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.
Wednesday, February 10, 2010
Tuesday, February 9, 2010
"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.
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 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.
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.
Monday, February 8, 2010
"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.
Friday, February 5, 2010
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.
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.
Thursday, February 4, 2010
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.
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.
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