Let me start off by stating that words can in no way describe this experience in its totality. The sights, emotions, sounds and smells will remain as an indelible tattoo on my memory. Furthermore, this has all yet to sink in emotionally but I figured it best to quickly put down something which would answer the inevitable question, “How was it?” I apologize for the length of the “debrief” and it only scratches the surface – logistics were an extreme challenge under these circumstances so a lot of what is below involves the “how and why” in addition to the project itself. 

THE IDEA

One lovely Saturday evening dinner with friends and family led to a discussion which has changed my life forever. The conversation between six of us over some collectible wines drifted to the situation in Haiti where an approximately 7.0 magnitude earthquake decimated the city of Port-au-Prince and its surroundings. The news coverage continued to focus on the paucity of medical resources and the desperate need for physicians, specifically orthopaedic surgeons to care for the severely injured population. We discussed how helpless we all felt to realistically do anything about the situation. A business manager, a lawyer, an orthopaedic surgeon together with our spouses who all have so much yet felt impotent to have an impact in any meaningful manner. Maybe we could get there but really, what could the six of us do? Maybe it was the wine or the nature of the conversation but a spark was struck and I slept poorly that night – I wasn’t alone. The next morning, Gary Kress and I spoke and shared the stories of our restless night and like any good fire, my spark met some serious fuel.
 
Gary is the business manager for Matt Damon who has been involved with Partners in Health (PIH), a public health organization established in Haiti over 20 years ago – founded by Dr. Paul Farmer. Gary through Matt reached out to Partners in Health to see if there was any opportunity for us to provide some aid and he was informed that relief efforts at that point were restricted to medical personnel. He thanked them, passed on this information to me and stated he did not feel comfortable throwing only my medical hat in the ring under such circumstances. I told him he could throw my hat anywhere he wanted if it could lead to something that would have a meaningful impact and he warned me to be careful what I wish for…he COULD make it happen……and he did. Within one hour he gave me instructions to put together a medical team as he had an assurances from Mr. Damon and that together they would figure out transportation and logistics – by now, Gary may regret that offer….Two to three hours later, Newman’s Own Foundation agreed to help offering finances for medical supplies and later at my request, Gary secured 3 satellite phones in the event communication difficulties arose on the ground.

Personnel was my next challenge so I put in a call to my dear friend and senior partner Dr. Kevin Ehrhart to run the idea by him just to make sure I wasn’t crazy and although he said I might be, he was all in. With that as our surgical core, the request from Partners in Health was to include two anesthesiologists and 4-5 nurses to round out the team - as well as any medical supplies we might need. The next phone call was to another dear friend Dr. Jonathan Kohl, an anesthesiologist who ultimately threw his hat in the ring and telephoned his partner, Dr. George Herr who added another anesthesia cap. The next piece of the puzzle was from Saint John’s Health Center where we are all on staff, to assess their level of interest in supporting our effort. Their response was overwhelmingly positive. Within hours they offered 2 surgical techs, 3 recovery nurses and medical supplies to bring with us. Add in my wife, Monica who is the clinical operations manager for our orthopaedic group and our good friend Kerri Kilroy, RN who is the nursing director for our surgery center and this idea had some serious legs now.

A BUMP IN THE ROAD

A seemingly insurmountable problem (the first of many) then occurred when we were informed that Mr. Damon’s charter plane would not be able to land in Haiti – no problem, Gary Kress to the rescue. Calls went out to various individuals with private planes to see who would be interested and again the response was overwhelming. Mel Gibson offered his plane and he and Mr. Damon essentially agreed to share transportation expenses, an overwhelmingly generous offer.

ANOTHER BUMP - NO PERMISSION TO LAND IN PORT-AU PRINCE

Information on the ground in Port-au-Prince came to us through Donna at the U.S. office of Partners in Health in Boston. She informed us that planes were granted “slots” to land and to this point no immediate slots were available. Despite having a team, a plane, supplies and contacts in the ground, our mission was on hold. Communication with our team – thanks to e-mail – was easy but frustrating since people had changed their work and family schedules for departure and return and unfortunately the dates kept moving. Ultimately, a “slot” could not be obtained for our plane to land but again through persistence and communication with Gary, PIH, and SunAir Jets, a plan to fly to Opa Locka airfield and connect with a charter flight provided by MediShare which had permission and a coveted “slot” to land.

