Back in Haiti

Darin Talley, Billy Wynn, Rachel Hurst (PA), Avery Roller and Mason Roller left for Haiti on Saturday, June 12th. They met up with Dr. Ric Bonnell and others from Texas to work at Pierre Payen in Haiti doing surgeries and clinic this week.

I hadn't posted anything, yet, about the group being in Haiti, because we haven't gotten to talk to them much this time. The internet has not been working at the base, so they haven't been able to send updates. We have had a couple of quick phone calls here and there, but not photos or blog updates.

They are all doing great and surviving the heat! : ) They've been working long days and seeing a lot of patients. They've been able to do quite a few surgeries, too.

An amazing thing happened today. The little girl that they worked on while they were at Pierre Payen in March--the one that almost died--came into the clinic this morning with her mom. Darin sent Robin a picture of the little girl, her mom and Billy in the clinic this morning. That was a definite answer to prayer. She is the one they transported to Port-au-Prince in the back of the cattle truck during the night at the end of March. When they left Haiti last time she was still on a ventilator at the University of Miami Field Hospital in Port-au-Prince. They were not sure if she had lived or not. But today, they got to see her and had an emotional reunion! : )

Keep the team in your prayers the rest of the week, they are hot and tired, but excited about the work they're able to do. They were also able to get the anesthesia machine working on Sunday night when they got there, it had broke while the last team was there. ~Marty

Sunday in Haiti (Day 2, 1st Working Day)

We were supposed to do our 2nd blog entry on Sunday, March 28th, but things got a little hectic. Sunday was created as a day of rest, but luckily it came early in our stay in Haiti. Every day seems the same for Haitians because surviving the day is their focus. Sunday for some of them means all-day church. That may mean Christianity, Catholicism, voodoo or what seems more dangerous is the combination of Christianity with voodoo practices mixed in. The statistics in the U.S. about people who state they are believers sometimes seems to be just that--stats. In America, we're very good at saying “I believe in God, but…”. Some Christians in the United States may go to Church on Easter, some on Christmas, some once a month, or even once a week, vs. truly having a personal daily relationship with God. America likes to think of itself as a spiritual country, but we're a people often caught up in celebrating Earth Day, self-absorption, entertainment hits like Avatar and the love of money. These things seem to be many people’s religion in America. Haitians are very spiritual people but the problem is that the voodoo spirits are all about darkness. There is a battle going on between darkness and light in Haiti.

Sunday was a busy day in the OR. Holding clinic, seeing patients with appointments and walk-ins, was coming on Monday for Drs. Page and Talley along with Ryan Tolliver, the PA with our team. You tend to do cases as soon as they pop up because you never know what else may come rolling in the door. When you have tap-taps (small Toyota pickups with 10-20 people riding in the back) and buses with filled with passengers, cargo and people on top, you need to be available. Not to mention the motorcycles with 3-5 people riding on them sometimes carrying 2 gunny sacks full of rice. The possibilities for injuries in Haiti would make any OR team cringe.

Sunday’s OR cases:
Tibial external fixator removal
Femur external fixator removal
Dressing change on Jr., aka Junebug, see team 10’s blog for his story (www.haititeam10.blogspot.com)
Labial abscess by orthopedic/now GYN surgeon Darin Talley
Da-wil-she, 11-month old that aspirated on rice, beans, and had bronchiolitis
Coin boy - removed coin from esophagus of little boy with a foley catheter by Dr. Ric Bonnell

That is a full day of work when you consider that Todd Round and S.C. were saddled with the grunt work of finding the supplies, lugging them across the highway to be sterilized and then back to the OR.

The one thing I worried about before the trip to Haiti was doing pediatric cases with the limited resources and personnel. So when Ric came in with the story of the baby girl named Dawilshe that had been brought in, there was sphincter factor. The rest of this entry may be a little heavy on medical details but the anesthesia nerds might like it.

About 6 p.m. we decided since the baby, Da-wil-she, was retracting w/ sats in the low 70s we should intubate her and try to suction out the thick mucous or the rice/beans. With only isoflurane available, an inhalation induction wasn’t an option, ketamine dart or sux im was available but Leanna started an iv on an awake, squirming, dehydrated Hatian baby, amazing! We intubated her with a 4.5 ett (size large coffee stirrer or small straw) gave nebulizers down the tube but she was still retracting with sats in lo 90s. Ric’s idea of suctioning the tube on extubation gave us the best chance to get the aspirate or obstruction out. Extubated, she continued to retract and struggle. We reintubated with sux turned on some iso, nebs down tube and she started to respond to the treatments, so about 8 p.m. we extubated her and made a xoepenex plus epi treatment in a dinasour mask that luckily team 10 had put on the wish list for Pierre Payen. Elizabeth (Ric’s 13 year-old daughter) held her and Mom and Dad were in the OR so she was held upright with the nebs going and she looked better. After few minutes, Ric and Tim (a medical resident who had been there for month) stayed with them in the OR so the rest of team could go eat spaghetti that was originally served at 5:30. 15-20 minutes later, Leslie St.Fleur, a paramedic from Ft. Lauderdale whose parents were Hatian and had taught him Creole growing up, came across the highway and said the baby was not breathing. The funny thing was that the only person who heard him was Leanna who is deaf in her left ear. (And, we never poked fun at her either, haha!) So we took off running back to the OR.

