Tuesday, May 25, 2010

Empowering the Youth of Haiti

Empowering the Youth of Haiti

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An on-the-ground report from Cassie

Our anesthesiologist Cassie Gabriel just submitted a detailed synopsis of her and the team's experience at Hopital Adventiste on Haitibones.org which you can read here.

Cassie's role was unique for several reasons. At times, she was the only anesthesiologist available at Adventiste and she had the daunting task of sorting through several boxes of supplies, some of which had not been organized. She also had the added pressure of administering the component that would allow the surgeons to perform their jobs. And she did it all with a cool and experienced precision, worthy of a mountain of praise.

For those interested, she offers a few recommendations for future groups:

  • We felt well taken care of staying at the hospital in the volunteer quarters-running water, clean drinking water, one delicious meal per day, air-conditioned break room with Wi-Fi, ready access to patients in need!

  • Including the Haitian hospital staff/volunteers allows for better continuity of care when you leave. Pick out one or two and teach them (and learn from them). They are there always and our flying in and out with all our individual styles and preferences is challenging for the most patient workers.

  • Enjoy the atmosphere of beautiful people working together to heal Haiti one patient at a time.

Friday, May 21, 2010

Returning to Haiti in June

I feel extremely privileged to announce our return in June to Hospital Adventiste. In addition to the Plastic Surgery team, we have two fresh faces both eager to provide a helping hand.

We discovered early on in our first visit that the little things go a long way. That's why I'm putting together a list of supplies we would like to take with us to distribute. In addition to medical supplies, the area of greatest need are basics like clothing, water bottles, food bars, sleeping bags, tarps and tents. Monetary donations are also useful and will go towards the purchase of supplies. If you are interested in making a donation please email me or go to Haitibones.org.

Thursday, May 20, 2010

A Drive Through Port Au Prince

Here's a short video I put together to offer a small glimpse into life in Port Au Prince four months after the earthquake. The music is by Haitian artist Bélo whom you can read more about at belohaiti.com.

Monday, May 17, 2010

Photos uploaded to Flickr

I've just completed uploading all of the photos from the trip to flickr. You can view them by following the link here. Please feel free to share with your friends and anyone else who might be interested. I'm still slowly adding descriptions to each photo so please bear with me during this process. I will also be adding those from other cameras in the near future. Some images are graphic in nature as they involve surgical procedures so please use viewer discretion. Thanks very much and I look forward to your feedback.

Response is overwhelming!

Upon return back into the states, the response and feedback for our efforts is overwhelming. We never dreamed of getting so many positive comments and exceptional support. And the momentum is in full swing for new participants to continue the amazing work. We need your help.

In the next week, I will be setting up a link to donate to the rebuilding effort at Hospital Adventiste. Anything helps and your generosity is crucial to the survival of this amazing program. You've already seen and read the stories of how much of an impact just a few people have in the lives of so many people affected by the earthquake and this is just the beginning. This is not a situation that will resolve itself overnight as you can read more about here.

In the meantime, If you are interested in donating or volunteering directly, please go to haitibones.org and click on the tabs on the right. This is an experience that will change your life and I recommend anyone with a positive, can-do attitude and a willingness to work hard to participate. The rewards are seen in the faces of ordinary Haitians who are struggling each and every day. While I know we all have many problems that exist here at home, it goes without saying that Haiti is facing one of the most difficult struggles in it's history. Thanks for your interest.

Saturday, May 15, 2010

Leaving but never forgetting

It seems like we just arrived to Port Au Prince and today we are leaving. Although it is usually time to pack, the team is still doing surgeries. If they were to stay an extra hour, they would be doing more. The need will always be there. From the minute we arrived and sometimes throughout the night. It goes without saying that we will miss all of the wonderful volunteers and staff here at Hospital Adventiste. One week is not enough time to stay and it feels like we should be here much longer. We would all like to thank Loma Linda University and Scott Nelson, MD, Southwest Washington Medical Center for their generous donation of medical supplies and especially to all my friends for donating whatever you can. This has been a fantastic and rewarding experience for all of us in every way.

