Our last full day in Haiti appropriately began and ended in rain. The gray sky mingled its drops with our tears as we said good bye to new friends; Haitian, American, and from around the world; patients and coworkers. Unlike so many trips I have been on in the past where there is sadness in saying good bye, there is usually a sense of celebration over a job completed. But our hearts are heavy as we leave a job undone; so many loose ends, so many sick missing arms and legs, open wounds, scarred souls, their country in ruins. It seem so inappropriate to drive away to Santo Domingo, to enjoy a nice meal in a restaurant, a hot shower, a real bed, an air conditioned room, and electricity at will.

Never will we be able to think of Haiti as we did before. I knew it was the poorest country in the hemisphere, ranked in the last four with Nicaragua, Bolivia and Honduras. In my mind I compared Haiti to Honduras, where I lived with my family for seven years, but not any more. In the past as I heard of hurricanes bearing down on Haiti, I thought, “Too bad!” This hurricane season I will plead, “GOD, PLEASE SPARE HAITI!” as I think of the hundreds of thousands, maybe millions, who now call a tarp, a lean to or a tent their home. Having lost their supposedly solid home in an earthquake, their frail dwellings will so easily fall prey to a tropical wind of very minimal force. I can see it in my mind, and it brings tears to my eyes.

So let us not forget Haiti! The job is not done. The work is becoming more specialized, more specific. We will continue to help as we are enabled, to send people and supplies, to make useful contacts, to help Haiti heal, for we have been called into the healing profession, and healing we must do! -- David Drozek, D.O.

7:26am, March 5, 2010

As the residents and I have talked, the last few days for us at CDTI have felt a bit light nights on call as an intern or early resident, feeling like a ping pong ball, putting out one fire after another. Yesterday was a good example of such a day for me.

Since the afternoon before I went to Community Hospital with a transfer patient I missed a dressing change. One of the patients who had been buried for three days in rubble, and developed severe pressure sores that will eventually need plastic surgery would not let the Mexican team change her dressings. She said they were too rough. So she refused the dressing change on Wednesday. First thing in the morning we moved her into the emergency room for her dressing change before the Mexicans arrived. Her wounds are doing well, but still harbor some infection that needs resolved before she has surgery. We made arrangements to transfer her to Community Hospital where a group of American plastic surgeons has set up a base of operations for 6 months. The patient seemed reluctant to go. She asked all kinds of questions, and then finally asked if she would be sleeping in a tent there. I told her, “no”, which caused a fair bit of anxiety. She is afraid to sleep in a cement block building after what she has been through. I assured her that the building looked very sound when I saw it. She reluctant agreed to go.

Then I walked up the three story ramp, the first of probably 20 trips I would make for the day, to repair a hernia on the Haitian orderly that had watched me do the same operation a couple of days earlier. I had started to give the anesthesia myself, when in popped two of the Mexican nurses who offered to help, one managing the anesthesia, and another circulating. Before the case was done, the Mexican anesthesiologist was also present helping! We had a truly international experience in the OR, playing the music of Danilo Montero, one of my favorite Hispanic artists, in the background.

With help, we rolled the patient down the ramp to the recovery area and found his wife. I Talked with her via an interpreter, then went to the pharmacy and picked out some medication for the patient to take home with him.

At this time, one of the nurses brought me a note from another facility that a patient had carried in. It was a referral for a breast lump. She even had an ultrasound report. I went on a hunt for a private place to examine the patient and hung a curtain. Then I found a female translator and examined the patient, who indeed did need surgery. I went up the ramp to schedule the case, and returned with the information.

Then another doctor asked me to see another patient who had a breast abscess, a pocket of pus beneath the surface. I started her on antibiotics and scheduled her for surgery. She was worried about things and asked if she would be able to have more children. I assured her this would not be a limiting factor. “Good!” she said. Her two children had died in the earthquake, and she had hopes of another family!

Then I was told about two more patients who had breast problems! One was a family medicine problem, but the other sounded like a surgical problem. This patient had what appeared to possibly be an aggressive form of breast cancer that involves the skin. She needed a biopsy. As we talked, she mentioned that she had not had a period in two months, since she had an abortion. On examination, she appeared to yet be pregnant, but there was no way to be sure the baby was alive. I took her to ultrasound, talked with the Haitian radiology resident, and left the patient in line to have an ultrasound of both the breast and the pelvis.

I was then off to climb the ramp to surgery again. The orthopedic surgeons were running behind, and I had offered to help with some of their minor cases, and with anesthesia. There was one young patient who had a broken forearm with a pin in his ulna, one bone of the forearm and a plate with screws on his radius, the other bone. He had developed swelling of the entire hand which was suspected to be an infection. I was to pull the pin, open the wound, clean out the pus, and remove the plate. I gave the patient two injections of Ketamine, an anesthetic akin to LSD which dissociates the mind from the body. I removed the pin with a good tug, and then turned my attention to the swollen wrist that seemed to be pulsating. I used a needle to withdraw fluid from the swollen area, which was blood, not pus. I talked with one of the orthopods in the next room who “broke scrub” to join me. He placed a tourniquet on the patients arm and reopened the wound to find the swelling caused by blood. After rinsing out the clots, he cautiously let down the tourniquet and what we feared was present, a hole in the radial artery; probably a weakened area in the artery from damage from the fracture or from the surgery, had broken down and had formed an aneurysm. The orthopod quickly moved aside and said that this was more my specialty.

I checked the artery for back bleeding from the ulnar artery, which would mean that the other of the two arteries feeding the hand was intact, and I could simply tie off the leaking artery; but no such luck! This was the only viableblood supply to the hand! We found some fine vascular suture, about the diameter of spider web. I had to take off my glasses and place my face a few inches from the wound to see well, and was able to suture the hole in the artery. It looked like it would do well as long as the artery didn’t break down further. I closed the wound, transported the patient downstairs, and headed for ultrasound.

The abortion had not worked and the patient had a healthy appearing 17 week pregnancy! The radiologist had convinced her to keep the baby since it was too big for a simple abortion. I wheeled her upstairs for removal of a little piece of the abnormal skin of the breast with a local anesthetic. I will take the specimen to my pathologist in the states, since there is no reliable way to get pathology results in Haiti right now.

