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“The wind was a torrent of darkness among the gusty trees,
The moon was a ghostly galleon tossed upon cloudy seas,
The road was a ribbon of moonlight over the purple moor,
And the highwayman came riding,
Riding, riding
The highwayman came riding, up to the old inn-door.”All Stanzas from The Highwayman by Alfred Noyes
Noah and I on watch during the crossing from Jamaica to Roatan
Alone out in the middle of the ocean this stanza repeated itself over and over in my mind. I was scared for this crossing—what I was leaving behind was not just the town of Petit Goave, but the me of before. The me before I was witness to a country brought to its knees, before I had to leave a boy that I knew was being abused by his care takers, before I gave my heart to an orphan I called ‘Cheeks’, before 3 teenagers worked their way onto our boat and forever into our souls, and before we had to leave them sitting in their small canoe watching as our boat grew smaller and smaller in the distance. I felt alone in the ocean- the vast expanse of open water echoed the void that all of those I left had filled. The last thing that I said in Haiti was “ Moi Matrin es Tris”—meaning, my heart is sad.
How I will reconcile all of these experiences is still unknown to me. I find my heart and head wandering around the streets of Petit Goave late at night now restless in the unknown. I miss Haiti terribly.
Our time in Honduras has already been so productive- we are spread out between three clinics on the Island while also working as the doctor and medics on Aeromedical a helicopter that flies emergency victims to the main land. I have already found my little boy love- his name is Oscar and he is a gorgeous 3 year old that suffers from Down Syndrome. He is the most incredible and rambunctious little soul- unable to speak but communicates in a way that speaks directly to the heart. It’s hard for me at times, I
feel his little body in my arms and can feel the same warmth and heart beat that was once my Cheeks. And I know that one day I will be holding another little one and think of my time spent with Oscar– each of them holding onto a piece of my heart long after they forget the details of our time spent together.
Little Man ‘Cheeks’
“Look for me by moonlight;
Watch for me by moonlight;
I’ll come for thee by moonlight,t hough hell should bar the way”
I wish that I could take each of them by moonlight- take them to a place where no pain or stigma exists- I wish that the my love would ease any burden- but I am honored to be the one that holds these little wonders, still so happy and full of joy no matter of the obstacles that lay in their way. My heart, I hope in some ways, will always beat in time with theirs.
Smiling Oscar- melting hearts.
There are no safety nets in what we are doing- not for us, for our minds, and most of all for our hearts. Each of the crew will carry the joys and scars of our experiences, we will carry those that are left behind with us until our hearts stop and our bodies are freed from the confines of this life. I am lucky to have heard the laughter of children playing in the rubble piles of Haiti, to have felt the hands of a Honduran boy unable to speak grasp my fingers while fighting his way up a flight of stairs, to have seen the ocean glow green on a moonless night in the middle of the Caribbean Sea, and to have done all of it with the finest group of people I have ever know.
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Here in the darkened back room she sits like a stone- hands shoved under her small thighs, eyes fixed on the worn floor. The muffled noise of the other children playing drifts in like waves through the slatted window– but in this room everything is still. I sit with my hand on her back reminding myself that I am the adult and strong one here– it is not my turn to cry. I watch as the tears run down her nose making perfect circles of darkness on her dirty pants. “I just don’t like it when they look at me while I’m in the shower, but it only happened once”…”It mostly happens to the other girls”. I hear this from all 6 of them….”The boys here hit us”….”we are worked from morning until night and I’m tired”….The room spins as I hold back the choking sobs that are clawing their way up my throat. A knock at the door and a bidding from the house mother and she’s gone– off to the kitchen to prepare lunch for the 23 other orphans. I watch as she pulls herself together, she is 9, she should not know how to hide pain like this. All 6 girls have claimed abuse over the past two hours and here we are left – 2 shells left shocked into silence. I can not show emotion, I can not allow the owners of this hell to see that I know what kinds of evil the night brings here.
Our allotted time is up and we are escorted out under a the watchful eyes of those in charge searching our faces for any sort of recognition “do we know?” “How much did they tell”. The girls pull at my arms as we leave… am I coming back, when, when, when? “Bye Sky, Bye Sky, when are you coming back”? I can see the pleading behind their words… don’t leave me here, please don’t leave me here. I promise them I will do everything that I can.
