Saturday, February 27, 2010
Friday, February 26, 2010
Really fast, crazy day
It seems like today is the point where things are really starting to come together.
I went to bed last night, with a friend of mine creating a post on the MAAPR website (www.maapr.com) talking about the deployment to Haiti. Earlier in the day, I had set up a Facebook group to try and get people interested in helping out.
This morning I woke to a ton of emails, questions, well-wishers and donations. Most of them just a couple of bucks, but it is adding up. Fast. Yesterday I was worried about the price of anti-malarials. Today, I'm realizing that I'm going to be able to afford them.
Some people are sending me contact information for individuals from Haiti, or who have recently returned. I'm really hoping to meet or talk with all of them before I head down. Getting good information about what is happening on the ground is incredibly useful.
THE local pizza place, Joe's Pizza and Pasta, at 5555 Lee Highway, Arlington, Virginia, is hosting an all day fund-raiser at their restaurant. Anyone who asks will be allowed to donate a portion of their bill to the cause. Wow! Great support from a local business.
Unfortunately, none of my traditional "Community Boards" are still up. Safeway, Harris Teeter, even Starbucks, don't allow for the soliciting of donations on their community boards (or don't have them). Dogma, the local pet bakery, does have a community board. Casual Adventure (wow, I can't say enough about those guys) is also putting up a flyer.
Donations are starting to come in. I've gotten my first donation from someone I've never met, or even heard of. What do you say, beyond the obvious "Thank you!"? How do you convey that $12, from someone you haven't met, means so much? Is it wrong to ask "Why twelve dollars? Why not ten?" Does that mean something to them? Should I be thanking their father, who died when they were 12? It seems silly, but it seems like it should mean something, beyond this simple donation.
Thank you. Thank you. Thank you.
Thursday, February 25, 2010
Your personal security
OK, another tangential post. Well, not even tangential, but completely off topic.
http://www.huffingtonpost.com/2010/02/18/harriton-high-school-spie_n_467491.html
Harriton High School required all students to use school designated Macbooks (I'm wondering who picked up the cost for these items). Students noticed several bizarre glitches, occasionally the webcam light would flicker. The students were told that this was a glitch with the computer, and there was no problem with it.
It turns out that the school system had installed, what they call, remote management/administration software on the computer. They claim that this was designed to allow the school system to track the computers. In reality, it allowed the school system to remotely access the computers, including the web cam.
The question now, is when was this web cam activation used? Well, that's the question that the FBI wants to have answered.
My question is how did this ever happen in the first place? This is an invasion of privacy of an incredibly high degree. The fact that incredible measures were taken to conceal the invasion, and that it was repeatedly lied about, just makes it more insidious. The crime happened when the software was installed. It became a major issue when the school system lied about it.
Imagine you're a teenager. You already have trust issues (I did). You're in an incredible transition. You're not a child. You want to be treated like an adult. People continually expect more from you. Then the school district pulls this crap on you.
Good job.
If you're interested in the technical aspects of this piece of software, here's a great blog. Some of it is really technical, but the guy does a good job of explaining the meat of the matter.
We need to take responsibility for our own security. No where is this more important than in the security of our privacy. No one is going to tell you when they're nefariously invading your privacy.
I'm just incredibly struck by this incident at the high school. The students were forced to use the computers. If they attempted to bypass the monitoring features, they were threatened with expulsion. Even if they had the knowledge and ability to take control of their privacy (something we should be advocating), they weren't allowed to.
OK, 'nuff said.
http://www.huffingtonpost.com/2010/02/18/harriton-high-school-spie_n_467491.html
Harriton High School required all students to use school designated Macbooks (I'm wondering who picked up the cost for these items). Students noticed several bizarre glitches, occasionally the webcam light would flicker. The students were told that this was a glitch with the computer, and there was no problem with it.
It turns out that the school system had installed, what they call, remote management/administration software on the computer. They claim that this was designed to allow the school system to track the computers. In reality, it allowed the school system to remotely access the computers, including the web cam.
