Haitian Relief Effort- Lowell, MA

Haiti Blog 1

Shortly after the earthquake struck, we were contacted by Partners in Health, which is the disaster response team from the Massachusetts General Hospital. They requested that we put a team together, covering all potential specialties which might be helpful in Haiti. They were running 8 or 9 fully equipped hospitals in Port au Prince and the surrounding area.

A team was quickly assembled, documents obtained, and immunizations updated. We were offered the services of a private jet by Johnson and Johnson (the hosptials use a great deal of their orthopedic products). Michael and Frannie Demoulas Kettenbach (lifelong dear friends of mine) got wind of our efforts, and generously put together almost a half ton of food supplies courtesy of Market Basket. We were on the launchpad with engines running. Then, we were notified we were on delay.

It turns out that the number of teams put together through the Mass General effort far exceeded the capacity of their clinics. We were incredibly disappointed.

My concern was that we were all in private practice, or worked at the local hospitals. It is not as easy for us to arrange time off or coverage as it would be at an in town medical center. I was afraid all of our work would be in vain, and our effort would fail before getting off the ground. After a brief period of deflation, I made a call to the American College of Surgeons, asking if they could use our team anywhere. When I described the makeup of our team, they were quite excited (I'll outline that for you). They promptly put us in touch with a group on the ground, and actually gave us a sat phone number with which we could directly communicate with the team currently working. They were exhausted, and wanted us there yesterday.We now had two days to arrange everything. Unfortunately, without MGH Partners in Health support, the financial burden would be on each member of the team. Both Saints Medical Center and Lowell General Hospital were quick to step forward and offer medical supplies. As you know, Michael and Franny Kettenbach, as well as the entire Demoulas family have been incredibly charitable through the years, mostly in a quiet, under the radar manner. When Michael and Franny got wind of the change in our status, they generously offered to underwrite our efforts.

We are scheduled to leave Logan tomorrow at 6 AM, stopping briefly inthe Dominican Republic. From there we will be on a charter to Jacmel Haiti. As opposed to our initial plan with the MGH, staffing fully equipped hospitals, this would essentially be working in the field. We will be staying in tents, on the grounds of a convent. Apparently the nuns will cook and care for us. I understand they even sing ! (Sound ofMusic without the Alps). The Canadian army will be surrounding the perimeter. We will be going out to the field every day, working with Cuban doctors.

The team as it currently exists:

Deann Valliere, LPN Operating Room Scrub Tech Saints Medical Center, 10 years experience in pediatrics

Suzanne Forte, RN Emergency Room Lowell General Multiple trips on charitable health care relief efforts to 3rd world nations

Gary Loudermilk, RN Emergency Room Lowell General Wilderness survival expert, ER nurse

Natasha Rousseau Center for Wound Healing, Lowell General Hospital. Wound care expert, nature photographer, frequent travels to tropics

Peter Roman, MD Orthopedic Surgeon, Saints and LGH Wilderness Survival Physician

Paul Burke, MD Vascular Surgery Lowell General Hospital and Saints Medical Center

Bill Fennell Ortho Tech Lowell General Hospital

Marie Dupic-Washburn, MD Fast track, Triage physician Saints Medical Center

Vijay Kumar, MD Chairman, Dept of Anesthesia Lowell General Hospital

Paul Burke, Peter Roman, Deann Valliere, Natasha Rousseau, Vijay Kumar, Gary Loudermilk, Marie Dupic-Washburn, Bill Fennell, Suzanne Forte

Haiti Blog 2

Scheduled to leave Sun AM for Haiti

Saturday afternoon we met at Peter Roman’s house to finalize packing. We had to divide our personal gear, medical supplies, and 350 pounds of food donated by Market Basket (quite an assortment of dried salmon, packaged tuna, dried fruit, etc) It was made clear to us by JetBlue that we could have 2 bags max, and they could not weigh a pound over 50.

After completing that complicated task, we then made arrangements for travelling to Logan the following day. Those leaving from Andover would meet at Peter’s at 3:45 AM.

On arrival at the airport, it was somewhat alarming to see that it was mobbed, with long lines everywhere. Yes, at four in the morning!
Fortunately, we were directed to a special counter to check in.

My wife Honey had come up with the idea to solicit from her friends a donation of Beanie Babies to hand out to the Haitian children. Pretty good idea, especially since we were to be camping across the street from an orphanage. I should have said, it seemed like a good idea at the time. She had collected hundreds of Beanie Babies, and at the weigh in they topped the scales at 50 Lbs !

What followed was both chaotic and amusing. Our careful weight apportioning of the previous afternoon was out the window as we scrambled to divide up all of these stuffed animals. We had all the cases opened. Put some here, some there, all under the watchful glare of passengers waiting in line. During this mayhem, a passenger waiting in line passed out and fell to the ground. Marie quickly rushed to his side to attend to him. Don’t know what the problem was. Too busy with the Beanie babies!

Believe it or not, we were successful!

Following successful check-in, we were then accompanied by a JetBlue agent to the security checkpoint. I felt very uneasy as she led us past everyone right to the front of the line. Instead of grousing, however, once the waiting passengers found out who we were and where we were going, all we heard were “thank you for what you’re doing” and “God Bless you”. I felt very uneasy with this. It is not something that we are used to. I am the first person to thank uniformed military personnel. I consider them to be true heroes. What we are doing is not heroic, it is just what we do.

Landed at JFK, and transferred to a non-stop to Santiago, Dominican Republic. I do believe we are the only non-Hispanics on the flight.

Do you think I should have been offended and cried “Profiling” when I was handed a US versus a Dominican declaration form on the plane?

As I write this, I am looking out the left side of the aircraft at Cuba. For those in my age group, you can’t help but think back to that October so many years ago, when the U.S. naval ships were circling these waters.

Arrived at the Dominican Republic. Lots of red tape, but not a big deal.

While walking down the street from the international airport to the private aircraft area, we saw a teenage girl riding towards us on a motor scooter. She did not have a helmut on. I commented on how dangerous that was. We all had a big laugh when she took a big swig of an El Presidente beer as she rode past. Our driver told us that in the Dominican you could not use a cellphone while driving, but there are no laws against drinking!