On my return downstairs, I was asked to look at a 12 y/o who had an undescended testicle. It could be seen on the lower abdomen instead of in the scrotum. I scheduled him for surgery to remove the testicle, which would not be functional and would have an increased risk of cancer, and to repair the associated hernia.

After a quick late lunch, I did another dressing change, then headed upstairs to give anesthesia for another orthopedic case. After transferring him downstairs, it was about 5:30 and time to call it another day at CDTI! -- David Drozek, D.O.

6:53am, March 4, 2010

As I awoke to the sound of rain this morning, it reminds me that change is around the corner. There have been evening showers, but usually by morning the sky is clear. We have heard the worried predictions about rainy season, and the additional hardship it will bring to the tent cities, adding to sanitation problems and hindering reconstruction.

As I reflect on the future of medical relief, having a long list of medical providers who too want to be involved, I see the direction as two fold. First, the urgent needs of the immediate post earthquake are fading into the need for physical and occupational therapy, plastic and reconstructive therapy, orthotics and prosthetics, continuing orthopedics to handle the fracture non-unions and osteomyelitis (bone infection) cases.

I also see the ongoing daily medical needs. We are seeing trauma patients; motor vehicle accidents, gun shots, construction (demolition) injuries. There has been a plea for pediatricians to help handle the neonatal problems and premature babies, as well as the usual childhood diseases that are becoming exacerbated by the crowding, lack of food, and lack of sanitation. Primary care teams to the tent cities are going out and seeing long lines of people for the “mundane” complaints common to a family practice and urgent care facility in the States. We have already mentioned the very frequent post earthquake complaints of gastritis, rash, insomnia and palpitations, not to mention the always frequent headaches, back aches and generalized body aches. There is also malaria, but many doctors unfamiliar with the presentation are likely missing the diagnosis. Some facilities are using rapid test kits that are revealing the illness and increasing the providers understanding of the disease.

So, as OUCOM continues its relief effort, what should be done? I think people need to be sent to address the needs mentioned above, with expectations to match. We should be moving into a role of filling specific needs rather than sending down anyone who cares to go. We can coordinate our efforts with the folks at Quisqueya and the University of Miami tent hospital near the airport, to help them continue their work efficiently. We may want to “adopt” a community, such as Lilavois, and support the reconstruction and development of their hospital, bringing their operating room into function where we could send future surgical teams.

Supplies are stacked everywhere we look! There are unopened boxes and containers with yet unknown caches of medical materials, some much needed, some probably destined for the dump. For at least the near future, relief workers probably don’t need to bring boxes and bags of supplies, unless there is something very specific to their job, and / or there has been a request for a particular item.

As the Port au Prince airport returns to normal function, relief workers can fly directly into Haiti. Those who are bringing bags are not receiving them for a few days since everyone is trying to bring extra things to Haiti to help. The planes filled to capacity are forced to leave some luggage behind. If a relief worker can limit themselves to their carryon and personal bag (purse, backpack) he / she can arrive with all belongings and more quickly proceed through customs. If arranged appropriately on line through Quisqueya at http://relief.quisqueya.org, someone will pick you up at the airport. Flying on days other than weekends may increase the flight availability since most teams seem to be traveling on weekends.

As Joanne and I return, we will be meeting with Dr. Gillian Ice and others to plan out our future role in the Haiti relief effort.

More to come! -- David Drozek, D.O.

10:32pm, March 3, 2010

Tuesday and Wednesday's assignment: Cazales

Cazales blew me away. First, the drive is gorgeous - we headed out of the city, into rural areas with hillsides naked except for shrub and cacti. There are a few tent cities set up here and there along the way; some almost look abandoned as the various fabrics and tarps flap in the breeze of early morning. Why don't these people have tents by now? When it rains at night the people have to get up from the ground and stand with all their belongs in hand, or their baby as the case may be, until the rain stops. Otherwise everything gets wet. It has rained two nights since I've been here - thankfully not for long each time. It isn't the rainy time yet.

Then we headed west along the ocean coast (this country is very oddly shaped - look at it on the map and cover the Dominican side and notice Haiti's politically decided shape), past a few small towns and markets and turned right up a river valley where for a while there is lusch-ness and well kempt homesteads. We climbed higher, over a river (one of the first rivers that doesn't look completely polluted), and made a right at the fork in the road, continuing along nearly desert roads. After a few stops for questions we knew to continue to the end, the way way end.

Lori, an American born woman married to a Haitian who has lived/worked there since at least '99, gave us a tour of the small clinic/hospital of Cazales. In a space smaller than most of our houses they have organized the pharmacy and med bulk supply room; the lab - they are working on gonorrhea and chlamydia tests as well as a trial of using vineger to diagnose CIN, cervical cancer. No one here gets cervical cancer screeing and Haiti has one of the highest rates of death form cervical cancer. Then we saw the 4 different consultation stations where nurses see patients. There is a special place for pregnant and newborns. If a mother brings her baby back for a 10 day check, they get a baggy with a receiving blanket, diaper, a set of clothes and a few other items. Women will walk for hours to get this "small" supply. I've never seen so many pregnant women in all my
life. They showed us the small birthing kit they give them: a razor, a few sets of gloves, some clean ties for the umbilical cord. Most women birth at home - often without a midwife.

Finally we went to see the children: children abandoned, brought, dumped and found are brought in to this place of miracles to try to surivive and for nourishment: a special blend of peanut butter, milk powder, vitamins. They go from emaciated dull or dough-faced infants and toddlers, to brimming, thick playful children. (Medical terms for this are kwashiorkor and marasmus) The room is overwhelming - 50- of them in a 15 x 20 foot room They spend most of there day on a mat and blankets (they had a better space before the quake - they are doing what they can for now). About 3 workers tend them, and a long term American Volunteer Anna runs the nourishment center. They kids are up to the table for meals and a bath to clean off the remants of rice after each meal. There isn't as much need for diapers if they are just hosed down 3 times a day! (But i'm sure they would welcome a larger supply of diapers.) God forbid if a rotavirus or other infectious diarrhea starts being passed around! Parents can visit whenever they want. Some parents haven't visited for years - missing, deceased, or just not able to care for their child. Some children have been there for several years. Several wtih stick bodies have only been there for a few days or weeks. Today a baby with severe protein malnutrition came to the clinic - it's body is puffy from lack of protein in teh diet, the skin breaking down causing sores on its legs and hands. It is one of the most severe cases I have ever seen.

