Wednesday, July 21, 2010

chemo day in haiti

I just realized I didn't send this a few days ago...

SOP (Standard Operating Procedure) for mixing chemo in Haiti:

wear gloves, closed-toed-shoes, and face mask (if available). Do procedure in the parking lot, not in an enclosed, non-vented space. DO NOT get pregnant anytime soon...

I'm typing this as I'm waiting for the pre-chemo IVFs (a liter of normal saline with 20 MEQ of KCl and 2gms of MgSO4) to run into my patients veins. She looks like a pin cushion; came in super dehydrated and we had to start the IV at the wrist, but we can't infuse the chemo that way. I'm praying the fluids will "plump her up" so we can find a good vein on her arm. Otherwise, it's an IJ (intra-jugular) on the right side so it dumps into the vena cava (thanks, Anu, for that clinical pearl!)

For the record, we don't do chemo at our facility in Haiti. But the Haitian oncologist who agreed to carry out the palliative chemo plan for this lady designed by the providers in the states totally bailed, and, well, I'm a softie for cancer patients. Always have been.

I was sitting there talking to her parents through a translator, holding back the tears.  This isn't my first rodeo, and while it gets easier to hold on, it's still a bumpy ride.  Palliative chemo is not curative, which is a hard concept to get in the states, much less through a translator in a third world country. We're doing some sublingual morphine intensol to help with the pain, and have nausea meds on hand just in case.

Chemo isn't something I normally "play with", and I got nervous about the base IVFs suggested by the doctor - after some research and a "phone a friend" call to Toni at Samaritan, we changed it to the correct ones.  I am so grateful to all of the teachers and mentors I have had along the way.  It really does "take a village," and mine is a global one.   So with the right recipe in hand, time to wait to see what sort of access we were going to get.

... a few hours later...

A liter and a half of fluid, and still no luck getting good IV access in her arm.  An IJ it is then.  Well, actually, to be precise, an EJ.

Per our "SOP," I mixed the chemo outside.  We have no hood, no real ventilation in the pharmacy, so it's actually safer for me to mix outdoors.  It was quite the show, quite the drama for a few needle punctures, but there needed to be some safety measures beyond what is normal in Haiti.  On went the closed-toed-shoes, the face mask, and gloves.  Rony, Shane, Hannah and Sam stood watch - both to watch me, and to keep others from coming to "hang out" while I was mixing poison (or as I explained it to Shane, mixing radioactive waste).

The bag was hand carried over, and I hung it myself.  Spent the rest of the day checking in on her - monitoring pain and nausea.  We kept the pain at bay, and the nausea too, so I'd chock it up as a success.

After the chemo, we did more supportive fluids, and I chatted with the parents about making sure she is well hydrated before next month, so we don't have to do another EJ.

I emailed Matt, the doctor whose overseeing care from the states.  His email back was short, and the lyrics brought a smile to my face:

"Some will fall in love with life and drink it like a fountain that is pouring like an avalanche coming down a mountain. I've only met you once, but I think it fits you. Thanks."

~PJ

Sunday, July 18, 2010

my 15 minutes with anderson cooper

Okay, for the record, I never get "star-struck."  It's not that uncommon for celebrities to come through the Medishare Hospital.  But this was different - this was ANDERSON COOPER.  I got to meet Anderson the other night at The Plaza, and spent about 15 minutes chatting with him.  He held out his hand - "Hi, I'm Anderson" - very genuine, personable, and it was all I could do to carry on an intelligent conversation without giggling.

He had been in Port au Prince earlier in the week to cover the six month anniversary of the quake, flew back to New Orleans to cover the capping of the oil spill for a few days, then came back for a personal visit.  I mentioned that I hadn't heard the news about the oil spill ceasing - when I'm working long days in the hospital sometimes I forget the rest of the world exists.  So he filled me in on what's happened since I left the states.  Yes, my friends, Anderson Cooper gave me my own personal newscast.

He mentioned how sad it is that so many of the NGOs are pulling out of Haiti, and I was quick to mention that Medishare is still here.  "Oh yeah, I love you guys!  You do great work!"  When we parted ways, he thanked us for our continued work down here, and reminded us that we are making a huge difference for the people of Haiti.



Anderson Cooper 360

~PJ

Friday, July 16, 2010

say "aahhh"

It's funny how we sometimes end up exactly where we're supposed to be, even if we don't know we're supposed to be there.  The other day while sitting in the logistics office, waiting for my caffeine to set in, I started talking to a couple of University of Miami students about their project.  They were here field testing a very interesting "tele-medicine" software developed by MIT.  Their plan was to head out to New Life Children's Home (www.newlife4kids.org) to shoot some video footage and talk with Miriam, the Missions Director, about how the software might be useful in Haiti.  Janet (a teacher from Oregon whose "alter ego" is a warehouse pixie in Haiti) had brought a bunch of school supplies to donate, so was heading out with them.  One of the UM students, Sean, seemed a little disappointed that they weren't able to do more for the orphanage they'd been working with, so I suggested we "de-worm" all of the kids.

Miriam estimates that approximately 90% of the children in the tent cities have some sort of intestinal worm.  The living conditions are filthy, with many people sleeping on the dirt, and there is really no way to have anything be "sanitary."  When a worm infestation isn't treated, the worms migrate out of the intestines and into other areas. Seeing a kid cough up worms that are 6 inches long is one of those things you never forget.  And in a country where so many of the children are already malnourished, parasitic worms are even more deadly.  Many organizations and school will periodically de-worm all of the children as a precaution.  Anti-helmintics (de-worming medicine) are worth their weight in gold in Haiti, and I'd just been gifted a few thousand mebendazole chewable tablets, and playing with orphans is always a fun way to spend half a day.

