Photo by Nelson Aquino

In honor of September being Disaster Preparedness Month, Children’s physician Deb Weiner, MD, PhD, looks back on her experiences as one of the early responders to the January 2010 earthquake that devestated Haiti.

I remember that we were extremelty busy from the moment our National Disaster Medical System (NDMS) International Medical Surgical Response Team (IMSuRT) arrived at the NDMS Gheskio field hospital in Port-Au-Prince, just days after the Jan 2010 earthquake. We were there to relieve colleagues from Children’s Hospital Boston who were currently there, including first-responders Drs. Gary Fleisher, David Mooney and Shannon Manzi from Children’s Hospital Boston.

As the only Pediatric Emergency Physician and Pediatrician on the relief team, my work began immediately. Before I even had a chance to grab my stethoscope, a frantic family arrived—each person carrying one extremity of a febrile seizing teenager who we ultimately determined had meningitis secondary to a basilar skull fracture sustained in the earthquake.

Over the nearly two weeks our team was there we took care of seriously injuried children, some who had been trapped in the rubble for days, and children with illnesses we rarely see in the U.S., including tuberculosis meningitis, tetanus, rheumatic fever and typhoid. It was intensely gratifying for us to see these children improve in response to our care, and to see the smiles return to their faces and those of their families.

One of the most memorable patients was a 6 week old who arrived just as most of our team was leaving Gheskio to be replaced by a new team. After birth it was determined that the child had congential heart disease, and without surgery—now an impossibility in Haiti—wouldn’t survive. The local pediatrician we had been working with approached me and our Commander, Dr. Susan Briggs, to inquire as to whether we could arrange for care for the child in the U.S. Immediately, we contacted Children’s to arrange evaluation and surgery. Not surprising, Dr. Francis Fynn-Thompson responded from the other end of the satellite phone with a resounding “of course we will help!”

Deb Weiner, MD, PhD

The Hatian pediatrician arranged for the family to bring the child and the medical records to our field hospital the next day. The child arrived just as we were loading the truck to leave for the airport. I evaluated the child, reviewed and photographed the records, deidentified them and emailed them to Dr. Fynn-Thompson and his team. With my worried team members shouting that we were going to miss our plane, I joined them in the open back of the truck and off we went. Dr. Briggs—who was remaining at Gheskio—began the process of arranging transport, which we knew would not be trivial because of all the permissions and documentation required.

The next day President Bill Clinton, who was visiting our field hospital, met the child and family, and thanks to him, they were able leave Haiti and travel to Children’s to receive further evaluation and life saving surgery. The team at Children’s took care of all of the child’s needs—and the family’s—in the same way they always do.

I have had the pleasure of seeing this child and family in the Emergency Department since the surgery. They are doing very well and are so grateful. I’m proud to be part of the NDMS, along with many of my colleagues at Children’s, and proud to be part of the Children’s Hospital Boston team. I tell this story to highlight the fact that there are needs and opportunities for involvement for all healthcare providers who are interested in disaster care and planning, whether at the disaster site, your own practice or your community. Please contact your local institutions and agencies, the AAP and/or disaster relief organizations for further information.

Michael Felber, RN, is a nurse at Children’s Hospital Boston. He spent two weeks as a medical volunteer in Haiti in March of 2010, in the aftermath of the earthquake that devastated the country. The following February he returned with a group of clinicians from the Global Surgery Program at Children’s, to work at a hospital founded by Partners In Health. While there he met a child who changed his understanding of the relationship between caregiver and patient. This is the second half of his story, for the first blog entry, click here.

Louveda's first day in Boston

I was working a night shift at Children’s Hospital Boston when Louveda finally arrived, accompanied by David. Jay, one of the nurses from the Children’s team, met her at the gate, brought her to the ambulance that would take her to Shriners Hospital. When I made my way to Shriners Hospital’s Acute Care Unit the next morning after my shift, I felt a wave of relief and gratitude when I saw her name on the board behind the nurse’s station.

She was frail but remarkably upbeat. It had been months since we had last seen each other, but she greeted me as if I had just stepped out for the afternoon, and told me she wanted to visit my house. She was clearly enjoying her new surroundings, but you could also sense her nervousness. She asked every new person she met if they were going to “take [her] skin.” She was still hugely protective of her wounds, and unsure of her new caregivers.

At Shriners Hospital

I visited her as often as I could, usually after working at Children’s. Sometimes I drove down from New Hampshire with my wife or one of my children, who quickly befriended her. On a few occasions I even worked a shift at Shriners as her nurse, although I preferred just spending time with her. Beverly Small, another nurse from the Children’s team who visited Haiti, visited her regularly as well. Partners In Health scheduled daily visits from their Boston staff, and from other Haitians living in Boston who could offer her a small sense of home. Just as she had done in Cange, Louveda formed bonds with all her new caregivers and quickly built a strong support network in Boston. She had a cell phone that she could use to call Anita, who was now living in a foster home next to the hospital in Cange. Somehow she figured out how to call my phone, and took to calling me to make sure I would visit her after work.

Loveda and David Bayne

She loved trying on new outfits and having her hair braided. She learned to write the alphabet, her name and do simple arithmetic problems in Shriners’ school program. She was clearly proud of her accomplishments and loved to show off her new skills. In class she made a new friend, a 12-year-old girl from El Salvador, who like her was alone in Boston and being treated for burns. After a few days we started to hear each of them speaking a blend of Spanish and Haitian. She worried she was going to forget how to speak Haitian. I began to realize that all of the newness and wealth of Boston didn’t really change who she was, or what mattered to her. She liked making friends and meeting people. But she also missed Anita, and asked when she would be able to return to Haiti.

When it was time for her to go home my daughter and I drove her to the airport. While she waited at Shriners for her discharge she sang church songs from Haiti and danced. She gave us a running commentary of Boston as we drove. She laughed at the rowing teams on the Charles River, “Why do they have such small boats?” she laughed.

I knew I was going to miss Louveda, but goodbyes are part of nursing. You make a decision every time you exit a patient’s room when you decide they are well enough to be left, and now was that time with Louveda. She was better, and she wanted to go home. And somehow seeing her leave for home made the world seem a little more right.

Sybill takes Loveda to her flight home to Haiti

To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end. When you accompany someone you travel with them.

Helping in that context is a shared, collaborative experience. I think Louveda understood that from the beginning.

Michael Felber, RN, is a nurse at Children’s Hospital Boston. He spent two weeks as a medical volunteer in Haiti in March of 2010, in the aftermath of the earthquake that devastated the country. The following February he returned with a group of clinicians from the Global Surgery Program at Children’s, to work at a hospital founded by Partners In Health. While there he met a child who changed his understanding of the relationship between caregiver and patient.

Michael Felber and Louveda

In February of 2011 I spent a week working with a Children’s team in the village of Cange, in Haiti’s Central Plateau. The region has been served by Partners In Health and its Haitian sister organization Zanmi Lasante for over 25 years. Together they have built a hospital and a multitude of programs to improve health, education, agriculture and social services. Our goal was to collaborate with PIH and Zamni Lasante, in their development of surgical programs and medical education for Haiti.

Our first patient was Louveda, a sweet and articulate 12-year-old girl with severe burns on her thighs and abdomen from a kerosene lantern accident two months earlier. Both her parents had died in the past year so her 14-year-old sister, Anita, was her primary caretaker. (Since Louveda’s accident, the two girls lived at the hospital, sharing a single bed.) She was wrapped in wet, stained bandages. She tried to remain as still as possible because it hurt her to move. She said it was hard to rest because her bandages were hot and itchy.

With the help of the Haitian clinical staff we arranged for sedation in an operating room so we could change her dressings and assess and debride her wounds. We brought a stretcher to her bedside, and in a calm and mater of fact way she asked, “Am I dead?” It occurred to me that in the two months she had been in the main surgical ward of the hospital, an open room with about twenty other patients, she had seen others die and be removed on stretchers. And it was realistic to assume that she too would not survive her injuries. Despite it all she seemed calm. In the operating room she smiled and held my hand as she went to sleep.

While she slept we cut her bandages off with scissors. The smell and wounds were overwhelming. Her upper legs and stomach were covered with deep, angry red wounds. There was a pressure ulcer on her left ankle, nearly exposing bone. We washed her wounds and put her in a clean gown and fresh bandages. As the initial shock of her injuries wore off, we began thinking of a long-term plan for her.

The good news was she was medically stable, but that wouldn’t last. She was anemic and malnourished. (A common complication for burn patients because they tend to have greatly elevated nutritional needs.) Her body was compensating physically, but would not be able to do so indefinitely. Her breathing and pulse were too fast and her muscles and skin were wasting and breaking down. She needed nutritional support, blood, physical therapy and help for emotional trauma. And mostly she needed skin grafts to close her wounds. Her injuries were extensive but treatable, but not with the resources available in Cange at this time.

City street in Cange

I emailed a friend who works at Shriner’s Burn Hospital for Children in Boston. Within a day Shriner’s accepted her for free treatment.  It was great news, but with no parents or adult family members and no birth certificate or school records, the immigration process would be daunting. Luckily Sybill Hyppolite, the coordinator of Partners In Health’s Right to Health Care program, which specializes in helping patients who need medical treatment not available in their home countries, was coming to Cange the next day. I knew she would be crucial in getting Louveda to Boston to receive the treatment she so desperately needed.

For the rest of the week we continued daily dressing changes, working with Romero, the staff anesthesiologist, as well as the Haitian Operating Room nurses. We brought her Ensure to supplement her diet. Together with the Haitian ward nurses we instructed Anita on ways to keep her from lying on her ankle. With the help of Anita and the entire floor staff we encouraged her to walk more. The most difficult thing was getting her out of bed regularly because walking was painful and scary for her. I remembered her matter of factly asking if she had died the first day we met her. I imagine she still was not expecting to survive and didn’t see the value in trying to walk when it was so painful. The support of the Haitian nurses, whom she already knew and trusted, was invaluable in enlisting her cooperation.

