Austere environments (HAITI) and WLS

Mar 07, 2010

Austere environments and WLS

I recently came home from an extremely austere environment, Haiti. I went to Haiti as part of the New Mexico Disaster Medical Team; I was told that this deployment would be the most austere environment that the team has ever been deployed on. Guidelines were strict as team health was a concern for this deployment; hypertension, heat issues, and BMI’s greater than 35 were among the disqualifications for deployment.  Four days after the quake we had our quarterly training where our team commander dropped the bomb shell on us saying that we had a 75% chance of deploying to Haiti prior to our official on-call month and a 15% chance of going to the Olympics. He laid out the criteria for the Haiti deployment and asked that if we had questions to please hold until after the briefing and any medical concerns to bring them to our medical director. He also said that we should start hydrating now for waiting until the team is in theatre to starting hydrating would place the person behind the eight ball. 

I was only over by 2 points on my BMI and so I spoke to our medical director.  His first question was; “How do I feel?” I responded by saying that I have never felt better and I wasn’t lying. He knew that I had undergone weight-loss surgery and I answered the questions that he asked well as I could.  I went on to tell him that if chosen to go, I would be bringing food that I knew would be safe for me to eat as he was concerned for my well-being.  I was 266 pounds and so looking forward to going, I packed my bags with enough clothing/gear to last the entire deployment and enough food also but remain under the 45lb weight limit imposed by the team.  Some how I managed to pack all of my gear, clothing, and food; 2 cans of Monster Milk, Sesame crackers, high protein granola, etc. and still manage to come in 12lbs under the limit.  We get to Atlanta and it’s snowing, the weather seemed to follow the team from Albuquerque, we wondered if it would follow us to Haiti. We joined up with a 20 member surgical augmentation team with members from Oregon, Ohio, Massachusetts, Illinois, Arizona, Alabama, Texas and Alaska.

Before leaving the hotel, I filled my hydration kits as we were told that we would be heading directly to the site once we hit the Port-au-Prince.  Its 3pm and like 90º+F, we board these tour style buses that look to have been armor plated.  We start out to the field hospital that would be our home for the next two weeks, we found out why our vehicle was fortified. The streets of Port-au-Prince were rough; the belief that the bigger vehicle had the right of way was quite evident. This made the worst traffic in the U.S. seem like a nice stroll in the park, there were functioning traffic signals but they were rarely obeyed.  We get to the site and it looks like a war zone and in the back of my mind I was thinking oh my god what have I gotten myself into?  Everything was surrounded by razor wire and a detachment of the Army 82^nd Airborne, I felt safe.  We settled in and began the transition process as we were taking over from another team and had to hit the ground running. The first few days were a bit rough; I found out that I am allergic to DEET. So not only did I have to acclimate to the environment, I also had to deal with the allergic reaction,  mosquitoes and the chemoprophylaxis medications that we started prior to deploying for malaria.  

While everyone consumed M.R.E.s (meals ready to eat/meals reluctant to exit) for the first few days and then started to complain about the constipation that ensued, I merely continued my high protein regiment and had normal movements.  I didn’t account for the heat, I knew it would be hot but I didn’t expect that it would be that hot; heat indexes were generally over 105ºF.   So I started consuming more water than I would have normally, easily double the amount and I added electrolytes so I wouldn’t get sick.  I decided to throw in an occasional M.R.E. to my meal rotation so to keep things fresh.

Meal choices weren’t the best, meatloaf (w/ anchovies), jambalaya, chicken and dumplins, chili, and several other horrible meals. Now each kit contained a full meal; drink pack, main course, a bread type product, desert and condiments for an average meal of about 4000 calories, 300grams of carbohydrates, and about 125grams of proteins.  That’s enough to kill in my opinion.  I pretty much stuck with the jambalaya and a cheese omelet MREs, I didn’t eat the sides just the main course and over a couple of hours.  I began to see the issues that the others were commenting about, but having the Duodenal Switch I didn’t seem to have them as bad as the others.  I figured that I would eat my food and augment with the MRE as necessary to maintain the food supply. We were able to get showers at our site so that was a big thing and I was able to get some of my clothing washed. It was nice to be able to have clean clothing and body.  

We were a 24/7 field hospital and so that ment that we had teams up and working in the middle to the night. A couple of nights we had late night arrival of patients, many pregnancies and multiple casualty accidents. One night we had two women present at our gates at what appeared to be full term without pre-natal care, they both delivered healthy kids. The next night, 30 minutes after shift change we heard a commotion on the 82nds radio, it turned out that it was an accident down the street and was a pick-up truck/bus called a TAP-TAP vs a dump truck, you can guess who won. Ten patients, 3 surgeries and probably 5 hours later we only kept 2 of the ten overnight.  Life was never dull at the Gheskio field hospital be it; rain that made the hospital area a lake, gun shots, the ever looming smells of burning petro-chemical products (tires, plastics, Styrofoam) as many of the Haitians used them as a source of heat in the evening hours.  

Going to Haiti has really put my life in perspective on things that I took for granted; getting short for things that I didn’t get right away, patience, and many other things/luxuries that we Americans take granted. If I had not had the surgery, I do not have a doubt in my mind that I would have been disqualified to go. I made some great new friends; those in Haiti, people from other teams, and strengthened the friendships of those on my team. It has almost been one year since surgery and in that time I have lost 171 pounds, and I am only 11 pounds from the goal weight my surgeon, Dr. Crookes set for me and only 69 from my own goal weight.  The heat was intense, mosquitoes were a nightmare, the living conditions were rough, and the earthquakes were crazy but my DS and I made it through the two week deployment and if given the chance I would still be there to help make a difference, to work with our translators; Estime and Jerry and hang out with some of America’s finest men, the Army 82^nd Airborne.

In the end we were forced to shut down at night and stay at the embassy as the structures we worked in and around were again damaged from the quakes. The hospital was transitioned to a clinic and we worked with a Non-Gov’t Org to assume care of the citizens of Port-au-Prince. We left Haiti and returned to Atlanta, where the team celebrated a successful and injury free mission by enjoying a REAL meal. I had a 6oz filet steak and a lobster tail… it was to much to eat but it looked awesome.  Now I am home with my better half and settling back into a routine. As of this morning, Sunday, March 07, 2010 we have just finished being on ALERT for deployment to Chile, we were on ALERT for potential deployment if the Secretary of State deemed that disaster medical teams were necessary to go. 

I miss my friends in Haiti and I pray that they are safe.

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