Wednesday, February 10, 2010

"How Will Haiti Recover?"

Alicia Hernandez
RN and Go Team member


My last few days in Haiti were a new experience as I responded to a call for volunteers suddenly needed in the Petit Goave region of Haiti to replace the volunteers leaving the mobile clinic sites there on Friday.

A doctor from Chicago, Stacy, and I set out apart from the rest of International Medical Corps (IMC), and arrived to the mobile clinic where just two IMC nurses had been working with Haitian staff for a week.

It was a tent clinic in one of the tent city Internally Displaced People (IDP) camps that served the people living there mainly with primary care issues. The tent was supplied mostly only with oral medications and some wound care materials. The IMC nurses gave us a quick debriefing at around 11 a.m. and left us on our own by noon. Talk about getting your feet wet.

We jumped into the over 100 people waiting to be seen as the clinic had not opened that morning at the usual time. They were waiting for us to arrive with the restock of medications. We quickly began rolling through the patients.

I triaged with a quick initial assessment and vitals while Stacy and two other Haitian doctors saw and prescribed medications for each patient. Everyone got something if only multi-vitamins, although generally at least three different things from the Haitian doctors - mainly to treat coughs, UTIs, [other] infections, scabies and gastritis. Most were mild enough to send "home" with oral medications. We did receive one obviously sick man - most likely with TB - on our first day.

The dilemma was then where to send the patient as we did not have the capacity to care for him in the tent. We decided to send him with our personal driver to the nearest hospital. We found out later the hospital is currently only staffed with one doctor and one nurse. It has no functioning X-ray or laboratory. Stacy and myself had a debrief that night with the one other IMC staff staying in Petit Goave, Pascal the French logistician, about the current situation.

Pascal´s job had been to arrange everything for us from accommodations to transport to interpreters as well as everything for the mobile clinics - tents, staff, supplies and sites - and gathering all the info we needed to best serve in our clinics. He was our "go to" for more supplies to request from IMC or from other area NGOs and for knowledge on what services are available where.

Pascal Made A Big Job Easy

It was a big job - but he´s been doing this for over 15 years in so many disaster zones around the world he made it look almost easy. He said Haiti has been his hardest assignment yet. So Friday night the three of us figured out that there is an MSF - Medicins Sans Frontier, a.k.a. Doctors without Borders) hospital 45 minutes away. That was a better option for a referral than the nearby non-functioning hospital. We also set a plan to open a second new clinic on Saturday that Stacy and a few of the Haitian staff would go to while I would stay in the current clinic with the rest of our current Haitian staff.

Pascal said we would each have our driver although that didn´t quite get arranged in time and I manned the clinic with no phone, no driver, and no other IMC staff. It was me and five Haitian health care workers and over 100 patients again.

A Sick Girl - Typhoid

I was impressed at how well the Haitians were running things. It was all fine until we received a very sick girl, potentially with typhoid. I had no driver to take her to the hospital or way to contact anyone to ask for help. She had shortness of breath, cough with dark sputum, vomiting, diarrhea, and temperature of 104. The Haitian plan was to give her an antibiotic injection and some Tylenol and keep her on the examination table there to recheck her temperature after an hour or so.

If it started to decrease, they would send her home and tell her mother to just bring her back on the next clinic day, which was Monday, for another injection unless she improved. This girl really would have benefited from IV fluids, repeated IV antibiotics, and closer monitoring. I kept checking on her to make sure she was still breathing, as she looked grim, lying face-down on the cot, eyes slit, no movement. The scream she let out with the antibiotic injection was some extra reassurance she was still very much alive.

I continued to work, with glances at her every few minutes. A temperature check showed a slight decrease. After a couple of hours, with my last glance, she was gone. They had sent her home. There was no means to do anything more.

I still think about her days later and only hope she will be alright. Saturday Pascal had worked to secure us another driver and to find names of villages with potential need for more mobile clinics either due to vast quake damage and displaced persons or loss of the existing health care source from the quake.

Collapsed Buildings Common

Sunday was spent visiting these villages and assessing need. Collapsed buildings around Petit Goave are as common as in Port-au-Prince but with less open spaces, as in city parks. Actual tent cities were not as common. Tents simply lined the streets. Driving took some careful maneuvering and I can only imagine living in one of those tents where cars constantly pass only inches away.

One of the villages we visited was as poor and as devastated as anywhere we had seen. There were collapsed buildings on top of the poverty that already exists. It was also a place on the coast where the ocean floor had shifted and the water level rose and flooded everything near the coast. As we were driving through, Pascal said, "I´m sure there´s need here but where are the tents?"

It was interesting to learn there had to be obvious need resulting from the earthquake in order for us to spend the donor money there and help. They couldn't just simply need help. In another village, they had a fine standing facility that once served as a clinic. The complicated task then was to find out why it wasn't functioning now. Was it functioning prior to the quake? Was the facility damaged in some way? Were there staff losses? Were they just not showing up to work now because the government stopped paying salaries - or did they stop paying them because they stopped showing up? So many complexities involved in disaster relief, especially in a place like Haiti where the health care system was barely functioning in the first place.

Mission by Boat
There was another site Pascal had heard of that wasn´t reachable by car, only by boat from Petit Goave that was rumored to be affected by the quake and had received no services or even visits from outsiders since. So we put together a mobile boat clinic and sent them out Monday to do the assessment and [set up a] new clinic there at the same time. Apparently it was a success. Medical services were brought there and they were affected by the quake, losing their water source as well as their usual means of receiving medicine and food.

I had three and a half short days in Petit Goave and saw and learned so much. And I hopefully helped some as well. "Short" and "hopefully helped some" are two of my main thoughts as we head home now.

The biggest thought, however, is how will Haiti recover? How long will it take? What more can we do? What more can I do? How do I go home and back to life there? Haiti will stay with me now. I feel a responsibility to spread that to others. To get them more help, and to get back and do more. This leaving now is not the end of anything.

2 comments:

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