El Dia de los Muertos
Again today, our group divides up tasks and sites. As it happens, I'm the lone Philadelphian assigned to ride into two bateyes with Dr. Dorka Carrasco, an internist from the Centro de Salud Divina Providencia, and her team of two nurses and a trusty driver. This foursome visits, on average, two bateyes per day, seeing sick patients and providing anti-parasite medications to the healthy ones.
On the way out, Dr. Dorka tells me about a patient she saw two weeks ago in one of the bateyes we're visiting today, a three-year-old girl with a loud heart murmur and a swollen right lower leg. Even with my broken Spanish, it feels similar to conversations I have with my colleagues back home almost every day, working through the particulars of a case and discussing the right approach to a work-up.
The bateyes feel familiar as well: structures ranging from improvised homes made of scrap wood and corrugated tin to freshly painted concrete community buildings; muddy roads in which the children walk barefoot, only sometimes hopping away to dodge a pile of goat feces; lush trees and bushes whose branches hang low with the weight of fruits and flowers. In the first batey, we set up our clinic in the one and only schoolroom; in the second, we arrive in the church and are greeted by a dozen families patiently waiting for us in wooden pews. The chief complaints, as always, range from the ubiquitous "gripe," or upper respiratory infection, to less straightforward ones like the boy with a month of hoarseness and Dorka's patient with the murmur and swollen leg. We work fairly quickly, Dorka's team being a smooth operation, and see some thirtyish patients in all -- a light-to-medium batey day.
As we wrap up our consultations and start packing up our equipment at the end of the day, a little boy who looks about a year old catches my eye. Toddling along the pews while Dorka finishes taking his mother's blood pressure, he's bright-eyed and plump, with a smile that won't quit. "Que precioso," I can't help saying to his mother, and everyone hears me. Dorka, the nurses, the mother, and the batey's health promoter all nod as though this little guy is obviously something special and I'm just catching on. Breastfed, they tell me, all of them smiling with obvious collective pride.
Back at home with our evening plans (baseball game in San Pedro de Macoris) thwarted by threatening clouds, a few of us take a walk to the cemetery in Consuelo, where we run into one familiar face after another. Today is el Dia de los Muertes, the Day of the Dead, a Latin American holiday on which families pray for and honor their loved ones who've passed away. It seems that the whole town has turned out. Families buy bouquets of flowers, little white votives, and bags of oranges from vendors at the entrance of the cemetery, and the place is alive with conversation (and the roar of the occasional motorcycle speeding along the rows). Another delicious Martina meal, a meeting to debrief about the day's experiences and to plan the week ahead, and a kitchen dance party (now heading into its second hour as I begin writing this) follow.
Tomorrow is a big day: for probably the only time during this trip, all of us are heading to the bateyes. We've packed our bags with otoscope tips, tongue depressors, and alcohol wipes. We're bringing our charla flip-books with us in hopes of stealing a moment for an impromptu lesson on parasites or handwashing. If the weather holds out, we'll be all set.
A Return to Barrio Filieu
Several hundred people live here, among them many children under 5 years old, who are eligible to receive free health care at Ninos Primeros en Salud (NPS), the pediatric arm of the Centro de Salud Divina Providencia, the clinic with which CHOP is partnered (and yes, you read that right: Kids First Consuelo!). Routine well care here involves the same important basics as at any pediatric practice back home: plotting heights and weights on growth charts, age-appropriate anticipatory guidance, vaccines -- with a nearly incredible ninety-eight percent vaccine compliance rate for NPS kids under 5 in a recent review. The NPS staff also carries out malnutrition surveillance and twice-yearly doses of antihelminthic (de-worming) medications.
Hope heads out for another field trip!
I got caught in a wind tunnel crossing University Avenue yesterday, running back to Epic training in Colket after a mid-morning caffeine fix in Abramson. My hair and scarf whipping in a gust, leaves and construction grit swirling above the pavement, coffee cooling too quickly in my to-go cup...it seemed almost unimaginable that in 36 brisk little hours I'd be shrugging off my cardigan in balmy Santo Domingo.
Global Health Team Prepares to Depart Haiti
Final thoughts sent back from a few team members as they prepare to depart Haiti on Wednesday morning on a plane provided by Partners In Health:
We all leave here wanting to do so much more. The Haitian people have taught us more than we could ever have taught them in the context of this natural disaster. Hopefully, this will be an ongoing initiative to assist the Haitians toward a stronger health care system overall.
The experiences we bring back to CHOP will be diverse yet tied together with a common thread. The pain and suffering is crushing... the strength and resilient nature of these people inspiring.