I spent the two days at Cazales seeing patients, mostly children. Almost all report fever, though what that really means is hard to determine. Is it malaria? awful water supplies and GI illness?, a regular run-of-the-mill cold? I want so much to do the right thing for them . Unfortunatly sorting this out is the hardest part. What is the best course of action when I am working through an interpreter, in a culture I don't understand, and with a group of
people dealing with situations impossible to imagine surviving. I encourage lots of fluids, but if they only have contaminated water will that just make things worth? (many use the river as a water source. The same river the cows and horses drink from).

Most people don't look too sick, but I did see a a few pretty sick people: a severe malaria case, a 14 year girl that passed out, a few dehydrated babies. Oh the babies! they just don't have the reserves to survive this harsh sun and poor water and parents who just aren't equipped with resources and knowledge. I gave out a lot of peanut butter and protein nutrition shakes today. Perhaps a few more toddlers will survive the next few months. -- Katy Kropf, D.O.

6:15am, March 3, 2010

We are all well! Our Internet was down for a couple of days, plus it has been very busy, especially trying to get 12 of us into situations that we feel we are being best utilized.

Because of the size of our group, we were sent to four different facilities. Monday, only the folks at CDTI felt good about their assignment. Yesterday went much better! Most people want to return to their same spot. Peter, Kathy and Joanne are working at an amusement park turned hospital! Brian is working with a Dutch group, and actually will be spending the next two nights there. Katy is at a more remote are that has lots of primary care needs. The rest of us will be at CDTI hospital.

That's it for now! I have encouraged others to write; don't know if they have, other than Jesse. -- David Drozek, D.O.

8:01am, March 2, 2010

As our team members reassembled for the evening meal, we exchanged stories. The stories highlighted a couple of things: 1) people are pretty much the same wherever you go, 2) there remains a fair bit of disorganization in Haiti and the relief effort.

A couple of our groups went to man clinics. Most of the people presenting were not really “ill” but were presenting for headaches, backaches, etc, the usual “aches and pains” of life, that we in the States have learned to deal with by taking whatever we have in our medicine cabinet. Unfortunately, for many of these patients, their medicine cabinet is buried in rubble, and the neighborhood pharmacy is closed due to damage, or lack of stock, or lack of money in the community to make it profitable. There is an underlying anxiety that runs through the population that has experienced something so dreadful, so unexpected, so out of their control, leaving their lives forever changed, minus many of the foundations of their lives; family, friends, home, neighborhood, that seemed indestructible before. It is no wonder they flock to the clinics run by foreigners, hoping that maybe somehow there is something that they can take, a bandage to a wound, that will make it all better!

For us as North American relief workers, we often have our preconceived ideas of charging in and saving the day through the dramatic, the things that make the news, hauling the living from the rubble, patching the acutely injured bodies, performing the life saving operations. But as for much of life, the mundane rules! People still have headaches and back aches, and diabetes, hypertension, and common colds; and they have a vast emptiness that they can’t express, nor find the cure for; a deep seated anxiety that they can’t find relief of because no one can promise them with sufficient certainly that things will indeed be all right again.

Despite the huge effort that is underway that appears to be remarkably well organized, yet at times it appears chaotic. Multiple organizations are involved, some duplicating efforts, other things falling through the cracks; two teams from different organizations showing up to serve the same community, as happened to one of our groups yesterday, while other communities remain unserved; volunteer drivers losing their way, going to the wrong place, or getting times mixed up, since everyday is different, and the language they speak is different from that of the person giving them directions. Supplies keep arriving swamping the storage capacity; needed items remain buried somewhere in a box or container, while an excess of less useful items fill the limited shelving space.

The relief effort is big, is accomplishing much, yet leaves something to be desired in an ideal situation for which one could plan. But who could really plan for something like this, accounting for all the details and variables? So we do our best, try to be flexible, deal with the frustrations, and help those who are in need the best way we can under the circumstances we face. -- David Drozek, D.O.

10:00pm, March 1, 2010

Clinic is winding down at CDTI. Joanne, the nurse practitioner, Dorinda, the family medicine resident, her husband Jesse and I were part of a group of nearly 30 people at CDTI from Quisqueya, in additional to staff from other groups of relief workers.

After we loaded the bus this morning, we found out it wouldn’t start. This led to quite an international discussion on what to do. A mechanic was called. It was suggested to push start the bus. The driver called the owner who didn’t want it pushed started. He wanted a mechanic to evaluate it.

We then sent 8 of the most essential people on ahead in a pickup, and prepared to send another 14 in our rented van with the slow fuel leak. By the time we loaded the van, a blown fuse in the bus was changed, so we returned to the van and were on our way.

The crowd of patients waiting for us at CDTI was the biggest I have seen yet. Mondays everywhere seem to be the busiest! About half our relief workers were new, so it was a slow start requiring time for orientation and becaming familiar with the system. The Mexican marines were already busy in the wound clinic. I was planning to join them, but was called to the ambulatory wound clinic to check a skin graft. From there I was asked to see another patient who I had seen last week and had asked him to return for an anal exam under anesthesia. I thought he may have an anal fissure.

Then my phone rang. It was Greg, one of the Life Flight nurses, who was traveling with Bev and Jeff from Life Flight, and Dr. Brian, on their way to a clinic. They were evidently lost. The driver took them to another clinic that was not expecting them. I went on a search for the director of the relief effort at CDTI, Justine, a D.O. orthopedic trauma surgeon who left her practice in Colorado Springs to come to Haiti after the earthquake. She quickly became the driving force in turning CDTI into a functioning post earthquake hospital.

When I finally found her, Greg had called back to ask what to do. Justine had a Haitian cell phone, which I used to call the logistics folks at Quisqueya who then called the driver of the van our guys were in. A short time later I received a text that they had reached their destination!

