Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine

PENN MEDICINE In Haiti -- Dispatch 4

January 27, 2010 07:18

Subject: Day 3 morning report

 

Good morning. We had an uneventful evening. We were able to spend some time with our hosts, assisted by Prestege Beer. Between sips we put together today's OR schedule.

 

We posted 10 cases, 1 of which was transfered to Port au Prince last night. Cases range from a hernia repair in a 2-year-old, lots of orthopedic cases, ending with an open cholycystectomy in a pregnant HIV positive patient.

 

In addition, our team will try to assist with dressing changes as much as possible. These folks are not able to receive analgesia-anesthesia before these procedures, and we hope to help with this.

 

Our hosts are incredible. The PIH staff include volunteers who are medical students and residents. They are bright and work very hard.  They made great effort to get us integrated into the flow of things, something they have to do very often as teams come and go.

 

The local staff are also working very hard. They continue to impress us with the efforts they are making to help us help them.

 

In the OR we are running 2 rooms. We will be working with an anesthesiologist from Cuba, as well as CRNA students. They actually run a CRNA school here.   Of course, there us the problem of not being able to say anything to them, since neither Tom or I speak Spanish or French. Lots of hand waving.

 

The ORs are small but functional. The anesthesia machines have Sevi and Forane. They were very happy we brought LMAs, which they prefer to use. They reuse an LMA until it wears out.  Intubation is less desired.

 

They seem interested in regional but do not seem to use it much. We will I troduce it to them today, as we plan on a fem pop block for the pregnant lady.

 

We have identified 41 cases to do and have not yet seen everyone. In addition they admit new folks daily through a small ER. I think the pace will be steady but not crushing until we leave.

 

Until next time

 

Michael

 

PENN MEDICINE In Haiti -- Dispatch 3

January 26, 2010 13:32

Subject: Surgery ward

 

There is a church located by the hospital. It has been changed into a surgical ward and today has 55 patients. The patients are tended to by a PIH physician who is a med - peds resident. He was here at the time of the earthquake and had to quickly learn how to care for patients with orthopedic injuries.

 

About half the patients are children, about half of which have family with them. Injuries range from open fractures to spinal cord injuries.

 

Post-operative deaths have mainly been due to PEA cardiac arrest, presumably due to pulmonary embolus. They are using SQ heparin, which is very hard when 2 nurses are caring for 50 patients.

 

So far every single Hatian we have met - patient or staff - has lost at least 1 family member in the earthquake.

 

We probably will have around 10- 15 cases to do tomorrow, plus a number of wound dressing changes we will do with anesthesia.  Ten cases will be ortho, about 5 general.

 

Regards

 

Michael

 

 

PENN MEDICINE In Haiti -- dispatch 2

From Michael Ashburn 1/25/2010 20:45:

Folks are wandering around with their names and specialty on their scrubs ("Michael - Anesthesia). Looks to facilitate role definition rather nicely.

 

Our preparation is being noticed. Apparently others have not arrived with bags in the team's colors. Shirts help ID the team in a crowd.

 

Folks wandering around in shorts and flip flops. No bugs here to speak of.

 

Goodnight

 

Michael

PENN MEDICINE In Haiti -- dispatch 1

PENN MEDICINE has established a mission in Haiti.  Working though the organization Partners in Health (PIH) an organization that has a strong, ongoing presence in that country, the first team from PENN MEDICINE is already in Haiti.  Members of the Department of Anesthesiology and Critical Care are part of that team which consists of orthopedic surgeons, trauma surgeons, intensivists, and nurses with experience in critical care, post anesthesia care, and operating room care.  The Team Leader, Michael Ashburn, M.D., MPH, Professor of Anesthesiology and Critical Care, sent us the following e-mail dated January 25, 2010, 20:36

Folks:

 

We are now safe and sound in Port au Prince. We are in a secure tent city. There is water here, and we ate well on the plane. We gave our remaining food away to Haitians and elected to survive on Power bars until we reach the hospital sometime tomorrow.

 

The drive in from the airport was interesting. Only a few lights were on due to limited power (mainly from generators). People were out everywhere on the streets as they are afraid to sleep in their homes. Some food vendors were out, especially near the airport. There is tight security near the UN headquarters which is now beside the airport.

 

Devastation is everywhere.  While some  buildings are standing, every block has damaged houses, some are just piles of rubble.

 

The Haitian people we have met are very grateful and are gentle, polite people.   I find this amazing considering the state of life they find themselves in.

 

All of our gear is still with us. We will sleep with the important gear, and get up early to make sure another team is not tempted.  No worries; the drugs are under the watchful eyes of the ladies and the ortho supplies are guarded by the ortho docs.  They now snarl at anyone who walks by their tent. Ha!

 

There are teams from several other institutions here; most of them are working in the city. They report improving supplies, but increasing frustration over poor collaboration between groups as well as critical needs such as no working autoclave in the Port au Prince major hospital. They say that they still have several hundred patients with ortho injuries, such as open fractures, waiting for surgery.

 

The ride to the hospital where we will work is expected to take 4 hours due to the road conditions.  We do not have a departure time but are hopeful it will be fairly early to allow us to start working tomorrow and to avoid travel in the heat of the day.

 

Until tomorrow,

 

Michael

 

DSS:  I made a few light edits – added some verbs to convert phrases to sentences and clarified some of the abbreviations; otherwise this e-mail is as Dr. Ashburn sent it.