Tag Archives: Carrefour

A Kaiser Permanente RN Reflects: ‘The Eyes Tell So Much More’

It has been about three weeks since returning from Haiti and I think I have finally started settling into my “normal” life here.  I decided to write about what Haiti was like from a nurse’s perspective.

The devastation was overwhelming. Everywhere I looked there were buildings crumbled, people standing on broken roads, and women standing in lines that went on for miles, waiting to be distributed a simple bag of rice. I spent my time in Carrefour with Relief International and slept in a tent amidst the mosquitoes, heat, rain, and roosters who had no internal clock and crowed all night.

As a RN, I was fortunate to see every patient who waited for hours to be seen. During our triage time, I was able to speak with them and not only get their chief complaints, but also hear about what happened and where they were during the earthquake. Everyone I came upon had lost someone close to them. Most were still sleeping in the streets because either their house was demolished or they were too afraid to enter because of the fear of another quake hitting. The poverty was overwhelming and malnourished children were the norm.

I was lucky to be able to spend my time there with my friend and fellow Emergency Department colleague Deb Lyon. Together we assisted in training Haitian nurses to take over the clinic as we left. The doctors were wonderful and came with all areas of expertise. During triage we knew who would get the malnourished child, and who would get the patient with hypertension. Our triage skills became stellar.

They say a picture tells a thousand words, but I believe the eyes tell so much more. I can never describe what I have seen, heard, felt, and even smelled, but I do know I will always have a special place for Haiti in my heart. This has been an experience I will forever hold close to me and would do it again in a minute. It has reminded me why I became a nurse and I believe it has made me an even better nurse.

I want to say thank you to Relief International and Kaiser Permanente for giving me this opportunity to share my knowledge and compassion as a nurse to those in need.

Patti Parker, RN, CCRN

Kaiser Permanente Vacaville Medical Center

Patti Parker, RN, poses for a photo with a Haitian child injured in the Jan. 12 earthquake.

Patti Parker, RN, replaces a splint for a Haitian child in Carrefour who suffered a fractured tibia and fibula.

‘Dr. Deb’ Recalls Her Work in Carrefour

Dispatch from Carrefour, 2/26/10

As I get ready to leave Haiti, I want to write for the first time.  Before this, I have felt unwilling to talk or write very much about what is happening here.  The immensity of the disaster makes words seem trivial.

First, I’d like to describe the daily routine of our Relief International team. We can hear (among the barking dogs and crowing roosters) people lining up as early as 3:30 a.m. for the clinic. There is a soft murmuring outside the wall of our compound, and an occasional baby crying. We get up between 5:30 and 6:30 and have a wonderful breakfast of Haitian coffee, hard-boiled eggs, and fresh fruit, and every other day we also had some oatmeal with cinnamon. We sit for a few minutes and then get ready for clinic, which begins at 8.

Yesterday morning, our routine was interrupted at 7:15 a.m. by a mother carrying her unresponsive 4-year-old son to our gates.  One of the security guards rushed her in and the docs and nurses started working, along with our cook, Guerline, who acted as translator.  We got the history that this child had had a seizure 2 hours previously and our fabulous ED nurses got an IV started and discovered his blood sugar of 41 (low) within minutes. He was immediately arousable after IV glucose and was swiftly packed into one of our cars (transport to a local hospital had been arranged during resuscitation).

 We then got back to readying the grounds and our tents for morning clinic. At 8 a.m. a few of the nurses and MDs “walked the line” to number the patients according to the acuity of their illness. The rest are taken in order. The rest of our day was relatively quiet with one mobile clinic going to Grassier while the “fixed” clinic continued to operate.

The Grassier site was in the courtyard of a school that was heavily damaged in the earthquake, while some children were in attendance. We sat under the trees with the breeze blowing off the ocean while we saw our patients.  I asked a lot of patients to tell me about what happened to them during the earthquake. We are seeing a huge amount of post-traumatic stress disorder. The mother of a 5-year-old girl who had scratched herself to the point of bleeding from head to toe, told me that the girl’s  twin brother had died. The team has seen suspected malaria, pneumonia, pyelonephritis, lots of diarrheal illnesses, malnourishment and a variety of problems related to a lack of chronic care for hypertension, diabetes, seizures, etc. I have spoken to parents who are starving themselves out of their feeling of responsibility to feed their children.

