Dr. Anthony Coletta ’71 Offers an
Insider’s View of the Haitian Disaster
Dr. Anthony Coletta, Class of 1971, Executive Vice President and Chief Medical Officer of the Holy Redeemer Health System, is in Haiti volunteering at the Centre de Sante Clinic in Croix de Bouquette. This is his third trip to the area since it was devastated by an earthquake in January. He chronicles his trips through letters sent to family and friends. Here is his latest letter.
Haiti, June 22, 2010
Family, friends, colleagues,
Greetings to all of you from the Centre de Sante Clinic in Croix de Bouquette. Our team of 12 arrived in Port au Prince on Sunday around noon and by late afternoon, following a routine that many of the team members are already familiar with, the small operating room, central supply and pre-OP, post-Op rooms were prepared for our first day of clinic and surgery.
Things at the clinic and the Hope Orphanage are going along as well as can be expected. Bert and Roberta Anderson, the American couple that live here and are our hosts, have been caring for construction and medical teams every single day since the January 12 earthquake. Nonstop. Greg Benson, CSI's man on the ground for decades here in Haiti, had to move out of the guest house in Port au Prince which was destroyed in the earthquake. He lives with his wife Kathy on the second floor of the Hope Orphanage. That building has been restored to safety and the 20 young girls being cared for by Tim and Tobey have moved back into the first floor.
Greg is overseeing the construction of a new orphanage on the grounds right between the clinic and the old building. Through the generosity of a family owned construction company from his home town materials and workers have been mobilized, including 28 Haitians who are working full time. The second floor framing has begun. It is a continuous, arduous effort. Greg, who was a farmer before he came here, described it to me as a continuous harvest season, with no down time, no winter in between.
Here at the clinic, there are two full time Haitian doctors, and they and their staff are seeing as many as 100 patients a day. Most of this is primary care including prenatal care and of course the management of chronic illness and some infectious disease. They saw a spike of Malaria in March and April, but that has subsided for now. Compared to the days immediately following the earthquake, the clinic has come alive again.
Two large containers have arrived here on the grounds bringing supplies and donations from all over the country. The containers have been purchased and now provide much needed storage.
We have completed two successful days of surgery. There is a new sterilizer and a new anesthesia machine. We can use isoflurane now instead of the archaic halothane inhalation anesthetic. Many of our team members are here for the second or third time and for those who are on their first trip, they have not skipped a beat. We are operating on many of the patients who had been scheduled in December 2009 to have their surgery in February of 2010. Of course, the earthquake postponed their care for 5 more months. But by getting back to work here, our team is demonstrating to this rural, impoverished region, that Centre de Sante can provide even more than primary care. And with that comes some hope.
Many people ask me upon my return from these trips, have things improved? Is Haiti making progress? What is different now than what you saw in January or April? If I could only say that the hundreds of millions of dollars that have been pledged, that the promises of great and powerful nations to come to the aid of the Haitians left displaced and homeless by one of the worst humanitarian disasters of our time, that all of this was making a meaningful difference. Something that I could see and feel. But that is not the case. It is easy to feel that the world has turned its back when you know (or want to believe) that it has not. This afternoon, we lived and breathed this reality for ourselves.
Pierre is our interpreter. His is a fine Haitian gentleman who has worked with me every time I have been down here. We have talked over the last few days about the tent cities that have arisen around our clinic. There are 5 of these "cities" all together. Local Haitians who have lost their homes, or others displaced from Port au Prince. One of these "towns" is right down the road from the clinic. Pierre is doing what he can to help those living in tents there. So after OR today, carrying with us tee shirts hand made with messages of hope and love by young students at the Rosemont School of the Holy Child here in Pa., our team followed Pierre and we walked into this new neighborhood down the road.
The amazing thing here is that each of these tent communities have organized themselves into their own form of local government. We met the leader, a bright, vibrant man with a healthy Haitian smile. He had put together committees to work on safety, sanitation, logistitcs and education. Independent of outside help and virtually without a penny. Hundreds of children came forth from these makeshift tents. From far away, they appear to be true tents but on closer inspection they are nothing more than tarp tied onto sticks. There is little sanitation. I am not certain where they get their food. But together they constructed a larger tent with a semblance of a roof. This is their school. Some teachers have been displaced and live in this "town" where every tent has a painted red number on the front. A street address of sorts. The hope is to encourage these teachers to begin to work again, with or without the funds to pay them.
