With a gentle touch, soothing words and skilled hands, Dr. Mark McAndrew helped heal and console dozens of Haitians who had broken bones and lost loved ones in the Jan. 12 earthquake.
McAndrew, 56, an orthopedic trauma surgeon at Springfield's Southern Illinois University School of Medicine, spent 13 days in Port-au-Prince in late January and February as part of a surgical response team organized by the U.S. government in the late 1990s.
McAndrew wants to return to the impoverished Caribbean nation soon to provide follow-up care even after dealing with the wafting smell of human waste and struggling with dehydration due to diarrhea and sweltering operating rooms.
"It's the sense that you're doing something that No. 1, virtually no one else wants to do. And No. 2, it's something that really has to be done," McAndrew said. "Because of what I do on a daily basis, I'm more prepared than a lot of people to deal with the badly traumatized person from the physical and psychological standpoint."
Medical team
McAndrew was part of a 15-member medical team of doctors and nurses and 150 others from across America assisting earthquake survivors. The team members -- who essentially were volunteers, although they received modest stipends -- operated an American field hospital in tents with lights, ventilators and anesthesia machines powered by generators.
Several hundred yards away was a soccer field used as a tent city by displaced Haitians with no access to running water or conventional restrooms. The field hospital had no running water most of the time, either.
The patients, though often grieving for lost loved ones, in many ways weren't different from other trauma victims, McAndrew said.
"Everybody's badly injured," he said. "It's something that's happened in a moment, without any notice, and they're all dealing with the guilt, the anger, the 'Why me?' sort of question."
McAndrew was one of several orthopedic surgeons who focused on stabilizing broken arms and legs.
"What we did most of all as orthopedic surgeons was to make patients ambulatory," he said. "They were up on crutches when we finished."
Being mobile made it more likely people could survive in a city with no social-welfare safety net and few options for people who need others to carry them around, McAndrew said.
Despite four years of high school French in his hometown of Kalona, Iowa, McAndrew said he struggled to understand the Haitians' Creole language. He depended mostly on interpreters and his experience as a doctor to explain what patients needed and what they should do to help recover from their injuries.
"Most every human being responds well to touching, and what orthopedic surgeons do has a lot to do with touching," he said. "And the tone of your voice is really important. These people were very, very appreciative and tried really hard to do the things we tried to teach them to do."
Austere conditions
Living conditions for the Americans were austere. McAndrew used earplugs to drown out nearby generators and allow him to sleep. Without running water most of the time, he carried water to a toilet so it would flush. He survived on military MREs, or "meals ready to eat."
He used the local water supply only to swish his mouth clean when he brushed his teeth, but it was enough to give him diarrhea. Dealing with that, and sweating through his surgical scrubs several times a day in the 90-degree heat inside the operating tents, left him dehydrated.
He remained able to work by "sucking down Gatorade" and water.
McAndrew said he focused on the work that needed to be done.
"You just kept moving," he said. "When you're doing it, you don't really think about it."
He helped treat dozens of patients, including some Haitians who were crime victims and pedestrians hit by cars.
"The drivers are crazy over there," he said.
He feels satisfaction that he might have been personally responsible for several patients' survival.
"There are 12 people down there walking on crutches that would otherwise be lying in bed," he said.
But he knows that many of the field hospital's patients will need reconstructive surgery later. That's why McAndrew wants to go back.
"You get the sense of not wanting to leave someone behind," he said. "These people are very dependent on what anybody with enough knowledge of their anatomy, their physiology, can do for them. Even in better times, Haiti didn't have the doctors it needed."
Dean Olsen can be reached at 788-1543.
Haiti needs overwhelming, nurse says
Almost hopelessly overwhelming.
That is how Petersburg resident and nurse anesthetist Emily Zimmerman described the needs she tried to meet during eight days in Port-au-Prince, Haiti, as part of a United Nations-sponsored relief effort.
"It was just kind of chaos," Zimmerman, 26, an employee of Memorial Medical Center, said last week.
