Category Archives: What’s Happening

Raising Reina

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I arrived in Haiti on January 2, knowing that I had an accepting hospital, air transport by a corporate jet, but also knowing that I would have to achieve acceptance from the American government in Haiti regarding reina and mom’s humanitarian parole status, and it was a holiday weekend. My wonderful friend Brittany, also the chief nurse officer at the BM of the PM (Bernard Mev of Project Medishare, had been maintaining Reina and knew what we had to do next, at least as best anyone can know when dealing with the government in Haiti. Joe Watkins and group had committed to pay the outrageous fee of 325.00 American for each one (total 650.00) and we had many communications regarding how that would be achieved, prior to going to the embassy. Then we had to search out a western union, that A. was open and B. had money! Finally after about three hours we had the cash and proceeded to the American Embassy. Everyone at the embassy was helpful and kind, but were unsure if we could approve status in less than 24 hours, as the petition for humanitarian evacuation is usually sent to DC for approval. But the clerk said she would try. Also, the fee had increased and credit cards not accepted so we now had to find more money (I had some…enough anyway) back at camp…so off we went! And returned again! After this basic petition and payment was done, we had spent nearly 7 hours in this process, but still did not know if we could leave the country. And then my iPhone stopped working completely, freezing on a screen that I could not leave…all while trying to arrange the final details of transport. The Internet was down and the ICU was madly busy as well…so not until 6 pm or so could I make any contact with Marianne of Aerocare. When we were finally able to talk using the communal cafeteria phone, she gently told me that if we could not leave Tuesday, we might not be able to go at all if I did not have approval…when I hung up I was literally in tears. Thank you David for hugging me. I frantically emailed the embassy…but of course they closed at 5! Then Marianne called back at 830 or so, and said that her connections with many persons of influence had come through…we were approved to go! The time would be the next day, Tuesday and that we had to be at the airport by 130 pm. Now on to the next barrier! How to get an ambulance? JPHRO had an ambulance and said we could use it! I began to organza my list of meds and my supplies for the three-hour trip with an unstable, ventilated 12-year-old GB patient (what was I thinking?). Next morning, I proceeded to procure all that was on the list and then some (thanks to Gillian and Ashley who ran their butts off and organized everything). Then the news: ambulance is not functioning. Now what? A pickup truck came to the rescue! Reina on a backboard, ventilator and monitor on battery, 4 larger 02 tanks, and 2 02 smaller tanks, bulbs to perform suction, meds to dry secretions, meds to sedate and sleep Reina, meds for pain, meds for emergency and 6 of us in the truck, leaving the hospital with 100 Haitians waving goodbye!  The transport to the airport was all-good, but we had to wait for about 20 minutes on the tarmac. When loading Reina onto the plane, we had to make a 95 degree turn in a narrow hallway…this part was difficult. I had been bagging Reina because of course this process could not be performed with vent intact, and I maintained her airway, but could not also continue oxygenation for about 45 seconds. She immediately ” crashed” so once on the plane and delivered to the couch we spent about 45 minutes restoring her back to her guarded condition. When we (team Brittany, Chris, David, a young man from Global dirt, Ryan, Kensey and flight attendant Vicki) got her to an acceptable level, I said GO! and everyone except Vicki and myself jumped off the plane and we took off. The whole ride was uneventful although the entire trip was spent with manipulating oxygen, volume and pressures on the vent, her chest tube, medications galore and our transfer off the plane was as difficult as the transfer onto the plane, but only 10 minutes or so required once we got there! The EMTs were somewhat surprised at how sick this child was…very unexpected for them, but they were great! We went with full blast siren and lights and got to the hospital in about 8 minutes…and were met by my friend Nick Widder, the best RT in the world, and the individual who had introduced me to Dr. Bob Johnson, the accepting physician. Whisked rapidly to the ICU, both Reina and Mom being cared for in a clean white room with sheets, no flies, no mosquitoes, warm water, a Servo I ventilator and every resource known to man…. and a Creole transporter…I finally took a breath…really the first normal one since this process began. We were here! She had survived! She would get better! Everyone totally embraced her care and her mothers needs. I gave Nicole (mom) four hundred dollars (most of which had been donated by current volunteers) and spent three hours with Reina, Mom, Doctors and Nurses. Then back to the airport, where my magic and miraculous chariot awaited to bring me back to south Florida. Jim, Vicki, Alan and Dave…flight crew, cum medics, my heroes for all their assistance beyond anything I thought possible. Nicole was completely adopted by the unit nurses, doctors and therapists. They won’t let her spend any of the money we gave her, but have bought everything she needs. Every day the local Haitian community provided interpreters, food, prayer and love!

 

On April 9th, my husband and I brought Reina and her mother Nicole back to our home in preparation for our flight to Haiti.  After one nights rest, we went to NYC via JFK and spent the night there as well. Reina’s family in Brooklyn came to have a special time with her and to also enjoy some homemade creole cooking!  The next morning we rose and dressed and went on the final journey back to Port au Prince. We were all so excited!  But upon arrival, the customs officers had some questions regarding how we left the country.  At one point I thought I might be arrested, but thank goodness, all finally went well.  After finding and moving our total of 15 suitcases and donation boxes (no small task in Haiti), we left the airport and found Reina’s father and Brittany, the CNO of the Bernard Mevs hospital. We very quickly split and I was so concerned we had not had an appropriate goodbye! I don’t know about anyone else, but I was crying buckets! But the whole family followed us to  the hospital to award the ICU and myself with a beautiful metal sculpture.   While I continued with my work at the hospital over the next two weeks, I was privileged to visit Reina and her family at their home 3 times.  As of today, May 17 2011, Reina continues to work hard and do well.  Attached is her most recent email!

Raising Reina is a miraculous tale from beginning to end, absolutely defining TEAMwork. To all mentioned here, and those who I have not named, there is a special blessing for all of you! Thank you so very much.

Stop Sepsis

System wide Healthcare Collaborative for Sepsis Quality Initiative

AHA’s Piedmont Hospital Sepsis program summary: When the critical care team at Piedmont Hospital started using the Surviving Sepsis Campaign/ IHI sepsis bundles, they discovered that the sepsis knowledge deficit   coupled with the implementation of bundle requirements was an overwhelming barrier to change. They stepped back and asked, “? What can we do to get the most improvement?” With the guidance of the Process improvement team and Barbara McLean, MN, CRNP, CCRN, FCCM, an external expert consultant, a newly developed and focused approach geared towards Sepsis Prevention was initiated in the ED.  A point based, simple algorithm was designed based on the SIRS criteria and infection-exposure risk, enabling staff a method of identification of those patients at high risk for severe sepsis. If a patient is identified as a possible sepsis case, a nurse immediately starts the modified sepsis protocol. Now the protocol is embedded in practice.

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Education was applied to all providers, with intensive education and testing for a certification mode. The algorithm was linked to simple protocols for fluid and antibiotic management in the first 60 minutes after identification.  A very intensive, all provider education program was initiated at the same time, complete with certification process.  The increased identification and the rapidly following interventions promoted a significant and sustainable decrease in mortality across the entire system.

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