Haiti 2010

I returned to Kirksville yesterday afternoon from my amazing trip to Haiti. There were so many things that happened but I will likely leave some things out. Here is a synopsis of my trip.

Friday night (3/12) & Saturday (3/13)= Packed up my stuff and loaded the van with seven other people. We pulled out of Kirksville at 12:20 am and drove to St. Louis, arriving at 3:30 am. We checked in the different groups flying together and separated into three groups to make our way to the Dominican Republic. The group I was in, there were six of us, boarded a plane from the STL to Chicago. That first flight was delayed with us sitting on the tarmac for over half an hour waiting to take off. We got into Chicago and checked the departure board to find that our next flight was listed as being on time, giving us ten minutes to get to our plane to Newark. We raced from the F terminal to the A terminal only to arrive winded and discovering our flight was an hour delayed. We were able to sit in the airport and get to know one another a little better. We finally boarded the plane bound for Newark around 10 am. The flight started with one of the flight attendants having to almost kick a lady off the plane, then we got close to Newark and the air was so unstable that we were put in a holding pattern until conditions improved. While waiting for the weather to get better we started getting low on fuel so they had us land in Hartford, CT to refuel. We sat on the tarmac there for around half an hour and the flight attendants had to open the "emergency kits" to give us each a granola bar and some water. We got back into the air, headed back towards Newark with hopes of landing finally. The pilot tried several times to descend with no luck which resulted in us landing in Albany, NY around 5 pm. At this point we had missed our flight to Santo Domingo which meant one of our team members was on his way to the Dominican Republic on his own. Most of our group headed to the bag claim while I headed with another member to the ticketing counter to sort out how we were going to make it to the Dominican Republic. We waited in line for close to an hour before we were helped. The gentleman at the Continental ticketing counter (who obviously held a job in baggage and not ticketing) was unable to get us tickets on the only available flight Sunday to the DR and informed us the only day he was able to guarantee us all tickets was on Tuesday. I requested that he put us on standby for Sunday's flight and we joined back up with the rest of the group (who had discovered that one of our bins was missing) to board a bus to drive us from Albany to Newark. The bus ride was spent with our team leader on the phone to his mom, who had also missed the flight to the DR with the two others in her group and was stranded in Newark, trying to figure out how to get us down to the DR. While he was on the phone with her, I spent over half an hour on hold with Continental to be told they could get us tickets to Port-au-Plata, DR on Sunday but we had no idea how to get from there into Port-au-Prince. The group at Newark found out from Continental that there were six first class tickets available on the Sunday flight to Santo Domingo but we had to be there to purchase them. So the plan was for us to purchase those tickets as soon as we arrived in Newark which was supposed to be a little before midnight. Well, like everything else that happened that day, that didn't go as planned. The bus driver got lost in New Jersey and we ended up driving for an hour and a half longer than necessary.

Sunday (3/14)= We finally made it to Newark at 1:30 am and went to find out about the location of our missing bin. After about fifteen minutes of searching for the bin, we decided to go to ticketing to purchase tickets and met up with the other group in Newark. A member of the other group went off in search of the missing bin and the rest of us ventured to the Continental ticketing counter. We spent over an hour pleading with the ticketing agent for the tickets and arguing about the price of the tickets. The members of the other group had been told that upgrading the tickets would be half of what they were now saying we had to pay. With no other choice, we purchased the seriously overpriced first class tickets. Miraculously, a seventh seat in first class also became available which meant the one member from the other group was also able to be taken off of standby. Also, the missing bin was found. So we checked our bins of supplies, went to get some breakfast and finally boarded the plane for Santo Domingo. I can't say that the six of us really got to appreciate all the perks of riding first class because by that time most of us had not slept for 48 hours and so we all passed out. All I know is that the seats were comfortable enough for me to fall asleep before we took off and require the gentleman seated next to me to wake me up to fill out the customs forms. We collected all of our baggage, though the group that met up with us in Newark was missing five of their six bins, and took a bus from Santo Domingo to Port-au-Prince. We passed through little towns that had speed bumps in the highway and armed officers seated beside these bumps, the barbed wire gate into Haiti, and began to get a glimpse of the destruction from the earthquake as well as the poverty of Haiti. We finally arrived in Port-au-Prince at about 7 pm and had our first team meeting to decide which members would be going to the mission clinic and which would work on the mobile clinic. I was assigned to the mobile clinic and as soon as the meeting was done, I went to find a bed and fell asleep.

