Haiti Feb 27 – March 7 2010
We left for the airport in the USA with some reservations. We knew that we were doing the right thing, but we were all afraid. What other choice was there? We were the luckiest people on earth, able to help and make a difference. “You are an orthopedic surgeon who can help”, my wife said to me as we watched the news which showing photos of the mass chaos in Haiti, from the comfort of our Indiana living room.
The Haiti earthquake was the biggest orthopedic disaster that anyone could imagine or recall. Our flight to PAP airport in Haiti from the states was just three weeks after the disaster. This was not a long flight time from Miami, but it felt like hours. What would we see? On our approach to PAP, we saw destruction from the sky on the coast and city. Buildings toppled over on their side, dirt, and in places it appeared quiet.
What was surprising and most impressive as we made our final approach, were the many US naval ships at sea that we spotted, including the USS Comfort. It was massive, white in color with multiple red crosses on its hull and decks. We landed and were told by Bob Caudle who had our instructions on how to get from the airport to the hospital, we should “look for a dwarf or a one-armed man named Jackson” and that they would get to St. Damien Hospital. I knew right then and there, whatever I anticipated this medical mission to be, I couldn’t possibly have imagined.
Once we cleared customs, we came upon a gate with several hundred Haitian man standing there offering to get us a taxi to our final destination. We each had a back pack, a carry on bag and 2 suitcases with medical supplies weighing over 50 lbs each. We couldn’t find either the dwarf nor a man with one arm and after about 20 minutes of looking, we started to think of alternatives. Jen very quietly looked at Andy B and said “that man has one arm”. Andy approached him and asked if he was Jackson. He said reeking of alcohol, “Everybody knows Jackson….Of course I am Jackson”. O.k. then, we’d be on our way. We loaded all of our belongings into the truck with Jackson sitting on Andy’s lap. Jackson was completely drunk and was sound asleep within 5 minutes and our driver spoke no English at all. Somehow, we stumbled upon the 82nd Airborne Battalion Compound and the soldiers wielding machine guns stopped our driver. We had no map but did know that the hospital was near the US Embassy. They gave us directions and we made it to St Damien’s.
I had assembled a team of four. Our team was Andy Day, anesthesiologist, his wife Jennifer, a nurse, and Andy Bulla, PA that I work with. They were all great at what they did.
That night we met the rest of our group. Bob Caudle is a pediatric orthopedic surgeon from Raleigh, NC, and was my contact person that led us to this opportunity. April is a scrub RN from NC. We joined up with a team from Montana that included 1 MD, 1 PA, 2 PTs, 2 Nurses, and a sales rep who became Team Gofer. There was another orthopod from Bloomington and an excellent OT as well. We had the makings of a great team.
Monday began with a mass by Father Rick and Father Scott at 7 am. I’ve only been to one Catholic Mass and was not real impressed. The sermon by Father Rick however had a gift and was a tremendous speaker. This morning was a funeral for 5 children that had been dug out from a school that had collapsed and killed all 200 inside. Apparently, everyday bodies are brought to the hospital from this site.
There was not a dry eye in the small chapel. Many of the stained glass artwork was broken and rubble was everywhere; however, Father Rick preached Hope and I felt good after the sermon. We were off to a doctor’s meeting after the service and then on to the day.
Much of the team started in the Clinic where I was told they saw about 80 patients. It was 80 – 95 degrees. I went off to surgery to operate on forearm fracture that occurred during the earthquake and never healed and to operate on a lady who had a femoral head fracture dislocation with an acetabular fracture. Minouche Civil is a 22 you female L hand dominant woman with a nonunion of the BBFA variety. It was shortened and atrophic and significantly deformed. Andy Day performed a scale block and I was nervous about surgery for the first time in many years. Our OR was about 12 by 18 feet and had a pole in the middle.
There was no anesthetic machine, boxes were everywhere, and the bovie did not always work. We had some plates and screws and thought we could cut the large screws into small ones if need be. We had the only functioning C Arm in PAP. The room was about 90 degrees and there was only a fan. The surgery went surprisingly well and I felt like we really helped this woman. She went from having a useless arm to one that should heal if she doesn’t get an infection.
