Sunday, February 14, 2010

Haiti: Follow-up, My Medical Experience and Future Needs.

I felt I should summarize what I did from a medical point of view and some new principles I notices. Also I will talk about the future needs.

I was with a group of 13 physicians and nurses. The first day we split up and eight of us went to CDTI Hospital (one of only two hospitals in Port Au Prince{PAP} still standing) and joined the American team of about 25 already there. The other 5 went to an orphanage 20 minutes away. The hospital had severe damage to the patient room section so all the patients were kept in the courtyard in eight(8) tents set up by the French. The Americans were responsible for four(4) and the French the rest. The Americans were there from 7:30 till 8:30 each day, and we left 3 military medics there over night. The French were there 9AM to 4:30PM and left no one to take care of their patients at night. If one of their patients had a problem hopefully their family would get one of the medics and they could handle it, otherwise the patient died as happened. 3-400 patients came to be evaluated at the hospital each day. I was consulted on about a dozen each day.

The surgeries I performed or assisted in included:
  • Four reverse solius flaps (assisted 2 and performed 2)
  • two gastrocnemius flaps
  • Above elbow arm amputation
  • Ten (10) dressings under anesthesia (ketamine/versed sedation)
  • Eight (8) Drainage of abscess and/or debridement of wounds (bone.muscle and skin).
I saw the first patient I ever witnessed die of Tetanus. After that I gave every patient with an open wound a tetanus vaccine.

We had two patients who were anemic, one with HCT=17 and another with HCT=21. I wanted to transfer the patient with 17 to a facility when I found out we could not get blood to our facility to do the transfusion. I was told because of the limited resources we could not transfer the patients till their HCT=12 or HGB=4. This, by the way, is the point when 50% of patients will die. I was told to stop doing blood counts since we most likely couldn't do anything about it. This was one of the hardest things I have ever done in medicine (except maybe the next story).

I was the lead physician of a trauma patient that came in. He was a fifty something man who had been struck by a truck. The police brought him in a police car and dropped him on the curb and drove off without waiting or telling us anything. The man was in coma and had obvious abdominal trauma. In the states he would have been brought immediately to the operating room for an exploration. We had no anesthesia personnel, no labs, no x-ray. He had no blood pressure until we resuscitated him with three liters of fluids. We called the director of the hospital and asked her to arrange transport. She told us there was no transport and to put him in the courtyard on a stretcher and if he is alive in the AM we will then deal with it. I could not accept this. So I told the medics to pump fluid into him to keep his blood pressure over 100 and his urine output over 50 cc per hour. With hard work they kept him alive over night and had to give an additional 7 liters of fluids. He had a liver injury and a fractured pelvis. We transfered him to the French Hospital ship. We found out he had survived.

I wrote about baby Noah multiple times.

Privacy: There was none. Foleys were put in in an open co-ed tent with the other patients and their families looking on. Patients washed themselves out in the open.

There were many patients, I took care of 4 of them (amputating the arm of one and one other had the HCT=17), who had closed crush injuries of their arms. They came to the Hospital 7-14 days after the earthquake with a compartment syndrome. This is when from a crush injury the muscle swells to the point that the nerves and muscle in the limb dies. the skin and bone survive. If you see the patient within hours of the injury (usually less then 6) opening the arm and releasing the pressure can save function in the arm. Opening the arm at 7-14 days has no chance of saving function. It only exposes dead tissue to infection and gives a massive surface that will slowly loss blood (thus the low HCT). If they had not done fasciotomy(opening the arm) the patient would have ultimately needed an amputation but could have had a functional id forearm amputation instead of being condemned to an above elbow amputation.

The temperature was 85-94 degrees every day with 70-85% humidity. This is the definition of an incubator to culture bacteria. Except for the operating room there was no clean areas of patient care. As a matter of fact the patients were housed in an open field with every bacteria blowing around. Every open wound was contaminated, most with pseudomonus. The problem wasn't that we didn't have the antibiotics, we did. It was that with all those open fracture. Open fractures are being treated by putting on an ex-fixiture (ex-fix) to stabilize the bone. The problem is that the area of the fracture with the open skin wound has poor circulation so the antibiotics do not get there. To over come this I started using Daikin's solution. This is a 0ne percent clorax solution. I would drip it at 10 cc's per hour into the wound and the next day there would be no infection.

It was felt that a large number of early amputations may have been unneeded. Therefor before we left there was a policy in place that two American and one Haitian surgeons need to concur on all needs for amputation.