Monday (3/15)= The group headed to the mission clinic left around 9 am and the group set to head out to a tent camp in the mobile clinic had to wait until the leader returned to take us to the camp. In this time, we began organizing material that was left by previous teams or that had been sent to the mission. We found so many things that were expired and had to throw them out. It was sad that things had gone to waste and couldn't be used to help the Haitian people. We finally headed out to the tent camp at about 11:30 am. Arriving at the tent camp took my breath away. The camp was home to over 1,000 people and when I say tents, I don't mean tents like what we are used to sleeping in while camping. These tents were constructed from bed sheets and blankets. Very few had tarps for roofing. As soon as we began setting up, the people started lining up to be seen. We had three stations for seeing patients and I was assigned to one of them. I nervously settled in to my seat to take my first patients. I was so scared that being that I have not had all the med school courses that I wouldn't know what to do but my interpreter was so encouraging, telling me that I was doing good and continually thanked me for coming to help his country. We saw broken bones and wounds from the earthquake, many urinary tract infections, rashes, worms in all ages, and almost everyone was dehydrated and suffered from poor nutrition. There were a few kids that came in with burns that we were able to clean up and provide them with materials to reduce infection. We also came across a two year old boy with accessory digits (he had a sixth finger on both hands) who we told to come back the next day so we could remove them after we got the correct tools from the mission clinic. By far, the most memorable moment from the first day occurred with the very first patient I encountered. Two women came in with a two month old baby and another child saying that the children were sick. The children checked out to be fine. While getting vitamins for the group and other meds needed, my interpreter brought over one of the women and began telling me and another member of the team her story. Turns out this young woman was only seventeen and there were nine members in her family. She was the only one that survived the earthquake except for the two month old baby that was her sister's. She had no means of taking care of the child but wanted to make it clear that she did not want to be separated from the baby as it was the only family she had left. Her tears broke my heart and it really scared me for what I would encounter in the days to come. We vowed to bring the young woman items she would need to take care of the baby. Another member of our team took care of a little boy who was handicapped and blind. When we returned that day from the tent camp, we shared our stories from the day with the rest of our team and were told by the mission that items would be given to us to help the young woman and a wheel chair would be brought to the little boy.

Tuesday (3/16)= We returned to the same tent camp that we went to on Monday and I once again saw patients. We were much more organized and started getting in a groove. By noon, we had treated several patients and while waiting for lunch to be prepared we were able to go out and interact with the kids. One of our team members went out and played soccer with the kids which led some of the children to begin chanting "Jackie, Jackie, Jackie...", they thought she looked like Jackie Chan. We also removed the accessory digits from the boy we came across on Monday. The physician that accompanied us on the trip allowed us students to take part in the removal. It was a great learning experience. We saw the little boy at the end of the day, happily playing, paying no attention to the Co-Flex bandages on his hands. After the procedure, we all went back to seeing patients. A system began to develop between us students, and working together, we improved our turnover times and were able to see more patients but with the same quality of care. We had a group of kids that were lined up by the pharmacy cheering our names every time we walked over to the pharmacy. I saw a man with a deep cut from the earthquake that smelled horrible but after spending about fifteen minutes irrigating the wound was able to bandage the area up and instruct the gentleman how to keep the wound clean. Towards the end of the day, I was taking care of a teenage girl who presented with a headache and no appetite. I finished with the work up and was about to go to the pharmacy to grab the items I needed when I was asked by a male student to do a breast exam on his patient that presented with left breast pain. He agreed to give my patient the meds she needed while I took his patient onto the bus to examine her. I performed the breast exam and found no cystic areas or lumps but came to find the physician to make sure that my findings were correct. In my search for the doctor, I found out that as soon as the woman had vacated her seat, another patient took over her chair so my patient had yet to be given her meds and sent on her way. The physician examined the woman and verified my findings (or lack of findings) but instructed me to give her some pain medication. I went to the pharmacy to obtain her drugs and while walking over to the table of drugs, I kept getting a "hey you, hey you" from a group of people outside the roped off area. The hey yous didn't catch me off guard as kids had been lining up the whole day doing the same thing but instead of ignoring them as I usually tried to do, I went to instruct them that they would have to go to the back of the line. In doing so, one of the women in the group lifted up a 14 month old little boy and turned him around. As soon as I saw his backside I knew what was wrong (that year spent working in the surgery/pathology department paid off): he had a prolapsed rectum. I don't know if anybody reading this knows what that is, but it is when the rectal tissue becomes pushed outside the anus. This can happen if there is lots of pressure put on the stomach or from too much straining. We found out that he had had this problem for two months so he could have been smashed in the earthquake to cause it, we aren't sure though. Sadly, I had to tell the mother that there was nothing that we could do for him but that he would need to be taken to a hospital. I reluctantly returned to the two patients I needed to give meds to and took a few more patients before we packed up the clinic. While packing up, a truck pulled up with members from an organization, GAiN= Global Aid Network, that we were partnered with and the physician on our team convinced them to drive him and the Miami University hospital set up at the airport. We students took off in the bus back to where we were staying and the physician and the child were taken to the hospital. The little boy received the care he needed and his prolapsed rectum was fixed in fifteen minutes and was returned back to his family within a few hours. It was pretty incredible that we were able to see this little boy's treatment all the way through to completion.

