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Team 4 (Team Montana)

Tuesday, February 2 Daily Summary Report:
Team 4 has contacted the head doctor at the St. Nicolas field hospital in Saint Marc, and the doctor says he would welcome Team 4's assistance because people have fled north (some have gone beyond Saint Marc) and toward the Dominican Republic. OCHA released a map documenting these movements and WHO has also documented this.

The doctor said that there is an even greater need at a place south of Saint Marc. It is likely that the team will need to find a way to travel to this place depending on what more is learned. Pending information on transportation to Haiti, the team has an ETA of Wednesday, February 10 at St. Nicolas Hospital in Saint Marc. According to the doctor, Jacmel may also need staff when the team arrives; however, it appears that the team will be most effective assisting those in the areas north of Port-au-Prince.

Currently the team is researching lodging in Santo Domingo and transportation from their to Saint Marc.
Wednesday, February 10 Daily Summary Report:
Team 4 arrived safely at the Santo Domingo airport in the Dominican Republic. After spending the night at "Bettye's Exclusive Guest House", the team woke up to what was described as "a million car horns blasting every time they went by the alley" in front of the guest house. They like the place, it's set up like a hostel with bunks in large rooms. Charles remarked that Santo Domingo "looks and smells" a lot like New Orleans.

Their travel plans are turning out to be a bit more complicated than they had originally hoped due to some miscommunications, but things are working out. After turning down a ride the night before from a taxi driver who offered to drive them all the way to Sen Mak (it just seemed sketchy), the team learned that their plan to travel through Santiago (in the Northern Dominican Republic) and cross the border to the North was simply not feasible, due to the distance involved in the detour.

Although they were hoping to avoid traveling through Port-au-Prince (hence the discussions of alternate routes), they have accepted that there's no reasonable alternative. At this point, the plan is to take a "Caribe Tours" bus at 730am Thursday from Santo Domingo to Pétionville, a suburb in Eastern Port-au-Prince. They should arrive around 1pm, and are expecting to meet with a "large" pick-up trick which will take them North to Sen Mak, where they will begin working at a field hospital.

Basically, they spent the day wrangling with travel itineraries and visiting grocery stores for last minute supplies. They still have convenient internet access and have definitely been taking advantage of that.
Thursday, February 11 Daily Summary Report:
Sen Mak (Saint-Marc), Haiti

Team Montana is on the ground in Haiti! In Travis's words, "the eaglets have landed!".

Today was a very long day of transportation, starting with their 7:30 AM bus departure from Santo Domingo. The bus headed over the border and dropped them off just east of Port-au-Prince, in Pétionville. They had arranged with a Canadian relief worker to have several vehicles meet them there, and successfully linked up with their transportation, loaded up, and headed Northwest.

The team was split between two vehicles, stuck in terrible traffic along a coastal road and hampered by what they described as "shoddy comms". They finally arrived at their destination, Sen Mak, this evening.

Travis says their contact, Odson, is "the man". Odson's family is putting the team up and everyone is very happy with the arrangement after such a long, stressful day on the road.

The team is anxious, but excited to start working at the hospital in Sen Mak tomorrow. In their words, they're looking forward to "getting their elbows dirty." Today was only the first of what will probably be many exceptionally long days and folks were headed to bed as Travis was sending the final email of the day. They plan to have their first "full" check-in conversation tomorrow.


Friday, February 12 Daily Summary Report:
Team 4 is settling into their role at the hospital in Saint-Marc and working with the inevitable logistical wrinkles that are cropping up during their first full day on the ground.

They have hooked up with their hosts and the hospital, and have reported that they are "busy at the hospital assisting doctors with everything!" Since the team contains Paramedics, Wilderness EMTs, an RN and an herbalist, they're involved in a very broad spectrum of patient care and other tasks around the hospital.

Their comms are more limited than planned. Although cell service and Internet service is generally working well in much of Haiti, neither is working well at their location. Their best comms route is texting and email through the Blackberry service (although there is insufficient Blackberry bandwidh to handle voice calls from their location in Saint-Marc.)