While waiting to be flown out on the small aircraft to Haiti, we were amazed at the scene. There were private pilots from all over the world who flew down here simply to shuttle aid workers from the DR to Haiti

One pilot I spoke to was from Seattle. Probably about 40 years old. He admitted that he made some money in the last few years, spent 3.7 million dollars on a plane, and serves charities throughout the western hemisphere. He was shuttling people to Haiti, back and forth many times a day from the DR. They would also transfer supplies. We were assembling at a warehouse on airport grounds, apart from the terminal.

I wouldn’t say that we were nervous, but there was a bit of apprehension as we awaited our airlift. Once we left the DR, we knew that our world would change.

When it came time for us to fly, imagine our surprise when we saw it was a Cape Air plane. The pilot usually flew from Hyannis to Nantucket, but in the winter obviously business was slow. The

owner of Cape Air, Dan Wolf, donated two planes for the relief effort. It had cost him 80 thousand dollars thus far out of his pocket. Deeds like that should not go without recognition.
We then flew our Cape Air aircraft (pilot Spencer Day from Plymouth) across some pretty serious mountain ranges, elevation about 11,000 feet. Amazingly, there were actually primitive homes up there, with no visible access roads. They were growing some crops, maybe coffee, maybe something a little less legal.

As we passed over Port au Prince it was a truly amazing site. You could see the US Comfort anchored in the bay, an AWACS circling over the airport, and a constant stream of aircraft in line to land. Heard a Japanese air force jet request clearance for landing.

We passed over Port au Prince, at low altitude, and kept heading towards Jacmel. This is a beautiful little seaside town which was devastated by the quake. It is actually the same distance from the epicenter as Port au Prince.

Our guide told us that the devastation to Haiti was in part due to the engineering and building practices. He said that the San Francisco earthquake was of equal magnitude, but resulted in only 18 deaths. Thus far, there are over 200,000 confirmed fatalities.

Arrived in Jacmel. Quite a sight. Helicopters coming and going. The airport is controlled by the Canadian army. It is very reassuring to have them here.

We then loaded up a couple of vans and drove to a school run by the nuns. They have a secure room which is serving as a warehouse for our medical supplies.

Originally, it was planned that we would be sleeping on the grounds of the convent, but we were thrilled to hear that there was a house available for us to stay in. Most of the Haitians are still afraid to go into buildings. We are sharing the house with a team from Washington,D.C. Sleeping on the floor, but it beats braving the elements.

Tomorrow, they are sending us up into the mountains with a Cuban team. Apparently, there are many Haitians who have not been reached, and are unable to make it down. We do have the option of having them picked up by Canadian Army’s helicopter and flown to the USN Comfort.
More tomorrow.

Haiti Blog 3

First things first. Roosters do not crow only at dawn. Those suckers go all night long. Talk about a cacophony! Dogs, cows, roosters, goats nonstop.

Beef jerkey for breakfast.

Hot and muggy.

Rode through town on the way to our clinic. The devastation was phenomenal, but to be honest the nonstop CNN coverage over the past couple of weeks did prepare us for the visuals. What it couid not prepare us for was the smell of decaying bodies buried under the rubble.

Stopped at the Cuban medical tent. These guys are tough, but with a great sense of humor.

The smiles on the faces of the children are priceless, particularly considering their lot in life. I must admit that given the abject poverty, no organized health care, and a life expectancy of 49, I was very surprised to see how beautiful the Haitian population is.

The medical compound consists of a number of white tents, constructed by Doctors Without Borders. I had not known much about this organization until today. They are a truly international outfit, and require a commitment of at least 6 months. My analogy would be that these guys are regular army, and we are the reserves.

Worked all day with a general surgeon from Argentina. He is a ruggedly handsome guy, smokes like a chimney, about 40, no family, and worked in a successful private practice back in South America for a few years. He joined Doctors Without Borders 2 years ago, and has not been home since. His last assignment was Africa. He is paid about 2 thousand dollars a year. This guy is a hero and a saint.

There are a couple of camera crews from CNN who followed us around the medical compound. I pushed them off onto Peter Roman who is working like a madman.
Peter actually missed the van back to our quarters. This is actually more serious than you might imagine. We have no idea where we are staying, there are no taxis, we do not speak the language, and he has no cell phone coverage. With respect to the language, Creole is unlike anything you have heard. There is no resemblance to French much to my surprise. Whenever one is about to travel to a foreign country, you are always told “they all speak English.” Not the case here. Believe me. Only 40% of the nation is even literate.

Our liaison sent someone back for him, and they fortunately hooked up. He returned on the back of a moped. While stopped in traffic, a man came up and tried to pull his wallet out of his back pocket. Peter threatened him with his bandage scissors, and successfully thwarted the robbery.

One thing I find amusing. There is a big, burly Haitian fellow who I believe is one of our security detachment. His cell phone ringtone is Celine Dion’s “I’m Your Lady, You are My Man”. Every time it goes off I chuckle, but he doesn't seem to think it's funny.

First case this morning was an adorable 12 year old girl who was buried under the rubble for 8

hours. She had massive crush injuries to her legs. She has been taken to the OR every few days to remove a little more of the dead muscle. Her surgery is performed under a local anesthetic of sorts. We were told ahead of time that she sings softly to herself through the surgery, and when the pain gets a little worse, she sings a little louder. Sure enough, she had the most beautiful voice, and was quite brave. When I went to see her post-op, I told her I enjoyed her singing. She gave me an embarrassed smile, and a thumbs up. That could make the most hardened person melt.

The OR is quite interesting. Our assistants speak not one word of English. There are flies all around, which VJ is getting good at swatting away. We finished our first case, and the Haitian nurses came over, lifted her up off the OR table, and placed her on another table 2 feet away. We quickly found out that that was where the patient was recovered. We did our next case with the previous patient in the “recovery room” an arm’s length away.

When we first went into the OR, I was concerned that the Haitian nurses would resent Deann invading their turf. Thank God they didn't. Again, they didn't speak a word of English and Deann was great.

We had a seven year old girl who had a tonsillectomy just before the quake. She had some trauma to the neck during the earthquake, and came in today with an enormous neck abscess. Called my good friend, and ENT surgeon extradinaire Arthur Lauretano, for a cell phone consult. He advised me expertly from thousands of miles away .

We were told at the end of the evening, in a nice way, that we had worked too hard and too late into the evening. Apparently the Haitian nurses are not paid to work past 4 PM and things usually shut down. I hope the ORs in Lowell don't hear that.