 The clinics run smoothly from morning through afternoon, even though the humidity has everyone running for water breaks – they’re never enough. Most don’t take adequate time to drink and there have been several episodes of dehydration among staff members. The late afternoon can be used for resting, or, more recently, emailing and calling from our “dining room table” since an NGO called NetHope came and installed these services for us.  They even work most of the time, depending on the available of city power or our generator. We wash our clothes, haul water  from the cistern into the bathrooms for bucket baths and toilet flushing,  stock the tents and chat. Sometimes a few of the team members help Guerline prepare dinner in the kitchen. Cooking is done over a small propane stove, or over charcoal. The suppers are very tasty and consist of Haitian rice and beans, or spaghetti, often with a chicken or vegetable stew.

The cohesiveness of our team is the best of any of the medical mission teams with which I have worked. After dinner, we have lots to do. We wash dishes, clean up and collect ourselves around the table for pill counting to restock for the next day’s mobile and fixed clinics. We pack the mobile clinic duffel bag and some of us work on guidelines for malnutrition, commonly encountered local clinical conditions, and nursing guidelines for incoming staff — RI or national. For me, it’s 10:30- 11 p.m. by the time I finally crawl into my “bug hut” and end my day.

The days have been busy and instructive, heat notwithstanding.  I love working with the Haitians. The people are courageous and gracious. The team has helped me look after my broken foot (from a hiking accident two days before I left for Haiti). I was given an ACE wrap and lots of instruction to keep my foot elevated (forget about ice!), which of course I did not do. I’m moving pretty quickly now.

The young Haitian men who serve as the primary source for our drivers, translators and security are very willing to talk about the situation here. They are sensitive and very protective of us. I hope Americans know that we are seen as a source of hope for the Haitian people. As Garry, a translator, said to me yesterday: “For Haitians, first God, then the U.S.”

Respectfully,

Debra Cohen, MD, aka “Dr. Deb”
Pediatric Endocrinology
Kaiser Permanente Santa Clara Medical Center

An OB-GYN Returns from Haiti, Ready to Go Back

  It’s great to be back in the land of hot showers,  but I came home too soon and will go back later this year when I can.  I left with a sense that I could have done much more,  had I stayed at least a week or two more, as I was just getting into the swing of things.  I became used to electricity failures,  no running water,  bucket baths (stand in the shower with a 5-gallon bucket of water,  pour cups of it over yourself,  wash,  rinse) and a limited menu (lots of spaghetti,  rice and beans).

We lived in a house in Carrefour, a red zone where the UN did not venture (too dangerous).  We saw patients in medical tents on the grounds of a house behind walls and a gate. The house is owned by an American doc from Wisconsin who has lived in Haiti for more than 30 years with her partner, a nurse.  They were moving to a town in western Haiti before the quake to start a clinic and they continued that process after the quake. They rented their house to  Relief International (the group I went with) and we’ll be there for some time until,  eventually,  a base clinic can be found/built.  Our group ranged between 12 to 20, with nurses and docs from the United States coming and going at different times.  Sleeping bags and mosquito nets were the rule.  I saw men, women and children with medical complaints.  I didn’t see much gyn stuff,  really — many cases of vaginitis that actually were not — but I did see some pregnant women and delivered three babies. Two were delivered at a hospital that we formed a loose affiliation with a few miles away and one that barely made it to a Doctors Without Borders hospital nearby.  That was wild: walked in, our group of patient, paramedic, translator and I were pointed in a direction where the delivery area was, found it, asked if there were a doc or midwife (none came) so I did the delivery, beautiful baby girl, smiles all around, and left. Where else on earth could an unknown doc walk into a barely staffed hospital, deliver an unknown patient, and walk out without anyone asking what’s up? If we hadn’t made it to the hospital that baby would have been born in one of our medical tents, perhaps tent one, the fertility tent, where a dog with her new puppies had established herself.

We also went to a couple of sites where we did mobile clinics, usually areas near tent cities where there were no other non-government organizations like our. We’d pitch our medical tent, see patients until we had to leave and do something similar in another location the next day.  We had a curfew of 6:30 meaning that if we were outside our compound we had to be in it again by 6:30 p.m.  The UN had been called to Haiti in 2004 since the government was ineffective at curbing random gang violence that was terrorizing Port au Prince and they’ve been there since. The head of the UN mission in Haiti was killed in the quake, along with other UN peacekeepers.  It was they who established the curfew and our group followed it;  others did not. The first few days I was there we would walk outside the compound a block or so in either direction.  Our translators and drivers come from the neighborhood and a couple were raised in an orphanage not far that was badly damaged and they were our guides.  One translator’s house collapsed completely; the family escaped but lost everything.  A neighbor family escaped,  all but a 2-month-old baby still under the rubble.  The building next to the orphanage collapsed with 13 people inside and the smaller children were afraid of their ghosts and refused to go near the orphanage buildings;  they lived in school buildings and tents just down the hill.  Many stories like that.  Our outside walks stopped when it was learned that we had become targets for kidnapping given our regular schedules.  So, we only left in SUVs and generally in a convoy with at least 2 vehicles.  I never felt unsafe,  though,  and am not sure about the kidnapping thing,  though that was happening before the UN came.

