Day II: Derac and Milot

Day Three.

Second DeRac Clinic a success. Saw some 240 patients according to the census.

When we started out from Living Hope Mission, a young man approached the van asking to have a doctor look at a mouth issue he had for quite some time. We told he we would be happy too, but had to get the team to Derac. He agreed to return later.

Out at DeRac, we ran well ahead of schedule and things we more coordinated. Our pharmacy team had taken control if the meds by now and were running the process with great efficiency, All the teams were humming along and we even got in a little surgery.

The most interesting surgical case was a 2year old boy. Now as this is a family blog, I will spare the gory details and tell you only that the child required a procedure related to a circumcision to relieve what is called a phimosis.

The surgeon did not have a scissors small enough to do the delicate job. Many of you have heard me brag about the leatherman being the ultimate bush tool, even superior to the Swiss army knife with the leatherman's pliers, multiple blades and tiny tiny scissors.

Maybe I should skip the details of what happened next, but suffice to say, after extensive sterilization, the that Leatherman once again proved it’s worth.

Back in Cap, we finally got to see the patient with the mouth issue and sad to say there was nothing we could do for him. The growth in his mouth was making it harder to eat and swallow and without intervention, it would end very badly,

Then I remembered bumping into some doctors who were going to the hospital in Milot who gave me a card and said if I needed anything to call. Well I needed something.

We jumped in a truck and were off to Milot.

It was a different experience than last time I was there. Three years ago it was a hair raising ride through what felt like some sketchy territory. This time, it was a drive to Milot, no more exciting than a ride to the mall. We were able to walk the streets between the hospital and the living compound and basically be ignored. The most action we saw on that street was a Cardiothoracic surgeon scoring a good deal on some Haitian paintings.

The hospital in Milot has been transformed from a small outpost into a tent city with uncounted numbers of Americans working away. One of the nurses walked into a ward there and the charge nurse looked up and said “I’m not going to remember your name so don’t bother. Just tell me what your capable of.”

There were five larger tents housing maybe 40 patients each. Many amputations and external fixaters on. Surgrons were working in an OR smaller than most restrooms I’ve been in. They are however getting the job done.

We found “Dr. Tony” who we met in the airport on the way over and he enthusiastically agrees to help us. He brings us to meet the coordinator of the hospital who comes across like a character from a Clive Clussler novel or perhaps Lt. Col. Kilgore from Apocalypse Now depending on your reading/movie preferences.

His name is Tom Traynor and he has a large gray beard and a shock of unkempt gray hair running off in every direction. We find him seated chomping a cigar with a Haitian gentleman and they seem to be watching Mr. Traynor’s pet goat. I introduce myself and he too agrees to help. I give him a card with my email on it. I am told they copy the info into the computer, then feed the card to the goat.

Either an incoming team of facial surgeons will help here locally or perhaps he’ll be brought back to the states for surgery. It’s a fascinating case that any OMFS service would kill for.

Mission accomplished, we break for home, but again, this is not the Milot of 3 years ago and honestly, it was just a nice ride home. The dogs kept me up all night again, but so it goes. I am wondering how long till the sleep deprivation causes a psychotic break.

Am I really in Haiti, or is this the Third floor(Psych) of the hospital at home?

More later.

Haiti: Day II Derac

Day II: First day of field operations in Derac. Just south of Fort Libertie across the border form the Dominican Republic.

http://maps.yahoo.com/#mvt=m&lat=19.549976&lon=-71.888511&zoom=11&q1=haiti

The first thing that struck me was that the roads are actually paved. Outside of takeoff and landing at the airfield, this is the first time I’ve done over 25 miles per hour in Haiti. Unbeliveable! Remember that I am in the north far away from the quake zone which our hosts tell us is still to treacherous to access outside the controlled zones.

Still we saw a few people from Port au Prince for wound care and so forth. Our surgeon Dr. Rob Jones, had such a light touch and a good bedside manner, people started asking for him. Word travels fast. Dr. Jones’ addition to the team has definitely been a stroke of luck/ Rob Coker turns out to be an engine of healing and, despite his initial reservations about how effective he might be, turns out he took to the work like a fish to water. Dr. Moon and Dr. Niedich too just plowed through patient load in astonishing fashion. All in all the team has gelled and we’re ready for round two tomorrow.

As far as the pathology, I’d say the patients are sick her than I’ve seen in the past. We found what is most likely inflammatory carcinoma of the breast in one young lady and are trying to get her to a surgeon for management. Another gentleman came in an collapse with an incarcerated hernia and he wound up stat transported to the hospital for emergency surgery. I think that was like my third patient of the day. Heck of a way to start out.

We saw a few children with protein malnutrition and one lady came in screaming, had to be carried to to my area and after 1 tab of Naprosyn raised her hands to Jesus in thanks. She went away a happy camper. I’m still not quite sure what happened to her, but I have a feeling she’ll be back tomorrow.

All in all a successful day, though not without it’s challenges. My nephew tells me he’s exhausted. I replied before I thought:

“There are a lot of days in your life that you’ll become exhausted, but very few where you’ll have done as much good getting there.”

Dang I’m philosophical.

