Liz Drum, M.D.
February 6, 2010
Subject: First day here - ER
It is my first full day here. I made rounds this morning with the team that is here. The orthopod is on his way home, but two more will be here this afternoon.
There are about 30 inpatients, in four "wards" which are either open air buildings or tents. They have beds or mattresses to stay on, and family members take care of their basic needs. There are many orthopaedic injuries, mostly healing well, but disposition on leaving here will be an issue.
No surgery yet today, but as soon as our orthopod gets here, there is someone with an open tibia fracture sent from a clinic.
Here is a boy named Christian with a family member who has a femur fracture in external fixator.
The 8 day old baby left, but now there is one who is 3 months old but only 3 pounds, as you can see in this picture.
Many of the patients are here with basic medical needs, not all are earthquake related.
I am going to look at the OR and figure out exactly what I have in terms of anesthesia equipment and supplies for later.
I am staying in a building with a working toilet and cold water shower. People from the hospital are providing us with three meals a day. I had spaghetti, peanut butter and half a grapefruit for breakfast.
Time to get to work!
February 7, 2010
Subject: Liz's first day of surgery
Today was a busy day. I performed my first surgeries at the hospital at Jacmel. Our surgeons didn't get here in time yesterday to do any cases, so we had several today. Most people go to church, and the generator isn't turned on until after church, and we need the generator for the OR, so we didn't start until 11:30.
Our first case was a four month old who had a wound on his arm. He was pinned under rubble, his mother was killed and his father injured. He will probably have some long term damage to his hand.
We also had a patient with a hip dislocation, and one with a tibia fracture. Some things work great, some don't. We have a great anesthesia set up, but no real tourniquet for surgery. The team had to improvise a tourniquet for this patient.
We had a child come in hit by a motorcycle, there was some concern about a closed head injury or cspine injury but all we can do it evaluate clinically and get plain xrays.
We are trying to get several patients evacuated to Philly for treatment, but the logistics are complicated. People want copies of documents but there are no printers or copy machines. Two people had to fly to Port au Prince today via blackhawk to get the papers stamped.
We are having a make shift superbowl party tonight! The link below is for Doctors United for Haiti which is the group I am working with. From the home page, click on "Team Ange" to see a description of our activities and more pictures at www.dufh.org.
Many people have expressed their support for me. Thank you all! Please keep praying for us and for all those working to assist in Haiti!
February 8, 2010
Things are hopping today. We took care of a 12 year old with a parotid mass. Now we have two patients with forearm fractures, a patient with a shoulder dislocation, one with a hernia and one with fibroids. There will probably be more.
It is hot and sunny. The OR has no windows but a small air conditioner that keeps it tolerable. I don't really have to worry about the patients getting cold!
If anyone knows someone with a plane or who is willing to finance a plane to transport patients from Haiti to the US, let me know. We have several patients who have been granted humanitarian parole for medical reasons to come to the US, and hospitals willing to take them, but we need to get them from here to there.
We are also looking for ways to have supplies flown from Florida to Jacmel. We had a busy day, we ran two ORs, there are about 30 inpatients, and hundreds of outpatients every day. But I have a place to sleep, food to eat, a place to take a shower (cold water), and am meeting some wonderful people.
The Haitian people are happy, friendly, stoic and very gracious. They are quite content even in the midst of very difficult circumstances. Many of the people we are seeing now have medical issues, not necessarily related to the earthquake, but we are able to take care of them, whereas the opportunities for that have been limited in the past. We are also now seeing some of the longer term issues from the quake-wounds not healing, fractures that need further attention, things that got put aside because they weren't life threatening.
I am grateful for all of the support from so many people.
February 9, 2010
Here I am with Dr. Deep Kohlen taking care of a 12 year old for a closed reduction of a wrist fracture.
Dr, Deep Kahlon and Dr, Dan Fitzpatrick are doing a closed reduction.
Emily, our OR pharmacist, transporter, scrub tech, and arborist, is assisting.
I am doing fine. It is a little surreal here, but also very good. It seems like we get very little done for a lot of effort but the smiles on peoples faces make it worth it.
Patients are flying to Philadelphia now on a jet provided by the Eagles football team!It should land between 9 and 11 pm tonight. Three patients are going to Shriners Hospital for Children, one to to Dupont, one to Geisinger.
February 10, 2010
Subject: Making it work with what we have
Preparing to move a patient with an improvised stretcher.
