Haiti Volunteers

Nurses - We need nurses with ICU experience or those with a great deal of experience in wound care. The best fit is for teams of nurses to come together so that your team can take responsibility for a patient ward and setup your own shift rotation.

Pharmacists - We have a need for Pharmacist at this time and going forward.

Anesthesiologist,Orthopedic Surgeons, and Plastic Surgeons - We are going to have to conduct stump revisions/skin graphs on hundreds of patients and will have an ongoing need for your help for the next year at least.

Family Practice and Internist - We need you now and will have a need for you for at least the next year.

Nephrologist - We have setup a Dialysis Clinic and need your help now and going forward for at least a year. Patients that were trapped in the rubble for days without water have experienced kidney failure.

You will need to pay your own way for a round trip ticket  to Santo Domingo in the Dominican Republic. You will be working in the very hot and humid conditions. Your accommodations will be primitive but secure and you will most likely be sleeping on the floor. If you are up to the task please complete this form.

The IMA Mission for Haiti @

Hospital Buen Samaritano

In Jimani, Dominican Republic

 

What to know before you go!

 

            On behalf of IMA and the many patients devastated by the Haitian earthquake, thank you so much for your interest and enthusiasm to donate your time and skills to the effort to provide care and comfort following this tragedy. What follows is some basic information which should be helpful to you as you plan your trip.

Please understand that the situation at the site is dynamic and fluid, and information is frequently outdated, including the information here-in. Most of the change is rapid progress for the better, but you should also expect not infrequent set-backs and frustrations, both technical and political (many people, nationalities, governments, conflicting authorities are involved). The wonderful thing is that at heart all are present through their own generosity of spirit and working towards a common goal, something to keep foremost in your mind. The most important things to bring with you are a positive “can do” attitude, extreme flexibility and the ability to shift with changes as they occur, innovative and creative ideas of how to get the job done with limited resources, a team spirit and a self-less volunteer attitude where regardless of training, credentials, skills, and professional stature, no job is to big or to menial to just jump in and get it done! Fortunately, for those with such large hearts and generous spirits as have our volunteers, all of this comes naturally. You can look forward to meeting some wonderful people from all over the world.

 

Background

 

            The site in Jimani is located in the Dominican Republic, at the closest Haitian border entry to Port-au-Prince 35 miles away (2 to 6 hours by car depending on humanitarian traffic going both out and in). The site consisted of an outpatient clinic, able to do outpatient surgeries such as cataracts and minor orthopedic procedures, a Chapel for worship and a recently added two story orphanage. The site was undamaged and as earthquake victims were able to be extricated, there was a crescendo influx of trauma patients transported, often by surviving family members, from devastated Port-au-Prince. Within days the outpatient clinic was transformed as best possible to a 6 “OR” trauma center with “recovery room/ICU”, (for amputations, debridements, fasciotomies and external fixations, done under regional blocks, spinal, epidural or TIVA with only minimal, hands-on monitoring), 2 portable trailers were converted into a second “ICU”, the orphanage into a triage center/emergency room/minor procedure site/patient wards, and the Chapel, with a large tent behind, transformed into more post-operative ward space. (Although critical care is being delivered, the ORs and ICUs are minimally equipped, lacking monitors and ventilators). Renamed “Hospital Buen Samaritano del Mision Global” by its founder, owner and director, Dr. Marc Pinard, it has since been attempting to deliver tertiary level trauma care by its all volunteer staff. It is important to remember this site was never designed to deliver such care and will continue to experience intermittent problems such as lack of water and/or electrical supply (now much improved). Initially there were no autoclave, X-ray or lab capabilities (there is now x-ray, C-arm and a laboratory able to do CBCs, electrolytes, and pregnancy tests). Capability is increasing rapidly with dialysis capability coming on board soon. Blood bank service was available early on, with the support of the Jimani hospital, and was lifesaving. Estimated peak census of over 450 occurred on January 21 and 22, with 70 surgical procedures performed on each of those days! Also remember that this booming facility falls under the hospital regulatory jurisdiction of the Dominican department of health, and needs to remain in cooperative compliance with their requirements for continued operation.

The field in front of the clinic has become a Helicopter pad, delivering patients and transporting critical patients to Dominican hospitals and the USNS Comfort, anchored off of Port-au-Prince. Many of those patients have been further transported to ICU’s in Florida and other US sites.

 

The Present and the Future

 

Many patients remain, requiring further surgical care (debridements, revisions, skin grafting, etc.) and there is now a huge population of amputees and those with skeletal deformities and neuromuscular deficits who will need rehabilitative and orthotic care for years to come. The Hospital has therefore already moved beyond just acute field hospital trauma care (ongoing for new arrivals) to attempting to also provide more comprehensive ongoing care for these victims, many of whom have lost family members, their homes and their possessions. What will be needed moving forward are rotating teams of caretakers who can provide a continuous staffing presence to carry on this work. Creole, French, Spanish translators, nursing staff, physical therapists, physiatrists and hospital administrative and infrastructure support personnel as well as ongoing anesthesia, surgeons and surgical support staff will all play an essential role.