We get into the car unable to speak , unable to file away what we just saw and heard, left stricken by what people are capible of. They will not allow me access to the girls, I asked to take them once a week– for the first time on this trip there is suddenly “proper procedures” that take months that have to be followed before I can spend any time with these forgotten no named little girls. There is no one for us to turn to. A barrier put in between that has been so far impossible to traverse around– they are money makers who have been taught to shut their mouths for if they speak they are given up to the streets and the ugliness of the sex trade. I have fought to see them, fought to come back… they have my phone number and they call still pleading asking for my return. At night I think of them laying stone faced in their pathetically pink painted bunk beds scared of any noise in the night and what it will bring.
This is the ugliness of humanity- I see it as I toss and turn in my own bed- their hushed tones narrating the visions of their experiences haunting me into wakefulness………..
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Holly and I finally face the task of completely clearing out, organizing, and restocking our medical go-bags
This week saw the first heavy, 3 day long pouring rain for several weeks (of course, while we are trying to load the boat and finish our preparations for departure) and the tying off of many threads we have been following for months…we closed up our clinic in Oakridge, packing everything up and saying hasta luego a mi pacientes. Un momento muy difficile. Thank goodness we plan to return to open the clinic permanently as a satellite clinic, open every day with a doctor and staff on site even when Southern Wind is working elsewhere. Knowing we are coming back after this voyage, and knowing that with what we learned and the relationships we forged on Roatan, we can and will open that clinic, makes it much easier to say farewell. Instead, we say (we are going to Haiti, after all) aur revoir.
We finished off a lot of rainy day projects inside the boat (there are always, always more
Capt. Ed cutting a new gasket for our 671 GM engine pan...doin' it old school
projects), and got down to the business of prepping to load—that means taking every item out of its storage onboard, condensing everything, repacking all our medical go-bags (thank you Dr. Holly!), and most important: we took delivery of our 5 pallets of material left over in Miami from our last mission to Haiti (thank you Gary, Donna, and everyone at Roatan Rotary!), and our 40-foot container from Direct Relief International, packed with medicine and equipment for the clinics in the island and distributed the material to 5 clinics and the public hospital on the island.
And the unloading begins...
This is a crowning moment for Sky. To get this container in, it required over 1,000 emails between Sky, the shipping company, Direct Relief International, Joseph Natale from Fundacion Heart Ventures, the customs office, the customs broker, Roatan Rotary, a cross-country trucking company and a local trucking company in Miami and another in Roatan, the warehouse in Miami with our 5 leftover pallets, the Ministry of Health in Honduras, 6 different clinics on Roatan, and Cepudo (a Honduran NGO on the mainland).
Roatan Public Hospital emergency room with the floor up to fix the backed up sewer
The difficulty is not in sending down material—anyone can order a container and have it
Gary and Sky picking up the pallets Rotary helped us bring in
shipped down here…but not without enormous import fees. It is sending down material and getting it cleared through customs as donated material without $30,000 worth of customs duties applied that is difficult, not to mention that we wanted to create a conduit so that we could send containers on a regular basis. One time is easy…to set it up to be sustainable is way, way more difficult. It took more than anyone else will ever know to get it set up by Sky, but I will always know and always be impressed how much the people you already love and admire can still amaze you.
Holly checking the pile earmarked for the Pandytown Centro de Salud
In a few months I will begin contacting the clinics again, finding out their needs and getting another request for DRI and container number 2…
Our staging area for the distribution to the clinics--thank you Gary and Donna for letting us use the tents!!!! Lifesavers!
Our aid station at the triathlon finish line
In the midst of all this, we still see patients, provided the medical service for the Bay Islands Triathalon (including the kayaks monitoring the swimmers during the first leg), and Dr. Holly—whose training
heading out...some swimmers were really struggling, and a few got lost and started to swim to Guatemala, but thankfully no one went under and didn't come back up
includes major scene accident management—provided 2 days of training for the Fire Department, following up the training provided by our volunteer Sirin last year.
Maintaining head control as Johel comes out
Dr. Holly showed the firemen a particular extrication trick—when you have a patient with suspected spinal injury from a car accident, you can extract the patient through the back window by lowering the front seat, sliding the board in through the back window and taking the patient straight out. Since we have the use of Gary and Donna’s open jeep, we could simulate the extraction without having to smash a car’s back window. We are nothing if not adaptable.
The weather is looking good for this weekend (pouring rain now)…high pressure pushing down, maybe keeping the low centers at bay over our projected route. Loading the IV fluids tomorrow and the next day…Finish securing the boat for sea…provisioning….and a last good night’s sleep.
Then give me that horizon.
Photos of patients used with patients’ express permission.
