Bonjour from Haiti
Nurse anesthetist Emily Zimmerman’s experience in earthquake devastated Haiti
From: Emily Zimmerman Date: Fri, Jan 29, 2010 at 8:47 PM Subject: Bonjour from Haiti Hello friends and familyConditions are worse than imaginable. The entire city has suffered destruction. The streets are lined with make-shift tents. Even families whose shelter remains standing choose to live in the streets for fear of after-shock. Recently orphaned children sit blank-stared on sidewalks just lost. As we drove to the hospital, the smells are overwhelming. Many bodies remain trapped under rubble...it has now been over two weeks. My team joined with other Doctors Without Borders. We sleep in tents outside the Hope for Haiti clinic across the street from Hospital Adventista. My first night, I was awakened to someone from the hospital across the street calling for the “blonde-hair anesthesia”. There are two anesthetists (myself included) on our team. I grabbed my new-found CRNA friend and ran next door. There was a stat C-section at the hospital. The conditions are unbelievable. Make-shift ORs with out-dated drugs that I have only read about. But we have an anesthesia machine! This morning I worked in a public health clinic. Six of us assessed over 250 Haitian men, women, and children. Later in the afternoon I went back to the hospital to help with anesthesia. Tomorrow more surgeries. Will try to keep in touch later. Take nothing for granted. Love you all. Emily
From: Emily Zimmerman Date: Sat, Jan 30, 2010 at 10:05 PM Subject: Day 3 in Haiti Hello friends! Day #3 in Haiti. My medical group has now teamed up with an organization with many groups that provide all various needs. One group cooks and serves food, one group of contractors and engineers covers construction and rebuilding, and my team provides medical care and the public health clinic. Together, all groups are trying to serve the Haitian people and enable them to rebound from the earthquake (or as they refer to it, “the event”... no one wants any reminder of the earthquake). The entire organization is “Operation Hope for Children”. It has established a web site: www.operationhopeforchildren.org. The man who started the organization is actually running for President of Haiti in 2011. His web site is: www.delaleuforhaiti2011.com. There are some pretty amazing pictures from the event. I spoke with him tonight about getting more medical teams into Haiti now that the initial help is filtering out. We are now left fighting old fractures, infection, and severe malnutrition...the worst cases imaginable. Right now, my time is divided between the clinic and anesthesia at the hospital at night. The public health clinic I worked at today saw over 400 people between about seven doctors. Oh yes, and today…in Haiti...I am a doctor. ?? Many of these people have never received medical care in their lives, so they are very appreciative of anything. I started an IV on a two month old that was terribly dehydrated and took her over to the hospital. Love and God bless, Emily
From: Emily Zimmerman Date: February 2, 2010 1:17:59 AM EST Subject: Back in Haiti Sorry no update yesterday. It was one of my longest, most challenging days so far. The public health clinic was closed because it was Sunday, so I spent the entire day in the OR doing anesthesia. It still amazed me that nearly three weeks after “the event” many with broken bones and large wounds are just now getting to the hospital for treatment At this late timing, outlooks are poor and infection is rampant. I’ve never seen so many gangrenous limbs. Anesthesia is difficult because no one will allow general anesthesia. No patient wants to go to sleep. They are all afraid that we might amputate a limb while they are “asleep”. Their fears are understandable. During the early response after the earthquake, out of desperation and lack of resources, many doctors had to resort to amputation to save the patient. ...and so, my skills in spinal blocks have gotten lots of practice. Hospital Adventista is amazing. I feel like I am working at the United Nations. In one case, I might have a surgeon from France, one from China, a circulating nurse from Thailand ...oh, and an anesthetist from Illinois. It has really been remarkable to see so many people of such different backgrounds come together for the same united cause. The hospital, though it has suffered severe damage, is one of the few hospitals in Haiti left standing. There are many great big cracks in the concrete and foundation and some parts of it have fallen, but just the fact that some of it remains “serviceable” is more than most other buildings surrounding the epicenter of the earthquake. Aftershocks are still occurring—though I haven’t felt any since I’ve been here—which makes working in the hospital a bit scary at times. With so many hundreds injured and so much damage to the hospital, there is no room for patients. Instead, they have created “tent villages” to which patients have been assigned. Rows of tents fill the entire yard with the confines of the hospital gates. Tents so close the are touching. There are so many sick people. It’s often hard for us to locate patients within the tent village to be able to bring them to surgery. Patients have become identified by their tent numbers.
