Special Report: To Haiti and back

Jen Turnbull )l), assisted by Gilliam Morantz (r), places an IV in the forehead of a three-week old triplet. / Photo: Robin Cardamore
Jen Turnbull (l), assisted by Gilliam Morantz (r), places an IV in the forehead of a three-week old triplet. / Photo: Robin Cardamore

McGill medical residents pitch in to do their part

By Robin Cardamore, Gillian Morantz and Jennifer Turnbull

It has been more than two months since a massive 7.3 earthquake devastated Haiti, killing some 230,000 people and leaving an estimated one million more homeless. While the world community responded to the tragedy with an outpouring of humanitarian aid, each passing day finds the story getting pushed further into the back of our newspapers and our collective consciousness. But just because we hear fewer reports coming out of Haiti doesn’t mean the need for help has diminished.

In February, Jennifer Turnbull, Gillian Morantz and Robin Cardamore traveled to Haiti as part of the McGill Humanitarian Studies Initiative for Residents (HSIR). There they worked in the country’s largest field hospital located in Fond Parisien. The challenging nature of their work in Haiti and the hardships faced by the battered nation as it rebuilds is captured in the following excerpts from correspondence between Turnbull, Morantz and Cardamore and their friends and family back home.

Morantz: Day One

Jen and I arrived today and set up camp. We will be working with medical teams from all around the world at a makeshift field hospital and Internally Displaced People’s (IDP) camp in the Haitian town of Fond Parisien. It is right near the border with the Dominican Republic and they receive post-op transfers from there as well as the U.S.S. “Comfort.” The field hospital is on the grounds of Love a Child, a Christian organization and orphanage, and the medical care is being co-ordinated by the Harvard Humanitarian Initiative (HHI).

It looks like I will actually be quite useful because this place is brimming with children, many of whom are unaccompanied and injured. I am going to work with the Child Protection team that is responsible for sorting out the disposition of unaccompanied minors. I will also be working at several clinics here, at the IDP camp and in Port-au-Prince (PAP).

The security situation seems OK except for the mosquitoes. And there seems to be enough food/water. Phew.

Cardamore: Hitting the ground running

I arrived in Haiti less than two weeks after the initial earthquake hit. Not knowing what to expect, I hitchhiked my way overland from Santo Domingo, Dominican Republic, with various disaster relief organizations and, seven hours later, I found myself standing on the side of the road just inside the Haiti border with all my gear.

Thinking to myself that I must be crazy for doing this, I made a call to staff from the HHI working at a field hospital in Fond Parisien. Thirty minutes later, a black Ford Explorer pulled over to pick me up and I was greeted by Christian Theodosis, a HHI graduate and ER physician at Chicago University.

The term “hitting the ground running” was definitely true. I received my 15-minute tour then was informed that I would be in charge of running the triage tent for the duration of my four weeks in Haiti. After a 16-hour work day, during the evening staff meeting someone needed to volunteer to be on call that evening. I slowly put up my hand. The following day at 8 p.m. I finally got to set up my tent and lay down for the first time.

The injured pray at a makeshift church by the hospital. / Photo: Robin Cardmore
The injured pray at a makeshift church by the hospital. / Photo: Robin Cardmore

Turnbull: Zero creature comforts

Since January 12, about 730 patients have come through the camp. Of these, approximately 250 are currently admitted patients in the hospital (tents). In total though, there are more than 600 people living in the camp when family members are counted. Down the road 6.5 km, is the IDP camp. We are unsure of their numbers right now, but these are “healthy” people who have migrated out of Port-au-Prince because they are homeless.

The original “mandate” of the Fond Parisien camp is surgical and post-surgical care. However, as news travels around the country about our hospital, people are streaming in on foot, by truck, tap-tap (taxi) and from the IDP camp. These people have a wide range of medical issues that we are now caring for. Many very sick children and adults are often rushed in on the backs of trucks and dumped into triage.

Our surgical/post-surgical patients arrive (often unannounced) by various modes of transportation. The USS Comfort sends five to 15 patients a day via helicopter. School buses and trucks also arrive full of patients from hospitals in the Dominican Republic.

The foreign staff, and some of the Haitian staff who don’t live in the nearby town, live in a tent city within the same compound. So far security has not been a major issue beyond tents getting rifled through. Shower facilities consist of metal planks with blue tarps around wooden frames made of branches. To shower we fill a five-litre bucket with water and douse ourselves using a used water bottle cut in half. We are also lucky to have access to the flush toilets that were already part of the original buildings.

Patient complaints range from typical stuff we see at home (headache, back pain, heartburn), to truck/helicopter loads of post-op amputees and fractures. I’ve also been doing a makeshift orthopedic clinic out of the ER because truckloads of people are arriving to have casts removed and X-rays taken. The sound of my cast cutter really draws a crowd! It’s quite sad because it seems most people with closed fractures were quickly thrown into casts immediately after the earthquake. X-rays are showing badly healed displaced fractures that need operations. Everyone thinks we are taking them to the OR to amputate. Luckily we haven’t yet.

