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On Jan. 22, Dr. Tom Lyon, physician chief of Orthopedic Trauma at Lutheran Medical Center (right), traveled with a team of 19 medical and surgical professionals to Hospital Eleazar Germaine on a relief mission to help those affected by the Haitian earthquake.
As news updates continue to unfold, the devastating effects of this tragedy are even worse than originally estimated, with upwards of 1.5 million people hungry and homeless - over half under the age of 18.
Thousands of volunteers like Dr. Lyon, are facing the daunting task of providing life-saving medical care to those in need, under dire circumstances. We have received first hand accounts from Dr. Lyon of the earthquake-ravaged scenes he has witnessed, as well as the small glimpses of inspiration and hope he's seen. Please continue to check back, as we will post updates throughout the group's stay. This relief team plans to return to the U.S. on Jan. 30.
About the hospital: Hospital Eleazar Germaine is located in Pétion-ville, a suburb in the hills of the nation's capital, not far from the earthquake's epicenter. Pétion-ville is part of Port au Prince's metropolitan area. While Hospital Eleazar Germaine survived the tremor, another local Pétion-ville hospital was completley destroyed.
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The Palm Beach Post's coverage of the team.
ELCA News Service coverage on our efforts related to Haiti.
Hospital Association of New York State's Haiti Disaster Relief coverage.
New York Post coverage of Dr. Lyon's mission.
Courier-Life interview with Dr. Lyon.
Brooklyn Daily Eagle reports on Dr. Lyon's mission.
Day 1: "What can I say? We are all so lucky."
Jan 24, 12:57 a.m.
On first late night arrival we were a little discouraged as we were shown a hospital up in the hills with good facilities and potential for 50 beds and 2 operating rooms, but there was no one there except 2 administrative staff and no inpatients!!
It had been previously noted that the operating room "isn't being used for lack of a qualified surgeon. The gynecological room has been converted into a morgue for the steady stream of bodies brought in."
We couldn't understand how such a facility could be empty in this situation but soon learned that it was widely known as a "private" hospital and had not really had staff to open up yet. One of our local hosts suggested getting on the radio and we announced that we were here and ready to treat all comers free at the Hospital Germaine.
More on the team's work with radio in Haiti.
The response to our radio call was excellent. With a number of transfers in from a French group down in Port au Prince that was overwhelmed, we took about 40 patients. We saw lots of 12-day old open fractures untreated, and almost everyone with soft tissue crush.
Crush injuries are the most common injuries resulting from structural collapse during an earthquake.
A few elderly people were brought in dead or dying from 10 days dehydration and similar ailments. We operated without anesthesia machine (spinals, blocks and Ketamine) on at least a dozen people, almost all orthopedic. Had to hit the local hardware store and bargain for a hand drill but it worked well for the ex-fix cases including a 3 year old with a crushed femur. The young boy lost his father in the quake. Him and his mother, along with so many others here, still have that far away look in their eyes like they aren't really there.
What can I say? We are all so lucky.
|Photo by Lannis Waters/The Palm Beach Post.|
Day 2: "Overcoming frustrations."
Jan. 25, 12:10 a.m.
Like most relief workers Dr. Lyon and his team are dealing with the environment and various levels of organization as best they can:
We are frustrated here up on the hills around Port au Prince as our initially empty hospital is now filling up and we need nursing at night and have none. We need to get stable patients out so we can take on new patients, but there is nowhere to send them except out on the streets without food. Our local hosts managed to get food from a local restaurant gratis.
As a facility 10 minutes up in the hills from Port au Prince, we rely on transfers. We have been getting them mostly from a French team working out of the stadium. They show up in HUGE military trucks with 1/2 a dozen patients each and 4 or 5 soldiers carrying machine guns with one doctor [note: Dr. Lyon has noted however that they have not seen any security problems]. We hit a low point today as teams getting frustrated with lack of any nursing, etc.
Day 3: "On a roll."
Jan. 26, 12:12 a.m.