Every patient coming to the hospital was dehydrated and malnourished. I will talk about food and water in a separate post. It is just that from a medical point of view they started behind.

The obvious biggest need is food and water. From a medical perspective the care of the 200-300,000 open fractures is the major medical work that will be done over the next 3-6 weeks. This is phase two of these open fractures, phase one was applying the ex-fix and doing the early amputations. The third phase will be late amputations over the next two months. all of these 200-300,000 open fractures are at risk of this. This could double the number of amputations. Phase four is rehab. There will need to be multiple centers for rehab centers. There will need for 400-500,000 artificial limbs and the people to fit them and the people to do the rehab. I'm currently working to help start this effort. Also there are some inexpensive prostectics used in the third world. I am planning on contacting them.

Finally the rainy season will begin in one to two weeks. This means that almost every day there will be a one-two hour deluge delivering one to one and a half (1-1.5 inch) of rain. Almost every drainage ditch is filled with rubble. Even with them open many streets were turned into rivers in past rainy season. This year with almost no functional drainage ditches most streets will become rivers. With almost 1,000,000 homeless and living in tents on the streets, 200,000 buried inadequately in mass graves and 100-150,000 still under the rubble, a public health crisis on unimaginable proportion is on it's way. I cannot even imagine how to prepare for this or how when it happens it will be handled but I plan to return in the middle of the rainy season so I will be able to report on it.

cdti Hospital, Haiti, earthquake, disaster, Dr. Alan Koslow, french, patients, tetanus, solius flap, gastracnemeus flap, amputation, anesthesia, transfusion, trauma, fasciotomy, pseudomonus, daikin's, rainy season

Haiti: The Disaster and the People.

I am going to write a series of essays on the state of things in Haiti from my observations and my opinion. Do not take these as authoritative, they are the observations after six days on the ground and my analysis. I welcome any comments and corrections. All of my photos are posted on my facebook page:http://www.facebook.com/alan.koslow?v=wall&ref=profile and the videos are posted on my YouTube page:http://www.youtube.com/user/alankoslow .

Despite having the worst Urban disaster in the history of the world:
  • 230,000 bodies as of 2/12/10 recovered
  • 125-150,000 bodies still expected to be recovered still buried
  • 300-400,000 amputations performed already
  • 200-300,000 patients still at risk of amputation secondary to infection of open fractures
  • 400-600,000 new orphans
  • 800,000-1,000,000 homeless
  • before earthquake 70% of population earned less then $3.00/day
  • One of thirty poorest country in the world
  • one of the highest per capital debts in the world.
This disaster happened in 30 seconds but will worsen critically with coming rainy season.

The Haitian people are among the proudest and dignified people I have ever encounted. They, despite being one of the most sh-t upon people in the history of the world (first by the French, then by the world economic system, by their own government and now by mother nature), have a dignity that is hard to express in words.I have been in several very poor slums (Brazil, Mexico, Middle East, El Salvador) and have been panhandled by many, yet I rarely felt panhandled the entire time in Haiti. Actually while walking by myself through a tent village only one person approached me and it was not for a hand-out but for a translation job at the Hospital. I almost got the feeling that despite they deserve handouts they are too proud to beg. They want to do something for you to earn what you give them. I was blown away by this.

I will be talking more about the makeshift economy and the tents cities that sprung up, but it was amazing how organized despite no-one organizing them they have become. The people want a normal life. The economy and their political system before the quake has conspired against that happening..

These are a people who expect to be sh-t upon yet show a grace that is one of the most noble things I have ever seen. how can you see this grace and nobility and not be moved to help them.

The Haitians are very stoic. I did dressing changes on patients that would not be tolerated by the typical American patient. I did major operations with local anesthesia and the patient awake and watching the operation and sometimes singing or praying.

I was impressed with the professionals I met. They would be impressive people here in the USA. I feel there is hope for Haiti with people of the caliber that I met. Not only are they intelligent they demonstrated a creativity that they do not allow their situation to bridle.

Saturday, February 13, 2010

Hait Relief Mission: Dr Koslow Day 5

These are my facebook posts. I am puting them together in a blog for each day. If you read posts don't need to reread. If you want to see these posts with the comments go to facebook.com/alan.koslow

Haiti Relief Update:Just finnished doing dressing changes in the OR on my two big cases from yesterday. The solius flap looked great(forgot to take photo). the arm amputation looks good also. She feels much better. I have two more big cases a gastroc muscle flap to cover infected tial fx and a Full thickness skin graft. may not have enough anesthesia & OR staff to finish one or both. lots of cases booked

February 4 at 10:57am

Haiti Relief Update:the stafing situation is getting critical. We had close to 50 nurses/emt's/drs and helpers till now. by sat they are going to be down to 12-15, No way the hosp can keep running.Most of the 15 are drs and they won't be able to do routine post-op nursing care.they desprately need nuses and emt's.The second disatser is these patients who need special care not getting it and losing their leg or life.