Subject: This is what makes it all worthwhile
One of my patients leaving the hospital with her mother after treatment.
Subject: A 5 year old having leg surgery
Here I am with a 5 year old boy who is having leg surgery.
While it is cold and snowing at home it is quite hot here!
Yesterday I mentioned patients being flown to Philadelphia. Because of the weather, the airport was closed and they did not make it, but hopefully will be able complete their journey soon.
It is 8 pm and I am sitting in the OR recovering a 5 year old patient after we took care of his leg for a very bad infection. Normally we would take the patient to a recovery room staffed with nurses specially trained in the care of these patients. When stable, the patient would go to his room. If he needed oxygen or a monitor we would order it. Here there is no recovery room or recovery room nurses. After we decide he is safe to leave our care, we will carry him or use our makeshift stretcher and take him to a mattress on the floor in a tent shared with 8 or so other children. He had a very badly infected leg and was very stoic. He didn't cry when we brought him to the OR, and only did so when we checked his IV.
The people here are amazing. They are happy, and grateful for care. Their family members provide all the basic needs such as clothing, bed linens and food. The conditions for them are very poor. No bathrooms, no water, no comforts.
We have the best facilities in Southern Haiti. This was a hospital that was well established before the earthquake. It was started in 1979 by Dr. Brinson McGowan as a member of the Baptist mission. It is called CME or Central Medical Emmanuel in Cayes Jacmel. The property was really not damaged in the quake. Most of the damage was in Jacmel, right next door.
February 11, 2010
Subject: Patient being transported to Philadelphia
Here is a patient with a cervical spine injury in a pickup truck going to the Jacmel airport. The patient will be flown to Jefferson Hospital in Philadelphia for treatment.
Subject: A baby girl is born in our clinic
She is 30 minutes old in this picture.
Mom is holding her!
In a place of difficulty and suffering, joy has come also.
This morning started with readying three patients for medical evacuation to Philly. Hours of coordination went into this: locating an accepting hospital and physician, applying for and actually obtaining humanitarian parole to allow the patients and one family member to travel to the US for treatment, arranging the actual transportation and host families in the US, and trying to work around the weather! By the time you read this, all three patients and families should be in Philly, and the patients from the other day should be there also.
Every day brings hundreds of patients to the out-patient area seeking medical treatment. There are only a few treatment/exam areas, and patients and families are literally everywhere. We are still seeing patients with injuries from the quake who are just now seeking medical care. We have discussed working with other local teams to send mobile clinics to remote areas.Today we took care of a 2 year old with a leg injury from the quake.
Late afternoon we had a baby born in the clinic. I was not there, but I was privileged to meet mom and daughter when baby was 30 minutes old. There were four women in the room, and I honestly could not tell who mom was; I had to ask before I took the picture!
Many of our team are leaving tomorrow and Saturday, so there are lots of transitions this weekend.
We struggle with things like electricity from the generator. Without it we have no lights in the OR. We can't get an xray ( we can only get simple ones in the clinic) or use any electrically powered equipment like monitors or our anesthesia machine. In the OR we all have our head lamps and we don't even miss a beat when the generator goes off. Surgery goes on by flashlight.
Many of the medical things we take for granted in the US don't exist here: charts, medical records, labs and xrays, and CT scans and MRIS. No ICU care or ERs or ambulances or ventilators. Many cell phones don't work here. AT&T works best here where we are. Those of us with iPhones are in the best shape, but we still struggle sometimes. You can't call the Dominican Republic from here, and you can't call a Haitian number. I brought two old cell phones from home and finally found someone to unlock them so I can use them to call local numbers.
New adventures tomorrow! I am making rounds on all of the patients starting at 6 am tomorrow, so that I can make sure I know the medical plan for all of them. By late Friday or Saturday, I will be the only physician here who has been here for the last week and will be responsible for the medical operation.
February 12, 2010
It rained overnight and feels more humid than usual today. It usually starts cloudy but quickly gets sunny.
It is relatively quiet this morning ( for which I am grateful). It is a "holiday" today, more accurately a day of fasting, prayer and remembrance because it has been one month since the earthquake. I have been told this will last through the weekend. There is a church next door and I can hear them singing "How Great Thou Art".
I am still trying to figure out who is coming when and from where. Transportation gets complicated through the Caribbean islands and into Jacmel.
