27/8/2011

Day 8
Saturday is finally here!!!!!!
I'm so ready to go home....
I'm up & ready to check in for my last 6a shift. Our shuttle is suppose to pick us up @ 12:30. Bags need to be packed & out of the room by 9am. So it only makes sense that I don't take a patient assignment today. I'm smiling:) I will be there in the unit to offer my services/support . Since I have limited cash, I am going to try to barter with an "artist" here that has several many pieces of artwork & figurines displayed.

So for $22 I got two figurines of mothers holding babies & a painting  for my kitchen. Excited!!! The word on the streets is that port Au prince is known for it's artwork. I'm bringing alot of Haiti home with me, mentally & physically. I purchased Brooke an personalized bracelet. I'm sure shell toss it to the side, hence it's not a toy:)

Bags packed & I'm ready to go. I've donate my sheets, to Saul, one of the interpreters whom made a special request for them:) I gave my tennis to Kati, an Haitian day shift nurse that I worked with often. All of my left over food when into the stash of everyones else's and will be given to one of the interpreters, per Dr Sam request. Dr Sam volunteered as the American ER doctor for the previous week, but went home on Tuesday. This was his 2nd time volunteering.

I'll say my goodbyes today & take the last of pictures I can. I dropped my camera earlier in the week & my lens has been acting crazy ever since. Working when it wants to. it's rather difficult, rude & inhumane to take pic of those whom are suffering. So that leaves little for me to capture. I'll do the best I can.

Last death of my stay.
I pop back into medsurg to see if my help is needed and I see chest compressions are beginning, SMH. I just turn my back. This young lady came in on Wednesday afternoon looking like a classic liver failure patient. Sunken eyes & lethargic, difficult to arouse, yellow eyes and edema throughout. Her abdomen could pass for ascites, but unfortunately she's 7 months pregnant & the baby has died I utero. Uncertainty of how long the babies been dead, doctors ate saying this mom is suffering from HELP syndrome. Plan of care to send her to the on hospital for delivery & care. She lays in our ER for 3-4 hours, I guess waiting for transportation , then decision is made that were going to keep her & induce labor. Before I know I'm giving pitosin, vitamin k & antibiotics. To aid in increasing delivery & treating her sepsis. Her lab work has come back and she very sick. Shes unable to produce clots so when she does deliver she will bleed to death. Sad.

Baby was delivered overnight and the mother continued to circle the drain.

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26/8/2011

Day 7
This says it all...
I made the decision that I needed a mental health day! I didn't have to call in or report to anyone. Did any supervisor or DON come & check on me? No!
I slept in all day:) it was so necessary. I was drained. I just realized I've worked 70 hours in the past week! That's incredible, out of this world for me.! All for a good cause. My patients received excellent care, I must say.
The units were staffed rather well by the Haitians from what I hear, because my other colleagues that staffed other units,  where able to get in a lengthy afternoon nap. Were all pooped!

I'm so happy to be leaving port Au prince in 24 hrs. It's been the best & the worst week of my life thus far:)

I have had this lingering sore throat for several days now, hopefully it resolves itself. Or antibiotics will be on board soon.

I've heard death came to visit again today. We received a man in the ER yesterday whom was in a MVA. After CT done, revealed several head bleeds. Pt was agitated & left unsupervised, while yet tied to an back board with a neck brace on. Pt falls off ER cart while yet attached to the back board, restrained. He fell face down to the floor. Attempts were made to transport him to a facility with a neurosurgeon but it was unsuccessful. Pt continued with increased agitation & eventually died from the head trauma/s.

Lastly I hear my patient I've had all week is not doing well today. She's HIV positive which we assume has advanced to AIDS. She had multiple brain lesions & comes in & out of consciousness. but with the addition steroids & additional antibiotics she was beginning to follow commands & keep her eyes open & track. That made my heart smile. Her family has left her here to die. They do not come to see about her. Unlike all other families seems like the culture is that you come & take care of your loved. You bring sheets, clothes, good. You bathe & turn & complete all cares. Extremely different from American culture.
So I found my lady some clothes & I donated a sheet that was given to me. I also gave her some soap & deodorant that I had as extra. When I was done washing her, she smelled great!!! And looked great:)  believe we bonded on some level.

So maybe when I didn't show up this morning, she became sad. The nurses told me its very hard to stimulate her to arousal. I'll check on her later this evening to say hi or I may wait till the morning shift. I hope she's still around....
Dinner consists of Mac & cheese. I also had some chicken drumsticks & green beans. Last dinner in Haiti.
Looks like I'm going to the UN tonight, maybe......
Another night @ the UN, lol
The UN has been an outlet and a great source of sanity!!! So needed

Scary....we got stopped at a checkpoint by Haitian police tonight. And from what Ive read and seen, there are not to messed with. Crooked cops and corrupt. As the armed(shotgun strapped across chest) Haitian officer approaches  this van of 20, 2 blacks all the rest Caucasians. I feel a sense of fear. I feel like this could easily become an episode of locked up abroad as he begins negotiations/conversations, (who the hell knows because there speaking french) with our driver. The officer requests the front passengers passport, a white girl whose determined to go home tomorrow, so she refuses to hand the passport to the officer, fearing she'll never get it back. He peers at it with his flashlight and asks bout vehicle registration? Who knows! The driver reaches into the glove compartment and shows him papers. You can feel the fear in the van as the nurse next to me whispers that she just "shit" her pants. LOL and that her high was completely blown...LOL!!! I'm sure it is. Please GOD let me make it back to safe soil.

We were eventually let go after about 5 minutes. During that time there was another office checking vehicles and pedestrians as they approached this check point.




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25/8/2011

Day 6
Dead @ delivery..tap tap
Favorite patient goes home
8 month dead in ureto & mother dying from DIC
1st admission...Left breast mastectomy
4year old tetralogy  of flow dies... Never repaired
Traumatized by mva patient that fell off ER stretcher face first, whom eventually dies, after driving all over the city looking for a nuerosurgeon to fix his head bleeds. No one would take/assist him. So back to Bev Menards he comes, to die, because theres nothing here we can do for him, but provide him with a bed. This has taken the cake for me!!! The trauma lies in the fact that he fell off the ER stretcher while still secured to a transport board. On top of all that how is it that there's at least one Haitian dr and two haitian nurses standing in the area and I along with another colleague respond and assist in picking him up off the floor, faster than those surrounding him. My heart aches.......
I decided that I'm not working tomorrow!!!! Mentally & physically I have been pushed to the limit. Mental health day for me. I declared it.... Now what!!

Night @ the U.N. Last night with robin & Julie the berkley residents:) good gals!!! Robins been traumatized by delivering dead babies.

It's been a taxing day!! Port Au Prince is sad & resilient all at the same time.  Bev Menards hospital is a sad place. Its a place of last resort. The people arrive here in the worst shape possible. Its a place to come and die. I'm ready to go home. Happiness misses me.

Random but true. My ankles are swollen like tree trunks. I feel abused.


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24/8/2011

Day 5 Wednesday

Good morning!!!
It's going to be a good day. No death today. But night shift had it hard. An 4 year old asthmatic died from breathing really hard for 18 hours. She was dehydrated & needed to get intubated, the anesthesiologist was unable to get a line for access to intubate. She later died. The grandmother whom brought the baby in tried to commit suicide by banging her head on the ground and attempting to cut her self. She grieved for her grandchild. Bless her heart. She took the babies urine and wiped it all over her body.  The child's mother is in the hospital. Staff later had to sedate the grandmother & send her off via ambulance. My prayers are with the family.

4 patient assignment today:)
Nathan mission worker from another organizaton with dengue wants to die in Haiti. Cipro/Tylenol & he misses fligh twice, despite all the doctors warnings that he needs to get back to the US for care and recovery. Nathans another story. He's in la la land.....

I've secretly have a favorite patient, #4. Older man. Reminds me of an grandpa. Very patient & quiet. I finally properly introduced myself to him today. He informed me that I treat him very well. Hes recovering from abdominal surgery. It's day 6 post op for him and he should be able to go home tomorrow. I want him to stay till Saturday. That's when I leave.