February 4 at 11:02am ·

Haiti Relief Update:Yesterday I had a pt that needed a blood transfusion. The pt had a HCT=17 HGB=5.5 we had arrange transport after I found out we could not get blood here(I asked the 1st dayand told enough blood was avail.). So I I forgot about the patient and today found she was not transfered because you need Hct=12/HGB=4 before they will accept you for tx for transfusion. 50% of the pts will die before.

February 4 at 11:08am

Haiti Relief Update:The original was home Sun then Sat since no flight Sun.(It would also give me a day to recover before work on Mon.) Then last night told they have reserved seats on flight fri and cannot assure getting out Saturday. i am torn because they need help and would like to stay even single day more if I can but don't want to get stranded. They cannot assure a flight till Tues. if I miss friday.

February 4 at 11:14am

Haiti Relief Update: The busiest people are in triage and urgancy(ER) they see 2-300/day then call us for a question.Interesting things I've consulted on have been baby with chronic hydrocephelis, woman with a brachial plexus injury from arm trapped 6 hrs, Uterine bleeding.They get no rest and are out in the hot sun w/o aircondition.They & the tent nurses are doing the most work & most are leaving w no replacement.

February 4 at 11:23am ·

aiti Relief Update:The pts are in 8 to a tent. They have no change of clothes & we guard what they have. They undress in the open with no privacy. today I walked into a tent and a women was standing there undressed washing herself.Those around her when not paying any attention.Tues we put a foley cath in a pt out in the open were everyone could look and see. Everyone acted like nothing was happening & ignored us.

February 4 at 11:30am

Haiti Relief Update: I am back in Des Moines. I will keep posting till I run out of things to post about. I have lots of pictures still to post and lots of video. I will spend my entire radio show Monday on Haiti. Go to DesMoineLocalLive.com at 2:00 PM central time Monday and click Watch the full video experience. I would love to have you call in and talk to me about my experience.

February 5 at 10:21pm

Hait Relief Mission: Dr Koslow Day 4

These are my facebook posts. I am puting them together in a blog for each day. If you read posts don't need to reread. If you want to see these posts with the comments go to facebook.com/alan.koslow

Haiti Releif Update:I found out the baby is doing well. Did three wound debridements under anesthesia yesterday. Then went with Dr Savam the owner of the Hospital to tour some of the damages and also to see the nice part of Haiti. we went up to the mountains at 3900 feet and saw a beautiful country.

February 3 at 8:05am


Haiti relief update:Just heard Sunday there will be almost no flights so will try to get out Saturday, back to USA. Do not know what city I will land in, will then have to find way home. Hope the airlines are accomadating.

February 3 at 8:00am

Haiti Releif Update: now for the fun part. Monday night we went to Pizza garden. I had Kibby an apetizer that is a falafal outside wityh a very spicy beef inside. Very good. The piza I had a slice of seafood and a slice of vegitarian. IT was as good as any I have had in States. All the resturants are about 20 minutes drive to an area hardly hit by earthquake. This seams to be the new social center.

February 3 at 8:07am

Nicole Ovregaard I just wanted to let you know that I have been reading your Haiti updates and find your work inspiring, its helping me get through my less than exciting school work. I want to be involved in medical humanitarian aid in the future. I know my mom told you a little bit about what I want to do but hopefully when you get back from Haiti we can talk more. Good luck!

February 3 at 2:18pm ·

Haiti relief Update:The french are playing nicer.I just did a fascinating case that the fr Plastic surgeon, he thinks fr are snoty also, helped me. I watched him do 2. A muscle flap that is never done in USA,reverse solius flap.She has a bad ankle fracture and it was poring out pus. I cleamed it out past 2 days and dripped a weak solution of clorax bleach over night. Today we did flap. Only chance to save her leg.

February 3 at 2:25pm ·

HaitiReleif Update. I have a sad case today a thirty year old mother of two who said it was hard doing her work before the quake. She had a crush injury and now her are is infected she is septic and at risk of dying. I will do an amputation to try and save her live at firstshe said she rather die then have it. The Haitian Ortho Doc talked to her and we are going to do it in a few minutes. Hope it saves her life.

