Wednesday, March 24, 2010

A Plea for Haiti

By Sienna Miller
Global Ambassador, International Medical Corps

I came to Haiti as an ambassador for the International Medical Corps, an organization that I have been working with for over a year. Their teams arrived 22 hours after the devastating earthquake of 12th January and have been a powerful and leading medical presence ever since.

I arrived in the Dominican Republic from London on the night of March 18th, and met up with my friends Margaret Aguirre from International Medical Corps, and David Serota, a talented filmmaker who has come to document the long-term health care needs that lie ahead for Haiti.

We flew the following morning to Port-au-Prince and were met in the chaos by Andy Gleadle, our operations director, (the kind of 'man mountain' that you hope to be around in disaster zones like this one) and were briefed on the security issues we potentially faced. For starters, the local jail was destroyed in the quake, and as a result, 5,000 prisoners are free and roaming the streets. There were serious security problems in Haiti before the earthquake, but of course everything has now intensified. Three NGO workers were kidnapped the previous week, so Andy told us what to expect and how we would be protected (a two-car convoy at all times, watchmen by the tents etc). Afterward we drove to the guesthouse to meet the team, drop our bags and then head out to start the day.

Our first stop was St Louis, a neighborhood in Port-au-Prince, to visit Dr. Joseline Marhone. I sat with her in the shade of a tree, her patients surrounding us on beds in tents nearby, and asked her to share her experiences with us. Her house was destroyed in the quake, but thankfully she and her son were in the basement at the time and survived. Her two cousins upstairs did not survive. I found it so difficult to ask the questions that I suspected would be hard for her to answer. Journalism of this sort does not come naturally to me, but she explained that it helped her to talk about it. So she speaks, with a resilience and strength far superior to mine upon hearing her. She was the director of nutrition for the Ministry of Health in Haiti. The nursing school where she taught collapsed, killing every one of her students. She told us that she had found that the best thing for her to deal with her enormous pain was to keep busy and carry on doing what she does so well. To date, on the grounds of the ruined church where she once worshipped, she has treated over 4,000 people. International Medical Corps has provided her with the medical supplies and volunteers that she needs in order to do this. She is so beautiful and open, walking around with a smile that melts, wearing the same long blue cotton skirt that she was wearing on January 12th when the earthquake struck.

My role here as ambassador is simple: we need to raise awareness of the road ahead for Haiti – and raise a significant amount of new funding through appeals to the public. Most people just don’t realize that the problems Haiti faces are really only beginning. This country was in desperate need before the earthquake hit. The problems they are now facing are tenfold. The onset of the rainy season, which is imminent, means that the temporary camps that are housing hundreds of thousands of people will be washed away. Water-borne diseases will be rife, nutritional needs will become even more prevalent and there is inevitably a massive increase in sexual and gender-based violence within the camps. Donors have been incredibly generous, but as always, much, much more is needed.

After a fitful night’s sleep in a tent with Marge, (gunshots, roosters, crying babies, the works) we have a cup of coffee and set off at the crack of dawn to visit some of the mobile clinics and projects set up in those early days after the earthquake by the stunningly beautiful and clever Dina Prior, who heads International Medical Corps’ Emergency Response Team. We drove to Petit Goave, three hours outside of Port-au-Prince. The coastal regions are far more difficult to access, and it takes an hour by boat to reach the small beach community of Platon. It looks like heaven to me. The kind of untouched postcard paradise we westerners are constantly searching for. White sand so fine it feels like flour, azure blue sea and old handmade fishing nets thrown haphazardly over the ancient palm trees. We are greeted with smiles and cheers by a beautiful group of men, women and children, so grateful for the work that is being done. However, they are hungry, incredibly poor, and virtually cut off from the essentials they need. Until International Medical Corps arrived here, they faced a two-hour journey just to receive any medical attention at all.

The following day, we went to the General Hospital in downtown Port-au-Prince, and spent the morning being shown around by Dr Gabriel Novelo, who is overseeing operations for International Medical Corps, and Megan Coffee, an infectious diseases specialist who is handling the TB ward and patients with everything from HIV to typhoid. They were warm and generous, taking the time to explain to my untrained ears the many facets of their work. I was amazed to see that despite the sheer number of patients – sometimes 800 a day - they are on first-name terms with almost all of them.


