Saturday, May 29, 2010

amazing slideshow: Haiti After the Quake

Here is an amazing slideshow of Haiti from the Arizona Daily Sun:

Haiti After the Quake

Soundslide presentation of Hait earthquake aftermath. Photos taken and soundslide presentation put together by Josh Biggs.

~PJ

Thursday, May 27, 2010

"snuba" diving, crab racing and fire dancing

Over the weekend, I got a chance to check go "under da sea" off of Roatan.

On Saturday I went "snuba diving" with the med and nursing students. "Snuba diving" is like a cross between snorkeling and scuba diving. You have the mask and respirator like scuba, but the air tank is on a raft that floats above the water instead of strapped to your back. There's no certification necessary, but you can only go down 25 feet. It was a fun adventure, and really got me excited to do some actual diving on Sunday! Photos might be posted of this adventure later - our guide, Clint, had an under water camera and took some pictures that he'll be emailing to me, but my experience has been that underwater photos don't come out that great.

Sunday I got up early and headed down to the Coconut Grove Dive Shop to "discover scuba diving". I knew I must be at the right spot when I was introduced to the owner, PJ. It was pretty funny - every time someone said "PJ", we'd both answer. I suspected my instructor, Marco, was having a bit of fun with it, so when people called out his name I yelled "Polo". Actually, the first time they yelled "Marco", I instinctively yelled "Buffalo" - long, inside story, but it's how to find my family in a crowd.

PJ, scuba instructor, and PJ, la farmacista:


The class was very small - just myself and a girl named Lexi. We spent the morning in the classroom and in the lagoon testing our skills before heading out to do our first open water dive. I love, love, LOVE scuba diving! We saw lots of fish, lobsters, interesting corals, and I swam with a sea turtle about 40 feet under water! My plan is to complete the whole certification course (Denise said she'd do it with me the next time I'm on Roatan). Apparently the classroom stuff can be done online, so I'll try to get through that in "all my spare time."

With Marco (scuba diving instructor):


After a day under the sea, I met up with Denise and Scotty at BananaRama for dinner, crab racing, and fire dancing on the beach!




~PJ

working in the Pharmacy at Clinica Esperanza

Most of my photos are of me and my new friends relaxing and enjoying the beautiful tropical paradise of Roatan, but let's not forget what brought me here - Clinica Esperanza.


As you can see from the picture, space was a little tight in the pharmacy!

Dr. Patrick was great. He reminds me of a younger version of my Uncle Paul, so in a way it was like I was family from the start! I greatly appreciate him letting me pluck his brain about all sorts of things, including IDA orders and the challenges of running a NGO. It was also great to joke with someone who understands about the "junk for Jesus" donations!

Me and Dr. Patrick:


Dr. Raymond's youngest son came to work with him on my last day at Clinica Esperanza. I enlisted his help counting vitamins so his dad could see some patients. We both needed some practice counting to 30 in Spanish, so it was great for the pair of us!

Take your kid to work day at la Clinica:


 Working in the pharmacy in Clinica Esperanza:


~PJ

gecko love

One of the best parts of my trip to Roatan was where I stayed - Ms. Marilyn runs a great place - way cheaper than most of the touristy places and most of the people staying there are locals (always a good sign). My two upstairs neighbors, Denise and Scotty, were super friendly. Most nights you could find the three of us, sitting on the porch, sipping something cold and giggling about the "gecko porn" all around us.


In addition to a cheap, clean place to stay with friendly neighbors, Ms. Marilyn runs a restaurant - about $5 for a huge plate of delicious, authentic island food for either lunch or dinner. I suspect I gained back a good portion of the weight I lost in Haiti while staying there!

Ms. Marilyn asked me to come back to Roatan to help her out the week before Thanksgiving, and I'm going to try to make it happen. For Thanksgiving she makes a huge feast and invites all of the poor children on the island (most of whom go hungry quite often) to come stuff themselves at her house. Last year she fed over 300 kids, and is expecting more this year!

Ms. Marilyn & Mr. Doland:


Me with Denise & Scotty:


The beach dock that approximately a 3-minute walk from our apartment:


~PJ

first international geocache

I taught my neighbor, Denise, about geocaching and logged my first 2 international geocaches!



~PJ

Wednesday, May 26, 2010

where in the world is PJ?

