International Medical Corps

Addressing Mental Health in Pakistan Along With Cultural Needs

2010-08-31T13:46:00.000-07:00

By: Mahmood Iqbal
August 31, 2010

Akora Khattak, Pakistan - As International Medical Corps makes mental health care a priority in our emergency relief efforts, we are providing psychosocial services to help Pakistanis cope with the enormous emotional toll of the floods. In addition to providing individual and group support sessions through our mobile clinics, we also deployed a female psychologist to deliver specialized care to women and children.

“We have been witnessing behavioral changes, particularly in women,” said Dr. Sanam Rahim, a female psychologist working at our clinic in the civil hospital in Akora Khattak, about 9 miles east of Nowshera. “The majority have psychosomatic symptoms and increasingly complain of body aches and other illnesses.” Dr. Rahim is able to provide culturally-sensitive care to Pakistani women who feel more comfortable consulting with a female doctor.

Having already had extensive experience working with the internally displaced people in violence-torn Buner District, Dr. Rahim notes that the worst natural calamity in recent history has caused severe mental stress and psychological reactions among flood-affected people. She spoke of 45-year-old Roshmeena who complained of having body aches, but after clinical examination and psychosocial counseling was found not to be physically ill. A resident of Akora Khattak village, Rashmeena has 10 children and an unemployed husband. Already struggling financially, the floods washed away the family’s home and all of their belongings, leaving them without even the most basic resources. “Mental stress and anxiety can convert to psychosomatic disorder,” Dr. Rahim explained. “We want to see Roshmeena for regular follow-up visits and advised her to do muscle relaxant exercises.”

Like Roshmeena, others in Pakistan also complain of body aches and other illnesses, which are actually symptoms of psychological distress, according to specialists. Dr. Rahim recalled seeing a 10-year-old boy complaining of severe hiccups. His mother explained that he had feigned hiccups since the floods struck their village.

“Such psychological illnesses are growing among the flood victims,” Dr. Rahim said, noting that counseling of the child revealed that children in the area had lost all recreational facilities to the floods. “The schools are closed and the lack of recreational activities often leads to mental complications among the children.”

Comparing the displacement of people from Buner district to the devastation and displacement caused by the recent floods, Dr. Rahim notes that a natural disaster often leaves deeper after-effects on local populations because it is so unexpected and sudden that victims have no chance to prepare emotionally. “In Buner and Swat, people knew beforehand that a conflict was brewing in the area. In a sense, they were mentally prepared to leave their houses. But, with the floods, there was no warning. People were caught unaware and they could not even find time to rescue their most valuable items.”

Through International Medical Corps’ mobile clinics in Pakistan, patients suffering from emotional stress are identified during clinical check-ups and referred for further psychosocial counseling.

“When stress converts to depression, it becomes a long-term process to cure,” Dr. Rahim says. “Early psychosocial counseling helps lower the stress and prevent the conversion into acute post-traumatic stress disorders.”

To date, International Medical Corps’ psychosocial support staff has conducted individual and group sessions for approximately 920 individuals, including young children.

Nursing 101 in the Tropics

2010-07-28T11:13:00.000-07:00

Perspective from a nurse volunteer in Haiti

Sheri Hathaway RN was a volunteer with in Haiti for International Medical Corps and is currently a Clinical Manager with Bayada Nurses.

On May 16, I left Pittsburgh, PA for the experience of a lifetime to work as a volunteer nurse in support of relief efforts in Haiti. My trip was arranged through my employer, Bayada Nurses, a national home health care agency that is recruiting and sponsoring registered nurses and licensed practical nurses to work in Haiti for one month. Bayada is coordinating the trips for registered nurses through International Medical Corps, a non-profit organization that has been sending medical personnel to assist with relief efforts around the world for over 25 years. Bayada previously worked with International Medical Corps in Kosovo in 1999.

I am an experienced nurse and supervisor, but nothing could have prepared me for how I would deliver skilled nursing services to my patients. Nursing curriculum in the US briefly details diseases endemic in the tropics such as malaria, typhoid, diphtheria, and tetanus. Most nurses in America will not care for people with these diseases in their lifetime, but in Haiti, it is an everyday occurrence.