The next case was a 39 yo lady named Rosamay Sylvestre with a femoral head fracture and posteriorly dislocated hip since the earthquake. I heard someone say, “Dr. Tannenbaum, we have a patient who is depressed”. This young woman and mother had been lying in bed for 6 weeks on her belly and was really depressed. A Brazilian surgeon operated on her a few weeks back but she remained dislocated. Andy Day brought a home made anesthetic machine and he did probably the first and only General Anesthetic in this hospital. They were only using Ketamine and local prior to this. The surgery went well and I used an Austin Moore prosthesis and took what was left of the femoral head and turned it into a posterior wall. We lost blood and her Hgb was 10 preop.
In Haiti in these conditions, you did what you could with what you had. There was no blood available for transfusion. I injected everyone with marcaine with epi to try and decrease blood loss. Somehow, she was 7.8 postop and seemed OK. Finished about 7:30 that night. The girls in the OR worked real hard. They were stars!
They scrubbed, circulated, cleaned all instruments, cleaned the room, and sterilized everything. I tried to help as did everyone. It was real team effort. Made it back to the guest house for freeze dried beef stew….it tasted great. The OR was so hot that we had to drink 4 bottles of water after the case. Hands were water logged in gloves and scrubs soaking wet. Andy Bulla and I stayed in his tent on the roof of the guest house. It was concrete but everyone slept there in case of another earthquake…people felt safest on the rooftop so that we wouldn’t be crushed. The first night we didn’t sleep more than 30 minutes without waking up hurting somewhere. This night we found some warm Colt 45 beer, the can of which described it as America’s Beer. I slept a little better and sat in the tent for a long time thinking that this may have been the most gratifying day I have ever had in the OR. We were changing lives, perhaps for generations to come.
It took all day in our little, humid, sweating OR, but we truly changed the lives of 2 horribly unfortunate people. I felt better about this than any surgery I have ever done before. At home, there is always some one who can do what I do, but in Haiti there aren’t. I really missed my family as there were no phones, but I knew that they understood and encouraged me to go to Haiti.
Tuesday began like the day before with another funeral and a mass. This funeral was a little different in that it was a middle aged woman who died of “a broken heart”. Her family was killed in the earthquake…her parents, husband, and all children. She was in a tent and overcome with grief. Father Rick carried the entire funeral in Krayol for her friends and it was tough to hear about her losses. I was in the ortho clinic today and we saw about 75 patients. There were at least 8 kids in spica casts that we took off and watched them take their first steps since the quake. I saw many Ex-fixes, some healing some not. The malunion/nonunions are the hardest to fix. They always are in the best of conditions, and these were not that.
I think about 50% look to be in satisfactory alignment and may heal, the others will need surgery. Learned today that they think 300,000 people died, 20,000 had major ortho injuries of which there are 4,000 lower extremity amputations and 1,000 upper extremity amputations. I had to walk down the hallway to look at X-rays. This walk was emotionally very difficult. St. Damien’s is primarily a children’s hospital that is continuing to take care of kids in addition to the massive adult trauma. I saw hundreds of people waiting all day to be seen.
There were screaming crying babies, mothers hot tired, nursing their infants, people on stretchers and in wheelchairs with big metal exterior fixators on their legs and arms, and many sad, emotionless faces looking at me in my scrubs. wow. It was hard to walk by with my health without feeling horrible at times, guilty and so grateful for the incredible life that I have. There was an ER filled with really sick babies that were dehydrated and septic. I’m sure babies died there everyday. I did see some happy kids that day and their faces are what really kept me going. If you had your own kids, you couldn’t help but feel grateful for their good health. During the clinic, there was an aftershock that we later learned was 4.5 on the Richter scale. The Haitians were freaked out and ran into the courtyard of the hospital screaming. They are residents that have houses still standing but will still sleep in tents at night because of their fear of another life altering quake. We had another busy and satisfying day and hoped that we would sleep better that night. Unfortunately, a sick dog barked all night. He kept us up that night but we never heard him again.
