Mission to Haiti: Dr. Persharon Dixon's travel blog - WLOX.com - The News for South Mississippi

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Mission to Haiti: Dr. Persharon Dixon's travel blog

Dr. Persharon M. Dixon with Coastal Family Health Center recently traveled to earthquake ravaged Haiti on a mission trip. She shared her travel blog and pictures to show the great need that remains there.

Day 1

We arrived in Port au Prince early morning on Saturday. It is the coolest part of the day and is already in the mid 70s. We were given a brief introduction and escorted to the sleeping quarters where we were to select a cot for the duration of our stay. Our baggage arrived shortly after, unfortunately, one of our team member's bags did not arrive and is not expected to be here until Monday. Along with her bag is our supply bag, but most important is her bag. She's a trooper and says it is okay. Others had the same issue, some taking it well, others not so well.

It is interesting the combination of folks who have chosen to come here. The Chief Medical Officer is right, some of us will do fine and some of us won't, "you learn a lot about what you can tolerate in situations like this". I think we all will be surprised one way or the other.

Lesson learned: always carry your meds and one change of clothes in a carry-on bag.

We joined the CMO and COO for a general briefing. They explained to us that because of the holiday season we are terribly short staffed much like staffing shortly after the Earthquake, so we are considered to be in Earthquake mode and asked to be flexible in our duties.

It just so happens this week CBS will be filming here. Katie Kouric will arrive on Wednesday.

Next we were oriented to the medical units. Just as we were starting orientation a truck arrived with a woman clearly in severe pain. With no old volunteers around, my colleague Dr. Norma Mobley, quickly assessed the patient while I went for a wheelchair. The woman had severe lower belly pain and bleeding and, because of the language barrier, that is all the information we had. Once we delivered her to the ER there was a bit of panic since there are no OB-GYN docs here this week. Norma and I both let the staff know that in our previous lives we were OB-GYN Physician Assistants and would help if needed. Turns out it was a ruptured ovarian cyst and not a troubled pregnancy.

We first toured the pediatric tent which has a current status of 20 children. Diagnoses include Failure to Thrive, hydrocephalous, burns, and premature births to name a few. Only two orphans remain at this time and the staff is busy trying to find placement. Twenty orphaned children were here over the last two weeks and have been placed. Some children are here longer than they would be in the states due to the risk of infection and the high possibility of no follow up.

Just as we are learning about the new system an orthopedic surgeon interrupts to notify our Peds chief that one of the children who was to be discharged today would not go home because they have been able to arrange surgery for her which could possibly save her limb. The surgeon seems excited as does the Peds chief given this is their 5th day in the camp also known "hitting the wall" day. The CMO, Dr. Ichy, laid out the usual psychological and physical pattern we should expect. The first 2 days would be getting use to the heat, the 3rd and 4th day exhaustion will begin to set in, and by the 5th day physical fatigue and mental exhaustion will begin to take their toll.

Now we are taking a break and will regroup to discuss our shifts. We are here and we thank God we can help. We are ready.

Day 2

I can already begin to characterize what I am seeing here, having been on call the first night. It is like the 3 to 4 months after Hurricane Katrina in that this could be labeled the transitional phase. That is the time period when the emergencies due to the disaster itself are over and everyday medical concerns and new concerns indirectly related to the disaster arise. Many of the kids in the hospital now are here for pre-existing problems and acute problems that are the result of their living conditions since the earthquake.

For example: we have several children on the service for Failure to Thrive (due to starvation), and hydrocephalous - a condition of the brain that is usually caught in early infancy in the States. As the CMO reported, this hospital is the only one of its kind in the country! Kids are getting procedures and care they never would have gotten, like VP shunts in the brain to allow drainage of the fluid causing large head growth.

We have several burns in the unit secondary to unintended injury from mothers using large pots to boil water over fires created on the sides of the road where they are now living. One unfortunate case is a Mom who was tending to a large pot with one baby in her arms and the other tugging at her leg. She tripped and the baby in arms fell into the water and died while she and the other child suffered 3rd degree burns over the lower half of their bodies. The living child wakes at night screaming and has to be sedated- she is believed to have PTSD. I wonder if anyone has attended to the mental health of the mother.

