Wednesday, February 3, 2010

Caring for the Youngest Earthquake Survivors

Dr. Jose Irazuzta practices pediatric critical care medicine and pediatrics in Jacksonville, Florida. He joined the Project HOPE volunteer staff onboard the USNS Comfort on January 27th to care for children injured in the January 12 earthquake in Haiti. Read his powerful story.

At times it is surreal. The Comfort is a massive structure that is 8-10 stories in height and 830 feet long with 1000 hospital beds and 11 operating rooms. It can even desalinize water and make oxygen.

The ship is now stationed 2 miles off the coast of Haiti, surrounded by other ships, speed boats with supplies, patrols, etc. With a crew of 1,200, plus patients and their families, we are close to 2,500 souls onboard.

If not for the big red axes on the walls, latches on every door cabinet and floor anchors where beds and equipment are secured while sailing, it is easy to believe that you are working in a very large, crowded, city hospital.

People are working at less than 3-feet from each other. The halls are narrow with constant traffic.

A friend warned me, “One gets lost many times the first few days.” But it is not a problem. If you just ask one of the crew walking by, they stop, say “follow me Sir,” and take you to your destination without chit-chat and then get right back to their business.

The Intensive Care Unit(ICU) is staffed with highly-skilled nurses, quick on their feet, multitasking and improvising with little talk. I have yet to hear a single complaint.

Helicopters fly continuously during daylight, moving patients or restocking the ship. Sometimes we are short on supplies, like gloves for a few shifts... we use the ones from the people in the kitchen.

At 6 a.m. the loud speakers blast: “Reveille! Reveille! All hands heave out and trice up,” followed by loud whistles.

I usually get to the last meal of the day when the “Chow Room” reopens at 11p.m. Because there are no windows on the ship, I try to get to the upper deck at night. Finally when I pull the curtains on the little, lower bunk (berthing), the only private place you have on the whole ship, even the hard mattress feels like heaven.

We are currently operating 3 ICUs with 20 or more pediatric patients. When we send one child out another is flown in from a hospital inland. They do not fly at night. Occasionally we hear requests in the evenings for patients to be processed to come onboard the next day, but in the morning they never arrive and we wonder.

The stories are hard, severe brain injuries with contaminated open fractures, sepsis, amputations, renal failures and the worse... infants found after the earthquake without parents or neighbors, malnourished with secondary infections. The sailors take turns when off duty holding them in their arms while the little ones latch to them like leeches.

The crew, all races, sexes, shapes and orientation are “pure- of- heart” and self- disciplined. they are learning at least one Creole word every day and are polite but firm when bringing to your attention that you broke a rule...”scrubs are not allowed on the deck Sir.” I have heard that the sailors maybe “hot racking” (a bunk is used by people on different shifts) to make room for people from Haiti.....nobody makes a big fuss about it, they just do it.

In Haiti, grandmothers often take care of several children while their parents work in other towns. One of them was taking care of 2 infants when the ceiling fell down during the earthquake. She was only able to pull one child alive from the ruble. The mother arrived three days later for the funeral of her son....yet he was still alive with a large bump on his head. After 2 weeks he started vomiting. Some medical personnel saw the child and found a large skull fracture with his brain protruding from it, but covered with skin. He was flown to us, the neurosurgeons, and the rest did their part ...the rest is a happy ending.

Women under stress are delivering their babies too early. We treated a premature infant that had necrotizing enterocolitis, a gastrointestinal disease that affects premature infants. We could not feed the baby, his bowels just distended. There is no form of total parenteral nutrition (intravenous feeding) to support a child that will need it for several years in addition to 3-4 delicate surgeries in this part of the world. Still, the mother begged us to try anything. We understood. With no house left and the rest of her family dead, this child was the only remainder of a previous life. He died despite all our efforts. With the nurses and the sailors, we just surrounded the mother to cry off her pain.

There are 1,000 sailors, a bunch of Navy medical personnel, 32 Project HOPE volunteers as well as Red Cross volunteers on the Comfort. The reality is that we cannot notice the difference anymore. We are all on the same boat for the same reason.

-Jose Irazuzta, MD

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