Carrefour, Port-au-Prince, Haiti — January 28-February 4, 2010
By Emily Mae Zimmerman, CRNA, MS, via correspondence with friends
and colleagues, describing her experience as a CRNA volunteer in Haiti.
Please note: Patients' faces have been concealed on this page in order to protect their privacy.
Thursday, January 28, 2010
Take nothing for granted.
Communications are extremely limited to the few cyber cafes still standing, but I wanted to send a quick note to let you know that I am alive and well. The iPhone is no match for Haiti. I joined my team in Chicago and we departed early in the morning. We arrived in Port-au-Prince around noon, but were stranded at the airport until communications could be made to find transportation to the hospital. In the end, we managed to fit 24 people and luggage in the backs of three trucks.
Conditions are worse than imaginable. The entire city is in ruins. The streets are lined with makeshift tents. Even families with houses that still stand choose to live in the streets for fear of after-shocks. Recently orphaned children sit blank-eyed on sidewalks just lost.
As we drove to the hospital, the smells were overwhelming. Many bodies remain trapped under rubble...it has now been over two weeks.
My first night, I was woken up by someone from the hospital across the street calling for the "blonde-hair anesthesia." There are two anesthetists (myself included) in our team. I grabbed my newfound CRNA friend and ran next door. There was an urgent Caesarean section (stat C-section) at the hospital. The conditions are unbelievable. Makeshift operating rooms (ORs) with out-dated drugs that I have only read about. But we have an anesthesia machine!
This morning I worked in a public health clinic. Six of us assessed over 250 Haitian men, women and children. Later in the afternoon I went back to the hospital to help with anesthesia.
Tomorrow more surgeries.
Take nothing for granted.
"Old sheets and tarps have become many Haitians' only shelter from the elements. These 'tent cities" have emerged from 'the event'".— Emily Zimmerman, CRNA, MS
A young girl sits amid the destruction.
Destruction and rubble cover Port-au-Prince.
A makeshift outdoor field operating room, consisting of two large blue tarps held up by a branch and a cinder block, lit solely by one dim, ancient floor lamp.
"It was really a disturbing scene; as if I was back in the Civil War era,.. only this is 2010. Like nothing I could have imagined I would ever witness in my entire life. Only a few hundred miles from my home in Illinois....yet, in so many ways...it was a world away." — Emily Zimmerman, CRNA, MS
Saturday, January 30, 2010
My medical group has now teamed up with other groups to provide all various needs. One group cooks and serves food; one group of contractors and engineers covers construction and rebuilding; and my team provides a medical care and public health clinic. Together, we are trying to serve the Haitian people and enable them to rebuild from the earthquake (or, as they refer to it, "the event"...no one wants any reminder of the earthquake).
Now that the initial help is filtering out, we are left fighting old fractures, infection, and severe malnutrition...the worst cases imaginable.
Right now, my time is divided between the clinic and anesthesia at the hospital at night. The public health clinic I worked at today saw over 400 people between about seven doctors. Many of these people have never received medical care in their lives, so they are so very appreciate of anything. I started an intravenous on a two month-old that was terribly dehydrated and took her over to the hospital.
Gotta go. Internet is running out.
Emily's Team was made up of physicians, surgeons, and nurses from countries all over the world.
These past few days have kept me so busy in the OR that I've gotten behind in my correspondence.
Another long, busy day in surgery full of fracture repairs and wound debridement. The smell of the three week-old wounds is overwhelming. Poor sanitization conditions combined with long hot days spent in crowded tents with little to no ventilation. Thank heavens for Vicks VapoRub!
I left the hospital around 8 p.m. to return to camp. We now have running water! I immediately headed straight for a shower, which really consists of bathtub and garden hose pulled through the bathroom window. It's freezing cold, but I can't wait to "come clean" of today. I yell for someone outside to "turn on the hose!" and not more than two minutes later, hear a voice outside, running down the alley and coming toward the clinic. A nurse from the hospital pounds on the door of the clinic for me to "come quick" to the hospital..."a stat C-section." Still soaking wet, I throw on scrubs, call for Sandra (the other anesthetist and native Haitian), and we follow her back to the hospital.
We quickly gather whatever supplies we can find through all of the mess of medical equipment just shipped in (thank you to all who donated!). Turns out there are in fact two C-sections, but only one surgeon. The most critical goes first: umbilical cord wrapped around the baby's neck. Spinal block and within four minutes the baby is pulled out, blue, completely limp, and lifeless. It was then that we realized that there was no one available to take care of the baby, who is cyanotic and silent. The surgeon continues to suture, while I leave mom to help the baby ("patient abandonment" and illegal in the U.S.)...not to mention the fact that I know extremely little about labor and delivery nursing! ...desperate times. Sandra takes over the care of mom, while I attempt to stimulate and suction the baby. Yes,... I am screaming for help the entire time. A Canadian emergency room doctor hears me and comes to the rescue. Together we stimulate and suction large amounts of aspirated meconium, and soon....hear crying. The most beautiful sound in the world!