Our last stop was at the intensive care unit tent. Everywhere I looked, there were doctors and nurses from around the globe. They all work incredibly long hours, as volunteers, helping the relief effort out of the goodness of their own hearts. I saw a woman die two meters from where I was standing. A team of doctors then spent ten minutes doing intense revival work, giving her CPR, adrenaline shots to the heart and defibrillation, basically demonstrating the relentless commitment that goes toward saving a life. I stood and watched, hoping and praying for a miracle, as her pulse was checked again and again without a murmur. Every ER doctor has experienced this hundreds of times, but I am a woman, in a tent in Haiti, watching something I never thought I would witness. They fought and fought, and miraculously, revived her. I saw a life lost and saved by the medical teams International Medical Corps has working here. I watched this woman fight for her life. I saw her husband crying, not only for himself, but for their two children, and marveled at the simple fact that these volunteer doctors have the ability to bring mothers like her back into the world.


Later that day we headed to Petionville, an enormous displacement camp, to visit a new facility we have within the compounds. These people, like most, are living in tents, except that this camp (or rather city) is in a giant basin-like valley. When the rains come, and they already have started, this and its 60,000 inhabitants could be washed away. Logistically moving that many people, with the imminent monsoon and hurricane season lingering like a time bomb, is a terrifying reality that they are all facing. We met up with my friend Sean Penn, who is doing incredible work here through his organization, the Jenkins-Penn Foundation. They are providing medical care and devoting their energies toward the protection of these vulnerable people. We discussed ways of collaborating and were taken on a tour of the camp by Sean and Pastor St. Cyr (who is holding daily services for those living here, a vital task for a devoutly religious population). There is an area where tents balance precariously on the edge of a ditch that drops 10 feet into what is now a dry riverbed. When the rains fell a week ago, that ditch became a raging river and two children very nearly lost their lives. International Medical Corps is bringing in floodlights to try and prevent disasters like these from becoming a reality.

The following morning, we headed back to the General Hospital, where I spent a few hours with two fabulous psychiatrists, Dr. Lynne Jones and Dr. Peter Hughes. Obviously there are massive psychological repercussions to a traumatic event like this, and previous mental illnesses have been exacerbated in many cases. They are treating patients in the general hospital suffering from a range of illnesses from psychosis to epilepsy. The care being given here is a vast contrast to what is happening at the old mental hospital next door we visited later. It is beyond anything I could imagine. This being the poorest country in the western hemisphere, education is not at the standard that we are fortunate to have in the developed world. The treatment here is archaic, the conditions inhumane. The people I saw were obviously seriously unwell. Some were screaming, some blissfully happy, very few are clothed and during my visit, most stood in tiny rooms, naked and covered in excrement. They push their heads through sharp and rusting holes in the iron doors to have a look at us, screaming for help. A mental institution is an intimidating thing to see for someone with no experience in this area like myself, but this made “One Flew Over the Cuckoo’s Nest” look like The Ritz. It was shocking and like everywhere in Haiti, desperately in need of funding.

The amazing thing is that this country has a spirit that very quickly gets under your skin. The people are friendly and welcoming, and everywhere I look, I witness examples of human courage beyond imagination. They are sticking together through what has been the most devastating earthquake in a hundred years and it is vital for the various NGO groups to do the same.

I suppose what I am attempting to do is use whatever means I have to generate some sort of attention for a country I feel utterly passionate about. I am not a writer, but one thing I have always somehow managed to do is garner press attention. I am now hoping to exploit that for a very good cause.

Please, if you can, donate now to International Medical Corps - an organization that is doing this incredible work, saving the lives and building a future for these beautiful people. To learn more about them and about how you can help their efforts in Haiti please visit www.imcworldwide.org.

Tuesday, March 23, 2010

My Mind-Changing Response to Visiting Haiti

By David Serota, Filmmaker with International Medical Corps

That is what this is. That is what Haiti is. On every level. In every way. From the Haitian people. To the people who were compelled to come here. All the way down the rabbit hole -- to me.

Standing in the rubble that was once Port-au-Prince and Leogane (the actual epicenter of the original earthquake) you are instantly struck by what those in the media could not capture and our Western sensibilities cannot address. I tend to enter a 'situation' with a "you know what they should do" mindset. The places I have been fortunate enough to travel to have reduced this knee jerk response to a certain extent but Haiti might have changed it for good. Changed me -- for GOOD.

