Mission Haiti.. Project Change Bermuda and Feed My Lambs

Time To Hand Over The Baton. Another Team Arrives, As We Depart..

2010-01-31T14:49:00.000-08:00

Montrouis, Haiti. January 31, 2010

No doubt this will be the last installment written in Haiti for this mission. We are schedule to be flown out of Port aux Prince by Mark Byrne of Longtail Aviation and Flagstone Re. It is time to say Au Revoir to Haiti; yes, until we meet again. On the drive to town, it was apparent that the earthquake did not crush the will of worshipers to gather for Sunday services. Many churches have been decimated, forces services outside. Churches are not only places of worship in Haiti, the compounds also serve as living quarters for the members. I visited one church this morning and several of their parish members died in the melee of the earthquake. This church held their service under a canopy made out of an army parachute. This is also were the congregation sleeps at night. The Pastor defiantly reassured me that they would rebuild but he confessed that he did not know from where the money would come. Haitians are simply not built to break. If I was a betting man, I would place my money on this preacher and Haiti to overcome any obstacles.

We completed a total of 115 surgeries with today's procedures. Unfortunately, there are so many patients that require procedures and ongoing care. We are now tasked with staffing and securing funding for this lonely outpost of a clinic. Again. If "faith the size of a mustard seed can move mountains" I would wager that Phillip Rego and his Ministry will be providing excellent medical care to the needy for a very long time. For the moment, this weary surgeon and his team will have to be rotated to the back of the battle field. We will eternally grateful for the steadfast dedication, work ethic, and love the surgical gave without hesitation. Dr Alicia Stovell-Washington worked tirelessly and seemingly effortlessly, often outside of her field of training. For this she is deserving of a medal of honour or the Bermuda equivalent. Our surgical technicians were no less impressive in their devotion, sacrifice, and tenacious will to achieve our goal of providing world-class surgery to these humble Haitians in their hour of need. We would also like to extend a debt gratitude to Lois Wilson and Dianne Flood who, from Bermuda planned, worried, and willed us through this mission through their words on encouragement and their deeds. We would also like to thank Dr Stanley James and the EMTs (Erin Lovell and David Foley), who participated in the mission. Additionally, the two surgical techs - Derrick McLin and Derrick Washington.
Their contribution will not be easily forgotten. Finally, this mission would not be possible were it not for the vision, sweat, blood, and tears of the beknighted Phillip Rego. This is a humble man who performs noble acts with the stealth of a "thief in the middle of the night.". He represents the best that Bermuda can be and we are proud to have shared this pivotal moment in the history of Haiti with him. We leave in the knowledge that Haiti will survive and thrive. We are taking with us some life altering lessons on dignity in the face of overwhelming despair and triumph on the precipice of crushing defeat. We leave a part of heart here with the promise that we return and continue the work that we have started. Au Revoir, Au Revoir Haiti: Until we next meet.

Dr. Christopher Johnson

The Contrast...

2010-01-31T13:52:00.000-08:00

Dusk at Montrouis. The mission is now over. 115 surgeries completed. This is a picture of contrast: There is a fisherman close to the shore and an aircraft carrier in the background.

What To Do With The Dead? (So many...)

2010-01-31T13:37:00.000-08:00

Site of mass graves for victims of the earthquake. Located just north of Port aux Prince.

Missing Parishioners... II

2010-01-31T13:35:00.000-08:00

Missing Parishioners...

2010-01-31T13:32:00.000-08:00

Church service was held for this congregation under a parachute made into a tent. Many of the parishioners were killed during the quake. The Minister plans to rebuild but he does not know where they will get the money.

103 Operations...

2010-01-30T16:39:00.000-08:00

Bon Repos, Haiti. January 30th, 2010

Today we operated on 6 patients bringing our total number of surgical procedures performed during this mission to 103. We treated a 5 year old with 2nd degree burns of the abdomen. She fell into an open fire whilst playing. Her mother and 3 other siblings have been living in a car since the earthquake. Our unsuspecting patient fell into a fire used for cooking. The mother was hungry, exhausted, and nursing an infant of 2-3 months in age. We had purchased rice, onions, and noodles for our lunch but these were quickly passed on to this family that needed sustenance more than we did. (See photos below..)

