This letter was written by David, a fellow volunteer with Project Medishare. Due to funding cuts, the woman who was responsible for cleaning the pediatric ward, including the NICU, was recently let go. Following her termination there has been a drastic increase in the mortality rate in the NICU, many babies dying from sepsis. We are hoping that we can raise the funds to cover her salary, a mere $350 a month. David wrote this letter to the National Association of Neonatal Nurses asking for their help...
I'm sending you this letter because of a trip I
recently took over Christmas to volunteer at a hospital in
Port-au-Prince, Haiti. It was my first such experience volunteering
internationally as a nurse, and I had little idea of what was in store
for me on my trip. I volunteered with Project Medishare, a group founded
by physicians at the University of Miami. Immediately after the 2010
earthquake, they established a permanent hospital in the middle of Cite
Militaire, an impoverished neighborhood in Port-au-Prince. Together with
MSF and a paltry few remaining government-run hospitals, they are
responsible for the acute care of an estimated 3.7 million Haitian
people, up to a quarter of which are still displaced, living in tents
and other makeshift structures. I want to share with you the story of
our experience the week we arrived:
Day 1: A rotation in pediatrics. Understand that I
am not a pediatric nurse. Aside from caring for some post-op BMTs and
T&As, my last interaction with an infant-to-school-aged population
was in nursing school. Lots of hydrocephalus. Shunts are intermittently
successful and surgical histories frequently hard to come by. Lots of
infection. Many children are orphaned; their parents don't return
because they are unable to care for them. The children here who do have
families are constantly attended to by them. Mothers are here 24 hours a
day, washing, feeding, and changing their children, sleeping upright in
folding chairs. The NICU is separated from the peds ward by a doorless
doorjamb. The sound of monitors alarming proliferates the whole
building. There is one nurse for 4 babies. Surfactant, albumin, blood
products (aside from whole blood) do not exist here. Blood cultures do
not exist here. Gram staining is available if a source of infection can
be isolated. 1 of the 4 hospital ventilators is in use currently for a
neonate with pneumonia. There are a pair of twins here of unknown
gestational age. They are approximately 1.7 kg each. This is their
second day here. Their mother is in another hospital with unknown
complications from birth. We have no pregnancy history or birth history
for them. They are febrile but stable and being treated empirically with
antibiotics. There is one final neonate in a fourth incubator who
appears to be nearing what would be his term weight.
Day 2: I have spent the day in Triage/ER and am
ending my shift quite late around 11:30 pm. I am on the roof to get some
fresh air and hoping to catch a wireless internet signal to send a
message home when I hear and respond to a code in the NICU. I arrive to
find that the second twin who had been in respiratory distress earlier
that evening is in and out of a pulseless rhythm. There is an ICU
doctor, a pediatric nurse practitioner, a Haitian RN, an American EMT
and myself. Already on a dopamine drip, he is intubated and given an
epinephrine bolus after which he retains a poorly perfusing sinus rhythm
of around 100 bpm. It is 1 AM and I have at least 6 mosquito bites
during the last hour alone. I can see 4 mosquitos flying over the
incubator and over my head. Over the next 2 1/2 hours we tried more
fluid and epinephrine boluses, adjustments to dopamine and a levophed
drip, and eventually an epinephrine drip to stabilize his heart rate and
blood pressure. His antibiotic regimen had been adjusted once due to
his poor response to therapy, but without being able to fully assess the
source and location of his infection we were largely left to guessing.
At 3:30 AM having been unable to improve upon a pulse rate of 90 and a
blood pressure of 36/16, with no further interventions left to consider,
we had no choice but to allow him to rest peacefully on the ventilator
until time made the ultimate determination of his fate.
Day 3: I awoke at 8 AM to learn that twin #2 had
passed around 6 that morning to join his brother who had died the
previous day, approximately 6 hours before our code. His decline had
been nearly identical. The premie with pneumonia passed today as well.
The last neonate graduated from his incubator to a nursery bed, his
mother beaming. The children in peds who are well enough (a boy with
septic arthritis who has been there all week, some kids from the spinal
cord unit upstairs) are outside playing and ask about all the noise last
night in the NICU. We tell them about how we are taking care of very
sick babies, but they know the real truth as they have seen it before.
Curious parents who speak English do the same but in hushed voices.
Day 4: Today is Christmas Day. My peds assignments
are over, but I learn from others that more neonates in the NICU have
died from unspecified presumed infectious causes. Someone has found a
Santa costume and Santa visits the pediatric ward with candy canes and
little presents. The mood is infectious and everyone is smiling and
laughing. Anyone who has the day off is tasked with completely
evacuating the NICU of all equipment and scouring every inch of the
place.
We will never know the definitive reason why so many
neonates have been unsuccessful in the NICU over the past month, but
the loss of the staff that is responsible for cleaning the NICU is at
the top of our suspicions. L'Hopital Bernard Mevs is the only hospital in Haiti that has functional ventilators, and as such is the only NICU/PICU.
Post-earthquake relief funding has all but dried up, and indeed the
hospital lost most of its international funding requiring them to cut
their budget and lay off 2/3 of the Haitian staff that had been
responsible for running the hospital. The NICU is cluttered and swarming
with mosquitos. It is all that the Haitian nursing staff can do but to
keep up with an inconsistent and often overwhelming patient census.
While the NICU had a dedicated housekeeper it enjoyed a much higher
success rate. This woman's salary was estimated to be $350/month. We are
looking for an organization or a group of people who are willing to
sponsor part or all of her salary for a designated period of time.
Even if the NANN is unable to undertake this amount
by itself, I would encourage you to share this story with others who
might be in a position to help. I am certain that with little
bureaucracy photos and updates could be shared with a sponsor.
