surgical teams serve in haiti

A perioperative nurse’s experience in Haiti

An interview with Denise Lauria, RN, a perioperative nurse at Massachusetts General Hospital, by OR Manager’s clinical editor, Judy Mathias, RN, MS. Lauria served for two weeks in Haiti from January 15 to 30, 2010, with Partners in Health, a Boston-based nonprofit that has provided health care in Haiti for nearly 25 years.

Q. Who was in your group?
We had about 14 surgeons, anesthesiologists, and OR nurses as well as internists and medical nurses.

Q. Where did you work while you were in Haiti?
We were in St Marc, which is about 60 miles north of Port-au-Prince. We were at St Nicholas Hospital, which is a functioning but quite old hospital that I believe partners with PIH. Primarily what they do at this hospital are c-sections.

Q. Was that area hit by the earthquake? Were they bringing patients in from Port au Prince?
No, it wasn’t hit. There was a news announcement that there were personnel brought over to St. Nicholas to help the earthquake victims, and then they started arriving. They arrived on flatbed trucks and things like that—however they could get them over. They were carried on doors. They were carried on ironing boards. They had splints made of cardboard.

Q. So you were seeing crush injuries, broken bones?
A lot of open fractures. We did debridements and amputations. There were infections. Nothing in the US, at least where I work now, could quite parallel what I was exposed to in Haiti. In Haiti, you could smell the pseudomonas. Just like a textbook, you could see that blue-green pseudomonas on the tissue.

One of our ED doctors was an internist and brought over a sonogram machine, and she was able to do a lot of diagnosing with it. She did an ultrasound of a little boy who had a hard abdominal mass. She felt it to be an abscess, and when we opened it up, it was awful. I don’t have a word for the smell. [The boy was treated with antibiotics and survived surgery. His postoperative course is not known.]

Q. What kind of anesthesia did your team use?
We learned, and we were very flexible. We would watch outcomes with general anesthesia, and decided to switch to spinal anesthesia, which worked perfectly.

I came to recognize being back at work that, first of all, we have a wonderful medical system. Also, we have healthy patients, and if they’re not healthy we know they’re not healthy. In Haiti, there were lots of comorbidities, but you didn’t know what they were. The only lab work they did was an H&H, syphilis, and HIV. That’s it.

Q. What were the sterilization facilities like?
For sterilization, they have an autoclave, but it is very small, pretty primitive in comparison to what we do here. To wrap their instruments, they tore up OR gowns, and they’d tie them with gauze. Everything that came out was a wet load. You were given it wet—that’s what you had to work with. So, essentially, it was probably pretty clean and not sterile. And nothing was marked. You couldn’t see through anything, so the only way you knew what you had was by feeling.
They had things in the OR that we called “dim sum,” because it was like a dim sum tray. So they would clean them out with Betadine and peroxide. They they’d put sterile equipment in there. They had tongs that you could go in there and take them out.

iPods help occupy young patients during surgery and recovery.

Q. Is there one patient who stands out for you?

There was a little two-year-old girl, and she had a below-the-knee amputation. And when she first came to the OR, she wouldn’t look anybody in the eye. She would watch everything going on through the corners of her eyes.

And her mom said after her amputation, she never smiled. So she would come back to the OR frequently because her amputation, her stump wasn’t closed. So she’d had to have an IND [incision and drainage] of the stump. And then she’d have dressing changes down on the ward. She came back this one time, and it was the same thing, looking through the corner of her eye. She was the cutest little love bug. A couple of the doctors came over with Nemo or Cars on their iPhones, which they had for their own kids. We would turn it on for the kids, and they loved it, because they had never had this exposure before.

So she watched it. And she was transfixed; it was the greatest medication; she had a spinal, and she watched Nemo the whole time. When she came out postoperatively, we exchanged a lollipop for the iPhone. She acted like she’d never had one before because I’ll tell you she licked that lollipop like nobody’s business. The next time I saw her for closure of the stump, she was making eye contact.

Q. Other comments you would like to share?
Just a couple of things. One is that I have no words to express the great team that I was with. We were randomly chosen, but I think that it was God’s work because we gelled. We just worked so well together. You know what it’s like to be on a team. This was God’s work.

The other thing was that the Haitian people are very tough, stoic, wonderful people. Also, the Haitian health care workers worked tirelessly to help us. We’d have translators, and if we asked to have something done, it was done. We couldn’t have done it without them.

And the patients that we saw came in with horrible injuries, and not a peep. No one cried, no one screamed. They just were so stoic. I don’t know if they were in shock, I don’t know the reason for it, but I think it goes to say about the whole country and how it survived. They just are a very stoic, wonderful, hard group of people.

Q. Did you get into Port-au-Prince at all?
Yes.

Q. How was that?
The buildings were toppled over. I think the poverty is what overwhelmed me. You had the earthquake on top of it, and knowing the history of Haiti, this added insult to injury.
Some of the buildings, a portion would be all caved in, another portion of it untouched. There are portions of Port-au-Prince that are just completely overtaken by this disaster. And the people are displaced.

Q. Did you feel any of the aftershocks?
Yes, yes. I was there for I think it was a 6.2 aftershock. It was one morning, we were all in bed, and I have never been in an earthquake before. I felt some rumbling and then my roommate jumped up and screamed “Earthquake!” and everybody else in the building just jumped up and ran out outside.

Q. Were there security issues?
No, I found just the opposite. I found people to be helpful. We were a group of white people, clearly foreigners, walking down the street in scrubs, and everybody, would say, “Hi, how’s everything going?” in French. Everybody was very friendly. The kids had an easy smile for us. So that was a good feeling that we felt that we were welcomed to help out.