After the quake: Help for Haiti

Author: Dr. Ralph P. Pennino' 75


Dr. Ralph P. Pennino, a 1975 Notre Dame graduate, is among those organizing a major Notre Dame relief effort in Leogane, the site of the ND Haiti program and an area near the epicenter of the Jan. 12 Haitian earthquake.

Pennino is a Rochester, New York, surgeon and president of InterVol, a nonprofit providing medical care organization that brings supplies to the needy and the underserved worldwide. Within five days of the Jan. 12 earthquake, Intervol brought in medical personnel and 3,000 pounds of necessary supplies to the Notre Dame effort. Pennino and fellow ND graduates Dr. Kevin Olehnik and Dr. Dan Towle arrived in Haiti by air transport donated by two corporations, Tradewinds Aviation and Constellation Brands.

What follows is Dr. Pennino’s report from the both the United States and Haiti.

January 19, 2010

Hello to all,

It has been a busy week with many ups and down. I am in New York, and tonight the Rochester, New York, community came out to support our efforts. We had more than 50 volunteers come to our warehouse and pack over 150 boxes of medical supplies requested by our friends in Leogane at the Notre Dame Haiti Program. We still have over 500 more ready to go. Added to this are the meds donated from around the country and shipped to Rochester for the relief effort. Many thanks to Pat Leary and Jamie Slandzicki for their contributions.

We have purchased two reverse osmotic water treatment units, tents and other needed supplies such as iv fluids, tubing, etc from Rochester General Hospital.

The key connecting point to all these individual points was Constellation Brands — a Rochester- based international company — donating the use of their corporate jets in this relief effort.

The jets will be packed tomorrow and leave late tomorrow night for the Dominican Republic. There we will transfer docs and assets to U.S. military Black Hawk helicopters for transportation to Haiti and hopefully Leogane. This part is still fluid (a word I come to use routinely) depending on the ground situation. We are determined to get there. Of note, the Canadian troops arrived in Haiti today, which hopefully is a sign of better things to come.

Six doctors will make the trip — Drs. Olejnik, Towle, Cole, Ellison, Powers and myself. All will stay in Leogane except me. I will return to work on future trip logistics. The main purpose of this group is to deliver the supplies and assess the ground situation for future teams to provide help. At this time we have no idea what to expect.

Many, many of you want to go and help. Once a stable environment to work with food and water becomes available, we would like to work and set up teams to rotate in/out on a regular basis. There will much work in the months to come. The number of docs, nurses, emts, etc. asking to part of the team is incredible. We want to facilitate all your wishes to do good but in an orderly manner working together and with other aid groups. Long term we would like to see the ND Haiti Program come out stronger to help serve those Haitians in need.

In addition I believe that they will eventually ask civilian docs, nurses, etc. to help out on the USNS Comfort or other facility. One of the pleasures over the past few weeks was to work with Commander Nobrega and Major Powell at Southern Command. I’ve talked with them at 6 a.m. and midnight in the same day and through the weekend. They are in a difficult situation but always willing to try and help us. I did try to bribe them with tickets to ND-Navy and ND-Army (at Yankee Stadium) in return for our own Black Hawk. Obviously I’m still working on it.

I’ll keep you all informed of the progress. Again, many thanks to Constellation Brands for connecting all the points of service. Thanks to my home institution RGH and its staff for all the help. Many, many thanks to all the InteVol volunteers working in the warehouse.


January 22 update

Hello from Leogane. In brief:

The Good — The group of docs and supplies (over 3,000 lbs. medical supplies, meds and food collected by InterVol) have all made to the ND residence.

The bad — Leogane is as bad if not worse than what is reported.

Our new favorite word is “fluid”. Our trip preparation and final means of transportation illustrates this. Originally the two Constellation Brand planes were to fly us to Santo Domingo and the military was to helicopter us into PAP then ground transport to Leogane. On the night this was planned we could not get final confirmation from South Com and were on a standby basis. We have been networking with other aid groups who are working in Leogane. They set up an air bridge from Santiago, Dominican Republic, to Leogane using Caravan prop plans.

The problem was there is no airport in Leogane. Haitian director Jean Marc Brissau ’08LLM is working with the U.N. and other aid agencies (more about that later) blocked off an initial section of a road — 1,200 feet — cleared trees and shrubs, etc and now you have instant airport. They are running three shuttles per day of two planes each. Each plane can take about 2,000 to 3,000 pound of weight. Our landing was better than any Disney ride I’ve been on.

Jean Marc has been doing a great job working with the other aid agencies on the ground and with the U.N. who was here locally before the quake. He is notified by the flight crew when the planes are to arrive. He then coordinates with the U.N. troops, who block off the road and provide crowd control. A small refugee camp is adjacent to the landing site, and crowds of very hungry people come out looking for food and water. The supplies are then loaded into 3-4 trucks from the ND house and Hospital St Croix and transferred back to the residence.