As the children laughed and played and donned their shirts and posed for pictures, some with us were moved to tears, because as we looked around, we saw that these Haitians (and there were hundreds and hundreds just in this one village) were doing what they could for themselves without any visible help anywhere. But we also new and could feel that disaster was imminent. One significant hurricane over the next few months and many of those same children would not survive. This tent city would be blown away like matchsticks. Those in power, those with access to money and resources must understand that. Are we truly powerless to respond? It is hard not to know why pre-fabricated sturdy housing is not being built in earnest everywhere. Even some kind of large sturdy shelters that could provide refuge to these tent dwellers, strategically placed, for when the time comes. And it inevitably will come.
I do not think that those of use who walked into this reality today will ever be able to truly explain what we saw. But tomorrow, we will get back to work and we will do what we can, one patient at a time. And on Friday, we plan to return to that "town" as Pierre tells us that some of the remarkable tin artists now live there and they will show us their wares. And money they collect will help to pay for the teachers. And so they are doing what they can for themselves, by themselves. Remarkable.
Thanks to all of you for listening. On behalf of our team, we cannot thank you enough for your love and support.
Tony
--
(Anthony V. Coletta MD, MBA, FACS)
On Saturday, April 17, 2010, Devon Prep Class of 1971 Alumnus Dr. Anthony Coletta, Executive Vice President and Chief Medical Officer of the Holy Redeemer Health System, led 18 medical professionals into Haiti to live and work at the Adventist Hospital in Carrefour for a week.
This was his second trip into the country after it was hit by a devastating earthquake in January. As he did the first time, Dr. Coletta wrote several letters about his experiences while he served in Haiti. His most recent letters are below.
Sunday, April 18, 2010
Hello to all!
We arrived safely here to the Adventist Hospital in Carrefour in the early evening yesterday. This hospital is far closer to the epicenter of the earthquake than the Community Hospital of Haiti where I last worked. So the ride here was riddled with destruction beyond anything that could be conveyed in the evening news.
The management infrastructure of this hospital is far better than what I last experienced. On the other hand, the disarray remains. The confusion. the disorganization. None of that has changed. And today is Sunday. So I can only imagine what tomorrow will bring.
Our team has jumped in with both feet. Hank and Joe in the ER. Cal with logistics. Nurses, nurse practitioners, family docs. There is more work here than we will ever be able to do, so, as the others, we will do what we can.
Some of the amenities are gone. The two meals a day have been narrowed down to one if there is enough. Some of us are in tents on the roof, others on mats or cots on the floor. But regardless, we are far better off than the Haitian people.
This morning, while on the roof watching the sun rise, a young 23 year old Haitian (can't recall his name) joined me and told me the story of where he and his family were the day the earth shook. Miraculously, they are all alive. He has volunteered here at the hospital since that day. He also grows food in his small garden. And that food has served to feed his brothers and sisters as well as others in the neighborhood. He tells me, the Haitian ground is so fertile that whatever you plant will grow, Just give it water. He dreams of the day when he will be a successful farmer, living off the land and giving back to his country and his people.
You have to be here to believe it.
Tony
Tuesday, April 20, 2010
Good morning to all! It is 6:30 am here in Carrefour. We make general surgery rounds at 7 am and the entire staff meets on the steps in front of the hospital at 7:30 am to discuss issues and prepare for the day.
So time is short and it is difficult to put together all of the experiences and put them to "pen and paper". But I thought I would take a moment to reflect on some of what has changed since three days after the earthquake.
The tents are far better. What were shanty towns for the homeless, created from sticks and tarps, are now tent cities with real tents that have structure and likely will provide some protection from the wind and rain. An incredible contrast to my last visit.
The injuries are different. Orthopedics is mostly now reconstructive and rehabilitative. Infections are common but not rampant. Much of the general surgery is acute (we did an appendectomy on our first day), and some chronic conditions such as painful hernias, etc. There are a collection of infected abdominal wounds. That sort of thing.
There is less death. That is not to say that babies and/or adults are not dying because we don't have the basics that are needed to keep them alive. But there is less death.
