Throughout this trip we are learning to become very flexible, adapt to new situations, and think outside of the box. Their is a lack of everything here - proper equipment, organization, support services, nursing staff which means that we are often thinking outside of the box and taking on many different roles in order to provide the proper care to our patients. Gurpreet has been doing all the EKG's for us and performed a "poor mans stress test" - where she took the patient for a walk outside instead of in a controlled room with a treadmill and heart monitor, Becky has been giving breathing tx among many other things, the PT's are in charge of wound care and managing the patients on the floor as well as occasional discharge planners/case managers, my nurse manager Brad stood and ventilated a patient for like 3 hours because we dont have any ventilators. We have been supplementing missing equipment with anything that will work, I have been asked to triage, pre-op, wound care, and ED nursing - most of which are all pretty new/unfamiliar roles to me. So the environment allows us to experience a lot of new roles and skills and learn how to work with what we've got.

below are some more pictures. I wish I could write more but we have to start our morning rounds.

Its about 12:30 am here and I am having a hard time winding down. Gurpreet, Becky, Shaun and I just returned from playing "santa" to the kids in the hospital. We created little goodie bags with coloring books, crayons, pixie sticks and toys and then placed them by each sleeping child so that they could have a suprise when they woke up!

This morning we woke up early to do rounds with the orthopedic surgeon. Afterwards we had planned to begin doing wound care on the patients but the triage tent was so busy that Gupreet and I were asked to help down there. Dr. Turner and Emily had a long line of people waiting to be seen. I was told to take vitals and triage but after an hour and a half I was drenched in sweat and began to feel overwhelmed as I realized there was no end in sight. Not to mention I still had a lot of dressings to change! I decided to ditch the triage tent and do wound care with Brad. Wound care has been taking a lot less time because we did a mini "LEAN" project on our supplies bin. There are still a few complicated wounds, one patient takes an an hour + no matter how much we prepare for it, but for the most part we have a good workflow. I am even proficient enough in my creole that I find I dont need my translator to be with me during the dressing changes!
After lunch the wound care team was helping the ED. There was plenty for everyone to do - lab draws, giving meds, starting IVs in dehydrated people, and if nothing else there is always someone who cant find a supply they need and needs a "gofor" There is a definite lack of organization here with the supplies. It is immensly frusterating. Gurpreet was involved with some complex cases today as well as being stuck with entertaining 4 nursing students and teaching the lab about the necessity for correct lab supplies in the ED. I had tried earlier with an interpreter but gave up because not even my interpreter understood me. Becky is just doing great things in the ED and is the go-to girl in that department.
We also went out to eat tonight at a local restaurant. We had a few beers and shared our "war" stories of the day as we munched on fried plantains and piccoleas (sp?). It was nice to get away after a long crazy day. We had this young 24 year old mother with the skull fracture was a very sad case. She was assualted by a baseball bat last night and sustained severe head injuries. She has no family or relatives that we know of and the only one who came with her is her employer. She was transferred from Doctors without Borders, and after more than 6 hours spent trying to save this girl which included measures such as cooling her core body temp, inserting our only central line in the hospital in her, intubating her, giving her IV meds and IV fluid and more it was decided that there was no hope for her after a consult call was made to a neuro surgeon and the MD director advised letting her go. The whole situation is just extremely unfortunate and sad. But even in the best hospital we couldnt of saved her.

OK well I have to get at least a few hours of shut eye before tomorrow.

I will try and post pictures later. It might take some time because my laptop is the only thing with a built in cardreader and its dead. (i didnt bring the charger)

good night :)

pictures from the first day

second day/sabbath in haiti

The most cutest things in Haiti are the kids here. They all have such big and beautiful eyes and beautiful smiles on their faces. Yesterday felt like an orientation day and today Linda, Melanie, David, Brad, and I spent all day doing dressing changes. Most wounds are so complex, especially the ones with external fixators that if we were in USA, we would probably medicate the patient before, during, and after the wound care process. But here, we had to change most dressings without any medicinations which made the dressing change process longer. During this time, I had the opportunity to get to know some the patients and translators. After learning about their stories, I almost felt like I shouldn't have asked because their stories are just so heart breaking which makes me want to cry but how can I in front of these patients who are so happy to have us here to help them. I know what you thinking Candace but I'm holding on. So many patients here don't have any place to go if they were to get discharged. One of the patients asked me if I can help get her a tent and there are so many who need tents. Man, I would not be able to do whole lot with the translators. They are so helpful that they even know where the dressing supplies are and they are so friendly. We did take some time to eat lunch and by the end of the day, my feet were hurting so bad. When I finally sat down, I couldn't get out of the chair for while and today was supposed to be an easy day. Anyway, I better go. Take care. Love, Gurpreet.