Many of our nights were in the "ICU" tent taking care of families who now have come to know our faces and names. These families are dedicated to the care of their loved ones, standing by to provide drinking water or assist with other personal needs. They sit vigil 24 hours a day, sleeping on cardboard boxes under the hospital cots at night -- even the patient's children.
Each night we bring water and energy bars from our camp to hand out to these families as there is no other food or drink available during overnight hours. By the end of the week, they would anticipate our needs as well, and jump to assist us whenever they were able.
They often sit and chant prayers. We've been told by our interpreter, Charles, they include us in many blessings for the kind care we give their loved ones. They have such resolve and clarity to what their reality is, and showed grace and patience as we adapted.
Death happens here. The resources are minimal. Antibiotics are in abundance, but suction and ventilators are not. There are no monitors, no 24-hour labs, no replacement linens or hoppers to empty waste. It helps us understand what the effect of inadequate infrastructures has on a community.
We all look forward to returning to our families stronger, humbled and eternally grateful for the opportunity we've had here. Haiti is far from what we expected. It is profoundly richer.
The Global Health medical team completed its first week treating patients in Haiti. They are staying north of Port-au-Prince in a tent compound established by the aid group Partners In Health and have access to fresh drinking water, showers and two MREs (Meals Ready To Eat) per day. Some team members developed a bartering system with military personnel to exchange their Power Bars with MREs of spicy chicken in a bag.
“MREs (Meals Ready to Eat) are delicious in the middle of the night,” explains Global Health volunteer Warren Frankenberger, a nurse in CHOP’s emergency department.
Resources, not just food for the medical workers, are scarce everywhere in Haiti. The team rushes blood back to a makeshift Red Cross area in hopes of salvaging a unit of O-positive blood, and shuttles oxygen tanks from tent to tent, hoping they don’t run out. They are conserving glucose strips for those who “really” need it, and there is one ventilator operating in the entire hospital compound.
“This is triage at its core,” observes Frankenberger.
A great struggle for the team is witnessing the end of life that could be prevented in better circumstances, and balancing that with their ability to relieve suffering which they are doing continuously. In these difficult times, our CHOP volunteers stand side by side with the families, other doctors, military paramedics and nurses from several different countries, their heads bowed while a someone says a prayer and they share in this experience of humanity.
Four Deliveries in One Hour
Four deliveries in one hour! The Global Health team working at the University Hospital (HUEH) delivered four babies in under an hour last night, giving some of CHOP’s pediatric nurses a crash course in midwifery. By morning all four babies were doing well and our team was sleeping off the adventure, according to Global Health volunteer Warren Frankenberger, a nurse in CHOP’s emergency department.
Earlier in the week, team leader Fred Henretig, M.D., met up with a group of Swiss pediatricians already stationed at the hospital. The Swiss team was thrilled to learn other pediatricians had arrived at the hospital to help care for the children. Dr. Henretig set out immediately to establish a schedule of rotations and transition of care between teams. One goal is to maintain a 24-hour staffing system to keep in place after the CHOP team returns to the U.S. next week.
There are medical volunteers working at the hospital from all over the world. A group of Haitian-American nurses tracked down the Global Health team to express gratitude for their presence at the hospital and to offer assistance. The nursing needs in Port-au-Prince continue to be huge in all areas of care. In fact, several CHOP nurses are working hard to support the medical and intensive care wards, where nursing coverage is very short. They are assiting with procedures and care for some of the sickest patients in the hospital.
Yesterday afternoon, a few Global Health team members went on "rounds" to receive reports on many of the children. The pediatric ward is in four tents, each with about 20 to 25 children. Much of what the group sees and treats is completely preventable in the US, such as blood and wound infections, dehydration and post operative care. However, the required equipment remains scarce: there are no working ventilators and very limited oxygen. There are many cases where the physicians have had to take extreme life saving measures with a lack of lighting and medical tools.
Back at home, Global Health representatives are preparing for the team’s return on Feb. 10. And, they have also arranged a brief prayer service for Haiti and our Disaster Response Team in the Schlimm Center for Prayer and Reflection on Monday, February 8, at 12:10 p.m. The Center is located on the 1st floor of the Main Hospital, near the gift shop. All are welcome to attend.
