Saturday, February 27, 2010

Travel, triage and the importance of training

The overall trip to get to Haiti was exhausting, and I was anxious about the “unknown.” We departed San Francisco airport on January 15, 2010, at noon and made it to Santo Domingo the morning of the 16th. Staff from the International Medical Corps, my volunteer group, picked us up and took us to stay in a Clarion. We had breakfast, took a shower, and were driven to the Santo Domingo military base.

We waited for hours and were told we weren’t a priority because of the numerous VIPS traveling into Port-au-Prince…along with the food and water being flown there. Dr. Bob Norris, one of our team members, spoke with representatives from International Medical Corps. It was decided we would take the bus to Port-au-Prince, and we headed out the evening of January 16. Forty-five minutes into our drive, the bus broke down. An hour later our replacement bus showed up.

We arrived in Port-au-Prince the morning of January 17.

The ride into Haiti was surreal: people around town walking everywhere, many living in makeshift dorms, women cooking outside, and kids running around. I spotted a couple of the children digging into dumpsters for food. There were dead bodies stacked randomly throughout the town, people burning dead bodies, and dogs eating and chewing bodies (including babies) and dragging bodies around like rag dolls. It was a scene of absolute depression and desperation.

University Hospital, Port-au-Prince, Haiti

As we drove through the tall green gates, we were mesmerized by the mass amounts of collapsed buildings and the few that were still standing from the 7.0 quake. In the middle of the compound there was a “garden area” we named “the jungle.” Patients and family members were everywhere! We made it to the back of the compound to a building designated as International Medical Corps’ headquarters. About 400 yards east of the building was the morgue, where over 500 bodies were stacked before our arrival, waiting to be picked up, disposed of and buried. The concrete was stained from the decomposition of the bodies and liquefying of adipose tissue. The smell was indescribable. We put Vick’s vapor rub under our noses and wore N-95 masks, but the smell was still very strong. I found myself unable to deal with the “smell” and almost threw up. I realized I was in a state of shock.

We were immediately greeted by volunteer Dr. Rob Fuller, MD, chief of Emergency Medicine at the University of Connecticut and Dr. Matthew Howell, an emergency physician from Tampa Bay, Florida along with representatives from International Medical Corps.

We broke into teams. A few days later, I was asked to team with Dr. Howell to open up a designated triage area, and an organizing supply room.

When we arrived at University Hospital on January 17, 2010, a group of surgeons were doing amputations around the clock. Volunteers were just starting to trickle in. There were more physicians than nurses, which made our jobs challenging.

Physicians in the states are used to directing care, and nurses are used to providing care. It didn’t always work this way in Haiti.

We had to teach our physicians to do many things, including mixing antibiotics and connecting primary and secondary IV tubing properly (to them, all IV tubes are alike).

Being nurses and well aware of getting “scope of practice” pounded into our head, it was very hard to move away from our training in third world disaster medicine. As long as the physician is comfortable with your skills, you are up for anything and everything you are competent and can be trained to do. Dr. Howell, along with other physicians taught me many procedures during my stay such as; nerve blocks, hematoma blocks, needle decompressions, fracture reducing/splinting, debridement, paracentesis, thoracentesis, and conscious sedation. It is amazing to see yourself using the nursing procedures to save lives. The other nurses and I diagnosed, prescribed, treated, and “discontinued” medications; we were “acting physicians” in a time of crisis.

I didn’t think twice or regret anything I did within my stay. My time in Haiti set a new precedent of what matters most and what suffering truly is. Tears still fill my eyes knowing that people who would have been saved with the technology back here in the United States were dying before me without any control of their fate.

In the United States, only “seasoned” nurses triage. In Haiti we had military personnel doing triage, and they were as capable as nurses in seeing who was in distress and who could wait. Black and white …it was either a decision that they were able to be saved with the limited resources, or it just was not in our capabilities to save their lives.

One day a nurse came in to work in triage when I had some of the military staff filing out triage forms…

The nurse looks at me and says, “Wait, they aren’t qualified to triage. They aren’t even medics.” I looked him in the eye and reply, “Do you plan on living here the rest of your life and triaging, or would you rather train people so when you leave you know that at least you handed the torch over to the next group and the system we all worked so hard to initiate won’t break down?”

Nurse Gabriela McAdoo
Photos by Margaret Aguirre

Follow Interntional Medical Corps

No comments: