On-going Earthquake Updates
from Family Health Ministries
- Week of 8 February 2010
Reflections
from Ob/GYN Serving in Leogane, Haiti, after the Earthquake
Arriving in Haiti
The ten-seater, single engine plane was flown by volunteer pilots. The flight from Santiago, Dominican Republic was picturesque until the Haitian border. Rolling hills covered by green trees gave way to scrub dotted, anemic dirt mounds with the occasional mudslide.
Port au Prince, from my vantage point, was relatively intact. There were concrete slab roofs as far as the eye could see. The sun was shining, the ships were in the harbor. We veered south and the city of Leogane appeared beneath the plane. There were crumbled piles of homes and businesses everywhere.
Later, driving through the town on our way to the nursing school, the streets seemed narrower than they had been in October, when I came for a Family Health Ministries medical clinic. The streets were lined with corrugated tin “pup tents.” Women were cooking and hanging out laundry. Men were busily shoveling debris.
The Setup
I put up my tent on the grounds of a Bill Gates medical research compound. There were about 20 in our camp. We had a short, seventy five foot walk to the nursing school dormitory which housed our operating rooms and medical supplies.
The Japanese Disaster Relief Camp was at the other end of the school. Mario, a Family Practitioner from Chicago, had made one of the dormitory rooms into a Labor and Delivery “Suite.” During our daily clinics, the pregnant women were culled from the crowd under the tarp outside and allowed to wait to be seen in the relative coolness of the dorm.
The Christian medical team was currently disadvantaged compared to the other teams in town. They represented formal agencies: Swiss Doctors Without Borders and the governments of Japan, Cuba and Canada. We didn’t have cots, a ventilator, an anesthesia machine or many of the other medical comforts of home… The organization World Wide Village would install a 50 bed hospital on these grounds the weekend after I left.
Providing Services
I borrowed an ultrasound machine from the Japanese camp about 10-15 times per day. But then, they didn’t have an OB/gyn so they frequently brought me patients for consultation. During the day, I ran an OB/ gyn clinic seeing about 10-30 patients per day. The rest of the doctors worked in the medical clinic, dressed wounds, changed casts or performed orthopedic or plastic surgery.
Luckily for me, Stephanie, a Haitian-American nurse from Florida, came down to help with the relief efforts. Since she was bilingual, we were able to mobilize many of the local nursing students to practice taking vital signs and teach about prenatal care. We also had the sad task of confirming miscarriages as well as unwanted pregnancies. We treated bladder and pelvic infections. We handed out prenatal vitamins.
I had the happy job of measuring bellies and hearing heart tones (I brought a Doppler, donated by Cooper Surgical). In the States, we have continuous fetal monitoring during labor but at least we could listen intermittently to keep track of how the babies were doing. We delivered about 2 babies a day. We had a number of babies with cords around the neck; my Doppler allowed me to know when a cesarean section was required for safe delivery or when a woman just needed to push with all her might…Luckily all of our deliveries were healthy.
Dr. McKain with a newborn and her parents
Christine and Yolene
Christine is a 37 year old Haitian banking clerk who worked in Leogane. She was in the bank when it fell and spent the night of the quake buried in the rubble. She called out for help but heard the people outside say that it was not worth the effort to dig her out because “surely she would die.” She was pinned down by her feet but her pregnant belly was free. I saw her in OB clinic one of my first days in Leogane. She had elevated blood pressure and I ended up inducing her labor.
The last patient the Japanese Relief team brought me, Yolene, is a young woman who had started bleeding that morning. She lived in Port au Prince. The day of the quake, the house she was in with her extended family, collapsed, crushing the people at the back of the house (including her husband) but spared those in the front. She was about 20 weeks pregnant by dates but the ultrasound showed a younger fetal demise. Second trimester miscarriages are high risk and may be complicated by severe hemorrhage. Sometimes they require surgical intervention.
So, that last evening my time was divided between Christine and Yolene… Christine delivered a healthy 7-8 pound baby girl by c-section around 8pm.
The rest of the Americans retired to “the house” and I camped out waiting for Yolene to complete her miscarriage. I was nurse and doctor: running the Pitocin (to maintain adequate contractions and “prevent” excessive bleeding), injecting intravenous sedation (hoping I hadn’t given her too much…but not wanting her to suffer unnecessarily.) I checked her blood pressure, watched her chest rise and fall as she breathed and prayed that she wouldn’t hemorrhage.
Around eleven pm we lost power, a common occurrence in Haiti. I flipped on my REI head light and paced. An aftershock hit and her sister-in-law left the building to sleep in the relative safety of the school yard. Yolene delivered around 1 am, without incident.
Final thoughts
I thought back to that cryptic email I had received from my friend, Jules, on Sunday, after I told her about my first delivery. “Amazing, what if you hadn’t been there, little pencil?”
Once home, I found the quote that she had sent me, but that I had missed when reading my Blackberry in Haiti:
I am a little pencil in the hand of a writing God who is sending a love letter to the world. Mother Teresa
I am thankful that Family Health Ministries gave me this opportunity to participate in the recovery of Haiti.
Kristina K. McCain M.D.
Dr. Kris McCain, posing with a painting she bought for
FHM's Blanchard Clinic in Port-au-Prince
Dear Friends,
We finished our week of clinic work and it was an awesome experience with an awesome group of people. The medical team arrived safely home today. I drove them to the DR border yesterday afternoon and our DR contacts were right on time for picking up the team and getting them to Santo Domingo. Thanks to Missy Daffron and all her contacts in the Dominican Republic! They were a wonderful help in making this week a tremendous success.
Working and living at the Blanchard clinic went well. We saw a total of 1508 patients, a one week record for FHM which I do not care to break in the near future. I cannot express enough our appreciation to the Haitian people for their love and care of us. They were greatly appreciative of our presence and expressed it in so many ways. Pastor Leon Dorleans has asked FHM to send medical teams as frequently as we can over the next few months. When I return home we will put together a plan for follow-up teams.
Tomorrow, I am meeting with our contacts to review FHM satellite needs for the Blanchard clinic. Currently we are connected through an existing network in the compound which sounds to be deficient for our needs. Duke University has graciously donated satellite phone systems for our three communities that will make future communication much easier during this rebuilding period. After this meeting, I am planning to load up supplies for Fondwa and go out to spend a few days with the Sisters. It will be good to finally get out and survey the community first hand. I will not have internet contact for most of the rest of the week so this will probably be my last email until at least Wednesday afternoon or Thursday.
I plan to spend a day with Delson Merisier on my way back through Leogane. It sounds like he has made great strides in getting the concrete of the second floor off the clinic’s first floor. It would be wonderful to get the clinic back and functioning by mid March. The Blanchard staff is already back hard at work seeing patients and even screening women for cervical cancer. Our staff at both clinic locations are a tough bunch of people and very dedicated to their communities.
Kris McCain was our OB/GYN representative out in Leogane last week and was the primary women’s health provider at the nursing school field hospital. She delivered babies and provided emergency c-section deliveries when needed. Kris has been a team member for FHM on numerous occasions providing care at both Leogane and Blanchard. She also was a pivotal person in getting our cervical cancer program up in running in Blanchard this past summer. Please watch for Kris McCain’s reflections sometime this week.
It has been a long 10 days, but a personal blessing to me. We celebrated Jackie Dorleans birthday yesterday which had an extra special meaning this year. I went to worship at both Repatriate and Cite Soleil today and spent the afternoon resting. It was great to have a day with not much activity before the start of the new week.
Many Blessings,
Kathy