MOBILIZATION OF TROOPS AND SUPPLIES

Word came from Sun Air Jet that with our current medical team of 13, we were limited to 400 pounds of cargo which would severely limit our usefulness. At that point a difficult decision had to be made to decrease the proposed team by two people to gain additional cargo capacity – one ENT surgeon and one nurse had to be trimmed from the team – I truly appreciate their willingness to participate and was disappointed they could not be included. Next, a visit to Saint John’s Health Center was required to preview the cargo and assess weight and size prior to transporting it to Camarillo. I met with Rebecca Siason (Saint John’s OR Director) and Karina Aparicio (lead surgical tech on our mission) that morning and previewed the medical supplies, instruments and implants generously donated by Saint John’s Health Center, Newman’s Own Foundation, Synthes, and Stryker. With a definitive plan for departure, we met in Camarillo, CA and flew through the night to Opa Locka Executive Airport in Florida. We spent nearly the entire day awaiting the departure of the charter flight during which time we re-packed our supplies for the third time to minimize the number and size of the boxes and supplies we wanted to bring across. The only bright spot of the lengthy wait was running into Dr. Paul Farmer who founded PIH and Dr. Louise Ivers, PIH’s Medical Director in Haiti. We ultimately arrived that evening at sundown in Port-au-Prince and were met by PIH staff and spent our first night in our little version of a ‘tent city’ (see below). Not lost on a single one of us was the enormity of the contrast in our day whereby we flew in a luxurious private aircraft to the capitol city of the poorest country in the western hemisphere which was just destroyed by a natural disaster.

After our night in Tent City we met with PIH Chief Medical Officer Joia Mukherjee, MD and the other medical teams to discuss deployment of personnel and resources. At that point based on the composition of our team we were transported to Cange approximately 2-3 hours outside Port-au-Prince in the Central Plateau region of Haiti. Of course, prior to that we again re-packed and prioritized supplies for transport….we were getting good at this.

In Cange, we were greeted by the current medical team at the hospital, oriented to the grounds, and then proceeded to round on 140+ patients spread through 5 medical “wards” including 40+ patients being cared for in the hospital’s church. Each ward had a medical leader ranging from a 4th-year medical student to attending staff. Our team divided and conquered with some members of our team orienting themselves to the operating rooms, some organized and stored supplies while Kevin, Stephan (our current fellow at SMOG who is fluent in French) and I triaged each of the wards and created a priority list where surgical patients were classified as either A) Urgent Surgical Need, B) Surgery Needed sooner rather than later or C) Surgery Needed but less time-sensitive. As important or perhaps more important than triaging the patients that needed surgery, was identifying several patients who had significant spine injuries requiring urgent surgeries to offer them a positive outcome – 4 such patients during our stay were transferred to the USNS Comfort – a floating hospital in the region with capabilities to handle these injuries. This day was mentally and emotionally exhausting but having had our first true patient contact, there was a sense that we could actually help many of these patients and were energized to tackle the enormity of the work to be done.

THREE VERY BUSY SURGICAL DAYS

Not knowing whether we would be operating in a tent or an OR, we were delighted with the facilities which included two operatories, a sink in between them, a back hall with a sterilizer, and a small, tight hallway out front that acted as pre-op, post-op, supply storage and our OR desk – what else could one want?

With very finite resources and the unbelievable support of the local medical team, we were able to do nearly 40 major surgeries in the operating rooms consisting primarily of fractures in the upper and lower extremities many with complex soft tissue injuries as well. In addition, complex wound care was provided on the wards, often requiring sedation to perform due to the severe nature of the wounds. Creativity was required; patience was an absolute necessity and camaraderie got us through whatever fatigue and frustrations came our way.

The system simply worked through a cooperative effort of anesthesiologists, nurse anesthetists, surgeons, surgical techs, nurses and our “coordinator”, Monica who was one of the inspirations to aggressively pursue this mission in the first place.

THE VOYAGE HOME – THE ADVENTURE CONTINUES

As challenging as it was to obtain a “slot” to land in Haiti on our outbound flight, it proved equally challenging to get a slot for our departure. Gary again thru countless phone calls and emails arranged for “our” plane to not only pick us up but deliver another team of doctors with a half-ton of supplies at the same time. Our departure date changed several times and although it remained a bit of a distraction to not have a defined ‘exit strategy’, we knew people were doing everything in their power to assist us and our team was committed to the task at hand. We ultimately obtained a slot to deliver the Miami team and pick us up and our ground transportation was arranged back to P-au-P by PIH staff to get us to the airport with time to spare.

Before our departure, we rounded one last time to come up with a plan for some of the more complex patients and smooth the transition to the teams of surgeons from Ireland and University of Pennsylvania who were arriving as we left and would inherit the reins.

The level of poverty in Haiti is well known and seeing it first-hand is striking enough that our team felt strong enough to leave behind as much instrumentation, implants, and medical supplies as possible. Calls to Saint John’s were made and 95% of what we brought was ultimately left in Cange to support the subsequent orthopaedic teams – thanks again to our medical sponsors Saint John’s and Newman’s Own Foundation.