Saturday, February 13 Daily Summary Report:
The team has been working dawn to dusk at the field hospital in Saint Marc. They are being housed by their local contact Odson just a few blocks away from the hospital. The team has been working with local hospital staff as well as a crew of Boston-based doctors from Partners In Health, and have a positive relationship with most everyone. The team feels that the doctors are good, but a bit pushy in the stereotypical American way. Charles related that every team of American doctors to come through this particular hospital has "pushed everyone out of the way and some of them [the Haitians] blame us..." The current bunch of doctors is leaving soon and will be replaced with medical professionals from Florida (arriving today) and St. Louis (arriving Tuesday). Most of the local Haitian nurses are cool with the team being involved, but a few people (understandably) can't tell the difference between pushy Americans and Team Montana. The team is definitely working on the language barrier to make sure they're on good terms with everyone. They're also having to spend some time making sure people understand that they are not doctors themselves. As for their involvement at the hospital, they are doing everything.

The team has direction and everyone is fully engaged all day. Outpatient care, Inpatient care, Pre-Op, Post-Op, they're doing it all. Roman has spent the past two days helping with surgeries. Charles has definitely mentioned them balancing helping where they're needed with staying within each members' individual scope of practice. They are seeing what was described to me as "unreal wounds, massive infections and crushing injuries", but also many, many people suffering from a chronic shortage of medical care. Saint-Marc is inundated with refugees, with more reportedly on the way, and the hospital is slowly being overtaxed. The WHO change in policy is NOT helping; all health care is now "pay as you go" and the team is seeing things such as amputees being sent home without crutches because they couldn't pay for their care. It is especially frustrating, as the team knows for a fact that the hospital has a "warehouse full of supplies".

The team has not needed to use much of their personal stock of supplies yet, and is working with Odson to devise a plan to distribute most of it in the surrounding community where it will do the most good. Although they would like to secure supplies from sources other than the WHO, they don't feel that going to Port-au-Prince would be an effective use of their time. It was fairly time consuming and expensive for them to travel from Pétionville (outside PaP) to Saint-Marc, and the team doesn't want to repeat the trip until they're exiting the country.

Their exit plan is the one weak link at this point. Charles described getting from Saint-Marc to Pétionville and onto a bus to the DR as "one of the biggest challenges we will face". Although the team was able to work out transportation from Pétionville to Saint-Marc for $400 (two trucks) on the way in, they do not have a solid plan for leaving the country... yet. Noah and Jeff a. are working on it, and are providing more travel information to the team. Stateside logistics probably won't be able to help them much with their transportation between Saint-Marc and Pétionville, which will be an arrangement they will have to make locally. Stateside support is currently researching schedules for the Caribe Tours buses from Pétionville to Santo Domingo, as well as looking around for any info on flights from Port-au-Prince to the Dominican Republic. They have expressed willingness to spend the night in Pétionville or Port-au-Prince if necessary on their way out of the country. The team is very motivated to get their exit plan worked out as early as possible.

Comms have continued to be tricky as best. Emails through the team blackberry are reliable so far, but phone connections are poor, and internet through a computer is not fast enough to be of much use for them. We have found a combination of phones that works for calls, but they are unsure of the international plan for their particular phone (a different phone than the original choice for the daily calls), and are currently researching the costs involved. We hope to get the research portion of this shifted to stateside support so that the team can focus on medical aid.

Physically, the folks on the team are hanging in there. Two members are coming down with a stomach bug. Stateside support recommends that the team take a day off (or at least work a half day), maybe Wednesday. Everyone is tired and overwhelmed, but positive about the work they are doing. They're stressing to me that there is NO shortage of work to be done for folks with the proper training. Emotionally, they seem a little flat. The inability to communicate by phone is a bit frustrating and hampers a better read on their emotional and energetic situation. Odson continues to be very solid, and has been helping folks on the team with providing a safe, quiet place to sleep. Last night he apparently showed up with beer and "rotgut whiskey" and the team was decompressing a bit after being at the hospital all day.