The question now, is when was this web cam activation used? Well, that's the question that the FBI wants to have answered.
My question is how did this ever happen in the first place? This is an invasion of privacy of an incredibly high degree. The fact that incredible measures were taken to conceal the invasion, and that it was repeatedly lied about, just makes it more insidious. The crime happened when the software was installed. It became a major issue when the school system lied about it.
Imagine you're a teenager. You already have trust issues (I did). You're in an incredible transition. You're not a child. You want to be treated like an adult. People continually expect more from you. Then the school district pulls this crap on you.
Good job.
If you're interested in the technical aspects of this piece of software, here's a great blog. Some of it is really technical, but the guy does a good job of explaining the meat of the matter.
We need to take responsibility for our own security. No where is this more important than in the security of our privacy. No one is going to tell you when they're nefariously invading your privacy.
I'm just incredibly struck by this incident at the high school. The students were forced to use the computers. If they attempted to bypass the monitoring features, they were threatened with expulsion. Even if they had the knowledge and ability to take control of their privacy (something we should be advocating), they weren't allowed to.
OK, 'nuff said.
Wednesday, February 24, 2010
Begging for money
So I set up a Facebook Cause. Lets see if this social networking thing works.
I've been trying to find contributions for this cause.
The hospital has grown a tremendous amount. They need some laptops, so I tried Microcenter. Anyone who knows me knows that I have probably carried Microcenter through the recession. Certainly if you add my father into the mix, we've spent a bundle there (OK, maybe not that much, I'm just trying to give you a sense of my geekitude, and the thousands of dollars spent there).
I thought this business would be perfect. A couple of laptops. No problem. The technology recently changed, so there should be some older models, at the back of the shelf, that wouldn't go missing.
Except Microcenter only does their donations in August....
WHAT?
Look, I know you're a big company. I know you have to have a process, but seriously? Once a year? That's it?
It's funny. I've asked a couple of businesses now. So far, I've only had two notable encounters. The first, at the local grocery store. The minute I talked to the pharmacist about a 21 day supply of Malarone (a current generation anti-malarial), she said "God bless you. Let me see what I can do."
She can get me a 10% discount on $180 worth of medication. Yikes. One hundred and eighty dollars of medicine. For three weeks. We can do better! We need to find better medications, or even a vaccine.
The next (and actually my first stop once I found out I was going) was Casual Adventure, in Arlington, Virginia. I wanted to talk to these guys because they outfit people going all over the planet (I'm surprised they don't have a photo of their sticker, located on the space station). I had some questions about water purifiers, mosquito netting, well, stuff. I also wanted to find out how much this stuff was going to cost. More importantly, I wanted to talk to guys who sold you what you needed, not what you could afford.
So I walked in the store, and saw that they were already collecting for Haiti. I told them where I was going, and they (Well, Eric, actually) lit up, with a smile. They're going to try to put together what they can for the hospital. They'd rather send it with a guy they know, than to a general supply depot in Haiti.
Local business, working locally, to help globally. I love this.
On the flip side, I helped some friends consolidate their business this week. Consolidate is a nice word for "take two locations and merge it into one". It sucked.
I was really hit hard by this. The restaurant was a local place, just up the street. Good food, lots of beers, really friendly staff. I started volunteering there right after my divorce. It was a project to throw myself into, and something I could really believe in (Good food, good drink, within stumbling distance of the hosue? Hell yeah, this was a local project I could get behind!).
The two owners are local minded ladies as well. I was thrilled when I saw the T-Shirts blazed with "Drink Local" across the back. They worked incredibly hard, not just with the businesses (which were their whole lives, 24/7), but to improve the community on so many levels. It's a real privilege to work with them.
So I definitely recognize that we're still in the tough times. Watching someone fight for their business is just like watching a parent fight for their child, except for the constraints of professionalism. It's truly incredible watching their passion, and perseverance through incredibly tough times.
