3/1/10 3:00 pm, Leonard Mason, MD
Finally, Team ISHI arrived in Miami beginning our trek to Haiti. Our mission was placed on hold numerous times due to scheduling conflicts by Medishare (the organization coordinating our arrival from Miami to Haiti) and delays in securing seats on a chartered plane to Haiti. By the way, we found out during check-in that our flight was delayed 3 more hours but by this time after multiple delays who cares! I was skeptical and disheartened at first (My wife, Marissa, could see the daily disappointment I had after the trip was cancelled 3 times). I think we will perform a good job in Haiti helping the disaster victims because we have the very best intentions. The team members are very sociable and personable so I think we will work well together. It may sound cliché but I want to help the unfortunate people of Haiti in the best way that I can: surgical management. Of course, it will be with the help of Dr. Bale.

3/2/10 Asha Bale, MD
We are at the tent hospital. It is extremely hot and humid. The conditions are difficult, but the more than one hundred volunteers are working great together and have a wonderful team spirit and attitude. There are volunteers from all over the world, all of whom are showing great enthusiasm!! This morning we all got our assignments. Dr. Mason and I decided to do triage, and helped to see over two hundred patients outside the compound gate. Yvette Jupiter, our scrub technician, scrubbed in for multiple surgeries, an exploratory laparotomy, an incarcerated hernia, and a ventriculoperitoneal shunt, to name a few. Nurse practitioner Cathy Blaskewicz and RN Emilia Wawszczyk did a great job seeing acute patients in the ER and triage areas. RNs Jhoselyn Catalina Riffo and Mona Nelson were assigned to med- surg and are caring for patients with a range of problems- everything from post-surgical issues, to dehydration, to pelvic fractures. We are also still seeing lots of pediatric patients with injuries related to the earthquake. RN Diana Eagen is in the ICU and Dr. Regevik is working all over, from the ER to the inpatient areas. It broke my heart to see a baby this morning who was brought into the ER by her grandmother because both her parents had died in the earthquake. There are so many stories like that. But the Haitian people are strong; and they are resilient. We are looking forward to the rest of the week.

3/2/10 Cathy Blaskewicz, Nurse Practitioner
Had a great day so far. So many needs here and so many grateful patients. Worked in the triage area and cared for 34 patients. Saw a lot of back pain, sleeplessness and general anxiety. Also saw much sicker folks, burns, wounds, etc. So much spirit among the Haitians, they know we're tying to help them. It's very, very hot, at least 95 in the sun. The giant tents have some cool air blowing into them, but it's little help. The workers are from all over the country and all have an interesting story of why they came to Haiti. My story is that ISHI was going and I hopped aboard. What a great opportunity for me

3/2/10 Leonard Mason, MD
Our day started at 7:30 am with an overall general orientation. We found out our assignments for the day and how the tent city functioned on a daily basis. Our base is separated into different wards: med-surg, ICUs, peds, ORs, eating area, and supply room. It's amazing how the tent city functions as a regular hospital but without all the amenities. I began the workday helping to triage over 200 patients then transitioning over to performing a Gastric ulcer repair with Dr. Bale. In between cases and seeing patients, I made a couple of friends specially a Haitian medical student named Nick who was helping out with the translations. He said that he was grateful for us helping the people and that he wanted to help serve his people in the same way after graduating. I have to say that I am feeling a plethora of mixed emotions from ecstatic to melancholy. I know we're doing a good job but what happens to the people we treated months from now. What will happen to Haiti years from now? I have had enough contemplating for the night. I will try to get some sleep on my little old cot. God I hope I don't have to use the bathroom tonight. I hate the Port-a- potty.

3/3/10 Jhoselyn Thomas RN ER
I am so grateful to be here. Being a nurse in one of the busiest hospitals of NJ (UMDNJ) has definitely helped my transition to working in the University of Miami Medishare hospital in Haiti. I feel that our nursing training is excellent. We are truly prepared for anything and if we are not we definitely know how to make it work putting the patient first. There have been many sad moments, especially when a 13 yr old boy walked up to me looked me in the eyes and asked me to adopt him. What can you do? I wish I could take him home with me, I wish I could take all of the people that have touched my heart home with me. But in a way I know I am, I know that our team (ISHI) has made their life a little better, has given them a glimpse of hope and a bit of light at the end of this long tunnel. As far as the boy all I could do was hug him, give him some food and cry my eyes out. But that's enough of that. ISHI is getting to be well known here and we all mention where our training comes from - UMD is the place to train if you want to be able to do anything anywhere no matter what you are given.
From Project Medishare hospital tent, sitting on top of hay and tons off cots and mosquito nets.
A happy ER nurse