Photos of unloading and interior boat construction (pretty much most of the nice-looking photos) courtesy of Dan Chomistek
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His right hand took the most injury because he was using it to defend himself
As we were closing up shop after a busy clinic day in Oakridge, we got a call from the Roatan Zoo—one of the new keepers had been badly mauled by one of the monkeys while cleaning the enclosure. Oh man…after a late night working on the computer and a CRAZY day in clinic I was looking forward to lying down for a while, but when the call comes for help, you have to help–so we grabbed our minor surgery bag and some antibiotics and headed over.
Apparently, the victim had been employed there about two months, and was working (as usual) with the main keeper, who had been with the zoo
On arrival we found he had been bitten about 40 times on the legs, hands and arms
for 5 years. They had been in the cages together many times before, and had no problems, but this time the head keeper stepped out to grab some additional cleaning supplies and one of the monkeys decided to challenge the new guy.
While with the head keeper, he had been safe—the head keeper’s place in the monkey society was well established (as boss), so the new keeper got a free pass. But when he was left on his own, one of the males just went for him. He was knocked to the ground and savaged, bitten and clawed all over his legs and his arms and hands; the monkey actually went for his face—all the wounds on his arms and hands are classic defensive wounds. Fortunately the head keeper heard the commotion, ran back and pulled the monkey off (the monkey immediately submitted to the head keeper).
The male in question had been horribly abused in its previous home; it had come to the zoo nearly dead…now it is in fine form; I guess it feels strong enough to challenge newcomers in its little kingdom. Everyone always looks at monkeys and goes ‘Awwww….how cute.” And it is true, with their little human faces and adorable antics, they are pretty fun—but they are also wild animals with motivations all their own, and with lots of strength, agility, speed and teeth and claws!
One tough hombre...he was smiling when we arrived, but I gave him a shot for pain before we started
When we got there, the poor guy was a little shocky, covered in blood, dried monkey saliva, and dirt and debris from the bottom of the monkey enclosure. He was so filthy and crusted that we couldn’t even see where the wounds were. Pretty bad scenario from an infection point of view; monkeys have fangs that can bite pretty deep and inoculate your tissues with their raw sewage-like saliva (pretty similar to human saliva, probably).
I immediately gave him an injection of ceftriaxone and an injection for pain. We used a garden hose (the water at this resort/zoo is filtered and potable) to soak off the filth and dried blood as it would have taken more gauze than we had with us, and been more painful. The hose helped gently soak open the dirty scabs over the wounds, and let them bleed out a little to help clean them. Finally we could see the wounds—lots of them, probably around 40 bites and claw marks. If he hadn’t been wearing jeans, I think he would have lost half the skin on his legs, and if he hadn’t had his arms up in front of his face things would have been a whole lot worse.
After disinfecting and irrigating all the wounds, we salved them with antibiotic ointment, dressed them, and gave him oral antibiotics and painkillers, and fresh bandages for his family to change for him if he got wet. We also started him on acyclovir, an antiviral given as prophylaxis for monkey bites. The next day, all his wounds were clean and dry except for his right hand and left forearm, which were very swollen (and pus was expressed from the hand). We added a second, stronger antibiotic and got him to start bathing his wounds in hot soapy water a few times a day.
Gave an injection of ceftriaxone (antibiotic) as well as tramadol for pain
It worked—his swelling went down and his wounds are healing nicely. Never a dull moment practicing medicine in the tropics, but most of all I liked that we were able to bring care to his home. The house call is still my favorite consult.
When I was a kid I watched my dad do house calls in Los Angeles…practicing Alaskan small-town doctor medicine in a big city. In my folks’ house, as long as I can remember, there is an old print of a painting of a doctor, circa 1830ish, on horseback with a lantern and black medical bag in the dead of night, riding slowly through a driving rainstorm. There’s no adrenaline rush about the figure; the doctor is not flying down the road, coat trailing behind and sparks flashing from the horse’s shoes on the cobbles.
Rolled Gauze to hold the 4x4s on and to cover all the small scratches
Instead, the doctor looks cold and wet—can barely see his face behind his upturned collar, peering head through the dimly lit night. He has the air of one doing a job that he is doing because he has no choice, because it is who he is. It would never occur to him that someone else should be the one to go out in the night and go help a sick patient. He goes, and gets cold and wet and more tired (he must be a critical care doctor), because to him, that is what a doctor does. It isn’t even a sacrifice, just a part of his core being. I always felt like that picture captured some of the essence of what being a doctor means to me.
All photos of patients are depicted with consent of the patients.
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Roatan, Honduras
Downed Trees After Hurricane Richard
Wow, what a ride…a few days ago, Hurricane Richard passed almost directly over our position here on Roatan. For several days, we watched it approach, slowing down and gathering strength as it hesitated out in the Atlantic, almost as if it were undecided about whether to move northwest, as most hurricanes do, or to move directly west and sweep over the Isla de Bahia in Roatan. Naturally, we began to take elaborate pre-hurricane precautions, hoping that they would not be necessary.