At first she argued loudly about getting up. I told her she didn’t have to walk but at least needed to sit up. She protested, but soon began to enjoy watching the goings-on of the hospital around her. It wasn’t long before other patients and the nurses began encouraging her to walk. She argued with them, but we could see the tide turning. Soon she was up with her walker, looking pleased with herself. We came back later to get her up again. Again, protests, but this time she made it to the bathroom and back. I pulled out my Ipod and played a Wyclef album. She smiled and started moving to the music, and then stood up and danced with me for a few moments, grinning ear to ear. All around her patients and nurses clapped, laughed and cheered.

We tried to make her feel more like a child and less a patient. We surprised her after one dressing change with new sandals and scented soap from the street market outside the hospital compound. We tried to end her walks on the patio, where she could enjoy sitting in the fresh air with Anita and playing with other children. She loved listening to music, visiting and playing dress up.

Louveda enjoys dressing up. Here's some of her princess finery.

I was pleased with her progress, but knew she needed more specialized treatment to survive. Together with David Bayne, a medical student working with Partners In Health, we worked on a plan to keep her stable until her transfer to Boston. He secured an operating room and anesthesiologist for regular dressing changes. He walked with her and made sure she was getting Ensure. The Haitian physician supervising her care ordered a blood transfusion. I knew that David and the rest of the staff in Cange were going to be crucial in keeping her safe and healthy, and in keeping her spirits up.

When I said goodbye to Louveda and Anita I didn’t say anything about Boston. I didn’t want to make a promise I wasn’t certain I could keep. I told her she would be able to get better, but that she needed to keep eating and keep walking to do so. She cried a little, and asked me if I was ever coming back to Haiti. I told her I didn’t know. Beverly Small, one of the nurses on our team said that she visited Haiti every year. “If I am alive, please visit me,” she said.

It was the most hopeful thing I had heard her say all week.

I didn’t sleep much that night. It had rained in the evening. The air was hot and humid. I woke up restless several times, and kept imagining how itchy and uncomfortable she must have been in her wet dressings.

For the second part of Louveda’s story, click here.

Sunday is Father’s Day. In early anticipation of this special occasion, here’s a story about how a father’s humanitarian efforts has inspired his daughters to follow in his footsteps.

When Sarah Hartman was 14, she took an unusual spring break. Unlike a lot of her friends, who were heading south or hitting amusement parks with their families, Sarah and her father went to Cambodia to help secure housing for a young woman who lost her leg in a landmine accident. Sarah’s father, Lester Hartman MD, serves on the Board of Directors for Children’s Hospital Boston’s Pediatric Physicians Organization, and for years had been actively involved in a global effort to ban and unearth landmines across the globe. He wanted his daughter to understand the nature of his work abroad, so in 2005 he invited her to accompany him to Cambodia, in what some might call a very extreme version of ‘Take your daughter to work day.’ Sarah accepted her father’s invitation, and the experience stirred deep emotions in the young girl.

“My mother and father have always taught us about how people live in other parts of the world, so I thought I had a good idea of what to expect when I got to Cambodia,” remembers Sarah. “But being there made everything seem much more real. Seeing how this woman lived, in poverty and without her leg, but still managing to maintain a positive attitude, it was all very inspiring.”

Richardson, Pascal, Jothson (three young men Lester and Holly sponsor to attend school), Lester Hartman and Sarah in Juampas a few days after the earthquake. Both Pascal and Jothson were in Port-au-Prince during the quake. Pascal's school collapsed, and he had to dig his way out.

When Sarah and her father returned to the States, she had a new appreciation for life, as well as desire to help others. She soon began accompanying her father on trips to Haiti; where he had been working at a medical clinic run by the humanitarian group Haitian Organization Program for Education and Health (HOPEH.) “Sarah loved meeting new people and having all these experience so far from her own,” Dr. Hartman says. “It spurred an interest in social justice in her that’s she’s held on to all these years.”

Hartman first got involved with HOPEH in 2003, when he joined family members that were helping the group build a much-needed medical clinic in the town of Juampas. After working with the organization for a number of years, a stirring speech by HOPEH’s founder, Marline Olivier, inspired Hartman’s wife Holly to get involved, and she now serves on the group’s board of directors as treasurer. (“When it comes to recruiting, Marline was far more convincing than I was,” jokes Hartman.)

In 2006, Lester and Holly (along with Sarah and their youngest daughter Laura) began traveling as a family unit to Juampas, to assist in HOPEH’s mission of providing the people of Haiti with the tools and environment that will allow them to be self-sustaining and teach others to do the same.

“Our families’ involvement with the people of Haiti just happened naturally, but we’ve really fallen in love with the island its people,” Hartman says. “Once you get there and meet the people you realize how wonderful a place it is. And when you see the hardships many of the Haitian people endure, it really changes your perspective about what’s important in life.”

It’s a sentiment shared by his daughters, both of whom have been volunteering and doing missionary work in Haiti for over five years now.

Members of Juampas gathered for a meeting about the Hartman girl's research outside of the HOPEH clinic

“From a relatively early age our dad wanted us to see first hand what other parts of the world were like and what people who lived there had to deal with on a daily basis,” says Sarah. “He set a real example for me in wanting to reach out to help people and learn more about global health in the process.”

