At this point, Michael and I decided this was all too complicated so we decided to go back to our compound and check in with the team. As we were escorted back to our beat-up toyota, the Marines guarding the gate asked how our meeting went. When I said, "not too well", they were very interested as to why. The toyota seemed to be running better and as we pulled up to the entrance to our compound, I noticed a big iron gate on the ground, a victim of the earthquake and the reason we couldn't secure our compound. One of our team members, Nate, a volunteer Woodway police officer was guarding the gate with a rope across it and told us he'd been successful at turning away all Haitians except those with life-threatening issues......as instructed by one of our team doctors.
As we drove through the crowd of Haitians to the "treatment area", all the docs and nurses were still hovering over the patients with camping headlights as the only source of illumination. We discussed our meeting with Marines and decided that Nate was doing a good enough job for now. Just then, (queue the "Indiana Jones" music), the Marines drive into our compound in two Hummers! There were in full body armor with M-16's strapped to their sides. It was the gate guards and two of the Marines who heard the CO's comments in their headquarters tent. They said, "we talked the CO into letting us be here as just a "presence"....but not security for you!". These guys were sympathetic to our cause. All they had to do was stroll through the crowd just once and it dispersed. Things were much more peaceful now. The Marines said they couldn't stay long so after a few minutes and much thanks from us, they departed. About 5' after they left, in drive the Spanish! Apparently they had decided to come after our seizing pregnant lady. They had on OB/gyn with them and he asked all the right questions that made us assured that she would be in good hands. They loaded her into their military ambulance and drove off with lights flashing. A few minutes later, we heard their chopper taking off and heading out to their hospital ship. The Spanish called the next morning asking to borrow some of our IV medications for our pregnant patient. We needed some Foley catheters so we made a deal and an exchange with the Spanish. They said the patient had an emergent C-section that nite, fetus was still born as expected but mother was doing well.
Back to the nite before,...so now we had 3 burn patients, and two trauma victims in serious condition to watch over nite. We decided to take 2 hour shifts overnite, one doc, one nurse at a time. I had the 11pm to 1am shift with an awesome Angel of a nurse from Michigan. We had all kinds of issues with a Foley catheter (hence our need for more) on one of our burn patients and had to rig something made out of syringes to make it work (an idea of Michael's, our miracle-working McGyver). All the patients seemed to be stable as we handed off to the next shift. Sleep did not come easy after this adventure and about 2pm, I could hear some rumbling in the distance, then heard the metal roof shaking on the nearest building. Sleeping on the top bunk, it then started to shake pretty good for about 5 seconds......an aftershock.
We all awoke the next morning and made the rounds on all the patients. A few more patients walked up in the middle of the nite, it was reported, but they weren't serious so they were assessed and "discharged" from our compound.
About this time I was alerted to a pregnant patient who had walked one and a half hours out of the mountains. The story was she had delivered a stillborn child at home but the placenta had not passed. The patient arrived with the "midwife", it was explained to me, from this mountain village. Strangely enough, this "midwife" was a middle-aged MAN. This midwife feared she may have another baby inside of her. I assessed her......her uterine fundus was high indicating her uterus was not empty. No fetal heart tones were heard with doppler so either there's another non-viable fetus inside or just retained placenta. Cervical exam did not reveal any fetal parts. One of the ER residents on our team gave some anesthesia as I manually explored her womb and removed the retained placenta. We gave her some IV fluids and IV antibiotics and were able to discharge her home in good condition a few hours later.
One or two more posts to come soon, then i'm done!
Monday, February 15, 2010
Thursday, February 11, 2010
Continuing on.....
The second burn victim was a middle-aged gentleman. Both patients had similar burn patterns covering roughly 40% of their bodies, which can be fatal within several days. The teenage burn patient and another pregnant patient (who was in false labor........ not the eclamptic one) arrived with paperwork from a Haitian doctor in Petit Guave who had evaluated them earlier in the day and referred them to us. We were now the secondary referral center for the area! This was crazy! We were working on patients on the floor of a temporary wooden shack and under tarps outside, all in the dark without electricity!