Much destruction all around,  everywhere you look.  People are living in tents even if their houses are standing, fearing collapse in another tremor.  I felt at least four aftershocks, all minor and similar to the little quakes we have here all along.  A couple were strong enough to send some of our group fleeing outside and produce screaming from the tent encampment next door, along with lots of dog barking and rooster crowing.  Roosters and dogs seemed to be everywhere and set up random racket through the night,  leading to  sleepless nights sometimes.  I slept in the building among the boxes of bandages and supplies. Most slept in tents in the yard and experienced rooster songs near their heads.

The Haitian people have endured so much for so long that this latest calamity is only one of a long string, though certainly the worst in history. We hear numbers like 220,000 dead, as many injured, a million homeless, 70 percent of schools destroyed, numbers that are incomprehensible but are made real by individual people we see. There are the children with no parents,  people with amputations and wounds coming for dressing changes, old people who’ve seen too much,  happy and beautiful children with the whitest teeth I’ve ever seen,  adults who are survivors of a tough environment that doesn’t allow for laziness or complaining.  People try to keep clean,  living under a tarp on the street but still bathing with a bucket of water that’s not so pure; possessions may be lost and destroyed but dignity thrives.

These are a religious people and God is not far away, a rock on which to depend during this time, not so much to question why but to thank for being alive and to help celebrate the memories of the lost.  These are a remarkable people.  Someone told me that you either loathe Haiti and can’t wait to leave its heat,  poverty and filth, or you come to love it and its people and the spirit that drives them.  I’m in the latter camp.  I’ll be back, to continue what’s been started and to help where I can.  I have much to teach and much more to learn and what better teachers?

Kaiser Permanente Hayward Medical Center

 

Finding Perspective in a Carrefour ‘Copy Shop’

I have been in Haiti for over a month now, working with Relief International.  It was only a few days ago, while waiting for photocopies to be made, that I had time to reflect on the gravity of the situation here.  While I waited at the “copy shop” I could only marvel at how quickly I adapted to the utter chaos and destruction around me.  On the way to the shop I did not find it strange to have our driver maneuver around rubble piles, or pass by one collapsed building after another, observing people bathe in the street water or shovel through the rubble for goods and loved ones.  I did not find it strange to skirt our way around a crushed vehicle parked in front of the crumbled shop, then watch the copy shop man power up a generator to run his single copy machine.

This realization also allowed me to reflect on what Relief International has been able to create amidst such chaos.  The Relief International fixed clinic in Carrefour has been running smoothly and orderly since Jan. 20.  Within the grounds of our clinic, one would hardly believe the chaos just beyond the property wall.  Our patients are getting healthier by the day, and it’s now unusual to see a true emergency waiting at our gate at dawn.  The same phenomenon occurs with our mobile clinics.  We often are greeted by a few very sick patients when we first arrive at a new mobile clinic site.  By the second visit at each site, chronic medical problems are the bulk of our patients’ medical issues.  So, despite the chaos outside our walls, Relief International is doing its part to ensure that the population it serves is getting good and appropriate medical care.  The impact within the communities we serve is undoubtedly obvious.

Relief International’s long-term goals in Haiti initially seemed overwhelmingly grand.  However, we are getting closer to the goal of setting up five fixed clinics each day.  Dr. Garzon returned to the U.S. and left big shoes for me to fill.  However, he worked hard with Relief International staff to lay out the groundwork for Relief International’s long-term mission.  Our clinic has seen more than 4,000 patients to date, and delivered one baby.  Several national support staff have been hired, and Haitian medical providers will be hired this week.  A large team of expatriate physicians, nurses, and paramedics joined our team to increase our mobile clinic capability, and to get our clinic programs and systems developed and running.  Relief International is continuing to work with the Haitian Ministry of Health to open the four other fixed clinics.