The team is very inspired by the resilience of the Haitians they are treating and working with. Everyone on the team seem very happy to be where they are, helping as much as they can. They are working very, very hard every day. Team Montana is definitely in "treatment mode" and is giving their all.
Monday, February 15 Daily Summary Report:
Sen Mak (Saint-Marc), Haiti

First off, everybody on the team is healthy again. Trenton, who was apparently the sickest, fought off the stomach bug with the help of Cipro and a few bags of IV fluids administered by the now-departed Partners In Health doctors. Plenty of other folks in the area had been sick with the same general illness for the past few weeks, and a combination of cipro and an IV of fluids seems to push it back. Trenton related that one of the PIH nurses needed something like 6-7 liters of IV fluids over the course of several days to feel healthy again.

Speaking of Partners In Health, their doctors rotated out of the country on Sunday, with the next PIH team due in on Wednesday. This has left a 4-day window with no team of doctors at the hospital... meaning Team Montana is working with the Haitian nurses to take care of ALL of the surgical patients and most everyone else at the hospital. One of the biggest issues is that the PIH doctors are the best in their respective fields in the US and are pulling off major, life saving surgeries - including skin grafts - in what's basically a "country hospital," leaving patients with gigantic surgical wounds - both traumatic wounds and surgical wounds - in a less than ideal environment. It's important to remember that this hospital does not have an EKG or an AED, let alone an ICU ward. The team feels very strongly that if they weren't there for this window of time, at least some of the patients would have ended up with massive infections, if not worse.

The hospital is a very real place, for lack of a better way to put it. Patients generally come with their families. Their families bring the bed linens, take care of meals, etc. The hospital is just FULL of people, and any time a patient passes away, the grief just spreads like fire beyond their family and into the streets. That said, the team is holding it down, working all day doing all sorts of care. Two ED nurses from a missionary organization showed up a couple days ago, and they've been helping out a lot too.

A few basic care stories:

• The team was present for one of their patients passsing away yesterday. She was an older woman who came in with her family, and had an arm amputated, then re-amputated higher up after infection started spreading. The team had been caring for her for several days, and was on great terms with her family. The patient went into arrest, members of the team immediately started CPR with an ambubag, but she slipped away. It was very hard on the folks who were involved.

• Trenton was involved with the PIH team in transferring one of the patients, an older woman with a broken femur (if I remember correctly) to another hospital 45 minutes away.

• The team is still working as hard as they can to get their patient with the perforated bowel evacuated to a better hospital, or to the Comfort.

One unexpected benefit of the team of Boston doctors leaving is that, in their absence, Team Montana's relationship with the local nurses at the hospital has vastly improved. Charles explained that, with the pushy doctors gone, many of the Haitians are realizing that the folks on our team are different. The team is staying just down the street from the hospital, eating local food, using the local motorcycle-taxi contraptions, and generally interacting positively with everyone they run into. They are putting as much energy into building positive relationships of trust as they are putting into their medical work.

It's important to point out that there's NO American military presence in Saint-Marc. The UN and WHO drive through in Land Rovers every day or two headed someplace else, but they never stop. There is an Italian military medical team that flies in every couple days to a field hospital on the other side of town, but the team has had little contact with them so far. Everyone is just intensely busy. The team has been building a working relationship with an American midwife who lives in Haiti and does patient tracking and other things for PIH. She travels to Saint-Marc regularly to check in on the hospital, and a few days ago Charles was talking with her about the idea that's been tossed about back here in the states that there just isn't much left for medical teams to do as far as disaster relief in Haiti goes. She looked absolutely shocked, and said something to the effect that there's obviously still an overwhelming amount of work to do, caring for injured locals and refugees.

Saint-Marc is apparently a pretty interesting place. There's no streetlights, and nobody in the city has any flashlights, so you can stand out in the street and see all the stars. This comes with a bit of a price, as there are constantly trucks, motorcycles and bicycles flying up and down the streets, often with no lights at all. One bizarre (or perhaps not so bizarre) sight in the city is fleets of Coca-Cola semi trucks rumbling here and there. While I was on the phone with Charles, he must have commented on them at least a half dozen times, and this was at 9pm! They've also been finding a few minutes here and there to explore the city a bit. The other day, some folks from the team went down to the beach to check it out, and it's "absolutely carpeted with garbage." They were there for a little while and watched little kids and pigs run up and down the beach and swim in the ocean. When the next PIH team settles in, Team Montana is going to go up to Odson's family house in the country outside Saint-Marc for part of a day for a bit of a breather.