Goat for dinner. Very good.

More tomorrow.
PB

Haiti Blog 4

I am going to try to convince the Canadian troops to practice their marksmanship on the Roosters!

This is a good start !

Went out to a small village along the coast. The scenery was beautiful, but the area very hard hit by "Le Event" as the Haitians call the quake.

The Canadian army helicoptered in a portable operating room donated by the Swiss. This is a self contained unit the size of a large dumpster, with all required equipment to perform surgery. I got a kick out of seeing this Canadian army detachment of big burly men being led by their officer Captain Meghan. She was a girl who looked about 25, but you see how her soldiers respected her.

As we were traveling there, we passed the Peace of Mind hotel. There are not many hotels in Haiti, in fact very few. Anyway, this was completely leveled yet all surrounding shanties remained standing. We were told that an American perished in the rubble. Name of the hotel quite ironic.

I had to do some primary care medicine today between cases, as the clinics were swamped. I actually correctly diagnosed a young girl as being pregnant. She was initially happy, but on reflection became quite grave. It turns out she was studying to be a teacher, and she would likely be thrown out of school. In addition she was very afraid of what her boyfriend's reaction would be.

The HMS Halifax is moored off the coast. Each night it actually pulls out of port and goes out to sea. I suspect it for earthquake protection. Each morning it steams back in. It is very reassuring to see the Canadian platoon stationed outside our medical compound.

There was a young child today who needed tertiary care in the States. A Philadelphia hospital accepted her, and the woman who coordinates our team actually convinced the Philadelphia Eagles to donate their jet to transport her.

I asked our driver today about religion here in Haiti. He said about 40% practiced voodoo, but since "le Event" everybody is a Christian.
Later,
PB

Haiti Blog 5

Another Day.

Angelina Jolie visited our town today, but we didn't see her. That's OK. I always liked Jennifer better.

We encountered some big time politics this morning. On arrival to our medical compound, we found that all our equipment had been moved out, and we were being displaced by Haitian doctors. It turns out that they had become jealous of the international teams, and wanted to flex their muscles. There was a toe to toe argument at the gate until they backed down and allowed us all to enter. It dawned on me as I watched the scene unfold, that the Haitian people were being treated by some of the best health care providers from around the world, and they came close to being deprived of that care by local third world politics.
Fortunately the problem was resolved and it was back to work.

It was hot and muggy today, but we have all experienced this type of climate during our summer months at home, so we can get by. Conversely, I do not believe the Haitians could easily adjust to the weather you are experiencing back home.

The room which we are using as an operating room is in a building which was 75% destroyed in the quake. The building has been declared unsafe by the Canadian military engineers. This is denoted by a big fluorescent orange X painted on the side of the building.
Unfortunately, we have no other option. I am told that the Canadians are not happy, but they have looked the other way.

The room next to where we are operating is the pediatrics room which was destroyed. The crushed gurneys are still there, and we were told that 2 patients perished there.

There was an aftershock yesterday afternoon. Our colleagues from D.C. were on the second floor, felt the building sway and quickly left. They walked quickly past us without a word. It was only later that we found out what had happened. They thought we had also felt it, so they didn't bother to stop to tell us!

Peter amputated a young man's arm today. He had been buried in the quake, and had been concealing his mangled arm in a cardboard box since then. It was dead. Natasha had to walk beside him and hold support his arm in the box as he entered the room. His eyes teared up as we told him what we had to do. This is a 24 year old man in a country in which his future was dismal a few weeks ago. What does his future now hold without his dominant right arm?

Our translator today was a great kid named Ted. He is a college student and was on the 6th floor of his school building when the quake hit. The building collapsed beneath him, but because he was on the top floor he survived. All students on the lower 5 floors were buried. They have not even begun the excavation as they do not have enough equipment. He has 22 friends that perished beneath him. He does not have a scratch.
Great kid. He hangs out with us constantly. We started to call him Dr. Ted. I once slipped and call him Ted. He quickly corrected me . . ."it's Dr. Ted, please respect the title". He then erupts with a Geoffrey Holder laugh. This kid’s potential would have no limits in the US. Here, his life expectancy is 48 yrs. Actually, the life expectancy in Haiti was 48 years before the quake. Will probably be less now.

I spoke to a Haitian doctor today about vascular surgery on the island. It does not exist. There is one vascular surgeon in Port au Prince, and his practice is exclusively trauma. The reason for the lack of vascular disease is readily apparent. First of all, cigarette smoking is almost nonexistent. They can’t afford it. Secondly, most vascular disease presents in patients in their 6th or 7th decade of life. Very few Haitians reach that age.

As we are driven to the medical compound each morning we pass by hundreds if not thousands of red Coleman tents, all on the right side of the road. Some have even put their street number on the tent. Apparently they were donated by the UN.

There are street vendors everywhere. Believe me, it is not all that appetizing when the fruit is displayed in front of a destroyed building reeking of the smell of decomposing flesh.

There are no stores or restaurants in Haiti. It is strange, but I would love a cup of coffee but there is no where to buy one. Everything is sold from ramshackle shanties, where the goods are simply hung out in front. Having been to many 3rd world nations, you can usually find a convenience store or even a supermarket. Not here. This country is like no other.

I had one patient that I was supposed to operate on today. I had seen him the day before and asked him to return around 11 AM today. Unfortunately the Haitians decided to close the operating theater this afternoon for maintenance. I informed the patient, and asked him to come back tomorrow. He shrugged his shoulders, agreed, and turned away. Out of curiosity, I asked him where he had come from. He had driven his moped for two hours over God awful roads, spending money that he does not have on gas. He accepted the cancellation with a shrug of the shoulders. I could only imagine the response if a Bostonian drove his moped via back roads to Portland, ME and was told to come back tomorrow.

There is no diet coke, or diet anything in this country. This afternoon we ran out of water, so a couple of us went out the front of the medical compound where we had seen a woman selling drinks from a cooler. No problem, the bottles would be sealed. When she opened the cooler and moved aside her dirty laundry that was soaking in the water, we figured our thirst could hold off for a little longer. Dr. Roman says that we can survive three days without fluids. I prefer that route to the dirty laundry.

There was a two year old girl crying alligator tears this morning. I gave her a little beanie baby dog. The tears immediately stopped, and she kept saying "woof woof." Really cute. It’s funny, but the kids love the tropical fish and bird beanie babies, but look quite confused when we hand them a moose or walrus. They love them nevertheless.

