A Drop in the Bucket

Anxiety. Confusion. Fear. Exhaustion. All amplified by near total darkness and uncertainty. This is what I felt standing on the tarmac at the airport in Port au Prince near midnight less than three weeks after a major earthquake destroyed most of the capital of Haiti. The military presence with Humvees and transport trucks carrying troops with automatic weapons did not seem to quell these emotions. As I helped to unload the plane (there were no baggage handlers in Haiti) and searched for my luggage, a sense of cohesiveness started to form with my fellow volunteers. Although I did not know anyone on that plane initially, bonds were formed as we pulled together, knowing we were all here for the same reason: to give our time and expertise to a city that desperately needed it. After all the luggage and supplies were unloaded, I found my bags and threw them in the back of an unmarked truck that I hoped was going to the Project Medishare tent compound. Customs gave a cursory glance at my passport and I jumped into the back of a pickup truck with a pediatric orthopedic surgeon from California and a physical therapist from New York. We all assumed that by sticking together, the old adage of “strength in numbers” would hold true. As it turned out, it did.

On January 12, 2010, a 7.0 earthquake leveled most of Port au Prince, affecting an estimated three million people. Many died immediately while others were severely wounded. The infrastructure of the country, which was marginal prior to the earthquake, was crippled. People were displaced, homeless and injured. Project Medishare, partnering with the University of Miami, which initially was established in Haiti in 1994, recognized the immediate need for healthcare and started to build a tent compound adjacent to the airport to act as a hospital. A call for volunteers to run the “hospital” went out. Dr. Robert Kirsner sent out an email through the Wound Healing Society. I responded, rather quickly and impetuously, that I was available. They informed me of my deployment date and that I needed to get my immunizations and anti-malarial pills. Reality set in. On the day I was to leave, I received a call from Project Medishare asking if I would be the Wound Care Team Director during my time in Haiti. Once again, without really knowing what it meant, I agreed.

As we passed through the gates, guarded by the 82nd Airborne, I felt a little more secure. Razor wire and automatic weapons provide that kind of effect. I retrieved my bags, which had food (power bars and beef jerky), water, and my supplies for the week, and managed to find a cot in the large tent available for the healthcare workers. Needless to say, I did not sleep much that night. Every noise seemed amplified and the constant commotion of people settling into their space did not provide a peaceful environment. Helicopter, airplane, and truck engines constantly roared. Despite the lack of sleep, I did not need an alarm clock the next morning.

During morning report, when new issues at the hospital were communicated to the group, I was handed a 3-page list and told, “These are your patients.” Unfortunately, the previous Wound Team director left the previous day and my checkout could only be accomplished via written letter, describing my duties and responsibilities. I was in charge of organizing the wound team, recruiting team members as needed, ensuring that all wound patients were seen (as the wound team was responsible for all dressing changes), communicating with the surgeons, taking inventory of the wound supplies, and attempting to transition patients from inpatients to outpatients. Discharging patients proved difficult, as most of them did not have a place to go. After a brief orientation and a tour of the compound, I realized boredom would not be an issue. I divided the team into smaller groups and we started to take care of the patients. Finally, I felt in my comfort zone. Treating wounds is what I do. If only that was my sole responsibility. I found the administrative aspect unexpected and quite challenging. Troubleshooting, finding the correct supplies or something that would be an acceptable substitute, and coordinating with the medicine and surgery teams consumed as much time as direct patient care.

Although the sheer volume of patients and conditions made wound care difficult, the wounds themselves were just that: wounds. Most were in young and otherwise healthy patients and caused by trauma from the initial quake. The main concern of the wound care team was to keep the wounds clean, prevent infection and hopefully get them ready for a skin graft or closure. Other issues included malnutrition and mobilization. But the supplies were available and adequate. We had access to everything from the VAC to advanced silver dressings. The supply tent, nicknamed “Costco”, housed everything from baby formula to crutches and everything in between. It was loosely organized, but could still take 15-20 minutes to locate something specific.

Certain things we take for granted, however, were in short supply. Running water, toilets and sanitary conditions did not exist. Labs and cultures were not available. Physical exam of the wound became your only diagnostic tool. Electricity was a commodity and we were constantly rearranging the VACs to keep all of them running. We had to explain to patients their VAC was more important than their cell phone and the VAC needed the outlet. Light was also a premium and headlamps became the fashion statement of the camp. Even a simple ballpoint pen to write in the chart became scarce as the week went on. Since the temperature topped 90 degrees during the day, everyone was encouraged to carry a bottle of water with them. It was like camping and working at the same time. Flexibility and improvisation paved the way.

Overall, this experience reaffirmed my faith in the altruistic nature of healthcare workers. All the volunteers worked under extreme conditions to care for people who started with next to nothing, then had it taken away. No one ever said “no” when asked to do something. Everyone came together, as a team, without asking for anything in return. The healthcare debate was left in the airport in Miami. Doctors, nurses, therapists, medics and techs from all over the country came together and just took care of patients.

On the way back to Miami, I thought of all the work left undone and the enormous need that remained. I made the comment to the person sitting next to me that I felt like the work we did was only a drop in the bucket compared to what was still needed. She looked at me and said, “Yes, but with enough drops, we can fill that bucket.”

I would like to thank a few whose contributions to the relief effort should not go unrecognized: first, Dr. Kirsner, who coordinated the effort for wound care; KCI, who donated over 5 million dollar of VAC supplies; Project Medishare and the University of Miami, who organized the entire relief effort nearly overnight; and finally, my family, who supported my efforts.

Andrew J. Applewhite, MD, CWS, UHM is Medical Director for the Baylor University Medical Center’s Comprehensive Wound Care and Hyperbaric Center in Dallas, Texas. Dr. Applewhite can be contacted via email at Andrew.applewhite@BaylorHealth.edu

Want to Help Out

There are many ways to help. The website for the group that Dr. Applewhite went with is www.projectmedishare.org. 100% of the money goes to the project. No administrative overhead.

Another option is:
Mobile Medical Disaster Relief
5409 Maryland Way, Suite 214
Brentwood, TN 37027
615.833.3002
www.MMDR.org

Mobile Medical Disaster Relief is a 501(c)(3) nonprofit humanitarian organization that exists to help fulfill the medical needs of the vulnerable and under-served people in the USA and throughout the world.
MMDR had first responders in Haiti within 60 hours of the earthquake in January. They made a commitment to lead medical teams into Port-au-Prince for one week each month for the 8 months following the disaster.
You may find more detailed information about the organization and the medical brigades on our website at www.MMDR.org