Michael Agus, MD, reports from Haiti

Michael Agusby Michael Agus, MD –  director of Children’s Medicine Critical Care Program

A few weeks ago, multiple waves of teams from Children’s Hospital Boston left under the auspices of Project Hope for the USNS Comfort, which remains anchored in the harbor of Port-au-Prince. As Comfort’s mission began winding down, Robert Truog, MD was able to transfer and join a land-based effort already underway through Partners In Health (PIH). I was scheduled for the Comfort as well and due to Bob’s efforts was able to re-deploy to the same site right after he left.

Day 1
I boarded a plane early in the morning on Thursday, March 4 from Boston to Miami. In addition to a large pile of energy bars, mosquito netting and a camping pillow, I brought donations from my kids’ school, including stuffed animals and drawing pads from my 1st grader’s class.

The front page of The Boston Globe the prior day had pictured Cardinal O’Malley visiting sick children in a tent at a Catholic hospital in Haiti – St. Francois de Sales. I was able to use the picture to show my 3 sons (ages 13, 10 and 6) where I would be the following day. In the airport in Miami, I ran into the Cardinal and we discussed his and my trips. He expressed continued amazement at what he described as the worst human disaster of our time.

I boarded the packed plane to Port-au-Prince along with over a hundred missionaries from various groups, many singing spiritual songs as they found their seats. Several Haitians were among the passengers as well. A serious mood pervaded the air, now almost two months after the earthquake. Even the pilot acknowledged the two populations that filled the plane.

Agus 2As we made our final approach into Port-au-Prince, we could see the USNS Comfort still anchored nearby, and although I could hardly make out collapsed buildings, far more obvious were the thousands of tents lining streets, filling parks, with hardly a single uncovered piece of land in the immediate area. In stark contrast was the beautiful mountain range towering above the valley which surrounds the city. I was met by a representative from Partners In Health who brought me to the walled, gated compound where the volunteers stay in tents. I was welcomed by the current cohort of volunteers, primarily from numerous Boston hospitals, including physical & occupational therapists, nurses and physicians.

Day 2
At 6:00 AM I breakfasted with the overnight volunteer team members who were bussed back from the hospital after their shift. I joined the day team and we rode through the battered streets of Port-au-Prince to the University Hospital, the only teaching hospital in Haiti. The hospital campus sits a few hundred yards from the devastated government capitol building which remains a caved-in memorial.

Agus 3Filling the parks next to the once grand buildings are thousands of tents, some of high quality donated by foreign governments, others of sticks and tarps. And yet the streets are bustling with cars, brightly colored buses, pedestrians and vendors, many of whom have clearly moved their wares outside of cracked and crumbling stores and onto the sidewalk.

Walking around the hospital campus was a difficult combination of depression and inspiration. There were hundreds of children and adults cared for in dozens of long, overheated, overcrowded tents. Yet the Haitian faculty and staff, together with multiple NGOs and PIH were able to provide various coordinated aspects of care.

The Pediatric tents are grouped together in seven long tents, each one housing up 20 beds and cribs and one isolation tent which housed a patient with diphtheria. The tents each cater to different age groups and acuities. I spent most of my time in the acute care tent, called the Pediatric ER, but where patients may stay for days until they are well enough to move to a lower acuity tent. Many patients had one or two family members sitting and sleeping by their side, while others did not have any.

I spent the day supporting the Haitian medical residents, all of whom had suffered some sort of personal tragedy including the loss of one of their rank, a resident who was visiting with her family at home in between shifts. The majority of the dozen or so residents returned to work after the earthquake. The medical students and interns who should have been part of the care team had not yet started their year when the earthquake struck.  They still have not begun to work, stretching the care team extremely thin.

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Children in these tents are almost exclusively sick with illnesses that are not directly related to the quake. The orthopedic injuries have largely been treated and those who were critically injured have already succumbed. Crowded with their families into tents or shacks without running water and little food, spread of communicable diseases is rampant with common diagnoses including TB, typhoid, malaria, or some combination of the three.

Special needs children, some of whom have lost track of their caregivers, are particularly vulnerable. I spent a large part of the day caring for a child with seizures and respiratory failure, intubating and utilizing a donated LTV-1200 ventilator for the first time in the pediatric tent. Ventilators and acupuncture needles are easier to find than tegaderms and diapers. This child survived her illness, but another was not as lucky that day.

At 9 pm the night reinforcements arrived, including fellow Medicine ICU colleague Kevin Waterman, CCRN. Kevin joined the effort in Haiti with 30 hours notice and no hesitation.

Day 3
I arrived for the day shift after hearing from the overnight crew about yet another child lost despite their best efforts. I have learned that by the time patients have made the trek from a distant neighborhood or city, they are often much sicker than when their parents first made the decision to bring them in. Newborns delivered in the tent next door to the pediatric ER have the best shot of receiving timely care, though with incubators and reliable electricity in short supply, thermoregulation (commonly compromised in premature babies) can be an absolute requirement for survival. Almost nightly members of the overnight pediatric team must respond to the cries of a mother in labor and assist in the delivery while the main OB team is involved in other pressing events.

Agus 4I treated a 1-year old who aspirated a pebble on her birthday three days prior and had been in severe respiratory distress ever since. She was in need of specialized equipment to safely extract the oblong stone, which was lodged deep in her trachea. PIH staff located a surgeon and equipment in two locations in the country. As my shift ended and the HUEH pediatric resident prepared to transport her to the nearer location, I quickly reviewed various rescue techniques in case the patient came into trouble, including holding her upside down by her legs and banging the stone out – obviously not an optimal mode of extraction.

Stay tuned for more coverage of Agus’s time in Haiti.