The following nurses left their homes in the United States with no real plan in place, a limited understanding of the language, and little more than a desire to help. They traveled across the island to unknown working conditions and devastation. And they echo each other: you cannot put the destruction into words.

“What do you tell them?”

Nurses listen to the calls for help, says Rosario Medina- Shepherd, Ph.D., A.R.N.P., F.N.P.-B.C., A.C.N.P., Vice President of the National Association of Hispanic Nurses and an assistant professor of nursing at Florida Atlantic University. Within two weeks of the earthquake, Medina-Shepherd joined a medical mission through her church. “I just packed up and left,” she says.

After landing in Cap-Haïtien, a city on the northern coast, she jumped into a rundown pickup truck with 15 strangers. They drove for over 10 hours through the mountains and quiet countryside. At night, they passed people congregated by the roads, where there was light from candles. “It truly was entering a different dimension, not one I can explain,” she says. The trip exhausted her, but it gave her time to prepare mentally.

By daybreak, she began working with patients at a hospital in Saint-Marc, a relatively stable coastal area experiencing an influx of refugees from Port-au-Prince, just over 60 miles away. “The medical staff at the hospital were from different parts of the world, but it did not matter where you came from,” she says. “We were there for the same purpose.”

Medina-Shepherd had packed lightly, filling her duffle bag with gear and medical supplies leftover from a 2006 medical mission to Ghana. When her team unpacked her equipment at the hospital, “suddenly everyone who spoke Kreyol wanted to be my friend,” she says with a bit of wry laughter.

“Everything we take for granted [in the United States] was nonexistent,” Medina-Shepherd says. “We’re so spoiled.” Even hours from Port-au-Prince, food and water were very hard to find. People came from miles around with buckets on their heads looking for it, and children played in the dirty water pooled near the road.

She felt afraid at times, sleeping on a mattress on the floor, surrounded by barred doors and windows, but she trusted the people who gave her team a place to stay. “They really just wanted to take care of me so I could take care of their people,” she says.

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Medina-Shepherd was made medical director after arriving in Haiti, appointed by the director of the Gulf Stream Baptist Mission Association. The chief of medicine looked half her age, and the nurses and other volunteers seemed to need guidance. After making rounds, she assisted in wards staffed by nurses and physicians from a Boston-based team. They had flown in on military planes and were relatively well equipped, but conditions remained frenzied. “There were people all over the place,” she says. “It’s not America. It’s not how we run medicine.”

People recovering from surgery, including amputees, lay on the floor without pain medications or fresh dressings for three or four days after a procedure. After receiving a dose of morphine, they were suddenly up and walking out the door. It was hard to follow up with patients post-op—the physicians only looked after the most severe cases—so Medina-Shepherd set up a post-trauma clinic on other side of hospital.

Anyone could write prescriptions. There was no oxygen in the ER; “it was a place to go lay down and wait.” There was no way to intubate dying infants. One Haitian doctor said, “Get over it. Babies die here all the time.”

Medina-Shepherd and her team also established a makeshift clinic in a school in Arcahaie, a town about 45 minutes south of Saint-Marc. They worked from about 7:00 a.m. until 2:00 p.m. and saw over 100 patients. Some just came looking for free medical care, not available before the disaster. The Haitians complained of abdominal pain but only felt it when they didn’t eat, Medina-Shepherd says. “What do you tell them?”

Yet, despite the country’s devastation and the squalor in the hospital, the Haitian people wanted her to know that they were okay. The pride and reassurance is part of their culture, she says. In the early morning hours, from her mattress, she could hear people singing praise songs and worshipping in Kreyol. “That was my backdrop,” she says.

“I think we all need to go,” she says. “I would go back in a heartbeat.”

“Makeshift everything”

Chioma Ohiri, R.N., B.S.N., first went to Haiti in October 2009 to visit her mother’s family. A telemetry med-surg nurse at Parkland Hospital in Dallas, Texas, she wanted to reconnect with her roots. “The country was alive,” she says. “A lot of color. A lot of happiness.” Ohiri left feeling “complete.”

Chioma Ohiri, R.N., B.S.N.Chioma Ohiri, R.N., B.S.N.

When she returned to Haiti in January, a week after the earthquake, the once bustling airport was empty. United Nations troops guided her team around the tarmac, and they unpacked their own luggage from the belly of the plane. “My heart was so heavy,” she says.

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Ohiri went with Hospitals for Humanity, a small-scale nonprofit with limited experience responding to such disasters. They gave her some travel information, she talked to her managers, and eventually skipped a vacation in Cancun to travel to Haiti. Ohiri joined nurses and doctors from all over: New Orleans, Chicago, Las Vegas. The team stayed with one member’s family in the coastal tourist town of Montrouis. Every day, they made the two-hour commute to Port-au-Prince.

They set up a clinic in one of the remaining structures, an abandoned church. Though it did not have any walls, it protected their medicine and equipment from the heat. But the Haitians were terrified to enter a building, and the nurses and doctors had to convince patients it was safe. It was a challenge, eight days after the earthquake. Ohiri was also there for the aftershocks, quakes between 5.9 and 6.1 in magnitude.

For medical supplies, they only had what they came with. “We had to make our own makeshift everything,” Ohiri says. Patients slept on the floor, and the team used church benches to make little triage areas. Ohiri assisted in a cesarean section performed on the ground, without surgical supplies or anesthesia. She just applied Lidocaine to the woman’s stomach. Both the mother and baby survived, and he was named for the doctor who performed the procedure.