Stay tuned for more photos and posts in the next few days as there are tons to sort through. This is only the beginning of what will be a lasting bond with Haiti. We will never forget you and the struggles you have been through. Our hearts are with you forever and we hope to return soon.

Friday, May 14, 2010

This afternoon, the trauma patient that we saw three days ago returned for an evaluation. Although she still has some difficulty opening her eyes she is still a healthy little girl. She really bonded with Shelby whom she remembered when she was in the ER.

Later on I accompanied Lynn from the Ukiah team over to the Pediatrics unit. It is situated outside of the main hospital building just to the right of the main entrance. Hospital Adventiste is actually one main building surrounded by several clinics only reachable from outside. Some of them have been setup after the earthquake.

As we make our way outside, the front steps are surrounded with many young children, translators and other people. The children approach as if they know you. One boy keeps referring to me as Dr. Joe. I find it very funny and innocent, so i don't correct him. A majority of these kids are orphans with no other place to turn. They plead and beg for you to give them basics things like flashlights or water bottles. If you offer money, they become sad as it is of no value to them.

Later in the afternoon, I again meet up with my friend Sam for another excursion into Port Au Prince. A little weary of the weather conditions as rain looks to be setting in, i grab a plastic bag for my camera. He runs a little late so I make my way outside the front gate of the hospital. The entrance connects to a busy street with various beverage and fried corn vendors. Discharged patients, some with crutches or wound wraps, wait across the street for a ride back to home, if they have one. Children and teens wander past in school uniforms and chat with each other with jovial grins and laughter. I start to become a little more worried as Sam is running late. Traffic in Port Au Prince is terrible.

Finally, from the right I see the forrest green Suzuki SUV with various decals, a cracked windshield and bald tires speed up the hill towards me. It is customary in Haiti to deliver curbside service for your guests. I did not know this rule as I naively ran across the street to get in the car only to watch him make a U turn right back to where I was standing. Embarrassed, I pile in to the car as he introduces me to his brother and cousin. They both happily and cordially move to the back seat to allow me to sit in the front. The kind of hospitality that occurs rarely when I am back home.

Our journey starts through Port Au Prince and winds up through the other side of town. It is just before sunset and the light is breathtaking. The scenes from the passenger window are even more. As the Kompa music blares from the blown speaker just below my right knee which is smashed against the glove box, I look out onto the hill to watch the dusk light cascade across the slope. The storm clouds cast a heavy shadow in between the soft glow of dusk while concrete buildings mold the landscape. People flood the street in droves. The air is thick and dusty.

We make our way through Port Au Prince and up to another town just on the outskirts. I was beginning to think it was spared most of the heavy damage until I look over and see and large building pancaked completely on itself. The floors look like a stack of documents. Less than a block later, another building collapse, this time it almost appears to be in frozen animation, tilted half on its side with each floor visible from the street and anchored in a pile of rubble. We get further up the hill and Sam points out another building. It is what used to be a shopping mall, with buildings connected and pieced together much like a modern condominium or apartment complex in the states. The roof line resembles the stock market index, with fluctuating degrees of collapse. Sam tells me he almost died in that building, as he was inside at the time of the quake.

Just as the sun dips below the horizon we head past the UN headquarters and US Embassy. They are literally across the street from one and other. I start to get a little worried i will not get back in time and he tells me we are on the way. We move back towards Port Au Prince as the day quickly turns to night. Every few blocks people have set tires on fire. The traffic is still very heavy and despite the darkness people are out in abundance. I begin to wonder where some of these people sleep each night.

Finally, we arrive back at the hospital to a slightly worried staff. However, the mood lightens quickly as plans are made to head out to dinner for our final night in Haiti.

Physical therapy key to movement

It rained very hard last night and left with it a thick stagnant air. Normally conditions like that make it hard to sleep but I was out like a light. The morning began with a visit to the OR for a ped's case and we then moved into the patient floors for more rounding. I met up with Jen, a physical therapist who just arrived from Handicap International. This is her second visit to Haiti She said most of the cases of rehabilitation are prevented by the Haitian's simple fear of moving after surgery. Most of the time, steady movement is all it takes to begin recovery.