Metrics used to measure health in the West do not apply in developing countries. For example, people in Haiti function at much lower hemoglobin levels, largely due to chronic under-nutrition and malaria. Children are typically small for their age compared to growth charts used in the US as the result of chronic under-nutrition. Before the earthquake, access to medications and health care was infrequent or non-existent for most. It also appears that infections here are resistant to drugs that are effective in the US.

My assignment was split between one of International Medical Corps’ 15 primary health clinics, located in the heart of the “tent city” that now fills the grounds of the former Petionville Country Club, and the emergency department of L’Hospital Universitat d’etat Haiti (HUEH), the largest hospital in Port-au-Prince. My work in the clinic and the hospital were two very distinct experiences, with each one having their own separate set of challenges.

The clinic at Petionville Club is made up of two tents that sit on a wooden platform above a sea of red and blue tarps that are home to some 40,000 men, women, and children who were displaced by the earthquake. Many of the cases we see here are women and children with skin diseases, diarrhea, and malaria. While these ailments are both treatable and preventable, diarrhea, and preventable childhood disease account for 80 out of every 1,000 deaths in children younger than five, according to the World Health Organization. That is why having care available to these vulnerable populations is so critical to saving lives, particularly as the rainy season approaches.

In contrast to the primary health setting of the clinic, my work at the hospital has focused on emergency and intensive care as part of International Medical Corps’ response to the immediate aftermath of the earthquake. At the height of the response, more than 900 people came through the hospital seeking medical services, most of which was provided in tents averaging 100-degree temperatures. At present, the patient load has lowered significantly and the Emergency Department was able to move back inside the hospital to its original location.

No Westerner would be able to believe what the hospital system is like here. I am amazed at how the hospital has evolved in such a short time because of International Medical Corps’ and similar groups’ ongoing efforts. But the hospital still lacks advanced medical technology, forcing US-trained medical professionals to think on our feet and make do with what is available. On any given day, the way we administer treatment might change depending on what is available to us.

We see many kinds of cases here, including anxiety and mental distress, violent trauma, gunshot wounds in adults and children, severe lacerations, and advanced malaria and tetanus. HIV/AIDS is also highly prevalent. We have also been treating many "hysterias" or PTSD. This experience has shown me how different cultures manifest traumatic stress differently. In Haiti, people will seem to experience paralysis and catatonia. It’s very strange, but if you give them a Tylenol they recover. Some people arrive DOA via ambulance, family members carrying them, via makeshift stretchers.

One patient that that I will always remember is Christopher, a 27-week gestation male infant, who came into the Emergency Department with hypothermia and very near death. Without an incubator on-hand, we used a technique called “Kangaroo Mother Care,” where skin-to-skin contact between mother and baby is used to raise the infant’s core body temperature. Largely because of this technique, we were able regulate his body temperature, even in the absence of an incubator. Christopher fought for life for more than 72 hours under our care, but tragically did not make it. We all called Christopher our miracle baby while he was with us in the ER. and I think many of us will always remember him because he held on against all odds.

What we do is so appreciated by the local people. While they are visiting the clinic or hospital, they want to be seen for everything because they may not have the chance to be seen again for a long time. I was changing the dressing of a patient with an amputation and the father of a young man in the next bed said, "You Americans are good people."

I felt so proud to be an American.

But beyond the international assistance, it is the resilience of the Haitian people that will rebuild Haiti. Regardless of where I worked, the transition in Haiti from emergency response to long-term development is evident. The nursing school at HUEH that collapsed in the earthquake, killing more than 100 students, is now resuming class. HUEH residents and staff now have a more regular, consistent presence around the hospital. National doctors and nurses, rather than international volunteers, now run the primary health clinics.

At the hospital, the patients’ families are just as important for patient care as we are, making sure their family member is bathed, clothed, fed, and nurtured. In the camps, people come to visit the clinic in perfectly ironed shirts and dresses, even though they are living in tents. Everywhere you look, people are carrying on and rebuilding their lives.

It is this resilience that I will bring home with me and it is why I am confident that I have learned more from the Haitian people than they have from me.

For information on International Medical Corps and their work in Haiti, visit http://www.internationalmedicalcorps.org/.

