dispatch from haiti

2010

Brigitte Smith, RN

After our fitful first night in Port-au-Prince, sleeping in the concrete courtyard of a condemned school with military flights ringing in our ears, we were eager to begin our advance work in Pignon.  Our transport could only accommodate five essential personnel and critical supplies to perform emergency medicine.  As we prepared to board our two-passenger planes, our first miracle happened.  The pilot came out to greet us and unload his precious cargo, a nine-year old little girl who had been rescued from the rubble of her family's home.  In fact, the first words out of the pilot's mouth were, "Do you know where we can find an orthopedic surgeon?"  My colleague Dr. Tim Johnson replied, "you're looking at one," and with that, we knew our mission had started. 

As we could only take so much weight on the plane, we once again condensed to only critical supplies and held back staff in order to take the child, Meika, and her mother on the first small plane so we could immediately start her care.  Dr. Johnson, Dr. Hogarth (anesthesia), and I took Meika and her mother on the first plane.  We had immediately started an IV for Meika as she was severely dehydrated.  Her feet had been partially amputated and infection was beginning to set in.  Meika had lost her father and two siblings to the earthquake and was lucky to be alive.  Her mother had spent three days removing rubble to get to her daughter, Meika, who had been trapped under a fallen wall.   Our entire team is grateful to the Paul Chester Children's Hope Foundation for allowing us this opportunity to uphold their mission; and Meika is just one child of many for whom PCCHF has provided care and changed lives.

Once we arrived in Pignon, tired as we were, our adrenaline kicked in. We were met by local missionaries and transported along a bumpy dirt road to the remote but undamaged hospital.  We did the obligatory meet and greets, then scrubbed up to make our initial rounds of the two-story hospital.  Meika remained on a table, as there were no beds or stretchers available.  Beds were being made from whatever could be used that had a flat top and could support someone.  By this time the second plane had arrived carrying Sue Cooke, our recovery nurse and Greg Bennett, representative for Community Coalition for Haiti and our Physicians assistant. 

After we assessed the critical patients, we realized we had to perform our first surgery immediately.  It was imperative as this young lady, I would guess in her 20's, was septic and near death.  With only minimal supplies at that point  (our supplies would be arriving later), we did what we had to do and made do with what we brought. 

As we took this young lady to the operating room, it felt as though the mood of the hospital changed to one of hope.  Our first case took us deep into the night and we did not finish until 6 AM.  This patient had been given an amputation in the field that had become infected.  The infection turned into a necratizing fasciitis which is essentially "flesh eating bacteria."  This is very difficult to treat, even under good circumstances.   She subsequently was returned to the OR for a hip disarticulation to give her the best chance of survival. 

In addition to the multiple surgeries this woman received, she also needed a blood transfusion.  The hospital had no blood leaving our doctors and team to donate their own blood.  Our emergency room physician, donated twice in one day, as the need for blood was critical.  I remember during surgery that night, he started to get sweaty and faint, having the patients' health before his own.  So not only do the patients grab our hearts, but also the members of our team can never put into words how much we appreciate each other.  Although we come from different states, we come together on these surgical missions with cohesiveness that supersedes any operating room in normal, everyday life.

The next morning, after just 3 hours of sleep, we returned to the hospital and took Meika to the operating room.  Her mother's greatest concern was that she did not want Meika's feet/legs to be amputated.  Dr. Johnson assured her that he would do whatever possible to save her feet.  But again, infection had set in and Meika had multiple debridement’s and an extended amputation of what had already been amputated.  After the surgery, as dressings were continuously changed, Meika's expressions became happier and happier.  She smiled and laughed for the first time since we had received her in the plane. 

Our group continued to assure that Meika and her mother had food and water and new clothing.  She became our foster child, capturing the heart of every team member.  Though she lost her entire life as she knew it, as did her mother, they both continued to be positive throughout the entire experience.  Just as remarkable, selflessness, our Dr. Timothy Johnson personally paid for Meika and her mother to be hospitalized in a private room where the care was more frequent and individualized.  What’s more, he arranged for them both to stay at one of the local missionaries facilities where Meika could attend school and be close to the hospital for future care and prosthetics and her mother could work in exchange for living space. 

Later in the week, a new medical team arrived, bringing a plastic surgeon that could collaborate with Dr. Johnson on Meika's care.  Together, they were able to save most of her foot, leaving enough of her heel to enable a prosthetic in the future - a remarkable outcome even in the best of circumstances. 

Another remarkable child we encountered was a boy who suffered a complete fracture of his femur when his school collapsed during the earthquake.  He only survived because his instinct was to get on the ground and crawl as far as he could.  He made it out and was spirited to help by a man volunteering his time and plane to fly these patients to us.  This boy was one of only three survivors in the entire school. 

Yet another case of incalculable loss: an entire nursing school went down, with only one nursing student who survived.  She received a chest tube for a pneumothorax (blood in the lung) and a broken mandible (mouth).  She, too, was flown to Pignon.  One mother endured many fractures, one after the other, as she continued to make trips back into a collapsed building. 

One of the most difficult cases was a man who had suffered multiple fractures of his shoulder, elbow, forearm and humerus.  Even in third world conditions, we were able to fixate these fractures.  We operated with no autoclave, so had to use Cidex; our drill was one that was donated from my hospital because it was old; but we made use of everything and anything.  On these missions, you learn to become creative.

A recurring theme among our patients was their strength of purpose: many were the only member of their family to survive, yet they knew they must remain strong so that their loved ones would not be forgotten.  After seeing the devastation, I am truly proud to have known these individuals; their courage and will to live is great. 

I am honored to be a member of the Paul Chester Children's Hope Foundation and to have participated in this urgent mission to provide many lifesaving and life-changing surgeries.  Their mission is true to their values and with continued support, we will continue on these endeavors.