We cleared all of our gear off the decks and lashed all the big stuff down tight, covered our bridge windows to protect them from flying debris, charged our batteries and filled our water, stocked up on food, added about a dozen dock lines and more fenders, and prepared to ride it out. These are the moments that are a true exercise in letting go; when you have taken all the precautions you can, and done everything you could–then whatever happens is beyond your control. The sea can be a very scary and intimidating place when you try to maintain the illusion of control on the water.
From the bridge, we waited, and tracked the storm on satellite imagery. As it came nearer to our position on the screen, the air felt heavier and heavier as the pressure dropped, and all of us–including Tweek and Giles, our ship’s dog and cat–started feeling restless and agitated…I guess it is true what they say, the waiting MAY not be the worst part, but it is surely no picnic!
First, the weather turned dead calm and still, the only change being the plummeting barometer…then came the rain, and then more rain, and then a LOT more rain…and then the wind. At first the wind wasn’t too bad, blowing at around 30-45 mph for the evening, but as 3:00 AM rolled around the wind began to pick up sharply, whipping the trees around us and surging the already full-moon high tide up over the concrete dock. Thank goodness we had had a chance to adjust and tune all our dock lines while the wind was still blowing only 30, since by the time the wind hit 79 mph it was difficult to move around safely outside.
The boat rocked and heaved amid the spiderweb of dock lines holding her out in the middle of the basin–one line snapped, but Captain Ed and Noah managed to get a replacement line around another cleat in time to keep us from being
Our Boat Is At The Middle Of A Cat's Cradle Of Docklines
pushed forward onto the seawall 8 feet dead ahead. As dawn brightened, the wind began to die down to gale force, and eventually petered out amidst a series of heavy showers into a preternatural stillness, and the first tiny patches of blue sky we had seen for days finally peeking out in the eastern sky.
Then all hands checked the lines one more time and turned in for some well-earned sleep–back at it in the clinics tomorrow! What did Graham Greene say about the sea.. “The ocean is an animal, passive and ominous in a cage, waiting to show what it can do.” The power of the Hurricane, this ‘little’ category one hurricane, gave us a brief glimpse at the forces that lie in wait under the deceptively calm waters and blue skies of the tropics.
The price of having even a chance of survival on the sea is eternal vigilance…when situations turn bad, they tend to do so quickly. Better to prepare thoroughly every single time than be caught out the ONE TIME you fail to take every possible precaution.
Live to sail another day!
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95 Degrees Training In Brush Gear With 95 Percent Humidity
“Superinfermera”
Here in Honduras, as it was in Haiti, on any given day my crew are usually spread out at several locations, and when I find out later the details of what they have been doing, I am always astonished. Today we recognize the awesomeness of the work done by nurse and instructor Sirin Petch. By the time we had been here about a week, we learned that the single fire station on Roatan had not been given much formal training, and Sirin agreed to work with Maddie to provide training in emergency response. Nearly every day for almost two months, Sirin worked with the firecrews to provide training in airway management, scene assessment, lifting and immobilization, choking, and other techniques necessary for EMS response. Some of them had joined the department when they were 14, but few had been able to get formal training. The firemen are paid very little (they have to buy oxygen for the ambulance out of their own money), and they work hard.
Sirin first asked the Firemen what they would be most interested in learning, and looked at the resources that were available and would be the most useful instruction for work here in Roatan, and then provided training. Maddie was instrumental in helping communication, plus she is a naturally gifted teacher, and later they were joined by Zach, one of the pilots on the emergency helicopter, and Yolanda, a paramedic from Montana volunteering for a couple of months on the helicopter.
Sirin and her team trained the fire crews, went on night calls with them, and even after Yolanda and Maddie had gone home, Sirin continued with the firemen. Near the end of Sirin’s time with us (for now?), an incident occurred that says a lot about the relationship Sirin created with the Bomberos. I got a phone call to transport a patient on the helicopter to the mainland, so I made my way to the landing field, prepped the gear in the helicopter and waited for the Fire Department ambulance to bring a patient with suspected barbituate overdose. The ambulance arrived, the doors were kicked open, and out jumps Sirin and the firemen, who hand off the patient to me on the helicopter.
