Midwest Orthopaedics at Rush surgeons John M. Fernandez, M.D. and Jeffrey Mjaanes, M.D. have traveled to Haiti to deliver medical care to those hardest hit by the recent earthquake. The physicians will be sending updates on the progress being made by the teams who are taking part in this humanitarian mission to the devastated country.

Friday, February 5 12:00 PM - Well, we are back. We arrived at O'Hare Wednesday evening. Some of us returned to work yesterday, some took a day to decompress. The reality of returning to life back in Chicago is starting to set in. After a day back, the time seems right to try and put the experience in perspective.

I AM CHANGED.

Even though the trip was brief, the experience in Haiti has changed me forever, in ways I could not have imagined. The question: "How was the trip?" is impossible to answer in a one-word sentence. Although filled with sad stories and tragedy, my time in Haiti renewed my faith in humanity and re-ignited the reasons I entered medicine in the first place.

I WITNESSED.

In some ways the conditions in Haiti are worse than the media reports: even though I tried to describe the reality of seeing whole city blocks filled with homeless, block after block of collapsed buildings, it is truly hard to fathom what it's like until you see it. The tragedy is immense. Yet, in some ways, the situation is better than one sees on the news. Violence is sparse and not widespread, which is remarkable given that millions are displaced and without electricity, thousands have no food or clean water and hundreds and hundreds of thousands have suffered so much loss. We saw no looting or stealing as we had expected from media reports. What we did see was compassion, love, giving, assistance - Haitian brother helping brother and sister helping sister, as well as the outpouring of aid and volunteers from across the world.

I WAS MOVED.

Seeing the almost complete physical destruction of a city and hearing the stories of tragedy, I was moved to tears many times. I met children who lost their parents, spouses who lost spouses, families torn apart in less than a minute. I tried to comfort the woman who lost her entire family wondering why she survived. I tried to encourage the young father who is now caring for his infant daughter after losing his wife and son. I felt helpless and wondered how I could possibly make any difference in this enormous tragic situation.

I also experienced happiness and joy. I examined a baby trapped in the rubble for four days who was literally unscathed and I was able to tell her mother that she was just fine. I met children who lost everything but still shared whatever they had with those around them. I met parents who told stories of how neighbors came to dig out by hand their children trapped in the debris. Stories of courage and love and people-helping-people that will stay with me forever.

I WAS HUMBLED.

The Haitians I met are incredible people. Lives and homes destroyed, yet they have picked themselves up and have persevered. I met strong people who have lost limbs or fractured several bones in their body and yet did not complain of pain or want any medication. I met brave people who went back into half-collapsed buildings to save relatives, neighbors or complete strangers, risking their own lives in the process. I met the 10 year old boy who cared for his 8 year old brother on the streets after losing the rest of their family and their home. After meeting these extraordinary people and marveling at their strength and resiliency, I am not sure how I will respond to the sometimes trivial complaints I hear back in the States. It certainly put life in perspective.

I AM THANKFUL.

I cant help but feel guilty in way returning from Haiti. I know logically this does not make sense but it pains me to know all that I have when so many are going without. Seeing people survive with so little has made me realize all the blessings in my life that I have taken for granted and to be thankful. Even though people had suffered incredible loss in Port-au-Prince, they were still grateful for what they had - a lesson I have and can still learn from. I am also grateful to have had the opportunity to work alongside such beautiful, caring people. I met dedicated volunteers from all over the world who came to lend a hand. The physicians and nurse in our group from Rush are truly amazing people, not only for the talented skills they possess, but for their compassionate nature. I am so proud to have served with such an incredible group of people. All of us believe that anyone could have gone to Haiti and done the same work we did - no-one in the group thinks of themselves as special or unique, just people trying to lend a helping hand to fellow humans in a time of need and show Haitians that the world cares about them and has not forgotten them.

Lastly, and I think I speak for everyone on the trip, I am thankful for all of you who followed our blog and supported us on our trip. To our families, friends and co-workers who helped cover our responsibilities at home while we were away, we owe our sincere thanks and appreciation.

THE NEXT STEP

I hope people realize that Haiti still needs our help and will for a long time to come. Long after the media and the cameras have left, people in Haiti will still need homes, medicine and food, prostheses and therapy. I hope people continue to be generous with their time to volunteer directly and with their pocketbooks to support the emergency assistance and rebuilding efforts. Donations to the Red Cross and similar international organizations are a great way to continue to help or people can feel free to contact Rush as well.

Thanks to all for listening to me ramble on about my experience in Haiti. I apologize if this has been a mishmash of random, discombobulated thoughts - just remember, I am a physician, not a writer!

Thanks

Jeff

Thursday, February 4 4:00 PM - I feel like I was in a time capsule. When I was away I had little sense of time. We woke up at day break. We went to work. We left after dark. And I went to sleep thinking of what the next day would bring. During those days I did not think once of healthcare reform or Toyota gas pedals. My mind was uncluttered.

When we left for Haiti the news was dominated by the stories of loss and hope, death and relief, Anderson Cooper and George Clooney. After landing in Philadelphia I read my first newspaper -- The Philadelphia Inquirer. The only story about Haiti was on page 11. A story about 10 people arrested for trying to get a bus load of orphans out of the country. Child traffickers?

I am not naive. I know the world will not grieve forever.

What made it even more ironic? I was on that bus. They came to our camp because they knew there was help there. But the camp had rules. Rules made for our safety. Do not go out after dark. Do not provide treatment out of the camp. The camp was faced with a difficult choice. Turn away these children, or risk getting flooded with similar refugees. Dr's. Ansell, Mjaanes, and myself were allowed this one instance. We were to triage their problems quietly, quickly, and to return immediately. Fortunately we were able to treat their problems. But during that time we met those same people that now sit in a jail in Port Au Prince. These were not the people described in the newspaper I read. The child traffickers. The kidnappers. These were people who at worst were exhausted and overwhelmed; trying to do what they though was in the best interest of these children.

I am not naive. But I did not expect the the cynicism to start this early.

When I left I weighed 185 pounds. I now weigh 178 pounds. I never felt hungry and I ate when I wanted. I wasn't even running like I usually do. How strange I should lose 7 pounds? I thought to myself in a corny way that maybe those were the pounds of clutter, the weight of my own cynicism. And now I wonder if I will gain it back as I consume the news as it is fed to me.

I had a dream last night that I was swimming underwater. I was going deeper and deeper trying to reach something I did not know. I was not alone. One of my sons was holding me around the neck swimming with me on my back. I could sense that he was starting to struggle and could not continue. But I still had this urge to go deeper. I woke up startled. Not just because of the dream but because I had not remembered dreaming the entire time I was gone. I thought that was strange.

As my kids woke up and crawled into bed with me and I felt a guilty-pleasure -- the kind you felt when you pretended to be sick to get out of going to school. I knew there was work to be done. Patients needed to be seen. Wounds needed to be cleaned. But I could not deny the warmth of that bed and their love and affection. It anchored me there even though my mind thought of these other things.

I have already started the familiar routines of my day. Hot shower. Hot coffee. Kiss the kids. Go to work.

But when I got into the shower the water felt too hot. Almost like my skin had changed. I kept turning down the temperature until it was as cold as it was at the camp shower. I wondered to myself how long that will last. Will I want tomorrow's shower to be warmer?

I have had many people thank me for what I have done. I accept the thanks. But I feel selfish without acknowledging I could not and did not do this alone!! My wife caring for our children. My patient's giving up their scheduled surgeries. My staff and partners caring for my patients. None of us makes a difference alone.

I don't know if I will dream tonight. I don't know if my shower will be warm in the morning. I don't know if I will gain my weight back. But I do know (feel) we are all connected. We all have a role no matter how small or large. When we sacrifice something we don't lose it; we gift it to someone else. And that sacrifice can be something as big as a life, or as small as the time spent on a thought. Even if we cannot be in Haiti today or tomorrow, we can be there in our thoughts, in those tents, with those children. Even if more a moment each day.

John J. Fernandez, MD

Thursday, February 4 6:30 AM - John and I (and Geoff VanThiel) have returned from Haiti - we got back last night. I will be back in clinic today at OAB.

I just wanted to thank everyone at MOR for their support and help with coverage for allowing me/us to go and lend a hand. Special thanks to Krys Bigosinski and Josh Blomgren for covering my pager, Trinity & DePaul. Special thanks as well to Alonzo, Joe and the cast room staff for helping us get supplies. And, special thanks to the admin for giving me this opportunity.

It was a life-changing experience and I hope to have, on some level, made a small difference for the people of Haiti.

Jeff

Tuesday, February 2 6:45 PM - Well, we are on the bus leaving Port-au-Prince. The trip is coming to a close. I am trying to reflect on the past week and make some sense out of all that I have seen, heard and felt working in Haiti these past several days.

I have done medical mission work before and have had the fortune to travel a bit to underdeveloped countries, but this trip to Haiti has been like nothing I have ever experienced. The double tragedy of extreme poverty and a natural catastrophe has left me searching for words to describe what is happening to this country.

It is hard to fathom the destruction until you see it. Pictures in the press and even from our cameras cannot truly capture the devastation. Building-after-building, block-after-block, neighborhood-after-neighborhood, in a city of 10 million people, houses, churches, schools, colleges, stores, Internet cafes, hospitals all lie in ruins.

Hundreds of thousands are displaced, each empty lot, park and open space are filled with make-shift tents, people using scraps of plastic, tarps and sheets to make a feeble shelter. Garbage and rubble is everywhere. Whole areas are without running water. At night, a city of millions is plunged into darkness - the only light comes from vehicle headlamps and the few houses lucky enough to have a generator.

So much loss. The human toll from the earthquake was incredible - every patient lost someone: children, parents, siblings, friends.

Everyone was affected somehow. So many lost their homes and everything in them - they literally have nothing left. In the U.S. we hear of tragedies in which people lose their houses to fire or flood, but for most there is a chance to rebuild. Here there is no insurance, no government infrastructure to help - and the magnitude, an entire city broken. So many will continue to live on the street, with little to no food, clothing or clean water for months, if not years. And the future for the children of this country...?