Bottom line: Team Montana is making a huge difference at the hospital where they're working. They have direction and local connections, and are providing the best care possible under the conditions.

Monday, February 15, 10:30 PM:

Jeff, our stateside comms person, just had a long conversation with two members of the team. We've finally solved most of the comms troubles that have plagued us for the past few days. Jeff has a whole lot of notes to distill into a report, which should hopefully be available sometime tomorrow. Everyone in Team 4 is now healthy and they are doing amazing work in Saint-Marc.

Tuesday, February 16 Daily Summary Report:
Sen Mak (Saint-Marc), Haiti

Leah is fighting a bit of a sore throat, possibly due to the intense amounts of dust and vehicle exhaust they're always around. Interestingly, she reported that the team has seen almost no rain; Tuesday night they were subjected to a five minute sprinkle, but that's been all the rain they've seen so far. It's generally hot and humid, but dusty as hell, and she thinks it might just be the local climate around Saint-Marc. Team Montana definitely has not seen the rainy season yet.

Saint-Marc made it through the earthquake without any very serious damage. Many of the buildings have significant cracks, but the team hasn't seen any collapsed structures. Even the hospital is cracked; Leah was assisting with some work in the OR on Tuesday, and one of the Haitians offhandedly pointed out the large cracks in the wall of the room. The reliance on concrete as a main building material seems to have exacerbated the damage from the earthquake, as concrete doesn't flex very well.

Like everyone else who has reported in from Team Montana, Leah is floored by the strength and life of the Haitians they are surrounded by every day. She remarked several times on the strength and solidarity the team sees every day. It is important to remember that Saint-Marc is flooded with refugees who have left Port-au-Prince and other devastated areas to return to their ancestral villages. Although Haitian politicians are talking about "officially" moving people out of Port-au-Prince and into other areas, many have already done this on their own.

Things at the hospital were still pretty intense on Tuesday, as the new surgical team from Service International (St. Louis) had arrived, but hadn't really settled in yet. About half the patients Montana sees are earthquake victims, and the other half are "everyday sorts of injuries that are much worse due to the conditions." Team Montana was still managing all the pre- and post-surgical patients. They explained to me that most of the Haitian hospital staff was afraid to touch the post-operative patients, as they had never seen surgeries as intense as the PIH team was pulling off. Before leaving, the PIH team had taken the time to train Team Montana in the specific post-operative care the patients needed; as a result, they ended up providing much of the care themselves as, again, the Haitian nurses were afraid to touch the surgical wounds and make a mistake.

Leah related this anecdote: she was in the ER, specifically in a small room where they do a lot of more private work. One of the Haitian doctors was working with Josh to suture a patient's forehead, and Leah was standing back and handing them supplies, etc. Another Haitian doctor walked in, asked Leah her name, and asked "So, did you just come to Haiti to work, or are you dating, too?" Leah said it was probably one of the more awkward moments of her time in Haiti so far.

The team is extremely well-liked around town. Leah actually has a group of younger, 20-ish boys who follow her around. Everyone knows her name by now. She's been busy enough that she's been able to stay grounded most of the time, but (like everyone on the team) she's had to occasionally take time to sit in the bathroom and cry.

She related another aspect of the story around one of their patient's passing away while team members were performing CPR. The women around the patient's bed started wailing, and the grief spread through the hospital like fire, eventually overflowing outside the building and into the streets. It's important to remember that in Haiti there's no HIPAA and little privacy whatsoever. The hospital is FILLED with people, from patients to family members. People constantly mill around the ER. The operating room is apparently the only place where there's any modicum of privacy, and even that area will have multiple translators in addition to the surgical team and their assistants. Leah feels that the strong, interconnected sense of community provides a very strong form of support, and helps keep folks healthier overall in the face of a chronic lack of general healthcare. She said "The whole community cries together, it doesn't matter if they knew someone or not."