A good day. Team is starting to gel. Several folks felt a little tremor last night but not me.
We are building a hospital system piece by piece. Lots of MacGyver moves to make wound VACs and such.
A Wound Vacuum Assisted Closure (VAC) device is used to facilitate wound healing by converting an open wound to a closed wound.
Got our first lab today from a place down the street. Hemoglobin of 4.4 on a patient scheduled for revision of an infected AKA. The surgery had to be cancelled. The patients' family was given his blood specimen and told they need to get to the Red Cross and get him blood, bring it back, and then we can transfuse. This will take most of a day to accomplish.
Due to the limitations, routine procedures such as a blood transfusion, become much more complicated, labor intensive and time consuming.
A 6 p.m. curfew was imposed today by local law, supposedly under direction of Marines who are here now, though I have only seen French and U.N. Not exactly sure where people are supposed to go other than the streets or their tents. The streets have become the location of almost all activities, including bathing. The burning of garbage, a common disposal technique, combined with the other scents leaves a "funky" smell that lingers in the air.
The good news is that the patients, for most part, never complain and are just relieved to be on our facility. We are really starting to roll now in a large part thanks to our local hosts here in Haiti along with a great crew that has learned to deal with frustration and look forward. I see and have read emails about many groups that have come down only to leave a few days later out of frustration as they didn't understand what they were getting into and found they couldn't hack it alone.
What we could use most is a battery powered drill and self-drilling pins. I have placed about 6-7 frames so far and could use more bars, clamps, etc. My kingdom for a Wound VAC machine or two and some Ioban. There is a van that can get to airport for pickups. Thanks to all.
|Photo by Lannis Waters/The Palm Beach Post.|
Night 3: "I sure felt that one!"
Jan. 26, 6:40 a.m.
The first quake was responsible for a number of intense and frequent aftershocks. After feeling one early Tuesday (1/26) Dr. Lyon writes:
I sure felt that one! I know the building I'm in is built like a rock but kind of hard to sleep after that [aftershock] in pitch black with all the dogs barking, roosters crowing and mosquitoes all over.
In a country reeling and ravaged from the disaster Dr. Lyon is one of the lucky ones to have at least a thin mattress but finding rest is hard; technology has provided some comfort though:
Well, if I can't sleep at least my iPhone works so I started to read The NY Times. I couldn't copy the link but check out an article today 'deadly quake in seismic hot zone.'
Mental note to self: sleep closer to the door tomorrow and don't forget to take your Malarone [Malarone is an antimalarial agent].
Day 4: "Tremors frighten many from the hospital at night."
During morning rounds it became apparent that our peds ward had mysteriously emptied out completely overnight. Where are all the children? Turns out they were all out on the street in front of the hospital with their moms who had abandoned the building during last nights tremor. Most of these kids have lost one of their parents and a sibling and I can't imagine how frightening it must be when the earth shakes in the middle of the night.
Team is working great now we are managing more and more cases daily, taped up an OR schedule chalk board. We found and have rigged up a suction machine as a giant octopus with arms (hoses) going to 5 different patients for wound VAC suction. Only problem is if there is a leak in one dressing the whole system fails so we have to be vigilant.
Revised a BKA [below the knee amputation] to a through knee today on an 18-year-old girl and a through knee to an AKA [above the knee] in a young man. Both of these kids had come in from the stadium where their guillotine amps [amputations] were very infected. Our usual protocol has been to rehydrate these, debride [removal of dead, damaged, or infected tissue] once or twice and then move to a definitive amp that we can close. There will be a huge need for skilled prosthetists in this country for many years.
Some new team members coming in so continuity of care should be good for at least next week and via our local hosts we are trying to change the status of this hospital to one that takes in acute surgical cases. We are training the local staff here on how we work and they seem to be catching on. We have cold water at the house now so no more bucket baths, still no electricity but alls well otherwise thanks to our gracious hosts.
|Photo by Lannis Waters/The Palm Beach Post.|
Day 5: "Baby Germaine"
Jan. 28, 7:08 a.m.
