The Poorest of the Poor Have Song

Dear Friends

I do not have TV at my house. When the earthquake hit Haiti I only heard stories and my imagination made the pictures for me. I heard of incredible destruction and death, of a lost child finding his way to an orphanage and being turned away. The orphanage had fallen and they could not take care of the children they had. The image of a parent less child wandering the streets alone, that is when I decided I was going to Haiti. The rest is history. Laura and I joined together, she took on organizing the medical mission and I took on the children, we decided to find an orphanage to sponsor while working at the Hopital. Before we left for Haiti we began planning a benefit music festival for the children. We found our orphanage and chose it because it is a safe and loving home. Today I called Charlucie (Lucie) Jaboin the president of the Reveil Matinal Orphanage Foundation, she is Haitian and lives in New York City. This is the girls orphanage in Port au Prince we wrote about in a previous blog. It is the home of 20 girls age 3 to 12. Their dream is to move to a larger place that will be able to have boys, and will be located within walking distance of the Hopital Adventiste d'Haiti. Today I told Lucie that we want to help her realize this dream. Charlie MD and I are going to be interviewed on our local public radio station KZYX/KZYZ 91.5 and 90.7 on Wednesday June 2 from 9 to 10 am. For people out of Mendocino County you can stream the show on the web at kzyx.org. We are going to call the orphanage and the girls are going to sing for us.

While working at the Hopital I came to realize a deeper value of song. Groups of people would break out in song throughout the day. A person may have lost everything and they still sing. The singing is beautiful, healing and full of love. The music gave us a sense of peace and true beauty.

Please Save the date for our benefit: Hearts Helping Haiti, Saturday, August 21, 12 to 7 pm, family fun, music festival, at the Nelson Ranch, south of Ukiah. Please volunteer to help we will need 100 people that day. We are having 2 slide shows/receptions on June 17 and 18 as a kick off for the benefit.

The following story is about Adnise, the 22 year old woman who walked with David and Melanie for the first time in her life.

Pictures: The Girls of Reveil Matinal Orphanage, Ukaih Team at work in the ER at UVMC Skip in the middle is in Haiti now and our wonderful supportive Hospital President Terry Burns toward the right, David and the shoes for Adnise.

Words by David our Physical Therapist

I am not going to be so arrogant as to say that Adnise has never owned any shoes. While likely she hasn’t it is always possible. I can assure you that none of them have been adequate to actually fit her bilaterally clubbed feet. This is a project that we have been working on for the last week. Once I saw how good she was doing walking I enlisted the help of one of our great handymen. After I introduced him to this young woman, he wanted to make some good shoes for her as badly as I did. He took wooden reinforced shoes and cut them down to her size and rounded the edges. We then spent a good chunk of the afternoon sewing straps on. Once we had them all fixed up we took them down and gave them to her. She was experiencing some muscle cramps when we arrived which definitely dissipated some of the excitement of the moment. After a little soft tissue work on her feet she was smiling and ready to be up and trying out her new shoes. She was able to walk much better without the pressure of the hard tile floor on her little feet. She continues to complain of the weight of her braces which are actually very light, but when you haven’t walked in your entire life, everything seems heavy.

Everyday we try to make as much of a difference as we can, sometimes it is the little things that mean the most. Building relationships is as important as anything else that we are doing here. It is an opportunity for us to step back and realize that we
don’t have a list of things to accomplish, we are here to reach out to people in whatever way we can.

LOVE MORE, RISK MORE, DREAM MORE

Words by Emily

Dr Nelson's morning talk included excerpts form a memoir of someone who worked with Mother Theresa, and he ended with the above quote.

Becky and I decided to go across town to visit Toby Salz, our UVMC ED physician who was volunteering at the General Hospital in Port au Prince for 5 weeks. We took Jimmy, our interpreter who had been raised in the US and speaks American English. Due to some unfortunate circumstances involving our legal system, he'd been deported back to Haiti after 26 years in the US. We took care of him when he showed up in the ER at the Hopital writhing in pain from a kidney stone. He was so happy to be around Americans again that he is volunteering and hoping to work his way to a hired position. We took a Tap Tap (small trucks with seats in the back, colorfully painted). The General Hospital is considerably larger then our Hopital Adventiste d’Haiti but similar, as both hospitals are under equipped, understaffed, and caring for seriously ill patients. Toby has been the acting medical director of the ER there, as he has been there the longest, and is coordinating the withdrawal of the international volunteers. The plan is resumption of exclusively Haitian staff, a process which was not going smoothly.

We drove by the palace, still a crumbled ruin, slated for rebuilding at some point, to be paid for by another country - Belgium?. We pushed our way onto a crowded Tap Tap to ride home after walking through the degraded and trash-lined streets. The people were friendly, I never felt frightened or threatened in any way, but was still relieved to see the white gates of the hospital grounds.

Our last day was a flurry of working in the urgent care clinic and helping the new family practice doctors get oriented. They hit the ground running. I went to the pediatric nursery one last time to say goodbye to the babies and spent some time trimming Sara's fingernails. We spent an hour on the steps of the hospital waiting for our driver, the interpreters couldn't get their fill of the beautiful nurses of the Ukiah team. I know for all of us, the Haiti experience will remain some of our most moving memories and hopefully will result in some long lasting friendships.

