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Reflection on experience treating earthquake victims in Haiti
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Clearly the experience in Haiti was a life changing experience for anybody who was there, myself included, but our efforts could not have been possible without the tremendous support and donations provided from all of those back in the States and abroad. There were countless people involved behind the scenes providing financial support, personal sacrifices and time to help the suffering in Haiti and the relief efforts of those on the ground.
Speaking for myself, I clearly benefitted more than I gave from the whole experience, and feel privileged to be able to contribute. I think most who were there would say the same. We may never see another calamity on such a large scale occur so suddenly, but I am comforted by the immense response I witnessed from the American and international community in support of humanity, and I feel proud of the efforts everyone gave.
As surgeons, we are trained to deal with injuries. That was the easy part. Coming to grips with the severity of personal grief and suffering dealt to the Haitians, and witnessed daily, was not as easy, and still haunts me, as well as others, I am sure.
I plan to continue to stay involved in international relief now more than ever, and I encourage everyone who has a chance to consider doing so. You will not regret it.
The following are some of the e-mail posts that I sent while volunteering in Haiti:
January 30, 2010
11:32 call from Dr. Anderson
To all, this is John Anderson calling in with Team 3 ready for departure out of Grand Rapids, Michigan. We have a very solid team heading down composed of myself, Michael Jabara, Adam Post and his wife Amanda Post who will be serving as surgical techs. We have Mary Herzog one of our fine orthopaedic residents as well as Libby Mondue and Bret Doud providing anesthesia and Denise Richards helping out with nursing.
We appreciate all the efforts, support, prayers, time, commitments and the donations from all the members of our orthopaedic and anesthesia community as well as from the community at large which makes it possible for us to do what we do. We are all honored and privileged to represent Grand Rapids and look forward to getting down there and getting started to do God’s work.
We will keep you updated with daily blog updates. We look forward to seeing everybody again upon our return. We look forward to seeing our comrades who will be returning today and sharing their stories.
God bless, talk to you soon. John G. Anderson, MD
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Images: Anderson JG |
January 31, 2010
Team 3 has arrived safely and received a successful handoff from team 2. They all look relieved and eager to return home after what has been a hectic week. We were fortunate to have a bus waiting for us and while we loaded up, team 2 was preparing to taxi off. Now en route to Double Harvest [a 200-acre mission where the medical camp was set up] where we will unpack, take inventory, and get situated. I think we could all feel the tension mounting as the plane approached Port Au Prince. The airport is quite hectic but in an organized way. Rubble and people everywhere. Will try to keep all well informed over next week. Big thanks to team 2 on a great job.
January 31, 2010
On the ground for 3 hours at Double Harvest. Getting to know all the players. This place is nuts. 35 plus team leaving in AM. We are it after that. Took in 7 tonight. All old unsplinted untreated injuries, femurs, tibia, bad wounds, pneumonias, 5 yo FNF, hip. Brand new GE xray making job much easier than predecessors had. Busy night ahead of us. Update tomorrow.
John G. Anderson, MD
January 31, 2010
Hi everyone.
It is 5:45 and we have a little lull. Last night was busy getting situated and getting to know our seven new patients. All received a thorough workup, including history, exam and complete X-ray. We can spin down pipettes to gather a hematocrit, which helps tremendously in planning who we want to fix under conventional means vs provisionally.
We have a big day ahead: seven debridements of various injuries in various stages of convalescence; one hip spica; one femur external fixation in an 80-year-old with a bad femur fracture (how she made it 2 weeks and found her way in here is anybody’s guess); one ankle fracture and a femur we hope to ORIF. We took in a lady with a complete thoracic spinal cord injury who was cared for by her family for 2 weeks and arrived for 1st medical treatment. Amazing … no bed sores… they did a great job. We can certainly sense a resiliency to the Haitian people.
Miami folks were a great help getting us situated. They all just left in a stampede — right after the generator went out. We all caught a little sleep outside. Wild dogs barking all night with a full moon lighting up the mountainside … quite surreal.
Will make rounds, eat and get busy. We miss everyone already, but are well and in good spirits and we really appreciate the prayers and support from all. More later.
John G. Anderson, MD
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February 1, 2010
Hi everyone.
We had a busy day today (Sunday 1/30). Most of us had very little sleep last night: maybe it was nerves, maybe it was sleeping outside. Mostly it was the wild dogs barking all night and some tribal chanting which was coming from across the ranch.
Only 24 hours have gone by, but we have already made many friends. The smiles on the healthy children’s faces contrast sharply with the fear on the faces of the injured. We did some good orthopedic cases and quite a few wound debridements. There are many amputation wounds, as we expected. The patients in the census for the most part have clean wounds now, thanks to the efforts of OAM team 2. We seem to be reaching the point of no return with regard to fracture management. They are now 2 1/2 weeks out from day of injury and starting to heal. Closed reduction is no longer an option. Open reduction and internal fixation is a challenge, particularly in the children who heal so quickly, but also in the adult long bones. 2 1/2 weeks of muscle contracture have resulted in bayoneting, which is difficult to stretch out to length. We had to accept some alignments that normally would be unacceptable, but there isn’t much choice.
Today we served a young woman with a femur fracture; a large surgery and we had no chance of giving blood products if we got into trouble. Mike Jabara and I tag-teamed it, with heavy manual traction on the leg. After lots of sweat it came together. Fortunately things went smooth and we only lost a little blood.
We had a 10-year-old boy who walked in with his father pointing at his umbilical hernia. It looked simple enough, but turned out that he had an acute bowel rupture. Our general surgeon friend, Dr. Andy, who thankfully arrived today, took good care of him. Unfortunately post-op sepsis lead to rapid deterioration and manual ventilation most of the day. Ultimately we had to ship him off to the USS Comfort. We are not really equipped to run an intensive care unit.
Tonight Mary Herzog, our orthopaedic resident, put her OB skills to work on a term labor in the early stages. Stay tuned and pray for a happy delivery.
Peace and love John Anderson and the members of Team 3
February 2, 2010
Today started uneventfully. We had only a few cases scheduled that were left over from the night before. We caught up on our sleep and spent some time working out kinks. We had generator issues all day yesterday, with power drops that were short but enough to wreak havoc on our sterilizer. Because of the generator problems, we powered down most of the night. Amazingly, a brand new generator arrived today, courtesy of the military.
The morning brought a rush of follow-up patients to the outpatient clinic. Most did not need surgery. Our morning inpatient rounds revealed that a lot of patients were now in good enough condition to be moved to an outpatient setting. The outpatient is growing, through our own hospital overflow as well as word of mouth. There are lots of injuries that were simply splinted in some triage facility and the patients are coming to us for follow-up care.
We cleaned out many beds in our hospital, so we were anxious to bring in new patients. Dr. Andy (general surgeon from Indianapolis), Dr. Elysee (Haitian medical doctor) and I went on a recon mission in Croix De Bouquet and near the airport in Port Au Prince. Mike Jabara, Mary Herzog, Libby, Bret Dowd, Jill and Denise Richards (the crew) did a great job keeping things in order at the Double Harvest. The whole team is working very hard.
Our first stop was a Cuban military facility in Croix De Bouquet. They did not have any patients in need of urgent care … more clinic type work, fevers, illnesses. As we walked along, we came across a dead body laying on a stretcher, shot on the street 1 hour earlier for fighting and trying to steal some food. We thought it best to leave.
Next was a stop at a small mission on the outskirts of town. A woman from West Virginia was in charge. She and her husband had lived there for 3 years. The facilities were extremely primitive. She had unbelievable stories of people brought to her for care after the earthquake, most of whom she could do nothing for. One was a boy whose abdomen had been torn open. She could do nothing but change bandages on his exposed intestines for 3 days, before a doctor stumbled across her mission site. We went into a tent and found people of all ages with arm amputations, femur fractures, ankle fractures. All splinted without benefit of X-ray and with no follow-up or notes to guide us. We noted which patients we could have brought to Double Harvest the next day for treatment.
She told us of another camp. Here we met a shady man holding hundreds of people in a locked, gated lot. He was a business swindler, looking to get relief agencies to give him money to help finance his “mission.” We were warned he was holding many seriously injured patients purely for secondary gain, which he was. We spent over an hour trying to convince him to release the most seriously injured patients so we could care for them, and he wanted us to pay him for this. Eventually we convinced him to do what is right. The whole scene was unbelievable.
Last stop was a long shot. We went to the airport to look for some much needed equipment, not sure if we could get in. Much to our surprise, after somehow getting through multiple armed guard security checkpoints, we reached a university-affiliated medical unit. Our facility was actually better stocked than theirs, but they had exactly what we needed. Met a colleague there. After some chit chat, he told me to take what I need as they couldn’t fix anything anyways because their X-ray machine was broken and they were overwhelmed with infections. Met many others who were around the epicenter facilities providing care. It remains very crazy and overwhelming. Infections are everywhere and I got the impression that casualties continue on a daily basis.
