University of Miami/Jackson Memorial Hospitals/Project Medishare
Port-au-Prince, HaitiJanuary 27-31, 2010
On January 27, 2010, Mercedes Weir, CRNA, and I took off from Miami International Airport headed for Haiti with a group of medical professionals from the University of Miami and Jackson Memorial Hospitals, in conjunction with Project Medishare. We would be stationed at a makeshift tent hospital located on the aiport grounds. The anesthesia department at the University of Miami Hospital (UMH) where we work, was influential in the creation of the fascinating tent hospital complex. By the time we arrived, it had grown from a corner at the United Nations (UN) compound next door, with no toilets, water, or food supplies, doing rudimentary emergency lifesaving surgery to an organized, efficient, and even somewhat comfortable tent hospital.
"Candace is about to administer an intramuscular (IM) combination to a child prior to a dressing change for crush injuries to both arms and I think her legs also. Dr. Sean Ward, a podiatrist and wound care specialist is looking on waiting for the medication to take effect. It was sometimes heartrending as we were in a 'children's ward' and the next child to receive dressings would hear the screams of his predecessor receiving the shot. Fortunately, it was shortlived as ketamine works very quickly." – Mercedes Weir, CRNA
"I have sedated this girl who had very deep open tibial wounds and a sacral burn wound that Dr. Sean Ward, was debriding. The injection consisted of ketamin, Versed, and Robinul. We had no oxygen for wound care, and one pulse oximeter to share. Every time I hooked a sedated child up to the pulse oximeter it read 100 percent. I have come back with a new respect for ketamine! The man holding the patient's hand is her father, who is very protective of her!"—Candace Brown, CRNA
By the time we arrived, there were lots of anesthesiologists to staff the operating room (OR), and the two nurse anesthetists who were from UMH that we were replacing had already told us of the important role they had played during their five days with the wound care team, sedating the children for their painful daily wound debridements
and dressing changes. They begged us to continue, so the children could have this done without pain! And so we did. Other nurse anesthetists there sedated the adults for dressing changes and debridements. It is a perfect place for our skills, and an incredible experience to do such good for those people in their time of need!
As CRNAs we also had the opportunity to organize the system somewhat, set up a nothing by mouth (NPO) list, start intravenous drips (IVs), answer medical questions, etc., and utilize our expertise to help the nurses and ancillary staff be most productive. There are no bosses at Project Medishare so eveyone can do what they do best, each addding a bit of expertise and creativity to support the whole picture. No pressure, no boss. If you are feeling overwhelmed, go lay down for awhile!
A tiny baby with a superficial foot wound, no sedation needed.
CRNAs are still needed. I spoke with one of the coordinators of Project Medishare today, and she said there are no CRNAs on the list for this next plane out! When Mercedes and I left, we sought out two other CRNAs already there, to replace us on the wound care team. We also felt it important to replace ourselves with others who could safely, heavily sedate these kids! Please if any CRNAs are feeling the need to volunteer in Haiti this is the perfect spot! It is located on the airport grounds with military personnel everywhere so it is quite safe. It has evolved into a place with Port-a-Potties, abundant water, and even military ready-to-eat meals. Mercedes ate them and said they were quite good, I did not! We slept in a communal, air conditioned, white, circus-sized tent with good-smelling Port-a-Potties, and even cordoned off areas for showering! There isn't always running water, but a big bottle poured over one's head does wonders!
"A father holding his daughter who had extensive wounds to her leg. She has already been sedated and Candace is holding her hand as the child also holds her. Candace is feeling for chest rise, etc. We had one pulse oximeter to share between the two stations. So Candace is carefully observing the child's airway, respiratory effort, color, etc., (as well as providing comfort and support) because electronic equipment and supplementary oxygen were not available at that particular station."—Mercedes Weir
"This little girl had head wounds, right leg and right and left arm wounds. You could see the whole tibia bone when we took off the leg dressing! Again sedated with ketamine, Versed and Robinul. Sometimes I had to redose and give another injection if there was no IV. The podiatrist doing the debridements was phenomenal! I met so many talented, dedicated people!"—Candace Brown, CRNA
It is easy to find your niche in this tent hospital. When you arrive, go straight to the OR area and tell them you are a CRNA and are here to help. There is O2 (oxygen) in the OR and two working anesthesia machines, and four OR tables. It is in this area that we got all our supplies and medications (meds) and you can stay there all the time if you like! No one will tell you what to do. Anything you can do to help will be appreciated! Also, the best spot to charge your cellphone is behind the anesthesia machines in those multiport electrical strips!
Think about volunteering there, they desperately need us, and are arranging teams and airplanes, a ride there and back, for five days at a time.