Thursday, May 13, 2010

All walks of life

So it's official that I have truly lost track of time down here. The funny thing is I don't find that I need sleep while I am here. There is so much to do and see throughout the course of a day.

This morning began around 7am. We wake up to the subtle murmur of Haitian Creole and quiet footsteps whispering back and forth through the halls. I roll out of my cot which is situated upstairs in a covered veranda with an open air balcony with multiple cots covered with mosquito nets. I then crawl downstairs to get a snack, we'll call it breakfast. One meal a day is served to the volunteers at the hospital. The rest is whatever you decide to bring with you. If your Powerbar supply runs out, too bad.

The diet of Haitians coming through these doors is a key factor in wound recovery. If you do a skin graft, you must have an adequate source of protein to rebuild that skin during the recovery process. As most Haitians cannot afford to eat and food supply is so scarce, most wound recovery is either slow or cannot occur at all.

At 7:30 a meeting begins outside at the main entrance. Volunteers line up on the stairs to hear how the course of the day will unfold. The team this week is brand new and we decided to utilize our friend David from Atlanta to help with translation. Dr. Gabriel called him his bodyguard (he's about 6'5")! I look around the room to see the different people and compare ailments. Families look curiously at me while I follow the team around. I am unable to speak Haitian Creole so I smile to them. They smile back.

Shortly after the team rounds to dress wounds, I head into the OR to see Dr. Gabriel and the LEAP team perform a second surgery on a young burn victim. Kelly is doing anesthesia this time. I glance over to the wall to see two exposed wires and flickering overhead flourescent light. The doors are battered and missing paint, the floors have mismatched tile, the operating table made of wood. The medical teams do not let these obstacles get in the way and I admire them for that. Meanwhile, several Haitian residents watch with a careful eye to witness the surgery and pick up on their technique.

This afternoon, I made an appointment to record video of a Haitian translator named Bermann Alexis. He's a truly talented young man with a big heart. His dream is to come to the US to play and sing his music to patients. He is just 33 years old and he has no brothers or sisters. He lost his parents to illness nearly ten years ago and says he has nothing to lose by pursuing his dream of performing in the US.

Wednesday, May 12, 2010

The Smile Behind the Lens: Portrait of a Photographer

They say a picture is worth a thousand words. Knowing the photographer that is responsible for capturing the amazing moments shared on this blog, I feel completely confident in assuming that he would tell you being here to take these photos is worth a million words...

Any task here at Hospital Adventiste is a challenge. People flood the hallways early in the morning in hopes of seeing a doctor at some point in the day. Volunteer staff from all over the world, including local Haitians, zip through the hospital halls, busy operating rooms and crowded patient corridors, in hopes of finding supplies that will get the job done to the best of their abilities with the limited resources available. To capture these quick moments on film is a completely different type of challenge, but one of equal importance. With the daily increase in patient population translator availability is decreasing and it is easy to get lost in patient care without ever truly knowing the patient. At the end of the day, you find volunteer staff from all specialties and clinics set up through out the hospital congregating in the volunteer lounge. As we share stories with eachother of miraculous success, we often find that Matt has captured that moment of triumph in a still image that sums up our stories more than our own words. To be present in the moment of helping someone is an incredible feeling, but it is all to easy to miss the eye contact made or the hope that spreads across a patients face as you reassure them they are getting better. Thank you Matt, for capturing these life changing experiences and presenting our family, our friends and all the volunteers with a picture book that will last a life time. You have gone above and beyond not only as photographer, but as team mate and a friend.

Cassie the hero!

I made my way up to the volunteer breakroom for a snack and walked right into orientation for the team from Atlanta that just arrived today. I was editing pictures on my laptop, now covered in dust and scrapes while other fantastic volunteers and medical staff trickled in to take a load off.

