Day 8: Saturday, December 11, 2010, Out of Haiti

Last night Fabian told us that there might be a possibility of a UN chopper taking us out to Port-au-Prince, time unknown for security reason.Apparently the UN chopper would be delivering IV fluids and could take us back on their return trip.

This morning I went to the ICU to round which most likely would be our last round. Mary rounded in the step-down unit.

When I went back to the Mission, I learned that we were expected in the heliport at Port-de-Paix in 30 minutes, that would seem impossible given that the trip would take an hour and half under the best circumstances. Since the rain, the roads were filled with pools of water and we did get into marketing time and hence traffic jam. All the way we prayed and hoped that the UN chopper would wait for us. When we finally arrived at the razor wired UN compound, we saw the chopper still parked in the heliport. Fabian said, "Thank you, Jesus."

We flew to Port-au-Prince and from there boarded a small airplane to the Dominican Republic, arranged by Ted at the PAP airport. We left our mission a day earlier than planned and I fervently hope that there would be other people coming to help with the cholera epidemic. For now we have no idea how the epidemic is going to evolve.

This was my first Disaster response trip with Medical Teams International and I felt very honored to be asked and to be part of the team. I wished we could have stayed longer and helped out in this desperate situation. I do hope that the outbreak would ease for the sack of the people of Haiti.

Day 7: Friday December 10, 2010, The Rain came Pouring and out Came Our Boots.

Had to go running this morning. On my way I encountered at least three remnants of road blocks or burnt tires and an abandoned car with smashed windows.

Soon the rain came pouring down. As the clinic was quiet, Tom would go rounding with Mary while Sherry and I went to visit the orphanage next door and Alan went to the Pediatric clinic.

The streets were flooded and so was the front porch of the clinic. The ICU was barely half full, what with the demonstrations and the rain, we were not surprised that the patient census had dwindled to 17 to 20 patients today. The woman by the door continued to worry Dr. Shirley. A Foley catheter was placed in her earlier and she had no urine output. She worried that the patient had renal failure. Looking at her, I wondered she was not actually dry and that I would challenge her with more IV fluids and sure enough after 15 minutes she began to have some urine output. Her other problem was she continued to be wet from her profuse diarrhea and we found more dry clothes for her.

At lunch Fabian gave us the option of evacuating this afternoon to Port-au-Prince via a commercial flight which was available. She was not sure when the next flight out of Port-de-Paix would be. Sherry joined twelve other people to fly out. The rest of us elected to stay.

In the evening the rain had eased to a drizzle. On my way to the ICU, I could hear the toads croaking, it was time for them to play. I rounded with my evening translator, Sylvester at 7:30 and 10:30 pm, thinking in the back of my mind that this might be my last evening here in St. Louis.

Day 6: Thursday December 9, 2010, The Census Continued to be Down

Clinic was about half occupied today. Apparently the patients came from east of here where there were demonstrations. The thought being that once the demonstrations died down, there would be an influx of patients.

The gentleman with the low blood pressure last night recovered sufficiently overnight. Gesynlyn and I took care of a newly admitted youngster who looked moderately dehydrated. We completed rounding in all three areas in a matter of an hour. Many people were discharged today. Gesynlyn and I took time off on the balcony overlooking the ocean. We had bonded very well together and worked excellently as a team. I was very lucky to have her as my translator.

Alan and Sherry went to visit La Puente today.

Day 5: Wednesday, December 8, 2010, Riots in Port au Prince

Gesynlyn and I went to clinic right after breakfast and right away we noticed two very sick patients. One was a young girl in John's old bed, we were unable to get a blood pressure. We started 2 IVs and poured in Ringers Lactate. Within the hour she was awake and sat up at the edge of her cot smiling. The other was a little boy with thready pulse and he was difficult to arouse. His IV had malfunctioned, Gesynlyn restarted another IV and also within the hour he woke up.

In the last bed of the large ICU, there was a woman with massive diarrhea, we found some dry clothes and blanket and changed her into a dry cholera cot.

The man in bed 1 and his baby had been moved to the step-down unit and they were fine. The woman who was seven-month pregnant was looking well. I saw John in the street with his mother looking strong and happy.

After lunch we learned that there were riots in Port-au-Prince after the provisional results of the election were announced. The airport was shut down and American Airlines canceled all flights till further notice. From the roof top of the mission we saw young men with rocks, bottles and pipes in their hands running. We were told to stay inside and not venture out to the clinic till it was safe to do so.

