Sunday, January 31, 2010

There are Many Children Who Need Care - But Few to Deliver It

By Beth Sloand
Assistant Professor in Hopkins School of Nursing and Hopkins Go Team Member

I spent the day in the pediatric wards, which means four Red Cross tents filled with children and parents-- all sick, many recently post op, most with no homes to return to.

It was a challenging day. There many children who needed care- but few to deliver it. The supplies were difficult to come by; things were very confusing- with Swiss physicians, Haitian doctors and nurses, and us with our translators.

I had one translator, Daniel, who was a sort of EMT--he set up the IV for a child whose IV had blown. There was no nurse or doctor in the pediatric orthopedic ward,-- none-- from mid- morning and for hours later. I tried unsuccessfully to find someone who could care for them. After several mothers and fathers asked me for help, it became clear that there was no one else to help, and so I drew on my hospital nursing experience from years ago and managed the IVs, pain meds, dressings, antibiotics, etc. A bit overwhelming but there was not much time to think about it.

There is so much new to me here. Though I have been in Haiti multiple times for many years, this post-earthquake situation is a war zone. There are so many people here who have come to help, but that is both a blessing and a challenge. I am fascinated by the role of NGOs in this disaster situation. Groups we have worked with here: the Haitian Red Cross, the Swiss Red Cross, the World Food Program, Unicef, the U.S. Army 82nd Airborne group (complete with big guns), Wings of Help (Germany), Spanish helpers whose organization I don't remember, the Scientologists, etc, etc. The challenge is huge, with coordination, communication with various languages, cultural differences, etc. Then there are the Haitians, who are in shock and grief mode. The Haitian pediatricians that I worked with seemed numb, sad, barely there. All understandable. But that is difficult because we really need their expertise.

One sad thing- there was a nursing school on the grounds of the University Hospital here. It collapsed. The bodies of many nursing students are still there-- somewhere between 70 and 140-- I've heard varying estimates. No matter- it is terribly sad because this building is on the hospital campus and I walked past it several times today. The bodies are entombed there. So that represents another huge issue- the Haitian health system has lost many, many nurses, physicians, and others that are so important in the already stressed system. They will have to work without these many professionals as they rebuild the country and health system. As a nurse educator - I am still struck every time I walk past that building. So very sad. Can't get used to it.

Haitians Seeking Primary Care

By Thomas D. Kirsch, MD, MPH, FACEP
Associate Professor and Hopkins Go Team Member
Dept. of Emergency Medicine - The Johns Hopkins School of Medicine
Dept of International Health - The Johns Hopkins Bloomberg School of Public Health

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 health care 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 250-350 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 everyday (despite the ongoing chaos).

Saturday, January 30, 2010

First Day Realities in Haiti

By Alicia Hernandez
Johns Hopkins Go Team disaster medicine team member

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 nonchalant 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 it regularly, and dealing with so much worse.

But with this particular individual, we had the privileige 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 gun shot wounds from a riot setting to chronic illnesses sent from other hospitals also drowning in the situation, to Jane Does 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 One. We will make a difference. I am determined. I don't know how. I know even less so how than I thought I did three days ago. But with the good will and determination I sensed today, it will happen, no matter how slowly.

Haiti - The First Day

By Rocky Cagle
Johns Hopkins Go Team disaster medicine member

On the first day here at University Hospital in Haiti I was assigned to the ICU. The role of the ICU here is to received patients that are complex from the ER and post op from the OR.

As I walked onto the unit at 7 a.m., I was looking for nurses to receive a report from them that took care of these extremely sick dying patients at night, but there were none. I began rounding with an American RN to "train" me for this ward to take charge of it for the next 2 weeks while I'm here. As I walked from patient to patient reading their 1-2 page chart, I realized I was in for a rough 2 weeks. The unit had no electricity or lighting. I was soon starting IVs with my headlamp and taping the IV with out dressings because of lack of supplies.

Many people needed to be ventilated but no vents. There was no privacy for patients if you can only imagine one room with 10 pateints and one RN for those patients.

Working with my Creole translator I didn't see a doctor until 1130 a.m. Working off what I have taught to the best of my ability, I worked for the rest of the day with a Haitian doctor, an American RN and an Haitian RN taking care of 40-50 patients.

Patients here are in great need of our help and are very thankful we are here.

Tuesday, January 26, 2010

Johns Hopkins Go Team prepares for recovery care efforts

On Jan. 13, 2010, Haiti experienced a 7.0 magnitude earthquake. The earthquake caused extreme devastation, hampering communication and relief efforts. Johns Hopkins medical response group - Go Team - made it their priority mission to help relieve Haiti.