Final day of surgery for Sutter medical team

This was the final full day of surgery for the team from Sutter affiliates CPMC and Alta Bates. They had expected it to be a relatively quiet day as the team had already taken care of most of more serious injuries - but some auto accidents ensured a supply of fresh patients. Fortunately the portable x-ray machine the team brought with them meant those patients could get the excellent care they needed. Just as well. Check out the x-ray of that patient's fractured legs. Ouch.

The conditions that the team have been working in are much improved since their previous visits in January and March. They say it's impressive just how much progress the hospital is making in trying to get back to normal.

Below are two photographs. The first shows the patient ward back in January, shortly after the earthquake hit. The second one shows the same ward today. Clearly a huge improvement.

Making progress in Haiti

The Sutter-affiliated team of doctors and nurses from CPMC and Alta Bates are able to help more seriously injured patients on this trip than they were on the previous two medical missions. The big difference this time is access to machinery, such as portable x-ray devices, that allow them to repair more complex injuries.

For instance this photo shows Dr. Taylor Smith repairing a tibial plateau fracture that happened during the earthquake. He could not do this procedure properly without the flouroscope. Hopital St-Nicholas is now one of only four hospitals in Haiti with intropertive x-ray capabilities.

Here is the patient after the procedure. After months of pain she has finally had the surgery she needed to realign her knee. No wonder she's smiling!

While Haiti is still continuing to struggle to recover from the earthquake progress is being made. Take a look at these two photos of the radiology lab at St. Nicholas' hospital where the Sutter team is at work. The first photo shows the lab in January, immediately after the quake. The second one shows it today. Clearly a huge advance, one that benefits patients and makes it easier for doctors and nurse to do their work.

Medical team hit the ground running

Using power tools (loaned by Stryker) and flouroscopy (donated by Hologic), Dr. Taylor Smith (California Pacific Medical Center) and Dr. Lamont Cardon (Alta Bates Summit Medical Center) place an intramedullary rod in a patient with a complex leg fracture.

The Sutter Health medical volunteer team wasted little time getting to work after arriving at L'hopital St-Nicholas in Haiti, outside Port au Prince. The team from California Pacific Medical Center (CPMC) and Alta Bates Summit Medical Center (ABSMC) arrived Friday in Haiti on Friday and by Saturday morning were already at work in the OR. Using equipment, generously donated by the manufacturers, the team started with patients suffering from complex fractures. On this trip, unlike previous ones, the team has a portable x-ray device that allows them to be more precise in their work and better able to handle complex cases.

Dr. Lamont Cardon (ABSMC) at work repairing a wrist fracture

Helping Haiti - A Third Time

A third team of doctors and nurses from Sutter-affiliated Alta Bates Summit Medical Center and California Pacific Medical Center are heading back to Haiti to help the earthquake-ravaged country.

Watch this KTVU report

Welcome Home

Our Sutter Health volunteer medical team has returned from Haiti.

Thank you for your dedication and service to our worldwide community of patients.

Saving lives -- one child at a time

Bernice Doner, R.N. (California Pacific Medical Center), Nadine Burke M.D. (California Pacific Medical Foundation, Sutter Pacific Medical Foundation) and Jodi Davi, M.D. (California Pacific Medical Center) resuscitating a child at HUEH Hospital in Haiti.



Toni Brayer, M.D. (Sutter Health West Bay Region) helps another sick baby.



At other times, all the team could do was give a hug or a toy to help ease their suffering. Below is Earvin Ledi, R.N. (California Pacific Medical Center).

14 hour shifts take their toll

Working the 14 hour night shift is hard on our Sutter Health team -- everyone tries to sleep but the sunlight, bugs and oppressive heat make it tough.

Some Photos of our Team in Haiti

Meet Alex

From Toni Brayer M.D.





I mentioned that we've hired the son of a patient as our interpreter. Above is a photo of myself, Cassie Kinser R.N. (California Pacific Medical Center) and Alex - our star interpreter.

Another long night

From Toni Brayer M.D.

