quotes to remember...

"'I told one of the volunteer translators that I wanted to do something nice for him before I left, 'Why,' he said,'you are a volunteer too.' 'Yes,' I thought, 'I am...but I'm going home at the end of this, and this is your home.'" ~Tammy an RN from CA.

"White is so good," Juanito said grabbing my hand. "Black is bad, white good." He muttered looking down at our arms. 'No!' I said, 'Black is beautiful! You are beautiful.' ~Juanito is about 13 years old.

"I figure if the worst thing I leave here with is scabies I'm doing pretty good. " ~Tammy

"I always think I'll make a difference here, but the people always bless me." ~Michellin, a Haitian American.

(After being taught to squeeze the mango until soft and drink the juice out of the hole in the top) "But the center is still hard?!?" "Uhhh, that's the seed, Jessica." ~yeah, that was me.

"If it had fallen on my head, I'd be dead." ~elderly man with a broken and infected leg.

Luke (after stopping at it three times): "We found the one stop light in Port-au-Prince! ...wait, (to driver) is this the one light in Port-au-Prince?" Driver: "Yes."

"...okay, so really....how many times did you flush the toilet paper...?"

Patricia: "We're going to visit ADRA!!! Me: "Ok, what's ADRA!?! I ain't no Adventist!" Patricia: "Oh, right. Adventist Disaster Relief Agency. And you will be when we're through with you."

"A couple days after the quake there were over a thousand people living on the hospital grounds, one morning someone started singing, 'What a Friend We Have in Jesus.' It poured through the whole place voice by voice. Wow, I thought. What a friend we have in Jesus." ~ Dr Scott Nelson

home.

Twenty eight days ago I sat on the roof of my Uncle's beach house in the Florida Keys looking at the ocean, towards what I imagined was Haiti, and wondered if I would ever get there. I had been signed up with three different organizations since January 14th trying to get there. They had all fallen through.

I wondered many times if it was God telling me not to go. That despite the strangely strong calling I felt towards the disaster maybe He didn't want me there. Maybe I couldn't handle it.

I don't think I ever believed that I was going to Port au Prince until our plane landed at the tiny airport. It was strange how familiar the place felt (due to my time in TZ) and how incredibly at peace I was being there. The first two days were frustrating and overwhelming as many of you have read, and I wondered what in the world I had come to do.

On the sixth and last day I got it. After loading our critically ill patient into the Land Rover turned ambulance I was finally understanding. After we got her situated with medications in hand and vital signs visible and stable I had a moment to stop and notice what I was doing. It was odd, but I knew that this was what I was meant for, this was why I had come. This was why I had changed my major from theatre to nursing, gone to summer school to catch up, failed a class my first year in the program...and not given up. This was why God had led me to extern in the emergency room for a year and a half. This was why I had stayed in Macon at a trauma center. This was why I had chosen to work in the Surgical Trauma ICU over the other four areas of critical care. I never knew why...and had often thought I may have made the wrong choice.

When beginning nursing school I never wanted to be a nurse in the United States. The last two years have been wonderful. I have loved and liked and disliked my job. I have struggled and cried and laughed and screamed. I have learned.

I attended the Urbana mission conference in 2006 hoping to find a way to do nursing overseas. I met a missionary nurse from India who told me to absolutely not go on the mission field until I knew how to be a nurse. I knew she was right, so I didn't.

Now, four years later, I know how to be a nurse. I'm not a great one yet, there is still so much to learn. But when a sat hovered over my patient speeding down the streets of Port-au-Prince, dodging people and pigs and rubble, in 100 degree heat wearing scrubs filthy and wet with sweat hoping to get a woman whose name I did not even know to a facility that could keep her alive, I knew that I was finished. Finished waiting to be ready. Finished preparing for some great unknown. Finished wondering if I could ever live and work and grow and serve in a third world country. I knew that I could.

The last twenty four hours have been full of tears and questions and longing and missing. They have also been full of hope. I realized today while driving the 1.5 hours from Atlanta to my house in Macon that there was no reason for me to be so sad. There is nothing keeping me from quitting my job, selling my possessions, and moving to Haiti or Tanzania or Honduras. There isn't a lack of education, experience or support making me insecure.

