Greetings from Port au Prince Haiti where almost nothing exists but the cyber cafe across the street from Matthew 25 (M25) (look for website) in Delmas 33 where we have ended up staying because in the confusion the two places we thought we were going don't need us particularly. The patients they are expecting from the USS Comfort have not arrived nor have the tents, beds, sheets, etc. needed to keep the patients comfortable.
The trip here was very long. Air to Santiago okay but then the road trip to PaP. The Dominican roads are okay until 50 KM before the border. The border was closed but our Haiti contacts (Penny, a nephrologist in NJ and her Haitian husband Renee) somehow got it open-no passport control, just drive through. The road to PaP is hair-raising for the first part - rough and narrow and along a lake, but then okay. We stayed at Renee’s brother’s house the first night because it was too late to cross PaP. There are some problems with thugs-reportedly by the local population the same group that have always been thugs-but the real problem is everyone sleeping in the streets. It would not do to cause further injury or death.
They very kindly put up 11 of us which is to say we, along with almost all of the household, slept in the yard. Their house was okay but the guest house adjacent crashed. I really thought I was too old for camping but this will be a week of it and I slept fine (but it turns out that was on grass. The hard pack the next two nights in the M25 yard was another matter. We finally commandeered mattresses from the house.).
Aword about our team: 4 Haitian Americans-2 translators and everything else that needed doing, one ob nurse, one retired pathologist who took intake histories, 3 pediatricians, a 4th year med student, PT, West Point engineer and Dominican-American trained as MD in DR but working as an eye surgery tech in the US. 11 in all and we really worked together amazing well. 4 of us had never been with the group before, 3 had never been in Haiti before and spoke no French or Creole.
Our first morning here we were taken on a tour of the city to see the damage - much worse than anything shown on the US news and heart breaking. All the art in the churches and the Cultural Center is destroyed and whole neighborhoods in rubble. Many of the institutions of higher learning (as well as lower level schools) are destroyed-including students and faculty. The medical students escaped decimation because they were out demonstrating about something or other. What a disaster to the countries ability to recover-much of their brain power gone. The Olafson is standing and in its usual use by the news folks. Mostly make shift tents in every open space including the main market and square in front of the palace. So far we have not had any after shocks but everyone waits and there are daily rumors that a bigger one will hit. Some folks have started repairing or rebuilding housing (seems without any new construction safeguards. The market vendors are starting to return along the streets.
M25 has set up a clinic/health service in the tent city that has grown on their soccer field. It is really a guest house with guest services but since they had some doctors and their supplies in residence when the quake occurred, word rapidly got out and they became a health service de facto. We will be in charge of it for the week we are here-clinic hours from 9 to 4 and any walk in emergencies at any time. We have set up working at an orphanage around the corner from Matthew 25 and working their clinic in shifts--too hot and wearing to work a full day at one thing. The orphanage has 30 or so kids but the entire neighborhood including all the adults come and the lady who runs it can't say no because they all help her feed and take care of the kids. Her husband was killed in the quake.
The excitement at the end of our second day was the water people bringing us a seizing kid from Cite Soleil because the hospitals only take patients by referral-or at least that is the general understanding. We used the last valium to stop the seizure and sent him off to the hospital for care (arranged by a French doc staying at M25 but working elsewhere).
M25 has folks-mostly 20 somethings –from a variety of NGOs and in a variety of areas. Some are new to the country and some have been here for a few years. Many are based elsewhere in the country but in PaP to find supplies, contact donors, etc. Everyone is gracious, tries to help and to be quiet since the place is loaded with visitors and part of the building is not supposed to be inhabited. We are sharing (probably 30 of us in all) 2 bathrooms and one shower. But we have running water and flush toilets. The building has been inspected by the earthquake engineers and most of it is okay. The permanent residents are staying in their own rooms and the dining room is in use, cooked food supplied twice daily so we all may gain weight before this trip is over and the power bars may go to the folks who work in the hills during the day or the kids in the camp.
We have a few amputees, post ops, the coughing from the dust; headache and stomach ache probably a combination of stress and insufficient water; and scabies is starting. We are looking for tetanus but haven’t seen any, fortunately! Our physical therapist got the amputees up on crutches and did some OT as well. Our older child with a unilateral lower extremity amputation went from lying on a mattress to roaming around the camp, made clothes for her teddy bear and then decided the teddy needed to have an injury wrapped in bandage just like her-so she gathered the necessary items. Two depressed painters finally got to work when we scouted up some paint and wood for their use.
