I received this message recently from some new dear friends I met while in Jimani, DR.

Our dear friends Darrell Brown ( http://en.wikipedia.org/wiki/Darrell_Brown_(musician) ) and Rosie Casey wrote this song in tribute to those who helped with IMA's efforts in Jimani. It came straight from their hearts. Joe Cronin put the music and images together. It's a gift to IMA and they hope it can be used to raise support and funds for the ongoing effort.

Enjoy.

Lee and Patty

Here is the production:

IMA from Joe Cronin on Vimeo.

BRK

One of the most amazing things about this mission was the overwhelming number and breadth of volunteers. I met physicians, nurses, anesthetists, pharmacists, medical students and just plain people who came from across the US (and the world) to help. Many of these volunteers were part of impromptu groups. Just as I arrived a group of about 20 volunteers from Spain were departing. From Vermont groups of about 10 people rotated through for 1 - 2 weeks at a time. A similar set of groups from Baton Rouge rotated in and out. Of course there were also many individuals who came to help, some associated with organizations like the Peace Corps but also some who acted on their own.

Nurse, Ritu - Peds Infectious Disease, and John - Pharmacist

Physical Therapist from the Baton Rouge group

New volunteers arrive from the Vermont Group

Brenda, a school teacher from Nebraska (with cornrows) with Nurse from CA

Medical Students from The Mayo Clinic, some of whom helped with the victims

Ed, Chief Surgeon and Orthopedic Surgeon Extraordinaire

What was truly amazing was how so many individuals from such varied backgrounds worked so well together. Within minutes of meeting we were setting up an OR, operating and recovering patients. It seemed like we had been working together for years. I think this was because nearly everyone I encountered there was very experienced and tops in their disciplines.

Unfortunately, there are always a few bad apples. There was the occasional "volunteer" who was at best opportunistic. Although the credentials for the MDs, nurses, and others were scrutinized as much as in the States, the non-professional volunteers had no such credentialing upon which to rely. Some were there to try and gain experience in procedures that they could not perform legally in the states. Others, it seemed wandered from mission to mission in search of no particular goal, it seemed. I also encountered the occasional physician (although well qualified) who was along for the "joy ride." They were looking, I believe in this order, for recognition, good cases and to experience in a somewhat voyeuristic way human tragedy. When these did not materialize to their satisfaction, they moved on. I called this phenomenon medical voyeurism.

More to come

BRK

Most of our patients were housed in the "tents". We had several by the time I arrived there and were able to close one by the time I left. Each housed about 20-30 patients. The patients had cots that kept them off the ground, but that only came after a few weeks. In the first days after the earthquake they stayed on the ground.

"Spanish Tent" - named for the volunteers from Spain who staffed this tent
(and of course charted in spanish).

The tents were outfitted with makeshift nursing stations and power supplies.

Nursing Station

Novel Power Supply for Lamp

Desk for working on charts

Bathrooms consisted of portable outhouses. Patients had to be carried, often by family, to and from them.



Next up, the volunteer who made it all work.

BRK

Follow this link to read and/or hear an NPR story about "donor fatigue" when it comes to relief efforts. Very interesting.

http://marketplace.publicradio.org/display/web/2010/03/02/pm-chile-donors/

thanks
BRK

As I mentioned before, the mission of IMA in the DR and Haiti is two-fold this year. Yearly, they run missions to the Haitian population on the border of Haiti and the DR providing primary care, GYN care and some small specialty care. This year the earthquake resulted in a morphing of the mission to include the emergency care of earthquake victims.

It is my understanding that the facility we used for our "hospital" was designed and built to be used as an outpatient facility. This building was converted "on the fly" to a hospital. The other new building on the grounds destined to be an orphanage was used for patient rooms early on in the relief effort.

Main Building "Hospital"
The tent in front is food storage

The main building acted as center for operating rooms, central pharmacy, intensive care unit and storage.

A well stocked pharmacy

A typical operating room. We had 4 of these, two for orthopedic surgery and two for plastic/general surgery.

Equipment was utilized however we could. This walker was converted to an OR table long before I got there.

OR tables made from wood. Some of the operating room beds were made from wood so that X-rays could penetrate for the orthopedic procedures

We were blessed with X-ray, courtesy of RAM (Remote Area Medical) an organization that specializes in setting up medical outposts in remote areas and at short notice. This X ray machine was digital and fairly portable. We also had fluoroscopy in one of the operating rooms. The only limitation were the frequent power outages.



