Day 4- Tuesday

Today's challenge is in organization- finding a way to get things to the people who need them involves identifying their needs in the first place. What this place could use more than anything is a big, fat needs assessment.
I finally found a rhythm of sorts doing wound care rounds, but I left it too soon, to my regret, again hoping I would be needed more elsewhere. I was wrong, and spent the rest of the short day doing nothing but following people around, trying and failing at being useful. I am dissatisfied with everything- with myself, with the situation, with my inability to function autonomously here and commit to something. I guess I really just do better with structure, but I think it would be hard for anyone to come into a short-term, chaotic situation without a well-defined role. This is not teaching me what I thought it would. It is unfulfilling. I am ineffective. I am a little overwhelmed today, and probably dehydrated but at least I am not sick!
The novelty has worn off, the adrenaline rush is gone, reality is glaring in my face. Heh, it's the 4th day, playa bends set in at burningman about this time... This isn't easy, glamour or glory. Nursing is rarely glorified work, but what did I expect? To those people coming in behind me: have a plan. Have a role you are stepping into, otherwise you'll be totally lost. Know where you're going and what you're doing. Expect all of your plans to change. You are not the expert. There was a routine to things before you got here, and it will continue after you leave, so don't try and shake things up too much. There are lots of problems here- don't become another one. Remember that EVERYTHING you do helps. Every smile, every kind word, everything.
Made some new friends on the ward during wound care rounds. The man in the corner likes his name written on the bandage on his knee. The young woman across the way is one of 3 survivors from her nursing class of 85. The other two survivors are downstairs. She is missing a 6"x3"x4" hunk of flesh from her right butt. Her wound gets packed with wet gauze twice a day - in the US, we would administer heavy doses of morphine for such a large wound. Here she gets a couple of tylenol. She spends most of her day lying on her belly. She likes us to use some alcohol to remove the tape from her 5 or so other bandages so the tape doesn't hurt as much. I kept rounding with an advanced EMT from the US who will be there another 3 weeks. She shared with me some of her frustrations about the constant chaos and well-intentioned volunteers. Some people make promises to help, to send money, to bring kids to the States and then disappear. The Haitians wait for that. They look toward the door every hour to see if their new friend has come back with the food, soccer ball, or other thing that was promised. The Haitians remember. "Relationships are about saying goodbye" she told me. I'll remember that.

We discovered today that the supplies being donated to Les Cayes General - the "county hospital" type facility we started out at - are being sold back to the patients. We had to wait 20 minutes for a man's family member to go to the pharmacy and buy the valium we wanted to administer to him before trying to reset his dislocated shoulder. We were unsuccessful, and scheduled him for surgery. He thanked us when we left. For what, I'm not sure. Now our Ortho surgeon has a fever. We're going home Thursday. I am done.

Day 2-Sunday part 2

I spent Sunday doing what I could as an OR nurse. Without an anesthesia machine, endotracheal tubes, pulse oximetry, cardiac monitoring, oxygen, suction, or even a proper BP cuff, there wasn't much for me to do but take inaccurate manual BPs and a radial pulse. The anesthetist did what he could with spinal anesthesia and ketamine. The Supernatural Anesthetist. He did well, much of the time. Our Ortho surgeon fixed femurs, tibias and a humerus or two. I started an IV in the ER in a man with a large, bloody bandage around his head. I left later after I realized he was in agonal respirations and no-one was going to do anything. I kept looking at him and thinking "he's really sick." "He's REALLY sick. He needs help." "Can't one of our docs see what's under that bandage and do something?"
Oh yeah. There isn't anything to do. If he's bleeding that badly from that much of his head... There's no ICP monitoring, no pressors. If they cut a window in his skull to relieve the pressure, the flies will take up residence there, too. The feeling of helplessness is still with me.
Failure to prevent the inevitable. No attempt at clearly futile heroics. Powerlessness. Humility. Faith. Grounding.
I'll get over it, but I know his stridor will echo in my ears for a little while.

Day 3- Monday

Today we drive around looking for more trouble. At General, there are 2 American teams- one from Maine with 2 Ortho surgeons, an advanced practice nurse first assist, an anesthetist, a PACU nurse and a nephrologist who has spent a lot of time here and serves mostly as an interpreter. We are a ragtag group consisting of a cardiac nurse from NYC an Ortho surgeon from Atlanta, a retired Ortho surgeon from Eugene and me, the labor and delivery nurse. We are a team only because we are sharing housing and a driver, but are seeming to work better together than the Maine crew. There's some friction between the two groups- (Survivor-Les Cayes General...) add that to the chaos of the situation and communication difficulties between all of us Americans and the 2 Haitian surgeons and... Well, we thought we'd see if we could be helpful elsewhere.
Cité Med was crowded and had tiny private rooms. It seemed more a clinic and less a hospital, but there were two cute sisters on the 2nd floor recovering from similar leg fractures who grinned and giggled at us.
Hopiteaux Brenda is usually an ear-nose-throat clinic, but now has big UN tents outside and is seeing all patients. Some American, Canadian, Brazilian and Uruguayan medical staff seemed to have things under control. A nurse that we spoke briefly with told us that without interpreters to help us give care we would be in the way and we could help organize the stock room but that was it. I considered staying to do whatever I could, I could call our driver to fetch me at any time... I should have stayed. I am finding I do better with some structure, and have not had much success at finding my own opportunities or my own way. I have found some security with my new friends and am clinging to them. I hope they don't mind.
I want to be self-sufficient but fear a little for my safety and am not as confident as I want to be. Need my H here, or something. What did I think I was going to do? Start IVs, change dressings, organize paperwork... The nurses here sit behind a desk and chart. I have yet to see one change an IV bottle or give a medication. Not all that different from home I guess- who am I to judge? Language barrier makes it difficult to give instructions or explain a procedure, but I have to remember that love, caring and comfort are universal. And every little thing we can do helps.

