Pastors Keep Community Spirit Going in Haiti

By Gene Gincherman, M.D.
Emergency physician and Go Team member


While on a trip outside Port-au-Prince (PaP)during a recent medical mission to Haiti, I noticed one essential quality to people's suffering there: namely, it's essential loneliness.

It was less prevalent in PaP, where people are closer together and seem to have more of a sense of community. In smaller villages, it seemed like more people fended for themselves. Some of them seemed to spend their whole days sitting in makeshift tents, not doing much.

It seems to me that if that idleness is allowed to continue, it will lead to despair, and further suffering. One experience on this trip gave me a glimmer of hope for the future. We happened to be visiting on Sunday, a day a lot of people in Haiti go to church. As a consequence, we got to meet with five different pastors.

Considering the lack of civil authority, they seemed to be the inspiration for their communities. They were interested in every aspect of daily lives, from fulfilling the spiritual needs to providing food, medial care and building latrines.

If Haiti is going to recover and overcome not just the outcome of the earthquake, but also years of mismanagement, suffering, and corruption, they need more people like the pastors we met.

"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.

"...Why Did We All Do It?"

Gene Gincherman, M.D.
Emergency doctor and Go team member


As all of us start to decompress a bit in the Dominican Republic after our work in Haiti, more and more thoughts come to mind. It seems that the most fundamental question is: Why did we all do it?
It seems to me that the answer lies somewhre between doing it completely out of altruistic notion of trying to help people around you who are suffering horribly and going on an ego trip to prove something to oneself.
People who are in Haiti to save the world burn out too fast,and become a liabiity to themselves. People who go on an ego trip are unable to become good team players and destroy the sense of community that immediately develops in such austere and stressful environment.
I am proud to sat that the Johns Hopkins team has developed a sense of togetherness from the start, which played a tremendous role in our ability to take care of each other and our patients.

"Everyone is Sleeping Outside. Everyone"

Beth Sloand
RN and Go Team member

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 people who are 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 that went on and on. People climbed over it to get to the other side of the street. 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 the small jobs along the side of the road and the walkways. These folks are doing all the work by hand. I have heard that this effort is funded by the UN or an NGO, but am not sure exactly who or what. Certainly someone has provided the shirts. 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 there is usually an angry one or two people who yell in protest. Understandable.

"Children...Suffer In Silence

Beth Sloand
Pediatric Nurse Practitioner and Go Team member
The hospital is mostly outside in tents. Tents come from the Red Cross and Red Crescent of various countries. There are six pediatric tents. The infant tent has about 30 little cribs crowded inside - only a few inches separating them. IVs hang from tent strings. There are no chairs in the tents, so parents sit on their child’s bed. In the infant tent, parents slept under babies’ cribs at night on a piece of cardboard or sheet or whatever they had.

The American military, all in full uniform fatigues, and the Scientologists, with bright gold T-shirts, distribute food at times. A funny combo. There are two pediatric orthopedic tents, since orthopedic injuries predominate from the earthquake. Lots of broken femurs as well as other bones.

Children mostly suffer in silence. There is little crying in any of the pediatric tents. There is some pain medication given, but not regularly. Children tend to be stoic; they are not used to life being comfortable. Everyone is on antibiotics to treat or prevent infections.

Parents seem to have a pleading look in their eyes, or maybe it is my imagination. For all those hospitalized, a predictable hurdle is discharge. How do you discharge people who have no home?

Conditions in the tent camps scattered throughout the city are much worse, and it is difficult to know that recovering surgical patients will be living there.
I worked in the ER Monday, joining a team of about 16 nurses and physicians. It's a hopping place. We saw 470 patients. The range was wide -- a woman who had just been hit by a car, a man who was found unconscious on the street, a child with an infected orbital fracture, as well as those with back pain and headaches and fevers. We have a lab with basic capabilities; radiology that works for simple films, and a limited pharmacy. Supplies are available, but not always what you need or want. There are some Haitian nurses and physicians who are very helpful when they are around.
It is a loud place, with lots of yelling and people talking. The outside venue doesn’t lend itself to tranquility, and there are several patients being seen in the small area. We have three ER tents. In Tent 1, where I worked, I lined up kids and adults -- three or four -- on the edge of the bed, and then worked through them.
The questions are redundant: What brings you here? When did the pain start? Have you sought other care? And so on... My translator, Stevenson, was helpful and reliable. We often have to move patients off the bed for a more seriously wounded or ill person who arrives. Then we see them on a chair if available, or just standing. Not optimum, but it works.

"...Bringing Light To The Darknesss"

Rocky Cagle, RN and Go Team member

We arrive to the university hospital around 7:15 a.m. We have a short debriefing and then off to our units. There is no way to know what we are in for each day. I meet with my interpreter and we chat about our previous night. I ask about his family, how his wife and kids are and he always says they are good. It's hard for me to comprehend they are "good" with their home destroyed and having to live in a small tent that is meant for two- but accommodating five. He says his kids love not going to school.