Our clinic ended early and I took a motorcycle ride to the center of town. As I moved closer to the epicenter, I felt as though I was descending into Dante's circles of hell and suffering. The excessive magnitude of the earthquake is underscored in the accordion-like toppling of multistory buildings. Whilst the world has seen the front of the Presidential palace with its fallen domes and collapsed central roof, few have seen the back of the palace which looks as though an enormous machete simple surgically sliced off the posterior walls. You look into the offices as one would a doll house that has missing walls. The number of shattered buildings is overwhelming and I did not realise how affected I was until I felt moisture on my cheeks, which much to my surprise proved to be tears.

In the vicinity of the Presidential Palace are tent cities set up in the Parks, known as the Champs de Mars. If Port aux Prince is Dante's Inferno then the tents cities are incarnations of his Purgatory. The people are calm though visible worn by either trauma or hunger or perhaps both. This notion that we need security is simply ludicrous. There is order, as can be seen with the vendors, port-o-potties, and areas to wash. Statues of the heroes of the independence movement of Haiti (Henri Christophe, Jean Jacques Desaline,Pontion) loom high above the tent cities; they appear like shepherds mourning over troubled flocks.

Dante's final canto in the Divine Comedy is Paradise. Though it is imagine that anything other than despair could exist at the Heart of Darkness of this earthquake;I can say I found hope in the smiles of children playing in the tent city. I saw expectations for better times every time I heard someone shout God Bless America to a US Soldier. This moment, this tranquility, this honeymoon period will not last forever nor is it unconditional. Haiti will need partnerships in rebuilding for a long time and we shall all be held accountable. When CNN, the BBC, FOX News all turn their attention to some more newsworthy event: Haitians will still be caught somewhere between the Inferno or Purgatory, unless the world take this on as long term project similar to the Marshall Plan that rebuilt Europe after WW II.

Palace Destroyed...

2010-01-30T16:35:00.000-08:00

The front of the Presidential Palace.

Destroyed Market...

2010-01-30T16:33:00.001-08:00

The Destroyed Public Market- Hippolyte of Port aux Prince.

Bus Trapped...

2010-01-30T16:29:00.000-08:00

Bus trapped under the destroyed Nursing School of Port aux Prince.

Vendor hawking medicines outside of tent city today.

2010-01-30T10:17:00.000-08:00

Burn Victim (Follow)

2010-01-30T10:16:00.001-08:00

5 year old with burns of the abdomen.

First The Quake - Now Fire..

2010-01-30T09:18:00.001-08:00

5 year old girl fell in a fire whilst playing yesterday. She presented to our clinic with second degree abdominal burns. The patients, her mother, and three other children have been living in a car since the quake. They have barely eaten.

The People Are My Heroes...

2010-01-29T16:55:00.000-08:00

Montrouis, Haiti. January 29th, 2010

Les Mise'rable

For prophetic or perhaps poetic irony, the theme song from the popular musical Les Mise'rable was playing on the sound system of our hotel as we returned from our clinic in Port aux Prince. The backdrop of Les Mise'rable is the French Revolution; noted for starving people rioting in the streets of Paris. While we have not experienced rioting we still get reports that many people have not received food since the earthquake. Mr Rego's Ministry "Feed My Lambs" hands out care packages of rice and beans to the patients who attend our clinic. This is strong medicine that complements the surgery and drugs that we doctors administer. Many of the people who receive this support from Mr Rego and his ministry probably do not know who or where this vital help comes from. No doubt that he because it is given freely, without strings attached or paperwork. The dignity of the needy recipient is preserved and these quiet acts of selfless giving are done subtly without fanfare. I am honoured to be a witness to this ministry and I can say that Mr Rego is a role model for what philanthropy should really be.

Our team has completed over 97 surgeries and procedures. We continue ti receive fresh casualties from the earthquake and our battle seems to be lost and won on a minute to minute basis. There is no predicting what might come through the door but my surgical team always rises to the challenge. A young woman came in with a fever to 103.9 and an infected scalp abscess. She required minute to minute care whilst other patients were also being treated. Multitasking is an underwhelming description of what is required of these surgical techs and surgeons. They too approach their craft and duties with a quiet but tenacious conviction and watching this theatre of survival and healing leaves one in awe.

