Sunday, February 28, 2010

Even with the progress we've made, mixed feelings about leaving Haiti

January 25…
At the end of our 9th full day working at the University Hospital in Haiti, we have made remarkable progress in a little more than a week, and a hospital has emerged.

Our tent E.R. saw nearly 300 patients today, and we are preparing to see more than 500 tomorrow, in what are essentially two rooms. To keep the place running, we are electricians, masons and plumbers, as well as doctors.

I find myself beginning to lose my endurance. Everyone is getting tired…I can see it in the faces of all the people with whom I work from every country and whom I have come to admire a great deal. Every day brings new crises of capacity, supplies, sudden patient influx or something else. We have been with these people more than a week and have come to know them, so deaths and disfigurements affect us a lot.

The media frenzy is beginning to die down. Four days ago, you could not turn without a camera or reporter being there to document the activity. If that brings resources to Haiti, I am all for it. I have been disappointed, however, in some of the inuendos. Let me tell you the truth – everyone is working incredibly hard, getting along, cooperating, and there are very few controversies. We have the operating rooms coordinated, a way to care for orphans, and a small blood bank. Our big problem is space, but USAID [United States Agency for International Development] just brought us three big tents tonight, which is a huge relief.

I visited many of the patients I know this afternoon, just to touch their hands, wipe their foreheads, and encourage them. They are all missing a leg, an arm, and many relatives. Think about how life has changed for them and about what you might do to make it a bit better for them. Please pick a relief organization and make a small donation. It truly makes a difference.

January 26…
On the 10th full day in Haiti, we find ourselves at the transition point where we must carry out our duties, but begin to transfer responsibility to the persons who will assume our roles upon our departure.

Some of our team has begun to “hit the wall” physically and emotionally. I am fine emotionally, but these old muscles are aching for sure. However, every time I walk past a young Haitian child who has lost a limb, yet still smiles and tries to give me a wave, I am energized. It will be very difficult to leave, but I know that within a few days, we must get our batteries recharged.

The hospital complex is really taking shape now. The tents are wall-to-wall and all filled with patients. We have arranged for electricity and sanitation. We have oxygen bottles and new stretchers. Yet, we are still missing critical sterilization equipment for surgical instruments, modes of transportation, phones, and sufficient supplies to call this a complete medical operation.

Some of my new friends from other NGOs have begun to rotate out, and I miss them already. We have become close “under fire,” in a way that is not possible in any other venue. We would trust each other with our lives.

Three of us shared a common experience today, individually, as we walked down the road past the crushed nursing school and towards the Swiss surgery tent compound. We all noticed for the first time beautiful flowering bougainvillea that had been completely overlooked when we marched, heads down, along what was only a week ago a thoroughfare of death. We smelled the cooking from the street, and walked past tents of injured persons singing, trying to be happy, attempting to begin to get back to normal. They are so brave and so deserving of all that we can give them.

Our group has befriended the young 5-year-old boy who was pulled from the rubble after a week. He comes to visit us, and clings to the nurse who was most attentive to him during his resuscitation. His parents are lost now and he is an orphan. He is like thousands of children in Haiti now. The orphanages are filling, and reconstruction cannot occur fast enough to avoid enormous tent cities.

January 27…
We’ve been here working at the University Hospital in Port-au-Prince for nearly two full weeks, and it is shaping up. The care being delivered is remarkable given the circumstances since the earthquake.

There are two operating rooms running 4 beds each, a tented medical unit for our sickest patients, a fully stocked pharmacy, an increasing laboratory testing capability, and more tents. Still, this is not a hospital as we have become accustomed to in the US. It is a medical facility under tents, and the conditions are not sterile. While the situation is improving, and we have optimism that it will continue to improve, for the patients who have suffered bad injuries, they are certainly not yet all out of the woods.

I find myself going back to visit a few patients, like the young woman professional dancer who lost her leg. She was returned to the OR today for a revision of her stump, so was postoperative and asleep when I saw her. In the crowded tent, she was covered with flies, so I sat by her for a while and fanned them away with a small notebook. In another tent, I watched a mother bathe an emaciated infant. The baby will not make it through the next two days. One tent over, a woman shouted out in pain during childbirth.

The garbage is being picked up and we should have upright portable bathrooms tomorrow. That is a triumph towards which I have struggled for days. Once again, the U.S. military showed its compassion and coordination when nearly 50 patients were evacuated to more advanced care.

Yesterday the generator went out for many hours, so we could not run the O.R., or so I thought. A team of resourceful surgeons wore their headlamps and made it through some of their cases.

Tomorrow we will finalize coordination of sanitation, electrical lines, tent placement, number of physicians needed through the next two weeks, and how to accelerate the return of Haitian physicians and nurses. There is much work to be done.

We got word today that we may be going home soon. I have mixed feelings about that. It will be difficult to leave, but all signs point to it approaching the right time. Emotionally, I am OK, but my legs are a bit wobbly. I wake up as tired as I was when I went to sleep. The people here deserve fresh legs.

January 28…
We found out today that we are going to ship out tomorrow. My feelings are certainly mixed. There is an incredible amount of work to be done here – we have only contributed to the first wave of what is necessary. I cannot remember the details of much of what we did the first three days, when we were functioning on hyper-drive in a battlefield setting. My recollections become detailed after the third day, when we were able to see only four or five patients at a time, and we stopped triaging amputees to the operating room.

Teams of non-Haitian surgeons have left to go home, because the operations to be performed now are largely orthopedic and plastic surgery, as well as specialty cases. Sadly, there are scores of patients with spinal fractures who are paralyzed, and little can be done for them this far out from the initial injury. Children continue to reach out to us. I had a small child who is a triple amputee offer me his cracker with his remaining hand. One can only pray that the memories he carries of this tragedy are erased swiftly, that he is assisted in his rehabilitation, and that his life improves. All of these will, of course, be hard to achieve.

I visited one of my favorite patients, the young woman who danced ballet professionally before she lost her leg below the knee. She had a revision of her stump yesterday, so she was asleep, recovering from anesthesia, when I saw her. Today, she was bright and alert, and gave me a big smile when I walked to the side of her stretcher bed within a very hot tent. She motioned me to come closer, and we exchanged contact information. I will do what I can to stay in touch with her.

Many of our interpreters are living outside in enormous congregations of people in parks. I gave my tent to one of these persons and am distributing everything that might be useful to victims of the earthquake and to medical persons who have just arrived to take over from those leaving to rest or return home. There are plenty of medical supplies – the Haitian people need shelter, food, and water. Soon, they must begin to rebuild and take what was a feeble economy and turn it into something. This will be no small undertaking.

I am so proud of my Stanford colleagues and all the other doctors present in the compound who have worked tirelessly for the past two weeks. The teams from California, New Hampshire, Massachusetts, New York, Switzerland, Norway, Canada, Spain, Taiwan and many other locations all pulled together in a model of collaborative behavior.

It became time today for me to hand over the reins to Dr. Solomon Kuah, who will assume my role as the medical coordinator of the NGO activity. I said goodbye to many persons with whom I have become close under the most challenging circumstances. These are wonderful people. In a meeting of the leadership present, I told them that I have never been so proud to be among such an incredible collection of talent and dedication. Then I allowed myself to be infused with 9 liters of IV fluid so that I could get vertical and walk out under my own power.

Dr. Paul Auerbach
Photos by Margaret Aguirre

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