Just a taste of what a day is like down here. The Haitians are good people. They appreciate what we are doing. Keep them in your prayers.
All for now.
John Anderson
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February 3, 2010
Not much new to report today. Clinic was very busy. Surgery schedule was less busy. This is probably a good sign that progress is being made, but the situation changes very often and very quickly. There are still many who need follow-up care and we identified many undiagnosed injuries today. Most are severe and complex fractures that will forever change lives. They are the fortunate ones, as nearly all have lost family members. Wound management is taking over as the biggest priority. Fixation of fractures is much less common.
One of the docs made another recon trip into other medical camps today. He brought back two patients with broken femurs and two babies with severe dehydration. It is clear we are one of, if not the best-equipped facility on the ground based on these recon excursions. Our limiting factor is beds and nurses to care for them. Those we have are working double time. Denise Richards has held everything together and deserves a lot of credit. We are finding other facilities eager to transfer patients to us and we plan to continue to go out and get them as long as we have capacity to care for them.
Again the stoic nature of the Haitians is evident. The day is filled with stories of survival and of family members lost. Every patient who comes in to the clinic has one.
Surprisingly, all the patients tagged during yesterday’s recon mission showed up today, with my taped notes in place to see Dr. John at the Double Harvest. All needed treatment and three went to surgery. There are thousands more of them out there laying in tents, hoping to be tagged and helped. The needs will begin to change within the next 2 to 3 weeks as the fractures heal and again when the rehab takes priority. Casts need to be changed. External fixators need to be adjusted or removed. Wounds will need care for a long time (months). Therapy will takes months and even years.
Transportation is limited, so outpatient care requires travel over long distances on very bumpy roads. Therefore, we try through interpreters to educate them to do as much as possible on their own to limit the travel. Those who need daily dressings sleep outside the hospital.
As health care professionals, we all often feel limited in what we can offer, as we are used to doing so much more with far greater resources. In 4 days there has been no complaining. Most gratifying is when the patients smile, usually because of personal effort to get to know them. I give Dr. Jabara high marks for his growing Creole vocabulary and ability to make patients laugh. Reverend Spaulding from Double Harvest gave us a history lesson today about the Haitian people. The Haitians want more than anything else to be respected and treated with dignity. They can tolerate going without and are stoic during great suffering as that has been their history. They don’t like pity, but welcome and respect compassion.
One point to all that warrants mention is that this is not a situation for tourism and curiosity seekers. There are some in Haiti, but I have not encountered any. Most are here to help and are doing a great job. There is plenty of need here, much of which is non-physician support. I see these efforts paying dividends in the lives of those around us and I encourage all to keep it coming. It is my hope that these updates enlighten rather than titillate the curiosity, and ultimately bring to light why the things you are all doing back home is not only worth it but necessary.
Peace,
John Anderson
February 4, 2010
Another busy but productive day for all at the Double Harvest. We saw some staffing changes and had to say goodbye to many friends made over the past 4 days who will not be forgotten. Spending 4 days together in high-intensity conditions and in close quarters has a way of forging bonds between strangers that aren’t often made.
The team from Indianapolis was great to work with. Nancy, one of our star nurses had to leave to go home to Florida. The team from Miami returns on Friday. In the meantime we will make do with our team from Grand Rapids and some die-hards who have been here for weeks. I had a chance to connect by phone with Team 4 today in a debriefing and strategic planning meeting the next group had in Grand Rapids. This will be critical to ensuring that they are able to hit the ground running and meet the needs that are changing daily. Terry Endres and Chuck Bukrey will be leading that team for OAM. I am certain they will do a great job.
The work remains steady. Now our 5th day here but they are blending together. Our presence is felt. Our long-term commitment and continuity of care provided by succeeding teams is really helping to maintain order in here at the Double Harvest. Dr. Bob, who has been here for 17 days, was scheduled to leave today, but is staying 1 more week because he sees how effective our team approach has been and he wants to continue to be a part of it. I am happy to see him stay. He has been very valuable and a great guy to have around.
