Annie Lewis-OConnor, Brigham and Womens Hospital in Boston, was part of a team that worked with Partners in Health, worked in Haiti Jan. 28 through Feb. 14, 2010. She shares her experiences in a series of journal entries.
Profound Effects of RealityAerial view of bodies in Haiti.
Before our arrival in Port au Prince, we enjoyed the luxury of a private jet, a memory that would soon be passé as we boarded a sports utility vehicle at Loussaint International Airport and began our tour of the city. Evans, our driver, greeted us with a big smile. He would become our friend, our chauffeur and our protector.
I will never forget what we witnessed firsthand; the reality of it all has had a profound impact on me. I was no longer surprised or questioned the death toll that at the time officials said had reached 230,000. It has been estimated that at least 1.5 million people are out of their homes; even those with homes are afraid to go back. I can still smell the stench from Port au Prince the smell of decaying bodies, urine and feces lingering in the air. I suppose people have gotten used to it, but I feared that I wouldnt as I reached for my Vicks vapor rub to cover the odor. I wondered if it would smell like this where we were going.
As I snapped pictures of the ruins, I wondered, how many people lay within? I found myself holding back tears. I imagined the suffering that occurred being buried alive, struggling to get out from under.
The streets were jammed with people (I thought about how much I hate crowds). The noise of motorcycles, cars and people was palpable (I do not like noise or chaos). I saw women carrying large bundles on their heads, men with wheel barrels of wood, children naked and men urinating. At the time I thought, Life is happening, it has not stopped to grieve or process, it continues. Where is everyone going? Do those children still have parents? Where did all that fresh fruit come from? Do people have money to buy it? How will the amputees navigate this terrain?
My mind raced with so many questions. I felt overwhelmed and held back my tears, afraid if I started to weep I would not stop, and it was too early into this trip to fall apart.
Those who remain in and around Port-au-Prince occupy makeshift refugee centers or makeshift tents, and some make do in the rubble. It was hot (I hate the heat), yet I did not wonder for a second why I was there. It was where I should be, where I wanted to be. The colleagues I traveled with forged a bond we didnt anticipate. Over the weeks, we laughed together, cried together and supported each other through it all.
Through the Iron GateLewis-OConnor and her colleagues volunteered at St. Nicholas Hospital in St. Marc, Haiti, visible in this photo through the green iron gate.
As we traveled north to St. Nicholas in St. Marc, we felt the adrenaline pumping through our veins in anticipation of where we would work, whom we would care for and where we would sleep. I worried if I had the skills that were going to be needed, if I had the supplies and equipment needed to give excellent nursing care. The drive was unforgettable: fast, weaving in and out of traffic and horns always beeping (I think there is actually a horn language: one beep is I am here, two beeps means Please move, three beeps says get out of my way and anything over three beeps is not good.)
As the iron-gate opened to the sound of the car horn, we got our first glimpse of where we would spend the better part of our days in the weeks to come. There were people everywhere, and all eyes were on us as we descended the vehicle. Some would smile; others would look away. In the Haitians intense dark eyes, you could see pain but also spiritual resilience. Most patients carried a Bible with them. I was cognizant of the fact that I was a visitor and a minority member.
I welcomed the challenge of embracing the work and was mindful that the Haitians and I had much in common. It was those commonalities that would foster our relationships. As we toured the units, it became clear that we would be challenged like never before. I began to count the number of amputees and then lost count. I saw external fixation devices, antiquated beds, mattresses on the floor, family members everywhere, nurses dressed pristinely in uniforms and no privacy amidst a feeling of chaos. Then there was the smell wounds weeping with foul drainage and flies swarming around the wounds.
We discovered that no one had been out of bed since the earthquake. We were told that six patients died before our arrival (the histories suggest pulmonary or fat emboli was the etiology). Where and how would we begin our work? Stephanie Victoria, RN, set out to ensure that all immobile patients received heparin. This required providing education to the Haitian nurses and physicians and began our journey in providing culturally sensitive patient care. The focus had to be on prevention of further harm in collaboration with our Haitian colleagues. We had to remember that we were there to assist and not to take over. I would remind myself of this repeatedly. Ed Arndt, RN, NP, said, We need to be careful not to Americanize Haiti. We want to be conduits to positive change.