For those playing the "Where in the World is PJ?" Game: I'm back in San Salvador, looking forward to a late dinner/early breakfast with my sister in Venice Beach!

~PJ

Editor's Note:  We have added a "Where in the World is PJ" snippet to the sidebar on the right --->

Tuesday, May 25, 2010

roatan, parte uno

I know, it's been a while since I've written anything. Between clinical interventions at Clinica Esperanza, working on my first IDA order for my "new job", and exploring Roatan, I've been pretty busy. Oh yeah, and I've been catching up on 3 weeks of sleep.

Clinica Esperanza

First of all, you might be wondering what I'm doing in Roatan, or as several people have phrased it, "who said you could leave Haiti?!?!". I was asked to come to Roatan to help at Clinica Esperanza and assess the possibility of bringing students for rotations. My alma mater, Pacific University, is partnering with the small community safety net clinic on an island off the coast of Honduras. Pacific University is planning to send health profession students here for rotations starting with the Physician Assistant Program this fall.

I was pleasantly surprised at how excited everyone was when I showed up - and how grateful they have been for my help and expertise. Clinica Esperanza has been around for almost a decade and has never had a pharmacist so much as visit the facility. In fact, other than me, there is only one licensed pharmacist on the entire island that has a population of about 60,000 (more like 100,000 if you include all the ex-pats) and has several pharmacies, clinics and a hospital. Apparently, pharmacies here are run as dispensaries, with no consultations and no way to check for drug interactions. So when we visited the public hospital there were many questions for me, and again at la Clinica.

It's been an interesting experience - especially on the heels of so much time in Haiti. In many ways, things here are way more organized; we're in a building (not circus tents), with a room specifically for the pharmacy - with shelves, a computer system (with real prescription labels!), and running water. But there is a lot of work to do here - no one runs interaction checks, counsels on side effect profiles or proper use of medication. Well, let me rephrase that - the nurses here, who are often the ones explaining how to use the medications (en espanol, por su puesto) would gladly relay the information if they knew it.

For example, the other day we dispensed alendronate (generic fosamax). It has very specific instructions on how to take it: first thing in the morning with a full 8-ounce glass of water, at least 30 minutes before any other medicine, food or beverage, and the patient has to stay upright (no laying down) for at least 30 minutes after taking the pill. I explained (in Spanish) to the nurse how to take it and how important it was to take it properly, and she said no one had ever told her to tell patients that. Taking the medication incorrectly can, at the least, cause it to not be absorbed, or at the worst, cause erosion of the esophagus.

Over the past week I've been able to make some important clinical interventions, help with medication therapy management and "therapeutic substitutions". I've also been able to identify some great projects to help improve services here at Clinica Esperanza. And there's been a few added bonuses: I've been making friends and exploring a beautiful tropical island, and have been able to network with an NGO and get all sorts of advice for my new job...

"New Job"

Late one night during my last deployment in Haiti, I was discussing formulary management with Tom (the Chief Operations Officer), and said to me "I need you here - you can't leave".

It may be old news to some of you, but I have officially accepted the position of "Chief Pharmacy Officer" with University of Miami / Project Medishare. It's a temporary position that runs through the end of August, and spans the transition from "three-tent-circus" hospital to our new building - Bernard Mev.

I also found out that a move date has been set - June 5th we will be moving out of the tents and into an honest-to-God building with electricity and A/C that work all of the time! Of course, I'm not holding my breath; they've been saying we're moving for months. But we've got a lease, and an actual date, which is way more than we've had in the past!

Being here in Roatan has been so helpful for my new position! The chance to learn from health care providers experienced in matters such as IDA orders, finessing customs agents, and dealing with massive quantities of expired/un-needed donations has been invaluable.

I meant to write about my adventures here in Roatan, but I think my neighbors are taking me out to dinner so I'm gonna sign off for now...

Que tengas una buena noche!

~PJ

Wednesday, May 19, 2010

safe and sound in Roatan

I got into Roatan this morning (after very little sleep in El Salvador), got a quick taste of the city hospital and Clinica Esperanza, then had a fabulous lunch/dinner by the beach. It's only 6pm, but I'm headed to bed early!




~PJ

a week of crisis medicine in Haiti

Article about Project Medishare on CapeCodOnline.com:

A Week of Crisis Medicine In Haiti by William A. Golden

~PJ

why I do what I do...

