Thursday, November 11, 2010

Journal of the Plague Year

There is very little time to write or report, but this is in response to the many who had asked for an update.  Stef is on the ground in Port-Au-Prince. Cholera patients who contracted the disease locally are now showing up at Bernard Mevs / Project Medishare Hospital.  There are unconfirmed reports of at least 140 cases in or adjacent to Port-Au-Prince, and we have confirmed reports of cases in the earthquake camps.

It is clear that there is political interference so both the death toll and the number of cases is being under-reported by at least a factor of 4 or 5.

She went up north yesterday to one of the very many improvised Cholera Treatment Centers (CTCs).   This is not her report, but it is sadly representative of conditionson the ground:

On Nov 10, 2010, at 1:56 PM, Tiffany Keenan wrote:



From partners in the north....



I made a visit to both Limbe hospitals yesterday and brought more supplies to Bord de Mer Limbe clinic (Haiti Village Health) where I ended up staying night due to huge volumes of rain and assisting with cholera patients here. Even with the rain (likely causing many to never make it) clinic is seeing 5-10 patients a day. 6 to the hospital this morning one of whom died. Late last night we were at (Hospital) Bon Samaritan which is overflowing with patients. We talked with Shawn (Hodges) who said the last two days had been crazy and they were hoping to set up a second tent today to accommodate increased patient load.

The situation at the other limbe hospital (Government hospital St Jean) was worse. We brought a patient there only to discover that a huge tent and building full of patients was being attended by noone. There was no doctor or nurse present, dry IV bags, and when we asked how a doctor could be reached noone really knew. All patients from the clinic are now being routed to Bon Samaritan after stabilization with IV or oral fluid and the hospital has said to send them along no problem.

Personal contact....

also had another report from Clinic Ebenezer who said they were overrun with patients and on their last box of saline. Staff have been overwhelmed and they are looking for nurses.

Personal contact from Cap....

I think that things are not great at the hospital (St Michel) or at the gymnasium where they are putting the suspect cholera cases. I had thought that MSF was all set up, but they still won’t be for a couple of days apparently. There have been a number of deaths in the community around FSM (Fort st michel), and I understand people don’t want to stay at the gymnasium. I also understand that they are treating people at Milot. I have been in touch with people from the Baptist Convention Hospital in Quatier Morin, about possibly opening a ward there.

I have been speaking with contacts in PAP and they are hoping to send more supplies and staffing but many more are needed, as you can see how the spread is happening.

Tuesday, June 29, 2010

Gun Shot Wounds

I am waiting for the Haitian police to make me feel more secure.    It looks as though it may be a long wait. 


About two weeks ago we received a young man with a gun shot wound to his neck.  After seven or eight feverish hours  he was not yet stable, but it looked like he had a chance.   That was when the police swarmed into the hospital, insisting that they had to take our patient away because, they claimed, some rival gang would otherwise storm the hospital and shoot it up.


Well, the police took him and we were gunshot free until two a.m. a few nights ago when a man who decided he needed medical attention demonstrated his displeasure that we were closed by firing several rounds into the air.  


Our would-be patient, of course, was another policeman.  I felt so much safer when I learned that if one of us were felled, it would be by police bullets.  

Why I Don't Get Out Much Anymore


We have rats in the morgue. 

So when a 12 year-old girl died of something easily prevented and easily cured almost anywhere else in the hemisphere, we put the body in my room so her mother could mourn without our adding to this horror.

That is how I wound up going on a run for a transfusion.  And that is how I realized how much I have been avoiding the streets.  And why. 

More than five months after the earthquake, the devastation is endless.  The many, many bodies still trapped under the rubble have liquefied and no longer smell, but that painful stench has been replaced by an even more painful sight -- the million mile stare of people who have given up any hope that it will ever get better.

I shuddered and began weeping, and had to explain to the guy who was driving me that I was alright.  Sort of.

Sunday, June 20, 2010

@#!! THE DALLAS MORNING NEWS

OK.  Everyone can pay a few gourde for care.  (The Haitian Gourde is basically worth about two cents in U.S. money.)  And they should.  But why are the U.S. papers running stories whining about how Haiti's private medical sector is being 'crushed' by the onslaught of free, U.S.-based care?


There are a relative  handful of Haitians who can afford to pay for their care.  And they should.  The doctors here have a right to make a living.   But for the 95% of Haitians who can't afford malaria medicine or food . . . 







WTF??   What is the 'private sector' doing for this infant??


Ooops.  I guess you can tell I've finally gotten some rest.


Sorry about that...

Perpetual Sorrow

So we've moved.  We had to because of the rains.  


I just wish it hadn't been this way.


We have gone from being a 200+ bed hospital to a 68 bed hospital.  So the first thing that happened was that Three-quarter of the Haitians were laid off.  These are people who have worked side by side with us and who have become members of my extended family.  The only grace note is that I didn't have to pick who stayed and who went.  


But I did have to see my dear friends, crestfallen and listen to them weeping.  And could not help wondering where they would go, and how they would feed their families in this mess.


Then came the subacute patients.  And many of them children.


Lots of kids -- mostly orphans, had been brought here  with open wounds that had become badly infected because they had no one to care for them.  Because nutrition is so important to get these wounds to heal.  we kept some of these kids quite a while.  


OK.  Originally we kept them because they were very ill and needed our care.


Then we kept them because they needed to be fed if the wounds were to heal.


Then we kept them because we loved them.


And now we would have to send them away.

One of those was a 3 year-old boy I wrote about earlier, who had been named Movaux.  We later learned his real name was Sonson.  He's the boy who Tamara, a dynamite lady and one of our hardest working volunteers had just fallen in love with.




