Answering the Call

Most of my 36 years in nursing have been spent carrying out nursing goals. One goal that always seemed to elude me was that of delivering healthcare during disaster relief. Bayada Nurses, a national home health care company, is sponsoring a campaign to send volunteer nurses to help with relief efforts there. It is through this campaign that I was able to join International Medical Corps, a relief and development organization working in more than 20 countries around the world, in their efforts to provide assistance in Haiti. And in a little under a month, I was on a plane destined for Port-au-Prince.

My assignment was the Emergency Department Nursing at L’Hôpital de l’Université d’Etat d’Haïti (HUEH), a 700-bed hospital in downtown Port-au-Prince that was left barely functioning after the earthquake and where International Medical Corps doctors and nurses have worked since January 13.

I have been a school nurse, a supervisor of a family medicine residency program, a director of health services in a residential treatment facility for adolescent psychiatry, and I was an ER nurse…20 years ago. I quickly reviewed my books on trauma and communicable diseases, memorized algorithms, and practiced suturing and applying splints. Nothing I did prepared me for what I was about to encounter.

My first day in the ER I was assigned to triage. I believe this is the ultimate test for the newcomer. I would equate to the “initiation rites” at most Universities. The line of patients from the street to the door was 30-people long and three-people wide. Opening that door, I knew was opening Pandora’s Box, and I was feeling more than a little uneasy.

Armed only with my translator, Jamisen, we proceeded out the door to assess the situation. Whom to see first? Newborns with fevers over 104 F, elderly people with blocked catheters for days, wounds created by machete strikes, children severely dehydrated from vomiting and diarrhea, abdominal pain with ascites, broken bones from car accidents, festering wounds left untreated for weeks, limbs with maggots feasting upon them, and one dead young gentleman who waited too long before seeking treatment for his asthma.  And the heat…oh the heat. By noon the outside temperature was at least 100 degrees and the inside temperature was 102.

As most of the beds in the ER are full, it is left to the triage nurse to care for these less acute cases in the triage area. So between surveying the line and registering the patients, the triage nurse is also irrigating catheters, cleaning and dressing wounds, dispensing antibiotics, writing prescriptions, giving tetanus shots, doing pregnancy and malaria screenings, and rehydrating patients with IV’s. Only the most severe cases are sent back to the ER.

Although there are adequate medications from donations, the challenge lies in determining what the medication is. Medications come from not only the US but also the UK, China, Denmark, Sweden, Germany, and Israel, just to name a few. Tylenol is not only is spelled differently, but no two pills look alike. The key to survival was being open to suggestions, adaptable, resourceful, and creative. A pillow for pulmonary edema was a box with a half-inch layer of foam taped to it. Patients relieved themselves in our empty water bottles that were then capped and collected with “trash removal.” One tank of oxygen could supply a tent of 10 babies by rigging up serial IV tubing. Tube gauze was used to tie down disoriented and combative patients.

However, all of this kind of thinking provided me with only a temporary distraction from what I was really seeing. The silent suffering of these poor people was almost unbearable at times. The disease, violence, and emotional trauma were unconscionable. One 10-year-old orphaned boy was run over by the car he was sleeping under. Orphaned babies were abandoned in the ER by exhausted, overburdened aunts who no longer had the resources to continue. Young children and babies die here from malnutrition. Other deaths occurred from dengue and cerebral malaria because they had no mosquito nets and did not know to ask for one. Vaccine-preventable deaths such as diphtheria, tetanus, and meningitis are on the rise. Tuberculosis is rampant due to the lack of infection control measures, poor long-term medication compliance, and proper equipment.

What is truly apparent is that NGOs are making a difference. These are the people on the front lines everyday and there are many doing tremendous work in Haiti. Some have installed water filtration systems for the tens of thousands that still live in tents. Others are working on alternative housing projects, clearing more land, and removing concrete, rubble, and human waste from the streets. Not all are professionals and not all are here with organizations. There are so many selfless people who have been here since the earthquake and have no immediate plan for leaving. There is still so much work to be done.

International Medical Corps hopes to be here for at least two years, or however long funding will permit, so that they can help Haiti rebuild itself back stronger and more self-reliant than before. In addition to their work at HUEH, they are also running 15 primary health clinics as well as programs in mental health, nutrition, and water and sanitation in the earthquake-affected areas of Port-au-Prince, Jacmel, Leogane, and Petit Goave. Since the earthquake, International Medical Corps has had more than 400 volunteers from all over the globe working in harmony, with a singleness of purpose, to give Haiti back to the Haitians. I am sad that I could not have done more, but am proud to have been a part of this amazing effort and thankful that I was able to give a little more than just money this time around.

Not everyone can do it, but those who do leave here with much more than they came with.

Help us save lives.