3/3/2010 Mona Nelson, RN
Working the ICU in Haiti
I feel very for fortunate to work in a place like UMDNJ to allow me to take this trip with Dr. Bale and her team (ISHI). I left Haiti 20 years ago, and this was a reality check. We take things for granted in America. I had a 5 min orientation and then began working immediately. I received some type of report, and then begin running around crazily. The portable vents were beeping, and there were no respiratory therapy available. What do you? Figure it out!! Myself and the other nurses were the primary care providers. We had different types of pt with disease processes from MI to pedestrians involved in motor vehicle accidents. In the ICU, there are only five beds. The space between them is so limited that the nurses constantly bump into each other. Because supplies are limited, we have to be very resourceful. For example, one patient had a Foley urinary catheter, but no collection bags were available. We had to use an empty IV bag to tape to the Foley with a clamp. Normally, vasopressors are given with a pump however we made it work without one. The patient responded well to the treatment, and then was finally extubated successfully.

3/3/10 Emilia Wawsczyk, RN
Haiti is a place I definitely want to return to…I can't believe I didn't come here sooner…the last two days have been just incredible…I did not expect to feel so comfortable in my nursing shoes here…the people of Haiti are so grateful and so welcoming….they believe that we can cure any and every illness…a few patients today have come from many miles away, some drove for 10 hours to see if we can help them…..I guess I didn't realize that people would be coming here for reasons unrelated to the earthquake (DUH I know)….people still get sick, and people still need to deliver their babies (9 months of cooking is enough)….somehow word got out that we have a Neurosurgeon on board….and every neuro patient from the half of this Hispaniola Island decided to come on over….Today for the very first time I witnessed an exorcism…a lady came in, she was clearly having some psychotic episode…blank stare, throwing herself all over the stretcher…naturally and instinctively I called for 5 and 2….a term which we use in UMD ER quite frequently for patients who are acting this similar way…..we gave her this cocktail of vitamin H and vitamin A….and nothing….it didn't even touch her…I was quickly made aware by our translator that this is not a medical or psychiatric problem…this is the problem of the devil or the evil spirit that is now inside this woman….this made me kind of chuckle on the inside…a Haitian nurse came over, put the patient on her stomach and crossed her hands behind her back….and began to pray…. The woman was still throwing herself for a while….after which point she calmed down, got up and walked away…The Amazing Power of Prayer…..I prayed that night…before going to sleep….i found myself praying quite frequently before and after this trip…

3/3/10 Asha Bale, MD
In the hospital we have many translators- There are Haitian locals and speak English very well. They understand the cultural beliefs of the patients, so they are very helpful in not only translating, but also in helping us to understand what the patients expect and need. One of our translators is Nick, who was a medical student before the earthquake struck. Since his school was demolished, he has no classes. He works with us and we are happy to have him! Many of the translators themselves are homeless and live in tents. Everyone from the taxi drivers to the workers have lost family members in this tragedy. But all are trying to put the pieces back together- the attitude is that life goes on. There are moments of sadness and memory, but not all the time…
I think Haiti will need longterm help from international groups. The rubble from the earthquake is just starting to be cleared, but it will take a very long time. We drove around Port au Prince today, and it seems as if tens of thousands of people are living in tents. There will need to be some kind of plan for these people to be moved to more permanent housing.
Our team consists of nine volunteers- We have all done international work, but not in a disaster situation. Working outside of the US helps us to be able to think outside the box- to work with less resources than we are used to, and sometimes use our imagination to get the job done. The team is a seasoned bunch!
Some of the operations being done here include fracture fixations, skin grafts to wounds, abdominal surgery for ruptured intestines, abdominal surgery for rupture of a stomach ulcer, and hernia operations.- There are still some isolated incidents of violence and we have seen some stab wounds and gunshot wounds. We have also seen a baby who required placement of a shunt in the brain for water buildup in the brain ventricles. And so many more.
There are many infectious diseases that we are seeing and treating- typhoid being one of them. HIV disease is widely prevalent here also, as is malaria. The worry is that the rainy season may contribute to a breakout of more diseases like cholera and typhoid, which are directly related to food and water contamination and poor sanitation. The tents are made up of anything and everything one can find. Some are good tents that were distributed by relief agencies- but there were not enough. So people have used tarps, plastic sheets, cloth sheets and even pieces of junk sheet-metal that they found- all to create a shelter from the sun. It rained here yesterday and I started to worry because many of the shelters look like they would crumble with any sort of strong rain or wind.