 

 

Preparing for your Mission

 

            Please consult immediately with your local health department for vaccinations and anti-malarial medications:

1)     Typhoid

2)     Tetanus booster

3)     Hepatitis A + B vaccines

4)     Suggested: regular influenza and H1N1 vaccines

5)     The falciparum Malaria in Haiti is sensitive to all anti-malarials including chloroquine, doxycycline, Malranone, etc. (Doxycycline may sensitize your skin to sun burn. If travelling on short notice, Malranone is recommended to be started just 2 days before travel as opposed to chloroquine and doxycycline which are recommended to start 1 week prior to travel. Some also report fewer GI side effects with Malranone.)

6)     DEET or other insect repellant and mosquito netting if you have it (recently Dengue fever has also been reported out of Haiti)

7)     Water purification tablets or UV purification device (bottled water is safe and usually abundant: use it for everything including making coffee and brushing teeth)

8)     Sunscreen, hat

 

Hepatitis C, HIV, and resistant TB are all problems in Haiti. Knowing you have a negative PPD, hepatitis C and HIV status prior to travel can be helpful later, and some have carried a bottle of Combivir (a combination of 2 anti-retrovirals) for HIV prophylaxis, starting after a dirty needle stick, one tablet twice a day (testing of patients for HIV is not available). (Rabies is also common and there are many stray animals. Some have elected to be vaccinated for this but the original series of vaccines takes 3 weekly doses.)

Please remember to bring all personal medications, as well as extra doses in case of travel delays or changes in your plans (seeing the need, some have volunteered to stay longer).

 

Documents

 

            A valid passport (with an expiration date greater than 3 months after your planned return) is needed to travel. Please make copies (one page) of your passport photo ID page, your current healthcare license and your DEA certificate. Keep one or two copies with you in case you lose your original documents, and please give one to the staff at the hospital—this serves as our “credentialing” process.

(A copy of your immunization record is also useful.)

 

 

 

 

Travel

 

IMA volunteers have traditionally provided for their own transportation to Santo Domingo, Dominican Republic. Please fly into Santo Domingo, Las Americas International Airport, symbol: SDQ. (There is another smaller airport: STD). If you are a group of 5 or more people or if there are multiple groups that arrive by 3:30 pm, you will most likely be picked up either in a van or small bus and driven out to Jimani the same day. If you arrive in a group of less that 5 people on a day that we do not have multiple groups arriving, you will either be picked up by our driver or take a cab to the bus station in Santo Domingo to catch the bus to Jimani. The ride to Le Buen Samariton Hospital in Jimani is about 4 to 6 hour ride, depending on traffic. Only one pickup trip is possible each day, so be prepared to wait at the airport until the final arrival, usually around 3:30 or 4 pm. Look for someone holding up a sign saying “IMA” (frequently written on a pizza plate). Immediately to your right as you exit on the lower level of the airport is a pizza parlor where people tend to gather, eat and wait. If you arrive after 4:30 pm, you will most likely have to spend the night in Santo Domingo and then travel to Jimani the next morning as it is a long ride and best not started late in the day.

Your return flight should be scheduled to leave in the late afternoon (Delta has a 3:30pm out, American a 4:40 departure). This would allow you to ride down to the airport the morning of your travel, although road delays do occur and some prefer to make the trip down the day before travel. There are many hotels in Santo Domingo that are very nice to stay at for a night.

           

Carey House Hotel

            Calle Cesar Nicolas Penson 12-A

            Gazcue

            Santo Domingo, D.N.

            Dominican Republic

            (near the Presidential Palace)

 

            www.careyhousehotel.com

            info@careyhousehotel.com

            809-688-4808 phone

            809-685-1558 phone+FAX

 

            Hotel Conde de Penalba

            Calle El Conde Esquire

            Arzobispo Merino

            Zona Colonial, Z-P1

           

            www.condepenalba.com

            809-688-7121

            809-688-7375 Fax

 

           

The current exchange rate for the Dominican peso (DPO) is anywhere from 30 to 35 pesos per dollar.

 

 

Accommodations

 

            Volunteers will either be housed in the hospital’s volunteer living quarters when possible. The hospital has electricity and running water. There are showers available in the hospital. Please bring sheets, pillow, and a towel with you. Most volunteers live in their surgical scrubs because they are light -weight and comfortable in the heat. There are facilities to do laundry on-site. A flashlight or head-lamp is a must as there are many power outages. Ear plugs for quiet at night are useful. It can be cool (60 F) in the early AM and a jacket might be useful. Bring a fanny pack is very good thing to have.

 

Food

 Bottled water is readily available. Snacks are handy to bring. Breakfast and dinner are available each day. Use common sense in what you eat; fully cooked items are usually OK.