I think to myself that perhaps they have not yet realized that their schools are destroyed and the devastation of the earthquake has taken the lives of their classmates and teachers. After the brief conversation we are ready for our day, both of us knowing it's going to be long and hot.

We don't give the conditions a second thought as we are immediately focused on making a difference -- bringing light to the darkness that surrounds so many here.

Arriving on the unit I take inventory to see what supplies we have for the day. I have learned that many of our supplies are missing. Already patients are waiting for care. The long lines twist
down the street. American care is here and the Haitians have welcomed it with open arms. They have a robust confidence in the work we do -- often expecting a cure for the incurable.

As the chaos begins, there are doctors and nurse swarming the tents. Novice nurses work side-by-side the seasoned health care providers. The newest additions to our ER flounder briefly asking questions like, "Where is this antibiotic? Where is this narcotic? Will you start this IV? Can you figure out what is wrong with patient.? I am new here can you help with what I should do?"
The intensity drives all of us to push our limits and immediately adjust to the demands from all sides. After 10 hours of craziness in 100 degree heat, we finally come to a day's end and take time to reflect on the day.

Have made the right calls? Have we truly done out best to make a difference. The realization that our Hopkins group will have worked over 1,000 hours within 10 days, does not ease the demands I have for myself and the short-comings I have identified within myself. It's two weeks
out of my life -- a short time to do the good I set out to do.

Pierre, my translator has stood by my side all day. He's held my supplies at my side, tidied my workspace, and spoken every one of my words. He comes here every day to make a difference of his own. Knowing his family awaits him, he sets off back to his "home."

Despite leaving the ER for the evening, my mind is continuously rewinding through the day. How will I be better tomorrow? Am I good enough for these people who depend on us so much? I think of each face of each patient, each heart I have touched. The strain and stress can be overwhelming but I find a strength in those who depend on me. I will return tomorrow with a smile on my face, a soothing touch to my medicine, and shoulders to carry the burden of a broken country.

"They lost their house..."

Rocky Cagle, R.N.

Go Team member and ICU nurse

Today was a good day. We saw a good bit of patients today. As some of you may not know I am now in the ER because they needed more help there. The whole Johns Hopkins crew runs the ER. All 8 of us.

It is better than staffing the ICU because there is nothing I could do for those people. I am charge nurse of the ER so it is good to be running the show and having people look up to me. (Cagle in middle of photo left)
My Creole interpreter has a wife and three kids. They lost their house in the quake and his brother died. He had 5 U.S. dollars for the past two days to buy food for his family. He gets paid $20 a day but has not been paid them since last Friday, 9 days ago. They live in the tent village about 15 miles away. He has to take a cab to work every day which costs money. I got some MREs for him and his family today. His wife is washing my clothes for some money. I gave him $10 for him and his family. He said "How - I don't know how - I will ever repay you!"I plainly stated I couldn't do anything without him; he owes me nothing. I plan on giving him everything I have left if anything when I leave here. We were walking around today, and he decides to tell me a joke and his broken English, "as we walk here let me tell you joke, Jesus and Peter were hanging out. They were about to go on a walk but before Jesus told peter to make them a chicken. Just a chicken with nothing else to eat before their walk.Peter said OK and proceeded to make the chicken. When the chicken came out it only had one foot. Jesus said Peter what happened to the chicken's foot?

Peter said all chicken only have one foot. Jesus said Peter my Father made chickens and I know they have two feet. Peter said no they all have one foot.Jesus said well OK, and they went on the walk. Right outside is a chicken standing on one foot. Peter said look Jesus one foot, Jesus looked and scared the chicken and it ran off, with two feet.Peter said Jesus you always make miracles!It was funny and heartwarming.

Other than that we are dealing with patient that have dengue, HIV,tuberculosis, malaria, a lot of sores, gunshot wounds, etc.

"Heartbreaking to see..."

Today was another day in Haiti - hot. I work in the ER now because there are great needs there. The Johns Hopkins crew is pretty much running the ER now with good outcomes.

We saw 470 patients today (triage at University Hospital in picture at left); others walked away. There is a lot of continuity of care and we work together well. We see cases from tuburculosis, malaria, typhoid, tetanus gun shot wounds, motor vehicle accidents, CHF, etc. We are good at diagnosing these cases but there is a problem with medications; they are hard to come by.

We could save most of these patients with good facicilities and meds. It's heartbreaking to see people that we know are going to die without treatment that we can't perform. Ten more days to make a difference in these peoples lives. If I only make one difference in one life, it will be worth this effort. - Rocky Cagle, Hopkins ICU RN.