The trip to the residence took us through central Leogane. Pure devastation!! No earth movers or search groups seen, yet hundreds of collapsed buildings and you know there are people in them.

The field in front of the ND residence is now become a small town of either homeless people living in tents of small makeshift shelters. Most are afraid to sleep indoors. We had another aftershock last night. We are all meeting inside the residence. I didn’t know some of my friends could run that fast to get outside. One of the volunteers told us about the 4 second rule — you have 4 seconds to get out or ?

Most impressive is how all the local aid groups who have been working in Leogane for years are now coordinating efforts to work together. Jean Marc and the ND Haiti program folks have really excelled. The ND residence is used for coordination and Internet communication.

Next to the residence is a nursing school which is still standing. A group of docs working with World Wide Vision, Save the Children and Children’s Nutrition Program turned it into a makeshift hospital. They had one surgeon — Craig from Wisconsin, a spine surgeon — among the group of docs, and he made a makeshift operating room form a dorm room. The conditions are primitive by any standard, but he made it work. The nursing students are helping. They have set up a triage station and pharmacy with a pharmacist from Iowa who has database and inventoried the meds coming in and used. Actually there is a small group from Iowa.

After being here only a few hours Craig came over and asked for help on a complex hand injury. Patient had an avulsion injury to his wrist with nerve and tendon injury. The wound was already eight days old with little aliens moving in. Two of us in the group do hand surgeries, and we have two anesethiologists who brought some of our favorite drugs for iv sedation and we went to work. He not only lost skin but lacerated his median nerve and four flexor tendons. Something we routinely do in the States but under these conditions.

Later that night we all got together to talk on how we can we can coordinate efforts. Even though it over a week since the quake, there is little that has made it to Leogane, let along the outside smaller communities. People have no means to get the injured to our makeshift hospital, so they are sending a group out to bring them in — usually by carrying them in a stretcher of blankets. While we need doctors and nurses, it has to be the right ones or they will only burden the overall effort. This is little to no infrastructure and one has to provide everything. Many want to help, but it has to be organized. Various groups on the ground are trying to do this.

What is critical is getting food and distribution. Unfortunately much of the food is not getting to those who need it the most. Jean Marc is working with the local U.N. contingent to explain how it should be done.

Medical supplies are starting to come in and the other groups have access to more. What is needed now:

— electorcautery
— suction
— narcotics
— anesthesia meds – Diprivan, fentanyl, versed, morphine, toradol, ketamine
— ortho surgical instruments

Jan. 23 update

A.M. — Left on the 7:30 prop plane that brought in more of the InterVol supplies (5th plane load) from Santiago. We arrived in Santiago and picked up eight Haitians — four adults and four children — who were flown out of Leogane. This was also arranged by Jean Marc. The Constellation Brand plane’s pilot offered to fly back anyone who we could evacuate. These folk lost their home and had family back in the States. We had a little issue with customs in North Carolina but worked it out. One of the children was a U.S. citizen. We brought them to a private area upon return to Rochester (word leaked out to press) and Ginny Clark from Constellation (who was with all the way to Leogan) arrange transportation to their family in Brooklyn.

Jan. 31 update

It has been days since I last wrote and much has happened.

The first group of docs we brought to Leogane last week has done an incredible job working with the other docs from One World Vision, CNP and the Notre Dame Haiti Program. They have made a makeshift hospital at the nursing school situated next to the ND Resident house. Within one week they had set up three operating rooms with bare essentials, pre op, post op and phase 2 post op. Now don’t get any glamorous ideas that this is similar to home — it isn’t but it works. There is a triage area for new patients coming in run by ER docs, primary care, etc. All are working together.

InterVol sent a second medical/surgical team of Rochester General Health System physicians and nurses, along with badly needed medical/surgical equipment to Leogane, Haiti last Friday. Much of the surgical equipment, donated by the Rochester General Hospital and its affiliates, along with other Rochester community organizations, was transported from Rochester to Santo Domingo, Dominican Republic. Constellation Brands has again generously donated the use of its planes for this humanitarian mission. These planes have transported over 7,000 lbs. of supplies, equipment and food along with two teams of docs and nurses. Once in Santo Domingo the docs and supplies were transported by prop plane to a road in Leogane (the new Leogane International Airport with curbside plane service. This group will stay until Feb 6 or so. I haven’t figured our exit strategy yet, but as always we have many options and the situation is fluid.

The group includes:
Ralph P. Pennino, M.D., plastic surgeon
Andrew Smith, M.D., plastic surgeon
Patrick Riggs, M.D., vascular surgeon
Jeffrey Wasserman, M.D., anesthesiologist
Paul Cross, D.O., anesthesiologist
Emmy Branigan, R.N., Rochester General Hospital operating room nurse
Bill Joyce, InterVol volunteer EMT

We have affectionately named the new facility Leogane Shock Trauma Hospital —LSTH — with an impressive staff. We have had many deliveries at the LSTH in many different ways. We have the usual childbirth, emergency C-Section and a dramatic front-seat-of-a-car delivery this morning in front of the residence. They got here a little too late. All are well.

