Notes from Haiti - February 17-27, 2010
I flew to Santo Domingo, Dominican Republic, arriving about 1 pm, and waited several hours for other group to show up – 13 medical students from Kansas City and an RN from Colorado. Together we went in a bus, first to a store similar to Sam’s, where the med students bought about $1000 worth of cabinetry and shelving to take to the camp.
Then we started our long drive (at least 7 hours) to Jimani and arrived around midnight. Jimani is at the border of Haiti and the camp was run by International Medical Alliance out of Knoxville, TN by Dale Betterton MD and his wife, Dorothy RN.
Our bus was met by a few men who told us some of the rules, and we were told to stay across the street in what appeared to be a mansion-like building. The entire inside was covered in white ceramic and marble and completely empty of furnishings. Thin mattresses were piled on the floors, some occupied and some not. We all claimed one, set up our personal belongings around the mattress and fell asleep in one huge group. I had bought my little 5 inch fan that runs on batteries since I knew from jungle work that it could be hot at night – and it was, so that was a life saver. I still got a few mosquito bites, but not many. There was only one bathroom with no light, but the toilet worked. Thank goodness I remembered my flashlight.
The next morning I gathered a set of clothes and toiletries and walked across the street into the compound similar to the one where I stayed the night to find the shower. I had to ask someone for permission to use the shower in a group room. I wandered around until I found the office and went in and registered, showing my nursing license and telling them that I had administrative experience. They decided to put me on 12 hour nights as a nurse, 8 pm – 8 am. My heart sagged since I really didn’t know if I could do it. They told me to rest for the rest of the day so I asked if I could be relocated to the main compound with the nurses, which as it turned out, had air conditioning in the rooms. There were at least 4 rooms with 12 or more beds and or mattresses on the floor with a bathroom. I was assigned to one and relocated my personal things and took a nap. I then made rounds in my tent – the Brown Tent – and met the 20 some patients and families staying there. I ate lunch and ended up taking another nap before my shift started. At approximately 7 pm, everyone gathered in what was a temporary dining room and Dale Betterton conducted a small briefing of the day’s events and happenings. Then I reported to my tent, set up outside the building along with 3 other tents housing patients.
The tent was indeed brown, with 2 large glaring lights in the top. Around the tent in a big semicircle were the patients on cots of every design and shape, with families on cots or cardboard on the dirt floor between them, with 2 rows of patients down the middle. The nurse’s station was a few cinder blocks with cardboard placed on top to write on and a couple of plastic chairs. There was a row of shelving which held supplies and medicines to the side. Bottles of water were sitting in the dirt, along with larger supplies and a garbage can.
I worked with a nurse for the first 4 hours who oriented me and assisted with my numerous questions about when to give the medicines and how to read the makeshift charts. The charts were folders with the medication and treatment sheet stapled to the left side and doctor’s notes, orders and nursing and physical therapy notes stapled to the right. The charts were kept on the beds of the patients. The entire extent of my job was to give medications, manage IV’s, and change dressings. The families took entire care of the patients, giving and emptying bedpans, bathing the patients, changing sheets, washing clothing and sheets, turning, assisting them with eating, etc, etc.
After my 4 hours of orientation, I was left alone with my tent with 21 patients, most of them having had complicated orthopedic surgeries. Since we were 5 weeks out from the earthquake, most of the more minor and simpler surgery patients had healed enough to leave the camp, so we were left with long bone fractures of legs, and crushing injuries needing plates and rods. Although statistically they had taken care of about 5000 patients, there were about 60 patients left when I arrived.
Much of the talk of the leadership was whether the Dominican government would allow people waiting across border in Haiti for care to enter the country. There were huge tensions between Haiti and the Dominican Republic, but I do not know why. Ultimately as days went by, it became clear that this would not happen and the camp would close as patients healed and left the compound.
I worked 7 twelve hour shifts in a row. The first 4 hours was working as hard and fast as I could, dripping sweat. I had to go to pharmacy if meds ran out, go to supply room if supplies ran out, go to tent for more water and carry heavy items back to my tent. There was no ancillary staff to help.
At approximately 10 pm each night, a preacher or designee would conduct a service of prayers, chanting, singing, and sermon for about an hour. We tried to have most of our busy work done, but since that was usually not possible, we just struck a deal that they would start the service and let me continue to work during the service.
The Haitian service was Baptist in content, and every single patient participated in singing and chanting and raising their arms in praise. Their faith seemed quite important and probably sustained them in these most trying times. Many patients had their entire belongings in the world in a bundle on the dirt floor beside their cot.