The beanie babies are enormous hits. I felt a tug on my shirt this afternoon, turned around, and there was a mother who had chased me down for a beanie baby for her daughter. It is amazing how something so simple provides so much joy. I wish all the people who donated them could see the look on these kids’ faces as they hold their new stuffed animal. I am actually going to forward my many pictures to the Beanie Baby company to let them know how their product has taken Haiti by storm.

Bill Fennel, is the Lowell General ortho tech that accompanied us. I think that it is safe to say, without hyperbole, that there has never in Haiti's history been better cast applications than what they are receiving with our team. I am very serious.
I only found out tonight that it is not only Bill's first trip out of the country, but this was his first time on an airplane ! How much does that attest to someone's character, that he would be quick to jump on this mission, facing uncertainty and maybe some risk, with virtually no travel experience? This ain’t Hampton Beach . However, Bill has adapted like a world traveler.

Lots of cockroaches where we are sleeping, but at least they don't make noise like the roosters.

More tomorrow.
PB

Haiti Blog 6

This is not for the feint of heart.

Last night at about 1:30, I heard what I thought was a small animal walking around my sleeping bag. I turned on my flashlight and saw a cockroach the size of a gerbil. It quickly scurried away.
There were quite a few mosquitoes last night, so I had rigged some mosquito netting around my head (malaria is a big problem here)
I decided to drown out the roosters with my ipod, so I plugged in my headphones and listened to my favorite album side of all time, the flip side of Abbey Road.

A little while later I felt something crawling up my neck and across my face. It was the cockroach. Because of the mosquito netting, I kept flicking it off but it kept coming back and eventually crawled down my shirt. I finally was able to shed the mosquito netting and squash it. My team members were shocked to hear the run of “expletive deleted's“ which I was quickly able to string together. Deann said she couldn’t wait to get back to the OR to tell them that she heard me swear !

Trying to get back to sleep, I then heard a large group of people led by a man with a megaphone. They kept getting closer and closer, chanting all the way. They got within a quarter of a mile, and stopped. I was relieved. An angry, chanting mob heading your way in a third world country is generally something to be avoided.

We had actually witnessed a CNN type scene yesterday while being driven back to the compound. In the center of town, the Red Cross was dispensing water. They ran out. Talk about anger. Unfortunately we had to stop right in the middle of it because of traffic. Couldn't get out of there quickly enough.

I have come to a conclusion during this visit which I hope may be unfounded. Observing the manner in which the third world nations deal with eco issues, I believe our efforts towards the development of a green planet will be for naught. Although buying an auto that get 25 versus 18 mpg may make us feel better, it is but a drop in the ocean compared to the flood of various pollutants dumped by the third world nations. In countries where the average annual income is two hundred dollars, to think that they will consider spending $100 for a filter for the motorbike is ludicrous.

Being a pilot and aircraft aficionado, I must admit that I have seen some very strange planes circling overhead this week. Our coordinator said that last week at the airport it was like a scene from Apocalypse now. There was a B1 bomber on the runway, an AWACS over head, and 2 large Chinook helicopters guarding the perimeter.

One of the guys in our group (from DC) was waiting in line at the airport bathroom, and Harrison Ford walked out. Apparently he is personally helping with the delivery of supplies in his own plane. It was a surreal experience to Indiana Jones in his big hat, flying in a tropical country

I’m not sure if I should thank, or curse Mike Kettenbach and Market Basket, but I have become absolutely addicted to beef jerkey !

Can you believe that our orthopedic team has been performing admirably all week without the benefit of xrays?
I hope the US insurance companies don’t find out about this and consider the tests non-essential. We also have no lab or pathology department.

Gary Loudermilk is our energizer bunny. Wind him up, assign a post, and he goes all day without a break. .

Dr. Roman needed bolt cutters for one of his patients today (don’t ask). There are no hardware stores (or any stores for that matter) in Haiti, so we were in a quandary.

The Canadian Army to the rescue ! Captain Meghan personally delivered a bolt cutter in her troop carrier.

There have been a lot of medical supplies donated from around the world, some absurd. We go through the warehouse each morning to take the appropriate supplies.

They have $20 thousand dollars worth of vascular access grafts which will never, ever be used in Haiti.

Very early each morning we have a meeting to decide where our personnel resources will be distributed. It is very reminiscent of the meetings we have at golf tournaments, where we make or receive assignments. These surroundings quickly bring you back to reality.

A fifteen year old girl came in for an appendectomy two days ago. Uneventful. Last night, unknown to us, she started to develop shortness of breath. When we saw her on rounds this morning she was gasping for breath, confused, and had pain behind the left knee. We immediately diagnosed pulmonary embolism based on clinical exam (remember, no Xray). This is easily treated with great success in the US. Unfortunately we have no heparin in Haiti. I asked that she be helicoptered out to the USS Comfort as soon as possible. I went to operate, and came back after surgery with VJ to see how she was doing. When I didn’t see her in her bed, I was greatly relieved that they had been able to get her airlifted expeditiously.

That is not why her bed was empty. She was only a teenager.

You do this long enough you get somewhat hardened. Not in this case. A simple medication that is available in every hospital or clinic in the US would have saved this girl’s life.

From a distance, I watch Marie Dupic-Washburn, an ER doc at Saints, work tirelessly and with such great compassion. She makes me proud to say that I am a doctor.

A couple of guys went to the Cuban tent this morning and had espresso! I find this out on our second to last day ?

It is interesting to work with so many health organizations from around the world. . WHO, UN, Save the Children, OxFam, Doctors without Borders, etc. There was even a volunteer group of firefighters from Normandie, France

I must say that I have made one observation.
We Americans and French are frequently at odds for a number of reasons. However, these world aid organizations are saturated with French volunteers. It is my impression that over the past few decades, while other superpowers(out of necessity) have been involved in military efforts around the globe, the French have been dedicating their efforts on the social issues, and they have been doing a great job.
Along those lines, I have not seen any effort here by the UK. This is surprising, as we even have teams from the likes of Antigua.

We are scheduled to work tomorrow, and be airlifted out of country to the Dominican Republic. We now find out that there may be a glitch getting out of Haiti. They’re working on it.

