Leaving Jacmel

Mom and baby one day old

Wilfranz fixing the water pump

Children are still children even when they are patients!

Alexis and his new art supplies

Outside the tents where some patients stayed

The house we stayed in

Transition is hard!

I am sitting at home on my couch with the radio on watching the snow fall. We may get up to 18 inches today and tomorrow, depending on which report you believe. It seems quite odd to go from 90+ degree weather to snow. It is wonderful to be home, to spend time with Marc, to talk to family members and relax. But I am finding that transition is hard. People told me it would be, but it is hard to describe.

When I left Jacmel around 10 am, I hadn't had much time that morning to think about the fact that I was leaving. I went to see a few patients, had some art supplies to give some of the children that Lisa Parker, my sister-in-law sent, I said good bye to a few people and set off for the airport. As we took off, I looked out the window and said goodbye to Jacmel but it didn't really sink in that I was leaving. I looked through my pictures and took a little nap, and before I knew it, I was in Nassau. I did customs, got to the main terminal, got my boarding pass for my flight home, checked my bags and went to the main terminal. Then it hit me: I saw shops, food, drink, souvenirs, people obviously coming and going on vacation. They had no idea that less than three hours away were people who literally had nothing. A mattress on the floor in a tent with no water or sanitation was all they had, and that was good compared to some. It was all I could do not to be in tears the whole way home. I couldn't stop thinking about the patients I left behind, especially ones I had cared for and about intensely. I was mostly ok in the air because it was a little more isolated, but being in the crowds in the terminals was difficult.

I washed my hands in the restroom of one of the airports and felt warm water. It was the first warm water I had felt in almost three weeks. I could drink water out of the faucet. I can brush my teeth with water directly from the faucet. My bed is unbelievably comfortable. I dried my hair this morning, something I haven't done in three weeks. I need two sweaters to be warm. I don't need to use hand sanitizer. I slept pretty well the last two nights. My dreams were about things in Haiti. Nothing specific, but unpacking boxes, suturing wounds. I haven't ventured out of the house much. Now that it is snowing I will probably not go anywhere until tomorrow. I am enjoying a slow pace. I still have stacks of mail to go through, phone calls to make, people to see. It can wait.

I am still involved with things in Haiti. I got a call yesterday from someone I had met there who didn't realize that I was home. He was looking for a place to send a sick 2 month old. I was able to connect with people at the CME hospital where I was, and the baby got sent there and the baby was taken care of. I have talked to people here in Philly about our on-going efforts and how to best plan for the future and provide continuing service. I talked with the team leader of the team on their way today. I also have talked to other friends and colleagues who are about to go to Haiti with other groups.

I have so much to be thankful for. We have so much to be thankful for. The people of Haiti are friendly, warm, grateful and will be in my heart forever. I very much want to do whatever I can for as long as I can to help them.

Stay tuned to my blog. I have many more pictures to post, updates to add as I get them, thoughts about my time there that are still whirling around in my head. I know many of you followed my blog. I would love to hear from you directly. You can email me at edrum19@yahoo.com or go to my facebook page that I just set up (I am trying to keep up with technology). Thanks for all of your love, thoughts and prayers!

Liz is home!!!!!!

Liz is now safely home. She looks very tired but good. Her journey from Jacmel to Philadelphia went very smoothly. She is going to get some rest now.



Here she is in the airport, waiting for her big luggage!!











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Thank you to everyone for your kind support.

(posted by Marc)

I am on my way to the airport to pick up Liz!!!!!

(posted by Marc)

There were several aftershocks last night, and it was a bit disconcerting. I was surprised at the noise -like thunder. We went outside for a while just in case but after an hour or so came back in. Between the emergency case and the aftershocks, I didn't sleep that well.

Departures from Jacmel are on a catch-as-catch-can basis. There are no scheduled commercial flights. I had committed to staying until the current group got oriented. They will start to leave on Thursday and another group will arrive Friday.

Short stays work well for busy professionals but take their toll on continuity of practice and care. Staying for almost three weeks has given me a much different perspective on the entire effort.

Because so many people are leaving later in the week, I started asking about flight availability a few days ago. Relief flights still come in with people and supplies daily and usually leave empty so you can usually get a ride, just can't always predict when and to where. Because I got to know people at the airport, they alerted me to a flight to Nassau this morning. So right now I am in Nassau waiting a flight to Philly via Charlotte.

It was a very bittersweet morning. I am so happy to be coming home, but still concerned about many of the patients and the logistics of the relief operation. I will still get and answer questions and queries about things when I get home. I am overwhelmed with many many emotions right now.

Please stay tuned as I have many more pictures to post, hopefully updates on the activities of Team Ange, and a trip to Ethiopia on March 18th. Would I go back to Haiti? Absolutely, in a heartbeat, and have already talked to people about it. Thanks for all of your thoughts, prayers, good wishes and messages!