I simply have to decide. Decide through prayer and petition and council and advice, but there are no limitations on what God can do with and through me. How amazing. The God we serve is so huge and so challenging, so hopeful and so direct. He's controlling and jealous and guiding and fulfilling. He loves being glorified.

And He is. Even through destruction and death and trauma. Through earthquakes and orphans and sickness and deformity. I don't always know how, but I know that it's true. I know because I have seen it.

...on a jet plane...don't know when I'll be back again.

I finished up my assigned patients (wound care for the whole hospital) early today and was eating lunch when I heard that there was a code blue going on in the ER. Apparently she had been breathing terribly when she came in and needed to be intubated. I decided that I would go see what was going on since I didn't have an assignment for the afternoon.

I walked into what had obviously been a critical situation (the room's alwaysa a mess after a code...in this case it was the middle of the hallway with at least six patients watching). The patient was on Dopamine, being bagged(intubated) and had been given sedation and paralytics. For the time being her pulse and blood pressures were good.

We set up suction and placed an OG tube...the ER MD had already started a central line (amazing! I had no idea we even had them). After awhile our director arranged for transport to Miami University's hospital in Haiti located by the airport. An ER nurse, the ER MD, and me...the ICU nurse were elected to take the patient. However, it is a national holiday (Haiti's Independence or Flag Day) so everyone was very concerned about whether or not we could make it. Apparently there had been rioting downtown and the traffic was supposed to be terrible.

We loaded into the ambulance, sirens and all and took off on the Haitian roads. There was actually less traffic due to the holiday I thought, but we still ended up driving on the wrong side of the road a lot of the time. It only took us 25 minutes to travel to the hospital where we learned that they had an ICU with three vents...which were all occupied. I am not sure what the plan was, and I began wondering why we had taken her there to begin with. We could have turned one of our four ORs into an ICU room with a vent.

The patient was still critical when we gave her over to the receiving doctor's hands, but they had more than enough help. I saw at least four ER doctors (compared to our one).

The ride back was eventful as well. I got to see the palace! And there were rioters in the street. I don't understand why they were upset, but they were insistant that we not take pictures...which we did. Later we passed a parade which was pretty cool to hear the band and see all the children marching.

I am not ready to go home. I think it would be perfect if I could stay until Monday. I have finally gelled with my teammates, gotten to know patients by name, and even heard a few "where were you when" stories. The faces of the Haitian people will not be forgotten.

Nadine does not know how old she is. Someone found her sitting in a market crying because her pain was so unbearable. They brought her to the hospital. She used to live with her aunt but she does not know where. She was diagnosed with HPV and has massive lesions all over her abdomen and buttocks. She is in constant pain. The callouses on her feet are about an inch and a half thick...like nothing I have ever seen. She is beautiful. I would love to take her home a give her a...life.

The doctor today told me that they are not doing anything else for her, that she could probably be discharged home. Well, I said...she really has no where to go. She's too young to take care of herself, too deformed to get a job, and in too much pain the walk further than across the room.

But Haiti has help. I am not sure for how long. But for now there are volunteers everywhere committed to seeing the situation improve. I hope that we don't bring about more long term destruction than short term improvement. But I have to believe that even in six short days some impact has been made.

5 ways to lose your nursing license.

5. Write prescriptions...tetanus shot anyone?
4. Treat over twenty patients (wound care) without reading a single order or even looking at a chart.
3. Regularly fill prescriptions with a different drug than what was written.
2. Carry morphine in your pocket and give patients a little extra when no one is looking and...