Wednesday (3/17)= Wednesday, all of the students from KCOM joined up with Dr. Tillman and ventured out to a new tent camp close to the first camp we treated. It was like any other day in Haiti, no signs of green beer and I would venture to say that nobody was Irish dancing in that country. This new tent camp had a rather larger tented area which was the camp's church. We sat up the clinic within this structure and prior to taking our first patients, the leader of the camp led the waiting patients in a prayer and song. It was so moving to hear them all singing together and with such enthusiasm. We had no idea what the exact words of the song were but you could tell with their passion that they were praising for the things they had and not asking why this happened to them. It was a great start to the day and amazing to experience together as a group. We got underway seeing patients, pairing up two students and one translator. I paired up with Nicole Tillman and together we worked with Nicky. Nicole and I alternated who was using the translator, one person doing a workup while the other was getting meds together. At one point, we started to overlap a little and I had a mother and baby sitting there waiting for me to treat them. The organization at this camp was fantastic. Most of the patients were seated in the rows of the church and one of our translators who was in charge of keeping order went through the line and instead of just writing the name and age of each patient, he also wrote down their complaints. The woman and child that were in front of me handed me their little sheets of paper and I found that the child, a sixteen month old, had a cough and a fever. While waiting I decided to listen to the baby's lungs and upon inspection heard a snoring sound in the lower lobes of the lungs. For those who aren't medically inclined, sounds in the upper lobes means tuberculosis and lower lobe sounds is pneumonia. In the United States pneumonia isn't too serious although in children it is a little more concerning, but in a place like Haiti where they don't have the means to properly care for the illness it can be more severe. I had Dr. Tillman come over to listen to confirm my findings. He listened to both the right and the left side and laughed at me saying that it was just the way the baby was hunched over. He double checked and on his second pass heard what I had heard. I went and dug through the bins to find augmentin (many of the drugs we had were from Germany or Spain so this was definitely a task). Finding the antibiotic, I then had to figure out how to reconstitute the powder mix and figure out dosing for the little one. I found this to be one of the more challenging things that I had to do while in Haiti. It was so stressful to me to be mixing drugs and doing dosages having not had pharmacology and then giving people medication that can potentially be harmful to them if taken in large quantities. I went over the dosing several times with the mother before sending her off. I was fairly proud of myself for catching the pneumonia and it provided the opportunity for all the students to listen to the lung sounds associated with pneumonia on a real patient instead of just in a patient simulator. Other cases that we saw while at this tent was anomegaly which is an overproduction of growth hormone (think Andre the Giant), a 2nd year med student did manipulation on a boy with one leg shorter than the other that was in pain, treated many skin infections, and a multitude of other problems. At the end of the day (after Nicole and I saw 107 patients together!), Nicole and I became surrounded by kids. We let the children listen to our heart beats and their own with our stethoscopes, joked with them, sang with them, and laughed with them. We went outside the tented area where the interpreters were singing while some children danced with another member of our team. It was a great end to a great day spent with the team.