The group has done over 120 cases to date, ranging from fractures to wound-care issues, skin grafts, etc. Part of the problem is these open fractures are now over two weeks old. They need multiple debridements, and then wound closure. Where possible (and if available) they have used external fixation devices. It is an incredible sight to see patients walk home on crutches with their ex fix. There is a small capacity for overnight stays in a tent which has been erected outside the ND residence.

There is also a unit from Japan’s Self Defense Unit. They have some nice equipment and have been sharing the use of their X-ray (using film processing — not digital so a little slow, but better than nothing).

Background Information Regarding Leogane, ND Haiti Program and InterVol:
The ND facility we are staying at is called Residence Filariose. Notre Dame Program has over 10 year history working with other groups (CDC, etc) to prevent lymphatic filariasis. This is a parasitic disease that is transmitted by mosquitoes.


Feb. 2 update

It was an eventful day. It started with the usual singing from the refugee camp and ended with a Canadian special observation unit spending the night on our roof checking things out.
The mornings are peaceful. The air is much cooler and tolerable. The roosters are all doing their thing, and we can’t figure out why they haven’t become dinner. Singing is followed by sunrise.

This morning the lines for the clinic started early and stretched from the nursing school (aka Leogane Shock Trauma Hospital — LSTH) back to the Notre Dame residence. By the end of the day the medial team had processed over 300 patients with various problems. As I noted prior the doctors and nurses are from many areas in the U.S. working with various NGOs such as World Wide Village and the University of Iowa group, Children’s Nutrition Program, Save the Children and InterVol through the Notre Dame Haiti Program. All are working well together because our end goal is the same.

Our group is mostly surgery and anesthesia. We got a good workout yesterday. It was would closure day. Most wounds have followed a similar pattern. They are big, located on the lower extremity outer leg or dorsal foot. Back home we would simply use a dermatome and harvest a split graft. It would not take long. We have no dermatome so all grafting was done freehand taking full thickness grafts. This is a laborious and tedious process due to the size of the grafts we had to harvest. Most had to be taken from the lower abdomen and when we closed the donor site it looked as if we did abdominoplasties on our patients. It wasn’t so bad for the older women who had multiple pregnancies but was a little unusual for the children and teenagers. Our biggest concern is post op healing. We have no inpatient capability and patients are sent back home — aka refugee camp — to return for post op wound checks.

LSTH has become a referral hospital. Word was out about our three makeshift operating rooms and ragtag team of surgeons, anesthesia, nurses, ER docs, primary care, EMTS, pharmacist, and many other groups are sending patients to us to treat. We had three patients sent from a Canadian Field Team for skin grafting. The Canadian Military has set up a mobile 100-bed hospital about a 10-minute car ride from the ND residence. Since they are new, they are mostly empty (that will change). We were visited by their docs and asked if we could admit our post op patients for proper care. Their docs had no problem with it but we had to get an OK from the administrators. This has yet to happen. Hard to believe — we are working in a school with no place to put patients, while this air-conditioned field hospital sits almost empty. What the hell gives! If I had a bus, we’d move the patients and get squatters rights. Hopefully this will change today.

We don’t need access to their unity for long. A benefactor donated a 50-bed field hospital with one real operating room to World Wide Vision. Their president, Randy Mortensen, was on site yesterday trying to get it set up for our combined group’s use. The problem — we needed a bulldozer to prepare the site or there was a chance they would pull the unit, which is being delivered in over 50 large crates. My first trip to Leogane was over a week ago and despite the 80-90 percent destruction, I have yet to see a bulldozer. A strange thing happened — a bulldozer appeared in the early evening and graded the field.

We had an urologic emergency this morning requiring the expertise of the 8th member of our group who is from Florida and a fellow Domer (class of 74) — Marty Dineen. We had an older gentlemen with severe abdominal pain, swelling in the lower abdomen and an indwelling urinary catheter that was clotted. Marty quickly analyzed and treated the patient but we still couldn’t answer the long term question — where does he go for further treatment? This is becoming more of an issue as access to health care facilities is little or nil in areas affected by the quake.

That evening we were visited by a Canadian Observation Team who spent the evening on our roof to observe the community and various refugee areas. They were a great group of guys who let us look through their night vision and thermal camera equipment. It is amazing what you can see in the dark. They left in the morning and were replaced by another unit which spent the day. This type of company we don’t mind.

Side note – Our water system

After the quake, safe drinking water was an issue. The first InterVol group working with Jean Marc and the ND Haiti Program was able to bring in two reverse osmosis units, which now provide clean drinking water at the ND residence for all the groups working together.