The hospital

The Hospital is very close to the airport, about 5-10 mins drive away. The safety conditions in the country are far from normal. People are being killed and injured all the time. During the time we were there four police officers were killed. I do not any more details about this event. Accordingly, Haitians do not go out of their living area after dark, the drivers don't dare driving after 6, and people who can, walk around armed.

Thus, the hospital is surrounded by a fence and has two entries both of which are policed by Haitian guards. Those guards from what I understood are not reliable, sleep on their job, let in people who are not supposed to get in, etc. Thus the security is not great. In reality anyone who really wants to get in - can do it with minimal effort. There are many Haitians who work for the hospital (from what we've been told they are getting paid about 5 dollars per day). So, even if you see someone who is Haitian on the area of the hospital you never know whether they are safe to interact with or not.

Our badges were composed of piece of tape with our name on it and MD or RN or any other abbreviation that explained who we are. So, anybody could be presented in the role they wanted to be. There was no checking or verifications on the area of the hospital. We did have an incident where a Haitian guy pretended to be a pharmacist and was giving inaccurate info to nurses.

The hospital itself is composed of two separate tents that are on the ground. Not even cement on the floors, just rocks and dirt. The first tent is right in front of internal gates. Right as you go through the gate you walk into the emergency department. After you go through the ED you get into the pediatric area. There is a pharmacy and lab on your left next to the entrance. Peds is a large open room where many cods are placed somewhat strategically . Patients are sleeping with family members in bed, other family members are sleeping on the floor between the cods.

Further down on the right side separated by a tarp there is PICU and NICU. On the opposing side of it, separated by tarp there is an TB room for peds (no separation other than the tarp) and ICU with three cods. As you walk further you get into the OR. It is the only department in the hospital that is separated by a wall and has an actual door. There are 3 operating tables in there made out of wood, on which patients can be operated on and three bed PACU.

The second tent has the main pharmacy on the right side and serves as medsurg unit. Also, next to the pharmacy located the X-ray which is the only diagnostic tool we have in the whole hospital. The cods in this unit are placed in the same way as in peds. People are stacked on top of each other and family members are sleeping on the floors.

Patient's restrooms are located outside the gates that are in front of the ER. Restroom is a porto potty and shower is a piece of wood on the ground with one wall, and a tarp that doesn't cover anything. Privacy does not exist. All the procedures, cleaning, pooping and peeing are done in front of everybody. There are no sheets to lay on. There are barely any blankets. They are either brought by the med professionals who were there before us or the military who donated stuff. There are no chucks. There is no water in the hospital. NO WATER AT ALL!!! Personnel washes hands with sanitizers. It's impossible to maintain basic safety precautions.

The morgue was a non refrigerated tent in a over one hundred degrees weather.

The lab is closed at night and is on call. On call for ONLY life threatening conditions. The woman who is running the lab and is on call every single night is a microbiology professor with a PhD who teaches in UCSF. She was exhausted from working all day and being woken up regularly at night. The ISTAT is very hard to find, but even if you do find it, there are no cassettes. There are no ABG kits, no NS bags, no chucks...

Nurses were placed in departments they never worked before during the shifts they've never done before. We all had to do the best we could under given circumstances. It was very hard to find equipment and figure out how to work it. The pressure was ridiculous and we were all tested big time.

All the equipment and meds were placed in the storage tent. It was impossible to find anything there. We were running out of essential stuff. We ran out of NS and had to use D5 in non diabetic pts. We were running out of IV tubing and IV start up kits. There was no food to give to pts nor water. The conditions were impossible. It was amazing that we were able to somewhat successfully provide medical care to people we didn't speak the same language with and were not familiar with their culture. Patients presented differently than in the states. Haitians believe that if they are sick god is punishing them, thus when they came in, their presentation was very dramatic for conditions that were far from life threatening. But people who were really dying were very stoic and non approachable. Everything was flipped upside down. Basic things like start an IV were twice harder and took four times more time. Having said that, all of us did an amazing job under very hard circumstances :)

Additional notes:
The equipment was very limited in the hospital. Here are few examples. There were two vents that kept acting out all the time. There was a situation where we had to manually bag newly intubated patient for an hour and a half due to the malfunction of the vent. We didn’t have drips available, so I had to serve as a Nitro drip and to push it manually. At some point we also ran out of NS prefilled syringes and had to manually make them.