Another long night at HUEY has come to an end.



Above is the ICU tent. The team is elated that everyone is still alive at the end of the shift.

We are finding more and more tents scattered around the hospital area with patients and no doctors or nurses attending them. Are dressings being changed? We don't know. Families are caring for the patients, bathing and feeding them.

Partners In Health does not have the resources to cover everywhere and the government hasn’t paid the doctors or nurses for months. It is a truly broken system and we are so worried about what will happen when we are gone. Today there are no doctors to cover the ICU and only one nurse.

Above in the hand washing station in the ER tent. I wish we had one in the medical ward. I have never appreciated good hand washing as much as now...when there is no hand washing.

In the ICU

Charles Morris, M.D., Internist, California Pacific Medical Center and Grace Cheng, R.N., Intensive Care Unit, California Pacific Medical Center in the ICU.

The medical ward

From Toni Brayer, M.D.

Family often stays with patients in the hospital, finding anywhere to sleep.

Swamped with patients

From Toni Brayer, M.D.

Last night was a bad night for some of the team – more of our patients died. University General Hospital (where we’re providing care) is serving over 3 million people. And there are only two relief groups here helping the fragmented Haitian medical folks – Partners in Health and and another international medical group that is running the ER. Below you can see the line for the ER tent around 6 a.m. The ER care team tries to treat as many patients as possible but the doctors and nurses can't get to everyone. We learned today that a girl with sickle cell died after waiting all day to be seen.

This man was leaving the busy ER tent and had a large burn on his leg. We brought him into the medical error where Lucy Duffy R.N. (California Pacific Medical Center) put on a zeroform dressing.

There is a doctor here from UCSF who I’ve been consulting that also runs a TB tent. We are swamped with patients all the time and the post-op tent was unattended last night because we have such few resources. The patients in post-op are very sick but there isn't enough help to go around.

Patients find joy in soccer

Josh Richards, M.D., orthopedics, Alta Bates Summit Medical Center sent us a short video of two Haitian patients learning how to find joy again in the country's favorite pastime - soccer.

We Lost Three Babies Before Midnight

From Toni Brayer, M.D.

“The Sutter team is hoping our efforts make a small difference but we are all aware of how huge the problem is.

Above you can see the ICU tent (tent 'L'). We admitted a 48-year-old woman who had a stroke involving her entire right side. Her daughter told us that the family fell from the fifth floor of a building during the earthquake. Her father and other family members died. One of the children in the family broke his leg – they couldn't believe they actually survived. They are living in the street and now this.

Hearing story after story like that and experiencing the sadness with these people up close brings us all to tears daily. All you can do is wipe away your tears, start IVs and try to practice first world medicine in an impoverished developing country.

Caring for the children is especially tough. You can see the pediatric ward above. The pediatrician team lost three babies before midnight. They are so resilient and each of us had had to come to terms with our own sadness.

Because of a daylight curfew our work shift has been extended. It makes for a long day and challenges our ability to debrief as a team. We also need to rest so we can take care of patients and guard our time to sleep like gold.

We send our greetings to the folks at home who are reading this blog.”

Complex Medical Problems

From Toni Brayer, M.D.

Since the people of Haiti primarily speak French and French Creole, interpreters are critical in our care of patients. The first night we struggled because our patients’ health histories are complicated and they so many co-morbid health issues. Without charting we have to rely on patients and their families to understand their problems. To help, we have hired the son of a patient as a translator and he is fantastic. He stays awake all night to help. I am also giving him our extra food. He wears a smile every day.

The young postpartum mother with sepsis was sitting up this morning in the ICU. With interpreter help we discovered her newborn had not been fed for 5 days as it was a home birth. We sent the father home immediately to bring the baby back to breastfeed (if possible). I hope to check up during tomorrow’s shift.

We are dealing with seizures tonight on medicine ward. The degree of cardiomyopathy and heart failure is profound, even in young people. Dr. Charlie Morris (California Pacific Medical Center) brought a portable echo cardiogram machine and has been very busy. Many patients do not have homes and live on the street. There is no way to comprehend how they can deal with their illnesses in those types of living conditions.

