The "End of the Road"

Tom Kirsch, M.D.
Emergency doctor and Go Team leader

I spent the last 3 days doing assessments. We were trying to identify areas with unmet needs to see if International Medical Corps can fill the gaps. We drove out of Port-au-Prince (PaP) to the west, down the long peninsula that reaches far into the Caribbean Sea to the towns of Leogane and Petit Goave. The road passes directly over the quake's epicenter and so the damage there was far greater than in PaP.

In some towns more than 90 percent of the buildings had collapsed. At points the road was ripped and roiled with larger fissures slashing along and across the road.

The area we went to was literally at the "end of the road."

The road started as a poorly maintained ribbon of asphalt that was more potholes than smooth and gradually faded away into a scrubby dirt track only suited for feet. Initially we drove through alternating areas of forest, banana or sugar cane farms, or crumbled towns. The dirt road started as a turn that ran south towards the mountains out of the town of Leogane through an essentially flattened town with few functioning buildings. Then it headed Southeast, paralleling a briskly flowing creek that was lined with shacks and concrete houses.

Only the shacks were really left because they were made of wood and palm fronds and metal sheets rather than the brittle and poorly reinforced concrete that crumbled into dust.

There were three scattered IDP (internally displaced people) camps along the roads. They were haphazard affairs with tents and shacks thrown together in closely-packed groups made from an assortment of tarps, scrap wood, and old, rusted corrugated metal sheets. The road ended at the last camp.

It was the worst of the lot. Only yesterday Save the Children had delivered tarps - which had been used to create shelters of a variety of interesting configurations. But there was nothing else there. They did have the creek which was used for drinking and washing and bathing and probably as a toilet.

A Place We Call 'The Forest'

Tom Kirsch, M.D.
Emergency physician and Go Team leader

There is a place in the hospital we call "The Forest."
It is the place where the lost souls end - a purgatory or limbo.
In reality it is just a courtyard with some semblance of shade from the scraggy trees and tarps strung among them. It is a square of dirt and scattered grass further by an ‘X’ of concrete walkways with a dead fountain at the crossing.

Originally it was a patient care area when the hospital was so inundated, filled completely with old beds and cots and blankets with tarps strung between trees; and then a further "forest" of intravenous poles and dripping fluids. We cleared out all the ill people a week ago and cleaned out the trash and feces.

Now it is just limbo - a miniature refugee camp. There are about 35 people still there, setting up camp on the old and mostly broken hospital beds. They have converted the IV poles into tent poles to hold up their tarps. They have brought in sheets and blankets and pillows and dishes and other small reminders of the homes they used to have. They do dishes, but don’t need to cook since food is available and there is clean water and port-a-potties.

This is the place where we let those with nowhere else to go to wander off to after we have completed their medical therapy. We aren’t supposed to transfer patients there because there is no one who is responsible to care for these people - we don’t have the staff.) But sometimes we mention to the most desperate people that they can just walk over there and grab an empty bed until the hospital administration decides they are no longer welcome.

Bernard is one of the lost souls. He is a thin, craggy, elderly gentleman with fizzy grey hair and a lost look in his eyes. He came in, or was brought in for unclear reasons, and was too confused or demented to give us a coherent story.

He had a paralyzed left wrist, most likely from a nerve-compression injury after the earthquake and was clearly dehydrated and maybe malnourished. He had no family or friends or the ability to tell us where to find anyone. We gave him fluids and food and a splint and he was done. But there was nothing else for him.

I walked him to the forest and sat him in a bed in the shade. I go by daily to see him. He sits there patiently, legs dangling from the rusted hospital bed. Always in the same spot with old foam boxes of food at his side, biting the corners off the little bags of water that the volunteers bring by, and then sucking out the contents. I never see him talk, or even walk, always just sitting there and watching. I wonder what he sees and wonder if he remembers.

There are so many lost souls like him that it is incomprehensible. They come and go like tides every day. Some stay in our Forest.

All In a Day's Work

Tom Kirsch, M.D., Emergency physician and Go Team leader

For the most part I haul stuff, including patients. Yesterday I was an electrician and rewired a tent and put in more fans.

Haitians Seeking Primary Care

By Thomas D. Kirsch, MD, MPH, FACEP
Associate Professor and Hopkins Go Team Member
Dept. of Emergency Medicine - The Johns Hopkins School of Medicine
Dept of International Health - The Johns Hopkins Bloomberg School of Public Health

Work here is hard- 12 hour days, essentially on your feet constantly in boiling hot tents with limited electricity.

We have truly transited to the primary care phase, although occasional people come in with untreated wounds and fractures from almost 3 weeks ago. There is so little that we can do it seems, with the limited resources we have, and even less to do for an essentially non-existent Haitian health care system. We can treat acute infections, but pretty much anything else is almost impossible.

People are pouring into us because they think that we can give them the care they can never get in Haiti - horrible and massive cancers, HIV and AIDS, chronic abdominal problems, diabetes, whatever. But all we can do is bandage, fix the acute problem and give a few pills to go and hope that maybe at some point they may get the long term health care they deserve. Still, we see 250-350 people a day and give the absolute best care we can considering the resources.

The team has been amazing and has taken over the management of the emergency department. Everyone is pulling their weight (and then some) and using their intelligence, wit and grace to make this place better everyday (despite the ongoing chaos).