January 2012 Archives

Greetings from Saint Damien's Hospital, Week #2

from John Heimerl, MD, 3rd year pediatrics resident at University of Minnesota:

Another week has passed here in Haiti. It has been a busy week.

Since my trip to Saint Damien's overlapped with the team from Brown University, I was put to work in one of the hospital wards for the week.

Initially, I was working with Dr. Vaz from Brown University.

We divided the patients up and tended to them one by one.

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Seeing patients in the Orange Room on the wards at St. Damien's Hospital for Children

By the end of the week, I had developed quite a relationship with the parents and patients. A few of the children have been here for months.

The girls' room has a three year old with cardiomyopathy and TB who has been in the hospital for more than six months.

A few of the days she would sit on my lap as I worked my way through the charts.

Another girl had a right-sided empyema with a chest tube in place. After having the tube in for a week we got a CXR, and it showed no change. While the chest tube and collection system are the same we would use back home, there was no suction attached to the reservoir to assist with draining her plural fluid.

After she had had a few days of fever while on broad spectrum antibiotics and I had realized no more fluid was draining via gravity, I decided to see what I could pull out with gentle suction and a 60cc syringe.

Thirty-five mL of purulent fluid later, she was feeling much better and has actually continued to drain into the reservoir.

Following morning ward duty, I've spent afternoons assisting in the urgents (ER), where we are seeing all sorts of pathology--things I will never see in the U.S.

A few of the patients I have seen this week include a girl with CXR consistent with miliary TB as well as malnutrition of all sorts, from kwashiorkor to extreme marasmus.

One child I admitted over the weekend was 16 months old and was on breastmilk till 1 year of age, then apparently was fed cookies and juice. My interpreter made it clear to me that is was not "natural juice", which I thought was slightly humorous, as the nutrition value would still be minimal. Needless to say, this child should improve with proper nutrition, and along the way we will ensure the family receives some education.

A few patients have not made it.

On Saturday a six year old with pneumonia experienced complete respiratory failure.

I taught a Haitian medical student, who happened to have been walking by the boy's bed, to properly bag mask, then gathered the necessary intubation supplies and determined how to operate the ventilator. The intubation actually went remarkably well, however, I discovered that I had not paid enough attention to the respiratory therapists back home, and I didn't properly secure the tube.

The episode seems to have been a good learning experience, both for the med student and the nurses, though unfortunately, as expected, this child did not survive.

I did think it was a start at transitioning to the next level of care, and hopefully over the next couple of weeks, we can continue to teach the nurses.

I have had the opportunity to do a couple of day trips on my days off.

Last week I went with the Brown team to the beach.

Friday, I took a half day and was driven around the city. 

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Public transportation in Haiti is called a "tap-tap".

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We drove by the National Cathedral, which lays in ruins from the earthquake.

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After the drive we had a wonderful, authentic Haitian lunch...

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...topped off with fresh sugar cane.

Sunday I had the day off and went to the Kenscoff Orphanage for the 25th anniversary of NPFS (Nos Petit Freres et Soeurs, "Our Little Brothers and Sisters") the organization that supports St. Damien's and multiple orphanages.

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Father Rick (pictured) and the archbishop attended the anniversary celebration.

Kenscoff is a breathtaking mountain retreat from the city. We made the trip with children from another orphanage that's located next to Saint Damien's.

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This amazing view was taken from Kenscoff Orphanage, looking out over the adjacent hillside.

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Following mass there was entertainment and dancing.

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One more picture: this local artist makes these pieces out of 50-gallon steel fuel barrels.

Dr. Heimerl's First Week in Port au Prince, Haiti

Written by John Heimerl, M.D., 3rd year pediatrics resident

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Chapel at sunset on grounds of St. Damien's Pediatric Hospital; Port au Prince, Haiti.

Well, I have embarked on my seven-week experience in Haiti. I arrived on Monday, January 16.

My flight was slightly delayed in getting to Port au Prince, due to the airport controller delaying our landing.

This circumstance allowed for us to circle the island prior to landing, and I recalled my first year of medical school when we read Tracy Kidder's Mountains Beyond Mountains.

It is no mystery where he got the name for his book: there are mountains beyond each ridge of mountains. It sure is beautiful topography.

Most of the population lives in the coastal town of Port au Prince, but houses and huts are scattered among the deforested slopes of the mountain.

I can only imagine how far residents must travel for water and supplies, especially since there are very few visible roads.

We ended up landing after dark and headed to St. Damien's Pediatric Hospital, where I'll be rotating. I imagine the distance was not very far, but the stop-and-go traffic made it seem further. We eventually arrived.

I was greeted by Sister Judy at the entrance of the hospital and met the two attendings and residents from Brown University that I'll be staying with, who have agreed to take me under their wing for a couple of weeks.

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Recently the hospital upgraded from canvas tents to prefabricated houses. The prefabs each have three rooms with a small communal space and bathroom. Oh--did I mention they are air-conditioned? (The only such place in the hospital.)

As with any working communal living situation, I was told of the short list of house rules and also told that this side of the house was against the labor ward, so to expect screaming at all hours of the night.

Nevertheless, I had a great first night's sleep.

On the following morning I got to work and began with observing the triage process. Patients begin assembling at 0645a.

From triage, patients are sent to various places depending on how they look, their chief complaints, and their temperature.

Some are sent home with Tylenol, others sent to the adjacent clinic to be evaluated, others are sent for further triage, to the malnutrition unit, or to the cholera tent, if they have severe diarrhea.

The sickest are sent directly to the emergency department. I am told this triage process continues throughout the day. 

The services are free.

The hospital, which serves kids 3 months to 12 years old, is a complete pediatric hospital with OR, Lab, XR, blood bank, NICU, an ICU (Critique), wards, oncology (the only such unit in Haiti) and ED (Urgents).

I will be spending most of my time in the Urgents, which also functions as a extended-stay unit; after evaluation, they may stay for several hours or for days.

The mornings are spent rounding, first on the patients who are boarding in the Urgents, then with the new patients.

Mostly we are seeing meningitis, pneumonia, sickle cell crisis, malaria and other tropical diseases. Mixed among these are the more routine pediatric admissions.

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I've been spending the mornings this week working in the general wards. Each room has a name that corresponds to the painting outside it, so today I was in Balloons and Watermelon.

Each room houses around ten patients. Each day there are a couple of new patients who made it up from the Urgents. My rooms had kids with chronic heart disease, sickle cell, meningitis, and pneumonia.

January 10th marked the second anniversary of the Haiti earthquake.

You can see evidence of the destruction in the adjacent buildings and on the patients who have scars or are missing limbs.

I am told a large ceremony was held that day at the hospital. Saint Damien's was built in the early 2000s prior to the quake and, due to its Italian engineering, sustained minimal damage.

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I am told there were some cracks in the cement walls. Most have been repaired, but in one hallway, they have left the damage exposed as a mural of remembrance.