Well, here's the rest of the story . . .




Child rescued from Haiti rubble is orphaned again

6/18/2010 5:57:04 PM
Associated Press

PORT-AU-PRINCE, Haiti  — Time was up, not 10 minutes into the visit. The social worker went to pull the 3-year-old orphan out of the arms of the woman he calls "Momma."

The boy turned his face and dug his hands into her clothes. He kicked his legs. He screamed as they carried him away.

Tamara Palinka covered her mouth to hold back the sobs. The 37-year-old Canadian volunteer aid worker did not know when — or if — she would get another glimpse of the child she was desperately trying to adopt.

International adoption has always been a sensitive subject in Haiti, a reminder that the country is too poor to care for its own. After January's quake, the Haitian government effectively slammed the door shut on most adoptions altogether. With no foster care system and virtually no domestic adoption in Haiti, untold numbers of children orphaned by the quake — like the 3-year-old known as Sonson — now face a lifetime inside an institution.

The crackdown on adoption came in response to two incidents. First, Pennsylvania Gov. Ed Rendell flew 53 children from a destroyed orphanage run by two Pittsburgh sisters back to the U.S., after a tense standoff with officials at the Haiti airport. Then a group of U.S. missionaries tried to take 33 Haitian children out of the country without papers, claiming they were orphans when in fact all had at least one living parent.

Infuriated, the Haitian government announced that all children leaving the country would need the signature of Prime Minister Jean-Max Bellerive. Since then, the government has relented somewhat, but it still allows only the adoption of children orphaned before the quake or those relinquished by their parents in the presence of a judge.

"The sad part is that because of a few people's mistakes, children that could find a good home and are waiting for a home will now have to suffer for years — and may never get a home at all," says Miriam Frederick, founder of the New Life Childrens Home orphanage.

At another orphanage, Sonson sits apart from the other children.

He stares at the floor.

"Who is your momma?" asks an orphanage worker. "Mara," he whispers. "Do you miss her?" He nods.

___

The first thing people saw after the ground stopped shaking on Jan. 12 was the thick, white cloud. It was the dust kicked up by hundreds of falling buildings. People pulled out of the destruction looked like they had been doused in flour.

Three weeks passed before anyone noticed the 3-year-old. The only part of him not covered in white dust was his foot, which was stained red with blood.

Two women saw him playing by himself on top of a destroyed house and assumed his parents were nearby. But after four days and nights, they realized he spent all day on top of the rubble by himself.

Then they noticed his belly was getting bigger, a sign of malnutrition. He was picking through the rubble for trash to eat. They carried him to the nearby office of the Salvation Army.

The toddler was covered with dust, didn't talk and looked dazed, according to the charity's report. His foot was infected,
so they transferred him to a field hospital set up by the University of Miami on the grounds of the airport.

___

Palinka could hear the hospital before she saw it.

Hundreds of people were screaming. Children moaned in pain as nurses changed bandages on their raw stumps. Families yelled out for help for their dying relatives.
For the next two months, she often worked 24-hour shifts without a break. She was paged when the generator stopped working, when the medical supplies ran low, when the water ran out and multiple times a day when a patient died.

"Everyday I catch my heart in my throat," she wrote in a journal entry.

An athletic blond, Palinka had been working drafting safety procedures at an oil refinery. By the time the quake hit Haiti, she had enough saved up to take a leave of absence.

She had been at the hospital for three weeks when the 3-year-old was brought in and placed in a cot. It was dark when they told her an orphan had been rescued from a trash pile.

The other children in the pediatric ward had parents nearby. At night, the mothers crawled into the cots with their children.

Palinka felt a sudden sadness. The boy looked so small, swallowed by the adult-sized cot. She didn't want him to wake up alone.

On a whim, she got in the cot with him.

She tried to sleep but couldn't. She listened to the sounds inside the sauna-like tent — coughing, the whimpering of a child in pain, nurses brushing past, doctors talking and the alarm set off by a little girl in the emergency room.

In the morning, the 3-year-old stirred. He rolled toward her, glanced at her, then quickly turned away. She felt that her side was wet. He had peed all over the cot.

She changed him. She gave him baths inside a plastic laundry tub. She rummaged through the donations flown in from Miami to find him fresh clothes and a play pen.

When she first tried to clip his toe nails, he pulled in his feet and curled them into little balls. Coaxing him in Creole, a Haitian nurse slowly got him to extend his feet.

The food at the hospital came in a styrofoam takeaway container. She placed the box in front of the 3-year-old. He opened it and threw one leg over it, as if to shield it from anyone who might try to steal his food.

He ate in famished gulps until he couldn't eat anymore. Then he hid the box under a table. When she took him outside, he grabbed a fistful of dirt and stuffed it inside his mouth. The doctors determined that he had worms, most likely from eating food off the ground.

At lunchtime, the nurses placed the takeaway box on the floor of his play pen. Palinka returned to find him asleep in a pile of rice. When he lifted his face, chunks of rice were glued to his cheek.

One morning, as she lowered him into his play pen and turned to leave, he threw up his arms and screamed out, "Momma!"

___

At first the little boy only looked at his feet. She would tell him softly, "regarde moi" — "look at me." He started to give her furtive glances. She took him into her tent, away from the clamor of the pediatric tent.

He started to talk to himself. Sometimes he sang. One of his favorite games was to blow on her stomach, making the sound of a motorboat.

She asked a Haitian translator to figure out his name. The translator got down on one knee to ask him. The child stared at his feet. He repeated the question. And then the child answered.