Day 2- Sunday

Frustrated by finding a different opportunity than we imagined. Chaos, somewhat. Inefficiency somewhat. No lack of patients, that's for sure but we don't feel like we are doing disaster medicine per say. There are lots of fractures that need fixing, on top of the usual chronic human diseases complicated by scarcity of resources, trained personnel, and wellness knowledge. What these people have in plenty, though, is family, quality relationships and a faith in god. They have more prayer than anything. I am not sure it's helping. Everyone is dressed in their Sunday best- frills and ribbons, tucks and pleats. Another of many ironies here- little girls in fluffy dresses picking their way across filthy, cracked streets, through trash and poisoned water, motorcycle exhaust and skinny dogs to school or church. Chaos, yes they have in plenty.
Maggots. Maggots keep the wound clean, at least. This is a 92 year old gentleman with peripheral vascular disease. His poor circulation has caused what I am sure was a scratch at one point to brew into a large hole in his shin with tunnels that host little friends. They squirm away from the light when we remove his filthy yellow bandage. I am not as squicked out as I would be normally. I am not sure why. The little worms keep the wound a little cleaner, at least. Giving the pseudomonas and staph and whatever else less dead material to grow in and infect the rest of him.
How do they get there? Do flies lay their eggs there? Do all maggots look the same? I wonder about the fly's lifecycle. I wonder about my lifecycle.
Too many doctors, not enough nurses. Doctors fight over cases, try to organize themselves into an effective OR, but without anyone to structure things, they flail a little.
We all do.
Haitians are stoic in the face of pain and laugh, joke and tease their way through daily life. They shout, sing and stomp their prayers, but intense pain is met with a quiet "Oh-oh-oh..." I wonder if we subject them to more pain than is necessary because they do not complain about it. There is no 5th vital sign, here. I saw morphine on one man's chart but haven't seen any evidence of it being used. "Beaucoup doule?" I have learned to ask, despite having nothing but a smile and a pat to help when sometimes the answer is "Oui, oui."

First day.

Sooooo unhappy about having to pare everything down to 20 pounds. Food or notebook. Water purifier or batteries. iPod or socks. This is a game of what do I need, rather than want. This may be a lesson in "enough" rather than strength, fortitude or skill. Flying into Les Cayes, over barren brown hilltops, roads on the ridges mirror the rivers in the valleys. Dusty tracks wind without reason- Haitians create roads where they are needed, not according to any plan. Like everything else in their haphazard, chaotic existence. They cling wherever they can find a ledge or scrap, through political unrest, pseudooccupation, a thousand insults to stability, growth and country (I learned about how the charcoal industry stripped the entire country of it's trees...).
It's a stark contrast to the neatly ordered waterfront estates I flew over in Ft. Lauderdale less than 24 hours ago- each fenced in it's own pool of isolationist narcissism.
I am getting away from myself and am a little jaded.
Namaste, namaste. The God in mee recognizes and honors the God in you. "Hey give me food!". "Hey give me money!" the kids chant at the fence while we unload the plane. A smashed box of donuts swelters in it's embarrassment atop our pile of bags. Each if us brought more clothes (well, I am still a little miffed about my paltry three sets of scrubs...) than these kids will own in their lifetimes. "Hey give me food!" it's the same empty phrase called at fences and ditches and breadlines around the world, with white people on one side... "I need, you have." They cry, fingers bunched at their lips: the international sign for "please, I am hungry."
The language changes, but the words stay the same. Americans get fat on their own privilege.
Here I wax jaded again. Salvation or empowerment? Do we need to give these people food, or teach them...? Do we perpetuate their dependence because it gives us more glory, more gore, more to do, more to save... More to prove?

DFW-FLL

My nurse pen works, but not the black or blue... Technicolor thoughts, crash course in French in green and red. Wishing I had my "kindness" necklace, but my first wedding token and "namaste" rock will do just fine to remind me both why I am here and where I am home. "The God in me recognizes and honors the God in you.". Namastizzle!!
The state of Florida has interesting topography. A giant swamp; trees stand in isolated groves, clumped like a skin cancer. Like colonies of staphylococcus in an agar plate with their burned- out cores. I thought: look at this, miles of dead trees! There are spots of green here and there, but all the thousands of dead ones! And here, a house in the center! What virus, what beetle or chemical hath wrought it's wrath here and aren't the inhabitants of these houses concerned....?
Oh. Yeah. It's January. All the trees here are deciduous, even the coniferous ones. They aren't dead, just denuded of leaves, hibernating for the winter. I must be from the Pacific Northwest.

The night before.

Stuffed a small orange teddybear down in my bag, down past the box of sutures, the baby bottle, the IV needles & electrocautery. It's wrapped around my big serrated knife- who's protecting whom in this disquieting juxtaposition? I just have no idea what to expect.