And still they're fighting
I'm going to try to end each post with the "Donate" button. I'm going to Haiti. I need help. 'nuff said
I've been trying to find contributions for this cause.
The hospital has grown a tremendous amount. They need some laptops, so I tried Microcenter. Anyone who knows me knows that I have probably carried Microcenter through the recession. Certainly if you add my father into the mix, we've spent a bundle there (OK, maybe not that much, I'm just trying to give you a sense of my geekitude, and the thousands of dollars spent there).
I thought this business would be perfect. A couple of laptops. No problem. The technology recently changed, so there should be some older models, at the back of the shelf, that wouldn't go missing.
Except Microcenter only does their donations in August....
WHAT?
Look, I know you're a big company. I know you have to have a process, but seriously? Once a year? That's it?
It's funny. I've asked a couple of businesses now. So far, I've only had two notable encounters. The first, at the local grocery store. The minute I talked to the pharmacist about a 21 day supply of Malarone (a current generation anti-malarial), she said "God bless you. Let me see what I can do."
She can get me a 10% discount on $180 worth of medication. Yikes. One hundred and eighty dollars of medicine. For three weeks. We can do better! We need to find better medications, or even a vaccine.
The next (and actually my first stop once I found out I was going) was Casual Adventure, in Arlington, Virginia. I wanted to talk to these guys because they outfit people going all over the planet (I'm surprised they don't have a photo of their sticker, located on the space station). I had some questions about water purifiers, mosquito netting, well, stuff. I also wanted to find out how much this stuff was going to cost. More importantly, I wanted to talk to guys who sold you what you needed, not what you could afford.
So I walked in the store, and saw that they were already collecting for Haiti. I told them where I was going, and they (Well, Eric, actually) lit up, with a smile. They're going to try to put together what they can for the hospital. They'd rather send it with a guy they know, than to a general supply depot in Haiti.
Local business, working locally, to help globally. I love this.
On the flip side, I helped some friends consolidate their business this week. Consolidate is a nice word for "take two locations and merge it into one". It sucked.
I was really hit hard by this. The restaurant was a local place, just up the street. Good food, lots of beers, really friendly staff. I started volunteering there right after my divorce. It was a project to throw myself into, and something I could really believe in (Good food, good drink, within stumbling distance of the hosue? Hell yeah, this was a local project I could get behind!).
The two owners are local minded ladies as well. I was thrilled when I saw the T-Shirts blazed with "Drink Local" across the back. They worked incredibly hard, not just with the businesses (which were their whole lives, 24/7), but to improve the community on so many levels. It's a real privilege to work with them.
So I definitely recognize that we're still in the tough times. Watching someone fight for their business is just like watching a parent fight for their child, except for the constraints of professionalism. It's truly incredible watching their passion, and perseverance through incredibly tough times.
And still they're fighting
I'm going to try to end each post with the "Donate" button. I'm going to Haiti. I need help. 'nuff said
Friday, February 19, 2010
Some Milot Facts of Life
First, I found out that I'm the only emergency medicine guy on the team going to Milot. Seeing my name on the list was a bit of a thrill. I guess I'm getting too cynical, but it didn't seem real until I saw it in print.
So I got a little additional thrill this morning. Then I read the rest of the email. A frequently asked questions (FAQ) attached to it was pretty sobering.
The good news: I can take one change of clothes with me. The rest of the time I'll be in hospital provided scrubs. This is going to be the first time I've been practicing medicine in the field, in scrubs! Hot showers are available. Also pretty nice.
Unfortunately, that's the good news.
There are specific warnings about tetanus. They've already had patients succumb to tetanus. There are docs in the US who will never see a case of tetanus in their lives. It's a vaccine we (should) all get as children, and updated as a matter of course every 5 to 10 years. The Haitians may survive being crushed under a building, only to die from a completely preventable disease. It's chilling.