Team managed to rock out 15 cases today - a new record. We are getting a reputation as a great place to go, so more and more patients are coming. A Russian team that is leaving dropped off 2 horrendous cases, we got 5 from the stadium and the rest were dropped off by friends and family that heard we were here though the grapevine. Fifteen cases is a lot when you are carrying stretchers up stairs and also mopping floors, etc.
Pediatric census is now 6 including a cute little newborn baby boy whose mom slipped away during the morning and had not returned by the end of the day. One of our Haitian nurses swaddled him up and brought him home with us. She called an orphanage in town about adopting him and it looks like he is coming back to the states with us. Back at the house we all pass him around and take turns feeding him. There was a lot of discussion about a name, but in the end we all agreed on "Germaine" which is the name of the hospital where we are working.
During dinner back at our house one of the neighbors came running over, explaining that her friends had been in a car accident just down the road. We were faced with two guys with two broken legs and some blood. We rushed back to the hospital to throw a cast on the closed one and get some antibiotics into the open one. No way to run OR at this point, so he is on schedule for tomorrow. On the way home we see the wrecked car left in middle of the road.
Dogs, roosters and mosquitoes are still ruining good sleep, but at least the ground was finally quiet. Is it bed time yet?
Day 6: "Our wish list keeps growing."
Jan. 29, 7:58 a.m.
We just received our first picture of Baby Germaine! Dr. Lyon says: "Baby Germaine goes everywhere with us." See Day 5 post for more information on Baby Germaine.
We see huge piles of garbage being assembled with a bulldozer and the traffic circle in town is now functional during the day. The middle of circle is a wall-to-wall tent city where some of our patients go "home" to.
Fifteen cases on the schedule including some big ortho cases, hip fractures stabilized with exfix [external fixation of a fractured bone by a splint, etc.] supracondylar/intercondylar femurs. The large frag set that the Sinai group handed off to us on their exit has proved invaluable.
A collection of big gun Marines arrived outside our hospital and we are all ecstatic as Sergeant Steve Countois of the 73rd cavalry assures us that they are here to help. We assemble a wish list that just keeps growing and growing. We have to prioritize and many items may not come, but this is still great news.
Our scouts at the stadium send up a 16 year-old with a hot belly [internal bleeding of the abdomen]. They open him up and find a perforated bowel. This is a well-known complication of typhoid. Prognosis is that, even with surgery and hardcore antibiotics, it is grim but he does well during surgery and sits in our "PACU" [postanesthesia care unit]. (Mental note: take your Cipro [a prescription antibiotic effective against a broad range of bacteria] and wash your hands more.)
A young girl with a clavicle fracture among other things is brought in from the Egyptian/Jordanian group and is wrapped in a full upper body cast which we all find amusing, except for the patient. We cut it off for her and even though she made such a nice looking mummy.
Back at the house, UNICEF folks drop by to explain adoption process to our new mother. She will need the signature of the Prime Minister along with a lot of other paperwork but this should all be doable as our hosts are tight with the PM!
The Filipino team that will replace us came by for a look. They wanted to come here but apparently the government may have needed them somewhere else, and at last second our exit strategy was in jeopardy. In the end they convinced the government that our facility can do the best job and they want to keep building on our success.
Time to buy a ticket out of Florida back to the Big-Apple!
Day 7: "We say goodbye, it really has been worth it all."
Friday is ex-fix day, a 12-year-old femur, segmental tibia and an ankle fusion. We have upgraded to a battery powered drill from local store and if one doc is the "driller" who has sterile bits placed into drill we can disconnect and then wipe down dirty part with alcohol. It works great. Thanks to the folks from Stryker for the implants.
The Filipino team does rounds with us. We are impressed to hear that they brought with them 150 boxes of medical equipment. Problem is it was last seen in Puerto Rico and the Marines haven't come on with new supplies yet. They probably have enough supplies for one more day so it's up to Marines now to deliver.