Words of Becky

Brianna and Oscar from our lab arrived. Their Thursday arrival was helpful as it allowed us to show them the ropes and share whatever knowledge we'd been able to scrape together.

Our last day at the Hopital was bittersweet. David, Melanie, Mike, Dale, and Brad left early in the day, we all got up early for a group photo. Talk about a great team building experience that our hospital will surely benefit from. Linda, Gurpreet, Becky, and Emily put in a few more hours of work as help was needed. We had a wonderful send-off from the remaining staff and the translators. What a great group of people. I will be forever changed by this trip to Haiti. A week is not enough time, I fear that I may have gotten more than I gave.

Last 2 photos:
Emily and Becky find Toby in Haiti
The Morrisons in their luxury digs

Everyone Here Has Chest Pain

Words by Mike

Day two in the urgent care tent. I counted 97 patients seen by myself, Emily and Rick, our uber pediatrician from Los Angeles. A smaller crowd than yesterday. We have tried to apply some simple order to the tent, everything in place before the doors open to the throng waiting patiently outside at 7:30, a triage person taking vitals and simple history, a numbering system for the patients, etc. But the forces of disorder and disorganization are relentless. It began with no "papier" on which to write notes and minutes lost trying to make copies, then endless lack of various this and thats, people jumping the queue while dozens resignedly wait on the benches. Periodically something dramatic presents itself, an asthma attack or a head wound which is ushered through to the ER. Medicine is something of a spectator sport here, the bench people listen avidly to the clinical details related by the patient at the doctors "desk", a crooked tray table cum folding chair. I don't inquire about the comments and jests coming from the gallery.

Some of the patients problems are straightforward, but management never is. Doctors may have been seen before, but there is never a diagnosis by history. Medicines may have been given, but they are unknown. Patients always run out of medicines. But they have no money, and to get a medicine refilled for free requires a long trip to the hospital and a half days wait. Everyone over forty seems to have uncontrolled hypertension. Some tests may be ordered but generally require another visit for "results". Many simple tests are unavailable, even simple things like thyroid function. You can write prescriptions but the pharmacy may not have the medicine or you might have written "incorrectly" so virtually every RX generally requires me to walk down to the pharmacy to see what is there. Many problems result in consultations for nonexistent consultants. For example I've seen several large hernias. Supposedly a general surgeon is coming in two months, so all we can do is take the patient's phone number (or the number of the neighbor lady) and promise that they are being placed on a list to be seen. There are no urologists on the horizon. No ophthalmogist for my lady with the cloudy cornea and eye pain.

Everyone here has chest pain. They also have stomach pain, back pain, headache, palpitations, dizziness, and weakness. But they are worried about the chest pain. The EKG machine does not work. This had been the only available technology for assessing acute chest pain. If ischemia is likely we skip down to the end of the algorhythm and treat with the few medicines we have. But the majority of our chest pain patients have obvious and profound post traumatic stress disorder. You don't have to scratch too deep to encounter sadness, uncertainty, pain and deep anxiety. I think: what can be done for these people? So I walk down to the pharmacy and ask to see if there are any available psychiatric meds. There is a big bottle of diazepam. What else? A ha - I find a bottle of zoloft. Not much, but certainly enough to treat the unemployed school teacher aware enough to frankly write "depression" as his chief complaint. "Oh no no" said the pharmacist, "this (zoloft) is a very very strong and dangerous medicine and you should not give it to anyone."

Another universal complaint is epigastric pain. Haitians are an abstemious lot: few smoke or drink. Few can afford to buy NSAIDS (Ibuprofen). As they live in crowded conditions I suspect H. Pylori to be quite prevalent. But still, why so much epigastric pain? But today the pattern finally emerged. Most people describe a gnawing epigastric pain relieved by meals. Well then, I ask "how many meals a day do you eat?" The answer, in general, seems to be one. Some people eat two. I've yet to find a patient who eats three. And for some, the answer is "Sometimes one - sometimes none". Haiti is hungry. Very hungry.

Pictures: The super cute baby, Becky and Brad hard at work, the uber pediatrician Rich and the preemie.

Miracles in Chaos

Words from Linda

“It’s about 12:30 am here and I am having a hard time winding down. Gurpreet, Becky, Shan and I just returned from playing "Santa" to the kids in the hospital. We created little goodie bags with coloring books, crayons, pixie sticks and toys and then placed them by each sleeping child so that they could have a surprise when they woke up. We were very stealth about it and no one woke them up!

This morning we were up early to do rounds with the orthopedic surgeon. Afterwards we had planned to begin doing wound care on the patients but the triage tent was so busy that Gurpreet and I were asked to help down there. Dr. Turner and Emily had a long line of people waiting to be seen. I was told to take vitals and triage but after an hour and a half I was drenched in sweat and began to feel overwhelmed as I realized there was no end in sight. Not to mention I still had a lot of dressings to change! I decided to ditch the triage tent and do wound care with Brad. One wound patient takes an an hour + no matter how much we prepare, for the most part we have a good work flow. I am proficient enough in my creole that I don’t need my translator during the dressing changes. David and Melanie the PTs have become experts on wounds and wound vacs - they have been here the longest and provide continuity for the patients.