3/4/10 Cathy Blaskewicz, Nurse Practitioner
UMDNJ has prepared us for anything. I work in triage, practically out on the airport tarmac, airplanes and helicopters landing right next to me. It's about 90-95 degrees. I'm seeing 35-40 patients a day. Most with back pain, body aches, acid reflux, hypertension headaches. The anxiety of living outside in the damp compounds everyone's illnesses. The patient's are so happy to have someone show concern and smile. In triage, our job is to weed out the really sick patients and send them to the ER. So far we've sent in a pneumothorax, multiple fractures, wounds, and those with severe dehydration. We have adults and babies lined up drinking Gatorade. So much anemia here, everyone goes home with vitamins with iron. I'm lining up surgeries for Dr Bale and Dr Mason. Huge hernias usually get turned away because they treat emergencies first. I tell them, wait a minute, I have a surgeon for you! Find me Dr Bale. ISHI ROCKS! We are getting a great reputation here. Everyone works so hard, so eager to help, so much kindness to share.

3/4/10 Jhoselyn Thomas RN
Today is Thursday morning and yesterday the lights were turned off at 10, It was an incredible day. Each day I am more and more amazed at the resilience of the wonderful people of Haiti. The culture is such a happy culture, they sing and pray and dance even though they have nothing, even though they have pain and have lost their family, friends and independence. I learned some Creole yesterday, everyone is willing to teach you their language. Everyone shares even though they don't have much. Every day there are these 2 guys that come around with guitar and keyboard in hand and sing to the patients and the staff, its very therapeutic and I think it helps them get through each day. I met a social worker yesterday who is staying with her family member in the med/surg tent. Shes originally from Boston but is staying with her aunt who lost everyone. She has been the advocate for all in need, she translates, finds them clothes and keeps the patients informed of their needs. She's not part of the Medishare group but she helps us anyways. Everyone on our team here is fine, no one is sick, thank God. I've been spending my days between the ER and the med/surg tent. My name here is Joseliene. If you were to compare what we are doing here its something like MASH on TV. Our training back in Newark has definitely prepared us for almost anything that comes through the door or should I say the Gates. I wish I could come back soon, but I definitely miss my family, my daughter and my hubbie.

3/4/2010 Mona Nelson, RN
Today was an interesting day in the ICU. I was kind of surprised by how things run. Even though it is tough since we have limited resources, we still manage the pt. I think OSHA would've been proud! We had to clean and reuse the equipment which in the US we would have discarded in the garbage. What makes me feel so good is that the family and patients are so grateful. I was moved by the stories that the patients told me- how they said they had given up on their loved ones, but then the care that they received at this hospital revived them. This place has some exceptional nurses, and I was so fortunate to have worked with them. Every place you go, you are going to meet people with different type of skills and personalities. There are many kinds: I worked with a super-nurse, the kind that you would want to take care of you if you were a patient- the one that doesn't take a break, and goes beyond her duties to make the pt comfortable, the kind that is so resourceful that she can work anywhere with limited supplies.

3/4/10 Yvette Jupiter, Surgical Technologist
My day began at 6am. I felt good and ready to start working. At 7:30 am we had an orientation, where we found out what the rules are and also what to expect. We were told that this would be different than what we were used to, and that at times it would be challenging. At 8:45 am we started in the OR. I did four cases. This day was a day to remember! But with my experience at UMDNJ, especially the trauma experience, I got to survive this day! I did a case with Dr. Bale and Dr. Mason, and three cases with a team from Chicago. Everyone works well as a team. The OR is different than the US- The OR table does not move, there are no OR spotlights, so we use headlights. Today the generator went out in the middle of the case so we used flashlights! Luckily, the anesthesia machine and ventilator continued to work, but the surgeons had to use flashlights until the electricity came back about 5 minutes later. We use less instruments, but the surgeons use whatever I give them! It is really a great experience. Everybody is so thankful and appreciative. I'm ready for tomorrow!

