Children's and Project Medishare: reflections from the adult ward

Jill Merna, Nancy Joseph, Carla Odiago worked the night shift in the adult ward taking care of over 80 adult patients.
Jill Merna, Nancy Joseph, Carla Odiago worked nights taking care of over 80 adult patients.

From April 10 to 18, Children’s Hospital Boston sent a group of 26 clinicians to a field hospital in Haiti. Here, those who staffed the adult ward reflect on their experience.

Nancy Joseph, RN, BSN, MSN, FNP-C; staff nurse in CHPCC

This was my internal cry after arriving our first day. I thought I was going to lose my composure when those two women came in on the back of a truck requiring emergency C-sections.

Ayiti Cherie….
Bel mon, Bel moun, Bel lang
! a je!
Ou bel !
Cote nou rive la !?!?
Coma sa fete ?!?!
Jody-a mwen vini na pie ou
pou mwen sevi ou
Yo ban mwen deu jour
Ou pa ber zwen pe
Map mete men
Petit ou,
Nancy

Translated:
My Dear Haiti
Beautiful mountains, people, and language
Oh! my goodness, your beautiful
How did we get here ? How did this happen?
Today I have come to your feet to serve you
I have been given a couple of days to give a hand
Your daughter,
Nancy

Both moms and babies were eventually discharged home in a few days. No one went home without their Hepatitis B in toe. I would have given them IV Ig, but we had none. I was officially named charge nurse of our 76 bed adult unit, of course this is a group effort. God knew I might feel overwhelmed, so he had me take care of a Quad patient. He was robbed for his money and told to open his mouth, during which he was shot and left paralyzed. He needed his hs lovenox, however the dose of his medication required two shots. After I explained what I was going to do, he agreed. After I gave him his second dose, he says to me, “Mwen pap pran twazem pici”, I will not take a third one from you. In Kreyol, I told him I would not give him a third one. “Mwen di sa pou fe ou ri”, “I only said that to make you laugh”, he proceeded to thank me and wish me a good night. Their resilience, the Haitian people, gave me such strength.

This same night, I had a new post-op urostomy, He called me “mama”. At first I thought, Nancy, you have really aged. However, when his wife reprimanded him for calling me “mama”, his response was “Any woman taking care of me when I am sick is my mother, so I will call her ‘mama.'” What an honor ! The nursing care I was trained to give was right up there with mama’s TLC.  Until my last day at Project Medishare, he never referred to me with the typical “Miss”, the nickname used to address nurses in Haiti, always “mama”

Day three was a personal day for me. For the first time in 37 years of my life, I met my cousin Patrick. As soon as I saw him, I knew he was family. He described the horrible conditions of the country since the earthquake. He had only met me for 10 minutes before he asked me if I could take his daughter back with me on Saturday. My heart sank to my feet. I could see the desperation in his face and hear it in his voice. I am still ill over my response, I know my family could offer his baby a better opportunity in the states, however it was not possible. This was a joyous and sad day at the same time.

Jill, shown on right with a patient who needed trachesotomy care.
Jill, shown on right with a patient who needed trachesotomy care.

Jill Merna, RN, 8E

At the start of my second night in the adult med/surg tent I immediately noticed a new patient. He had a trach and looked generally ill. I was told the ICU didn’t want to send him out but they had no choice, they needed the bed for sicker pts. When I asked the day nurse where his suction was, I was told he didn’t need any suctioning and that was why he was transferred. I was told he would be fine over night. Because there are limited supplies, the only portable suction machines I could immediately locate were in the ICU. These were unavailable to me as there were two vented patients that needed them.

I asked several people to help locate an extra machine and then I moved on to my other patients, of which I had over 20 that night who were nearly all hours and hours behind on diuretics, pain meds and IV antibiotics for massive wounds. I kept a close eye and ear on my trached pt the whole time.

Around midnight I could hear and increase in his secretions and know he would need suction soon. No one had been able to find a machine for him yet. I pleaded with the ICU nurse to let me borrow her machine; I promised to bring it right back. I ran back to the my pt’s cot and bent down to plug it in. There were no outlets! I couldn’t find an outlet in the entire tent! I ran over to logistics to try and locate someone who could help trouble shoot with me. I could not locate the cot number for the head nurse or the logistics personal I knew would be able to help me. OK, I thought at this point. This pt needs suction now and I’m not going to spend any more time trying to bring it to him, I am going to bring him to it. I rallied up transport and moved him over the ED where there was a stationed suction. We did a deep, thorough job clearing copious thick secretions which allowed him to remain comfortable and safe for the remainder of the night. In the morning I borrowed a long extension cord from the logistics tent and was able to set up him with at least a constant electrical source at the bedside. The portable suction machine would have to be shared. The remainder of the week I provided this pt with frequent aggressive pulmonary toileting and watched him improve every day. At first he hated it when I gave him chest PT but he soon realized how good it made him feel afterward and he starting asking for it.

When I first became a nurse two years ago, I never thought I’d ever be running through a hot rainy night in search of something as seemingly basic as a suction set for a trached patient. But when I found myself in that position, I found that I had enough resources, I just needed to figure out how to manage them. And none of this was lost on this patient. He was so appreciative of everything I was able to do for him, I feel like I could do it a hundred times over.

View of the high volume, high acuity adult tent.
View of the high volume, high acuity adult tent.

Carla Odiaga, RN

I finally went off the hospital complex on Friday, and went on a brief tour of Port au Prince. At first, I sort of just took it all in… the sights, colors, sounds of folks getting on with life, all with the stark evidence of the recent horror all around… rubble everywhere, tipped over buildings, mangled cars… tent neighborhoods filling various spaces.

Then I let it sink in. The rubble and mangled vehicles represented the world suddenly caving in on these folks, literally. The patients I’d been caring for, with broken necks and backs and missing limbs, had been going about their lives when the world fell down on them!… was still falling as they grasped that they were never going to walk again, or have children… These were things my patients were dealing with, now… still…. forever. I was looking at evidence of the world falling down… after 3 months worth of cleaning up. It was – is – overwhelming! And then the colors, music, sounds of life and resilience! I sat in the back of that rickety minibus and cried.