Update from former SF Medic (18D) Mark Hayward: 100120 Haiti (teamwork) The day got off to an early start when I woke up a few minutes after 6AM because somebody was shaking my tent. I found this irritating, as I was planning on getting up at 7. I became less irritated, and much more intrigued, when I realized that I was experiencing my first earthquake. Frankly, it felt as though I was lying on a bunk in a sailboat at anchor, being hit by the wake of a very large passing powerboat. The ground wobbled, like jello. This went on for a little while and then faded away. I considered going back to sleep, but the yelling and excited conversation caught my attention. When I heard Jeff describing how he had been washing his, uh, nether regions, with baby-wipes inside the presumably empty novitiate building, and upon feeling the earthquake, had sprinted into the courtyard wearing only his flipflops, I laughed so hard I figured it was time to get up. “Normal” is a word I wouldn’t really use down here, but I suppose we are developing a little bit of a morning routine. We packed medical supplies, reviewed our possible missions for the day, mixed up oral rehydration salts, and headed out to the general hospital. (No soap opera jokes, please; we’ve told them all several times.) Our numbers and logistical requirements have grown to the point where we were traveling in two tap-taps and a rental Suzuki from the DR... We looked carefully at the buildings as we drove along (occasionally being cheered on by locals shouting “We love you! Thank you!”) And when we got to the hospital, it had CLEARLY been devastated by this morning’s earthquake, but not at all as we expected. The BUILDINGS were completely intact. But, in a very understandable act of caution, all of the PATIENTS (and their beds) had been moved outside onto the paved street surrounding the hospital courtyard. And, in a predictable though very problematic excess of caution, the hospital administrator was unwilling to allow the patients BACK into the buildings until it had been proven beyond a reasonable doubt that it was safe. And so, when we arrived, the patients were still outside. On their hospital beds. In the sun. Largely unable to move due to their extensive orthopedic injuries. Without water, because the hospital staff themselves were on the verge of running out of water. And, as we found when we asked the logical next question, many of the patients had also been without food for 2 or 3 days. Needless to say, our immediate responses were to get cardboard sheets as shade for as many patients as possible; secure and distribute drinking water; and have Jeff and Craig (our firemen) do a top-to-bottom building assessment to see whether the hospital itself was in any danger of falling apart. What they determined (before the last sheet of cardboard had been cut) was that there had been no appreciable change to the structure since yesterday. What they next determined (before the last cup of water had been distributed) was that the hospital administrator was not going to accept any authority less than that of the US Army Corps of Engineers to declare the building safe for habitation. And so we set to work turning a street full of randomly scattered beds into a functional, non-injurious open-air emergency room. Although I tried to focus on patient care, like Dr. Griswald, I simply couldn’t carry anything through to completion as I got more and more involved in working on the shade-water-organization-food problems. Solutions that I can describe in a few paragraphs took hours to carry out. Many of the patients had arrived after our departure from the ER and they had no registration slips (with minor information such as patient name, age, injuries/medical conditions) and previously rendered treatment. Patients who had already been scheduled for surgery when we left last night, such as the grandmother with the pelvic fracture, were still exactly as we had left them, except of course for being outside in the sun. The beds were jumbled any which way, mixed in with patients who had been brought in on boards, doors, and other random platforms and left on the sidewalk. And, of course, more patients were coming in all the time: not a flood, but just enough of a flow to ensure that any space opened for any duration of time would very quickly be occupied by more patients. Dr. Griswald was evaluating and directing treatment for patients with passion and skill. The two nurses and three or four technicians were doing yeoman work trying to actually provide the ordered care to the right patients. But every act of medical care was taking place in a continuing welter of chaos that doubled the time of every action and virtually ensured that critical injuries were overlooked or left untreated. Dr. Dolhun had been grabbed for surgery as soon as he arrived (fortunately the ORs, in another building uphill from the main hospital, had been declared safe, so surgery was still taking place.) However, Dr. D never even made it up the hill to the OR; he was grabbed wile passing through the doctorless OB “ward” (in the middle of the courtyard) where eight to nine patients, two with acute medical problems, were actively laboring and trying to deliver new lives into the world under the bewildered supervision of one non-OB nurse. That took both of our doctors “out of the fight,” so to speak. My decision then was either to focus on patient care alongside Griz, or to take charge of the effort to change his work environment so that he could actually manage all of our patients. So I took a deep breath, mentally removed my “PA” hat, put back on my “Army problem-solver” hat, and along with the rest of Team Rubicon got to work making order out of chaos. First order of business was...
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Posted
Jan 20 2010, 11:01 PM
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