Memories from a Haitian Cholera Treatment Center
Submitted by Kevin Mollenhauer BS RN CNOR ONC
In January and February of this year I worked in Haiti with United States NDMS DMAT and ImSurt teams providing medical and surgical care to the victims of the January 12th earthquake. What I experienced during those weeks only partially prepared me for what I would experience upon my return to Haiti on November 19th. My earlier experiences were in dealing with less critical and more chronic medical conditions. This time I would experience acutely ill patients requiring immediate life-saving treatment…
In October of this year, cholera erupted in the earthquake ravaged nation of Haiti. By the evening of my arrival in Port-au-Prince, the number of cases had grown to over 21,000 with 1250 deaths reported. This time I would be working with the J/P Haitian Relief Organization in response to an international call for medical personnel to combat this deadly outbreak.
Upon arrival at the J/P HRO housing that night, I received updates on the status of the cholera outbreak and learned I would be part of a medical team of J/P HRO medical volunteers, New Reality Medical volunteers, and Partners in Health healthcare providers and would possibly be heading the next morning to Hopital Ste. Therese in Hinche. Early the next morning J/P HRO co-founder Sean Penn received a call from Dr Paul Farmer of Partners in Health who stated “If you don’t send us any of your doctors and nurses you have available, people will die.”
With that simple statement, our team of seven (4 nurses, 2 translators, and our driver/security guard) were cleared to travel to Hinche, a three hour drive along often narrow and broken roads through the beautiful and rugged mountains and countryside.
We arrived in late afternoon, unloaded our gear and got an immediate orientation to the cholera treatment center (CTC) located on the grounds of Hopital St Therese from the team nurses already there. I believe we were all shocked by the world we entered. The CTC was fenced off to isolate the cholera patients and control access to the treatment area. Each point of access had an attendant who would spray the shoes of each person entering or exiting the CTC with a bleach solution in an attempt to minimize the carrying of any cholera bacteria into or out of the CTC.
The CTC facilities consisted of a triage and short term oral rehydration tent staffed by Cuban and Mexican physicians and nurses, and three additional tents (men’s, women’s, children’s) and an old church for those critical patients requiring IV rehydration with each facility holding up to 24 patients. Our medical team of four US RNs, two Canadian RNs, and one US physician along with a limited Haitian nursing staff were responsible for these critical care patients.
The tents were old military heavy canvas, with USAID tarp floors constantly wet from the never ending mopping of human waste and with roots and old foundations underneath which presented constant trip hazards. The tents were dark and hot, even during the day when we would roll the sides up for some ventilation. Cots and cholera beds were crowded inside with very little space between them to provide care. We all became very adept at positioning ourselves to start or manage IVs. Even finding ways to hang the IV bottles became a skill as we had few IV poles and found creative ways to secure the IVs to the tent framework using pieces of rope often appropriated from parts of the tent support system. It was not uncommon to see chickens walk through the tents as well as the camp dogs wandering in and out. One of my most vivid memories of the tents is a member of our team, in what appeared to be a yoga position, starting an IV while a small dog sat in the tent entrance and a chicken pecked at the ground beside her.
The old church was dimly lit with little ventilation. It was downwind from the fire pit where medical waste, cholera patient’s clothing, and trash were constantly being burned. Late one evening, I witnessed an older Haitian woman perform a voodoo ceremony for a young patient in our care. In the morning I met the family, and though it was a bit unsettling, received a blessing from the same woman.
Working in the CTC at night provided additional challenges- less staff, poor lighting (both in and outside the tents and church), broken foundations, exposed tree roots, tent ropes and stakes, and a constant cacophony of noise- the cries from patients, sounds of dogs, goats, and chickens both in and outside the CTC, the sound of passing cars, trucks, motorcycles, U.N. vehicles, and occasional shouts from the gate for help from the families of arriving patients. And yet when you had the chance to look to the heavens you were struck by the beauty of the evening sky. One of my fondest memories was pointing out Orion’s Belt in the night sky to our Haitian security guard and him sharing the Haitian names for the stars in Orion’s Belt and how they were used for navigation.
We either never had, or ran low, on so many basic items- no NG tubes for inserting through the nose and into the stomach to get fluids into a patient, no IV extension tubing, few IV poles, not enough cots and cholera beds, and when gowns to cover patients ran low they were replaced with bits and pieces of clothing from our own suitcases and then with plastic garbage bags. When we ran out of patient cleaning materials, a bucket of bleach water and a mop were used to clean patients. Patients who were confused or demented and were pulling out their IV’s were often primitively restrained by the Haitian staff. We learned to work with extra large gloves and a limited choice of IV needle sizes. We learned to place IO IVs using a simple 16 gauge needle, and place external jugular IV’s when we could not find a peripheral vein. We turned our headlamps off when not performing critical tasks so we could conserve batteries. When certain supplies ran low we made difficult decisions on how they would be allocated. And when a patient died and we had no body bags to place them in- our transporters simply wrapped them in whatever they could find and carried them over to a space near the fire pit to hopefully be claimed in the morning. Every night at some point the generators would stop and we would be immersed in total darkness lit only by the headlamps of our team. After one such blackout we went into the men’s tent only to find a patient missing- no one seemed to know where he had gone- after an exhaustive search his lifeless body was found by the fire pit. We were never able to get a clear story regarding who declared him dead or moved him. And when our US physician left and we were without a doctor we remembered his words- “Do what you can, you are all they have.”
Over the course of five days, a thousand patients, tears, laughter, life and death- we became a close team, forged by experiences and enduring conditions we could not have imagined upon our arrival in Haiti. We became friends, colleagues, teachers, mentors, and “shoulders to lean on”. We found strength in each other during even the darkest moments. One of our team members shared a great way to deal with the darkness advising each of us to find “a face to remember”- the face of one patient for who you know you made a difference. For me it was a young child named “Evans” who when I first carried him from triage to the children’s tent was unresponsive, severely dehydrated, and had only a femoral pulse. Three of us worked on Evans for over three hours to find IV access, finally succeeding in placing two IO needles in his legs so we could get the vital fluids his body so desperately needed running. For the rest of the night Evans showed little improvement. Early in the morning we again attempted to find a peripheral vein for an IV and as we attempted to stick the IV in his arm he suddenly tried to bite our interpreter who was holding him down. Three hours later Evans was sitting up and as I left that morning gave me a fist bump and the most beautiful smile!
Even now as time and miles separate us and our memories begin to blur and our stories begin to fade- we will remember this:
Together we saved lives, we made a difference…
Aashika, Amanda, Deborah, Jane, Mandy, and Dr Phouc Le- Thank you for being there and for what you do!
To our friends at J/P HRO- you brought us together…
To the Haitian staff at Hopital Ste. Therese- you are an amazing, dedicated group of people!
And to our family and friends- Thank you for your love, compassion, faith, and support which allows us to do what we do.