When the Jan. 12 earthquake struck Haiti, Cathi Goldfischer, RN, ACNP-BC, nursing section chief of the NJ-1 Disaster Medical Assistance Team, knew that her unit was on call that month. After checking with the commanding officer, Goldfischer alerted NJ-1 DMAT nurses, and the next day, the team was activated.
After organizing in Atlanta and receiving malaria prophylaxis and needed immunizations, the NJ-1 DMAT landed in Haiti on Jan. 15.
Part of the National Disaster Medical System, NJ-1 DMAT is a group of professionals who provide disaster medical care primarily to citizens of New Jersey, but they have been deployed throughout the U.S. The team has been activated for disasters such as Hurricane Ike and Hurricane Gustave and planned events, such as the past two inaugurations and State of the Union addresses. The earthquake in Haiti was the teams first international deployment.
An NP and chief of her local ambulance corps, Goldfischer often talked about her DMAT experiences with fellow nurses at Englewood (N.J.) Hospital and Medical Center, where she works as an ED staff nurse. I found her stories intriguing and wanted to give back in some way, says Arlene Keys, RN, BSN, CEN, ED staff nurse, EHMC. Even though I had never done something like this before, I decided to go through the screening and application process.
Little did Keys know that less than a year after intensive training, she would be going with Goldfischer and the NJ-1 DMAT to Haiti.
Basic and Creative CareIn Haiti, Cathi Goldfischer, RN, nursing section chief of the NJ-1 Disaster Medical Assistance Team, cared for patients with open fractures, gangrene and infected wounds, lice and more. The Haitian men behind her assisted with caring for the injured.
For most of their time in Haiti, Goldfischer and Keys worked in Petionville. In a field medical hospital at a mountaintop, they cared for patients with open fractures, gangrenous and infected wounds, burns, lice, scabies and active TB, and assisted two women in giving birth. At the bottom of the mountain, about 40,000 to 50,000 Haitians had set up a tent city.
They used crutches and plastic tiles from the ceiling as splints, and family members carried loved ones on doors or fences for miles to bring them to the medical base.
After the 6.2 [magnitude] afterquake, I saw medical personnel using a drill to pin a patients fractured femur right on the street and then applying Kling and stabilizing it with rocks in a gallon jug, Goldfischer says.
Since there was a shortage of gloves, dressings and other supplies, the team applied Purell to their gloves and reused them, mixed normal saline and betadine in their water bottles to irrigate wounds, and used crutches as splints, water bottles as sharps containers and leftover tubing from IVs for wound irrigations. Nothing was ever wasted. It was basic and creative care, Keys says.
We even made a bottle for a father with a 2-week-old baby whose mother had died in the earthquake by using a water bottle and the fingertip of the glove as a nipple, Goldfischer says. Never has Tylenol and showing support by holding patients hands ever meant so much.
Collaborative CareCathi Goldfischer, RN, shares a ready-to-eat meal and bottled water with a Haitian woman and child in a field medical hospital in Petionville, Haiti.
Along with Haitian medical and nursing students, local individuals volunteered their services. The DMAT team hired translators who were paid with ready-to-eat meals and bottled water, and wet nurses who nursed babies whose mothers had died or were too dehydrated to nurse. Haitian community and church leaders were responsible for disseminating information from the base to patients and families in the camp.
The team also sent out strike teams, protected by the military, which traveled to surrounding areas by truck or foot and either provided medical care or sent those who needed more care back to the field hospital.
Traveling with the commanding medical officer and the commanding officer to the crumbled Haitian Coast Guard base, Goldfischer spent several days caring for patients with electrocutions, burns, traumatic amputations, head injuries, gangrene, open fractures and spinal injuries.
Using desks as exam tables and seeing more than 100 patients a day, Goldfischer and colleagues, along with the corpsmen, developed a system of communication and care that included keeping patients who needed to be medevaced in one area, writing dates and care given on patients dressings, and indicating on tape secured to patients foreheads whether they needed to be evacuated.
Whenever we asked patients to check back with us for additional care or evaluation, they would always gather and wait at the designated time under the trees by the base, Goldfischer says. As bad as things were, the Haitians were always polite and grateful for our care. They are a resilient and stellar group of people.
Prepared and Ready
The 35-person NJ-1 DMAT team that traveled to Haiti consisted of nurses, NPs, MDs, physician assistants, medics, EMTs, pharmacists and mental health specialists.
During the year, we have field training exercises where we set up mock scenarios with large volumes of patients, and practice triaging, identifying how to treat and move patients, both before and after arrival to the site, Goldfischer says.
During my field training, I learned how to set up a cache, build a western shelter, make MREs, and learned about what I needed to pack in my backpack, three-day pack and 14-day pack, Keys says. Since I had not been a camper, this was a whole new experience for me.
Keys feels grateful to be a part of an exemplary team and says she witnessed such grace in the American efforts and such patience and gratitude in the people from Haiti.
As our support continues, I think about how much we can do as nurses. The hospitals there are desperate for supplies, and old stretchers and other medical equipment that we dont use could help them build a better system of care, Goldfischer says. After setting up alliances with nursing schools in Haiti, we could offer nursing training programs in the U.S.
Editors note: EHMC is in the process of pursuing an alliance with a school of nursing in Haiti. For more stories on Haiti relief efforts, visit www.Nurse.com/Haiti. For a photo gallery of the NJ-1 DMAT team’s trip, visit www.nurse.com/galleries/public/index.html?galleryID=210004