Recently, the Hartman girls were in Juampas for three weeks, collecting data to find out what services the local people felt could improve their lives, as well as record nutritional information, so HOPEH can have a better idea of how to serve the Juampas population. It was the first time the girls had done HOPEH work without their parents, but Sarah says her father’s influence was always with her.

“My dad laid the foundation for my interest in working with the Haitian people, but this last trip was a far more independent experience for me,” she says. “It was wonderful. I felt like I was much more immersed in the culture than ever before.”

Lester and Sarah on her first trip to Haiti

“I’m just happy I was raised in a household where this type of travel was possible and an emphasis on caring was an everyday part of life,” she says. “As I start to think about my future, it really makes me appreciate everything my dad has done in the past.”

Photo by Geoff Bartlett

Today marks the one-year anniversary of the devastating earthquake that ravaged the island of Haiti, leaving 300,000 dead and over a million people homeless.

In the immediate aftermath of the earthquake, Children’s Hospital Boston Chief Executive Officer, James Mandell, MD, said that the hospital would continue to support the Haitian relief efforts, and this has proven to be the case. More than 50 staff have been to the island since last January – as recently as last month – with more scheduled to go in the coming months.

Conditions have been extremely difficult, with hurricanes, a deadly outbreak of cholera and riots making difficult work even harder. But Children’s staff have persevered. They’ve been in the pediatric ward, operating rooms, emergency ward and ICU. They’ve delivered babies immediately after the disaster, taken care of the sick and injured aboard the USNS Comfort, helped young amputees learn to walk again, connected school children across an ocean and have done training here at Children’s that they hope will help improve the care they deliver in the next disaster they’re called to help with.

There’s been national media coverage of their efforts, and we’ve chronicled their stories here on Thrive throughout the year, but today we hear from some of them in their own words, a year after the quake, about what they saw, what they learned and what their hopes are for the country.

Have you been to Haiti and have a story to share? Do you have thoughts about Haiti on this one-year anniversary, and how the world can continue to help the impoverished nation get up off its knees. Leave stories, comments and hopes in the comments section below.

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Anne Stack, MD

“I was very thankful for the opportunity to provide medical care in Haiti in January of 2010. For me personally, it was the hardest thing I have ever done in my life. I hope I was able to make a difference for the individual patients for whom I cared. The ongoing needs are almost overwhelming. It is my hope that Children’s will continue to support the Haitian people in a substantive and lasting way, using the depth of resources we are lucky enough to have to develop academic, educational and clinical support for the people of Haiti.”

Anne Stack, MD
Clinical Chief, Division of Emergency Medicine
Children’s Hospital Boston

Dennis Rosen, MD

“I was in Haiti twice in the aftermath of the earthquake, in May and in November, and both times were very emotionally intense. On the one hand, it was extremely gratifying because everything we did there, no matter how small it may have seemed, had a big impact on someone else’s life.

On the other, it was tremendously frustrating to watch children die of severe malnutrition or diseases such as diphtheria, which are both preventable and almost nonexistent here in the United States. My experiences there reminded me why I went into medicine in the first place, and I hope to continue to have opportunities to do this kind of work going forward.”

Read a post from Dr. Rosen about his most recent trip to Haiti.

Dennis Rosen, MD
Division of Respiratory Diseases
Children’s Hospital Boston

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Johanne Jocelyn, RN

“Although it has been a year since the Earthquake, for the Haitian people, my own people, it is still very relevant news. There are people who are still living under tents. There are people who are presently dying of hunger. There are people who are suffering and in need of the most basic humanitarian care.

I went to Haiti in January and in March, in collaboration with PIH (Partners in Health). It was one of the most important decisions of my life, but in the end, going to Haiti or providing aid in whatever way you can isn’t about you, it is about reaching out to people in desperate need of your help.”

*To see a video of Johanne speaking about her time in Haiti, please click here.

Johanne Jocelyn, RN
Surgical Technologist, BLS Instructor
Children’s Hospital Boston
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Photo by Geoff Bartlett

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Michael Felber, RN

“I went to Haiti for 11 days in March, working a night shift in a tent in Port-au-Prince before flying home the next morning.

Since coming home not a day goes by where I don’t remember what I saw there. I think about the raw power of the earthquake and I remember faces and stories I heard and saw. I also know that I saw only a tiny fraction of it. There is so much unfinished work there.”

Michael Felber, RN
Staff Nurse, Surgical programs
Children’s Hospital Boston

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Craig McClain, MD, MPH

“I was able to go work in Haiti in the immediate aftermath of the earthquake last year. I have also had to opportunity to return to Haiti in March of last year, and will go again this upcoming February. It is a bit of a struggle to put into a few sentences the big picture. I have spent time working in poor parts of the world, but had never seen such a cataclysmic event overlaid on such abject poverty.

I cannot begin to imagine how the people that lived through the quake felt. I’m very glad we went, and continue to go. I truly believe it is absolutely the right thing to do. However, it seems like a constant uphill battle. There is just so much that needs to be done; it seems overwhelming. I feel like we’re simply fighting windmills down there.

Then I think about the individuals that we have been able to do something for and I feel like, when the overall situation is viewed through that lens, there’s a glimmer of hope.