As our week progressed we worked out a scheme for giving patients an abbreviated medical record to keep so docs following us would know what was done. We struggled with figuring out what to do for patients with chronic conditions who had no idea of the names/dosages of medicines from either before or after the quake; and many lost all their meds in their house collapse. We also put some order into the pharmacy (set up in the living room) so that we could know what was available/needed and where to find it in a hurry. We also saw a couple of young women who had tried to abort (and talked with more who either wanted to or planned to if they were in early pregnancy). We had to send them to the hospital to control the bleeding. They knew to a great extent about how to create a medical termination (along with a lot of hocus pocus) but whatever they were sold on the street with the correct name did not do the job.
This finding led us to talk with the camps leaders about doing a health education session for everyone. Our Haitian American ob nurse and the pharmacist along with some other help put on a show Saturday eve for everyone in the camp. About 300 showed up-all ages included. There was a lot of give and take between the audience and teachers and all seemed to have had a good time. Everyone over 15 who came forward was given a few condoms at the end. We then discussed with the leaders and the pharmacist continuing monthly sessions and gave a few suggestions for topics.
Other health highlights: One bilateral lower limb amputee’s husband had rigged a wheel chair for her using bicycle tires and a plastic lawn chair. She liked it better than the chair we brought with us. So PT and our Haitian fixer man rigged the US chair for a pre-quake very tall quadriplegic- son of one of the workers at the Missionary Flight site (they coordinate privately donated supplies). They were so pleased when we brought it to the airport that we were given carte blanch of supplies to take minus one palette which had already been promised. On Sunday we held a tetanus (DPT, dT vaccine available) vaccine clinic. Saturday night we sat around the dining table and made mini (1x2 inche) vaccine cards to give out and between 10 and 3 we vaccinated almost 800 folks. We had just about run out of needles and syringes when a US medical team about to head for home came by and gave us their supply. We also helped one of their EMTs decide to stay for an extra week and help us. It was probably fortunate we did (showed him what we had set up and how to manage things) because the team of docs who had stopped by Saturday for orientation had not shown up on schedule when we left Monday morning. Just before departing a young man arrived with shaking chills, fever, sweating and feeling generally awful. Is it malaria? Typhoid? Dengue? (fortunately no stiff neck so we could exclude meningitis for the moment). No lab, etc. So, we treated for the two treatable considerations and hope he gets better or another doc arrives. The two nurses in charge are very good, but there are limits to their authority.
Our original plan had been to leave for Santiago early Tuesday and take the last plane back to the States. But, it became apparent on the trip to PaP that that would not be feasible so we left Monday. The trip back was interesting because we could see the landscape. We almost had a problem at the border. We had not had passports stamped upon entry and when we went to sign into DR we were told we would have to go back to the Haitian side of the border (one hour travel time) to get signed in and out before we could enter DR. We decided that was not reasonable and that if we had never been signed out of DR there was no reason we could not just go back in from the no mans land area. It turns out no one even stopped us to ask for papers, etc. when we crossed the gate. We did get stopped about every mile for the first several by DR authorities; reason unknown to me. They would stop the bus, get on at the doorway, look around and wave us on except one stop when the guard discovered the driver was an old friend and a short conversation ensued.
Our Dominican American colleagues maternal family took us in for the night-real beds, Mama cooked food including a fantastic avocado, hot water and 3 bathrooms. For breakfast we had fresh laid eggs, just picked papaya, squeezed OJ, sweet lemon and Mama’s carrot cake along with French baguette and jam. And lots of good coffee (M25 also had good coffee if you got up before the giant pot was emptied). We managed to get on an earlier flight direct to JFK (original plan was via Miami at night) and the two who were going to Miami got a ride to the airport for the morning flight.
The experience was heart rending and exhausting, but I think we are all glad we went; felt like we really did do something useful for the camp (about 3000 folks all told, plus some more from the neighborhood) and helped set up a system which can continue as others come. The situation will probably get worse in many ways-the rains will come and there are insufficient shelters and more inadequate sanitation. Scabies was starting, the diarrhea will get worse; measles will probably reappear if vaccine campaigns don’t occur. School for the kids (or at least some regular activity) needs to restart in some fashion-they need stability and they will critically need the education in future years given the destruction of the older educated youth. The amputees and those physically disabled in other ways from injuries need PT appropriate to the conditions. And, the Haitians need to openly mourn (we saw very little upset among the camp even in those who lost almost everyone and everything). Hopefully the national day of morning scheduled for the end of the week we left will help.