On the way back to the station, Sirin and the firemen got a call for a woman in full arrest. Sirens blazing, they arrived at a house surrounded by wailing family members. A larger woman in her 40s had a full arrest, in a house at the top of a 30-foot embankment. Using the techniques Sirin had taught, they put her on an immobilization board, inserted an airway, maneuvered her down the hill to the ambulance and raced to the hospital. They worked hard to resuscitate the woman, both in the ambulance and the hospital, but eventually had to call time of death. Sirin helped arrange the body and deal with the distraught family thronging the hospital corridor, then she and the Bomberos headed back to the Fire Station, only to be diverted to a brush fire. They gave Sirin a brush jacket and sped off to a banana plantation, arriving as it burned itself out. Scrambling up the smoking, scorched earth, they made sure the fire was completely extinguished, then returned to base.
Beyond the skills and training that she made available to the firemen, I believe that Sirin gave them something much more valuable. They looked at what Sirin knew, and her professionalism, and saw its value. She earned their respect (not always easy for female professionals in Latin America) and their friendship, and helped inspire them and motivate them to want more training and to seek it out. They have asked Sirin to send EMS instruction books and have increased their physical training (Noah has worked with them in the gym and done lifting and transferring instruction with them, and a few days ago I boxed with another).I am very, very proud of the work at the Fire station, and very proud to have seen Sirin rise to such a challenge. Long after we are gone, I hope the knowledge and professional pride she left behind will continue to grow and help people.
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Awesome O.T. Ashleigh Using Finger Paints With One of the Kids From the R.B.C.
On Wings Of Angels
A few days ago we did a house call from the RBC Center to a lady who was 6 weeks post stroke. The family’s house was at the top of a 35-foot steep slope, and she had pretty complete right sided paralysis. Her speech and cognition were affected badly; she seemed unable to understand questions and had no speech. She had a permanent indwelling catheter, and could eat and drink when fed but her swallow was affected and she seemed to be aspirating a little bit (saliva or fluid entering the lungs). Like most elderly or infirm family members in the developing world, she was being cared for at home.
There was not much I could do to help her improve, although her stroke was so recent that it was impossible to say how much spontaneous improvement she might experience over the coming weeks. We told the family to interact with her as much as possible and Annee demonstrated passive motion exercises the family could do with her to help prevent contractures and blood pooling, and discussed turning and bedsores. We talked about signs of urinary tract infection (always a danger with permanent indwelling catheters). And the folks from the RBC center are going to try and help out. Overall, the prognosis was not good, but there is one thing this lady had going for her that many elderly patients in the US and Europe never enjoy.
In the US and Europe, the general tendency is to stick elderly family members in nursing homes and visit them occasionally, usually out of some kind of guilt or obligation. I worked in Care of the Elderly in Ireland and I saw it everyday. The first time I did a house call on an elderly woman in Africa, who coincidentally had also had a stroke, I was ashamed of how we treat our elders in the developed world. Here in Honduras, as in Africa and Haiti and everywhere I have been, older people live with and are cared for by family members in their homes. They do this for two reasons—first, because they have no choice; there are few nursing homes to deposit and forget elderly family members. The second reason is because the culture in most developing countries has much more respect for the older generation, and elderly people get home care and attention from their families simply because that’s the way it is.
The granddaughter of the elderly stroke victim hovered over her grandmother, stroking her hair and talking to her. The family washed her and cleaned her, emptied her catheter bag, fed her and talked to her and interacted with her. Lying there paralyzed, she received the most tender care and inclusion in the life of the family. There may have been no advanced tech available but this lady was being wonderfully cared for. And a week later, she got some of her comprehension and speech back, and some control over her right side mobility. With love and more care, hopefully she will recover enough to regain some measure of independence, but if not I have confidence in the care I know her family will provide if she remains permanently disabled.
The RBC Center, para los ninos con incapacitados, is staffed and run by people who have extended the kind of care they would provide a family member to the kids and people in the community who have cerebral palsy, have had a stroke. Ashleigh has been there nearly every day she was with us, providing Occupational Therapy and Physical Therapy and helping the clinic workers learn new techniques of therapy.
I am amazed, and very proud of what Ashleigh has accomplished at the RBC Center. She and Annee started a Yoga class for the mothers of the handicapped children, many of whom have bad backs and joint pain from carrying their immobile grown children everywhere. The women who come to the center love the class; one 57 year old woman said it was the first time she had ever exercised, and she was so proud of herself. Peggy from Clinica Esperanza gave us a couple of children’s walkers, and a few days ago a 7-year old boy walked for the first time, and a 9 year-old boy wrote his name for the first time.