Others aid organizations (besides Partners in Health) are working here at the hospital. Another group runs the ER and the ICU during the day. The ER is a tent – they’re using tables as stretchers, portable table fans to keep the tent cool and there is a line of people out the doorway needing care. Earvin Ledi R.N. with California Pacific Medical Center is an ICU nurse and is helping connect us with the needs of patients in the ER and ICU, as well as holding down the ICU all night.

No rain yet which is a blessing and I still don't have my suitcase.

The First Night Shift

Sent from Toni Brayer, M.D.

“We are having a long night and the conditions are very grim. There is no running water at the hospital and we often see mice running across the floor. Families stay with patients in the hospital, so there are many people sleeping on the floor and even under beds. Also food is scarce so families bring in meals for our patients.

There are about 45 patients in the medical ward alone – more in the ICU and pediatric units. Each of these wards is in different buildings/tents and patients are suffering from conditions like cerebral malaria, cancer, cirrhosis and heart failure. There are no diagnostic tests and little treatment available. Thankfully, we do have morphine now and some antibiotics.

Tonight I transferred a postpartum patient with sepsis to the ICU. This means the ICU doctor and nurse come over with a stretcher and literally carry her to another building. The ICUs are running codes all the time. We are at the hospital from 5pm to 7am – it makes for a long 14 hour night. We are trying to take shifts but with the acuity of patients it is hard.

Haiti is much more impoverished than I thought. Everyone is so poor and hungry and thin. I gave my box dinner to a patient family member who is helping interpret. We would not be able to help patients as best we can without him.”

Arrival - Port au Prince, Haiti

From Toni Brayer M.D.

"The team has arrived in Haiti. Our accommodations are rustic but good. We have flush toilets and two showers and very newish tents with a new mattress pad. The weather is overcast and muggy but very pleasant. Many of us do not have our bags yet, so we are making due and when we arrived we had a nice goat and rice lunch.

We will be relieving the Haitian doctors by working the night shift at HUEH hospital -- 10-12 hour shifts.

Although we are pretty exhausted from the flight -- got only 3-4 hours sleep last night -- we are anxious to begin our work and help the patients here in Haiti."

Second Team Leaves SFO...Bound for Haiti

Seventeen medical volunteers from across our Sutter Health network left today on a medical relief mission to Haiti.

This is the second Sutter Health team to visit the earthquake-ravaged country. The team will work the night shift at Hospital de l'Universite d'Etat d'Haiti – also known as University Hospital in Port-au-Prince. They'll be providing vital medical services for one week.

Throughout Sutter Health, doctors and nurses have also donated their own time to provide vital medical care to patients in Haiti.

Team members include:

Physicians

• Ken Barnes, M.D., Internist, California Pacific Medical Center (St. Luke’s campus)
• Toni Brayer, M.D., Internist, Chief Medical Officer Sutter Health West Bay region
• Nadine Burke, M.D., Pediatrician, California Pacific Medical Center
• Jodi Davi, M.D., Pediatrician, California Pacific Medical Center
• Charles Morris, M.D., Internist, California Pacific Medical Center
• Marc Pollock, M.D., Critical Care, Alta Bates Summit Medical Center
• Josh Richards, M.D., Orthopedics, Alta Bates Summit Medical Center

Nurses

• Corey Allen, R.N., Intensive Care Unit, California Pacific Medical Center
• Teresa Bettencourt, R.N., EMT, Medical Surgical/Pediatric Intensive Care Unit, Sutter Roseville Medical Center
• Grace Cheng, R.N., Intensive Care Unit, California Pacific Medical Center
• Janice Davis, R.N., Oncology, Medical Surgical, Alta Bates Summit Medical Center
• Bernice Doner, R.N., Adult and Pediatric Emergency Department, California Pacific Medical Center
• Lucy Duffy, R.N., Critical Care, Emergency Department, Pulmonary Acute Care Unit, California Pacific Medical Center,
• Jessica Feinerman, R.N., Emergency Department, Sutter Pacific Medical Foundation
• Cassie Kinser, R.N., Medical Surgical, California Pacific Medical Center
• Earvin Ledi, R.N., Intensive Care Unit, Medical Surgical, California Pacific Medical Center
• Steve Novak, R.N., Emergency Department, Sutter Medical Center, Sacramento
  

Second Team of Sutter Health Medical Volunteers Heads to Haiti

We're thrilled to share with you that a second team of Sutter Health network doctors and nurses are heading to Haiti to provide vital medical care to the victims of the massive earthquake that struck the country in January.