There is plenty to do helping the ED - lab draws, giving meds, starting IVs on dehydrated people, there is always someone who cant find a supply and they need a "gofer" There is a lack of organization here with the supplies. It is frustrating. Gurpreet was involved with some complex cases today as well as being stuck with entertaining 4 nursing students. Becky is just doing great things in the ED and is the go-to girl in that department.

We went out to eat tonight at a local restaurant. We had a few beers and shared our "war" stories of the day as we munched on fried plantains and piccoleas (sp?). It was nice to get away after a long crazy day. The young 24 year old mother with the skull fracture was a very sad case. She was transferred from Doctors without Borders, and after more than 6 hours spent trying to save this girl which included inserting our only central line in the hospital, intubating her, giving her IV meds and IV fluid etc., after a consult call was made to a neuro surgeon and the MD director advised letting her go. The whole situation is just extremely unfortunate and sad.
OK well I have to get at least a few hours of shut eye before tomorrow. “

Words from Becky

“Being here is hard, great, wonderful and awful. The inflexible and unadaptable need not apply. Doing things that are simple at home are very difficult here. Starting IV's kneeling on the hard floor in low light, with any variety of strange IV piggy tails or IV tubing, making our own saline flushes. Trying to find a small drinking cup to bring a patient some water so they can take a pill. Finding a good working thermometer and then run out of probe covers and resorting to doing axillary temps without probe covers, until that thermometer stops working and you have to search high and low for another one that works. Weighing the moms holding the babies and then the moms alone to get the weight of the baby. Wanting to explain something to a patient and scanning desperately for a translator. Wanting to give Septra/Bactrim to a patient but finding out that this antibiotic is currently not available here. Helping the patient connected to the large oxygen tank use the bathroom; the tubing is not long enough to reach the bathroom, they do not have a portable tank available, and they don't have a bedside commode or even curtains separating patient rooms. What do you do? Luckily the Haitian people are not very modest. They can't afford to be.

Dale and I had a sad case yesterday. A 12 year old boy came for a cardiology consult. He was very polite and wore dress shoes and grey trousers with a button up shirt. His oxygen saturation would drop below normal, and when I listened to his heart I heard a very pronounced murmur. Dale discovered the boy had a strong thrill (vibration) on his chest that was the source of the strange heart sound. He also pointed out his clubbed fingers. With the help of the translator it turned out the boy has a congenital heart defect. His mother said he needs surgery to try to repair it, but they cannot afford it. Dale is compiling a list of cases to refer to charitable organizations when we get back to California in hopes of finding someone who would do the surgery.

Apart from getting to feel good that I am helping people in need I am becoming a better nurse. I am getting comfortable doing things they taught me in nursing school but wasn't very confident in doing before; EKGs, nebulizer treatments, manual blood pressures. With so many really sick people, my triage skills are being put to the test.

Rich the pediatrician had a great case today. He saw a 3 month old baby that came to the hospital in with a cleft lip. Reg the ENT repaired it in surgery this afternoon. A success story to keep us going. (Miracle in Chaos)

Linda and Gurpreet are turning into little ED nurses, and Brad has been fantastically helpful in a number of tough situations. The Ukiah team is a very significant presence here (all of the teams). "Oh, you're from Ukiah, too!" We were the ED today. It is amazing to me what a huge impact our little hospital from our little town is making here and I'm very proud of us and thankful for the UVMC family for allowing it to happen, including those left behind to run the show short-staffed."

Pictures: Baby with the mom in the yellow shirt is one of the dehydrated babies, Becky with some new friends.,Ukiah team down time.

PAS GEN PROBLEME (No problem...)

Words from Emily
"Our interpreter, P. Roosevelt, taught me some Creole last evening at dinner:
Ki kote ugan dule? Where does it hurt? I used it a few times today. Mostly we rely on our trusty interpreters, but I have resorted to sign language, a bizarre mixture of Spanish, English and even some French which I am recalling from some faint recesses in my mind, learned in high school. Today started out with a flurry of activity as we had a toddler in status asthmaticus, a temp of 105 and seizing. The two pediatricians, Michelle, and Rich, were tied up in the newly cleared trauma room, which is also the storage room for the ED. We have already used it several times in the 2 days it has been set up. We couldn't get an IV started, so they finally started an IO line in his leg, then shipped him out to Miami Field Hospital, with another ambulance ride for Michelle. Meanwhile the Urgent Care tent was filling up with two long waiting lines full of people - lots of kids, babies...Mike waded in and saw most of the adults, while I helped when I could and also ran interference in the ED. I took care of some of the waiting babies - did we mention that they are CUTE? Rich finally got out to the tent and steadily worked his way through them, he and Michelle ended up admitting several. The nursery is now overflowing. There is a tiny six week old who was born several weeks premature, weighing 1.25 kilograms at birth. He still looks like a tiny newborn, and is being treated for diarrhea. He was taking a bottle but not very well, so they may start tube feedings.

Last night we went to dinner at L'Hotel Olaffson, antiquated and historic. Many famous people have visited over the years. The restaurant and lobby are full of wonderful Haitian art, some of it featured Voodoo symbolism. It took a while to get our dinner, it was pleasant to relax with our team as well as three of our interpreters.

