Dr. Joshua White, a student in the Opus College of Business Health Care UST MBA program, currently is in Haiti providing medical treatment to victims of the recent earthquake.

Read his regular updates from Leogane, Haiti - sent via text messages, Facebook and email - as he and his team of medical volunteers from World Wide Village do whatever they can to help those in need.

(Note: In spring 2009, Dr. White wrote a prescient article in B. magazine on the desperate need for medical assistance in Haiti. In “Haiti Waits,” White describes the challenges of providing care to Haitians through his volunteer mobile clinics. You can read the full article and see a series of photos here.)Editor’s Note: Final Haiti update from Dr. White can be found at the bottom of the page.

Monday, Jan. 18, 2010
(Via text)
The preliminary plan is to fly into Santa Domingo, Dominican Republic, on a commercial flight and then arrange ground transport across the Haitian border into Port-au-Prince.  The plan is to do our work in Port-au-Prince, figuring transportation to Leogane would be difficult, and walking with all the medical supplies would not be a smart idea.    

Tuesday, Jan. 19, 2010
(Via text)
World Wide Village comes up with a privately donated jet transport for the team straight into Port-au-Prince.  Transportation is found to be easier, and the team is able to get into Leogane, set up our clinic and see some patients all that afternoon.

(Via Facebook)
We made it to Leogane safely. Phone is dead, but found a random Internet connection. Place has been devastated. Most buildings are down. People are calm, however, and it is not unsafe.

(Via text)
The airport is like a military base. The road is better than expected. Petrol is better than expected. Populace is fairly calm, devastation is massive.

Getting ready to crash for the night. Hard to get calls out. People are singing hymns. 

Wednesday, Jan. 20, 2010
(Via text)
First aftershocks this a.m. Obviously, this freaks the town out. Cliff bars for breakfast. Everyone is fine.

This is unreal. Leogane is flattened. World Wide Village partnering with a lot of groups to set up a mobile hospital here for 6 months.

The wounds are awful. Did a face lac on a 3-year-old with quarter of her scalp missing.

105 degrees today. The duct tape melted.

Choppers going over every 10 minutes. Feels like a war.

We got an orthopedist today. Done a couple of amputations.

We are not really spending any time in buildings. (Response to the question: Do things feel any more unsafe after this last aftershock?)

Patient numbers aren’t too bad right now. Japanese and MSF (Medicine Sans Frontiers) are all here. Some Canadian military and Sri Lankan UN.

The Japanese let us use their ultrasound and X-ray, they are great. (Text)

(Via Facebook)
I had a rough day. Some godawful (sic) injuries here. Some good news though … expecting a large food shipment for the populace this weekend and a 50 bed mobile hospital as well. Got an orthopedist yesterday who’s been a huge help. Working alongside the Japanese Ministry of Defense and Medicine Sans Frontiers. Canadian troops are hanging out in Leogane, and the Sri Lankan UN Force has been here for years. Neat folks.

(Via email)
Hello everyone:

Day 2 is coming to a close.  Was brutal hot here today, 105 according to my watch, and I believe it as our duct tape melted.  Everyone did well, although Shane is suffering from a bit of dehydration at the moment.  Nothing serious, but the plan is to pump him full of IV fluids so he’s going full bore again tomorrow.

Leogane is in awful shape. Probably 80 percent of the homes are flattened or damaged enough to be unsafe. We are sleeping in the Filariasis house compound.  It’s gated and quite safe. The aftershock was our wake-up call this morning.  Very brief.  Not too alarming. Tent certainly isn’t going to fall down. The people are all building shelters and tents to live in … don’t know if they have a permanent plan. Fortunately, we have food coming in this weekend that World Wide Village has arranged. Save the Children has been a wonderful partner and will help us store/distribute it. I know a bit about disaster management, but nothing about mass food distribution. Excited and nervous about the mobile hospital. Things are coming together to run it, but this is going to be a ridiculous amount of work. Chris and I are admittedly worried. We know we can do it, but it’s a daunting challenge.

