Medic's e-mail gives glimpse of Haitian disaster

Published Feb. 3, 2010
By Lt. Col. Kenneth Williams
81st Surgical Operations Squadron

KEESLER AFB, Ms. -- Editor's note: Colonel Williams, 81st MSGS anesthesia flight commander, is a nurse anesthetist deployed to Honduras to support the training mission underway there. He and 81st MSGS operating room nurse Capt. Elberta Carter were deployed from Honduras to Haiti to assist with the relief effort. This is an e-mail he sent to his commander, Col. (Dr.) Bartlett Hayes.

We arrived 2 a.m. Monday (Jan. 18) at the airport and put up a big tent (4:30) and we all slept on the floor until it was light out.

About 9:30 a.m., we got some transport to the U.S./Haitian Coast Guard base, with some U.N. Sri Lankan soldiers for security. We had a small area to set up our tents and it is literally right next to a lot of Haitians living on the sidewalk right outside the small, low fence wall. We set up two tents, one for the (operating room) and one to sleep in.
A big problem we had is we had three planes to bring all of our stuff, but the last plane got diverted to Florida for two days! Of course, it had some important equipment on it, especially our personal bags that had most of our packed gear. I lived out of a small backpack for 2½ days (one clean pair of underwear and socks and Air Force gym clothes).

It's extremely hot and humid and I'm always sweaty. I don't have enough baby powder to fight it. Bathrooms sort of work. The bathrooms have running water only in the early morning and at night. Of course, the water comes out in a weak stream and fills up two big 55-gallon drums. From there you either dump water over yourself for a "shower" of cold water or you use the toilet and you get about a gallon of that water and "flush" the toilet by dumping it in. Oh yeah, you can't put toilet paper in it because it'd probably clog up. The good news is I've sweated so much I only go to the restroom in the morning and at night. That's right, only one or two twice a day (and no reading in the toilet either).
Last night and again tonight I'm sleeping in the OR because it can't lock and I don't want our stuff to walk.

OK, I'm getting ahead of myself. The Coast Guard and some Navy folks were treating a lot of Haitians as best they could with limited skills and meds (no anesthesia), so they welcomed me helping with some sedation cases that afternoon (with absolutely no monitoring, just placing my hand on their chest to make sure they breathed. At least they could get an IV).

Truly a horrendous experience -- I don't know if you saw some pictures of wounded people just lying around waiting to be treated, but that's exactly what it was. No order, just anyone laying wherever and doing one and two wherever. Hardly any food, but at least the U.N. guards had water for everyone -- a huge plus compared to some.

The Navy flight surgeon said some of the people had been there from the time of the earthquake (seven days?) just waiting to be seen. They had five tables (literally tables or desks) for people to be laid on. There were some Haitian medical folk helping, but they were scary -- the doctor (?) was always yelling at the Haitian nurses. I don't know how many people they saw, but they worked from 8 a.m. to 5 p.m. and I'm sure they worked their tails off. They left after our first day of seeing patients.

Our first OR day was in the tent and we had several reporters. (Associated Press) and Time took lots of pictures and wrote down our names. Maybe you saw or read about me/us?

We did five cases the first day and six the second. Actually, that's pretty remarkable since I didn't have an anesthesia machine that worked. I did all my anesthesia by strong IV medication. I've never had to do it before but I had one class on it - thankfully it worked fairly well. The only downside was it took a long time for the patients to wake up.

From the OR we carried them on an Army gurney about 75 yards around the tents and over very rocky ground to the "treatment hold" area for people to be watched.

During the afternoon of Day 2, we had a bunch of Navy help. We moved our whole OR to a big classroom in a nearby building the engineers said was safe. We had a total of 1½ hours from the last patient to moving the whole OR to treating the next patient. Oh yeah, we share the OR with OB -- a lady delivered a baby during our surgery!

By Day 2, things are already becoming better organized. Our primary care team (cared for) a lot of folks waiting to be seen and treated.

That night, our real bags arrived that had all our stuff -- kinda like Christmas seeing all the stuff we had packed that we really missed, like clean underwear and socks! This was the first night I slept in the OR, but it was OK because I found some egg crates in our packs so between that and my sleeping bag I was fairly comfortable, much better than the Army cot I tried to sleep on the first night. Also, it's pretty noisy in the tents -- we have a bunch of chickens and roosters around and they like to crow a lot! So really, the OR isn't too bad. Oh yeah, it's actually a little air conditioned -- at least you only sweat a little bit.

