Rose Johnson, RN
No Second Thoughts
The decision to venture into the world of disaster relief nursing was an easy one. As a matter of fact, there was never a minute of doubt as to whether or not I would go to Haiti. I never gave much thought about the differences I would face or the impact the people of Haiti would have on me as a human being.
Hoops
On our arrival to Jimani, Dominican Republic, we were told that we were not in Haiti but would be treating Haitian patients. Dominican Republic officials would make the decisions regarding length-of-stay and would have to give a referral in order for us to care for any patients.
Language barriers were a given, but we were blessed to have awesome translators. They were by our side around the clock to assist us. They became just as involved in patient care as we nurses and doctors were. These patients sensed that they were not welcome in this country, only three miles from the Haitian border.
The Hospital
Good Samaritan Hospital in Jimani, Dominican Republic, would be our destination for the week we were deployed. I am eternally grateful that my first trip would be here. A small, white, two-story building with two outer buildings surrounded by a cinderblock fence was our home. The first floor housed five operating rooms, PACU, pharmacy, X-ray, one private room and supply rooms. ICU was also here. The one private room in the compound housed a new mom and her baby whom was delivered there. ICU was more of a ward; there were four beds in each of two rooms, with one nurse for each room. I was assigned one of the ICU rooms.
Dial-a-Flows
Vital signs were taken the old fashioned way. IV drips were infused by counting drops or using one of a few dial-a-flows. The patient’s chart was a manila folder with paper stapled inside. No separate nurses notes or MD orders. Everything was handwritten on a piece of paper.
Family Involvement
This small country hospital had the most amazing family presence I ever dreamed of seeing. We didn’t do bed baths, empty bed pans or clean patients. The families were there and very quickly assumed these tasks; on some level, they seemed almost offended if we offered to do this. I finally was able to look at one patient’s backside when the son who had been caring for her stepped out of the building.
Necessity—Mother of Invention
There were definite drawbacks to being in a third world country. First, and probably most important, was the lack of laboratory services. We could get a CBC and Chem 7 on a good day. Many of these patients received Vancomycin. There would be no peak and troughs with the third dose done. Secondly, the lack of equipment presented a major challenge. Something as basic as an incentive spirometer was nowhere to be found. They say that necessity is the mother of invention, and I sure was happy to see that someone could invent. Thanks to Patty Hagan, RN, we had a very useable home-made incentive spirometer (see photo).
Hgb 2.2
Blood transfusions were done after a type and screen. There would be no transfusion slips, crossmatching or blood bank personnel to make sure that we had the right product. As we transfused a 9-year-old who had presented with a hgb of 2.2, I was really wishing for a bp machine and an IV pump. He did well, and we both made it through the three units of blood he got. By the second unit, he was up running around like a 9-year-old should.
Challenge and Reward
When Knox asked me to write this, I thought it would be a piece of cake. Unfortunately, this has not been the case. Trying to put things in context isn’t always easy, and making it understandable is close to impossible. For people who have done disaster work, you will understand what it’s like to care for people in almost frontier-like conditions. For those who haven’t done this, you should. It is the hardest, most rewarding work you’ll ever do.