 

Communications

 

            ATT cell phones have the best coverage, Verizon phones work in Santo Domingo and in Jimani at the hospital site, but not in La Descubierta. Whether voice, data (e-mail) or text works is variable with location and time of day. Cellular One phones do not work. There are GATR enterprise satellite phone lines to the US in the second floor administrative area, although there is sometimes a lineup for their use (free, thank you GATR technologies!). There is wireless Internet connectivity at the Hospital through the same satellite system as the phone lines. Electric outlets are 120 volts and most chargers work without problem. You will find keeping one US contact up to date, with them distributing information to others, the most efficient.

 

Languages

 

            Creole is the primary language of the Haitian patients, but many also speak Spanish (the Dominican Republic language) and some are multi-lingual (Creole, French, Spanish and English) and are very helpful as translators. Multilingual medical translators are very much needed. A small list of Creole words and phrases is available on the second floor of the Hospital, in the administrative area.

 

 

The Hospital

 

            Each day when you arrive at the Hospital Buen Samaritano del Mision Global in Jimani please go up to the 2nd floor administrative area to check in and receive a volunteer ID and a work assignment. (There is also a Dominican community hospital in Jimani, the “Jimani Hospital”…this is not our work site, although they have been very supportive of our efforts, helping with laboratory and blood bank needs.) It is useful to wear your own Hospital’s picture ID, but also to label yourself with your name, specialties, and languages spoken. A large tape label on your back is very useful so you are labeled coming and going. Please remember to maintain a positive team spirit…your most useful skill at any given moment may be translating, lifting, carpentry, plumbing, pharmacy assistant, central supply, nursing, respiratory care, physical therapy, etc., rather than your particular medical specialty. Also remember that this facility is in the Dominican Republic and must remain in compliance with Dominican regulations. Other volunteers at the site can help you with the particulars.

 

Supplies

 

            If you are able to bring medical supplies with you that is wonderful. Check with your air carrier as to how much you can bring and their policy for overweight luggage (limit on checked luggage is usually two bags under 50 lbs each). Please bring stethoscopes, otoscopes, ophthalmoscopes, and BP cuffs.  We have a running list of supplies that we need at the hospital. We are in short supply of glucometers and urine dipstick test strips, and pregnancy tests.  Pre-existing hypertension and diabetes are common underlying diseases in these trauma patients. Operating room monitors (with re-useable probes) are still in short supply and if you can bring any and donate them that would be wonderful. Your pharmacy may be able to assist you with obtaining and packing pharmaceuticals, as well as the DEA controlled substance exceptions that have been implemented for this crisis.

 

 

Security

 

            You will notice many Dominican soldiers and armed guards at the lodging locations and the Hospital. For the most part our areas are all very safe. However, please use common sense and travel in groups, hopefully with a Spanish speaking member. Always check in on arrival at the hospital and check out when you leave (so you can be located at all times, especially in an emergency). Let other members of your group know your daily plans and locations. Do not change these without telling folks. Valuable volunteer time has been wasted looking for volunteers/spouses/friends who were presumed lost or missing, when they were actually just delayed or did not show up for assignments. There is no hospital paging system, and cell phone communication is not always reliable!

 

 

Caring for the Caretakers

 

            Remember that all our patients have not only been severely physically traumatized, but also emotionally and spiritually. Most have lost family members, or their whole family, or just don’t know about their loved ones. Many were poor to begin with, with poor health care, and are now destitute with nowhere to go and no means to sustain themselves, even if physically healed enough to be discharged.  We must always be sensitive to their emotional wellbeing.

Remember also that none of us are immune to the emotional impact of this devastation. In addition to keeping yourself physically well, by consciously remembering to stay well hydrated, well nourished, and getting as much rest and relief as possible, please also maintain an awareness of how these conditions may be affecting you emotionally. Please share with others any distress, concerns, fears and frustrations. Sharing these with co-workers will let you know that you are not alone with these feelings and you’ll be pleased with the camaraderie this engenders. Also, please be vigilant for your coworkers and help remind them to stay hydrated, nourished, rested as best possible, and positive in their generous work. If you notice a fellow worker avoiding eye contact, acting withdrawn or tearful please do not ignore these signs but let others know of your concerns so that early contact and intervention can head off any larger problems. Because of past incidents and concerns, from time to time there will be volunteer mental health professionals present to help not only with patient distress, but caretaker concerns also.

 

 

Thank you, Thank you, Thank you!

 

            Thank you once again for your generous donation of your time, skills and expertise. We hope you will find your time volunteering not just challenging, but immensely rewarding and fulfilling. The need will continue for years to come and we hope your enthusiasm for participating on a regular, rotating basis will grow as you get to know these unfortunate but remarkable people who in spite of their devastation maintain a hopeful and even joyous spirit!

 

Our volunteers have donated their time and expertise to provide free surgical, medical and dental care for impoverished children and adults in developing countries around the world, as well as serving in the U.S. Gulf Coast after Katrina and Rita.  IMA is dedicated to visiting each of the countries yearly, as long term follow-up and a years worth of medication for each patient remains a high priority for IMA.

Our volunteers pay for their own travel expenses while on mission with IMA.

It is this commitment as well as the generosity of our benefactors and volunteers that makes our work possible.  

To all of them, our deepest and most heartfelt thanks.