1. Tonight I was sitting on the hospital steps and a lady approached me with a bag of medicine (vials of pain medicine)she told me through the translator that she was in pain and needed someone to give her a shot. He asked if I could do it. "umm, I don't know this drug and....where did she get this?" He told me that she had gotten it from the hospital for her pain (I hope that was true). I said, "okay and she wants me to give her a shot?" "Yes." "Okay, one minute." I ran inside to the pharmacy to "get an alcohol swab," located a drug guide and looked up the drug. It was an IM (given in the muscle shot) and an NSAID...something similar to Tordol (the same class as Advil but stronger). I checked the dosing to make sure I wasn't going to kill her. When I walked back outside she had already dropped her pants(on the hospital steps!) ready for the shot in her butt! Hilarious..."Wow, I thought, only in Haiti."

Port-au-Prince

sunday.

I finally did some post-op trauma work. Today my team was only scheduled to work until 12:30 because the afternoon was set aside for our tour of the city and dinner with the medical director.

I decided to stay out of the ER and do wound care on the ortho floor. What an adventure. The ortho floor is all patients with injuries from the quake. Most of them with multiple fractures now held in place with external fixators. I don't really understand why these patients REMAIN in ex fixators this far post-op, but that isn't something I've been able to ask the ortho MD yet.

I loved doing the dressing changes because I was able to be in control and do as I wanted. Thinking back on it now it would have been better to train a Haitian nurse in the correct way of doing it...maybe there is still time.

My ICU protocols kicked in as I searched the pharmacy donation rooms for any kind of barrier creams...so many patients are stuck in bed on terrible mattresses that they are now getting bed sores! Again, education is key!! If they would only turn the patients major wounds could be avoided.

The afternoon was a drive through Port-au-Prince and dinner at the Medical Director's sister-in-laws hotel. It was obviously built for American visitors and was far nicer than anything I thought we would get to see. I even got in the pool...amazing in 100 degree heat. There is so much that the people are not saying and we Americans are afraid to ask. At dinner the Director opened up a little, telling us that his family (all seven children living in Canada) were unable to reach he and his wife after the quake. He said they alerted the Canadian news to the fact that their father was a doctor in the PauP area and he said the DAY AFTER the quake he had Canadian media at the hospital looking for him! Amazing. The Americans and French followed the next day and competed for thanks.

I am eager to get back to a full day of work, since the weekend has been much slower paced. But I hear Mondays are terrible here, so maybe I shouldn't wish it upon myself. There are three ER nurses here from California so I think I will steer clear of that stressful environment. It's hard to believe we have only two days of work left...I feel like we just arrived.

Sabbath

Tonight is the first day I haven't left work with a headache. Not because it was any easier, but maybe because I'm learning to let it go.

Today was the Sabbath which means almost no one was working at the Seven Day Adventist Hospital. It was nice to have fewer patients and fewer Haitian staff to conflict with, but frustrating that no one in the lab or pharmacy was very helpful.

There is such a lack of education here. I discharged a patient with a prescription for Tylenol and she brought me back the script because the pharmacy told her they didn't have the drug. So I walked myself down to the pharmacy to discover that the pharmacy tech didn't understand that even though the prescription was written for 600mg tablets, it would be okay to give the patient more 250mg tablets and instruct her accordingly. I'm also not convinced that any of the antibiotics we are giving out will be taken on any kind of schedule...the people rarely wear (or own) watches here. How will they know to give their baby amoxicillin every 4 hours?

Today while cleaning out an exam room (organizing the supplies) I found a box of vials of morphine. I think I cussed. We spent over two hours trying to find IV narcotics yesterday. We had an ER patient in desperate need of pain medicine and apparently we have no morphine in the hospital. There is limited Dilaudid but they keep it in the OR on lockdown.

I really wanted to hide the morphine for our ER patients, but I took it to Luke who about fell out. Clutter and disorganization once again.

If anyone knows anyone still sending supplies to Haiti...tell them to send morphine and Normal Saline. They are like gold here. And out hospital is almost completely out of both.

We walked the four blocks to the Adventist University today. Johnny,one of the Haitian Americans on our trip told me that he attended classes there in the 90's. The entire campus is now a tent city, and even though most of the buildings are intact, no one seems to be living inside of them.

I asked Johnny what it was like. Seeing his old university like this. He said on his first trip over (a couple months ago) he couldn't sleep or eat when he returned home. Completely dumbfounded. There are two other Haitian Americans on my trip seeing Haiti for the first time since the quake. I think it is the hardest for them. They have tears in their eyes while the rest of us just have dropped jaws.

The highlights of my night were buying a coca-cola off the street...flavored water is getting really old already... And talking to my siblings...always the greatest encouragers.

Time with the team has been wonderful today, despite the awkwardness of church this morning. I feel like I am finally getting to know a few of them and learning so much. Danielle, our leader is quite a little warrior. She told me the story of how she came down here on her own at the end of January. Everything possible went wrong with her travel "plans" but she made it and God used her hugely in the first few weeks after the quake in everything from supplying baby formula to making the first contact with her cousins.

Tomorrow I'm taking a break from the ER to do some wound care. I'm looking forward to seeing some trauma patients. We'll see how it goes.

photos

a tent city child: team meeting: my hernia repair: active MI patient with two Canadian volunteers.

day two

A somewhat more sucessful day in the ER, although I have yet to see a single lab result and the squatters are still...squatting.

They seem to throw us a new ER physician each day from some volunteer agency so the morning mostly consisted of my explaining to the new ER guy (who won't be there tomorrow) what to do...so effective. He was very good though and between a 14 year old who ran in the door with his thumb hanging off and a man hardly able to stand likely dying from lung cancer (but we have no biopsy measures) we had a pretty productive day.

My favorite part of the day was leaving the hospital. Luke, the interim "guy in charge" who has no medical expereince but somehow seems to always know the answer, asked me if I'd go with him to transfer one of our sick babies to a more capable hospital. She was burned over 40% of her body in a cooking fire several weeks ago, but the burns were not cared for, so when her pregnant teenage looking mother brought her to our hospital. The plastic surgeons said she was too infected to undergo a skin graft...yeah that's alot of info...but basically the Doctors Without Borders Hospital has some sort of burn unit...we were told. So we took her there.

Just being in a car and able to see the streets of Port au Prince was refreshing...and enlightening. The medians are covered with tents and the camps are too many to count. The atmosphere so closely resembles Tanzania, that sometimes I forget where I am...although I cannot read a word of the language here. Piles of rubble lie in the streets and don't look to be moving anytime soon. Collapsed buildings sit abandoned and I can only wonder how many bodies remain inside. But all and all life seems to be progressing with some normalcy as street vendors, barber shops and taxi services continue.

The journey to the hospital was no less than an adventure. I was in the back seat holding the baby with her mother next to me and the translator beside her. Luke was the front passenger. We'd been driving for over an hour when the momma next to me began throwing up all over the floor and the translator. The driver refused to let her use the towel that was in his car and instead gave her a plastic bag to throw up in as we drove on. I had no medicine with me besides the fluids attached to the baby...so there was not much to be done.

About ten minutes later while stopped in traffic we were rear-ended. Honestly I didn't expect anything to happen. I thought we would keep going, but the driver was not happy. He now had vomit in his backseat and a dented rear bumper. Luke and i were laughing...to ourselves of course.

The driver and translator got out of the car and there was lots of yelling and carrying on and cleaning up of throw up before Luke told them that we really had to get going.

Arrival at the hospital went smoothly and the baby was passed into what I can only pray were capable hands. The journey home included a stop to pick up supplies. An old hotel turned into a distribution center run by some pot smoking 20-something Americans gave us boxes of exam gloves and sterile drapes for to OR. The guy giving us supplies said he'd just shown up to help after the quake, met some other dudes looking to do the same and now they distribute to clinics and hospitals like ours.

It seemed kinda sketchy to me, but we got the supplies.

Tomorrow is their Sabaath, so the work load is said to by lighter, we will see.

ohh, and i'm covered in red dots...but i've only seen two mosquitos...hmmm

DAY ONE

Well the first day wasn't as encouraging as the first night. The disorganization is unbelievable. I'm not sure I've even known the meaning of the word until now. I have been working in the ER as the MD's right hand and doing at much as I possibly can. The chaos is overwhelming. There are no medical administration records, so even if you give a medicine there is no way of knowing if a Haitian nurse already gave it or gives it right after you...incredibly dangerous. The communication is terrible, and there are too many patients and not enough time to try to figure out what in the world any of the Haitians are doing! We have been asked to educate them, but when you have a lady walk in having at ST elevated MI (active heart attack) and a 1 month old baby hardly breathing at the same time...you're lucky if you can even find a syringe that matches the random IV supplies. Oh, and did I mention we have one monitor? Yeah,the MI lady was on it all day.

I think we have plenty of supplies, but no one knows where anything is and even if you had the thermometer one second, good luck finding it in 5 minutes. Nothing has a place.

The people here are incredibly patient. But also very frustrating when there is absolutely nothing wrong with them and they won't get out of the way so that you can actually care for someone who is ill.

I have seen very little, if any trauma, that has anything to do with the earthquake. If I had been on the ortho floor that would probably be different. But the ER is also the Med Surg ICU so we are treating DKA, MIs,asthma, car accidents and stubbed toes all in two hallways. The physicians are as kind as they can be, but have little time to address all the patient. I was writing prescriptions this afternoon doing my best to remember fairly accurate doses...yeah.

Thank God no one is checking behind us.

On a brighter note, my little man from surgery last night was discharged home today doing well, and I just ate my first MRE...which was really good!

"umm..there is a baby who needs surgery, now..."

photo by Matt Schoolfield


I decided frequent short updates are the way to go so that I can remember everything I'm doing. I walked around a long time last night not really ready to go to sleep...adrenaline I guess. Then when I finally got tired I jumped in the COLD shower only to be disturbed by my leader at the door saying there was a baby downstairs that needed surgery now...the OR nurses from the day had left and were unable to come back for this emergency...so i said...ok, I'm not really a OR nurse, but I'll see what I can do.

The two year old had a inguinal hernia that the surgeon (awoken from his cot) needed to repair ASAP. Thankfully there was a CRNA still in the building and one other nurse on my team actually knows how to scrub in. So after unsuccessfully attempting two IVs on the baby...uggghh! better luck next time. I was assigned to prep and circulate...except there is no charting here...which is actualy awesome because you can do what matters instead...like location supplies. The surgery went very smoothly despite the fact that it takes us about 10 minites to find each thing in the OR...what a mess! But the baby did well and I went to sleep.

we have arrived

The airline threw away my peanut butter. Our leader almost missed the flight...i mean, not even almost...the standby people were taking seats around me. I almost got kidnapped at the airport (it's really okay mom) and I had to put my mosquito net up with medical tape (thanks MCCG). But all in all it has been a smooth trip and we have made it.

The team is beautiful. Five Haitian Americans, eight African American's, and one crazy white girl, who already gets the most attention. All of the motherly instincts deminished a little bit when I told them I'd lived in Africa for 10 weeks.

I haven't seen any patients yet, other than those that hang out on the lawn with their wrapped limbs and external fixators, but I'm ready for our 7:30 meeting!!

The food tonight tasted nothing less than Tanzanian! Rice, stew and beans. Beautiful. And some kindof watermelon juice! Delicious.

That's all for now. The internet here is wonderful and the phone works pretty well also...too bad I don't know anyone's phone numbers...

And mom, the computer didn't break.

Love to all and please pray for the adventures ahead!

Haiti

I will be traveling to Port-au-Prince Haiti from May 12-19th. I am going with seventeen other team members from a Seven Day Adventist Church in the Atlanta area and will be working as a staff nurse at the Hospital Adventiste de Diquini. This is currently the #1 Hospital in Haiti doing all orthopedic surgeries. I'm not sure as to the nature of my work yet (ER vs. ICU vs. OR) but I am open to wherever they need me.

Hospital Adventiste de Diquini's blog is here if you are interested in reading about what they've been up to. I will have internet access while I am there so I hope to update this blog as much as possible.

Thanks to all those who have been praying for me, for Haiti and for those who have given both time a resources!