3/4/10 Asha Bale, MD
Today is Thursday and it has been busy. Dr. Mason and I went to the General Hospital in Port au Prince. They had hundreds of patients lined up to be seen by the doctors. Many patients are kept on cots in small tents, instead of inside the hospital building. Perhaps the structure is not completely stable. The local Haitian doctors are slowly taking back control of the hospital and the patient care. There are still international teams working in the ER and in the wards. There are much fewer resources there than in the US, so the work can be challenging at times. There are many patients with tuberculosis, and many with malaria. We are seeing some tropical diseases that we never see in the US, like typhoid fever.
When we were driving to the hospital we saw many of the buildings which collapsed during the earthquake. The rubble has not been cleaned yet. But life has returned to the streets- People are selling things like juices, and clothes and shoes by roadside stands. School has not opened since the earthquake, so children usually play during the day. There are tens of thousands of tents and makeshift homes- entire communities. Last night it rained, and they say the rainy season will start soon. People are worried about that, as the tents are not sturdy.

3/4/10 Leonard Mason, MD
Day 4…It was a long day yesterday. We received two patients from General Hospital located in downtown Port-au-Prince. I assisted Dr. Russ, a general surgeon with a private practice in Chicago, in exploring a patient who had an intra-abdominal abscess developing from stool that poured in his belly via his colostomy. His initial injury was a gunshot wound to the abdomen. He was transferred to our hospital because he was septic needing an operation. Our team drained his abscess, irrigated his abdomen thoroughly with saline, and then revised his colostomy so that it would drain appropriately into a bag. Within 24hrs, the patient was extubated successfully, and transferred from the SICU to the floor as his condition improved substantially. If not for the quick thinking from the doctors at General Hospital, he would have died slowly. Dr. Bale operated on a 20-year-old male who developed an ileal perforation secondary to typhoid enteritis. This disease is very rare in the U.S. however very prevalent in Haiti. One of the reasons why I'm excited I came is that I have had to learn to think outside the box. The diagnosis is not always clear. Acute localized right lower quadrant pain associated with fevers, chills, nausea, and vomiting is not always acute appendicitis. I do not know how many times I have had to look up certain diseases specific to Haitian population. Nevertheless, Dr. Bale repaired the perforation, and he is currently stable in the SICU.
Today, Dr. Bale and I decided to venture to the General Hospital in downtown Port-au-Prince where we received those two patients. We were able to see first hand the devastation caused by the earthquake. Multiple dwellings were leveled to the ground. Their capital, the Palace, is completely destroyed but they almost appear unfazed by the devastation. One of the translators lost his mother and three cousins, but you would never know that because he always was smiling and laughing. I really admired him for that because I don't know if I could be so emotionally strong so quickly. The Haitian doctors have resumed control of the hospital trying to let everyone know that we are here to help our own. In the end, it will be mainly the Haitian people that will overcome and rebuild their nation. From what I saw today, I think they are ready.

3/5/10 Cathy Blaskewicz, RN
It's day 5 in Haiti. After a full day of work in our assigned areas a few of us took a car to tour the city of Port of Prince. The devastation is extreme in some areas and not bad in others. It seems the worst collapses and greatest loss of life were in the biggest buildings. We saw multiple schools, churches and office buildings that were practically leveled. We passed buildings where several hundred people died, yet the house next door had little damage. People are living in tents on the streets everywhere, with maybe 6 inches between the tents. Some tents are no more than bed sheets. Laundry is hanging along the wreckage that was once important government buildings. The amazing thing is that the Haitian people seem to be going on with life as usual. We passed a tent camp where people were gathered around and cooking and laughing. The kids are playing, Moms are cleaning their tents and watching after the kids. Patients come to hospital clean and groomed after sleeping in a tent in the rain. Feel sorry today is the last day. I think the ISHI team feels like we still have a lot we can do here

3/5/10 Emilia Wawsczyk, RN
Another memorable day it Haiti….our day started off with breakfast at the UN….finally no MRE's (military ready to eat meals) (no offense to US Government)….we were just happy to get more than 2 grams of fiber in our meal…Just as a side note….UN has a huge base in Haiti with representation of many countries in the world…thanks to Jhoselyn's people skills (they do come in handy after all)….two officers agreed to take us around Port au Prince…the destruction that we have seen is unlike anything imaginable…buildings crumbled….people living on the streets….tent cities with some tents made out of blankets and sheets….with no sewage, no clean water…..most children are not going to school at this time…because many of the schools were destroyed…life is not back to normal…surprisingly to me anyway….many of the old buildings….buildings still made out of wood, were there standing amongst all the rubble…..we drove by the US Embassy, and the building was untouched by the earthquake…we worked our evening shift in the ED that evening….our last day here….it is incredible to me how so many professionals, from all over the country, some from other countries can come together and work as a team….for a common good…most of us have already decided to return….PS: Thank you Ortho Docs for teaching us your secret handshake….it will be in our memories forever…..