I wondered at these patients, who were from every walk of life, some well-educated with jobs and nice homes, as well as very poor people – each in the wrong place at the wrong time. All were thrown together in these tents, men and women, old and young, all bathing and using bedpans with no privacy – their entire lives and emotional ups and down just out in the open, for weeks and weeks. And there was little continuity of the people that they depended on to help them, all of us coming and going through their lives at different times.
So there I was, at midnight on my first night alone with 21 patients who I barely knew and couldn’t speak their language. All patients were Haitian and spoke Creole, a form of French, a few spoke Spanish and a couple spoke a little English. My night interpreter, who seemed to be around inconsistently, spoke Spanish and Creole. So that was how I got by - I spoke Spanish with him and he translated into Creole and back to me in Spanish. It worked.
The patients and families insisted that those 2 big lights be turned out at about midnight, so a large candle was lit and lights went out. I sat with the nurses from the other tents right outside in the night air, which was quite welcome since it was cooler. Every hour or so, I would make rounds with my flashlight to made sure all was well. If a patient needed something, a family member or the interpreter would come get me. During the night, the greatest need was for pain medication and IV medications given at intervals around the clock.
As it turned out, my fear of the night shift was unfounded as the air was cooler with breezes, as opposed to the hot day shift where nurse uniforms were soaked with sweat for 12 straight hours. I also had the pleasure of working with a great bunch of nurses on nights and we enjoyed getting to know each other and sharing our down time in the wee hours of the mornings, sharing snacks and food, playing cards, and just talking.
We were lucky in that we felt needed at the camp. We knew what our role was. We knew what we were there to do. Unfortunately for many people there, very little direction was given. There seemed to be quite a bit of disorganization, more than was really needed in a disaster relief situation. We felt the leadership falling apart, with communications back to us sporadic, and daily briefings eventually stopped. As days went by, leadership became less and less visible, new people were arriving without people to greet them and tell them what to do or where to stay. There was both underlying and overt anger from these volunteers. Food for volunteers became less and less, so most of us depended on snacks and what we had bought with us. When we had food, breakfast would be a huge pot of what looked like dishwater, with small hotdogs floating on top, with leftovers of tuna and such thrown in. Only the most desperate and hungry seemed to be able to stomach it. Dinner would be hot tuna fish in a huge metal bowl with moldy bread on the side. (After our shift was over in the morning, we would walk a few blocks toward the little village and get potato chips for breakfast – it was also our only exercise each day). Tensions between the Haitians and Dominicans increased and we found supplies being stolen, our entire bottled water supply stolen, our food being eaten by Dominicans. There were sporadic increases in security at times, and then we wouldn’t see security at all.
The night nurses just continued to work, taking care of the patients we were getting to know on first name basis. They would all yell “Diana” when I walked into the tent at night. We chased cows, goats, dogs, and pigs (I worried about those pigs slipping into the tents and causing chaos). Trucks and buses arrived at night and we checked them all out when security wasn’t around as we felt we needed to protect ourselves. We did have an older Dominican gentleman dressed in fatigues carrying a machete. He was not formal security, but seemed to assist us in investigating unusual occurrences and we shared our food with him.
One night when the winds were strong, the tarp covering the open side of the pediatric area came loose and was flying wildly 30 feet in the air, flapping around and making a horrendous noise. And the children were cold. So there we were, not a man in sight, 5 nurses doing battle with this tarp in the middle of the night. We corralled it in, tied ace bandages together, laid a bench on its side and tied the bandages to the tarp and the bench to secure it. It worked, and although we tried to get someone to fix it properly the next day, no one did and it remained that way until we left.
There were no psychologists or counselors in the camp, which was quite unfortunate. We did have a chaplain arrive during our stay. Nightmares were numerous after this traumatic occurrence in the patient’s lives. One of my young women patients began seizure-like activity one night, and although we knew it was not a seizure, she did not stop. So after 15 minutes, I went to get the doctor. By that time she had stopped the shaking and started screaming like a banshee, awaking the whole camp. I drew up medication in a syringe, and the family came racing up to us saying that she would die if we gave that to her. They insisted that there was an animal in her, and that only Jesus could drive the devil out. So we got the chaplain. She and another woman came and prayed with her, using the name of Jesus frequently, and after a long while, the patient fell asleep. She awoke about an hour later and asked for a pain medication, so I gave her the tranquilizer by mouth and she slept the rest of the night, awaking as if nothing had happened.
I watched an older lady patient be tearful, but without being able to speak her language, there was not much I could do except to show a manner of concern and caring. Oh, to have a counselor!
