"We have it so good, it's not even funny." - Atif Malik, Team Leader, AMS Disaster Services
Comment made on flight returning from Haiti to USA
February 9, 2010
Our team of five doctors, one nurse and a photographer just returned from the Island of Hispaniola a few hours ago. We went to Haiti on a short trip, to see if we could make any difference in what has been the most significant natural disaster in recent memory.We went under the auspices of the Comprehensive Disaster Relief Services, directed by Todd Shea (info about him: Link 1 and Link 2. Getting directly into Port au Prince by air is complicated due to frequent cancellations of commercial flights, inconsistent private charter flights, and general mayhem. Therefore, we flew into Santo Domingo on commercial flights, and CDRS arranged overland security and vehicles which brought us to their main encampment in Port au Prince. We got there in the afternoon, after the on-site clinic which provides primary care, specialty and surgical care for any and all (typically several hundred patients every day) had wound down for the day. Since our "work" for the day had ended, we dropped off our donated medical supplies and personal gear then trucked over to the main hospital in downtown Port au Prince. The main hospital building itself had been damaged in the earthquake, and while still standing, was unsafe and unstable due to structural damage.
We arrived at the main entrance (guarded by US military) and offered up our services. We were met by a physician from Partners in Health, who said that while plenty of volunteer doctors were available in the daytime, the night coverage through the weekend was minimal at best. For the night, the Emergency Room (a large tent) and all the wards (another series of large tents) were covered by so few physicians that our teams of 5 physicians more than doubled their coverage immediately. We split up into medical and surgical units. Dr. Amer Syed and Dr. Nilay Shah maintained the ER, sub-acute units as well as over saw medical wards which had hundreds of very sick people. Amy Wadderman, RN and our photographer Saima Malik assisted with helping patients with what ever was needed including putting in catheters, IV's, registering patients and getting supplies. Dr. Sherif Algendy, Dr. Mohammad Elkersh and Dr. Atif Malik managed patients with orthopedic / musculoskeletal injuries as well as ran the anesthesia for minor and major surgeries that were needed. Apparently "many times we couldn't operate, especially at night" said Dr. Araba (another volunteer resident surgeon from the USA) because Anesthesia was unavailable. "We would put people on IV drips and antibiotics and pray that they make it until morning," reported Dr. Araba. Although the majority of injuries directly related to the earthquake have subsided, we saw many patients who needed basic health care as well as acute ER care at a hospital. The ER and various "Wards" which simply consisted of a series of large tents! These tents were better equipped than the previously destroyed hospital and had x-ray and laboratory capability but still didn't have all the supplies needed. It took Drs. Elkersh, Malik and Algendy nearly 2 hours to find a laryngoscope to intubate one of the very sick patients who needed surgery. When one was found it didn't have the batteries and a pediatric scope was used instead which made the procedure very difficult. Still, these large medical M*A*S*H tents were a major improvement to the largest hospital in Haiti which before the earthquke had only a capacity of 87 patients. These M*A*S*H tents had been set up by various organizations and countries, but were manned primarily by physician volunteers from the US. Besides the Partners in Health docs, we also worked side-by-side with physicians from the International Medical Corps.
If you are familiar with the Television show "M*A*S*H* from the US in the 1970s-80s, you may be familiar with a military hospital situation in a war zone. Well compared to that TV show, the facilities we had to work in were horrible! Sadly, because things had been so destroyed, and the situation was so desperate, there was NO sanitation to speak of, and equipment consisted of a mish-mash of donated supplies that were put in the back tent. Each "ward" (i.e. tent) had its own random cache of supplies, which was usually just piled up on a cot or even on the floor in the corner of some tents. Despite these harsh working conditions, we were able to provide a "reasonable" standard of care for the majority of people who showed up. Granted, this truly was war zone medicine, and so the "reasonable standard" would be considered completely inadequate by modern day standards. Basically, if we were able to keep people alive, we were happy - and so were they.
We were even able to help work on two operations in the middle of the night; one patient had a perforated small intestine by typhoid and the second was a Haitian translator who nearly died from an "acute abdominal hemorrhage" and lots of blood in her belly. We had patients come in with bone fractures, paralysis, malaria, meningitis, head injury, lacerations, infected wounds, spinal fracture, shoulder dislocation, stroke, and many children arrived dehydrated, with diarrhea and fever. We saw tetanus (lock jaw), meningitis, and so many other conditions which were really hard to treat because of the (lack of) facilities we had to work with. In a nutshell, from a medical standpoint, the medicine we practiced in Haiti this past week was SO unlike anything we have ever been trained in.
