Dr. Elie Schochet '97 shares his Haiti relief story
Dr. Elie Schochet ’97 is a general surgeon in Florida. On Jan. 25, he and six others from Holy Cross Hospital in Fort Lauderdale departed for Port-au-Prince with backpacks full of water, food, and survival gear, and with 1,100 pounds of medical supplies and medicines in the belly of the plane. The following are emails he sent back home on his Blackberry. You can see additional pictures from his trip and find out more ways to help Haiti here.
Monday, Jan. 25
"Well, I am here at last and my first job is to go take a nap because I will be taking the night shift tonight. It's hard to nap when you're so wired after the experience of the last 10 hours, but will try. We got to Miami Airport at 3 a.m. They took us in buses directly to plane bypassing TSA (thankfully as my pocket knife and 20 lbs. of water probably wouldn't have made it through) there were enough people to fill a 737 with people from all over the world in different relief capacities.
American Airlines was great. They had meals, pillows, blankets, care packages on the flight. With Miami's large Haitian population, many of the American flight crews are Haitian and they were working tirelessly to get our flight off the ground. All the more impressive considering we had to stuff anywhere from 50 to 150 pounds of gear per person on the plane itself as the belly was full of supplies.
Flying in (a beautiful above cloud sunrise at 6 a.m.), Cuba, Dom. Rep. and Haiti all look like beautiful mountainous, islands with miles of reefs and beaches. Descending in, the only abnormal thing was smoke plumes from multiple fires throughout the city (was to learn later that they've started burning the garbage and human waste piles to try to clean up the streets, and produce coal for fuel).
On the tarmac, there was a veritable U.N. of relief efforts visible. The entire infield was filled with small compounds of crates and machinery from U.S., Germany, France, England, Italy, Israel, Mexico, Bolivia, and many others. Cargo jets were landing and helicopters were taking off hauling large pallets continuously. Once our planes were unloaded, two things were evident. First, our supplies which should have been there on Saturday were not there. Second, all the groups got picked up but us.
As an aside, they started refueling and reloading the jet with outgoing relief personnel as soon as we emptied. I saw an Israeli jeep pull up to the plane and two fully armed paratroopers hopped out and began to escort a physician to the plane. I thought I recognized him so I went and said hi to Ruben Cohen, my freshman year dorm hall mate from Brandeis University. A facial surgeon at NYU, he had been here for over a week in the Israeli hospital compound fixing facial trauma. I can only imagine the tremendous good he accomplished while he was here.
As another aside, there were four nuns on the plane and while waiting on the tarmac, I saw one lift her right hand and then with her left index finger point to a spot on her hand. This maneuver is easily recognized as the universal sign for "I live in Michigan," so after introduction were made, I found myself with four Sisters of Mercy (the same order as my sponsoring hospital) from Michigan, one of whom was not only a general surgeon but also a graduate of my alma mater Michigan State, Her excitement was quickly doused however when she realized that 20 years had passed from her class of ‘83 to my class of ‘03.
Once our four vans showed up, I went in one with a few of the physicians to scope out a possible hospital and the other four from our group went to the mission compound itself. What followed was a 90-minute drive through the streets of Port au Prince.
I think the biggest realization was that except for the destroyed architecture, this city looked really awful before the earthquake. I suspect that a 90-minute drive a month ago would have evoked much of the same emotions as today except for the realization that this couldn't have happened to an already worse off people so it just makes you wonder what’s next.
We passed the Presidential Palace, and I felt like I was looking at an Escher drawing with pieces collapsed and sticking out at all angles. We saw the demolished courthouse, general hospital, and nursing school. In downtown I saw very few injured people. There were numerous areas of tent cities and shanty villages throughout the drive however I am unsure whether these were new or old.
The saddest thing I saw was driving on the four-lane highway (biggest in capital), in the median which can't be more than six-feet across, a tent row was evident and clearly new and spontaneous. The vast majority of inhabitants were under the age of 10. I saw babies and toddlers inches away from traffic because they had nowhere else to go. As the father of three young boys who don't like to 'look both ways,' it was very sad to see these kids just sitting and watching traffic. This was tempered by the occasional glimpse of a bright smile when eye contact was made with one of the kids.