Landing in Dominican Republic at night was like waking up in a dream. No sense of time or place. Driving through city streets, not sure what is on either side of you. It could be the ocean. It might very well be a cliff. A late dinner with most of the team I traveled with in DR Congo last Spring (Margaret Aguirre, International Medical Corps’ Director of Global Communications, and film actress Sienna Miller) and we headed back to the hotel. An early morning taxi pick up and then off to the airport once again for our flight to a place that was once the only thing on television and is now barely a mention on CNN or in the NY Times.

Woke up late and rushed down to meet everyone in the lobby. Our taxi wasn't there. So we grabbed another one and headed for the airport...the wrong airport. This not being realized until we got there. Through morning rush hour and then along a Caribbean coastline we motored to the right one. Luckily the plane we were on was delayed so we made it with plenty of time to spare. A reminder. When traveling, what can go wrong, will. Journey on.

Upon landing in Port-au-Prince you are thrown into the melee to come. Plane cargo trucks backing up to open bay doors where they throw your bags with impunity and then out into a traffic jam of people trying to exit gates that are dressed with people in need. Begging for something to make life...livable. Fortunately, the chaos was made easier as we were met by Andy and Crystal from International Medical Corps. International Medical Corps arrived less than 24 hours after the quake to deliver emergency assistance and I am here to document their long term response to Haiti's recovery. Crystal is the communications officer for the operation and Andy is our security advisor. International Medical Corps always travels in convoys. It is important to ensure safety, strength in numbers, and because people can always pile into one vehicle if the other breaks down. It is not for show and it is not for insurance reasons. It is standard operating procedure and another one of their lifesaving methods. Aid workers are often targets of violence. Three have been kidnapped in the past week here in Haiti.

The destruction is everywhere but it is hard to absorb. It felt like it could have happened 5 minutes or 5 years ago. But then it digs in a little. There are people in there. Hundreds of thousands of them.

One of my favorite parts about traveling with International Medical Corps is that they employ the local people and none more important than the drivers. This time we have Steeve. He is 27 years old. Learned all his English from television and music. Always in an oxford and slacks. Always rocking out to hip hop. They take you everywhere. They navigate the traffic and streets like they went to school for it. Avoiding pot holes that would have swallowed you up. We learned about his friend. Trapped in the quake. Steeve was at school for thematics. When the quake happened he jumped from the balcony. He and a few others went looking for a friend. Found him. Trapped. Only identified by his sneakers. They could not reach him. So for 10 days they passed him food and water with a rope. Eventually. Nobody took the food.

International Medical Corps has set up a guesthouse in one of the remaining structures still standing. They have 39 full time staff and around 59 rotating volunteers. It is compound like. High walls, metal gate, armed guards. But inside it feels a bit more like a college fraternity house. People live out of duffle bags, even those on 6 month rotations. Everyone is from a different country but they all have one thing in common. They have traveled extensively. Mostly doing aid work. They LOVE what they do.

The courtyard is a tent city. Not only because there are not enough rooms to house everyone but aftershocks are still prevalent. There was one last night. We threw our stuff down and were out the door to our first location.

The morning after the quake, a Port-au-Prince local, Joseline Marhone, opened an emergency clinic under a grove of trees adjacent to the wreckage of the Church of St. Pierre in the St. Louis area of Port au Prince, just a few miles from downtown and began treating the injured. Several of her medical students quickly joined her. A tent was erected, canvas sheets were put up and mattresses were hauled in to create a 13-bed in-patient section to the clinic. She sleeps in the pharmacy, which is outside. Her dinner table is an Igloo cooler and her bed is a worn out piece of foam. She tells me this with the most beaming smile you have ever seen.

At night we gather on the terrace, download our days and unwind with drinks and dinner. Everyone getting to know one another. Exhausted, I climb into my tent and go to bed. The sound of chickens who do not know what time it is, gunshots and screaming babies serenade me.

Early the next morning we take a long drive out through Leogane, a town by the sea. That is where we board a small motor boat to visit one of seven mobile clinics International Medical Corps is operating on that part of this island nation. Before the quake this area had never received any kind of medical attention due to the steep hillside making it only accessible by water. Once we arrive we immediately saw International Medical Corps’ presence. A field clinic steps from the beach outfitted with basic medical supplies. They even provide mental health specialists for those with psychiatric needs. It is a sight to see. We felt welcome. I thanked them then and I thank them here.