I then headed for the CDTI computer to activate my international plan on my ATT iPhone. Up to Feb 28, service to relief workers in Haiti was free. It now is only $19.99 a month plus a reduced rate for texts and calls for relief workers. I had tried to activate the plan before I left the States, but the person on the phone said I needed to call on March 1 before I made any other calls. I could not get through to ATT with the numbers she gave me. Worried that my phone bill would be astronomical, it became a priority to activate the plan. Finally, with a very slow Internet connection, I was able to get to the right web page and check the right box.

Meanwhile, my patient with the pain in the behind was waiting to see if a Haitian anesthesia provider would show up. While finishing up on the computer, I heard a very strong voice say, “Hi, my name is Larry. Which way is the OR? I am an anesthesiologist sent her to help in the surgery.“ I told him that I had a minor case for him, which he was happy to do. Larry is a no nonsense very pragmatic anesthesiologist with a fair bit of international experience with Mercy Ships. I told him the scant information I had on the patient, expecting him to want more. His response was, “Show me the OR and bring the patient in!” Our entire charting for the whole process was on a scrap of paper.

As soon as I finished and walked out of the OR I ran into a nurse who was looking for me to see a guy with an abscess, a large pocket of pus, under his arm. As we were leaving the surgical department, we were almost run over by a group pushing carts loaded with suitcases and duffle bags. The announced “We are an orthopedic team here to operate,” which was a welcome surprise to everyone. I asked if they brought an anesthesia provider. They did not, but Larry was available! I gave the orthopedic surgeon and his PA a quick tour, introduced them to the Mexican orthopedic surgeon who informed him of some cases that needed done. The Mexicans were afraid to work in the hospital beyond the first floor, so the cases had not been done. The other limiting factor was that Xray was not functioning over the last few days.

Very quickly the orthopedic surgeon surveyed the injuries, and began wheeling people up to surgery to use the portable C arm Xray unit to evaluate fractures. This led to a parade of gurneys and wheelchairs up the ramp three floors. Many surgical cases were quickly identified. By the time I finished draining the abscess, the orthopod was ready with his first case.

It was about 1:00 by this time, and the Mexicans were leaving. I then took over the wound clinic finishing with the patients remaining, two who needed sedation to change their bandages. Larry ran down the three floors between cases to give sedation for one patient, and gave me instructions on what to do for the other, which I did assist by a nurse, much as I had done many times in Honduras.

Things are now slowing down in the clinics. Tomorrow, if I can squeeze into the now growing OR schedule, I have a hernia to repair, and a circumcision to do on a child whose foreskin has grown so tight it is restricting his urination.

Such pleasant thought to end the day! -- David Drozek, D.O.

7:58am, March 1, 2010

Yesterday morning started out with a shower under the stars, oatmeal, coffee and pineapple for breakfast, and a crowded ride to CDTI.

Sunday was significantly different than the prior two days. The patient population was a bit less, and our staffing shifted. Some groups had left, others needed a day off, some came for half a day. Wound clinic was packed with doctors; three orthopedic surgeons, one from Canada who practices in Minnesota, one from Akron, and one from the Mexican navy. There was also a Mexican general surgeon. There were three Mexican nurses and a couple of U.S. nurses. And there were only three patient beds! They didn’t need me doing wound care! We did have two anesthesia providers as well, a Mexican and one from Akron. But all of the folks above were only working half a day, and the OR was closed for the day, so everyone crowded into the emergency room to work.

While we had plenty of help in the wound clinic, we only had one transporter. Prior days we had at least four. It is pretty difficult for one guy to carry a stretcher! The head nurse, Beth, who quit her job in the states and bought a one way ticket to Haiti after the earthquake has been working without break, and looked beat. She gave me her list of patients who needed dressing changes, and disappeared for a few hours of rest.

Since we had several patients that needed sedation for their dressing changes before the anesthesia providers left, I took the list and headed for the patient tents, identifying which ones needed sedation by reading the notes in their charts from the prior day. I helped grab a stretcher and began moving patients. It was quite the task to maneuver folks with broken extremities and metal pins protruding from their bones, often missing arms and legs, which greatly inhibited their ability to help at all, not to mention the pain with movement. We had to somehow get them from a cot, onto a stretcher, negotiate other patients and their belongings in overcrowded tents, dodging tent poles, ducking to go through the entrance and watching to not trip on tent lines nailed into the ground, finally lifting the stretcher onto a gurney to wheel up the hill into the wound clinic. Then we moved the patient into the crowded wound clinic, dodging people, rearranging trays and beds. After the dressing change, the whole process was reversed! We were quite happy when we found a patient that could go in a wheel chair. We even had two stoic ladies that insisted on walking, because the physical therapist told them they needed to walk to get better! My respect for the transporters was raised a few notches yesterday!

When all the help left, I found myself alone in the wound clinic with the last few simple dressing changes, which we finished up at 1:30. Thinking I would then have time to straighten up the clinic which literally looked like an earthquake had hit it, or maybe I should say a hurricane, I started to wash instruments. O nurse came through the door to the ER and said I was needed in triage. I was surprised to find out I was the only doctor left in the hospital! So I helped see the few remaining patients that were in the ambulatory clinic. One included a man with a minor wrist laceration. I retrieved one of the dozen tubes of super glue I had in my back pack and soon had the wound sealed and the patient on his way.

By early afternoon, things were winding down, and groups were taking a walk around the block from the hospital. It was a very moving experience to view the destruction in detail, and with time to take it all in. The block included a Catholic cathedral and a kindergarten. I struggled with emotion as I thought about the horror and death that struck this neighborhood on January 12.

Our reinforcements from Ohio arrived about sunset. I was on the phone to my wife, taking advantage of the last free phone day that ATT provided for relief workers in Haiti, when I saw the low riding van, stacked high with luggage on the roof, drive into the parking area. It was a happy time to see familiar faces and meet new folks whom I only knew via email.

Their trip was uneventful other than scraping the bottom of the van on some rough road, causing a small fuel leak. When they arrived at the border, the driver explained the leak to the border guard, who waved him trough immediately, foregoing any official paperwork, not wanting an explosion near him! We will have the leak evaluated today by a mechanic.