At the hospital

Here is the street entrance to our hospital.



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This mother was in labor for a very long time. We finally had to deliver the baby by emergency c-section.










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Here I am with the brave mother and her new baby.


















(posted by Marc)

Scenes outside the hospital

While our hospital fortunately was not damaged by the earthquake, many buildings in Jacmel were.










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Some buildings, like this one, have been completely destroyed.









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Because of the damage to infrastructure, we need to buy our water in bottles.











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Here are some children in the street outside the hospital.











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Many people are living in tents as you can see here.












(posted by Marc)

It is 1:30 am. I am about to go to sleep. There was just an aftershock that shook the building. It was a scary thing, I can't even imagine what the real earthquake was like.
I was told that a structual engineer checked the building we are staying in before we were allowed to use it. I can see why people are afraid to return to their homes and other buildings.

It has been a crazy, whirlwind past several days. Thursday night there were just a few of us here. More people and supplies came over the weekend. We have been incredibly busy with multiple emergency surgeries and many sick patients. We continue to see patients with earthquake related injuries. We also continue to hear very sad stories. I had a patient yesterday and today who was 16, in labor with her first baby for 36 hours. Both of her parents were killed in the earthquake. She is living in a refugee camp. She ended up having an emergency csection.
We had a very sick patient last night for an emergency operation that needed an ICU which we don't have. We kept her in the OR all night because that was the only place we had oxygen and monitors. We had a very badly burned patient who died after 12 hours of emergency care. We had a patient who died from a severe asthma attack today. Tonight we are doing an emergency operation for a severe head injury.

Liz has been extremely busy over the past few days. She has not had time to post to the blog as a result. As she has been the team leader this past week, she has had many organizational issues, in addition to medical matters, to attend to.

There are still patients coming in with injuries resulting from the earthquake, but many others are people seeking other types of medical care. There are many patients and others at the hospital every day and she has been working from early in the morning until late at night. It is extremely challenging and exhausting.

Please keep Liz and all of the Team Ange members in your prayers.

(posted by Marc)

A banner to lift our spirits

Liz's sister in law, Lisa Parker, made a banner for Team Ange which arrived today. As you can see, we hung it up right away! Some of the pictures were drawn by children in Lisa's neighborhood who had been told about the relief mission to Haiti.









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Lisa also thoughtfully sent along art supplies that the many kids in and around the hospital could use and enjoy.
















(posted by Marc)

Patients in tents

Here is a tent with patients waiting for or recovering from treatment, along with many family members. Obviously, it is quite different from the patient setting at a typical hospital in the US.










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Even under very difficult conditions, the children still can smile!















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Collapsed building in Jacmel

Supplies arrived today

A shipment of much-needed medical supplies arrived today.









As you can see, there is a lot of stuff all over the place.



















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It will take us a while to get everything sorted!!

My little baby who was wheezing last night looked great this morning and went home.

We had several surgeries today including someone with a wrist fracture from the earthquake that hadn't yet been treated.

Every day I have people coming and going. We also have doctors, nurses and medics who get sent here to help us. There is a physician who is coordinating all local medical relief efforts in Southern Haiti. She is based at the airport and knows who comes and goes, and helps connect needs and providers. She has contacted me twice this week to offer help, which I accepted. I have a fair number of contacts and can ask for help if I need it.

There is a five year old boy that needs medical care that he won't get here, and I am working to see if I can get him evacuated to Philly.

I delivered another baby girl tonight!

I delivered another baby girl tonight

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Here is mom with her new beautiful daughter!

Dr. Henry, Dr. Ney and Lou

Andy, Tami, Dr Chris, Dr. Miles and me

Dr. McGowen, Dr. Phillipe and Dr. Meriam

It is midnight and I am ready for bed. We just finished taking care of an 11 month old girl with bad pneumonia and wheezing. She was admitted in the afternoon, and when we made evening rounds she was worse. We took her to a treatment room in the clinic because trying to treat her in a crowded tent just wouldn't work. At home she would have been in some kind of monitored area, Here she is in a hot crowded tent with about 10 other patients sleeping on pads on the floor with several family members each. Her oxygen level was only 88% but with some aggressive therapy she is a bit better. If we hadn't gone to check her, I am not sure she would have survived.

Support from the home front

Meanwhile back home in Philadelphia, the weather is very different from the hot and humid climate that Liz has been experiencing. We have been inundated with snow from two major storms (and we are getting more snow tonight!)
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Led by Liz's sister-in law Lisa Parker, last Saturday an intrepid band loaded up a convoy of vehicles to transport supplies over to the Team Ange "base" house in New Jersey. We took up most of the street!

Here is Martha Drusedum, Marc, Lisa and Walter Drusedum. Dr. Ruby Camerena also assisted.