We have been out on several recon missions now, including today. This allows us to identify and bring back those patients we are most able to help, given the resources we have available. Most of these patients have fractures that others are not able to fix, because of lack of equipment, lack of OR’s or lack of sterile environment. Today we transferred some patients from the University Hospital in downtown Port-Au-Prince and from the tent facility run by University of Miami at the main airport. We had to hand carry them out on a stretcher and brought them back on a flatbed truck rigged with mattresses across some very bumpy roads in the hot sun. Despite the conditions, and despite having a truckload of seriously injured people riding on the back who hadn’t eaten all day and had now survived 3 weeks without treatment for broken arms and legs, there was not even a hint of complaining. Not one even asked for water or food. Fortunately we had water. When offered, they would smile and politely accept.
Once back, they were admitted, hydrated, fed and readied for surgery the next day. We had considered working through the night but it had been a long day for the patients and we all thought it best to let everyone eat up, rest up and have a big day tomorrow.
We met some members of the US Army on our trip today. Our hope was to develop a transport system with them to coordinate these daily transfers. To my surprise, we had visitors tonight from our country’s finest, serving in the 1st Battalion, 325th Regiment. A shout out to Bill Ives, Sargent Garrett, Specialist Steinepreis, Private 1st class Rantala, and the rest of the 1st Battalion, who I hope stay safe and are reading our blog. They are doing a fine job and representing our country well. I send my thanks.
Another shout out to all those I see here in Haiti making a difference in our ability to provide help. Amway and Steelcase for generously providing transportation, Zimmer, Biomet, Synthes, Depuy, Aircast, and many others in the orthpedic industry for donating supplies, GE for donating an X-ray machine which is so valuable at this time, the great folks at the Double Harvest who are changing the lives of thousands at significant personal expense, and Spectrum Health for many of the supplies we use every day and for letting their superior staff come with us. Adam and Amanda Post and Denise Richards are pro’s in every sense. Anesthesia Associates have also been great partners in providing anesthesia coverage. Bret Dowd and Libby Mondoux have been stalwarts and their efforts are greatly appreciated. Partners in Health has taken on tremendous leadership on a massive scale, and have been instrumental in the Haitian relief efforts. There are many others, too many to mention them all.
Lastly to all our partners, co-workers, friends and family who are covering for us, thinking about us, and praying for us, we thank you.
Hope all is well back home.
John Anderson
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February 8, 2010
To all:
It is hard to believe a week has passed by so quickly. Team 3 has completed our work here this week but the work is far from done, and Team 4 will have plenty to do when we pass off to them tomorrow. Most of us feel bittersweet about leaving. The atmosphere here is chaotic but so uplifting.
The Haitians are inspiring. They have a mental toughness that seems to allow them to do anything. They are trusting, proud, and very stoic, all qualities you can only admire. When you think about all the goodwill being spread throughout Haiti and how much it is appreciated, you realize that the efforts of so many are worth it. Those back home aren’t here to hear the stories, see the faces, get to know the patients and families, or share in their personal pain, suffering and moments of joy, but rest assured if you were, you would double your efforts.
There is no greater cause than to help those in need. No one needs it more than those here in Haiti. I think this week has reminded us all why we chose this profession in the first place. We strive to heal, to soothe, to comfort, to provide care and compassion, to help this country and its people through this crisis. You never really feel as if you are doing enough. You do your best. But you can see the gratitude in the Haitians' eyes and you are glad you did what you could. There have been difficult moments for all of us. Many we will never forget. It is amazing how much your perspective can change in a week.
We have bonded with Haitians and Americans alike. We are the same, in so many ways. You simply need to get to know them. Their response to hardship is startling. Witnessing it, I certainly feel I will take home more than I gave.
Some stories to remember:
- An 18-year-old young man we picked up from Miami hospital with a broken femur. He endured 3 weeks with his leg flailing around. We fixed him yesterday. Large surgery and very painful. He met us this morning sitting up in bed eating breakfast and smiling. He left today, hoping to catch up with his family, who still did not know if he was alive.
- Waking up each night to the sound of singing. Our medical unit has grown to exceed capacity, so many patients sleep outside. They have broken arms and legs, amputated limbs, open wounds with bandages that soak through in their beds, yet they find it in themselves to sing at night. We should all hope to be so full of life.
- Our coordinator at Double Harvest, who showed me around for 3 days. We told stories, worked side by side, laughed and talked. In a quiet moment I asked him if he was married. He told me his wife and one-year-old son were killed in the earthquake. I had spent 3 days getting to know him and had no idea of his grief. It was a difficult moment.
As it is now clear, everybody in Haiti lost someone dear to them. I learned to assume this and address my questions accordingly. Those that survive have a long road ahead.
Tonight we will rest, secure knowing our loved ones are safe and very much looking forward to seeing them again.
John
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