Dina Prior is the head of the Emergency Response Team in Haiti. Her job is to setup International Medical Corps after a disaster. Imagine that. Trying to coordinate, triage and implement a scalable RESPONSE in the midst of a communication blackout, in a city still shaking and still on fire. That night at the guesthouse she details for me the the first days. A rock star in every way.

There is an amazing lighthearted nature to the staff. Perhaps a primal response to the intensity of their days. The fight and then their flight. Save a life and pal around. All in a days work here.

Today we went to the general hospital downtown. The buildings were all left uninhabitable so International Medical Corps has set up tent clinics for every issue imaginable. TB and AIDS patients, an intensive care unit and a pediatrics ward just to name a few. While in the ICU a young girl went into cardiac arrest. The alarm on the monitoring machine sounded with the audible scream of a flatline. A doctor raced to her bedside and immediately began chest compressions. Nothing. More doctors. More compressions. Still nothing. They move on to the defibrillator and finally to adrenaline injections. Nothing. The tall doctor pressed with all his might. It was his first day on the job. The heat inside the tent was almost unbearable. The RESPONSE of International Medical Corps to save this girls life left me in awe. 20 minutes later, when many thought he should have given up, she responds on her own. Her future is unknown. Although her blood flow was maintained by the chest compressions brain damage might still be a result. The irony of tomorrow's health care vote is not lost on me. Every life deserves a fighting chance.

After that we went to an internal displacement camp of approximately 40,000 people in an area called Petionville. We went to visit Sean Penn and his personal efforts to address the disaster in Haiti by focusing his attention on these people alone. A gigantic task and an admirable one. He used his own financial resources to deliver a RESPONSE that is effecting change for thousands of individuals. Unfortunately the camp is set on a hill so when the rains come it will not be sustainable. We walked up that hill to the top where we found Sean and his camp. Both modest and dialed the compound is very cool to see. We chat for a short while and once again take a walk through the camp with our guide Pastor Sincere. Yes, really. The people stop you. The people thank you. I am overwhelmed by the RESPONSE.

Sean passes by in a small 4×4 vehicle and gives us a lift back up to the top of the hill. He stops and interacts with many of the camps residents. They know him. They like him. There are no cameras here. This is not a photo op. This is who he is.

Back at camp we talk about the upcoming rainy season and he details his next steps and we all trade observations and opinions. Unfiltered. Same team here. Sean says something that stuck with me. "The Haitian people are punished for their strength." It is true. In every Haitian you meet you see it. You feel it. They are STRONG.

Thing is, nobody is protected from the upcoming hurricane season. Housing for both International Medical Corps and the Haitian people is temporary. When the storms come...

Tomorrow is our last full day and I am sad. Not by what I have seen but that I am leaving. That is my RESPONSE. Haiti is in me now. And I will come back.

Soon.

Monday, March 22, 2010

Global Ambassador Sienna Miller visits Haiti


Sienna talking with Francois, who broke both legs during the earthquake. His home was destroyed and he's been living at International Medical Corps' clinic ever since.








Sienna speaking with May, one of our volunteers from Columbia.




Far From the Last

By Crystal Wells - March 22, 2010

March 22nd marks the 18th World Water Day, a date set aside each spring by United Nations proclamation to celebrate the importance of fresh water. For those living in the Developed World, it’s a chance to remember that an estimated 900 million people globally still lack access to the minimum daily required amount of safe fresh water. This is the story of what befell one of those 900 million.

Max is a petite 17-year-old Haitian girl, who lay in the ICU tent at Port-au-Prince’s University Hospital, her belly swollen and bandaged. In the next bed was another woman in the same condition.

Max, like the woman next to her, came to University Hospital with sharp stomach pain and a swollen abdomen. In the United States these symptoms would likely be appendicitis. Not in Haiti. Following the Jan. 12th earthquake that destroyed so much of the capital, hundreds of thousands now live in overcrowded, hastily thrown-together tent cities, at risk to something practically nonexistent in most of the developed world – typhoid.

I was introduced to Max and her attentive father, Jacksone, at the University Hospital, where International Medical Corps has been working since January 14. Her battle with the disease has been going now for two months.

When I learned why this beautiful, young, and otherwise healthy woman laid in a hospital bed for nearly two months, I had to share it. I share it for her and because I know the monsoon-like spring rains now bearing down on Haiti will certainly claim more victims amid post-earthquake Haiti’s large displaced population.

When the 7.0-earthquake hit the country more than two months ago, clean water and sanitation, already issues for Haiti, became that much worse. Heavy rains will only add to that misery and to the threat of disease, including typhoid.

