oh- to be able to SIT on a toilet seat again!). But I looked out at all the tents and felt sad that I'll probably never again see the patients I grew to love, and never know where they'll end up.
First, as a follow up, Carlyle, my translator was able locate a sister of the 14 yr old girl who I mentioned in the previous blog. So she was making her way to the camp from Port-au-Prince the last I heard. So I was thankful for that.
There are so many images I have in my head and I don't know how to describe them. Time and time again, I would watch patients family members helping their loved one to the port a potty, which was a fair distance from the tents (for obvious reasons). I remember seeing one of our patients who has a below the knee amputation on one leg and an external fixator on the other, being helped by her young daughter. The whole process of getting her there in the wheelchair over the gravel, helping her out of the wheelchair and into, then out of the port a potty took the better part of 45 minutes. I can't even imagine having injuries like that and not having a readily accessible bathroom. I also remember the worried look family members would have as their loved one was carried on a stretcher into surgery. And the young man who went to surgery for a debridement of his leg wound and when he woke up, the first thing he asked was if they had amputated his leg - thankfully they didn't, and it looked as though if it was going to heal. I will never forget Rose, the young, 3 months pregnant mother of a 2 yr old, who had a large skin graft on her foot on the first day I arrived. There was some thought that she may lose her foot if the graft didn't take. We watched closely, and she was so compliant with everything we told her to do - which included keeping the donor site on her thigh and also the foot graft clean, which is an almost impossible task in the camp. By my last day, it was apparent that the skin graft was going to be successful. With physical therapy, she should have full function of her foot.
The things I experienced and witnessed on this trip eclipses anything I've seen in my previous 20+ years in hospital nursing. The post operative patients - many of them amputations or fasciotomies - would possibly receive 2 intramuscular shots of Morphine 2mg the evening after surgery (for those non-medical folks reading this, that's a very small dose), and then a Percocet every 12 hours the next day. My stethoscope never made it out of my suitcase, and the only vital sign I checked the entire time was a temperature on one of my patients who felt very warm to me (and turned out to have a fever of 104 degrees). The only charting was to write on silk tape with a sharpie the date of the last dressing and what type of dressing was used, ie wet to dry, xeroform, packing strip - or whatever and then affix it on top of the dressing. We (usually me and the MD that was assigned to row #5, and if I was really lucky, a second nurse) started rounding at about 7am to try and beat the mid-day heat. By the the time we usually finished seeing all the patients and doing the wound care, it was somewhere between 11am and 2pm - depending on how the patients were doing, and if I had to remove sutures or staples, which always added time and was traumatic for the patients. We gave vitamins to everyone every day, and medicated pain with Tylenol or Ibuprofen - or Percocet if they were a new post op. I have never worked so hard in my life, under such harsh conditions. I have also never felt so needed and useful as a nurse. The feelings of exhaustion, hunger and my aching feet at the end of the day paled in comparison to how rewarding it was to care for these patients who are so gracious and appreciative. I live in admiration of their spirit to overcome their circumstances, and their cheerful outlook, despite being dealt such a blow.
Many of the MD's were forced to be more "hands on" than most of them were used to due to the shortage of nurses. The worst part of that is that the Operation Smile team that replaced us had even less nurses than we did - it caused a pang of guilt to hit me as we were leaving to know how hard they're going to have to work. There was a bit of a glut of doctors - many had been assigned to non-patient care duties like logistics and even stocking supplies.
The people on the Operation Smile team were awesome. There is no way to describe how much I enjoyed getting to know each of them and working with such dedicated and caring professionals. I will never forget Jeanne, Genie, Dianne, Ann, Brenda, Craig, Natasha, Joelynn, Stan, David, Tim, Lisa, Donna, Susan, Violette, Tracy, Stuart and Terry (plus Mark and Tory - our team coordinators who did a great job). I truly hope to work with them again, if the fates allow.
It's nice to be home and not feel hot and dusty for the first time in almost 2 weeks. But I'll miss my patients and the feeling that I was somehow making just a small difference in some of their lives. I'll never forget how proud one of my patients was at being told that she had done a great job doing the pin care I had taught her the previous day on her bilateral femur fixators, that she asked me to take a photo of her both her legs.
The day before we left, an unfortunate boy with a scrotal abcess arrived at triage. The doctors called several places to try and get treatment for him, but no one would take non-earthquake related problems. So our plastic surgeon ended up taking him to surgery and doing an incision/drainage . So this was definitely territory he wasn't used to, but the surgery was a success, and the boy was up and walking the next day and felt much better.
A few of our team members including me went into Port-au-Prince (about 30 miles East of Fond Parisien, which is about an hour drive on Haitian roads) on Friday, the 12th - exactly one month after the earthquake. Our plastic surgeon speaks French and was able to communicate well enough to be our translator. The devastation there is indescribable. And what's worse is that we saw almost no one with heavy machinery clearing away rubble. The one exception was at the Hotel Montana where many foreigners perished. I can only hope that Haiti will get the help it needs from the international community and that the millions (or is it billions now?) of dollars raised will actually go towards helping rebuild that country, and realize it's potential.
On Saturday morning as I was on my last round of dressing changes and was telling my patients that it would be my last day, one of my patients, Marcelin, reached out and kissed me on the cheek and I didn't need a translation to know that she said "I love you Katty." I'm so glad I went and I hope to return sometime in the future.

