Author: Matt Cyr

Children’s nurse Kristin Sullivan is featured in this Boston Globe article about the challenges she and other clinicians from Massachusetts face as they provide care to Haitian patients aboard the USNS Comfort.

Nelson Aquino, a nurse anesthetist from Children’s, is still in Haiti with a group of Children’s clinicians. He’s been sending us updates and photos almost daily. Today he gives one more update before he and the others members of the team head back to the United States:

Today (Thursday) was our last day in the OR. The Haitian surgical team will be taking over their OR tomorrow with the few left over volunteers. Tomorrow, the Haitians will be administering their own anesthesia and providing nursing care. This is great that they are ready to become independent again. We all hope they will be able to do so.

We started our day just like we ended our first night, resuscitating a newborn baby. Dr. McClain, Dr. Waisel and the OR team were able to resuscitate the infant and transfer him to the DMAT. In the OR, our team managed two rooms and the Haitians took over the other two. Dr. Meara and Dr. Rogers finished their last surgeries today. I was able to finish my cases today with spinal anesthesia and sedation. Overall, we estimated about 70 surgeries total, not including the sedation in the PACU and in the tents.

Our nurses did amazing work this week making sure all the tents and patients were well cared for, despite the lack of resources. Day in and day out the OR nurses, scrub tech and field nurses cared for hundreds of victims and their families. They were able to teach and empower the Haitian nurses to provide the highest standard of care for their patients.

Terri and Lisa devoted their time in the pediatric tent on their own. Sadly, they lost an infant who presented with dehydration and febrile seizures. The nurses say the EMT s were giving mouth to mouth while they were doing CPR. When I stopped by to visit, the child had just passed and you could hear the mother wailing in the streets. It was terrible to hear and so sad because at home this baby would be alive.

Follow-up care will be provided by the Haitians and volunteers left at the General Hospital. One patient that Dr. Meara stitched up yesterday was from Brockton and will actually see Dr. Meara on Monday in Waltham!!! The man was visiting Haiti, fell and needed stitches on his upper lip. Now that is continuity of care!

As I sit here tonight, thinking about our trip, I am extremely humbled by this experience. It is bitter-sweet, knowing we have helped hundreds, but sad to say there are hundreds of thousands more that need our help.

Tomorrow we head to the airport and will fly home on standby. Some of us may end up in Chicago or Miami tomorrow. If possible, some of us may get flights into Boston late Friday night or during the day on Saturday. Cross your fingers!

What we choose to leave behind are the huge Air Force cargo planes flying over our heads all night long every 30 minutes. It will be so nice to be home to see all our family and friends and get a good night’s sleep!

One last request is that no one should ever forget the devastation that took place here only 12 days ago. We have left behind all that we brought: medical supplies, clothes, sleeping bags, money and even our shoes for the people.

May we hope the infrastructure will change and the good will that all of the world has shown will continue. It may take a while, but we all need to stay vigilant. We heard a story from one of our volunteers whose friend was heading home to the U.S. Upon coming to customs the Haitian officials were charging missionaries and medical volunteers money in order to receive donated supplies to the country. We all need to encourage our government to promote change in Haiti. If this is not done, the people will continue to suffer and die.

Thanks to all of you following this blog. Thank you to our Children’s team, Partners in Health, and to all the people in Haiti for your  inspiration and continued faith in the world.

Yours,

Nelson J. Aquino, CRNA, MS

Staff Nurse Anesthetist

Children’s Hospital Boston

Editor’s note: All three members of the other Children’s team on the ground in Haiti, Pediatrician-in-Chief, Gary Fleisher, trauma surgeon David Mooney (left) and pharmacist Shannon Manzi, are featured in a Boston Globe article today about how infections are becoming the big problem for the people of Haiti.

Nelson Aquino, a nurse anesthetist from Children’s, is in Haiti with a group of Children’s clinicians. He’s been sending us updates and photos almost daily. Here’s his most recent email:

Today was another hectic day in our makeshift OR. And to make it worse, we did not have any electricity the entire morning. But we continued on safely using our portable monitors, homemade suction and no bovies. You would be amazed how much work we got done without light or electricity. Things are starting to get better each day. As old teams leave and new ones arrive, we continue to get our work done. We all feel like we hit  the wall today. The fatigue is starting to get to us even though we are hydrating and trying to eat  as much as we can.The mission of Partners in Health is to eventually have the Haitians running their own hospital again with our help. Today, we were able to work toward that goal by having the Haitian doctors, surgeons,  anesthesia and nurses work with us in the OR, PACU and outside tents.

