CRNA Volunteer Angela Williamson, RN, BS, BSN

Haiti Foundation Against Poverty and Project Medishare/University of Miami

Port-au-Prince and Les Bours, Haiti
January 27–February 3, 2010
Nurse anesthesia student Angela Williamson, RN, BS, BSN, volunteered in Haiti January 27-February 3, 2010. Angela volunteered through the Haiti Foundation Against Poverty and Project Medishare/University of Miami. Angela volunteered in both Port-au-Prince and Les Bours, Haiti.
I am a second year student at Oakland University in Rochester, Mich. My "home base" is Beaumont Hospital in Royal Oak, Mich. I had the opportunity to go on this trip with a wonderful group of healthcare professionals from Midland, Mich., consisting of two registered nurses (RNs), an obstetrician gynecologist (OB/GYN), an OB/GYN resident, a pediatrician, and a photojournalist. I have always wanted to go on a mission trip, but never had the opportunity present itself, nor have I sought it out. The anesthesia program has changed me in a way I never would have guessed, and gave me the confidence and courage to finally go through with this experience.
The email I received about the mission trip to Haiti was from a friend of a friend of a friend, who passed it on to our class. When I volunteered, I was told four days later that security was breached in the area in which we were to stay, and the trip for me was off. Somehow, the night before departure, a new place to sleep was established and someone was unable to go. I was in. The flight was $500 and I took $500 in cash, all of which was my own money. As you know, anesthesia students don’t have any money, so this was a great sacrifice for my family and me. I packed that night and left the next day after getting immunizations, gathering supplies, and kissing my family goodbye. They were all very worried, but I knew in my heart it would all work out. It was something I had to do.
My flight was apart from the rest of the group, so I had to meet them at the airport in the Dominican Republic. We had to find transportation to Haiti, and were fortunate to have a missionary by the name of Mallery Thurlow on our side.
Mallery Thurlow, founder of The Haiti Foundation Against Poverty, has close ties with many of the team members I was with and was the reason we made it across the border and had a place to stay. It took us 10 hours to make what should have been a three hour trip. When we got to the border, there were people bathing in mud puddles on the side of the road, and tons of food and supplies that just sat there because there wasn't enough transportation to get the goods across the border safely. The roads were a mess and the dust was unavoidable, but there were also hundreds of amazing people waiting to get over that border to help.
Our destination was a village called Les Bours, outside of Cité Soleil, which is considered a slum of Port-au-Prince. The largest obstacle at the border was figuring out how we were going to get to Mallery, who was on the other side waiting for us. Our drivers had to stop and could not cross. We either had to figure out how to hike it with our 25-plus bags (among seven people) or find another ride across. Somehow a miracle occurred and Mallery was able to cross to get us.
When we arrived in Les Bours it wasn’t the violence and masses of human remains that the media sensationalized. Indeed, their buildings and roads were in ruins, and there were piles of burning garbage everywhere, but there were also volumes of people selling food and other items on the side of the road, many were on their way to work, and children were walking to school. Somehow this city found a way to return to some kind of normalcy and order, despite the devastation.
We stayed at an orphanage Mallery had been affiliated with, and the scene was heartbreaking. Most children had been there before the earthquake, left by parents who could not support them due to disabilities, syndromes, or simply could not afford to feed them. Gretchen was the “mother,” and ran a very tight ship. She had helpers, but the older children picked up the slack by bathing, dressing, and feeding the younger or more disabled kids. They even brushed their teeth for them. Gretchen tried to make us meals when she could, and the mornings were always filled with an amazing array of fruits and hot water for coffee. This was the only hot water I encountered the entire time I was down there. There were some positive, happy moments I had with the kids. There were a few I was ready to bring home with me!
We set up a clinic at one of the schools that had been closed due to damage in most of the rooms. The size of the "operating room" (OR) was about six by eight feet, with a “pharmacy” next door with piles of drugs that had been donated. We used what we had or could; many medications were from different countries so we were either unfamiliar with their alternate brand names, or unfamiliar with them all together.
We saw neighborhood patients, mostly looking for affirmation that they were okay. Some were just looking for something to eat or drink. A few patients had serious injuries that needed attention, such as a gangrenous finger, or rapidly expanding mass in the neck. The physician that I went with brought an array of equipment and drugs for me to use, but I was at a loss. I had laryngeal mask airways (LMAs), air-shield manual breathing units (ambu bags), airways, and emergency drugs, but no oxygen, no intubation supplies, and I was a student without any licensed professional to support or guide me. I chose to give verbal anesthesia for safety, and provided intravenous (IV) placements (starts) and antibiotics, local anesthesia (per the surgeon), and performed dressing changes. It was a wise choice.
After three days, we felt we were not seeing the people we needed to see. The neighborhood was so pleased to have us there and found comfort in our reassurance, but we knew there was more we could do. On a whim, we traveled to the airport after someone told us there was a “hospital” there. What we found was exactly what we were looking for. The University of Miami and Project Medishare had collaborated to create a campus with tent-hospitals that were functioning the best they could. That day we packed up our supplies and set up our new residence there.
The hospital consisted of a staff tent, an OR, intensive care unit (ICU), pediatrics (peds), a wound care tent, an orthopedic surgery (ortho) tent, three isolation tents, and a supplies tent. There were thousands of pallets of supplies in the huge supplies tent we called “Costco.” It was like a gold mine buried in a haystack. We couldn’t find anything. It was such a treat to walk in there and find something you could use, even if it wasn’t what you were looking for.