Not only was this a concern for patients and families. Staff was in need of help as well. One of the neediest volunteers that I encountered was the young woman doctor assigned to my tent. She was tearful on and off all the time as she cared for patients. From my standpoint, she was impossible to please, and frequently yelled at any and all staff, changing her mind and her orders, and getting mad when the simplest of questions or clarifications were needed. I would not have put up with her behavior in the US, but here I realized that she was in crisis, and there was no one to help. So I carried out her erratic orders, and just put up with her ill-mannered behavior quietly, since I was frankly worried about her and hoped she would talk to someone when she went home. She became completely involved in the patients lives, which in general would not be a bad thing, but it was to the point that she needed reassurance from them that things would be OK, sitting on their beds crying.
Which, of course no one could know. About 30% of the patients had homes or families to go to, which meant that the other 70% were being discharged to refugee camps or a simple clinic-like area in Haiti. Other NGOs were issuing a small tent and set of pots and pans to get them started in the camps, and we were rounding up any and all extra luggage or garbage bags for them to place their meager belongings for the trip. We went on scouting missions to find extra sheets and blankets to send with them. Since some of the patients could barely get around on crutches or walkers, straighten or bend their legs, we could not imagine how they would be able to get from mattresses on the floor of a tent to sitting and walking positions. But this is how it went. As the time got closer and closer to closing the camp, more patients were sent out in comprised conditions and 30 days worth of medicines.
There were about 25 patients left in 2 tents when I left, with the expectation that the camp would close within the week. Supplies and medicines were being packed up to ship to other clinics, or to make future disaster packs.
Observations and trials:
*Working in dirt floor, seeing bedpans sitting in dirt
*Amazed at how families cared for patients – there were no decubitus ulcers, no bad smells, patients were clean
*Using medical supplies from numerous companies at the same time – this was a challenge, trying to fit syringes and IV tubing and supplies from many companies that didn’t fit with each other – and for me, doing it in the dark. More than once I spent a great deal of time drawing up medicine in a syringe that didn’t fit the access port in the IV tubing, then trying to find one that did fit in a grab bag of syringes and tubings. And different patients had different IV tubings that were not necessarily replaced with same kind of tubing, so you could not anticipate what to expect.
*The same for medicines – the pharmacist had placed the same medicines in one bottle from many different companies, so that when you opened the bottle there would be pills of many shapes and colors, all the same medicine – but it did not inspire confidence. Bottles of 1000 tablets of Vicodan and vials of morphine just sat around with other medications, which just seemed unusual, although I know of no incidence of problems with theft.
*The Haitian patients and families in general seemed happy and smiling, which must have shown something of their culture and their outlook and way of living their lives.
*There apparently exist everywhere people who are insensitive, which may have been more irritating to me than other aspects. Too often people would show up with cameras and just start taking pictures of patients and families, without asking permission or even introducing themselves. Probably the pictures were on Facebook the same day. A doctor’s wife, dripping in diamonds and camera in hand, interrupted our church service at 10 pm at night. I asked her twice to please be quiet, but she continued to walk around and engage patients in talk and photos, so we just suspended the service until she left on her own. Flashing wealth around people who have lost everything seemed so out of place that it was amazing how someone could miss understanding that, or not have respect for a church service.
Three days in a row, there were strong aftershocks felt in our camp, which we heard knocked down more compromised buildings in Port au Prince, about 30 miles away.
At the end of my stay, I found out that the buses back to Santo Domingo were leaving either Thursday morning or late Friday afternoon. I had intended to work one more night, but 4 people who I worked with needed to leave Thursday morning in order to make a flight late Friday, so I decided to leave with them. On Thursday Feb 25, we took the long, long miserable, uncomfortable 7 hour bus ride back to Santo Domingo. One woman reserved 2 hotel rooms on the Boca Chica beach at an all inclusive resort. We split the costs of the rooms and felt like we were in a time warp, as we saw tourists lounging around the resort as if there were no problems occurring elsewhere 90 miles away. Of course I suppose we looked the same. Away we enjoyed our first meal in 10 days, I slept 11 hours straight, and we spent Friday together on the beach. Our flights were all at different times on Saturday and I arrived home to Lima at about 1 am Sunday, fairly exhausted.
Yes I was very happy that I went, and felt quite needed and that I provided continuity of care for 21 patients during my stay. I was hungry most of the time and mostly sleep-deprived since I couldn’t sleep more than 4 hours per day. There was an underlying element of unrest the entire time with lack of leadership, lack of security, and tensions within the countries of Haiti and Dominican. People who went to Port au Prince reported bodies, limbs, and body parts still littering the streets, so I never felt the need to leave the camp, nor did I feel the need to cross the border into Haiti. There were frequently long lines of people trying to cross and of course more tension.
My costs of the trip were my air ticket Lima to Santo Domingo, transportation by bus to camp both ways, and the hotel the last 2 nights, approx $1100, or $100 a day.