Some of the Haitian workers seem really receptive to us while others are still traumatized by the loss of their family members and loss of their homes. I can’t imagine what they are all experiencing, but as I have said before, it amazes me how strong willed the people are going on with life. During this whole experience, we have met some wonderful people. The US 82 Airborne has been helping us throughout our journey. The medics are awesome with crowd control, placing IVs, helping with anything and just being there for all of us. These guys were supposed to be in Afghanistan but got re-routed to Haiti for now. The OR folks allowed these medics to scrub him and help with surgeries. The medics were so enthusiastic and willing to learn!

We have also started to notice the prevalence of HIV within the Haitian community. We cared for several confirmed cases including children.

One of the other things we are noticing is that many of the people are  so afraid of losing their limbs. When the patients return to their tents from the ORs, everyone would sing praises and songs for not having a limb amputated. Tonight we dropped off one lady who returned and the entire tent was singing praises. They all kept thanking us in prayer. But the part that really sucks, is that in morning we have to tell her that she will die if we don’t amputate her leg.

Each day we experience special moments which we will always remember and we are so grateful for all of them. We hope to share more when we all return. As of right now, we are hoping to complete our mission by the end of the weekend.

Thank you to all of you following our blog and for all your messages and thoughts. We all appreciate it!!!!

Nelson J. Aquino CRNA

Today we all made huge progress with our new OR. Our Children’s team

now has teamed up with the Brigham and Women’s and NYU teams to do surgery. Early this morning, our first group headed out to set up the OR and seek out our potential patients.

At the general hospital, we opened a preop area, 4 OR tables and a  PACU. Our team leaders worked hard today with the IMC (International Medical  Corporation) to make this happen.

While searching for extra beds, and the right Red Cross tent, Jay Hartford, a 7 South nurse, and I stumbled upon some chaos. A 2 day old baby had been  seizing on and off since birth. A team of paramedics were screaming for intubation, but only had large endotrachial tubes (ETT). So being a  pediatric CRNA, I naturally swarmed over and told the team that. Immediately they moved everyone aside and said, “Let him intubate.” As  the paramedic removed the ambu bag off the neonate, I used a large blade and intubated this 3 kg baby. As they listened for breath sounds and confirmed placement, everyone was clapping. The U.S. military arrived and helped us transport this neonate in a hummer. With no monitors, no meds and an unstable IV, the military guys shut  the doors and it was pitch black and 100 degrees.

Both Jay and I looked at each other and really couldn’t believe this was happening. This small baby’s life was in our hands. During the 10 minute ride to the DMAT (Disaster Medical Assistance Team) unit, I manually ventilated the baby as Jay held the ETT. We were both praying and hoping this baby would make it there. We felt no pulse at one time and started CPR. When the doors on the hummer opened we rushed the baby to the disaster tent.

When we arrived we were greeted by Dr. Mooney and pharmacist Shannon Manzi from CHB! We couldn’t believe it!!! Also, I was greeted by a fellow Nurse Anesthetist Mike Storey, CRNA (who trained me). We handed off to Dr. Mooney and his team. The baby was alive and stabilized. What a miracle.

As we rode back in the hummer, we were wondering if our team knew we had been gone? When we arrived our first post-op arrived. Our teams today did 7 to 8 cases. Our anesthesiologists, Craig McClain, MD, and David Waisel, MD, teamed up with and did some amazing work. Dr. John Meara and Dr. Gary Rogers worked the entire day repairing broken bones and optimizing wound healing.

Lisa Pixley, a nurse from 7 south, and a team of MGH and Brigham and Women’s nurses, treated wounds, changed dressings and provided pain relief in many tents. Everyone pitched in and at one point I scrubbed in handing over surgical equipment. Joann, our scrub tech, did amazing work translating and working at the same time.

One challenge we had was making sure all our postops had beds and would be cared for tonight. We found a group of paramedics and EMTs to look over everyone!

By the end if the day, everyone was exhausted. We tried to keep up on water and food, but several of us needed IVs for hydration.

We headed home early around 6:30 pm and were welcomed home to mattresses in our tents, dinner, snack room and showers!!!

What an unbelievable day! Tomorrow is another adventure. Everyone here misses all our families and friends! Thank you for all your support!

Nelson J. Aquino, CRNA

PS – Also read an amazing story from Partners in Health Medical Director Joia Mukherjee about how a team that included Children’s Plastic-Surgeon-in-Chief John Meara, MD, DMD, MBA, saved the life of a critically ill newborn.