We are working alongside the Japanese Ministry of defense and Medicine Sans Frontiers.  There is also an orthopedist working with us from Madison, a number of Canadian Troops, and the Sri Lankan UN force. We are referring to ourselves as the Iowans, given that that is the largest contingent amongst us and that we represent so many different organizations.  We hope that the cooperation here will be reflected in the states. I must especially recognize Save the Children … they are making our lives and job so much easier.

The camp is like a war zone. We have set up a series of tarps outside such that we’re not under a building roof.  A lot of folks here think we’re a little over cautious, but what are you gonna do with the ground shaking every few hours? Horrible trauma, although now a week old. First patient this morning was a 3-year-old with about a quarter of her scalp missing.  We were able to get some Ketamine from the Japanese and sedated her and did what essentially constituted a face lift by undermining all the skin on her scalp and pulling it tighter to cover the open skull. It came out reasonably well, all things considered. The rest of the day was more of the same. There are choppers going over every 10 minutes and two blackhawks brought in the orthopedist yesterday, landing about 100 yards away. It looked like fun. We’re watching a couple of amputation patients tonight in our “ICU” (a 10-person tent).

Well, I am hoping for my first meal that isn’t a Cliff bar in a few minutes. I miss and love you all. Forward this around to those that might be interested. Looking forward to seeing the second team. Can you get us a list of participants? Any arrangements to get in yet? I’m quite certain we can arrange transport from P-a-P to here. We’re developing a very good relationship with Save the Children, and HSC/CNP still have a number of resources. Can we get some more details on the trucks/shipment? (i.e. … will it be on pallets, containers, itemized list …) If I already have this information I apologize.  I have 109 unread emails.

Peace,
Josh 

Thursday, Jan. 21, 2010
(Via text)
Lots of aftershocks. We are fine.

It’s a balmy 102 today.

So now we are running two OR’s. Got plastics, hand, ortho and general surgery now.

Trauma and ref clinic running full bore. Got a truck clinic driving into the community getting people to us that aren’t mobile.

Americare has us fully stocked and Save The Children got us a mobile warehouse.

Just saw the hospital. It’s bad. (He is referring to the hospital we always work out of when we go down to Haiti, Hospital St. Croix in Leogane.)

(Via Email)
Have had update requests, so here goes … We flew into Port au Prince on a donated corporate jet. Sweet ride. The airport is effectively a military base at the moment. We got out on a convoy with Save the Children to Leogane, probably the hardest hit city in Haiti. I’m estimating 80 percent of the structures here are unlivable now. Tent cities popping up everywhere.  There has been some unrest in Port au Prince, but not here. We know many people here and relief is starting to come in steadily, so they are the same friends as always, only the city is unrecognizable. It’s difficult to navigate … landmarks are gone and roads are impassable, either with rubble or downed wires. The wires are rather scary as power was so spotty beforehand … We are managing most of the medical relief coming into this area.  Now have two functioning ORs with hand, ortho, plastics, and general surgery capabilities.  We have a trauma/general clinic and a mobile clinic.  Trucks go out into the city looking for people with wounds severe enough that they can’t get to us.  Americares has set us up with a medical supply line.  Save the Children has arranged for a mobile warehouse, security, and some funding.  World Wide Village has arranged for a mobile 50 bed hospital with an OR and air conditioning with a generator.  They (we) are staffing it and have split food/water/diesel sources with Save the Children.  Children’s Nutrition Programe is working on clean water and some infrastructure rebuilding.  A Japanese disaster response team is working alongside us, and have allowed us to use their xray capabilities.  We are swapping patients and supplies with them and Doctors Without Borders.  I hope that all the cooperation continues, as the politics of these things can be ridiculous.

The wounds are atrocious.  My first patient was a 3-year-old girl with about a quarter of her scalp missing.  We did a reasonable job of putting it back together, although I’m excited for our newly arrived plastic surgeon to have a look at her tomorrow.  Lot of ortho, huge infected wounds.  Lots of new amputees which is really sad.  Saw a guy today with a ruptured globe, so if anybody knows an opthalmologic surgeon, call me …

It’s very hot … 105 yesterday.  Periodic aftershocks which actually don’t bother me that much.  They are more odd than anything.  It seems that most of the buildings that were going to come down already have.  Haven’t bathed in 4 days and I’m living on Cliff bars and sleeping in a tent with a lot of other folks who haven’t bathed either.  Hard to imagine being happier, however.

