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Report of Joseph Pulvirenti M.D. 2/28 THROUGH 3/6/2010
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( Megan Coffey is still the Heroe, after two months in the AMHE-HUEH HIV tent)
 
1-The country was already in bad shape before the earthquake; after the earthquake it became even worse
 
2- Haitian government appeared to be non existent and when it did appear it tended more to obstruct than to help
 
3- there were a lot of wasted supplies because of disorganization and lack of effective leadership
 
4- working in the government hospital, groups of doctors took on roles without any clear cut coordination
 
5- patients were frequently transferred out of the ICU only to be ignored by their doctors and nurses once they were placed in general medicine tents. Also, numerous incidents of patients getting operated on without follow up care by the surgeons
 
6- major diseases I saw were cerebral malaria, TB and pneumonia with some PTSD, a number of cases of postpartum cardiomyopathy, gunshot wounds, typhoid fever with small bowel perforation
 
7- Haitian doctors and nurses working in the general hospital appeared to be very apathetic; told by American Haitian doctor that this was related to living in the squalid conditions (many living in tents after the earthquake) and that they had not been paid for weeks to months
 
8- Many heroes seen;2 that I worked with Megan Coffey who worked the TB tent for 6 weeks and Jeff who was a nurse anesthesthesist who worked in the ICU and tried to organize a chaotic situation
 
9- the ICU was in a tent where beds were crowded one on top of the other ; probably about 28 beds with less than 1 foot between beds. It was an infection control nightmare. No plumbing in the ICU and sporadic electricity. Oxygen was either administered by a large heavy rounded oxygen tank which had to be maneuvered over large distances from tent to tent or bedside to bedside or was administered by these portable air compressors that relied on electricity which frequently went out during the days that I was there
 
10- It was hot outside with the temperature in the tent at least 10 degrees warmer. There were a few portable fans in the ICU tent that helped a little
 
11- the blue TB tent was even hotter with no circulation; no fans (no electricity) and the hospital administration forbad opening of tent windows for fear of spreading TB
 
12- place where I stayed- Quisqueya was a converted school which housed a couple of hundred medical personnel from many groups and many countries (groups from Germany, Swiss, Canada, mostly Americans) as well as marines
 
13- place we stayed was a classroom where we laid sleeping bags on the ground, got airmattress the next day from groups that had left earlier; made life much more bearable
 
14- all 23 of us camped in the same room and got along quite well
 
15- conditions on camp were somewhat primitive; outside showers; blue tarp, partially exposed to outside so can get rained upon while taking a shower, cold water only and had to take short showers
 
16- group toilets- not suppose to flush toilet paper down toilet but leave in waste basket
 
17- food at camp- AM- terrible coffee and something that may have been cold oatmeal but tasted like vomit; PM chicken and rice and beans
 
18- people getting sick in camp- 1 nurse got N and V after exposure to child with diarrheal disease; another person in that group also got sick as well as others in the camp; treatment- IV fluids, zofran and cipro; most recovered in 24 hours; one member of our group got sick- fever and chills and weakness and diarrhea.
 
19- personally I feel tired and at times febrile- ran out of malarone; so missed last couple of days of Px. When got back home, felt tired and weak and had diarrheal disease which I self treated successfully with flagyl
 
20 - at ntight- we sat around talked to each other, played cards, drank and generally enjoyed our company
 
21- our group was the loud group who liked to enjoy themselves
 
22- ICU- chaotic- one groups of doctors on different days; ID MD from Evanston Hospital when first there; first couple of days I worked with Megan in TB area; hard to figure where to fit in because there was no system to fit in and felt that I was slowing Megan down who seemed the most knowledgeable about what was going on with the patients
 
23- difficult to get Xrays- no portable Xray and no CT scan; pts had to either be walked over or brought by stretcher to the Xray department and may get lost for hours. So if you had an ICU patient you frequently did not get an Xray for fear of your patient getting lost in radiology and possibly dying there
 
24- labs were even slower and restricted to elytes, CBC, malaria rapid test and HIV test and sputum AFB; frequently not drawn or lost; lab tent was chaotic and many patients waiting long periods of time. Went to tent to pick up labs on one occasion; line of patients waiting to get labs drawn was about 100 people waiting. Order was kept by young men with clubs. Even though we were able to jump the line, the person who “helped us” took her time and we had to wait for about ¾ hour to get 3 of the 6 results we were seeking. Frustration levels ran high among the patients, staff and Haitian personnel. It felt like the end of the world
 
25- people got lost for long periods of time; pts in tents and in the IM catacombs not seen by doctors or nurses for days
 
26- major problem was not lack of supplies but lack of logistics and coordination. Many groups working in there w/o any clear cut oversight. This would be difficult in an organized environment but in an environment where there was no organization, this became even more problematic
 
27- future groups should be flown into Port a Prince and a 2 week stint would be better than a 1 week stint
 
28- the pharmacy in the general hospital needs to be better organized. Perhaps sattelite pharmacies in areas close to the inpatient units for rapid distribution of medications. Or at least develop a good par stock of medications. IMC had there own pharmacy with supplies right outside of the ICU but were reluctant to share medications with me. Had to buy them off with trades of paper and other medications that I brought
 
29- the medicine unit in the building is known as the catacombs for good reason; lighting was exceptionally poor and patients tended to get lost there
 
30- there was no clear assignment of patients at all in the general clinic
 
31- some groups in Quisqueya went directly into the tent cities with their own meds and administered therapy there. Most direct way to ensure that patients received care. Best way to ensure that the supplies you brought were utilized correctly. On the other hand it only contributes to the chaos as it does not fall under a system. However, if there is no medical system, perhaps this is the best that can be done

In summary, there is lots to be done in Haiti
 
1- the Haitian MDs and nurses and medical staff need to be paid and held accountable for providing quality health care
 
2- there is a drastic need for logistics and planning experts that should work with the Haitina government in an attempt to restore order on this chaotic system
 
3- Medical missions should have a clear cut knowledge of what they are getting into and should be there for at least 2 weeks with a clear cut assignment when they hit the ground
 
4- lab and Xray services need to be more easily accessible
 
5- The tents need to be better ventilated and air conditioned if possible
 
6- there needs to be known patient assignments, rounds on all patients on a daily basis and communication between the MDs nurses etc…

I am sure that I can say a lot more, but the first thing is to organize the place
Hope this helps
 
Joseph Pulvirenti M.D.
 
PS- Paul, I thoroughly enjoyed working with you and the rest of the group and would be happy to go on additional medical missions with you in the future if you would have me.