Morantz: Taking careof the children

I can’t believe its only Day Seven. It seems like much longer but not necessarily in a bad way. It’s amazing how quickly a place can feel like home even though it is rather unlike anything I’ve experienced before.

We work long days here, in excess of 12 hours. And even though I am no stranger to hard work, it’s not usually in 30-degree heat and under an unforgiving sun. Needless to say, I am sunburned.

I have been assigned the task of child protection, meaning that I am responsible for the 30 some unaccompanied minors in the field hospital. This involves an investigation into their situation and then trying to facilitate family reunification whenever possible. I hear a lot of really heart-wrenching stories. But we’ve also had some amazing family reunions.

When I’m not taking care of my “kids,” I am doing clinical work among the wards (a.k.a. tents) and in triage and the malnutrition clinic. We have had some fairly acute pediatric cases, particularly neonatal sepsis/pneumonia, severe dehydration and marasmus. Because we have no lab facilities but a relatively well-stocked pharmacy, we pretty much treat them for all eventualities.

The rudimentary operating theatre. / Photo: Jennifer Turnbull
The rudimentary operating theatre. / Photo: Jennifer Turnbull

Cardamore: Technology reunites families

The last two weeks I spent working with the Operation Medicine Institute (OMI) developing an iPhone application called Haiti IT Rescue Project. This pilot project evolved tremendously from simply a patient census that could track unaccompanied minors and amputees to a product that allows physicians to view patient’s X-rays in the field, document assessments and plans, track epidemiologic data from the SPHERE manual, track vulnerable patient populations, display an accurate and up-to-date hospital census all from your iPhone effortlessly. With the family contact information component, this program was instrumental in reuniting family members with lost loved-ones during a disaster situation for the first time ever. With hand-held technology evolving so rapidly, the applications during disaster situations are endless.

Turnbull: Triumphs amid the tragedy

Yesterday, I was working in the triage area. This is essentially a medium-sized event tent (think white, graduation-ceremony style), with 15 patient cots low to the ground. A six-month-old baby was carried in – unresponsive, and in severe respiratory distress and hypovolemic shock. I put in an IO [intraosseous infusion, whereby an injection is made directly to the bone marrow] then a femoral line (actually an 22-gauge IV) and intubated the child while kneeling in the dirt, with about 20 people watching. We rushed the baby across the border to a hospital on the Dominican Republic side. There we were going to airlift to the capital that had ventilators. We bagged the child [used a hand-held device to pump air into the baby’s lungs] for 40 minutes in the back of a pick up truck over very bumpy roads. The baby took a bad turn part way into the trip and I ended up starting compressions because his heart stopped in the Dominican hospital (again 20 people watching). We gave two rounds of epi [epinephrine or adrenaline] and got the heart back – the whole time hoping the helicopter was on its way. The helicopter was not on its way.

There have been happier stories of critically ill children whose lives we’ve saved. This is pretty amazing considering we are working under tents in the dirt in a giant field (kind of M*A*S*H* style but bigger). One three-month-old child presented post-seizure and in hypovolemic shock. But, following IO, IV fluids and a course of ceftriaxone later, the baby is at home with mom. Another two-month-old infant came in with severe respiratory distress due to pneumonia. Oxygen saturation was 83 per cent. Things got so bad we almost intubated. Five days later, the baby is off oxygen and is going home tomorrow.

The rows of tents at the hospital. / Photo: Gillian Morantz
The rows of tents at the hospital. / Photo: Gillian Morantz

Morantz: Finally, a day off!

On Sunday, Jen and I took our one day off to go into Port-au-Prince.

The devastation is horrific. It’s impossible to understand. The city is also horribly dirty, disorganized and polluted. Most people are living in haphazard tent cities – even people whose homes are still standing. Many, understandably, are too scared to sleep indoors. We are still experiencing aftershocks. Most of the tents are made from sheets and bits of plastic. I have no idea what they are going to do when the rains start. It’s terrifying to imagine. Their ordeal is far from over.

At the hospital and the IDP camp clinic, we have begun to see more manifestations of depression and post-traumatic stress. People are getting over the initial shock and for some, a sense of despair is setting in. Nevertheless, most people are rather philosophic, just grateful to be alive and deriving strength from their faith. As I write this, I can hear the singing from the hospital’s makeshift outdoor church.

Despite the appeal of a real shower, it’s going to be very hard for me to leave here next week, particularly because of the relationships I’ve formed with some of the kids.

I am pretty sure I will be digesting this experience for a while to come (especially since I’ve had so little time to reflect) and that the people here will never be far from my thoughts. I am really worried about the rainy season and what other disasters it might unleash, such as diseases. I’m terrified the world is going to forget about Haiti once some other news trumps it: lack of shelter and disease don’t make as good a story as an earthquake, but they can be just as devastating to those living it.

Cardamore: Enduring experiences

Looking back, the first week and a half was definitely the hardest. Functioning in 30-degree heat with no food was grueling. PowerBars and granola bars can only get you so far. The good thing was that you were too hot to be hungry. A week later, food finally arrived. By week four, I found myself not wanting to leave and trying to figure out how I could stay another two weeks. The patient stories, friendships made, and medical experiences will stay with me for a lifetime.