We got to the hospital around 11 a.m.. It is a Seventh day Adventist Hospital in Diquini, I believe we are west or NW of the city based on my sense of direction. As we pulled in, the human face of this tragedy emerged. The entire grounds of the complex are covered in tents. There is a large (40-60 including security) French military contingent that appeared to be doing most of the work. Hand-written signs for registration, pre-op, post-op and others were nailed on trees. They have a PCU (think ICU for post-op patients) outside in a 30-ft inflatable air-conditioned tent. Everywhere one looks there are sick and injured Haitians, some with one bandage, but most with multiple.
There are other contingents of providers here including Japanese, South African, Southern California, and Boston teams. They are basically running two shifts, 16 hours each, with the overlapping used for sign-out.
They were very happy to see us and appreciated the offer of assistance. Their volume has not lessened as they continue to battle quake injuries and everyday sick people too. Mike Rush (radiologist), his son Tommy (a med student) and I stayed here so we could start helping right away while the rest of the van went to go to the mission and see what was going over there. I think that we are going to move the entire team over here tomorrow as they definitely need us here and there is plenty to do. While the mission is only 20 miles away, it can be a four-hour car ride because of the traffic.
I have been teamed with an orthopedic surgeon from LA and at 5 p.m. we will take over as the night crew for all the surgical patients both new and post-op, as well as function like an urgent care center for the approximately 700-1,000 people staying within the hospital compound
My adrenaline rush has finally wound down and I can't feel my thumbs anymore after bb'ing this email so its bed time, gotta go to work in a few hours.
Tuesday, Jan. 26
Wow, has it only been 30 hours since my last novella? I woke up Monday afternoon after three hours of very interrupted sleep. Usually a three-hour nap midday is a luxury but I was too wired to really rest.
At 5 p.m., I met up with French doctors and French Canadian recovery room nurses. They showed me the area outside the hospital where immediate post-op patients are laying on tarps, mattresses, or stretchers in open air surrounded by family who tend to their basic needs while we deal with the sickest patients. We walked around and they signed out the patients to me, informing me who needed nighttime antibiotics and other various details regarding their medical care.
From 5 p.m. until 7 a.m., Mimi (an orthopedic surgeon from San Diego) and I took care of those things, and other random needs for the tent city which has sprawled up in our hospital compound. We mostly provided basic medical needs. People throwing up, people with pelvic fractures from walls caving in that were getting obstructed because they had not had a bowel movement since the earthquake, bleeding after surgery, many people just scared and hungry looking for anything. A lot of placebo…Tylenols were given.
A group of four ICU nurses from San Diego (Cassia Chevillon, Shelly Noland (Go State), Brenna Jupin, and Angela Klinkhamer) and one Anesthesiologist (Jessie Yi), and a lone straggler who financed her own trip solo named Cindy had been working tirelessly for days getting the ORs, pharmacy, and PACU in order. Much of what had been accomplished in the hospital the prior week was directly attributable to their non-stop effort and determination. They had even started walking around the entire camp at 11 p.m. and 4 a.m. with boxes of basic meds, fluids, and wound dressings putting out any little fire they could find. Their dedication at night saved many lives as they could identify sick patients in the tents who needed to be under closer watch.
They had been sponsored by ACTS (Active Community Teams Serving) Worldwide Relief Agency who along with Doctors and administrators from Loma Linda University had running the hospital and much of the primary care outreach in the immediate vicinity.
At 7:30 a.m., the French and Canadian teams returned and we turned the hospital over to them. What soon became evident was that basic referral politics were in place even here. French triage officers send surgeries to French surgeons, not American, although orthopedic surgeries outnumbered general 10 to one. With that in mind, we spent most of the morning walking around the camp trying to be useful and find work. The French team really is running a tight ship and it’s hard to fault then (ironically, most Haitians hate the French because of their long colonial history, maybe their presence here assuages the French guilt over how they personally devastated Haiti over the last 300 years).
At 11, the rest of the Holy Cross team arrived and we got them settled. They came with all of the Holy Cross hospital meds and supplies. We felt however that there was enough at this hospital and instead, with the help of ACTS, we arranged to have them transported across the street to a primary care clinic called Children of Hope, supported by the hospital. When we walked over there we found an empty house with no furniture, 80 of our boxes and a line of people around the corner who heard we were coming.
After some quick unpacking, we started seeing patients with all sorts of basic complaints and also performed minor surgeries. Some furniture and two exam tables were brought in which made life easier. At 3 we heard some people were heading about a half-mile away to a large tent city with about 10-14,000 people that had sprouted on the campus of a nearby university. We headed there with pockets stuffed with candy, stickers and smiles. When we got there, we hopped out of the back of a truck.
On one side were university buildings and the other were tents as far as the eye could see, not organized military tents, but one large sunroof-less tent that stretched forever, multicolored fabrics and sticks made up the forms. It's hard to tell how you get to your tent if its in the middle of the clump. Tons of little kids and we soon were very popular as our pocket were emptied of treats.
Just an aside, I remember the news talked about the spirit and resiliency of the Haitian people. I can tell you it really is true. I have yet to see a fight, hear an argument. Everyone is smiling and dealing with their problems. There is a core of young men here who act as interpreters, security, transportation. They work tirelessly for free and as far as I can tell it’s all volunteer. Many of the kids don't know what happened and appear to be as happy with their current poverty and squalor as they were with the pre-earthquake Haiti.
Back to the tent city. After wandering around for a while as goodwill ambassadors, I saw a large Canadian tent with a line of people into it. I wandered it and found a group of New Yorkers from Adventist Community Service also running a makeshift clinic. After introducing myself, they immediately put me to work evaluating a little girl with abdominal pain and vomiting. I then spent the rest of the day till sundown working in the tent along with some of the others from our group. We also arranged to go back today with a shopping cart of meds and supplies.
We walked back to the hospital at 5 to take sign out from the French and Canadian teams and start the night shift. Around 8 there was a spur of the moment dinner party as all the Americans in the hospital (seven of us from Ft. Laud, two from Oregon, six from Southern Cal, and a few assorted others) pooled snacks and food and hung out with some good music (I knew bringing my portable speakers was worth it). I got a bit of sleep before getting up to start my own shift.
So now Wednesday am and I'm on my way to the tent city for the day. We plan to go to the airport Thursday a.m. and hop on any outgoing flight. Apparently there are military transports leaving every three hours to somewhere and we have to get on one first come first serve.
Thursday, Jan. 28
Another 30 hours gone.
Wednesday was an incredible day. At 9:00, Kate (a Nova PA student, also a Spartan), Lee (a Family Practice doc from Portland, OR) and I headed for the tent city laden with supplies. We each carried full hiking packs full of medicines and supplies (80% Portland, OR, and 20% HC hospital) and also candies, water and extra change of clothing (when you see the pictures, you'll understand).
As we were walking up to our clinic tent we could see the line of a couple hundred of people who were waiting in the already hot sun to be seen by us. Our arrival was greeted joyously by the wonderful Adventist group out of New York. We were able to set up a pretty good system based out of our main tent. Inside tent #1, there were seven school desks against the wall which would be our desks. Each had a box of gloves, thermometer, penlight, small 2x2 inch pieces of paper (to be used as prescriptions) and a pen.
Seven university students who no longer had a school (as we were sitting in the destroyed remains and the tent city covered the remainder of the grounds) were there to act as translators. Mine was named Emmanuel. He is 26 and had been two weeks away from graduating with a law degree from the university. Now there are no records and he does not know what he's going to do.
Across from us stood seven desks which would be our exam tables. On the other side of the tent was our dispensary and pharmacy. We would write prescriptions and then they would wait in line where two nurses were doling out medicines mostly for pain and antibiotics, but also blood pressure medicines, wound care, asthma meds, diabetic meds, skin crèmes, vitamins, diapers and formula.
