GUEST BLOGGER - WENDIE NASH

Today's guest blogger is Wendie Nash, RN from Sterling, Nebraska. She is a long time friend of Kim Harm.

It was a Friday.  Friday’s are the day everyone looks forward too as it means the weekend is near.  This particular Friday I wasn’t thinking about the weekend.  I wasn’t even thinking about the upcoming week.  I had butterflies in my stomach, this particular Friday, I was nervous.  I was about to embark on a journey that ultimately would change me.  Last Christmas I was asked if I wanted to take this adventure and without a seconds thought I said, “yes.”  I made the call, got introduced to people, plans were set in motion.  Then the day finally arrived to begin this journey.  We arrived at the airport, a bunch of people who were brought together for the same reason.  Some of us knew others, some of us met for the first time.  I didn’t know it on that Friday, but I would come to love each of those people who were strangers to me.

I am not a world traveler, but I have traveled a lot in my lifetime.  Been across the ocean a time or two, but this was my first time to a different country.  A country struck with poverty and in need of help.  I wasn’t expecting to see lavish resorts or beautiful beaches.  I had done my research prior to my trip and I knew what I might encounter.  I watch the “Amazing Race” I thought I knew where my adventure would take me.  We made our way to Haiti without any problems.  We arrived and quickly loaded ourselves and the supplies and made our way to our living quarters for the next week.  The ride was long and the view was like nothing I have ever witnessed.  Seeing devastation first hand is beyond humbling.  I sat there amongst strangers, trying to not get emotional.  At that moment, I forgot about the world I left behind and started getting excited knowing I was there to help.

The week went by very fast, almost in an instant my time was over.  It was like a whirlwind of sorts.  Those who had come before us told us it would be a lot of hard work.  Coming from a small critical access hospital, we have days that are long and very busy.   My busiest, most emotionally charged day at home didn’t even compare to what I did every single day I was working at Pierre Payen Hospital.   As tiring as the days were, I felt accomplished at the end of the day.  I’ve always considered being a nurse as a thankless job, similar to that of being a mother.  The people I encountered were all so gracious and thankful.  I had been thanked, blessed, and even prayed for by the family members of my patients.  Such unwavering selflessness.   I saw so many people, I didn’t remember names just diagnosis.  I have a few names and faces I will not ever forget.  Like Clarisse, the smile behind the sad eyes.  I may not remember their names, but I will remember their stories.  I will remember the huge sense of community.  I will remember Maurice sitting in front of the door, without words, watching his friend trying to breathe. 

I take away from this adventure, this journey, this experience so much more than I gave.  I take away humility, bravery, and compassion.  I saw and felt things I will never forget.  This will be one of my defining moments in life.  One of the greatest things I have ever done… and will do again!   I feel happy knowing I helped, even for a little while.   I am truly blessed to have been a part of this group.  I am thankful and grateful.  “My cup runneth over.” (Psalm 23)

Wendie, Namdar and Mary.

Wendy........ hot!

As the week drew to a close, we had a group meeting.  We were asked to share our highs and lows.  My high was encountering people who would show me graciousness.  My low was knowing I was leaving the next day.  I wasn’t thinking of the weekend activities, going back home, or going back to work.  I was leaving a place that changed my heart, changed the way I saw the world, changed me.  The next day I left Haiti with a full heart and no butterflies.  It was a Friday.

CMMT at The Indigo resort on the ocean, the last night.

 

 

SUMMARY FROM DR. JOE MILLER

April 20, 2014

Dear team members now and past, supporters and others who are interested,

Wow!  We had another great trip, 67 total team members with 40 first week and 36 second week. Sorry, Edgard, for all the stress.  We pushed the facility to its max. Donna, thanks for the use of your home. We had 8-10 there each week. We saw over 1000 patients in the clinic and ER and 110 procedures, mostly in the OR. The clinic and operating room were our initial focus but this has become much bigger than seeing patients. We are trying to create an infrastructure, physical plant, supplies, technology and most importantly, human resources that are self sustainable. 

Patients waiting at the gate.

We brought over 5000 lbs of supplies and equipment. This included basically an ENT office set-up donated by Dr. Nila Novotny and John Novotny. This included an operating microscope, a flexible nasal/laryngoscope and light source and more. The microscope can double as a culpascope. We now have an ECG machine and it was utilized multiple times including a stress test this trip. Nila also spearheaded a book campaign for the nursing school and we brought thousands of dollars of books and posters, most of them in French (the professional language).  These were used to set up a library at the hospital at Pierre Payen because of questionable viability of the nursing school. Also, thanks to Jeff Burg and Bryan LGH for providing us with urology fluids at the last minute.