ok now its Linda writing.
today was another busy day! I woke up to the sun rising and the sound of patients and families starting to move about. ( we are sleeping in an area that I guess is best described as a loft that is right above the med/surg patients. ) At 630 we rounded with the ortho doc then at 730 the Sabbath was celebrated ( Adventist = sabbath on saturday) and we went to the english church service and I actually got roped into being a part of the song group. (not excited about that)
Anyways, we had a lot of difficult dressing changes today like gurpreet said. The humidity doesn't make it any better. THe whole process of changing dressing seems to take so much longer here due to lack of available supplies being readily available - we are often running back and forth to the central supply station downstairs just to grab things like a sterile q-tip or chucks. Not to mention that just putting on a glove takes about five minutes because our hands are drenched in sweat. One patient's wounds were so bad that we had to recruit the CRNA (that just arrived today) to provide conscious sedation during the change (another story). Another wound vac change literally took over an hour- luckily there was a fan in that room and we had live music going from the creole/french church service going on downstairs.
The goal of this week is to have the Haitian nurse start to take over the wound care. Our team will be leaving soon and so they will be responsible for these dressing changes and a LOT of teaching needs to be done. I had one Nurse who decided to watch me change one of my patients dressing - when I asked her to get involved she said "no no just watch." So I explained to her what I was doing and tried to walk her through it, but everything was via translator so Im not sure which pieces got through and which ones might of been lost in translation. Another nurse approached me and said he wanted me to watch him change this dressing on a wound. I really couldnt watch for too long without having to speak up- and it felt kind of awkward trying to tell him that he was doing everything wrong, and not just minor things.. Things like blatant breaks in sterility and even when he tried to be helpful it was in the wrong way. SO we have our work cut out for us in terms of education. We plan on holding an inservices for them every night while we are here.
Otherwise, I am having a great time getting to know the Haitian people. One of my patients is teaching me how to say the days of the week in creole. Everytime I pass her in the hallway she quizzes me. Now I keep a cheat sheet in my fanny pack and study it really fast before I go out and see her, I can almost remember all the days: Dimanche (sun), Ledi, Medi, Merkedi, Jedi, _____, Samdi. I do have my own translator, Claudene, with me during the dressing changes but the patients seem to appreciate it so much more when they see you trying to understand the language. Claudene is also helping me a few phrases like "how are you?" "are u having pain?" etc. As he was teaching me to speak creole in the hallway of the hopital and a few people stopped by to hear me fumble with the creole phrases. I guess they think its a pretty funny thing to watch.
another story or two to reiterate the lack of adequate supplies here:
1. had to do a dressing change on a patient who had severe wounds due to being electricuted by a electrical wire. VERY painful. needed morphine. asked nurse for morphine - 10 minutes later she hands me a syringe filled with 3cc, the bottle thats taped on it says that its morphine 10mg/ml in 1 ml bottle- well we couldnt figure out what consisted of the other 2 cc's so went to go grab our own only to discover that there really isnt ANY morphine to be found
2. I was eating dinner when a translator ran in to get someone to help the pediatrician - apparently he needed a pulse ox and couldnt find one. THe only people he knew with one was a midwife who had left the grounds to eat dinner. I asked around and came up with one that I ran down there only to find that it wouldnt work because it was too big for this 3 year old baby who was working really hard to breathe. Finally 15 minutes later I had found another pulse ox but I had to rummage through the nurses cardboard box of supplies to find it and then only to realize that the batteries were dead, well then i had to find someone who had AA batteries, that was David the PT who was in the shower.. luckily he didnt take too long and as soon as I found him and replaced the batteries I ran the pulse ox down to the ED and slapped it on the poor girl - luckily the 02 sat's were in the high 90's but she was definetly using all of her accesory muscles to breathe.
so I am finding there to be a lot of problems/inefficiences and areas that need work but most of them cannot be fixed due to lack of money. period.