We had already been caring for one "inpatient," a 4-year-old burn patient whose burns were becoming infected. He was getting IV fluids and IV antibiotics. So, now we had 6 ICU level patients under our care for the night. We decided we had to get the seizing preeclamptic transferred to a higher level of care as she was likely to die if her dead baby were not removed by immediate c-section. Samaritan's Purse had a med-evac chopper and our compound had transferred several patients out by this option in previous days. Our call to them was fruitless, as they said they weren't flying at night as no air-traffic control was available in the area. We then decided to call the Spanish. They said they would check with their commanding officer and call us back. This didn't sound promising.
At this time, we decided we needed the help of the Marines next door for crowd control and possibly to help with transfer of our seizing pregnant lady. A call to them was unsuccessful, as cell service seemed to be down at the time. It had been spotty earlier in the day. We decided to drive next door and talk to the Marines in person. I can't recall the details, but somehow I was the one chosen to go next door. Our acting pharmacist, an amazing 20-year-old gentleman called by God to serve (more about him later), and I hopped in a beat up Toyota pickup and started the drive next door. We joked that the accelerator might get stuck on the way. The truck would barely run as we pulled out past the gathering Haitian crowd. We approached the gate of the Marine camp and asked to speak to their commanding officer whose name I'd been given. Walking into their headquarters tent, I had to give our story to about 3 Marines, I guess working my way up the chain of command. Finally the CO strolls in. He listens to my story and I ask him if he can help us. He says that the U.S. Armed Forces have been given strict orders not to "engage" Haitians and they could not provide security. He could not provide helicopter transport, as they also were not flying at night. He then proceeds to say, "This is a disaster and you guys VOLUNTEERED to come down here. People die in these situations and things can get bad. There are no rules down here. Anything can happen." This gentleman apparently has ill feelings toward Christians, as he then proceeded to say, "What rules do you guys refer to?.....Oh, yea, you've got that BIBLE to refer to, don't you?" This made me very angry, but I decided I would just look him in the eye and not say a word and show no emotion. A VERY LONG silence followed. I sensed that the other Marines in the tent realized the CO had said something inappropriate. One younger Marine then said, "I'll give you some phone numbers to call." He then wrote down the numbers to the UN, Samaritan's Purse (which we already had) and the Haitian Police. He said the Haitian Police could probably help. He said he's not sure why, but the Haitian citizens seem to be very scared of the Haitian Police. This Marine gave me the Haitian Police Chief's home phone number. He also said the UN had been authorized to provide security, but their compound was on the other side of town. I didn't have confidence that our beat up Toyota would make it, so I asked the CO if one of his men could transport us to the UN compound. He said yes, but they couldn't wait around to transport us back.
More to come later......
The second burn victim was a middle-aged gentleman. Both patients had similar burn patterns covering roughly 40% of their bodies, which can be fatal within several days. The teenage burn patient and another pregnant patient (who was in false labor........ not the eclamptic one) arrived with paperwork from a Haitian doctor in Petit Guave who had evaluated them earlier in the day and referred them to us. We were now the secondary referral center for the area! This was crazy! We were working on patients on the floor of a temporary wooden shack and under tarps outside, all in the dark without electricity!
We had already been caring for one "inpatient," a 4-year-old burn patient whose burns were becoming infected. He was getting IV fluids and IV antibiotics. So, now we had 6 ICU level patients under our care for the night. We decided we had to get the seizing preeclamptic transferred to a higher level of care as she was likely to die if her dead baby were not removed by immediate c-section. Samaritan's Purse had a med-evac chopper and our compound had transferred several patients out by this option in previous days. Our call to them was fruitless, as they said they weren't flying at night as no air-traffic control was available in the area. We then decided to call the Spanish. They said they would check with their commanding officer and call us back. This didn't sound promising.
At this time, we decided we needed the help of the Marines next door for crowd control and possibly to help with transfer of our seizing pregnant lady. A call to them was unsuccessful, as cell service seemed to be down at the time. It had been spotty earlier in the day. We decided to drive next door and talk to the Marines in person. I can't recall the details, but somehow I was the one chosen to go next door. Our acting pharmacist, an amazing 20-year-old gentleman called by God to serve (more about him later), and I hopped in a beat up Toyota pickup and started the drive next door. We joked that the accelerator might get stuck on the way. The truck would barely run as we pulled out past the gathering Haitian crowd. We approached the gate of the Marine camp and asked to speak to their commanding officer whose name I'd been given. Walking into their headquarters tent, I had to give our story to about 3 Marines, I guess working my way up the chain of command. Finally the CO strolls in. He listens to my story and I ask him if he can help us. He says that the U.S. Armed Forces have been given strict orders not to "engage" Haitians and they could not provide security. He could not provide helicopter transport, as they also were not flying at night. He then proceeds to say, "This is a disaster and you guys VOLUNTEERED to come down here. People die in these situations and things can get bad. There are no rules down here. Anything can happen." This gentleman apparently has ill feelings toward Christians, as he then proceeded to say, "What rules do you guys refer to?.....Oh, yea, you've got that BIBLE to refer to, don't you?" This made me very angry, but I decided I would just look him in the eye and not say a word and show no emotion. A VERY LONG silence followed. I sensed that the other Marines in the tent realized the CO had said something inappropriate. One younger Marine then said, "I'll give you some phone numbers to call." He then wrote down the numbers to the UN, Samaritan's Purse (which we already had) and the Haitian Police. He said the Haitian Police could probably help. He said he's not sure why, but the Haitian citizens seem to be very scared of the Haitian Police. This Marine gave me the Haitian Police Chief's home phone number. He also said the UN had been authorized to provide security, but their compound was on the other side of town. I didn't have confidence that our beat up Toyota would make it, so I asked the CO if one of his men could transport us to the UN compound. He said yes, but they couldn't wait around to transport us back.
More to come later......
Tuesday, February 9, 2010
Saturday Night in Petit Guave
Saturday night is when the large majority of Petit Guave residents discovered we were providing medical care. After supper, when we thought we were all done, we heard shouts of "docTOR, docTOR" from some Haitians on the other side of our pharmacy. We arrived to find 3 victims of a motorcycle vs. pedestrian accident. An elderly couple in their 80's had been hit by a young man in his 20's. All three were hauled in either on motorcycles or in the backs of cars. The young man was unresponsive but had stable vital signs, with possible internal abdominal injuries and internal head injuries. Without diagnostic capabilities such as Cat scans and xrays, it's impossible to tell. We decided to give him time and let his injuries "declare" themselves if they were truly present. The elderly lady had a huge hematoma on her head and either a shattered right knee or severe ligamentous injury. Internal head injuries could not be ruled out on her, either. The elderly gentleman had some lacerations that were sutured but no severe injuries.
As we were finishing up with these, a pregnant lady was brought in unconscious. History via interpreter was that she had seizure activity. As we were attempting to start an IV, she started seizing again. This made it impossible to start the IV. We had to give her seizure medication by intramuscular injection. Her blood pressure was high; it was clear she had eclampsia of pregnancy. This can be fatal for mother and baby. We could not pick up fetal heart tones via a doppler monitor, so we assumed baby was already gone. We had no ultrasound to confirm.
At this time we heard shouts and some scuffling outside. Apparently, the relatives of the elderly couple were seeking revenge on the young motorcycle driver. We could not confirm this as the interpreters were gone. By this time a crowd was forming, pressing in on our treatment area and several other patients showed up with some minor complaints. Then two patients with large severe burns arrived. The first was a teenage boy who was wearing a dress because the burns were too painful to wear pants (or maybe his only pair of pants was burned in the fire).
More to come later . . .
As we were finishing up with these, a pregnant lady was brought in unconscious. History via interpreter was that she had seizure activity. As we were attempting to start an IV, she started seizing again. This made it impossible to start the IV. We had to give her seizure medication by intramuscular injection. Her blood pressure was high; it was clear she had eclampsia of pregnancy. This can be fatal for mother and baby. We could not pick up fetal heart tones via a doppler monitor, so we assumed baby was already gone. We had no ultrasound to confirm.
At this time we heard shouts and some scuffling outside. Apparently, the relatives of the elderly couple were seeking revenge on the young motorcycle driver. We could not confirm this as the interpreters were gone. By this time a crowd was forming, pressing in on our treatment area and several other patients showed up with some minor complaints. Then two patients with large severe burns arrived. The first was a teenage boy who was wearing a dress because the burns were too painful to wear pants (or maybe his only pair of pants was burned in the fire).
More to come later . . .
The Adventure.