Ric was doing compressions and Tim was bagging her because she had went from labored breathing to agonal respirations and asystole. We re-intubated her and there was brown-green vomit in her oropharynx, epi got her pulse back to 60, so with the 02 and a dose of atropine her rate went back into the 160’s with bounding pulses and sats in the low 80s. At this point, Larry Page prayed over Da-wil-she and her family. After a while she started gagging and fighting against the tube which we took as a positive sign. Now the question was what to do because the ventilator at Pierre Payen didn’t work and there was no chest x-ray. The thought of all night bagging in shifts with no end in sight did not seem like an option, so Tim and Ric called the University of Miami field hospital (think of a fancy MASH unit with AC). The personnel at the field hospital said they didn’t have a ventilator available either, but they would try to wean a patient off of one before we got to the hospital.

Her sats were still in the 80s and no one was that excited about starting a 1.5 hour trip with sats that low, so we decided instead of packing her oropharynx with gauze, to change to a 4.5 because of the leak around the tube. Switching to the bigger tube and getting rid of the dead space of the circuit by going to an ambu bag brought her sats up into the high 90s. Ryan and others on the team lashed a huge Ecylinder of O2 in the cattle truck and put a mattress up against the cab. Darin Talley mounted a flashlight and made a place to hang her IV with duct tape. We ran from the OR with Darin carrying her on room air. As we climbed in the truck Darin slammed his head into the metal beam that runs down the middle of the truck. The rumor when we got back to Pierre Payen was that we had banged Da-wil-she’s head.

We pulled out with Mom, Dad, Ric, Callie (a paramedic), Leslie, Darin, and a few others in the back of the truck. Steve Mossburg, the missionary (http://www.project-help-haiti.blogspot.com/), was driving the truck and I told him later I was glad it was him driving and that I felt a sense of calm with him at the wheel even though there could be dogs, goats, people, or motorcycles without lights on the road. The full moon was beautiful and provided him with good vision as we cruised along at 60-65mph in the truck to Port-au-Prince. We would slow for police check points and Ric would listen to breath sounds as I continued to bag her. Her breath sounds had actually gotten better over the last couple of hours. Believe it or not you can actually hear breath sounds thru the precordial with all the wind riding in the back of a truck. We took a little longer route to the University of Miami field hospital because the shorter route was only ‘safe’ during the day. The road became bumpy inside Port-au-Prince and Ric and Darin held her down to keep her from bouncing and dislodging her tube. We entered the compound, Ric and others entered the field hospital to facilitate the transfer. All of a sudden it was just Darin and I and the baby in the back of the truck with a bunch of Haitians peering in and shaking their heads while they watched us (probably thinking crazy white doctors).

We laid the baby on a cot in the “PICU” and turned over care to a nurse, respiratory therapist, and a PA. As they put her on the vent, her sats plummeted into the 60s. Darin said at that point I became a little bossy and took her off the vent so I could bag her and stated that her sats were in the high 90s in the back of a truck at 65mph surely we could keep her from coding in the hospital. As the vent settings got figured out, it was hard for us to just walk out of the field hospital after working on her for six hours. It was a gorgeous night and a much more relaxing drive back to Pierre Payen. We rolled into the compound about 2 a.m., but it was a little hard to fall asleep after the day and evening we had experienced. I prayed throughout the whole ordeal for wisdom and the ability to remain calm. The biggest answer to prayer was the people that God put in place to help take care of Dawilshe.

The next day the University of Miami was called and she was still on the vent with a diagnosis of pneumonia. We called on Thursday from the Port-au-Prince airport and she was still on the ventilator but was having to be sedated because she was becoming more active, which tends to be a good sign.

