Monday, February 22, day one of the FCCS course

Diane, Kaina and Mama Maggie (she takes care of all of us) at Rendezvous Restaurant.  A long day after Monday's FCCS lectures and skills station instruction 

Yesterday was most noticeably a weekend day because the rows and rows of benches in the waiting areas were empty.  Monday morning was a stark contrast.  Throngs of Haitian citizens filled the benches, every inch of waiting space was taken and there was standing room only otherwise and even that was packed.  Like sardines, packed.  My first thought was "are they really going to see all these people today and where does the line start and end?"  The hospital's clinics see upwards of 700 patients per day, the ER sees 100 patients.  It's amazing, unbelievable and unfathomable from our perspective but these people have access to this wonderful facility that costs them just $15 or 50 Haitian gorde.  That buys them a lifetime of hospital care so it's no wonder that they're all here.

Sunday in the waiting area of the outpatient clinic

Monday in the same waiting area.  It has been like this everyday.  People are lined up against all the walls in this area and every bit of sitting room is taken.  These are Moms with their sick children, young adults, men, women or elderly all waiting to be seen.  

There's a clinic down the street that is also run by the hospital and that too has throngs outside waiting to be seen or just waiting for family members being seen.  On the outside, these folks look hardy and healthy.  Some obviously look ill but for the most part they look good, well fed.  They are all nicely dressed.  No shorts or tshirts.  They're in dresses, slacks and dress shirts and we were told that out of respect for them, we were to dress in like clothing.  It is hot here but we aren't running around in shorts and tshirts unless we're by the pool or doing yoga every morning, led by Dr. Prystowsky.  Jason graciously leads yoga every morning making sure we are all following using a flow is perfect for us.  I'm impressed with the flexibility of our team!!!!

Mario doing his BioMed thing to 1 of their 35 Engstrom Carestation vents.  We discovered many deficiencies including one big one.  No one takes ownership for these vents so there is no vent expert here, the docs manage the vents and their bio med staff is probably overwhelmed with duties.  These 3 year old vents are poorly maintained but can easily be maintained.  On Thursday, Mario and I will teach an ICU nurse to do some regular maintenance on them after each use.  Just the simple steps we will teach her will add years to their ventilators' life.  We will take some time to ensure all 35 vents are in working order and their ER transport vent is set up and good to go.  

The benches I mentioned above and pictured below are actually beautiful pews that were donated from a church in Boston.  Dozens and dozens of them.  This photo below was taken on Sunday when their outpatient clinics are closed.  On Monday, they would be full of people crammed in like sardines waiting to be seen.

Dr. Fried teaching mechanical ventilation and respiratory failure

We dropped off our equipment on Sunday but were able to set up audio visual equipment just prior to the course commencing and we got off to a great start, an hour late but still early enough, 9 am.  This will be the starting time because we were told that many who catch the bus cannot get here till 9, so 9 it is.  We expected 30 students, a mixture of residents and nurses.  24 attended.

Lectures were given in the morning by Dr's. Fried, Johnson and Prystowsky followed by a lecture by Diane Barkas.  We have four interpreters with us translating our teachong into French.  The slides are in French.  Each lecture takes twice as long because of the interpretation.  Mario and I went into their ICU to tend to a vented patient with Tetanus.  They have awesome Engstrom Carestation vents but the need our help to come up with a troubleshooting guide and cleaning process.  They have 35 ICU vents and 1 LTV transport vent used in the ED.  We will put the same processes together for the ED vent as well.  Maggie and Patti also helped to care for this patient noting the care is very different here where resources for Meds and supplies are just not the same that we have.  But, they cleaned him up and made him as comfortable as possible.  We wish he could be paralyzed and well sedated to aid in the healing process.  This is a very sick man who was struck with a machete and could not get a tetanus shot as resources ran dry.  His injury occurred a week ago.  He was intubated last night.

After lunch we set up three skills stations:  Airway taught by Dr. Prystowsky, Kaina and Mario.  We clapped and cheered after each student successfully intubated the mannequin.  It was difficult to intubate. We will leave the mannequins that we brought so this education can hopefully continue, even if we have to come back.  The central line station was taught by Drs. Lisa Ferrigno, Kacie Brumley and Connor Johnson.  Lisa is an excellent teacher who patiently and graciously talks each student through the skill in French.  The ultrasound station was taught by Patti and Diane, our critical care educators extraordinaire who used Connor as their patient.  The students were all engaged and eager to get some hands on practice.  The residents were a mixture of surgical and medical, the nurses were from ICU.  Our day ended at 5:30ish.  Everyone is tired and sweaty and sticky.  There's no air conditioning.

We headed from the hospital to a restaurant in town called the Rendezvous.  It was a buffet style meal of fish, goat, chicken, potatoes, French fries, spaghetti noodles, lettuce, tomatoes and cucumbers.  We had their local beer called Prestige and last night we tried their Haitian rum which was very good.  We joked the first night when someone spied Dr. Fried taking a bite of lettuce, a no-no in a country that doesn't have treated water to wash Veges with.  He hasn't lived down that bite of lettuce yet but he hasn't been sick either so maybe he knows better than us.

Before we left the hospital, we took a photo, with their permission of course, of a family of four on a motorcycle, with a newborn baby in its fathers arms.  They were happily taking their little bundle of joy home, to where and how far of a journey, we will never know but it looked quite precarious.  I hope their journey was safe.