Children’s and Project Medishare: reflections from the Emergency Department

by Melissa Jeltsen on May 12, 2010

The ER team: from left, Sarah Wingerter, MD, Stephen Monteiro, MS EMT-P, Sarita Chung, MD, Alexis Schmid, RN, Michelle Marini, RN.

The ER team: from left, Sarah Wingerter, MD, Stephen Monteiro, MS EMT-P, Sarita Chung, MD, Alexis Schmid, RN, Michelle Marini, RN.

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 Emergency Department reflect on their experience.

Sarah Wingerter, MD, Division of Emergency Medicine

In retrospect it seems hard to believe we only spent 8 days in Haiti.  Each day was so intense and so replete with new experiences and powerful emotions.   I remain awestruck and humbled by the fortitude of the Haitians I met, both patients and Medishare staff members.  To know that they continue to work on putting their lives back together despite the unimaginable challenges they face has given me a new perspective on what used to seem like inconveniences in my own comfortable life.  I learned a great deal about patience, humility, and selflessness from patients and parents who waited hours in the sweltering heat—many after walking miles to reach the medical facility—for the opportunity to receive care for medical problems they had endured for months or even years.

Despite the challenges of working in an unfamiliar, resource-poor environment, the work we did with Project Medishare was the practice of medicine in its purest form; we were there solely to take care of patients, with no competing responsibilities or demands on our time.  When necessary we stepped out of our defined roles as we know them at Children’s and simply filled the needs that arose.  We stretched beyond our personal and professional comfort zones, and the reward was to have grown in ways we could not have anticipated.  More than anything, what I took away from my experience in Haiti is tremendous gratitude: for having had the opportunity to participate in an important relief effort, for having witnessed the resilience of the human spirit as embodied by the Haitians I met, for the inspiring colleagues—old and new—with whom I  had the good fortune to work.  This experience will continue to inform my work as a physician and my commitment to humanitarian efforts, and I will seek  opportunities to participate in similar endeavors  in the future.

Steve Monteiro, EMT-P

Steve Monteiro, EMT-P

Steve Monteiro, EMT-P, Director Emergency Management

All Emergency Departments have the following priorities (even in Haiti): 1) An unpredictable workflow- patients with non-emergent and others with life threatening injuries arrive at unpredictable rates.  The challenge is sorting those who can wait from those who can not.

2)   Communication- The ED cannot be successful in its primary task of stabilizing and transferring patients (a.k.a “treat and street”) without close communication with receiving departments (adult med/surg, adult ICU, pedi med/surg, pedi ICU)

3)   The skills found within the ED are used to assist other areas (IV support, code support, more)

What was different and challenging about the Haiti- MediShare ED:

1)  It was outside where the average daily temperature exceeded 90 degrees F

2) Mango “tree”age—Primary triage took place under a mango tree ¼ mile from the ED (security under this tree had guns)

3)       Supplies came in all shapes and sizes and it was a real challenge to hold on to working equipment once it was identified.

4)      Every night it rained—equipment needed to be moved to avoid being soaked by torrential downpours

5)       It was crowded—at times it was difficult to deliver emergency care amidst the constant flow of family members, interpreters, transporters, security, other ambulatory patients and volunteers.

6)      It was small- ED areas designated as emergency (4 beds), urgent (4 beds), ambulatory (tent with 3 benches) and waiting 4 benches with little-to-no shade.

What was striking about the people I meet in Haiti

1)       The average persons tolerance of pain (man with 30% upper body burn walked in and sat down at triage table)

2)       The devotion to religion (Sunday morning volume was nearly non-existent.  1pm- sick people with emergent injuries were arriving…dressed in their church clothes)

3)       The dignity of each earthquake survivor (I did not observe people: pushing, yelling “when is it going to be my turn”, and I did experience people saying “thank you” they spoke, even when their injures are not severe enough and they are asked to come back tomorrow

4)      The active role of surviving family in caring for the sick.  Under almost every patient bed, lay a family member who at sunrise, emptied bed pans, washed and fed the sick.  Without this kind of support our clinicians would not have been able to provide advanced care.

What was so inspiring about the Children’s Hospital Boston Team

1)       Day two- a long term Medishare team member commented “Your team is awesome.  You group has lifted the spirit of this camp…others [long-term staffers] feel that more is possible since you all arrived

2)       We laughed together, we were emotional together, held each other accountable, we kept each other safe.

Why we should make a long term commitment to Haiti

1)       The need is so great- Haiti is the poorest country in the Western Hemisphere

2)       The medical infrastructure is in desperate need of leadership and support

3)       The children are so adorable

4)      We can make a significant and meaningful difference.