As the only member of the team without an EMT or nursing certification (she has a sub-EMT certification called a Wilderness First Responder; for an example description of scope of practice, see here), Leah has taken on a unique role. She is the team herbalist, and has been using her supplies and knowledge to keep the team healthy. Almost every member of the team is taking herbal medicine on a daily basis. Many of the local community members know Leah is an herbalist, and she has been asked to travel out to the edge of the city to see an earthquake victim who only wants to receive herbal medicine. She's also been learning a lot about the local herbs available in Haiti, and was taken to see a "medicine tree" by some of the local folks.


Roman reported in that he was feeling good, and was satisfied with having five solid days of work under his belt so far. He was still working with the 6-year-old girl who was dragged under a truck and had received large skin grafts. She is apparently bandaged from her knees to her groin, and from her belly to her chest, and was slowly becoming septic. It was very hard for her, as she spent much of her time in extreme pain, and Roman was working very hard on a transfer. He wanted to send her to the USNS Comfort, and was trying to make sure at least one family member would go with her. She needed way more than he had access to, including steady antibiotics, regularly cleaned dressings, serious pain management. He explained "The hospital in Saint-Marc is a zoo, and we just don't have the capability to provide the level of care she needs to start recovering."

The team's relationship with Odson and his family continues to be amazing. Tuesday night, Odson and his friends turned buckets and seed pods into instruments, and played music, sang and danced with the team, who joined in with drumming on rum bottles and glasses. I get the feeling that the team is receiving very good support from Odson and the other folks they're working around; it seems like every night they find something beautiful to do to help decompress from the pressure of the hospital.

Roman also mentioned the dust and fumes that were bothering Leah. He definitely feels it in his chest. He is sleeping well, despite Saint-Marc never really achieving any sort of quiet atmosphere. Most days he's up by 4am. As for food, he reports "I'm not eating as if I were in the states, but I get my fair share of rice and beans."

The team had some serious successes with patient transfers Tuesday, including getting their septic patient who was beaten by the police (more details soon) moved to Albert Schweitzer hospital, a private institution about 45 minutes away. Team Montana was repeatedly blocked from transferring this patient by various levels of Haitian law enforcement, before succeeding after days of effort by the team, Odson & his friends.

An anecdote from Roman: he was walking to the hospital with his stethoscope around his neck. A local Haitian stopped him in the street and asked to have his blood pressure taken. Roman did so, and immediately noticed that a large line of locals had formed, each wanting to have their blood pressure taken. He spent the next 30 minutes taking blood pressures, telling folks "You're good!" or "Your BP is a little high, you might want to try to eat a bit better and get more exercise if it's possible."
Wednesday, February 17 Daily Summary Report:
Sen Mak (Saint-Marc), Haiti

Charles reported in; he was in a good mood, enjoying a bit of local rum and decompressing after a long day at the hospital.

The team from Service International was settling in. Charles explained that they came with a group of 10 surgeons, nurses... and a professional electrician. They are likeable, but seem to be unused to working in disaster or third-world situations; "totally used to working in St. Louis. It'll take them a minute to get used to the way things work around here..." The SI team has been looking to Montana for briefings, intros to patients, where everything is, learning the rudimentary system Montana and the original PIH team set up at the hospital.

The electrician on the SI team has been very useful so far. The power constantly goes on and off in the hospital, but the electrician figured out how to hook the OR power into the emergency generators, which will be a huge help for those performing surgeries. Charles related an experience with the SI team. They had brought a very expensive skin graft machine with them, but it ran on DC power and its plug didn't match the wall socket in the hospital. One of the surgeons attempted to rectify the problem by cutting the plug off of the cord, and shoving the naked end of the power cord into the wall socket. The resulting electrical current "cooked the machine into a lump of copper and plastic." The SI team is now trying to figure out a way to efficiently perform grafts without their machine.

Another, as yet unnamed organization is apparently coming in to Saint-Marc soon with a team of 16 people, including builders, electricians, etc.

One problem Team Montana is having is with transferring patients. The hospital in Saint-Marc used to have two ambulances; before the earthquake hospital staff had driven them north of the city to try and pick up some patients, but something went sideways and both of the ambulances were "shot up and disabled." Charles had spoken with some of the folks at the hospital about trying to locate the vehicles in the hopes of fixing them up, but had quickly abandoned the idea.