A sad case in the ED this afternoon - a young woman who had a skull fracture from an assault. The ED team including Becky, Linda and Brad worked on her with Mark the ER doc, cooling her down to try to get brain swelling reduced, and preserve function, but the CT scan showed severe brain injury and they finally extubated her and let her go. She had no family except a baby daughter who had been left with friends, she worked as a maid, her employer accompanied her to our hospital. Her last experiences were of kind touch and concern.."

Trauma Queen speaks from Ukiah: Today Laura, Kristy, Dale, Tami, Leanna, and myself (Lynn) were all back from Haiti and working at UVMC (Ukiah Valley Medical Center). Leanna is wearing this gigantic Cheshire cat smile every time I look at her, like we are sharing some fabulous secret. I was floating around, trying to get grounded. When I close my eyes I see our Haitian babies and external fixators. I kept thinking there was a door in our hospital like the magic wardrobe that we could walk through and be back at the Hopital Adventiste d'Haiti. I am so glad our team 3 is there, carrying on the work, we all feel the link. I sat with Terry Burns our hospital president today. He is proud of our special little hospital that is sending 10% of our employees to volunteer at the Hopital. He sent a challenge out to the other Adventist Hospitals to beat us and send a higher percentage of their employees! We have another team of nurses and lab techs arriving in Port au Prince on Friday. I am putting the word out on the radio and everywhere to donate sheets, towels, and chux to send down. Dale has some more Bactrim suspension to send so Emily please pass the word to the Pediatricians.

Jean was my fabulous personal interpreter. He chose to work in pediatrics because he loves children. He is a mature, articulate professional. I am happy to say that we decided to give him a micro loan to start a language school. He went to linguistics school for 4 years and was a language teacher when the earthquake hit. His school and job are gone and he has been volunteering at the Hopital since the disaster. We are giving him a large tent and school supplies to start out. I have a sense of peace that our support of Jean will be a sustainable benefit of our volunteer work in Haiti.

Pictures: 2 brothers, Linda arriving with supplies, Lynn and Jean

THIRD WAVE HITS THE SHORES OF HAITI

First picture is of Melanie helping a 22 year old woman walk. She has a rare bone and connective tissue disorder causing her knees to be frozen backward and her feet malformed. She has been at the Hopital for treatment, they slowly brought her knees to straight, and the picture shows her talking the first walk of her life with Malanie at her side.

May 21. Headed to the airport early this am we are Ukiah Team 2 passing Ukiah Team 3 in the sky as they arrive. On our way home, none too soon. I was having trouble keeping my vital organs healthy. It will be a relief to be in a climate where it doesn't take constant vigilance to maintain my electrolytes in balance. As we passed through the city of Port au Prince, there was hustle and bustle everywhere. People were crowding the streets moving purposely along, to school, to market, to work. This sounds like a typical city morning, but these people were moving along with the streets piled with rubble, broken cracked buildings everywhere, piles of garbage, open sewers and dirty water to slosh through. Pigs were out in numbers eating garbage. At one place near the market there was a tanker truck accident and there was an oil spill covering 2 city blocks where people were slipping through this thick gooey substance that consisted of oil, dirt, water and garbage, it covered everything that touched it.

10 of us were crammed in a hired van to get to the airport, the traffic was insane and we got is a car accident in a turnabout (fender bender). The place was crawling with UN peacekeepers in military uniforms from around the world. They witnessed the accident and pulled us over. It was a bit unnerving, at the same time fascinating. The officer who spoke to us was from Senegal. The UN forces are the government in Haiti now, the police force. They were appropriate, our driver was a professional and had all his papers in order, we were set on our way in time to catch our flight out of Haiti.

The ride was hard for me with profound questions on what good we had done, what is the best way to bring aid, what is sustainable? What is the answer to the extreme poverty, pollution, disease? I met a volunteer in the airport who was an agronomist. She had come to teach people to raise rabbits sustainably.

THIRD WAVE HITS THE SHORES OF HAITI - Words of Gurpreet, Emily and Becky on their arrival at the Hopital

“The ride from the airport was filled with experiences that assaulted our senses; the mob outside the red gates, the miles of rubble and trash-lined streets, the crowds of beautiful Haitian people, many children and no fat people. Emily PA, Becky RN, Gurpreet RN and Linda RN, Brad RN, Dale MD (cardiology) and Mike MD (internal medicine) the new Ukiah Team joined with Rick the pediatrician and Reginald the ENT doc.

Luke, pre-med student and administrator oriented us to the hospital, we changed into scrubs and got to work. Dale was immediately enlisted to help with Laura’s cardiac patient. We were happy to find David and Melanie from the Ukiah team, the only ones who knew about the med/surg patients. Dr. Nelson welcomed us warmly but seemed disappointed that our team did not include any OR nurses. Gurpreet, Linda, and Brad jumped into doing wound care, of which they are rapidly becoming experts, especially dealing with all those external fixators from the orthopedic surgeries. Becky and Emily headed to the ER where we met Mark who after one week was running the place. George, also ER physician, was busy seeing patients. Shan is the other pre-med student who is incredibly helpful. In the background is the hard-working Haitian team of doctors, nurses and, most helpful, the translators (they even know where the dressing supplies are!)

We went to the nursery and met Lynn and Leanna's baby, Sara, who is continuing to be more responsive and interactive all the time. Michelle the pediatrician is great to work with and will not be shocked if she sees another dehydrated baby or two tomorrow.
Today we took care of an asthmatic woman in severe respiratory distress. She got all the treatments and medications we would have given at UVMC but still remained hypoxic with extremely labored breathing. We arranged a transport to the Miami Field Hospital. Mike accompanied her in the ambulance and later said they almost had to intubate her en route. They were relieved to arrive at the well-equipped ICU at Miami.

After Mark, Emily and Becky ran in circles all afternoon trying to find medicines and supplies, it was wonderful to see Reginald organizing the ER supply room. He even cleared space in the middle of the room as Mark had envisioned to be better prepared in the event of another code (after running two codes on the floor last week). Becky is very proud of her first dehydrated Haitian baby IV (DHBIV) and also wishes there was an RT volunteer in this group as Becky and Emily have been figuring out how to do the EKGs. We helped suture the last open wound on the face of the young girl who had facial trauma from a brick that fell off a wall. Sadly she remains blind in that eye, presumably from optic nerve damage as the eye appears normal. She was discharged home today.

The cutest ones in Haiti are the children. They have big beautiful eyes and smiles on their faces. Today Linda, Melanie, David, Brad, and I spent all day doing dressing changes. Most wounds are complex, especially the ones with external fixators. If we were in USA, we would medicate the patient for the wound care process. Here we had to change dressings without medications which made the process longer. I had the opportunity to get to know some the patients and translators. I almost felt like I shouldn't have questioned them because their stories are heart breaking and make me want to cry. How can I cry in front of these patients who are so happy to have us here to help them? (I know what you are thinking Candace but I'm holding on). So many patients here don't have any place to go on discharge. One of the patients asked me if I can help get her a tent, there are so many like her. We did take some time to eat lunch and by the end of the day, my feet were hurting so bad. When I finally sat down, I couldn't get out of the chair and today was supposed to be an easy day. I better go. Take care.”

Picture of Emily at new resusitation station in the ER, Bus load of Ukaih Team 3 arriving from the airport

Near Riot Caused by Lynn and Laura

Laura wants me to tell the story about our work today at the "Canada" tent. We are doing the Hopital a big favor and have taken on the complicated task of discharging some patients from the tents around the hospital. Last week we organized a survey and determined that there are 46 patients in a total of about 20 tents. The patients need their families here also, as they feed and care for them, that swells the residents to 200 or more. The biggest nicest tent was donated by Canada. The first time I saw it I had this emotional reaction of love for Canada. This tent is beautiful, has room for 15 patients and was put up by the Canadian response team right after the quake. It is full of patients who were injured with amputations, and multiple fractures who are getting physical therapy from Handicap International/Christian Blind Mission (CBM).

Some of these patients are ready to be discharged. Discharged to where? Rubble, starvation?? It is no surprise that they do not want to leave. It is complicated but since I represent the Hopital, I can say that we need the beds for patients that are in the hospital that require only physical therapy. Due to the Grace of God there is an organization called the International Organization for Migration (IOM), which is part of the UN. They have social workers who help find placement for patients who have been effected by the quake. They give each person a tent, a tarp and provide transportation to their home, if it is rubble they help them find a place to pitch their tent. They help the patients get to medical appointments.

The IOM came to the Hopital to take 4 patients today. I had patients to move into their spaces so I went out to the Canada tent to determine where the new patients would be placed. I noticed that 4 of the cots had been folded up and placed with the departing patients belongings. This is a problem. Places to lie down are at a premium. We do not have enough beds in the hospital, in the ER yesterday my patient was getting her IV hydration lying on the floor.

I called Luke our sweet young administrator on the walky talky and informed him that the patients were leaving with their cots unless he came down here and did something. Next thing I know a determined looking Haitian woman with big hair comes striding through the crowd with a nice Haitian man following behind. A loud conversation begins in Creole and voices get heated, people start moving in and Sherie from CBM and I start slowly backing out of the tent. We back way out of the crowd and listen for many minutes. Pretty soon the man and woman come out and carry the cots into the hospital. There were angry people looking at us and saying all kinds of things, but I had no clue so didn't take it personally. My interpreter said at one point that a lady said "I have no bed". I looked her in the eyes and said, "I am sorry". At the same time I thought of the little boy with the multiple operations on his leg that needed that cot, the elderly woman who was crushed in the earthquake and has not walked since, who was supposed to move onto that cot. I love these people all of them.
With time things settled down, the 4 people left and we moved the new patients into the Canada tent.

Kudos to Tami W. for sticking with the urgent care tent for the whole 2 weeks. Day in and day out she dedicated herself to serving the endless flow of out patients presenting for care. It is a hot, humid tent, filled with patients waiting to be evaluated. I am sure she is tired and has learned more that she ever dreamed possible.

We are saying our goodbyes all over the hospital. I only cried when I said goodbye to my baby Sara and her Mom. I hope to organize another team in January. Let me know if you want to join us. We have a great team coming in tomorrow so this blog will continue to bring you the story of the Ukiah Team at the Hopital Adventist d'Haiti.

Pictures: Painting of the Earthquake, Michelle our pediatrician with Sara and her Mom, The Canada tent in front of the Hopital, The Second Ukiah Team at 6:30 am, Tami in the urgent care tent, Cindy with her baby in the ER.

