Giving care in Haiti: perspective from a nurse

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Michael Felber, RN, and Kathryn Barrett, RN, take care of a patient in Haiti.

Children’s nurse Michael Felber came to Haiti on March 15, where he’s been working in the town of Fond Parisian. On Monday, he joined the Global Surgical team in Cange. Here, he reflects on his experience so far.

Being in Haiti is a little like the fable of the three blind men and the elephant – each of them had different experiences based on what they encountered. In someways things look a lot like most Latin American countries- it’s hot, the cities are crowded, the people are wonderful. Port au Prince looked mostly ok from the air, but then when you look closer you can see that some areas are rubble, and there are tents everywhere, even where the buildings are standing. The tents here at the field hospital are easily over 100 degrees, but many people are still afraid to go inside buildings. The kids here are wonderful – big friendly smiles, love to play soccer, make kites. Still pretty much everyone has lost family members. Many don’t have homes to go to, and rainy season is coming soon. Its hard to imagine that possible a quarter of a million people died in the earthquake and the days after. Where do you go from there? One of the patients said to me, “I’ll see you tomorrow, if god is willing”. The hospital is well run, especially considering how many people are coming and going. The pharmacy is as organised as I have seen anywhere. There are electronic medical records, although much simpler and more user friendly than ours. You have to be comfortable stepping out of your comfort zone. Tonight I am covering the night shift in Triage. It’s like an ER in a tent, hopefully more quiet now that everyone has gone to sleep.

3/16/2010

The large white tents are being put up to shelter people during the rainy season, which is due within a month. I slept for about an hour last night while things were quiet in triage. There is a daily outdoor church service with loud singing and clapping at 4 am every morning, so lots of people were up early. We got an urgent call to see a thirty year old man who had had a recent surgery to his leg. He was crying in pain and fear. His bandage had saturated with bloody drainage, and started to come loose. I think besides the pain the blood scared him, but it stopped after I rewrapped the bandage. We brought him up to the triage clinic, started an IV ( I will be good at putting ivs in by flashlight if this keeps up) and gave him morphine and IV fluids. I rewrapped his bandage and helped him calm down. Deep breathing works as well here as anywhere else. A few other patients came in ­ a very sweet 13 year old girl with a repaired femur fracture who couldn’t sleep because of pain, but was comfortable after having two ibuprofens.

I was hot and tired after the night. I had a shower before turning in. You get a bucket of cold water and go to a bunch of stalls enclosed with tarps, clamp them closed with your Kelly clamps, and for about 5 minutes you are cool. I only wish I had two buckets!
I slept in a classroom for the day. The lesson was still on the board for January 11th, the day before the earthquake that changed Haiti in an instant. It made me think of how quickly this hospital, which wasn’t even an idea in someone’s mind two months ago, came together. It’s pretty amazing. I had a similar feeling at the daily 7 pm staff meeting. We are totally dependent on the work and flexibility of our staff. Virtually everyone is
working outside their comfort zone and area of expertise to some extent.
Managing a community of injured patients after a cataclysmic earthquake just isn’t in many people’s job descriptions. It’s pretty impressive to see how well it comes together. In addition to the medical and support staff, the patients have chosen community leaders who help with day to day problems.
The best part of Haiti is still its people. They are some of the most gracious and tenacious people I have ever had the pleasure of knowing. The kids can stop you in your tracks with a smile and greeting. And the weather report for tomorrow is ­ hot .
3/17/2010
It got pretty noisy for a while last night. Around 2 in the morning a man started praying  and singing, walking amongst the tents. I asked Pierre, the translator who does nights with me, what he was saying. It was pretty strong and deep praying, and after a little while others joined in. It went on for about an hour and a half. When one section of the camp became quiet another would start. Nobody seemed bothered by it. One of the translators told me later on that if people see a bad spirit or are afraid they pray.

I went to the evening church service, which is held at the bottom of the rows of patient tents. There was a band ­ the music was like a blend of reggae and gospel. People danced and sang along. When the prayers started a little girl sitting next to me motioned for me to bow my head. When you work in health care, you get used to seeing injuries and disability and suffering. There are all kinds of ways of distancing yourself emotionally from it ­ you have to. Every time I look around here I see people with amputations, with external fixators, with disabilities of different degrees. None of that really bothers me ­ it is what it is. But there was something about standing with all of those people as they sang and danced and prayed that really moved me. Life really does go on. This afternoon after I woke up I saw a teenage couple, both with external fixators and crutches, holding
hands like teenagers do all over the world.

3/20/2010
I finished my last day in Fond Parisian. Tomorrow morning I will join the Children’s Hospital team in Cange, in the Central Plateau. I haven’t thought about leaving too much. The nice thing about this work is it keeps you busy right up to the end.
We organized the pharmacy stock room over the last few days. The stock room was
really testimony to how chaotic the response to disasters can be. There are medications from all over the world, some of which are familiar and some that aren’t licensed in the U.S. There are too many of some medications and not enough of others. We have thousands of doses of Lasix, a diuretic mostly used for elderly patients and heart patients. We have been using the boxes to hold up tables. Still, we got the job done, and I will be able to bring some of our extras to Cange tomorrow.
I also spent time over the last few days working in the rows of tents. Working in the tents really shows you that this is more than a hospital ­ it is a very vibrant community. Patients socialize, listen to solar powered radios donated by the UN, braid hair, read (mostly the bible) and play. When you go in a tent to change a dressing or give a medication you are greeted and invited in like you are a special visitor in someone’s home.
3/22/2010
The drive to Cange, in the Central Plateau of Haiti, was spectacular. The mountains are dry and dusty, the lakes and rivers are beautiful. There is a nice paved highway to the plateau, and then the pavement stops and you are sharing a winding, narrow and rocky road with people, animals, motorcycles, trucks, and packed busses. The hospital here is pretty impressive. It’s part of a larger complex that includes a school and a church. I met with the team, enjoyed a non sardine meal and a real shower.
The staff has had to deal with a huge workload, compounded by the fact that nearly everyone here has family in Port au Prince that were affected by the event. Like Fond
Parisian, there are a lot of wounds and amputations. I worked with two young women amputees. Their makeup, hair, and clothes were perfect. They had done up their prosthetic legs with stockings and pretty shoes. We called them the princesses. One was a double amputee. She walked up a very steep and long hill with me. I suggested she sit down and enjoy being outside. Out came the hairbrushes and gel, and I realized it was
going to be a long physical therapy session. After an hour of socializing and hair braiding she refused a wheelchair for the trip back down the steep hill. Two of us walked her down, and she did great. She’ll be able to leave soon. I hope she has a good place to go to.
This morning we started out with dressing changes. There are pressure sores, and wounds caused by falling roofs and cinderblocks. I did wound care at home, but I have learned much more in the last week. Cassandra and Kathryn (Children’s Hospital nurses) went around and problem solved the wounds together. Sometimes treatments that would make sense in the US, like leaving things open to air, don’t make sense here.

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