As we began to see patients, I grew suspicious of a possible outbreak as four or five children in a row all had cough and fevers to 101.8. I soon learned two very important things. First, everyone has a cough which I suspect is secondary to all the destroyed masonry and concrete, (akin to 9/11 pneumonitis). Secondly I learned the right way to take an armpit temperature with a mercury thermometer (something I have not used since I was five and my kids won't know what one is). It was 101.8 in our tent, and the kids were fine. I asked why we were in a shadeless courtyard instead of some large nearby shaded areas under overhangs and was told that the Haitians would not come into the tent under a building because they are so fearful of aftershocks.
We continued to see patients for nine hours until closing at 5. If you think it's strange that a surgeon is running an urgent care clinic, keep in mind that the station on my left had a PA student, and the stations on my left had a dentist and then a foot surgeon. At one point when the heat got so bad, a couple of people set up shop outside, including a few hour stint by our interventional radiologist, Mike Rush, and his son Tommy, a medical student. Lack of training or experience did not stop us from seeing over 600 patients. I estimate that at least 50 percent had no discernable problem but were merely hungry, scared and looking for comfort. To these people, we offered what we could. Kids who landed at my station got Jolly Ranchers or Tic-Tacs, and I was rewarded with lots of smiles.
The majority of problems that we could help with were respiratory infections, asthma, urinary infection, yeast infections, scabies, and aches and pains from untreated injuries. We had diapers as many people had not had access to fresh diapers for over a week. There was a lot of breastfeeding education as well. Haitian culture has not embraced breastfeeding, and even worse, many moms who had been nursing chose to stop after the earthquake for reasons I have been unable to understand fully. It seems it might be related to their religious beliefs.
Among the surgical things I saw were dozens of umbilical hernias in older kids (in the US we routinely fix them in all kids if they don't close by age four) and tons of fresh and infected wounds. Our foot surgeon is a ulcer/wound specialist so that came in very handy. She was able to start a wound clinic in one corner of our tent. I saw a couple of large inguinal hernias, and innumerable skin lesions, unfortunately, none were emergent enough to take back to the hospital with me. (And of course I forgot to bring my business cards :) ).
Finally at 5, dripping in sweat, and after giving our two volunteer translators some cash to take back to their families, Kate and I trudged with our empty backpacks back to the hospital. Empty backpacks, but full hearts as we finally felt like we had really done some good for the people who are suffering so badly yet deal with it so bravely, smiling and helping each other.
Imagine our surprise when we got back to the warm smells of Chinese food. Our new friends from Portland had neglected to tell us that their Chinese American medical relief society is also a vegan group and during the day, additional members had brought in food and equipment and cooked enough vegan food for every employee, volunteer, and 1 meal per refugee family. I will remember that meal for a long time, especially after one of our translators had managed to obtain a dozen bottles of Guinness ale. Their goal is to be up and running and cooking enough food for the entire hospital compound by Friday.
During the day we were gone, another group had built an entire new building approximately 15 feet by 15 feet which will house water purification and treatment equipment to provide clean purified water throughout the hospital.
Many of the staff including the Holy Cross team were leaving Thursday morning to go back home, so Wednesday night we all pooled our supplies and had something of a last night campfire (we had French military ration kits which had solid sterno tabs for fire). It was at about this point that I realized I wasn't ready to leave Haiti. I finally felt like I had done some real good instead of just being a tourist who used his scrubs and stethoscope to come to Haiti and gawk. I decided I needed to stay another day and keep up the work. After a call to my wife (did I mention how wonderful she is), I told the HCH group I was going to stay. Kate, the PA student decided to remain as well.
Because I was staying and they were leaving, they did the night shift while I slept five hours. At as I went to sleep at the end of the third day, I was pleased except for that faint nag because I still had not had the chance to do any surgery. Now, the inside of a Haitian belly looks the same as the inside of an American belly, but I came here as a surgeon. There had been a rumor of a possible bowel obstruction in the camp but a surgeon had seen it earlier in the day and decided it was stable. I woke up at 5:30 Thursday to see the team off. I enjoyed a gorgeous Caribbean sunrise over the harbor (which we found out we could see if we climbed to the roof).