The Europeans are gone. At least at this hospital. The disaster experts and the search and rescue teams have been replaced by voluntary American health professionals. Slowly there is a transition taking place as more Haitian doctors and nurses return. And here at the Adventis hospital, efforts are being made to facilitate that vital transition.
And I learned about this place called Loma Linda University in California where the medical school trains medical missionaries. So throughout the hospital are staff and medical students who are amongst the most remarkable I have ever met. Alex is a fourth year medical student who is on rotation here. He has been accepted into a surgical residency at Loma Linda, and he is training to become a missionary surgeon. We may be at the epicenter of the earthquake, but Alex is the epicenter of this hospital. He is the go to guy. And he has been assisting me in the operating room. Besides his exceptional maturity, his logistical expertise, his clinical knowledge and his calm, cool demeanor, Alex can operate better than most third year surgical residents I have ever met in the States. The missionary world has gained a young prodigy.
With all that, there are still far more supplies than there are nurses. Boxes and boxes of supplies that remain unopened and will likely take months to sort through. But these are durable goods and will be put to good use some day.
Finally, there is one thing that has not changed. The Haitian spirit. The Haitian faith. Their will to survive and to nurture their families. Or what is left of them. Actually, I may not be right about that. There may have been a change. In the direction of strength.
From the "Green Team" (in honor of our lime colored tee shirts) here at the Adventis Hospital in Carrefour, thanks to you all for your love and support.
Tony
Thursday, April 22, 2010
We are approaching the end of our week here. There are many stories to tell of life and death, of survival and hope. Stories that cover the spectrum from the routine to the completely unexpected. From appendectomies to a life saving laparotomy for a 4 year old boy. And for Anne, the 52 year old American missionary who dropped a bottle at a site about 10 minutes from our third world hospital and arrived in a jeep with a potentially lacerated brachial artery in her arm. There was a tight dressing in place and her arm was blue and without pulses. Ann found herself surrounded with a team of US surgeons, anesthesiologists, ER docs and nurses. And amidst the OR room with no lights (except for regular room light), and whatever suture and instruments we could scavenge, we were lucky to find that she had missed the artery by millimeters, the bleeding was from veins which we controlled. And within a couple of hours, she was on her way back to her base camp. I saw her the next day and everything was fine. They are a team of missionaries helping to treat post traumatic stress disorder here. She's more qualified than ever!
And downstairs, Chery Bonel, a 63 year old man with a very painful hernia waits patiently for surgery in a room that must be 103 degrees. I had seen him 3 days ago and we tried to set him up for today just so we could get him done and relieve his pain. His injury is not related to the earthquake, but his suffering is. I thought we would have to send him home today because we just did not have the time and the staff. But he is surrounded by his family and his son, his daughter, his wife pleaded that we take care of him. So the way you handle that here is you find a cot, and you find a space, then you get an interpreter and you get permission to put him in the cot in that space. And you tell them to hold onto their papers and you keep a watch on him. You ask the Haitian nurses to start his IV. And now he's under my care and we will get him done, one way or the other before we leave. That's what it always comes down to. One patient at a time.
There are times that the misery is overwhelming and it seems that this country has once again been abandoned. And the thought that we will be leaving Saturday is, as Alex, our senior medical student extraordinaire, says, bittersweet. But we all have to just keep in mind that we are planting one seed at a time, and changing the face of the mountain.
Internet access here is undependable, so I'm not sure I will have the chance to tell any more stories this time around. From all of us, to all of you, thanks so much for you undying support.
Tony
'First Letter
January 21, 2010
Dear Family, Friends and Colleagues,
Things are beginning to move fast here again for me. I am not certain, but I believe I will begin my journey to the Haitian/Dominican Republic border today sometime between 10:30 am and 1 pm. If so, I will lose all contact for about 5 hours and then will have at least some functioning messaging capability on my cell phone. As of now, I have a flight out of Santo Domingo on Saturday, that gets me back to Philly around 2:30 pm on Saturday afternoon. I am assuming you will hold off any snow for me?
