After a helicopter flight off of the USNS Comfort, a rumble through the streets of Port-au-Prince, a military evacuation flight to Orlando and a commercial flight to BWI, Kim Hairston and I are back in Baltimore today. We both felt some guilt in leaving the ship and the country behind when so many others don’t have the chance. We hope to be back soon.

The first two weeks of the Comfort’s mission to Haiti showed us the potential of Navy humanitarian medicine. The humanitarian mission in 2007 felt like a vacation in comparison; This trip had the urgency and the seriousness of purpose of a military campaign. And unlike the ship’s earlier visits to Haiti, with limited crew and more public affairs specialists than surgeons, this time the Comfort made full use of its tools.

We also saw how much more is left to be done. For all the sick and injured patients in the ship’s treatment beds, you see many more with a casual stroll through the streets of the city. Capt. Jim Ware said Wednesday that a stay as long as six months is not out of the question.

The American military presence in Haiti continues to astound, and not just the array of grey-hulled Navy ships bobbing around the Comfort in Port-au-Prince. We visited a Catholic Relief Services food distribution site at the suburban Petionville Club (shown here), where the 82nd Airborne Division has moved in 400 troops and taken over the clubhouse as a headquarters. At the Port-au-Prince airport we were told no one can get in unless they have a verified charter flight or an American passport. U.S. Air Force cargo planes landed throughout the day.

One of those planes took us home. After verifying our American residency and signing a form promising to pay the government back later, we were given wristbands designating us as evacuees. After a few hours waiting in a tent set up on the tarmac, we boarded an Air Force C-17 for a flight to Orlando. The scenario continued throughout the day. The tent filled up with people wearing wristbands until they were shuffled off to an awaiting Air Force plane. You don’t know your destination until you’re onboard. The woman sitting next to me cringed when they told us we were going to Orlando. She lived in Miami.

I’ll try to answer all the emails I’ve received the last two weeks, now that I have an internet connection that doesn’t rely on a shaky satellite signal. And I’ll try to answer other questions about the Comfort’s trip too.

Photo by Kim Hairston

Posted by Robert Little at 5:14 PM | Permalink
        

Haiti's medical needs a week after the earthquake are overwhelming -- even with the presence of the USNS Comfort and the influx of doctors from the United States and other countries. As I note in this audio interview, to treat serious burn patients, who require months of medical attention, the Comfort has made arrangements with a stateside hospital for continuing care. But the hospital ship also has had to turn away some patients -- those with serious brain injuries, for example -- who would take up a disproportionate amount of medical resources. That will allow the ship to focus on other patients who can be treated and released.

That very difficult issue lands at the Comfort because it is the most advanced hospital in Haiti. The ship's medical operations director told me that putting three hospital ships side by side in Port-au-Prince harbor wouldn't be enough to solve the problem. I think you could drop Shock Trauma and all of Hopkins hospital here and they would be still be overwhelmed.

Posted by Robert Little at 12:34 PM | Permalink | Comments (2)
        

Today in The Baltimore Sun, I wrote about "angel flights," used for those who have died onboard the USNS Comfort. As aircraft land and depart throughout the day, the call eventually goes out for an "angel flight," a term familiar to anyone who has deployed to a war zone. For a brief moment the activity stops, a chaplain appears on deck, and crew members carry out the stretchers loaded with black bags. They are loaded onto the helicopter for a last flight to the island.

"We're mindful of the fact that these are extraordinary circumstances and many of these people have large families and loved ones who aren't with them right now. But we're a family and we're with them," said Cmdr. Dave Oravec, a chaplain at National Naval Medical Center in Bethesda and one of three serving aboard the Comfort.

Posted by Robert Little at 11:14 AM | Permalink
        

Back from a couple of days in Port-au-Prince, I can say that the city is different than I've ever seen it. There are thousands of people sleeping in tents, and the park across the street from the national palace is filled with lean-tos made out of blankets and pieces of platic. It seems like a pretty precarious place right now.

You can hear more of my impressions on this audio interview.

Posted by Robert Little at 2:35 PM | Permalink
        

The crew of the crowded USNS Comfort has come up with an alternative to the dreaded “hot-racking” system in place now, which calls for two people to share beds, sleeping in shifts. The Navy is making plans for a second ship to anchor alongside the Comfort and serve as a sleeping facility, with some sailors working 12-hour shifts on the hospital ship, then spending 12 hours on the other ship to sleep and relax.