Supplies were plentiful in many respects while deficient in others. The shear volume of incoming supplies resulted in disorganization and few people available to organize them. Most volunteers were involved in caring for the victims and had no time, nor the experience, to sift through boxes of donations. Only after I arrived did the pace slow down enough that we could devote some time and effort to organizing the equipment/supplies. In addition they broke ground for a warehouse to put some of these supplies before the rainy season begins, which is right about now. It was clear to me that support for such an effort like this is probably better in the form of cash so they can purchase what they need, when they need it.

Supplies would arrive by the truckload on occasion, many other supplies were brought by volunteers as they arrived. I brought dressing supplies, equipment for skin grafting, and surgical instruments.

Sorting supplies as they arrive.

Supplies piled high on the front porch.

One of our supply rooms

Anesthesia supply room

Two volunteer taking a short break from stocking duty.

Due to the sheer volume of supplies and equipment and the limited indoor space to house them the group arranged to have a warehouse built. They are trying to build this rather soon as the rainy season is coming and anything without shelter is likely to get ruined.

The beginnings of the warehouse and therapy tent.

Ideally, supplies at this IMA facility would be distributed to the smaller and less well equipped facilities within Haiti itself. Unfortunately, the politics in that regiion often limited the cooperation between the two nations. More about that later.

Next I will discuss the inpatient facilities and some of the types of injuries we treated.

BRK

The latest news from Chile really highlights the frailty of Haiti. Shortly after the Haiti disaster the experts who analyzed the effects and response accurately pointed to the intense poverty and lack of infrastructure available. Now that we see how a more developed area has fared in the face of an even larger earthquake, it is clear that these analyses are correct.

Of course, some are concerned that Chile will draw critical relief efforts away from Haiti. The more pressing issue is that as the memory of both of these disasters fades and the news media moves on to the next, more sensational story, the aid and support and volunteer efforts will drop off drastically.

While in Haiti/DR, I had some long talks with Dorothy (one of the founders of IMA)who has experience with other disaster releif efforts including New Orleans after Katrina. Apparently, as physically demanding as it is, the early relief effort is the easiest part of the overall aid. At some point soon, the support will predictably dry up and keeping up the efforts over the years is real challenge.

I hope that the world continues to support Haiti, Chile and the many other areas that need help. This includes those in our own backyard !

BRK

Well, I'm back. I apologize for the lack of posts but the communications were sporadic and spotty, at best. It might actually be better to post after I get back anyway as it gives me a chance to organize my thoughts and pics instead of a daily log.

I will start with an overview of the mission and in the future posts discuss more including the injuries and surgeries we managed, the people of Jimani, the political situation, the volunteers and other topics.

I'll start with the IMA (International Medical Alliance). IMA long preceded the earthquake in Haiti, but their role drastically and immediately changed when the quake hit. In general and historically, the International Medical Alliance(IMA) is a nonprofit organization that provides medical relief and care to under-served and vulnerable people around the world through medical mission trips. They run medical mission trips to the Dominican Republic and Kenya (among others)and revisit each of the villages once a year to establish long term relationships. In the Dominican Republic, they provide care through day trips to remote villages termed Batays.
These are communities that surround the sugar cane plantations and were created by the Dominicans who populated them with haitians. The Haitains who live there are not Dominican citizens and any Haitian child born there is not given a Dominican birth certificate nor considered a dominican citizen. basically these people are stuck there and will never get out unless they go back to Haiti. These people live in abject poverty and may not receive any medical care other than that provided by IMA. The general medical mission for which IMA is known continues and happened to coincide with the week I was there. I am grateful for the opportunity to see that side of the organization and work with IMA's regular volunteers caring for the native population of Haitians.

Part of the mission of IMA included a new facility in the town of Jimani that was to be used as an outpatient clinic and another new building that is to be an orphanage. When the earthquake hit Haiti, the "clinic" was inundated with victims. They arrived by car, foot, helicopter, any way they could get there. Within days the facility at Jimani, DR was transformed into a hospital. The volunteers set up 4 operating rooms, patients were housed in large tents and some of the rooms in the clinic were designated as an intensive care unit. My fellow colleagues who were there in those frenetic weeks tell me of endless amputations, wound repairs and fracture fixations.
It was reported that they had approximately 500 patients, 25% of which became amputee´s, they hosted about 1000 volunteers both medical and non-medical, had 14-15 deaths and at one point had over 2000 people living on the compound.


The clinic turned Hospital at Jimani


Patient Tents


Pt tent in foreground, the foundation of a warehouse, and in the background a new orphanage building used to house early victims.

