Operation Rainbow brought a photographer Michael Lee to document their trip to Buen Samaritano. His photos are breathtaking, and their work is inspiring.
I’m writing to you on my last night in Jimani; feebly attempting to discover a metaphor that would describe any part of this slice of time in this spot on our planet. It’s an impossible task; I can only share what in the telling seems like brief episodes of a two dimensional mini-series compared to actuality. And I’m feeling very sad.
I’m not sure exactly how long I’ve been down here. I believe it’s been between 2 and 3 weeks. Down here = on a hot dusty piece of real estate owned by folks from Tennessee who set up a hospital, clinic and orphanage called “Good Samaritan” or “Buen Samaritano” in Spanish, in the border town of Jimani, Dominican Republic. We can see Haiti from our “home”. After the earthquake, Haitians began crossing the border into Jimani any way they could, looking for emergent medical assistance. At first it was completely disorganized, however they could get a ride, and some of them walked. Eventually earthquake victims were sent here by helicopter and ambulance as well.
Buen Samaritano was inactive at the time of the earthquake. The systems and supplies sprang up almost immediately, and were ever-evolving as more patients and volunteers arrived. As I write, we have 2 highly functioning operating rooms with PACU, 2 pharmacies, digital xray at the orphanage and fluoroscopy at the main building; we’ve been staffed with ortho and trauma providers, nurses, EMTs and paramedics; infectious disease, ob-gyn, plastics, physical therapy, psychology, and more.
As soon as we arrived, our prayers were answered: we were able to do what we came here to do - work really hard (and, serendipitously, fall in love with these amazing people). Initially, we worked 7 twelve hour shifts in a row (both day and night crews did – I would not recommend it, but it mostly worked).
The heat and the sweat were incidental. The aching feet eventually became so as well. The 12 hour day shifts passed very quickly for the staff because there was so much to be done. For the patients I think the days must have been endless, like a nightmarish Groundhog Day. The nights dragged on for some as well, who couldn’t stop thinking about how their family members died, how they tried to get their children and parents and siblings out of the rubble, but couldn’t.
At the beginning, the Vermont team was caring for 40-55 patients in the post-surgical ward A (other Vermonters were in PACU or ICU), sometimes with only 2 RNs or EMTs or med students, and if we were fortunate, 3 or 4. We begin every shift rounding on every patient, managing pain, doing assessments, and taking notes for that day’s plan of care. Rounds typically took up to 3 hours when the census was high, because patients always had immediate needs. Family members would also come get us when their loved ones needed something. After rounds, we would start doing dressing changes on the major abrasions, avulsions, amputations, and pin care on the external fixation devices. We had no xray for at least 10 days: external fixation was performed by landmark and physical assessment. When we finally got the digital xray, every patient had films taken, and many had fixation adjustments or revisions. Some had undiscovered fractures. And then we planned for and assisted with mobility, bowel management, and chronic medical problems.
The family members with each patient are as heroic as the patients. We could not have done our work without them. We were able to leave supplies of medications, even opiate analgesics, with instructions at the bedside – because the patients and the families were incredibly responsible. The families bathed the patients, and assisted with toileting.
3 weeks ago, most patients were afraid to move. Many were afraid to be taken to the operating room because they might find a part of their body missing when they awoke. Yesterday and today, I witnessed two sights (among many the past few weeks) that were a holy balm for the accumulated ache moving through my heart for all of this suffering.
The first – I was with a patient on the front porch of the orphanage when I heard someone call my name. I looked up to see, waving at me, twenty something year old Wilfred with his new above the knee amputation, beautiful twenty something year old Chantel with her new complete arm amputation, and feisty twenty something year old Emmanuel with her new below the knee amputation all walking together outside of their cardboard/bedsheet ‘shantytown’. I hadn’t seen them out of their cots together since I’d been there. They’d overcome their fear of mobilizing, and were so excited to be walking about together, like they were all going out on the town. Indescribable joy.
The second – I visited a similar disaster relief clinic in Haiti today called Love a Child, about an hours drive away (depending on the traffic). We have gradually been discharging patients from Buen Samaritano to Love a Child (previously a well established orphanage). Amos Hare and I rode on a school bus there today with more of our discharged patients there, including 14 year old Lorentia, and her mother Saintenise. Saintenise also has a 3 month old baby who she hasn’t seen since the earthquake; both Lorentia and her mother have left fractured femurs with external fixators and were sent to Buen Samaritano while the father and the baby had to stay in Haiti. Today – Saintenise and her baby were reunited – as was the whole family. Indescribable joy.
For most of them, the future beyond physical rehabilitation in Love a Child or any other clinic is a colossal unknown. And still, they gave us such grand affection and love, and grew to trust us immensely. This alone was a magnificent gift and honor, one that I will treasure for the rest of my life. Though I’m using first person narrative, it is not my story - it is theirs. I will probably never see these people again. I remind myself that this great beauty in this great tragedy is a collection of moments that continue to pass all of us by, and that grasping to the feelings or to our new friends will only diminish the power of the love and insight that has passed between us.
