The ride back to Port au Prince airport

When we arrived a week earlier, the ride to Mirebalais from Port au Prince took 45 minutes without traffic.  It was quite a different trip back to the airport.  We were picked up at 7:30 am for a flight that left at noon.  We now know why they wanted to pick us up so early.  The 45 minute drive took nearly 3 hours.  We encountered the worst traffic jam probably just minutes from the airport and when our driver questioned other drivers making their way at a snail's pace headed in the opposite direction, we couldn't understand the replies but we understood the nods to the negative.  Traffic jammed in one direction jams up traffic in both directions it seems.  Two lanes turn into 6 going in all directions.  Cars start using both lanes to get to where they need to go, even if headed in a different direction than the lane was intended for.  So our driver proceeded to turn around and though it seemed like he was driving in a circle for a half hour or more, he took an alternate route that eventually led us to the airport. 

A mild translation of the traffic jam.  This was just prior to our turning into it then becoming one with it.  

 11 of us and all of our bags were crammed into one vehicle.  It didn't have to be this way but we didn't want to use a second Partners in Health vehicle unnecessarily so we sent it back to the hospital.    When Jason suggested that we send the 2nd vehicle back to the hospital, the group agreed.  Everyone in this group was so flexible.  It seemed the right thing to do, to make another contribution to a resource poor country.  We would have tied up two vehicles for three hours unnecessarily.  Zadok, Jason and Connor were stuffed into the back seat with Connor half off the seat.  The heavy heap of luggage was resting against Zadok's head.  Maggie covered her mouth and nose with a scarf, protected from the nauseating fumes from cars in front of us.  Black exhaust poured out of cars and trucks in front of us.  Mario was unable to sit back in his jump seat.  They were troopers.  No one complained.  Not one complaint!  I didn't hear "are we there yet?" even once.  

We made our way at 15 - 20 mph (or less) down dirt roads with huge potholes, the noise from the undercarriage of the car was loud and nerve-wracking.  Our driver drove around every obstacle, how ever   he could.  He was awesome!  At one point I wondered if we were even going to make it.  I didn't say anything but I worried that we were going to miss our flight.  There are no real rules of the road.  There are two lanes going in opposite directions however at traffic jams, the cars start going in any direction and even the police we passed don't stop to direct the chaos.  There is no enforcement of rules here.  What rules? It was such an adventure and so interesting.  It was our last gift from Haiti and it didn't disappoint.  

What?!  How'd they get from Haiti to Waikiki so fast?  Doesn't it look that way?  Jason (he has the selfie smile down pat!), Patti, Mario and Connor at the beach in Fort Lauderdale during our layover on the way back to LAX.  What a handsome group! 

The Jet Blue seat monitor as we depart PAP

FLL sunset before boarding the flight to LAX

Our team photog.  Dr. Fried took most of the photos posted in the blog

Leaving their unified footprints in the FLL sand

Dr. Fried going through customs in FLL 

A tap tap and a passing gentleman

Graffiti Haitian style

Graffiti is universal

A tap tap during Saturday's trip back to the airport.  

Young Haitian men sitting along the roadway

Haitians carry everything on their heads.  His bundle is full of water sachets; a nickel apiece

The dry cleaners - that's an amazing sight in Haiti

More team photos

2 ICU nurses with Kaina and Mario, getting the 7 year old settled post op.  Soon after, we were asked to set up another PEDS vent for a second OR case on a 4 month old with free air in its abdomen.  We did not see this second patient come out of surgery.  

Diane and one of the Residents

Diane, Maggie and Kaina tending to the 7 year old with the perfed jejunum

Kacie, Connor, Sean, Jeff and Jason in the ED

In the ICU, not sure who I was sneering at.  How frightening!  

Zadok and Toni

One of our nightly team dinners

Jason, Kacie, Connor and Maggie laughing it up

The Con man and El Guapo

Connor, Kacie, Mario kept us all in stitches and feeling young at heart

Neonatal Intensive Care

Paul Farmer's koi in one of the healing ponds/gardens

The Neonatal Intensive care unit

Patients come from long distances with their family members who can't afford to stay in one of the few hotels so the hospital allows them to camp out in the outer halls of the units.  The photo does not do the scene justice.  We literally weaved our way through mattresses, pots, pans and other belongings in almost every outer hall of the hospital during our Sunday tour.

This is one of the entrances into the hospital next to the ED where we entered the hospital each day.  There was always a lot of activity at every entrance.  This was an unusual moment, a Kodak moment for Dr. Fried (our photographer) 

The CT scanner.  They use tele radiology with a Boston radiologist or sometimes there's a visiting Radiologist which may be an infrequent occurrence.  

Lisa checking Jason's GCS which was quite HIGH!   