If you get time, please read this letter carefully. I am sending it for several purposes. First and foremost I am hoping that reading this story will give all of you who want to help and who are planning to help, an idea of what is needed and what it takes. I understand there is a conference call tonight, and in the story I hope for you gain insights. Secondly, it is a type of diary for me but there is no lock and key on it. Sharing it will help me, and perhaps help all of you who have prayed for us and given us strength. Finally, I have been out of touch with the outside world (not even sure who's on their way to the Super Bowl!) and so I am not sure what is being reported. So I wanted to give you an insider’s view. All of you deserve it.
As many of you know, I have been working at a small clinic in Croix de Bouquette for the last several years. This is a region just outside of Port au Prince. We have travelled here as a team, gotten to know the missionaries, knew about the Hope Orphanage, understood the terrain, and learned about what Haiti is like when it is at its best. Chaotic, with little sustainable infrastructure, but filled with strong faith driven people who are stern, but smile easily, who know what it means to suffer and know what it takes to survive. So I had the benefit of having a destination, with CSI (Christian Services International) in control of how I could get to the clinic. Very knowledgeable, very professional missionaries. I would not have taken the chance to travel alone to the clinic without knowing that they had given the go ahead. Many teams have travelled here without a destination and they have gotten caught up in logistical nightmares. Also, even though only 3 years into this, I had some experience of travelling in Haiti. That is essential from this point forward as far as I am concerned. I would not encourage newcomers for now. Also, those wanting to travel to help need to be in good physical condition. Significant existing chronic medical illness, although under good control in the USA could translate into a dangerous problem here.
Although my original intent was to get back to Philadelphia and travel in with supplies, I could hear the compelling message from Jody at CSI. At this point, they needed me more than supplies. I could not only help with the victims, but assess the logistics and medical issues on the ground to help with the decisions ahead. At that point, I had made the decision to get to the clinic from San Francisco (while attending a leadership conference there), and knowing the magnitude of the disaster, I knew to travel as light as possible, bring as much cash as I could get and safely bring with me (turned out to be $600) in small bills (ones and fives). This way, I could pay my way through the country if I needed to. I also began to see quickly that it would be better to avoid the main airport. Either a smaller airport, or stay on the ground and get into Port au Prince from the north or east. I bought whatever clothes I needed along with a light small duffle bag, shipped my suitcase home, and left for Miami and then on to Santa Domingo in the Dominican Republic and the redeye January 15, arriving in Santo Domingo around 1 pm or so on Saturday, January 15. There, as I walked out of the baggage claim, knowing I had a destination, and understanding that someone from CSI was meeting me there, stood Tim Deyoung, shoving a piece of pizza down and holding a hand written sign with "Coletta" scrawled on it. I had met my chauffer!
Tim is an amazing guy. Suffice it to say that he loved to drive this truck, spoke fluid Spanish and Creole, and had made the trip across the border into Haiti hundreds of times. Within moments I knew he was "the man". It occurred to me, though, and quickly to Tim, that he had this American surgeon in his truck with a functioning Visa card and space in the back and 30 minutes into the trip, we did a U turn and spent an hour at this incredible supermarket. An unbelievable contrast to Haiti. We took two carts and split up and gathered as much non-perishable food that we could to bring with us to the clinic. A couple of the young Dominican shop baggers helped us pack everything into boxes and we were off on our way again. About a 6 hour drive to the border including a stop for some fried chicken and turns onto small streets that only Tim would know. As nightfall came, we were not sure if we could make it across the border, or if someone was even going to meet us there. But Tim just kept moving in a singular direction.
When we reached the border at around 9:30 pm or so, on the Dominican side there were border guards and some UN. Every time gates were opened, there were 30 or so Haitians trying to get through but being held back. It was not chaos but it was a dark, unnerving environment. When Tim told them we wanted to go through they questioned if we were willing to proceed without security. When explained the situation, they let us through. No more than 75 yards away was the Haitian border gate. It was open, everything was dark, there were a few unarmed Haitians sitting by the gate. We just drove through.
