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A Pediatrics ED – Under a Tent

I am a doctorally prepared pediatric nurse practitioner who just finished a 2-week volunteer stay in Haiti. I left New York on Feb. 8 and returned on Feb. 22nd. I practiced in the University Hospital in Port-au-Prince with the International Medical Corps, establishing a makeshift pediatric ED. This is my story.

After a brief layover in Santo Domingo, I rode by helicopter to Port-au-Prince. As I flew over the Dominican Republic border, lush vegetation soon gave way to rugged mountains and massive deforestation. The destruction below came into focus as I neared the city, and the images were none I had ever witnessed. The helicopter doors opened, and immediately the smell of burning refuse filled my nostrils. SOS and help signs hung by the roadside, where roof lines crumbled onto the street. People were digging through rubble, collecting metal scraps, large pieces of cinder block and any other items that could be valuable.

The University Hospital campus was once a place where medical and nursing students flourished. Now where paved stones of a courtyard and entryway once stood, tents serve as EDs, ICUs and med-surg units. Buildings that still stand house ORs. Buildings that didn’t survive the earthquake consist of large chunks of cement, still holding the bodies of those who could not escape.

A child treated for malnourishment.

The hospital itself now consists of tents, which on a typical day can reach more than 100 degrees as we see more than 600 patients. Cots serve as beds, and creative colleagues devise effective equipment when supplies aren’t present. For instance, we did not have a chest tube, so IV tubing was inserted into the pleural space. Clinical assessment and critical thinking are crucial in this environment — the diseases are different, space is limited and treatment varies because of fluctuations in medication availability and a lack of diagnostics.

I started evaluating patients in tent one, the frontline of the tents, and quickly realized that pediatric patients waiting in a long line could be triaged separately and seen by me and another pediatric provider. This change improved rapid care of some sick children who otherwise might have died. Unconventional treatment of lacerations, meningitis, fractures, malaria, living larvae in wounds and dehydration took place outside the tent under a makeshift canopy deemed the pediatric ED. A child of 10 years had severe nuchal rigidity; treatment consisted of IV ceftriaxone and sending the patient home to return the next day for an evaluation. Sterile instruments were often unavailable, so wounds were closed with clean instruments and antibiotic prophylaxis was initiated.

Education on safe water supply and newborn care were essential components we tried to instill. Some newborn mothers had lost everything in the earthquake and had little, if any, resources. Children suffered dehydration and sometimes malnutrition. Resources were scarce; however, that is changing as more Haitian providers offer nutrition services and maternal child primary care.

During my time in Haiti, I was amazed at people’s resilience. Most no longer had homes to go to and those who did chose not to sleep indoors because aftershocks were a daily occurrence. Yet they were so thankful to us, offering a smile or a warm hug — when it is I who want to thank them. This experience has left me with many memories and a reflection on how we practice health care. There is still much to be done in Haiti, and I would like to thank my colleagues who continue to offer their hard work and perseverance there.

By | 2020-04-15T14:26:43-04:00 February 25th, 2010|Categories: National|0 Comments

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