A Haitian woman and her donkey, loaded down

A typical Haitian home.  We thought this area was hit hard by the earthquake since many homes look half built (or half destroyed, either one) but we were told that Mirebalais wasn't affected.  Port au Prince is where most of the damage was.  It's very dusty here.  Most of the streets in Mirebalais are dirt roads, the main road is partially paved.  

On our drive to Mirebalais

Zadok Sacks, our host from Equal Health with Patti 

Diane relaxing after a long day 

Dr. Fried and a local artisan who visited us three times and made sales each time.  Cha-Ching!  

Our last day in Mirebalais

The students taking the course post test

Taking the post test

We started the day like any other, with yoga at 6:30 by the pool for 45 - 60 minutes followed by showers then breakfast.  Breakfast has been fruit, usually papaya and mango, crepes, ham and cheese omelettes, bread and coffee.  Our two transport vehicles (2 SUVs) arrive around 8 am to take us to the hospital.  Part of the team went upstairs to set up for the last lectures and part of the team went to the ER to check on the patients we put on NIV yesterday.  After ensuring they were doing well, we made our way to a bay where the ER docs were doing a quick assessment of a 7 year old that was kicked in the abdomen by a horse two days ago.  He will go to the OR to resect a perforated jejunum.  He is awake but quiet, just watching all the docs around him with wide eyes.  He doesn't look afraid. 

The ED docs doing their assessment guided by Amy, a visiting physician from Minnesota, now studying in New York City.

We then make our way to the ICU to check on our vented patient.  Sadly, he passed away last night evidently suffering from a tension pneumo.  The team is devastated.  But, as in the states, death is a part of what we do and we can't dwell on it, so we reorient, thoughtfully, and move on to our next task.  After readying more vents and delivering them to the ED, we returned to the ICU where Mario was called (Mario is called several times a day to do this and that.  He can and he does!) to troubleshoot the vent.  The 7 year old is back from the OR, hypotensive.  Thankfully we set one of the vents up yesterday in PEDS mode so it's ready to go but like at Cottage,sometimes the outlets don't work!  Or maybe it was a dead cord?  Miraculously Mario and I put our heads together and set the vent up for the 7 year old.  Mario texted Justin Werth in SB and he agreed, the settings were appropriate.  Victory!  

Mario and Kaina working on the 7 year old after surgery 

Diane organizing the lectures, coordinating the course.  She has coordinated the schedule and materials, the equipment and skills stations.  Diane and Dr. Fried made this course possible here in Haiti.  It took much planning and organization for us to be here.  

Maggie is a star.  She not only keeps the team organized, ensuring we are fed, transported everywhere  and all around happy campers but she has also jumped right in there to retrieve stored ventilators and ventilator parts from BioMed.  She put all the components together, cleaned them up and tested them to ready them for use in the ED.  The ED docs were ecstatic to get them.  As one of them explained, "We LOVE Bipap!"  There's a poster on the administration walls of a study done on heart failure.  Of 938 patients admitted, 300 had heart failure.  For some reason, heart failure is a huge problem here.  They need a cardiologist here.  

Yesterday Mario was asked to assess a young man with flash pulmonary edema in the ED.  He was retracting and tripoding, desperate for help with wide eyes, struggling to breathe.  Another older female patient was also suffering from heart failure and Cameron, the visiting ED physician was faced with a decision of which one to put on NIV with their single LTV.  Mario explained that their ICU vent also had a noninvasive mode so Mario quickly put both patients on BIPAP.  This morning both patients are still in the ED but both are off BIPAP on O2, looking much better.  

The R2s at the airway skills station taught by Jason and Mario.  Despite the awesome smile from the gentleman at the head of the bed, Jason stopped him and told him not to ever take his eyes off the vocal chords.  Jason asked him to manually ventilate the patient for two minutes until his hands were sore, then reintubate the patient.  Lesson learned! 

Our new RCP, Maggie readying one of 12 brand new LTV transport vents that we found in BioMed.  These vents are identical to the ventilator we use on the Pediatric transport rig at Cottage.  It's an excellent vent.  12 were just sitting in BioMed which is a hot, dust filled room near the front of the hospital.  We found two ICU vents in partial disarray as if they are being used for parts.  

Day Four

SB Team Haiti with our Haitian student physicians and nurses

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Diane teaching ACS and cardiopulmonary resuscitation 

The hospital gates - this is original art made of oil barrel tops

Another kumbaya moment between Jeff and Jason.  Ohmmmmmmmm.....

An original by New Orleans artist Laurel True

The local peacocks that live in a huge tree by night and if lucky, we see them by the pool otherwise they disappear during the day and miraculously appear in the tree at night.  We've counted 9, two males with their harem of 7.