Date: February 2, 2010 1:17:59 AM EST Subject: Back in Haiti (continued) Pre-op and initial ER is outside too. There are even tents still set up as operating rooms outside from the first days when limbs were being amputated outside in the masses. Tonight I even ran a code on a woman rushed in from the “village”. Family yelling 15! 15! 15! ...her tent number. She was carried to the outdoor OR tent, which consists of two large blue tarps and one dimly-lit ancient floor lamp. The OR table is nothing more than a slab of metal on blocks. It was really a disturbing scene; as if I was back in the Civil War era, only this is 2010, but like nothing I could have imagined I would ever witness in my entire life. This is Haiti right now. The scariest part is that this is not temporary and not going away any time soon. In fact, I’m afraid of the weeks ahead. I’m afraid of infections, effects of long-term immobilization, and severe malnutrition and dehydration. While Haitian people are very peaceful and appreciative, in the face of hunger and starvation, people become desperate. I don’t ever feel unsafe, though. People recognize the need for doctors and nurses and are extremely grateful for help. The US Navy just arrived today; some of the first groups of Americans I’ve seen outside the airport in Port-au-Prince. Je t’aime, Emily
From: Emily Zimmerman Sent: Wednesday, February 03, 2010 2:14 PM Subject: Unfair Sunday, Jan. 31, 2010: These past few days have kept me so busy in the OR that I’ve gotten behind in my correspondence. Another long, busy day in surgery full of fracture repairs and wound debridement. The smell of the three week old wounds is overwhelming. Poor sanitization conditions combined with long hot days spent in crowded tents with little to no ventilation. Thank heavens for Vicks Vaporub! I left the hospital around 8pm to return to camp. We now have running water! I immediately headed straight for a shower, which really consists of bathtub and garden hose pulled through the bathroom window. It’s freezing cold, but I can’t wait to “come clean” of today. I yell for someone outside to “turn on the hose!” and not more than two minutes later hear a voice outside running down the alley & coming toward the clinic. A nurse from the hospital pounds on the door of the clinic for me to “come quick” to the hospital...“a stat C- section”. Still soaking wet, I throw on scrubs, call for Sandra (the other anesthetist and native Haitian), and we follow the nurse back to the hospital. We quickly gather whatever supplies we can find through all of the mess of medical equipment just shipped in (thank you to all who donated!). Turns out there are in fact two C-sections, but only one surgeon. The most critical goes first; umbilical cord wrapped around the baby’s neck. Spinal block and within four minutes the baby is pulled out, blue, completely limp, and lifeless. It was then that we realized that there was no one available to take care of the baby, who is cyanotic and silent.
The surgeon continues to suture, while I leave mom to help the baby (“patient abandonment” and illegal in the US)...not to mention the fact that I know extremely little about labor and delivery nursing...desperate times. Sandra takes over care of mom, while I attempt to stimulate and suction the baby. Yes, I am screaming for help the entire time. A Canadian ER doctor hears me and comes to the rescue. Together we stimulate and suction large amounts of aspirated meconium, and soon....crying. The most beautiful sound in the world! Sandra and I must quickly get ready for the 2nd C-section. I wheel the last newborn into the room with us. Again, there are so many things wrong about the conditions we must work under, but we must just adapt and adjust to what we have. There is no NICU. New babies and moms get sent back outside to the yard (literally) just after delivering. This baby was no where near stable enough to be left unattended. Sandra and I were getting ready to do a spinal block on the next mom when a code was called on a baby that had been rushed into the hospital from the “tent village”. A woman crying and pleading (in Creole) to help her baby. The infant was intubated and coded for over 20 minutes before time of death was called. I completely broke down. I tried to hide behind my glasses and mask as I cried right there in front of everyone. It was unbearable. And even still, after experiencing such heartache, I had to return to the OR to finish the last C-section. I’m thankful I stayed. As difficult and cold as it felt at the time, I needed a “happy ending”. I got just that. One loud, crying, healthy baby. As two new lives were brought into the world tonight, one was taken away. A harsh and unjust life. The hardest part about tonight was wondering the question to myself, “what if?”; “what if this baby had been in the US?”...same baby, same illness, only with better medical access. Would the outcome have been the same? I seriously doubt it. That’s what makes it so hard...wondering why some are so fortunate and privileged, just by the geographical location in which we have been born; while others are born into nothing. It’s just seems so unfair.
