Members of the Penn Medicine team wrote blog entries and took photos while in Haiti. Here are excerpts from entries written by Michael Ashburn, professor of anesthesiology and critical care and the director of the Division of Pain Medicine and Palliative Care in the Department of Anesthesiology, as well as Samir Mehta, assistant professor of orthopaedic surgery and chief of the Division of Orthopaedic Trauma, and Babak Sarani, assistant professor of surgery. To read the blog entries in full, go to: www.uphs.upenn.edu/news/features/haiti/.

Jan. 25: The mugginess was upon us and the noise. I quickly realized there were a lot of people walking around in fatigues with M16s. In addition, there was a lot of traffic back and forth, but the airport itself was eerily quiet. ... In a country devastated, I can only imagine what these people were thinking as we made our way through their streets with hundreds of thousands of dollars worth of supplies and food and potential life-saving equipment for their loved ones. The stares were daunting and I was embarrassed because of what we take for granted on a daily basis—food, water, sterility, air conditioning, safety.
—Samir Mehta

Jan. 26: We’ve gotten a tour of the facility—in disbelief ... of what these people have endured so far, disbelief of the injuries sustained and disbelief of the conditions here. However, despite certain limitations, the facility, the staff and the volunteers clearly care about their patients and their country. Every single member of the staff has been touched by this tragedy—losing loved ones. With nearly 130 to 150 patients, 90 percent of patients (at least) have orthopaedic injuries and of those, the majority are open. It is staggering.
—Samir Mehta

Jan. 27: Our hosts are incredible. The [Partners In Health] staff includes volunteers who are medical students and residents. They are bright and work very hard. They made great efforts to get us integrated into the flow of things, something they have to do very often as teams come and go. The local staff are also working very hard. They continue to impress us with the efforts they are making to help us help them. In the OR we are running two rooms. We will be working with an anesthesiologist from Cuba, as well as [Certified Registered Nurse Anesthetist] students. Of course, there is the problem of not being able to say anything to them, since neither Tom [Floyd, assistant professor of anesthesiology and critical care] or I speak Spanish or French. Lots of hand waving.
—Michael Ashburn

Jan. 27: I am stunned at the turnover time. Patients are moved quickly. Post-operative recovery is at the bedside for all of a few minutes to at most an hour. Between cases, our wait time is less than 15 minutes—enough time to write orders and plan for the next case.
The cases covered a wide variety of orthopaedic and general surgical procedures. It was a bit unsatisfying—knowing the queue of patients that needed to be treated, the lack of radiographs (no films available) and the continued need and desire to “check off boxes”—treat patients so that they would not need to keep coming back to the OR.
—Samir Mehta

Jan. 28: Cases moved smoothly, but we were realizing that every patient was infected—wounds that were closed, wounds that were open, wounds that we thought would be closed—it was all infected and this continued to be a source of frustration. …
I wonder what it is that we do here—how it even makes any bit of difference when there is no follow-up really, no prosthetic care, no therapists to do crutch training, fly swatters in the corners of the operating room. Is there really any benefit to what we are doing or is it simply a drop of water in an ocean of wreckage?
—Samir Mehta

Jan. 31: The people here are nothing short of gracious, trusting, benevolent and extremely polite. We are greeted by everyone with “Bon jour, Doctor” during the day and “Bon soir” after noon. I cannot imagine how the patients and their families are able to give us such trust when our ability to communicate with them is rudimentary and requires an interpreter. ... How will they recover their life with missing limbs, destroyed homes and lost loved ones? How are they able to smile and stay gracious under such strain?
—Babak Sarani

Jan. 31: We exited the medical complex through the front gate we had entered one week ago (and had not been outside since). ... I was immediately reminded of the drastically different world that we were in. As we walked past the thatched roofs, the pigs tied to trees, the naked babies bathing with their naked siblings, kids playing soccer with plastic bottles, a boy passed me a deflated basketball—probably the most telling symbol of their life. As I walked by all of this, I was amazed even more by what the [Partners In Health] team has established at Cange—an infrastructure, daily meals, schooling, healthcare, a society.
—Samir Mehta

Feb. 2: Dr. Maxi [an OB/Gyn at the hospital complex] informed us that Cange had grown in size by nearly 1,500 people who had traveled all the way from PAP [Port-au-Prince] since there was nothing left for them there. This explained the additional people walking around the medical campus, the number of “new” splints that I didn’t recognize or at least slightly remember … 1,500 people also meant a lot of neglected or incompletely treated injuries.
—Samir Mehta

Feb. 3: Today we continue to see patients arriving from Port-au-Prince with un- or under- treated orthopedic injuries and wounds. The number of people living on the compound continues to grow. We were awakened this morning at daybreak (around 5 a.m.) by the sounds of many families engaged in the morning routine. We are surrounded by life as well as suffering.
—Michael Ashburn

Feb. 4: We decide to go for a hike as we have already completed Wound Rounds. We come to a football (soccer) field on a plateau with a steep drop on three of four sides. We’ve watched the Haitian kids play football on this field after school lets out, chasing down the ball after it goes off the cliffs. The ball they play with deflates every so often and so the kids stop to pump it up. The next time I come (and there will be a next time) I plan to bring lots of soccer balls, basketballs and candy.
—Samir Mehta

Feb. 5: I’m not sure how I feel leaving. I have no idea what will happen to these patients, who will take care of them, who will pack their wounds daily, who will check for infection, what their X-rays will look like (and who will be assessing them). I am worried.
We are leaving nearly everything behind for the facility here. Hopefully, we’ve left a little more than just material goods. I know that part of me has been totally changed by this experience. One might ask how? I don’t know. It might be that when I start up in the OR on Monday at HUP I am no different than they way I was before I left. It may be that it comes out in very subtle ways ... I know I feel different. ... When we came here, we were hungry with anticipation and some concern over what we were embarking on. Now, as we ride back, I think our thoughts turn more to admiring what these people have accomplished despite having limited resources.
—Samir Mehta

Feb. 5: Dr. Maxi, the Haitian physician who is the chief of the hospital, had kind words for us this morning. He said, “God brought you to us. You have been wonderful. You are now part of Haiti.” We could ask for nothing more.
—Michael Ashburn

Feb. 6: It was a rough night in terms of sleeping. Between the mosquitos, the chickens and the planes, it was hard to really get some sleep. Our driver was to arrive at 6 a.m. and so while I was craving sleeping a few extra hours, I also wanted to watch the sunrise. The design of the Aristide Complex prevented that. ...
At 1:50 p.m., we touch down in Philadelphia. I am staring into an airport hangar. Is it really over? This is it. We’re done. Hmm. A bit anticlimactic. ... It’s good to be home but I know I’m not quite me anymore.
—Samir Mehta