By the time I arrived it was 4 weeks after the earthquake and most victims had either begun to make a true recovery or had lost limbs or died. As a result, most of my work dealt with open, difficult and/or infected wounds and general medical and supportive care. Each day we were bused from our lodging in the nearby town of La Descubierta.

View Larger Map
Typically, we would operate in the mornings and see patients in the tents in the afternoons. During our rounds we treated wounds, coordinated care with the medical doctors, review their antibiotics and medications and arrange the next days operating schedule. We had ample time to interact with our patients and really get to know them. At the end of the workday, we returned to La Descubierta and had time to share experiences with the primary care teams returning from the Batays.


Inside the Pediatric patient tent


A part of the medical team heading out to a Batay

Our accommodations were simple but sufficient. One of the officials in the D.R. had opened his house in La Descubiata for the teams, but there were many more volunteers than this house could hold. Additional beds were found in the two hotels in town. No hot water, food was good but predictably rice and beans with occasional chicken or goat, and fruit. The officials at IMA had hired locals to cook and maintain the house.




Images of the town of La Descubiata


The Chow Line...he looks perplexed !!


Our Cooks and Caretakers

The next post will discuss the "hospital" and how it was set up and organized.

BRK

Finally in Jimani, 1AM Monday

One thing I won't miss!

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Thanks to all those who have stepped up to help, including vendors with supplies, my colleagues covering while I am gone and all the nurses at MetroHealth who have organized equipment. A special thanks to Miggy in the OR.
BRK

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Thanks to all those who have stepped up to help, including vendors with supplies, my colleagues covering while I am gone and all the nurses at MetroHealth who have organized equipment. A special thanks to Miggy in the OR.
BRK

Preparations continue for my trip. I spoke with the director of the clinic, Dr. Jeffries about some of the specifics. Apparently, between ground zero in Haiti and Santo Domingo there is little else that has any sophistication. As a result some of the more complicated cases are being referred in, while many others less acute moving out. Most of the work now seems to be wound care, revision and reconstructive surgeries.

The clinic/hospital is located in Jimani, DR and is due east from Port au Prince.


View Larger Map

I spoke with Dr. Benjamin Lind, a vascular fellow at Rush University in Chicago who came back from Haiti last week. He reported that conditions in Port-au-Prince were still quite severe and that, although critically important, the surgical care they could provide was limited by the conditions. His hope is that our situation, being a little removed and still able to maintain some organization will be most productive.

I also have been collecting materials and supplies needed for our efforts and for the IMA facilities. This is a fascinating social situation, and I heard about this recently on an NPR radio report. The outpouring of support has resulted in an influx of supplies, often so much that facilities are literally buried in materials. As a result, they can often not find the needed instrument or medication because it is buried somewhere beneath so much other stuff. Dr. Jeffries reported that they are only now finding some of the surgical instruments needed and that they are flush with sutures, dressing supplies, etc (at least for now). It seems that the most efficient way of contributing is money so your relief effort of choice can purchase what they really need, when they need it.

I have been on medical missions before and many of our colleagues volunteer regularly. There is a routine of leaving boxes around the hospital and OR where supplies that would normally be discarded are collected and delivered to the mission. While effective, I've learned this is not always the most efficient for the reasons I described above. I want to give recognition and congratulations to Medwish (www.medwish.org) a cleveland organization that collects these items, inventories them and will deliver the needed supplies upon request. I called them yesterday and they are truly a professionally arranged organization, very efficient and a pleasure to deal with. They fulfill a serious need and I thank them.

More to come.

Please visit the International Medical Alliance website: www.imaonline.org


BRK

It is with a combination of sadness and anxious anticipation that I set up this blog. The earthquake in Haiti has resulted in devastation and personal tragedy beyond compare in recent history. We all watch the events and aftermath unfold before us with a sense of deep frustration that we can not help more.

The purpose of this blog is two-fold. First and foremost to help spread the word about a wonderful organization that IS helping, the International Medical Alliance. I have only recently been introduced to the organization but already see that they are genuine. They have been in the area on the border of Haiti and the Dominican Republic for several years providing basic medical care and hosting routine medical missions. Their commitment started long before the earthquake!

They are in dire need of support. You can find them at www.imaonline.org.


Next, I hope to be able to chronicle the experience of helping the IMA. If the communications are sufficient I will send updates during our trip starting February 13th.

Thank you for any support.

Bram R. Kaufman, MD