We arrived at the CSI clinic in Croix de Bouquette by around 10 pm or so on Saturday night. Bert and Roberta and Tim and Tobey were there to greet us. Valiant people demonstrating faith, strength and resilience that I will likely never understand. But I could see it in their eyes and hear it in their voices. What they had experienced had literally uprooted their world in so many ways. We unpacked the supplies, I listened to their recounting of the moments before and after and what they planned for the next day, and the day after. What I was not sure of that night was whether we could expect injured patients once word was out that a surgeon was here and if so, could we handle it. I also wondered if what we should do is prepare to get our supplies out where ever they were needed and for me to go with them. There were so many unknowns, and I can tell you that as of this moment, there continue to be. Anyone who has been here before, you can use some of your basic understanding of the country and the culture, but you need to be prepared for the completely unexpected.
On Sunday morning, we quickly inventoried the clinic and began to move things around so that the operating room could be functional if we needed it. What I saw was a wealth of supplies that I was certain would be needed in this earthquake ravaged region. Gauze, tape, some splints, antibiotics, pain medicine....the list went on and on. I knew what we had, I had an idea what we could do. But, looking back, I had no idea about what I would eventually encounter.
At the direction of the CSI missionaries here on the ground, the decision was to travel into Port au Prince to the Quisqiveya Christian School where Ted Steinauer, the plant manager there, had become a logistics expert on the needs of the region. We would seek guidance from him regarding what would be our best next step. Very, very important to find people like Ted in this region right now. Travelling through Port au Prince, we saw thousands and thousands, probably hundreds of thousands of homeless Haitians in makeshift tents in the region of the airport. I still cannot fathom how this many people will ever be cared for. And I had no idea amongst this multitude who were injured and who were simply homeless. We had stopped at a smaller airport to pick up others who were joining us, and in a small cinderblock cubby whole right next to where we were standing, a young boy grabbed my hand and brought be behind a wall where his grandmother lay with an open fracture of her leg. We did what we could to cleanse wound and change her dressings. We gave her water and some ibuprofen. I promised them I would be back. We would never return. This was my first patient encounter in Haiti. And the first of hundreds and hundreds where I would learn that we could only do what we could. That basic medical care was almost non-existent. And that we would comfort but we would likely rarely cure.
Ted Steinauer made it very clear. Don't even consider opening the clinic to injured patients. It was unlikely that the types of injuries that needed care by that Sunday could even make it to the clinic. And he made us acutely aware, in ways that I will not share here, that security was likely to get worse and worse and unless we were prepared for that at the clinic, we would not be able to protect ourselves. Another signal of the fact that there were so many unknowns, and that we were trying to manage the unexpected. Seeing the masses of humanity in that makeshift shanty town outside of the airport only drove that point home. It was the beginning of the countless times that I would ask myself how this country would ever survive. While at the school, though, a call came in that doctors and nurses were desperately needed at the Community Hospital of Haiti, one of the last standing hospitals in the city. At this point, it was clear why I had made it this far. I needed to get there. Expecting this might happen, I had brought my small bag, I had with me my passport, $50 and a credit card. I was already wearing scrubs. I had my strap on headlight. Everyone agreed that I should go where I was needed.
On the way, we made it to Greg Benson's house, CSI's man on the ground here in Haiti. The mission house where he and his wife lived was uninhabitable. All along his street there were homeless Haitians in makeshift tents. We had to ask a few to move to get into his gate. When I saw him standing there, I saw one of the most resourceful and resilient man I had ever met, still strong and standing tall, but clearly exhausted and a sadness in his eyes I had not seen before. But he was undaunted. He had set up an incredible command center behind his house, his own little shanty town. And before I left for the Community Hospital, I told him I just wanted to let one of my family know where I was going. And on his control desk, in the midst of his survival space, was a direct dial phone that allowed me to call Maria and let her know what was happening. They gave me a satellite phone which would be invaluable that night when I tried to reach home again not only to let them know I was ok, but just to hear a loving, familiar voice in the midst of human misery that I had only heard about on news accounts.