To learn about Bayada Nurses for Haiti, Volunteer Relief Campaign, visit www.bayada.com/haiti.

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In Haiti’s Sea of Loss, A Life Gained

2010-07-06T17:11:00.000-07:00

Crystal Wells is a Communications Officer for International Medical Corps and is currently in Haiti helping with the relief effort

The late night hours were filled with panic, dread, and death.

It was midnight on January 13 in Port-au-Prince. Just seven hours earlier, a 7.0-earthquake shredded the capital, leveling whole city blocks and burying thousands in concrete tombs. But in the tragedy and destruction, one woman was fighting to bring new life into the world.

On January 12, Turlanje, 32, was nine months pregnant with her third child. Just before lunch, she started to feel the first pangs of labor. They continued throughout the day and then, just before 6 pm, her house started to shake violently. “I did not know what was going on,” she said. “It was not until later did I find out it was an earthquake.”

As a result of the quake, her neighbor’s house toppled over her two-room home, causing the roof to crash down. Miraculously unscathed, she and her husband emerged to find their neighborhood reduced to slabs of concrete and webs of rebar. Dazed, they joined the steady stream of people heading to the grounds of St. Bernadette’s Church in Bolosse.

The baby was still coming and soon after they arrived at St. Bernadette’s Church, Turlanje and her husband were forced to get their midwife. “Everybody was crazy,” Turlanje says. “Even the midwife lost one of her children. But even in her loss, she took care of me.”

Around 10 pm, Turlanje realized she was going to have to deliver the baby in the yard of St. Bernadette’s Church, amidst the panicking crowds, clouds of dust, and piles of rubble. “I was worried,” Turlanje explained. “I was not expecting to deliver my child during a tragedy.”

Despite her fears and the chaos that ensued around her, Turlanje pushed. And pushed some more. “I was suffering a lot,” she says. “But I was helped by God.”

She pushed and pushed until 1 am, when she finally gave birth to a perfectly healthy baby girl. They named her Gael, after the baby’s father, Gaeton. “She was beautiful,” Turlanje says, beaming.

Now nearly six months old, baby Gael hardly ever cries. No matter where they are, she rests contently in her mother’s arms and watches the world pass by with wide eyes. Turlanje goes to church almost daily and wishes she could leave Port-au-Prince to live with her mother in the country.

After living in a camp at St. Bernadette Church for a few months, the family is now back in their two-room, block-like home in Bolosse. Half of their roof is still missing. “Life is difficult. My husband is not working,” Turlanje explains. “We are just trying to survive.”

Problems sadly not uncommon in Haiti, particularly as families try to pick up what was shattered in seconds on January 12.

But despite their troubles, Turlanje does not worry about medical care. Whenever she or her children need to see a doctor, Turlanje travels up the road to International Medical Corps’ clinic at Bolosse, where they can receive care regardless of their financial circumstances.

“This clinic means a lot to [us],” says Turlanje, resting Gael on her knee. “Sometimes when our children are sick, we might not have the money to send them to a doctor. Now we can bring them here. Thank you.”

It isn’t only the health care that keeps Turlanje coming back. She also has a special connection to the place. Hugging the side of St. Bernadette’s Church, the International Medical Corps clinic also marks the site where baby Gael was born six months earlier.

“I came here to this spot on January 12,” she says. “Other people were crazy...[a]nd I gave birth to this child.”

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Tabar-Issa Clinic

2010-06-07T14:24:00.000-07:00

An International Medical Corps doctor gives a check up to a little boy upon his arrival to Tabarre-Issa, one of the new relocation camps in the outskirts of Port-au-Prince.

A sea of tarps at Petionville Camp, where some 50,000 relocated following the earthquake.

Above, children in one of International Medical Corps' medical tent at Tabarre-Issa

A baby is weighed in one of the International Medical Corps clinics at Tabarre-Issa as part of the health screening for new arrivals to Tabarre-Issa.

International Medical Corps volunteer doctor and a new arrival to Tabarre-Issa.

A Haitian girl sits on a suitcase after moving to Tabarre-Issa from the Valle Baudoin, an area prone to landslides and flooding.

Big thanks to our Former Field Site Coordinator for Port-au-Prince, Carrie Hasselback, for sharing these wonderful photos with us!

