A blog by Dr. Jane Jenab '94 (at right in photo below) of Fort Bragg, Calif., who recently served as medical director of a Heart to Heart International relief effort in Haiti.
See Jane's Facebook albums: Feb. 23/24 | Feb. 25 | Leogane | March 1
My first day working in Haiti
First day of clinic was incredible. We are working in the second story of the Church of the Nazarene right at ground zero in Port au Prince. Clinic started with a bang...while seeing my second patient, I was summoned for by the current medical director. A young girl was lying unresponsive and shaking on the floor. Turns out she has a history of seizures but can't get the meds she needs at the moment. We got her to my table, took care of her and then tried to get her to a local hospital. They wouldn't accept her, so the team spent hours searching for a pharmacy that is still standing to find anti-seizure meds. She finally got the meds she needed and went home.
Second-to-last patient of the day (after 35 in between) was an 18-month-old with a HUGE swollen lymph node in his groin, fevers, and headaches. All we could do was to provide a written request for a local pediatric hospital to see him and hopefully work him up for for a malignancy. Poor kid! Saw a woman who may have been having an MI or an aortic aneurysm and couldn't do anything for her but refer her as well. Lots of infections, scabies, stress reactions, asthma. There is a feeling of helplessness at what we can't do combined with a feeling of joy when a woman told me tearfully how grateful she was that I had come all this way to help her and how happy she was with my care and how she prayed that God would protect and keep me.
A very emotional day that was certainly influenced by the utter devastation around us. The National Cathedral and Presidential Palace are in ruins; multi-level buildings are pancaked to near ground-level. Across the street from our clinic was a middle school that lost 200 children instantaneously. It's simply like nothing I've ever experienced before. Through it all, the Haitian people are still smiling, grateful, and working hard to put their home back together. Please continue to keep Haiti in your thoughts and prayers. They will be in need of our help for a long time to come.
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Day two at Bel Aire Clinic in Port au Prince
Today was a little hectic. Clinic started fine. I was summoned for a patient who "really wasn't feeling well" and found a 25-year-old with left lower quadrant abdominal pain and almost unresponsive. She was severely hypotensive (very low blood pressure) and we started IV fluids with little response. We had no idea if she had a ruptured ectopic pregnancy or hemorrhagic cyst and was bleeding into her abdomen, or if she had a severe gyno infection and was septic. She had been on her way to the Cuban Hospital for an ultrasound and passed out on her way there. We decided to transport her, and I went in the tap tap truck with two interpreters and the driver. It took all of us to get her into the truck. We made it to the hospital after an incredibly hot, dusty, and bumpy ride, our patient nearly unresponsive on the floor of the truck, me perched precariously on the bench above her holding the bag of IV fluids, and were turned away. Turns out that, although they have an ultrasound machine there, the only docs they have are ophthalmologists and none of them could treat her. Back into the tap tap and on to the next hospital, the University Hospital of Peace. After arguing with the receptionist for several minutes, I decided to take matters into my own hands and hunted down a very nice Nicaraguan doctor in the ER. He generously agreed to see her. Mission accomplished. I only wish I had some way to know how she did.
Otherwise, I treated several cases of malaria, lots of stomach complaints and stress reaction. It was incredibly hot in the clinic today and several times I found myself light-headed and had to remind myself to drink water. Hard to do when there are so many patients to care for. The saddest realization of the day was that while I gave my best care to the woman above, it meant taking hours away from everyone else. It makes you realize that no matter how much we give, it's simply not enough right now.
I've been trying to think of a word to describe how Haiti feels to me. Devastated just doesn't seem to capture the horror. Apocalyptic is about as close as I can get. They say it will be a full generation before they even come close to recovering. That's IF there isn't another cataclysmic event of some sort.
It's raining now. This is horrible news for the Haitians, because almost everyone is sleeping on the street or in the tent cities. Pray for them tonight.
