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This blog exists only as an archive. It is a journal that serves as a window into my life as a Marine combat veteran serving in Iraq and Afghanistan; it was written with no filter, no politics and no agenda. Please feel free to follow my journey from beginning to end. Welcome to my life.

Thursday, January 21, 2010

From former Army Special Forces Medic Mark Hayward

100120 Haiti (teamwork)

The day got off to an early start when I woke up a few minutes after
6AM because somebody was shaking my tent. I found this irritating, as
I was planning on getting up at 7. I became less irritated, and much
more intrigued, when I realized that I was experiencing my first
earthquake.
Frankly, it felt as though I was lying on a bunk in a
sailboat at anchor, being hit by the wake of a very large passing
powerboat. The ground wobbled, like jello. This went on for a little
while and then faded away. I considered going back to sleep, but the
yelling and excited conversation caught my attention. When I heard
Jeff describing how he had been washing his, uh, nether regions, with
baby-wipes inside the presumably empty novitiate building, and upon
feeling the earthquake, had sprinted into the courtyard wearing only
his flipflops, I laughed so hard I figured it was time to get up.

“Normal” is a word I wouldn’t really use down here, but I suppose we
are developing a little bit of a morning routine. We packed medical
supplies, reviewed our possible missions for the day, mixed up oral
rehydration salts, and headed out to the general hospital. (No soap
opera jokes, please; we’ve told them all several times.) Our numbers
and logistical requirements have grown to the point where we were
traveling in two tap-taps and a rental Suzuki from the DR.

We looked carefully at the buildings as we drove along (occasionally
being cheered on by locals shouting “We love you! Thank you!”) And
when we got to the hospital, it had CLEARLY been devastated by this
morning’s earthquake, but not at all as we expected. The BUILDINGS
were completely intact. But, in a very understandable act of caution,
all of the PATIENTS (and their beds) had been moved outside onto the
paved street surrounding the hospital courtyard. And, in a
predictable though very problematic excess of caution, the hospital
administrator was unwilling to allow the patients BACK into the
buildings until it had been proven beyond a reasonable doubt that it
was safe. And so, when we arrived, the patients were still outside.
On their hospital beds. In the sun. Largely unable to move due to
their extensive orthopedic injuries. Without water, because the
hospital staff themselves were on the verge of running out of water.
And, as we found when we asked the logical next question, many of the
patients had also been without food for 2 or 3 days.

Needless to say, our immediate responses were to get cardboard sheets
as shade for as many patients as possible; secure and distribute
drinking water; and have Jeff and Craig (our firemen) do a
top-to-bottom building assessment to see whether the hospital itself
was in any danger of falling apart. What they determined (before the
last sheet of cardboard had been cut) was that there had been no
appreciable change to the structure since yesterday. What they next
determined (before the last cup of water had been distributed) was
that the hospital administrator was not going to accept any authority
less than that of the US Army Corps of Engineers to declare the
building safe for habitation. And so we set to work turning a street
full of randomly scattered beds into a functional, non-injurious
open-air emergency room.

Although I tried to focus on patient care, like Dr. Griswald, I
simply couldn’t carry anything through to completion as I got more and
more involved in working on the shade-water-organization-food
problems. Solutions that I can describe in a few paragraphs took
hours to carry out. Many of the patients had arrived after our
departure from the ER and they had no registration slips (with minor
information such as patient name, age, injuries/medical conditions)
and previously rendered treatment. Patients who had already been
scheduled for surgery when we left last night, such as the grandmother
with the pelvic fracture, were still exactly as we had left them,
except of course for being outside in the sun. The beds were jumbled
any which way, mixed in with patients who had been brought in on
boards, doors, and other random platforms and left on the sidewalk.
And, of course, more patients were coming in all the time: not a
flood, but just enough of a flow to ensure that any space opened for
any duration of time would very quickly be occupied by more patients.