The tragedy is that typhoid is easily preventable. Vaccination is routine for infants born in the Developed World. As a bacterial disease spread by eating or drinking contaminated food or fluid, typhoid is also prevented through clean water, sanitation, and hygiene.

Max’s story is similar to that of thousands of Haitians. Their home was completely destroyed in the earthquake and they were forced to live on the street, without even a tent for shelter. Clean water was also impossible to find.

“In the first few days, many of the water pipes were broken, so I would collect our water from them and boil it for my family,” said Jacksone.

Despite the boiled water, Max started to complain of stomach pain. The pain persisted for days and her belly began to swell. When Jacksone took her to the University Hospital, she was rushed into surgery to remove part of her bowel.

“In severe cases of typhoid, the bowel can swell and, like a balloon filling with water, it eventually bursts, leaking human waste into the rest of the system,” said Megan Coffee, an infectious disease specialist at University Hospital. “The only option at that point is to do surgery to repair the bowel and then clean the human waste away.”

And that is exactly what Max went through - and the woman beside her. “If she did not have surgery, she would have been in real trouble,” said International Medical Corps volunteer, Dr. Susan Levine from Connecticut.

I am told that Max will recover and, with the diligent care of International Medical Corps volunteer doctors and nurses, I do not doubt it. But as the spring rains prepare to roll in, I can’t help but wonder how many others here will suffer from typhoid in the coming months.

As I was leaving the ICU tent, Levine pointed out a man tossing and turning restlessly on his cot. “He is another one who came in with severe typhoid and required surgery,” she said.

And definitely not the last.

As we mark World Water Day, please help us spread the word about waterborne illnesses like typhoid by sharing this story with your family and friends.

Wednesday, March 10, 2010

Quiet Hero

By Tyler Marshall

Samuel Abelard is an unlikely hero, quietly lending a hand as Haitians rebuild the pieces of their broken lives.

The graying 54 year-old father of four simply showed up and began working at a mobile medical clinic after it was set up in two classrooms of a small Port-au-Prince teacher’s college following the Jan. 12th earthquake.

From the start, Mr. Abelard—as he is respectfully known to all—has effectively kept the clinic running. He is the pharmacist and the storekeeper, steadily keeping track of new medications and other donated supplies that come in, noting what gets used and alerting the medical staff when replacements are required.

International Medical Corps volunteer physicians and nurses who work at the clinic say the order he maintains increases efficiency and thus helps them see more of the hundreds of local residents from the working class Bolosse neighborhood who crowd outside each morning to get treatment.

But that’s just part of Mr. Abelhard’s contribution.

“He’s a leader,” summed up Diana Rickard, a physician from UCLA who recently completed a two-week stint at Bolosse. “The local nurses and other staff all look up to him and come to him for advice.”

Mr. Abelard notes that keeping the clinic’s small pharmacy organized isn’t all that different than storekeeping. He learned the basics of medicine as a boy from his father, who was a pharmacist for nearly 20 years. Rickard says he’s eager to build on that base.

Before the earthquake, he had a steady job as the storekeeper for a restaurant in the United Nations compound, but that all ended in a few terrifying minutes on the afternoon of Jan. 12th. The UN building collapsed and the restaurant went with it. Several miles way, the family home was badly damaged, too. Still, he considers himself lucky: His immediate family survived.

His wife suffered a fractured pelvis and now uses a walker to get around. The family now lives in one of the hundreds of tent settlements that have sprung up in Port-au-Prince during the weeks since the quake struck. Mr. Abelhard’s eldest daughter, the family’s only other wage earner, lost her job too when the school where she worked as a teacher collapsed.

Like so many Haitians, he lives today mainly on meager savings and emergency food distributions. Although he says his family depends on him for income and that he hopes one day to return to his job at the United Nations restaurant, he stressed that he plans to stay at the clinic as long as he can make a difference.

“People need me here,” he said, quietly. “This is where I belong now.”





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Monday, March 8, 2010

Dr. Rahul Khare's Photos from Haiti

The following photographs document some of Dr. Rahul Khare's experiences as an International Medical Corps Emergency Response Volunteer in Haiti.










Above is a picture I took of the remains of a Port-au-Prince restaurant.





















Here I am supervising a paracentisis on a patient who had liver disease and was short of breath due to the ascites in her abdomen.
