"Sonson," he said.

She brought a different translator. And then a third one. Each time the answer was the same. On her Facebook page on Feb. 13, Palinka wrote: "Sonson is a good name."

Two days later she posted: "Tamara Palinka wants to take Sonson home! will start the process tomorrow."

In Alberta, Palinka's mother Kate Millar wrote back: "Is Sonson a child you are hoping to adopt??? Am I going to be a grandmother???"

International adoptions by U.S. households have fallen from a high of around 23,000 in 2004 to roughly half that last year, according to U.S. State Department figures. Haiti is the latest of several former "donor" countries to put a freeze on such adoptions.

Vietnam and Guatemala have halted adoptions altogether. South Korea — one of the first countries from which orphans were sent — has revised its rules to make adoptions increasingly difficult.

"There is a sense in many many countries that to be a 'sending' country is an embarrassment," says adoption lawyer Diane Kunz, executive director of the Center for Adoption Policy and an expert on adoptions from Haiti. "Their perspective is 'Our patrimony is our children.' It's as if you are giving this away."

___

By his second week at the hospital, Sonson was transformed. He sang and danced. At dinner, he beat a stick on the back of the styrofoam container like an instrument.

He begged for food. Other volunteers gave him candy and snacks. Some days Palinka would come to feed him and see he had already two empty styrofoam boxes in front of him. Several times he vomited on her. One night she took him to see a doctor at 2 a.m. because he was complaining of a stomach ache.

She taped a sign to the back of his shirt. "Please do not feed me," it said. "My mommy does that."

One time, she went to get him for his nap and couldn't find him. A volunteer had walked off with him.

"I was like, 'What are you doing?' Don't you ever ever walk off with him again."

___

"I've made up my mind so don't even try to stop me," Millar wrote her daughter in an e-mail. "I'm coming down to see my grandson."

The two slept with Sonson between them.

Millar saw her daughter transformed into a mother. It was in every gesture — from the soft way she spoke to him, to the constant attentiveness she showed him.

"In my case that is something that I grew into by giving birth myself to a child. She didn't grow into it by being pregnant," Millar says. "When I saw her, she was a mom — in every way she is a mom. This is her son. ... I'm so proud of her."

___

As Palinka spent more time with Sonson, her attention began to shift away from the hospital.

Then the order came from Miami. The rainy season was starting. The hospital needed to downsize.

None of the orphans had medical conditions that required them to stay. Palinka was tasked with contacting the government to transfer them to orphanages.

She clashed bitterly with the hospital's management, according to several volunteers. She accused the hospital of trying to 'unload' the orphans. Hospital officials accused her of letting her feelings for Sonson blindside her. A spokeswoman for the hospital said it does not comment on personnel issues.

Within days, the orphans — including Sonson — were registered with the state's child welfare agency.

When Palinka returned, hospital officials relinquished her of her duties. They said she was spending too much time with Sonson.

A 6-minute video shot on a co-worker's Blackberry phone shows Palinka's final moments with Sonson before he was taken away.

He is sitting on her lap in the backseat of an SUV. He pinches her lips together, like a fish. Then he leans forward and kisses her over and over again.

When the SUV pulled away, Palinka waved until the car had driven out of sight. Then she sobbed until she started dry heaving in the hospital's parking lot.

Within a week she aged. Her eyes were hollows. Her face was taut. She carried his toy car in her pocket for comfort.

"I see her, and you don't even want to ask what's going on," says Jen Jasilewicz, the hospital's chief nursing officer. "It amazes me. You have someone who wants to give her love and all those beautiful things to a child, and she is not being allowed to."

Haitian officials say they are trying to protect children from possible exploitation.

"International adoption should always be a last resort," says former Deputy Gerandale Telusma, who headed a committee charged with drafting the country's new adoption law. "We need to first make sure there is no other family willing to take the child ... to make sure they don't enter into some kind of nightmare."

It is a position backed by the United Nations Children's Fund, which helped create a database for unaccompanied children after the Haiti quake. The aim is to reunite children with their extended families, even if family members say they cannot care for the child.

Michel Forst, the United Nations' independent expert on human rights in Haiti, says the adoption freeze is necessary.

"There were lots of people that were coming here and doing whatever the heck they wanted. So it needed to be put on hold so that we could make sure that these adoptions were being done in a legal manner," Forst says.

"And yes, it's hard. It's hard for the well-meaning families that are waiting to adopt children. And it's hard for the children that are being prevented from running into the arms of these families."

___

Sonson was transferred to a modern orphanage in a village a 1½ hour drive from downtown Port-au-Prince. Palinka spent her remaining weeks in Haiti trying to get visitation rights.

On her first visit, she was told to call a child welfare case worker at 8 a.m. Palinka says she called more than 20 times between 8 and noon and each time was told to call back "in 10 minutes." She was then told to drive to the side of the highway leading to the village and wait.

She says she waited for more than two hours in the sweltering car before the case worker arrived. Jeanne Bernard Pierre, the head of the child welfare agency, declined to comment.

The woman took her to see Sonson. She didn't recognize him.

His head had been shaven. He was sitting by himself on the floor. The other children rushed at her, screaming. "Where is he?" she asked.

"Don't you recognize him? That's him," said the woman.

She crouched on her knees. "Sonson?" she said. He looked up and then away. She scooped him up in her arms. He held on tightly. He made no sound, until they tried to pull him away. And then he screamed.

In the month since they were separated she has seen him twice more. Each time she finds him diminished. "He looks smaller. He's no longer making eye contact," she said.