With luck we will be leaving tomorrow, leaving a trail of about 200 smiling kids with Beanie Babies.

PB

Haiti Blog 7

Enough already of this Stanley Livingston role playing!

The mosquitoes are particularly heavy tonight, but I was not interested in an instant replay of my cage match with Mr. Cockroach. I opted for the DEET. My sales associate at LL Bean insisted that I get the full strength, non diluted. You do not want to flirt with malaria. Well, I took his advice.

I went to bed much later than the team. Applied the ointment liberally and lay down on my pad. Within five minutes my tongue swelled and my eyes shut completely. My heart rate went to 140.

Anaphylaxis ! (no, she’s not the Greek girl next door). I knew Suzanne had an epi pen as she has a bee allergy, but I decided to wait to see what course this would take. Since I had awakened everyone the night before with my profanity laced assault on the cockroach, I did not want to wake them again. Thankfully my symptoms cleared in about 10 minutes. What aggravated the situation was the fact that we have no running water, so I could not flush my eyes or skin.

When your lifelong outdoor pursuits have taken place on oceans or fairways, there has really no prior need for me to use DEET. Hence, this was to be my first, and certainly last exposure to that poison!
As mentioned, we are without water and electricity. You really can get by without power, but living without a source of water is tough. The packaged “Handi- Wipes” are very helpful, but simple things like brushing your teeth or flushing a toilet are sorely missed.

I didn’t relate the whole story about the teenage girl who died the day before, as I wanted to keep politics out of this entire relief effort. However, some of us are taking it harder than usual. It turns out that if the international medical hierarchy had allowed me to perform a simple procedure, one that I have done more than 2000 times in the States, she would be with us today. The procedure is a vena caval filter. It is a small filter made of titanium that we insert through a simple needle stick in the vein above the clot, so no further clots can break loose and travel to the heart and lungs. It’s a five minute procedure if that. We had filters in our possession and a portable ultrasound. The honchos were clearly not familiar with the simplicity of the procedure, and because it was not on their list of approved procedures to be done in a disaster relief zone, our pleas were turned down. It is not easy to live with a beaurocratic decision which led to such a horrific end.

I guess we should be proud of one accomplishment. Our team was asked to work with “Doctors Without Borders” the last few days. We were happy to, really didn’t think much of it. Last night, the Doctors Without Borders director in country told us that it was the first time in the organization’s history that an outside group had been asked to work alongside their doctors. They are an incredibly powerful, incredibly closed (and by reputation, arrogant) outfit. Again, it made us feel pretty proud that our team’s work was noticed and appreciated.

We saw a tough case on rounds today. This 42 year old woman, who was in one of our tents recovering from quake wounds, was found to have breast cancer on physical exam. It was fairly well advanced. She was occasionally confused, so they felt she had a chance of brain metastases. I asked about obtaining a biopsy, but the international team didn’t think it was worth it because she couldn’t be treated anyway (there is no radiation therapy or chemotherapy in Haiti). I asked about transfer to the States, but since it was a non-urgent situation it would not be possible. I asked if I could do a needle aspiration of the mass and take the specimen home for one of our guys to look at it. At least we would get a tissue diagnosis. No, it is against international laws to transport body parts. It is getting tough to lose these battles knowing that this young woman will likely not live a couple of months.

We have established a role for Suzanne Forte that utilizes her abundant talent as both an ER and ICU nurse. We have asked her to establish a recovery room. She is so flexible, which is of paramount importance in this entire mission.

I went to visit the 18 month old whom I had seen the first day. She had an above knee amputation and I wanted to check her incision. I addressed the woman sitting there as her mother. She corrected me. This little girl had lost her mother, father, and all brothers and sisters in “the Event.” This peanut who had a smile that could land her a modeling contract has absolutely no one in the world, in addition to having a very high leg amputation! She will never be able to walk with a prosthesis, as there is not enough stump. To top it off, she won’t even be eligible for adoption options as she is “deformed.” However, she still plays hide and seek with us whenever we walk by. Tear jerker.

Speaking of prostheses, this is going to be an enormous problem going forward. Word is that there are 40 thousand amputations in Haiti. In the U.S., amputees have the very best prosthetic fittings, yet there are always problems with correct fit, etc. There are constant revisions. If the prosthesis does not fit properly, abrasions and ulcers can result. This is in the U.S.! What will happen to these patients who may not even get a chance at prosthesis? I would imagine that the life expectancy of 49 years will trend downward in the years to come.
I have started to think about establishing some sort of an organization at home where prostheses from deceased souls, or nonfitting limbs which have been discarded, can be channeled to Haiti. Natasha is on board with it.

I stopped by the bed of the 12 year old girl with the gangrene of both legs (she is the one who sings during surgery). I secretly gave her a little money, and told her not to let anyone else take it and use it for anything else. I told her to buy the prettiest dress in all of Haiti when she gets out. Hopefully she will have both legs, but I would put the chances of that at about 50/50.

Speaking of pretty dresses, it is amazing how these people dress to come in for their follow up visits. You can tell that they are wearing their finest available clothing. One little girl had her first communion dress on today. Big smile when I told her how pretty she looked.
The ward tents are crowded, hot, and fetid. I asked the head nurse why so many family members were always hanging around. She explained that traditionally, even before the earthquake, when patients are admitted it is assumed that the family would provide hygiene and food for the patient. That is something that the hospital is not expected to do. This certainly enlightened us as to why our hospitals at home frequently deal with the situation where a recently immigrating patient has the entire family in the room throughout the day. This also leads to an interesting array of aromas, as the food is brought from home and frequently on one floor we see many different nations represented.

Natasha has probably been the busiest of all of us. She is a specialist in wound care, and has been doing a remarkable job with incredibly complicated wounds. As you might imagine, some of these people could not get any medical care for weeks, resulting in wounds that you hope not to dream about.

We had a scene this morning which made us all double over with unstoppable laughter. As we were pulling through the security gate into the medical compound, the tire of our van caught a baseball sized rock perfectly, propelling it like a missle. It caught an elderly man in the thigh. He angrily accused a group of young kids standing nearby. They didn’t have a clue what he was talking about. When some of his friends walked up a minute later, he pointed back at the kids and started yelling at them again. We couldn’t breathe we were laughing so hard. Gary says he saw him later on and he was still rubbing his leg.

