Friday, February 26, 2010

Dr. Paloma Pina: Looking back on two weeks in Haiti

I had the chance to volunteer in Haiti for the past 2 weeks with International Medical Corps.

Today my journey in Haiti has ended and it is just now that I have the time to think about what really this experience meant to me.

Now I’m back to reality or is it surrealism? It’s hard to tell what is what now.

Too many words, too many things and images come to my mind: Hope and hopelessness, despair, frustration, helplessness, impotence, need, hard working people, people, gratefulness, happiness, appreciation, help, inspiration. Mixed emotions.

It has been an experience at so many levels: personal, medical….Inspiring….

My first impression when I arrived at Port-au-Prince was that I was just placed in a movie set. Devastation would be the best word. A whole city torn down, rubble and more rubble. Hundreds of people walking, thousands of people sleeping in the streets. Tents all over.

I brought my camera with me but to tell you the truth I didn’t take that many pictures… It just felt weird to try to take a picture of somebody, of anyone while they’re suffering, in DESPAIR, waiting for something better to happen.

I was prepared to sleep outside, in my tent like everybody else, but we were the lucky ones to sleep under a roof, with water and food.

Some nurses in our group were born in Haiti but were now living in the States, and most of them refused to sleep in a room as they could not stop thinking about their people, outside, fewer than 100 feet away sleeping in the streets.

The best way to describe the hospital setting would be a big field filled with dozens of tents and surrounded by abandoned buildings except for one small part: the Internal Medicine Building, which was still functional. The nursing school, inside the hospital campus, can be seen totally collapsed. More than 100 nurses lay dead inside.

Hundreds of patients lying under the hot tents or in the dark building waiting for somebody to take care of them. Hundreds of people waiting in line to be seen in the ER tents. Amputees and more amputees...

Patients fearing saying the tragic word “earthquake” and referring to it as “l’evenement” or just “Tuesday 12th”. Some feeling hopeless, some full of hope.

Malaria, cerebral malaria, tetanus, typhoid fever. Common diseases in this part of the world, new to us. Everything is malaria until proven otherwise. Fever + Constipation =high suspicion for typhoid fever. TB and more TB. HIV.

FRUSTRATION was a common feeling the first day. It was frustrating to see people dying of common diseases curable and treatable in other parts of the globe. How to discharge somebody with diabetic ketoacidosis without insulin simply because there is no more insulin in the hospital. A patient with alcoholic cirrhosis and ascites and no spironolactone to give. What about decompensated heart failure, (and let me tell you is all over) and intermittent availability of furosemide.

Deep venous thrombosis and no enoxaparin or heparin; warfarin and no way to check INR. Head trauma and no CT scan. A presumed MI but no EKG, no enzymes to diagnose. This was really back to the basics.

And there were more: A 2-year-old with congenital cyanotic cardiomyopathy and no place to go…

A father who will pay what it takes for the tetanus immunoglobulin for his child with tetanus…It’s just that sometimes, even outside there is none to buy…

How to explain to a father, to a wife, to a son, that his family member will die from something as simple as pneumonia as we were unable to intubate?

A 4-year-old child with Acute Lymphoblastic Leukemia, curable somewhere else but no chemotherapy at the moment. We managed to transfer him outside the hospital for chemo to be brought from Boston. He was the lucky one. Transfers, transfers and more transfers….Those were the lucky ones who could escape the hospital and its lack of supplies, of attention, medical care. But there were so many more that are just there waiting in that dark room, for a better chance or simply to die.

Don’t get me wrong, Haitians, Americans, Spanish, Japanese, Dominicans (that would be me), a lot of people working together. More medicines and more staff local or international will arrive on a daily basis, it’s just that is not enough….More help and more supplies are needed everyday…Haiti needs more help…

Impotence. How to discharge a patient home? Where is Home? How many times did I hear: but where should I go? My house is gone, my family is gone, and I’m by myself where should I go? Some of the patients decided to stay because of the shelter provided by the hospital but also, they had “someone” they knew, that other patient lying next to them who would pray and talk to them.

INSPIRING people met along the way. The patient’s family members. They were nurses, physicians, physical therapist and much more at the same time for their sick families. But what happens to those who have lost their loved ones, who are just by themselves in that bed, in that room or that tent, that’s just another story. Who will clean you, who will feed you? Your neighbor might help but he has also other problems…

Inspiration: a tragedy and people still standing…

The staff, the Haitian staff. Few of them were there but they were caring and willing to work. Lots of them were touched directly by the earthquake: a mother, a father, a sister, a son deceased, or just their house totally destroyed, and still they were there. I had the chance to work with them. I say chance because that what it is, I met incredible Haitian attendings, nurses, residents, caring, knowledgeable, who were there, working for their people despite being themselves affected.

Michael was one of the Haitians Internal Medicine residents. He was great. Some of us had the chance to work closely with him. He would go every day to the hospital; he was eager to learn and was always so grateful and thanking us every day for being there. We went with him one afternoon to visit his “home”: the back of a destroyed church were hundreds of people are staying under the tarps, fearing the rainy season soon to come. Living as a community under the moon…..And yet he will always be there, on time for work.

International Medical Corps staff, physicians, nurses, administration, dozens of different NGOs, the Haitian staff and administration working together for the same goal, working together as if we were one big family and if we had known each other for years. Same goal, HELP. Hard working and caring people.

An ID doctor, who made a difference, working nonstop for her patients,. A nurse who came by himself just to help, without knowing where he would sleep. Just caring. So many people, but still not enough….

After a day working at the Hopital Universitaire d’Etat d’Haiti you felt that you belonged there. Intense work but gratifying. We were all part of the hospital.

The gratitude in people’s faces when just giving them PEPCID for their GERD (and they all have GERD!). Those patients who could be actually treated and be discharged, those who came to you and said THANK YOU. What a great feeling!

We are now more appreciative for what we all have back home: our families, our legs, hands, health, house, being able to provide adequate medical care.

HOPE. We were in Haiti for the 1 month “commemoration of the earthquake”. Prayers and prayers, celebration, the people of Haiti with Hope. The parade, people chanting and praying for a better life, thanking GOD for those who are still alive. The superstition and the hope that marching seven times around the National Palace would stop the curse that had just been thrown to Haiti. And we were there, some of us, marching with them, singing and celebrating with them, with the crowd. It was really something.

I hope I will still remember all this, THEY hope we will all remember all this after the media leave, after the aid leaves….

Two weeks went by so fast, but as the end was near, changes could be seen, positive ones: more and more Haitian staff in the hospital, transition slowly taking place but also some negative ones at the same time: aid going away little by little when there is still too much need.

Dr. Paloma Pina
Photos by Margaret Aguirre

Follow Interntional Medical Corps

No comments: