Letters to home during Haiti Earthquake Relief

Editor's note: Dr. Ed Landry, an orthopedic surgeon in Kennett, is part of the Jimani Project that recently provided much needed medical services to the people of Haiti following the earthquake there. Dr. Landry is sharing some thoughts with his family and friends back in the United States as his schedule and circumstances permit. He has graciously allowed the Daily Dunklin Democrat to share his accounts of the work taking place there. There will be personal references meaningful to family and friends interspersed with his account. What follows are the five updates from Dr. Landry.

Part 5

Dear Family and Friends,

Back in the USA!

I have waited a day to send this final note about my time in Jimani.

We left the Jimani Project Saturday, January 23 about 9 AM for the airport in Barahona. Before boarding the bus, each of our group had last minute desires. Check on this patient, get a photo of that, where's Dr. XZY, etc. Bill Ragon and Mike Cobb had special concern for a burn patient they'd spent hours with earlier in the week. He was loaded up and set for transfer to one of the Navy hospital ships, with a helicopter due in shortly after our departure. I never did see it happen, but I do believe it did, thanks to Clint's persistence and Caleb's satellite link which enabled communication with the ships.

When we got to the airport in Barahona, we met a large group of firefighters from CA, "Firefighters for Christ" their shirts said, from multiple locations. They were mesmerized by Dave Vanderpool's stories of his trips into PAP. I think that's where they were headed, but I don't know if they knew themselves where they'd be sleeping Saturday night. We also found the US Air Force setting up a base at the runway's edge, for coordination of incoming flights with supplies. Sounds like the Barahona airport will be a staging area for what needs to go by road into Haiti in the coming weeks. Chuck Sutherland's plane came in loaded with meds, etc. to put on our now empty bus for the return trip to Jimani. We found Mike Cobb's name on some of the boxes, those had been left in Knoxville on our trip down for lack of space. So you can imagine just how hard it is to get a box of this or that from the US to Haiti. Mike's supplies had been in the Knoxville airport since January 18.

So we had to stop in Atlanta for customs and Chuck left us for his grandchildren with the pilots to fly us on to Tennessee. I did not actually kiss the asphalt in front of his hangar, but I admit to some jumping up and down!

Now we're all back home with thoughts of patients we left behind. Mike's worried about a woman whose arm was amputated to free her from rubble. He had to revise the amputation twice due to skin loss and infection. Bill worries about the burn victim he got thru the longest operation done while we were there. John Williamson left his patient post emergency hysterectomy with fever, though it was declining. Neil Barry had so many patients I can't tell who he was the most concerned for. Dave left thinking he could have gotten more injured out of PAP if he just had a bigger vehicle. Chuck, Mr. Fix-It to the end, left wondering if the broken pump for the water supply he'd correctly diagnosed as shorted out would get fixed quickly (we lost all running water at 2 AM, Saturday morning because of the fried pump). And I left worrying about I month old Annika (I had her name wrong earlier). I gave her over to Dr. Ben from Boston, and feel sure he'll do whatever it takes to save her arm.

I am left, naturally, with some striking images from this experience. Our group shared some of these with each other Friday night over dinner. Everyone had incredible moments of unbounding joy. My own personal moment came Wednesday, January 20. I found 2 huge boxes of new sheets lying on the grass outside the hospital, a gift from only God knows who. I carried as many as I could hold, and grabbed a young volunteer to do the same. We then gave all the patients in recovery, who had been on bare mattresses only (some blood stained), clean, new white sheets. I wish I could describe the look on the faces of patients and family members. I felt like Santa Claus!

There were, of course, many episodes less than joyous. Mike Cobb explaining through an interpreter to a dying woman's family that her only hope of survival was amputation of 3 extremities. He did the absolute best anyone could possibly have done to answer all their questions and fears. She refused and did die 24 hours later. For me, it was having to remove the burned skin from baby Annika's forearm. It's just a nightmare.

This last story is about Clint Doiron and faith. The Jimani project was Clint's dream. Now, as one of the Knoxville crew pointed out, it is Clint's Noah's ark. He built it, and finished just in time to take on those sent there. So when Clint went into PAP on Wednesday, he came across 2 Catholic nuns in a vehicle with injured Haitians. One was a 7 year old boy with a facial injury. Clint was sure there was a fracture and told them to come to the Jimani Project hospital. So the nuns did just that. When they arrived, the nonmedical person in charge of signing in patients told them they couldn't leave the patients there. He basically said "there's no room in the inn and you've got a van, take them on elsewhere, besides we have no one who can handle this head injury". When Clint got back later, he was asking for the young boy's location. I told him what I had heard had happened (I was not there, but was in the OR). He would not accept the possibility that patients he had personally promised care to had been turned away. He anxiously searched the orphanage (remember it is 2 stories with probably 400 patients and family) until he found the boy. Now I know the nuns were shunned by the "gatekeeper", but then again I've had some small, personal experience with Catholic nuns in the course of my life (beginning at age 6 with the School Sisters of Notre Dame), and I know damn well you cannot tell one NO! (if you do....straight to Hell!). The nuns had essentially ignored the gatekeeper, found a nurse, and parked the patients exactly where they needed to be. Next Clint wants me to look at the boy, well it's a bone and it is broken, right? The plastics guys looked too. Clearly there was nothing we could do at Jimani for him. But you see, Clint had promised because he had faith that doing the right thing would lead to the child's getting the right care. By Friday, some of the volunteers (I am not sure who) had taken the child back to PAP, to the airport where the U of Miami had a field trauma hospital. They felt he needed a neurosurgeon, the one specialty they did not have available! So what did they do? Well they violated several international laws, probably dissolved our treaties with the rest of the Caribbean and Central American nations and flew the child back to their neuro pals in Miami! So I learned that it's not just doing what's right, but it is having the faith that when you do God is your back-up. Thanks Clint.

Love,

Dad/Ed

Part 4

Dear Family and Friends,

First of all, I deeply appreciate all the love, prayers and support you are sending my way. I feel very honored to receive such grace.

So today from chaos, some order. We got up with roosters making noise just before sun-up. Mike Cobb and I were in the OR by 7:30 AM and worked together until about 6PM. We made up for yesterday's frustration thanks to my new hero, Dr. Ben an ortho/hand surgeon from Boston (last names hard to come by here). Looks like Harry Connick, Jr. so Ben Hollywood could do. He arrived yesterday, and was stymied by the lack of an OR for him to use. Within hours he happily accepted his new calling in life to run the OR schedule for 5 operating rooms, 11 orthpaedists, 2 plastic surgeons and an unknown number of pending patients. Without picking up a scalpel he did more than enough to credit him with the gold star of the day. We sent our #1 OR ortho nurse, Danya from Omaha/Creighton , to the orphanage/hospital to line up surgeries since she understood our capabilities. Patients have to be moved by ambulance the 200 yards from orphanage to hospital. Lots of bumps, dust and heat. Lots of lifting up and down, carrying stretchers. No one complains. Ben said we did 58 surgeries (still without Xray) with only one cranky surgeon from CA giving him a hard time. So do we feel well accomplished? I just don't know how to even measure progress here.

As we worked along thru the day we heard various reports. Some are checking in with CNN, some have family sending odd news reports asking if we can confirm. Luke, I saw your note about US support. I hope your "tree shaking" reaches the right person. So from "rumor" the USS Comfort is either full or not doing anything. The U of Miami has a field trauma unit at the airport in PAP, and may take some critical patients from us, but the critical probably can't handle the car/truck ride. Clint/Dave Vanderpool/Luke are all pushing for help to get patients moved out of here, we all wonder which agency is going to step up to the plate.

We still saw patients today who had no significant care since their injuries. I honestly don't know how they are getting here. One was a 70 year old lady for whom Mike did external fixation for a femur fracture, completely by feel, since no Xray. We are all amazed by the strength they show. They have tolerated so much pain, and frankly we sometimes just look at each other in the OR wondering HOW DID THIS PERSON SURVIVE THE LAST 10 DAYS? The Haitians look after each other quietly and with dignity in the most bare of surroundings. We had one woman today whose right arm was cut off to get her out of the rubble. Mike revised the amputation and has her lined up with plastic surgeons from Gainesville for skin grafts on Sunday. She never stopped smiling, never complained, yet I am sure she is in pain. And there are far more just like her.

I have so many stories, I may not be able to keep them straight. Some are just too terrible to put to writing. This is a small part of one, with a lot omitted that goes into the too terrible category. Our OB-GYN professor from Lincoln Memorial Medical School in TN saved a young woman's life early today. Dr. John Williamson has been coming to Jimani with Clint for years. A nurse came looking for him late last night. The patient was about 20 weeks pregnant when she was crushed in the quake. The baby died and she appeared here out of nowhere with high fever. I really don't want to go into the medical issues, but when John told her husband emergency surgery was needed at 2AM, he agreed without question. When John said, "Do you understand how serious this is?", he replied "Because you are doing it now at 2AM I know it is very serious and you are doing the right thing because no one in my country would ever have an operation at this time". Clint was there for the whole surgery, and I know he will have much more to say about it.

There was a very minor tremor here about dark, none of us felt it but the patients and their families lying on mattresses on concrete floors did and ran out of the orphanage into the parking lot area. I did not see this, but 2 patients with IV's jumped from the second floor. 3 docs went to check them out. Danya was just getting things in order again, putting people back to bed, when we felt another, bigger jolt. This is the first thing I have noticed so I am now in our bus typing away for awhile. I'll go check on my post-op patients in a little bit.

When we occasionally stop and look beyond the Jimani Project at the surrounding views, this is a beautiful spot. There is a large lake with vistas to green cliffs in the distance. Hawaii is the only place I can compare this to. But, it is much hotter than Hawaii! Must have been 100 degrees in the sun at midday and 90 in the OR. I consumed well over a gallon of fluid today. I can't imagine how this adds to the stress on our patients, we keep pushing fluids and using antibiotics far more easily than I ever would at Twin Rivers. Thank God we have all of that we need.

The CRNA's (nurse anesthetists) working with me have kept my patients magnificently pain free with little of our usual 21st century devices. We can't even monitor oxygen levels appropriately. Bill Ragon who came with us from Jackson, TN "trained in" 2 new arrivals from Knoxville today during surgeries Mike and I were doing. There we are in a OR with screens covering open windows, doing surgery, while Bill quietly gave his replacements (I do believe it will take 2 to replace him) his advice given our resources. By the way, I have not heard a patient crying in pain in the recovery area immediately post-op. The anesthesiologists and nurses running the recovery/post-op areas are just incredible. We keep pushing them to discharge patients so we can bring in more. They have 6-8 patients on cots in small, hot rooms plus patients in the hallways, the laundry room, and every alcove available. They have never said a sour word doing the toughest of jobs.

Speaking of jobs, I really love what I do. My Dad said he enjoyed 20% of what he did in dentistry, and that made up for the other 80%. I have always felt fortunate to enjoy 80% of what I do, more than making up for the other less enjoyable 20%. And come to think of it, at this moment, I don't know what the 20% I thought I didn't enjoy is anymore!

The volunteers here are just amazing. Not just the docs and nurses, but everyone. I just met Caleb Pal from Huntsville. Luke, he is the man (I swear he looks 13 and has never shaved) Troy Moore got to come down to hook up the satellite link. I decided his IQ is too high for me to count to. He put a blow up bubble on the roof with the dish inside and is working on a second. He brought a black box smaller than a carry on suitcase that will be a cell tower giving a mile radius for our phones to connect to it. We can then call US through any cell provider one would have just as if in US. He says we are a "cell service provider". He's working on how to call in to Jimani right now, next to me here in my dorm room. I am sure he hasn't had any time to think about why he got into this. I think 99% of volunteers are here because they felt called by God. This is one of our usual discussion topics over power bars and bottled water. I met a young surgeon yesterday on his arrival. He was so arrogant the nurses told me they wouldn't work with him. But today he was crying along with the rest of us, his eyes the "Jimani red". And he started asking for advice in the OR, which I guarantee never happened before. And he does great work! He did a "free flap" of skin from the abdomen to a calf wound for one of my 11 year old patients to cover a huge, painful open wound in record time. And within minutes had figured out how to use orthopaedic hardware to fix a 7 year old's jaw, that was broken in 2 places. So I guess he just didn't know where the phone call that got him here originated from until today. We are all being changed by our time here, but it was incredible to see this man become so different so fast.

Several of us rode our bus into the town of Jimani tonight. The local hospital looks more like a bus depot to me. (Forty) people milling around outside, tiny windows, little light. Would not pass for anything medical in the US except a warehouse. We just gawked, speechless. I have truly led a sheltered and charmed life, and assure you all of my pals here feel exactly the same.

So we now have enough orthpaedic surgeons here that I feel comfortable leaving. I had always planned to return 1/23, but with the reservation that I couldn't if I was needed. Mike Cobb came planning to stay for 2 weeks. We both feel comfortable about going since we have more than enough colleagues to hand off to. The humanitarian crisis may be more apparent on CNN, but so far we all agreed the many (over 100, 58 the last 2 days I think) patients we put external fixators on have to stay here. Where can we send them with pins and bars on their legs? They can't walk on these and many have both legs injured and can't even use crutches, which we actually do have. And some need further surgery.

So far we've had by one count 500 patients here at one time. We just have no next place to send them, so many will stay and limit the input of more. Clint won't turn anyone away, he has faith that his pleadings will hit the right ears soon.

Everyone is heading back into the buildings now, but our bus driver, Francisco, is keeping me under protective custody on the bus for a while longer. I don't think I can get off!