We are resuscitating a 3-month-old baby who came in lethargic with vomiting and diarrhea, probably due to contaminated water found in tent cities.

















I’m looking over the ER schedule after dinner.

Thursday, March 4, 2010

A few thoughts as I reflect on my two weeks in Haiti

By Mark Haseman, RN

As I sit before my computer, a mere 4 days since returning to Chicago following my 2 weeks at University Hospital in Port-Au-Prince, I can't help but feel pangs of guilt and perhaps a bit of jealousy. I know there is someone else in "my tent", working as hard, or harder than they ever have, likely way behind on fluids and nutrition, without adequate space or resources, and loving every minute of it. As I grow older, time passes faster, with the calendar now behaving much more like a clock; still it amazes me how quickly my time in Haiti flew by.

Even more amazing is how much can be accomplished, under what can only be described as deplorable conditions, by a group of dedicated, committed, passionate, and ever so hard working professionals with singularity of purpose. I won't even attempt to name names, as I do not want to risk missing anyone. Those of you who served know who you are and what you did and I salute all of you. I know I will think of you often when I return to "work", and will not feel that sense of global camaraderie that was so prevalent in those 2 ER tents.

Our team arrived a month after the earthquake, during the commemorative 3 days of national mourning. Of course, people didn't stop getting sick, they just stopped going to the ER so they could mourn and pray. The number of patients had been comparatively low as a result, but the respite ended abruptly on Monday. At one point on Monday the hospital administration, toting a bullhorn, announced to all that only the sickest people would be treated and all others should come back another day. Guess they don't have to worry about Emergency Medical Treatment and Active Labor Act here!

For the most part, by the time we arrived, direct quake related injuries were few and far between. However, there was still the occasional fractured ankle here or arm there, and even a woman who had suffered 2 pelvic fractures and a fractured ankle. She arrived with her family, who had carried her on a wooden door as a stretcher. Traveling an unknown distance "from the hills" and in no doubt considerable pain, they finally arrived at the University Hospital a month after her local hospital was unable to provide anything more than an x-ray.

Of course there were plenty of quake related illnesses, in particular Diabetic Keto Acidosis (DKA), a result of diabetics not being able to get any insulin to treat their disease. Even the ER ran out of regular insulin on more than one occasion and was constantly low on normal saline. Laboratory services were very limited, often taking up to 8 hours to get a result, further compounded by chronically short supplies of finger stick blood sugar monitoring equipment.

There were so many cases of malaria (which reminds me, I haven't taken my doxycycline yet today), typhoid, much of which was suspected, as the lab was always out of reagent to run the test, rabies, tetanus, TB, HIV, pneumonia, cellulits/wound infections and a smattering of CHF and asthma. With only 1 oxygen tank per tent and only one regulator to share between the 2, it was very difficult to treat shortness of breath, regardless the etiology. We could give asthma breathing treatments but only to one person at a time via an archaic nebulizer machine. We did have to resort to the occasional SubQ epinephrine, though we eventually scored a supply of prednisone. CHF was a bit more difficult, as we had a limited supply of IV lasix, no EKG machine, and no way to follow cardiac lab markers. Sublingual nitroglycerine, perhaps a nitrodur patch and oral lasix, and hydralazine, or calcium channel or beta-blocker, if we had any in stock. Morphine was usually in adequate supply, however the concentrations available would make any JCAHO investigator apoplectic. For much of the time we were forced to use intrathecal concentrations of 50 mg per 1cc, with a standard dose being 2-4 mg. They told me there wasn't going to be any math!

I haven't even mentioned the volume of pediatric patients, most of whom were treated outside the "waiting area”—a tarp stretched out from the front of the first tent. I really have no idea how many patients were out there during the course of a day, as only the really sick ones made it into a tent. That said, I am eternally grateful to our Pediatric Nurse Practitioners, as well as the doctors and nurses who threw themselves on that grenade day after day. It was a noticeably better environment when they were around.

That leaves us with trauma, of which there was no shortage. Daily, we treated gunshot wounds, vehicular trauma, and the occasional loser of a machete fight. We were fortunate to have 2 portable ultrasound machines, a functioning operating room and usually enough surgeons around to treat those that needed surgery. Ultrasound came in handy a few times gaining IV access in patients and it was the only "pregnancy test" available for part of the time here.