Hi everyone!

After a couple of nights, our group figured out the dynamics of how to get OR time, so we took the first bus in to the hospital.

When we arrived, we jumped into action to find out what our plan was today. Stella took charge and got our team going minus John (Meara) and Craig (McClain). In the meantime, the military commander was looking for the baby we took care of last night. So we all searched and searched and later found out the guys brought him to another DMAT unit. I also learned that unit was headed by Dr. Mooney and FEMA. The baby is alive stable and was handed off to Dr. Mooney and mom is good.In the morning, Gary (Rogers) and the ortho guys did some rounds to gather patients for the night OR. Some of us did pain management and sedation for the many wound and amputee dressings. Jay , Lisa and Terri did awesome putting IVs and helping the Mt. Sinai and Dartmouth Hitchcock team.

The OR group gathered furniture and equipment to make a new OR. Stella , Pam, Trish and Joann were working to make the OR night happen. Joann has been so vital translating and making sure all the locals are in tune with our plan.

We headed home to camp at 2 pm and rested till the night shift started by 7 pm. At camp, more teams started to arrive. We noticed a pattern of uncertainty and being lost, just like we felt when we came. As the first group to arrive at camp, we all helped to make their transition smooth.

At night, we had many drop-offs, meaning military men would walk up with patients and say, “Here you go.” Some were lucky to get some triage, some a bed, some went directly to the OR and some were not so lucky. The people are desperate for any kind of help. You will be working and 10 people are pulling you in any direction and you can’t understand them. The tents need nurses so bad, to give meds, pain meds, antibiotics, dressings and basic care. You will be lucky to have a local Haitian nurse, but last night it was me, Jay and Teri manning five tents (over 100 patients) and a post op area. There were a few doctors there helping and we had the director/ founder of PIH Paul Farmer helping us.

Some of the things we saw were a young man who had a wall fall on him last week. Tonight he arrived from the Israeli hospital with family and looking for intensive care and hope to get on the Comfort Ship. But now it is too late to transport so we did the best we could. I put my pulse ox on and it was 48 and he was in respiratory distress, pain, borderline obtunded. Dr. Meara and Dr Farmer managed to assess and determine this was not surgical. We administered antibiotics, morphine and heparin for him and watched him overnight.

Thank goodness we met and befriended this team of FDNY paramedics, doctors and physician assistants who mended all the patients at night. They willingly found beds and accepted our postops late at night. These guys were amazing!

Last night, we did 5 surgeries too. One triage trauma, mva, ortho trauma and a massive orbital degloving. The teams were busy till 11 pm when we stopped surgeries. Jay and I bonded with a father who son needed septum surgery. He spoke English and told us he had lost his entire family. It was just him and his boy. He said his boy was a “diamond,” the most valuable thing he has now. Despite his losses, the father was there helping other families and I saw him later unloading a warehouse for the paramedics. That is pure humanity to see in these conditions.

I cant even describe the hundreds of other patients we’ve seen or the experience in the OR, but I hope this gives you all a tiny glimpse that we are making a difference!!!

Thank you all!
Nelson

After several days of trying to make their way to the site of the devastation in Haiti and get their field hospital set up, the Children’s team is working hard in Port-au-Prince to care for the earthquake victims.

As detailed in this Boston.com article, Children’s Pediatrician-in-Chief, Gary Fleisher, MD, even helped bring some light into a very dark situation when he delivered a healthy baby boy yesterday.

We’ll have more updates on the work of the Children’s team as soon as we have them.

Lester Hartman, MD, is a Children’s-affiliated pediatrician who works at Westwood-Mansfield Pediatric Associates. For several years he has run a clinic in the mountains of Haiti through a program called the Haitian Organization Program For Education And Health. Hartman made his way to the region within days of this week’s earthquake. Below are three updates from Hartman as he has tries to make his way to the clinic and begins to grasp the level of devastation caused by the earthquake.

Friday, January 15, 5:53 pm – We are heading to the DR [Dominican Republic] Haiti border in a little bit and drive thru the night as is 6 hrs and then we will cross in am in a faltbed truck with $8000 US meds plus PLUMPY NUT- hi calorie peanut butter paste for malnourished kids. This may be my last contact until crossing the border back. Lots of Haitians trying to cross the border.

Friday, January 15, 2010 6:01 pm – We are in the mountains our clinic is intact. We will arrive at the clinic tomorrow with additional meds to help with the evacuees coming up the mountain. We are 5 miles west of Lascohabos in the Central Plateau region. This is Katrina X100. We expect to see more malnutrition.