Zimmerman, who arrived in the Carrefour section of the Haitian capital on Jan. 27, worked in one of the few medical buildings left standing in Haiti after the Jan. 12 earthquake. She was the only Illinois resident in the group of volunteers and didn't know that Springfield doctor Mark McAndrew was serving Haitians in another part of the capital.
Zimmerman spent several years as an intensive-care unit nurse at Memorial before completing her anesthesia training. However, she said the time she volunteered in Haiti was the most "intense" experience of her professional career so far.
In an essay she hopes to submit to a nursing journal, she described making rounds in tents near the hospital and encountering many recently orphaned children who were "looking lost."
One of them, a 4-year-old boy, would rush up and plead with her in Creole to adopt him.
"My heart broke again and again," she wrote. "Each time I had to tell him 'no.'"
Zimmerman described one day when the desperation caused by a lack of adequate medical care in Haiti - both before and after the earthquake - became obvious.
She described two mothers needing emergency Caesarean section deliveries but only one surgeon was available. While one mother waited, Zimmerman gave the other mother a spinal block. When the baby was delivered with an umbilical cord around her neck, she was "blue, completely limp and lifeless."
Zimmerman frantically tried to resuscitate the infant, rejoicing when the baby responded and let out a "loud, lusty, life-affirming cry." But with no one to watch over the still-sick baby girl, Zimmerman carried the infant with her as she began to prepare anesthesia for the second C-section.
Just then, another Haitian mother carried in her motionless 18-month-old daughter. The girl wasn't breathing because of some sort of respiratory failure.
Efforts to revive the girl failed, and Zimmerman had to hand the lifeless body back to an inconsolable mother.
"This crushed my spirit and broke my heart," Zimmerman wrote. "I cried right there in front of everyone."
The second mother delivered a healthy baby by C-section.
"Tonight, as these two new lives were brought into the world in the center of such destruction, one life was just as easily taken away," Zimmerman said. "This was the harsh and unjust reality of life under these incredibly challenging circumstances."
Zimmerman told The State Journal-Register she was glad she went to Haiti because she did some good "on a small scale," but she felt inadequate.
-- Dean Olsen
Excerpts from Emily Zimmerman's Haiti journal
Here are sections from an essay written by Emily Zimmerman, a nurse anesthetist at Memorial Medical Center, after she volunteered in Port-au-Prince, Haiti, in the wake of the Jan. 12 earthquake:
"In Port-au-Prince, conditions were worse than imaginable. The entire city had been left in ruins. Hundreds of displaced, Haitians lived amidst the rubble in makeshift tents that lined the sidewalks and streets."
***
"At the hospital, it quickly became our routine to walk through the rows and rows of tents in search of patients still needing surgery. During those rounds, we encountered many recently orphaned children, sitting blank-stared, looking lost. One boy became familiar with my 'route.' Somehow he always seemed to find me. Each time I passed, he would rush up to me, wrapping his arms around my legs and pleading, 'Tenez-moi, tenez-moi,' meaning 'keep me, keep me.' My heart broke again and again, each time I had to tell him 'no.'
***
"The dynamics of the hospital were amazing; like working at the United Nations. One surgical case might have a surgeon from France, another from China, a circulating nurse from Thailand, and a nurse anesthetist from Illinois. Seeing so many people of such different backgrounds come together for the same united cause was remarkably inspirational to me."
***
"Reflecting back on those long days, I am flooded with so many memories. Memories of people, strong and resilient people; all hold their own unique and inimitable story. One day, in particular, stands out vividly in my mind. It started like most days in Haiti; another long, busy day full of fracture repairs and wound debridement. The smell of the three-week-old wounds had become overwhelming. Poor sanitation conditions combined with long hot days spent in crowded tents with little to no ventilation contribute to the stench.