Our team’s energy remains amazingly positive and is the reason we work so efficiently and well together. It is because of this Relief International team that we have been able to find any kind of order within such chaos.  And, it was only after I stopped for a  few minutes in the copy shop that I realized how successful our work here has been.

Vivian Reyes

Kaiser Permanente San Francisco Medical Center

Sent from my iPhone

Dr. Garzon Returns to Haiti

It’s been many days since I’ve sent any updates, and I could probably write a book about the past three days alone. I’ve been back to Haiti for three days but is seems like a lifetime!

Suzy Fitzgerald led the Relief International emergency response medical team through the first week of work, seeing more than 2,400 patients. We have had nine physicians, three nurses and a paramedic on the medical team (nine of these from Kaiser Permanente). In the humanitarian relief world, organizations usually either do emergency relief or development.  Relief International is one of the few organizations I know that does both well. We have been running a single fixed clinic and occasional mobile clinics in the Carrefour area, just east of Port au Prince, near the epicenter or the earthquake. While our clinical staff has been very busy with patient care, Relief International’s staff has been busy applying for additional funding to continue relief operations and establish development programs.

Our presence here doing disaster relief has contributed significantly to the success of qualifying for the two grants for which RI has applied. Four weeks after the earthquake, much remains to be done. There are many people who still need definitive care for infections, poorly healed fractures, amputations, and other trauma from the earthquake. In addition, the mental health, physical therapy, and occupational therapy needs are huge. At the same time, there is a rebuilding process that has to begin for the entire society.

Relief International has received two grants to continue the health sector rebuilding process. The bigger one is for six months and includes funding to establish five primary care clinics staffed by both local health care providers and international volunteer staff. We will continue running the current clinic and have tentatively identified sites for the five others. In addition, we have been busy looking into sources to hire local health care staff and have made an affiliation with one of the five collapsed medical schools in Port au Prince. This will allow additional training of local health care providers and contribute to the “capacity building” work done by RI. We are also looking to bring in another large cadre of volunteers from the U.S. before the end of February to support these clinics.

The second grant is to create a service that hasn’t previously existed here, which will fill a huge gap in the current health situation. There are many patients who are in health care facilities that need transport to a different facility, but there is no existing ambulance or patient transport service. Relief International has been given a grant that will support a five-ambulance “Critical Care Transport” team to fill that gap. Here again there is a need for more physicians, nurses or medics to help run this system for the next two months. This as well is under construction, and should be up and running within a week. We expect to bring in another 15 clinical volunteers before the end of February.

My apologies if this brief summary of a hugely complex process loses a bit of the intensity of what is going on here. In the midst of this continued chaos, the medical team is still doing incredible work. Our initial team is largely home and we have a second wave of incredibly motivated volunteers. It is an honor to be here to help. In the face of tremendous suffering there is still amazing opportunity and hope. We just have to get comfortable with the incredible uncertainty that also exists. Perhaps the attached pictures can say more about what the work is about than these words…. In the morning, our clinic day starts by doing a visual triage of the usually long line that begins to build around 4 a.m. We triage the sickest to come in first and then take the others as first come, first serve. One picture is of this triage of the morning line which on this day was 180 people long. The second picture is of one of our nurses with one of those sick babies that was seen first.

-Hernando Garzon, MD

 

 

 

Dr. Fitzgerald Leaves ‘With a Hopeful Heart’

Feb. 1, 11 a.m. I’m on the tarmac at the Port au Prince Airport waiting for the military flight that will begin my trip home. I wish more than anything to stay here in Haiti and continue this work, but professional obligations require my presence elsewhere. I hope to return very soon.

In the meantime, Dr. Vivian Reyes will be taking over as the Med Team Leader, and Dr. Hernando Garzon will be returning to Port au Prince in a few days.

It seems a lifetime ago I was frantically packing and repacking my bags and making all those trips to REI.  I remember the military helicopter in from Santo Domingo, the land below turning from the lush green of the Dominican Republic to the stark destruction of the Haitian landscape.  I remember landing at the U.S. Embassy and meeting the rest of the team and then taking that first SUV ride through the rubble-filled Port au Prince streets.  I remember the first patient femur fracture we treated, the first wound infection that improved, and the first time I said a shy “Bonjour.”

I remember the Haitian people beginning to live again — hearing it in the rhythmic strike of hammers and seeing it in the effortless posture of the graceful Haitian women returning from market with large baskets of food balanced perfectly on their heads.

I remember everything, yet at the same time nothing — the past two weeks has been a blur of sweat, dust, exhilaration, and fatigue.