After slipping and sliding through Northeast Philly, we made it to the house and unloaded our cargo.

While we were at the house, we met Mike, a physician who had just come back from the hospital in Haiti and had met Liz, and Joe. Frank Iacona and others are working hard to organize the shipment of needed supplies. Also many thanks to the shipping department at Abington Memorial Hospital who helped us get supplies that Liz had arranged for.

Our effort is only a small part of what many people are doing to support the efforts of Team Ange. Thanks to everyone for helping Liz and the entire team!

(posted by Marc)

The airport is our lifeline

Many people and supplies come through the nearby Jacmel airport, a short drive from the hospital.

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The airport is being run by members of the Canadian Air Force. Here is a picture of their camp. This airport is vital to use for getting the things we need and for transporting patients who need urgent care to the USA.







(posted by Marc)

God is very near

Liz has mentioned that there is a church near the hospital where her team is working. She often hears people singing there and went to church this last Sunday (see previous post)

Here are children outside the church dressed in their best clothes.












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Here is a hymn in Creole. People here enjoy singing!























(posted by Marc)

Monday is a busy day

(Monday morning) We will probably have over 300 patients today as the clinic was closed except for emergencies for the last three days. These are patients who have already been triaged and screened waiting for treatment. This is one hour after the clinic opened.












Here are the surgeons treating a patient with a large hernia.

New baby, Mom, and me

Here I am with newborn and her mother.

We see the cycle of life here in Haiti. A day or so ago, one of our patients died. She wasn't that old, late 50s and had chronic bleeding.
Yesterday we had a woman come in 7 months pregnant. She was bleeding and had dangerously high blood pressure. We couldn't hear the baby's heart beat. She had an emergency C-section, but the baby was already dead. It was a very sad thing, but I was very proud of the work of our whole team: ER doc, surgeon. nurses. Fortunately we have a psychologist here, and she was able to talk extensively with both mom and dad. Mom is doing quite well tonight and will probably go home tomorrow. We gave them a small box to bury the baby in; I probably won't look at a box like that the same way again.
Dr. McGowan said half of all children don't survive to age 6, and that some families don't even name their children until then.
On a happier note, I delivered a baby girl tonight! Mom and baby are quite well!

It is raining very hard tonight. I am grateful to be inside a building and not outside. Four new people arrived today, one yesterday, two tomorrow and many more on Tuesday. I think we will be up to 18-22 on Wednesday and then people start leaving. A new crew comes next weekend.
I went to a local Baptist church this morning. I couldn't understand much of it, but they were certainly enjoying their singing! There were at least 25 bright eyed children dressed in their finest clothes.
I went to the Jacmel airport today and there are still planes landing and taking off all the time. There are literally tons of supplies coming in daily. The logistics of getting them to the right place and having the right stuff are overwheiming to almost everyone.

As an anesthesiologist, I don't usually have much to do with primary care - care of patients with non surgical needs, and I am usually only responsible for the patients while they are in the OR or recovery room. So having 25 patients in the "hospital" that I need to make sure get care is a different experience. I am changing dressings, deciding about antibiotics, diagnosing malaria based on clinical signs, deciding when people can go home, etc. Most of it is basic medical care, but it has been fabulous to have people around to help with the responsibility.
Yesterday was a second day of mourning. We heard singing in the next door church, a ceremony of some kind at the rivier behind the building we are staying in, and the activity level has been a little quieter.

It has been a weekend of transition. Except for Andy, an OR nurse, everyone that was here when I arrived has gone home. There are 4 others here that came after me and are leaving in a few days. We had a great crew including another anesthesiologist, a nurse anesthetist, 3 orthopaedic surgeons, an ER doc, infectious disease, pediatrician, pharmacists, and some awesome nurses and probably someone I forgot. It seems oddly quiet without them. The comraderie we developed in a short time was amazing. The synergies of information and energy were palpable. I am really going to miss them. A few new people arrived, and there are more on their way. By Tuesday, I am expecting to have another full house of 18-22. I am being a logistics coordinator of planes, people and stuff. Need to get from the Dominican Republic to Haiti? I can probably arrange it!

Haiti relief blogs at ASA site

One of Liz's professional organizations, the American Society of Anesthesiologists (ASA), has posted blogs of several of their members that are serving in Haiti medical relief efforts. Liz's blog is one of them!

ASA Haiti Blog Page

(posted by Marc)

It rained overnight and feels more humid than usual today. It usually starts cloudy but quickly gets sunny.
It is relatively quiet this morning ( for which I am grateful). It is a "holiday" today, more accurately a day of fasting, prayer and remembrance because it has been one month since the earthquake. I have been told this will last through the weekend. There is a church next door and I can hear them singing "How Great Thou Art".
I am still trying to figure out who is coming when and from where. Transportation gets complicated through the Caribbean islands and into Jacmel.

