Showing posts with label Dr. Beth Sloand. Show all posts
Showing posts with label Dr. Beth Sloand. Show all posts

Sunday, February 28, 2010

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


We drive 45 minutes each way, from the hospital in Port-au-Prince to Gressier. It has been an eye-opening experience, since prior to this I have only been between the hospital and hotel, a 5-minute drive.

* Everyone is sleeping outside. Everyone. Those who have their homes flattened, those whose homes have cracks, and all others. Everyone is afraid to sleep or work in any of the buildings until an official government engineer inspects a building and finds it safe to re-inhabit. This affects Port-Au-Prince and all the towns we passed on the way to Gressier. I suspect it affects the third of the country most heavily hit by the earthquake.

* Sleeping outside means that people are gathered together in tents to sleep. Tents are mostly sticks lashed together with sheets or towels or shirts stretched across. Sometimes, cardboard or tin or other materials are added to the mix. The tents are in large areas, such as parks or open spaces, all packed together. They are also pitched in small areas, such as the median strip of highways. Daily life goes on in front and within these tent areas — people wash their clothes and their children, prepare their meals and eat. There is little privacy, a luxury here.

* There seem to be increasing numbers of sturdy tents from NGOs. Shelterbox provides beautiful tents for families, and I am seeing more and more of them in some parts of Port-au-Prince. That is a great thing because many fear the rainy season and the difficulties it will cause for people living in flimsy dirt-floor tents.

* The condition of the roads, never very stellar in Haiti, is getting worse each day. As we drive to Gressier, our driver and translator exclaim periodically when we encounter a new split or depression in the road, probably caused by the frequent aftershocks. Says translator Denise, “the earthquake crashed the road more, and cut it worse.”

* An increasing problem: trash. Trash pick-up seems to be on hold as any large trucks and resources are dealing with the bigger issue of earthquake rubble. Meanwhile, people have nowhere to put the mounds of trash — plastic bottles, cartons, wrappers, etc. Haitians tend to use and reuse whatever they can, so there is much less trash per person here than in the U.S., but what is here is simply adding up and combining with the dirty water in the streets. We saw one whole street with a continuous mound of trash 6 feet wide and 4 feet high. People climbed over it to get to the other side of the street and children played along the edge — a public health problem brewing. This also makes driving difficult, as you have to weave around the trash piles, as well as slow down for the new cracks in the road and avoid other rubble and wires. (There was one tangle of wires hanging across a street we routinely travel. One day last week, it had dipped so low that there was a spark when our bus went under it and didn’t quite clear. The next day the wires were removed, thank goodness.)

* Clean-up crews of citizens have taken to the street — men and women, young and old. We saw hundreds with blue T-shirts, armed with shovels and brooms and wearing masks to protect their lungs from the thick dust that is in the air. By the end of the day, there was a visible improvement in the look of some neighborhoods. These crews are dealing with small jobs along the side of the road and walkways. These folks are doing all the work by hand. Bigger machinery must come to remove the huge concrete slabs and chunks of concrete bricks from destroyed buildings.

* Crushed buildings seem fair game for scavengers. In these circumstances, people are struggling to survive, and they are willing to dig through rubble to pick up pieces of wire, wood, and other items that they will reuse.

* Food distribution is a tricky business. We pass one area where the UN and U.S. soldiers stand a few feet apart in a long line to provide security as the distribution occurs. Some programs are giving the food to the women to bring home to families. Once, there was a brewing protest — it seemed people didn’t like the method of distribution.

* Generally, a sort of daily life has somewhat returned. People are seen walking along the street, moving their wares to sell, bringing home food, children playing, etc. The streets we have seen are mostly quiet. There is no sense of violence or lack of safety that I have observed. One exception is when a foreigner sticks a camera out the window to snap a photo of people bathing or the tent camps, etc. Then usually one or two angry people yell in protest — understandable.

Dr. Beth Sloand, Johns Hopkins University School of Nursing




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


Gressier has a public health clinic that was functioning before the earthquake. A Haitian nurse staffed the clinic, offering well child, prenatal, and sick care to the community. When the earthquake hit, the clinic stopped functioning and people had nowhere to go for acute or chronic health care. International Medical Corps has stepped in to help bring health care to this and other communities.

International Medical Corps is providing staff and support at the University Hospital ER and some inpatient units, and has extended staff and support to several communities in Port-au-Prince and the surrounding areas.

Staff and Setting
The Gressier clinic has a staff of 2 Haitian physicians, 3 Haitian nurses, 2 Haitian nursing students, and 2 other staff who register patients and assist in various ways. In addition, 2 of us from International Medical Corps, Dr. Joel from Chicago and myself, supplement the staffing.
We bring 6 big boxes of medicines, supplies, and equipment with us each day, since there is no place to keep items secure during the night. The building is not secure at this point. We would like to work inside but Haitians are very worried about the stability of the building so we are waiting for it to be evaluated by Haitian engineers. Meanwhile, we see patients outside under a couple of trees, moving every couple of hours as the sun moves in the sky. We all try to avoid being in the direct sun, especially me.

Patient mix and diagnoses
Adults and children walk in from the surrounding area. I have seen a 6-day-old baby, another baby born the day of the earthquake, many infants and young children, their parents and a few elderly.

We see 200 to 300 patients per day. The nurses and Dr. Joel spend the first 2 or 3 hours doing wound care. There are still many people who have huge wounds from earthquake injuries, some post infection, some look like healing burns. A few of the children cry in pain as their dressings are removed and wounds are dressed. The nurses hang gauze and Lactated Ringers from the tree for the wound care. The patients lie on a table or sit in a straw seat chair. It is quite a production.

Besides wound care, the patients come to us with mostly general primary care issues, such as fever, headaches, abdominal diarrhea, hypertension, fatigue and shortness of breath, aches and pains. We've also seen some new injuries, as people are now trying to clean areas, build better tent dwellings, etc. So we have had new lacerations to suture, as well as the old.

Some of our most frequent diagnoses are severe anemia, intestinal worms, insomnia (not surprising given the sleeping conditions and the facts of life this past month), tinea capitus, acute gastroenteritis, vaginal candidiasis, impetigo, and acid indigestion. We have also confirmed several patients with malaria, some children with acute pneumonia, and referred some others with TB and suspected HIV.

People also come to us with more random issues. A 35-year-old man came with a limp that he said began with the earthquake. We sent him for an X-ray, which showed Legg Perthes disease that he likely has had for years. No doubt he feels the limp more now since the earthquake but it is clearly not a new problem.

Parents brought a 2-year-old in who has a colostomy because he was born without an anal opening. They would like us to operate to fix it all. Another mother brought a 3-year-old who does not walk or talk. She requested some surgery or medicine to cure this developmental delay. I had to explain the hard facts about our limitations, and give them encouragement to involve the child in daily life as much as possible. When they see a clinic with foreigner staff, people sometimes think that miracles can happen. Unfortunately, that is often not true.

So acute post-earthquake conditions with broken bones and severe injuries has evolved into primary care plus continued care of the old injuries. One man came in with arm pain that he has had since the earthquake. His upper arm was out of alignment. We referred him for an x-ray, suspecting that his humerus had broken when his house fell on him but without care it has healed poorly. It is possible that an orthopedic surgeon at the hospital will be able to repair it to be more functional.

Breastfeeding
I have counseled many mothers to continue breastfeeding their babies. Several have told us that they believe their milk is bad since the earthquake. Now we have infants suffering from diarrhea, as they are being fed foods and drink other than breast milk. With the difficulty finding clean water in Haiti, and the near impossible chance of mixing formula or dry milk powder in a clean bottle with clean water, breastfeeding is truly life saving for babies. So we educate and encourage. "Breast milk is the best food for your baby." "Breastfeed to keep him strong and healthy." "Breast milk is the best medicine." We hope the message is heard for the improved survival of infants and young children here. The odds are tough for these little ones.

Aftershocks
Generally, the patients wait quietly and patiently to be seen. Many have to stand or they sit on the ground, most without any water or food for the hours at a time. Children rarely cry. In the midst of a quiet clinic day, the people suddenly cried out as a group and ran into the street. They had felt and heard an aftershock. This happened three times on February 6. There is a lot of continued fear with each aftershock. Confirms that people will be staying outside, sleeping in various and sundry tents, for quite some time.

Dr. Beth Sloand, Johns Hopkins University School of Nursing

Wednesday, February 17, 2010

Home from Haiti, Haunted by Images

by Dr. Beth Sloand

We returned home from Haiti two days ago. It has always been true for me, over the past ten years and countless trips to Haiti, that the transition from Haiti to home is far more difficult than the transition from home to Haiti.

At the end of a visit, you leave Haiti. But Haiti doesn't leave you. It has a way of clinging to your heart, never far away. This truth is even deeper in 2010, post-earthquake Haiti. Haiti haunts; it does not leave you alone. Memories are vivid: bandaged limbs of all sizes, odd surgical repairs, thick dust in the air as crews of Haitians sweep trash and shovel rubble, flies swarming wounds and IV bags in hospital wards that are open tents, patients limping from tent to latrine- holding tubing and bags of fluids, and more. Touching moments are plentiful- the kindness of neighbors, a mother singing hymns at her baby's bedside, an adolescent with forehead laceration who is pleasantly surprised to see her photo: "Look, we're still beautiful." And much more.

It is hard to summarize the medical relief trip to Haiti. We were away for a little more than two weeks, with the mission of providing needed medical care post earthquake; it felt like two months. Each day was filled with the intensity of overwhelming work in unrelenting heat, all against the backdrop of profound sadness.

Thousands of people have died; thousands of people are maimed; thousands of children are left orphans.

Thousands have lost their loved ones- mothers, fathers, children, their homes and businesses, their city and country.

Thousands are living outside in makeshift tents, with their homes destroyed or damaged or with fear of the next aftershock. Practically the whole city is homeless, gathered into tent cities wherever there is space to be.

The city of Port-au-Prince and many surrounding towns are filled with huge piles of rubble that used to be buildings, buildings large and small that crumbled in the earthquake; unknown numbers of bodies are still buried in the rubble. Port-au-Prince has become a graveyard; we drive through this graveyard to get to work; people walk through the vast graveyard that is Port-au-Prince to get food, seek medical care, and fetch water. There are no longer bodies piled up and visible in the street, but there are entombed bodies everywhere.

International Medical Corps has brought important medical care to the people at University Hospital in Port-au-Prince and to those in several clinics throughout the city and surrounding area. Our Hopkins team did what we could to help through International Medical Corps. It was a great privilege to be in Haiti among so many relief workers from around the globe. We most certainly made a contribution. My translator Denise said, "Thank you for coming. Without you, many more people would have suffered and many more would have died. We are sorry that we have nothing to give you; we can only thank you. God will thank you."

The truth is, the real heroes are the men and women, boys and girls of Haiti who have survived and are working each day to pick up the pieces of their lives and go on. They will need a lot of help for a long time to come.

Dr. Beth Sloand, Johns Hopkins University School of Nursing