Miss you all and look forward to seeing you soon.  Let everyone know that I am well.  Appreciate all the trades, especially as it looks like I will be down here a lot thru the next few months.

Peace,
Josh

Friday, Jan. 22, 2010
(Via text)
Was 105 at 12:00 today. Got a ripping headache. Clinics are going very efficiently. We rapidly overwhelmed our new surgeons.

Scalp injury is doing great. Plastics said they had nothing to add for at least a week. (This was his response to the question: How is the little girl with the big scalp injury you repaired?)

Opening a 3rd OR tomorrow and a 3rd mobile unit.

We’re trying to figure out how to air drop food into the 15 refugee camps in the mountains.

Saw Marie Yves’s mom yesterday… was rough. (He is talking about a little girl the team has been treating for years. She had an endocarditis and a valve replacement in the United States seven years ago. She was thriving and had the hearts of all the team members. She died in the earthquake.)

We are trying to manage an obtunded DKA in a tent with saline, unrefrigerated insulin and a glucometer. GCS of 6. Dying in front of us. Got 6 docs standing in front of her and there is nothing more we can do. (She died that night.) 

Saturday, Jan. 23, 2010
(Via Facebook)
Tired. Working nonstop for a long time now and no real end in sight. The work is good but the logistics of running a mobile hospital in Haiti are unreal. How do you get an 8000 lb generator to Leogane? Anybody know somebody with a C130? Anybody got experience making an OR schedule? I love this work but I wish my wife and daughter were with me …

(Via text)
Very hot again. Moving over 200 a day thru clinic now.

3 OR’s running now with direct lines into Partners in Health and the USS Comfort so we’re shipping out cases that require fluoro, etc.

I am tired. 107 today. Things are going reasonably well, however. Complicated medical patients give us fits though. 

Sunday, Jan. 24, 2010
(Via text)
We have been becoming the tertiary care center here in Leogane. Getting patients from Cubans, Maltese, Japanese, Americans. (Josh later described on the phone how a woman showed up in DKA with a note from the Cuban camp.)

Monday, Jan. 25, 2010
(Via text)
Remember the stories about the Haitians singing Hymns at night? … Not awesome. (His team has been sleeping outside in tents, in a gated community.)

Check the St. Louis Post-Dispatch… story about us tomorrow and Sunday. 

Tuesday, Jan. 26, 2010
(Via email)
Hey all,Internet has been bad as of late.  Sorry for the time span since my last.Only a couple more days before we’re scheduled to ship out. It’s been surreal.

We have a 3rd OR up and running now. A lot fewer amputations now, mostly wound debridements under sedation. Each OR is doing around 10 cases a day, so we’re staying busy. Managed to sort out an OR schedule as well, so that’s good. Trying to manage all the surgeons has been a bit challenging, however.

Our camp has become a bit of a tertiary care center for the area, which is both bad and good. It feels nice to get the respect, but a lot of sicker patients are heading this way. I’m worried we’ll run out of body bags before the next shipment and am not interested in trying to figure that out. Cubans dropped off another DKA patient 2 nights ago. Very difficult to manage with nothing but a fingerstick glucose monitor in a tent, but she made it. We have eight inpatient beds (read: tents) now, and are doing rounds. Rounds are frequently interrupted by choppers going overhead and we have to wait until the noise dies down.

Lots of reporters are figuring out that we’re here now, which is both good and bad. Good PR to get more aid into Haiti, but they certainly can be a pain in the @ss to babysit. We actually had a couple of the actors from the show “The Doctors” roll in last night with a “stat” pelvic fracture. I think they were a bit put off when we looked in their vehicle and commented that the patient was fine and could go home. They had to wait around, however, for their batteries on the TV cameras to charge. They tried to get some footage, but I’m not sure how good it will be secondary to all the snickering in the background. We did give them some meds, as they were woefully unprepared to deal with anything outside of a minor lac.

Sleeping is troublesome. There is a preacher who wanders through town all night and periodically stops and starts various rousing hymns at all hours of the night. The people in the refugee camps happily comply. When I came down here, it sounded quite nice.  It’s not. Clapping and singing is really not all that awesome at 3:00 am. Then there are the barking dogs, the gate to the compound opening and closing, various individuals snoring, etc., etc.  Despite all this, people are remarkably cheerful.