Every day brings new adventures

This morning started with readying three patients for medical evacuation to Philly. Hours of coordination went into this: locating an accepting hospital and physician, applying for and actually obtaining humanitarian parole to allow the patients and one family member to travel to the US for treatment, arranging the actual transportation and host families in the US, and trying to work around the weather! By the time you read this, all three patients and families should be in Philly, and the patients from the other day should be there also.

Every day brings hundreds of patients to the out-patient area seeking medical treatment. There are only a few treatment/exam areas, and patients and families are literally everywhere. We are still seeing patients with injuries from the quake who are just now seeking medical care. We have discussed working with other local teams to send mobile clinics to remote areas.Today we took care of a 2 year old with a leg injury from the quake.

Late afternoon we had a baby born in the clinic. I was not there, but I was privileged to meet mom and daughter when baby was 30 minutes old. There were four women in the room, and I honestly could not tell who mom was; I had to ask before I took the picture!

Many of our team are leaving tomorrow and Saturday, so there are lots of transitions this weekend.

We struggle with things like electricity from the generator. Without it we have no lights in the OR. We can't get an xray ( we can only get simple ones in the clinic) or use any electrically powered equipment like monitors or our anesthesia machine. In the OR we all have our head lamps and we don't even miss a beat when the generator goes off. Surgery goes on by flashlight.

Many of the medical things we take for granted in the US don't exist here: charts, medical records, labs and xrays, and CT scans and MRIS. No ICU care or ERs or ambulances or ventilators. Many cell phones don't work here. AT&T works best here where we are. Those of us with iPhones are in the best shape, but we still struggle sometimes. You can't call the Dominican Republic from here, and you can't call a Haitian number. I brought two old cell phones from home and finally found someone to unlock them so I can use them to call local numbers.

New adventures tomorrow! I am making rounds on all of the patients starting at 6 am tomorrow, so that I can make sure I know the medical plan for all of them. By late Friday or Saturday, I will be the only physician here who has been here for the last week and will be responsible for the medical operation.

A baby girl is born in our clinic

She is 30 minutes old in this picture.

Mom is holding her!

In a place of difficulty and suffering,
joy has come also.

Patient being transported to Philadelphia

Here is a patient with a cervical spine injury in a pickup truck going to the Jacmel airport. The patient will be flown to Jefferson Hospital in Philadelphia for treatment.

It is 8 pm and I am sitting in the OR recovering a 5 year old patient after we took care of his leg for a very bad infection. Normally we would take the patient to a recovery room staffed with nurses specially trained in the care of these patients. When stable, the patient would go to his room. If he needed oxygen or a monitor we would order it. Here there is no recovery room or recovery room nurses. After we decide he is safe to leave our care, we will carry him or use our makeshift stretcher and take him to a mattress on the floor in a tent shared with 8 or so other children. He had a very badly infected leg and was very stoic. He didn't cry when we brought him to the OR, and only did so when we checked his IV.
The people here are amazing. They are happy, and grateful for care. Their family members provide all the basic needs such as clothing, bed linens and food. The conditions for them are very poor. No bathrooms, no water, no comforts.
We have the best facilities in Southern Haiti. This was a hospital that was well established before the earthquake. It was started in 1979 by Dr. Brinson McGowan as a member of the Baptist mission. It is called CME or Central Medical Emmanuel in Cayes Jacmel. The property was really not damaged in the quake. Most of the damage was in Jacmel, right next door.

A 5 year old having leg surgery

Here I am with a 5 year old boy who is having leg surgery.

While it is cold and snowing at home it is quite hot here!

Yesterday I mentioned patients being flown to Philadelphia. Because of the weather, the airport was closed and they did not make it, but hopefully will be able complete their journey soon.

This is what makes it all worthwhile

One of my patients leaving the hospital with her mother after treatment.

Making it work with what we have

Preparing to move a patient with an improvised stretcher










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Oxygen supply and improvised oxygen concentrator







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A patient in our makeshift recovery room









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We are busy treating patients

Here I am with Dr. Deep Kohlen taking care of a 12 year old for a closed reduction of a wrist fracture.

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Here are Emily and Jen:

transporting a patient to the

"PACU"

and...

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...organizing needed supplies!













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Here are two "wards" - tents for patient beds












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Dr, Deep Kahlon and Dr, Dan Fitzpatrick are doing a closed reduction.

Emily, our OR pharmacist, transporter, scrub tech, and arborist, is assisting.












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I am doing fine. It is a little surreal here, but also very good.
It seems like we get very little done for a lot of effort but the smiles on peoples faces make it worth it.

Patients are flying to Philadelphia now on a jet provided by the Eagles football team!
It should land between 9 and 11 pm tonight.
Three patients are going to Shriners Hospital for Children, one to to Dupont, one to Geisinger.