Endoscopy equipment.

The first week there were seven in the "construction crew/ McGyvers" who started on the second floor of the guest house, along with moving wires, doing plumbing, trying to keep "the beast" (big autoclave) going and many other odd jobs. Second week crew of 2-3 (Adam PT vs construction) assisted by some Haitians put a roof over 90% of the second floor, set forms for the bathrooms and started on interior walls. This addition will be amazing.  It will reduce the heat on the first floor and with the second floor being peaked and screened on all sides it will also stay cool. I stood up there Friday afternoon after the team left and the cool breeze was wonderful. 

Working on the new 2nd floor.

The most amazing part of the trip was the educational piece. In November 2013, we taught a couple of classes to a handful of nurses and physicians that were well received.  This trip we taught classes from 2:00-5:00 Monday-Thursday each week for all the nurses at OSAPO, Pierre Payen, some nursing students and resident physicians. Lunch was provided. We had over 50 attend each day and over 75 total people. They were given certificates at the end.  It was very well received and will be a part of each trip in the future. 

Mary giving her lecture.

We had very sick medical and surgical patients.  One was a 24-year-old female with respiratory distress that we ended up intubating and anesthetizing all night followed by transport to Port-au-Prince to an ICU at Bernard Merz Hospital. She is still a mystery to them, is on the ventilator and was to get a tracheostomy. We had 2 patients that required transfusions from team members. Thanks to Naomi, Adam, Michele, Simeon and Melinda for your special contribution.  Some of the surgeries were quite complex dealing with problems that would have been taken care of many years sooner if the patients were in a first world country.  Unfortunately we saw way too many end-stage cancers and other medical/surgical problems that could be easily fixed in the USA but are disabling or killing the Haitian patients. This is always difficult to deal with for the group. We thank God for our many successes and care we provided. We pray we do no harm.  

Kelsey, Dr. Leach and Dr. Miller early morning, after ventilating the asthmatic patient all night.

Transporting the patient to the van.

Pharmacy development, organization and inventory was another nice improvement. Having professional pharmacists both weeks on our teams was unbelievable compared to even a year ago (ask Shirley). Having an inventory and meds prescribed each time we go will be helpful.  We can post for each team going down throughout the year which will help with planning. 

Wichita State University (WSU) sent Mark Shaver, Audiologist Professor, with 2 students first week and Ngoyi Bukonda, Public Health Professor, with 3 students second week.  Both groups worked on and off campus within their specialty and assisted the medical/surgical team. 

Our audiology students, Megan and Kambra.

As usual we did have a few people get dehydrated needing IV fluids. But this is the first time we have had a team member get critically ill on a trip. Unfortunately, we needed to medivac (thank goodness for insurance) Dr. Deb Placek to Fort Lauderdale Friday after the rest of the team left that morning. Deb wants to thank all of you for your care and concern. Thank you to Namdar for staying with me to care for Deb and to Dr. Gardy for transporting us right onto the tarmac for the flight. As of April 20, Deb is still in the ICU in Holy Cross Hospital in Fort Lauderdale.  She would appreciate your prayers.

Longstanding relationships, dreams and leadership are important in order to make Pierre Payen and the Victor Binkley Hospital sustainable. This trip, more than ever before, we began building relationships with the physicians practicing at Pierre Payen.  Dr. Frank (Cuban OB/GYN), Dr. Nereyda  (Cuban pediatrician), Dr. Bayord (physician in community clinic), Dr. La Vaud (physician in community clinic and director of the HIV program), Dr. Efrantz Toussaint and Dr. Christine (both social residents), Dr. Thomas (orthopedist from St. Marc) and Dr. Jovin (ENT from Port-au-Prince) all had meaningful interactions with the team. Growing these relationships is important.  The dreams and leadership of Steve Mossburg of Project Help Haiti and the OSAPO leadership team of Dr. Gardy, Dr. Sterman Toussaint (congratulations new Daddy) and Ronald Toussaint are the driving force to not only sustainability, but a place of excellence. They are working on human resource development, plant development, program development and budget. Dave, Judy and I feel honored to be included in some of this visioning, development and planning. 