The title Les Mise'rable has been variously translated as "The Wretched, The Poor,The Victims, The Damned, or The Miserable Ones.". The doctor, the author can state without hesitation that this description would not apply to the people of Haiti. Haitian are a proud people who despite this present challenge manage to survive, dream, laugh,and share what little they have with a stranger. For 1 week, I have had the pleasure of watching these people patiently queue for medical care, push their sickest and most vulnerable to the front of the line for treatment, and accept amputations without weeping and wailing. These people are made of some resilient substance the strength of which I have never seen before. The people of Haiti are my heroes and I will always save a special place in my heart for them.

Front the front lines of the battle,
Cj

97 Surgeries And Counting...

2010-01-29T15:07:00.001-08:00

We have to date completed 97 surgeries. Patients with untreated earthquake-related fractures and wounds continue to present to our clinic.

Photo:
Children waiting to be seen today at our clinic. Some have not received medical care since the earthquake. Others require follow up.

4 year old with untreated femur fracture. We were joined by Dr Greg Saunders, general surgeon of Coquille Oregon.

2010-01-29T15:05:00.001-08:00

Child with broken femur now in body cast.

2010-01-29T15:03:00.001-08:00

Paradise Lost or Paradise Won?

2010-01-29T05:41:00.000-08:00

Montrouis, Haiti January 28, 2010

I must confess that the sunset over Haiti this evening was perhaps one of the most sumptuous and beautiful natural wonders that I have ever witnessed. One could easily be persuaded that this is paradise. The reality on the ground is starkly different. We continue to perform surgeries and offer continuing care to patients who have infected wounds from living in the tent camps. Even in a crisis, "bread and butter" surgical disease still presents. We have a woman with a suspicious breast lump who will require a biopsy and pathology analysis. We will perform the biopsy and transport it back to Bermuda for analysis. Another gentleman presented with seizures because he has not taken his medicine since the the earthquake. These patients need thoughtful and seem less continuity in their medical care. I observed a woman picking up grains of rice from the dirt around our clinic where our cook had opened a bag of rice. This was a sad and poignant reminder of how truly blessed we are. My sense is that most people go to bed a bit hungry and underfed. We are so used to eating until we are full and/or stuffed each day, often leaving uneaten food on our plates. Life is so different in this paradise that has loss so much to natural disaster, corruption, poverty, and indifference.
Christopher L. Johnson, MD, MSc, FACS

Armed UN Troops Patrol The Streets

2010-01-28T13:56:00.000-08:00

Armed UN soldiers in traffic just outside of Port aux Prince. I had to take this surreptitiously.

Christopher L. Johnson, MD, MSc, FACS

Was A Young Boy Shot By UN Soldier Today? (Unconfirmed Reports)

2010-01-27T19:58:00.000-08:00

* Unconfirmed Report*

Our Medicin Sans Frontiers chopper pilot friends tell us that an 8 year old Haitian boy was shot in the chest twice by a UN soldier today. His alleged crime was stealing food from a UN convoy. He was stable and flown to the DR for medical care. We have no way to confirm this story but we are aware that many UN soldiers are armed with live ammunition. I did pass a UN convoy coming from the north and they were heavily armed with pistols and machine guns. If this story is true, it is an inappropriate show of force. We have not experienced any threats to our volunteers, many of whom have roamed through Port aux Prince, including its tent cities, without security. Our field of view is limited however as we are on the periphery of the city. Many earthquake survivors do relate that they are underfed but I do not sense that they are riotous or on the brink of insurrection. We feel quite sage at the moment though we are vigilant in monitoring the situation. We will keep you informed if this situation should change.
Christopher L. Johnson, MD, MSc, FACS