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"Lost Track of Days"

2010-05-13T14:00:00.000-07:00

Dr. Mark Courtney is from Northwestern University and is representing the Chicago Medical response team with International Medical Corps in Haiti.

I've kind of lost track of days. It's Sunday. A large group of new doctors and nurses have arrived. That means a whole lot of the old people have left as of last night. We got a room for the 3 of us who deployed together. It's got a single gigantic king bed and smells like an ashtray but it's got a shower -- hallelujah! The shower I took this am was the second since I've been here.

Another improvement is the presence of Haitian staff. Hard to know who will be there at any given time and for how long but at least we are moving in the right direction for now. This is the major challenge during this transition time. We've introduced a very high level of care (by Haitian standards) and transitioning some (not all) of this will be the main work of the future.

There are great examples of excellent care being done exclusively by Haitian personnel. The pediatric feeding tent is a great example -- there are regular measured feedings of formula and measured daily weights and as a result, the kids getting better. One orphan was dropped off at our ED weeks and weeks ago by an aunt has since gained a kilogram. Came in at around 7 months and weighed 3.2 kg. That's about 7 lb. He's been in the feeding tent since then and doing well.

Another example is the TB program. Pretty much everyone gets oral observed medication (given and watched by an nurse). It’s supervised by Haitian nurses but single handedly lead by an Dr. Megan, who's down here on her own for who knows how long. She's essentially put her fellowship on hold to care for these patients.

I'm pretty tired now and eager to get some sleep. Worked the 10-7 swing shift. Am on at 7am tomorrow.

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Halfway Through Deployment

2010-05-12T15:59:00.000-07:00

Dr. Mark Courtney is from Northwestern University and is representing the Chicago Medical response team with International Medical Corps in Haiti. We'll be posting his updates from the field over the next week.

At this point I am halfway through our deployment.

I have seen a rapid transformation of the emergency department in a short period of time. Right before we arrived they had recently just moved all ED operations out of the tents and inside. That being said, in many ways it is not at all like an ED that you could imagine. To reiterate, we have no X-ray, no CT scan, no air conditioning, no flushing toilet, no running water even. We are using gel hand wash between patients. At one point while working in the ICU, I successfully discharged a patient with congestive heart failure (a major achievement) and the family started unplugging all these fans that were around her. I was a bit upset and not sure what to do about them stealing what to us was a precious commodity until I relized that all the fans in there were belonging of the patients and their families that they brought in.

All our oxygen comes from standing huge oxygen tanks that have to be rolled slowly and carefully around from patient to patient. During one ICU shift, we had to scramble to jerry rig some splicing and tubing to get 5 patients oxygen that normally would be allocated to one. There are no monitors to continuously monitor patients (well that is not true -- there is one but only one and saved for the sickest patient). We transfer patients to "the medicine ward" which is a frightening place with billions of sick patients packed in with near darkness and often no nurses or doctors to see them for days at a time. Honestly it is better to send people back to their home or tent even with severe illness than to the medicine wards which are at times affectionately termed “the catacombs”.

Still in many ways our ED has rapidly evolved to look exactly like an ED back home. This is amazing since there is no history of emergency medicine or even an "ER" in Port-au-Prince. True, they had a pre-existing "urgent" department but this was not in any way staffed 24 hours a day with an emergency specialist. Just 3-4 weeks ago they still were seeing ED patients in adjacent tents. So it is surprising to now see people coming to our ED with things like chronic pain, anxiety, sickle cell disease, hoping to get surgery for a long standing problems or at least a second opinion. These problems in the US are common ED presentations but are best dealt with in other departments.

It is also not uncommon to get "transfers" from other hospitals or clinics without much regard for our capacity or environment. Some other medical NGO's will not send us patients in an ambulance with a note in French stating need to be admitted for surgery or oncology care without any understanding that at the time our surgeons happened to be on strike (well not sure you can say they are on strike since they have not been paid for months many not since the earthquake. Is that called being on strike or is it just not having a job?). Anyway this movement of patients from hospital to hospital is a totally a common occurrence in the US and it is amazing to me that our ED and the overall health care delivery system has some of the same problems we see in the US. The good things are that we can transfer patients to higher level of care for some things, for example women who need a C-section. I recently got a patient of mine with burns over 50% of her body transferred to a hospital that specializes in burns.

