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.

Mango Pig Out

We are swimming in Mangoes. They are stacked in piles along the streets. Not a lot of other food, but who cares if you can eat all of the sublime mangoes you want. Last night we ventured beyond the hospital gate to buy roasted corn from the vendors who roast it over a little charcoal fire. It is hard, chewy and real tasty. We are all loosing weight, this is a new concept in residential weight loss programs (fat farms). It is painless because you loose your appetite when you are working hard and drenched in sweat.

It rains in torrents at night. I hope the tarps are keeping people dry. It is soothing to listen to the rain when you have the hospital roof over your head. On the rare occasion that I look out from the hospital I see lush green, beautiful.

On the first night we got here we were fairly tired from the travel. We bedded down in our cots and tents, relatively comfortable. About 1 am an ER person came to Charlie's tent, "Dr. Evans wake up, we need you in the ER". There was a man who had got himself into some kind of trouble that ended up with a machete attack. Huge laceration behind his ear into the mastoid which could have taken his head off, all extensors tendons on his hand and much more. So Charlie was up all night repairing his problems. Hussan the orthopedist took him to surgery to repair the tendons. The next morning we were doing rounds and the patient was sleeping when we came to him. He woke up and looked at us and said, "Am I alive?" The machete man is doing fine and has been discharged.

Our team changed today, farewell to Dale (see his picture playing at the orphanage), Leanna, Charlie, Patti and Mohammad (our adopted Ukiah team member). Hello to Shan pre-med student, Kristy RN, Beth ER Tech, Mikell RN, Cyndi Pharmacy Tech, Tami H. RN. Tomorrow David and Melanie physical therapists. Laura, Tami W, Sheila and I are staying on for 1 more week.

Tami has been stationed at the triage tent next to the ER. It is hot as heck and smokey from tires burning near by. They treat the people who have minor problems, and admit the sicker people to the ER. Patients sit in the sweltering heat and patiently wait to be seen (picture). Today she was scanning the group for patients who might be sicker and need to be fast tracked to the ER. She saw a woman holding a towel, and looked again because there was the tiniest little foot sticking out. "There is a baby in that wad of towel!" She pulled back the cloth to reveal a hot little premature baby boy with a fever. Off to the ER with him, then admitted to Peds, so now he is my responsibility. His due date is June 25 and he was born on April 4. All you people who are praying out there for the people of Haiti, keep at it!

For all of you adrenaline junkies we had one of those heart pounding experiences yesterday. I was working in the Peds unit trying to keep all of those babies alive and Charlie comes in with this 4 week old baby in respiratory distress. Retracting, stuffed nose (babies are obligate nose breathers, stuff their noses and they can suffocate) fussy and uncomfortable. Charlie goes, "Lynn I have a baby for you". I look at the baby and think, "Oh no". Charlie thinks the baby will be fine if we give nebulizer treatments every thirty minutes. So we go into high gear and get the nebulizer going, suction his nose and watch him like a hawk. He is so cute and so mad that his nose is not working. He is vigorous and keeps trying to nurse. He was pretty stable so I was willing to go along with this if he improved rapidly. Well as fate had it he only got worse. At one point I decided that I had to watch him every second and did not leave his side. Then he got worse, I sent Leanna running for Charlie and he said he would be down in a minute. My heart rate was rising by the second as I watched him struggle to breath through his nose, I tried to reposition him but he just kept getting worse. A few more minutes went by and I decided that I was not just going to stand there and watch him stop breathing so I told Leanna to grab the IV and we took off running through the hospital. I was so scared that he was going to have respiratory arrest I got a little excited. At times like this it pays to pray for help, (thank God). We made it to the ER and Charlie got it that we had a problem here. We made space and he took over, Tami came in and they were able to get him into one position where he could get his air. To make a long story shorter we ended up transporting him to the Miami field hospital by ambulance. Charlie, Tami and Leanna rode along. See the hair raising picture taken in the ambulance (as soon as I can find it). They made it to the hospital and I have not gotten a report of his condition.

I transferred out 2 babies to the Miami hospital from my unit today, a 4 month old with a GI bleed and a septic malnourished 3 month old that had an enlarged liver and was probably acidotic. Things were looking like a piece of cake until we got the premie.

OK guys I know I left you hanging on the issue of hope when I told you the story of my baby with the new onset smile. I have lived my life believing that there is always hope, so this has been a big one for me. Just mention the situation with this baby and her family and I start to fall apart. The good news is, there is always hope! Today I met with the case managers of the International Migration Organization (IMO), they are here in Haiti and arrange to take earthquake victims to appropriate shelters, where they are given shelter, medical care and food!!!! They have accepted my baby and her whole family. I told her Mom today and she wants to go, the IMO will transport them and make sure they are safe. Blessings on all of the people who care and together we will bring love and hope to the world.