Two days to go. Today seem so regular to me. Like I've fallen into the routine of things. I was able to chat it up today in surgery with 2 twin brother general surgeons. Haiti born, but schooled in Europe. I discovered there's an HIV outpatient clinic!! I'll try to go visit it tomorrow, excited. Also spoke with the hospital social worker & psychologist & supposedly I'll get to round on the inpatient HIV unit. Looking forward to it!!

Got a lingering headache & sore throat....very sleepy. Gonna hang out @ the UN only because two of my fav res doctors are coming & they haven't been able to get away from the hospital. It's about 20 of us going to hang out. Picked up 2 kids here at the UN doing mission work & one potentially has malaria? I don't understand how you come to a third world country to do mission work and not getting vaccinated!!!???


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23/8/2011

Day 4
Good am. Were losing 4 of our ER/icu nurses today. That's a saga...Because hurricane Irene's headed toward Miami, and flights are cancelled for the next 2 days. Boy are they heated. They want out and they want out now!!! I dont blame them, but sometimes you have to have peace and be still. Especially under these conditions. They finally find a flight out on Thursday, $1,000 a piece ( Medishare will reimbursement) 22 hour flight into Panama City, one other stop and final destination San Francisco. 2 hour ride from san fran to Sacramento. Whatever works. They made it home and guess what.....they used some of my blessed oil:)

Sick ER dr. Sick emt...

HIV antiretrovirals from home taken to Martin in pharmacy

City tour

Phone call with Mr Bly

Ramen noodles for dinner

Good night


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22/8/2011

Day 3
6a-6p
I'm ready to go home. It's sad. But if I weren't here, the quality of care would be even worse. So I'll suck it up. Today i gained 2 additional patients. Total patient load...5. 2 nurses for 12 patients. Again this is why I don't do med surg!!!

I've gained a older nonverbal man whose been seizing all night & a 12 year old orphan who had a block fall on her back. Whom now has a spinal injury & shes unable to walk.  In addition to being an orphan, she was raped & presented with having a STD. Long pause.....

The morning starts with coding of one of the icu patients, whom dies.A young lady whom had been suffering from a pulmonary embolism and whose respiratory drive had been long gone. She basically could no longer breathe on her on and her heart was tired of trying to do all the work. Sad that we were just sharing smiles with each other less than 24 hours ago.  OK absolutely not the way to start the morning. Breakfast consists of boiled eggs, bread, cheese spread & banana. Yummy!
By noon another demise:( a visitor walks up to me & tells me that she thinks the patient is dead. I go and look & the patients mouth is O. I'm hightailing it to find a doctor. Sure enough the patient was dead. She was chronically ill. The family gave such a show. I never seen grieving to this degree. Overstimulation!!! The family danced & cried & crouched over the dead body & screamed, and threw their bodies to the ground, hit their heads on the wall. Peeing on themselves. I see some Voodoo presenting itself. Quite a scene!! For all...patients & families. Just sad:(
2 deaths in less than 6 hrs. Time for a mental health day. I hope this is not what hell feels like... It's awful here... Hot humid & tons of body odor. I wiped up enough  poop  !!!! the past two days... I hope I've earned my stripes:) Lord God please let me into those Golden Gates.

Dinner... beef,rice, slaw tomatoes, eggplant.

My little orphan girl gets  transferred to Med surg A, which is full of spinal cord injury patients. She'll get even less attention over there. At least in Med surg B, the nurses played with her, combed her hair, bought her toys and snacks. Took her outside in a wheelchair and let her sunbathe for a while.

Phone call to Brooke

UN (United Nations Bar & Grill) with crew....

Side note, I woke up this morning  scratching my butt cheek for about 2 minutes, subconsciously.
only to realize I had 4 large lumps horizontally.., Mosquito bites!!! Malaria... omg!!! Race brain begins....I've been slacking on the mosquito spray


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21/8/2011

Day 2
Shift begins @ 6a-6p. Breakfast served at 10am & lunch @ 2p. Meals are cooked by some local Haitians? Saturdays lunch was meatballs & rice & tomato & corn salsa. Sunday breakfast beef & cabbage soup with bread.         Dinner consisted of BBQ chicken, rice & pigeon peas, potato salad , garnished with onion & cucumber.  The meals are good. Starchy...but good. And..... No travelers diarrhea!!! I'm all about the food:)

Today was a much better day as far patient care/routine. I felt in control & confident. I took the  same 3 patients. An HIV+ women with brain metastasis, unconscious & responsive to stimulus. An elderly man with abdominal pain &an abcess & lastly an 61year old woman with an history of breast cancer. With c/o r hip pain/ & lower extremity weakness. She also had a decubitus on her right hip about 4x4 in size.

My biggest barrier with patient care was the language barrier & having to use an interpreter for every interaction.

The are no nursing rules here!!! I write my own orders, there no pumps! Everything's manual. No electronic nothing!!! There's no hierarchy of order. Everyone's equal on a first name basis.  You have to be very creative!!! I've seen very interesting things here....

The Haitian nurses are... Dedicated/powerful/humble/smart/proud women. I have to take my hat off to them....

I learned two french words
Merci... Thank you
Wee.. Yes
Bonjour... Hello
I'm trying. I tried to learn "how can I help you?" but it didn't sound good:( I'm working on it.

So I'm all over this journaling. Making it a point to journal daily. I often have scatterbrain, which will be reflected. I'm using the notepad app on my iPhone to store my memories. Journaling occurs @ night in my bunk. It's my time to De-stress and put my thoughts out here in the universe.

I share a room with 4 ER nurses. 1 nurse midwife. 1 med student. And 1 ophthalmologist from Mexico. The ER nurses are from Sacramento & there pretty much trauma freaks!!! Typical ER nurses. But party girls. The midwife older & mellow. Maybe was a hippie in her time.

So sad news I death today. I happen to see her take her last breathe. History of HIV DKA & Steven Johnson syndrome. SJS is very rare & presents as an burn case. Sad day for the family & the Haitian icu nurse.

So at this point what do i miss the most?????
Wine,Brooke, hot water & fresh fruit!!! In no particular order... Lol!!!

There's tons of hype around a tropical storm coming this way. Monday into Tuesday. I'm going to pray. And I got my blessed oil:) I'm covered. On that note, goodnight.


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20/8/2011

Just touched down in Haiti. Local time 7:30am. Day 1 of 7 nursing mission work.

Arrived at hospital via truck of 8, sweltering hot. Next truck carried our luggage. The drive from the airport to hospital last about 10 min. The city looks rather sad. It breaks my heart to see a city so ravaged. Tents camps in 90 degree weather. Chaos in the streets. No organization whatsoever.
Once at the hospital orientation takes place in the cafeteria/computer/kitchen. takes about 2 hours to go over protocols, rules/reg etc. The Haitian people are all over the hospital grounds. Waiting for service & caring for loved ones.
Time for a tour. Rather sad, the state of the people here.

I'm going to pause to try to nap before night shift begins @ 6p. Med surg unit. This shall be interesting.....

Awaken @ 1p by DON to be told that I need to work day shift. YAY! Hadnt worked night shift in 4 years...... Due to lack of staffing. 3 nurses called off before the mission started. So I had to regroup and get my mind right!!

Off to medsurg B. An 10 bed unit shared with a 4 bed icu unit. And a 2 bed ER. Here we go....sink or swim. I have an 3 patient assignment.

Feelings... Scared! Nervous! Ansty! What did I get myself into....I wanna go home:) the patients look miserable, it's 100 degrees & there's fans blowing hot air. Theirs an elderly woman moaning groaning & trying to crawl out of bed. There's no privacy. Boobs & butts hanging out every where. And there's a huge language barrier. Haitian creole is the native language. An interpreter is used for all encounters. There are people just hanging out in the courtyard. The hospital is considered a safe haven. I'll soon discover that at night, it becomes sleeping grounds for many.

TBC....

Day 2 Random thought as I am sitting outside pharmacy waiting for Tylenol. I am thinking it's day 2 & what have I gotten myself into? This medical surgical unit is why i don't want to do inpatient care. Long term chronic illness....