22 Procedures Today

2010-01-27T16:12:00.000-08:00

January 27th, 2010. Bon Repos, Haiti

22 procedures were performed today bringing our total number of surgeries to 70 procedures. I write to you from the from seat of a "Tap Tap" the traditional open air truck that the locals pack themselves in for transport. Our van went to the frontier to collect badly needed supplies that were routed via the Dominican Republic. Our work day was busy and the air in our makeshift operating rooms was thick with humidity and flies. So many of patients require daily debridements of deeply infected neglected wounds. One child, an 8 year old boy posed a particular challenge to us. He presented yesterday with fever and what appeared to be an infected compound fracture of the right foot. He was treated with drainage of the infection and intravenous antibiotics. This child came in again with high fever to 103. Tylenol, further wound drainage, alcohol bath, and IV fluids did not touch this child's high temperature. He appeared to have no symptoms: no cough, no headache, no abdominal, no neck stiffness, etc. Consultation with internist Dr James was undertaken and a diagnosis of acute malaria exacerbation was entertained. Please understand, we have no working lab upon which to confirm our diagnosis. We only have our hands, stethoscopes, thermometer, education, and our hearts. Fortunately after several hours the fever broke and we heaved a great sigh: realizing one the one hand the poverty of our abilities without our CT Scans, MRI's and other technologies and on the other hand the joy that something as simple as relieving the fever of a suffering child can bring in the midst of this tremblement de la terre (French for earthquake). We are so blessed to be here and we continue to do what we can.

Chopper Lands...

2010-01-27T15:34:00.000-08:00

Helicopter parked on the lawn of our hotel. The pilots work with a French NGO and they ferry the sickest patients from Port aux Prince to the Dominican Republic.

Tent city near our clinic.

2010-01-27T15:33:00.001-08:00

So Many In Need of Care...

2010-01-27T05:43:00.001-08:00

Dr. Johnson attending to a young patient with a broken arm.

2010-01-27T05:43:00.000-08:00

- Typical building in the neighborhood of our clinic.

- A tent city in the vicinity of our clinic. Many of our patients are brought in from here.

Christopher L. Johnson, MD, MSc, FACS

Recovery Room is crowded. Two Patients To A Bed.

2010-01-27T05:34:00.001-08:00

Christopher L. Johnson, MD, MSc, FACS

Dr.Stovell-Washington preparing to drain an infected haematoma (blood clot) caused in the quake by blocks falling on the patients head.

2010-01-27T05:29:00.001-08:00

Crushed 5th finger in the boy of 3

2010-01-27T05:25:00.000-08:00

Young Boy Wth Crushed Finger

2010-01-27T05:18:00.000-08:00

2010-01-27T05:03:00.000-08:00

-Tech Derrick McLin Attending to a Patient and Family and Dr. Stovell-Washington Debriding a Leg Infection.

January 26, 2010 Bon Repos, Haiti

Yesterday proved to be very challenging. A young girl suffered a respiratory arrest after reduction of a humerous fracture reduction. Without oxygen, she required mouth to mouth resuscitation for 10 minutes and she recovered. This is "bush" medicine but we have to use the resources that we have. The patient returned today without any consequences but we are reminded that the technological advances of the past two decades can be substituted by common sense and ingenuity. My team performed 24 procedures and an additional 20 patients were evaluated. Surgeries consisted of finger amputations, wound debridements, setting of broken bones, and care for patients with severe back injuries. Our EMTs went to a local tent centre and returned with several patients, two of who were quite infected and in need of care. One young man with an infected foot fracture presented with a fever of 103. Despite antibiotics and surgical release of the pus, he continued to
be dangerously febrile. We instituted alcohol rub downs, Tylenol, and tender loving care. His fever abated and he was discharged. He will require close follow up and antibiotics. Two US Army Airborne Rangers arrived at our facility. They will provide security and logistical support for our zone. They agreed to assist us with supplies and they will be checking on us. We have been waiting for a supply chain to be organised and we have had to order the items that we require from Bermuda (KEMH has donated much of what we need) and the Dominican Republic. These guys were a wonderful site to behold because it also means that the soldiers can bring sick patients to us. The second wave of this calamity is overwhelming infections, diarrheal disease, and malnutrition. We are seeing a number of patients who were treated elsewhere but have had no followup. Several of these patients have post-operative infections and we will be seeing these patients on a
daily basis with leave a plan in place so that these patients will be seen by a physician after we leave. This is a long-term problem and placing a band aid on the problem will not be enough. I am in awe of our team. An Orthopaedic Surgeon from Walla Walla, Washington joined our group today. He came in with another charity but they had no plan or facility for him to use. He fit in beautifully with our team and we were able to provide more patients with care. On a more human note, the young boy with the crushed 5th finger that is seen below was ravenously hungry. The cook for the medical center had prepared a meal of rice, onion sauce, fried potatoes, and salad. I made a plate for him and his father. They ate but then they shared those two plates with all the other patients who had not eaten. This was done quietly with grace that we would not see in a disaster in our more affluent neighborhoods of Bermuda or the US. This act of kindness touched
my heart and taught me more about what we can do as humans than anything that I learned at Harvard Medical School.