Code Blue

Beth was part of a code yesterday and told me this story. It was flag day, and the streets were crowded with celebration, parades and dancing. A women age 40 something felt really sick, her family took her to the closest clinic. The clinic recognized she was critical and called an ambulance to transfer her to the Miami Field Hospital, traffic was at a standstill and she was deteriorating so they brought her here. The woman arrived and was placed on a cot which is about 1 foot off the ground. She was initially responsive but no blood pressure. Beth says she ran for the EKG machine which was down the hall in a closet that was locked, it is a very old machine, she puts on the sticky tabs for the electrodes and Shan followed her hands putting tape over the electrodes because the patient was diaphoretic (sweating)(who wasn't?). She had flash pulmonary edema and rapid atrial fibrillation heart rate in the 200s. The anesthesiologist comes to help and got a central line, they started dopamine, and they shocked her. Luckily, the day before Beth and Tami had found the defibrillator plugged it in and straightened out the cords (Tami says it looked like macrame). They charged it up found the pads which were somewhere else and had it set up. All the people in the ER and family members were watching (privacy violation in the US). First thing the anesthesiologist says is can you raise this gurney (not quite). So people were on their knees on the cement floor running the code. They decided to intubate as her O2 sat was dropping to 8,(normal is greater than 90), they had no suction, they only had 45 minutes worth of versed to paralyze her. They used all of the drugs and all of the resources the hospital had on one person. Laura says,"Our concern is how many people will come in the next 24 hours and need those resources. They used up all of the oxygen and versed. It was worth it because she was salvageable." She was shipped to the Miami Field Hospital. A state of the art tent hospital. The code went well because Beth, Mikell and Tami had done codes together before, and Mark is a great ER doctor. The ambulance transfer was a comedy, a very tight space, they put the patient on a stretcher and then put it on Mikell's foot.

In Haiti we do rapid diagnosis with very little tests, if the problem is not curable, or out patient treatment is not sustainable we back off. In retrospect, Laura looked at the EKG and felt this woman was going to live and the treatment was worth it.

For the past year in our hospitalist program at Ukiah Valley Medical Center (my day job) we have been focusing on improving end of life care. We have a holistic approach and do everything we can to provide physical, emotional, and spiritual care. In our hospital the sheets are clean, the rooms are private, the morphine is available. Here at the Hopital we have few sheets, no privacy and rarely morphine, but we do have spiritual care. Yesterday Laura had an elderly man die and I called in a RN volunteer who lives in the US and is Haitian. She came into the room and lead a long prayer in Creole, then I lead her to this beautiful sweet elderly woman who has been here for several days. The patient came in with chest pain and is suffering from an acute heart attack. Everyday her chest pain gets worse and she knows she is dying. She kisses our hands and thanks us for caring for her. We prayed together in Creole, holding each other in a knot, she was so moved she seemed almost ecstatic.

Today was the club foot clinic. Children from all over Haiti come here for recasting to straighten out their feet. I was walking down the hall and the families and children were sitting in a row waiting. They gave me permission to take their pictures. Scott says it is a pleasure to be giving care that is "elective" and not a response to the earthquake, moving forward away from the disaster, making a big difference in the lives of many children.

The Leap team (plastic surgery) is here during the week. They go home at night to the Leap house. Near them they found an orphanage with about 100 children. They noticed some health problems and asked us to go examine the kids. Laura, Michelle the pediatrician and I went out there and examined about 20 children. We gave them medicine for scabies, impetigo, and fungal infections. Michelle recommended, lab test and follow up visits on a few of the children. The place was incredible, the noise level was deafening, the kids were running around crazy. The house was big and had been a mansion in a past life. This orphanage as opposed to the other one we visited does not turn any child away and has both girls and boys. We left clothes, toys and medicine, but much more is needed. There were several American couples there arranging to adopt children that had been orphaned before the quake. There are many parents here in Haiti who want to have their children adopted because they cannot provide food or schooling for them. They want the children to have a chance to live to their potential I have had several talks with Gregory one of our translators who placed his 3 daughters in an orphanage, one died about a month ago and he wants Patti our nurse to adopt the other 2. The Haitian government allows adoption if the parents are alive and sign the papers, at this point they do not allow adoption if the parents are dead.

Pictures of Laura the Condom Lady at work, the orphanage house, Laura with the baby girl at the orphanage she called "her girl" and would not let go of, code blue in our ER, Miami Field Hospital, club foot clinic, Flag Day parade/traffic jam.

Drenched in Sweat

Meet Mark the ER doctor pictured with Beth and Mikell. Good news for the Hopital Adventiste, new arrivals yesterday, Michelle the pediatrician and Mark, both staying for 2 weeks. That means our incoming Ukiah team will have the support they need. You would think that after a long travel a person would be able to rest the first day, not so at the Hopital. Mark was entrenched in the pathos in the ER in less that an hour.