He cannot be declared an orphan for at least six months, to give his family a chance to reclaim him if they are alive. After that, he enters the bureaucratic labyrinth of Haiti's adoption limbo.

Even before the earthquake, the waiting time for the roughly 300 Haitian children adopted each year into U.S. households was two to three years. So even if the government accepts Palinka's application, 3-year-old Sonson will be waiting for about as long as he has been alive.

___

On her last supervised visit, Palinka was allotted 20 minutes with him. She arrived an hour early. She brought him his bike with the training wheels.

Through a translator she tried to explain what would happen next. "I'm going to go away for a long time, but I will come back for you," she told him.

When the visit was up, she lifted him onto the bike. Engrossed, he pedaled away.

She quietly slipped out. She kept her bloodshot eyes on the ground as she walked briskly out of the gravel driveway, his toy car in her pocket.


Rainy Day Woman #35

Well, this disaster has definitely lost that 'new car smell'.  The immediate drama of people screaming, partially trapped in rubble has passed.  The drama of emergency surgeries to save the victim's of the earthquake's immediate effects has passed.


We are left with raging wound infections because the people we discharged to the street are now sitting in mud and water-borne waste.


We are left with diphtheria and other communicable diseases.  Our betters at the UN Health Clusterfuck insist that it is not an epidemic.  All I know are the children I see who are dying from it.  Maybe there aren't enough of them to count.  Or maybe they just don't count enough.  All I know is that early this week we carefully put the body of a twelve-year old girl who had died of diphtheria in my sleeping area, because the place where we normally store the bodies had rats, and I couldn't let her mother see her like that.


I have cleaned the wounds of horribly burned patients -- sometimes without enough anesthesia.  Although I hear their screams in my sleep, nothing will ever touch the helpless wails of a mother who has lost her only surviving daughter.  


We are also left with the "normal" fare -- Haitians in car accidents, Haitians who are caught in the crossfire between police and gangs, or Haitians who have been shot in the face with rubber bullets or tear gas canisters by UN "peacekeepers" while demonstrating to demand the return of ousted President Aristide.  


Traffic accidents here are a trip.  As best I can determine, there is no universal agreement about which side of the goddamn road to drive on, so head-on collisions are common.  


The Project Medishare compound had grown to become pretty well established.


Here is what we looked like:






The small tents on the right were the living quarters for some of the long-term volunteers.  




The volunteers who were just here for five days or so lived in one of the large tents on the left of the aerial shot.  Imagine 100 people or more bunking together with limited or no access to showers.  But then again, no one had access to showers.

This worked OK until the rains hit.  I have been in tropical storms.  But I have never seen anything like this and could not even imagine it.  It was less like being in a field hospital, and more like being on the deck of the Titanic.

One night the Peds unit flooded and we had to move all the kids into the adult tent.  That meant there were rows of cots between the rows of cots -- which made nursing care kind of interesting.   

Then the ICU flooded and I discovered what "interesting" really means.  Even in a field hospital, intensive care requires LOTS of electrical equipment.  This means lots of strung wires and cables, carefully taped down so we didn't fall and break our necks.  That was OK until we flooded.

Something had to be done.  We just couldn't wait until a 'real' hospital was built.  

This began the plans to move to a secure, dry, but smaller facility.  And it began my real experience with loss down here.  I thought I knew loss.  But the world had just been toying with me until now.













Saturday Night Live

I have much news, but my time has been dicey these days.  I will try to write more in a bit as the break is much needed.  

Yesterday we admitted a GSW (about 0100 in the a.m.) and it was a nightmare.  We at least saved his life . . . 

However, about 9 a.m. I noticed over 20 armed policemen, numerous undercover "police" and lots of security descending upon the ICU  ....  hmmmmm, I said to myself.  Then, in a sort of elated, yet very serious dialect of something Creole/French/English - "esque" sentence, one gave me the news.  

The young 18 y.o. we had saved was allegedly part of a kidnapping / drug ring, who had been shot in the back by an unknown person.  His gang had organized overnight and had allegedly threatened to not only take him from the hospital but to avenge the police shooting.... by shooting up the hospital.  

I must say it was a bit exciting (she says disconcertingly)  - because I was the only US volunteer nurse left in the camp -- and shooting me at that point would not have furthered their cause because I was too tired to even put up a resistance were we to be held hostage .  Shit.  I was too tired to even cry.  I was not concerned for myself, but was very worried for the Haitian staff....  

A  police ambulance came, scooped up the patient we had worked feverishly to save,  and off they went into the streets -- allegedly toward the General hospital.  Oh well ----- it was't my place or my desire to question whether it mattered that he might be innocent....  life is just not that way in Haiti.  

Sadly, for Haitians, life has evolved into a series of unrealistic contracts made with God in the hope for survival through another day of demoralization.

Thursday, May 13, 2010

Is There Joy in Mudville?

Much too much has happened and I feel like sh*t for not posting -- but I was working 15-16 hour days at Medishare and was simply too beat to text stuff to Kleiman and get him to post it.  I did take notes which he is threatening to transcribe and get up later.

We'll see.

After a two-week break back in the States I returned to Port-Au-Prince three days ago.  Hard to even begin describing the scene.


  • A huge fire took out part of the OR area.   (No one was injured, at least.)

  • The entire pediatrics ward was flooded and all the sick and injured kids had to be moved into the adult ward.  That was OK, except it really IS a ward, and with all the extra cots for the kids, it was almost impossible to move around and take care of patients.

  • Wednesday night we had only two nurses and two assistants for sixty patients.  I ended up with responsibility for the entire unit and had 32 patients under my care.   We got the worst injured of patients from a 15-car auto pileup and I worked nonstop for about fifteen hours.  Gaby and I got a one hour break before we had to pass out medications at midnight.  

