Wednesday, March 31, 2010

The Aftermath

After more than a month of returning from Haiti, and a few glasses of wine into the night, I am finally sitting and taking the time to "have at it" with my experience with the aftermath.

Pictures can tell a lot and so can news casts and magazine articles, but nothing will bring it home like an actual visit. I was there for only a week, so I claim no ownership in the rebuild. However, it brought out every emotion you could imagine and even though I saved a few lives, it is devastating to think about how such a resilient people have been blasted yet again.

Lofty and high, I glance down to a view I have seen numerous times in magazines and text books. From the air, Haiti, a dry and deforested brown tundra outlined by the bluest Caribbean water. With the cool breeze of the condensed air conditioning blowing on my face, I think about everything this country has endured.

I sit nervous in my cushioned airplane seat and wonder how the following 8 days will go. I try to remind myself that this is exactly why I went into nursing...to work with those who have nothing. To provide a skill that can help people live healthy lives. To see different cultures...to travel the world.

Like most developing countries, there is no rhyme or reason to orderly things. Lines don't exist, wait times are extravagant and I am certain that the metal detectors we walked through on touch down were turned off. Very typical. We gathered outside the terminal with an unwelcoming swirl of humidified heat to find a mass of Haitian hands grabbing the rails of the gate. A million little eyeballs fixed to the newest crew of white volunteers. We couldn't decipher if they were welcoming stares or angry glares. Either way, it felt intense from the moment we landed.

Project Medishare is a partnership with the Miami Global Institute offering relief to the victims of the earthquake. Putting us 2 months after the quake, I anticipated my time at the makeshift hospital to pair more with medical surgical wound care than trauma resuscitations. We had a taste of everything. The Emergency room was set on gravel and the OR was hidden between shelves of surgical supplies. With its 70 bed adult ward and more than 50 pediatric patients, including the very first and only NICU and PICU, it was an oasis in the sultry heart of a burning dessert. It was a full force of multi-disciplinary teamwork, in the middle of the poorest country in the western hemisphere.

I could rant on about the discomforts that come with 105 degree work days and the truth that came from being hungry and itchy, but I guess that you get the point. I know that for most volunteers, the reality that home was only days away, gave serenity in our nearly flattening heat coma. The UN, blesstheir unorganized presence, provided cold beers and french fries for our moments of starvation, not to mention endless entertainment of Bolivian soldiers shaking their Latin hips to songs from a crusty radio.

It was more than sad. The roads were nearly impassible. Intersections completely blocked by fallen debris. Most buildings pancaked to the point of unrecognizable cement. The government building, which once stood so white and round, had completely capsized and stood on its side. Schools gone. Hospitals gone. Bike lanes....not a priority.

Every week, the hospital would open it's iron clad gates (barbed wire) to fresh volunteers. On average, people stayed for a week only, some opting to extend. A large white circus tent erected as our lodging with rows and rows of cots. They were actually quite comfortable and if you were lucky, which I was only after my first assigned area flooded, to be placed in the back left corner where the air conditioner blasted your brains out, then sleep came with ease. If you were a night shifter...which praise Allah I was not, you would have to endure the balmy hundred degree day temperatures which made for a toasty nap. No one could complain. It was shelter and pretty cush for Haitian standards.

Locals would arrive at the hospital early in the morning to sit for hours in hope they would be seen by a doctor. Just like in the states, it was common to see everything from complaints of headache and fever all the way to full thickness body burns and car crashes. At triage, it was our goal to pick and choose which patients needed immediate care as our goal at Medishare was to serve as the trauma center and emergency room only. Imagine looking upon a row of the thin and ill, and handpicking a select few who are to be seen by a doctor. Horrible. All other complaints were referred to outside clinics and the county facility.

Except for the children. We held no restraints on the children. Every baby was given oral rehydration bottles and brought into the shade. Most were admitted for malnutrition, typhoid, malaria and oddly enough hydrocephalus, a condition that literally means "water on the brain". It was shocking. There was such a high number of babies born with this disorder it made us think there was something in the water or perhaps, a lack of water. The brain swells to astronomical size because intracranial fluid can not regulate normal levels and drain properly. The pediatric ward looked like a room of bobble heads. The solution? Surgical placement of a shunt that allows passive drainage. The amazing thing? The surgeries were possible as there were world class surgeons readily available in our world class open air operating room.

It was really incredible. Hard to find the right word to sum it all up, but I am glad I went, I am glad it is over, I want to go back, I hate really hot places, I love speaking foreign languages, It is frustrating being lost in translation, It was really funny, It was terribly devastating, I saw reality, Things and people can be faker than you think...


A link for my pictures. I am not the best at whipping the camera out to snap photos, but here are the few I gathered.


Monday, March 15, 2010

Haiti Bound

We have all seen the news. CNN can't get over it. The images are devastating and when you hear over and over again the magnitude of the quake, something deep inside your heart shakes more furious then those tectonic plates.

Haiti seems to never catch its' break. Ravished by poverty and a corrupt government, the Haitians seem to continually be hovering right below the water surface. Drowning with every unfortunate circumstance that attracts to them like a magnet to steel. I can't see any fathomable solution to a lifestyle so desolate. They are starving, they are poor, their landscape has been forested and pulverized, their workforce monopolized. Even their neighbors to the east in the flourishing Dominican Republic, cast them as second class.