Food -- MREs, what else? But I must say that they've really improved on them since Desert Storm. I really haven't eaten that much between the heat and just plain tired. The second evening my supper was a granola bar and the pack of cheese spread from an MRE. Oh yeah, drinking lots and lots of water.

After the second day when our "lost" equipment came so did the medical maintenance guy to help me set up the anesthesia machine and he had my (oxygen) tanks anyway. After we got it running I had to learn how to operate it -- it's a new one I've never seen.

Anyway, I was about to lay down at 12:30 (a.m.) when the Haitians saw the OR light was on and came and got me (this is the first night some Haitian medical folks took over; I don't know how it was arranged but it really helps) because a guy in the tents outside was having something like an asthma attack. He said he wasn't injured by anything, but from breathing in a lot of concrete dust during cleanup, he was having problems breathing. I checked him out but decided to go wake up one of the docs. We didn't have any albuterol (locked up in the pharmacy) but I did have some epinephrine I gave him (subcutaneously) and got him some oxygen. After the second epi shot, he was doing much better. Finally I got to bed at about 2:15 a.m. and got up at 6:15.

OK, this is our third patient day and we did 10 OR cases today because I now have an anesthesia machine that works (sort of). I don't have any wall oxygen like in a real hospital; I have an air compressor that runs the anesthesia machine and I have an oxygen concentrator that I plug in to the facemask to give extra oxygen -- I didn't know we even had such things.

It's very sad the cases we're doing; lots of scalp and foot injuries, some amputations of fingers because of gangrene. I've treated at least five or six kids, too.

After the OR, we carry the people on a stretcher up a flight of stairs to the overnight area. We can hold 20 patients. Some will stay for a few days for dressing changes and maybe back to the OR in a few days. Today, things are vastly improved organization-wise. Lots of people are gone because we treated them and they could leave but mostly because the USNS Comfort arrived and we sent a bunch of patients to them (they have 12 ORs and they can hold 500 patients and already mostly filled up by today, I heard.)

I have no idea what we'll be doing tomorrow. I'm sure they'll find lots more to do in the OR. Right after our last case, they called me over to the primary care area to extubate a patient. It seems some of the Haitian hospitals are sending us patients so they'll get shipped out. This patient was intubated and one of our Airmen had to bag him for 45 minutes. All of a sudden he started to wake up and fight a lot so they called me. I extubated the guy and he had a bunch of stuff clogging his breathing tube so he probably couldn't breathe too well. He was still a mess. He was hit by (something) during the earthquake and hit his head. He somehow got shipped out. Either that or I was going to have to re-intubate him and put him on a mini-ventilator, which I strongly voted against.

We did have problem with our mission. They wanted 23 of us to set up and man an OR (five of us), treat primary care patients (two docs) and have 20 inpatients overnight. That was way too ambitious. There would only be two nurses and three techs to run primary care and overnight patients!! Do the math. You can't do that for long. That's where we got lucky with the Haitians covering the night shift and helping during the day.

Oh yeah, we had to take turns doing guard duty too -- two-four hours overnight in shifts of two. (And yes, I did carry around my loaded M9 pistol.) The U.N. soldiers are on guard duty, but the bosses decided we needed to do it too. However, today some Marines arrived and they'll take over guard duty.

We have one Air Force nurse who runs the inpatient and she's really done wonders in two days. I give her a lot of credit. I'm glad she's a (pediatric) nurse at Landstuhl (Regional Medical Center), Germany, since almost half the patients are kids. Hopefully the major influx of people is over. I hear the Navy is going out in to the community tomorrow and will direct people to us if needed.

Today is Friday and we only did five cases, but three deliveries in the OB/OR room. I didn't help with the deliveries (no epidurals) just gave them IV narcotics. Tonight I may go out to a Navy destroyer to eat, get a hot shower, get laundry done and sleep. Most of the other people have done it and said it's nice.

That's my story to give some indication of what it's like here. Started as chaotic but now getting much more organized. Everything is safe here. Oh yeah. The Marines set up camp right next to ours and have taken over 24-hour guard duty.

I don't know how often I'll get to use the computer but I'll try to stay in touch.

Take care,
Ken

Medic’s e-mail gives glimpse of Haitian disaster