Anyway, things here are progressing -- most would agree that the state of emergency health care here has never been better (at least for the poor in urban Port-au-Prince). The challenge is how to maintain it in a sustainable, local manner.

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"Survived the first night shift."

2010-05-10T12:10:00.000-07:00

OK. Survived the first night shift.

It's now day 6 in Haiti. Kirk and I were the night doctors and overall had an outstanding experience. We resuscitated a CHF patient who otherwise would have died -- as of this morning they were giving us the thumbs up sign. The usual machete wounds to the scalp were a bit more common at night. There was a case of diphtheria, which is minimal risk to us but maximal risk to Haitians with almost no vaccinations.

Yesterday we saw a kid with a leg fracture happy to be splinted and another standard shoulder dislocation. Unfortunately there was a very sick septic baby who may or may not make it but there is an unbelievable team of pediatricians here from Partners in Health -- many are from Boston Children’s Hospital. Bottom line is there is incredible talent here.

There are plenty more crazy medical stories but I've now really connected with the people here, which is perhaps equally rewarding. For example, our translators are young Haitians hired by International Medical Corps. Many of them live in tents. They speak Creole, French, Spanish and English and most are self taught. One guy is looking for an English slang dictionary to hone his skills. One is working 12 hours nights with us and then is in school during the day and is only 18. They are smart as can be and the hardest working people in hospital. We rely on them massively.

In medicine, without CT scans and blood tests, the history a patient tells you becomes all the more critical. I'm really looking at the positives. There are plenty of kids in school uniforms going to school every morning who are healthy. They hold hands and smile at each other like other kids. Things are clearly better than in the past and better than they could be. I'm just trying to add a bit to that. Sometimes just talking and listening to people is as helpful as medicine and high levels of US style care.

It's raining cats and dogs right now but cooling things off.....

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Figuring it Out

2010-05-07T16:46:00.000-07:00

Starting day three. Yesterday I worked triage. This was challenging; due to the very limited resources you really have to figure out if you should bring people back.

There is no CT scan -- the chest X-ray is reserved only for the most sick patients. We’ve been seeing lots of cerebral malaria but they get better pretty quickly after an IV of quinine. Bottom line is patients with symptoms that at home that would mean a hospital stay, like mild chest pain that could be early heart attack, sky high blood pressure, or moderate pneumonia, in Haiti are treated with some pills and returned to their home-tent. They almost have to be in some respiratory distress, altered mental status, or high fever. Almost everyone else gets sent out or treated in a triage chair.

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The Winning Goal

2010-04-19T15:44:00.000-07:00

Crystal Wells is a Communications Officer for International Medical Corps and is currently in Haiti helping with the relief effort

Wilson has always loved to play soccer, especially the feeling of kicking the winning goal. This was a sensation that at only 20 years old Wilson very nearly lost forever, but thanks to the quick and thorough care of International Medical Corps volunteer doctors and nurses, he is now returning home to play the game he loves.

I met Wilson on his eighth day at the University Hospital in downtown Port-au-Prince, where he was making small laps around the ICU tent braced by a walker and his family beside him.

Aside from the walker, everything about Wilson looked healthy and strong, from his slender, athletic frame to his easy, fluid smile. I wondered what could have made this young athlete so cripplingly sick to land him in the ICU for a week unable to walk.

The answer is malaria.

Transmitted by mosquitoes, malaria infected an estimated 243 million people and led to nearly 900,000 deaths in 2008, according to the WHO. It is endemic in Haiti and affects tens of thousands each year. The predominant strain in the country P.falcipurum or cerebral malaria is the most deadly and can lead to impaired consciousness, convulsions, and coma.

Wilson's story is probably not too uncommon for post-earthquake Haiti. Displaced by the earthquake, Wilson now lives with 16 of his family members in a camp in Carrefour, just outside Port-au-Prince. One day, he started to feel nauseous. The flu-like symptoms continued for an entire week and then, on the eighth day, Wilson's legs gave out. "I could not even stand," he said.