So what to do? Send money. Send supplies. Financially support an organization whom you put total faith in.

When the tragedy first hit the Caribbean in January, my most obvious first reaction was "Shitballs, San Francisco is next." I have recently become completely freaked out with the notion that giant tectonic plates are sliding up and getting cozy with their other flat and hardy neighbor. First it was the smelly seals at Fishermans Warf...one by one.. heading north to Oregon. Then, Haiti is rocked (literally) to the most devastating degree. And finally, Chile, whose disastrous 8.8 quaked our days a zillionth of a second shorter by changing the tilt of the earth. Of course San Francisco has had a drill or two to prepare the city for what could be the next "big one" which may give us an upper hand in the aftermath, but I am hoping to the highest and most fictitious god in the lofty heavens that I am out of town when one San Andreas Fault decides to get down and shake its rump.

So, after that first reaction of "thank god its not me and wooohooo for not being Haitian" passed, my more compassionate side kicked in and pensively thought..."I should go help with the relief."

I filled out forms noting my incredible resume of knowing how to deliver babies AND deal with drunk people who fall, hit their head, bleed profusely and possibly break a fibula or tibia. If Haitians didn't have a problem with binge drinking before the earthquake, they certainly will now. Wouldn't the Red Cross be happy knowing they are staffing a nurse who can deal with their post-drinking tremors and their crush injuries? But no, I heard nothing. Just updates about how the military was sending in all their medical personnel and that too many have offered to help...there was no need for a nurse like you.

It was weeks later that the idea came back and tickled the inkling to travel down south. Dr. Singh, an emergency physician I work with, was joining forces with some of her UCSF Medical cohorts, creating a University of California at San Francisco contingent to head down there. They needed nurses badly as, to be expected, people were sick and getting sicker from open wounds. Did anyone want to go to Haiti? All you have to do is fly to Miami and bring a sleeping bag.

Sign me up.

And so now, I have just popped the third of my four oral anti-typhoid pills and have just hung up the phone with Phil, the nice yet repetitive man at REI, who is holding for me the last Mombasa Defender Mosquito net http://www.rei.com/product/728960 in all the Bay Area. In combination with Malarone and no less then 13 bottles of DEET OutDoors, I am hoping I can ward off such known diseases like Dengue Fever. (I couldn't be less afraid of malaria) Nothing would be more tragic then my liver and spleen experiencing another bout of that raging bull...not even another 7.0.

There will be about 40 of us I think from UCSF. Nurses, doctors, respiratory therapists alike. We will be working in cahoots with the University of Miami school of medicine and the Global Health Institute at the hospital directly next to the Port au Prince International Airport. It was leveled right after the disaster and sits right on top of swamp. Which should prove to be quite interesting when the heavy monsoons strike, scheduled to arrive right around the time we touchdown.

But the boggy underground and the noisy 747 airplanes are not the only concerning aspects of this situation. Here are a few more....

* Temperatures are topping around 95 degrees in the daytime with sweltering levels of humidity.

* Military style meals will be provided graciously from the Global Health Institute but I hear they go fast so if you are not ready and present at distribution.........let's just say I could feasibly lose a pound or two on this trip.

* We will be sleeping in a 140 person volunteer tent, cot-by-cot. Apparently there is a camp-wide scabies outbreak and chances are pretty high that everyone who comes to volunteer, leaves with those little bastards biting your skin. I would rather get typhoid....

* There are four showers for the entire refugee camp...and water is never promised. I will be lucky if I don't come home with dreadlocks.

* Most patients are in need of serious antibiotics. All the charting is done on loose leaf paper sheets so it looks like I will need to learn how to calculate drip factors and dosing rates as I won't have any of our fancy schmancy brain IV machines to do the work for me....oh brother. Use my brain?

* Family members have been unplugging their loved ones' wound vacs, a silly machine that could possible keep them from going septic and dying, and replacing them with their cell phone chargers. I don't think it will be like the trauma center here, where I kick out family members for being annoying and obnoxious. I have a feeling these family members might make me cry and feel guilty for living a very comfortable and easy American life.

It looks like it is destined to be a very challenging week ahead. I just hope I can hold it together and stay focused on what needs to be done. If I even for a second let down my guard, I could easily come home with two or three babies and a bearded old man. They could live in my sauna room!

Anywho, I am so hoping no governmental coups take place like they did back when I was very first scheduled to go to Haiti in 2004. All packed and immunized, just a week before takeoff, Aristide, the dominating dictator responsible for nearly all the downfall of the Haitian people, was ousted by local guerrillas. Boooo. I was then detoured to El Salvador where on my 21st birthday I sat in the campo, surrounded by horse flies, purple soda and hot dogs. The local people had thrown me a surprise birthday party! With hotdogs! I was given the only refrigerated beer in all the land. Jealous eyes from my travel companions stared as the cold bubbly slid down my dry throat. Oh what could have been in Haiti....

So send me good luck wishes as I am sure I will need during this mentally, physically and emotionally taxing time. No need for donated medical supplies but if someone could send me there sleeping bag, as my sister was too selfish to send me hers, that would be fabulous. (just kidding, I just want Sam to know that I am the giver in the family.)

Love to you all. I will keep you posted in the days to come. Seek stable ground if it starts to shake and remember that when heavy things fall onto your bones...they possibly could break. Steer clear from obvious fault lines and for good measure,,,,wear a helmet every minute of the day.

XOXO
Jamie