Dr. Novotny and Dr. Jovin, ENT from Port au Prince with equipment donation. 

Five years ago I had no association with Haiti and today after 12 trips to Haiti, 10 times taking teams, over 300 different team members, many Haitian friends and my Haitian brother (Dr. Gardy), Haiti has become my second home.  I want to thank all of you for your support and commitment to not only helping the Haitian people but to your commitment in making Pierre Payen a self sustainable institution of excellent health care in Haiti. This will benefit Haiti more than any number of trips.

The next 2 trips are set for November 14-28, 2014 and tentatively April 10-24, 2015.  I need feedback on the April date.  November is set.  Those of you that want to go, please let either Dave Ingram or me know.

God's servant,

Joe Miller

The team on the last night at the resort by the ocean.

Dr. Joe Miller, team leader Grace 4 Haiti. 

GUEST BLOGGER - KELSEY BERLIN

Today's guest blogger is Kelsey Berlin, a 4th year medical student who grew up in Columbus. Here is her story:
How do I even begin to describe my first medical mission trip? For as long as I can remember, I have been interested in medical missions. God has been tugging at my heart for years and I have wanted to see if this would just be a onetime trip with me running the other way, or if medical missions would be a part of my career in the future.  When the opportunity to travel to Haiti with Columbus Medical Mission Team presented itself, I couldn’t sign up fast enough and I am glad I did. 

Kelsey with Dr. Carlson doing a procedure. 

Now that it’s over, reflecting and being completely honest, I’m not sure if I helped change the lives of Haitians or if they changed my life even more.  If I could summarize the trip in one phrase it would be “Catch 22” -- the happiness of being able to minister to many patients and offer a surgery that would change their lives forever or the sadness of not being able to help other patients because their disease was too advanced. 

Look at the spine on the far left.  This was a 17 year old boy who broke his neck diving.  He had a high fever and had infection all through his body.  We sent him home with no treatment.  He was paralyzed from the shoulders down and barely breathing. He may not have lasted the rest of the day.  It was heartbreaking for us all.

In case anyone was wondering, Haiti is HOT, so HOT!!  I started sweating as soon as we arrived and I’m not sure I ever stopped.  But that cold shower at the end of the day was better than any shower I’ve had at home.  One thing I was hoping for the week was maybe a little Haiti diet, i.e., I probably won’t like the food and lose a pound or two, but the food was good, so no such luck there.   I could have done without the mangoes dropping on our house in the middle of the night sounding like a small cannon going off, but they sure tasted good in the morning!

Breakfast always included mangoes, banana and pineapple.

We worked hard in Haiti. I am not sure I have been so exhausted after a week of work and felt so rewarded at the same time.  I have never seen so many large tumors. Large thyroid tumors that were obstructing a patient’s ability to move their neck, jaw tumors that had taken over a patient’s whole mouth, a facial tumor that had paralyzed a man’s face and doubled the size of his face.  Thankfully we were able to remove multiple tumors and the patients did well and were so thankful for our help. Unfortunately, some of the tumors were just too big and all we could do was biopsy the tumor to have a correct diagnosis and ask the patient to come back to see a different surgeon with the next mission team. 

We think this was a salivary gland malignancy.  We took a biopsy, but it went deep into the neck and looked inoperable.

The most rewarding case I was able to take part in was repairing the cleft lip of a beautiful baby boy. Knowing that one surgeon will so drastically affect him and his family is a feeling that I cannot put into words. This is an example of why I chose medicine as a career.   Unfortunately, another cleft lip surgery was cancelled when the baby girl could not handle the anesthesia well and we didn’t feel comfortable moving forward. Again, a Catch 22. 