Day 9 - it's ok to wear boxer shorts when you operate

Wow - the patients keep coming. They are setting up more and more tents and there never seems to be enough room. The last I heard, we have about 200 patients.
The last couple of days, some I.T. guys from Harvard have been here trying to help set up a system of banding/identifying patients and keeping track of their tent location. Because of overcrowding, there was also a decision made that each patient could have one "attendant" to stay with them in the tent - to help them eat, bathe, etc...Most of the patients have now been officially "banded" and their one attendant (who is usually a family member or friend) was given a special blue band to show that they could stay in the camp 24/7 and eat the meals and use all of the services. Needless to say, the blue bands have become highly sought after. They're being tracked in an i-touch application so we just have to know their first or last name to track them down in this ever growing sea of tents. It has been very helpful.
One of my patients is a 20 year old named Vanessa. She has an external pelvic fixator for a fracture, plus various other injuries. She's been feeling poorly the last couple of days and I knew something was up when she was moaning and crying this evening - she has never complained once about pain or anything else. She had a high fever, and the doc and I had her transported out of her tent to triage to be able to examine her more thoroughly and figure out what was going on. After several hours, there is high suspicion that she might have malaria. There was word that the Ecuador team can do a malaria blood smear, so we're hoping that's true. Anyway, I felt so bad for her - I can't even imagine how horrible she already feels with her injuries - and then malaria.
The Operation Smile team is the hardest working team I have ever worked with. The surgery crew was operating yesterday and it was 93 degrees in their makeshift O.R. . They have air conditioners set up, but they're no match for the Haitian mid-day sun. The plastic surgeon had to change his scrubs several times during one case because they were dripping wet, and finally resorted to just being in his boxers under his surgical gown.
The nurses out in the tents - which includes me - have kind of gotten a system down to see all our patients and get the dressing changes, meds, etc.. done before noon. . We try and get as much done as possible before 11am when the searing heat starts.
We continue to see long term complications starting to emerge. We have many patients with DVT's, which I think I mentioned in an earlier blog. We've been treating them with Lovenox twice a day, and also giving it prophylactically to the immobile patients. Now, because of a Lovenox shortage, we're now only able to treat the known DVT patients, and hope the other immobile patients don't develop one.
I have a great translator named Carlyle. He has been with me almost everyday. Today, while translating in triage, he became very teary eyed and upset after hearing one of the new patients tell her what had happened to her. She was a 14 year old who had already had surgery to remove her left eye, in addition to many facial fractures. She had spent 3 days waiting under cement rubble to be rescued and was taken to somewhere (?) in Port-au-Prince to have surgery. She was then transferred somewhere else - she couldn't tell us exactly where - and then finally to us. She had no idea where her family was, or even if they were alive. She was so traumatized, and it was just heart wrenching to listen to her tell the story. Carlyle and I both cried. We took all her phone numbers and are attempting to locate some family for her. I hope there is a happy ending.

Day 7 - bon jour Katty!