After work we went to the universitie that was just outside of the hospital grounds. As we entered the universitie grounds we realized that it had become a huge tent city. The little kids came running up to us smiling and waving. This one cute little girl just started holding my hand and walking with me speakingin creole and smiling at me. SHe got really excited when I snapped her picture and wanted me to keep taking more and more! Another little boy taught me some more things to say in Creole. they were all so adorable. but we had to leave almost as soon as we got there because it began to rain.


right now I have three small fans pointed at me and im still sweating.
did I mention that I forgot to pack the rods to our tent and so we cant use it? so we are currently sleeping on cots under mosquito nets that have holes in it.

more to come later but its after midnight here and i have get some sleep! -- will post more pics later !!!

Haiti

we made it to haiti at last! we walked out of the plane to be greeted with the humid heat of haiti and a crowd of porters aggressively attempting to take our bags from our carts and "help" in order to get a tip. We survived the mob and then walked over to our bus with the hospital staff that came to greet us.
It was about an hour ride to the hospital because of all the traffic. My first impression of the town was that it reminded me of other 3rd world countries that I had visited. The blatant poverty on the streets, the smells of street vendors cooking near the remains of the dead animals that they were roasting, the tin shacks, people crammed into tap tap's and vans to the limit - and not one street signal. The rubble from the earthquake is still there, it looks like the ruins havent been touched since the event - haitians have set up shop in the remaining cover of dilapidated buildings or on top of the rubble. In that hour I only saw 3 sites that people were cleaning up debris and one construction site. The majority of the population are housed in tent cities - their address spray painted on the outside. When we finally arrived to the hospital it seemed relatively calm. THe cardiologist that came in our group was immediately pulled out of our "orientation" time and called to the floor- apparently they had lined up the cases for him. We were shown our sleeping area where we found two PT's from UVMC. It was such a nice welcome to see them here! Melanie the PT updated us on what their plan was for us. Apparently the previous MedSurg nurses had made big striedes in wound care and their were high expectations that we would fill their shoes.
Inside the hospital people can be found laying on cots in rooms or in hallways. patient privacy is not a concern here. A few of us RN's started helping the PT's with wound care. I was sweating pretty much like a pig The patients were extremely grateful for their care and they try and help you as best they can. It is so rewarding to see them laugh and give you a big smile. I already feel appreciated and I have only been here for 9 hours.
After a while I started to feel light headed and nausea's I think the heat and some anxiety as well as malaria pills were the culprits I tried to play it off as i listened to the doc rounding on the patients but I had to run to the bathroom thinking that I was about to puke.. thankfully after i splashed some water all over me, sat in the a/c breakroom I felt a little better.

luckily the weather is cooler now because there is a thunderstorm and its bringing wind and cool rain. it feels amazing.

ok well i have people lining up to use my computer. bon swah (?) or goodnight.

"the divine in me recognizes the divine in you"

The history of Haiti emulates the resilience of the haitian people. They have lived through so much suffering whether it be through natural causes or oppressive dictatorship. Not to mention the multiple times countries have gone in with supposed "positive interventions/influence" only to find that their actions mirror that of locusts more than an act of help or healing. It is extremely unfortunate because these individuals makeup what is known as the poorest country in the western world with one of the highest rates of infection.

NamasteHaiti was created to share our story about volunteering in Haiti. I am a new nurse at a small hospital in Northern California. When the news of haiti's suffering reached the general public one of our amazing MD's and PA's decided to organize a medical relief trip to provide aid in Haiti. We held many fundraisers and benefits asking for donations to help fund our trip - over 30 of our medical staff volunteered to be in haiti for a combined period of a month. The response from the community was incredible, we raised over $13,000 at one of our benefits not to mention the many boxes of donated goods including medical supplies, toys, scrubs, prenatal vitamins, condoms, etc.
Namaste is Sanskrit and essentially means that we are all interconnected and that we are the same. The Wikipedia definition of Namaste is: "The divine in me recognizes the divine in you and acknowledges we are the same"







my roommate (on the right ) and me decided to try on our gear for the trip. please notice our stylish fannypacks, knee pads, and the outdated scrub pants that were graciously donated to us for this trip






PACKING FOR HAITI






I think I have somewhere around 1,000 condoms packed in both of my suitcases. My roommate has just as many if not more. It feels a little wierd having SO many scattered throughout my suitcase. I mean, I dont care what the airport people think because I can easily explain myself. But I do think the people doing our recycling will wonder why we have so many empty condom boxes in the trash saying in big bold letters: "HUGE condoms for the more endowed.