Nurse Erik Bartkowiak accompanied four critically ill patients on a medevac plane out of Haiti to receive the medical treatments they desperately needed--treatments that no medical facility in Haiti could provide. Read his story below.
I would like to give you my account of the events of January 16, 2010, when I worked with Drs Joia Mukherjee and Evan Lyon and their Haitian colleagues to evacuate four Haitian survivors of the earthquake in Port-au-Prince. I am a Registered Nurse with over 12 years of emergency and trauma experience.
Previous to this, I was in the US army, and only mention this because, in a strange coincidence, I was part of a 7-man special operations team that helped remove Raul Cedras and reinstate Jean-Bertrand Aristide to power in the fall of 1994.
As I watched the footage in Haiti on the news and again saw the plight of organizations on the ground, I remembered hearing of Partners In Health as a small organization during my time in Haiti. I found PIH’s website and called to offer to donate whatever I could to help. I talked to Jesse Greenspan from the PIH procurement team, and told her that I could put a fully outfitted critical care medevac team on the ground as soon as possible with supplies, security and aircraft. I then contacted Cpt. Lance Lechtworth of Sea to Sky Air LLC, a pilot and aircraft owner that I fly with regularly, and asked him if he would be willing to volunteer for the mission. He immediately said “of course,” and that was set. All I had to do was find a paramedic to accompany me. I called all my usual contacts and asked them if they would be willing to volunteer their services, and all of them stated “No.” My only choice left was to ask my 60-year-old father, who is a retired firefighter/paramedic, if he would be willing to come along, and he immediately answered “Yes.” The crew and aircraft were set.
This all took place during the day on Friday, January 16, while Jesse worked hard at getting the arrangements made on her end. I have to commend Ms. Greenspan for her determination, as I am sure her normal job is not to coordinate emergency medical evacuations. I began to gather all the medical supplies I had on hand in the office, IV equipment, and medications. We grabbed as much water and granola bars as we could fit, as well as a ton of sheets and blankets that we had collected and loaded it all on the plane and waited.
I got an email from Jesse on Saturday morning with the phone number for Haitian Flight Operations. I called the number and asked how to get a landing slot, not really expecting much to happen. But after a 30-second phone call, I got us a slot to land in Port-Au-Prince at 8:00 PM that evening. I immediately called Jesse (who appeared just as surprised as I was), contacted the pilots, and began our plan.
We had no choice but to go ASAP or miss our slot. We did not know patients’ names, injuries, or even really how many. I contacted the University of Pennsylvania hospital [who had agreed to take the patients] to warn them we would be there early the next morning, and they seemed as surprised as could be.
We landed in Port-au-Prince after circling and dealing with chaotic air traffic for a bit, at around 8:30 pm. I attempted to contact Dr. Muhkerjee via text message and was informed that she was trying to get things together but was lacking transportation. We acquired a small bus at the airport, lowered the seats and lined it with plywood. We asked her to give us her location so we would come to her with our makeshift ambulance. The cell service was sporadic, and she never got the message.
In the meantime, while the pilots unloaded the supplies off the jet, my father and I went across the street from the airport where there was a small encampment of injured that had formed. We began administering as much aid as we could, putting in about 25 IV’s and splinting and bandaging a huge number of fractures and wounds. We then got a message that our patients were on their way.
We summoned our “ambulance” and gave the driver $40.00 and a case of water to take as many of the people that needed treatment to the Partners In Health hospital. I am still curious as to how many of those patients actually got transported. My father headed back to prep the aircraft, and I waited out front for the patients to arrive.
At around 11 PM, three SUV’s arrived with patients, and medical staff crammed in the back. We exchanged quick formalities and headed around to where the aircraft was parked on the tarmac. It was pure chaos. Planes were everywhere—so were people and vehicles. We pulled the three vehicles in line and opened the backs, where I was quickly given a rundown on each patient by the medical staff. Then we began to formulate a plan to load the patients into the aircraft.