Wilson panicked and sought medical attention immediately. His cousin carried him all the way from their camp, taking buses or tap taps wherever they could until they reached the University Hospital. He was rushed into the emergency room where International Medical Corps volunteers received him, completely unable to use his legs, and quickly tested him for malaria. When it came back positive, they transferred him to the ICU for round-the-clock monitoring and treatment.

Over the course of a week, Wilson's movement and condition improved bit-by-bit. He began physical therapy to strengthen and stretch his legs. Eventually, he could stand, and then walk, on his own. "The care, everything, was perfect,"he said with a grin.

And now Wilson, having defeated malaria and regaining his strength by the day, is well enough to head home. "I am so proud of you,"said Mary Perry, a volunteer nurse with International Medical Corps who worked in the ICU for two weeks. "When he got here, he couldn't even stand and now look at him."

Watching Wilson smile and laugh with his family, so excited to get home and play football with his friends, I felt so proud and inspired by what he and volunteers like Mary Perry overcame in this swelteringly hot ICU tent following one of the most catastrophic disasters in centuries.

It's the ultimate winning goal.

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Michelle Obama's Promise to Haiti

2010-04-16T15:40:00.000-07:00

Crystal Wells is a Communications Officer for International Medical Corps and is currently in Haiti helping with the relief effort.

First Lady Michelle Obama’s visit to Haiti brought with it a familiar frenzy of flashing cameras, microphones, fresh legal pads – and a lot of chaos. But the best part was how welcome it seemed to have the world’s eyes back on Haiti.

Because there is a lot that needs to be done here.

My colleague Dina Prior, head of International Medical Corps’ Emergency Response Team, attended the meeting during which the First Lady and Dr. Jill Biden thanked relief workers for our efforts here. To Dina and me, and probably many other international assistance workers in Haiti, the most rewarding message out of this meeting was not her words of appreciation, but her promise of continuing to support for this battered country at a time when the emergency phase is officially winding down and public attention is waning.

We all saw the heart-wrenching images that poured out of Haiti in the weeks immediately following the January 12 earthquake, the bodies scattered across the streets and search-and-rescue teams frantically moving iron rebar and heavy rubble from destroyed buildings to rescue those who were trapped.

The world shook with Haiti. And all levels of the international community - the United Nations, NGOs, governments, corporations, and individuals all around the world chipped in what they could or got on a plane to help. The result was unprecedented. Millions of dollars were raised. Hundreds of thousands of lives were saved. And a country did not lose hope even in its darkest hour.

Despite the scale of the relief effort, the truth is that Haiti is about to face two more emergencies, and much of the world is unaware of it. I’m afraid the world is now numb to Haiti’s troubles, and I’m hoping the First Lady’s visit will remind people that our commitment to Haiti should not end with the official emergency phase.

The heavy rains are starting to fall nightly, and the United Nations and NGOs, including International Medical Corps, are working together to start the long process of relocating camps that either are perched on a hill or buried in the crevice of a riverbed - so that thousands of lives are not lost in landslides and flash floods.

International Medical Corps is already facing increased operational challenges trying to prepare for these rains. We are fortifying our clinics with sandbags, plastic sheeting, even platforms so they do not close when the rains fall hard. We also need to heavily stock our field sites outside of Port-au-Prince so that they can continue their programs even if roads and bridges are washed away. Our clinics, many of which are located in camps, could be even more critical during rainy season, as diseases like malaria and typhoid fever and ongoing issues like malnutrition are likely to increase.

And all of this will be followed by the second emergency, hurricanes, which could begin as early as July.

These are challenges that now face a country that is still reeling from a 7.0 earthquake that killed more than 230,000 people and left another million homeless. And Mrs. Obama’s pledge that the United States will not forget Haiti, that it is committed to helping it recover and rebuild, was one that I hope inspired others to not forget Haiti, even when the camera lenses are pointed elsewhere.

Because, as I say, there is a lot that needs to be done here.

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Haiti's Future is Now

2010-04-15T14:44:00.000-07:00

President and CEO Nancy Aossey has led International Medical Corps for more than 24 years and has overseen its expansion to include over 50 countries.

The mothers sit in a circle, babies on their laps, sharing stories of lost homes, husbands, and livelihoods. They ponder basic needs like clean water, sanitation, and getting out of makeshift tents as the rainy season begins. But most of all, they express an overwhelming fear of what the future will bring.

Recently I traveled to Haiti, where International Medical Corps has been operating since 22 hours after the 7.0-magnitude earthquake struck.

This disaster zone is among the worst I have seen in my two dozen years of international relief work. Building after building flattened, tent cities numbering in the hundreds. I truly don't have words strong enough to describe what has happened to Haiti - or the look on the faces of the women I meet at the Petionville Country Club camp, so named because it sits on the grounds of what once was a country club for the nation's elite.

Here, our volunteer doctors and nurses from around the world are providing primary health care, psychosocial support, nutrition services, water and sanitation – while training Haitians to provide these services in their own communities over the long-term.

My dozen new acquaintances display an admirable resiliency. However, they and all 60,000 or so of their fellow tent-dwellers in Petionville camp, are in danger. Built on a precarious slope, Petionville is highly susceptible to mudslides and flash flooding as the tropical rain season begins.

They and the nearly one million others displaced by the quake face the ever-mounting risk of a “second humanitarian crisis”, not only from being washed out of their homes but from the infectious and water-borne diseases that could result in many additional deaths. For these women, the crushing weight of their day-to-day struggles is being compounded by the fear of what very well could lie ahead.

The issues and uncertainties they face echo in the far-away policy world, where the international community has made a nearly $10 billion commitment to rebuilding Haiti. But the $10 billion question is how do we address Haiti’s long-term and short-term needs, both of which are immense? We feel it can and must be done.

Even in the middle of an emergency, International Medical Corps works to establish a stronger, more accessible health care infrastructure over the long-term. The two must happen simultaneously. Haiti’s health workers badly need training and updated standards for integrated primary health care delivery. So from the day our doctors and nurses arrived in Haiti and began treating patients, they also trained our Haitian counterparts to do the same.

As we have learned over the past quarter century from our operations in other crisis areas around the world – places like Afghanistan, Somalia, and Indonesia - one of Haiti’s greatest needs is a broad-based training program in integrated primary health care practice for all health workers. That desire for a more comprehensive and resilient Haitian health care system came through clearly and consistently in my meetings with the Minister of Health, the director of Port-au-Prince's University hospital, our Haitian doctor-colleagues, and the community health workers who are the engine of Haiti’s health system.

That training of front-line health workers at all levels is essential and already underway. They help to treat tuberculosis, dengue, malaria, HIV, and other diseases; support safe motherhood and child survival; provide nutrition education; and deliver psychosocial support. They promote improved hygiene and sanitation to protect against an outbreak of diarrhea and ensure that all mothers - such as these with whom I sat - have access to clean water and readily available oral rehydration salts for their children, and understand how to protect them.

I’ll never forget the women sitting in a circle with me at Petionville camp. For them, I’d like to envision a future in which their families have access to a level of care that did not exist before the earthquake – and a health care infrastructure that can withstand the uncertainties that lie ahead.

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Haiti: Thankfulness and Compassion Amid the Destruction

2010-04-02T14:45:00.000-07:00

British nurse Nancy Connolly volunteered with International Medical Corps for two weeks in Haiti at the Petit Goave mobile clinic.

I left for Haiti on Jan 25th, two weeks after the earthquake and spent the next 2 weeks primarily in Petit Goave setting up remote clinics, following a couple of days at the hospital in Port-au-Prince.

When you leave the airport, you drive past incredible destruction. At first you take a few pictures but as the reality settles, you simply stop. It is difficult to comprehend the amount of devastation. Spray painting on the outside walls of buildings looks at first to be graffiti and then you realize it is a message: the building has been searched for dead bodies.

The road out to Petit Goave is cracked and rockslides continue with the daily after-shocks. International Medical Corps set up clinics in 4 locations and we saw over 1,000 patients in little over a week. I want to stress that entire population is living outside in tents or under tarps, offering little protection from the coming rains. Portable water has to be transported from a clean well and medical supplies are being brought in but overall resources are limited.