Thursday (3/18)= The team as a whole went out to a smaller tent camp close to where we were staying. The camp consisted of about 400 tents and was set up by a water filtration system (the water was better than . It was in much better repair than the other camps we went to. Most of the families lived in actual tents and they were located in a fenced in area with a curfew of 9pm. The leader of the camp was an English speaking man who was a photographer for the Haitian newspaper. Upon entering the gates to the camp and getting out of the bus, we found a ten year old girl named Kimberly. She had swollen knees which made her unable to straighten her legs. She had to use a walker to get around and you could see how the inability to stand up straight was taking a toll on her feet and ankles. We wrapped up her knees and throughout the day visited with her. She really touched all of us on the team. She wasn't able to go out and play with the kids but she was always happy. She even fell down once and you could tell it hurt her but she got herself back up and put on a smiling face. My first patient of the day presented with what looked like a wart on her finger. It was painful and you could tell she got it caught on things. I asked Dr. Tillman, being that he is a dermatologist, to look at her finger. Turns out it was a pyogenic granuloma. Dr. Tillman asked me if I would like to take it off and after receiving permission from the patient I proceeded to setup a "sterile" area where I could remove the granuloma. He walked me through the whole procedure and the woman was very appreciative to have it off. This took some time to perform and I eventually got back to seeing patients. I treated a little girl who was about two years of age and in checking her lungs she became very interested in my stethoscope. After getting her and her mother drugs, the little girl put out her arms to me and came and sat on my lap. She sat there and played with me for a while. When her mom would reach out to take her the little girl would slap her mom's hands away. I felt really bad because I didn't want the mom to be upset but I absolutely fell in love with this little girl. If I could have brought her back I would have. We closed up the clinic around noon and waited for other members of the mission to meet up with us at the camp. This gave us time to pass out supplies to camp members and play soccer with the kids. We brought a whole bunch of peanut butter crackers with us into Haiti that we decided to pass out to the kids. The formed an orderly line in front of the leader of the camp and he passed them out to them. Next, we had items that were donated to us for our hygiene pack: Kotex and tampons. We gave the leader the items and he laughed and returned with "watch this". He announced something on his bullhorn and all of a sudden there were women pushing their way to the front of the mob that formed in front of him. He first started handing out tampons and the women were very disgusted. Seeing their disgust and lack of interest he switched to passing out the Kotex. Thus the mob seen returned. It was hilarious. We then were all able to interact with the camp while we waited. One of the girls instructed the camp's nurse how to use tampons, one girl played soccer with the kids, and a bunch of us had little kids crawling all over us. My little girl came back to me and again wouldn't leave. Such a cutie. When the members of the mission showed up we got all set to take off to drive down to downtown Port-au-Prince to see the main damage. Getting into the downtown area took a while not because of the distance (it was only about 8 miles away) but the traffic was crazy. It allowed us some time to relax and Dr. Tillman treated us all to Cokes. I don't drink regular Coke normally but let me tell you it tasted so good and it was cold which was definitely a treat to us. As we made our way into the downtown area the number of buildings damaged or demolished began to increase. We went to drive up a hill and our bus unfortunately was unable to make it the whole way up even when most of the guys jumped off. We had to turn around in the middle of a busy road. The interpreters, who were the ones taking us on the tour, took us by the medical school that was completely destroyed, the nursing school which was also completely destroyed, the American built hospital that showed no damage and was functioning, and the Haitian university which was completely damaged. The most touching thing about this trip is that our interpreters were not afraid to take us by things even though it may have been hard for them. All of the interpreters we worked with that week were well educated, almost all worked at the university, some were working on their PhDs or masters before the quake and were in the university at the time. We were also taken to the soccer stadium where 10,000 people are living. The people were living peacefully together, there was no crime, no fights, just smiles and laughs. Pretty amazing compaired to the distruction that occurred at the Superdome after Katrina. In the stadium seating there were two choirs. They would switch back and forth who was singing. Talking with the leader at the stadium I learned that the choirs came from the same church and there used to be a third choir but they were killed when the church collapsed in the quake. The two choirs vowed to honor their memory by singing every other day at the stadium. It was beautiful to hear. The leader took us down on the turf and we were able to interact with the people in the camp including visiting a girl that had to have exterior setting of her femur. Making our way back home we were taken through the streets that are spilling with rubble yet people are still selling goods along it, huge churches that had only single walls standing, and past the Presidential Palace. Later in our team meeting, we found out from one of the members of the organization the one of the interpreters was in the same room as his father and cousin at the university during the earthquake and they were standing only 5 feet away but Junior, our interpreter, was the only member to survive. So sad.