Dr. Griswald was evaluating and directing treatment for patients with
passion and skill. The two nurses and three or four technicians were
doing yeoman work trying to actually provide the ordered care to the
right patients. But every act of medical care was taking place in a
continuing welter of chaos that doubled the time of every action and
virtually ensured that critical injuries were overlooked or left
untreated. Dr. Dolhun had been grabbed for surgery as soon as he
arrived (fortunately the ORs, in another building uphill from the main
hospital, had been declared safe, so surgery was still taking place.)
However, Dr. D never even made it up the hill to the OR; he was
grabbed wile passing through the doctorless OB “ward” (in the middle
of the courtyard) where eight to nine patients, two with acute medical
problems, were actively laboring and trying to deliver new lives into
the world under the bewildered supervision of one non-OB nurse. That
took both of our doctors “out of the fight,” so to speak. My decision
then was either to focus on patient care alongside Griz, or to take
charge of the effort to change his work environment so that he could
actually manage all of our patients. So I took a deep breath,
mentally removed my “PA” hat, put back on my “Army problem-solver”
hat, and along with the rest of Team Rubicon got to work making order
out of chaos.

First order of business was the patient identification. No
registration information. Not even any cards or pens. No tape. No
idea who was who among our thirty-plus patients. Resources located
within fifteen minutes inside the “uninhabitable” building. Marines
and firefighters filling in for nurses on skilled nursing tasks like
wound care and medication administration, so that the nurses could get
baseline vitals and patient history for registration.

Simultaneously was the problem of shading the main triage and
treatment area. Griz rocks and he is a brilliant doctor. He’s also
on the far side of fifty, sleeping on the ground in a foreign country,
and doesn’t run marathons in his spare time. It was easy to see that
he wasn’t going to last 30 minutes at the pace he was going if he
didn’t slow down, drink some rehydration fluids, and get out of the
sun. At this point it was already stupidly hot and humid and it
wasn’t even close to the hottest it would be during the full heat of
the day. So, we took it in shifts to keep an eye on Griz while we
built an enormous shelter over him and the entire “working” end of the
“ward.” Ever tried to make a decent shelter using only a 25x25’
plastic tarp, miscellaneous chunks of rope, and various chunks of
concrete? (Note that the interesting element is: NOTHING TO HANG THE
TARP FROM.) Thank God we were working with (former) Marines.

While the tarp team built something out of nothing, Jake and I got to
work making nothing out of something: namely, getting the seven
immobile/broken/junked CARS that were parked on the sidewalk (i.e.
SCATTERED ALL THROUGH THE PATIENT CARE AREA), out. With the help of
our trusty offensive hardware kit (in this case, a small but very
useful axe), we bypassed the doors, disabled the steering wheel and
transmission locks, and rolled the offending vehicles OUT of our
makeshift ward. Suddenly we had enough space for all of our patients,
so that they weren’t being bumped by cars passing through the
compound, and could actually be lined up neatly on the sidewalk for
Griz to examine and direct treatment.

The next issue was shade, and that was frankly impossible. The only
thing we could do was scavenge cardboard sheets for shade panels. One
patient had family, who had brought her food, water, and a giant beach
umbrella. Everybody else got cardboard panels. Clearly it was the
time to get moving forward on getting back into the building.

Of course, writing things like this just can’t do justice to the
utterly chaotic nature of all this activity. Everything was going on
at the same time and mostly in the same physical space. For some
reason we were getting a reputation for solving problems, so doctors
from throughout the hospital were coming to us asking for things.
Most of these were minor issues, such as the fact that the OR was
within three or four surgeries of being completely out of pain
medications and anesthetics. Other problems were a little more
pressing, such as the fact that a Haitian medical provider was
performing major surgeries WITHOUT anesthetic on screaming pediatric
patients who were physically tied down on plastic chairs in the
courtyard street for these procedures. This was addressed rather
bluntly, when a nameless Team Rubicon member, at the impassioned
request of two different surgeons, simply took the man’s ID card away
from him, walked him down to the gate, identified him for the company
commander of the 82nd security element, and directed them not to let
him back into the compound. The gesture proved to be somewhat limited
in its scope, as the hospital administrator later ordered the 82nd to
let the man BACK into the compound and demanded that he be allowed to
return to seeing patients. However, at least he got the point, and
confined himself to wound care and allowed the ORs to do the
amputations indoors under anesthetic. It’s a little unclear as to
what the moral of this incident is. It’s just a note in passing.