The team is continuing to move in the direction of checking out the villages around Saint-Marc. At this point, they are planning on splitting the team in half. The two emergency-specialty nurses from Touch Ministries who have been in Saint-Marc for a few days have contacts in the villages, and have invited Team Montana to come with them. Because the team knows the hospital so well, half the members would stay in Saint-Marc, and half would accompany the nurses outside the city. The hospital still really, REALLY needs help, so the team feels it's important to continue working there.

After days of providing all sorts of care for patients at the hospital, Team Montana has developed very good relationships with the patients and staff, to such a degree that the SI surgical team is looking to Team Montana for orientation and help. Roman, for example, was spending most of his time in the OR, showing surgeons, anesthetists and nurses where everything was located. The surgical team also gave Montana very strong praise when they examined the pre and post-op patients Montana had been caring for over the past 3 days since the PIH team had left. The RNs had this to say:

• "Every single wound that we uncover that wasn't complicated by being an amputation is in perfect condition."

• "The wound care that your team provided was the difference between these wounds being terribly infected and these wounds being ready for the next step of care and healing."

• "An absolutely perfect job of caring for these very, very complex wounds."

For those three days, Team Montana put everything they had into caring for the patients.

Leah went to the countryside to meet with the patient of a local herbalist . She rode out with the team's contact Odson and one of his friends on the back of a motorcycle. Leah rode on the back of one motorcycle; Odson's friend rode on the back of the other and carried her box of herbal medicine.

She was meeting with a patient who had broken the lower bones in her leg and had her foot crushed during the earthquake, but had had negative experiences in hospitals. Because of her history, the patient was insisting on herbal care. The local herbalist caring for the patient had contacted Leah for either a second opinion or some assistance. After seeing the patient and some discussion Leah administered herbal medication to complement what the local herbalist had already been using.

She explained that it was very interesting to work with a Haitian herbalist and enjoyed the opportunity to learn about the local remedies and treatments that were used. After finishing with the patient, Leah spent time at the herbalists shop, and soon had a line of people seeking treatment. She spent several hours seeing various patients, then returned to the city.

An update on Travis, who all the locals call "Chavez". He now has a "flock of children" who love him and follow him around whenever he isn't working. He spent time Wednesday drawing tattoos on their arms, and they loved it.

The team's housing situation is still amazing. Odson's family is wonderful. Team Montana has worked out an arrangement where they pay for the food, and Odson's sister cooks meals that are large enough for the team, the family, and all their friends. Charles described the food as "wonderful", rice and beans, chicken, sausage, sweet potatoes. Odson's sister is a volunteer nurse at the hospital. She was living in Port-au-Prince when the earthquake struck and lost her house, so she traveled back to Saint-Marc for the time being and is helping at the hospital every day. The team has decided that, when they leave Saint-Marc, they will give Odson's family whatever money they have left after travel expenses, in exchange for housing and taking care of them for two weeks.

The team is planning to return to the US soon; they will be traveling with Odson on a school bus from Saint-Marc straight through to Santo Domingo on Sunday the 21st. The ride will cost them approximately $800-$1,000 for the whole group. Once in Santo Domingo, they will pay for Odson to take a Caribe Tours bus to Santiago, and give him enough money to catch a cab from the bus stop to the airport, so he can fly home. They feel it's the least they can do for how much Odson has helped them.

The team is tired, but is still working very hard, from sunrise to 6pm every day. Charles explained that the sky is "full dark" by 630 every night. They are literally working nonstop every day, "the work never stops, there's so much to do." Despite the unrelenting schedule, they have direction and rhythm in their work.
Thursday, February 18 Daily Summary Report, Team 4 (Team Montana):
Sen Mak (Saint-Marc), Haiti

Trenton reported in this evening for the team. Today Team Montana left the house early and arrived at the hospital around 730am. They actually arrived before the Service International surgical team showed up for the morning.