February 3 at 2:31pm

Haiti releief Update:Last night wewere just aboutto go to dinner when a man was dropped onour curb by police and they left very quickly. He had no blood pressure. we worked for an hr and resucitated him but could not transport him to hospital with blood till am. So we left him with army medics at our hosp. with order...

See MoreFebruary 3 at 2:36pm

Haiti Relief Update:Last night we went to gourmet fr rest.Balsamic and gorganzola salad, trad haitian fish dish, red beens &rice(w capers) , swt potato, plantain.Hd bananas flambet for desert. lunch has been the same each day, beens&rice, corn and sardines. Itwas ok 1st day but everyday, yech.Stoped at supermarket&got 10# friut, apples(3 types),tangerines and bananas.I'mnot starving. Actually I may have not lost wt.

February 3 at 2:53pm

Haiti Relief update:It is realy amazing. Ussually you go to a new Hosp. and it takes weeks to get to feel at home. I am the senior surgeon now that every other surgeon has lweft. I am after 3 days the old dog on the block. Also you make bonds with the fellow workers like you've known them for months not days and hours. It is amazing experiance. Waiting for surgery to start. Hope to post more pics tonight.

February 3 at 2:56pm

Haiti relief update. 3rd night in a row as we were leaving 7:30 emergancy comein. Monday Baby Noah,Tues-truck hit pedestrian, tonight two, woman with dysfunctionsal Uterine bleeding and 13 Y.O. w acute appendicitis The anesthesiologist did not want to stay to do case but we finaly conjoled one to stay(keeps all 4here so their stuck anyway.They are getting patient ready for OR dr David from NYC Gen Surg will do it.

February 3 at 6:50pm

Haiti relief update:baby noah had gone to german hospital, he is doing very well, theywere able to take out I.v. the women who found him and has beentrying to

February 3 at 9:54pm

Last pozst continued:have her own baby for ten years. She feels god led her to find baby and has never left it's side. She will be able to adopt him

Lisa N. D'Amico I have been reading your posts about the miracles you are performing in Haiti. Thank you so much for doing what you can to save lives. It has been harrowing, painful, shocking, and uplifting to read what you are doing. Please be safe and know that there are many, many people back here who are inspired by what you are doing. Bless you.

February 3 at 10:04pm ·

Debbie Dicker Keep up the energy and all your good will. My prays and blessings are with you. Keep enjoying the experience. Thanks for being you! Love you cus.

February 4 at 12:15am


Thursday, February 4, 2010

Hait Relief Mission: Dr Koslow Day 2 and 3

These are my facebook posts. I am puting them together in a blog for each day. If you read posts don't need to reread. If you want to see these posts with the comments go to facebook.com/alan.koslow

Have some great stories. I will post tommorow in Detail. Last night we saved a 3 month old baby that was found dehydrated in a drainage ditch. Baby Noah we named him. Also I have a new medical principal that I will be writing a letter to the editor of New England Jounal of med. Will post it here after I write it.
Tue at 2:55pm

In Haiti There is a desperate need for anesthesiologists and nurse anestetists. If you knowany that want to come I can help arrange it.
Tue at 2:58pm ·

Haiti relief update:Just heard Sunday there will be almost no flights so will try to get out Saturday, back to USA. Do not know what city I will land in, will then have to find way home. Hope the airlines are accomadating.
Yesterday at 9:00am

Haiti Releif Update:I found out the baby is doing well. Did three wound debridements under anesthesia yesterday. Then went with Dr Savam the owner of the Hospital to tour some of the damages and also to see the nice part of Haiti. we went up to the mountains at 3900 feet and saw a beautiful country.
Yesterday at 9:05am ·

Haiti Releif Update: now for the fun part. Monday night we went to Pizza garden. I had Kibby an apetizer that is a falafal outside wityh a very spicy beef inside. Very good. The piza I had a slice of seafood and a slice of vegitarian. IT was as good as any I have had in States. All the resturants are about 20 min...utes drive to an area hardly hit by earthquake. This seams to be the new social center.See More
Yesterday at 9:07am

Haiti relief Update:The french are playing nicer.I just did a fascinating case that the fr Plastic surgeon, he thinks fr are snoty also, helped me. I watched him do 2. A muscle flap that is never done in USA,reverse solius flap.She has a bad ankle fracture and it was poring out pus. I cleamed it out past 2 days and dr...ipped a weak solution of clorax bleach over night. Today we did flap. Only chance to save her leg.See More
Yesterday at 3:25pm ·

