Like most of us, I watched the terrible aftermath of the earthquake in Haiti on television, and gave money to a couple of NGOs that work there. But, as a primary care doctor I wanted to find a way to be of greater help. Then, fortunately, in early March—six weeks after the earthquake--a colleague in the Society of General Internal Medicine emailed me with a description of a field hospital run by the University of Miami on the grounds of the airport in Port au Prince where there was an increasing need for internists, pediatricians, nurses, and physical therapists. Since it was possible to volunteer for as little time as a week, I decided to take a week of vacation time and head to Port au Prince.
Project Medishare, an NGO associated with the University of Miami, was able to set up the field hospital within two days after the earthquake—its quick response made possible because the project had been working in Haiti since 1994.In the first hours after the earthquake, Dr. Barth Green, a Miami neurosurgeon who founded Project Medishare, organized a group of Miami surgeons and nurses who were already working in Port au Prince to begin to do emergency surgery in tents on the grounds of the airport.
Gradually the team got supplies, most of them brought on flights from Miami, and built up a 130-bed hospital, which is now housed in four large tents. One tent contains the adult medical-surgical patients, with 80 cots in long lines and a separate area that is used for wound care; another the pediatric patients, ICUs, and OR; a third is the supply tent; and the fourth, with 150 cots, is the sleeping tent for volunteers.
I met the group of about 100 volunteers at 5 a.m. on a Saturday morning in a very quiet corner of the Miami airport where we would board our charter flights. I immediately got to know several other doctors and nurses from the University of Miami and Jackson Memorial Hospitals and also from various other parts of the country. Like me, they were exhilarated about the opportunity to provide real help to people who were suffering but also apprehensive about the challenges of the work. We filled a 737 with volunteers and took off for the short flight to Port au Prince. From the airport we were shuttled in small groups in cars that took us to a different gate about half a mile from the terminal and entered the hospital grounds. I had seen photos but the size of the large tents, and the setting, on a flat, treeless area in a far corner of the airport near the end of the runway was an impressive sight. It was unlike any hospital I had seen.
We met a like number of volunteers who had arrived the past Monday and were introduced to our work areas by the Chief Medical Officer and the chiefs of the different services. I started to see patients, lying in long rows of cots, in the med-surg tent. The majority of the patients had earthquake injuries: fractures, amputations, and spinal injuries with paraplegia. There are more recent admissions as well, who had other types of trauma (mostly from motorcycle accidents) and medical problems such as pneumonia, malaria, and TB, which are common illnesses in Haiti and have no relation to the earthquake. The saddest cases are the ones with severe injuries who will find it very difficult to rebuild their lives. One young man with paraplegia and an unstable spine fracture has not been able to even sit up. A young woman with a below-knee amputation was lying in bed, not moving and barely speaking. Two sisters sat beside her cot and tried to help her deal with her feelings of hopelessness.
Not long after I had started to work, the chief medical officer of the hospital came looking for me. A senior U. of Miami surgeon, he arrived on the first team with Dr. Green. He told me he was leaving on the coming Monday and had yet to identify anyone to be the next CMO. One of the other internists had told him of my administrative experience at Harlem Hospital in New York as Associate Director of the Department of Medicine and the director of the Medicine residency program and he therefore believed that I was the best candidate to serve as CMO for the week. I spent the rest of Saturday and Sunday shadowing him to find what he did. After he left early on Monday morning, I found myself, with as much confidence as I could muster, telling the medical and nursing staff at the daily 7:30 a.m. staff meeting that I’m not from the University of Miami, had just arrived in Haiti for the first time in my life, and was going to be their leader for the week. I led the staff meetings and also meetings with the chiefs of each service every day for the duration of my time at the hospital. Most of the issues were coordination of the medical services although we occasionally dealt with trying to make important changes such as infection control and better disposal of needles and other contaminated sharps. The other duties of the CMO include such things as making sure call schedules are made and distributed, getting the hospital census and other data reported to Miami every day and participating in conference calls with the leadership of Project Medishare. It is also the job of the CMO to sign a letter that serves as a death certificate; I signed a number during the week.
As I think back, it is hard to explain what I did with all my time but I was busy often from the moment I left the tent at 6 a.m. until 7 or 8 p.m. I listened to sign-out rounds of the internal medicine docs in the morning and evening to keep up with what was going on and sometimes give advice (being the most senior person there). This was usually about managing difficult cases. One example of the challenges was management of TB. Patients had to be isolated in small separate tents which made nursing care much more difficult. On a couple of occasions it meant making very difficult decisions about which patients were unlikely to survive and would receive comfort care. I spent much of the day going back and forth from one tent to another, finding people who needed to speak to each other or helping find supplies or answering various sorts of questions. This had to be done in this low-tech fashion because communication was done using a limited number of walkie-talkies. So I often went looking for a surgeon if there was an urgent need in the ER or the psychologist to help the family of a baby who had died. We were also getting multiple requests from other hospitals and clinics in Haiti since we had more specialized surgeons and more intensive care unit capabilities than any place else in Port au Prince, and I helped with the decision making on those. Many were head trauma cases (motorcycle accidents) and the hope was that our neurosurgeon could help. Another was a request to accept premature triplets into our neonatal ICU. (We did and two of them died anyway.)
We sent some doctors to other facilities for a day. Sometimes this was because there was a special need and we had extra resources (especially orthopedic surgery and other surgical subspecialists). Some other hospitals have better OR conditions but not enough surgeons. We also sent internists to General Hospital, the main public hospital in Port au Prince, which was badly damaged and is operating partially in tents. Many physicians and nurses were killed or injured in the earthquake and there continues to be a dire need for physicians.
The mission continues to change as the needs change. The major focus of the Medishare hospital continues to be trauma and care of earthquake-related injuries. That now means continued care of wounds and fractures. Accidents and illness comprise the new cases are now mostly motorcycle accidents and medical problems mentioned above. There are also more children in the neonatal and pediatric intensive care units. The NICU presents a special problem since it is the only one in Haiti and the capacity is very limited (in equipment and specialized nurses). If or how the hospital can continue to serve critically ill neonates is a difficult question. There have also been more and more outpatients arriving at the gate with minor and chronic illnesses. Whether the hospital will continue to try to serve this population is up in the air at this moment because Medishare never intended to do basic primary medical care and is not equipped with staff or space to deal with as many as 400 ambulatory patients who had begun to show up daily at the gate.
Most of the volunteers sleep in the same large tent—there are 150 cots in long lines with only about a foot of space between each. Toilets are Port-a-Potty style and showers have only plywood surrounding them for a tiny bit of privacy. A very dedicated volunteer got up to have coffee ready at 5:30 a.m. every day under a tarp labeled “Starbucks Haiti.” We ate military Meals Ready to Eat (MREs) bearing a label saying they are “warfighter approved.”
A couple of nights one of the physical therapists who is also a yoga instructor held yoga class on a large plastic sheet laid out on the field beside the sleeping tent. On the last night I was there about 15 people formed a circle and did the exercises together. It was amazing to find that it was possible to concentrate and relax in that moment even though a very bright security light was beaming down on us and planes were landing 200 yards away.
I already miss several of the wonderful volunteers I worked with. It was such an intense experience to spend so many hours every day working so closely together and then go our separate ways.