More info will be coming soon and our team will again be providing us with blog updates from the ground.

If you have a question you'd like to ask our doctors or nurses, email us at quality@sutterhealth.org and our team will do its best to respond.

More Sutter-affiliated doctors head to Haiti

Three doctors with Sutter-affiliated Palo Alto Medical Foundation left for Haiti on Valentine's Day with a Silicon Valley medical team they assembled. Best wishes to our colleagues Drs. Choi, Croke & Lane - & the team.

See more from their trip at:
http://www.facebook.com/pages/Enoch-Choi-Foundation/417718500061?ref=ts#!/pages/Enoch-Choi-Foundation/417718500061?v=wall&ref=ts

February 1, 2010 - Home from Haiti

From Toni Brayer, M.D., Chief Medical Officer Sutter Health West Bay Region, Leader for Sutter Health's Help for Haiti

As our Sutter Medical Relief Team makes their long way home from Haiti, they should be prepared for some mixed emotions when they step on home soil. They will be overjoyed to see their family and friends and will try to explain everything that happened in that "week that seemed like a year."

Intense emotional events seem to imprint differently on the brain and time lengthens. With sleep deprivation, circadian rhythm disruption and the constant stress of doing something new (and critically important), the team may feel a little disoriented for a day or two upon return. They may find themselves mentally back in Haiti with the sounds, cries, different scents and lighting.

They may be unable to "turn-off" the thoughts of certain patients or colleagues with which they worked closely. Unpacking and looking at photos (and this blog) will bring back a flood of memories.

Most of the team has to hit the ground running, back at their "real jobs" this week. It is a tribute to their sacrifice and professionalism that they will pick up the ball and be ready to go. We know there are more photos coming from Haiti and we look forward to "de-briefing" with the team.

We are aware of other medical relief teams that have gone and are going to Haiti from our Sutter family. They are on missions with other agencies and we are so proud of their work and efforts in this horrible crisis.

Thank you.

January 31, 2010 - Homeward Bound

The Sutter Health team departed St. Marc at 5 AM. After a three hour bus ride to Port au Prince, the team divided in two. One half is flying back to the U.S. immediately and the other half is spending the night in Port au Prince in "rustic" accommodations.



A note from Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):

"It's only been a week since we spent our first night in Haiti at this facility, yet it seems much longer...in a good way."

January 30, 2010 - A New Phase of Surgery

From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):

Canadian plastic surgeon, Dan Durand M.D. closes a large wound with Taylor Smith M.D. (orthopedic surgeon, California Pacific Medical Center), This is one of several reconstructive procedures performed recently as the focus of surgery shifts into a new phase.

January 29, 2010 – More Medical Evacuations

From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):

“We continue to evacuate critically ill orthopedic patients. If we are unable to secure a helicopter transport, our next option is to take the patient via ambulance. It’s a long ride to Port au Prince and patients with painful fractures may not be able to tolerate the bumpy ride.

For several days we have been attempting to evacuate a woman with a severe femur fracture, which had become infected. We were determined to evacuate her, so we prepared to drive the patient to Port au Prince accompanied by an anesthesiologist.




Above Liz Petruzzella R.N. (California Pacific Medical Center) helps John Donovan M.D. (anesthesiologist, Alta Bates Summit Medical Center) perform a peripheral nerve block. The nerve block is used for hip surgery and helps manage the pain associated with transport.

