I started writing this to post at one point last week, and then we left Le Plaza (the place we go to get internet when our power is out) and I figured I’d finish it later. Then things got crazy. So here’s two blog posts in one – congratulations to anyone who makes it to the end.
I was having a conversation with one of the volunteers earlier this evening, and he asked if I’d ever seen really crazy stuff when I was here. I told him that there wasn’t anything that insane, just some people that would come into the clinic after machete fights every now and then. He looked at me for a little then responded, “Do you realize what you just said?”
My return to Haiti EMS , so we’ve been overrun with logistical work. Actually, I don’t think “overrun” is the right word, because it implies that there’s action. This morning I rolled out of bed and went to the kitchen where Adam (DIRT director) began giving some sort of dissertation. He’s so ridiculously smart and his brain never stops working, and quite frankly, it’s pretty overwhelming. So he rambled on for a very long time, most of it went over my head, and then I got bored and started thinking how helpful it would be to have a textbook for his mind. The further I went with the textbook thought, the more I felt like I was sitting in an 8am Monday morning Nursing Theory class – hoping I got the important parts and figuring that between Leah and her friend Ashley (she arrived Saturday and is here to help us out for about a month), I’d get the general idea. So we’ll see if the numbers I worked out for this budget are what I was supposed come up with.
I did get to play nurse a few times in the past week. Tuesday afternoon we were driving somewhere to pick up some thoracotomy kits (those would’ve been helpful in the Saint-Marc clinic). These situations get kind of fuzzy and slow-motion in my mind, but I remember hearing a crash and then a seeing a bus more or less ramp the sidewalk. Two full buses and a water truck collided somehow a few hundred feet in front of our truck. No one was seriously hurt, which was amazing since the people were packed in the vehicles like it was a clown car. The most dangerous part was probably me walking around in all the broken glass with my flip flops on.
The next day was the anniversary of the earthquake (and also my 100th day in Haiti
When we finally left Cite Soleil, we were really hungry and tired from standing in the sun all day. So on the way back to Le Plaza to pick up the rest of our team, we stopped for street food. After everyone had their supper, Sully went to start the truck and nothing happened. The guys looked under the hood and messed around with it for awhile. Then some random Haitians appear out of nowhere carrying a new car battery. It sounds strange, but things like that happen here all the time.
Saturday I went out to an orphanage in Kenscoff, an area up in the mountains, with some people we know from another organization. We ended up walking the last ½ mile or so because the hills were too steep for the truck. Between another nurse and myself, we saw between 60-70 children. We started out doing well-child checkups, but eventually it turned into treating only symptoms. Everyone got treated for worms and given vitamins, and I also gave out some antibiotics. Someone said we should get shirts made that say, “I’m not a doctor, but I play one in Haiti
Part Two. “It’s really quiet around here” is a phrase that makes pretty much every medical professional, or at least nurse, want to club the person who says it. I’d been saying it for a good ten days, trying to get something to happen because I can only be cooperative with office work for so long. It finally worked.
This past Tuesday, we got in contact with German Air Two, these random helicopter pilots who transport patients. I’m sure someone else in the DIRT house knows how this happened, but I missed that memo. I just go where I’m told. The day started far too early, which is probably why I missed the details. Adam was wandering around looking for someone’s phone, muttering something about a car accident and a helicopter. Apparently, there was an accident up north and German Air Two was transporting the patients down here to us, and we’d then transport them to the hospitals. So Leah, Ashley, and I went with our driver to this field behind the UN base. We think it was some sort of driving school, because there were a few cones and people making laps. There were also various cows strewn about. Adam and Jon, a paramedic who was volunteering with us for about 10 days, went to a different location to wait for the other patient. Before they left, Adam warned us about how much stuff was going to be flying everywhere when the helicopter was landing. That was a bit of an understatement. It was like a dust storm. When I could manage to open my eyes, I could see maybe a couple inches in front of my face. I don’t know how long that actually lasted, but I started to get worried that I wouldn’t ever be able to see again.
The dust eventually settled and the patient and a priest emerged. This priest was also a doctor – kind of a curious combination, but it made for some interesting discussion. The patient was stable and could walk by himself, he just had a cervical collar on. We took him to the hospital and I stayed with him while he got x-rays. Getting a polo shirt off someone with a neck and shoulder injury when you can’t just cut it off because he probably only has that shirt is kind of difficult. But good news everybody, the patient still told me I’d make a good wife.