Yet another interesting occurrence here is that the Haitians sometimes obtain transportation via something called TAP-TAP. These are literally moving trucks that the locals who want to ride are expected to run and jump on. We now have 2 kids with neck and head injuries sustained from falling off the TAP-TAP.

The people need so many resources. I was on call last night and picked up 3 patients. All three were ready for discharge today, but all three had significant social concerns. One has a shunt in his brain, but no neurosurgeon to follow up with. We could only tell the parent what to watch for and cannot promise that if they come back a neurosurgeon or neurologist will be available. The other two had no clothing, no diapers, no food, and no good place to live. All terrible odds for kids who came in for respiratory distress and dehydration /malnutrition like these kids have.

That was day one and I haven't even shared my on-call experience of an unresponsive child coming to the ER! The shift started at 7pm and I was called to our rustic ER setting at about 7:15. This sad story began at 7am. The child had become listless after an uneventful night. He was taken to a local clinic and given an over-the-counter medication. He did not improve and the family began traveling here. It took over 4 hours for them to get to the site. We worked with him for 45 minutes; giving all the medication we could to relieve seizure activity. He is now in our intensive care unit. We are wondering if he has Cerebral Malaria, something we would never think of in America.

While I was on call the patients and their families had a prayer service which I am told occurs every night. This is probably special since it is now early morning of Easter. It started with just one man standing in the center of our unit humming, then escalating into song as others joined him. I found myself singing along because, even though in Creole, the tune was of a hymn sung in my own church! Soon the entire tent was repeating bible verses, and raising their voices loudly in praise of the Lord. Mercie Senjior (Praise the lord!) they shouted, with the children joined in just as loudly! Mercie Senjior!!

Day 3

We are very short handed of nurses, many left today, only 2 in Peds with census 18 now, several children discharged yesterday. I had late night admission yesterday- 12yo boy in for head injury and concussion sustained in a car accident. He was playing soccer in the road and was hit. Driver did not stop. Sister brought child but had to leave due to another child at home. Patient frightened most of night, worried his sister would not return. I had a Haitian-American mental health specialist speak with him.

His sister did return this afternoon.

Cultural lesson learned from mental health specialist. The Haitian people are very direct. They would tell the child and the doctor if planning to leave child, otherwise will come back. Sister reports traveling since 6a.m. to get here. Had to go home because no one knew where she went and there is no phone. Sister states mother died before Earthquake and father died during earthquake. The patient was living with father, now lives with her in a tent with 2 other children. We sent him home today with shoes, clothing, and a sleeping bag. The sister was very thankful, our patient loved his shoes and his new little soccer ball.

My baby in the ICU does not have Malaria. Team still unsure why the repeated seizures through all the medication. He is still having seizures despite care. We know we need to scan his brain, but that is not an option, no CT scan.

Volunteer gets Malaria! They didn't take meds.

New admission today - AV-Canal defect in Heart Failure. Father, brother and child took a boat and 5 tap-taps to get here. They traveled more than a day to get to "the Americans" at the hospital. They had been out of heart meds for 10 days - no more money-and an American priest told the father about the hospital. They live on small island at the foot of Haiti called La Gunave. I just happened to be traveling pass the ER, which had just been closed due to staff shortage. I wasn't assigned to the ER, but offered to see the kids who were being turned away.

I worked in ER the majority of the remainder of the day along with other docs who just joined in. This became a typical scene (ER supposedly closed – docs and nurses keep on working as the patients keep coming.) Older man arrived with gangrene foot and missing toes and he went straight to the OR for amputation.

Little girl arrives with septic knee and elbow from another facility, very sick. She is in septic shock. She goes to OR for surgery. The chief of Peds is called to help with an IV. Her illness has caused all of her veins to collapse. Her blood pressure is dropping so that a different procedure is performed to get access. An interocceus access is necessary which means a special large needle is placed into the middle part of her lower leg bone and fluids are delivered right into the marrow. It was her only hope for being able to get the fluids and medication she needed. I hope she makes it. The other facility is being staffed by medical students and one or two doctors.