Ashleigh does movement therapy, sensory therapy, passive massage; pretty much everything—Supertherapist! Fridays are my favorite day…on Fridays I always go to the RBC Center and see patients, young and old. I treat a lot of gastritis and arthritis there; the moms of these kids have lots of stress and physically challenging lives. But on Fridays, when I am there seeing patients, I get to see what Ashleigh and everyone is doing—giving attention to the children, giving the mothers a desperately needed rest from the constant care they have to provide, helping people get their mobility and independence back. Annee, Sky, Noah, Sirin, Rachel, and Nick have spent many days working with the people at the RBC., and I love when we get to all work in the same place.
It is wonderful what can be achieved when you are helping somewhere long enough to learn the lay of the land and what the real needs are, and make the friends and connections necessary to undertake more ambitious projects. Of course, you also need outstanding individuals like the volunteers that have come out to help us. Ashleigh was amazing in action; when she went home it was a sad day for us and also for the clinic staff and patients and families.
The clinic closes for an hour at lunch, and we usually walk down the road to our friend Sherman Arch’s Iguana Park. Sherman is caracol, meaning of white descent but an islander who speaks the patois of the island. He is second generation here, and on his property iguanas are not allowed to be killed, so over the decades they have congregated. He takes in rescue animals, including monkeys and coatimundis, and does turtle rescue. He often feeds us at lunch and sometimes gives us rides back to the boat in his truck or the 37-foot skiff he made himself. He has been enormously kind to us, esta un bueno hombre, another angel we have met.
High in the air during a night flight across the dark ocean a week or two ago, I suddenly remembered a story I read years ago that seemed appropriate for the moment. It happened on the way back from a patient transport in the helicopter to the mainland, and I was sitting in the back thinking about what Floating Doctors became after starting so long ago as a decision made on the plains of East Africa, when I decided to go back to the developing world with more help. I contemplated the path we followed to make Floating Doctors a reality; I thought of all the heartbreaking setbacks and the glorious triumphs that were achieved by the goodwill of people who seemed to come out of nowhere to help pick us up when we fell, and encourage us to keep going, and who worked side by side with us.
The story I remembered is about a man climbing a tall, steep mountain in his dream. After a desperate struggle, he makes it nearly to the top…then falls. The story says that when it comes to the dreams perched high atop the mountains of your mind, it is sometimes a mistake to climb to reach them—but it is ALWAYS a mistake never even to make the attempt. If you climb, you can either succeed or fall. And sitting there in the helicopter, thousands of feet above the dark, luminous, serpent-haunted sea, I understood in a very literal way the third option mentioned in the story: sometimes, when you fall during the climb to reach your dreams, you find out you can fly.
There have been many angels who caught us when we fell and who helped Floating Doctors continue forward. I know I talk about it a lot, but I don’t care. I wanted to thank you all again very much, and to know how much it means to me that you believed in us and helped us and worked with us to make Floating Doctors fly—both in spirit and, riding the clouds over the gulf of Honduras, in literal fact.
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The Million-Year Day
All Together One Last Time
I love the end of the day—not because our work is done, but because that’s when I finally catch up with most of my crew, who are often scattered in several locations across the island for most of the day. We return to our home on Southern Wind with stories, smiles and sometimes tears from what we have seen and accomplished during the day, and every night when I learn what everyone did that day I am astonished at the sheer number of things that happen. Each evening, the morning feels like a million years ago.
A couple of days ago is a good example. I started my day at 6:00 AM when I got up to say farewell to Ashleigh, Nick, Rachel, and Annee. Our friend Sherman, who runs the Iguana Sanctuary on Roatan, arrived at Barefoot Cay to bring everyone to the airport. These moments–when people that I have closely bonded with, lived and worked with for many weeks, shared so many experiences with and laughed with, have to leave and go home–are always tough for me. That morning was especially hard when I said goodbye to Rachel and Nick; Nick has been with us since St. Augustine when we were frantically rebuilding the boat in the marine yard, and Rachel has been with Floating Doctors since the days in Palm Coast with 13 people crammed into a house stuffed with medical supplies, working on the boat parked in the canal behind the house through record heat and record cold. It was hard to watch everyone drive away, getting a last glimpse of their faces and thinking of all we shared together, and wondering when our paths will cross again as we trudge the road of happy destiny into our futures.
At 6:45 AM, the helicopter called—two victims of a house fire in Coxen Hole (a 24 year-old woman and her 7 year-old sister) with 2nd and 3rd degree burns over their extremities, faces and torsos, probably right on the edge of what a person could potentially survive. Sirin, Zach (the helicopter co-pilot who has been staying on the boat and helping us) and I suited up and deployed to the local powerplant, where the helicopter is now parked in a field surrounded by high-tension wires (I’m glad our pilot has over 18,000 hours). Our friends the Bomberos delivered the two patients, we loaded them into the helicopter with two family members and took off with all speed, climbing high over the ocean to weave a path through the weather and over the high mountains of central Honduras.
