There is Hope--part 3--The Story of Heartline Hospital

You can read part 1 here and part 2 here. (My apologies that it's taking months and months to tell the story...it's a long story and it's still in progress!)

Within the first 6 hours of the clinic/ER/OR being open, it became very evident that we'd need an inpatient ward for patients too sick or injured to return "home". In retrospect, we should have anticipated this need in the days before we opened. But at the same time, I look back on those first days and I can remember how intense they were, and how many unknowns we faced. We could barely anticipate what the next hours would bring, let along the next days or weeks. I remember that on one of our very first days, someone e-mailed me and asked about volunteering in March. I remember thinking to myself, "March? Are you serious? It's difficult to even anticipate what volunteers I'll need next week..." It wasn't that I didn't appreciate the offer of help (I did), it's just that, at that point, it was impossible to plan that far ahead. In light of that reality, it's not surprising that we didn't think of the need for an inpatient ward before we started.

makeshift inpatient ward, outside ER/OR, night #1, 1-18-10

It didn't matter---everyone stepped up to make it happen. On that first night, we housed about 10 patients in our ER/OR area and in the outside courtyard. We quickly realized that this wasn't a viable long-term plan. On the second night we started moving some patients over to Heartline's former "boys home" (where about 10 boys waiting to be adopted lived prior to the earthquake), just one street over from the ER/OR. We started out with very little---a few army cots, some mattresses on the ground, one tent in the driveway, a few tarps strung up with rope, as many sheets and towels as we could pull together, a makeshift charting system, MREs, IVs hung by pieces of gauze used as rope, and a few medical providers volunteering to work the night shift, including one Haitian nurse, Wini, who showed up on day one wanting to help us out. After a few days we were able to officially hire her, and she's still working with us.

early inpatient ward, 1-22-10

Over time, the inpatient ward evolved. Little by little, we acquired more cots--a few from here, one from there, two from someone who happened to stop by and drop them off. It went on like that for awhile, until we were able to bring in a bigger load of cots on one of the charter flights after a week or two. We also acquired a growing supply of sheets, towels, and other necessary supplies. We organized a better meal schedule, including nutritious high-protein meals three times a day. Looking back now (at the end of July), it's still hard to believe how little we had at first, but we made it work.

1st inpatient census board, ~1-20-10

The tarps provided sufficient cover until the end of February, when the rains started. A visiting group put up a more permanent half-dome tent structure in early March. Other organizations continued to donate supplies to us. Eventually, sometime in early February, we had acquired enough cots so that everyone could sleep off of the ground. We would occasionally have a patient sleep inside the house, but this was rare, as no one wanted to sleep inside a house made of concrete blocks. And when you saw their injuries (most inflicted by falling concrete blocks) you could understand why.

makeshift traction, 1-21-10

Prioritizing our needs during those first couple weeks was incredibly difficult. Each charter flight had a strict weight limit. In the beginning we needed everything, and we needed it all right now---a huge variety of medical supplies (everything from penrose drains to crutches to casting material to urinary catheters to wound dressings to a cast cutter), medications, medical personnel, food, cots, sheets, office supplies, and everything else you can imagine you'd need to run an ER, OR, and hospital. But we couldn't have everything right now, so we made do with whatever we could get.

I just looked back at one of my "supply wish lists" from the first weeks, and it brought back some very specific memories. I remember people handing me lists--black Sharpie marker scribbled on a ripped off piece of cardboard box, blue pen on a half sheet of notebook paper, copies of our makeshift charts covered in notes. It wasn't uncommon for me to update the supply list several times a day. The U.S.-side people had to deal with my very frequent e-mails, nearly all of them marked "urgent!", and they did a great job getting us what we needed, over and over again. We were flying in about two charter flights per week during the first few weeks, so the state-side volunteer staff had a HUGE job. They worked just as hard as any of us who were on the ground in Haiti.

We would get e-mails from random people offering supplies, and we took advantage of every generous offer of something we needed. Sometime this involved trading. I remember one day John Ackerman walked in with morphine. We needed morphine in a bad way. He handed it to me, asking, "So what are you going to give them?" "Who's them?", I asked. "The Germans," John replied. I think I started laughing at the absurdity of the whole situation. I didn't ask him to elaborate on what he meant by "the Germans" and I didn't care---I was so happy to finally have some more morphine. I gave John a couple boxes of Versed (we had lots of this) and we called it a deal. Needless to say, there is no DEA in Haiti.

Another connection brought someone from the U.N. to our hospital. She handed me a list of medications that were stocked at a warehouse...somewhere in Port au Prince. If I'm remember correctly, it wasn't a U.N. warehouse, but she had access to it. I quickly read through the list and marked off the medications that we needed. I was a little skeptical that we would actually get what I "ordered", but I was willing to try anything at that point. The following day, she showed up with boxes of medications--including Tetanus vaccine (the first we'd had since opening). It felt like Christmas! What a relief.

On January 23rd, Tara wrote the following:

A US Military person told me (Tara) that he was very upset with the lack of urgency for getting them on the ground and set up. He said they were made to sleep at the Embassy because no one would pull the trigger and give them clearance to go set up. They talked about danger and seemed not to know who had the authority to give them their marching orders. He said it took 9 days from his deployment to get to his post. He said there are politics in play and that it had been frustrating for him and his team. Meanwhile, independent, unarmed, non-military missionaries and aid-workers are running around the country without much trouble at all.

Having shared that, it has been amazing to see the ways little organizations have worked around the red-tape and the ridiculous politics and have found their own supplies and have traded out and rallied together for the greater good. Please continue to pray for order, cooperation, and successful teamwork -- it can only benefit the hurting if we all play well together.

This was our experience over and over again. We quickly realized that the best way to get things done was to network and work together with other organizations (usually small NGOs, though not always). When we had extra supplies or medications, we gave them away to people we knew needed them. When others had extra supplies, they showed up at our hospital to give them to us. It was beautiful. We also had the big advantage of not being limited by restrictive rules governing our movement. We had vehicles, we had diesel (brought in from the D.R.), and we had the freedom to travel around the city wherever we wanted, whenever we wanted. This wasn't the case for many other organizations, but it was critical for getting things done.

The stories our patients told us were unbelievable and heartbreaking. Buried alive for days. Laying outside for over a week with an open fracture and no medical care. Laying among dead bodies waiting to be rescued. There was fear and trauma on people's faces and in their eyes. One volunteer who worked with us back in January came back to volunteer again in May. He commented to me, "No one smiled or laughed back in January, but there is so much laughter now." He is mostly right--there were a few light moments in those first weeks that he didn't see, but not many. The injuries we treated were horrendous. We witnessed, over and over again, the extreme injustice that flows from the lack of medical care and the lack of a health care infrastructure.

6 month old baby with deep arm laceration...no care for 7 days...can you imagine?

Over the first two days of being open, we took in around 20 people who needed inpatient care. Of those patients, we had 11 who needed urgent surgical care that we couldn't provide. Many have already heard the story of how we connected with the USNS Navy Comfort ship on January 20th (the day after they anchored in the port, and the first day they started taking patients on board). Tara blogged about it here. I haven't written much about that day. At the risk of sounding overdramatic (which is not my intent), let me say this--it was, hands down, one of the most surreal, crazy, and ultimately, amazing days of my life. I want to tell the story in my own words...that is coming up in part 4.

tara watching helicoptors from the USNS Comfort take off with our patients, 1-20-10