A young man was brought into the mission after he was shot in the right leg. Tom, Alan, Sherry and Fabian attended to him. Tom stopped the bleeding and stabilized the shattered tibia and fibula and then he was transported to a hospital. We heard that the road might be blocked. Ironically, later that afternoon we saw a funeral procession from the roof-top, we wondered whether the person lying at rest in the coffin was a cholera victim.

In the late afternoon and evening we went on rounds, there was a man that needed close attention given his low blood pressure and continued vomiting and diarrhea. The ICU was quiet, only 11 patients left for the evening.

Day 4: Tuesday, December 7, 2010: Visits to La Puente and MSF

Went running in the village and by the beach which was filthy. I learned that we were not to swap places with Don and Ian after all. Tom and I went on a pick-up truck to pay La Puente a visit this morning. The cholera treatment centre was half empty, one tent was completely devoid of patients and the area with the tarp roof as well.

Gesylyn and I went into the tent to see a few patients on our own and then we joined Don for rounds. Later a doctor from MSF arrived looking for transfer of patients to their tents from any overflow. As it turned out they too were 50% full. We visited MSF cholera treatment center which was very well co-ordinated.

When we came back from La Puente in the mid-afternoon, we learned that there was one death in the morning, a 27-year-old lady who was in the ICU for less than four hours. I often wonder if it would make a difference if we had stayed.

Tom and I made rounds in the evening. The man in bed 1 and his baby returned to the ICU again looking dehydrated. We placed back their IVs as they both refused to take ORS.

Day 3: Monday, December 6, 2010, Situation was Getting Better

This morning the little girl with the IO, her name was Jasmine sat up and drank from a cup. It was a triumphant moment for all of us. John looked stable but the baby who was syringed fed did poorly again. His dad however was able to walk to the bath room on his own two feet. The five-month-old that was breast-feeding last night was also doing well, sucking at his mother's breast vigorously.

In the afternoon and evening, the ICU was quiet. So far there had been no deaths.

Day 2: Sunday, December 5, 2010, Surrounded by Sick Patients

After breakfast, I decided to go to clinic by myself to eyeball the ICU and realized very quickly that the boy in bed 3 in the little ICU was in trouble. Overnight his IV came out and was not replaced. He was restless, writhing in bed and his eyes had no life in them. Mom was trying to coax him into drinking ORS but he was not cooperating. Gelseylin was with me and she quickly placed an IV in him and we poured fluid into him. Within two hours he perked up and was able to raise himself up from his cot. He whispered to me that he was five years old and his name was John. Mom was very happy and enthusiastically made him drink his ORS.

The man in Bed 1 was looking a little better. I syringed fed a baby which turned out to be his.

After lunch we returned to the clinic only to find half the ICU empty, most patients were discharged to the step-down unit and the decision was not discussed with us. I went looking for the man in bed 1 and found him badly off along with his baby who had been having massive diarrhea and Mom had trouble convincing him to drink. Gelsylyn and I brought them back, both of us helping the man to walk up to the unit, Half way there he was exhausted and settled himself on the steps for awhile. Both of them needed IV fluids. Later in the afternoon another young boy was brought back by his mother from the step-down unit to the ICU and Tom took care of him.

In the front porch, two men carried a sick woman on a bed-frame. The woman had been sick for five days with vomiting and diarrhea and it was rumored that they had to travel for two hours to come to the mission. The woman was not able to answer questions, her eyes were glazed and she was dehydrated. I examined her and felt her belly and asked if she were pregnant. She turned out to be seven months pregnant. I told Gelsylyn that we would need two IVs in her. She asked me why. I replied that she was very dry, having been sick for five days and that she was pregnant. She looked at me and said, "Is the second IV for the baby?" Her face brightened up at the idea. She too brightened up within two hours having able to talk in whispers to us.

Later in the evening we went rounding, the ICU was hopping, many of the people discharged to the step-down unit came back and new patients arrived, including a baby being breast-fed by her mother. Alan placed an intra-osseous line in the tibia and a two-year-old. A second one was placed as the first one was not working, eventually an NG tube was placed by Sherry and she was fed via NG. After 100 to 200 cc of fluids were pushed into her, she became quite feisty. John's mother was on hand to help out and John could be seen milling around in the ICU, looking for his mother, a totally different boy from the one we saw this morning....the wonder of IVs and ORS.