Despite this, the people of Haiti taught us an important lesson. We gave our best efforts, and they showed us the true meaning of strength in the face of adversity. Even with all their poverty and loss, the Haitians we met were loving, kind, appreciative, and simply amazing. For example, we had the pleasure of working with four medical students. As we were coving the night shift for the hospital, we were there from 6:00 pm to 6:00 am. These four students (two young men, two young women) were eager to learn, running around helping us find supplies, and clearly making a difference. Dr. Shah asked them - "are you here each night, or do you take rotations one or two nights a week?" Since the earthquake (nearly four weeks ago), these four students spend every day AND each night at the hospital. When asked "Why?" - one of the students explained "by the grace of god, we were not in our classes during the earthquake." Their ENTIRE medical school class had perished, and only these four had survived. And yet, they worked, surrounded by the very rubble which had killed their friends and colleagues!
Another great part of the experience we had was the chance to work side-by-side with a division of the US Army. One platoon guarded the hospital, and so we had several soldiers working with us as medics, starting IVs, and in general helping A LOT with patient care. The eating facilities were non-existent, and so the soldiers we befriended were generous enough to give us many of their MREs (meals ready to eat). We tried many of the "delicacies" which come in plastic packets and cardboard boxes that our troops live on for months or longer at a time when they are deployed. For a few days, they are good, but eating this sort of food for extended periods has to take a toll on our brave troops. Standing and working besides these soldiers gave us a new-found respect for the great work these young men and women do, leaving their families behind for so long to go overseas and defend the principles us Americans take for granted.
In the course of our first over-night shift, we had a chance to catch a little sleep. We literally slept on the metal boxes the soldiers had brought gear in. At night it got cold and damp, and sleeping in a T-shirt and shorts with no blankets or pillows on a metal box truly was the most uncomfortable sleep any of us ever experienced. As morning came, we returned to our base camp near the US Embassy, and were soon put back to work running a primary-care clinic for several hundred Haitians. We were so busy, even the group photographer got into the mix and took histories from patients and helped work the clinic!
We hope that organizations like the Red Cross, UN and the American Military find a way to collaborate with volunteers like us (who used our own money and resources to get to Haiti to help) and assist with organizing, housing and transporting volunteers to areas of need. The level of destruction and breakdown of basic infrastructure in Haiti is so tremendous; there will be desperate need for help from the citizens of the world not just for a few weeks or months, but literally a generation. We were all changed by our experience in Haiti, and as demonstrated by the quote from Dr. Malik at the top of this page, have gained a much greater appreciation for all that we are blessed with in our lives. Every member of our team would go to Haiti all over again despite the physical, and emotional challenges we faced, as they were nothing to what the people of Haiti experience every single day.
Reported by Nilay Shah with help from Atif Malik, Amer Syed, Saima Malik,
Amy Wedderman, Sherif Algendy, and Mohamed Elkersh.
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| The Team plus some New Found Friends |
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| The overland border from the Dominican Republic to Haiti. |
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| A Picture of our Camp. |
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| Another Picture of where we stayed. |
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| We had our own on-site operating theater, PACU, and day clinic which served several hundred patients daily. |
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| And now pictures of the main hospital in Port au Prince, the nursing school and medical school were completely destroyed, resulting in the death of many of the nursing and medical students. This first picture shows the destroyed nursing school, which is on the grounds of the main hospital building where we worked over nights. |
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| Picture above - The now condemned hospital in the background and the entrance to the new "Emergency Room" in the foreground. Picture below - A picture of the "new Emergency Room" - a big tent with some crappy cots inside. |
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| Above - Dr. Shah making his rounds of the "Wards," going from tent to tent seeing if he can help any of the several hundred patients in the 8 or so big tents which made up the main hospital. |
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| Saima - our awesome photographer who took most of these beautiful pictures |
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| An exhausted Nurse Amy with one of her grateful patients (the baby in his father's arms) who spent quite a few hours getting treated for diarrhea and fever. |
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| Some of the docs after doing a middle of the night emergency surgery. |