Around midday we are all surprised to learn that the hospital administrators and local docs had brought in some good catered food and are throwing us a goodbye lunch. Everyone relaxes for a few minutes of camaraderie and then get a little choked up as one of our Haitian nurses fights her way through a very emotional thank you. It really has been worth it all and our local host believes that through his connections with the govt. he can turn this public hospital (that hasn't done surgery in years) onto a local "Center of Excellence."
The kid with typhoid is not doing well but almost everyone else is and we still manage to admit 4or 5 new patients who come in off the streets. We sent a team down to the stadium and they treat patients as usual but just don't refer up to us until the Philippine team is ready.
All in all we have treated about 350 people in the hell hole that is "the stadium," have treated ~300 in our ER, done 82 major surgeries, and too many fentynal/versed/ketamine cocktail bedside debridements to count.
We say goodbye to our patients one last time and head home. One of our nurses is Palestinian and has made friends with a Palestinian store-owner down the street who has been giving us and our patients food when we need it. He asks if we would all be his guests at a local Lebanese restaurant for dinner that is still running and we accept. Red wine never tasted so good and there is a lot of talk over dinner about Haitian culture, its history and the problems it has to deal with now.
UNICEF comes by to pick up baby Germaine as he won't be able to travel back with us right away until the paperwork is done in a week or two. His new mom vows to return for him and the folks from UNICEF assure her that this can be done. I say goodbye to "Baby G" and hope to see him sometime soon as he is the promise of a better future for Haiti.
Day 8: "This is a world I have only seen on TV."
Jan. 31, 10:27 p.m.
This week has felt like two and we are all psyched to get home.
Our driver knows a shortcut to avoid traffic to the airport and takes us through some incredible slums where people seem surprised that a car is even coming through. I see a family with their children washing naked in a garbage strewn muddy creek and a little boy dancing around with a toy string flying from his hand. This is a world I have only seen on TV. We pass a cemetery and one of the nurses spies a crypt with someone's legs hanging out.
Finally make it to the airport where the military and border patrol guys are heavily packed with guns but very nice to us. We wait on the tarmac for 5½ hours for our flight and witness an incredible display of military and international aviation. There are planes and choppers from Russia, Brazil, Canada and the UK. We meet teams from France and Australia, Nebraska and Miami. Over the last week we have received patients from the French, the Jordanians, the Russians and the Israelis. This is truly an international effort and reminds me of one of the things I love so much about Brooklyn.
A GIANT C-130 cargo plane pulls right up to within 30 feet of us and the sound is deafening. A caravan of forklifts is waiting and the whole unloading process takes only a few minutes. As he readies for departure the pilot is trying to gesture us through the little window by covering his face. We soon see why as he blasts the engines for a turn around and the whole crowd is subjected to a windstorm of dust, debris and pebbles.
Finally our plane is here (thanks to Joe Gibbs Racing for Donation) and we are all aboard. One of the anesthesiologists in our crew passes around a journal she has been writing and asks us each to write something to remember the trip by. I am struck by someone else's passage which I'm sure some of you have heard before but which hit home for me:
A man walks down a beach which has been littered with thousands of starfish washed up by a storm and they are all drying up and dying in the sun. He sees a little boy picking a few up, washing them off and throwing them back into the sea. The man tells the boy "it's no use there are so many. . . what your doing won't make a difference" . . . The boy picks up another starfish and washes him off and says "it will make a difference to this one" and then throws him back into the ocean.
There will be a lot of people in Haiti who need our help over the coming years and I know there are so many people both Haitian and otherwise who want to be involved in this effort at Lutheran. I look forward to working with all of you in another mission in the not so distant future.
Thanks also to Lance Wagner, Claudia Caine, Stephen DiCrescento, Jose Hernandez, Dr. Sclafani, Dr. Gambino, Dr. Vitale and all of the others who helped make this trip possible.
Please continue to check back, as we will post updates throughout the group's stay. This relief team plans to return to the U.S. on Jan. 30.