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Day three at Bel Aire Clinic in Port au Prince
Today was an easy day, comparatively. We had some wonderful new doctors and a nurse join us last night which gave us the opportunity to have five docs and two nurses in clinic. The day flew by! Two of our new docs left at 11:30 a.m. to go to our outlying site, Leogane, which was the epicenter of the earthquake. Even with losing them, we saw 133 patients today, the third highest number (I believe) since the clinic was opened, and we finished at noon! Well, five or six trickled in after noon, but that was it. It gave us the opportunity to organize the pharmacy and do two home visits. One was for a young woman who fractured her femur in the quake and had an external fixator placed six weeks ago. For those who aren't familiar with them, they are pins that are placed externally on the leg and attached by metal bars. She developed an infection a week ago and huge swelling in the leg. We tried to get her in for an ultrasound to see if she had a DVT but she was turned away. We have only been able to treat her with antibiotics and she's actually doing much better. The pins come out in two weeks. Her home is only slightly better than a shack, and she is the most gracious, beautiful girl you've ever seen. We will see her again on Monday.
As we were leaving her house, and elderly woman frantically waved us down and said there was a sick person in her home. We entered the home to find three beautiful elderly women, two of whom were sisters. One was emaciated and had enormous bliateral foot ulcers with filthy bandages. Our wonderful Med/Peds resident, Toni, ran back to the clinic, grabbed bandages and meds, and treated her. We will see her on Monday as well.
One of the beautiful things that happened today was that they held a service below us in the church. We are in the mezzanine, and it is open to the church below. The sound of singing and boisterous praise was an amazing thing to hear in such devastated surroundings.
The rain yesterday was not as bad as we had expected, but it did have one bad side effect. The smell of death is really powerful today. On our way to the clinic every day, we pass the largest supermarket in Haiti. It collapsed completely and there are hundreds of dead inside. The smell as we passed today was overwhelming. You certainly don't need any reminders of what happened here...it's everywhere, but this somehow made it even more heartbreaking.
Our interpreters are the most wonderful men. I believe that without exception they are all living in either the tent cities or the street. They have almost nothing to eat and we share our food with them every day. Some of them are suffering more in the way of PTSD than the others, but even so, the sound of their laughter is never far away. They will always hold a very special place in my heart.
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I was woken at midnight by a flashlight glaring in my face. It was Nancy, one of our logistics people, who told me someone in the compound was having a heart attack. I grabbed Jeanna and two of our new folks, Francina, an ER doc, and Wendy, a nurse from Canada. We grabbed our stethoscope and a bag of meds and ran out the door. The patient's husband was waiting for us outside with his truck and drove us to their house. He and his wife do aid work fighting child trafficking and child slavery trade here in Haiti. She had been having chest discomfort for a few days with exertion, then woke from bed at about 11:45 p.m. with severe pain and pressure in the center of her chest. We gave her aspirin and nitro, started an IV, and scrambled to find a way to get her to a hospital or out of the country, a nightmare in the middle of the night in Haiti. We finally found out that the University of Miami had a moblie clinic at the airport in Port au Prince and her husband drove her there with a supply of nitro and aspirin. Hopefully, she made it out and is doing okay. All I can say is that nothing is more important than having a great team with you in a situation like that. Everyone did exactly what was needed and did it quickly and calmly. Jeanna, Francina and Wendy, you guys rock.
Hard to get back to sleep after that. Please say a prayer for this sweet lady if you have a moment.
Our hearts go out to the victims of the 8.8 earthquake in Chile this morning.
