"I don't know what your destiny will be, but one thing I know: the only ones among you
who will be really happy are those who will have sought and found how to serve" Albert Schweitzer

Monday, May 24, 2010

Anesthesiologist Cassie Gabriel Trip Report

The following trip report was authored by Cassie Gabriel, an anesthesiologist from Vancouver, Washington.  As surgeons, efficient and safe anesthesia is vital to a  productive operative experience so we are especially grateful for Cassie's report and hope that it serves to stimulate other anesthesiologists/anesthetists to consider a volunteer stint at Hopital Adventiste d'Haiti.  I especially appreciated her last two recommendations at the bottom of her report: take the time to pass on some of your knowledge to the Haitian staff and enjoy the shared volunteer experience.  You can read more about the Southwest Medical Group Plastic Surgery trip on the Behind The Lens Blog.

My husband Allen and I have long held a shared desire to apply our skills to serve others in need. Allen is a plastic surgeon and I am an anesthesiologist. We are both graduates from residency programs at Loma Linda University, Allen holds an academic appointment at LLUMC and we are currently practicing in Vancouver, WA.
Almost immediately after learning of the devastating earthquake in Haiti, Allen tried to contact Scott Nelson, an orthopedic surgeon serving in the Dominican Republic. Allen knew Scott as an attending at LLUMC and worked with him on a previous medical mission trip to the Dominican Republic in 2008. It took a few days, but we eventually heard back from Scott who assured us that much help would be needed in the future for physicians in our specialties.
We were able to plan a trip to Haiti on May 9th. Our team included ourselves, Shelby Gialich (Allen’s medical assistant), and Matt Schoolfield, a freelance photographer and graphic designer for public relations at Southwest Washington Medical Center. Matt wanted to document our trip as a way to educate and encourage continued awareness and support for the people of Haiti.  In the picture below Scott Nelson introduces Matt to a new imaging medium.
The trip getting there was long with two layovers in SLC and JFK. We arrived tired, but anxious to get to the hospital and start working. The airport is third world but the drive to the hospital is truly an eye-opener for those of us accustomed to traffic laws and the right-of-way of pedestrians!
After a short orientation, we got right to work, I headed to the OR and the rest of the crew hit the floors for wound care rounds. We worked late and hit the cots around midnight for some much needed rest. Despite the uncomfortable heat and humidity, we fell asleep right away. Two hours later, we were awakened by an emergency room volunteer asking us to come see a young girl who was crushed by a wall that was all that had been remaining of her home. She lay very still and had severe injuries to the entire left side of her face. Unsure of exactly how extensive her injuries were, we took her immediately to the OR, knowing it was her only chance, so we would do everything we could to help her.
She never cried, she trusted us implicitly, and as we sat her on the operating room table, she laid her head on Shelby’s shoulder and placed and arm around both Shelby and Allen. Our highly esteemed scrub Lucia thoroughly washed out the wound, admonishing us that unless she got ALL the rocks and dirt out what we were going to do would be pointless. Allen spent four hours carefully reconstructing her face which had suffered extensive soft tissue damage, but to our great relief, no skull defect.

After a long but rewarding night, Scott was gracious enough to offer us some respite in an air-conditioned “suite” that doubled as his office. An air mattress never looked so inviting! We slept a refreshing four hours and then up for another day of providing much needed wound care and anesthesia for the ortho, plastics, and general surgeons.
An anesthesiologist's perspective:
Supplies in general are plentiful. I was able to find almost everything I wanted by searching the various storage rooms. It was time consuming and sometimes frustrating to have to look for things I could use. Previous volunteers have made some progress in organizing the vast amount of supplies sent in, but there is still much to be done. I really just tried to separate stuff I could use from stuff that was useless (circuits not compatible with our anesthesia machines for example). During longer cases, I would clean and organize, with the goal of making the most commonly used equipment/medications easily available. Again, in time I found almost everything I wanted. Bonuses were an abundant supply of propofol, yankauer suction sets and a much-needed delivery of Fentanyl. I did not find many circuits or facemasks, but a whole box of filters made re-using the circuits easier! I used a lot of LMAs and performed several spinals, so spinal kits and LMAs in common sizes like #4 and peds sizes are always needed. Not many Haitians need a #5 so there are hundreds of those lying about (lots of 3s too). There is no EtCO2 or gas analyzing capability yet.
Morning "pain rounds" = restart IV prior to easing pain
Patient histories are sketchy and charts sparse (and sometimes in French). Translator/transporter volunteers are available to help and they do an amazing job! Scott Nelson has worked hard to have standards that make the pre-op process run more smoothly such as ordering pre-op Hgb/CXR/EKG on all patients. Unfortunately, the best-laid plans…many patients did not have all these done, but we do have a Hemocue machine in the OR and I never felt I needed to put off a case for lack of information.
Ryan (PGY-5 LLUMC ortho), Albert (translator/transporter), cute Haitian patient, Cassie (anesthesiologist), Shelby (medical assistant), Kathleen (Ukiah team nurse extraordinaire)
We will be back at HAH on June 19th for another week with two additional team members (a scrub tech and a nurse). I plan to bring some specific anesthesia items and if anyone who has been at HAH recently wants to let me know of things that are running low I would sure appreciate it!
Finally, some recommendations from our group…
  • We felt well taken care of staying at the hospital in the volunteer quarters-running water, clean drinking water, one delicious meal per day, air-conditioned break room with Wi-Fi, ready access to patients in need!
  • Including the Haitian hospital staff/volunteers allows for better continuity of care when you leave. Pick out one or two and teach them (and learn from them). They are there always and our flying in and out with all our individual styles and preferences is challenging for the most patient workers.
  • Enjoy the atmosphere of beautiful people working together to heal Haiti one patient at a time.
 Allen and Cassie enjoying a refreshing Haitian mango after busy day

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