Anyway, the usual silliness continued to go on around us as we tried
to get work done. Jessie Jackson and Anderson Cooper came through the
compound and got all sorts of meaningful photos with refugees baking
in the sun. One nameless Team Rubicon member (coughJAKEcough)
politely requested of the Reverend J. that some actual food might be a
little more appreciated by the patients than a photo op. Another Team
member (coughGRIZcough) got interviewed by Mr. Cooper. Griz says he
just talked about things, but Jake claims that it was more of a verbal
pummelling of whatever nameless bureaucrats had decided to keep scores
of volunteer physicians and other medical specialists imprisoned on an
airbase “for security reasons,” when small teams of Americans were
moving freely through the city in hired tap-taps with no security
issues whatever. I did not get interviewed, but I did bump into an
O-6 colonel of the 82nd Airborne. The way I remember it, I very
politely mentioned to the colonel that the OR was running out of
certain important medications, which I listed for him, and I suggested
that it might be helpful if a single vehicle with a footlocker of
these more important medications might be sent directly to the
hospital, rather than waiting to be sent with every other scrap of
medical support in one huge convoy at some undetermined time in the
future. (Jake tells this story a little differently, but he is a
little confused; I think he got too much sun while he was working on
the monster tarp.)

Anyway, as we continued hacking away at whatever problems presented
themselves, things slowly started looking up. A convoy of food trucks
showed up with enough rations and water for everybody in the compound.
A two-vehicle command element from the 82nd brought critically needed
medications to the OR. A team from the Army Corps of Engineers showed
up to do a building assessment on the hospital, asked Jeff and Craig
to guide them through the whole process, and reported the exact same
thing that our firefighters had concluded when we first arrived. Best
of all, at about the time that another tap-tap showed up with the next
wave of Team Rubicon personnel, a 30-passenger busload of volunteer
physicians FINALLY showed up at the hospital, having at last been
released from “security protection” (house arrest) and allowed to come
take care of patients. So our team worked alongside Haitian nationals
to clean the recertified emergency room and move all the patients back
inside.

Once we got all of this taken care of, I finally got back to work
seeing patients. (Actually I didn’t get RIGHT back to work; I made
one other side trip to get pediatric antibiotics and
anti-inflammatories at the request of the OR chief, since the OR had
completely run out of these medications, needed them very badly, and
hadn’t mentioned them in the earlier conversations. Fortunately the
Catholic NGOs are NOT bureaucratically top-heavy, so I hitched a ride
back to the compound with a Mennonite relief specialist, found what I
wanted in the room full of donated medications, and left a written
list of what I had taken -- which was exactly what the logistics
officer wanted me to do anyway.) So I took the meds to the OR, and
then went back to the cleaned and repopulated ER. My one medical act
for the day was to reduce a displaced fracture of a young man’s left
radius and ulna, while Jake and some of the new arrivals
professionally applied a cardboard splint and ace-wrapped it into
position. (The man had wounds on his forearm that made it
inappropriate to cast his arm, even though our recently arrived Team
Rubicon elements had brought a box of Orthoglass casting material, as
well as Septra, Keflex, and a very interesting proprietary wound
dressing used by the Army special operations community.) And finally,
we called it a day.

Our trip back to the compound was uneventful. I got to meet the new
arrivals: another former Marine sniper who had hitched a ride into PaP
on a private propeller-driven plane with a team of security
contractors; a former Special Operations medic with a mysterious past;
two male nurses from Chicago (neither named Fokker); and a Brazilian
chef. At this point, I truly have NO idea what we will be doing
tomorrow. I’m not even sure the hospital will need us anymore: now
that the logjam at the airport has broken, there may be an
OVERpopulation problem with medical providers. But based on today’s
events, I think that our usefulness includes a number of different
areas. And I truly believe we ARE making a difference.

--Mark

5 comments:

  1. You folks are unbelievable! If only we had people like you taking charge in so many other places, and not having to put up with the idiocy of the bureaucrats. My thanks to you and other members of Team Rubicon for even taking the time to write your thoughts and experiences after such long hot days of accomplishing the impossible. I feel as if I am there with you. Please stay safe, please continue what you are doing for as long as you can....we can only pray, send funds to Team Rubicon, and share your story with others.

    (Tar Heel Native)

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  2. Thank you for what you've accomplished. Sounds like "problem solvers" and log-jam-breakers are precisely what was needed. Godspeed.

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  3. If you go to the video titled Haiti Supply Crisis up on Anderson Cooper's page on CNN, Dr. Griswell is at 1:40 or so.

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  4. You guys ARE making a difference! Thank you for all you are doing.

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  5. Sounds like you and Jake need to testify before congress and explain to them how bureaucracy kills and how disaster response should be done...

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