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.

"...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.

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.

"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.

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.

Saved a Newborn in Distress

Emmanuelle Clerisme-Beaty, M.D.
Go Team member

After almost a week I finally got to work in one of the medical wards, which is definitely more in line with my training. On my first night I covered the inpatient pediatric wards and the NICU. However after a rough start trying to take care of 60 patients with no nursing or ancillary staff, Mike and I ended our 16-hour shift by successfully resuscitating a newborn in respiratory distress.
To think that if this baby was born one day earlier, he would have died since until that night there had not been any in-house physicians until that night.

"...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.

"I Don't Know How People Are Surviving Here..."

Alicia Hernandez
Emergency RN and Go Team member

Day 6 in Port-au-Prince: Half-way through our stint here. I can't believe it was only one week ago that we were first flying here. It feels like so many more. I hit a brick wall yesterday as we have all been working almost non-stop since arrival. Some since the minute we stepped off the bus from the Dominican Republic into the hospital. It's the long hard hours in the sweltering heat of the tent, the relentless flow of patients desperate for miracles we can't provide, the lack of sleep, and continuous failed efforts to stay hydrated and nourished. At least one volunteer has succumbed to the pressures everyday since we've been here, to the point of being unable to walk and needing IV hydration.

I came dangerously close to that point multiple times about every 2 hours yesterday, needing to find shade outside of the tents, and force down some oral re-hydration salts (ORS).
I had at least 3 liters of ORS plus more water and still couldn't last more than 2 hours in the tent without feeling like I was going to vomit and pass out. I realized I had to take more than the time it took to down a liter of ORS away from this work. Thankfully everyone else realized it yesterday as well and time off is now not only being more welcomed, but mandated. I quickly stepped up to the plate to take the first day off. I finally slept better, I think knowing I wouldn't face the pressures of not only caring for others this morning but caring for myself in this condition.
That alone was a huge weight lifted for the night. And I still awoke nauseous and still feel so now. But I'll get through. All of us are (with a few exceptions of early flights home for fear of serious illness). With being awake through the night not only because of the heat and stress and mosquitoes, but because of having multiple trips to the bathroom with vomiting and diarrhea. The bonus of doing medical relief is that we all have easy access to medicines and IV fluids with the know-how to provide it to each other. I started an IV on another nurse that went down in the middle of the day yesterday. I have been offered IV fluids and Zofran and cipro by many of my fellow volunteers.
Everyone cares and everyone understands. It's great camaraderie and great inspiration to see what we are all going through to try and make some difference here. And I like to believe it's in the small ways that we are. We are so limited in what we can do for the severely sick and without Social Work, it feels so wrong to discharge those without a home to go to but that is nearly everyone. I don't know how these people are surviving but they are. Not only that, but they smile and thank for the simplest things - some Tylenol, a little cleaning and fresh gauze on a horrendous wound that covers half their leg that they have to limp out on. And to where?
A two-tarp tent, waiting for the next food and water drop. We pass by their lives,
sheltered by the walls of the bus and the walls of hospital, see them cooking and bathing on the sidewalks, bustling to and fro. Life goes on in unexpected ways.

"We lose one staff a day..."

Tom Kirsch, M.D. (pictured right) with Rocky Cagle, RN

Tom Kirsch, M.D.
Johns Hopkins Emergency Physician and Go Team Leader

The day starts about 5:30 a.m. when the hotel turns back on the power. The fans come back on at least. People begin stirring, snores fade away,
backpacks rustle and feet pad around.
The lights usually burst on at six and then the activity intensifies except for a few trying to squeeze out a few more minutes of sleep. People dress, food and supplies are gathered.
The bus leaves at 7 a.m., driving less than a mile past normal buildings and lives and crumbled ones and tent camps. Vendors have already lined the streets
past the ramshackle tents in the city’s main plaza- food stalls, haircuts, a Gno Kozes (snow cones), but most interestingly the guy with the truck. It is well lit
by fluorescent lights and has a rack of blenders in the back making smoothies.
At the gate of the hospital there is already a half-block long line of patients waiting to get in.
By 7:15 a.m. we have completed out briefing and are pulling supplies.
The little triage tent is bursting with people.
A report is given by the night team- there are always leftovers – usually very sick. They bring the sick ones from the rest of the compound back to the ED if they go bad at night, and only the really sick come in after midnight.
Patients start pouring in.
Our tents are hot, probably 10-20 F hotter that the ambient 95 F air outside. They have few windows and the power only runs occasionally to run the
fans.
We loose at least one staff a day to heat exhaustion.
Yesterday it was the 6’2” nurse from Utah. Dizzy and pale, then down and vomiting.
We run IV fluids and bring them to a cooler area. We have started mandatory fluid requirements, and push people to take breaks and now will have a
mandatory ½ day off every 5 days minimum.
The army guys might hook us up to one of their generators so we can at least run the fans. I got pizzas and cold Cokes delivered from the outside yesterday. A strange comforting little piece of normality.
The buses head back between 5:30 and 6 and it is always a scramble to tuck things away, restock and sign out to the night people. We usually miss the
bus and bet the late one.Debriefing 6-6:30 or 6:45 (although I usually miss the first few minutes, preferring to sit with my sore feet dangling in the cold pool water and drinking a
beer). Dinner cafeteria style is at 8. Most people start fading out around 9. The few hardy (stupid? gregarious? Insomniacs?) sit on the patio late
talking and drinking $4 beers or soda until late surrounded by the reporters furiously working on stories and hogging all the wireless bandwidth).Finally sleep in the dark conference room with 40-50 people scattered around in various odd sleeping arrangements- bed mattresses, inflatable ones,
cots, even tents pitched indoors. The stirring, rustling backpack and padding feet gradually fade away and a low-grade background hum of stores rise up
and the day ends.