Sandra and I must quickly get ready for the second C-section. I wheel the last newborn into the room with us. Again, there are so many things wrong about the conditions we must work under, but we must just adapt and adjust to what we have. There is no neonatal intensive care unit (NICU). New babies and moms get sent back outside to the yard (literally) just after delivering. This baby was nowhere near stable enough to be left unattended.
Sandra and I were getting ready to do a spinal block on the next mom when a code was called on a baby that had been rushed into the hospital from the "tent village." The mother just cried and pleaded (in Creole) to help her baby. The infant was intubated and coded for over 20 minutes before time of death was called. I completely broke down. I tried to hide behind my glasses and mask as I cried right there in front of everyone. It was unbearable. And even still, after experiencing such heartache, I had to return to the OR to finish the last C-section. I'm thankful I stayed. As difficult and cold as it felt at the time, I needed a "happy ending." I got just that. One loud, crying, healthy baby. As two new lives were brought into the world tonight, one was taken away. A harsh and unjust life.
The hardest part about tonight was wondering and asking myself, "what if?” "What if this baby had been in the U.S.?"...same baby, same illness, only with better medical access. Would the outcome have been the same?" I heavily doubt it. That is what makes it so hard...wondering why some are so fortunate and privileged, just by the geographical location in which we have been born, while others are born into nothing. It just seems so unfair.
Emily with her "miracle baby"....one of the emergency C-sections from Emily's "memorable night."
Sunday, January 31, 2010
Sorry no update yesterday. It was one of my longest, most challenging days so far. The public health clinic was closed because it was Sunday, so I spent the entire day in the OR doing anesthesia. It still amazes me that it is nearly three weeks after "the event" and many with broken bones and large wounds are just now getting to the hospital for treatment. At this late point in time, outlooks are poor and infection is rampant. I've never seen so many gangrenous limbs. Anesthesia is difficult because no one will allow general anesthesia. No one wants to go to sleep. They are all afraid that we might amputate their legs while they are "asleep." Their fears are understandable. During the early response after the earthquake, out of desperation and lack of resources, many doctors had to resort to amputation to save the patient. And so, my skills in spinal blocks have gotten a lot of practice.
Adventist Hospital (Hôpital Adventiste d’Haiti) is amazing. I feel like I am working at the United Nations. On one case, I might have a surgeon from France, one from China, a circulating nurse from Thailand,.... oh, and an anesthetist from Illinois. It has really been remarkable to see so many people of such different backgrounds come together for the same united cause. The hospital, though it has suffered severe damage, is one of the few hospitals in Haiti left standing. There are many great big cracks in the concrete and foundation and some parts of it have fallen, but just the fact that some of it remains "serviceable" is more than most other buildings surrounding the epicentre of the earthquake. Aftershocks are still occurring, though I haven't felt any since I've been here, which makes working in the hospital a bit scary at times.
With so many hundreds injured and so much damage to the hospital, there is no room for patients. Instead, they have created "tent villages" to which patients have been assigned. Rows of tents fill the entire yard within the confines of the hospital gates. Tents so close, the tarps and sheets that make up the walls touch each other. There are so many sick people. It's often hard for us to locate patients within the tent village to be able to bring them to surgery. Patients have become identified by their tent numbers.
Preoperative and initial ER is outside too. There are even tents still set up as operating rooms outside, from the first days when limbs were being amputated outside in the masses. Tonight I even ran a code on a woman rushed in from the "village." Family yelling 15! 15! 15! ...her tent number. She was carried to the outdoor OR tent, which consists of two large blue tarps and one dimly lit ancient floor lamp. The OR table is nothing more than a slab of metal on blocks. It was really a disturbing scene; as if I were back in the Civil War era…only this is 2010. Like nothing I could have imagined I would ever witness in my entire life.
This is Haiti right now. The scariest part is that this is not temporary and not going away any time soon. In fact, I'm afraid of the weeks ahead. I'm afraid of infections, effects of long-term immobilization, and severe malnutrition and dehydration. While Haitian people are very peaceful and appreciative, in the face of hunger and starvation, people become desperate. I don't ever feel unsafe, though. People recognize the need for doctors and nurses and are extremely grateful for help. The U.S. Navy just arrived today, some of the first groups of Americans I've seen outside the airport in Port-au-Prince.
Oh, and I randomly ran into my Haitian friend, Frandy, at my clinic the other day! The world (and Haiti) is so small.
Emily in front of the "tent city" within the walls of Hôpital Adventiste, where she provided anesthesia for surgeries.
Like a kid on Christmas, this boy was elated. After two weeks of immobilization, he finally got a pair of crutches.
Emily with her Haitian friend Frandy who helped serve as Emily's translator while she was in Carrefour.