At the school, a high school senior named Chris had been assigned to me as my interpreter. And Tim drove Chris and I that afternoon to the Community Hospital. As we arrived, there were already patients everywhere, lying on cardboard or dirty mattresses. You could sense the chaos. I saw a young nurse who spoke fluent English (Haitian resident) and told her who I was and that I was there to help. We went inside and she took me upstairs where an American orthopedic surgeon who was working in the Dominican Republic was trying to set up triage and logistics. There was a hand drawn map of the hospital and zones. There was a triage where we would put masking tape on the foreheads of patients. OR One - priority to OR, OR Two - next in line. I found that there were 3 OR's and 4 orthopedic surgeons working. At first I expected that I would be best used in the OR, but wisely they said that as an experienced general surgeon I was needed more in triage to treat those acutely injured and bleeding, triage level, manage post op patients. That seemed to be a strange use of my skills at first, but as it turned out, vitally important to the flow and management of patients. I learned not only was this not a place for the weak of heart, this was a place where clinical experience, basic examination skills, and quick, timely decision making was more important at times than actually holding the scalpel. It was also important to get the big picture of how the hospital was flowing. There were strong, determined, focused orthopedic surgeons from America, Jamaica and the Dominican Republic doing the best they could to save limbs, and removing those they knew they could not save.
The injuries were primarily blunt orthopedic injuries causing open and closed fractures of limbs, some simple, some very complicated. There were many, many deep open wounds, soft tissue injuries ranging from lacerations to simple abrasions. This was now day 4 after the earthquake. Many had their original dressings on, their wounds filled with dust and debris. Some no dressing at all. Within the next 24 hours there would be 18 rooms labeled Post Op with close to 80 - 100 patients who had had their surgery but were receiving little or no care. External fixation devices everywhere. Amputation stumps with dressing that had gone unchanged. IV sites that were occluded, bottles empty. Some patients crying, some quietly resolute. Occasional screams. Post op orders written on sheets of paper, no charts. Most orders not being carried out. No way to know if someone had gotten pain meds or antibiotics. No blood pressure cuffs. Only your hands and a stethoscope to determine pulse and blood pressure. Very little oxygen, no ambu bags, no suction, no ventilators. Surgeries were continuing, these rooms were filling up, the triage system had broken down. There were OR 1's mixed with OR'2s. And as night fell, with what I would estimate to be more than 200 patients, slowly whatever staff was there left.
Supplies were everywhere, there was no system. No pharmacy. Supplies over the next few days would come in faster than there were humans to sort it out. Supplies were everywhere. More supplies than you could imagine. But not enough doctors, and certainly not enough nurses. On the roof of the hospital, someone had set up tents for us with water, where we could go to get some rest. As night fell and the hospital darkened, we got word that the generator would be shut off from midnight to 2 am. I put on my headlamp. And with another guy who called himself "Doc" (that's what my nickname was in college!), who clearly understood what needed to be done in situations like this, we set about managing the hospital, one patient at a time. One volunteer stayed to help. There were 3 of us and one doctor in the ICU. I used my headlight. Doc kept taking us from patient to patient. A woman had been brought in in labor and that night she would deliver. A woman was brought in with twins that she delivered somewhere on the street. They appeared healthy. She was still bleeding. A man with a fractured pelvis and what I presumed was an injury to the prostatic urethra. We could only stick a needle in his abdominal wall and drain his bladder into a basin. A woman with a hydropneomothorax with a chest tube and no suction. But primarily very complicated orthopedic injuries and many amputations, all requiring not only acute care, but some plan for rehabilitation which I could not imagine existed. Please think rehabilitation medicine as you plan for supplies and teams. Adult and pediatric rehabilitation. Of broken partially fixed limbs and upper and lower extremity amputees. Think in terms of helping those who are still alive 1 - 2 months from now begin their lives again. Crutches, braces, physical therapists, physiatrists. I am not knowledgeable enough to know. But I can tell you, no one has begun to mention that. But in my opinion, as you read on, you will see why we must begin to think ahead. Please think about involving your rehab facilities in this effort.
I can say that night that most of us felt times of fear. When I did lay down in the tent, there was sporadic gunfire and I kept thinking what I would do on the top of this hospital in this tent if the ground shook again. My answer would come Wednesday morning. I could not sleep knowing that Doc was still downstairs. You just couldn't stop this guy. He kept saying we had to try to save one patient at a time. He was so right.