2010-01-26T14:44:00.000-08:00

Dr Scott Hudson, orthopaedic specialist from Walla Walla, Washington, treating a necrotic foot wound in an elderly earthquake survivor. We recruited this doctor at our hotel-- he came in with another group that had no work for him. We prayed for an Ortho guy and we received an angel. He is a great guy and he fit into the team beautifully.

Christopher L. Johnson, MD, MSc, FACS

Dr. Stovell-Washington

2010-01-26T14:36:00.000-08:00

Dr Stovell-Washington treating a women with a earthquake related back injury

Outside the Medical Clinic in Bon Repos...

2010-01-26T14:23:00.000-08:00

David Foley, KEMH EMT, Phillip Rego Bermuda Humanitarian, and Lieutenant Sowa of US Army Airborne Rangers at the Medical Clinic in Bon Repos. They are part of an organised security and supply chain. Whew!!! Just in the nick of time.
(The other EMT is Marcus Gremli of Bermuda and Tobago..)

The Rangers Arrive...

2010-01-26T14:04:00.000-08:00

The US Army Airborne Rangers arrived today today at our clinic in Bon Repos. They will also assist us with supplies, security and transport patients Lieutenant Sowa and his Sargeant are part of a supply network that will make sure that we get additional supplies. KEMH has donated a number of supplies that will reach us via the Cornerstone Ministry Ministry of Bermuda. Our doctors performed 24 surgical procedures today under humid and overcast positions. We recruited an Orthopaedic surgeon from Walla Walla Washington who was instrumental in getting several fractures reduced and treated. His group came without a facility to work with and he was turned down by the major hospitals in Port aux Prince. Luckily for us, we found him at our hotel and gave him a battlefield promotion to run our ortho section. This underscores KEMH's recommendation that volunteers should only come as a member of an organised group with a facility on the ground here. Our KEMH EMT's went into the outlying community and located several patients, some septic with necrotic and purulent wounds. Some have been operated elsewhere but did not receive or participate in followup. One lady came in with an IV that had been placed a few days after the earthquake. Long term and short term followup for these patients must me part of the recovery plan. I am very proud of our Bermuda contingent who have displayed valour, camaraderie, and compassion. We are grateful to the folks back at home in Bermuda and particularly at KEMH who have shown such overwhelming support for what we are trying to do.

Young Man with Infected Foot and His Father

2010-01-26T13:28:00.001-08:00

Infected Foot Fracture

2010-01-26T13:24:00.000-08:00

Lack of Follow Up, May Cost Boy His Finger

2010-01-26T11:36:00.001-08:00

Same boy with infected finger. He was operated elsewhere but had no follow up. He now will lose the finger though I have order some special equipment from DR that may allow me to repair the bone.

Christopher L. Johnson, MD, MSc, FACS

Damaged Clinic

2010-01-26T08:23:00.001-08:00

Feed My Lambs supported Clinic in Bon Rebos on outskirts of Port aux Prince. Note damage to walls but clinic is otherwise intact.

Christopher L. Johnson, MD, MSc, FACS

Young Girl With Compound Fracture

2010-01-26T08:20:00.000-08:00

My Personal Thoughts...