Day 4

Received an 8y.o. boy from the operating room today for a fix of a broken arm that was an open fracture, not such a big deal except that he broke the arm 1 month ago and the bone was still visible! He fell over some rubble in the road while playing with friends in the streets. He was taken to a hospital that told his brother they had no capability to fix it. Brother brought him here after hearing about Project Medishare. The Orthopedic surgeons say it was bad and extensive cleaning and removal of dead bone had to be done. He is now on very powerful antibiotics that he will need for a while to avoid infection. He is only wearing a pair of shorts now bloodstained from his surgery. I hope his brother will bring a change of clothes.

Watched a surgery of a young girl with a very rare congenital skin condition called Epidermylitic Hyperkeratosis. The dermatologist (brought in from Miami just for this case) had seen it before, but never one this big or looking this bad. Largest area was removed in the OR. Mostly likely would have become a cancerous lesion given its growth. This child is here alone. She does have family, but the village is far away and the mother is a double amputee. She has been here for 21 days due to infection of this huge lesion. She is only 14.

My first admission from Day 1 with the seizures has gotten worse. His head has grown very large indicating pending herniation, meaning his brain is swelling. He is expected to die within the week. Parents asked to give special tea today, supposedly has healing powers.

I helped Dr. Norma try to reduce scrotal hernias in a 36y.o. man with hernias the size of an eggplant. After 2 hrs we were not successful. Why are a couple of pediatricians working on a grown man? Because we are here and we can – this is a procedure we do in little boys, just never expected to have to do it on an adult. He came for surgery, he got us. We called the Chief Surgical Officer because he definitely needs surgery. He explained, although this looks bad, it is not life threatening and we are only doing life threatening surgeries. It is just not sanitary enough to put people at risk of a poor outcome for an elective procedure. The patient is disappointed; he has had this problem for five years. We want to fix everybody, but we just can't – frustrating.

Day 5

The CMO and I talked about my heart baby last night. I am working on getting her to the states for a life-saving simple procedure. We were hoping to share her story with Ms. Kouric, but no such luck. I did speak to Ms. Kouric briefly just about my experience here. According to the CMO, CBS and the Executive Director already had a game plan in mind which highlighted the good works here. Everyone would like to share their story, but time is limited. She did a great piece with a little girl on our ward.

On a better note, I have been successful in working with the Medical Director of Heart Failure and Heart transplant at the Univ. of Miami to get a heart surgeon to accept my little girl for heart surgery! Her story is awesome and I told it as many times as I could! We will work on Visas for her and her dad today.

New child on ward now with sickle cell disease pain crisis and high fever. My good friend from Mobile and I worked on him last night. As a PA, I worked with the Sickle Cell Program of Emory University and Grady Hospital. It is interesting how previous experiences continue to help you in life. Some of the things we were doing the father said had never been done or told to him before. (Different medications, Chest PT, high dose IV fluids). He was feeling much better within 2 hours when he is usually in pain for hours. He has antibiotics going and will get a malaria screen in the morning.

Nurse on medsurg broke down. Very distraught to be working with a patient she thinks is infectious. Has called home to get plane back. They told us in the beginning some would make it, some would not.

Met lady from the mountains today. Came here to get meds to take back up. Says she and some doctors are treating people in her front yard. Needed more Rocephin. I will try to go up to her area on Friday. So much work is being done all over the island.

Day 6

It's 5:30 am again, the tent is actually comfortable this morning as oppose to other mornings when it has been freezing. There is no in between here, it's either too cold to sleep or too hot. My preference is too cold; at least I can layer and become a turtle inside my sleeping bag. The mosquitoes don't seem to like the cold so I guess that's a plus. I feel guilty having a relatively good night's sleep considering my nurses have yet to have the same. They are on the night shift and the heat is quite miserable for those trying to sleep in the day time, never mind the noise from those who disregard the rather larger sign indicating day sleepers. I cannot say enough about their commitment to the cause. A couple of nurses have lost it, but the two with me, Darline and Rebecca, keep on going. Others are rousing and the coffee would be brewing except there is no water this morning. Thank goodness I filled my water bottle last night and took my late night shower under the stars (except there are no stars).

Today I am expecting a very special case to arrive. I have been asked to manage a very sensitive case of a young 13 year old female with a rare disorder of rapid breast overgrowth. The enlargement over a 4 month period has rendered her pretty much incapacitated. Her breasts are so heavy she is unable to sit for long periods without severe back pain and difficulty breathing.