While waiting for the ambulance, we suddenly learned that a helicopter was arriving to take her by air. We improvised, quickly folding down the seats of an SUV and driving to the landing zone with her legs sticking out the back (see photo below).”

Helicopter transports are usually done by the U.S. Navy. Here a corpsman accepts our critically ill patient.

January 28, 2010 - A Blood Transfusion Makes the Difference

From Dr. Vernon Huang, anesthesiologist (Mills-Peninsula Health Services):

A young patient who sustained severe leg injuries in the earthquake. Although we have no lab capability, her pulse was registering 180 and the condition of her nailbeds allowed us to make the clinical diagnosis of anemia.

We were able to give her a blood transfusion her and her condition has much improved.

January 28, 2010 - Training Local Providers

From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):

We’ve noticed a chance here in Haiti. "The acute phase of the crisis has passed but we are now entering a phase where patients are at significant risk of serious tissue infections. We had hoped to evacuate a critically ill adult patient in this condition – but were unable. There are countless cases such as this overwhelming the system.

To continue to help our patients here in Haiti, two Sutter Health-affiliated nurses are staying overnight at the hospital with patients that have major infections.

In the morning [January 28, 2010] I will be riding in an ambulance to Port au Prince with two patients. The roads are so rough and their wounds so painful that they need an anesthesiologist to go with them."

Our team’s time here is short but the people of Haiti will continue to need medical care for months to come.

Below, "while Taylor Smith M.D. (orthopedic surgeon, California Pacific Medical Center) operates, Isais Comacho R.N. (surgical technician CPMC) teaches a Haitian technician how to assist in orthopedic cases. St. Marc's techs have significant experience assisting on cesarean sections but have very little exposure to other cases.








Given the long road ahead for our patients, it is critical to bring local providers into the process."

January 28, 2010 - A Long, Difficult Day

From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):

"We started the day off with a relatively light day on the schedule. The thought crossed our mind that we might actually leave the hospital with daylight.

This changed quickly when we started to see pediatric patients with medical and surgical problems. We operated on a child with a ruptured appendix.

While we were rounding on patients doing wound care, we were frantically called to the ER to evaluate a critically ill 2-week-old child. Sutter physicians worked with Canadian colleagues to resuscitate the child who suffering from dehydration, sepsis and pneumonia.

Resources to manage a critical care case like this were scarce even prior to the earthquake – now we faced even more daunting problem – how to manage a neonatal patient that required critical care after the earthquake. The U.S. Navy could no longer take intubated children and it was impossible to find a ventilator at a Haitian hospital.

Finally, we were able to set up a transfer to a larger Haitian hospital via a UN ambulance for our young patient. The vehicle was brand new and nicely armored but did not have medical staff.

Steve Lockhart M.D. (anesthesiologist, Alta Bates Summit Medical Center) and a Canadian nurse traveled with the critically child on the 2 hour trip to the other hospital. In the end it was a long difficult day."

January 28, 2010 - Canadian Surgical Team Transitions at St. Nicholas Hospital.

A surgical team from Quebec City arrives at St. Nicholas hospital in Haiti. The team, which includes a plastic surgeon, intensivist, two orthopedic surgeons and an emergency physician, will provide care for two weeks.

Above, Susan Bailey, M.D. (vascular surgeon California Pacific Medical Center) and Dan Durand, M.D. (plastic surgeon, Hopital Anna-Laberge, Quebec City) change and examine the wound of a child.

Above, plastic surgeon Dan Durand (left) finishes closure of a complex wound with assistance from Isais Comacho, while DJ Edades R.N. (CPMC) watches.

January 27, 2010 - Our Sutter Health Team in Haiti

January 27, 2010 - Up and Walking

Christina Crane, R.N. (California Pacific Medical Center) works with a patient two days after she underwent external fixation of a serious leg fracture. The Harvard/Sutter Health Team was fortunate to have a large supply of these devices which are made by Synthes.

January 27, 2010 - Caring for Kids

Liz Petruzzella, R.N. (California Pacific Medical Center) cares for a young patient with leg injuries managed with external fixation.