Yet despite the tragedy, many beautiful stories. The Haitians are a truly amazing and resilient nation of people. If someone needed help, dozens would come to lend a hand. A car gets stuck in a hole, ten people run to push it out. When a woman collapsed in front of a store, passersby carry her into the clinic. Children share what little they have with friends and siblings. So many stories of courage and sacrifice: relatives and neighbors racing to dig out survivors from the rubble, taking strangers in their still-standing homes and houses of worship. The family who took into their home a boy on the streets who had lost his father and sisters and whose mother was in the hospital. The strength of the people I met is what impacted me the most. The 10-year-old who lost both parents and all but one sibling but had the determination to watch over his surviving eighht-year-old brother on the streets. The father who lost his wife and son, but now was trying to pick up the pieces and care for his infant daughter. I learned so much from these patients who, despite pain and unspeakable tragedy, can push ahead and carry on.

With all the sadness, it is easy to get depressed about the dismal road ahead. But, though it sounds cliche, what I leave Haiti with is hope. Seeing so many doctors, nurses and others who left their families and creature comforts at home to come and lend a helping hand. Working side-by-side with volunteers from all over the world, renewed my sense of optimism for the future of this country - and ours.

I definitely leave this country a changed and better person.

Jeff

Tuesday, February 2 5:30 PM - Dr. John Fernandez, orthopedic surgeon at Rush University Medical Center, sent us another text message today as the team leaves the hospital, gets on the bus and heads to the Dominican Republic.

He wrote:

The past 48-hours have given us some hopeful stories of sacrifice and compassion even among those with little left to give.

I gave a breakfast bar to a four-year-old, who we had operated for a bad leg wound. I knew he was hungry. He nor his father had asked for anything. When I saw him later he was still holding half the bar. I asked if he wasn't hungry. He said he was saving it for his brother at home. Compassion from a four-year-old.

When Dr. Geoff Van Thiel, our chief resident, rounded on one of our post-operative patients in the morning he was told she may have had a stroke. He suspected different and thought she may have the beginnings of tetanus as her jaw was ridged and she could not eat. She died later that morning.

The day before we had placed an external fixator on her ankle for a horrible wound. We asked some of the details of how she was injured. She was crushed after going back into her house for one of her children. Sacrifice from a mother.

I wonder how many acts of compassion and sacrifice have occurred here? Some small... some large. Most will never be recognized.

Despite the devastating injuries it is surprising how quickly we have become accustomed triaging and treating them. You make a quick calculation of what's wrong, what we have, and you do what you can. Simple. The hard part has not been treating the wounds, but being a witness to the stories of how they came to be.

Dr. John Fernandez

Tuesday, February 2 2:45 PM - We have packed our bus and are ready to leave Port-au-Prince, Haiti. We are picking up the rest of the Rush team still doing surgeries from Centre Hospitalier de Sacre Coeur and also the General Hospital, then to the Dominican Republic.

The primary care team spent the morning packing our supplies. We will make a large donation to the make-shift clinic in the Police Station serving the people on the streets in front of the National Palace. We also left a lot of supplies for the teams that follow us at the Quisqueya School camp.

Jeff

Monday, February 1 9:00 PM - Today was our last full day of work here, and it was quite a busy one. The surgery teams went to their respective hospitals.

Dr. Jay Dutton did two surgeries, including a large open wound repair on a woman with a fractured jaw from the earthquake.

Our vascular team performed 20 surgeries today - mostly revisions of amputations.

Ortho did 15 cases today.

Unfortunately, we had several sad events at the hospitals today as well. We had three deaths in the wards today, mainly from infection. One young woman developed tetanus today from the wound she sustained in the quake and passed away this afternoon. Tragic when you see someone die from a vaccine-preventable disease. Almost certainly more deaths from tetanus will follow as many people here do not have access to standard immunizations and the disease usually strikes about two weeks after the wounds occur.

Our primary care group returned to the police station in front of the National Palace today. Among the three of us, we saw almost exclusively pediatrics cases, almost 400 in all. Several kids were quite sick, including a four-year-old boy with sepsis from infected scabies bites, who we had to transport to the hospital. Another very treatable disease that is spreading like wildfire here because of the crowded, dirty living conditions.

We brought several tarps, baby bottles and formula to the clinic today and gave it all away.

Countless families came in whose houses had collapsed and they have lost all their possessions. Everything they owned in the world gone in 30 seconds. Parents with children who don't even have a sheet to their name to sleep on are on the street. It is truly tragic.

Jeff

Monday, February 1 8:45 AM - Update from Dr. Jeff Mjaanes as he travels with his team to work in the clinic.

Heading back to Main Police Station that serves as makeshift clinic for the homeless in the tent city in front of the National Palace.

Many roads are still blocked because they are still removing bodies from the rubble. On detour, saw a completely devastated neighborhood. Smell of rotting flesh in the air, and people searching through precariously perched buildings trying to salvage belongings.

We passed the GOC university where all seven floors collapsed killing hundreds of students instantly. The scope of this is so incredibly tragic - it literally seems like the entire city is destroyed.