Had a small riot out here yesterday. People are hungry, so it’s not surprising. Safety wasn’t really an issue.  It was more of a protest than anything. I understand that the Canadian troops are planning a food distribution near here today, so hopefully that business will settle down. The populace doesn’t really trust the Haitians in power, and various claims are being made about food and supply shipments being horded by the wealthy and priveleged. Maybe this is true. The protesters were calling for us “the whites” to distribute the food. We said no. Today there are a lot more guys hanging around with machine guns.People keep showing up and asking to help us without giving us a heads up and we’ve actually had to forcefully throw them back out. Lots of people with no real concept of logistics. For instance … we only have 3 OR’s, such that it doesn’t seem all that complicated to me that we don’t need 14 orthopedic surgeons. Similarly, the mobile units don’t seem to grasp that they can’t just be gone all day and roll in with 25 operative patients at 4:30 pm. The OR’s shut down when it’s dark because we can’t see anymore. So, don’t bring us 25 operative patients half an hour before the OR closes.  It’s not all that complicated. We actually had a group of 6 surgeons show up with no food. Seriously … what the hell were they thinking? Too many folks that just want to help but have put no real thought into what is a good way to do it.

Well, I should sign off and get back to clinic. There are around 200 in line or so and I suspect the other docs are getting irritated at me. Miss you all and am looking forward to a hot shower soon! And a meal that doesn’t involve freeze dried foods or cliff bars.

Peace,
Josh

Sunday, Jan. 31, 2010
I’m finally home and have had a chance to spend a little time with my family.  It was by far the strangest experience of my life.  By the time I left, we had seen around 1,400 or so in clinic and performed around 75 surgeries.  We felt really good about all that we’d accomplished and the transition team had arrived to keep things going.  We counted 25 total aftershocks that we could feel.  Most were quite minor, but there were a couple that caught everyone’s attention.

Dr. Buresh, Dr. Lambert, and I have agreed to run the mobile hospital for 6 months.  World Wide Village received a donation of a 50 bed mobile hospital with an OR and climate control with the stipulation that we keep it running for at least 6 months.  This will mean probably at least 1 trip a month down to Haiti for each of us.  Jury is still out as to whether or not this is the dumbest thing I’ve ever done.  It’s exciting though, and something that I feel a personal responsibility to do, given the need.  The hospital is in country, but not yet set up.  Can’t much count on anything until it happens, but I’m hoping for it to be up this coming week.  If so, there will be air-conditioning for the groups that rotate through.  That will also allow some labs.  We have taken iStat machines down there in the past, but they don’t function in the heat/humidity.

The OR’s are starting to slow down.  Not so many amputations anymore, but more chronic wound care and plastics cases.  Infectious disease problems are starting to become an issue.  What was poor sanitation, poor nutrition, and overcrowding is now worse.  Saw a case of measles in our clinic.  There are reports of more amongst the other mobile hospitals in the area, as well as a few cases of tetanus.  Everyone is starting to see big spikes of diarrheal illness.  Uncultured as far as I am aware, but probably typhoid based on a high prevalence in the area.  Historically there have not been problems with antibiotic resistance in the area, but it would be interesting to see if that changes with all this.

Transport in/out continues to be a problem.  I flew out on a Cessna that took off and landed on a road blocked off by the UN.  The rumor is that drug runners used to use this same roadway.  Our pilots found it amusing.  My guess is the charter donations will begin to dry up rapidly, but hopefully by then the commercial airlines will have regular flights in/out of Port au Prince.  The logistics of moving 10+ people in/out of there on a weekly basis are producing significant headaches for our staff here in the states.  Not a cheap endeavor, either.

If anyone knows of interested volunteers, however, refer them to the website.  www.worldwidevillage.org.  Under the “Community Health Initiative” tab, there is information and an online application form.  We are still being quite selective about who we bring, but the need is there.

Thanks so much for all your support, everyone!  We’ve done some good things and I’m pleased.  I’ll keep everyone updated on the situation as I go back and forth.

Peace,
Josh