From: Emily Zimmerman Sent: Thursday, February 04, 2010 9:13 AM Subject: Monday Feb. 1, 2010 For reasons that I will explain later on a more private scale, corruption and conflict has closed the doors of Hospital Adventista to medical aid by “outside” surgeons, doctors, and nurses. In other words only those individuals staying and living at the hospital would be caring for patients within the concrete walled confines of the hospital. As of late last night, entrance gates would now be heavily monitored. Sandra and I arrive at the hospital early in the morning, in preparation for a heavy surgery schedule today. We are denied entrance and sit on the hospital steps waiting for clearance. Over an hour passes, surgeries are on hold until the only two anesthesia providers in all of Carrefour are allowed inside. Unaware of the situation, surgeons began to worry and search for us. Within minutes, Sandra and I were quickly granted clearance and escorted into the hospital by the medical director of the hospital. He apologized for the inconvenience and explained the situation. Haiti is in devastation and things are not getting better any time soon. Many are desperate. The earthquake brought us to Haiti, but the tribulation of it’s people will keep “us” here long after the event.
From: Emily Zimmerman Sent: Friday, February 05, 2010 8:19 PM Subject: Home from Haiti Friends and family: One last note. This time to let you all know that I am back home safe and sound. My team was “relieved” by another medical team to cover surgery and anesthesia at Hospital Adventista, as well as more coming to help support and continue our public health clinic started through Operation Hope for Children of Haiti. Departing Port-au-Prince and returning to the states has become a little more challenging this week for civilians than in weeks prior. More and more commercial airlines have begun to pull out flights from Port-au-Prince, which has left many aid and relief workers to rely on military flights to get home to the US. The fears aren’t as to whether or not we would be able to leave, it was just a matter of when. Fortunately, a small group of us were allowed on a four-passenger Cessna. We made a quick stop in the Bahamas to refuel before landing in Ft. Lauderdale late last night. With the Super Bowl in south FL this weekend, all hotels were booked, so I got one more opportunity to “camp out” in the Delta terminal. With the help of my awesome brother, Damian, and his pilot college roommate, I made it back home to IL today. I can’t describe my appreciation for the “simple joys” that before I had always taken for granted: food, running water, clean drinking water, toilets, and a WARM shower!!! My last day in Haiti, as I gathered my clothes and supplies to donate to some new friends, I realized just why my hair had never really felt clean, even after a good garden hose shower: the “conditioner” that I had been using all week actually turned out to be “body lotion”. Whoops!! Yet another draw back to showering in the dark by flashlight.
Sent: Friday, February 05, 2010 8:19 PM Subject: Home from Haiti (continued) Leaving Haiti and all those still suffering has been more difficult than I had imagined. I have so many mixed emotions right now. I’m so grateful to be back home with my wonderful family whom I have missed so much. Yet, I can’t help but feel an enormous amount of guilt for those whom I have left behind. My time there feels too short, with so much left “unresolved” and “unfinished”. Regardless, I am thankful for the time I was able to spend there and humbled by all that I experienced in such a short time. I will try very hard to remember it every day. It’s a good reminder to stay grounded and appreciative of ALL for which we have to be thankful. Thank you all for the many kind words, thoughts, and prayers that I received while I was over there. Prayers and good intentions will always be appreciated, but the true praises go to those who devote their entire lives to serving “the least of these”. I simply responded to a small need during a time that had the opportunity. I hope this experience can be the first of many more. I love you all, Emily