This letter (read in camp a few weeks back) was scanned and sent to me by Bill (CMO week 1 of my second trip)...

 ~PJ

h1n1 recommendations from El Salvador

The National Health System in El Salvador recommends not traveling to countries with confirmed cases of H1N1... So I guess they're recommending I not travel to the USA... Of course, this sign was close to the sign that said "book store", but only carried liquor and cigarettes...


And I'm sure Phil Knight would be proud to know that the handmade sculpture of the drunk guy passed out, with beer in hand, is proudly sporting a "NIKE" hat...
 

sometimes Karma bites me in the butt

I'm in the taxi, on the way to the airport in San Salvador. Last night I wrote this amazing journal entry - easily an entire 2 pages in fluent Spanish, with another 2 pages of the English translation - joking about how my brain hurts from thinking in Creole in a Spanish-speaking country and explaining what I'm doing in Roatan over the next week.

Then I threw in a little "love note" to all my peeps down in Haiti (especially to CNO Jen) about how I was typing this while soaking in a hot bath, before luxuriating in a king-sized bed in a quiet, mosquito-free, air-conditioned room, thinking of them in the chaos and heat of Port au Prince. I even took a photo of me in the bathtub (from the neck up - totally G-rated).

I attached the wrong photo, went to delete the attachment, and deleted the whole damn journal entry.

And thus, last night, I discovered 2 things.

#1 There is no "undo" function on my blackberry

#2 I still know an awful lot of swear words in Spanish

~PJ

Tuesday, May 18, 2010

you know you've been to Project Medishare when...

For the record, I did not make the list, I'm just re-posting it... (I do, however, think I might be able to add a few more to the list...)

You know you've been to Project Medishare when....

You're surprised to feel bladder pressure.

Your camera is connected to your body at all times.

You wake up during storms with the urge to pull everything out from under your bed.

You keep leaving your fly open.

You keep waving your hand over patients in the OR.

Your scared to pass gas without extra underwear around.

You look for hair on your pork.

You feel parched if you haven't slugged down water in the last 20 minutes.

You walk into the shower with your scrubs on.

You reach for the Advil when a patient asks for pain meds.

You crave beer and burgers or kabobs after work.

You look for a handle to hover over a toilet seat.

You feel guilty taking a shower that is longer than 2 minutes.

Your idea of evening wear is mosquito netting.

Your idea of a nightcap is Motrin and Benadryl.

You forget to flush.

You can catch a mosquito midflight.

You suddenly notice port-o-potties all around town that you never noticed before.

You no longer use your air conditioner at night

You cannot sleep without the grumble of a generator

You have lost all cravings for subway

Someone rushes into a room and you want to know 'do they need a general surgeon to the OR, a pediatrician to the ER, a midwife to .........'

~PJ

landed in San Salvador

We just heard from PJ around 6:45pm PST and she has landed safely in San Salvador.

at the gate, destination Roatan

(sent earlier today around 2pm PST): At the gate now, heading to Roatan (I've got an overnight stop in El Savador).


~PJ

Monday, May 17, 2010

a new position

This afternoon PJ stopped by the Medishare headquarters in Miami and was officially offered a "real" (paid) position with the University of Miami Project Medishare: Chief Pharmacy Officer. Details are being worked out.

~PJ

i don't know, would Jesus piss in the shower?

(sent from Miami)

I forgot to share this "graffiti" written inside one of the shower stalls in Haiti... WJPITS... I giggled every time I saw this because my paternal grandparents are W and J Pitts (so it was one "t" off...)


~PJ

Sunday, May 16, 2010

forgot to hit "send" last night

Touchdown, Miami. You'd think after 3 weeks of 12-18 hour days that I'd just melt into a coma. I almost did - on the plane, in the back of the cab - but now, at 1:30 am, my eyes are open. I'm in my friend Claire's fabulous 24th floor apartment, with hot running water, toilets that flush, marble floors, and 2 huge balconies overlooking the city. It is like the Taj Mahal in comparison to my recent accommodations. Yet when I read the emails about the chaos of the day in PaP, all I want is to be back in my third-world-MASH-unit. Most of the people on my flight were happy to be heading home - they cheered as we landed in Miami - but I felt like I was leaving home, and tears ran down my face as we pulled into the gate.