The temperature is 95 degrees with 100% humidity. We slog through the day with sweat pouring off our faces and drenching our clothes. Yesterday my tongue was so dry it kept sticking to the roof of my mouth and I had trouble speaking (now that is a problem). I kept drinking, drinking drinking. I quit peeing and thought I was dehydrated so I drank some more. Then I got queasy, felt dizzy and had a headache so I drank some more. Then it dawned on me that I had water intoxication! Hyponatremia. A dangerous electrolyte imbalance. David our PT got me some gatoraide powder and I slowly started to improve, I had to rest for my first time in 11 days.(see picture) I managed to rally enough to take Michelle to the Peds unit and orient her so she could manage two new admissions, and I could officially pass the pediatric unit to her care.

Scott Nelson is the orthopedist that is dedicated to the Hopital Adventiste d’Haiti. He lives here most of the time and was here during the response to the earthquake. Yesterday he told this story. “The Hopital Adventiste d'Haiti is located 1 mile from the epicenter of the quake. It is the medical center closest to the most devastated area. After the quake, everyone was afraid to go inside buildings. There were 1200 people camping on the hospital grounds. They took the mattresses out of the hospital, patients and their families were lying on the ground in the open. Devastating loss, injuries,and pain. Everyone was overwhelmed and afraid. On the forth day at 4 am someone on the grounds started singing the hymn “What a friend we have in Jesus”, pretty soon another person joined in, then another. The singing spread to all of the 1200 people." They sang together in the night that beautiful hymn of love.

This past 2 weeks we have seen progress at the hospital. Slow recovery from the disaster and getting on it's feet. Our pre med student Shan helped the director of nurses clean out and organize the nurses station in the pediatric unit, it is beautiful, you can get to the sink to wash your hands. He worked with a public health doctor to make a system to identify the patients and number the beds. They made a form which is taped to the wall, before this it was hard to know who was who and why they were here. He is also on the official baby feeding team. Three times a day he goes to check on the babies, make formula and make sure the babies eat. What a man.

I have a new assignment which is bed control. Until now patients would stay in the ER for days with no one to coordinate getting them to the floor. I find beds and move people out. The ER looks great, there is room for new patients. Tomorrow I am going to work with the International Migration Organization to discharge patients from the tents outside and move people from the hospital to the tents. This afternoon we hope to go to an orphanage that has an outbreak of a rash probably scabies and impetigo.

Tami H. and Kristy have dedicated themselves to the inpatients. They told me that they have "One mind". They are creating a system to help organize the med surg area and are on a roll as a team. Picture of Tami with a patient, Kristy with my favorite nurse who is trying to learn English and is great at getting IVs into dehydrated babies.

Pictures of David and Melanie our Physical Therapists. They are out on the floor all day long working with the endless supply of earthquake victims with healing fractures.

Scott gives us an inspiring talk every morning at 6:30 am. He reminds us that the most important work we can do is make relationships with the Haitian people. It is not the quantity of our work but the quality of our relationships. Every time I walk through the hospital there are people sitting silently in thought, with looks of sadness, boredom, worry. I say Bonjou or Bonswa, and every time the people light up and greet me in unison, they come to life with big smiles of love and appreciation. That is one of my favorite joys here at the Hopital Adventise d'Haiti.

Surgery Girls are Alive and Well

Our Surgery Girls live in the Ritz. They set up their tent like a hotel room and they keep it so neat. Kathleen is our next guest blogger. She agreed to share this letter to her family.

"How I miss you all. Haiti overwhelms all of your senses. All day long you smell diesel to run the generators. Here at the hospital there is music playing from dawn to dusk. The singing is in french & I am guessing it is hymns. The are Mosquitoes, but the repellent seems to control them. At any given time there are several teams from all over working here. Today an team from Vancouver Washington are leaving. They are doing a blog. Go to allengabrielmd.com and you may see some pictures of Lin & I working in the OR. About the OR: IT IS A PIT. It is not clean, with exposed wires, bad light, non working monitors. We do surgery with only a pulse ox and blood pressure. It is disorganized, outdated with useless junk everywhere. There is a guy that is glued to my side and won't let me throw any thing away. I have to be sneaky. Then we have to deal with the flies and occasional lizard in the operating room. I ignore the lizard. If a fly lands on the sterile field they just cover that spot with a sterile towel. We have young Haitian men who work in the OR. they are great with the electric fly swatter. This is a skill I've yet to acquire. So far I haven't hit one fly.

At first we set our tent on the roof. It was smelly & hot. Then came the horrible thunder storm in the middle of the night. I felt totally exposed but we stayed dry. I could feel the tent start to float. The next day we were able to move to a covered open area. The problem with this is that it is even hotter than the roof with little air movement. Well forget that. You know how money solves all problems (at least this one). I paid one of our helpers in the OR to get me a fan. Of course that price kept going up. But I didn't care. I was desperate. Now fan keeps disappearing. I have to go around the hospital to find it. I told my helper the fan is for us or sick babies ONLY! Now the fan has stayed put. The patients are mostly in the hallway on cots. Their families have to supply pillows, sheets, and food beyond the one meal a day the hospital supplies. I was told by the previous team member when you take a patient to the floor (there. Is no recovery) make sure they are breathing-duh-, can open there eyes & that there is a family member to take care of them.

There is hotel about 5 minutes away by Tap Tap. A Tap Tap is a pickup with a raised camper shell & benches on each side. They pack as many people in as they they can. They are totally dangerous but they get the job done. Anyway we've gone there three times. The food is not great, service is very slow but the Presidente Beer is great. And I don't even like beer. Well I better get going for the AM."