Making Do, Making StridesHaitian refuges seek any shelter possible.
We would have many wonderful stories to tell. The collective teamwork forced us to think outside the box and return to basic nursing and medical practice. Chris Sampson, MD, suggested Dakins solution (bleach and sterile water) and acetic acid (vinegar and sterile water) to treat the wound infections. It made a remarkable difference, and now many patients could have skin grafting. I saw twins, born to a seizing mother, who were blue and unresponsive and had the lowest Apgar scores I have seen in some time, breathing spontaneously after 20 minutes of resuscitation no drugs, no IV line, no ventilator.
Getting people out of bed for the first time was intense and thrilling at the same time. We would celebrate (and breathe a sigh of relief) once the persons feet touched down and he or she stood erect. Roudy, the Haitian physical therapist, gave us a B on our physical therapy skills!
We successfully transferred four paraplegic patients to Montreal for care and felt energized to do more. As patients were accepted to the hospital ship USNS Comfort and Hans Albert Sweitzer Hospital for surgery, we knew we were making strides. Our progress sustained us and kept us strong.Twins born on the first day of Lewis-O’Connor’s volunteer service in Haiti. A second set of twins would be born on her last day in the country.
Twins were delivered on our first and last day! Cheryl Grove, RN, said, We are going out the way we came in with twins There has got to be some meaning in this. We will never know the true impact we had, but we do know from our last days and saying our goodbyes that we bridged cultures and provided the best possible nursing care, despite the limited resources. Everyone I cared for has left an imprint in my mind, in my heart. I hope I have left them with hope, Suzanne Fernandes, RN, said.
We also had our painful stories stories we struggle to share with our families and colleagues back home but stories we process with each other. It is painful to talk about the death of children from meningitis, fever and dehydration, as well as the death of an infant with a bowel obstruction, all treatable conditions in the U.S. We struggled to comprehend how Haiti will care for those with cancer, infectious diseases such as HIV and TB, amputations and psychological pain. These are the experiences that bring us to tears, make us ask why? and prompt us to give thanks for our privileged status in life. It makes us all be more mindful of our complaining.
All of us want to return. I will come back. I am compelled to come back, said Deb Pitts, RN.
Work Yet to DoThe second set of twins born during Lewis-O’Connor’s stay in Haiti.
As a nurse and advocate for women and children who are marginalized, one of my most profound realizations was the impact of the earthquake on nursing practice and womens issues.
Myriam Merlet, Magalie Marcelin and Anne Marie Coriolan, founders of three of the countrys most important advocacy organizations working on behalf of women and girls, were confirmed dead. More than 150 nursing students died in the earthquake, completely disrupting the education of nurses and midwives. Many of the nurses I worked with lost family members and loved ones. Many talked about their fear of not having enough nurses to care for a population now facing myriad medical and psychological health issues.
The destruction of the Ministry of Womens Affairs, as well as the loss of schools, educators and students, will complicate Haitis efforts to address the needs of women and the delivery of nursing care. The midwifery school had 78 students and turned out about 35 midwives each year. Midwives had important and much-needed contribution toward reducing Haitis maternal mortality rate. At 670 deaths per 100,000 live births, it is the highest in the Western hemisphere and one of the highest in the world.
Haiti has the highest rates of infant mortality in the Western hemisphere. Most deaths are preventable deaths caused by diarrhea, respiratory infections, malnutrition, malaria, tuberculosis and HIV/AIDS. There is an opportunity for nursing, medicine and public health Haitian and American to partner in forging efforts to improve the healthcare delivery system in Haiti.
The nurses and doctors of Haiti embraced us; their journey to recovery is very much dependent on the support and resources made available to them. Life continues in Haiti in the context of devastation and injustice. We were able to bear witness to hope, human connection and spiritual resiliency.