We unpacked, had dinner, received our assignments for the next day, had orientation, and headed for bed filling the room that used to serve as the fifth grade class room. Due to the size of our group, now 12, it would be difficult to keep us working together, especially with the needs so great. Dr. Peter Dane and his wife Kathy will be heading to a tent city to do clinic. The three Life Flight folks and Dr. Brian Kessler from Akron head to another clinic together. Drs. Katy Kropf and Krista, one of the residents, head to yet another clinic where there are lots of kids and obstetrical patients to see. Joanne Bray, Dorinda, our other resident, Jesse, our much needed transporter, and I will return to CDTI. I hope they will all bring pictures and stories back with them, and we can share those with you!

Time for breakfast! -- David Drozek, D.O.

3:42pm, February 28, 2010

The Quisqueya Christian school is a remarkable place! It has been transformed into the ideal location for disaster relief. (http://relief.quisqueya.org). The 4th grade class room has become “control central” where former teachers and school administrators have become the key players in disaster relief in Haiti. Daily communicating with up to 21 medical facilities to understand their supply and personnel needs, they coordinate the efforts of the ever changing pool of about 200 volunteers who are sleeping in tents and classrooms throughout the campus. And they continue to run their school, at a reduced pace. Most of their 200 students have been evacuated to other locations, but about 70 remain and balance their time helping with the relief effort and continuing with classes.

The Quisqueya folks have set two goals, seeing this as an opportunity to help rebuild a better Haiti. They want to maintain the urgent relief effort until the Haitian medical system is restored to 85% of its prior level of function. They also are committed to the long term restructuring of the Haitian medical system and are exploring what that means. They fear a vacuum in the system as the urgency and international interest subsides. The ongoing needs of rebuilding hospitals and teaching institutions, the need for reconstructive surgery, prosthetics and orthotics as well as the usual medical problems need addressed.

Because of the Quisqueya system, future volunteer opportunities to Haiti are greatly facilitated. All volunteers need to do is contact them through their web site and apply to participate. The volunteer should plan on air fare to Port au Prince and about $50 / day to cover the cost of their stay at Quisqueya. Quisqueya will provide transportation, housing, security, water, breakfast and an evening meal. No specific team “leader” is required. Medical and non medical volunteers are welcome, all though the current emphasis is medical.

Upon our return, OUCOM will be evaluating our continuing role in the Haiti medical relief effort. We have already raised funds dedicated to assisting in sending personnel and supplies. If you have an interest in going you can begin the application process via the web site for Quisqueya. I can’t think of a better way to spend spring break! -- David Drozek, D.O.

7:43pm, February 27, 2010

We finished in the clinic a little early today at 4:30. My last patient was a relief worker from Atlanta with right lower quadrant abdominal pain; my specialty! He didn’t have appendicitis we are both happy to report!

Our family medicine residents, Krista and Dorinda worked in “triage” today seeing patients who walked into the clinic with various acute and chronic problems. There was a boy with sickle cell crisis, a common problem we are seeing, increasingly more people with diarrhea, and sexually transmitted diseases, including a man with both knee joints infected with gonorrhea.

Jesse, Dorinda’s husband, was transporting patients, a very difficult job, hauling gurneys and stretchers into nooks and crannies that were not intended for patients, let alone bulky gurneys. All the patients were hurting, many with external fixaters, large metal screws imbedded into their bones at right angles, attached to each other like scaffolding to hold the bones in place for healing. These added weight, bulk and stiffness of extremities to the already difficult transfer process.

Today I had the great pleasure of working with a group of Mexican nurses and doctors from their marine corp. They are stationed on a hospital ship in the bay, flying in by helicopter each morning. They adopted me into their group, and assigned one of their nurses to help me in wound care. They had Spanish speaking interpreters which I also utilized to communicate with the patients.

In the midst of seeing chronic wound patients, in rolled a wheelchair pushed by someone yelling “Emergency, emergency!” The patient was a priest from Costa Rica who had been shot in the leg while leaving a bank. He had blood stained pants and someone had placed a tourniquet on his thigh with a piece of PVC pipe. The Mexican nurses quickly stated an IV while I cut of his pants. Fortunately he had a clean small caliber injury with entrance and exit wounds. The pulses in his foot were intact, as was his sensation. I released the tourniquet slowly; no bleeding. The Mexican orthopedic surgeon quickly checked the leg, and we agreed there did not seem to be any serious injury. The priest had a fellow worker who is a nurse. He preferred to leave and have his friend watch him for any changes to occur than to stay in one of our overcrowded tents.

In addition to using honey on wounds, that my new friend, Rosaline, a Haitian American translator with family in Port au Prince, I asked her to again visit the supermarket to buy me measuring cups, a spray bottle, Clorox bleach and baking soda to mix up Dakin’s solution, a good wound antiseptic to pack chronically infected wounds. Rosaline bought some spray window cleaner, which I dumped and rinsed, filling the bottle with Dakin's both to spray on patient wounds and on the tables between patients. By the end of the day, the Mexicans were using Dakin’s solution and honey on most of their patients too!

Today I saw many of the same patients from yesterday for their daily dressing changes. It was encouraging to see so many of the wounds looking healthier. Most of the patients smiled as they recognized me from yesterday. A few met me with fear, remembering the many painful dressing changes they have suffered through. I was happy to see that none of the patients that had honey on their dressings had attracted ants! A couple of patients had healed wounds and were ready to be discharged to home(?). Many don’t have homes to return too, a difficult problem. Some of the children in the hospital also lost their parents; an even more difficult problem!

That’s it for tonight! Time for our regular 7:30 meeting to get our assignments for tomorrow! -- David Drozek, D.O.

7:56am, February 27, 2010

After a good night’s sleep on an air mattress with the benefit of a fan to drown out the noise of the city, and after a very satisfying breakfast of oatmeal, served cold, appropriate for the climate, a wedge of pineapple, a banana and a cup of coffee, I am ready to start afresh!