  • Morale is very different here than it used to be.  People feel disconnected and even superficial on some levels.  One of the MD's came back from the UN bar unconscious.  She was carried in by her colleagues and whatever she drank just leveled her.  Several of us protested the fact that the residents with her were just going to put her to bed and "watch" her.  We were afraid she might vomit and choke on it.  Finally a CRNA put her in the PACU (post anesthesia care unit) until she recovered.
  •  
  • Tonight  a Haitian medical student and I are the entire nursing staff for some forty patients.  It seems the other nurses were too busy doing god-knows-what to show up.  But the med student, Sam, is a gem.  We'll get through this.

Monday, April 12, 2010

First Quiet Day

Sadly, today is the first quiet day since our arrival in Port Au Prince -- the first thirteen days were plagued with unending rain, the deaths of six children and the horrific realization that nothing we observe in the city, indicates any significant changes since the earthquake.

We arrived on March 29th sometime around noon on an American Airlines flight. It wasn't until we were boarded and awaiting takeoff, I realized there was this little thing called a customs declaration form, all passengers must fill out (something I've done many times). If we had been traveling under "normal" circumstances this would not be a pesky issue and there is nothing close to normal about a trip to Haiti. On this particular trip I have been given a gift of life saving HIV/TB medications, which will treat thousands of patients for six months or longer. There are three very large suitcases packed with thousands of pills from an amazing physician friend, who works with AIDS/TB patients in the United States. (and yes, everyone can call me a dumb a** for not thinking things through---I deserve it). The sick feeling in my stomach began and clock started ticking...

After filling out the customs form I wondered if I'd even get a chance to explain before being hauled off to some small, windowless room at some makeshift jail. We landed in Haiti and Brett was more nervous than I was at this point (thankfully I'd given him D.Jerry's phone number in case we were separated at customs/immigration). It was difficult to know if the sweat pouring off my body was from the excruciating heat, anxiety or both.

There was one moment, after we'd deplaned and searched over an hour for our luggage, a young man came and told us our bags had unfortunately been lost. Then it happened -- the unthinkable, this would be the first time in airline history, there would be no screeching passenger wanting to know where the hell her bags had been taken or where, pray tell, they'd been lost. I felt excited that maybe, just maybe they'd fallen off the plane, never made it on the plane or simply disappeared after being taken off the plane. However, my exhilaration was quickly replaced with horror when the same young man yelled across the hangar, in a voice that reminded me of an animated Disney character on crack, "Ah Stefanie! - look I found your bags!!!"

Our hearts sank, we begrudgingly took ownership of the bags and headed toward the woman at Customs Booth Number One. Brett and I looked at each other, hoping there would be no swooping in of some Tactical Haitian Swat Team (yes, we really thought it could happen) to interrogate us about our unusual items for declaration. We stood and held our breath, waiting for the order to follow some police officer to explain ourselves.

It was quite an interesting experience and a completely uneventful one. The Customs Agent simply asked me if I was certain the medications had no value and I nodded my head affirmatively. She then asked if they were for me personally and I somewhat slowly nodded negatively. Then she asked if they were for Haiti and finally, I found my voice and proudly said, "Yes Ma'am, they are for the TB clinic in Port Au Prince." She looked down at us, from her tall Custom Agent chair and smiled, then simply waved us through customs without any further inquiry or hesitation.

The airport, now functioning at about 50-60% was deceiving at first glance because it looks so much better than just three weeks ago. I was a bit excited to see that so much had been done and thought maybe my criticism of the U.N., Red Cross and a few other relief agencies had been too harsh. The thought was quickly ripped from my mind the minute we stepped outside the gates of Toussaint Louverture International Airport. It became painfully obvious how little had been done to ease the devastated conditions for the Haitian people. There were at least a thousand people outside the gates; a thousand faces that represent a thousand failures of the disorganized, chaotic and ineffective relief aid plans in Haiti.

Would someone please ask the Red Cross what they've done with all the money donated to Haiti? Then, would someone remind them that we were not donating to their debt relief plan -- we were donating to the people of Haiti!


Wednesday, March 31, 2010

I Am Back in Haiti and Conditions May Have Actually Worsened

I returned to Haiti two days ago.  It breaks my heart to see that if anything, things have worsened.  The supplies at Project Medishare are very very low and we have been instructred that we can no longer share supplies and equipment with outside organizations.  Very little is coming in.

Food is now being conserved in case none comes.  Apparently last week there was no food delivery at all.  We were notified in today's morning rounds that we should not expect to eat 3 times a day.  Sometimes the UN, which is just two miles away, sends us food, and sometimes it does not.  (I lost 32 pounds on my first trip and returned to the States slightly protein deficient.  Kleiman tried to pack protein powder for me but I jettisoned it in favor of TB medicine a friend had 'organized' from a Stateside infectious disease project.)

We often get food from our Haitian friends living in the city (and it's pretty amazing too). 

I've been back to the areas I lived and worked just after the earthquake and there is no UN presence - still.  The situation remains dire everywhere (with the earthquake affected areas especially bad off).  There remains no evidence of any organization.  No one on the ground believes that the  UN has any intention of helping.    As always, I would love to be wrong and if I am mistaken would be less critical.    

God, would I love to be wrong.

Wednesday, March 3, 2010

First Look

These photographs are out of order as far as the chronology of the posts so I have indicated the date, location and any other information gathered onsite. They were taken during the first few days as Steve, Jerry and Carla patiently drove me through Port Au Prince to see the after-effects first hand.