They had a good day at the hospital, but it ended up being about a half day, with Team Montana leaving the facility at about 2pm. It seems that the SI team is not coordinating or communicating terribly well with the Haitian medical staff, and there have been some conflicts and chaotic situations. Because of this, the folks on our team felt that the best decision they could make was to take some time and space to let things calm down a bit. Doctor Maxwell Raymond, the team's primary contact at the hospital, again told them that he greatly appreciates Montana's work cooperating with and respecting the hospital staff.

Trenton said "The Service International team is NOT working with the locals at all, and it's showing." One of the SI surgeons has been inconsistent with maintaining an actual surgical field, reportedly saying "We're not sterile here, we're clean." He has also apparently refused to wear gowns offered by the local nurses, performing operations without them. Trenton felt that "they feel that they're operating in the third world, and they're lowering their standards accordingly." This new surgical team, although certainly capable in their own way, is contrasting rather negatively with the cooperation and respect the PIH team from Boston had shown the local staff. [Editor's note: Going by the reports sent in by Service International to their website at http://bit.ly/c0EQch , it appears that prayer is of primary importance in the SI team's mission, as evidenced by this quote from an RN on the SI team:"This is totally a God adventure; we were able to pray with every patient we worked with in the operating room today." Their team's coordinator feels things actually went smoothly today.]

Despite these problems, the team had a productive time at the hospital. Stacey worked in the ER for much of the day. Trenton stayed in the OR area and focused on starting IVs and other medication-related tasks. One of the patients that Team Montana had been caring for for several days finally had her operation. This patient is a girl who had lost the back part of her heel in a motorcycle accident, and the SI team grafted skin onto the wound site. There was also at least one amputation performed, and that patient will probably receive a skin graft within a few days as well.

Team Montana was also present for the death of another patient, an 80 year old man with a history of strokes, congestive heart failure and a severe ulcer on his thigh (described as a large full-thickness wound 8-10'' across). He had developed this ulcer from staying in the same position in a bed for too long due to his partial paralysis, and no Haitian physician had been caring for him. The PIH team from Boston had cleaned out the wound, and Montana performed thorough wound care on him since the departure of the Boston team. This morning, Team Montana took this patient into the OR to take off the dressings on his leg and clean the wound. This required irrigating and repacking the wound, before carefully holding the patient in the air (due to his partial paralysis) and wrapping the bandages around his leg and midsection.

At some point during this process, their patient went into respiratory arrest, but still had a pulse present. The team moved quickly to assist his breathing with a Bag Valve Mask and made sure his airway remained clear. After a few minutes his breathing resumed. The team carefully moved the patient back to his bed so he could be with his son, who had been at the hospital with him the whole time. There just wasn't anything else to do. Within an hour, the patient had passed away, with his son at his side. Losing another patient they had treated, cared for and interacted with for as long as they had been working at the hospital was hard on folks. Leah checked in as well about this particular patient.

After this incident — and due to the growing chaos with the SI surgical team — Team Montana decided to take a half day. They headed back to the house, and Odson's sister made them a meal of fish with rice. Folks took a breather. Stacey, Leah and Trenton went to the beach, which is just "carpeted with garbage, with pigs all over the place wallowing in the sewer drains" according to Trenton. There's also what was described as a "bombed-out old box truck" there, which had a bunch of kids hanging out on the roof. Trenton described them flying kites made of trash bags with VCR tape as string. After a little while of watching them, the team saw another kid show up with a "real, home-made kite with actual string that he flew very high off the beach." Trenton really enjoyed telling me about the beach, which he described as "Cool in a totally bizarre postapocalyptic way," and took tons of "beautiful, tragic pictures."

Folks from the team also spoke with a bunch of locals about the various ways they use some sort of large melon or gourd that grows to about the size of a basketball or larger. They're apparently hollowed out and used for all sorts of things. They've also been getting more exposure to local herbalism. Saint-Marc continues to intrigue the team. It's rowdy every night in town , and folks are just very alive. Travis went and got his hair cut at the local barbershop near the house.