I have found the wide variety of shirts, hats, etc. that the Haitian population wears to be quite amusing. I have seen an elderly woman with a U.S. Ski team shirt, an elderly man with a tee shirt reading “Will Golf for Food”, and a boy with a Florida State Golf Association Jr. Championship hat. Through an interpreter I asked where he got it. He bought if for a buck on the street. This was clearly a competitor’s hat, and its journey to this kid’s head must have been quite interesting.
A young woman with an open leg wound came back for follow-up yesterday with a Burberry scarf wrapped around her wound! On my examination it appeared to be the real deal. She might not have known, but even if she had, I believe it might have been her only option and she would have used it anyway.

My anesthesiogist today was an assistant professor at McMaster University in Toronto. More importantly, she grew up in Scotland and her father is the long time president of Royal Troon Golf Club.

We had a laugh provoking conversation yesterday as we were deciding the day’s assignments. Some were to go out into the field, while others would stay behind. One of the women asked why she could not go out into the field. You can only imagine the howls of laughter from the team when I unintentionally responded that we needed her to stay with us as she could perform well in any position.
Gotta work on my word choice.

The girl who cleans our surgical instruments is from Paris, and a riot. The equipment room is situated a few feet above the operating theater, and connected by a ramp. When we call Lola, she runs around the corner, slides down the ramp like a snowboader, and says “Voila”. I crack up every time, but I don’t think she’s doing it to be funny. She’s adorable, with big eyes peering out over the mask. I don’t think she weighs 90 pounds. VJ said she looks like Penelope Cruz. I agreed, even though I don’t know who Penelope Cruz is (for that matter, how does VJ know who she is?) I played “Lola” by the Kinks on my IPOD during the operation and she got a big kick out of it.
Here is what I don’t get. This is a cute, twenty something RN from Paris who is working for a pittance in a poverty stricken nation paralyzed by a natural disaster. I asked her how long she wants to do this, and she said probably another 8 years as she finds it so rewarding. I can see if she were involved in direct patient care, but she is cleaning instruments in the back room! This is but one example of why I have a newfound and profound respect for the French people.

A BBC reporter told us this morning that the death count was now up to 230,000.
There is a nationwide prayer service scheduled for 4:53 this afternoon, to mark the exact minute of the quake. Apparently a powerful preacher has announced that if people don’t come, they will experience another ‘Event.” They are setting up a stage in the center of town. There is has been a steady stream of thousands, all in their Sunday best, filing into town.

You can tell that Deann comes from a long line of military family. When assignments given or requests made, they are just done. No questions asked.

Saw a Voodoo ritual this morning. Peter told a plus sized middle aged woman that she needed to have surgery on her leg. The hands went up, she started chanting, and the eyes rolled in the back of her head. Victor, the Haitian surgeon told me later it was a VooDoo thing. All set with that.
Victor is right out of training, and was actually establishing a nice practice for himself before the quake. He has been told that he can no longer perform elective operations, even if there were no quake related cases. He says he has a long list of patients who had been awaiting surgery before the Event, but he would not be able to do them for a while. I initially thought that to be absurd, but when he enlightened me as to the reason, I understood. They did not want him to do an elective hernia, for instance, and send the patient to the pus filled, fly infested tents for recovery. Point well taken.

Victor has a real thirst for knowledge, and I have been lucky enough to show him a few things this week. I told him as I was leaving that I have been doing surgery for some time. Nevertheless, on three occasions this week I had to call colleagues back in Boston for advice on certain things. I gave him my number, and told him to call me if I could help in any way. If I didn’t know the answer, I could find someone who did.

Got to get ready for our evacuation. We are scheduled to be taken to the airport at 10 AM.

Haiti Blog 8

Goat again for dinner last night. I am starting to grow horns.

Gary tells the story about working in the ER with a trauma patient, looking up to see a dog just wandering on through.

Speaking of trauma, there seems to be a moped accident every two or three hours requiring ortho intervention.

We saw a young boy who needed to have his ear sewn back on. It had been sliced off with a machete (never really got the details.) We also saw a farmer who had been bitten on the calf by one of his pigs! That must have been one big pig as the fang entry points were quite far apart. Tasha guessed that “the other white meat” would be on the menu that night.

Dr. Ted took us to the perimeter of the medical compound today. We were up on a bluff looking down at a huge valley which was a river bed. I would guess it was a mile wide and 100 feet deep. Anyway, there was a shallow meandering stream at the bottom, with hundreds of Haitian’s washing themselves and their laundry. It was like a scene from a movie. Fifty feet away and paralleling the river was the town’s dump. We could see these huge trucks pulling up and discharging their refuse right on the bank of the river! According to Dr. Ted, during the hurricane season, the waters fill the chasm to the brim, and wash all of the garbage out to sea.
Again, our Green Movement in the Western World may make us feel better about ourselves, but as much as I hate to say it, the battle is probably going to be a losing one.

We have decided to combine Suzanne’s skills an ER and ICU nurse to help create a PACU, or recovery room. She is the perfect example of what a team member on a medical mission should be. She is multi talented, yet is not afraid to pitch in and do whatever is necessary. (plus, she is one of the few people that laughs at my jokes)

We actually had a funny scene develop. In the evening on the way back to our housing, we stopped at the only hotel in the vicinity. It was hit by the quake, but one half was still functioning. The pool was even open. Suzanne sent a text message to Bill’s wife, joking that she should not feel to sorry for her husband as he was currently frolicking in a swimming pool. However, Bill’s wife did not receive the email until 4 AM ! She called Bill to find out why he was swimming in a hotel pool at four in the morning.
Gary went out to the field today. On the way back, a truck with propane tanks overturned on a bridge. The Canadian army quickly secured the bridge and would allow no one to cross. A Haitian American nurse who was with Gary’s group tried to explain that they were on an emergency medical mission, and needed to cross. Apparently the soldiers were cordial, but made it quite apparent that they were in
This was actually unfortunate, as we had been alerted that there was an infant with an orthopedic issue. Peter waited as long as he could, then the medical compound shut down. She would need to come back another day.
An anesthesiologist shared her pictures with us. She had a very dramatic photo of a school where the entire outside wall collapsed, allowing a clear view into the classrooms. One room where all the children perished had “God will save us” written on the chalkboard. The whole event lasted just seconds, raising the question as to what the teacher had been talking about as disaster struck.
I performed a stress test on a patient today. She had been complaining of chest pain on exertion. We had no ekg machine. I took her outside and walked her up a flight of stairs a few times. I felt her pulse as we climbed. Soon enough she complained of chest pain and became tachycardic. Problem is, what do you do about it. We have nothing to treat her with, not even nitrotabs.