I also discovered that the bowel obstruction had worsened overnight and now needed to be operated on. A general surgeon from Georgia, Samuel Harden, had arrived Wednesday and he and I went to get the patient ready for surgery. I was very pleased that I was finally going to able to do what I came here for.
Now my first task was to find a fresh pair of scrubs. Every team that comes brings scrubs which they contribute to a communal box of scrub tops and pants. There is a laundry team that has been cleaning the scrubs by hand so they are as clean as they are going to get. So by fresh, I mean, less dirty than the pair I had been wearing for about 24 hours. I went over dozens of used dirty scrubs in every shape and color until I came up with a San Diego green top and Chicago blue bottoms.
My next task was to evaluate the OR and the equipment we would have to perform major laparotomy a daunting task to say the least. They have one sterilizing machine, and I was able to pull together a mish-mosh of tools although we rarely had matching pairs of items. We were able to get cautery but not suction. We were lucky to have a new Anesthesia team from Rush University in Chicago and they did a great job. While many have heard stories of amputations being done without anesthetic, abdominal surgery without general or epidural anesthesia is a whole nother ball game.
There is a surgical mantra that, "the sun should never set on a bowel obstruction". This is because the longer you wait the worse it tends to be and tougher the operation will be. This should now be changed to, "the sun should never set on a bowel obstruction...except in Haiti". We ended up operating about 12-15 hours later than we should have, but thankfully were able to perform it successfully and get her to the recovery room without complications. Many thanks to Kate, who became the defacto scrub nurse because the 2 nurses helping us were regular floor nurses who had never been in an OR.
Full of enthusiasm following our successful operation, Dr. Harden and I toured the compound stopping at every area inquiring about belly pain, but alas we could find nothing to cut. We headed across the road to the clinic which had received all the Holy Cross supplies and found about fifty people lined up out the door and five docs (three from Rush, and two from Portland) working tirelessly. I headed back to the hospital to sleep because I had volunteered to take the night shift knowing that I'm going home in the am.
My last little highlight of the day was when a U.N. truck arrived with supplies and I got to take pictures with the Sri Lankan Special Forces Paratroopers who looked like the fiercest warriors on the planet. Needless to say, I've met and interacted with a more diverse group of people in the past four days than any other time in my life.
I'm now off to bed for a couple of hours till the night shift, then I have to pack. I found a ride to the airport for Kate and I at 6 a.m. Luckily, I don't have much to pack. My scrubs and socks stay here to be used by other medical teams. I've given away any remaining food to the Haitians, and I promised my sleeping bag, flashlights, and my second duffel bag to one of the translators I have befriended whose family is now homeless.
Thanks for all your warm wishes. If all goes according to plan, I should be in American airspace early Friday morning.
Saturday, Jan. 30
It is Saturday Night and I finally have a chance to sit down and go over the last 24 hours of my odyssey, before finally making it home to my family. My last shift in the hospital was relatively quiet except for the seven babies born, two by cesarean section. Thankfully, the director of the hospital is an Ob-Gyn and was in house, because I haven't caught a baby since my med school rotation eight years prior. I only had to cover from 10 p.m. to 4 a.m. because two additional physicians had arrived that day and were taking the shifts before and after.
The night went very slowly. I think the anticipation of finally leaving and getting on a plane kept me up even after my shift ended. I tried to sleep from 4 to 6 a.m. but eventually just got up, packed, and then went on the roof to catch one last Caribbean sunrise. Tons of thought were going through my head, mainly sadness for these people. Even with the thousands of volunteers and millions (billions?) of dollars that are going to come into this country, it seems an insurmountable task. Food, water, and medical care will eventually trickle down to the Haitians over the next few weeks, I have no doubt. But then what. There is no government, no functioning civil service, no natural resources, no infrastructure, rainy season coming, dare I say no hope?.
The amazing thing I guess is that the Haitians themselves don't seem to be daunted. They appear at first glance to be a hardy, spiritual, and resilient people, yet I wonder if that is just based on ignorance of how bad the situation really is long term.