I will hold many people close to my heart from my time in Haiti. One little boy, probably 11-years-old. sat before me with such dignity while he told me his symptoms and as I asked questions I discovered that all of his family were dead. He was now alone. I saw one woman sweeping off her brick makeshift steps in case a guest visited. She now lived under a 4x4 sheet, in a camp on the side of the road, but she took pride in keeping it clean. The 80-year-old woman who volunteered to translate all day and thanked us for helping her country. The many priests and ministers who preached to the Haitian parishioners a message of cooperation and asked them to thank the people who had come, and to work with them as they were all trying to help. All this amid a constant stream of funerals each weekend.

During the week the Haitian people are digging themselves out using shovels, pick axes and sledge hammers.

The last impression I will share is one of hope. Relief efforts continue and will be needed for a long time to come. Haiti was in trouble prior to the quake, that is true, but no country can function when so devastated. I saw the Haitian people working to bring order and although there are troubles, there is a rising intolerance toward trouble-makers. The majority are speaking out and letting it be known they want and respect the assistance they are receiving.

If you would like to see more images of Nancy's experience with International Medical Corps in Haiti, click here.

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A Plea for Haiti

2010-03-24T08:56:00.000-07:00

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 12^th 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 18^th, 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 12^th 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.

WATCH a Video of Sienna's Visit to International Medical Corps' Programs in the Democratic Republic of Congo in 2009

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.

READ Sienna's Blog Posts about Her Visit to International Medical Corps' Programs in the Democratic Republic of Congo in 2009

My Mind-Changing Response to Visiting Haiti

2010-03-23T12:22:00.001-07:00

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.

Global Ambassador Sienna Miller visits Haiti

2010-03-22T14:35:00.000-07:00

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.

		Checking on a patient with Dr. Bob Fuller.
		Transporting a patient at the University Hospital in Port-au-Prince.

		Dr. Patrick Shanovich

International Medical Corps

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"Lost Track of Days"

Halfway Through Deployment

"Survived the first night shift."

Figuring it Out

The Winning Goal

Michelle Obama's Promise to Haiti

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Haiti: Thankfulness and Compassion Amid the Destruction

A Plea for Haiti

My Mind-Changing Response to Visiting Haiti

Global Ambassador Sienna Miller visits Haiti

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Dr. Rahul Khare's Photos from Haiti

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A Promise Made, a Promise Kept

Observations made on the road to and from Gressier, 2/8/2010

Still smiling after moving around on a broken femur

Feeding orphaned infants

"Je aider..."

Even with the progress we've made, mixed feelings about leaving Haiti

Report from the mobile clinic at Gressier 2/10/2010

I find strength in those who depend on me

A team like no other

...we practiced continuous battlefield medicine...

A hard road, but we're moving forward

Lessons in volunteering

Travel, triage and the importance of training

Mobile Clinics in and around Port-au-Prince

Letter from Port-au-Prince, February 23, 2010

Those with nothing still able to give

The Right Place at the Right Time

Dr. Jennifer Schwieger: Training local health workers

Dr. Cynthia Waickus: Mobile clinics around Petit Goave, Haiti

Nurse Gabriela McAdoo: He will always be my little "Haiti Angel."

Dr. Matthew Howell: Pictures from Haiti

First Days in Haiti, January 21, 2010

Little boy from Gressier

Dr. Paloma Pina: Looking back on two weeks in Haiti

This is a problem that's not going to resolve overnight

To sum up what we did, we saved lives

Dr. Eileen Murphy: Pictures from Port-au-Prince, Haiti

They are my Heroes

A Drive to do Good

Dr. Robert Fuller: Proud of the team

To improve something with nothing

Someone to help you

Questions & Answers

A Glimmer of Security for Women Struggling in Post-Earthquake Haiti

Not Another Concrete Graveyard

Home from Haiti, Haunted by Images

We Need Help

Millions Mourn In Haiti

The Rainy Season Begins

“...on my final day, my mind tired and body aching, I find myself wishing for a couple more days.”

Combating Malnutrition in Haiti

The Spirit of Haiti

U.S.-Haitian Nurse Returns to Find Heartbreak, Hope in Haiti

Joseline is the face of Haitian optimism.

Two Separate Cities

Petionville

In Medical Parlance it’s called “Revising”

“It has been the longest week in years.”

“You need to remind yourself that your skills and equipment are not the solution...”