By: John Heim, M.D. – Special to The Packet
It’s just after 5 a.m. A peanut butter Clif Bar serves as my breakfast, washed down with a cup of water from the camp tap. How safe is the water to drink? I will find out in the hours and days to come. I arrived yesterday from Fort Lauderdale aboard American Airlines. Arrival date and time, Sunday, May 16, 2010 at 3: 15 p.m. Stepped off the jet, 100 degrees and humid. This is the morning of my first full day at the Medishare field hospital at the far end of the tarmac in the Port au Prince (PAP) airport, Haiti. On my arrival yesterday the first patient I attended was a 7-year-old girl in the recovery area who had come out of surgery an hour before. On her initial presentation to our makeshift emergency room, she was found to be in shock from a gunshot wound to the right flank. Abdominal exploration by a visiting American Navy surgeon showed the right kidney to be shattered, bleeding and not salvageable. She lost her kidney but gained life. She was doing well.
I find myself in a hospital made of canvas and plywood, walled off from the rest of the PAP airport by a 10-foot-high cement barricade topped with razor wire. Armed Haitian paramilitary, toting automatic weapons, patrol the perimeter at all times, ensuring our safety …
I am looking out over the mountains here in PAP. Just took a shower. The outdoor showers are also made of plywood. Four stalls, right next to each other, men and women. We are fortunate to have clean water. There is one spigot that serves the entire camp’s drinking water needs. It is reported to be "safe." The mountains outside of PAP are beautiful from where I stand. The beauty does not seem compatible with the suffering I see all around …
The last 24 hours has given me an appreciation for what the Wild West must have been like. Trauma medicine consumed the night. We have a very adept team to skillfully deal with whatever we might be called upon to treat.
A neurosurgeon from Michigan, a plastic hand surgeon from Miami are with us. Two orthopedic surgeons from Minneapolis and Boston, respectively. A complement of ER physicians, all very well trained. John Seybert from anesthesia and me. On the team is a Navy general surgeon, stationed in close proximity, who helps intermittently. It was he who treated the young girl shot in the flank.
It has been an eye-opening weekend. My life of privilege and comfort contrasted by the suffering and poverty I see all around puts it all into the proper perspective. The lack of air conditioning, tasty food and privacy don’t matter to me. I am always sweaty and stinky here, but so is everyone else, patients and staff alike.
The contrast is inescapable. Friday night was Gretchen’s prom. Her date, Russell, a quiet kid of good character, nice looking. Saturday, Anna’s graduation from Moravian College. Proud parents on a perfect day, sunny 70 degrees. Nanny, Pop-Pop, Abuelita all were there. The Prom. Stretch limousines chauffeuring teenagers in new clothes to a high school dance, college graduations and happiness abounding.
A few hours travel brought me an eternity away to a place of poverty, and hopelessness where even the basics are lacking. It doesn’t seem right. As much as we hope to help, in equal measure, I expect to receive lessons in humility and what it means to be thankful. I have more in my duffel bag than most here have to their names. I have too much stuff with me. That is except for Clif Bars, which make for great trading currency, much like cigarettes in jail.
So our day starts in this hospital made of canvas. Some 40-50 people to see on rounds, infected wounds to examine, orthopedic trauma to help with, scheduled surgery to complete. Children recovering from the ills of a violent society. Others recover from the usual conditions of childhood. I see a child in the physical therapy tent learning to walk after an amputation and I think about my own children. The legacy of the earthquake is all around.
Tuesday, May 18, 2010
Yesterday was a busy day, a blur of activity. It is a challenge to remember and put into order everything that we did. As I think back, Sunday I arrived in the early evening, with no big problems encountered. Within two hours, we had no less than 25 people admitted to the emergency room after a truck holding 15 American relief workers in their early 20s, and 10 Haitians, rolled off a mountain. They were standing on the bed of a truck descending a mountain road after a church service in a small high mountain village. The truck’s brakes failed and the truck crashed, turned over on its side and spilled its human cargo.
Six young Americans were gravely injured. They were stabilized and air-evacuated back home. Most were from Illinois. It seemed the Haitian passengers suffered the worst injuries and required amputations for contaminated, complicated, open-extremity fractures. My head hit the pillow Sunday night, 1 a.m.; the orthopedic surgeons were busy for many hours after and did not finish until much later that morning …
Wednesday, May 19, 2010
The beginning of our third full day here in Port-au-Prince. Abit cooler than yesterday. Last night, it rained and the ditches that were dug around the compound did their job and kept the flooding at bay. The rain was a welcome relief from the pounding sun and heat. Yesterday was an incredible day. We worked as a team – working outside our traditional roles, we attacked the work to be done. Today I treated a 29-year-old man who for many years had a huge, long-neglected growth in his neck. It appeared to be what looked like a massive goiter of the right thyroid lobe. I will admit to the difficulty I had in removing this large neck mass. Complicating the task was a lack of light and the 105-degree heat in the operating room. The sweat dripping off my forehead constantly stung my eyes and obscured my vision. Slow and safe was the mantra, three-and-a-half-hours later we were done, the young man’s tumor removed with minimal bleeding and his voice intact.
My first assistant, a fourth-year-medical student, Tanya, proved to be of great help. It is certainly suboptimal here, with inadequate lighting and bare-bones instrumentation. Just take a little extra time, be careful and do it right …
Saturday, May 22, 2010
I just returned to our hospital compound from the United Nations base where we had dinner tonight. We were able to enjoy three meals at the UN since our arrival. The UN facility is less than mile away and they have a reliable restaurant that receives what it serves directly from the U.S. This is comforting to know because you do not have to worry about eating contaminated food here. A big salad and a beef kebab hit the spot and then some. It is now 12:30 a.m. and I am at the far end of the compound, alone, looking over the tents. I stand in the dark, the rain just ended. It is very humid and still well over 90 degrees. A bright spotlight shines down on the tents. Most of the staff are tucked under their mosquito nets, asleep. Those not asleep are talking in muted voice or playing Parcheesi …
You occasionally get a sense of the surreal here. Last night a Chinese man in his 20s came to our emergency room in transfer from another general hospital. That fact that a patient would be transferred from a bricks-and-mortar hospital to our field hospital speaks to the lack of any significant health infrastructure.
This unfortunate young man was here visiting from China. At first glance, the story sounds crazy, but he was visiting Chinese friends who own a Chinese restaurant in Haiti. An automatic gate closed and somehow smashed the young man in the front of the face, causing a complex mid-face fracture and a cervical spine injury. Like others with complicated injuries who could not be treated here, he was stabilized. Contact was made with the Chinese consulate and arrangements made to transfer him, most likely to the U.S., for definitive care.
Who comes to visit friends in Haiti from China and gets his face smashed in by a gate? …
So, this is one tired, middle-aged surgeon saying goodbye from Haiti. I will be leaving at 8 a.m., bound for Fort Lauderdale, and then on to Philadelphia. I will carry the sights, smells and memories of this week for a long time. To leave this country unchanged is impossible. The good that we did here cannot be undone. Those we served are the better for our healing efforts … (but) it is up to us as compassionate, engaged people to nurture what has been started through a continuous commitment to volunteerism and a genuine concern for the global community in which we live.