While Shelby and I share stories and chit chat about the day, trauma nurse Lynn from the Ukiah group burst through the door. She's visually distraught and stumbling over her words. They had shown up with a two year old in the ER with a strangulated hernia, a condition that meant the bowel would die if not treated immediately. A life and death situation.

By now, the LEAP team had packed up and driven off to the house they are staying at several miles away. Unfortunately that means one of two anesthesiologists on premises is gone, leaving only Cassie. At this point, she has been utilized more than just about any other person on staff. She is exhausted and anxious at the prospect of committing to another procedure. However, she tirelessly puts her game face on and sets up the OR. The general surgeon from Fresno, Dr. Darain happened to be laying down for a snooze just as Lynn burst through the door. He has already performed at least three hernia cases in the short time I've been here. All with a remarkably steady hand and razor sharp concentration. His calm demeanor puts everyone at ease and he exudes an unspoken wisdom matriculated through years of experience. I expected nothing less from this procedure as well.

It was quite a story as to how the boy arrived at Adventiste. The Ukiah group who earlier this afternoon set out to Port Au Prince to find an orphanage stumbled across a tent city bordered by a concrete wall several miles from the hospital. Upon seeing the team of nurses, one of the guards at the gate frantically pleaded to one of the nurses to take his grandmother to the hospital who was bleeding from an unknown injury. Meanwhile, screams were heard within the walls as a baby was being hoisted through the crowd of people. They looked over and saw that the baby's testicle was protruding. They wasted no time in deciding that he needed to be treated immediately.

Everyone still on the hospital grounds who had any experience mobilized as best they could to get the child into surgery. And despite having only one anesthesiologist and a general surgeon, they pulled together to save his life.

Crash course in multi-tasking

So it is apparent here that no one has a specific duty. Everyone shares duties equally to the best of they're abilities. The facility at Hospital Adventiste has few resources but even less red tape to get through like you would with the US healthcare system. This results in exceptional efficiency. If only there were enough specialists to cover the diverse injuries and sick patients that come through their doors.

The most revealing part about spending a day here is the fact that the earthquake is not the primary source of injury. Haitians are plagued with a host of illnesses which for the most part are left untreated. Follow-up care is few and far between and infection is multiplied by poor infrastructure and lack of resources.

This morning we teamed up with the LEAP Plastics group from Madigan Military Hospital in Fort Lewis, WA. It's interesting how the dynamic changes once you are among a new team of specialists. However, it is impressive how two groups of specialists can form a cohesive unit despite a unique dynamic. The team worked incredibly hard to get a young woman through the ER to repair a critical leg injury. The surgery was a success, but the reality is there will be no follow up care. It is a story echoed all too often.

Four months later, the danger still exists

We were awoken early as a facial trauma patient came in to the ER. She was a young girl of twelve years and had been struck in the face by a large concrete boulder. The result of the family's house collapsing from damage sustained in the earthquake. Her five year old brother was also struck in the head. The Plastics team rushed down to the OR for emergency surgery to repair her face. Cassie administered anesthesia while Shelby provided a warm hand to comfort the obviously scared Haitian child. Although she was unable to see, she slowly found Shelby's arms to lean over and give a hug.

As she faded into sleep, Dr. Gabriel began to dibried the wounds. Shelby and Cassie stood by his side as he began three hours of meticulous grafting to save the young child's beautiful face. The result of the procedure was extraordinary. Every last scrape was repaired, preventing what would have been a permanent and horrific scar. All of which would not have happened without the team being here. They returned exhausted but relieved and got some much needed sleep for the remainder of the night.

Tuesday, May 11, 2010

Surreal Experience

It's the end of day two here in Port Au Prince and already the experience has changed my life. We arrived here after a 12 hours through the night and were all exhausted from the long flight. However, no time to complain as the work here begins quickly, me with my camera and no medical experience; Dr. Gabriel, the amazing Plastic Surgeon; his wife, Cassie, anesthesiologist extraordinaire; and Shelby, an MA who is making her first trip outside of the US.