We flew the patients to Tegulcigalpa, where the only burn unit in Honduras can be found, and coincidentally is one of the most notoriously difficult approaches in the world. Ringed with high steep mountains, at altitude, aircraft have little room to maneuver in Tegus. Also the minimum safe altitude approach is 9,000 feet from every direction—which meant a whole set of problems for me and Sirin manageing our patients in the back of the helicopter. Years ago, before I climbed Mt. Kilimanjaro, I bought a book of high altitude medicine to learn about the particular problems of human physiology at altitude, and that reading came in handy in the helicopter as we climbed quickly from sea level to ten thousand feet. Hypothermia, increasing pulmonary edema and tissue edema, swelling of the 2nd degree burn blisters, and low oxygen in the thin air all come into play when you manage patients at altitude, and burn patients are extremely fragile to begin with.
When you are working with a capable team, your focus can become quite intense—scrutinizing every drop of the fluid falling through the IV, monitoring heart rate and breathing and oxygen, knowing your team has the other patient or other responsibilities under control. Back to back, Sirin and I focused on our patients and willed the helicopter to greater speed as we passed sheer mountain peaks and fought through the cloud layers. The young woman was barely conscious, but the little girl was alternately sleeping and wide awake, and she was the bravest little girl I have ever seen. Third degree burns over her arms and legs, her hair scorched and face blistered, she was aware of us watching her and every few minutes would give us that little smile that means ‘I’m OK’ as she lay in the vibrating helicopter swathed in bandages. I have seen bravery many times, but I don’t know if I have ever seen courage like this little girl had.
Captain Ed Flies His Colors
We landed and transferred our patients to the airport ambulance, and after a cup of coffee we turned back towards Roatan. I passed out on the stretcher—the fatigue factor flying in the helicopter is very, very high, and after all the endorphins of the patient transport are spent, sometimes the tiredness takes over. Two and a half hours later, we made the approach to our tiny LZ on Roatan, landed safely, and riding high from a tough job well done, we returned to our home on the boat in time to take Giles for a walk before his dinner. It is so surreal, but just another day in the life of the Floating Doctors.
I love the helicopter flights—not only because each one is an adventure, but because there is currently no other medical crew to transport patients, and as far as I know the Aeromed helicopter is the only rescue helicopter in Honduras; certainly the only one that is available to fly impoverished members of the community. The resorts here all have memberships, which helps the helicopter service stay operating, but memberships are also available to the community. 40 families get together and each contribute $10 a month, and are entitled to unlimited emergency medical transport in the helicopter. And when people who are impoverished and are not members of the helicopter service need to be flown? The helicopter usually flies anyway, sometiems with money for fuel from Richard Warren, the manager of RECO (the electric company here). Since there is currently no other medical flight crew (Yolanda, the paramedic has gone home for a few months), we are in the right place and right time to temporarily fill a great need, and we are working to train replacements from among the firemen and local doctors to ensure that the service can continue after we leave. Sometimes people ask me if I miss the ‘Real World’ (not the show, the ACTUAL ‘real world’) and it always makes me a little sad. Every day here feels like a million years because it is packed with reality…look into the brave eyes and smile of a horribly burned 7 year old girl that you are working to keep alive in a situation where there is either you, or no other option for help. This is as real as it gets…real life is all around us, all the time and sometimes in modern developed society it seems like we somehow get blind to the richness and deaf to the heartbeat of the surge of lives and stories happening on all sides.
My dream was to create the means to stop where there was need and help in whatever way we could, and every day I watch my dream unfolding all around me. The people who have made that leap of faith to travel to this far shore and work with us, bringing my dream to life in ways I never imagined, have a spirit of goodness in them that I love to be around, and when they go I miss them very much. I can’t believe how lucky I am to have had the chance to meet and spend time with remarkable men and women who have worked side by side with me to bring help where it is needed. Tweek and Giles miss everyone too, they are moping and needy and looking around for people who aren’t here.
The boat would be very quiet with just Sirin and myself onboard, but thankfully last week we were joined by a new member of our crew, Captain Ed Smith. A McGuyver-level technowizard as well as a Marinero and all around great guy, Ed passed through the boat in one week like a storm, systematically knocking items off our to-do list and getting the boat set for sea when Noah and Sky and Bryan return in three weeks. I’m looking forward to having his skills and his company (he’s got awesome stories and a great laugh) as we navigate further south when we depart Honduras.