En Solidaridad,
Mari
The days are long, the work is endless and the needs of the people are virtually infinite but we all, patients, families and volunteers alike, move forward.
There has been a subtle but palpable change in the atmosphere here at Good Samaritan. Our roles are becoming more well defined and we are becoming more efficient in them. Our group, many of us virtual strangers at the beginning of the trip, are now a close knit group. As all of us become more comfortable in our individual roles here, we reach out to assist others in their roles here. We reach out to assist others in their roles, especially those who are newly arrived.
But most importantly, the energy of the patients and families have changed. Immediately following the disaster, everyone was concentrating on survival. Obtaining basic necessities and getting through to the next day was all consuming. That phase has past here. Now, the true healing is beginning. Patients, despite devastating injuries, are focused on getting better and stronger, not merely surviving. While the optimism here has astounded all of us from the beginning, it continues to grow daily. Certainly, the disaster remains the focal point of life here and will for many years to come but the strength of the people, once so drained, is growing. The feeling here now is that these people will survive, thrive and grow; we all will as the result of being here together.
Rich Salerno, MD
Nearly two weeks have past. As of today, nearly thirty Vermont-derived citizens are working or have worked at The Good Samaritan Hospital (Hóspital Buen Samaritano) in Jimani, Dominican Republic. What started as a small hospital run by missionaries was transformed into a trauma center run by volunteers after it was overrun by Haitian refugees after a devastating earthquake occurred on 12 January 2010, killing over 100,000. After a long search, and many obstacles, our Vermont teams have found a place at Buen Samaritano, and are making a difference in the lives of its patients. From smiles, to complex medical procedures and care, our Vermont Haiti Relief Teams are making great strides towards diminishing the devastation that has been brought upon the Haitian people.
Today is 1 February 2010. The Vermont Haiti Relief Team #1 has all but departed from Jimaní. Jeremiah, Bill, Susana, Joan, Sarah, Jackie, David, and Bob have already left, and are awaiting flights back to Burlington in Santo Domingo. Tomorrow, Brian G. and Brian C. will depart from Jimaní with four members of team two (Jason, Bob, Kate, and Mindy) and will make the five hour journey back to Santo Domingo for our flights back to Burlington. Mari C. will remain here and continue her work in the Orphanage and will return on Saturday. Team one and the members of team two that are returning are tired, and are ready to come home and hug their families. While leaving Jimaní will be bittersweet, team one fully expects and hopes that team two will continue to provide the standard of care we have established, and continue to represent Vermont. Team two has been working here for close to one week now, here’s an update on their progress:
Deb W. has been working hard (some pretty long days) in the area of the hospital working in the area known as the Orphanage. Her role there is multifaceted, including wound changes; she regularly acts as the charge nurse, assists with pain management, facilitates patient transfers, and much more. I have no doubt that she will continue to provide an advanced level of care, and will represent our team positively.
Rich S. has been working hard in the ICU, working as the only pediatric intensivist with the acutely ill pediatric patients in our hospital. He has consulted on two childbirths, and a number of complicated pediatric cases that our hospital would have been previously incapable of treating.
George H. (Big George) has been working as the charge nurse each day in our ICU. George’s daily job changes as the patient populations change, but George is frequently seen bopping around the OR, PACU, and our ICU regulating nursing staff, and is known as the one and only Big George.
Jason S. has assumed Jeremiah’s role as coordinator of transport for our facility. Jason’s transition was difficult, as there is a lot to learn, but he has done a phenomenal job. There are many intricacies and political caveats to Jason’s position and mastering them was difficult, and Jason is making great progress.
Mindy P., Wendy M., and Jess K. have been working nights in the orphanage as fundamental pieces of the Orphanage’s Ward A nursing staff. They all know their patients by name now, and are having a tremendously enjoyable time treating the residents of their assigned area. Each morning they have returned they have been smiling, and I frequently hear that their outgoing attitudes keeps the other nursing staff smiling during their night shifts. I’m also told that our hospital might be putting our Vermont nurses in Ward C to instill some order, facilitate better patient care, and to improve the care of its patients. Big props to our Vermont nurses.
Jason G., Peter C., and Courtney W. have also been working as key nursing staff members- Jason in the Orphanage, and Peter and Courtney in our ICUs. They have all been working tirelessly for their patients and fellow staff members while on shift.
Ken M. has been working with patient transport, and always seems to be working up a sweat each time I see him. Ken is working hard to keep our ORs busy and our patients happy.
Kate D. and Bob D. have been doing their best to cover our work down here but we have made it hard because we have been so widely distributed throughout our hospital. So far they have done a phenomenal job and working with them has been a pleasure.
This is my last post as a member of the Vermont Haiti Relief Team on the ground in Jimaní. Words cannot describe how intensely rewarding this experience has been. From highs to lows, this trip has most certainly elucidated a continuum of emotion I have never before experienced; and for that I will be forever grateful for those who have sent and supported me while here. I have no doubt that whoever takes over this blog will describe our work well.