The pictures are of Kathleen in her scrubs, she was the circulator for the birth of twin girls, Lin was second scrub. The first twin was the small one being born in the picture. The mother asked Kathleen for a name that would go with Carla, she said how about Cara, and the mom named her Cara.

Enoch is one of the best translators and a wonderful man. He was Charlie's dedicated translator for the whole week, they worked hard together and made a strong bond. Today Enoch brought us about 20 pounds of local bananas as a gift, they are all gone. I arranged a transfer today of our tiny premie baby to the Doctors Without Borders pediatric hospital. We were trying to make it through with him on two IV antibiotics, but he spiked a fever again last night, he looked good but I couldn't take the worry. He needed a pediatrician. Sheila spent some time holding him today. I discharged so many babies today that the nursery looks empty. Walking back to our compound I had this fantasy that a team of many hands would come over to the nursery tonight and clean the cribs and furniture, which has not been done for a long time. I have germ fear every time we discharge a baby and a new baby moves into the same crib without cleaning. I just mentioned it to Mikell and she inspired the many hands. We went through the whole nursery in less than 30 minutes. Awesome! We were just informed that a Pediatrician and ER Doc are coming tomorrow for 2 weeks!!!! Emily you have been saved. An answer to my prayers. Things are good.

My friend Jeff added a place in the upper right corner of this blog if you would like to receive the blog automatically when I post. I also found the harrowing picture of the ambulance transport of the baby in respiratory distress, scroll down to see it (Leanna, Charlie and Tami with the baby).

Ugly American gets healed at the Beach

Tonight we have a special guest blogger, Laura the incredible internal medicine doctor turned ER physician and pediatrician.
"I am sick. With a cold. I have also lost my voice. I pushed myself too hard and kissed on the babies too much. Since I can't talk I don't know how useful I will be tomorrow, but one day at a time and definitely no whining after all the suffering I see day to day. We went to the beach today. I insisted on it. I cannot come to the Caribbean and not get in some kind of salt water. The driver charged us way to much to go out there ($150) but there was ten of us so no big deal. A Haitian sees an American and only sees dollar signs. Sad but true. Haitians on average make $2 a day. I am getting the boys to bring me bags of mangoes (yes....you should be jealous) and slipping them $2 a bag. So the first beach we stopped at was a mess. Rocks on
the beach, loud music, sewer looking water, dancing Haitians and I said "no"! The ugly American. But there is no way I am swimming in waters in Port-au-Prince. I don't want to die of some infectious disease so young in my life. I told the driver that the group wanted a quiet beach with very little people. This was a classic cultural screw up. The Haitians must enjoy going to the "party beach" and dancing and drinking beer. So we drove another hour away and found this isolated beach and did not get out of the water for another 2 hours. It was so healing. I cried a little. O.K. I felt like I cried a lot. For all the loss this country has endured. For the families that sit for 4 hours to be seen by a doctor. For the gratitude that flows out of them with every little thing you do. For the little old lady who lost her four sons in the earthquake and needs a transfusion but has no family to go get the blood for her. For the old lady I took care of yesterday who had scabies so bad on her head that there where open sores after she tried to dye it black. For the seizing little baby I transferred out of the hospital this morning with a punctured ear drum that he must have had for a few months. For the poor 23 year old nurse that we had to shock last night without sedation because of a fast heart rhythm. I still feel spent. I think there are many more days of tears. But one thing I know for sure is that the ocean will heal you. And sure enough it did. I sat on the beach and ate a sweet mango and talked to the Haitian translators and other volunteers. We also got a coconut and drank some of the water (I put it in the fridge here and will eat the meat for breakfast). I came back and crashed for a few hours and woke up to eat and then back to bed. We got news about three sick babies and one of my diabetic patients we have transferred to other facilities in Port-au-Prince in the last few
days. We transfer patients to two other hospitals. One is called Miami, near the airport which is a fancy tent facility manned by American doctors and currently has 14 pediatricians volunteering. The other is "General Hospital" which also has a ton of Americans. One baby is doing well after bowel surgery and one may have died. Another child has HIV. The diabetic man has died. Another day in Haiti. I love you guys, Laura"

Short note from Lynn. Everyday takes me deeper into this culture, the language and the babies in the pediatric ward. Today I shared some quiet moments with my Haitian nurse learning how to say, calm, tranquil and quiet in Creole. I took the picture of my baby with her new doll, she holds it and is smiling easily. I finally rounded with Dr. Simeon the Haitian Pediatrician after 9 pm. She speaks pretty good English, and thinks I talk too fast. (Ha, for anyone that knows me). She taught me so much in such a short time it was incredible. She is concerned about a possible HIV in one child, but she says my baby is getting well and I should not worry about HIV in her. A wonderful woman who volunteers her time here at the Hopital Adventiste and works full time taking care of mothers and baby's living with HIV/AIDS. We blessed and thanked each other for serving her "family". The administrator here, Nathan offered my husband Bob the general contractor a salaried position here at the Hopital. Are you surprised that I want to move here? I added a picture of Lin with her interpreter. Lin and Kathleen are in the OR all of the time and we rarely get a chance to see them. I will have to adventure into the OR for a photo shoot.