Sean and Janet assisting with de-worming orphans

It was so sweet - the kids all filed into the classroom, and sang a song in Creole welcoming us and thanking us for coming.  Then they were seated and a translator helped me explain what we were going to do.  One of the hardest things for me to explain, even through a translator, is the concept of "chewing a tablet".  Remember, most people in Haiti have never even seen a doctor.  So I demonstrated for them.  (hey, it's been a while since I've been de-wormed)  Crunch, crunch, crunch, then I opened my mouth and stuck out my tongue and said "aaaahhhhh" to show the white paste that was covering my tongue.  All of the kids laughed.  As Janet, Sean and I gave each of them their dose, they chewed it up and stuck out their tongues and said "aaahhhh".  Much much giggling, and I'm sure the teachers were less than thrilled at the new game I'd taught their students, but it got the kids to laugh and not spit the tablets out.  I can tell you from experience, they taste HORRIBLE.  Well, horrible with a mint aftertaste.

After "dosing" all of the orphans in the classroom, I walked around and "dosed" some of the handicapped kids - it was much easier to come to them than get their wheelchairs inside.  The children from the classroom followed, clapping and laughing, continuing the game.

After the "de-worming party", Janet gifted the teachers at the school some much appreciated school supplies for the children.  From one teacher to another, even with the language barrier it was clear the gratitude for the gifts.  I spoke with Miriam and her daughter about medication needs for the Home, which has clinics for quadriplegics and paraplegics under their mango tree every Wednesday.  We're all in this together, and if we can provide help, we will.

 
~PJ

Monday, July 12, 2010

blood drive

Practitioners who are new to Haiti often ask about the blood supply; more specifically, if there is a supply. The answer is kind of, sort of, it's complicated.  Today was a perfect example.

We had a news crew show up at the hospital, and in the middle of "show and tell with Sanjay Gupta," the CNO came into logistics asking about our blood types.  A patient was just admitted who would die tonight if she didn't get blood.  When someone needs blood down here, the first thing we do is ask family to donate (if there is family).  If they're willing to donate, we type their blood to see if they match.  If they're not a match, or if the patient has no family, we look to our staff/volunteers to see if anyone is a possible donor.  No one who knew their type was a match, so those of us who haven't been typed yet (or couldn't remember our type) headed off to the lab to find out if we were a match.

It's a fairly simple procedure to be typed; lance the finger, a few drops of blood in each reservoir, add the chemicals, and spin around.  Jen, our PR person from Miami, ended up being a perfect match.  She hates needles, and it was clear that even being typed was a little out of her comfort zone.  But as she put it, a persons life literally depends on her donating - how can you say no?  I handed her a package of pop-tarts from my uuber-secret-stash on her way to donate...  It's not like the Red Cross back home where you get cookies and punch...

Of course, the work is not done once you find a match. Turns out today we had bags for blood donation without the chemical-anti-coagulants to add to the blood to make it useable...  So a new game begins...  Calling Big Paul from MMRC to see if he can locate some, or maybe we can sweet talk the Haitian Red Cross out of some.  Then there's the excitement of a trip to Hospital General to do the actual donation, and praying that #1, they don't loose the blood you've just donated, and #2, that you make it back in time to get the blood to the patient while it can still do some good (have I mentioned that traffic SUCKS in Port au Prince?).  In this case, the Gods were smiling on us.

Later on I caught up with our heroic donor, and she told me about meeting the girl whose life she saved, and how her eyes had lit up when the translator explained what was happening.  In her own words:

"After all the anxiety I went through---The cool thing-- I got to meet the patient. 'Mesi anpil,' she said. She grabbed my hand and pulled it to her chest. She was weak, but her smile and her eyes said more thanks than her words. It is something I will never forget. I know that my one donation may just buy her some more time. I hope that someone else is able to donate so she has enough blood until her medical problem is corrected. Just seeing that little bit of hope in her eyes meant so much to me."

In the states, we donate blood all the time, but it's more of a karmic donation...  We all give, so those who need it have access to it, and the idea is that should we ever need blood, it's there for us...  I can only imagine what it must have felt like to have that connection with a patient...  Although, I suspect, at some point I will know exactly what it feels like; at some point I'll be the match, and hoping there are still some pop-tarts left in the stash...
 



~PJ

Saturday, July 10, 2010

back from my hiatus

I’m writing this on the plane, heading back to Port au Prince, after a whirlwind week of family, friends, geocaching, gathering supplies, oh, and a minor operation.  As you may already know, I ended up having surgery when I returned from my first deployment to Haiti (which was in no way a result of anything having to do with Haiti).  Turns out we weren’t aggressive enough, and 2 months later, I had to have surgery again.  I wish it were something glamorous, with a cool story and a neat scar.  But it’s not – it’s been a pain in the butt.  Literally.

People say that healthcare workers make horrible patients.  I am, admittedly, one of the worst patients EVER. (Editors Note:  Yes, she is but we still love her) Rosales, my surgeon, just rolls his eyes at me when I mention I’m scheduled to return to Haiti 36 hours after he’s scheduled me for surgery.  He says he’s committed to fixing me, despite my commitment to “Save the World”…  He also says I used up a lot of “karma points” getting back to the states for my first surgery, so I should probably continue my work in Haiti to pay back my karmic debt.   Who knew karma points were like penny-carnival tickets?  Maybe next time I’ll trade some in for a gigantic, fluffy teddy bear…



I ended up changing my flight – adding a few days on the end of my trip to recover in Oregon.  Now I'm headed back to Port au Prince... to "take it easy"...
 


~PJ