Packard Children’s team offers vital pediatric relief

- By Erin Digitale

Courtesy of Joe BarnardHaiti Packard

Pediatric anesthesiologist Katie Larkin and surgical technologist Joe Barnard returned Jan. 30 from a nine-day relief effort in the Dominican Republic, treating children who had been brought over the border from Haiti.

The youngest members of Haiti’s society are now receiving care from a five-member medical team from Lucile Packard Children’s Hospital, who departed Feb. 2 to help the devastated population of Port-au-Prince.

During the two-week trip, the team of two pediatricians and three nurses, led by hospitalist Daniel Imler, MD, will pay particular attention to young earthquake victims who are unlikely to have other access to pediatric care.

"We have started to establish our different niches, filling roles in primary care mobile clinics, staffing the OR, doing pediatric ED and providing pediatric overnight coverage," Imler wrote in an e-mail sent Feb. 4 after the team's first full day at the general hospital in Port-au-Prince. Because Haiti suffered such heavy losses to its medical infrastructure and staffing, "the country is completely dependent on groups like ours," he added.

Imler is joined on the trip by fellow hospitalist Joe Kim, MD; hematology/oncology nurse Rich Ramos, RN; hematology and vascular access nurse Katie Purdy, RN; and craniofacial and wound nurse Elena Hopkins, RN. All five practitioners have prior experience on medical missions to the developing world.

The team took only what they could carry. Their personal items and medical supplies had to fit into 10 large duffle bags, two per person. Before departure, Imler worked closely with Rex Fieck, director of materials management at Packard Children's and Stanford Hospital & Clinics, and Robert Poole, the director of pharmacy services at Packard Children's, to make the best use of the limited luggage space.

"Most of the drugs that have come into Haiti via the military have been in adult dosages," Poole said. So the team packed liquid, chewable and suspension drug formulations designed especially for children. "Medication doesn't help if you can't get it into the patient," he said.

The final packing list included thousands of doses: antiviral and antifungal drugs; seven different antibiotics; pain medications; topical antihistamine, hydrocortisone and antifungal creams; drops for eye infections; and children's chewable vitamins. Haiti is hot, and the electricity is still out in many places, so none of the drugs need refrigeration.

When it came to other medical tools, Fieck helped select essentials that are in short supply in Port-au-Prince.

"We're talking about dressings, gauze, IV catheters, needles, syringes, tubing, baby wipes, sutures, scalpels – simple, basic pediatric medical supplies," Fieck said. The big duffle bags also hold kid-specific respiratory equipment such as pediatric aerosol masks and infant nasal cannulae.

The trip is sponsored by Packard Children's and organized by International Medical Corps, a non-governmental organization experienced in disaster relief. Stanford Hospital sent an eight-member team immediately after the quake that was also part of the IMC effort.

"They're going to help us coordinate our activities within the country so that we can make sure that we do the most good for the most people," Imler said before the team's departure.

The five providers now in Port-au-Prince are not the only Packard Children's staff to help with earthquake relief efforts. For instance, anesthesiologist Katie Larkin, MD, and surgical technologist Joe Barnard, CST, returned Jan. 30 from a nine-day trip to Jimani, in the Dominican Republic, where they cared for earthquake victims brought over the nearby border from Haiti. The needs of the children they helped give hints of what Imler's team may experience.

In addition to medical needs such as casts for broken bones, many Haitian children desperately needed some sort of entertainment, Barnard said. Missionary groups brought crayons, coloring books, paper and paint for the kids.

"There isn't a lot to do when you've lost everything, so having something to occupy the time of the children was important," Barnard said. He found out just how important when he helped treat a small girl who had her surgical dressing changed under anesthesia. After the case was finished, Barnard noticed a toothbrush sticking out from under the patient. That's funny, he thought. He asked the anesthesiologist to help him move the child.

"She had a total of four crayons, the toothbrush, and a coloring book beneath her, tucked into the top of her shorts," Barnard said. "At that moment I realized that those were likely her only worldly possessions. Realizing how desperate the girl was to safeguard her few belongings changed how he interacted with all his patients, he added.

Meanwhile, after just a short time in Haiti, Imler's team can already see the impact they're making. They are now working closely with another visiting team from The Children's Hospital of Philadelphia to make sure the pediatric ward in the general hospital in Port-au-Prince has 24-hour medical staffing.

"Prior to our combined arrival, there were no docs overnight, and they were losing around five kids a night," Imler wrote. "Now we can even keep preemies alive."

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