Whether that system will be an improvement over hot-racking, a much-hated tradition of Navy deployments, is not certain. Crewmembers sleeping on the other ship will have to get there by boat, adding another complication of scheduling and logistics to an already disjointed lifestyle.

Posted by Robert Little at 1:02 PM | Permalink | Comments (2)
        

Over the past couple of days, as patients poured onto the USNS Comfort, it has become clear that the ship is reaching its breaking point. Space and supplies are overtaxed. The injuries are so abundant and severe that an otherwise acceptable caseload is unmanageable. And medical staffers realize that the ship might have to accept a reduced standard of care for Haitian patients, who don't have the luxuries of long-term rehabilitation.

"Now, the staff may have to decline care to some critically injured patients, if only to free up room and resources that could be used to save more people. "We can't look at each individual patient and say we're going to do everything for them that is possible, like we do in the United States. We have to acknowledge that we don't have endless resources," said Capt. Andrew Johnson, the ship's director of medical operations.

Posted by Robert Little at 10:22 AM | Permalink
        

On one of the first days of the USNS Comfort's mission, I met Lt. Cmdr. Mill Etienne, a Haitian-born Navy doctor who is a true American success story. His parents fled Haiti when he was 5 and settled in New York, where his father drove a cab and his mother cleaned houses. Mill didn't want anything to do with his former island home and cringed at the sound of his family's tropical lilt.

Through hard work, he attended Yale, went to medical school and became a Navy officer. When Haiti's capital was devastated by the earthquake, the 34-year-old quickly volunteered to help on the Comfort. He's been treating patients pouring in from Port-au-Prince, and has even found time to help arrange cultural awareness seminars and write a manual describing Haiti's history and people. For more about his extraordinary story, here's a longer profile on Mill that I wrote with Jill Rosen in Baltimore.

Posted by Robert Little at 9:46 AM | Permalink
        

The goal Friday was to move 120 injured earthquake victims to the U.S. Navy’s modern, sterile medical facility floating off the coast. To coordinate the mission, the USNS Comfort sent a trauma surgeon with four combat tours, as well as a security team to establish a landing zone outside Haiti’s ruined presidential palace and begin ferrying patients by helicopter.

But Friday did not turn out as a day of humanitarian medicine for the Comfort’s shore-side Rapid Assessment Team — it only brought frustration and wasted time. By day’s end, stymied by logistical problems at every turn, the team had yet to send a patient to the ship. And the impact was palpable: The Comfort, which treated 102 patients Thursday, treated only 69 Friday.

Team leader Capt. Richard Sharpe bitterly summed up the long, maddening wait: “Here we are out at the presidential palace. People die, captain takes nap.”

The team had touched down by helicopter at 7:30 a.m. on the same palace lawn where 60 or more patients were flown to the Comfort on Thursday. But Sharpe had taken only a few steps away from the helicopter’s spinning rotor when a U.S. Army officer told him that the landing zone was closed until 11 a.m. The United Nations was planning to distribute food and other aid on the grounds, and didn’t want the American military around, the Army officer said.

Later, after hours of wasted time, the story changed. An Army officer said the landing area was closed out of concern that Haitians -- including thousands in a nearby tent city -- might think the Americans were taking over.

So the Navy team kept waiting on the palace lawn — under a mango tree with roosters and peacocks strutting around them — for a helicopter that never came.

Photo from the Los Angeles Times

Posted by Robert Little at 8:52 PM | Permalink | Comments (1)
        

In a day filled with still more moans and cries, broken bones and infected wounds from earthquake victims, the USNS Comfort got a surprise Thursday: a 4-pound, 5-ounce preemie named Esther. Her arrival - seven weeks early - in the Comfort's operating room marked a milestone of sorts. It's believed to be the first onboard delivery since the ship was converted to a floating hospital 22 years ago.

The expectant mother arrived on the ship Wednesday with a fractured pelvis. She said a building fell on her during the earthquake, and she had received virtually no medical care since.

"It's amazing that baby survived," said Lt. Cmdr. Susan C. Farrar, an OB/GYN physician from Portsmouth, Va., who delivered the child by Caesarean section. "She's been in a bed somewhere, with those injuries, since last Tuesday."

Here's my complete story about Esther and the day's events.

Posted by Robert Little at 9:10 AM | Permalink | Comments (1)
        

The first of the Comfort’s 350 additional crew members began arriving onboard Thursday morning, on helicopters from the airport in Port-au-Prince. The ones I spoke to had left Portsmouth, Va., two days earlier, spent a night in Guantanamo Bay, Cuba, then spent last night in Haiti. To meet one of the needs identified in drills and in yesterday’s first full-day receiving patients, most of them were nurses.