Michele Marini, RN

Michele Marini, RN

Michelle Marini RN, CPNP Emergency Department

The first 48 hours in Haiti were traumatic for me. The ED was housed in a small tent attached to the main tent where the OR, PICU, ICU and pediatric units were. The crushed stone floor was hard on the feet and the afternoon sun made the ED feel like a sauna. The array of supplies, many unfamiliar to me, were placed haphazardly on crowded shelves. There were no sinks to wash hands and the gloves often tore as you donned them over sweaty hands. Many of the patients were adults with problems ranging from cardiac, GYN, trauma, infections, or respiratory problems which initially was challenging for me. Many of the pediatric patients arrived with chronic health problems or birth defects that would have been easily treated in the states. After a 16 hour shift, the rain rolled in flooding the ED and wetting the supply shelves. I enjoyed the sound of rain and welcomed its cooling breeze but looked around and thought ‘what a mess’! We moved the supplies away from water leaks as best we could and left the ED for the night.

As I tried to fall asleep on my cot under the malaria net that night, I heard another rush of rain and felt rain drops on my forehead and tapping my sleeping bag. I sat up and looked around at my neighbors wondering if they were getting wet too. Lexi to the right and Sarah to the left sleeping soundly…how lucky they were I thought. So what am I to do? Out of my professional and personal comfort zones, trying to fall asleep in a leaking tent with 160 people. As the rain drops fell, I realized my bladder was full and the port-a-potties were lined up outside the tent…Ugh! Then I thought about the people we came to help. I imagined how their tents, which are now their homes, must be leaking with no bathroom facilities. How they do not have malaria nets to protect them from mosquitoes or a clean sleeping bag to crawl into. I thought about how many of them will be showing up in the ED tomorrow needing help and how I better get up early to clean it up for them! That was my Aha moment. I got out my umbrella and put it over my head under the malaria net, laughed a little, and finally fell asleep. I woke the next morning with renewed energy and ready to get to work!

We started the morning cleaning up and organizing the supplies as the patients began rolling into the ED. I was struck by how resilient and patient they were while waiting to be seen. I remember trying to find someone to hold the arm of a little boy for me while I placed an IV. Everyone was busy so I thought I would try and do it alone. What? Without the help of Child Life or a Clinical Assistant? This little boy never moved, never flinched, never cried while I pierced his skin with the needle. It saddened me as I thought how this child must know pain and suffering. I held his hand for a moment and smiled at him….but I needed to move on.

I could go on and on…..so much to say and so many have already shared their thoughts and experiences so eloquently. I will wrap up by saying that I am a better person and nurse for this experience and it was an honor and a privilege to spend that week with the people of Haiti. I would also like to say that it was an honor and a privilege to be part of the Children’s Hospital team. I was struck by the skill, resilience, and spirit of everyone while working outside of their comfort zones too!

angelaAngela Schuman, PharmD, BCPS, Emergency Medicine Pharmacist

Boarding the plane in Miami I thought about the upcoming week ahead.  I knew that each one of us was coming to Haiti to offer our skills and knowledge to the people of Haiti.  I knew that we were a group of very well educated and trained healthcare providers.  I knew that the work was going to be hard and the days long.  I knew that each day would bring new challenges and that I would have to be creative in how I did my job.  I knew that I would leave Haiti a better pharmacist.

Immediately upon arrival I realized how right I was in those assumptions.  We were tested early on day one with our first trauma, a critically ill adolescent who required each of us to be more creative then we ever have had to be.  What became even more evident during that first trauma was that we did not come to Haiti as individuals, but as a Children’s Hospital Team.  Throughout the week our team continued to demonstrate a cohesive dedication to provide the best possible healthcare to our patients in Haiti.  Every person relied on the next person.  Everyone stepped up to the challenge.  No one every said that we couldn’t do something, but instead worked together to figure out how we were going to do it.

At the end of the week flying back to Miami I knew that Children’s Hospital Boston sent a skilled and knowledgeable team to Haiti.  Our team used its education and training to its fullest ability.  All of us worked together harder then we ever had worked before.  Our days were long, but together we helped as many people as we could.  We met each challenge and overcame them with a creativity that I never thought was possible.  I have always been proud to work for Children’s Hospital Boston.  This experience has left me with a whole different level of pride.  I am proud to work for Children’s Hospital Boston, I am proud of the hospitals commitment to Haiti, and I am proud of every person on our team.  I left Haiti not only a better pharmacist, but part of a better team, and a better Children’s Hospital Boston.

1 comment

  • http://jostumpner.com jostumpner

    Thanks for taking the time to share your experiences serving in Haiti. I have been receiving daily updates from a member of my church who is also serving with a medical team in Haiti. I continue to be shocked each day as I read the details of the situation.

Previous post:

Next post: