Two Weeks In Haiti

Yesterday I returned from a two week mission trip in Haiti which was truly an eye opening experience. This trip taught me to appreciate many of the things that I take for granted day after day... like a good hot shower.

Our trip was two weeks in length, but was preceeded by another week of intense planning and preparation. Thus, getting back yesterday was wonderful and I truly missed my family. It has been wonderful to spend time playing with the boys and just relaxing with Julie. I missed them a lot during the trip.

Our mission was to address surgical needs of the Hatian people after the Earthguake. When we arrived to Haiti, the compound we were staying at did not have too many surgical needs at the time, but one of the sisters assisted in getting us connected with Sacred Heart hospital in Haiti. This was a true blessing as we were able to get connected with this facility and within minutes of arriving there get started with what our true mission was.

At Sacred Heart the team managed a number of fractures, x-fix adjustments, an amputation, and emergent appendix removal in addition to a few other surgeries. In addition to these surgical interventions, our team assisted with dressing changes which was a huge need as well as working in the triage area which was seeing in the order of 200 patients per day.

One of the most notable things about the trip is the multi-national nature of the response. While at Sacred Heart we worked with the French, Mexicans, teams from all over the US, Banglidesh, Brazil and others. The interesting thing was that despite many barriers, all groups learned to work together for the most part and tried to do what was in the best interests of the patients considering the circumstances.

That said, the conditions for caring for patients were less than adequate. Patients were hospitalized in tents where infection was rampant, care was spotty and supplies were sparce. We did not have the luxury of IV pumps and other equipment to make delivery of medications safer and more efficient. There were far more physicians than nurses and other support staff. Therefore, therapy, medication delivery and basic wound care often took a back seat to managing the acute needs of the incoming patients and those actively having surgery or dying.

As our time in Haiti progressed, some of these issues did improve. We saw more support staff assisting in the tents which helped to ensure that the patients received the medications that were ordered at least during the day-- the challenge remains that most teams leave at night and the patients are all left to almost fend for themselves with the exception of 1 or 2 nurses to care for everyone throughout the night.

Another thing that was severely lacking was a medical record! The 'dossier' as it was called was a single sheet of paper that was not written in multiple languages, so it was a best guess as to where certain things should be documented. In addition, many thought at first that they were exempt from documentation and therefore care was very poorly chronicled. Obviously this is substandard, but generally didn't create a major problem for patients that were seen in the triage area, however, for any patient admitted, this was a catastrophe. Determining when dressings needed changing was impossible, medication orders were a joke, and knowing what was wrong with patients was -- well quite a challenge. One of our goals which I believe we did a fairly good job of achieving was to set some 'professional standards' of documentation where doctors would write orders and note which doctor made the order. Support staff documented giving medications on the chart. It was still a complex system as the orders required you to read all the way back in the chart to the initial order, however, most charts were less than 5 pages so it was not a major ordeal. After implementing and demanding charting for things performed to patients, we noted when medications were missed and did our best to keep patients on a routine with important medications such as antibiotic therapy. For future events, the one thing that I would suggest as VERY important to the success of any program is development of a simple to use medical record system that all can follow and agree to utilize. Failure to do so places patients in jeopardy.

The acute phase of management of earthquake victims is rapidly approaching closure. The need to do wound care, x-fix adjustment and removal as well as intense therapy is now starting. Patients need assistance in getting our of bed, learning to adapt to their new handicaps as well as whenever possible try to get prosthetics placed to create a productive society that can truly move on post the earthquake.

My trip to Haiti was quite eye opening. The people of Haiti are strong and I greatly look forward to following the progress of the country during the rebuilding. The damage was extensive, the numbers of dead are overwhelming and the cost for rebuilding will be staggering. Haiti needs the international community not to lose interest now that media coverage of Haiti and the recovery is waning. There are lots of needs, many of which are still largely unmet.