CRNAs Share Their Volunteering Experience

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Ernest P. Ayo, CRNA, DP

Mission Location: Haiti

The medical mission 2010 to Haiti post quake was different enough to merit additional information which may prove helpful for Future disaster missions.
 
There are three stages in all disaster relief efforts.
 
First IMMEDIATE (dangerous with civil disorder -  5 to 7 days) usually done by trained response teams capable of providing food, water, medical triage and care. These teams are self sustaining and have security personnel capable of enforcing civil order. They are usually military in nature.
 
Second (order restored - 2 to 6th week) When infrastructure is somewhat restored,  with electricity and water available, more highly skilled groups arrive. They usually specialize in medical and social care, electrical, carpentry, plumbing and logistics. These teams are usually faith based or civic groups.
 
Third REBUILDING (months to years) This stage mostly involves clean up and construction with some follow up by second stage groups.  Third stage teams are mostly government and civilian. Many religious and civic groups help
 
If you are a member of a first stage team, all your logistics, supplies and equipment are in place. A member of a second stage medical mission team, I found myself dependent on hundreds of people who didn't know each other and most of whom I'll never meet. There were hundreds who donated funds to the hospital or through their Churches. People on phones and computers who recruited our support personnel. In short Cindi, a scrub tech and I became the hearts and hands of many who saw the disaster on the news and wanted to "do something" to aid the quake victims. Our hospital donated 1,200 pounds of anesthesia and surgery supplies and the local Ford dealer provided a van and driver to transport us to the Nashville airport. There we met an orthopedic surgeon who had 800 pounds of surgical instruments from his hospital. We flew commercial to Ft. Lauderdale on South Western airlines who transported our relief supplies at no charge. How's that for "bags fly free"?   We were met in Florida by a Church family and their pastor who fed us and put us up overnight. In the morning after breakfast, we were taken to a private executive airport and flown to Haiti in a large private plane by pilots donating their skills in this effort.  After three and a half hours we landed at a small undamaged air strip in Jacmel (Southeast, Haiti). By then the Canadian Army emergency response team had secured the area and the "Yanks" were welcomed. They told us it was going to break our hearts. I thought "This ain't my first rodeo bub"  By the time we were trucked to our base, an orphanage on the outskirts of Jacmel, our hearts were broken. We had not encountered such poverty before.  For our first meal, lunch we were given tuna, which was to be our noon meal for the rest of the week. We stayed in two long rooms with four bunk beds and two bathrooms which featured a pipe sticking out of the wall for cold showers. I grew to relish those cold showers each night. Each morning after breakfast (similar to what you'd have here) we took a truck about seven miles to a missionary clinic which had an ambulatory unit for minor surgery.  It wasn't designed to be a hospital, but became one as all other medical facilities in the area had been destroyed or damaged beyond use. 
 
Another surgery team from Philadelphia and nurses from Oregon had arrived a couple of days before us. They had brought in an anesthesia gas machine, monitors, instruments and medications. With our supplies added, I thought we were better equipped than most mission groups. Later we discovered we had overlooked many basic items, such as clipboards, scripto pens and medical forms. We were reduced to using scrap paper held together with surgical tape for patient charts. Word to the wise. Remember the non-medical items needed to do your job. We were fortunate to have water and electricity (clinic generators).

It took a great deal of time to set cases up, because the clinic autoclave was limited and we didn't have extra people, time or space to unpack all of our supplies. It was difficult finding what you needed when you wanted it. Also there was no surgery schedule. We just tried to do the worst first. These patients had been waiting in pain for 10 days.  You find yourself doing whatever it takes to get a case going, from mopping floors to cobbling together different parts to create functional suction machines or patient carts. Teaching our young anesthesia provider how to administer an anesthetic without monitors by using the five senses was a good exercise in basic care. Invaluable skill since our electric power was unreliable.
 
The vast majority of cases were done under regional with sedation or Keta-dip. We only had two "J" tanks of oxygen which were kept in reserve for possible general anesthesia. 90 percent of our case load was male. 50 percent were children under 12 y/o, 30 percent were 20 to 30 y/o and only 20 percent were over 50 y/o. So don't forget pediatric equipment and supplies. We saved many legs and arms.

We usually finished up about 8PM and had supper before we were trucked back to our base. The clinic had local cooks who prepared supper. Authentic Haitian cuisine which some of us tolerated better than others. It's a good idea to bring antacids, Imodium and Cipro.

Some required IV hydration. Some tried to survive on peanut butter and tuna with varying degrees of success. I usually go native and sometimes pay the price.
 
Medical mission work is like deep sea diving. You want to stay longer and do more. YOU CAN'T. It is not your culture or environment and like diving, if you don't return you can't survive. Packing to go is easy. You leave everything except the clothes on your back and a few personal items. Sometimes getting home is "iffy" in Stage two. We were dropped off at the airport with our duffel bags and a tuna sandwich. There we waited for planes delivering supplies that might take us back or to another island with commercial air service. Because the planes that day were all very small, we had to split up and meet the next day in Ft. Lauderdale for out trip back to Nashville.
 
There is a post mission let down or depression. Talking to others seems to help. Sorrow shared is halved. Joy shared is doubled. We saw plenty of both in Haiti.
 
As usual should anyone require more information or have specific questions I may be contacted at eayocrna@yahoo.com