Wednesday, January 27, 2010

Haiti diary: Pharmacy perspective #3

January 26, 2010

Hello everyone,

I realize I have not updated since January 20. We are so busy operating our medical teams, supporting the operations, and adjusting our response to the event that everything is a blur.

During the past 5 days, many things have happened.

Our teams are out in the city in operational sites established to provide health care or support other operations. One of our operations is in the middle of one of the worst parts of Port-au-Prince. I had to ride into the site a couple of days ago, and I will say, it was one of the scariest rides of my life; however, the operations are doing some amazing things. Unfortunately, because of the time lapse between the earthquake and access to care, many patients, young and old, need to have various parts of their limbs amputated. Young children, adults, and older adults are all affected by this event. Our teams that are doing this work are some of the most amazing professionals I know--working under austere conditions, with long days and little sleep and surrounded by thousands of displaced residents. They have delivered numerous babies at our operational site. In normal situations, some of these babies would not have made it because of the conditions they live in. These events significantly raise the morale of our teams working on site.

One of our other teams is supporting the USNS Comfort. The Comfort is a Navy medical care ship that is staged off the shore of Haiti. If you have been following this in the news, you will know that the Comfort arrived a couple of days ago. One of our Disaster Medical Assistance Teams is managing the staging point for patients to be medvac’d from Haiti to the Comfort. Unfortunately, not all of the patients are in strong enough condition to survive the flight to the Comfort. Again, an amazing group of clinicians try to make these patients as comfortable as possible, making their passing as peaceful as possible.

Two of our teams were deployed above the city in one of the towns outside of Port-au-Prince. The world has focused on Port-au-Prince, but other areas and towns outside of Port-au-Prince were devastated by the earthquake as well. Some towns were totally leveled. Our teams are trying to do outreach to those towns, but roads in Haiti are challenging at best.

Pharmacists are members of all of these teams; they are some of the greatest pharmacists I’ve ever had the privilege to work with. Last night, Scott Miglin, who is from the PA-1 team but is deployed with the NJ-1 team to Haiti, came into town to pick up a resupply order I had put together. He was escorted in by a team of soldiers from the 82nd Airborne Division in the middle of the night. These soldiers have done a phenomenal job protecting our team members. They are encamped in the area above Port-au-Prince with our team and continue to watch over them. Thank you to the 82nd Airborne Division.

Since I wrote you last, we have had three more earthquakes/aftershocks, the highest being a 4.3 aftershock that hit on January 22. Again, it’s a little scary when your desk starts moving, followed by the filing cabinets, etc. Not something I’ve experienced before and not something I will ever forget.

I’m still camping out on the American Embassy lawn with about 50 of my newest best friends under the stars. The bugs are still a little hungry. Parts of my arms are a little bitten up. I think the mosquitoes drink DEET for dinner.

There are so many stories I can’t even start to tell you all of them; however, I have been humbled to really appreciate what we have in the United States, like drinking out of a cup--not a bottle--of water, drinking something other than water, and eating hot food. As I wrote before, I have not had a hot meal since leaving home. MREs are not what they are cracked up to be. After a while, they all start looking the same and basically taste the same.

In closing, I will share one story. On Sunday, my replacement arrived in country. Dave "Clay" Griffin from Texas arrived midmorning. The irony of this is that Clay is the same pharmacist who replaced me after my first tour of duty during Katrina. We spent part of the day at the Port-au-Prince airport reviewing all of the pharmaceutical supplies we had out there. Then we went to the American Embassy to do the infamous paperwork needed to complete the transition. During the day, a large pharmaceutical order request came in from one of our sites. I knew it would be a challenge to get to the airport where our supplies are and back to the embassy safely at night. Therefore, I advised Clay that, as one of my last operational acts, I would go to the airport, pull and pack the order and wait for the team, escorted by the 82nd, come in and pick up the order; I would just sleep out at the airport.

While traveling out to the airport, I was talking to the driver. As I stated in one of my other e-mails, for numerous reasons, we have to hire all local drivers. As I usually like to, I asked the driver about his family and asked if they were okay. "Paul" stated that they were all ok, but his wife and kids still refuse to sleep inside. They are still scared. In order for his kids to go to school, he must pay their tuition. However, his daughter, although smart, needs some extra tutoring. This costs more, and he is upset that he does not have the money. He can barely pay for his sons' tuition and doesn’t know how he is going to come up with his daughter’s school money. Paul has had to spend a lot of the money he had saved to care for his family during these times. Everything is now very expensive compared with what it was before and his house is damaged, as were most of the things inside. After a couple of minutes of conversation, I was able to find out the cost of his daughter's school tuition.

As I was getting out of the truck, I pulled out some of the cash I had brought with me on the deployment. Since I have had literally nothing to spend money on, I had almost all of the money I had left home with. So I pulled out enough money to pay for his daughter's tuition. This cost was less than a couple of tickets to a sporting event. I walked up to Paul and asked him if I could give his daughter a gift. Remember, although the country of Haiti is destitute, the people of Haiti are a very proud people. They will work for everything, if possible, and only take handouts basically because they have to in order to survive. Therefore, this was a gift to his daughter, not charity to him. He graciously took the money. He went back to his vehicle and came back with a box. With tears in his eyes, he opened a small box. Inside were several cigars, including Cuban Cohibas. He opened it and pulled out two of the Cohibas, handed them to me, and said, "A gift from my daughter; thank you." At that moment, it sort of made the whole challenging deployment a little more worth it.

At this time, I am finally back on U.S. soil. I am in Atlanta. I left Haiti this morning after spending the night at the end of the active runway at Port au Prince airport. The army was moving supplies all around us all night. The dust, mosquitos, bugs, and looters trying to take whatever is not tied down are challenging. Our forward camp is next to the French National Search and Rescue team. They are always laughing, singing, and cheering all day and all night.

When we arrived in Atlanta, we had to clear Customs. Apparently, the White House had called ahead and advised the Atlanta Customs and Border Patrol (CBP) to "take care of us." Because I was the senior member on the plane, I had to meet with the CBP officers when we first arrived. They were great. They escorted our plane full of team members through the custom clearing process, while holding back all other passengers until our whole group was done. All the agents were shaking our team members' hands and extending words of thanks. It made our team members feel great.

Our leadership from Washington, DC--Director Jack Beal and Deputy Tim Walton of the National Disaster Medical System (NDMS)--met us at the luggage area. We were then loaded onto buses and taken to a local hotel. There we were debriefed, offered health care screening, any postdeployment medications, and counseling.

On Tuesday, I will be finally traveling home. Although I’m back, I will be taking the next week to spend time with my family. They are the ones who truly pay the price when I go out and deploy.

Thanks again for all of your e-mails, words of kindness, and concerns for my family and the people of Haiti. I truly appreciate it.

Thanks, and take care.

Bill Drake

William C. Drake, PharmD

Chief Pharmacist, IRCT Haiti, US Embassy-Haiti

US Humanitarian Medical Mission to Haiti Earthquake