I am proud to have worked with such an incredibly dedicated group of providers and workers.  Tremendously grateful to Kaiser Permanente and Relief International for getting us on the ground so quickly, and supporting us so well. Thankful to Medshare for those initial supplies, and extremely gratified to feel we have already helped, in whatever small way, 2,000+ patients affected by this event.

The Relief International program expands daily. In addition to the operation and expansion of the fixed and mobile clinics, several partnerships with the local pre-existing Haitian health care system are in the works. Capacity building has begun.

I also know the people of Haiti continue to need as much help as they can get. They need it today. They’ll need it tomorrow, the next day, and next month. They’ll need it for a long time and your support is crucial to the Relief International effort. Please donate what you can — your time as a volunteer, your money to the Relief International team, or your understanding when your KP colleagues drop off the work roster to head to Haiti for a few weeks.

There will be ongoing opportunities for KP physicians to volunteer in Port au Prince as the site becomes fully integrated into the KP Global Health Program.

What we have begun in Carrefour, Port au Prince is only a drop in the bucket — but at least there IS a bucket.  We can fill it together, one drop at a time.

I leave Haiti with a hopeful heart.

Suzy Fitzgerald, MD
Relief International
Kaiser Permanente – Diablo Service Area
Sent from my Verizon Wireless BlackBerry

Deploying Mobile Clinics

Greetings from Carrefour, Port au Prince, Haiti.

With the fixed clinic in Carrefour up and running, we have now been able to turn our attention to the mobile clinics.  We are targeting several areas identified by the Ministry of Health as especially in need of this service.  Sunday morning we loaded up our two-vehicle convoy complete with three MDs, one RN, and multiple expat and national staff, and left our fixed clinic at 8:30 am.  We set up shop at Tabanarre de la Grasse, an Internally Displaced Persons camp on the site of what used to be a school and orphanage.  After a whirlwind of activity, the team had the tents and the clinic up and running by 10:30 am.  By noon we had done our first two acute care transfers.  By 3 p.m., we had seen 114 patients. We estimate 30 percent were in urgent need of our services and would have become sicker without this medical intervention.  We continue to see previously untreated earthquake injuries and many wounds that have now become infected.

We also continue to operate our fixed clinic and gave medical treatment to 148 patients.  The plan for Monday is more of the same, including setting up a new mobile clinic at a large IDP camp near what used to be the Prime Minister’s office.  We will run this clinic directly out of the backs of our trucks.

As you might imagine, our team is tired but extremely happy to have reached this many Haitians.  We have everything we need thanks to the incredible hospitality of Dr. Catherine Wolfe and Cherlie Severe, RN.  They normally live and operate Friends For Health in Haiti near Jeremie, Haiti, and have opened Cherlie’s home here in Carrefour to us for both our living and our fixed clinic space.  The aftershocks continue and most of us sleep outside, but frankly, it’s quite nice to sleep under the Haitian sky.

We continue to believe there is a great deal of urgent unmet need out there, and will be working very hard to find and treat those patients.

We would like to thank everyone for the incredible support and heartfelt wishes.  All of it means a great deal to our team.  Between the support of those back home and the gentle and grateful smiles of the Haitians, our spirits and energy levels remain high.  Thank you all for helping us to do this work.

And a special thank you to the team here on the ground, who do anything and everything when asked and even when not asked, and do it with unfailing energy and good humor: Josh Weil, MD (Kaiser Permanente Santa Rosa), Vivian Reyes, MD (Kaiser Permanente San Francisco), Stephen Bretz, MD (John Muir Medical Center, Walnut Creek, Calif.), Catherine Wolf, MD (Friends For Health In Haiti), Linda Martin, RN (Kaiser Permanente Morse Sacramento), Kelly Belli (Kaiser Permanente Morse Sacramento), Cherlie Severe, RN (Friends For Health In Haiti), Barbie Law (Captain-Paramedic, Sacramento Metro Fire), Don Engle, DDS (Lafayette, Calif.), Serena Clayton (California School Health Centers Association), Mike Speaks (Denali Park, Alaska), Andrew Johnston (Project Coordinator, Relief International), and Tiare Cross (Team Leader, Relief International).  Hernando Garzon MD, who led the initial effort and established the team in Haiti, continues to be very much involved from the United States.

More later, we are heading out for clinics now.

Thanks to all!

Suzy Fitzgerald, MD
Medical Team Leader
Relief International
Kaiser Permanente Diablo Service Area

Update from Suzy Fitzgerald MD, January 26, 2010