Vehicular trauma was plentiful, and it only took a short bus ride to see why. Narrow streets lined with tents and vendors, thousands of people walking in and out of traffic, and cars, buses, motorbikes darting all over in seemingly random fashion. Cars and bikes passing on the right or left, sometimes 3 across. There was such a constant honking of horns that I began to think Haitians believed horns somehow provided protection while driving.

Patients would occasionally arrive via police vehicle, but as there seemed to be no 911 system or any other way to summon emergency services, most of them arrived via private vehicle. One evening I heard some commotion out front and went out to see what was up: a young woman in the back of a pickup truck had been struck by a car. She arrived with a horrible tibia and fibula fracture. The ED was full, so we popped an IV in her, gave her Etomidate and reduced the fracture under conscious sedation right there in the back of the truck. Fortunately, earlier in the day I had discovered a large, heavy cardboard box full of crap, which I emptied just to clear some floor space. Realizing we had no orthopedic supplies, I pulled out my Swiss Army Knife and carved the box into manageable lengths suitable for splinting material, a scenario that would be repeated many times over the course of the next few days. It was rather refreshing to do conscious sedation without a crashcart or nervous resident checking intubation supplies.

That was Monday—Tuesday would be even worse!


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Wednesday, March 3, 2010

A Promise Made, a Promise Kept

By Crystal Wells

If I remember but one face of Haiti, it will be that of four year-old Ornesto, with his big eyes and a nose that crinkles when he laughs. He is small and delicate, with a frame more like a child half his age, and a warm, rambunctious personality.

Beyond his energy and spunk, Ornesto is a survivor. Buried alive in a rockslide, Ornesto was rescued, but at the cost of his left arm. His head is scabbed and wrapped in bandages and he lives in one of the pediatrics tents at University Hospital, where International Medical Corps has worked since January 14.

I am not unique in my love for Ornesto. He’s easily stolen the hearts of a hundred women who have walked through the pediatrics tents, but I am bound to share his remarkable story in order to fulfill a promise I made to his father before I left the country.

It is a wrenching tale.

Before the earthquake, Ornesto lived with others of his family in the mountains above a town called Leogane, west of Port-au-Prince. They are part of Haiti’s rural poor. His father, 65, supported four children, including Ornesto, from the little money he made from farming and slaughtering livestock. He never learned to read or write—which I discovered only after he was after asking him to spell his name. He replied that he could not, so for lack of proficiency in French or Creole, I will spell his name like it is pronounced to my ear, Kesisan Claude.

Claude and Ornesto are rarely seen without each other. Where Ornesto is playing outside the pediatrics tent, Claude watches calmly and proudly in the shade. He sleeps on the floor beside his son’s cot and makes sure the bandages are changed on time. “We have no tent or anywhere to go,” Claude said from beneath the rim of his straw hat. “The earth crushed where we lived.”

In the minutes before the earthquake, Ornesto and his cousin, 5, went down into a ravine near his house to use the toilet. They were in the ravine when the earthquake hit and were pinned by falling rocks. Claude thought his son was dead, but still dug for six hours with a dozen others before they found Ornesto with his dead cousin crushed on top of his left arm. His head was badly cut and his arm mangled, but he was alive.

Without a car to drive to the nearest hospital, Claude carried Ornesto to Carrefour on the outskirts of Port-au-Prince, getting a ride when he could, before an American came and transferred them to the University Hospital. There Ornesto’s left arm was amputated and there they have lived since January 23rd. They are the only two living in Port-au-Prince. “His mother died,” Claude said. “The other children have scattered and live in other houses with friends and family. We are the only ones here.”

Claude worries about where they will go when Ornesto is discharged. He does not know how he will support his son after losing everything he had in the earthquake.

In sharing his tale, Claude exacted a promised: If I retold the story I must include that Ornesto, with his beautiful face and larger-than-life spirit, is up for adoption. Claude says he wants Ornesto to live a healthy life filled with opportunity and this is something that he is afraid that he cannot provide. Because of this, Claude hopes that someone will consider adopting Ornesto, even if that means giving his son up.

Please do not misunderstand me and think that I am advocating for Ornesto’s adoption. I simply had to share his story to shed light on what parents all across Haiti are praying for and dreading at the same time. If anything, I believe the plight of these parents underscores a need not for more adoptions, but for livelihoods programs that create new income-generating jobs so that Haitian parents such as Claude must never face such a heart-wrenching choice.

In all the promises I have broken and kept, this one had to be honored, even if I am one of a hundred women to do so.






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