Boston Medical Workers Prepare For Haiti's Unfamiliar Trauma

A half-dozen doctors and nurses are crowded in a chaotic operating room. A patient is bleeding from her mouth and nose. There's a deep gash in her abdomen. And her right leg is mangled — the knee twisted, the foot cocked unnaturally to the side.

[soundslide]http://www.wbur.org/files/soundslides/2010/wbur_0318_haiti-simulation[/soundslide]

The room is filled with moaning. "Help me, help me, help me. I can't feel my leg! Am I dying?"

The doctors work as fast as they can, but they don't have basic supplies or enough personnel. "Is there a surgeon here?" one doctor asks. "No surgeon? Can we get some oxygen?"

Then things take a turn for the worse. "She's vomiting, she's vomiting," another doctor warns. "Be careful. Stabilize the head, stabilize the head. Log roll, log roll."

Don't be too alarmed. The pained noises are made by a nurse who's a pretty good actress. And the patient on the table is actually a mannequin. Because most of these medical workers are leaving soon to do volunteer work in Haiti, this simulation is meant to prepare them.

It's a first-time trip for many of them, and they may not be prepared for what they'll find there. So Children's Hospital is helping the doctors get ready for the primitive medical setting.

Dr. Peter Weinstock, who runs the exercise for Children's Hospital, talks with them later about what went right and what went wrong. "When you turned her, she said something that sounded like 'my tummy' and she was actually saying 'I'm falling,' " Weinstock points out.

"Oh — I thought she was saying 'my tummy,' " says Tyler Hartman, a pediatrician at Children's Hospital who was a team leader in the simulation, which is a pilot program.

“We work in this environment where we would never fathom reaching for a cardboard box and putting a child in it.”

--Dr. Peter Weinstock"Yeah, it sounded that way," agrees Weinstock. "And it just raises that issue again to try and use translators as best you can, or also realize that some of the things you're hearing may sound like certain things but may end up being very different."

After the simulation ends, Hartman says the unfamiliar environment was difficult.

"Not knowing where everything is, not knowing who the people were, was extremely stressful because I'm used to knowing who can do what and relying on those people to do those things," he says. "And not knowing who can do what — I just felt like you couldn't tee up for a worse stressful situation."

But that's exactly the kind of situation he could find himself in daily when he goes to Haiti next month. Most of the medical workers there won't know each other. Some things they may not expect to have, like Internet access, might actually be available. But other basic supplies will be hard to come by.

"Things like proper-sized NG tubes, having enough syringes, things around stabilization of fractures, the kind of stuff that we pull right off the shelf," Weinstock says.

So the simulation program teaches emergency medical workers to be resourceful. To make neck braces out of rolled-up towels. To make oxygen masks out of plastic water bottles. To bring headlamps so they can do procedures without having to hold a flashlight.

"We work in this environment where we would never fathom reaching for a cardboard box and putting a child in it," Weinstock says. "One of our goals was to really just open their eyes to that concept that that may very well be the resources that are available to you."

It also teaches them to recognize illnesses that have been wiped out in the U.S.

One of the simulations, based on a real case in Haiti, involves a mannequin baby suffering from what looks like epileptic seizures. The newborn actually has tetanus caused by what some doctors call "dirty umbi." That means its umbilical cord was cut with an unsterile instrument.

Meghan Weake is a nurse at Children's who is leaving for Haiti on Thursday. She says the simulation made her feel better and worse about her trip.

"Better because I feel like we have a really good team going down and we'll be able to work well together," she says. "Worse because it's not like Children's where we can send them to the next floor or put them on monitors and monitor them."

The program also reminds emergency workers that if they get sick or dehydrated, they'll need medical resources meant for earthquake victims. So they're told to bring mosquito netting and powerful insect repellent to avoid Dengue fever. Dr. Weinstock says these little things can make a big difference.

"The hope of this program," he noted, "is not to have them hit the ground running per se, but have them hit the ground walking a little faster."

They're also advised that instead of acting immediately in a medical emergency, take 10 seconds to figure out who has what skills. Because that could save 10 minutes down the line, Weinstock says.

And in Haiti, every minute counts.