Stories from Haiti | The Children's Hospital of Philadelphia

International Medicine

Stories from the Field: Haiti

Following the devastating January 2010 earthquake that struck Haiti, CHOP sent a team of inter-disciplinary volunteers to contribute to the relief efforts there. In the short stories below, we can catch a glimpse into the challenging, life changing humanitarian experience that the CHOP Haiti Disaster Team was involved in.

What Haiti Looks Like Today: Feb. 3, 2010

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.

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Four Deliveries in One Hour: Feb. 5, 2010

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 assisting 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.

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Midnight Snacks: Feb. 8, 2010

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.

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Preparing to Depart Haiti: Feb. 9, 2010

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.

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