7:30 a.m. and the entire service has been called together for a meeting. The Chief Medical Officer and Chief Surgical Officer start by thank us for our dedication to the patients we are caring for. They note the difficulties we face in giving absolute quality care, given the lack of certain supplies and equipment, but point out that this hospital is the only one in the country providing the level of care that we are. They also take time to thank everyone who has helped to keep the ER flowing which has been a monumental task. Even when we think the ER is closed a few more slip in pleading for care. Next they talk about my teen case and make very clear that no pictures are to be taken and no questions of the patient and family by multiple people. I am so happy that even in this country where the people are so thankful they will let you photograph just about anything, the administrative team felt this young girl's privacy and mental health should be protected.

I made it my business to create a "private room" for her. The staff helped me to create a tarp covered area for her to be admitted to. Of course she arrived just after I left the area, but she was whisked straight to the OR. There awaited an entire plastic surgery team with a plastic surgeon, mind you, who specializes in breast reduction! What luck you say? The family says it's a miracle. I spend the next 4 hours in and out of the OR suite giving the family regular updates on the progress of the case. Finally, the case is completed at 6 and a half hours. Twenty pounds of breast tissue has been removed! She has done so well that she is sent straight to her "private room". It was an amazing job.

The team and I took the afternoon to go into the city. Our driver, Phillip, was a most gracious tour guide. He and his family live in Port au Prince, where he was born and raised. He says his own home is still standing, but has some damage which he cannot fix yet.

He drove us into downtown, but along the way we saw numerous tent cities. The tents were made with tin, wood, sheets, tarps and various other items families could find. The rustic homes were one after the other, row after row, very reminiscent of the FEMA parks resulting from Hurricane Katrina. Somehow though, the images here cooled my temperament of the vivid memory of the small cramped FEMA trailers that enveloped many areas along the Coast. It hit me like a ton of bricks that the people here would probably worship FEMA if trailers arrived.

As we past neighborhood after neighborhood I could quickly peer into some tents as the thin material chosen for a roof flapped open for a glimpse at children and families.

Day 7

My first admission on Day #1 died today. He was just two years old. We still have no idea why he became unresponsive and had the seizures. All I know is that I witnessed the true love of a father and mother who prayed daily by their child's side. I watched a father go to extremes to save his son. He brought in a voodoo priest 2 days ago to no avail, then found him crying and apologizing to the mother, who is Christian, for bringing him in. He said to her that he knew it was not the right thing to do, but he wanted to do all that he could. The Pediatric intensive care doctor told me the father prayed almost 9 hours straight over his son yesterday and that he held him for 4 hours before making his peace. This morning the child was removed from the ventilator and breathed for about an hour before leaving his earthly body. This is our 4th pediatric patient death this week.

My breast reduction patient is all smiles today as is her family. They say we are a miracle from God. Who would ever have expected a plastic surgeon with expertise in breast reduction to come to Haiti to operate? I have no doubt that miracles happen every day, even in the wake of disaster. I am glad to be used by God to help others experience his miracles.

We had a terrible rain tonight. The sleep tent flooded as well as the Pediatric tent, which flooded a lot! Patients had to be moved to the opposite side while staff and Haitian volunteers worked fervently to get the water out. Buckets and buckets of water were removed. Some even used the small basins to scoop water as fast as they could. Darline and I kept an eye on the patients and made sure no medications were missed. Now and again you would hear a nurse shout out "are the patients okay, have they had all of their meds!" Can you imagine? In all this turmoil, nurses still focused on the care of the patients. Not to be left out, the pediatricians were soaked and wet from helping to bail out water. Even our Plastic Surgeon was shoveling water with others. Finally someone arrived with a pump and the rains began to slow.

One of the counselors revealed that a young girl who was back in surgery was having a very hard time with the storm. She broke both legs in the earthquake and was under the rubble in the rain for some 12 or so days. She was the young girl many of us saw on television. The counselor sat with her for a couple of hours as she sobbed about the rain. She was back for another operation because she had a spontaneous break of one of her legs while in rehab.

Three motor vehicle accidents arrived to our flooded ER. One was hit by a bus and required an amputation. All this at our well built tent hospital, I wonder what the people in the city are facing in their tents made of pieces of cloth and tarp and sticks and tin? I am sure our place is a sight better and this is just the beginning of the rainy season.

This was one heck of a last night.

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