The pediatrics area was filled with postoperative (postop) children and medical emergencies. Hydrocephalus was common due to head injuries. It was severe and very hard to observe without tears. The pediatric wound care area was not equipped with a pulse oximeter (pulse ox) upon my arrival. After the death of a 14-year old occurred, a pulse ox was finally employed. The cause of her death was unknown, and may have been related to oversedation and apnea, or another cause, such as a pulmonary embolism (PE). Regardless, she had been apneic for some time and resuscitation was futile.
It was difficult for the staff to fully collaborate and standardize anesthesia areas, as people were coming and going each day. I do believe they were doing the best they could, and things were much safer when I left. Oxygen tanks, monitoring, and emergency airway equipment. and drugs were finally found for each station.
The OR was bare bones, but somehow very functional. Bullets were being removed from brains using large craniotomies, shunts were being placed in pediatric patients, and limbs were being amputated humanely with anesthesia. Drapes were made out of anything sterile and blanket-like; IV poles were anything tall, or a rope strung across the room. There were four anesthesia machines, but one was inoperative for mechanical ventilation after failing checks repeatedly. The OR tables were made of wood with whatever padding they could find to put on them.
Suction was connected to a battery that had to be turned on and off at the surgeon’s request. The OR pharmacy was like a flea market, but organization was slowly making its way and we were able to find more and more. I was able to perform two spinals for amputations in this area, but my unfamiliarity with the machines led me to the wound care area where I would be more useful, safely.
The wound care tent was very large and had about 200 cots. There was a pharmacy here as well, with a table about 30 feet in length, full of whatever people brought in or found at Costco. There was no pharmacist, and we all acted as the “pharmacist” at some point. This tent saw the most business. There was also an x-ray machine here in an open area at the front of the tent; there wasn’t really an x-ray room. Patients were lined up in cots that were about two feet apart. It was very difficult for family to stay with them. IV bags were hanging from ropes strung across the tent using tape, gloves, or whatever else we could find. The fluids were also whatever we could find: lactated Ringer's solution (LR); normal saline (NS); lactated Ringer’s solution with five percent dextrose (D5LR); or five percent in water (D5W), with no rhyme or reason; as long as it was a bag of fluid, it was being used. IVs were constantly going bad, so that was my job for three days. I was pretty good at starting IVs before, but I perfected a lot in Haiti. Patients were constantly in and out for admission, OR, or discharge. The wound care area where I spent most of my time, consisted of two stretchers, sheets to make a “room,” and emergency equipment. As many have said, ketamine was in full effect!
It truly was amazing to do 40-plus cases with ketamine, Versed and a touch of fentanyl with no oxygen and no desaturation. We did have a Nellcor™ pulse ox plugged into an extension cord, and a portable pulse oximeter (portable pulse) I wore around my neck. Oxygen was available for emergencies, as we did have two tanks, but they were never used.
The ortho tent was small and nauseatingly hot. The other tents had air conditioning that made it tolerable (with the exception of the staff tent), but the ortho tent did not. All of the fixations went there, and it was an area nobody wanted to man. The OB/GYN doctor that I went with ended up being the nurse, medical technician (tech), and doctor for this entire tent, working 36 hours at a time to take care of all the people in need. I did what I could do to help her, but often there was only one Certified Registered Nurse Anesthetist (CRNA) and myself in the wound care tent, so we were also working long shifts.
When I was done giving anesthesia in the wound care tent, I would change roles to whatever was needed. I was triage, bed coordinator, pharmacist, staff nurse, transport, trauma nurse, and a therapist. I went down there to do whatever I could, and that is exactly what I did. This experience changed my life. It was amazing to see what the Haitian people went through, when they had little to begin with. It was a very humbling experience. I had cold water three times when I was there. We had to filter it all and had no refrigeration. We ate MREs (meals, ready-to-eat) for meals, which were often just one to two times a day. I was eaten alive by some kind of “bed bug” the first two nights I was there, but I could not complain because I was safe and not hungry. Bathing was another interesting experience, as it didn’t occur too often. Hand sanitizer was my best friend, but it also attracted dirt terribly, which left me with black residue under my fingernails for days after my return to Michigan.
Professionally, I was able to gain independence and think very critically, while being completely responsible for my patients. I always had a CRNA or anesthesiologist with me, but they were back up. The largest gain was my new ability to take ownership for everything I did. It has helped me immensely in clinical, and I will definitely carry it with me in practice.
Personally, it was difficult for me to return to Michigan and listen to people get upset over trivial issues or complain about how “terrible” their lives are. It is more tolerable now, but I have chosen to live my life differently and try not to take anything for granted. I am happy to be alive and have a healthy family. I am full of warmth knowing I was able to help so many people, yet I am yearning to go back. I know there is so much more work that needs to be done. Haitian people are still being admitted to the hospital with devastating wounds from the initial earthquake, and from the aftermath of cleaning up and trying to repair buildings. There are so many buildings that aren’t safe to live in, but many people don’t know this, and Haitians are still getting injured and killed by crumbling homes. It’s haunting to think of it as I receive messages from friends I made, who have already returned to Haiti.
Thank you for allowing me to share this experience with you. It will always be in my heart and mind, and I believe I would like to do more mission work in the future. Doing something for others is one of the noblest things a person can do, and I would like to continue.