A new team from Chicago arrived with more MD's and a few nurses. There are also MD's coming from Port-au-Prince. I have to say there are too many cooks in the kitchen - we definitely don't need any more doctors (with the possible exception of surgeons) but have an unending need for nurses. Some physical therapists and one occupational therapist arrived, and they have their work cut out for them.
Some local Haitian nurses have been coming over and we're trying to train them in wound management. I spent the day with Lusien and taught her about wound care and dressing changes. She was very helpful, but it's difficult to teach through a translator, plus the Haitians tend to take everything so literally, that it's sometimes hard to get them to critically think through things. But she did great and I'm encouraged. I hope she shows again tomorrow.
Many patients are now post-op almost a month (at least the ones who arrived from Port-au-Prince) and are now having complications like bed sores and DVT's (deep vein thrombosis for those non-medical folks - it's a clot in an extremity that has the potential to break loose and end up in the lungs which can be fatal). We have a small ultrasound machine and 2 of my non-ambulatory patients were found to have DVT's. There are so many people with bilateral femur fractures, or other injuries that make them totally immobile. We've tried to teach family members to turn patients, (I cut up 2 camping mattress pads to make turning wedges) but it's so difficult when everyone is essentially camping.
We also have limited x-ray capability. The orphanage here has a small clinic attached (we're not using it - otherwise it would be trashed) and has allowed us to use their hand held x-ray machine. It's apparently for veterinary use (and has not been approved for human use in the U.S.- go figure), but we have found it very handy to verify pin placement or missed fractures on patients.
Today, the plastic surgeon and I had to tell another patient that there was no way we could save her foot and would have to amputate in the morning. It's impossible to describe how heartbreaking it is to see so many people going through this. It truly is mind boggling to see how many people's lives have been changed forever because of this earthquake.
Now that the local community knows that there's a medical facility at this site, we're seeing more and more patients who are chronically ill. Today a 4yr old boy was brought in by his mother. He was in liver and kidney failure. The docs were guessing it was caused by a parasitic biliary obstruction, but no way to tell for sure. After many phone calls, we found a place that in Port-au-Prince that has dialysis capability. He was flown by helicopter there, but there's serious doubts whether or
not he'll even survive the night.
We're also seeing a 2nd round of failed fasciotomies. So that will keep surgery busy with more amputations.
I enjoy my patients more and more each day. When I unzip the tents to go in, they call out "bon jour Katty" - since they can't really say the "th". Most of their wounds are slowly healing and they're making progress. I passed out clothes, sheets, soap, flip flops and toothbrush/toothpaste (thanks Alice Bigelow and her girls who gave those supplies to me - they're much appreciated by the Haitians!) Also, it wasn't quite so brutally hot today - or am I just getting used to the heat? I can't even remember what a hot shower feels like. I had licorice for breakfast this morning - and actually really enjoyed it.

Day 6 - Michaelange

Today the stream of patients continued. Some arrived by helicopter, others by car and bus. I triaged a 22 year old woman who arrived from a hospital in Port-au-Prince. Her name is Michaelange and her right leg had been amputated above the knee, as well as having a casted arm for a humerus fracture. She was literally naked, only covered by a sheet. I found that she had a bed sore on her back, and upon talking with her through a translator heard her story. There were no beds in the Port-au-Prince hospital after she'd had her amputation and she had been placed on a cement floor for 2 weeks. She didn't know where anyone in her family was, or even if they were alive. There are so many others with just as sad and heartbreaking stories. This photo is of her.
We continue to do wound care everyday on the tents we've been assigned, plus follow all of the Operation Smile surgical patients. One of my main responsibilities is to monitor if wounds are healing (or not), or if they've become infected and to alert our surgeon. We've had many patients that have been found to have pseuodomonas infections which we're treating with a myriad of IV antibiotics. The O.R. team is going from dusk to dawn. Today more amputations, skin grafts, debridements, external fixators. Speaking of, I have never seen so many people with external fixators (for those non-medical folks, it's a metal contraption that holds fractures in place) in my life. About a third of the camp has them and some of them on more than one limb. I have also never seen so many kids in spica casts (kind of a half body cast to hold their pelvis in a fixed position). Today a man came in with a dislocated mandible fracture and despite our best efforts, we couldn't find any place to accept him to do surgery (since we're not really equipped for that type of surgery). The plastic surgeon here called his maxillo-facial colleague back in the states and got suggestions on the best way to fix it. So they'll attempt to take him to the O.R. tomorrow. We rigged up a c-collar with Kerlix to try and hold his jaw in place. I am truly learning "Mcgyver" medicine here. There is no way to do any sterile procedures in the tents so we just try and keep things as clean as possible. We also keep running out of various supplies and just have to make due with whatever we have. Although I must say, I'm surpised at how well stocked we have been on most things. I continue to be in awe of the Haitian people and how appreciative they are. I see most of the same 30 or so patients everyday and they know me and are so nice and patient with how long it takes us to get to them. I'll say again we need more nurses! There is also a huge need for physical therapists.
I'm so tired, I know I'll sleep well tonight with my ear plugs in and be up by 6am to start all again.

Day 5 - cows and roosters

Today was such an incredible day. I saw most of the same patients that I had seen the previous 2 days and so when I showed up at their tents this morning, they called my name and would say "bon jour!." It was also nice because I had spent yesterday teaching many of the patients how to do their own pin care (there are SO many things to do that we're trying to let patients do as much of their own care as possible) and found that they were all doing a great job. I also organized our wound bag - a huge duffel bag we drag from tent to tent with all our wound care supplies - and so I was able to find things much faster than the first day. A group of badly needed physical therapists came yesterday and have been extremely helpful in getting patients out of their tents and moving.
We have patients continually arriving from Port-au-Prince by helicopter. Most of them are casted. Some of the surgeons in Port-au-Prince have written instructions on the casts of what surgical procedure was performed, when the cast is to be removed and even a diagram of the fracture. That is the extent of information that we receive on most patients who arrive. Most of the patients have their name and age written in magic marker on their arm, or on a piece of tape wrapped around their wrist.
Today a patient arrived by private car from Port-au-Prince. He had had an arm facsiotomy a couple of weeks earlier, but most of the tissue on his arm was dead and he had no sensation or movement. When the surgeon told him he would have to amputate, he refused and said he would wait and see if it would heal. He was told that it was already infected and he could potentially die from it if he didn't have the amputation today or tomorrow. He still refused, and so we're giving him antibiotics in the hope that he won't become septic - until the inevitable amputation.
It was a little slower pace today because it was Sunday. A local Haitian religious leader came and they had church under some trees. It was so touching to see the patients make their way down the row of tents with their walkers, crutches and stretchers so they could attend. They thanked Jesus for making the trembling stop and for helping so many people survive the earthquake. It was truly inspirational.
The Operation Smile team is really awesome. Everyone works so well together and is always willing to help with anything. None of us knew each other before the trip, but now it seems like I've known them all for years. Another orthopedic surgeon and anesthesiologist arrived yesterday. So we have plenty of doctors, but could use about another 20 nurses.
It's been brutally hot, but I'm almost getting used to it. At least it cools down enough at night that it's easy to sleep. I don't know what it is about Haiti, but you hear roosters ALL night and then here in Fond Parisien, there seems to be an insomniac cow that moos all night as well, which even my ear plugs can't completely block out.
Another very great day.

first days in haiti - fond parisien

After 2 days of almost continuous travel, our team made it to our destination in Fond Parisien, Haiti. Although this is the first time Operation Smile has sent a team for disaster relief, they are really prepared. They came with every supply imaginable (except for pens and paper, which are at a premium right now). Our team consists of 17 people - 2 orthopedic surgeons, plastic surgeon, 2 anesthesiologists, a pediatrician and the rest nurses. We replaced the first team who arrived about 2 weeks ago, and were very tired and ready to return home. We received a quick hand off report from them before they all loaded on a bus. I had to wonder what was in store for me in the next 10 days as their bus pulled away. Almost immediately, the first of many helicopters arrived to deliver patients to our field hospital.
We're stationed at an orphanage called "Love a Child" which has been very accommodating about having a few hundred people camping on their property. It is truly amazing to see how many Haitians have been affected by the earthquake. At this site, there are 9 rows of tents with 7 to 8 tents in each row. Each tent has 2-4 patients plus family members which makes it extremely crowded. Each of us are assigned specific roles - there are O.R. nurses, PACU nurses, and then wound care nurses - of which I am one. We have been assigned a certain row of tents and are responsible for all of the dressing changes in all of the patients in those tents. The first day was chaotic. I would go into a tent with a translator and find out about their injuries and try and get a history. I would then start changing their dressings - while all the other patients and family members looked on. Not to mention, that many times as I was changing a dressing, a big wind gust would come up and dust would get all over the sterile dressings and the wounds. It's impossible to do almost ANY sterile procedures here, outside of acutal surgery - which is housed in 2 igloo type of buildings which have been set up and are completey insulated.
As the day wore on, the temperature in the tents had to be in the high 90's (at least) and it was almost unbearable. I don't know how the patients sit in there all day. In the row I'm assigned, there are many patients with external fixators (put on by the surgeons on the US Comfort, or other various places around Haiti), amputations, crush injuries and burns. Most of the wounds are infected and the many of the patients are receiving IV antibiotics. One of my patients has an AKA (above the knee) amputation AND a pelvic fixator. Sometimes I'm in one tent for over an hour to get everything done. The amazing thing is that the Haitians never complain and are so gracious and appreciative. It makes me remember why I like the Haitian people so much.
There are a couple of tents with "unaccompanied minors" - children who lost their entire family in the earthquake. There is a team from Ecuador here who is doing a fantastic job have the two tent rows with most of the kids.
The Operation Smile O.R. team has been going non-stop. Today they did a couple of amputations, debridements, skin grafts, stump revisions and dressing changes,(the really big ones that need to be done under anesthesia). They worked in a cramped, hot O.R. and it doesn't look as though the surgery schedule will be slowing down anytime soon.
I'm truly in awe of how resilient the Haitian people are.