Driving through the city on the way to Hospital Adventiste was like a maze. Hundreds of people and cars form zig zags among loud diesel powered trucks and dusty sidewalks bustling with people either selling small fruits for penance or walking in groups to unknown destinations. Horns honk and people move out of the way. Straight lines and traffic signals do not exist and most roads if paved are cracked and filled with potholes. It is perfectly organized chaos. We are all glued to the window and cannot take in all of the scenes fast enough. Amongst the crowds of people the streets are littered with countless piles of debris and rubble amidst the thousands of plastic bottle and refuse. Each turn reveals a collapsed or partially collapsed building on the verge of crumbling. The damage is indescribable. I try not to think about how many bodies still remain inside, nor how many more will lose their lives to the remaining buildings. We arrive to the hospital after nearly an hour and unpack our things.

After a brief orientation, the medical team kicks into action. The method of care here is nothing like in the states. Patients line the hot non air-conditioned hallways waiting for preop and evaluation. They do not complain, nor do they exude any signs of suffering. They are incredibly resilient. Patient's family members, if they have them, are there with them sometimes for days on end. In Haiti, the family is the only source for post op care. Patients return again and again because of infection or further injury. The need for rehabilitation is immense as there are no physical therapists. We walk the floors and begin rounding.

Dr. Gabriel is amazing to watch as he interacts with the patients, all of which do not speak english. There are a host of Haitian translators who are here on a volunteer basis. I learn by talking to a couple of them that they were self-taught. After rounding, a host of patients are scheduled for surgery so we move down into the OR to set up shop.

It is a challenge to do the job of documenting and still remain helpful as a volunteer. Although I came down as a photographer, I realize that that is not the only skill that they can utilize. As Dr. Gabriel begins his first surgery of the evening I am asked to throw on some scrubs and provide assistance with the team. This is something that could never happen in the states and I jump at the prospect, not knowing exactly what that entails! The surgery was on a man who was electricuted and burned on his hands and buttocks while attempting to cut mangoes with a machete from a tree. Despite being in tremendous pain he waits patiently as Cassie administers anesthesia. Dr. Gabriel spends nearly an hour dibreiding the wound and I find myself absolutely fascinated. I felt proud for Shelby, who was given the opportunity to come to Haiti with the Gabriel's. She is having the time of her life and is fast discovering her passion for patient care in developing nations.

Day two begins with a call to Sam Claude, a Haitian who was in the CASS program at Mt. Hood Community College coordinated by friend Nikki Gillis. I was excited to learn that he would be showing me around Port Au Prince during my stay. After briefly exchanging some supplies we brought for him from the states I was whisked off into the heat of the day, excited to experience Port Au Prince with locals.

We left hardly any stone unturned in our journey through the city. As we walk along the main boulevard Sam points out that this was the street that most of the Haitians lost their lives. Every fourth building is completely collapsed or destroyed barely beyond recognition. People set up camp below the destruction and commerce flourishes despite the backdrop of debris. I snap pictures while Sam and his brother watch for traffic. We walk the length of the boulevard and zig zag through to the capital building. The temp approaches 100 degrees and i feel like a complete moron for forgetting sunblock. However, my whining is quickly forgotten as i look over at another of hundreds of tent camps set up in the city.

Throughout the day, I was on the lookout for reconstruction. As today marks four months since the earthquake, little has changed. According to Sam, things have actually gotten much worse. The feeling is that despite all the money that has been raised for reconstruction and aid for earthquake victims, it has not gone to the places where they need it. Tent cities are still there, buildings remain flattened and few things are being put in place for Haiti to prosper in the future. However, he views the situation with a cautious optimism and says that there just needs to be some leadership on the part of the government.

We continue our tour through the main hospital and back up past the cathedral building. As we get closer to the afternoon Sam suggests we get some food so we head to a local restaurant. We sit down inside a clearly damaged structure to enjoy our meal. The food is rich and delicious and I must confess, completely unexpected. We finish and head back to the hospital. We exchange goodbyes and I thank him for his incredible hospitality. Despite they're circumstances, the Haitian people are extremely generous and I was treated with the utmost respect and hospitality. They do not expect a thing in return.