By Monday morning, the chaos seemed to have started again as new patients began to crowd a hospital that was already overwhelmed. No one seemed to be in charge, and Doc was still in the wards saving one patient at a time, so I took control of logistics and as fresh teams arrived began giving them the lay of the land here at the Community Hospital of Haiti. Told them about the breakdown in triage, but asked for them to work in teams and think on their feet. Make decisions as they went. Explained as best I could the need. Two full teams were oriented before Greg Benson got to me and shortly I was in his truck, on my way back to the clinic, knowing that at least there were fresh committed docs and nurses, along with lay people (we called them logistics) doing what they could. But I knew what we would be facing. Many of those patients who had had their limbs repaired or amputated would not survive under these circumstances despite the valiant efforts of these orthopedists. The trip from the clinic to the hospital is very difficult, driving through a river, using precious resources of the missionaries’ time and fuel. I knew that if I was going to ask for them to bring me in again, it would be only one more time, and no matter what, I would work for 24 hours so they could get me in daylight.
Even though there were so few doctors and nurses to handle this sea of illness, they were clearly doing extraordinary things. Teams from Miami and Texas who had languished in the airport for days before someone had the wisdom to send them here. I can't remember all of their names, but I can see their faces. I can also see the face of the mother who had just delivered whose baby died within her sight as Abid (ER doc from Miami) and I tried to resuscitate him without a laryngoscope, pediatric endotracheal tube, oxygen or even an ambu bag. Or the patients in Post -op room 18 who watched as we coded a young woman who had had her femoral fracture reduced, had been lying in bed for 3 days without heparin prophylaxis, and upon her likely massive pulmonary embolus, no crash cart, not even an ambu bag and no oxygen. Then they watched as we wheeled out her stretcher, and out in the courtyard, those waiting for triage watched as we put her in a body bag and carried her to the makeshift morgue outside. If you are thinking of travelling here, in my opinion, you will be seeing more of this before it is over. It's not as if we had seen a huge number of deaths like that, but the hospital was full of these types of patients just not getting any modern post operative care.
On Tuesday morning, after a sound sleep and good food here at the CSI clinic, I stood outside to watch the patients come in. My sense was that if I saw more wounds or dressing changes that would be needed, I would stay and run an outpatient minor surgical clinic here. But there were none. Ted Steinauer was right. What we did see were about 45 patients just waiting for routine medical care. Their blood pressure medicine or their insulin. Patients with respiratory illness. Patients who had not sought any of their routine care. I wondered just how many of them were out there in Port au Prince. I was also convinced that there would be no way for a mobile medical team to sort that out right now. The need to care for the acutely injured and try to keep those alive who still had a chance would continue to overwhelm all else. And so it was clear that I needed to return to the Community Hospital one more time. I knew the lay of the land there. I knew I could help and it would be CSI helping Haiti. Yesterday morning, around 10 am, Burt and Isaac brought me back there.
We were facing all of the same issues, but we now had a couple of teams who knew the lay of the land. The magnitude of the injuries, the degree of the open wounds in patients who had still not been seen since the original earthquake had not changed. Perhaps the number was somewhat less. Hard to tell. But something else was happening. The smell was getting fouler. There was trash everywhere. Families were staying with their loved ones and eating there on the mattresses. Still, it was not possible to keep up with the dressing changes. More supplies were coming in numbers that outstripped our ability to use them. What we were starting to become short on was basic human needs such as water. That night there was a family practitioner working in the post - op area who asked me wasn't it about time to start getting people up, stop their IV's, taking them to the next step. Of course, I said, if she and her team could even accomplish some of that, we would be making strides. As night fell, it seemed to me that we were getting ahead of where we were on Sunday night and actually, the wards seemed to quiet down. But I kept wondering how a country where the scant medical care that existed previously had been now basically destroyed could ever handle the survivors. I am haunted by the fact that there will be fewer and fewer survivors from these treated patients.
That night, I got smart. With enough docs and nurses who knew the lay of the land, I placed an air mattress in one of the offices where team members were congregating and an air conditioner had been found. In fact, earlier in the day, through some kind of miracle, 20 domino pizzas were delivered and next thing you know we were taking a break upstairs and eating pizza in this room! We traded stories and talked about patients. And then went downstairs again. So in that room, sometime around 2 am, I laid down to rest. I could not sleep but I could rest knowing that this time there were more docs and nurses downstairs. As I arose, however, this morning at around 6 am, for 5 seconds by report, but to all of us more, there was another earthquake. You can call it an aftershock if you like, but to us, and clearly to our Haitian patients, another earthquake had struck.As I got out of that room and saw what had happened, I could see not only that the medical volunteers had been shaken, but as I looked down into the courtyard, what I saw stunned me. A sea of patients who just that night were immobile and lying in bed, were heading outside of the hospital. I saw several amputees crawling. Families carrying stretchers and beds, mattresses. There was a mass exodus of Haitians. They had seen this before. They were not going to stay inside.