BTW... cold water showers only for the next 7 days


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HISTORY: Nursing mission work in Haiti

This is my attempt to share my journey/experience of traveling to Haiti for 7 days with Project Medishare.
I am very excited because it has always been on my bucket list to do mission work, and now its finally coming to past. One small disclaimer, my grammar and writing will be very loose/informal, hence it is a blog. There will no such of editing going on here, so bare with me please.

I heard about Project Medishare about 3 years ago and initially I was going to attempt to complete the mission with some of my nursing classmate/colleagues at the time, but hence it was during August (hurricane) season, no one wanted to join. So I let it fall in the back of mind, to be revisited at a later date.

Which brings me to now, I received an email from Project Medishare, pleading for nursing help. The email read  that, there was a desperate need for nurses to volunteer and help out at Bev Menards hospital in Port Au Prince. The light popped on in my head and I was on 200%. Whatever I could do to help, I was determined to make it happen. And I made it happen despite what barriers may have come my way.

So I knew I would have limited WI-FI access, so I decided to attempt blog as much as possible on my note application with my handy dandy IPhone. Once again its lose writing and somewhat emotionally based but it what I could or couldn't bring myself to reflect upon.
It's rather ironic that Ive been back from Haiti now since Saturday night and I'm not at work but have been in jury duty for the past 2 days .Today I have not been called upon yet, which has allowed me to get this up and running. This blog is being created after the fact, but all of my notes are during my stay and some thereafter. Enjoy!!

I am excited because my dear friends are throwing me a welcome back to America party this Friday evening. I believe every ones on the edge of their chair to hear of what happened in Haiti. I have to be completely honest. I feel as if I am suffering from a form of PTSD (post traumatic stress disorder) . I have avoided any conversations and details mostly about my experience in Port Au Prince. I find myself thinking  words cannot express what I experienced nor can the pictures. You had to have been there to feel what I am feeling. Sadness, despair, resiliency, power. determination.......


I am very proud of myself. I felt as if I were going to have a meltdown prior to departure, because those around me made me feel as if I were going off to war. But I now understand it was just their fear of the unknown on their end as well as mines. I did not know what to expect at all. All I knew was that I was going to help those in need.

The meltdown happened once I got back to Miami Saturday night and I was in my hotel room. I sat on the floor next to the bed and began a phone conversation with my significant other. Midway between the conversation the silent tears began to flow as he began to ask me about my trip/experience. I was not ready to talk about it. I still don't know if I am ready to talk about, but I believe that is where I will find my healing. Meltdown number two happened after I spoke with Brooke on the phone. I had also spoken with her earlier in the week while in Haiti. Yet when I heard her voice, it did something to me. I kinda lost control, because as we were talking she says "Mommy why do you sound like that?" she could hear my voice crumbling. I told her it was because I missed her so much.

The onset of emotions truly began when I stepped foot into Miami International airport. As I waited at baggage claim, it became so real to me. I was home. I was in the U.S. I felt comfortable. I felt safe. It felt familiar. I could feel the lump growing in my throat, but I let it pass as I said goodbye to the new family I had gained over the past week.

I must say we were a brave group. The anticipated group of 27, was actually a group of 11 or 12 .Quite a few nurses backed out at the last minute, for various reasons. So there was myself, an ER nurse from Long Beach, an PICU nurse from Minnesota, an ER tech from Baltimore, 2 third year residents from Berkley, an ophthalmologist from Mexico city, and Flight nurse from I cant remember, an New grad nursing student from Michigan, a 1st year med student from the Boston area, an orthopedic surgeon from Boston with his son, and last but not least a nurse midwife from the Bronx. There was also a group already there that would overlap with us until Wednesday. 4 ER nurses from Sacramento, an ER doc from Minnesota with his son who's an EMT and another ER nurse from the Minnesota area. It was the second mission trip for the Orthopedic surgeon and the ER doctor, they responded when the earthquake first hit and gave care to thousands out of a tent hospital set up at the airport. The nurses from Sacramento were actually volunteering for 2 weeks versus 1.  Hats off to them!! I couldn't have made it through the 7 days without any of them. There was so much love and bonding going on amongst strangers, but only for a short time. We shared many emotions, lots and lots of sweat, laughs and tears/frustrations.

I could ramble on & on, but I think I'll stop and post my notes now:)

ENJOY