February 14, 2010
It has been a weekend of transition. Except for Andy, an OR nurse, everyone that was here when I arrived has gone home. There are 4 others here that came after me and are leaving in a few days. We had a great crew including another anesthesiologist, a nurse anesthetist, 3 orthopaedic surgeons, an ER doc, infectious disease, pediatrician, pharmacists, and some awesome nurses and probably someone I forgot. It seems oddly quiet without them. The comraderie we developed in a short time was amazing. The synergies of information and energy were palpable. I am really going to miss them. A few new people arrived, and there are more on their way. By Tuesday, I am expecting to have another full house of 18-22. I am being a logistics coordinator of planes, people and stuff. Need to get from the Dominican Republic to Haiti? I can probably arrange it!
As an anesthesiologist, I don't usually have much to do with primary care - care of patients with non surgical needs, and I am usually only responsible for the patients while they are in the OR or recovery room. So having 25 patients in the "hospital" that I need to make sure get care is a different experience. I am changing dressings, deciding about antibiotics, diagnosing malaria based on clinical signs, deciding when people can go home, etc. Most of it is basic medical care, but it has been fabulous to have people around to help with the responsibility.
Yesterday was a second day of mourning. We heard singing in the next door church, a ceremony of some kind at the rivier behind the building we are staying in, and the activity level has been a little quieter.
It is raining very hard tonight. I am grateful to be inside a building and not outside. Four new people arrived today, one yesterday, two tomorrow and many more on Tuesday. I think we will be up to 18-22 on Wednesday and then people start leaving. A new crew comes next weekend.
I went to a local Baptist church this morning. I couldn't understand much of it, but they were certainly enjoying their singing! There were at least 25 bright eyed children dressed in their finest clothes.
I went to the Jacmel airport today and there are still planes landing and taking off all the time. There are literally tons of supplies coming in daily. The logistics of getting them to the right place and having the right stuff are overwheiming to almost everyone.
We see the cycle of life here in Haiti. A day or so ago, one of our patients died. She wasn't that old, late 50s and had chronic bleeding.
Yesterday we had a woman come in 7 months pregnant. She was bleeding and had dangerously high blood pressure. We couldn't hear the baby's heart beat. She had an emergency C-section, but the baby was already dead. It was a very sad thing, but I was very proud of the work of our whole team: ER doc, surgeon. nurses. Fortunately we have a psychologist here, and she was able to talk extensively with both mom and dad. Mom is doing quite well tonight and will probably go home tomorrow. We gave them a small box to bury the baby in; I probably won't look at a box like that the same way again.
Dr. McGowan said half of all children don't survive to age 6, and that some families don't even name their children until then.
On a happier note, I delivered a baby girl tonight! Mom and baby are quite well!
February 15, 2010
Subject: New baby, mom, and me
Here I am with newborn and her mother.
Subject: Monday is a busy day
(Monday morning) We will probably have over 300 patients today as the clinic was closed except for emergencies for the last three days. These are patients who have already been triaged and screened waiting for treatment. This is one hour after the clinic opened.
Here are the surgeons treating a patient with a large hernia.
Subject: God is very near
Liz has mentioned that there is a church near the hospital where her team is working. She often hears people singing there and went to church this last Sunday (see previous post)
Here are children outside the church dressed in their best clothes.
Subject: The airport is our lifeline
Many people and supplies come through the nearby Jacmel airport, a short drive from the hospital.
The airport is being run by members of the Canadian Air Force. Here is a picture of their camp. This airport is vital to use for getting the things we need and for transporting patients who need urgent care to the USA.
Subject: Support from the homefront
Led by Liz's sister-in law Lisa Parker, last Saturday an intrepid band loaded up a convoy of vehicles to transport supplies over to the Team Ange "base" house in New Jersey. We took up most of the street!
After slipping and sliding through Northeast Philly, we made it to the house and unloaded our cargo.
While we were at the house, we met Mike, a physician who had just come back from the hospital in Haiti and had met Liz, and Joe. Frank Iacona and others are working hard to organize the shipment of needed supplies. Also many thanks to the shipping department at Abington Memorial Hospital who helped us get supplies that Liz had arranged for.
Our effort is only a small part of what many people are doing to support the efforts of Team Ange. Thanks to everyone for helping Liz and the entire team!
(posted by Marc)
Here is Martha Drusedum, Marc, Lisa and Walter Drusedum. Dr. Ruby Camerena also assisted.