By Wednesday we were all in a groove. Our work was very rewarding and we were at what was probably the best hospital in PAP for what we were doing. We found out that the US Government had 2 complete OR facilities near the airport. They had not done a single surgery in them. One of the guys went there looking for a bovie as ours did not work and he heard how the army surgeons were just standing around doing nothing. They were keeping one of the ORs there just in case and the other they were going to ship back to the states. Later in the week, a congressional group flew to Haiti for 5 hours of pictures. They were supposed to come to our hospital at which time we were going to make a plea for the supplies in that OR, but they cancelled the trip for more photo ops with the Haitian government. They flew all the way to Haiti for 5 hours!!!!
Nevertheless, I split my day between the clinic and the OR. I operated on a young Haitian with a femoral neck nonunion and did an Austen Moore with a Haitian orthopedist, Dr. Philip. He had seen one these about 12 years ago in Belgium, but had never done one. It was fun showing him how to do one….he was going to see this person in follow-up at one the adult hospitals, St Camille. We went to the US Embassy today and met 2 members of US Special Operations Forces. They picked up one of the young helpers from the clinic and took him in a Humvee to get pizza and beer for us after a long day. That night we had pizza and beer at “Father Ricks’s Café Disco”. It was great way to blow off steam and hang out on our newly named concrete home. We gave the above name to the rooftop and everyone at the guest house started using it. Andy Day and Patrick played the guitar while many sang along and had Cuban cigars.
The days continued to fly by. Thursday was a clinic day and removal of a few external fixators. We would take the fixators off for 48 hours, give antibiotics, and then rod the nonunions. We went to the rehab center and saw the Italians making prostheses for the patients. They were able to do this in less than 24 hours. Some of the kids I sent over on Tuesday were learning how to walk on Thursday….it was really neat. The team from Montana all had gotten really sick so we tried to get a good night sleep tonight. Unfortunately, there was a torrential rainfall and it soaked our tent. It was almost hard to believe these were conditions some Haitians worked in regularly. Andy and I had to rearrange everything in the middle of the night when our pillows became soaked and our faces wet with Haitian floodwater. There were showers available but the water just dripped out of the shower head. It was cold and really more of a wash cloth shower. The water was ”filtered” in some places but I often treated anything not bottled with iodine tablets. We had to remain healthy to treat these patients and care for as many people as we possibly could what we were here. I had a lot of post op work to take care of today. The nurses and patients only spoke Krayol and we wrote our orders in English…hmmm. There were translators that helped but the floor work was slow going.
Friday was once again a very busy day. It was busy, pretty frantic and just confusing and messy, but remarkably rewarding. t get an infection. Surprisingly, with all the dirt and despair, Haitians take pride in presenting themselves well with so little but have excellent hygiene. They looked a whole lot cleaner than me by the end of the week.
The pharmacist at Andy’s clinic sleeps under sheets and a tarp but is always perfectly dressed and looks as though she has had a great shower. The ex fix pin sites all look really good despite minimal pin care. I did a subtrochanteric nonunion with Bob Caudle. It went really well using the SIGN nail that is being used throughout 3rd world countries. Went for a ride with Special Ops guys around city and had farewell party at Café Disco. We met people from Italy, Spain, Germany, and other parts of US. It was really fun and made you feel really good to be in Haiti.
Saturday began with saying our goodbyes and a trip to the water front and Palace. The downtown area was hit particularly hard and every third building was flattened like a pancake. There was rubble everywhere. People filled the streets and tent cities were massive. Cars drove in all directions without any apparent order or street rules. Garbage was everywhere and pigs, dogs, and rats the size of dogs wandered the garbage piles. The Palace was twice the size of the White House and was devastated. The fence and surrounding lawns were pristine but the central dome was crushed. We could not get out of the car without being surrounded by children asking for food….food that we did not have. It was incredibly sad and we went to the airport. We cleared customs and waited for our plane.
We spoke with other groups about their experiences. I felt we really helped a lot of people but left with extreme feelings of guilt for all that I have and the inequality of all the poverty that I was leaving behind. I think I am beginning to understand how people like Father Rick devote their lives to helping people. What I do? I save lives through a technical skill I have learned. What he does? I’m not sure you learn it or you are born with it. His compassion is endless for every human being he sees.
I am looking forward to another trip like this. I was filled with sadness and tears as we took off from PAP toward Miami. Haiti is a tough place to be. The Haitian people are some of the kindest, warmest most appreciative people you could hope to meet and care for and I will be back.