If you look at a map of Haiti and the Dominican Republic, Jimani can be found due east of PAP, just inside the DR. I am told evacuees can't go south to Jacmel on the coast because the roads are impassable and the same to the west. Most will head east? We all wonder, another topic of usual discussion.

This is disjointed due to several interruptions to check patients in recovery, plan a last minute surgery for someone else to do in AM, try to convince Clint to go to bed (took 3 of us on that one), and calm a young journalist shaken by the jolt we got. Francisco finally allowed me off the bus and we'll let her sleep there. I actually have a bed tonight for the first time! With a nurse anesthetist waiting to take over in the morning when I leave.

So tomorrow I get back on Chuck Strickland's jet for our trip back to Knoxville. I have hugely mixed feelings about leaving but I know this was only Phase 1, I can't imagine not coming back some day, especially since Clint has learned I know how to get here.

Again, thanks for your thoughts and prayers,

Love,

Dad/Ed

Part 3

Dear all,

8:20 PM:

Another day of highs and lows. We had multiple communication breaks today. The patients that need surgery are more stable and less emergent. We have identified quite a few still lying at the orphanage with fractures that need repair. Unfortunately the volunteers fed them breakfast and lunch, so we (OR teams) decided not to do surgery on these and delay until tomorrow. There is less risk of anesthesia complications if one hasn't had food or drink for 8 hours pre-op. Less likely to vomit and choke when awakening. Given our limited safety equipment, and that the patients seem stable, we chose the lesser

risk of waiting for tomorrow. I had some lined up for surgery tonight but powers that be decided to close the OR's at 9PM. A group from Boston came in today ready to go, don't understand the decision process. Overall very frustrating combination of events. Harvard sent a 5 member disaster management team and they are coordinating the overall flow. We do hope to make contact with the Navy tonight and arrange to transfer the sickest to the USS Comfort in PAP. I will believe it when I see the helicopters.

So we did several surgeries today, but had a lot of down time in the OR. This allowed us (the ortho guys) to take stock of the post-op patients and we did find several that need surgery tomorrow. I found Dr. Tom Rivers from Sugarland, TX in his OR down time unloading an ultrasound machine at the orphanage so the OB guys can check out pregnancies. Just one example of so many. And we discovered several patients in need of surgery for lower leg fractures that we didn't know about. We will have a lot more help tomorrow, but as of now we don't have nurses to take care of 22 post-ops thru the night. I feel sure that will get covered soon, we expect the Puerto Rican group soon.

I operated on my first patient from 1/19 again today. One month old Amica. She has an aunt here caring for her. Father is definitely dead and Mother unknown. Her pediatrician, Kurt from Omaha, is threatening to take her home to Nebraska. I had to remove burned and dead skin from the top of her forearm. I have an orthopaedic hand surgeon from the Boston group lined up to take over her care for me when I leave (Saturday). I just don't know if her hand will survive.

Now we have very many people on site, doctors, nurses, EMT's,lots of people....which requires the bureaucracy to become involved. In the long run it will help. In the short run, we still have over 300 patients here that need a lot of care.

Several new states represented today. We had anesthiologists and OR nurses from New Hampshire and South Dakota arrive with a lot of equipment. Craig Greene from Baton Rouge got in a lot of orthopaedic fixation hardware we needed. We are still short of Xray in order to do more advanced procedures.

From what I hear talking to the folks in the administration end, we are the best functioning facility next to the Navy ships in the area. We had Dominican media in and out last 24 hrs and they agreed. I understand many small places are trying to treat patients inside the Haitian border without any resources. Our biggest problem is where to send the patients as they improve. 30 have been moved down the road to a Church.

We had a man come in today with 40% body burns. He is about 30 and was in his car when the quake hit, a building fell onto his car, and it exploded. I have no idea how he has survived until today, or how he got here. Mike Cobb and 3 general surgeons worked on him for 2 hours. He is our first priority to fly out if the Navy connection works.

Clint has been all over the place today. Trying to get help from the Dominican Republic. Trying to get us Xray stuff.

Worrying about little kids here, there and everywhere.

I am not much for commercial hype, but that TV ad for AT&T wireless internet is the honest truth, as I have found the internet in Jimani, DR. I enjoy the chance to send out this information and hear back. It is slow, so no pictures until I get home.

Computer battery is going out so guess that's it for now.

Thanks EVERYONE for the love, prayers and support. I promise I can feel each of you out there,

Love,

Dad/Ed

Part 2

Dear Family and Friends,

It is almost midnight here and seems much quieter. The volunteers here are from everywhere. California, Texas, Nebraska, NY, Louisiana, Tennessee, Brazil, huge group from Puerto Rico who come at night in starched white coats (haven't asked yet how they manage that), and of course Missouri.

