North Carolina Baptist Disaster Relief Mission
Community Hospital and Childrens’ Hospital
Port-au-Prince, Haiti - January 23-February 3, 2010
Originally written for the TANA (Texas Association of Nurse Anesthetists) NewsLetter
|Linda Gibson, CRNA, MS, volunteered from January 23-February 3, 2010, at Community Hospital and Childrens’ Hospital in Port-au-Prince, about 10 miles from the epicenter of the earthquake. |
The rented bus took nine hours to reach Port-au-Prince, dodging the potholes. Rescue 24 Team arrived exactly two weeks after the earthquake that leveled much of Haiti’s capital. A few wooden structures remained standing beside four-story businesses that had telescoped into eight-foot mounds of concrete. Colorful taxis passed with emblazoned slogans such as “God is good,” and hopeful smiles greeted us as we peered through bus windows. Our team of 13 included two orthopedic surgeons, two CRNAs, three EMTs, one PA, four nurses and a mechanic. We were silently wondering if we were up to what we had signed on to do!
In truth, you had to be flexible and lend a hand wherever needed. For me, the first day meant running the pharmacy under a huge tented outdoor clinic on the front lawn of the hospital. The doctors were medicating whoever they could send away, and putting "Admit" stickers on the foreheads of those needing to be allowed inside the hospital. A mass of humanity in need pressed the front gates, but only those of us with badges and Haitians with forehead stickers were allowed entrance by armed, military guards. Such is the way we found Community Hospital.
So many teams had brought supplies, but you had to rummage through boxes on the floor of a large room to find what you came looking for. Anesthetists scoured for spinal needles and volatile [anesthetic] agents. An obstetrician/gynecologist specialist was frantic for a vial of terbutaline to stop a premature labor. Intensive care unit (ICU) internists hunted for dopamine. By the fifth day of my adventure, shelves had been erected and medications organized by class and alphabetized. This helped immensely.
I have pictures in my head that may fade with time: a woman being wheeled back for a Cesarean section who only had one arm left with which to hold her newborn; an eight-month-old with no right arm, and the left amputated above the elbow; a father’s only son (a 14-month-old) dying of pneumonia from inhaling debris—he said he searched the rubble many days, but never found his wife.
The next two days I lost count of how many patients, aged eight months to 65 years, I anesthetized for stump revisions and wound debridements at the Catholic Children’s Hospital. Ketamine with atropine/Robinul and fentanyl/Versed supplemented were the standard anesthetics used because only one of the three rooms had an anesthesia machine with suction and a ventilator. The other rooms had a bag valve mask (Ambu bag) with various sized masks and a bulb syringe for suction! A nasal cannula dangled from a large oxygen cylinder. We wiped it with alcohol between cases. And no one recovered your patients for you; you tried to take a look now and then to make sure the babies weren’t falling through the slats. Patients were brought to, and taken from, the operating room (OR) on hand held, military, field stretchers. Patients lined the hallways on these stretchers for hours awaiting surgery. Trauma surgeons volunteered as stretcher bearers.
The fourth day there, I ran the ICU back at the larger Community Hospital. Thankfully, the USNS Comfort at anchor in the port allowed the worst cases to be helicoptered into their hospital. Our ICU had no ventilator, no electrocardiogram (EKG) machine, and no pumps to run the dopamine drips. ICU also served as the post anesthesia care unit (PACU) at Community Hospital. I might have sat down to eat for 20 minutes in my 24 hour shift. We had stroke patients, overdose patients, congestive heart failure (CHF) and pneumonia patients (I had to rescue breathe for two of them as they weakened), besides the post-operative patients. Then at 0400 that night, I was called to the OR for an appendectomy, leaving the ICU with one nurse and one doctor for nine patients, several of them in critical condition. When help arrived at 0800, the other nurse and I slept on the hospital roof, in a tent, in the sun, for a few hours.
The rest of my 11-day tour of duty was spent back in the OR and dressing change rooms at Children’s Hospital where, for lack of the right intravenous (IV) antibiotics, we packed a young lady’s pseudomonas aeruginosa infected arm wound with vinegar-soaked gauze. Perhaps soon the orthopedic doctors would be able to set the humerus fracture in her arm. A couple of patients had tetanus which made me wish I had gotten a booster before leaving the United States.
I made quick friends with my balloon animals at the close of each day. By the time all was said and done, the only phrases I could say in Haitian Creole were “one, two, three lift!” and “God bless you.” Indeed, God did sustain us, watched over our patients, and provided just what we needed among the supplies coming in daily with volunteer teams from all over the world. We worked side by side with the Yugoslavian (Serbian and Montenegrin) team, the French team, the Haitian team and the Italian team—each according to his or her abilities. It was an awe-inspiring adventure.
Linda Gibson, CRNA, MS
College Station, Texas