"No, I'm not reading....and it's not Sudoku either! This was me giving my best attempt at speaking Creole ....I needed a 'cheat sheet.'"—Emily Zimmerman, CRNA, MS
Monday, February 1, 2010
Today I met two of the most inspiring people I have ever had the privilege of knowing: Rachelle and her faithful brother, Eddie. Her story is nothing short of a miracle. Rachelle studied law at the University, where only two students survived after the fall of the Law School. Two days after the earthquake, just before bulldozers were sent in to clear out the remains of the building, Rachelle had still not been found. Convinced that his sister was still alive, Eddie pleaded to allow him to search one last time. Piece by piece, he dug through the rubble. Alas, he found his sister trapped at the bottom! Her arm had to be amputated to extract her, but thanks to a dedicated and talented ortho surgeon, a prosthetic arm may be in her near future! Just as impressive, her attitude and perseverance has never failed as she announces, "Jesus loves me," as she wakes from anesthesia. Her spirit inspires me!
The earthquake brought us to Haiti, but the tribulation of the people will keep "us" here long after the event.
A clinician with Rachelle and her faithful brother, Eddie.
Tuesday, February 2, 2010
A rewarding but also unfortunate part of surgery here is that I am now beginning to see "repeat patients" for wound debridements. We are developing close friendships with some of those children who are now homeless and parentless. One particular 11 year-old girl "Miranda" cries uncontrollably every time she enters the OR, but she knows that every time she wakes up she gets a Tootsie pop. It is the first thing she asks after opening her eyes...she never forgets either!
There were two more aftershocks today. During one of them the lights and power turned off completely, which also included my anesthesia machine. It was only a brief moment, but pretty scary nevertheless, and so devastating for the already terrified and suffering people.
Between cases later this evening, I am able to escape the chaos of the environment and sneak up to the roof of the hospital. The stars light up the black sky. From here, I can see across Carrefour, out to the sea, and along the beautiful mountains. For that brief moment, I am able to forget about the tragic event and just take it all in. It is absolutely breathtaking and surreal.
There is so much beauty here is Haiti. I wish everyone could see it firsthand to appreciate it. Until then, I'm taking lots of pictures!
Emily with one of the children of the tent city within the hospital walls.
"These tents housed over 900 patients for whom we cared. I would walk up and down the endless rows of tents seeing patients and taking some in for surgery. Yet, somehow this little boy would find me each time."—Emily Zimmerman, CRNA, MS
In the pre-op tent: This little girl is so happy, because today she will finally get her surgery.
View from the rooftop of the Hôpital Adventiste d’Haiti.
Friday, February 5, 2010
One last note: This time to let you all know that I am back home safe and sound (and will no longer have to resort to mass emails via my iPhone....thanks for ignoring the lack of editing or spell check). My team was "relieved" by another medical team to cover surgery and anesthesia at Hôpital Adventiste, as well as more coming to help support and continue our public health clinic started through Operation Hope for Children of Haiti. Departing Port-au-Prince and returning to the states has become a little more challenging this week for civilians than in weeks prior. More and more commercial airlines have begun to pull out flights from Port-au-Prince, which has left many aid and relief workers to rely on military flights to get home to the U.S. The fears aren't as to whether or not we would be able to leave; it was just a matter of when. Fortunately, a small group of us were allowed on a four-passenger Cessna. We made a quick stop in the Bahamas to refuel before landing in Ft. Lauderdale late last night. With the SuperBowl in south Florida this weekend, all hotels were booked, so I got one more opportunity to "camp out" in the Delta terminal. With the help of my awesome brother, Damian, and his pilot college roommate, I made it back home to Illinois today.
I can't describe my appreciation for the "simple joys" that before I had always taken for granted; food, running water, clean drinking water, toilets, and a warm shower!!! My last day in Haiti, as I gathered my clothes and supplies to donate to some new friends, I realized just why my hair had never really felt clean, even after a good garden hose shower: the "conditioner" that I had been using all week actually turned out to be body lotion. Whoops!! Yet another drawback to showering in the dark by flashlight.
Leaving Haiti and all those still suffering has been more difficult than I had imagined. I have so many mixed emotions right now. I'm so grateful to be back home with my wonderful family whom I have missed so much. Yet, I can't help but feel an enormous amount of guilt for those that I have left behind. My time there feels too short, with so much left "unresolved" and "unfinished." Regardless, I am thankful for the time I was able to spend there and humbled by all that I experienced in such a short time. I will try very hard to remember it every day. It's a good reminder to stay grounded and appreciative of all that we have to be thankful for. Thank you all for the many kind words, thoughts, and prayers that I received while I was over there. Prayers and good intentions will always be appreciated, but the true praises go to those who devote their entire lives to serving "the least of these." I simply responded to a small need during a time that had the opportunity. I hope this experience can be the first of many more.
Landscape seen from the rooftop of the Hôpital Adventiste d’Haiti.
More about Emily Zimmerman's experience in Haiti can be found at www.alestlelive.com
, the Southern Illinois University, Edwardsville, student newspaper.