This is when it became quite apparent to me that these were very sick individuals. Upon assessing each one in the back of the vehicles, it became a real possibility that three of the four patients may not live long enough to even make Ft. Lauderdale, where we would have to stop for fuel, let alone the 4 ½ hour flight to Philadelphia.
We loaded the supplies that we brought for them into their vehicles, cleaned out all our onboard supplies and medications down to the bare minimum, and said goodbye.
On the aircraft, we had very few supplies and no room to maneuver. We didn’t know the full extent of the patients’ injuries, and also had no way other than rudimentary hand signals to communicate with them. This was the first time in 12 years that I was completely overwhelmed and had to take five minutes to figure out how the hell this was going to happen!
My father and I decided that the best way to deal with the situation was to take them one at a time, from the worst to the most stable. I began to treat Celine, who appeared to be the sickest at the time. Her heart rate was 175 beats per minute, and her initial [dangeroulsy low] blood pressure was 64/27. We initiated large bore IV access and began to infuse large amounts of fluid and pain medication. With the fluids, her heart rate came down, but her blood pressure remained a concern for the entire trip. We sedated her and attempted to splint the lower leg as best as possible. When she was comfortable and stable, we moved on to little Given.
From the first time I saw this child he was lethargic and largely unresponsive. We had reduced and splinted his lower right leg on the tarmac prior to loading the best we could. Once on the aircraft he was barely able to sit upright, his breathing was rapid and shallow, and his heart rate was 170-180, with a weak pulse. Any movement to his right side elicited screams of pain. He was obviously in shock and in need of IV fluid resuscitation. However, due to the combination of shock, dehydration, poor lighting in the aircraft, and lack of room to maneuver, I was only able to get a small IV in him, which would not do enough.
He needed fluids badly, so we attempted the one thing that no kid could resist: Mountain Dew. We had three cans of Mountain Dew onboard, and we gave them to his father and told him to make him drink no matter what. He did not disappoint. Given drank all three cans throughout the trip, along with a bottle of water. We administered pain medicine and attempted to clean and dress his wound, but were forced to back off when faced with the pain it caused and when we saw the large number of concrete pieces and maggots that were in the wound. We just opted to dress it instead. He received more pain meds and began to stabilize.
The patient in the most pain with the largest wound was next. Sitting jammed into the back of the small jet, with her badly injured leg propped up on a makeshift shelf and sharing the only stretcher with Celine, was Sherline. She was in terrible pain. Her vital signs were relatively stable, so we decided to gain IV access, administer fluids and then sedate her so she could try and get some rest. Once she was sedated, I undressed her leg and attempted to find pulses. I was unable to, due to the severe compartment syndrome and necrosis she had in that leg. We put as much fluid into her to attempt to stave off side effects of rhabdomylisis [the destruction of skeletal muscle tissue] and renal failure.
Our last concern was Berline, who, all things considered, was the most stable of the four. We initiated IV access on her, began infusing fluids, and medicated her for pain. We had her leg propped up on the Tupperware bin that previously held the supplies we donated to the PIH crew, and she remained relatively comfortable. No attempt was made to redress her wounds, as they appeared to be doing well. It was only at the hospital that I saw the full extent of the massive degloving injury [exposure of the front part of the jaw] that she sustained. She never complained once. If that was me, they would have heard me scream in Philly from 43,000 feet in the air! She is a very strong woman.
For the remainder of the flight, we basically continued to administer fluids and pain medicines. All said and done we administered over 12 bags of IV fluid on the aircraft, gave 20 mg of morphine, 15mg of Valium, 20mg of versed, 6mg of dilaudid, and 3 Mountain Dews! It was quite an eventful five hours.
I am greatly appreciative for the opportunity to work alongside the wonderful and dedicated people of Partners In Health. It is unfortunate that it took a horrible incident to make the masses aware of the wonderful work your group has done for over 20 years in a country that most people forgot.
-Erik Bartkowiak RN