Haitian children

Pierre Lunistia says "merci Bo cue" (she's holding one of the toys Darin & Robin's kids sent to Haiti with Darin for the kids)

Photo of another joyful patient. : )

I pulled this entry and photos from a blog written by Steve Mossburg, the missionary that manages Project-Help-Haiti. He wrote it on Monday and posted to his blog, http://www.project-help-haiti.blogspot.com/:

Over the 11 weeks we have been doing disaster relief all of us here at Pierre Payen have had to be willing to step up and do things we really never trained for or possibly signed on to do. Last night being a make shift ambulance driver was one of those jobs I didn't sign on for. Yet, medicine and missions go hand in hand. I normally don't live here at Pierre Payen, I have my home up at our other compound at Borel. During the last last 80 days I have stayed here at our medical compound all but 20 of those days taking care of the needs of our visiting medical teams. This time spent here though physically exhausting has brought to life a small glimpse of Jesus' work of bringing hope to the multitudes of the sick. I can feel for Jesus when I read those passages in the Bible where he was overwhelmed with requests to help and heal everyday. Last night after I had returned from a day of working at Borel and being stuck for 40 minutes in the middle of thousands of people participating in a large street parade called a Ra Ra, I was ready to call it a day. At about 9:00 pm Elizabeth Bonnell, Dr. Ric's daughter, knocked on my door and wanted to know if we had a vehicle to transport a small baby to the University of Miami Hospital in Port-au-Prince. I had a choice of 2 vehicles to take, either a large stake side truck or my small 4x4 truck. the big truck ended up being the only choice as it had good bright lights which is a necessity when driving after dark here. The little eleven month old was near death when she was brought here by her parents, it seems she had chocked on some pureed bean sauce. Our doctors worked frantically to revive her but had pretty much given up being able to save her. Yet, a few minutes after a group prayer, the little girl showed signs of hanging on to life. The decision was made to transport her with a full medical support team with oxygen and IV the 1.5 hours to University Hospital (a tent field hospital). Though always dangerous to travel at night, the road was clear of traffic and there was a full moon to give a better view of the road. As of this writing we don't know the fate of the little girl, but before we left at 12:30 a m to go back to Pierre Payen she was greatly improved. Bedtime arrived at 2:30 last night for the ambulance crew. In God's love , steve

This is a picture of the Haitian girl that flew down on one of the 2 planes that took the guys from Ft. Lauderdale to Haiti on Saturday morning. The other picture is of the film crew from 60 Minutes, riding in the back of a truck filming the journey. This entry was written by Steve Mossburg, the missionary and manager of Project-Help-Haiti and posted on his blog on Sunday:

Saturday, as has been the case for the last eleven weeks, was team transfer day with team 10 leaving and team 11 coming in. Nothing different about that except for multiple flights and times for those departing, 3 to be precise and 2 coming in. The ones coming in were the challenge as they were both privately owned planes arriving an hour apart at two separate airports. These are simple things, at least to me, as I have become accustomed over the years and know that by day's end all will have worked out. The big challenge besides what I normally deal with was that Saturday we had to deal with working with a film crew sent here by Dan Rather Reports. They came to do a story about a 13 year old girl who was an auto/pedestrian accident victim brought to the Pierre Payen hospital the first week after the earthquake. The little girl whose name is St. Filia owes her life to the fact that the earthquake brought doctors here to our hospital that were able to administer life saving procedures. It was through their efforts and skills that she was stabilized enough to get airlifted by private plane to Fort Lauderdale, Fl. There she went through several surgeries to repair her crushed pelvis and internal organs that will allow her to walk and have children at some point in her future. Yesterday was the final part of her 2-month journey to return home and be reunited with her family and community. The challenge for me was to incorporate the transport of not only a very large medical team with supplies but a camera man, a producer, the pilot and his friend, a reporter, St. Filia and Lesly, an American-born Haitian who worked out of the Ft. Lauderdale Hospital as an EMT/fireman where she received her treatments. The 60 mile drive out to Pierre Payen was interrupted by the film truck at times behind us, other times often driving beside us and several times speeding ahead to set up a film segment as we drove through certain areas. Once we arrived out at the hospital they shot for several more hours as she was reunited for the first time in over 2 months with her family. Then we drove to the site of the accident where we found the lady who lifted her off the street after she had been hit by the bus. Finally we took her to the home of her cousin where she would being staying. Everywhere we went crowds gathered who were amazed to see her alive and able to walk on her own once again. Finally and almost right on time as scripted we drove to Club Indigo where a private helicopter awaited to rush the film people back to the airport to fly back to the states on their privately donated plane. Oh, I might also add that after the film people left I headed back to Pierre Payen got cleaned up and headed off to a wedding reception for one of my P-H-H employees. Bedtime came around eleven o'clock last night. These events that transpired yesterday may sound hectic, chaotic and exotic to many of my readers yet they have since the quake been a normal part of my life. I head home in four days for the first time in 3 months, that seems exotic to me. When God led me here eleven years ago this coming weekend, April 4th, I never dreamed I would still be here nor my life would be what it is today. Now and for possibly another 10 years Haiti will continue to be my normal life and the U.S. the exotic life of my dreams. In God's love, Steve

A Smiling Patient