HaitiReleif Update. I have a sad case today a thirty year old mother of two who said it was hard doing her work before the quake. She had a crush injury and now her are is infected she is septic and at risk of dying. I will do an amputation to try and save her live at firstshe said she rather die then have it. The Ha...itian Ortho Doc talked to her and we are going to do it in a few minutes. Hope it saves her life.See More
Yesterday at 3:31pm ·

Haiti releief Update:Last night wewere just aboutto go to dinner when a man was dropped onour curb by police and they left very quickly. He had no blood pressure. we worked for an hr and resucitated him but could not transport him to hospital with blood till am. So we left him with army medics at our hosp. with order...s to keep urine output and bp up.He was alive in AM, we tx him. He had pelvic fx, liver injury.See More
Yesterday at 3:36pm ·

Haiti Relief Update:Last night we went to gourmet fr rest.Balsamic and gorganzola salad, trad haitian fish dish, red beens &rice(w capers) , swt potato, plantain.Hd bananas flambet for desert. lunch has been the same each day, beens&rice, corn and sardines. Itwas ok 1st day but everyday, yech.Stoped at supermarket&got... 10# friut, apples(3 types),tangerines and bananas.I'mnot starving. Actually I may have not lost wt.See More
Yesterday at 3:53pm

Haiti Relief update:It is realy amazing. Ussually you go to a new Hosp. and it takes weeks to get to feel at home. I am the senior surgeon now that every other surgeon has lweft. I am after 3 days the old dog on the block. Also you make bonds with the fellow workers like you've known them for months not days and hou...rs. It is amazing experiance. Waiting for surgery to start. Hope to post more pics tonight.See More
Yesterday at 3:56pm

Haiti relief update. 3rd night in a row as we were leaving 7:30 emergancy comein. Monday Baby Noah,Tues-truck hit pedestrian, tonight two, woman with dysfunctionsal Uterine bleeding and 13 Y.O. w acute appendicitis The anesthesiologist did not want to stay to do case but we finaly conjoled one to stay(keeps all 4here... so their stuck anyway.They are getting patient ready for OR dr David from NYC Gen Surg will do it.See More
Yesterday at 7:50pm

Haiti relief update:baby noah had gone to german hospital, he is doing very well, theywere able to take out I.v. the women who found him and has beentrying to
Yesterday at 10:54pm

Last pozst continued:have her own baby for ten years. She feels god led her to find baby and has never left it's side. She will be able to adopt him
Yesterday at 10:58pm

Hait Relief Mission: Dr Koslow Day 1

These are my facebook posts. I am puting them together in a blog for each day. If you read posts don't need to reread. If you want to see these posts with the comments go to facebook.com/alan.koslow

At airport in Chicago. Waiting for flight to Haiti. Have met up with my team. There are 5 teams going on the charter flight. I did not get the list of what to bring, and was told wrong info. So I am sign. under prepared. Told that I will have to do amputations on people without anesthesi\a. I am thinking that if... I put turnaquit up at 300 for 10-15 minutes might make it bearable. This is as bad as civil war.See More
January 31 at 3:45am ·

I most likely won't be able to post till I get back. I will do a video blog daily and post them when I get home. The internet conection at airport is too slow to post the videos I have now. I may be able to post from my satelite phone. I will take lots of pictures and video. This experience will change me. I don'...t think I can even imagine what I am getting into. I will just do my bestSee More
January 31 at 3:53am

The devistation is amazing. 200,000 bodies have been uncovered, 150,000 are expected still buried. Estimated to be over 500,000 orphans. As most families have 5-8 children there is no hope for them finding homesin Haiti.One of the physicians saw a pancaked building with an arm sticking out. The hospital we are at o...ne of only two functioning hospitals Centre Hospitalier du Sacre-Coeur, and is refered to as CDTI.See More
Mon at 1:02pm ·

The devistation is amazing. 200,000 bodies have been uncovered, 150,000 are expected still buried. Estimated to be over 500,000 orphans. As most families have 5-8 children there is no hope for them finding homesin Haiti.One of the physicians saw a pancaked building with an arm sticking out. The hospital we are at o...ne of only two functioning hospitals Centre Hospitalier du Sacre-Coeur, and is refered to as CDTI.See More
Mon at 1:02pm ·

