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Sarah Kaspari Baker, a 47-year-old family NP from Bismarck, N.D., was invited on a medical mission by the founders of a clinic in Haiti. The earthquake struck while she was working at the clinic, and she was able to help victims of the quake before returning home on January 18, 2010.
A Last-Minute Decision to Go
At home in North Dakota, Baker provides primary care at the Northland Community Health Center in McClusky as well as trauma care in the emergency department of St. Alexius hospital in Bismarck. Bruce Bloomer, team leader of medical mission trips for Celebrate Jesus of Haiti, contacted Baker when a member of the medical mission had to cancel.
Bloomer, a friend of Baker's, had been "trying to get me to go for years," Baker said. Her family and friends stepped up to cover her work, and her husband and children were supportive. Everything came together, she said, so she decided to go. She joined a team of 12 volunteers, including three nurses, a pharmacist and pharmacy assistant, a physician assistant, two physicians, and three other nonclinical volunteers.
"One of the last e-mails I sent to Bruce said, 'This is going to change my life forever, isn't it?' and he wrote back and said, 'Absolutely,'" said Baker. "I guess neither one of us knew just how much change there would be."
The Clinic
Celebrate Jesus of Haiti was founded in 2002 by pastors Sonja and Jerry Dickherber, after many small mission trips dating back to 1991. The campus now includes a church, a school and a clinic. The group serves the people of Anse-à -Galets, on Gonâve Island (also called La Gonâve), about 45 miles off the west coast of Haiti. The island is about 37 miles long and 9 miles wide.
All schooling, food and healthcare provided to the people of Haiti is free. Baker was part of the first medical mission trip to Celebrate Jesus. Word of mouth passed into the mountains that people should come Monday, Jan. 11, for treatment of their health concerns. Many of the Haitians who arrived had never seen a physician or nurse practitioner before. That day, the team of providers saw 850 patients, including a child with typhoid fever and another who had a bean stuck in her ear canal for 2 years.
The Quake
On Tuesday afternoon, Jan. 12, Baker was seeing a patient when the earthquake hit. She described the sound as like a train, and then the building began to move. "It felt like walking on a waterbed," she said.
The experience was surreal. "I'm from North Dakota: I don't know earthquakes," said Baker. The providers got all of the patients outdoors while the earthquake was happening. After about a minute, Baker said, it stopped. Incredibly, the clinic sustained no damage.
They were able to make a few phone calls to Port-au-Prince before all communication was interrupted. During the aftershocks, the mission team continued to see patients, and they didn't hear word of the devastation in Port-au-Prince until patients began arriving by ferry for treatment.
Baker couldn't contact her family by phone, so Bloomer drove to nearby Wesleyan hospital to send a message by e-mail back to the United States that was disseminated to all the families of the medical mission volunteers.
The Patients
Friends and family members of Haitians on Gonâve Island started flooding to the island for acute care after the earthquake. They arrived by a 3-hour ferry ride, which had doubled its daily runs back and forth to the island. One patient, a street vendor in Port-au-Prince, had burns covering one leg, the result of hot oil being used by a neighboring vendor.
That woman's burns covered 19% of her body. Baker gave her a tetanus vaccine and intravenous antibiotics, but she could dose only two Tramadol before debriding the leg, because the clinic hadn't been supplied with narcotics. "And she did not cry out one time. these are tough people," Baker marveled.
A crush victim who had been caught under rubble for 2 days arrived with dehydration, broken ribs, broken jaw and broken fingers. "She looked ghastly when we got her," said Baker. The staff gave her fluids and set her broken finger. Another crush victim's head wound was so infected that it couldn't be closed with stitches.
"I think we're going to see a lot of amputations," said Baker, who noted that patients with wounds weren't being seen quickly enough to save their limbs before they were too badly infected.
Healthcare in a Disaster
Baker had to improvise to treat the influx of unanticipated injuries. "Trying to make do with what you had and make a difference, it was like primitive frontier medicine," she said. For one, Baker amputated an infected thumb with a sharp cuticle tool she had brought along to treat ingrown toenails. At the Wesleyan Hospital, Baker saw a physician perform an emergency cesarean section with only local lidocaine. The biggest improvisation Baker had to make was for a little boy who fell into a pot of boiling soup during the quake. The boy's arm had been submerged and was burned halfway up his forearm.
"His hand was like a claw," said Baker. She had nothing to use for anesthesia, so gave him IM Benadryl, oral phenergan with codeine, and Compazine. "And I mean tiny doses," said Baker. After the 18-month-old fell asleep, she was able to debride his wound, which had been "acting like a tourniquet" and would have required amputation if he hadn't been treated right away. Afterward, he had complete mobility of his fingers.
"It's hard, because that hard life does not lend itself to physical deformities. Loss of a hand could be a devastating injury for a child."
Fortunately, Baker said, her previous NP job in a prison and her experience in acute care and community clinic care prepared her to assess and diagnose quickly with few diagnostic tools. She says she will forever be grateful to her educators, because "I diagnose. I ask questions and I listen and I palpate and I use my stethoscope and come up with the probability." But it was still difficult: "I've seen multicar pileups, but we have what we need to take care of them when they come in."
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