I tried to leave good instructions - a recipe book for some of the compounds I make frequently, contact info for the incoming group (I'll still be acting as CPO, just "acting remotely" for a while), and I told Affia to make sure "the new kids" didn't mess up OUR pharmacy too much in my absence. She was upset to see me leave, and made me promise to hurry back. I hugged my workers goodbye, and started the mental list of "things to bring for the next trip".

I talked to Laura, one of my nurse buddies whose been to Haiti twice with me, about how hard it is to explain the need to return. I try, with these journal entries, to give people a little taste of what it's like. But the truth is, for those who've never been, no explanation is possible. For those who've been, no explanation is necessary.

~PJ

Saturday, May 15, 2010

heading to MIA

Many tears, and I'm at the Port au Prince airport.

Last time I left, I felt like I was going home. This time, I feel like I'm leaving home.


~PJ

Friday, May 14, 2010

wishlist for people coming down 5/15/10

For people coming down 5/15/10: our wish list includes: injectable KCL (40 MEQ per vial), syringes of all shapes and sizes, permethrin cream, vaginal creams (clortrimazole, miconozole, etc), nix or other lice medicine, Plan B, condoms, prenatal vitamins, childrens vitamins (both chewable and liquid), miralax, gabapenti..., vecuronium, rocuronicum, erythromycin eye ointment, albuterol MDIs, rain ponchos, fosphenytoin...

~PJ

the original gansta

So that I can rest through the day without being woken up too many times, I am posting that "Mubbasheer rocks!"

Oh, sorry, I mean, he's the original gangsta

~PJ

Thursday, May 13, 2010

a few more fun photos from Week 2

Roger being creative in the Pharmacy...


sleeping Pharmacists...


~PJ

an unexpected treat!

2am this morning: I had to take a photo to make sure I wasn't dreaming. When one of our Emergency Department guys (Roberson) offered to rub my feet at the end of the night, I was barefoot instantly! Ahhh...


~PJ

Wednesday, May 12, 2010

phonetic spelling: meli-te

Germain - one of the Haitian night nurses - is one of the hardest working people here. Two nights ago I was staffing overnight and noticed her limping. As the night wore on, her limp was getting worse, but she never complained. With one of the translators, I asked her to sit so I could see her leg.

Her left calf was noticeably larger and warmer than the right one, and painful (especially when Anne, one of the nurses, tried flexing her foot). I remembered Homan's sign from school - not good that she had the signs and symptoms of a DVT. I gave her an aspirin, and went to look for the provider on call. It was about 2am, and as luck would have it, the on-call doc had already been woken up for a transfer call. He examined her leg - luckily it was a strained and swollen muscle, not a DVT. We started her on 600mgs of ibuprofen three times a day, and decided she should try to stay off of it for the night.

She has such an amazing work ethic, and like many of the workers, is fearful of losing her job. I insisted she sit, and found her some food to eat with the ibuprofen (as I suspect the meal we feed her may be her main source of food for the day). The night crew here is amazing, and everyone helped out to make sure all the patients were covered while she elevated and rested her leg.

In the morning, she handed me a piece of paper - a hand written thank you note in English (clearly something that took her a while to write). I was so touched, I started to tear up, and was able to use my creole "word of the day" - meli-te (spelled phonetically, not correctly) meaning "you're welcome".

Back when I was in pharmacy school (and had received a thank you letter from a patient), I had a professor tell me that pharmacists almost never get thanked for what they do. Here I am thanked multiple times a day - it makes me feel blessed to be here, and I am grateful for the opportunity to make such a difference for these people.

In fact, as I'm typing this (in 4-point font on my blackberry), Fedneyer (the Haitian x-ray tech) just came up and told me "I feel better when you are here". I smiled, and told him I feel better when I'm here too.


~PJ

Saturday, May 8, 2010

it's so hard to say goodbye...

I'm growing to hate Saturdays around here. It's like the last day of summer camp, or breaking up with your high school sweetheart who is moving to another state - having to say goodbye, knowing that you may never again see the people you've grown so close to. Except while everyone else leaves, I stay to repeat it week after week. This week was especially hard; my friend Laura was down for the week with Kat and Jessica (three amazing ICU nurses!), and the chaos of the fire bonded this group pretty strongly. And let's face it - I suck at goodbyes.