Dear Friends and Family,
Many thanks for your prayers while we were gone. They were felt and much needed. Starting Saturday, it got busy and I couldn't talk to Lori much, so I'll type here what happened. First, let me describe the last 6 pictures on the blog. Lori and I aren't bloggers so we can't figure out how to go back and "subtitle" the pictures. The picture of the inside of the cargo plane with back end open and the Air Force airman sitting on the "tailgate"........this airman is directing the pilot via headset while this huge plane is backing up. "little more to the right, now little to the left........"
Let me digress and say how much I was impressed with our Military (except for the CO of the Marine compound next door......I'll talk about this later). We were VERY glad for their presence and I was impressed with their capabilities, professionalism, and POWER! The group at Quisqueya school compound were US Special Forces and were hulking muscular men, one a former defensive lineman for University of Nebraska.
The picture above the one described above (I'll go in ascending order now) is our "delivery room/procedure room" where babies were delivered, fingers amputated, etc. Speaking of the finger, we had seen a gentleman who had exposed tendons and bone on one hand and had been getting daily wound care since the earthquake. His fourth finger was barely hanging on so the wound care nurse that we brought with us asked if I would "finish the job and cut it off" since it was not viable. As was I numbing the man's hand with a shot, I noticed some pulsations deep in his wound - maggots. I pulled out 8 to 10 of them. Seeing maggots in a wound was a first for me (as was the amputation). One of our docs with some 3rd world experience said they were actually not too harmful and "only ate dead tissue". Thus we decided to leave some in and not risk spreading infection further by trying to get all of them out. They were deep in his wound. We dressed the wound and the decision was made to continue daily wound care and injections of antibiotics until we could get him to a surgeon for amputation of his hand. It was clear the infection was spreading slowly up his arm. All of us docs would get together and talk about how to handle difficult cases, which was a very good thing. In addition to sharing ideas, it held us all accountable and helped prevent any "head-strong" tendencies. This sort of thing doesn't happen much in the States.
Now back to the pictures. The next one up is a picture of 2 Marines providing a "presence" in our compound. "Hooooaah!" (that one's for you, Carl Gordon).
Next picture up is our pharmacy. The lady in pink is a nurse from New Brunswick, Canada.
Next picture up is our "clinic" under a tarp. The man wearing a cap in the distance is a New Brunswick Canadian GP physician who still works some ER time (his experience was helpful). The man in the foreground is a Paramedic with our group from Waco. He's also a Woodway (suburb of Waco) Policeman. His talents in both roles were also VERY helpful. The tarps are for shade, AND, to protect from mangos. Mango trees covered our compound and they were dropping frequently, especially around dusk when it cooled off a little. These trees were tall so the falling mangos could leave a pretty good "goose egg" with a direct hit on top of a head.
The top and final picture shows two Spanish physicians (from Spain, not Mexico). The tall one in the dark blue is a radiologist and the shorter grey-haired one is a surgeon. They were only there for about 45 minutes. The surgeon debrided a Haitian lady's bad foot wound with exposed tendon and spreading infection. They accepted her for transfer to their hospital ship for further treatment and possible amputation. The man with the maggots in his wound was gone by this time, unfortunately. We didn't know the Spanish were coming that day.
The first day, we say a grey Huey helicopter circling over head repeatedly. I could tell it was not American. It then disappeared, and a few minutes later the Spanish come driving up. I guess they could tell we were medical from overhead, or maybe they had talked to the Marines next door. They were "assessing" local medical needs.
I'll describe the events of Saturday nite and the interaction with the Marine Commander in my next post.
Many thanks for your prayers while we were gone. They were felt and much needed. Starting Saturday, it got busy and I couldn't talk to Lori much, so I'll type here what happened. First, let me describe the last 6 pictures on the blog. Lori and I aren't bloggers so we can't figure out how to go back and "subtitle" the pictures. The picture of the inside of the cargo plane with back end open and the Air Force airman sitting on the "tailgate"........this airman is directing the pilot via headset while this huge plane is backing up. "little more to the right, now little to the left........"
Let me digress and say how much I was impressed with our Military (except for the CO of the Marine compound next door......I'll talk about this later). We were VERY glad for their presence and I was impressed with their capabilities, professionalism, and POWER! The group at Quisqueya school compound were US Special Forces and were hulking muscular men, one a former defensive lineman for University of Nebraska.