Thinking back, I wish there had been some way for them to prepare me for the unspeakable devastation and now realize they were still trying to comprehend it themselves.

I am forever indebted to Steve, who opened his home (relatively undamaged by the earthquake) and family to me. I am especially grateful to Jerry and Carla who without question, concern or delay took me to the most devastated areas around Port Au Prince. They spent hours of their time helping injured people and helping me. They are amazing people who I am honored to call my friends.

Thank you Steve.
Thank you Jerry.
Thank you Carla.
I love you.
Stef


CITE' SOLEIL
January 22, 2010
Market destroyed hundreds trapped; multiple casualties







DELMAS 43
January 23, 2010
Business destroyed by EQ w/ multiple casualties

















Tuesday, March 2, 2010

Coming Home to Venice

I returned home six days ago and spent the first three days recovering from exhaustion, minor aches and pains . . . Oh, and sleeping - a lot! I tried to post an update over the past few days and finally asked Kleiman why my efforts were in vain when he realized he'd forgotten to invite me! So with that problem now resolved I will add photos and update information.
The reality of what has happened in Haiti sadly becomes more apparent the longer I am home. The feelings I anticipated once I returned home have become more noticeable the longer I am here. Guilt is the most overwhelming feeling and it doesn't seem to fit into traditional categories [such as guilt over leaving, the complete devastation of a country or even the tragic death toll]. It is far more complex and tends to increase with my education of Haiti's tragic history, the abuses committed against her and her beautiful people.
As Americans, the most important thing we can do to help in Haiti is to educate ourselves about her history and her people. We owe it to ourselves to at least understand the truth about our involvement and its effect on her people. The world's response to the devastating earthquake has provided immediate and life saving relief to the Haitian people. However, successful long-term recovery efforts in Haiti will depend on global education, acceptance of responsibility and a wholly committed effort to improve the human condition.
I will be returning to Port Au Prince on March 13 and Brett, my oldest son, will be accompanying me on this second trip. He will be assisting with several projects; one of the most important will be helping construct adequate shelter. The rainy season is rapidly approaching and the need for durable shelter is now a most pressing issue. The lack of shelter in any country poses a number of problems in spite of the circumstances and in Haiti it will undermine many of our successes. The risk of infection increases complications, which can lead to death and will certainly affect our patients recovering from amputations, wounds and other injuries.
Many people including friends and colleagues have asked how they can help as Haiti enters this next phase of recovery. There are a number of organizations to contact depending on the specific area of interest. The most critical is shelter, clean water, adequate nutrition followed by intensive clean up efforts and proper removal of the dead.
The day before I left I went back to the clinics we had set up in the early days and visited the homes where Jerry and Carla had taken me to treat people with injuries. It was distressing to see that very little had changed [in those areas] over 5 weeks and there was no coordinated effort to remove debris or assist with restoring vital services. However, the most disturbing aspect was the lack of assistance by any organization with removal and proper burial of the dead.
Once we arrive back in Port Au Prince and depending on the status of Internet connectivity, either Kleiman or me will begin daily posts about the relief effort. Please contact me if you would like to know about any of the agencies I have worked with in Haiti @ stefletcher@earthlink.net.

Saturday, February 20, 2010

Countdowns

I have finally settled in for the evening.  It is impossible to walk anywhere now without people stopping me and wishing me safe travels and showing me more love than an empty ocean could hold.

There have been only a few tears because Edry, one of the organizers of the transporteurs and a dear friend, made everyone promise that they would not cry at me today because I was still working.  Edry told everyone they could sing, cry, pray, or anything else tomorrow.  Edry even went to the airport supervisor to make sure the guards didn't flip out when they saw a bunch of my friends coming to the airport to see me off.

I am eager to see my loved ones at home, but I know I will quickly be counting the days until I return.

Some People Who Have Become Dear To Me

  Christine came by to let me see David again before I left, and to tell me she worried that I would not return to see her and David.  He's doing fine, as you can see.
















It's pretty amazing.  She has to travel four hours to get here, and she brought me some  tangerines for the trip.  Who is taking care of who??








And here is Mouvaux, the son Tamara is in the process of adopting. 
             Tamara has done amazing work in orphanages in Haiti and other 
             nations,  for years, but has never, ever adopted a child before.
             Mouvaux has become her sidekick (and mine) and it is changing her life.








And last, but not least, Nixon, on the left, who has become a great friend (and is an endlessly patient translator)








 and Adrian, our master electrician and power scrounger, without whom NONE of this would work.


American Airline's Departure Lunge

OK.  People have asked why I write that I am "trying" to leave on Sunday.

American Airlines began commercial flights Friday.  Kleiman has bought me one for Sunday.  But yesterday I learned that it might not mean shit.

About ten days ago American announced that it was resuming commercial operations and began selling tickets for Feb. 19.  Some of our docs seats on yesterday morning's AA flight out.  Dufflebags packed, good-byes said.  Families and "day jobs" looked forward to, they walked to the airport.

That's as far as they got.

Seems the geniuses at American, after selling tickets and letting these folks make plans to get home, decided that before any new passengers could fly, priority would be given to those who had flights booked which had been cancelled after the earthquake.

Those people should sure fly first.  But why the fuck sell new tickets to new people and not let them know they were really "stand-by" -- at $700/per ticket for a 90-minute flight, I might add.

Two docs, husband and wife, are beside themselves.  They had come for a week, leaving their young children with visiting grandparents.  This is not good.