But this new week has brought new surprises as well - my friend Paul (Dr. Gannon) whom I met on my first trip to Haiti showed up on a whim to take some photos for the weekend, and Mary Lou (the toughest broad I've ever met - and I mean that with the utmost respect) showed up! Mary Lou is an amazing retired nurse who has been to 47 of the 50 states to do disaster relief work.

At the end of this last week I was able to take a little bit of a tour with the girls (and Carlos), and saw a Tap-Tap be turned into a hearse. I swear they were going to drop the coffin as they were hand-raising it to the top of the bus! A group of us went "pirating" on Saturday - the clinic at "Love a Child" was pulling out, and they gave us a whole flatbed full of much needed medicine and oxygen tanks.

~PJ

Friday, May 7, 2010

the Becca mask...

Just a quick note before I go to bed...

The past few days have been a mellow roar - we've still got all of the patients in one tent, are re-wiring the OR/peds tent, and just today started doing some minor operations. I was elated to see Vince arrive - we met on my last trip, and he's come down to be CMO for the next 3 weeks. I've spent most of the past 2 days working on a "drug formulary" for the hospital.

Tonight I enjoyed a drink and some BBQ with some medic buddies at Mango-Mango and sweet talked a truck full of badly needed IVFs out of another NGO. It's off to bed a little early for me - I've got to be up early tomorrow to go on a "drug raid"... There's a hospital close by that's closing down, and they're offering to give us all their meds. (And I hear this rumor that the Miami Dolphins might be showing up here tomorrow... Hmmm... Might have to wear a Cowboys hat...)

PS. Check out the photo - I woke up next to my sister! (Now the Becca mask has been to Haiti)


~PJ

Tuesday, May 4, 2010

FIRE - the rest of the story

I had every intention of sitting down today and journaling about the "new crew" here at Medishare; about the three new pharmacists, and three rockstar graduate interns (anointed "pharmacists" by the powers vested in me as CPO...). About how there is now an AJ and another PJ in camp, the downpour of rain that flooded our sleeping tent (and brought out the biggest, nastiest looking tarantula I've ever seen), meeting a midwife from Bandon (OR). That was my intention, but all I can think of is one thing: FIRE.

The word strikes fear; hearing people scream "FIRE" causes panic, stampedes, and can test the strength of a group. I woke up this afternoon in a total daze - clearly it was all a dream - who evacuates a hospital not once, but twice in one night? But the soreness in my throat and aching muscles told me that this was clearly NOT a dream.

I was headed into to the PEDs/OR tent when I heard someone yell "FIRE" and saw a rush of people coming towards me. Someone was yelling about cutting the power, so I ran to find Tom (our COO). When I saw him running towards the tent, I headed back to help evacuate the children. It was chaos; children being thrust into the arms of whomever was nearby, and then someone yelled "it's near the oxygen tanks - RUN!". My heart has never pounded so hard in all my life - I was half expecting the place to blow up like you see in the movies. While it was true - it was sort of near the oxygen tanks - the flames and smoke was coming from one of the 100-pound light fixtures in the OR (back of the tent), more smoke than anything else, and we had all the tanks moved before it could have even gotten close to causing a Hollywood-style-explosion.

The power was cut, and we headed in with headlamps to make sure all the babies were out of the PICU - I was sure the nurses had grabbed them, but we had so many that we were putting them in crates on one of the exam tables, and I was scared one of them might have been missed in the chaos. I checked to make sure the building was empty, then grabbed my compounding supplies. Looking back, I'm sure it was a funny sight - me running from the smoke-filled building with a bedpan full of mortar, pestle, graduated cylinder, etc...

Thank God this didn't happen last week, when our NICU/PICU was pretty full and we had 8 patients vented. I can't even begin to imagine how our patients felt - so soon after the earthquake, and now two evacuations, they must have been scared to death.