It is heartbreaking to see the suffering of these Haitians. We feel about cried out, and then another situation comes up and one can find 4 gray haired orhtopaedic surgeons with tears we can't control. The Haitians sing together in the night, unbelievable. They want to comfort their hurt. I operated on a 14 weeks pregnant, 20ish woman today and through the haze of medication she was trying to sing. Dr. Mike Cobb (Jackson, TN) and I both were red eyed with that. He believes she was singing a religious song of praise to God.

We usually never know how they come to be here at Jimani. We had a young man come to us at the pre-op area with an X-ray of his grandmother's hip. She was in a van, if you can call it that. This is the only X-ray I have seen here, and was obtained in a nearby town where he was told to bring her here. She has a partial pelvic dislocation. Craig Greene, a trauma specialist from Baton Rouge put our last external fixator on her 2 hours ago. We hope to get more from the Domican Republic tomorrow. The Puerto Rican in charge of their group, a pediatrician, promised to help us get more. Luke, thanks for all your efforts on the procurement and money raising side. I will send you a separate email with special requests.

Turns out the helicopter guys who are helping us try to get Xray equipment are Mormons from Utah. They are flying 6 orphans to Miami tomorrow and have the adopted parents waiting! I am very impressed by the energy of these young men and how fast they make things happen.

It is hot here, like August in Houma. No mosquitoes, thank God. The one real OR room is air conditioned and we're letting the orthopaedic team from California use it. Don't know how that happened! The other ortho teams are using dental and exam rooms for OR's. These are not air conditioned, have screens over open windows and flies at times. Like I told Kit, we are doing battlefield aid station surgeries. At one point today, we had 3 teams putting on external fixators at the same time with doors open in between each room so we can consult with each other, share drills and 2 orthopaedic residents from NY and the one OR nurse. Can't send the pix because internet connection won't support that. Luke, that may change when your satellite tech shows up tomorrow and hooks up our dishes. We are all taking pictures, it is the only way folks will ever believe this.

Two babies have been born here in the last 24 hours, one by emergency C-section early today. I can't imagine what their lives are going to be like.

Love,

Dad/Ed

Part 1

Dear Family and Friends,

Today (Monday) found me traveling from Knoxville with friend and fellow grandfather (Kelley's father-in-law) Clint Doiron to the Dominican Republic town of Jimani near the Haitian border. This is home to Clint's hospital/medical clinic/orphanage, the Jimani Project. The Chadasha (ancient Hebrew for "new song") Foundation from Knoxville is the umbrella group over this. We had the gift of a private jet ride in a Sabreliner 65 for those who know what that is. The plane owner from Atlanta, Chuck Strickland, has stayed with us to help. The pilots flew back to Ft. Lauderdale and will return Saturday PM or early Sunday AM. No gas for refueling here. We rode up from the airport in Barahona in a very nice bus, think airport mini-bus, through countryside reminiscent of the leeward side of Hawaiian islands.

Then tough stuff. Arriving here with patients and their families all over the grounds of the clinic and the orphanage which is 200 yards away. The first patient I was asked to see was a 1 month old. The doc on duty was a nephrologist, Ross Isaacs. He carried her himself the 200 yds to the hospital and into the OR. She had a crushed/burned/fractured forearm with blackened finger tips and a hugely swollen hand. A wonderful nurse anesthetist, Tim from Omaha, put her to sleep and I basically opened up her wrist where burn tissue was a tourniquet. We'll see her in the OR again Thursday. Her mother didn't survive multiple injuries.

It was then one fractured leg after another. We have 3 other orthopaedic surgeons here. One is a professor from a hospital for special surgery in NY and brought 2 residents. I helped them thru several procedures and they helped me some more.

Luke, your Dad and I then talked a promise for $125,000 C-arm fluoroscopic x-ray from a young group of guys. They bought 2 helicopters here and are flying in and out of Port-Au-Prince (PAP) for supplies and the occasional wounded. We are still working on how to make that happen fully. We may have a portable X-ray tomorrow. So far, we are going by our judgement since we have no x-ray.

A lot of amputations were done here in the last 3 days. The helicopter guys tell us there are wounded in small clinics that have only nurses. Dr. Dave Vanderpool from Nashville is going to PAP tomorrow to survey that more. He's a vascular surgeon and has been here since Friday.

There are multiple family practice docs, internists, pediatricians, an OB-GYN, all doing pre-op and post-op care. Definitely need more nurses though. Can't keep up with all the IV's and med needs.

We are off to do Midnight rounds.

Love,

Dad/Ed