Wednesday we were to be meeting German Air Two again. This was supposed to happen at the airport. Unfortunately, it wasn’t going to be until the afternoon, and Adam had to fly back to the states. He’s the one with the capabilities and connections to be in restricted places or at least get away with things. So Leah, Jon, Ashley, and I headed to the airport hours early to get details worked out and hope we could get permission for various things we intended to do. First of all, let me just say what I got through airport security with. I was carrying a combat trauma bag that Brenden left with us. That’s what I bothered to put through the x-ray machine. In my pockets I had scissors, needles, a penlight, thermometer, a pen, and my phone. Leah and Jon talked to some security people who led them away to talk to a director so we could attempt to obtain permission to pull our pickup truck right onto the tarmac. Ashley and I waited inside the airport for a little while. At one point I got a text from Leah that served as report on our patient – that was definitely a first. Especially since it originally came from nonmedical personnel who said the patient had been “nbo since last night.” I’m going to go ahead and assume she meant “npo” based on the fact that the patient told me he was hungry and “nbo” doesn’t mean a thing to me.
Before too terribly long, Leah and Jon were back. The director decided to waive the paperwork we would’ve needed to do, and we had G (our driver) pull the truck up. While we were waiting for the Germans to land, we discussed the other call we’d gotten from them en route. Apparently after they dropped off the first patient, they wanted someone to ride with them to go pick up a baby. Jon and I decided we’d assess the femur patient and then decide which one of us was going to go along for the baby. I decided that I didn’t care much either way. I am really excited about potentially getting to be in that helicopter at some point, but then I also remember that unfortunate helicopter incident in Hawaii
The helicopter landed with much less flair and flying debris than the previous day. We greeted the Germans then Jon and I went to assess the patient. Before we could that, however, we were physically lined up by the pilot for pictures. When they opened the door to transfer the patient, we saw a cast on the patient’s foot. We looked at each other, a little confused, because we’d just heard that he had a fractured femur. When we actually got him out, we saw that the cast was only on his foot, and the flight medic told us that it wasn’t necessary because the patient did not have a foot injury. Jon did a brief assessment, then we loaded him into the truck and I began my own assessment while Jon took off with the Germans.
This patient was a young man who had been in an accident 11 days prior. He was driving a moto that got hit by a car. According to him, the doctor wanted $2500-$3000 American to do surgery and he didn’t have that, so the doctor did nothing. This guy’s leg wasn’t splinted at all. His femur was turned out and very swollen. Long bone fractures like that are really dangerous because you can lose a lot of blood, and with this bone broken, it could tear the femoral artery. So this guy was lucky. He also wasn’t having a lot of pain, considering the injury. My guess was that this was due to the fact that he had so much swelling that the nerves were more or less squashed, and my madre confirmed that this was a legit possibility. Nevertheless, we transported him to the hospital, where he has now had surgery and is doing well. Hopefully he’ll be able to walk again.
We were on our way back in the truck when we get a semi-frantic call from Jon in the helicopter. We were expecting it to be more of a routine health problem and transport (yes, a routine bowel obstruction), but the baby was not doing well at all. The three of us were stuck in traffic on the way to meet him back at the airport and there was no way we were going to get there in a timely manner. My dad always jokes about slowing the car down enough for someone to jump out. That’s pretty much what happened. Leah was still on the phone, the two of us jump out of the moving truck and start running to a guy I’m yelling at because we hope he’s a taxi. Taxis are just so much faster because, in general we’ll say we have a two lane road. Most of the time it’s three wide. The motos just ride between the lanes of traffic, weaving in and out as necessary. So we were racing to the airport, and Leah was on both of her phones trying to find a place for this baby, or at least ask if we could land a chopper at a hospital, and Jon called back so I was on the phone with him. Basically, we redirected the moto driver about three times before eventually ending up back at the airport. The helicopter had landed about ten minutes before, and there was randomly an ambulance there, so the baby left with them. We have no idea why they showed up there or who sent them.
There are so many more stories I could tell from this week, but believe it or not, I really am trying to keep this short (mostly because I’m supposed to be doing office work and writing emails…but I guess when your office is a rug you can be a little more flexible?). Anyways, yesterday morning we were transporting supplies and a volunteer to work at the We Advance clinic for the day. Leah, Ashley, and I intended to drop him off then head over to Le Plaza to have an office work day since the internet has been off at our house for three days. But while we sat there waiting for someone to unlock the clinic, Leah got a call from someone working with Medical Teams International. They have a clinic out in a village somewhere and they had a child come in who was really sick with cholera. About this time, the director arrived and we more or less threw supply boxes and were like, “Okay, thanks, peace out!” I had scrubs in a bag with me so I ran inside quick to change, and they joked that I was being a cholera superhero changing in a phone booth. Anyways, we didn’t have any IV solution or tubing for this child, so we ran up the road to Sister Marcella’s, where we had visited again that morning and she gave us what we needed.
After some confusion regarding where we were going, we arrived at the MTI clinic. I find it odd that it was so much easier to connect with people in Saint-Marc where the directions included goats and big rocks than it is here in Port where there are road names. But while we met the people working at the clinic and got report on the little boy, they started asking us if we would come back and transport another patient. He came in with what they suspected was TB as a result of HIV/AIDS and was projectile vomiting blood. So we agreed to come back for him. Our little cholera patient was perking up fairly well by the time we were en route, and only tried to climb out of the truck once. He was pretty angry with me because I wouldn’t let him drink all the water he wanted. I might be used to cholera and be able to spot it in someone’s eyes from a mile away, but its been awhile since I’ve been vomited on and I haven’t really missed it.
