American Nurses looking after emergency and disaster management were rushed to Haiti to offer their services of relief to the suffering humanity as result of a worst earthquake experienced by the island. Now they have reported back their feed back.
They stated that as an immediate measure they offered their help keeping in view their commonsense and knowledge of elementary nursing experience using the materials and equipments available there. The people treated ranged from minor injuries to life threatening conditions of injuries.
According to the comments of a Registered Nurse holding the post of a Professor, due to lack of facilities the job done is like an old type community nursing, learnt at school level.
The Registered Nurse quoted above had just reached Haiti with her husband a Physician just one hour before the earthquake struck Haiti, on a visit to see a first ever baccalaureate nursing school established in Haiti located at a village named Leoggane, for which she had played a helping role.
The earthquake prevented their going to the school they wanted to go and worked with other member doctors, at the premises of relief agency carrying on the first aid activities to the victims of the Haiti earthquake having fractured bones, lacerated wounds and other internal injuries. In the absence of required materials pieces of card board boxes and wooden pallets were used for immobilizing the fractured bones, in place of splinters required and was ensured that the bones alignment is nearly correct.
Practical Challenges of Locating Supplies Needed:
The Spectrum covering the event had interviewed large number of nurses, who had come to Haiti considering the relief required by the affected humanity in large numbers located at various hospitals, waiting for their treatment. The acute scarcity of the available material was because it was not known, where they were stored to the new persons. There was a temporary problem faced by the persons now handling the operations.
The comments by one more Registered Nurse a BSN graduate, describe how his belt he allowed to be used as a support tourniquet. The IV tubes were cut to make a foley tube using a plastic jug in place of Urine Bag. In place of a chest tube, foley tubes were cut to make it’s use as a chest tube.
One of the worker who had in the past made many trips to Haiti, had this time come independently along with a physician, started working in a field hospital organized by Miami University reported incidences jury-rigging.
Our intention was to reach the far flung rural areas, there were lot of misunderstandings and confusion among the local officials handling the arrangements our plan to go to rural areas was completely set aside.
Artificial Shortage of Materials:
The material required was available in unopened wooden cases, but no one had the authorization to open them and distribute. The health workers were search for the material not knowing where it is kept. Thus heap of goods are left scattered. The equipment they had received had lacked the compatibility to use. There are IV tube requiring a needle to use, but the needles are missing in the consignment opened. The needles have acute shortage. Temporary fitting of needles is done joining them with tapes instead of normal provision of needles with the IV tubes.
Setting Up PACU Facilities in Absence of Equipments:
A team of doctors, who had traveled by road after the Haiti earthquake, had to do improvement of a PACU to make it serviceable. They reported at a Government run hospital only to find the inadequacy of basic facilities like electricity, clean water and equipments required. The hospital was equipped with, just one oxygen regulator, only two blood pressure measuring instruments. The hospital was basically meant for imparting HIV/AIDS education and was not equipped to handle trauma cases, which were plenty to be attended.
It was found there were no facilities of PACU although OR was there. Normally surgical patients are lodged in OR for post-operative recovery. There was urgent need of establishing a PACU, for which some nearby room was searched. A room was located by the accompanying nursing staff, but it lacked regular supply of electricity. The next choice was a library room, having consistent electricity in one of the outlets.
The most necessary facility we required was for supplementation of oxygen, suction and pulse oximetry. The team had to travel to other hospitals to get the necessary equipment to make OR and PACU fit for use.
The 90 year old Hospital had passages to the halls from outside covered with tin sheds, the PACU did not have doors and it was often visited by stray dogs frightening the patients and nursing staff.
A Registered Nurse having working experience of OR was placed at a nearby by maternity hospital. At this location traumatic amputations were performed instead of C-section, the team acquired a hacksaw for using in amputations.
The services offered were absolutely basic, which one learns while beginning nursing. One feels a comfort, when the staff supports the hand.
They performed their skills with the help of least surgical instruments. One had to manage with what is available. The team was compelled to use the same mask all the time during the day. Instead of sterilization, the instruments were just kept in Betadine, there were no needle holders and hemostats were used instead of needle holders, one had to manage with bad scissors.
The team found so many patients were helpless and had never heard of so many amputations, they had to be convinced that amputations were being done to save them. Otherwise they shall get killed by the infection spreading if no amputation is done.
There was lot of tension in the mind of Haitian staff seeing, how we were amputating legs and arms of patients. They were unconvinced, what we were doing, because they had never seen so many amputations before. It was necessary to take them in confidence and explaining to the need of so many amputations.
There was likelihood that these patients for a long time were lying trapped under debris and occurrence of gangrene had already set in. considering the quantum of amputations required to be done, the team was amputating the patients at a fast pace.
The accompanying nurses helped Haitian staff do the charting and assessment of the response, which helped them in identifying the patients, the diagnosis of the patients and other information to locate the patients easily.
By using the services of an interpreter the Haitian nurses were acquainted with the postoperative care so that they can manage of their own and were in a position to deal with the patients and their families.
Initially the Haitian Medical Director had lot of skepticism about PACU, when every thing was functioning normally he was invited to meet the team of nurses and doctors, who worked for establishing the PACU with least men and material support. He was astonished at the transformations, which had taken place.