The first response of some of us was to stop them ask for them to stay put. But you could see it in their eyes. They were determined to get outside. They knew. And so we joined them. Helping them to get out. Trying to keep track of where they were going to put down so we knew we could keep them in our sphere of influence. OR1's, OR2's, post ops, families. Within an hour, the hospital was empty. And so we took whatever manpower we had and split up. Getting water and medications out to as many as we could. Going into tents, assessing the situation, making sure no one was dying. I tried to deploy any new providers as they came in. But when I returned into the hospital to walk the halls back towards the operating rooms, I realized a remarkable thing. It was empty, all of the patients were outside, and Haitian workers had been deployed inside. Brave hospital workers who knew it was ok to be in there. And they had begun to clean the halls, every room, remove the trash, mop the floors. Quickly, the stench was subsiding. By around 9 AM, the building was clean and empty and we began to move patients back in, reestablish our triage, getting the priority patients closer to the OR. New teams were coming in. Two patients in hypoglycemic coma were brought in and resuscitated. Triage was picking up again. The hospital administrator called several of us up to his office and we talked about how we could get this clean building and our patients back on track. Pull it back from the brink of chaos. I began to realize what had happened though. They say earthquakes are an act of God. This was an act of God. God had cleared this hospital and had done something we would never have been able to do, no matter how many able bodied men we had. The earthquake this morning got our patients up and out, either on their own or with their family and with our help.
Bert came to get me around 10 am this morning. As I write this, I know my work in Haiti is done. I leave the Community Hospital which yesterday morning was remarkably transformed, at least for today. It was clean and the OR's were functioning again. Patient triage was being reorganized. And the teams I now saw arriving were highly skilled, disaster medicine specialists with just about everything they critically needed on their backs.
I felt some hope where there were times it seemed hopeless.
So for those who are considering travelling here, for those who are considering sending supplies, for those who are considering how or where to donate their money and time, please see if you can find some answers in this. For my part, I would not recommend medical teams travelling here to the CSI clinic at least until, from a medical perspective, the true issues of treating those who have survived becomes clearer and until there are clearer indications that aftershocks like today are less likely to happen. I believe this may be at least a month away and possibly more but we will see. And when thinking about supplies and skills, think very carefully about Rehab teams and supplies as I mentioned before. The reality is that in 2 months, we will likely know who the long term survivors are and they will need months of rehab.
If what I am seeing now holds out, there will not be an overwhelming need for medical personnel here at the clinic and so that means transportation under very, very difficult circumstances. Based on the panic and chaos I saw yesterday morning and some sporadic crowd mentality around the hospital and based upon the medical and surgical challenges that will exist as the condition of survivors I can only imagine that I have seen a microcosm of this region. This county will require highly skilled disaster specialists for quite some time. And will be seeing more in the way of infectious illness and death. That is a certainty in my opinion.
And I will take the liberty to tell you what I told every CSI missionary I could find when I returned to the clinic today. It was CSI that got me here. These resilient Americans who have dedicated so much to this country of Haiti. I would never have had the ability to provide comfort, care and healing without them. It was not me. It was them. And all who have prayed for the Haitian people. And it was this clinic in croix de Bouquette that was my destination and where I have found safety and food and a shower and friendship. Please consider that when you consider your next steps.
Finally, please know that I felt the presence of every single one of you each time I kneeled by the side of an injured Haitian patient. Because for strength and prayers, because of the support of all of the organizations, I quickly felt that I was there on behalf of each one of you. I had the privilege of bringing care, comfort and hopefully some healing directly to these people, but in truth I was acting through you. You have touched many, many Haitians lives. Patients and families. So please do not feel helpless. You have already done so much.
Love and friendship to all of you. I am going to begin my journey home.
Tony Coletta MD
Second letter
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