I awoke in the night, my mind racing concerning what I had experienced yesterday and how it could have been more efficient. I will look again for my friend who purchased the honey to ask her to find some bleach, baking soda, a spray bottle and some measuring cups and spoons so I can make Dakin’s solution, an excellent wound dressing for infected wounds. We can also use it to sanitize the treatment tables and surfaces.

The food at Quisqueya is predictable, and very good! The breakfast is as I described. There is a choice between watermelon or pineapple. The evening meal is rice and beans drizzled with a very tasty sauce, a piece of chicken, lettuce, and a very spicy but delicious cole slaw that has you reaching for water! The rule is, “take what you want, but eat what you take.”

At the guest house, breakfast was typically white bread, sometimes a slice of mango, and usually some form of eggs or tuna. Tuna seems a very pragmatic choice for the situation. It is so versatile. We have had tuna puffs, tuna and noodles, plain tuna, and a tuna spread. With the lack of power it makes sense to see tuna here; easily shipped in, doesn’t need refrigeration, already in useable portions, and high in protein.

As out Quisqueya community comes alive this morning, I hear many languages being spoken, greetings exchanged, smiles all around. Last night was a bit noisy as people prepared to leave. There was some singing and dancing, with drums accompanying the music, beer and wine shared in moderation, tears and hugs as new friends parted; friendships forged in adversity and through common goals across culture, race, politics, religion, and age, things that would in other circumstances normally cause division and segregation.

Why does it take disaster to create unity? -- David Drozek, D.O.

10:55, February 26, 2010

Where do I start! It was an overwhelming day participating in organized chaos at the CDTI hospital. I joined up with the surgery team this morning and became a wound care doctor. I changed dressings, cleaned wounds, drained abscesses, pulled orthopedic pins and prescribed antibiotics all day. I saw a few run of the mill surgical patients in the mix, and ended the day dealing with a toddler who put a piece of corn in her nose!

Many of the trauma patients had already been operated on for broken bones and crush injuries. Our plastic surgeons had performed some skin grafts and other procedures. They and the orthopedic surgeon from Minnesota were my resources, instructing me on how to care for their patients, giving me advice on other situations. French, German, Mexican and Canadian medical professionals were all working side by side in a tremendous cooperative effort. We received orthopedic and plastic surgery transfers from other facilities.

Two of the most notable patients were two ladies who had been buried alive, one for two days, the other for three. One already had an arm amputated and had multiple pressure wounds from lying covered with rubble. She is also likely to lose part of her foot, which appeared dead today. The wounds are not infected so we will watch her foot a while longer to determine what level we will need to amputate.

The other lady buried for three days had some of the deepest wounds I have ever seen over her hips. They were both draining pus. She also had lost control of one foot on the side of the deepest wound. She needed some of the high tech devices we have in the states, but don’t have available here in Haiti.

I did ask one of the many interpreters to buy some honey for wound care. I had good success in Honduras with using honey on chronic wounds. It sterilizes the wound by releasing hydrogen peroxide,, prevents bacterial growth, stimulates healing, reduces scarring, is inexpensive and almost universally available. Many of the patients coming in for wound care can be transitioned to outpatients. For the moment they are staying in the hospital tents in front of the hospital. I am beginning to instruct them in home wound care with Dakin’s solution made with bleach and water to was the wounds, which they can then dress with honey and toilet tissue.

Throughout the day, the nurses and our family practice resident asked me to see various patients in the ambulatory wound clinic, the acute care clinic, and in the hospital tents. The need has been so urgent for acute care, and the physicians in limited numbers, that there has been no time to make official rounds on patients in the hospital tents. They are only seen by physician if they are brought to wound clinic, or by special request. The nurses are doing a great job caring for them, and asking for help as needed. They asked me to make rounds with them today, but we never got to it. Maybe tomorrow.

The need is so great, and the day so energizing, though exhausting at the same time, the family medicine residents and I plan to keep working during the weekend. CDTI will be short staffed this weekend as many groups are leaving and new folks arrive Monday. Wounds need cared for, and I expect people will keep showing up at the hospital, short staffed or not!

There is much more to share, but I need to sleep! -- David Drozek, D.O.

3:13am, Thursday, February 25

We have a change of plans! Life as a missionary in Honduras often required plan B, C, D and so on. We are moving to plan B!

The work at the clinic of Lilavois has decelerated. There were only 46 patients today, which our two residents, Haitian American nurse and I saw with our translators and Haitian staff. The Haitian doctor didn’t make it due to illness. We finished up the clinic in about half a day.

Our day at the clinic started late. We have two vans that transport the construction crew and medical folks each day. We had arranged to pick up three translators this morning at a designated location at about 8:30. They were not there when we arrived, so we packed one van with the work crew and one resident, and the rest of us waited in the second van. We waited, and waited, and waited! We tried to call our DELTA contact person, but the phone lines were all tied up. I tried texting him, iPhone to iPhone. It worked! We then received word from our Haitian contact which my DELTA contact was able to reach with a Haitian cell phone who then called the translators on their Haitian cell phones who said they were on their way! So we waited some more! Then we received a text that the interpreters were probably told their work day was 10:00-4:00, meaning they thought they were to be picked up at 10:00. By this time it was 9:45. I figured we would have to give them some Latino time and not expect them until well after 10:00.

By this time, expecting only an hour ride, my second cup of coffee worked through my system. Faced with at least an hour drive over bumpy roads, I left the van by foot in search for a place to relieve myself. There was a church nearby with a school. So I walked in and asked two ladies in Spanish and English if I could use the bathroom. They both looked at me as if I was crazy, talked among themselves in Creolleand laughed. They then pointed at a door down the hall, which proved to be exactly what I was looking for! When I returned to the van, another member of our team was very interested in hearing about my success. I then accompanied her back to the church, the two ladies smiled and nodded their heads, and there were then two of us who felt prepared to wait a while longer in the van!

Then my phone signaled a voice mail, which was from the resident that went on with the first van. The first van, packed as it was, was flagged down by the three translators about half way to the clinic, nowhere near where we expected them. They packed into the van with them and were at the clinic waiting for us! So off we went. We ate our power bars for lunch on the way at about 11:00, figuring that it wouldn’t look too good to arrive, work for an hour, and take a lunch break.

So our day started off slowly, but at least the van had AC and music!