In all seriousness, it IS true and it feels good to be this tired for a good reason.

Tomorrow, back to Derac!

K

Haiti Day I

Haiti First day in country.

We arrived relatively uneventfully after leaving Ft. Lauderdale. We loitered at the Cap Haitien Airport for a little over an hour because all of our luggae had to be put on another flight or we would have had to land for fuel, As it’s a two hour flight, I am lead to wonder how big the fuel tank is.

The luggage arrived without incident and we were off to Living Hope Mission. The crowd was a bit more aggressive outside the airport than I remembered in past years, but nothing overly concerning.

We had hoped to see some of Pastor Julio’s refugees, but will have to wait for now. In the mean time, we took a ride/tour into Cap Haitien to see how things were and they we as awful as I recalled. Yet people seemed to be going about their lives. Meg tells us that despite the ready smile, the people are so very stressed. Not sure what’s going to happen next, unsure of their children’s futures, unsure about where the next meal even is going to come from.

The new team members are floored and I find myself more focused on their reactions, making sure everyone is processing things OK, They certainly seem to be. The team is a mixture of newcomers and vets and have blended pretty quickly. Maybe six hours in the country and they cut through the pharmacy phase(Selecting equipment and distributing meds for each of the sites.) with ease. Rob Coker divvied up antibiotics like a ginsu master, Rob Jones had his wound care materials set just as fast and the nursing team Carol, Loretta and xxxxx got everything else sectioned up before I could tell what the heck they were doing.

I think I most delighted however at how well my nephew is doing. He’s a complete stranger to medicine, but jumped at the opportunity to come and he’s showing a real affinity for digging in and helping where ever he can. He save the day once already with already dandy roll of duct tape earning himself a “McGuyver” props from the team.

It’s 9 minutes before we lose power for the night and though the night is mild in Haitan terms, It will still probably be hard to sleep tonight.

On The Eve

Settled into the Hotel in Ft Lauderdale finally. The main group arrived about an hour after I did, and several had arrived before. Finally together, it is both an impressive and ordinary group.

ORDINARY!?!?!? What do I mean by that?

So often I hear people say "I could never do that!" Yet here are people from all walks of life, a marketer, an insurance agent, a mathematician, in addition to the "Medical" staff. Very Normal/ordinary walks of life.

I guess the point I'm driving at, probably incoherently and poorly at this hour, is that no one should ever say they "Can't" do this work. It doesn't take superman to go somewhere uncomfortable and show compassion to another human being. Though a good travel agent helps.

That having been said, on to the "Impressive" part. In talking to many of the people new to me, I sense that common theme of compassion and a desire to make the world a bit better. I very much look forward to the week ahead.

To bed.

K

Once more into the breech.

Once more into the breech.

My name is Kerry Forrestal. I am an emergency medicine physician working on Maryland's Eastern Shore. This journal is being started for two reasons. First as a document of time spent in Haiti on a medical mission to Cap Haitian and second as a prototype for "Dispatches from the Field" project for the American College of Emergency Physicians International Section.

A small amount of background.

This will be my third trip to Haiti. My first was undertaken shortly after residency fulfilling a lifelong ambition to become a doctor and go somewhere, if only briefly, where the need was great and medicine was practiced purely for the benefit of others.

Haiti filled that description and then some.

My local church had been going down to Northern Haiti for many years, at first to build things, and later on medical missions. Thus a perfect opportunity was born and with the support of my wonderful wife Shannon, I went.

I wrote a journal of my experiences in the country extensively, but did not write as extensively of my second visit. No particular reason, perhaps the dazzle of working in such a place had worn off and the difficult, necessary business of tending to people in an impossible place persisted.

This document will hopefully correct that previous omission and lead others to post their "Dispatches from the field" to share those experiences, teach those that comes after us and perhaps inspire some to try the work.

TODAY

Three days out from leaving I find myself scrambling for vaccines. I've long held the view point that a lot of the medicine we practice in Cap Haitian is impermanent. We leave and a month later everything is back to what it was with the exception of a handful of cases. Vaccines on the other hand leave a more permanent benefit and I've wanted to vaccinate the kids we see since my first visit.

I was discouraged from trying with information that it was already being done and that getting vaccine into the country required refrigeration. When Pastor Julio(My interpreter in Haiti) called me tonight, I found out that there really isn't much vaccination going on.

I'm continuing to check this out, including trying to get hold of some tetanus/DTaP shots.

As to the rest of the preparations, I found my "Haiti Hat", have my leatherman, and my daughters(Sarah 6 and Riley 4) are collecting up their coins to send to the "People in Haiti". I'm gathering and making an inventory of gear. We have to travel light as we have only 25lbs for personal gear. The remainder of a 50Lb luggage allowance goes to all of our medical gear.

I don't find the trepidation that I associated with the first trip. Haiti is no longer an unknown and I have friends down there now so my issue is more that I hate being away from my wife and children. But as I continue to say, doing these things are necessary and it sets the example for my girls that being a physician is not about privilege, but rather service.

One other note, my nephew, Jason, is coming with us. This will be his first such trip. Will ask him to share his views as well.

Here’s hoping!