At 6:30, Kate, Joe (A Loma-Linda Med School student), and I went with our bags (as I mentioned I now had one mostly empty bag instead of two stuffed ones) to the front gate of the hospital where Mimi (an orthopedic surgeon from LA staying up the road but working in the hospital with us) was waiting with a truck she had arranged to take us to the airport. The early morning drive was a little different than the mid-afternoon one although the route was the same. There was alot of activity on the street, lines of people already formed at western unions and banks where people were waiting to receive cash from abroad, open markets selling produce brought in from countryside, lines of buses which we were told were giving free rides out of the city twice a day in line with the plan to clear out the capital. The buses were mostly empty. I think by now anybody with family in the country has already mostly left for greener pastures.
The airport seemed pretty empty. There was a strong US military and federal customs presence. We flashed our passports and were taken quickly through an x-ray machine with Haitian security (Not sure what they were looking for as they ignored both my pocketknives and the guy behind me's shotgun which he had hidden in a violin case for his security). We went through to the tarmac and consular officials made us sign a form stating that we would be willing to pay the fair market value of a 1 way ticket from Haiti to whatever destination in exchange for being allowed to depart on a military transport. Not really sure what the going rate is, but that didn't really matter.
From about 7:30 until 11:30 a.m., we were herded into a large tent given water, and some snacks. We were given numbered bracelets (I was 56). Planes were already coming and going. I saw Bolivian, Brazilian, Russian, and USA(Delta, Suncountry, and Ari Force) planes. They couldn't give us any information, so we just sat and waited. Anderson Cooper and Sanjay Gupta were spotted about 20 feet away in an apparent VIP area. Mimi is a huge Sanjay fan, so we convinced the guards to let us out, ran over to him and took a picture. (I'm pretty sure they had a chartered jet; Didn’t see them on our flight :-)
Finally at 11:30, everyone seemed to get up and we walked behind a C-17 Air Force cargo jet towards the back ramp. They had us leave our bags at the entrance, one last passport confirmation and then up the ramp where we were placed in rows 8 across and then given blanket and pillow and sat on the cold metal floor of the plane for takeoff. Everyone was giddy and smiling and I think for the most part just happy to have gotten on a plane. They told us Orlando was our destination so I quickly texted Abby to look into auto rentals from Orlando to home.
The plane ride itself was sort of surreal. Taking off lying down holding onto a cargo strap made us think of those NASA shots of the space shuttle. The ride itself was uneventful and we got off in Sanford to a heroes welcome. Customs agent quickly got us through and then red cross volunteers had taken over the baggage claim area and were giving away food, drinks, medical help and travel arrangement help. It is amazing to think these volunteers must be on standby and get mobilized once or twice a day to help the offloading relief volunteers. It went far and above the call and I think we were all a little embarrassed to be receiving help we didn't think we deserved after so many days of just giving. They offered bus rides to Orlando airport about 30 miles away. Thankfully Hertz had a car ready and Joe, Kate and I were soon on the road heading for home.
You typically hear things like, "this will be a life changing experience", or ,"You'll never be the same again". I can't speak to any of that while it is so fresh, but I can come up with a few conclusions. The first is that going to do third world medicine is definitely addicting. Taking a few days off from Co-pays, Insurances, and hospital politics to step back and remember exactly why I trained to do what I do, and be able to just give of yourself and help people is intoxicating. I met a man who shut down his practice the year his last child went to college and now he does six months a year of locum tenems (part-time doctoring) to pay the bills and then six months a year of medical missionary work. He goes all over the world and will spend a month at a time in Africa, Southern Asia, South and Central America operating. While I don't see myself going to this extreme, I will definitely be doing something like this again.
Additionally, Haiti is going to need our help for a very long time. Even as they exit from this acute phase of the tragedy, there will be opportunities to help them for years to come. As many of the international relief efforts slow down in the coming weeks, the need for American assistance will be even more paramount. Before leaving, I spoke to the leaders of the two major Adventist groups that we worked with and I will meet with hospital personnel this week. We will be sending more trips and my plan is to sponsor the next one with the money we raised prior to me leaving (at last count about $6-7,000).
Signing off for now.
Thanks to all of you for all of your support and for following me on my journey.
Click here to read about Dr. Ruben Cohen ‘97’s Haiti medical relief experience.