- - - - - - - - - - - - - - -

There used to be the alternative of hitching a ride home on a military flight.  Chancy, but it worked.  The lucky ones would get a lift to Homestead AFB, a thirty-minute cab ride from Miami's commercial airport.  But for security reasons, the military, which just does this as a tremendous favor to the relief workers, doesn't tell you where the flight is going until you're airborne.  If you get to Homestead, great.  Or they could be going to a remote base that is hours from even the nearest car rental agency, much less a commercial airport.  Some of our volunteers have taken 2-3 days to get home after leaving PAP.

Now traditionally, the military stops airlifting NGO volunteers once commercial flights resume, so we have no idea if the risk of getting dropped somewhere obscure is even a possibility any more since we can theoretically get a ticket on an actual flight that might, one day, lead to a theoretical seat.

We'll see.

Departures

The staff was just devastated.    A wonderful, bright two-year old had come through surgery safely and was recovering well.  She spoke English as well as Kreyol and because of that was getting a lot of attention.


Mom was nowhere in sight and the little girl announced that her mother had abandoned her. Nurses, doctors, and aid workers were stunned and tearful. 


Then her mother returned.   She had left only to wash clothes, and was gone barely two hours.
Kleiman was in terror that I would try to bring this abandoned girl back with me and waxed cynical about  about childish manipulation. 


But this is a little girl who lost her father and older brother in the quake, an I am certain that every departure seems permanent to her.


I just went down to the OR to check on the neuro case still in progress.   Another pediatric disaster.  It won’t be okay.   It’s oddly calm because everyone accepts that we do our best.  We give our best.  We are the best that Haiti gets right now.







Yet we all know that it isn’ the best at all.  It is only the best we can do with what little we have.  It’s not the best because another child is going to die tonight.  In spite of our best.  Some of us will cry and some will try to apply some philosophical or religious spin to make it easier to sleep.  But it is just a delay tactic that we all silently deploy until we deal with the next cup of pain from this bottomless well of suffering.

Christine comes back every day with her baby, looking steadily into my eyes and quietly insisting "I want you to know this baby."


I saw Pierre and Kensey, the two night shift transporteurs / translators and amazing young men who bring their beautiful  spirits every night without fail to what must be a place of horror for them.  They have become my friends and family over the past month and tonight I had to tell them I am going to try to leave on Sunday.


I promised them I would be back and they trusted my word – but with great hesitation and sadness.  They will come with me to the airport on Sunday along with others who have become my family away from family to me.

I told them the truth about being exhausted and frustrated, and why I have to  leave for a while.  They already knew and were not upset or angry that I need a break from this overwhelmingly painful experience.  There are a lot of lessons about life and humanity to learn here but the most important lessons are about ourselves. 


I can’t wait to see Mark and Brett and David.  Sam, Big Mac  and George.  I will also be as sad to leave Haiti as I am glad to be home with you.  

Night Thoughts


Not my words, but they may as well have been.
The Haitian earthquake poses the big questions of the human condition. Life and death. Hope and despair. The good of doctors and rescue workers, versus the evil of thugs who raid orphanages in Port-au-Prince. Why? is the most obvious question; neither God’s will nor science seem adequate responses. Albert Camus’s belief in the absurd comes closest to it, but also fails to satisfy our need for answers.
My flight from Santo Domingo the other morning was filled with volunteer relief workers and journalists, heading back to the land of hot showers and cooked meals. The stewardess called a round of applause for the aid workers. Problem solved. We can go home now. Our short attention span is the biggest threat to Haiti’s recovery.
I’ll bet my bottom dollar that the poorest country in the Western hemisphere will remain so, that in a year or two or three, most of the two million Haitians whose lives have been shattered by the quake will still be poor, jobless and homeless. Urgent appeals have gone out for proper tents. But the rainy season will start in March. Even if tents arrive in the meantime, they’ll be washed down the hillside or mired in mud. We should have the foresight to start building houses on a massive scale, now.
A year after Israel killed 1,300 Palestinians in Gaza, the enclave is still under siege and little of the $4.5 billion (€3.2 billion) pledged to rebuild has materialised. A year and a half after the August 2008 war, Russia still occupies part of Georgia, and refugees cannot go home. I could give many more examples, but you get the idea. The lack of messy political issues comparable to the Arab-Israeli conflict or Russian irredentism made it easy for the world to agree on Haiti. Let’s hope that consensus continues.
The needs of our own countries militate against a sustained effort for Haiti. A young woman with the face of a black madonna, Francina Renard, followed me to the rope that separates US soldiers from Haitians at a camp for the displaced. “Can you give me a job?” she pleaded shyly. During the 10 days I spent in Port-au-Prince, I lost track of the number of Haitians who asked me for employment – not money, employment.
But how will the US government create jobs in Haiti, with 17 million jobless at home? Is America going to build shelter for one million Haitians, when 600,000 Americans are homeless?
Fortunately, Concern, Goal, Trócaire, MSF and the Red Cross will be there to nag our conscience. Their heroism in Haiti has been impressive. I distinguish between those with a commando attitude – who don’t let security worries prevent them rushing to help those in need – and the bureaucrats who waited in compounds for assessments, instructions and escorts. One often finds both attitudes within the same agency. It’s a question of character, and leadership.
Reconstruction will be complicated by the fabled corruption of the Haitian government, and the need to respect Haitian sovereignty, but neither must be allowed to prevent help reaching people.
John O’Shea, the head of Goal, tells how his agency redirected its post-tsunami efforts from Indonesia to Sri Lanka because of the unhelpful attitude of the Indonesian military. Aid agencies owe it to donors to impose conditionality and accountability, says O’Shea.
We should beware of the colour-blindness that affects our scorn for corruption. The biggest thieves in Baghdad after the 2003 US invasion were US contractors, who made off with hundreds of millions of dollars. Dealing with “our sons of bitches” (as Teddy Roosevelt called US-backed despots) does not preclude corruption either. Remember the Shah of Iran, Ferdinand Marcos, Saddam Hussein (before we turned against him), Hamid Karzai’s administration in Afghanistan . . .
Endowing Haiti with effective, democratic government may be the greatest challenge. On the night of the earthquake, what was left of President René Préval’s government got on motorcycles and rode up the hill to the US ambassador’s residence. But the Obama administration and international donors would rather deal with a strong government than a helpless client state.
“The only institutions that function throughout the Caribbean and Latin America are the Catholic Church and the gangs,” notes Patrick Moynihan, an Irish-American who runs a school in Port-au-Prince.
I rode around Port-au-Prince in a “tap-tap”, a Toyota pick-up with benches in the back for passengers. As we headed down the hill one morning, coasting without power to save petrol, a middle-aged man dressed like a clerk or office worker jumped in. Jean-Claude, the tap-tap driver, explained that we weren’t taking passengers, and asked him to leave. The man clutched his document file to his chest and refused to budge.
There was no public transport, he said, and he had somewhere to be going. The determination of the man in the tap-tap gave me hope for Haiti. So did the calm, dignity and resilience of the earthquake survivors.
Haiti is a state founded on two genocides – the native indigenous Indians, exterminated by the Spanish, followed by the slow deaths of up to one million African slaves at the hands of the French. In the 19th century, France demanded reparations from the world’s first black republic. Fearful that the example of rebellion would spread to slaves on its own territory, the US imposed a crippling trade embargo on the former “pearl of the Antilles”.
In Haiti, the evil done by men – including the island’s home-grown tyrants – has lived on. It will take tremendous determination, commensurate with the effort of the past two weeks, to prove that the chains of history can be broken.