After dropping off the patient at St. Damiens, we went over to Grass Roots United to pick up supplies to transport a TB patient. While Ashley was in the container looking for things, one of their volunteers came up to the truck to show us an injury. He had a nice slice on his arm from sheet metal. It needed just a couple stitches. I had been waiting for this moment for months now. There were only two of us who were medical, and I had seniority, since Mark, our new volunteer, was only certified as an EMT a few weeks ago. EMTB’s aren’t qualified to stick people with anything. Unfortunately, we really had to get back to the MTI clinic. I told him I’d come back after our transfer. He asked, “Isn’t it kind of useless after an hour or so?” Quite frankly, I have no idea what the answer is to that because nurses don’t do sutures. My only point of reference was the time I got stitches after a butchering injury, and my family wouldn’t take me to the hospital until more help could get there so I was exposed to the elements a good 7 hours before I got stitched up. But I just told the volunteer it would be fine and that I’d be back.
The clinic had closed down by the time we made it back, so a nurse and a pediatrician had gotten permission to ride along with us and get picked up somewhere. We determined that we didn’t really need the masks and isolation gowns we’d brought along, but then we also thought we might be able to get our truck through the ferocious Port-au-Prince
We were on our way back to the MTI house to drop off their staff and stop by Grass Roots when we stopped by the airport to return bottles to a lady we had bought drinks from the night before. There was a large crowd gathered, and they started yelling and running towards us. In retrospect, it was probably not wise for us to do what we did next, but we seem to have a fleet of angels wherever we go, so we all jumped out of the truck and ran to the crowd. They were yelling about a stabbing. We found a young man on the ground who had a bloody hand. Then we saw a 2x2 on his chest. Apparently he’d been stabbed with an ice pick. Leah was controlling the crowd, and according to her they were very respectful. I still thought they were really loud, but I was trying to hear breath sounds. We got him onto our backboard, secured him with our ratchet straps, and loaded him into the truck which G had pulled around. The doctor began assessing the injury and I was cleaning his hand. It appeared that he may have grabbed the pick to try to stop it, because he had lacerations between his fingers and onto his palm. I did a ghetto wrap job with the stuff I could find in the CLS bag. The problem with having a combat trauma bag is that it’s usually not practical for every-day injuries. Although I guess if getting stabbed with an ice pick is an every-day injury, you just can never be too prepared.
So basically, the entrance wound was very tiny, about the size of the tip of a pinky. However, we didn’t know how far it went in, or what it hit. The doctor was monitoring for signs of a pneumothorax. Mark kept trying to wake him up and keep him talking, and I was trying to figure out if he was bleeding internally because his extremities were cool. We arrive at the hospital only to discover that they have no beds. The doctor with us was talking to one of the staff and asking if they could at least do a chest x-ray. Unfortunately, their machine was broken. Awesome. But it gets more awesome. It was then that the MTI nurse told us she’d gotten a phone call from one of their directors and that she and the doctor were to stay at the hospital and wait to be picked up. I was feeling okay until the doctor was saying things like, “This patient is going to die before he gets to the general.” She asked me if we had a big needle. This is where the CLS bag comes in handy. Brenden had shown me the decompression needles and given me a crash course in using one. But that was a month ago now, and there was no way I was going to remember in a moment of panic. So before hopping out of the truck, the doctor reviewed with me what to do and what to keep looking for. It was kind of like sweet-hearted slap in the face. I already knew this stuff, I just needed to calm down.
The patient had been starting to get tachypneic (breathing too fast), and was also having brief periods of apnea before we left Medishare. However, he stabilized a bit and remained stable enough during the transport. Again there was very little traffic, uncharacteristic for that time of day in Port. The doctors at the general seemed a little bewildered about exactly what to do with him, and were kind of looking to us for orders. I might be white, but I’m still just a nurse. Leah and I looked at each other and had one of our trademark “non-verbal communication” conversations. We weren’t sure how long we should stay with the patient, but she then told them that we were just doing the transport and the patient was in their hands now.
After that, we finally headed back to Grass Roots (GRU). It had been hours, and it was way past the time when G gets off, but I felt bad because I told the guy I’d come back. When we arrived, however, they were in the midst of a meeting. Leah had tried to call the two directors to let them know we were coming (they have a strict evening visitor policy), but they never answered. So, hopefully the injured guy doesn’t feel like I abandoned him. And once again, the suturing is elusive.
If for some reason you just can’t get enough of Global DIRT stories or you want a different perspective, feel free to check out Leah’s blog
She has a video of this week’s first transports. I’m not yet that technologically advanced.
haha "ferocious!" love it...also love the theory reference! man i love your stories although they are very intense and crazy! praying for your safety! please come home soon!
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