The picture above the one described above (I'll go in ascending order now) is our "delivery room/procedure room" where babies were delivered, fingers amputated, etc. Speaking of the finger, we had seen a gentleman who had exposed tendons and bone on one hand and had been getting daily wound care since the earthquake. His fourth finger was barely hanging on so the wound care nurse that we brought with us asked if I would "finish the job and cut it off" since it was not viable. As was I numbing the man's hand with a shot, I noticed some pulsations deep in his wound - maggots. I pulled out 8 to 10 of them. Seeing maggots in a wound was a first for me (as was the amputation). One of our docs with some 3rd world experience said they were actually not too harmful and "only ate dead tissue". Thus we decided to leave some in and not risk spreading infection further by trying to get all of them out. They were deep in his wound. We dressed the wound and the decision was made to continue daily wound care and injections of antibiotics until we could get him to a surgeon for amputation of his hand. It was clear the infection was spreading slowly up his arm. All of us docs would get together and talk about how to handle difficult cases, which was a very good thing. In addition to sharing ideas, it held us all accountable and helped prevent any "head-strong" tendencies. This sort of thing doesn't happen much in the States.
Now back to the pictures. The next one up is a picture of 2 Marines providing a "presence" in our compound. "Hooooaah!" (that one's for you, Carl Gordon).
Next picture up is our pharmacy. The lady in pink is a nurse from New Brunswick, Canada.
Next picture up is our "clinic" under a tarp. The man wearing a cap in the distance is a New Brunswick Canadian GP physician who still works some ER time (his experience was helpful). The man in the foreground is a Paramedic with our group from Waco. He's also a Woodway (suburb of Waco) Policeman. His talents in both roles were also VERY helpful. The tarps are for shade, AND, to protect from mangos. Mango trees covered our compound and they were dropping frequently, especially around dusk when it cooled off a little. These trees were tall so the falling mangos could leave a pretty good "goose egg" with a direct hit on top of a head.
The top and final picture shows two Spanish physicians (from Spain, not Mexico). The tall one in the dark blue is a radiologist and the shorter grey-haired one is a surgeon. They were only there for about 45 minutes. The surgeon debrided a Haitian lady's bad foot wound with exposed tendon and spreading infection. They accepted her for transfer to their hospital ship for further treatment and possible amputation. The man with the maggots in his wound was gone by this time, unfortunately. We didn't know the Spanish were coming that day.
The first day, we say a grey Huey helicopter circling over head repeatedly. I could tell it was not American. It then disappeared, and a few minutes later the Spanish come driving up. I guess they could tell we were medical from overhead, or maybe they had talked to the Marines next door. They were "assessing" local medical needs.
I'll describe the events of Saturday nite and the interaction with the Marine Commander in my next post.
Monday, February 8, 2010
Saturday Clinic
Keith is home safe and sound, and will add lots of details and stories soon. He was so hungry that he actually requested a Whataburger WITH fries . . . that's something, coming from my grilled chicken
or salad guy.
or salad guy.
Headed Home, Praise the Lord
After spending most of the night in chairs in an army tent on the tarmac at the Port au Prince airport, the team was loaded into the cargo hold of a huge Airforce C-17 transport plane. They flew into the South Carolina airport, and they will hang out there today until their plane leaves for DFW at 4:30. They should get back to Waco around 10 p.m. It feels good to know that they are back safe and sound in the States.
Sunday, February 7, 2010
Sunday
The team held clinic today and then drove back to Port au Prince. Some of the team rode in this truck, but Keith rode in a small nissan truck transporting a pregnant woman with an IV back to the Quesqueya school. Keith said it was the scariest ride of his life, as the driver was going 60 on very narrow roads. Back at the school, they got to take showers and watch the Superbowl on a screen the army soldiers had concocted on a soccer field. They even got to eat Domino's pizza from the 1 remaining Dominos left after the earthquake in PAP. Keith laid down to take a catnap just after half-time, and he sleft through the most exciting second half, only to be awakened by people yelling that it was time to leave.
Originally, they were going to spend the night at the Quesqueya school, but then they decided to drive on to the Port au Prince airport and camp out there, waiting to be put onto any jet with open seats. We'll know more tomorrow.
Subscribe to:
Posts (Atom)