"I had left the hospital around 8 p.m. to return to our camp. We finally received running water! I immediately headed straight for a shower, which really simply consisted of a bathtub and garden hose that had been pulled through the bathroom window. It was freezing cold, but I couldn't wait to 'come clean' of the day's experiences. Not more than two minutes later heard a desperate voice outside, running down the alley toward the clinic. A nurse from the hospital pounded on the door for me to 'come quick' to the hospital for 'a stat C-section.' Still soaking wet, I threw on scrubs, called for Sandra (the other anesthetist, and a native Haitian), and we followed her back to the hospital.
"Quickly gathering any supplies we could find through the mess of medical equipment that had just been received, we discovered that there were actually two C-sections, but only one surgeon available. The most critical goes first: umbilical cord wrapped around the baby's neck. A quick spinal block was placed, and within four minutes the baby was pulled out: blue, completely limp, and lifeless.
"It was at that moment that we realized that there was no one available to take care of the baby, still cyanotic and silent. The surgeon continued to suture diligently, unfazed by our ethical dilemma. Again using triage principle, a quick decision was made: Sandra, another nurse anesthetist, took over care of the mom while I attempted to stimulate and suction the baby despite my lack of experience in labor and delivery nursing. While I hated leaving the mother's side, I realized that under these conditions, desperate times truly call for desperate measures.
"While I attempted to resuscitate the cold and limp infant, I shouted for help, hoping someone nearby might answer my plea. A Canadian ER doctor heard me and quickly joined my efforts. Together, we stimulated and suctioned large, copious amounts of aspirated meconium, and soon a loud, lusty, life-affirming cry was let out from that tiny, frail body. At that moment, to me, that high-pitched squall was the most beautiful sound in the world!
"A lack of staff and resources created next-to-impossible practice conditions. There was no neonatal intensive-care unit to monitor this fragile newborn. Shortly after delivering, new babies and moms were sent back outside to the yard. This little one, so fragile and unstable, could not be left unattended. I was forced to carry this tiny baby with me into the operating room as we prepared for the second Caesarean section. ..."
"Ready to place a spinal block for the second C-section, I was interrupted by shouts and screams coming from the 'tent city.' A mother emerged from the darkness, carrying a small lifeless body in her arms. This little child ... was in pulseless cardiac arrest. A code was called and CPR was initiated ... The infant was intubated and ventilated. Drugs were administered. Yet, our efforts remained unsuccessful. ... At 10:34 p.m., time of death was called. This crushed my spirits and broke my heart. I tried to hide my eyes behind my glasses and mask as I cried right there on front of everyone. It was unbearable. Even still, despite my feeling of defeat and grief, I had to return to the OR to finish administering anesthesia for the final C-section.
"In the end, I was thankful to have stayed. As cold and apathetic as it felt at the time, I needed a happy ending amidst all this suffering. I got just that: one loud, crying, healthy baby and a mother in stable condition. Tonight, as these two new lives were brought into the world in the center of such destruction, one life was just as quickly taken away. This was the harsh and unjust reality of life under these incredibly challenging circumstances.
"The hardest part about tonight has been my own wondering and questioning, 'What if? What if this baby had been in the U.S.?' Same baby, same illness, only with better medical access. Would the outcome have been the same? I heavily doubt it."
***
"Leaving Haiti and all those still suffering was more difficult, than I could have ever imagined. I am overcome with so many mixed emotions. I'm so grateful to be back home and have much greater appreciation for the 'simple joys' that before I had always taken for granted: food, running water, clean drinking water, toilets and a warm shower! Yet, I can't help but feel an enormous amount of guilt for those that I left behind. ... I am thankful for the time I was able to spend there, and all the lessons I learned about myself, about disaster relief, about triage. I am fully humbled by all that I witnessed and experienced in such a short time.
"It's a good reminder to stay grounded and appreciative for all that we have to be thankful. I try very hard to remember these lessons every day, and try to take nothing, absolutely nothing, for granted."
Photo courtesy Dr. Mark McAndrew Dr. Mark McAndrew was one of several orthopedic surgeons who focused on stabilizing broken arms and legs in Haiti.