We're advised to make sure we eat, and get 5-6 hours of sleep a night. This is going to be good practice for medical school and residency!
The hospital has a 6-8 bed ICU. Ventilators will probably be available by the time I get there. Once again, something that we take for granted in the US, simply doesn't exist down there. In the US, if you need a vent, we get you one. If this hospital doesn't have one, they'll rent one, or transport you to a hospital that does.
Think about all those hospital TV dramas you watch. The ones where the hero (or mom, or dad, the son or daughter) is hooked up to the scary looking machines, while the loved one holds their hand, and tells them to come back. We won't get to that scene, in this drama. The realities will end the show (the season, the show) much earlier.
This is also a safety net that just isn't there. Miss something early on, and you won't have the option of intubating the patient, and supporting their breathing until they heal enough to breathe on their own. You have to stay completely on the ball, and not miss anything.
This is made all the more scary by the numerous times the FAQ says "You need to time manage", or "You need to hurry". Those aren't the exact words, but that is the impression. We're going to be seeing a ton of patients. We're not going to have enough time for the numbers of patients (Do you ever?), but the consequences for missing those subtle, crucial signs, will be dire. I'll be saying that most famous prayer, "Dear God, please don't let me screw up"
The lab sounds better and worse than I expected. Most conventional blood and urine tests will be available. That's good news. Apparently everyone is anemic, so H&H's are getting run continuously. However, no cultures are done at the hospital. None. Something in my mind made me think: If they have a lab, they must be running cultures. Assigning antibiotics to challenging patients is going to be another challenge.
Most patients arrive by helicopter. In the States, this would be a very ominous sign, as typically only the critically ill arrive by helicopter. Now I'm worried that the sick are arriving by the helicopter load (You can fit a literal ton of people into a Blackhawk). However, this is the beautiful thing about emergency medicine: The sick show up, and you start working. You keep going until everyone is taken care of. You'll always have work, and it will always change and surprise you.
The skills of local personnel appear to be highly variable. There are definite cultural, educational, and experiential differences. It sounds like there are problems with night shift workers making sure that patients are getting care throughout the night. IV's are running dry, and clotting off over night. It looks like I may be spending some nights in the ER tent... I haven't done that in a while, but those were good nights too.
Pain medication is in short supply. To top it off, the recommendations are to "Be prepared and willing to give more pain medication than you are accustomed to prescribing". I heard that before in certain operational medicine seminars, but I've never been in a situation where there was such a need, with nothing to give. This is going to be hard, really hard. Our hospitals have tremendous amounts and types of pain medication. Our job is to alleviate suffering. Pain control is so pivotal to medicine, and a patient's perception of their care. I think this is going to be where my limits will be tested. A minute in severe pain is a lifetime to a sufferer.
There are two principal sets of rounds. Morning and night. This is similar to US practices. However, evening rounds may not happen till after midnight, or even 4am. These are some really long days.
Deep Vein Thrombosis is a common complication. For those that aren't big time medical people, I'll run this down. Clotting is a fantastic adaption that we have. If we get a cut, our blood (hopefully) gums up, plugs the hole, and begins the healing process. However, through disease, injury, or loss of homeostatic control, we can develop clots within our body. When these clots form in our veins (typically the large, deep veins in the legs), it's called Deep Vein Thrombosis (DVT). There are a large number of complications that can arise from this, so it is something that we want to prevent. In the US, this is typically done with specific doses of heparin (a blood thinner). In Milot, they're looking at using aspirin. It's quicker to administer, and may be just as effective. Everyone gets assessed for DVT.
Lessons learned, and I haven't even set foot on the island.
I had a nice talk with one of my sponsor's last night. They're working on my travel arrangements. With that taken care of, it makes the deployment even more "Real". I'm hoping they'll let me name names. Too often these quiet benefactors remain in the shadows. I gotta be honest, this trip wouldn't be happening without their support. I'm a poor college student (I'm not starving, but only through the benevolence of others, and occasional honest work), there's no way I could afford to fund this on my own.