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Today was our rest day. After a lovely relatively relaxed morning, I had the opportunity to go up to one of our remote sites. Leogane was the epicenter of the earthquake. Ninety percent of the buildings were destroyed. Of the ones still standing, virtually none are in use because people are too scared to be inside them. In the first days after the quake, we had a group up there working the soccer stadium that houses the largest tent city in Leogane. The Cubans, Canadians, Japanese, etc. are there, and a Doctors without Borders hospital is nearby. Soon after, we moved to a Nazarene church and set up a clinic. The Mennonites have a school for girls immediately behind the church, and our people have been staying with them. They have been cared for incredibly well with three hot meals a day. They are staying in tents and the conditions are more rustic, but everyone who goes there loves it. I wanted to get a look at the site to determine how we can improve our deliverance of care to the people in that area. I drove up with Jorge, a doc originally from Guatemala, and David, one of our nurses. They will stay for about a week, and Larry and Jason would come back with me to Port au Prince.
On the way up, I had the opportunity to get a great view of the USS Comfort, a floating naval hospital that has more than 100 beds. In addition, I saw the first signs of the heaving that must have happened the day of the quake. The road there is twisted and broken in many spots. Just another reminder of the immense force of this quake.
It was great to see Larry and Jason again. They didn't seem to want to leave, but they were very excited to get their first hot shower in a week! We took a trip to the stadium to check out the "facilities" and I use that term loosely. The still have our original site reserved for us. I have an even greater respect for the folks who were here early on. It is essentially some blue tarps covering wooden sticks with some benches and that's it. The Cubans are using the site in the mornings, but they leave at 1 p.m., even if there are lots of patients left to see. France is the woman helping to coordinate care in the stadium. She is a nurse, and there are many nursing and medical students who have been volunteering their services there since the quake. They have nowhere else to go because both the nursing and the medical schools were destroyed. Junior had just finished his second year of med school when the earthquake hit. He was at the top of his class. He spends all of his days at the stadium and has not been paid at all in the last seven weeks. He is unsure of his future and has no idea where to go from here.
We decided today to start an afternoon clinic in the stadium again, in addition to the clinic we have at the church. It just seems like the right thing to do.
On our way back we went past the market I mentioned earlier. The UN was out in force and the area was enveloped in foul-smelling smoke. They chose to burn the remaining bodies to do away with the odor and potential disease. Not something I ever hope to see or smell again.
It's amazing to me that tomorrow is our last clinic day. We leave for home again on Tuesday by way of the Dominican Republic on a U.S. Embassy flight. I don't want to go yet.
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Last day at the Bel Aire Clinic in Port au Prince
Hard to believe today was our last day. Also hard to express my sorrow of having to leave these beautiful people while their country, their lives, and their futures are still in such a horrible and tenuous state.
We had an overabundance of providers today which allowed us to put two teams into the field and see a total of 316 patients, which is nearly three times what they saw before we arrived. It was the busiest and most stressful of all the days I've had as medical director. I was constantly putting out fires and juggling staffing issues. We lost track of some team members for almost four hours when one of our docs transported a young pregnant mother with seizures and her severely malnourished infant to the hospitals where they could get care. On top of that, there was an aftershock. It was only a few seconds long, and I was so busy running around that honestly, I didn't even feel it, but it frightened our Haitian friends quite a bit.
Even with all of that, it was a pure pleasure to be there. Saying goodbye to our interpreters was one of the hardest things I've done in a while. That will only be equaled by the sadness of saying goodbye to this amazing group of people I've had the incredible good fortune to work with in my time here. One of the things I love best about doing international health work is the quality of humans I get to work with. Each and every one of them is here with only one goal - to help those in desperate need. It pulls us together and forms bonds with lightning speed. Bonds that I am sure will last a lifetime.
Tomorrow we take a military flight out from the U.S. Embassy, either fixed wing or helicopter. I don't want to leave. There is so much left unfinished. I am worried about my new friends who are still sleeping in the streets and hitchhiking in to work long hours with us in the clinic. I am terrified to get the news that one or more of them didn't show up one day and was presumed dead. I wish I could find a way to return very quickly. We'll see what life has in store for me. All I know is that the Haitian people will always be a part of my heart and soul, and we can never forget what has happened here and the enormous amount that still needs to be done.
If you'd like to contribute to future work, visit the Heart to Heart International website.