The case that affected me the most was a 24 year old female in status asthmaticus--  an asthma attack that would not break. The patient came to our ER early in the morning. She had been having a difficult time breathing for days and finally came to see us. Although her oxygen level was very poor,we were able to improve her condition with medicine and oxygen. However, this improvement was only moderate and we did not feel comfortable sending her home, so she was admitted to our hospital.  After more medicine, she was still not improving. Now she was even showing signs of using accessory muscles to breathe. This is a bad sign. It means that she was tiring out and was having a hard time moving air in and out of her lungs.  We gave her all the medicines we thought could even make a slight difference and watched her very closely all day.  Just after midnight, after over 18 hours of watching her struggle to breath, we decided she was too tired and not able to breathe reliably on her own. We took her to the OR to put in a breathing tube that would guarantee we could control her airway.  In the US, she would have been put on a ventilator and watched in an Intensive Care Unit.  In Haiti, we did not have access to a ventilator so someone had to manually pump air from a bag into the breathing tube every 6 seconds. This meant we stayed up all night breathing for her. By the next morning, we knew she would need to be transferred to a bigger hospital with better resources. In Pierre Payan, we were not even able to run a basic blood test such as electrolytes.  Thankfully, we had a paramedic on our team who converted a 15 passenger van into an ambulance so the patient could be transported to Port-au-Prince, almost two hours away.  We were able to somewhat stabilize her but her prognosis was grave. 

Kelsey helping with the transfer. 

The wondering of what we could have done differently or sooner or if we had been in the US was heavy.  It felt like we didn’t or couldn’t do enough.  This feeling was hard to carry around after being at her bedside for nearly 24 hours and being exhausted, but a so much better feeling followed the next day when we heard that our patient had turned the corner and the breathing tube was removed! Yes! She was going to live! The relief was the best feeling I have had yet in medicine, and it is because of that feeling that I know I will be doing more medical mission trips in the future.  

The trip to OSAPO.  www.osapo.org

Thank you Columbus Medical Mission Team for all you are doing around the world. And, a big thank you to all of you who have supported them financially.

GUEST BLOGGER - KEVIN HARM

Today's guest blogger is Kevin Harm, APRN.  Kevin has worked in primary care for several years in Columbus and saw patients in the clinic in Pierre Payen.

Haiti 2014

Good news for the trip, I had my wife along, bad news for the trip, we left in snow and came back to another snowstorm!?!? No one being part of a group like this can be "unchanged." The Kenya trip last year was an eye-opener and this trip also made a believer out of me once again, as far as "the human spirit." 

Who knows how to "start a clinic"  out of 80 suitcases and totes and see 79 patients on a day of orientation? Many of us were just happy to find a bathroom that had a "flush" capability. At the end of the day in the heat and humidity of Haiti, a cool shower was a treat. The people we met and the memories shared make an impact on each of us, especially as we "decompress" from what seems "normal" to the Haitian people. 

Port au Prince airport totes. 

One of many supply cupboards.

I told my wife how I felt when we came back from Kenya last year... nothing seems to fit anywhere. I felt like a square peg trying to fit a round hole... no other analogy makes sense. Our sense of purpose here is "production, outcomes, and patient satisfaction..." There seems to be an odd disconnect between here and there, us and them. 

Kevin and Kim on the 'mountain'.

We were thankful for little victories each and every day and although many were tiny (a baby with Molly as a Godmother) we learned from each other and from our patients and interpreters. In the end, again we realize we are more alike than different, no matter the language or the color of skin.

Mary with one of the Haitian workers. 

The kids seen were so happy to have the colors and the paper to draw on (a BIG thank you to Shawna Booth and her girl scout troop in Platte Center, Nebraska and also to Eakes Office Supply here in Columbus for donating the coloring book pages. Some kids ~ and a few interpreters were able to share their creativity and skills). Thank you so much for the gifts and God Bless you...

Dorlens, a pediatric patient before surgery.

Many people would walk for hours, ride a few moto's (taxi motorcycles) or "tap-taps" to get to a clinic and line up for hours in the heat to be seen. When asked about family, the parents are like any other... they light up as they explain to the interpreter how many, ages and any details about the family. Many are without work and live simply. It is a sad comparison to the "things" we have or think are important. Maybe that is what turns my insides more than anything else. However, they seem to be a pretty happy bunch for the most part. Even in illness, a touch or a handshake brought a smile or "merci." I know for fact we received way more than we delivered to Haiti.

A Tap Tap.  It's like a taxi.  You flag it down for a ride, then tap on the side to signal the driver to let you out. They were everywhere and always bright.  They often had people riding on top.

Our trip to OSAPO, a small hospital in the mountains was also a public health victory for Haiti... better outcomes by showing people how to do things themselves, not doing things for them. The fact that people can pull together a program in the mountains of Haiti and do public health on a small scale to make such a difference is something we could copy here if only...