The team was feeling very excited about getting out to Odson's family's village on Friday. They were planning on distributing supplies, checking on folks in the area, eating a meal, etc. In addition, it would be yet another opportunity for them to check out the local public transportation. The opportunity to provide care in a different setting definitely seemed to be one of the things Team Montana was interested in, especially since the hospital had a large number of Americans working out of it.
Friday, February 19 Daily Summary Report:
Sen Mak (Saint-Marc), Haiti

The team traveled with Odson by truck to the village where Odson grew up. They set up a temporary clinic at his family's farm in the village, and provided care to many patients over the course of about 5 hours. Stacey and Leah set up in one room and provided various kinds of continuing care, and the rest of the team set up in another area and checked blood pressures and performed wound care.

Leah related that she learned a lot of lessons on Friday, and is looking forward to applying them the next time she has an opportunity to do this sort of work. She felt that it was a bit overwhelming at times, and had to explain to some people that their conditions required visits to a doctor. It is important to keep in mind that it is very difficult for most of the folks in this village to seek care from a doctor, as there is no hospital within a convenient distance and few doctors visit the area. [Editor's note: conversations with two colleagues at work who grew up in Haiti indicate that generally, most Haitians in their experience as children, teenagers, and young adults regard all medical personnel as "doctors", and do not make the fine distinctions among Wilderness Responders, EMTs, Paramedics, Nurses, and Physicians that the United States does.]

The team also had some time to talk with the locals about medicinal plants, and Leah found that she and the villagers had the same knowledge about using tea made from the leaves of an almond tree to treat high blood pressure. Someone explained that they had always known to use the almond tree leaves to manage high blood pressure, but had never had an opportunity to find out what their blood pressure was.

Odson, the team's local contact, also joined the check-in call. He was having a good day, but had lost most of his voice from translating for the team every day. He spoke at length about the team's visit to the village, about how important it was as this was the first time anyone had ever visited the area and offered medical care.

He also took some time to explain how Team Montana's openness towards local culture had increased their effectiveness. He described it as "the team is more willing to help out the Haitians, instead of expecting the Haitians to help them." Odson felt that the team's willingness to interact with people outside the setting of their work at the hospital was very important: many foreign relief teams simply travel between their housing and the hospital where they were working, but never spent any time interacting with people in the local community. He also spent a few minutes talking about the team's response to a motorcycle accident near the house. Odson related that members of the team grabbed their gear and ran to the site of the accident without hesitation, and he felt that many members of the local community took this to mean that Team Montana was truly there to help them, not just limit their involvement to working in the hospital. Odson's willingness to join the check-in call helped put a lot of local perspective into the successes of Team Montana.
Saturday, February 20 Daily Summary Report:
Sen Mak (Saint-Marc), Haiti

This was the team's last full day in Haiti, and things were understandably a bit busy. Charles reported in briefly, then returned to the team's work on a local system to distribute the stockpile of supplies they had brought down with them. They were focusing on working with members of the community who could distribute the supplies for free, rather than leaving them with the hospital where people might be asked to pay.

The team spent about 4 hours at the hospital on Saturday, providing care and wrapping things up with the staff and their patients. Charles found it very difficult, feeling that he might never see some of the patients again. He explained "We'll probably see the translators and doctors again, but our chances of seeing these patients again are about zero. We're going our way, and they're going theirs." Although he's ready to leave, he wishes he wasn't. The team is certainly very tired, but torn, as they'd been providing care for some of their patients for the whole time they were in Haiti.

Saturday afternoon, about half the team decided to go to a "clean" beach that cost $10-$15 dollars to enter. They described it as "beautiful" and very relaxing. Other members of the team visited the "public" beach in Saint-Marc that the team has visited several times over the past week and a half. It seems that everyone was looking to experience as much as they could before it was time to leave.

In a seemingly fitting twist, the house had electricity Saturday night, for only the second night since the team had been in Haiti. Some folks were dancing and enjoying music, others were relaxing and reflecting.
Sunday, February 21 , 6 PM:
Santo Domingo, Dominican Republic

The team, accompanied by Odson, boarded a school bus at 5 AM for the trip to Santo Domingo in the Dominican Republic. As of this check-in, they have made it to their guest house in Santo Domingo, and are catching up with emails. They plan to make a longer check-in call later tonight. Most of the team is taking a day to debrief and unwind in the Dominican Republic before flying home on Tuesday.




Page last updated: Sunday, March 7, 2010, 10:13 AM HT