I went to Haiti in the wake of the Jan. 12, 2010, earthquake, but those weeks treating mostly chronic conditions barely prepared me for my return to the country Nov. 19. This time, I was faced with acutely ill cholera patients requiring immediate life-saving treatment. The deadly outbreak erupted in October, and by the evening of my arrival at J/P Haitian Relief Organization housing in Port-au-Prince, more than 21,000 people were infected, with 1,250 deaths.
Early the next morning, J/P HRO co-founder Sean Penn received a call from Paul Farmer, MD, PhD, of Partners in Health, who said, If you dont send us any of your doctors and nurses you have available, people will die. So our team of seven (four nurses, two translators and our driver/security guard) set off on the three-hour drive along broken roads through the beautiful, rugged mountains and countryside to Hopital Ste. Therese in Hinche.CTC tent with medical waste being burned close by
I believe we were all shocked by the world we entered. Triage and short-term oral rehydration tents were staffed by Cuban and Mexican physicians and nurses, and three additional tents (mens, womens, childrens) and an old church served critical patients requiring IV rehydration. Each facility held up to 24 patients. The cholera treatment center was fenced off, and an attendant sprayed our shoes with a bleach solution upon entering or exiting. The church was downwind from the pit where medical waste, patients clothing and trash were burned.
The heavy canvas tents had tarp floors that were wet from the nonstop mopping of human waste. Tree roots and old foundations underneath presented trip hazards. Cots and cholera beds were crowded inside.
Our combined medical team had four U.S. RNs, two Canadian RNs, one U.S. physician and a small Haitian nursing staff. We became adept at positioning ourselves to start or manage IVs, and we found creative ways to secure the IVs to the tent framework using pieces of rope. We learned to place intraosseous infusions using a simple 16-gauge needle and to place external jugular IVs when we could not find a peripheral vein. One of my most vivid memories is of a member of our team, in what appeared to be a yoga position, starting an IV while a small dog sat in the tent entrance and a chicken pecked at the ground beside her.CTC tent in the early morning hours
Working in the CTC at night provided additional challenges fewer staff; poor lighting; and a constant cacophony from patients, animals, passing vehicles and occasional shouts from families of arriving patients. The generators often stopped and left us in total darkness but for our headlamps. During one blackout, a patient went missing from the mens tent. His lifeless body later was found by the fire pit. We never got a clear story about who declared him dead or moved him.
We had no nasogastric tubes, no IV extension tubing, few IV poles, limited IV needle sizes, extra large gloves and not enough beds. When patient gowns ran low, we offered items from our own suitcases, then plastic garbage bags. We had to clean patients with bleach water and a mop.
Late one evening, I witnessed an older Haitian woman perform a voodoo ceremony for a young patient in our care. In the morning I met the family, and though it was a bit unsettling, received a blessing from the same woman.
When I had the chance to look to the heavens, I was struck by the beauty of the evening sky. One of my fondest memories was pointing out Orions Belt in the night sky to our Haitian security guard and his sharing the Haitian names for the stars in Orions Belt and how they were used for navigation.CTC in old church
During the course of five days more than 500 patients, tears, laughter, life and death we became one anothers mentors, colleagues and friends.
One team member advised each of us to find a face to remember one patient for whom you know you made a difference. For me, it was a young child named Evans. He was unresponsive, severely dehydrated and had only a femoral pulse. Three of us worked on Evans for more than three hours to find IV access for the fluids his body so desperately needed, finally placing two IO needles in his legs. Early in the morning, as we again attempted to stick the IV in his arm, he suddenly tried to bite our interpreter, who was holding him. Three hours later, Evans was sitting up, and as I left, he gave me a fist bump and the most beautiful smile.
Kevin Mollenhauer, RN, BS, CNOR, ONC, is an orthopedic service line nurse at Sycamore Medical Center, Dayton, Ohio.