Day 2: What Haiti Looks Like Today
The Global Health Haiti Disaster Response Team arrived in Port-au-Prince on Monday, Feb. 1, and spent their first day working at the University Hospital. Rakesh Mistry, M.D. and Warren Frankenberger, R.N., two team members from CHOP’s Emergency Department, reached out last night to Global Health Director Rodney Finalle with reports from the ground. The following summarizes what they are seeing:
The 12-member team -- four pediatric emergency physicians, a general ED physician, and seven pediatric nurses from the ED, ICU, and transport teams -- are staying in a tent camp on a concrete basketball court of a community center. Others staying at the compound are volunteer physicians and nurses sponsored by the aid group Partners In Health. The camp is about 30 minutes north of Port-au-Prince.
The damage inflicted by the Jan. 12 earthquake on the country of Haiti, and its people, is readily evident in the destruction seen while driving south to the University Hospital (HUEH), with rubble from collapsed buildings extending into the streets and highways, according to Rakesh Mistry, M.D., a doctor in CHOP’s Emergency Department and member of the Global Health team in Haiti.
Many Haitians attempt to restore a sense of normalcy and people walk the streets as they head off to work. Traffic is heavy. However, entering HUEH yields a quick reminder of the earthquake’s force. The nursing school building in the center of campus is a pile of stone, with known casualties still in the rubble. Several buildings are structurally unsound, forcing nearly all patient care to military and Red Cross tents throughout the hospital grounds. Hundreds of men, women, and children line up to receive care in a setting similar to a MASH unit.
“During our first shift, we moved from tent to tent, looking in on sleeping, and sometimes crying, children,” recounts Warren Frankenberger, a registered nurse in CHOP’s emergency department. “Often, a mom sleeping on the floor beside her child would grab me, plead to me in either French or Creole, to see her child. A perfect stranger with a stethoscope around his neck and a head lamp on becomes someone she immediately looks to for care of her very own child.”
Fortunately, much of the disaster-related injuries have been addressed yielding to the need for post-operative and ongoing medical care. So many children are injured with fractures and amputations. The medical need is great and the resources are minimal or makeshift.
“The pediatric ward remains full of severe orthopedic injuries -- I have seen as many femur fractures as I usually see in two years -- with amputees and complex hand injuries mixed among the patients,” Dr. Mistry said.
As Haiti emerges from the quake-related injuries, the medical needs have shifted towards care of the usual patients that present to the general hospital. Volunteers from several countries now participate in the care of more typical pediatric illnesses, such as pneumonia, meningitis, asthma, and diabetes.
“We continued to move from tent to tent, using our headlights and flashlights to see what is needed,” Frankenberger said. “A humble look at what nursing may have looked like a long time ago; but, here in Haiti it is what nursing looks like today.”
“It has been only 30 hours, and just our second night in Haiti, but we have learned much,” Dr. Mistry said.
Global Health Team Arrives in Haiti
The Global Health Haiti Disaster Response team receives instructions from Tony Rich, manager of emergency preparedness, during final orientation at the Incident Command Center at Children’s Hospital before departing for Haiti. The members are Team Leader Fred Henretig, M.D.; Rakesh Mistry, M.D. ; David Chao, M.D.; Neil Uspal, M.D.; Brian Barnett, R.N.; Marcia Carter, R.N .; Warren Frankenberger, R.N.; Diane Gardella, R.N.; Wendy Hemme, R.N.; John Kimbrough, R.N.; Kathleen O’Conner, N.P.; Steve Larson, M.D . (HUP Emergency Medicine)
After snow delayed flights Saturday, the Global Health Haiti Disaster Response medical team made it safely to Port-au-Prince yesterday and established a home base camp at a facility operated by Partners In Health. Their living conditions for the 10-day trip are simple, and include three tents, two meals per day, clean drinking water and showers. The compound is secure and safe, but very noisy due to constant military jets flying over, according to team leader Fred Henretig, M.D.
The CHOP team made an initial assessment at the hospital when they arrived and noted that the pediatric unit is large, and the care is fragmented , but the team just arrived and will have a better sense of the clinical needs today. The CHOP team is going to begin by covering the night pediatric shifts at the University Hospital. On the first night, six team members worked in the pediatric ward, a unit with about 80 to 90 young patients. For the moment, daytime pediatric shifts are handled by a Swiss medical team. There are several international medical teams working at the hospital, speaking many different languages.
The team plans to return to the U.S. Feb. 10.
Reflections - A guest blog entry
As the Global Health Team prepares to depart the Dominican Republic, Melinda Jones Daniels looks back on her stay.[Read More]
Bienvenidos a Barrio Feliu - A guest blog entry!
Pediatrician Mary Fabio, M.D., shares her impressions as the team visits one of Consuelo's barrios.[Read More]