Friday (3/19)= The last day we were in Haiti, which happened to be the only rainy day we were there, our whole team went out to the main clinic in Chambrun which is outside Port-au-Prince. A few members of our team treated patients while most of us spent time trying to organize the materials that had amassed in 3 of the 4 exam rooms and in the pharmacy. The teams that came in prior to us had left things in such a mess that it would have taken us the whole week organizing to get it all cleaned up. We left around noon to pack up and catch the bus back to Santo Domingo, DR. We got back to the house, cleaned up, packed the last of our things, said our goodbyes, and loaded in the back of two pickups to be taken to the bus. We had a fun ride back into the Dominican drinking Presidente beer and joking around. It was on the trip back that Dr. Tillman realized that the four of us biomed students on the trip had not taken the same courses as the med students and were maybe a little less educated on some of the disease states. I think though that he was more impressed with how capable we had become during the week and that we had functioned at the same level as the med students. We checked into our hotel in Santo Domingo, ordered pizza, and hung out. It was a fantastic last night with the whole team.

Saturday (3/21)= We had breakfast with the whole team and then it was time for portions of our group to head to the airport to head back to the States. This left four hours of time for the seven of us left to do whatever we wanted so of course we headed to the beach. It was gorgeous there. Sky blue water, white sandy beaches, and the best pina coladas I have ever had. It was a blast. We bought suveniers and tried some crazy foods they were selling on the beach. We went swimming in the almost bath temperature water and dried off almost instantly in the 95 degree heat. When the time came, we headed back to the hotel with our newly purchased treasures and got ready to leave. As the remaining members of our team made their way down to the lobby of the hotel we began to see a reoccurring theme: bright red sunburns for all. Some laughed about their sunburn, others were worried, and I think everybody laughed at Phil's bright red bald head. Our return flight into the US took us back into mine and New York Gov. David Paterson's favorite state (insert sarcasim) New Jersey....ugh. Our next flights did not leave until the next day and being that it was more than four hours prior to our flights we were forced to go from the international concourse to the domestic concourse which put us outside of security. We had to curl up on the hard tile flooring near our security checkpoint and attempt to get some sleep.

Sunday (3/21)= "Waking up" I was so excited to get the heck out of Newark. Six of us went to board our plane to Chicago while the seventh member had to wait a few more hours for his direct flight to St. Louis. For some reason, two of us had to gate check our carry on bags all the way through to St. Louis because they were "too big". The flights to Chicago and then to St. Louis were smooth sailing, getting into St. Louis at 10:30am though we found out that our seventh member's flight had been cancelled and now he wasn't going to be getting in for another 11 hours. The two of us who had our bags gate checked went to the luggage claim only to find out that our bags did not come on the flight with us (dang Newark gets me again). We left our information with the baggage services and decided to make the final journey back to Kirksville. Luckily our seventh member was able to get a ride back to Kirksville from another KCOM student who came in 20 minutes after him. And amazingly the St. Louis airport drove our bags up to Kirksville and delivered to us by 10pm.

One thing that really struck me was how the Haitian people never blamed God for the tragedies that befell them or were angry with him. It seems like so many in the US become angry for their misfortunes. Also, Haiti was in shambles prior to being hit by the earthquake and the destruction only made matters worse. This country doesn't have the resources to repair the damage. Cranes and bulldozers are a rare thing so the crumbled pancaked buildings are being taken apart bit by bit and taken away in wheel barrows. There are few hospitals or clinics available to these people and the earthquake has made this severly worse because many of the countries doctors and nurses boarded the flights run by our military into Florida. The voodoo that you hear about in our press was not once seen by my eyes while I was there. I only heard about God from the Haitians. Another major thing that struck me was the lack visability of Red Cross workers or other major aid groups within Haiti. I didn't see a single Red Cross worker even though they have received the most donations from the States. And I was very annoyed by the United Nations presence I saw there. There were a ton of UN tents set up but they were for the UN soldiers. We saw trucks of UN soldiers going out to "keep the peace" with their weapons trained on the Haitians. I never felt in danger while I was in Haiti so I didn't understand their peace keeping mission. So many Haitians were detered from coming to food lines because they were terrified of having a gun trained on them. Understandable I think.

Overall, the trip was amazing. The best learning experience, Spring break, career reassurance I have ever had. I strongly encourage anyone considering going to Haiti to go. It will take decades for the damage caused by the earthquake to disappear and will only be done with outside help.