Tabar-Issa Clinic

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!

Follow International Medical Corps

"Lost Track of Days"

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.

Follow International Medical Corps

Halfway Through Deployment

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.

Follow International Medical Corps

"Survived the first night shift."

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.

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.....

Follow International Medical Corps

Figuring it Out

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.

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.

Follow International Medical Corps

The Winning Goal

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.

Follow International Medical Corps

Michelle Obama's Promise to Haiti

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.

Follow International Medical Corps

Haiti's Future is Now

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.

Follow International Medical Corps