2010-01-25T17:58:00.000-08:00

On a personal note: the people of Haiti are far from pitiful or pathetic. They are a resilient, stolid, and strong people. They cope despite natural and man made disasters that attempts to thwart their very existence. We, the more fortunate, would crumble under the weight of such subsistence. The patients queue in a relatively orderly and peaceful manner. They really triage the cases and the young sick children are brought to the front without a problem. They are extremely sensitive to medications as most of them have not been exposed to Tylenol, ibuprofen, or other painkillers and anaesthetics. We are well stocked on local anaesthetics and sedatives/narcotics: so there are no "CNN torture chamber moments" where operations take place with anaesthesia on screaming patients. The macabre images of surgeons operating on patients with local or painkillers shocked me into action. KEMH donated a number of these medications--thanks to Dr. Donald Thomas, the Chief of Staff. Sadly we are running out of other supplies, which appears to be the case for my colleagues who are working in the region. We need a central coordinated body to get us the additional supplies. This is not a money problem-- this is an organisational and distribution problem. We are in close communication with our regional UN director and she is sending a chopper to get what we need. The chopper pilots are staying at our hotel---we are lucky. In this age of technological advances, we should be able communicate rapidly and efficiently. Hopefully I will have good news on our supply issue tomorrow. In the meantime, we truly blessed that these people accept us in this wretched tragedy. Often, in Bermuda or US, we question whether we are truly needed or appreciated. While this dilemma will not be solved easily, I know that I am exactly where I am meant to be; that feeling is peaceful, overwhelming, and no one can take it away.
Christopher L. Johnson, MD, MSc, FACS

An Early Day... A Long Day...

2010-01-25T17:51:00.000-08:00

January 25, 2009 Montrouis, Haiti

It was the best of times, it was the worst of times. Our day started at 7 AM with an early breakfast. We loaded up our supplies and residents and took a 1 hour journey to Port-aux-Prince. The road was bumpy at times but it became very well paved and we arrived safely at our destination. In the main harbour, we could see a large aircraft carrier and a large Navy floating hospital. As we came closer to the capital, the devastation of the earthquake slowly emerged. We arrived at our clinic in Bon Rebos; some 200 people were waiting for us in the hot sun. We quickly set up 3 works stations for our physicians and techs: Dr. Stovell-Washington, Dr. Stanley James, and Dr. Christopher Johnson. We performed over 14 major surgeries and 24 medical patients were seen. We set compound fractures, amputated mangled fingers on a 3 year old, treated malaria exacerbations and diabetic complications. It was a long day but it was extraordinarily rewarding. The
people are incredible humble and noble. There are no signs of looting, rioting, or public disorder. The only guns that we have seen were in the hands of UN soldiers travelling in normal convoys. North of Port aux Prince the country appears to be functioning. Children went to school, open air markets bustled, and their is a air of calm and quiet surrender to this calamity. The team is strong and Phillip Rego is to be commended for the organisational foundation that he has laid for us. The people clearly trust him and know him well. We are reminded why we went into medicine. There is so much more today and a greatest challenge is supplies. We have made contact we our local UN regional leader and she has agreed to assist us with obtaining the additional supplies we need. More tomorrow
Christopher L. Johnson, MD, MSc, FACS

Our Arrival...

2010-01-25T17:47:00.001-08:00

Our medical team of 10 arrived in Cap Hatien at 11 AM today. Our Pilot, Mark Byrne is also the Chairman of Flagstone Reinsurance landing us safely in this Northern city of Haiti. Flagstone and Longtail Aviation donated the plane which took us directly from Bermuda to Haiti. We were accompanied by the CEO of BGA, John Tomlinson, whose company generously donated over 10,000$ of medications for the mission. The landing was uneventful without any delay and we undertook a 6 hour bus journey just outside Port aux Prince. Our journey was punctuated by numerous funeral processions that reminded us of New Orleans, with brass bands followed by a throng of mourners. Suprisingly, in northern Haiti it appears to be business as usual. Shops are open, church goers thronged the streets in their Sunday best. Vendors hawk sugar cane, roasted plantains, and other goods. As we came closer to Port aux Prince, it became clear that an exodus from the city was underway. We made it to our hotel without incident. Tomorrow we will begin our evaluation and treatment of patients at the clinic funded by Phillip Rego. We will perform head and neck surgery, eye surgery, extremity surgeries and anything else that we can safely undertake. We will also be assisting with an American College of Surgeons humanitarian medical mission in conjunction with a local medical charity, Partners in Health. We will keep you posted and email some digital images as well. Our work will begin tomorrow and we are excited to work with Mr Rego who is the glue that binds us together.
Christopher L. Johnson, MD, MSc, FACS