Update from former SF Medic (18D) Mark Hayward:
100120 Haiti (teamwork)
The day got off to an early start when I woke up a few minutes after 6AM because somebody was shaking my tent. I found this irritating, as I was planning on getting up at 7. I became less irritated, and much more intrigued, when I realized that I was experiencing my first earthquake. Frankly, it felt as though I was lying on a bunk in a sailboat at anchor, being hit by the wake of a very large passing powerboat. The ground wobbled, like jello. This went on for a little while and then faded away. I considered going back to sleep, but the yelling and excited conversation caught my attention. When I heard Jeff describing how he had been washing his, uh, nether regions, with baby-wipes inside the presumably empty novitiate building, and upon feeling the earthquake, had sprinted into the courtyard wearing only his flipflops, I laughed so hard I figured it was time to get up.
“Normal” is a word I wouldn’t really use down here, but I suppose we are developing a little bit of a morning routine. We packed medical supplies, reviewed our possible missions for the day, mixed up oral rehydration salts, and headed out to the general hospital. (No soap opera jokes, please; we’ve told them all several times.) Our numbers and logistical requirements have grown to the point where we were traveling in two tap-taps and a rental Suzuki from the DR...
We looked carefully at the buildings as we drove along (occasionally being cheered on by locals shouting “We love you! Thank you!”) And when we got to the hospital, it had CLEARLY been devastated by this morning’s earthquake, but not at all as we expected. The BUILDINGS were completely intact. But, in a very understandable act of caution, all of the PATIENTS (and their beds) had been moved outside onto the paved street surrounding the hospital courtyard. And, in a predictable though very problematic excess of caution, the hospital administrator was unwilling to allow the patients BACK into the buildings until it had been proven beyond a reasonable doubt that it was safe. And so, when we arrived, the patients were still outside. On their hospital beds. In the sun. Largely unable to move due to their extensive orthopedic injuries. Without water, because the hospital staff themselves were on the verge of running out of water. And, as we found when we asked the logical next question, many of the patients had also been without food for 2 or 3 days.
Needless to say, our immediate responses were to get cardboard sheets as shade for as many patients as possible; secure and distribute drinking water; and have Jeff and Craig (our firemen) do a top-to-bottom building assessment to see whether the hospital itself was in any danger of falling apart. What they determined (before the last sheet of cardboard had been cut) was that there had been no appreciable change to the structure since yesterday. What they next determined (before the last cup of water had been distributed) was that the hospital administrator was not going to accept any authority less than that of the US Army Corps of Engineers to declare the building safe for habitation. And so we set to work turning a street full of randomly scattered beds into a functional, non-injurious open-air emergency room.
Although I tried to focus on patient care, like Dr. Griswald, I simply couldn’t carry anything through to completion as I got more and more involved in working on the shade-water-organization-food problems. Solutions that I can describe in a few paragraphs took hours to carry out. Many of the patients had arrived after our departure from the ER and they had no registration slips (with minor information such as patient name, age, injuries/medical conditions) and previously rendered treatment. Patients who had already been scheduled for surgery when we left last night, such as the grandmother with the pelvic fracture, were still exactly as we had left them, except of course for being outside in the sun. The beds were jumbled any which way, mixed in with patients who had been brought in on boards, doors, and other random platforms and left on the sidewalk. And, of course, more patients were coming in all the time: not a flood, but just enough of a flow to ensure that any space opened for any duration of time would very quickly be occupied by more patients.
Dr. Griswald was evaluating and directing treatment for patients with passion and skill. The two nurses and three or four technicians were doing yeoman work trying to actually provide the ordered care to the right patients. But every act of medical care was taking place in a continuing welter of chaos that doubled the time of every action and virtually ensured that critical injuries were overlooked or left untreated. Dr. Dolhun had been grabbed for surgery as soon as he arrived (fortunately the ORs, in another building uphill from the main hospital, had been declared safe, so surgery was still taking place.) However, Dr. D never even made it up the hill to the OR; he was grabbed wile passing through the doctorless OB “ward” (in the middle of the courtyard) where eight to nine patients, two with acute medical problems, were actively laboring and trying to deliver new lives into the world under the bewildered supervision of one non-OB nurse. That took both of our doctors “out of the fight,” so to speak. My decision then was either to focus on patient care alongside Griz, or to take charge of the effort to change his work environment so that he could actually manage all of our patients. So I took a deep breath, mentally removed my “PA” hat, put back on my “Army problem-solver” hat, and along with the rest of Team Rubicon got to work making order out of chaos.
First order of business was the patient identification. No registration information. Not even any cards or pens. No tape. No idea who was who among our thirty-plus patients. Resources located within fifteen minutes inside the “uninhabitable” building. Marines and firefighters filling in for nurses on skilled nursing tasks like wound care and medication administration, so that the nurses could get baseline vitals and patient history for registration.
Simultaneously was the problem of shading the main triage and treatment area. Griz rocks and he is a brilliant doctor. He’s also on the far side of fifty, sleeping on the ground in a foreign country, and doesn’t run marathons in his spare time. It was easy to see that he wasn’t going to last 30 minutes at the pace he was going if he didn’t slow down, drink some rehydration fluids, and get out of the sun. At this point it was already stupidly hot and humid and it wasn’t even close to the hottest it would be during the full heat of the day. So, we took it in shifts to keep an eye on Griz while we built an enormous shelter over him and the entire “working” end of the “ward.” Ever tried to make a decent shelter using only a 25x25’ plastic tarp, miscellaneous chunks of rope, and various chunks of concrete? (Note that the interesting element is: NOTHING TO HANG THE TARP FROM.) Thank God we were working with (former) Marines.
While the tarp team built something out of nothing, Jake and I got to work making nothing out of something: namely, getting the seven immobile/broken/junked CARS that were parked on the sidewalk (i.e. SCATTERED ALL THROUGH THE PATIENT CARE AREA), out. With the help of our trusty offensive hardware kit (in this case, a small but very useful axe), we bypassed the doors, disabled the steering wheel and transmission locks, and rolled the offending vehicles OUT of our makeshift ward. Suddenly we had enough space for all of our patients, so that they weren’t being bumped by cars passing through the compound, and could actually be lined up neatly on the sidewalk for Griz to examine and direct treatment.
The next issue was shade, and that was frankly impossible. The only thing we could do was scavenge cardboard sheets for shade panels. One patient had family, who had brought her food, water, and a giant beach umbrella. Everybody else got cardboard panels. Clearly it was the time to get moving forward on getting back into the building.
Of course, writing things like this just can’t do justice to the utterly chaotic nature of all this activity. Everything was going on at the same time and mostly in the same physical space. For some reason we were getting a reputation for solving problems, so doctors from throughout the hospital were coming to us asking for things. Most of these were minor issues, such as the fact that the OR was within three or four surgeries of being completely out of pain medications and anesthetics. Other problems were a little more pressing, such as the fact that a Haitian medical provider was performing major surgeries WITHOUT anesthetic on screaming pediatric patients who were physically tied down on plastic chairs in the courtyard street for these procedures. This was addressed rather bluntly, when a nameless Team Rubicon member, at the impassioned request of two different surgeons, simply took the man’s ID card away from him, walked him down to the gate, identified him for the company commander of the 82nd security element, and directed them not to let him back into the compound. The gesture proved to be somewhat limited in its scope, as the hospital administrator later ordered the 82nd to let the man BACK into the compound and demanded that he be allowed to return to seeing patients. However, at least he got the point, and confined himself to wound care and allowed the ORs to do the amputations indoors under anesthetic. It’s a little unclear as to what the moral of this incident is. It’s just a note in passing.
Anyway, the usual silliness continued to go on around us as we tried to get work done. Jessie Jackson and Anderson Cooper came through the compound and got all sorts of meaningful photos with refugees baking in the sun. One nameless Team Rubicon member (coughJAKEcough) politely requested of the Reverend J. that some actual food might be a little more appreciated by the patients than a photo op. Another Team member (coughGRIZcough) got interviewed by Mr. Cooper. Griz says he just talked about things, but Jake claims that it was more of a verbal pummelling of whatever nameless bureaucrats had decided to keep scores of volunteer physicians and other medical specialists imprisoned on an airbase “for security reasons,” when small teams of Americans were moving freely through the city in hired tap-taps with no security issues whatever. I did not get interviewed, but I did bump into an O-6 colonel of the 82nd Airborne. The way I remember it, I very politely mentioned to the colonel that the OR was running out of certain important medications, which I listed for him, and I suggested that it might be helpful if a single vehicle with a footlocker of these more important medications might be sent directly to the hospital, rather than waiting to be sent with every other scrap of medical support in one huge convoy at some undetermined time in the future. (Jake tells this story a little differently, but he is a little confused; I think he got too much sun while he was working on the monster tarp.)
Anyway, as we continued hacking away at whatever problems presented themselves, things slowly started looking up. A convoy of food trucks showed up with enough rations and water for everybody in the compound. A two-vehicle command element from the 82nd brought critically needed medications to the OR. A team from the Army Corps of Engineers showed up to do a building assessment on the hospital, asked Jeff and Craig to guide them through the whole process, and reported the exact same thing that our firefighters had concluded when we first arrived. Best of all, at about the time that another tap-tap showed up with the next wave of Team Rubicon personnel, a 30-passenger busload of volunteer physicians FINALLY showed up at the hospital, having at last been released from “security protection” (house arrest) and allowed to come take care of patients. So our team worked alongside Haitian nationals to clean the recertified emergency room and move all the patients back inside.
Once we got all of this taken care of, I finally got back to work seeing patients. (Actually I didn’t get RIGHT back to work; I made one other side trip to get pediatric antibiotics and anti-inflammatories at the request of the OR chief, since the OR had completely run out of these medications, needed them very badly, and hadn’t mentioned them in the earlier conversations. Fortunately the Catholic NGOs are NOT bureaucratically top-heavy, so I hitched a ride back to the compound with a Mennonite relief specialist, found what I wanted in the room full of donated medications, and left a written list of what I had taken -- which was exactly what the logistics officer wanted me to do anyway.) So I took the meds to the OR, and then went back to the cleaned and repopulated ER. My one medical act for the day was to reduce a displaced fracture of a young man’s left radius and ulna, while Jake and some of the new arrivals professionally applied a cardboard splint and ace-wrapped it into position. (The man had wounds on his forearm that made it inappropriate to cast his arm, even though our recently arrived Team Rubicon elements had brought a box of Orthoglass casting material, as well as Septra, Keflex, and a very interesting proprietary wound dressing used by the Army special operations community.) And finally, we called it a day.
Our trip back to the compound was uneventful. I got to meet the new arrivals: another former Marine sniper who had hitched a ride into PaP on a private propeller-driven plane with a team of security contractors; a former Special Operations medic with a mysterious past; two male nurses from Chicago (neither named Fokker); and a Brazilian chef. At this point, I truly have NO idea what we will be doing tomorrow. I’m not even sure the hospital will need us anymore: now that the logjam at the airport has broken, there may be an OVERpopulation problem with medical providers. But based on today’s events, I think that our usefulness includes a number of different areas. And I truly believe we ARE making a difference.