And so ends another typical day on Southern Wind, current position, Isla Roatan, Honduras. Every day is an adventure in life. A thought that drifts through my consciousness nearly every night as I fall asleep is always ‘I wonder what will have happened by eveningtime tommorow…a million years from now?’
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Two years after I decided to hang up my stethoscope in Ireland, leave the hospital in Dublin behind and move back to the US to organize the Floating Doctors, here we are in Lake Worth Inlet on the Southeast Coast of Florida waiting for a weather window to make the crossing the Haiti.
Captain Don Capo
So many generous hands and hearts have made FD a reality. I am thinking of our friend Don Capo, who helped us save thousands and thousands of dollars, guiding our work on the hydraulics and running gear, and hull repairs, and the refurbishment of many other systems. He finished the survey of our vessel the very morning we sailed from the dock at St. Augustine Marine Center and headed to the inlet to anchor. He stepped off the boat, and he grew smaller and smaller on the dock we left behind. His kindness and generosity are part of what we will carry with us and pay forward on our mission.
Crew Deploying Mooring Snubber
On the 200 mile transit to Lake Worth inlet on Florida’s southeast coast we broke up into three watches of three crew each, 4 hours on duty twice a day, 8 hours apart. My own was the 12-4 AM/PM watch. I am usually up till 3 or 4 AM anyway–when you are working on the boat all day and leading a crew, the quiet night hours are the best time to get paperwork and admin done. I have no difficulty sleeping till 9 or 10 AM after coming off watch at 4 AM, even with the morning noises accompanying the other two watches getting up to begin their day. Some of the crew are inherently early risers–you know, those folks who wake up around 5 or 6 AM every day and have no trouble falling asleep around 10 or 11 at night…lucky devils. Some have sleep patterns more like mine, so we were able to do a pretty good job spreading people around into watches that suited their natural sleep/wake cycles.
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On Friday January 22nd, we moved Southern Wind from the dock where we have been working for months in Palm Coast, 30 miles north up the Intracoastal Waterway to St. Augustine for a haul-out and two weeks of yard work at St. Augustine Marine Center before we sail for Haiti. Haiti has always been our fist planned destination, and ever since the earthquake we have been frantically trying to finish our work on Southern Wind and set sail. The Rotary Club here has raised money for additional fuel–normally we would travel under sail as much as possible to avoid using too much fuel, but people are more important than diesel and when we depart, we will travel with all sails up and both engines pushing hard all the way to Haiti.
Our project is designed to deliver medical supplies where there are no ports, so the devastation in Haiti’s commercial ports will not deter us from going. Also, we originally planned to sail on from Haiti, but we are leaving some of our field gear here in Florida to make foom for additional supplies and volunteers. Our friend Veronica from Rotary has a bus that we can store our surplus gear in and collect when we return to Florida to drop off Volunteers and take on new arrivals before departing for Central America.
St. Augustine Marine Centers 100ton Travellift
First, though, we had to get Southern Wind safely out of the canal where she has lain for ten years, over the 6-foot bar between our canal and the intracoastal, and safely up the intracoastal to the marine yard in St. Augustine for a haul out the next m0rning. Southern Wind is a BIG boat–70 tons, and this would be our first time feeling how she moves in the water. Captain Ryan Emberley, our friend from West Marine in Jacksonville, was aboard to pilot the ship safely on the maiden voyage of her rebirth after years of exposure to weather and slowly dying in her quiet canal.
We were to dock at St. Augustine Marine’s long dock on arrival, stay there the weekend, and haul Monday morning. We calculated that at 10 knots and no problems, the 30 mile run to St. Augustine could TECHNICALLY be made in 3 hours, but even though I think all of us figured there was no way things would go that smoothly, none of us anticipated the Three Hour Tour we would all experience over the next 72 hours.
Besides working so hard for so long, besides our desire to put our project into action, despite the earthquake in Haiti that has us chomping at the bit to set sail, we had one additional reason to want to move Southern Wind out of her canal–lots and lots of dead fish. A record cold snap (of course, right? While we were here in Palm Coast, we have had record floods, record cold…what’s next?) kept the temperature around or below freezing for days on end, and the canals got so cold that THOUSANDS of fish–mostly catfish, but also snook, jacks, mullet, needlefish–froze to death, and in the two slightly warmer days of preparation to move Southern Wind, all their rotting bodies floated onthe surface and the tides and wind brought ALL the canals’ dead fish down into our blind end canal.
Continue reading The Southern Wind Leaves Her Dock in Palm Coast For The Last Time…