There is a common expression often spray-painted on the walls of Haiti and towards the border of the Dominican Republic, “en solidarité” or in English, “in solidarity.” That phrase cannot better describe the spirit of the Haitian people. My trip here, as I have previously elucidated, has been characterized by transcendent highs, and unfathomable lows. The high points, which got me through the low points, were almost always related to an experience with a Haitian patient. From the feeling of a three-month-old orphan on my chest, to the resounding sound of happily singing patients in the Orphanage and numerous others, the highs I have experienced have been unlike anything I have ever experienced. While I trust that Vermont teams will continue to do phenomenal work here in Jimaní and in all our Haiti relief efforts, the imprint I have left here, and the impact this place has had on me will live with me forever. I hope that upcoming Vermonters will continue to come here- in solidarity- with unity or feeling among those with a common interest and be rewarded only by the smile on the face of their patient. Do good work, Vermonters.
-Brian C.
Hello again from the DR! It has been four days since my last update, and boy have we been busy. I have a lot to tell you all. To add some context to this post, I would like to preface this with the fact that I am currently in a bus on the way from Santo Domingo to Jimani with another group of Vermonters! There are 13 additional Vermont-derived staff members joining us and we are all very excited! But before I get into what’s transpiring today, let me catch you up on what’s been going on in Hospital Buen Samaritano in Jimani…
Since my last post, the members of the first Vermont team have been hard at work at the Good Samaritan hospital in Jimani, Dominican Republic. This team consists of health professionals from Fletcher Allen Healthcare, supported by the Vermont Nursing Union (props to the AFT for the aircard I’m using to write this post). Among these professionals are Brian G., Brian C., Jeremiah, Bill, David, Bob, Jackie, Sarah, Joan, Susana, and Mari. The certification levels include MD, EMT, RRT, and RN and all eleven of us have been spread around this facility assisting in any way possible. Brian G., Brian C., and Jeremiah have been coordinating the transportation of patients in and out of our facility and have been working tirelessly (especially Jeremiah) to allocate scarce resources to profoundly ill patients (of which there are approximately 300 in a facility suited for 30) that require more specialized medical care. This work has proven to be especially difficult, and has included substantial battles with local political figureheads, and been assisted by the US military, the Dominican military, and an entrepreneur and his friends from Utah that came to the DR with three helicopters to use for patient evacuations. Working with these men and the American/Dominican government has been a privilege, and they have made facilitating the patient movement far easier and have improved our ability to care for acute patients.
Bill, MD in conjunction with Kimball (another Vermonter), has been working in a clinic just over the Haitian border. The population of patients Bill serves is a one of the only clinics in the Haitian town of Fond Parisien, which received a massive influx of patients after the initial earthquake. Bill says the clinic sees approximately 300 patients each day, most of which present with medical issues (atraumatic) and require general medical care. A major focus of Bill’s presence at his clinic has been the establishment of a surgical facility in a separate building at the clinic’s compound. Bill found the building, which had been established by Christian missionaries a few years ago, but was never functional. It includes two birthing rooms, an operating room with an anesthesia ventilator, sterilization equipment, a post-anesthesia room with approximately six beds, and two bathrooms and two showers. Upon finding this “polished diamond in the rough,” Bill’s goal for this trip has been to make it functional. On 27 January, prior to departing for Santo Domingo to get the next group of people for this trip, Brian G., and Brian C. went to see this location, and found just that. What will come of this clinic, and our Vermont team’s involvement in it remains to be seen, but you can expect updates here as soon as they are available.
David, MD has continued his work in the wound clinic at Buen Samaritano working to clean and debride infected wounds. He states they are making substantial progress in this clinic, and has enlisted the support of a nurse anesthetist to perform conscious sedations on patients that require it.
Bob, our favorite respiratory therapist has been quite busy doing exactly what it is that he does best: making people smile. There isn’t a day that goes by down here that I don’t think about how great it is that Bob has made the trip with us. As Jen’s e-mail previously stated, Bob does what it takes to get the job done, and he always does it with a smile on. I frequently pass Bob driving the ambulance, moving patients, and doing what it takes to keep this place functioning at a high level.
Our nursing staff, our fabulous nursing staff, Jackie, Sarah, Joan, Susana, and Mari have been hard at work keeping the Haitian people’s needs accommodated. They have noticed that Haitians as a demographic are highly attentive to the needs of their family members, and frequently say they have easy shifts because their patients are so docile and accommodating. With respect to other nurses here, our Vermont nurses are getting high praise for their hard work…no surprise to us here, they work their butts off.
As I finish this entry on the bus to Jimani with this new group of Vermonters to work at the Good Samaritan, I can practically feel the energy they’re exuding. Their presence here is refreshing, and their optimism is inspiring. I hope that they will continue to build upon the connections we have made here, and continue to uphold the level of care we are more than sure they are capable of providing. Welcome to them, and I hope they enjoy their time at this lovely place.
-Brian C.