“There were a lot of things I didn’t expect to see,” Ohiri says. So soon after the disaster, their clinic was inundated with multiple fractures (as many as five in a single limb), head trauma, and deep wounds. A child came in with a gash that “looked as if a shark just ate the back of his leg.” Someone used white undershirts to stop the bleeding, and the fabric had grown into the muscle tissue. Showing the Haitians how to care for their injuries became a priority. “We had to do a lot of patient teaching,” she says, because their wounds would take weeks to heal, long after the clinic disbanded. It harkens to the overarching goal of helping Haitians back on their feet, but leaving them with the tools to rebuild themselves.

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“The people, they were so appreciative, so humble. That motivated me,” Ohiri says. The Haitians understood the nurses were doing the best they could, and the nurses in turn relied on each other to keep going. Everyone had so much energy, Ohiri says, and it helped her stay sane. “You put your heads together and anything is possible,” she says. “I ended up leaving with a lot of good friends.”

Ohiri says nursing outreach should not stop at Haiti. There is a debilitating lack of nurses in China, which was hit with a massive earthquake in May 2008 that left almost 100,000 people dead or missing, then another in April 2010 that killed over 600. She urges other nurses to volunteer. “Don’t be afraid, and just use your heart,” she says. “I feel honored to actually help.”

“Lines and lines of patients”

Joyce Vazzano, R.N., M.S., C.R.N.P., landed in the Dominican Republic on March 5, then took an eight-hour bus ride to Port-au-Prince. An instructor in the Department of Acute and Chronic Care at the Johns Hopkins University School of Nursing, she had volunteered in Haiti before, but seeing the stark contrast between the Dominican Republic and Haiti as she crossed the border was a new experience. “It was just so obvious it was a different country,” she says.

Vazzano traveled with three other nurse practitioners from JHUSON and a team of volunteers to a clinic in Miragoâne, a trade city on the west coast, 58 miles from Port-au-Prince. Though there were some toppled buildings, it was in much better condition than the capital city, she says. Unlike many volunteer medical workers she knew of, Vazzano’s clinic had a traditional exam room, though it did not have electricity or running water.

People came to her clinic from all around the country, including refugees from the capital. The earthquake affected everyone she saw. All had family who died in Port-au-Prince. “Every day, there would be lines and lines of patients,” Vazzano says. She estimates she saw one person every eight to 10 minutes.

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Vazzano spoke to many patients exhibiting signs of Post Traumatic Stress Disorder; they could not sleep because of night terrors, could not eat, and experienced heart palpitations and trouble breathing. Two psychologists with the International Medical Corps, a private nonprofit relief agency, trained the clinic staff to recognize PTSD and taught them basic intervention, such as relaxation techniques. With the Haitian culture dismissive of psychology, there was little other psychiatric care or medication available.

Patients also came with more common ailments and chronic diseases. Many had respiratory problems because of all the dust in the air following the earthquake and the coal used for cooking. “People bathe in streams littered with garbage alongside the pigs and cows. Or they shower in groups in the open along the streets if there is any running water,” she says. “We were seeing many patients with cholera from the contaminated water supply.” Medications were very limited. They didn’t have enough to fill prescriptions for things like asthma and hypertension, so the Haitian doctors and nurses would give small doses. Bottom line: “If they don’t have the medicine, they can’t give it,” Vazzano says.

After a week, Vazzano left for a downtown clinic in Port-au-Prince. She worked on hospital grounds in ER/ICU tents with a group of Haitian nurses. “We worked together to try and work with the equipment we had,” she says. At one point, she showed Haitian nurses and doctors how to use needleless IVs, but they chose not to implement the equipment the next day or going forward, favoring more familiar, if outdated, methods. They knew, and Vazzano quickly realized, it was more prudent to reject tools that would eventually be taken away when her team left.

Generators provided the tents with electricity, but they intermittently blacked out, so nurses and doctors kept Ambubags ready to hand-ventilate patients if necessary. During procedures, they tried to be as sterile as possible, at least wearing gloves and masks, but anxious family members would walk in and out of the hospital tents, often standing at the foot of the bed. They could not be contained.

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The patients arrived in droves, from 7:30 a.m. to 6:00 p.m. The 20 cots in the ICU, spaced about 18 inches apart, were always full. They treated ailments that read like a page from a history book: cerebral malaria, typhoid, and tetanus. “Some days, there were multiple deaths of patients who probably would have lived if they were fortunate enough to have the same illness in the U.S.,” Vazzano says. “They had so little before the earthquake and have even less now, yet they always had a smile for the health care workers and thanked us for whatever little thing we could do for them.”

The nurses chatted in the evenings, trading stories from their practice settings in the United States, Haiti, and elsewhere. No Haitian nurses worried about being sued if something suddenly went wrong, while the U.S. nurses followed pages of guidelines to protect the patients, as well as themselves. At the clinic, they just needed to work together to make sense of the chaos.

One of Vazzano’s peers in the Department of Acute and Chronic Care at Johns Hopkins, Beth Sloand, Ph.D., C.R.N.P., has volunteered in Haiti one or two times each year for the past 11 years. She became a leader for Haitian relief at the University, organizing one of the first JHU trips post-earthquake.

Sloand recommends registering now with organizations like the Red Cross, so when the next disaster strikes, they can quickly dispatch more specially trained nurses. She also suggests supporting relief efforts from home rather than going to Haiti, because the country has been swamped with volunteers when it really needs money and professionals.

Three nursing schools were destroyed in Port-au-Prince, and many nursing students and faculty died when the university hospital collapsed. “There’s a need for us to help support the nursing students in Haiti,” Sloand says and mentions donating to the Haitian Nursing Foundation or National Nurses United. “The Haitian nurses did a fantastic job.”

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