On the way to the medical compound we visited the tent city which had been set up on the soccer field in the center of town to house displaced families. There were masses of green canvas tents as far as you see. It was noisy, dirty, smelly and hot. I can only imagine what the temperature got to inside those dark green tents.

Later
PB

Haiti Blog 9

I am sitting at the Jacmel airport at this time.

The way it works, when you are ready to leave country, you are transported to the airport by van. For the past month, there has been a constant stream of aircraft of all shapes and sizes shuttling health care volunteers and supplies back and forth from the Dominican to Jacmel.

The Canadian Army controls the airport (the control tower is an open elevated platform).

What used to be a small lobby is now a room of packed with soldiers at desks marked “Communications”, “Quartermaster”, “Transportation”, etc.

When we arrived, there were two very small helicopters waiting to fly people back to the DR. And I mean small ! They were the type where the entire cockpit was a glass dome. Each chopper could only take 3 passengers, so I asked for volunteers. Peter, VJ, Deann, Suzanne, Tasha, and Bill would take the helicopters. Just one week ago, Bill Fennell had never been out of the country. He had never flown! Now here he was getting on a small chopper to fly over 10 thousand foot mountains to the DR. Amazing how someone’s life can change so much in just a few days. After they boarded, the helicopters took off together, made a pass over us, and then flew off in formation towards the mountains in the distance. You could almost hear the closing music from MASH.

Marie, Gary, and I will wait for the next aircraft to come in. There have been days when none arrive throughout the afternoon, stranding would be travelers. Hope that doesn’t happen, as we are booked on JetBlue at 6AM Saturday out of the DR.

As I sit next to Marie and write this, I am reminded of a story she told the other night about her grandmother. Marie was originally from Normandie, but her grandmother lived in the French Alps. During the war she had harbored injured French Resistance fighters in her home and nursed them back to health. Her bravery was incredible, considering that she had 7 small children of her own who were being put at risk. A German search party came once, and she remembered that she had a bottle of Schnapps. She sat down and drank it with them. They finally left, and apparently had forgotten what they had come for in the first place.

She would be very proud of what her granddaughter had accomplished this week.
I don’t mind the wait. To me, it is the tropical version of the Paris air show, with a steady stream of private and commercial aircraft of every shape and size. Big Sikorsky helicopters, citation jets, Cape Air planes, etc. It is a truly amazing operation. Private pilots and companies have donated their own time and resources. Without them, I am not sure how the relief effort would have ever materialized.
It is like the scene from an old war movie, where the fresh troops arrive to replace the old. (Again, in no way do I mean to equate our service to that of real heroes, those serving in Iraq, Afghanistan, etc.). It is easy to distinguish those who are arriving from those leaving by the looks on their faces . . . apprehensive vs. weary. I use the term apprehensive and not scared, because when we arrived just one week ago we were somewhat nervous about the unknown, but not fearful. Similarly, the word “tired” is more of a physical term, where ”weary” also encompasses the mental drain which we were all experiencing. You could almost feel your adrenal glands slow down the production of adrenaline, which for days had been running at barrels per minute and had now backed off to the more normal rate.
There was the usual banter among the incoming and outgoing. Many questions, with informative and hopefully reassuring answers. One group of arriving doctors consisted of a pediatric orthopedic surgeon, a high risk pregnancy OB-GYN, and a urologist from the University of Rochester. Again, a byproduct of this horrific natural disaster was that one of the poorest countries in the world was now receiving medical care at a world class level (although without the ancillary equipment and supplies).

As I had mentioned, I didn’t mind the wait. A middle aged fellow in shorts came up to us and asked if anyone needed a ride out of country. We quickly responded in the affirmative. He led us out to his luxurious prop jet. Seats 8, leather seating, mahogany details. When I told him I had my private pilot’s license, he invited me to serve as co-pilot. Quite a thrill.
This gentleman was an American, made a lot of money on real estate, and got out at the right time. He flew down here a couple of weeks ago with some of his buddies, and they were staying at a 5 star resort in Punta Cana, DR. He has been all over the world, and told me that this resort was second to none. Each day as his friends went to the golf course, he would fly the twenty minutes from Punta Cana to Santiago, then spend the day shuttling personnel and supplies to Haiti. At the end of the day, he’d fly back to join his friends for dinner, and retire to his luxury resort hotel room. I will miss meeting people like this and hearing their stories.

After a glorious flight (one of the best I have ever had), we landed in Santiago, DR.
No sooner had we stepped onto the tarmac, VJ called to tell us they had arrived. They had left almost 2 hours before us! It turns out that those small helicopters had to skirt the mountains and not fly directly. In addition they needed to make a stop to refuel.