I've got to go beg more supplies from businesses. It looks like Casual Adventure is going to be able to get some of our needs (One of greatest local businesses. I really love those guys). I need to hit Home Depot, Microcenter, maybe even Best Buy.
It's going to be a busy day. I'm probably going to take the weekend off from blogging. I'm hoping to get out and see my horse. My girlfriend and I are going to spend the weekend at her place, something we haven't done for a month (though the weekends I've spent at my sister's house have been fantastic), it'll be nice to get away and relax.
Thursday, February 18, 2010
Deployment to Haiti
It's official. Sometime around March 12th, I leave to volunteer at the Sacred Heart Hospital, in Milot, Haiti. The hospital is approximately 70 miles north of Port Au Prince, so it was not directly affected by the earthquake. However, they have surged in capacity to handle the massive patient influx from the disaster region. What started as a small local hospital has exploded in size to a massive medical center. The emergency room started out as a tarp over the concrete courtyard. It has since been replace/augmented by massive tents, capable of holding dozens of patients.
These patients look like they come any way they can. The hospital has "borrowed" one of the local school's soccer fields, and turned it into a helicopter landing zone. From the blogs and online photo galleries, it looks like the tent gets emptied, only to fill up completely in minutes.
Looks like my old ER, maybe a little worse :)
Another unfortunate staple of the postings from Milot is the number of amputations that are occurring. This is a tragic fact of life in austere medical conditions, particularly with the crush injuries that are common in natural disasters. Even more tragic is the lack of physical therapists. With the scarcity of resources (They're lucky to have x-ray capability, forget a CAT Scan or C-Arm), the surgeons have to operate to save lives, not limbs. It looks like they're doing a tremendous job, in difficult circumstances.
It looks like incredible work. The kind of work that I really miss. The downtime pictures show teams that looked tired, but happy. Caregivers are frequently seen with convalescing patients, with smiles on all their faces.
It looks like most deployments last a week. The folks that I've talked to have said it's an exhausting week. I'm hoping I can last more than a week. I've got the time, and I miss the work. Still, I think this is one of those things that you won't be able to judge until you see the conditions.
I'm running around now. Studying topics relevant to the conditions. There are a number of tropical diseases that I've never seen, but will be incredibly common there (Filariasis is a fact of life down there, and I've heard the mosquitoes are a sight to be seen). I'm also trying to learn a little bit of creole. My sister picked up a great book for healthcare providers, English/Haitian Creole Medical Dictionary, By Heurtelou and Vilsaint. The book looks like a kid's coloring book, but the simplicity of it will make it incredibly easy to use. Despite the simplicity, it provides significant depth in medical terminology. This was a great find.
I need gear. I haven't heard how the ER operates. I think I'm going to need to find a nice, adjustable headlamp for night shifts.
Also, while the hospital has filtered water capability, I imagine if the generator stops, so does the water... I need to find a decent portable water filter.
Malaria prevention is a big deal (at least to me). I just found out that one friend who deployed without taking anti-malarials is now laid up with malaria. Yeah, one guy is not a good statistical sample. Still, I'm a preventative medicine kind of guy. I'm going to work pretty hard not to get nailed with that little bug. So, I need to find mosquito netting, or even one of those combined hammocks. That would come in handy up in Canada as well.
Anti-malarials aren't cheap. In fact, the newer generation ones are insanely expensive. That's going to be a significant expense.
I'm only allowed 50lbs of personal gear. I'm hoping to find a cheap netbook. The hospital has occasional internet, and I should be able to upload things (like this blog). Hell, I wish I'd kicked my butt in gear awhile ago, and built that USB EKG box. That would be pretty useful right now.
I'll try to keep this updated. I guess I'll have to make sure I keep it clean and on topic, since I don't know who will be showing up. So if you read my earlier posts, I guess I have to change those rules. If there is information that you need, let me know. I'll try to get it on here.
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