Saturday, January 16 9:34 am – Got stuck in DR but found generous pharmacist who is getting us meds/ we got $6000 US food [and] about $6000 meds. It’s a drop in the bucket but at least it is a drop. This is going to be Katrina x 1000 and  my childhood home was flooded in Katrina. Our director is planning to bring victims up from PAP [Port au Prince]. Who knows, we might have a tent city. Heading out to Haiti in about 1-2 hrs. Not sure what our access will be.

We’ll update you on Hartman’s progress and that of the Children’s team that has been trying to get to Haiti since earlier this week as soon as we have more information.

In case you missed it, Margaret Chan, MD, the director-general of the World Health Organization (WHO), yesterday cautioned the world that the H1N1 pandemic is not over, even though you’re not hearing as much about it in the media or around the watercooler. “It is too premature and too early for us to say we have come to an end of the pandemic influenza worldwide,” Dr. Chan said at a press conference.

With much less attention being paid to H1N1 these days, Thrive asked Claire McCarthy, MD, a pediatrician and the medical director of Children’s Martha Eliot Health Center, if she thought families could stop worrying about the virus—and whether people should still get vaccinated if they haven’t already. Here’s what she had to say:

“I completely agree with the WHO. It’s true that we are seeing fewer cases and hearing less worry about it among patients and families. But while there are fewer cases, people are still getting very sick from H1N1, especially young people—and this virus is just too new for us to really know what it’s going to do. I am nowhere near ready to tell anyone that the pandemic is over. I’m still telling everyone to wash their hands (I sure am!)—and encouraging everyone to get vaccinated.”

In addition to H1N1 and the regular seasonal flu, which should be starting up in earnest pretty soon, Children’s researcher Florence Bourgeois, MD, MPH, recently published a study that said we should also be on the lookout for RSV this winter, since those infected with it had more than twice as many emergency department visits and six times more hospitalizations than those with seasonal flu.

In other H1N1 news, Children’s Adrienne Randolph, MD, MSc, is quoted in The Boston Globe’s article linking severe H1N1 cases with asthma. The decision about whether to vaccinate kids with asthma for H1N1 is something we wrote about on Thrive not long ago. Also check out Dr. Randolph’s very popular post on why you should get your child the H1N1 vaccine. The Boston Globe also reports that the H1N1 flu may be less contagious than we originally feared.

WBZ-TV yesterday shared the story of Charlotte Kelly, a 3-year-old Children’s patient who is battling stage IV neuroblastoma. The chemotherapy used to treat Charlotte’s cancer destroys the platelets in her blood, so she needs regular transfusions to replace them. Her mother’s colleagues from the Tynan Elementary School in South Boston gave the greatest holiday gift this week when they came to Children’s Blood Donor Center to donate platelets for Charlotte.

As you’re giving gifts this year, don’t forget to give the ones, like blood and platelets, that don’t cost a dime but help kids like Charlotte every day at Children’s and places like it around the world.

Related posts:

1. This week on Thrive: Dec. 14 – 18
2. Probing life-threatening flu
3. How can we help our teen son manage media so they don’t interfere with his life?

Good news for those of you who (like me) cringe and change lanes when you see someone two-handed texting while “driving” their cars: the Boston City Council yesterday voted unanimously to ban texting while driving. Boston Mayor Thomas M. Menino has said he’ll sign the ban as soon as it hits his desk, and Massachusetts Governor Deval Patrick has said he supports a ban on texting while driving, so hopefully the state will follow suit soon.

Last summer, Emily, a youth advisor in Children’s Center for Young Women’s Health, wrote a post on the Youth Advisory Program’s blog about the dangers of texting while driving.

Related posts:

1. Texting and driving
2. This week on Thrive: Dec. 14 – 18
3. Warning: This photo contains unrealistic body images

In case you missed it, the CDC today recalled 800,000 H1N1 vaccine doses meant for children, age 6 months to nearly 3 years old because they lost some of their strength after being released to the public. The good news is that there are no risks to any child who was vaccinated and you don’t need to get your child re-vaccinated if he or she got doses from the recalled batch; it just may be that your child isn’t quite as protected from H1N1 as you originally thought.

Check out the CDC’s Q&A on the topic.

Related posts:

1. Should my child get the swine flu (H1N1) shot?
2. H1N1 (swine flu) weekly update: Oct. 21 – 27
3. H1N1 vaccination starts at Children’s