With their brilliant smiles and frequent bouts of laughter, Carmene Guerrier, 16, and Julmiste Shelove, 25, light up the medical ward. Their friends come to visit often, sitting on the edges of their beds. They gossip, tease each other and teach simple Haitian Creole phrases to the English speaking clinicians. Although both girls have lived in the hospital for the past two months, where there’s few forms of entertainment, the near constant hair maintenance they partake in—braiding, corn rows, combing knots out and complaining about the lack of shampoo—never ceases to absorb them. When the physical and occupational therapists arrive to interrupt their fun, just like typical teens, they try distraction techniques to avoid what they know is coming. “Pa mal, pa mal,” says Shelove, as she points to her leg. Guerrier grabs the hologram stickers she received earlier and mimics that she wants more. Full story »
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Children’s in Haiti
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Michael Felber, RN, and Kathryn Barrett, RN, take care of a patient in Haiti.
Children’s nurse Michael Felber came to Haiti on March 15, where he’s been working in the town of Fond Parisian. On Monday, he joined the Global Surgical team in Cange. Here, he reflects on his experience so far.
Being in Haiti is a little like the fable of the three blind men and the elephant – each of them had different experiences based on what they encountered. In someways things look a lot like most Latin American countries- it’s hot, the cities are crowded, the people are wonderful. Port au Prince looked mostly ok from the air, but then when you look closer you can see that some areas are rubble, and there are tents everywhere, even where the buildings are standing. The tents here at the field hospital are easily over 100 degrees, but many people are still afraid to go inside buildings. The kids here are wonderful – big friendly smiles, love to play soccer, make kites. Still pretty much everyone has lost family members. Many don’t have homes to go to, and rainy season is coming soon. Its hard to imagine that possible a quarter of a million people died in the earthquake and the days after. Where do you go from there? One of the patients said to me, “I’ll see you tomorrow, if god is willing”. The hospital is well run, especially considering how many people are coming and going. The pharmacy is as organised as I have seen anywhere. There are electronic medical records, although much simpler and more user friendly than ours. You have to be comfortable stepping out of your comfort zone. Tonight I am covering the night shift in Triage. It’s like an ER in a tent, hopefully more quiet now that everyone has gone to sleep.
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Bev Small, RN, works with Haitian nurse Yanick Michel.
Before the earthquake, the hospital in Cange did eight, maybe nine operations a day, recalls Yanick Michel, a 26 year old OR nurse who’s worked here for a year. Almost immediately after the earthquake, the surgical caseload doubled. At the same time, donated equipment poured in to furnish the two operating rooms, including a new anesthesia machine.
To handle the influx of patients requiring surgery, visiting surgical groups, like this group from Children’s, are rotating through the hospital. As well as helping ease the patient load, the specialized surgical teams (orthopedics, plastic surgery and urology, for example) educate the local staff how to handle difficult cases they may never have seen before. “Although it’s been busier, it doesn’t feel hectic,” says Michel. “We adapt. I feel very comfortable because we have such a good entourage and we’re all trying to do the same thing. It’s all about the teamwork.” Full story »
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Joceyln Guerrier, shown receiving a dressing change, was injured when her house collapsed during the earthquake.
After the earthquake, the hospital complex in Cange was inundated with people suffering from fractures, crushed limbs, spine and pelvic injuries and deep cuts and abrasions. Now, almost two months later, the wards are still home to patients with wounds that are slowly healing—and require attentive care so they don’t turn more serious.
Monday morning began with wound care rounds. Nurses Cassandra Mombrun and Pat Lisle assisted Dr. John Meara as they took off old bandages, cleaned and dressed wounds, and looked for signs of infection. One dressing change was for Jocelyn Guerrier, a 28-year-old woman with a fractured leg and a deep gash wound on her calf, who’s lived here since the day after the earthquake. She was washing clothes on her balcony when she felt the house shake. She tried to run outside but didn’t make it in time, and the house collapsed on top of her. A car transported her to Cange, where she’s been ever since. Although her house was completely destroyed, her family stayed safe during the disaster. Full story »
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Kathryn Barrett, RN, plays with a boy whose leg was fractured during the earthquake.
Melissa Jeltsen, a writer at Children’s Hospital Boston, is embedded with Children’s Global Surgical team at the Zanmi Lasante (ZL) Sociomedical Complex in the village of Cange, Haiti. The hospital complex, located two hours north of Port-au-Prince, offers medical care to people living in the Central Plateau. Led by John Meara, MD, DMD, MBA, the hospital’s plastic-surgeon-in-chief, Children’s Global Surgical team is spending a week in Cange, performing surgeries, wound care, general pediatrics and occupational and physical therapy. This is the team’s first mission.
The plane from Miami to Port-au-Prince was jammed to capacity with various aid groups, each identifiable by their matching t-shirts emblazoned with hopeful slogans. One read, “I’m going to Haiti, where are you going?” another, simply, “Restore. Rebuild. Redeem.” The nervous energy in the plane, manifesting in sporadic giggles, contrasted with the solemn manner of the Haitian man sitting next to me. He’d been in Miami, where his cousin lives, arranging to have his kids come to the United States. He was happy, he said, that we were coming to help Haiti. “So many dead,” he said, drawing a finger across his throat each time he repeated the phrase. Full story »
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Here’s a quick look at what Thrive was up to last week.
Children’s Michael Agus, MD kept us updated on his relief work in Haiti. There’s a better genetic test for autism. Children’s CEO, James Mandell, MD, discusses the cost of children’s care. Children’s is featured in two National Geographic documentaries – one on the Shang Dynasty and the other on rare medical conditions. A newborn’s hearing screening should not be ignored. Thrive blogger, Melissa, reports on disaster relief simulation training. Are iPhone apps okay for toddlers? How can kids respond to email chain letters?
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A group of clinicians worked together to stabilize the "patient."
Clinicians working in high-resource settings, like Children’s Hospital Boston, rely on the availability of certain equipment to do their jobs, like ventilators, specially sized needles and tubes and a fully stocked pharmacy. But when they’re forced to perform without their gear—like in Haiti in the immediate aftermath of the January earthquake—many find it bewildering and even paralyzing. “We fall into these patterns of providing care,” says David Mooney, MD, MPH, director of the Trauma Program, who was one of the first medical responders to respond after the disaster. “One of the things I noticed in Haiti was that many doctors really fixated on what they didn’t have.”
That mental block can waste time and be counterproductive, so Children’s is developing a training program to prepare the doctors, surgeons, nurses, pharmacists and other volunteers who are going to Haiti to continue relief efforts in the coming months for the conditions they’re likely to find. Mooney, along with Shannon Manzi, PharmD, and Debra Weiner, MD, PhD, worked with Children’s Simulator Program to create the special training, in which clinicians reenact challenging situations on robotic mannequins. Peter Weinstock, MD, PhD, director of the Simulator program, hopes that by practicing in an environment with limited supplies, clinicians will be encouraged to think outside of the box to find the resources they need, and will be better prepared for a disaster zone.
(Listen to a WBUR story about Children’s new simulation program and read The Boston Globe’s White Coat Notes report of it.) Full story »
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by Michael Agus, MD, director of Children’s Medicine Critical Care Program. Agus is currently in Port-au-Prince, Haiti, where he is treating patients and sending us updates by email.
Day 10
I wasn’t supposed to work the day today because I now have to start working nights since there is a few days’ gap in the night pediatric physician coverage. But after a good night’s sleep, and with two intubated patients in the pediatric tents with no other intensivist on site, I felt like I should go for morning rounds, set a plan for the day and then sleep on the hospital grounds to rest up for the night. Full story »
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