There’s a quote that hangs near one of the entrances at the Brigham and Women’s Hospital that says, “Service to society is the rent we pay for living on this planet.” I hope that as individuals and institutions we take such sentiment to heart and continue, despite the current situation, to invest our efforts in doing what we can to improve the lives of others. If we can continue down that path, then I think what we did in Port au Prince will have been successful.”

Craig McClain, MD, MPH
Department of Anesthesiology, Perioperative and Pain Medicine
Children’s Hospital Boston

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Nelson Aquino, RN

As I reflect back at the year that’s passed since the earthquake in Haiti, what I remember most is the resilience of the people who endured the devastation. I wonder what their lives have been like since we last met and if the many we cared for are still alive.

During this last year, despite all the chaos, I am so impressed by how giving everyone has been in volunteering what they can, listening and sharing their stories is so important because that way we ensure that we never forget the struggle and power of the Haitian people.

I hope we continue our relief efforts in Haiti, and together we can bring stability and hope to Haitian people.

Nelson Aquino, RN
Staff Nurse
Children’s Hospital Boston

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“When I was in Haiti I experienced some of earthquake aftershocks that were so violent they brought me to tears. I can’t even imagine how horribly scary the actual earthquake was for the Haitian people. Despite it all, during my time on the island I was taken aback by how kind, strong, welcoming and thankful the people of Haiti were and after living through such a tragedy.

The day after I got home from Haiti the bathtub in my new house overflowed. My husband saw the water spilling everywhere and got very upset. It was an inconvenience, but after seeing what I had seen in Haiti I realized how inconsequential it really was. As we mopped up the mess I told him, “At least we have clean running water. We don’t live in a tent and our family is alive and healthy.”

My outlook on life has been very different since returning. I hate to complain and I feel so much more thankful for everything I have.”

Kate (Anastasio) Becla, BSN, RN, RRT, CCRN
Staff Nurse II Med/Surg ICU
Champs SME/Eclipsys Resource
Children’s Hospital Boston

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Michael Agus, MD

“My two weeks at the University Hospital in Port-au-Prince allowed me to understand both the extraordinary gap that has developed between rich and poor countries and the remarkable desire on the part of the richer countries to help rebuild the shattered country of Haiti.

Since I’ve been back in our elite hospital, I struggled with the idea that we spend so many resources on improving what is already an outstanding care delivery system in the US. I came to understand, however, that American achievements, breakthroughs, and even expenditures are exactly what are necessary to drive improvements throughout the world, including underprivileged societies such as Haiti.”

Michael Agus, MD
Director of Medicine Critical Care program
Children’s Hospital Boston

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James Sheard and Shannon Manzi in Haiti immediately after last year's earthquake. Credit: Dina Rudick/Globe Staff

“For so many reasons, my deployment to Haiti was a life-altering experience for me. Our DMAT team proved once again that we can deploy anywhere, in any conditions and literally build something out of nothing. I am extraordinarily proud of my team members and what we are able to accomplish, but more importantly I am proud of the people of Haiti. They have continued to show resilience in the face of unheard of tragedy, political corruption, infectious disease outbreaks and deplorable living conditions. May 2011 bring hope, health and progress to the people of Haiti.”

Shannon Manzi, PharmD
Pharmacist and member of Children’s Disaster Medical Assistance Team (DMAT)
Children’s Hospital Boston

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David Mooney, MD, MPH

“It’s hard to imagine that it’s been a year already since the earthquake in Haiti.  It’s not hard to imagine that the past year has brought a string of new crises to Haitians, drawing their lives down to a desperate new low. We have seen well intended relief workers labor against the chaos of a country which prays for a functioning government, something that many of our citizens railed against so recently.  We have witnessed celebrity samaritans stage helicopter-in photo-ops with freshly costumed starving children whose new playground is the otherwise undisturbed rubble of last year’s school, and hardscrabble true angels jailed on charges based more on voodoo than logic.

In the background, behind whatever media clamor is left, life goes on.  Every day Haitians find food, look for work, love their families and try to improve their condition.  Some days these simple things just happen for them, other days their challenges seem and are insurmountable.  ’I'm still here’ is how Haitians respond when asked how they’re doing.”

David Mooney, MD, MPH
Department of Surgery
Children’s Hospital Boston

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John Mera, MD

“We arrived eight days after the earthquake, and chaos still reigned. Our team, and several others from across the county, met at National University Hospital in Port-au-Prince, which, for the most part, had no cohesive O.R. or health delivery system. Combined we treated many different patients, for a range of conditions, including a 4-hour-old newborn for severe rectal bleeding. Coming home was odd— a most unusual contrast. I went from a country without enough of anything to one with too much of everything.  There aren’t too many things about which we have a right to get upset. As human beings, we all—particularly physicians and surgeons—have a debt to the rest of humanity, to give something back. Go to Haiti and help. They still need you.”

*Taken, in part, from the journal American Society of Plastic Surgeons.

John Meara, MD, MDM, BMA
Department of Plastic Surgery
Children’s Hospital Boston

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Joy Banks, RN, BSN

“My group arrived the morning after hurricane Tomas and the ensuing Cholera outbreak that reached Port Au Prince. I met Reina on my second day; she was a preteen in the ICU who was thought to have Guillian Barre. Our team was able to wean her from sedation in order to give her intense physical therapy and respiratory ventilation weaning. Physical therapy consisted of constant range of motion and stretches but more importantly, dancing! We danced everyday all day long.

While I shimmied around the ICU, she wiggled whatever she could and smiled around her breathing tube. Since coming home I’ve heard from her and her family sporadically, through email, and around her birthday I sent her an Ipod with music that she liked so she could keep dancing. Despite the language barrier we still keep in touch, and though life has not been easy, I know Reina is still dancing.”

Joy Banks, RN, BSN
Medicine Critical Care program
Children’s Hospital Boston

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It’s been almost a year since an earthquake ravaged the island of Haiti, leaving 300,000 dead and over a million people homeless. Since the disaster, clinicians from Children’s Hospital Boston have been traveling to the country to provide care. Recently, a team of nurses and physicians returned from Port au Prince, where they spent a week helping with relief efforts. Conditions were extremely difficult: on top of a rapidly spreading outbreak of cholera, hurricane Tomas hit the island a few hours before they arrived, increasing the workload of the Haitian medical staff, already working around the clock to provide care for the Haitian people. Patrica Lincoln, BSN, one of the Children’s staff members on the trip, shares her experiences.

Katie Wallace, FNP, with a patient in Haiti

On a dark morning in early November, four doctors and eight nurses from Children’s Hospital Boston left for Haiti to assist the healthcare workers at Hospital Bernard Mevs, in Port-au-Prince, as part of a continuing relief effort coordinated by Project Medishare.

All of us had traveled to Haiti before, some even had family on the island, but we all came back for the same reason: to work alongside and help the Haitian people who have displayed a remarkable inner strength and sense of faith since the devastating earthquake hit the country almost a year ago.

We arrived that afternoon, and as we flew over the island we saw flooding and other damage caused by a hurricane that had battered the island the night before. Still, despite the violent weather that had swept through the area just 24 hours ago, when we stepped off the plane we were greeted with bright sunshine. It was a peaceful moment, but a short-lived one; there was urgent work to be done.

We made our way to pediatric unit at Bernard Mevs and found a short summary of each patient’s condition attached to his crib or cot, left by the American group who had help staffed the unit before us. Through translators, the dedicated Haitian healthcare workers explained the work they had been doing, and what awaited us in the upcoming seven days.

Classes to educate Haitian healthcare workers were held in any available space

Within minutes of our arrival the first emergency occurred. A baby had been born earlier in the afternoon, estimated about 28 weeks gestation, and was breathing over 100 times a minute. We administered oxygen and IV fluids, but the only oxygen available was provided through portable tanks that frequently needed to be changed. Unfortunately, any small adjustment in the oxygen supply caused the baby’s heart rate and oxygen levels to drop dramatically. We provided medication and breathing assistance and closely monitored him to make sure he stabilized correctly. What a strong little boy, by Wednesday he was able to start taking small amounts of breast milk from a bottle, and slowly the oxygen he needed was decreased. His mother was taught how to pump her milk for bottle-feeding, until her baby grew strong enough to nurse.

Another baby was admitted later in the week, but she was so malnourished the team was unable to help her. The five-month-old girl weighed barely more than four pounds and was far too ill to be helped given the surroundings.

The cholera that had been sweeping through Haiti had already reached Port-au-Prince by the time we arrived. A separate tent had been established to treat patients suffering from the disease; everything in contact with the patients had to be washed in bleach – even our hands. The team did everything possible to ease the suffering of the youngest cholera victims, including making Pedialyte popsicles in the pharmacy’s freezer, which was the only cold-storage available in the whole area.

Joy Banks,RN,BSN and Katie

A majority of the Children’s team worked in the medical clinics, which took place from 7 am until the final patient had been seen. The lines were often a hundred or more people long. During the day, medical and nursing students from Port-au-Prince often joined the Haitian and American staff that was trying desperately to stay ahead of the growing case numbers in the clinic and hospital wards. The university building that housed their medical classes had been destroyed in the earthquake, and classes have not yet resumed because a suitable place to host them hasn’t been constructed. Rather than wait for a classroom to be built, these industrious students are continuing their education alongside the hospital staff, gaining invaluable on the job training that will greatly compliment their formal schooling when it resumes.

One of our team’s main focuses while in Haiti was to educate the local physicians and nurses so they may independently staff and eventually run Bernard Mevs. We provided much needed pediatric training in fields like CPR or taught the best ways to utilize baseline measurements in pediatric and OB clinic patients. Teaching the local medical staff the proper way to asses breath sounds was especially crucial, as reactive airway disease is very common in the area.

Denise Anderson, NP, with Haitian patient.

When formal teaching was required, classes usually took place in a small kitchen. Cholera treatment and prevention were among the more important classes, and a group of health care workers from the community joined the hospital staff for teaching.

By the following Saturday, our team was preparing our own patient summaries, so they’d be ready for the incoming Americans who would take our place. The week had been such a whirlwind few of us really had time to process all we had seen, but as we watched from the plane as Haiti turned into a fading dot on the horizon, it was clear the patients, families and hospital staff we met there had made an irrevocable impression on our hearts and minds.

Children’s employees do a lot of medical work abroad. Peter Rohloff, MD, a resident here at Children’s, started an organization to provide cultural and linguistically appropriate healthcare to the indigenous people of the Guatemalan Highlands. His work will be featured tomorrow on ABC News’s 20/20 program. Click here for a sneak preview.

It’s been almost ten months since an earthquake ravaged the island of Haiti, leaving 300,000 dead and over a million people homeless. Since the disaster, clinicians from Children’s Hospital Boston have been traveling to the country to provide care.

May, 2010- A pediatric tent at the General Hospital in Port au Prince

This coming Saturday, another team of 8 nurses and 4 physicians will be traveling to Port au Prince to help with the relief efforts. Conditions there are extremely difficult: on top of the reports of a rapidly spreading outbreak of cholera, hurricane Tomas is forecast to tear through Haiti only a few hours before they arrive. This is likely to cause significant loss of life, render tens of thousands homeless once again, and lead to the further spread of infectious disease, including cholera.

Here, Dr. Rosen shares his thoughts on his impending trip to the embattled island nation and why aid to Haiti is more important now than ever.

This weekend, our team of 12 nurses and physicians will travel to Port au Prince, Haiti, one of the many medical relief teams which have gone to Haiti from Children’s Hospital Boston to help with the medical relief efforts since the earthquake of January 12, 2010.

We will be providing direct patient care in the pediatric inpatient and outpatient units of Bernard Mevs hospital, which is run in collaboration with Project Medishare and staffed by Haitian nurses and physicians and American volunteers. We will also be doing teaching, both formal and hands on, at Bernard Mevs and at the General Hospital (HUEH) to help improve the level of pediatric care given in Haiti.

In addition to collecting supplies, raising funds and preparing the talks and lectures we will give, we have all spent the past few weeks reaching out to school groups and others in the community, reminding them of how tenuous the situation remains for the people of Haiti and involving them in our efforts to maximize the impact of our work there.

Unfortunately, in many ways, the situation in Haiti now is no better than it was in the immediate aftermath of the earthquake. The news of the cholera outbreak of the last two weeks, which has sickened thousands and killed at least 337, is a stark reminder of this.  So far, most of the cases have been concentrated in St. Marc, approximately 60 miles north of Port au Prince, and the Artibonite river valley.  While 5 people were diagnosed with it in Port au Prince, it is believed that they had contracted it elsewhere. If cholera does spread to the crowded and unsanitary tent cities in which more than one million displaced persons live, the results could be catastrophic.

Cholera is an intestinal infection which causes the intestines to actively secrete fluid and electrolytes, causing copious diarrhea, dehydration and electrolyte imbalances, and can be fatal within hours.  So far, the mortality rate in Haiti has been about 6.4%, with infants and young children at a higher risk for complications.  The diarrhea can be so intense that people stricken with it are often put on special beds with an opening under their buttocks to allow for the constant passage of the watery diarrhea into a bucket placed below.

Cholera had not been seen in Haiti for more than a century, and it is still unclear how it returned to the island.  It is very easily spread, and when it first appeared the hospitals in St. Marc were unable to accommodate the huge demand for care. Most patients are treated with an oral rehydration solution (ORS) consisting of water, glucose, potassium, sodium and trisodium citrate. The more severe cases are treated with antibiotics and intravenous fluids.  It’s a disease closely associated with poverty, as simple measures such as hand washing and providing access to clean water can dramatically reduce its spread.  However, clean water is not easy to come by in many parts of Haiti.

The most uplifting part of getting ready for this trip has been to see just how many people genuinely care about the plight of the Haitian people and want to help.  We have received donations from the hospital and individuals of medical materials, medicines, vitamins, textbooks, baby clothes, shoes and money to take with us to distribute while there.  Others have made donations directly to Project Medishare through a webpage set up by our team members.  While many of the people who have donated items have been people we know personally, others have been only indirectly connected to us, such as the coworkers of spouses of people we work with who heard we were going and wanted to do something to help the Haitian people.  This has transformed our trip from one of 12 individuals into a communal effort of those who cannot remain oblivious to the suffering of others, who we are proud to represent.

I think I speak for the entire group when I say that we feel excitement mixed with nervousness knowing we will be caring for extremely sick children, many of them malnourished, unvaccinated and suffering from diseases which could be easily treated here in Boston, but are often fatal in Haiti. We also feel very privileged and grateful to have been given the opportunity to help so many in need and to make a true difference in their lives.

Jill Merna, Nancy Joseph, Carla Odiago worked nights taking care of over 80 adult patients.

From April 10 to 18, Children’s Hospital Boston sent a group of 26 clinicians to a field hospital in Haiti. Here, those who staffed the adult ward reflect on their experience.

Nancy Joseph, RN, BSN, MSN, FNP-C; staff nurse in CHPCC

This was my internal cry after arriving our first day. I thought I was going to lose my composure when those two women came in on the back of a truck requiring emergency C-sections.