We evacuated everyone to the gravel parking area/road. It was fairly chaotic - Tom (COO) was working on the immediate fire danger, Jen (CNO) was trying to figure out how to fit everyone in the medsurg tent, and there was no one taking charge of the people evacuated into the parking area, so I figured it was time to put my years of crisis intervention training to use. I went about delegating people to tasks - patients families were worried about their stuff being stolen, so I posted security at the tent. All of our volunteers were out working, so I sent the Tennessee Baptists (non-medical volunteers) to guard our area. I grabbed Kinsey (one of the translators), and went through the crowd making the same announcement over and over - there was an electric fire, we cut the power, we are safe now. Everyone will be moved into the Adult/Medsurg tent. We've got a reporter from the AZ Star staying with us right now, and this morning he said to me "I'm not sure if I got any photos of you, but I sure got AUDIO of you". Apparently I have a fairly loud, authoritative voice...

About the time everyone got settled in the medsurg tent, two of the light fixtures in THAT tent flamed up, and we had to evacuate that tent. It is nothing short of a miracle that no one was trampled to death. The next tent over is the sleeping quarters for volunteers, and it occurred to me that people were still sleeping. I walked every isle of the tent, calmy (but LOUDLY) telling people "there have been some electrical fires, we are evacuating the hospital. Grab your headlamps and any spare chairs or blankets".

Power was cut everywhere except the ER, where we had the ICU patients. With the evacuation completed, it was now time to set up our "hospital" in the parking lot - and patients still needed meds. I turned to my crew and said "Remember when you were in school, doing SOAP notes, and the first problem was always "what will kill the patient first?", grab THOSE drugs." Pain, cardio/crash kit, asthma and seizures. Antibiotics are not a priority unless it's a septic patient, and none of ours are. We set up a mobile pharmacy in a central location with these drugs, huge jugs of water, diapers, baby formula, etc.

Word came from Tom - all the light fixtures were being taken down, and we needed to clean out the muddy, trashed mess that was our medsurg tent so we could get all the patients back in before there was more rain. Kinsey and I went through the crowd again, announcing in English and Creole "We have identified the problem, all of the light fixtures will be taken down. We will be staying out here until everything is safe." Picnic tables were moved in to put huge cherry-picking-ladders on to remove the fixtures, and cleaning solution was poured on the floors. We cleaned the tent as best we could to make it less of a hazard. A gigantic flood light was hooked up and moved out to the parking lot area, and we tried to calm patients and get some sense of order.

We decided to man the mobile pharmacy in shifts - now that the immediate danger was taken care of, some of us would need to sleep so we could be functional in the morning to relieve those of us staying up. The three people scheduled to be the "night shift" stayed with the mobile pharmacy, and the rest of us headed to bed. An hour and a half later, someone came yelling through the tent for one of the doctors, and I woke up with a start. Since I couldn't get back to sleep, I headed out to help and was brought to tears by what I saw. Army and Air Force soldiers, carrying our patients on their cots back into the medsurg tent. I relieved my three pharmacists, and "babysat" the mobile pharmacy until we moved back into the tent (after all the patients had been settled). By dawn were all settled safely (and snugly) in the medsurg tent.

It is amazing that our hospital functions as smoothly as it does on a daily basis - imagine if 95% of your staff turned over every week, working long hours sometimes in very harsh conditions. Now imagine throwing a fire into the mix. Not that I would ever EVER wish for something like this to happen, but it was one of the most amazing things I have ever been part of - it could have been so bad, but we worked together so well and the outcome was nothing short of a miracle. As one of our plastic surgeons (Harvey) said, "this was a test, and we passed."

~PJ

Monday, May 3, 2010

FIRE

I'm exhausted and bruised but safe. Rainstorm all day, electrical fires in both tents, evacuated all the patients, triaging in parking lot. Thank God for all the years of crisis intervention training, it came in handy. With the help of the Tennessee Baptists, the Army and Air Force, we got the faulty electric fixtures pulled and had all the patients re-situated in the adult medsurg tent by dawn. Taking a nap, will write more when I can.

~PJ

Saturday, May 1, 2010

day 7; It's gonna be a long night, but help has arrived!

Due to mechanical issues, our next group of volunteers (that was supposed to show up at 9am this morning) won't be showing up until about 9pm. Logistics has been running around crazy all day - figuring out how to do hand-offs over the phone, and figuring out how to staff a hospital with a census of over 100 with less than 20 people... And then, as if an answer to a prayer, a group of Army medics, nurses, and PAs from Fort Bragg (NC) showed up to save the day! They're here volunteering, after working hard days on base, to help us make it through this tough bit - even with the case of IV caffeine I found earlier, we'd be lost without them!



~PJ