We were met at the airport by an American missionary worker. She had a pickup truck, and was going to make two trips. At this point we were willing to pile in the back with our entire luggage to expedite matters. I had a picture taken of us riding in the back of a pickup truck through the DR. Can’t wait to share it with my Dominical friends. The mood was very upbeat.
We were perplexed as she drove right past the airport hotel where we had been told we were spending the night. She drove another couple of miles, turned off the paved highway onto a rural dirt road, passing shanties, litter strewn lots, goats, cows, etc. We were immediately flooded with recent memories. She pulled into a gated home and we all got out. Plans had been changed, and we were to spend the night at this house. She explained that there would be twenty-five of us in total, and she had prepared a meal. An urgent team meeting was called, and the first word spoken was a unified “NO.”
We tried not to hurt her feelings, but we did not relish the thought of sleeping on the floor again and having 25 people fight over 2 showers at four in the morning.
Back to the hotel which we had passed. Hot showers, a bed, reliable electricity, toilets that work. Be still my heart !
I had asked for a wake-up call at 3:45 AM, and two taxis at 4:15.
I received a wake-up call at 4:15, informing me that a taxi (only one) had been waiting since 3:45.
Rushed to the airport. Fortunately our flight was delayed an hour, so we had no problem. Gary and I had what we both agreed was the best cup of coffee we had ever had.
Interesting scene going through security.
As a background . . . Dr. Sigman had called me after Mike Kettenbach had dropped off the supplies at his house (it seems like decades ago). He described the abundant prepared meals, satellite phone, headlights, solar generator. He exclaimed “we even have booze.” I didn’t know what he was referring to, and quickly forgot it.
Those bags were checked going down, but Peter asked me to transport the electrical equipment in my carryon on the return flight. No problem.
I was detained at the security checkpoint.
“What liquid do you have in your bag”?
“I don’t have any liquid in my bag.”
“We will ask you one more time, what liquid are you transporting”
“I don’t know what you are talking about.”
They then rummaged through my backpack, opened the sat phone carry case, and produced two silver hip flasks. It must be the booze Sigman had been referring to.
“What is in these containers”
“I really don’t know, I was asked by another person to put them in my bag and take them on the plane”
The minute I had completed the sentence, I knew once again . . .poor word choice! Fortunately we were able to resolve the issue.
As we rumbled down the runway and took off, there was a feeling of relief and excitement in anticipation of returning home to our family and friends. It was dawn, and a bright sun was shining through my window. I pulled down the shade. All was good.
As the aircraft made a sweeping turn to assume its northward route, the sun no longer shone directly on my window, and I opened the shade a bit. We were passing over Haiti, still in pre-dawn darkness.
I am not generally an emotional person, in fact far from it. However, that one moment was a little tough. I almost felt that we were abandoning our new found friends.
Did we do some good this past week? Maybe a little. Not much. I truly believe that we have benefited far more from Haiti, than they from us.
Conclusion to follow.

Haiti Blog 10

Conclusion
There are those that have criticized the massive Haitian relief effort, financial and otherwise, put forth by Americans over the past month. We hear cries of “What about taking care of the poor people in the USA?”, “Why didn’t we come together like this for the residents of New Orleans”.
These questions are valid, and understandable. I do think that America responded slowly to the ravages of Katrina, and we have learned from it. However, in our discussions at dinner, we identified enormous difference between the two scenarios.
First of all, New Orleans was somewhat prosperous to begin with, so there were always opportunities for people to have bettered themselves. Not so with the Haitians, ranking poorest in the Western hemisphere.
Secondly, no matter what your station in life, after Katrina hit the gulf coast you did have an opportunity to move on. I don’t mean to make light of the fact that people lost their homes and possessions. That is an unspeakable horror.
However, the chief of surgery at Tulane, who writes an editorial for a surgical journal, packed up the family and took a new position in North Carolina. A clerk in the local Target could perform the same job in Houston. Even the families dependent upon government subsidies could get the same support a few miles away in Baton Rouge.
Again, I don't wish this to be misconstrued as a callous assessment, but there was a way out for these people as difficult as it might have been.
Not so with the Haitians. There is no vehicle by which they can escape their lot in life, which before January 12th was dismal, and now is beyond comprehension.
This country, as I have said repeatedly, is like no other. Because of a lengthy history of corrupt governments, there is virtually no industry, trade, or tourism. As such, the people have had very little in the way of exposure to outside visitors.
In addition, Haiti has historically had no government assistance for its citizens. This total lack of a welfare system has perpetuated an environment which could best be described as a survival of the fittest. Combine that with the fact that the people are virtually isolated from the rest of the civilized world, and I arrived at an interesting theory which I proposed at dinner one night. Haiti is somewhat of a Galapagos Island for humans.
This will now be forever changed.
It is a fact that the cities, and buildings within, were hit hardest by the earthquake. If a shanty constructed of palm fronds collapsed on a family, the damage was probably corrected in short order. However, the concrete buildings and homes were almost impossible to escape. The quake lasted only 30 seconds. After allowing a few seconds for recognition, it left little time with which to escape.
Because of this, the “producers” of this nation were more decimated than the “non-producers”. They were the people in the office buildings, banks, universities who have now been removed from the gene pool. A number now totaling more than 230,000. The farmer rebuilds his shack and moves on.
Peter Roman is of the opinion that Haiti will become a welfare state of the world. This is probably not far from the truth.
Do I think they can rebuild? Unfortunately, I do not.
I was in Lower Manhattan shortly after the Sept. 11 attacks. As we all witnessed, there was an elaborate, accelerated excavation plan in place which operated around the clock. Nevertheless, the project took years to complete. In my week in Haiti, we did not see one, and I mean one, excavation project at work. The collapsed buildings were left as is. I suspect they will forever remain a monument to the lost souls buried beneath.
The one thing that I and my fellow team members need to do is help sustain the effort to assist these people in their time of need. The attention span of the world’s people is short, and we have now transitioned to the chronic phase of recovery. We will try to formulate a mechanism by which the process can continue, hopefully involving more than just healthcare workers from our community. These people need help from all walks of life. . . communications, infrastructure, sanitation, etc. (no lawyers !)
As I had previously mentioned, we gained far more from our visit to Haiti than the Haitian people did from our presence. In my travels around the world, whenever I would encounter overly friendly and attentive people, there would always, and I mean always be an ulterior motive. Trust me; this is not the case with the Haitians. Their affection is genuine.
The cable news stations prepared us for the physical destruction. Our extensive experience in health care prepared us for the disease, limb loss, infections, etc. However, we were defenseless with respect to the emotional attachment we developed with our Haitian colleagues and patients.

I would like to thank all of the people who took the time to read these blogs. For the most part, I had written them as a vehicle to record our experience. I did not mean to be so presumptuous to think that what I had to say would be found interesting by people who are so busy with their own lives.
We do need to offer a tip of the hat to Dr. Scott Sigman. He provided the initial impetus for the trip, and helped put together a team which I would rank with the nation’s best.
Lowell General Hospital and Saints Memorial were very cooperative and generous with supplies.

Those who donated beanie babies will never realize how much of an impact they made on the lives of these children. No picture or written description can capture the look on the faces of these precious children as they received these simple little stuffed animals. For the past month, they have lived a life that no child should have to endure, and you made the smiles return.

Michael and Franny Kettenbach, as well as the entire Market Basket family provided support, without which this entire mission would never have gotten off the ground. We will be forever indebted to them. One team member mentioned that it was ironic how a man whom he had never met (Mr. Kettenbach) could change his life forever.
To my team, heartfelt thanks for a job well done. We have more work to do, and I know you are up to the task.

I now need to enter rehab to cure myself of this beef jerkey addiction !