there is hope--part 2

You can read part one here.

On Monday, January 18th, 6 days after the quake, Heartline clinic opened. John McHoul, Troy Livesay, Don Buxman, and Byron Tlucek are all Heartline missionaries who live in Haiti. Since the quake, they'd been around the city and had a good idea of where the injured were gathering. By day 6 there were some clinics and hospitals taking care of the injured, but everyone was overwhelmed. Everyone was turning away patients due to lack of supplies, medications, and space. Many of our patients tell stories about how they were turned away multiple times before they finally found medical care. Some never did. One dad told us how he'd taken his son, who had a crushed foot, to 4 different clinics/hospitals in Port au Prince, and he was turned away by each one. Finally, he made his way to Zanmi Lasante, the Partners in Health hospital in Cange (in central Haiti) about a week after the quake, and by then his son's leg needed to be amputated in order to save his life. Of course there is no way to know whether or not his son's leg could have been saved if he'd received medical attention sooner. And I don't blame any of the clinics that sent him away--like I said, everyone was overwhelmed and everyone had to make hard triage decisions.

Heartline operates out of several houses in Tabarre, a section of Port au Prince located about two miles from the main airport. It is not in a location that lends itself particularly well to taking care of walk-in patients, especially injured patients. For that reason, the decision was made early on that we would go out into the city (with large trucks) and find the most severely injured patients. During the first couple weeks, Heartline's trucks made about three trips a day out into the city, bringing back many critically injured patients on each trip.

Pre-earthquake, Heartline ran several programs for women, including prenatal classes, prenatal medical appointments, and a birthing program. Most of these programs are run out of one of Heartline's houses in Tabarre, which is not far from the airport. About a year ago, Heartline decided to offer prenatal classes and appointments in Simon Pele, a slum near downtown Port au Prince. After the earthquake, this was one of the first places Heartline's on-the-ground team visited. They found a large number of injured people at a clinic run by the brothers of charity. They were doing their best with a small number of medical supplies, but they did not have any doctors or nurses. Our first patients came from this clinic in Simon Pele (or Pele for short), and to this day we continue to visit this same slum three days a week and continue to take care of ill and injured patients from Pele.

As the patients arrived back at Heartline, they were quickly triaged based on the severity of their injuires. Those with the most severe injuries were brought inside and seen by a doctor and nurse immediately. Treatment for those with less severe injuries started outside in the clinic/ER's front "yard", which we'd transformed into a well-stocked wound care station. As space was available inside, these patients were transferred inside for more definitive care, including sedated wound debridements, laceration revisions, open and closed fracture reductions, amputations, splinting and casting, and abscess incision and drainage.

We worked in teams and we were in constant consultations with each other. The doctors, nurses, and other support personnel (medical and non-medical) were all amazing. Lori Moise, a nurse from Real Hope For Haiti worked with us for much of that first week and was a huge help. She’s lived in Haiti for 15 years and nothing fazes her. John Ackerman, another long-term Haiti missionary and nurse, also stepped in to help during the first several weeks. Many others who were here during the quake also helped out from day one. In addition to the drivers/go-anywhere do-anything guys mentioned above, Jonna Howard (midwife), Joanna Thiele (RN), Beth McHoul (midwife), Tara Livesay (go-anywhere, do-anything person & translator), Nikki Skovron-Filostin (amazing translator), Lisa Buxman (midwife), and Vivien Ingram (EMT) all played a huge role. John and Beth's daughter Morgan (RN and translator) and her boyfriend Tony (paramedic) also arrived on the first charter flight and worked hard throughout that first week. Karen and Tim (both are adoptive parents, and Tim is a paramedic) were an integral part of the team that first week. Dr. Tami Rice (anesthesiologist) and her husband Robert (another go-anywhere, do-anything guy and videographer) flew in on that first flight and spent a week here. The other doctors included Dr. Joe Boyle (emergency medicine) and Dr. Tom McKnight (family practice). It all came together somewhat haphazardly, but in hindsight, the mix of people we had those first few days was perfect.

As I've mentioned before, it felt incredibly gratifying to be able to provide sedation, analgesia, and anesthesia for all patients undergoing painful procedures (most of whom had not yet received any pain medication for their injuries). In a country in which people suffer many injustices, this felt like justice.

Near the end of our first week, two amazing paramedics from New York City (Rhona and Chris) arrived via the Dominican Republic. They transformed the way we conducted the truck runs into the city and raised the level of pre-hospital care we were providing. They instituted a system of early administration of IV fluids, early treatment of pain, early basic treatment of wounds, and pre-hospital triage. With their leadership, truckloads of patients began arriving with IVs in place, pain meds administered, and injuries/illnesses labeled on a piece of tape on their clothing. This expedited our treatment of the ill and injured once they arrived at Heartline.

Along with all of the hands-on medical work, I (along with some others) started working the administrative side almost immediately after the clinic/ER opened. This wasn't a huge surprise, but it did require me to change my thinking a little. It meant that my laptop (and later, an International Blackberry sent from Providence with Greg Erickson) became essential parts of the work we were doing. Coordinating patient care, arranging patient transfers to other hospitals, helping recruit and schedule volunteers, organizing, re-stocking, and taking inventory of supplies, negotiating for supplies and medications, and so on---all of this occurred daily.

Next up: procuring supplies, collaborating with other organizations, developing an inpatient ward