Cmdr. Mark Marino, the head of nursing, introduced himself to each one, asked them what their specialty was and sent them off to Intensive Care, the pediatric ward, the emergency/receiving bay, whatever. There’s was no time for orientation. “No amount of staff I get for Haiti is ever going to be enough, but we’re glad to have them,” he said.

Also onboard are several additional surgeons, including five orthopedic surgeons, bringing the total number of cutters to 24.

Posted by Robert Little at 5:29 PM | Permalink | Comments (1)
        

The crew of the USNS Comfort got a chance Thursday to deliver its first baby since its arrival in Port-au-Prince, but the procedure was creating as much anxiety as happiness.

A young woman, 34 weeks pregnant, arrived on the ship with a fractured pelvis that caused her uterus to drop, much as it would when she was ready to give birth. Because of the baby, surgeons can’t operate to fix her pelvis, so they were preparing for a Caesarean-section followed by exploratory surgery and a possible fix to her broken bones.

The Comfort already has plenty of babies onboard, some of them quite sick but many of them brought to the ship simply so their mothers would not have to look for post-natal care in Haiti. One of the first babies onboard was a young man named Vinson, named after the aircraft carrier U.S.S. Carl Vinson, where his mother said he was born.

Posted by Robert Little at 5:20 PM | Permalink | Comments (1)
        

The doctors, nurses and other medical staff on the Comfort are still feeling the initial adrenaline rush of helping the Haitians. They're enduring 16-hour days, and yet asking for even more patients. Meanwhile, the crew keeps growing, as new staffers come onboard this morning.

There is no shortage of injuries to treat. One Haitian man, a school bus driver, was pumping gas when the earthquake hit -- rupturing the gas pump and leaving him with horrendous burns. Yet when he reached the Comfort, this guy seemed like one of the happiest people on the ship. I don't think I've ever seen anyone so happy to be sitting in an emergency room. Here's audio from an interview Thursday morning for The Sun.

Posted by Robert Little at 11:29 AM | Permalink | Comments (1)
        

With the Comfort taking on a larger crew, life onboard has gotten increasingly cramped. On the way to Haiti, the public affairs office used an overflow patient ward, folding up the beds. But all that has changed, so the areas devoted to patient care can be maximized.
Every bunk is filled, and sleeping in a room where they're stacked several levels high takes some getting used to. Guys snore a lot -- imagine sleeping with 40 in a room. Sometimes it's louder than the ship's engines.
Still, no one's complaining. Everyone understands the importance of the Comfort's mission, and is more than willing to put up with minor inconveniences.

Posted by Robert Little at 10:05 AM | Permalink
        

The face of the Haitian disaster arrived onboard the Navy hospital ship Comfort Wednesday, as a procession of earthquake victims, looking lost and scared, staggered off helicopters or strained to look up from their stretchers while Navy corpsmen carried them below deck.

There was a 20-year-old man with a shattered right leg wincing; a 47-year-old woman with her arm in a splint crying; a school bus driver, burned from the tips of his fingers to the top of his head, smiling. They came from clinics and triage centers throughout Haiti, beginning just after sunrise and ending at dusk, shattering the ship’s military and clinical sterility with the cries and smells and blank stares of human anguish.

More than 70 were onboard when the helicopters stopped flying, the first ripple of what is expected to be a torrent of patients over the next few days.

“I saw more patients in six hours today than I would normally see in 24 hours back home,” said Lt. Cmdr. Dan D’Aurora, director of the Baltimore-based ship’s receiving ward and division officer of the emergency department at the National Naval Medical Center in Bethesda. “This is what we train for. This is what it’s all about for us.”

The patients were flown in by the Navy, Coast Guard or Air Force in one of the 30 helicopters available within the ship’s range. Plans for a boat-based shuttle were foiled by an earthquake aftershock that flattened the pier the Comfort had expected to use, and that jolted the ship as if it had hit ground. Ship officials identified an alternate boat-landing site by mid-afternoon.

Operations were also hindered Wednesday by the slow arrival of more than 350 additional crew members who are expected to bring the vessel up to its full 1,000-bed, 12 operating room capacity. Most of those crew members, expected to cycle onboard over the next two to three days, will arrive by boat.

But even with the slowed startup, the ship’s main treatment and assessment rooms seemed on the verge of being overwhelmed. As one helicopter touched down on the Comfort’s flight deck, three or more others could sometimes be seen circling in Port-au-Prince harbor.

Baltimore Sun photo by Kim Hairston

Posted by Robert Little at 8:19 PM | Permalink
        

After getting the first patients onboard overnight -- including six-year-old Lionel shown here, we were awakend this morning by what felt like us running aground. It turned out to be an earthquake aftershock. We're safe here, but worried about what's happening on land. There are reports that a pier the Confort might use has collapsed,, but I can't verify that.

Baltimore Sun photo by Kim Hairston

Posted by Robert Little at 10:56 AM | Permalink
        

Expecting to arrive within helicopter range of Haiti overnight, the crew of the Navy’s Baltimore-based hospital ship began a series of exercises Tuesday, using dummies and a fake medical script, trying to locate holes in the assessment and treatment plan crafted during the last three days at sea.

Not a bad idea -- until the vessel’s Master ordered an abandon-ship drill for everyone onboard. Fictional patients included.

The ship's officers found some things to tweak, but say they’re all set to begin treating earthquake victims, who could arrive on the ship during the night. “We don’t normally abandon ship in the middle of chest compressions,” said Cmdr. Tim Donahue, head of surgery on the Comfort. “But we did fine. We’re ready.”

Baltimore Sun photo by Kim Hairston

Posted by Robert Little at 7:24 PM | Permalink | Comments (2)
        

The mood aboard the USNS Comfort is a cross between anxiety, excitement and gratefulness that this part of the cruise is over. Everybody is ready to get to work. But there's more planning in store. Security issues are being worked out. And due to fears of malaria and other tropical illnesses, uniforms are being treated with insect repellent and medicines are being distributed to the crew. This audio interview provides more about my impressions.

Posted by Robert Little at 1:13 PM | Permalink
        

As the USNS Comfort nears Haiti -- we're expected to get there tonight -- the crew is scrambling to prepare for the first patients. Dry runs are planned today using dummies, to test the flow of patients around the ship (the CAT scan room is shown here). Outside, it's a calm, sunny day, unlike the rainy, windy weather that has buffeted the ship.

Meanwhile, Comfort commanders are working out the logistics of accommodating an expanded crew in Haiti. There will be about 1,300 people aboard ship, and only 1,200 beds, so they're trying to arrange for sleeping in shifts. They're also considering water rationing. The ship's ability to produce clean water can't keep up with the increased demands, and the water in Port-au-Prince's harbor is too polluted to be treated. To get a steady supply of water, the Comfort would have to steam out to sea again, which would hinder its ability to treat patients.

Photo by Kim Hairston

Posted by Robert Little at 11:13 AM | Permalink | Comments (9)
        

-- Length: 894 feet

-- Beam: 106 feet

-- Draft: 33 feet

-- Displacement: 69,360 long tons

-- Speed: 17.5 knots

Posted by Dave Rosenthal at 10:30 AM | Permalink
        

As the USNS Comfort buzzed Sunday with preparations, word came that the ship would add more crew members and be pushed to the outer boundary of its capabilities. The ship left Baltimore with enough crew and supplies to run the equivalent of a 250-bed hospital and four operating rooms — about a quarter of its theoretical limits. With the additional crew, which will board in Haiti, the 894-foot ship will reach its full operational capacity for the first time since it was delivered to the Navy in 1987.

So even before Comfort’s arrival in Haiti later this week, its already frenzied deployment has turned into a mission that will strain the ship’s limits and test the Navy’s capacity for expeditionary medicine. And for the vessel itself — whose missions to wars, disasters and impoverished countries the last two decades has left a wake of critics who say the Baltimore-based ship is too slow and cumbersome — Haiti could provide the first chance to show what it can really do.

“This is the right way to use this ship,” said Cmdr. Tim Donahue, a urological surgeon from Bethesda and director of surgery for the mission to Haiti. “It doesn’t make sense for us to go down there with only four operating rooms when we have 12 that we can use. If we’re down there, we need to maximize the capability of the ship. And we are.”

Since 2007 Comfort has twice sailed on months-long humanitarian missions around Central and South America, making scheduled stops to set up health clinics and bring patients aboard for elective surgery.

But those missions — which carried more public affairs specialists than surgeons — were more about foreign relations than disaster medicine. Each tour took more than a year to plan and coordinate, and the ship stuck to a rigid schedule even when hurricanes or floods presented unexpected emergencies within its range.