I have noticed some trends in the clinic patients which I think are earthquake related. Many have gastritis symptom that began with the earthquake. I wrote about that already. Many also complain of insomnia, which is not at all surprising, especially in light of the frequent tremors that we have experienced at night since we have been here.

Many of the patients have a rash on their exposed arms and legs that also started after the earthquake. Some have scratched their skin open and have secondary infections. The rash does not look like insect bites, which would be more likely as the people spend their nights out of doors. I wonder if it is a reaction to the dust from the concrete buildings that collapsed that reacted with their sweat causing dermatitis.

I better understand now why it looks like there is construction work in progress all over. The piles of fine material next to piles of gravel and stone are the products of the sifting process that took place when collapsed buildings were dismantled and searched for human remains. There are many areas where blocks are neatly arranged or even stacked where they had once been part of a wall. It looks like some ancient excavation sites I have visited where only the outline of the structure remains.

The construction crew at the clinic is winding down its repair work. The clinic looks almost new! It is well stocked, and the patient volume is manageable for one physician. We relocated one of our residents and our Haitian American nurse to Quisqueya this evening, the school that has become the medical relief command center. They will join up with our surgery team. The Quisqueya leadership has a goal of functioning in this capacity until 85% of the medical facility capacity is restored in the country. Our efforts next week will be through the coordination of the folks at Quisqueya, as we seek to do the most good with the resources we have.

We may yet return to Lilavois at a future date, but for now leave it with a sense of accomplishment and a heavy heart for one of the communities that has a long way to go to return to a near normal life. One resident and I will return tomorrow to help see patients and finish up organizing the pharmacy and medical supplies.

More later! -- David Drozek, D.O.

7:48am, Wednesday, February 24, 2010

Yesterday at the clinic in Lilavois we struggled through about 60 patients.  The struggle was lack of translation!  The clinic director, a recent pharmacy school grad, speaks some English, Spanish, French and Creole.   He was attempting to help the residents in his limited English, but was constantly being pulled away to answer questions about construction, give direction in the pharmacy and with crowd control, and to talk with various people who interrupted him for unknown reasons.

Our best translator, Guerline, a Haitian American nurse from New York, was busy running the rehydration area.  She functioned pretty independently, having a vast experience in ICU, ER and surgery postop.  She was bouncing around between multiple patients with IVs and the residents.

I began asking the people waiting to be seen if anyone spoke English or Spanish.  We did find one volunteer, Sandy, and artist and aspiring novelist who wants to write about the Haitian plight.  His English was very rough, and required a great deal of effort to work through.  But, we were able to see some patients with his help.

Toward the end of the day a pastor arrived who could translate well, which sped along the process greatly.  Tomorrow we are told there will be three Haitian translators present.  I expressed the concern that next week we will need more if we are to do the clinic work well that we have before us.

The first couple of patients I saw were trauma related; a lady with external fixation of a fracture of her leg.  I checked and cleaned her wounds, which looked to be healing well.  Two of her three children were killed in the earthquake.  We made arrangements to refer her to an orthopedic surgeon and to get x-rays to decide if the metal hardware is ready to be removed.

The next patient needed his cast cut off.  He was told he could have it removed a week ago, but couldn’t find anyone to do it.  We removed it with wire cutters that the construction guys lent for the job.

Most of the patients complain of stomach pain that started after the earthquake.  I would imagine that gastritis and stress ulcers would be likely.  The people continue to live in a high state of anxiety, terrorized by aftershocks, lacking food and clean water.  The adrenal levels must be continuously running at high levels.  They are in a constant hyper vigilant state of “fight or flight” as they seek to survive.

Last evening we met up with the anesthesia residents and plastic surgeons to see how they were doing.  Our attempts to communicate by phone, email and text had all failed.  They were in high spirits, excited about the things they were doing to help.  They are staying at the Quisqueya school complex, and working at a private hospital called CDTI where they are concentrating on wound care. 

The plastic surgeons have been doing flaps to cover amputation sites and skin grafts to cover open wounds.  The plastic surgery fellow removed a neck tumor, probably a thyroid cancer from one patient.  The anesthesia residents are under the supervision of an excellent teaching anesthesiologist.  The first year resident performed her first pediatric anesthesia on a four month old.  The senior resident was at one time monitoring three sedation anesthesia patients at the same time.  They are all doing the bulk of their work in the emergency room area since the Ors are currently being used by a team of French plastic surgeons.

The Mexicans have a hospital ship in the harbor, and fly surgery personnel in to the hospital every day.  Germans, Canadians, Argentineans, and many more countries are all cooperating in the effort!

The surgery team related that on Monday afternoon they too had a panic in their hospital, at the time our patients in the clinic ran out of the building.  None of our team members felt the tremor, but the Haitians have been so sensitized, they feel it!  They had to close down surgery afterwards, since none of the Haitian staff would come back inside the rest of the day.

Yesterday we drove by the airport on our way to Quisqueya.  It is certainly a hub of activity.  Vendors are set up all around.  Tent communities are everywhere.  People were in line to meet travelers arriving, or to leave on the reactivated commercial flights.  Helicopters were coming and going, as were military trucks of all types.  U.S. military personnel with full uniform and automatic weapons lined the perimeter providing security and maintaining order.  People were flowing to and from containers where they were receiving tarps and boxes marked “Samaritan’s Purse”.   It was a moving scene to see our military in an important  life saving role, and to see the cooperative relief effort seeking to meet such a tremendous need.

We have begun planning a mobile clinic for next week when our reinforcements arrive.  There are many communities that lack basic care and the Haitian pastors that have arranged for our accommodations are anxious that we visit some of them.

More to come! -- David Drozek, D.O.

7:04am, Tuesday, February 23, 2010

Sunday our group split up to more effectively use our talents for the most good. The anesthesia residents and plastic surgeons went to Quisqueya, the medical control center for medical relief efforts. The have a web site: relief.quisqueya.org.

This is a Christian school that became the headquarters for U.S. military assistance and a staging location for medical relief efforts. The class rooms have become dorms for medical professionals from around the globe who have come to help. The military has set up two large tents with AC that are filled with meds and supplies, available to anyone in their network.

