CRNA Volunteer Nina Bullard, CRNA, MNA

Operation Smile

USNS Comfort, Port-au-Prince, Haiti—February 2-16, 2010
It is amazing to me how humans adapt. The exercise might not be graceful or even conscious, but I have been witness to the most surreal, horrific, yet animated spectacles of survival, all the while sensing the queer feeling that suddenly I am here, in such a bizarre, foreign environment and somehow, this now becomes normal.
Flying from Naval Air Station Jacksonville into Haiti was delayed, so we arrived at Port-au-Prince Airport... tent city, barbed wire, old junk, and endless pallets unexpected in the pitch-dark night. As we circled, we tried to figure out what the flickering lights were along what appeared to be, streetlights? Landing, we found out that nobody really knew how to organize us. Operation Smile, Project Hope, the Orthopaedic Trauma Association, United Nurses International, Johns Hopkins Critical Event Preparedness and Response (CEPAR) disaster-response team. We were the guinea pigs, the first wave of NGOs (non-governmental organization volunteers) for Operation Unified Response.
However, the Navy was in charge, so we quickly became one unit and things started working. We got into two small buses, (the kind with the funky cloth curtains with tassels), and had a military escort (in trucks armed with machine guns) to take us through Cité Soleil. The images are impossible to describe. It was like a Disney ride through hell, seated in a vehicle driving through an apocalypse...shanty towns with thousands upon thousands of people standing around the streets, picking through gigantic mounds of burning refuse in the middle of the washed-out roads. Miles of faded red and yellow Coney Islandesque concrete buildings, obscured by graffiti and filth, yielding even more buildings, now toppled, or precariously deformed. Eventually the remnants of color faded to gray. Concrete, in all its possible consistencies and forms, consumed the landscape.
Plumes of dust erupted in the thick heat as our caravan careened around potholes and fiery garbage in the darkness. The choking smell of broiling refuse was sobering.

Everyone stared out of the windows in silence, watching the sea of human poverty pass by. -- Nina Bullard, CRNA, MNA
Occasionally, as we slowed to navigate questionable roadways or angular turns, the people near the street edge would gesture by touching their hearts and pointing our way or shake their arms skyward. I felt immediate systemic goose bumps. It made the arduous experience of hurry up and wait; we need you right now, get on a plane; sit and wait here; get on a plane, and wait out here (I hope you have access to your mosquito repellent); daisy-chain these supplies; and get on this bus...unconditionally meaningful.
We arrived at the Killick Haitian Coast Guard Base, where we were met by more armed sailors and grateful people waiting for our supplies. We carried 27 ($25,000 each) vacuum-assisted closure devices (wound vacs), orthopedic (ortho) hardware, nonsterile gloves, and endotracheal tubes, etc. The wound vacs were going to save limbs and lives. The hardware was to fix complex fractures (unbelievable!) on people who had been in a ward (bunks stacked two high!) with mind-blowing injuries for over two weeks!
We daisy-chained all of the supplies and luggage from the trucks to transport boats, hopped on board, and headed to the ship. We had Navy boats armed with machine guns all around us, as well as four sailors carrying machine guns with us. There was constant banter on the radio, watching for unknown vessels nearby. Simply awesome.
The odor was overwhelming and the origin became clear. The bay was a flotilla of garbage. Remembering the image of the disillusioned Native American with the tear streaming down his face (from a 1971 television commercial) was unavoidable, however this exponential magnitude of disgust was consuming. The shoreline was 20 feet deep in refuse of waste, garbage, petroleum, even animal carcasses which simply diluted without dispersing throughout the entire ten minute cruise out to the ship anchored off shore.
We arrived, were briefed, filled out endless paperwork, got bunk assignments, were sent to mess (aka mid-rats after 11 p.m., inedible… even by Navy mess standards) and went to find our bunks. I ended up in officer overflow on the bottom deck, fortunately, I found one person awake in the pitch black who pointed me to the sole open bunk, three bunks up. I unpacked just what I needed, threw a sheet and blanket up two feet over my head, climbed up, careful not to step on or wake up, those below me, rolled into the bunk (28 inches of space), made my bed, set my alarm for 4:45 a.m., checked the time – 1:18 – and passed out.
After two days of traveling... end of day one.
Nina Bullard, CRNA, Getting her Patient Ready in Pre-op on the USNS Comfort
A twelve year old girl who had been found trapped under debris. The pressure of the weight of the rubble had clotted-off her popliteal artery (imagine that tremendous ischemic pain!). The whereabouts of her family was unknown.
Initially, declotting the artery was unsuccessfully attempted, so she ended up with a femoral-popliteal (fem-pop) bypass graft (BPG).  She was coming back for a wound debridement (wash out) on her foot and an attempt to close a gaping wound on the lateral portion of her leg from her thigh to her calf, versus a skin graft, due to the possibility of further ischemia if they tried to approximate the wound itself. They opted to stage the closure and she came back again a few days later.
To me, this young lady is Haiti...battling physical and emotional pain, surrounded by people, yet very alone. She is courage, bravery, resilience and uncertainty wrapped into one beautiful, soulful package. 
She, like so many other children (and adults alike), attempted to deal stoically with their personal crisis, but once touched, clung on desperately and wouldn't let go. When I went to the pediatric ward, after my shifts, and asked what I could do to help, they simply asked if I could hold children that refused to be put down...for hours and hours at a time. Those nurses, as a matter of fact, all of the staff and ancillary workers, were the most remarkable and compassionate people I have ever known.
* Daisy-chain: Human chain method for transporting items that are passed from one stationary person to the next.