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Eye of the Storm

Two OR nurses and a NP from Hospital for Special Surgery galvanize to support Haitian relief efforts

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Long after the world's attention has turned from the earthquake disaster in Haiti, its people and the devastation will linger in the memory of a team of dedicated nurses at Manhattan's Hospital for Special Surgery (HSS).

Louise Strickland, BN, RN, CNOR, operating room nurse; Ronald Perez, JD, RN, CNOR, assistant vice president for nursing, perioperative services; and Patricia Donohue, MSN, ACNP, RN, orthopedic trauma nurse practitioner, mobilized in less than 24 hours to lend their nursing skills in the earthquake-ravaged Caribbean nation.

The nurses joined nine HSS physicians and two surgical supply technicians 4 days after the magnitude 7 earthquake hit the capital Port-au-Prince on Jan. 12.
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READY TO HELP: A medical mission from Manhattan's Hospital for Special Surgery mobilized in less than 24 hours after the Jan. 12 earthquake to help in Haiti. courtesy Hospital for Special Surgery


Led by David L. Helfet, MD, chief of orthopedic trauma service at HSS, the team arrived Jan. 16 after an overnight diversion to the Dominican Republic. The clinicians performed more than 120 surgeries in 4 days at Hopital de la Communaute Haitienne in the suburb of Freres, just a few miles from the earthquake's epicenter.

Worse Than on TV

Unbelievably, the situation appeared worse than on television. "It's horrific when you actually see it," Strickland said. "The overall picture is just awful. The people had no food or water. Because the United Nations [building] was destroyed, so many people who would be initial coordinators of the disaster were killed or missing. I don't think any of us was fully prepared for the devastation we saw."
The team worked nonstop the first 24 hours. "We just kept going because there were so many people and in such dire need," Strickland said. They slept on blankets among boxes in a storage room until a local woman offered her house for team members to nap in shifts.

"Sleeping arrangements were far down on our list," Perez said. "Our priorities were securing food and water so we would have sustenance to work."

Conditions were rudimentary, especially for a team from a world-leading hospital in orthopedics. There was no basic equipment - anesthesia machine, X-ray machine, blood pressure or ECG monitors - in working condition. There were minimal surgical supplies, other than what the team brought with them. Supplemental supplies flown in during the 4 days were intercepted between the airport and hospital and never arrived. There were non-medical volunteers helping, but no local nurses and support staff in OR.

Fighting Infection

Fighting sepsis to save limbs was an uphill battle. When the team arrived, approximately 750 patients had necrotic tissue, according to Donohue who performed triage. The 95° heat didn't help.

"The first night was surreal," she said, "walking around and trying to find which patients were the sickest. I know the smell of necrotic tissue, so I let my nose guide me and would undo their dressings and see these big gaping avulsed wounds. It was like playing God, trying to find the most emergent cases."

When the team had to amputate to save a life, obtaining consent was further heart-wrenching. The husband of a pregnant woman who needed below-the-knee amputation hesitated to provide consent, worried her role as breadwinner would be compromised. A 13-year-old boy required a Sims procedure - "we had to cut off half of his feet," Donohue said. "There were many emotional issues surrounding amputations," she said.

Language was another hurdle. Kethy Marie Jules-Elysee, MD, an HSS anesthesiologist, spoke the native French Creole language, Strickland and Perez spoke "a little" French and translators were available. However, "most of the [patients] had little education, and it was very difficult to understand [amputation] was the last option."

Donohue was particularly struck by family unity among the Haitians.

"If we were going to talk to a patient," she said, "someone would say 'I speak English - let me help.' There was always someone willing to lend a hand. I was just amazed by their sense of caring and lovingness. Your heart broke for them."

New Nursing Experience

Reflecting on the experience, the team members agreed they had never "seen anything like this," Perez said. "We were all here for 9/11, but there were no mass casualties that survived so we've been through a similar catastrophe, but not in terms of delivery nursing care."

Perez recommends fellow nurses take "a second look" at disaster planning courses available to them and ask themselves "if there's anything they can do to prepare themselves better."

Helfet is working with the Boston-based Partners in Health, a non-profit organization focused on delivering quality healthcare in poor communities, to obtain funds to build a rehabilitation facility for postop patients.

"We felt strange leaving," Strickland said, "but there was nothing else we could do at that point. Maybe we didn't change the world, but we saved some lives and let people know someone out there cared enough to come and try to help. It's a small start. If the money gets to the right place to help the people long-term and they can start to rebuild their lives and get some infrastructure, then it was worthwhile. It's definitely something none of us will ever forget."


Kathleen A. Waton is a frequent contributor to ADVANCE.

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My heart was so touched by the accounting of the 'reality' on the streets of Haiti. God's grace lead you there. I am a registered nurse and because of your dedication 'out of your box', I am investigating disaster planning courses to prepare myself to give as your group has. God not just bless America, but the world. Linda Frisina, RN BSN

Linda Frisina,  Registered Nurse February 17, 2010
Naples, FL




     

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