There was an inscription on the wall at OSAPO, something like, "We must be the change we wish to see in the world..." Ghandi

And another seen somewhere else that said, "To whom much has been given, much more is expected." Not sure who said it, but those two inscriptions brought tears to my eyes one morning. Ladies and gentlemen, we are them... coming home to what we have ,we know we are blessed in more ways than the folks of Haiti could ever imagine.  Oddly enough, a trip to the pharmacy showed one bottle of antidepressant medication... Out of the whole pile of meds in the pharmacy, one bottle. The patients I saw either don't know what depressed is or maybe there is no word for it. I did have one grandmotherly woman who had her daughter with her and she did tell me she was suffering from "grief." Her spouse had died and her only son had also recently died. She had the far away look that said to me, "this is hard no matter where you are from." To lose 2 men in your life seemed to be a large cross to bear, for anyone, but her faith and her family seemed to be doing the job for her. For her and many like her I have a new prayer list to work on...

OSAPO

I am thankful to have shared this trip with the most caring and dedicated people I have ever met. Many from New England and many from Kansas and Nebraska I am glad to call friends. Watching Cole do his run on the main highway was inspiring, watching John Diedrichsen become the gentle giant to so many little Haitian kids was enough to bring a tear to my eye as well. Everyone from the construction crew and McGuyver people to physicians and allied health and nurses seemed to do the job that needed to be done and make the operation run as smooth as it could have. I am very thankful to Dr Joe Miller for the invite and the opportunity to serve.

Thank you for supporting the medical mission team and if you are so inspired, please feel free to contact anyone on the team. Your efforts will not go unrewarded and you will be forever changed. God's Blessing's

Kevin

GUEST BLOGGER - JOHN NOVOTNY

Today's guest blogger is John Novotny.  John and Nila Novotny have been married 35 years.  Nila is the "dreamer" and John is the "implementer".  It makes the perfect team.  John works harder than anyone else I know and can organize just about anything down to the last detail.

From John:

John and Nila Novotny with the microscope.

This was my 5^th international mission trip, others were to Nicaragua x 2, Guatemala, Kenya, and now to Haiti.  My role on these trips begins with logistics of the trip and financing of it, and usually then turns into a MacGyver of some sort.  I was supposed to do some construction work on this trip, but the medical aspect did not allow for that on this specific trip.  I guess you could call me more of a “Bio-Medical MacGyver” for this trip.

John organizing supplies in the garage before the trip. 

Most of my time on this trip was spent setting up an Ear Nose and Throat (ENT) clinic at the hospital. There had been some visiting ENT in prior years, but the goal was to have a room dedicated to ENT, so that future ENT Drs. could more easily be recruited if they knew they didn’t have to set one up.  The process began long before our trip, in procuring equipment and supplies to be taken and donated to the project.  Some of the most key and major items for an ENT clinic would be an operating microscope, cautery, suction, flexible and rigid fiberoptic scopes, and general supplies like needles, gauze, retractors, forcepts, blades, and other items very specific to ENT.  Many of the items were either used items from our medical office, purchased by us directly or by donations.  A major factor was taking the items with us, fitting them into checked baggage, and not being over the airline weight limit.  Ultimately, mission accomplished.

Thousands of dollars worth of equipment to donate. 

ENT clinic setup tray. 

In a perfect world, we would have had two microscopes, one for the clinic and one for the Operating Room. However, we only donated one microscope and a way was needed to easily move the microscope from the clinic to the OR.  Normally, you might have the microscope on a heavy cast iron base with wheels, but, that was prohibitive for taking a heavy base in checked baggage, as the base would weigh in excess of 100 lbs.  A second way would be to mount it on the wall, but again, the microscope had to be portable. So I came up with a method to create a base sockett clamped on the clinic bed and a bedrail clamp on the OR bed, and it seemed to fit the bill.

The clamp to attach the microscope to the clinic bed.  It's made to attach to the operating room table, but not the clinic.

Another major project for me was to try to fix an air leak in an anesthesia machine.  I know nothing about these machines, but I know more now.  LOL  It was like a spaghetti plumbing nightmare, with needing smaller hands than I have to get into tight spaces.  In fact, Linda Carlson helped me get two hoses on with her smaller hands, thanks Linda!

John working on the anesthesia machine.

Closeup of the anesthesia machine.

All in all, this trip was about what I expected, having been on others.  Hot, humid, hot humid. Did I say, hot humid? The places and times of these trips might change, but the basic need is there for all of them.

John A. Novotny