While hailed as peacetime successes, the humanitarian missions raised questions within the Navy about their military value. And they exposed the complexities of using a giant ship — which often can’t sail within a mile of land because of inadequate water depth and port facilities in developing countries — to help patients on the ground.

Baltimore Sun photo by Kim Hairston

Posted by Robert Little at 4:00 AM | Permalink
        

The chief of Navy medicine expects the USNS Comfort's Haiti mission to be a long one, according to a report from the American Forces Press Service.  Navy Vice Adm. (Dr.) Adam M. Robinson Jr. visited the Comfort as it prepared to leave Baltimore harbor Saturday and said the deployment to Haiti will be “a life-defining assignment” for the crew.

“This is not a training mission,” Robinson, who led a medical hospital detachment in Haiti in 1999, said, according to the AFPS report. “I suspect that we will have medical and naval assets in Haiti [for] six months minimum, and I think longer than that.”

The medical staff aboard the Comfort mostly is from the National Naval Medical Center in Bethesda, Md., and Portsmouth Naval Hospital in Virginia. Other specialists from many other Navy hospitals and clinics in the United States are aboard the hospital ship.

Photo courtesy of the U.S. Navy

Posted by Dave Rosenthal at 6:01 PM | Permalink
        

Photographer Kim Hairston and I are embedded on the USNS Comfort, settled in for the trip to Haiti. Here's an excerprt from  my report on the rush to set sail and a photo gallery of the ship:

ABOARD THE USNS COMFORT — The U.S. Navy’s East Coast hospital ship sailed away from its Baltimore home Saturday, steaming toward a desperate and uncertain mission in Haiti that could last months. Tugs, draped with white sheets to keep bumper marks off the vessel’s white hull, started pushing the ship into the channel around 9 a.m. ... The 894-foot floating hospital, with 12 operating rooms and 1,000 treatment and recovery beds, deploys every year or so on humanitarian tours or training missions, and a skeleton crew stays onboard year-round for maintenance. But yesterday’s departure still bore signs of a hasty one.

By the time Comfort left the pier in Canton, most of the toilets in the berthing spaces were overflowing. Paperbacks in the ship’s library lay in a pile in the center of the floor. The ship’s store was closed, its empty shelves visible through the window in the door. Food was an immediate challenge, with the Navy cooks scrambling to assess the galley’s equipment and locate all its supplies. As crew members ladled out a lunch of meatball subs and fried fish, the menu board still hailed a salmon and roast pork dinner from last July.

Because of the Navy’s deployment rotations, most members of the crew had never been inside the ship before yesterday. The odd configuration of the converted oil tanker, peculiar to anyone familiar with the more symmetrical layout of a gray-hulled Navy vessel, had crew members pacing the passageways and clogging the stairwells trying to learn their way about.

“Everybody wants to be here,” said Cmdr. Deborah Carr, a physical therapist from the National Naval Medical Center in Bethesda. “You see it on the news, you see what’s happening there, you want to go.”

Posted by Robert Little at 5:23 PM | Permalink
        

The USNS Comfort hospital ship is headed to earthquake-ravaged Haiti for its biggest mission ever, and a story by The Baltimore Sun's Joe Burris outlines the challenges. Military Sealift Command spokeswoman Laura Seal said the staff of more than 600 (including 560 medical personnel and 65 civil service mariners) is on an open-ended mission. And the crew expects to encounter horrific conditions on the island.

"When we go to casualty situations on a grand scale, we're going to see things like skull fractures, aneurysms and neurological issues," said Chad Singer, a hospital corpsman from New York. "We'll have ventilators. We'll have people with severe blood loss, so we'll have to do transfusions."

The 894-foot ship provides full hospital services to support disaster relief in the U.S. and worldwide. It has one of the largest trauma facilities in the country and also has four X-rays, one CAT scan unit, an MRI unit, a dental suite, a pharmacy and an optometry and lens laboratory. The ship maintains up to 5,000 units of blood and can serve as many as 1,000 patients.

It marks the second time in less than a year that it will head to Haiti. In July, the ship served as the platform for humanitarian and civic assistance in Haiti and other Caribbean nations. It treated more than 100,000 patients.

Navy Lt. Cmdr. Thomas Olivero of Frederick said that one of the biggest challenges in readying the ship for the Haiti mission is supplies. "While we're in port, we don't do procedures, we don't take care of patients. So the supplies that sit on board sometimes expire."

Baltimore Sun photo by Jed Kirschbaum

Posted by Dave Rosenthal at 4:42 PM | Permalink