Every where you look you see pancaked buildingsand every blockhas families sleepingin tents on the street because the buildings are not safe or they are just afraid. I have no internet access or phone or 3Gon my Droid. Blackberries and ATT have service. ATT is giving free calls to USA, so I am using oneof the other ...doc's phone. Through friday they were doing 30-40 acute operation each day.See More
Mon at 1:06pm

Since Sat. they have been doing only 15 operation daily and they have been catch-up operations. It is noon and we did 5 operations on the American side. 3 Wound debridements that I did and I watched a solias flap that the french taught one of the orthopods that I am going to be able to use in my practice(makes whole trip worthwhile in itself).
Mon at 1:10pm ·

Things in Haiti are realy slowing down they have caught up to all the initial injuries. We are still doing great good. The wound care and 2 procedures will be an issue for 3months or more. I am trying to decide if a 30Y.O. woman will require an amputation of her arm. It was crushed and didn't receive care till 5 da...ys ago, She has no sensation or motor function and it will be useless. She may be better with amp.See More
Mon at 1:27pm ·

Thought I may not get Haitian food but we went to one ofthe few surviving resturants and hadLambi (conch- a large snail) creole with fried plantain (green) and a very spicy slaw on it. Itwas great. Justhad sardines with red beens and rice. Now back to work.
Mon at 1:31pm ·

I just did another wound change under anesthesia and it was terrible. green pus thatsmelled like pseudomonus(sp?). I had both the fr plastic and am ortho look. we will try to save it but it mostlikely will need an amputation.. I spoke to the husband and he said for days she was missing and he assumed she was alive ...so he is just happy to have her. He 'leaves it in G-ds hand to save her leg'.See More
Mon at 3:37pm

I wanted to talk about anesthesiain Haiti. The hospital does not have enough drugs foranesthesia, however we can dospinals and sedation with versed(like for colonoscopy)so we can do almost any limb procedure and even an apendectomy or c-section delivery with a high epidural. SoI don't have toworry about doing amputau...ion without anesthesia now but they did two weeks ago.See More
Mon at 6:16pm ·

I was done with surgery so went for a walk( about a mile I walked) by myself(yes I felt completely safe.) I cameaccross a tent city in a public park. I was struck by how amazingly organized it is. There are paths between the tents like streets laid out on a uniform grid patern. There are tents from an aid agency and... then between and among them are tents made from sheets and some from4X8 boards.See More
Mon at 6:23pm

The Haitians in these tentcities are developinglocalecomonies. Thereare women cooking plantain and others chicken that are regually placed throughout the tent city. People sellingwaterand others with gas generators that are charging tio charge cell phones. People are settingup kitchens outside their twents and they ...are creating a small economy. Children are playing soccer.See More
Mon at 7:31pm ·

I spoke with the CEO of airline ambasadorsThe umbrella organization that gotussde here to Haiti),to see if there is someplace that I could be of more use. Don't get me wrong I am being used but I have very specialized skills that are not being used. She is going to a meeting of all the aid organizations tonight and i...n AMI may find out they can use me better. Though I will do lots ofgood enven if I stay here.See More
Mon at 7:35pm

Frommy freind ' the guy who get killed in Hollywood movies, also japanese shaking hands man:'Read somewhere online "American's" are being detained from Leaving Haiti. I just wanted to make sure you had a 'out'. (just the paranoia of my 'old' life) I am hearing we go to the airport and they put you on flights to US in ...order you show up. So you can endupany where in US but everyone is gettinfg out on day they show.See More
Mon at 7:42pm ·

My friend Suzzie who is a great friend that I rarely get together with. asked me if there was still a need foramericsan Nurses? YESY YES YES. they have a much bigger need for nurses them dooctors. Get the word out. I can connect you with ways to get down here.
Mon at 7:46pm

IHere at the hospital in Haiti there is a big turf battlebetween the French and the Americans. The fr have an organized team that trains together and works repeatedly together and have been to many disasters together. They are fully paid while here and are not volunteers. The Am are all volunteers who have never seen... each other till they got here. The Am are less organized then the Fr so the fr have been snotty.See More
Mon at 7:53pm

The french here in haiti are very very efficient but at 5 pm they leave and assume someone will take care of the post op of their p[atients.... The Americans of course.
Mon at 7:54pm ·

Goodnight everyone from Haiti Day two in country day one working. See my earlier posts. Hopefully I will still be able to post and woill be able to post video and pictures, Otherwise I will post them when I get back.
Mon at 7:57pm