Ayiti Cherie….
Bel mon, Bel moun, Bel lang
! a je!
Ou bel !
Cote nou rive la !?!?
Coma sa fete ?!?!
Jody-a mwen vini na pie ou
pou mwen sevi ou
Yo ban mwen deu jour
Ou pa ber zwen pe
Map mete men
Petit ou,
Nancy

Translated:
My Dear Haiti
Beautiful mountains, people, and language
Oh! my goodness, your beautiful
How did we get here ? How did this happen?
Today I have come to your feet to serve you
I have been given a couple of days to give a hand
Your daughter,
Nancy

Both moms and babies were eventually discharged home in a few days. No one went home without their Hepatitis B in toe. I would have given them IV Ig, but we had none. I was officially named charge nurse of our 76 bed adult unit, of course this is a group effort. God knew I might feel overwhelmed, so he had me take care of a Quad patient. He was robbed for his money and told to open his mouth, during which he was shot and left paralyzed. He needed his hs lovenox, however the dose of his medication required two shots. After I explained what I was going to do, he agreed. After I gave him his second dose, he says to me, “Mwen pap pran twazem pici”, I will not take a third one from you. In Kreyol, I told him I would not give him a third one. “Mwen di sa pou fe ou ri”, “I only said that to make you laugh”, he proceeded to thank me and wish me a good night. Their resilience, the Haitian people, gave me such strength.

This same night, I had a new post-op urostomy, He called me “mama”. At first I thought, Nancy, you have really aged. However, when his wife reprimanded him for calling me “mama”, his response was “Any woman taking care of me when I am sick is my mother, so I will call her ‘mama.’” What an honor ! The nursing care I was trained to give was right up there with mama’s TLC.  Until my last day at Project Medishare, he never referred to me with the typical “Miss”, the nickname used to address nurses in Haiti, always “mama”

Day three was a personal day for me. For the first time in 37 years of my life, I met my cousin Patrick. As soon as I saw him, I knew he was family. He described the horrible conditions of the country since the earthquake. He had only met me for 10 minutes before he asked me if I could take his daughter back with me on Saturday. My heart sank to my feet. I could see the desperation in his face and hear it in his voice. I am still ill over my response, I know my family could offer his baby a better opportunity in the states, however it was not possible. This was a joyous and sad day at the same time.

Jill, shown on right with a patient who needed trachesotomy care.

Jill Merna, RN, 8E

At the start of my second night in the adult med/surg tent I immediately noticed a new patient. He had a trach and looked generally ill. I was told the ICU didn’t want to send him out but they had no choice, they needed the bed for sicker pts. When I asked the day nurse where his suction was, I was told he didn’t need any suctioning and that was why he was transferred. I was told he would be fine over night. Because there are limited supplies, the only portable suction machines I could immediately locate were in the ICU. These were unavailable to me as there were two vented patients that needed them.

I asked several people to help locate an extra machine and then I moved on to my other patients, of which I had over 20 that night who were nearly all hours and hours behind on diuretics, pain meds and IV antibiotics for massive wounds. I kept a close eye and ear on my trached pt the whole time.

Around midnight I could hear and increase in his secretions and know he would need suction soon. No one had been able to find a machine for him yet. I pleaded with the ICU nurse to let me borrow her machine; I promised to bring it right back. I ran back to the my pt’s cot and bent down to plug it in. There were no outlets! I couldn’t find an outlet in the entire tent! I ran over to logistics to try and locate someone who could help trouble shoot with me. I could not locate the cot number for the head nurse or the logistics personal I knew would be able to help me. OK, I thought at this point. This pt needs suction now and I’m not going to spend any more time trying to bring it to him, I am going to bring him to it. I rallied up transport and moved him over the ED where there was a stationed suction. We did a deep, thorough job clearing copious thick secretions which allowed him to remain comfortable and safe for the remainder of the night. In the morning I borrowed a long extension cord from the logistics tent and was able to set up him with at least a constant electrical source at the bedside. The portable suction machine would have to be shared. The remainder of the week I provided this pt with frequent aggressive pulmonary toileting and watched him improve every day. At first he hated it when I gave him chest PT but he soon realized how good it made him feel afterward and he starting asking for it.

When I first became a nurse two years ago, I never thought I’d ever be running through a hot rainy night in search of something as seemingly basic as a suction set for a trached patient. But when I found myself in that position, I found that I had enough resources, I just needed to figure out how to manage them. And none of this was lost on this patient. He was so appreciative of everything I was able to do for him, I feel like I could do it a hundred times over.

View of the high volume, high acuity adult tent.

Carla Odiaga, RN

I finally went off the hospital complex on Friday, and went on a brief tour of Port au Prince. At first, I sort of just took it all in… the sights, colors, sounds of folks getting on with life, all with the stark evidence of the recent horror all around… rubble everywhere, tipped over buildings, mangled cars… tent neighborhoods filling various spaces.

Then I let it sink in. The rubble and mangled vehicles represented the world suddenly caving in on these folks, literally. The patients I’d been caring for, with broken necks and backs and missing limbs, had been going about their lives when the world fell down on them!… was still falling as they grasped that they were never going to walk again, or have children… These were things my patients were dealing with, now… still…. forever. I was looking at evidence of the world falling down… after 3 months worth of cleaning up. It was – is – overwhelming! And then the colors, music, sounds of life and resilience! I sat in the back of that rickety minibus and cried.