Each evening there is a meeting of the leaders from each group present and assignments are made to various medical facilities around the area based on skills and needs. Transportation is provided. Morning and evening meals are provided to the groups. The service is free to the volunteers, but $50/day is suggested to cover expenses.

The rest of us, two family practice residents, a Haitian American nurse from NY, Jesse, the carpenter husband of one of our residents, and a work team from DELTA are concentrating in the clinic of Lilivois. This clinic is situated in a town of about 1500 where most of the homes were damaged or destroyed. About 200 were killed in the quake. The clinic was providing care with limited staff and supplies since the quake. Via the efforts of DELTA, they are now part of the Quisqueya network.

The clinic was still under construction, and is a sound facility. The OR was not functional, but it works very well as an acute care center. After the quake, the staff physician was delivering babies and did some amputations in the open air around the clinic, due to fear of entering the building. We are not doing any surgery there, but will transport patients to another facility as needed.

Yesterday the residents joined a Haitian doctor in seeing patients in the clinic. We had several folks severely dehydrated, including one with sickle cell. We gave them all several liters of IV solution and analgesics to help their severe headaches. We don’t have lab, and the communication is pretty limited with our translators that we never really determined if there was a cause of the dehydration other than lack of water and exposure.

In the afternoon I took a walk with the clinic director around the neighborhood. He showed my his damaged house, with his family camping out in front of the house. He showed me his recently constructed church that was flattened. He showed me where people were living in tents and under tarps, awaiting food and shelter. He told me again and again, “Take a picture of this! Send it to people who can help! We need food. We need medicine. We need help building our homes.” It was a very moving an personal experience to walk with this man through his devastated neighborhood, hear the stories of his friends and neighbors, some who died, the rest seeking to survive and rebuild their lives. I am sure his story is repeated many times over.

People were engaged in hauling water from somewhere. I didn’t see anyone cooking or eating. Many folks were sitting in whatever shade they could.

The clinic is in the center of this community. The need is great! We certainly are meeting a need like I never have before. I can’t help but wonder what would have happened to the six who received IV fluids if we hadn’t arrived with the needed supplies! They all walked out, a bit wobbly, but smiling and expressing gratitude.

More later! -- David Drozek, D.O.

5:47am, Tuesday, February 23, 2010

I am tired and hungry; have a headache and want a shower and clean clothes!

But, I have a bed to sleep in, under a solid, safe roof; power bars and granola bars, and a table to sit at with friends to enjoy dinner tonight. I have a shower with running water and an abundance of clothing to pick from. I have electricity and medicine and even a fan! I have a vehicle to take us where we need to go, even with air conditioning! I have a cell phone and can email and call my family and friends for free with ATT this week!

When I leave Haiti I will get on an airplane and meet my family at the airport, drive home in my car, probably have dinner at a restaurant, sleep in my own secure bed, and forget to think about all the people in Haiti who don’t have the things I have! -- David Drozek, D.O.

2:19pm, Monday, February 22, 2010

I am currently working on a sterilizer. Our generator in the clinic is running. The work crew is On the upper level of the hospital. Our FP residents are seeing patients.

Just a few minutes ago the clinic patients started screaming and ran out of the building. They thought they felt a tremor. I felt nothing, and wonder if is was a vibration from the guys moving beds.

The terror in the faces and voices of the people was beyond anything I have ever seen! Life will never be the same for them.

The clinic director wants to shut down for the day and begin open air clinics tomorrow so the construction noise doesn't cause another panic. -- David Drozek, D.O.

7:22am, Monday, February 22, 2010

My first impression of Haiti was that of a stark barren landscape. As we approached the border from Santo Domingo, Dominican Republic, the landscape along the southern edge of the island resembled the US desert south west; barren hills and mountains with beautiful patterns of color in the rock, scrubby growth of small trees, prickly pear and saguaro cacti. Unlike the US, these were interspersed with platano bananas and palms.

Clusters of simple homes, surprisingly many of them crudely made of wood, thin logs split into slats, as well as the more usual concrete block homes. Goats wandered around eating whatever, and small plots of sad looking crops were being attended by dark people.

When we first crossed the border, the road into Haiti was a narrow white strip between white limestone cliffs carved in spectacular shapes both by nature and by man harvesting the natural lime for construction material, and a body of water, the opposite shore appearing a few miles across the calm surface. No boats or fisherman were visible, no homes, no people other than the lines of vehicles negotiating the white path, each identified by a plume of powder revealing their position in the distance.

As we approached the first village, the signs were now in French, replacing the more familiar Spanish of the DR. Despite power lines, there was no evidence of light or electricity in any of the homes. People milled around outside some cooking, some eating, most just sitting, no soccer games, not much purposeful activity. It was Sunday, and as evening approached, more and more people were mobile with clean clothes and Bibles in hand.
There was only a rare bus, unlike my experience in Central America. But of course, it would not be possible to drive old school buses across the Gulf to Hispaniola. Instead, public transportation was predominantly by elaborately decorated pickup trucks with two feet of tube metal railing supporting an elevated truck cap, giving cover to the crowd of people seated on benches in the truck bed.

As we approached Port au Prince, we began to see evidence of earthquake damage. It was difficult to distinguish with certainty at first, since many half constructed homes, long abandoned, as evidenced by the plant growth within and around, had piles of gravel and sand scattered around, reminders of projects started when money was in hand in better times. Some of these had cracks and noticeable chunks of concrete missing, but it was difficult to be sure the cause.

Then we began to notice finished homes with damage, most commonly at first in the surrounding security walls, many with gaps filled with rubble. As we entered the urban area, neat piles of rocks, gravel and chunks of concrete dotted the sidewalks in areas remote from any visible damage. Again, it was difficult to discern what was construction material and what was debris from the quake.

Major destruction then became evident, but much more scattered than what I had expected from what the media had led me to believe, but of course why would they concentrate on what appeared normal? There were buildings completely collapsed, only a pile of rubble remaining, without a hint of the original structure. There were the majority of the structures standing with no visible evidence of damage, and then there were structures with all levels of destruction, from cracks to missing walls and collapsed roofs. -- David Drozek, D.O.