3/5/10 Nina Regevik, MD
I've been seeing patients in one capacity or another since my sophomore year in college, almost 35 years ago and I have never encountered a people so strong, so resilient and so dignified. To see family and loved ones never leave the hospital, to care for their injured, to tirelessly clean, feed and comfort them, to willingly learn some complex nursing procedures that will allow them to take them home, whatever that is, is one of the most uplifting and humbling experiences of my life.

3-5-2010 Asha Bale, MD
Saturday was our last day in Haiti at the Medishare tent hospital. I packed my things and made one last trip to the ICU to see our postop patients. Over this 4 day period, The surgeons here did about 40 cases, including general, orthopedics and plastic surgeries. Over 250 patients were seen and treated daily in the ER, triage area and wards. I am proud of the compassion and skill that my team demonstrated this week. Half of the volunteers leave the hospital today and the rest will leave on Sunday, as new volunteers arrive to fill our shoes.
We find out that our translators are homeless and are sleeping in tents at the old airport which was damaged by the earthquake, so we give away our bedding and any other things we think they can use. They thank us and say "God Bless you for coming to Haiti". As I look around the grounds people are exchanging contact information and taking group photos. Then I see a young boy about 11 years old at the door of the tent crying. Some volunteers are hugging him and trying to comfort him. I find out that he has been living in the hospital since the earthquake. His father had died when he was young and his mother died during the earthquake. I am told he is crying because he wants to be adopted. He watches all of us load our bags onto a truck and then climb onto the back of another truck headed for the airport. We wave goodbye to the boy and the volunteers. It was heartbreaking. This tragedy has left so many children homeless and without parents. I can't stop thinking about this boy- how he will probably never be able to leave Haiti, and how every week he will become attached to the volunteers, and then have to go through this again and again. What will happen to him? Will he ever find a family? What will happen to the others who live in the tent cities?
Checking in at the airport and boarding our plane which is headed to Miami becomes a six hour long process, but we are looking forward to a real shower and a comfortable bed. As I reflect on my visit to Haiti I have mixed emotions- Proud because my team was able to accomplish so much and truly provide life changing care, sad because there are so many more people who need help, unsettled because we can't help everyone who needs help, worried because the rainy season is approaching and so many people are homeless. I can't help but feel guilt- I will be leaving Haiti to find the comfort of my home and family, while so many people here have trouble finding food and water, have lost their family and are truly suffering. But in the end, I am happy that I came to Haiti and did whatever I could to help in this relief effort. My team and I agree that we will return to Haiti again. We board the plane and head for home, content that we did what we came to do and ready to share the bittersweet stories of our experiences.

3/6/10 Emilia Wawsczyk, RN
We are sitting at the Airport Internacional in Port au Prince…waiting for the new team to arrive from Miami….This morning was an emotional one for all of us… there were tears shed….and a piece of us is staying in Port Au Prince…as we said our final goodbyes to team members, patients, families, translators, transport, security….and all who have made this journey possible for us. We have added to our pool of life experiences that has made us all a bit stronger, a bit more in touch with humanity, and respectful of mother earth…The destruction that we witnessed in Haiti, and the number of lives that it touched and continues to touch every day has made us realize that this world is not a force to be reckoned with….it is fragile, and it is unpredictable…..but the people on it are strong and resilient…..many of us ask ourselves…what's next? What will happen now? When people stop coming here to help…when the news of this tragedy quiets down….when no one will donate to charitable causes….what then? Will the people of Haiti be OK? What we did was so so small in comparison to how much work is needed here…It became apparent to me that from birth on….the people in impoverished countries really don't stand a chance….with malnutrition and lack of education, to lack of jobs, and government corruption….But as people continue to come and spread the word of how much help is needed here….maybe Haiti will not be forgotten…I hope that all of you who read this and the rest of our blogs will some day, maybe soon decide to come here because it is so worth it….it makes you so grateful for your health, for your family, for food that you put on your table, for a roof over your head, for people around you who support you and love you no matter what…..

3/7/10 Diana Eagen, RN
It feels good to be back home..to hot running water in a shower, soft mattress, clean sheets, heating and air conditioning, cold drinks- all the amenities that make life comfortable- things that the people of Haiti don't have. Kind of make you feel guilty and thankful at the same time because you do have them. Wishing you could share more than just your time.
The people of Haiti are wonderful, loving, friendly and especially grateful. They have a long recuperation period ahead, but they are resilient, always smiling, ever thankful.
This trip has really stirred my emotions. More than I ever thought possible. I am so proud to have come on this mission and worked with such a great group of people.