I had the honor and privilege of volunteering in Haiti through the Association for the Advancement of Wound Care (AAWC) with the University of Miami Global Institute and Project Medishare in association with the University of Miami Miller School of Medicine Haiti Relief Volunteer Program. I was there from March 8-15, 2010. While many people have already gone to help the victims of this devastating earthquake, many of you would still like to go. First and foremost, it is important to realize that Haiti is still in need of volunteers. There is a void of assistance that remains. Upon returning, I have encountered several questions about my trip to Haiti and feel as though this blog may provide deeper insight and answers to some of the questions. Some of the frequent questions I have been asked are presented below. While this in no way reflects the thoughts or opinions of the AAWC or the Medishare program, the following solely represents my personal thoughts and suggestions. The majority of these suggestions will be for the nurses. Victoria Beall, a colleague of mine, recently returned from the same program and she will add to several of the categories as updates from her recent visit (stay tuned for My Experience in Haiti Part II). As you may have guessed, things are very fluid and are continually changing in Haiti.


Do I need to bring wound care supplies?

As far as wound care supplies go you will not need to bring anything by way of product. Many wound care supplies have been donated and are available for patients use onsite. According to the volunteers that have been there, you may hear that there is a better supply of wound care products in Haiti compared to what most of us see in our clinics or places of work here in the States. What is needed most, especially if you are performing the care, is a package that includes bandage scissors, permanent markers, pens, a headlamp, and a fanny pack.

Bandage Scissors

You should bring at least one or two bandage scissors. There are scissors there but as in most settings when you need them they are scarce and inaccessible. I recommend marking your scissors so you will know which ones belong to you.

Permanent Marker (Sharpie)

You cannot have enough of these. I would suggest at least three markers. It would be beneficial to pack two of the regular thickness, two of the Fine Point, and one Ultra Fine Point. If you are performing wound care you will always mark your dressings with the date you change it and the date it has to be changed. People are always borrowing them and you will be lucky if at the end of the week you have one of the three you came with.

Ball Point Pens

Bring at least three, same scenario as that of the markers. Keep pens and permanent markers in scrub shirt pocket. Because you are constantly bending over the army cots, almost all of the pens, permanent markers, and bandage scissors you may have on you (especially the breast pocket) will almost always fall out as you lean over. This can be prevented by taking your scrub suit tops to the tailor or having someone you know who sews make little compartments for your pens. Also, if you have your waist pocket sewn so it fits the outline of your bandage scissors trust me— you will be happy you did. Many used fanny packs. While you will also need those, you will find that constantly zipping and unzipping is time consuming and frustrating. Usually you only have one hand free and it is much easier to reach into the pocket than unzip and open and search around in your fanny pack for what you want. Having them in your pockets so you can get to them easily is so much more helpful.

Headlamp

If you are providing care at the bedside a headlamp will certainly make your work all the simpler. There is general lighting onsite, but keep in mind that there is no light above the beside. I used my headlamp for nearly every dressing change. The brand I saw the most was the Petzl brand. The cost was $38.00 and it has two different colors of light—one red and one white. The white light has three different settings, bright, dim, and blink. The red light has only two settings: on and blinking. I would highly recommend the red/white combination. The red light was best used in the sleeping tents usually around 10:30 PM. The red light was more people-friendly when I got up to use the bathroom.

What do I wear while I am there?

Clothes

Scrubs are the best choice of clothing. It is best to bring a clean pair for each day you are there. I strongly recommend spraying the clothes front and back with clothing mosquito repellant. Every night before bed we would change into a clean scrub suit and use that for our pajamas. This procedure was so convenient that when we got up the next morning we were already dressed for work. The less times you had to change your clothes, the better. There was no such thing as privacy. But by day 3, no one cared. It may be wise to pack an extra large plastic zip lock bag for dirty clothing storage. At the end of the day your scrubs become quite dirty, sweaty, and dusty. If you have a zip lock bag they will be sealed in your suitcase protecting your other clean clothes.


Underwear

You will want to bring clean underwear for each day. There is water and
sometimes you can find a bucket to hand wash your clothes. If you work in the outpatient wound tent, ER, or triage you will be in a tent setting but it will be outside and non air-conditioned. At one point the outpatient tent surpassed 106 degrees in the middle of the afternoon. To assist with excessive perspiring, some of us cut strips of approximately 3” x 8” of “Interdry AG” and pinned it to the inside back of our underwear to tuck between our buttocks. This helped tremendously in translocating the moisture and preventing us from sweating “back there” too much. Some clinicians would place pieces of it under their breasts in their bra allowing it to hang out approximately 2 inches for the moisture transfer.


Shoes

When it comes to shoes, this was the one thing I made it a point to purchase. I bought myself a pair of Merrill’s. The pair I bought was $98.00. I got the pair that looked similar to jogging shoes and are made of Gortex. When it rains in Haiti, you will be in mud and standing in water so you definitely want something to keep your feet dry. Fortunately, it only rained for about 20 minutes during my entire stay. I found that lightweight wool socks were ideal for the times it was hot and perfect during the night to keep my feet warm. I changed my socks every night when I went to bed. Sleeping in socks seemed to be the best way to transition between the warmth of the day and the coolness of the night.


Sleeping

Sleeping bags proved to be more efficient than standard blankets and sheets.
Several people brought sleeping bags knowing in advance they would have to leave them behind for the Haitians who typically relied on cardboard boxes for mattresses. While it was hot during the day it did get cool at night. Some nights it was very cold and I was very happy to have something to keep me warm. The people who tolerated the cold the best had some sort of plastic covering between their sleeping bag and the cot. With the plastic between the cot and the sleeping bag it would deflect the cold from transferring through the sleeping bag. Some people used an inexpensive air mattress.


Cots

We slept on army cots and to my surprise they were very comfortable. I never
heard one person complain about their back hurting because of sleeping on the cot. Certainly their backs would hurt from the bending, stooping, and lifting, but never as a result of the cots. The cots were very narrow and the person you slept next to was only 4-12 inches away from your cot. When you turned over you literally had to lift yourself up and reposition yourself in place. The slightest twist and turn would automatically roll you onto the person’s cot next to you. Mosquito nets are necessary for your bedding. I personally did not get one mosquito bite during my stay, but the people before my group and those that arrived after us felt the wrath of these insects! There are three kinds of mosquito nets. Those that hang from the rope hanging above everyone’s head, those that are like sleeping bags that are plastic on the bottom with netting on the top that you zip into, and the third kind, which to me, was the Crème de la Crème: you zip yourself in and out. At the end of the day, your cot was your own place of real estate. Everyone kept their suitcase and personal belongings underneath their cot.

Bathing

While there was no running water, there were showers. The showers are short and sweet. We were specifically asked that when we took a shower we turn the water on for 30 seconds to soap up, then rinse off for 30 seconds. The water is contained in tanks and is heated by the sunlight. During my stay, the water was cold, but you quickly get used to it. We found that one is usually there for about 2-3 days before taking their first shower. Partly because you are not exactly sure how it all works but also because the sleeping arrangements mean that everyone is in the same room and there is no privacy to dress and undress. In the beginning most people would dress and undress in their sleeping bag but as the week went on most of us realized it really did not matter and some would just dress and undress while sitting or standing by their cot. It was not long before all traces of pride vanished!

Towels
Be sure to bring several washcloths and a towels. There is a rope above your bed to hang them on. You are sharing the same space with the person whose head is at your head so there is not a lot of clothesline space.

Toileting/Plumbing

Port- o- potties were the sole source of plumbing in Haiti. They were cleaned every day and we never ran out of toilet paper. It would be in your best interest to bring toilet wipes to use in between baths.


Sleeping arrangements

Once I arrived, I checked into what can be referred to as the “Hotel Lobby”. They checked off your name and then you went into the sleeping tent, picked out your cot, which had a number on it and then you went back to the lobby and gave them your cot number in case they needed to find you for anything. There were approximately six rows of cots. Each row had approximately 20-25 cots. There were cots that butted up against the side of the tents. The other rows had two cots butted up against each other so just opposite of your head was the head of someone else. Which brings me to the necessity of earplugs: if you are not a sound sleeper and the sound of someone snoring keeps you awake, you will definitely want to invest in plugs. If you are unfortunate enough to have the person who snores, it can make for a long night.

What is the wound care like for the patients in Haiti?

While I was there we had the adult tent that had approximately 80-120 patients. There was anywhere from 23-35 patients on V.A.C.’s in the adult tent at any one time. Most of the VAC dressing changes were done in what we called the “anesthesia room”. This was for the patients whose dressing changes were painful and usually required larger dressings. However, some of the smaller VAC changes were performed on the floor. We also had a patient with active TB whose dressing change we did in the patient’s isolation tent. We had several anesthesiologists who administered the anesthesia and the wound care personnel changed the dressings. Dressing changes other than VAC changes were done on the floor.

What food should you bring?

There is food provided onsite but it usually consisted of some kind of meat and potato or rice (white or brown). Bringing some small cans of meat or tuna to
eat will help if you do not like what was provided. Don’t forget to bring a can opener. Some of the women found that they did not have an appetite for the first couple of days.

What about water?

Water was provided and it is imperative you stay hydrated. Ensuring adequate hydration consisted of volunteers monitoring how hot it was and how they felt. To help keep track of the amount of water you drank it was suggested each time you drank a bottle of water that you put the cap in your pocket to keep track. Haiti was the absolute best experience of my professional and personal life. It will change you forever. You will never see the world the same. After you return home it will take some adjusting and time to process what you have just been through. Know that it represents the best of times and the worst of times, but you will feel blessed to have served in one of the biggest tragedies of the world.