She had a severe allergic reaction. From what, we do not yet know. Her lips are swollen and she has a red bumpy rash across her eyes and right side of her face. She is barefoot. There is one wheelchair available, they get her in it, but it is missing one of the leg rests. There are no other wheelchairs in sight, so both legs are placed, one on top of the other, on the one sided leg rest of the wheelchair. Her family is directed and they wheel her to her diagnostic exam which is outside, across a courtyard.In the meantime two patients with gunshot wounds are pulled out of the back of a pickup truck; we are not sure who shot whom first; or who is the instigator and who was just defending himself. There aren't enough stretchers, so a box of supplies becomes the seat for one of the gunshot victims.
It's easy to imagine these same patients in the ER at which I work. Swollen lips? Possible allergic reaction? Possible airway compromise? Triaged at level 2, MD informed and interventions initiated immediately.
Wheelchair? Nurses would grab the nearest one, and they almost always have 2 Intact foot rests. Usually, specialized transport personell, will escort the patient to their diagnostic exam,which happens within the same building.
When our patients need labs sent, we send it up an electronic shoot. We get quite irritated about the time in our busy day it takes up, when it malfunctions. In Haiti, a lab and medication shoot is a far imagined dream. The nurse will run outside, across a courtyard with the labs and single handedly deliver the patient's specimen. Labs in this hospital in Haiti are only even drawn, once the family has paid a fee and shows a receipts as proof of payment.
Space? The forever unresolved problem in our constantly overflowing NYC ER. Oh, the speeches we give families as we kindly plead with them to wait in the comfortable leather chairs of the waiting area so we can create ample space for sick individuals. We promise them every delicacy from the cafeteria if needed, and cross our fingers, in hope that they agree to abide by the rules, or at least accept our bribes. Worst case we can have security do the mean work for us.
Space in an ER in Haiti? It makes the confined quarters of the ever cramped NYC ER feel like a mansion of ERs. The square footage of the small air conditionerless room in the middle of hospital compound that is considered the ER in Haiti, becomes overcrowded and outgrown rather quickly, by its constant flow of trauma cases that flood every possible inch of its quarters. There is no waiting area and no triage center. The waiting area is the landing outside the doors of the ER. There is a table near the entrance of the room that has nurses and a doctor sitting, and they triage the more acute patients, work them up and store them in rickety stretchers which are stored in any available space in the room. Once triaged, the medical workup can only progress once payment is made. You see, in Haiti, a patient does not even get labs drawn until a receipt of payment is shown and documented. A blood transfusion is not provided, unless the family members can donate their own blood. In situations where a massive transfusion protocol might be indicated, this process of blood transfusions, still remains in effect, sometimes compromising the patient's outcome.
Equipment; in the ER I work in, it seems as though there is an endless supply of needles, suction devices and cardiac monitors; some those simple ER, lifesaving necessities. In Haiti, much of supplies are sponsored so they often utilize equipment way beyond their stated expiration dates, and many of the equipment have defects as well.
If there were 3 words to describe my Haitian ER expereice, it would be: loud, chaos, & traumatic. Between medical staff speaking, patients yelling and complaining and infants shrieking. Many ERs are loud, rowdy and seemingly chaotic; this was chaos on a whole new level; and the cases that rolled in were of the most truamatic that I have ever encountered-probably in my lifetime thus far.
My mind ponders and my heart quivers at the infection rates on those benches alone. Patients sit with butts touching, noses sneezing and blood gushing for hours on end. The ER has one cardiac monitor, designated for the sickest patient. At one point our second to sickest patient was crashing; we just moved the monitor from patient to patient, just to see the rhythm. At one point as we intubated one patient, the patient newar him became bradycardic, i’m just a nurse, but I gather my ACLS knowledge, yell orders for atropine, it's given, but soon the patient codes, i verbally run the code as I assist the only MD in the room at the time with intubating a trauma patient with a possible cervical spine injury. Unfortunately, the coding patient does not make it, but now our C spine injured trauma patient gets to have the monitor placed on him.
Triage in Haiti is just a bit different than the ER I am used in NYC.
Triage in Haiti is just a bit different than the ER I am used in NYC.
The ER team: They buzz through their assignments in that ER so gracefully, like millennial versions of Florence nightingale as they improvise daily to complete even some of the basic tasks. It's almost like they are shining outcasts that bring light, calmness and a version of serenity to the loud, bustling, messy, and odorous environment that envelopes their beings as they go about their nursing duties in the sweaty, fly infested room they call an ER.