In a similar fashion, our team members left behind our warm clothing, sleeping bags, pads, and anything potentially useful to the hospital and its surrounding population. This proved to be a fateful decision. En route I text messaged our pilot and within minutes received a phone call from Annette at Sun Air Jets in Camarillo with some bad news: one of our two pilots sustained a bloody nose which could not be stopped and was in a local emergency room in Florida - he would not be cleared to fly for 48 hours…it took my breath away. The enormity of the situation was hitting me as I hung up the phone – my staff who had trusted me to get them there, help them be productive and get them home safely just took a glancing blow. It’s not as if we can go to P-au-P and check in to a hotel and stay a couple more days so my next move was obvious – call Gary. A voicemail with a heavy heart was left on his phone and although the tone in our car changed dramatically, we figured between him and Annette, things can be worked on from the US – they got us here, they’ll get us home. Meanwhile on our end, we figured we would go to the airport where we were informed that US citizens were being evacuated on planes after the planes dropped their cargo. Our plan was to take any plane headed to anywhere in the US and arrange transfer home from there. Annette later assured us that we could be picked up in the morning because they were flying in a pilot to function as the co-pilot to take us all home.

Upon arrival at the airport in P-au-P, the scene was a bit hectic but after flashing our American passports and explaining we were a medical team, we were ushered to an area where after going through security we waited in a line of several hundred US citizens standing in line awaiting evacuation…..5+ hours later, we boarded a C-117 cargo plane (see below), strapped ourselves in (literally) and took off for the United States to location unknown…..2 hours later, we arrived in Orlando – a leg of our trip that marked a highlight for Dr. Jon Kohl’s 60th birthday which we celebrated all day long.Upon arrival, our lemons from earlier in the day turned into sweet lemonade. Gary had e-mailed me our hotel accommodations for the night in Orlando… The Ritz-Carlton was awaiting our arrival, courtesy of Matt Damon. We were met by hotel staff upon arrival and treated like national heroes as they checked us in, sent toiletries to our rooms, and even had security open up their shop which closed three hours prior to get us some clean clothes. After an extremely enjoyable and much-needed HOT shower, we met for dinner at the hotel and again marveled at the events of our trip and the unthinkable contrast between where we woke up and where we were about to rest our heads. We were emotionally and physically exhausted but managed to have an amazing dinner – again courtesy of Mr. Damon – where we went around the table and heard from each team member what their thoughts were at that moment about our mission… a heartwarming and truly memorable meal topped off with a birthday cake and singing for our birthday boy.

We awoke Wednesday morning and took cabs to a private airfield where “our” plane met us and took us home sweet home…luxury travel filled with stimulating conversation about our experiences and where the fate of Haiti might be headed over the coming months and years. We each had unique ideas about what can and should continue to be done to help and my sincere hope is that each member of the team and our “sponsors” continue to remain involved with humanitarian projects and continue supporting Partners in Health (and similar organizations) in any way possible.

SINCERE AND SPECIAL THANKS:

No project or mission like this occurs without significant assistance and in the case of our project, the assistance was formidable.

Gary Kress – “The Skipper” – logistics, relationships, and communications

Matt Damon and Mel Gibson – Over-the-top generosity - transportation and
more

Saint John’s Health Center and Foundation – Medical Supplies and Staff

Newman’s Own Foundation – Medical Supplies

Partners in Health Administration – Donna was our electronic connection

Sun Air Jets – Pilots and staff – special thanks, Annette for logistics help

Bayside Anesthesia – covering their colleagues that I kidnapped

Santa Monica Orthopaedic Group – covering Kevin and me

Surgery Center of the Pacific – covering the loss of their Nursing Director

Synthes and Stryker Corporations – Instruments and Implants

MEDICAL TEAM STANDOUTS IN HAITI:

An incredible team of dedicated physicians/medical students/nurse
anesthetists and anesthesiologists didn’t sign up for this but embraced the
challenge with class and blew us all away with their knowledge and care for
each patient. The team we worked most closely with included:

Thierry Pauyo

Jonathan Crocker

Ranu Dhillon

Koji Nakashima

 

OUR TEAM:

Alberto Bustos – Surgical Tech

Karina Aparicio – Surgical Tech

Kristin Opaskar – Recovery Nurse

Elaine Larotonda – Recovery Nurse

Monica Modabber – Medical Assistant/Coordinator

Kerri Kilroy – OR Nurse

George Herr – Anesthesiologist

Jon Kohl – Anesthesiologist

Stephan Pro – Orthopaedic Surgeon, French Translator

Kevin Ehrhart – Orthopaedic Surgeon

Ramin Modabber – Orthopaedic Surgeon/Gilligan

The “12th man” was all the friends and family who provided so much
emotional support and encouragement via text, cell, and e-mail without which
this could not have been possible.

Information regarding Partners in Health and how everyone can help can be
found at www.PIH.org.

 

Thank you for reading;

Ramin