Pamela Louderback, MSN, ARNP-BC, of St. Petersburg, Florida, was in Haiti Feb. 19-23 to volunteer with Project Medishare.
Going to Haiti was one of the most memorable events of my life. I feel blessed and honored to have been a part of the mission of Hope Brings Help for Haiti (www.hbhh.org).
Once in Port-au-Prince, we were deployed to Project Medishare (http://projectmedishare.org), part of the University of Miamis Global Institute. Our group of five was part of the wound care team. I had the opportunity to work with world-renowned physicians and surgeons, as well as incredibly skilled nurses, physical therapists and social workers. What an amazing group of people, and all with one common goal helping the people of Haiti.
We were based at what had become the major medical center of Port-au Prince, just 200 yards from the airport tarmac. I understand this location is considered to be the crème-de-la-crème of the clinics in Haiti. That was hard to imagine, with only tents for protection and dirt floors.Louderback and one of her patients.
The adult care tent consisted of five long rows of cots that accommodated 75 to 80 patients. Since the cots were only 12 inches off of the floor, kneepads were a real luxury. Patients loved ones were permitted to stay with them most of the time. They would sleep on the dirt floor next to the cots, using cardboard or whatever else they could find in lieu of a bed.
In one corner of the tent was a minor OR. It was there that the larger dressing changes requiring anesthesia were performed. The pediatric care tent was about the same, just a little less populated.
This tent also housed the neonatal ICU and pediatric ICU areas, as well as the main OR. In addition to the two main tents, we had a smaller tent for the more complicated orthopedic patients and several individual tents for patients who needed isolation, including those with advanced AIDS or tuberculosis.
The Haitian people sometimes traveled as far as 20 miles without any form of transportation. They walked or carried their loved ones. In addition to earthquake survivors, I treated gunshot wound victims, a 41-year-old woman with heart failure, a patient with abdominal pain and a woman with uncontrolled diabetes.
Maintaining a diet for a diabetic patient proved to be difficult, as the food for patients, which was delivered locally, consisted mostly of carbohydrates like rice, beans and potatoes, with worms mixed in for protein. Yes, worms.
By contrast, our diet consisted mostly of protein bars and MREs (meals ready to eat), courtesy of the U.S. military. We also received bottled water daily and were encouraged to drink 10 to 12 bottles every day. Still, several physicians required IV fluids themselves due to dehydration. The United Nations was a nearby oasis, within walking distance. There we could have real American food hamburgers and French fries and a cold beer, which offered a nice break from camp. The U.N. even had flush toilets and showers.
We bunked in a large tent that housed more than 100 volunteers. It was air conditioned at night but almost unbearably hot during the day. Power strips were available for recharging phones and laptops, but not everyone had a workable phone service. Makeshift outdoor showers were available. Please limit your shower to 2 minutes was requested. Two minutes was plenty of time as there was no hot water. Another welcomed amenity were the Port-o-lets. I understand that just a week before our arrival, there were none. I was most grateful for our timing!
My work depended on an interpreter, as my French skills are minimal at best forget about Creole. My interpreter was a wonderful young man named Jimmy, who lost his entire family during the earthquake. He was working with Project Medishare for 85 cents per hour and one meal per day. I could not have functioned without Jimmy. He demonstrated a strong desire to learn, he was constantly by my side asking questions about every procedure and he would then eagerly sharing his retention of the information with me the next day. In addition to his interpretation skills, he never hesitated to help me position a patient or assist during a dressing change. He was invaluable.
The wounds were some of the worst I have ever seen: severe crush injuries with external fixation devices and many amputations. It was heartbreaking to see so many young people missing arms and legs. I found myself giving out as many hugs and kisses as I did dressing changes.A patient in the dirt-floored neonatal ICU prompted Louderbacks memories of her own grandsons experience in a neonatal ICU.
I could not keep away from the neonatal ICU. I had gone there originally to ensure that the incubators we brought with us, donated by Bayfront Medical Center, had arrived. When I first walked into the dirt floored ICU, I was overcome by two preemies in one suitcase-sized warmer. I learned that the two boys were not related, but there was not enough room to keep them separated.
My heart ached. It immediately took me back to about one year ago, when my own grandson was born at 26 weeks gestation weighing only 1 pound, 9 ounces. I spent part of every day for almost four months in the neonatal ICU at All Children’s Hospital in Florida just to be near our little miracle. No wonder that one of these little preemies Jeremy stole my heart. He weighed about 975 grams; and each day when I was able to leave the adult care tent, I would rush over to the neonatal ICU just to hold him.
One of my most memorable patients in Haiti was a woman who looked about 70 years old, but according to her chart a clipboard with poorly organized notes she was only 53. She had received a split-thickness skin graft to her left foot after a crush injury. The graft healed beautifully, and she was ready to begin ambulating. All she really wanted was a pair of sandals so she could walk.
At the supply tent, I learned that shoes were scarce. I gave the woman a $2 pair of flip-flops I had brought with me to use in the shower; one would have thought she had just received a $1,000 gift. At that moment, I remember wanting to give away everything extra I had taken with me and then some.
Another memorable patient was the famous patient, the longest known survivor, who was found after 28 days under the rubble. He seemed barely alive, just skin and bones. His mother stayed by his side almost constantly. I was able to talk with him through Jimmy. He was alert, responsive and somewhat depressed, which was not surprising after what he had been through. I treated him for wounds on both of his heels, but his internal medical problems were much more severe. Project Medishare was able to arrange his transfer to the U.S. on my second day with him. I find myself thinking about him almost every day.
One of the most disturbing things I found about being in Haiti was the hundreds of pallets of supplies just sitting at the airport, not yet delivered to the people who so desperately needed them. I couldnt help but wonder who was responsible for getting those supplies to the people. Port-au-Prince looked as though the earthquake had just happened. There was no evidence of any clean up, no bulldozers or heavy equipment attempting to remove debris. I saw people trying to live in severely damaged homes without electricity. People used fires at night for light.
I remain concerned about what will happen to Haiti and its people after the many countries now offering assistance leave. I fear for the lack of healthcare the Haitians so desperately need. While we were there, we did not see any Haitian physicians. I wonder if the patients will have long-term access to the same or similar healthcare they have been receiving through Project Medishare?
I wonder . I am concerned . And I care.