by Lara Marlow, Washington Correspondent for The Irish Times

Thursday, February 18, 2010

Other Highest Acute Care Priorities

We are still doing surgeries without real anesthesia.  We use very heavy conscious sedation which sorta kinda works but is really inferior.

We do not have decent lighting in the O.R. areas.

Our beloved scrub techs are great, but systematic sterilization will be a lot better, especially with the coming infections.

We need:


·         Tuttnauer 5075 Hsg Class B Autoclave – Stand alone – on wheels

·         OR lights – either DRE Medical free-standings or DRE Vision Excels

·         Anesthesia Machine --  Narkomed with ventilator and with servo forane vaporizers   

Merci


Gentleness That Rips Open Your Heart

The Haitian people do not celebrate Valentine's Day but they know it is a big thing in the U.S.  My sweet patient, Puerre, who at 16 lost his entire right arm in the earthquake, gave me his bear to sleep with so I would not be alone.

Who is caring for who?


Tents Won't Last. Plywood Yurts Will

From Kleiman:


For perhaps 2-3 times the cost of a tent which will not last the rainy season  (and is barely helpful now) Hatian families can be sheltered in durable yurts that will last 2-3 years.  
http://www.appropedia.org/Hexayurt.
Units take a team of three people around an hour to assemble. They are assembled using a 6" wide, 600+lb bidirectional filament tape, and anchored to the ground like tents. No heavy lifting, ladders or scaffolding are required.


Any wood shop or packaging factory can be taught to manufacture units in an afternoon. In emergencies, basic units can be manufactured on site with hand tools in half an hour each (only six cuts are required for each unit.)

Keep the Haitian People Close to Your Heart. There Problems Have Just Begun.

Haiti’s rain falls in diagonal sheets.  The raindrops here are the biggest I have ever seen. 

It is.  3:30 in the morning.  I’ve spent the better part of two hours trying to duct tape plastic garbage bags over the “windows” of the shelter box tent, which leaks from every zipper.   The shelter boxes are fine ideas, but not for Haiti.   There are leaks throughout my tent, after two hours of efforts to secure it.  And I have tape.

I don’t mean to complain, because our situation is by far better than most in PAP.  The majority of Haitians do not even have leaky tents.  They have plastic sheeting and tarps to cover their families and belongings.

Sean Penn left yesterday and is telling the world about the impending health crisis that will be caused by the rains if housing issues are ignored.    I hope someone at home listens to him because every good thing that has been done here (medical and otherwise) will be destroyed if we fail to address and solve some basic infrastructure problems.

Our transporteurs sat in the rain last night and begged me for plastic sheeting.  I tried to get them some but the project insisted (not unreasonably) that we need it for the hospital to patch up our own holes so the patients can be moderately dry. 

Mud is being tracked into and through the hospital tents.  More flies and mosquitoes will follow.

I feel so helpless.  None of what we have done will make a difference in a month or two.  All the people in casts will lose their limbs because the casts will get infected.  Once the water starts moving through the streets all of the human waste and human remains will move with it.  

We already saw our first case of salmonella poisoning -- from fresh lettuce at the U.N. restaurant!    

This will only get worse.  Fast.

Here is what my "shelter" looks like from the inside in the rain.  Apologies for the in-the-dark in-a-downpour quality of the images


Monday, February 15, 2010

Last night we were going to close the O.R. and reorganize it, to get better control of who walks through our sterile areas in the middle of abdominal surgery, which is what happened two nights ago.  Instead we operated through much of the evening, a steady diet of traffic accidents and a smattering of gunshot wounds and stabbings.

Now that the worst of the crisis has subsided, Haiti's Knife and Gun Club seems to have been reactivated.  Although it is no worse than I've seen in many U.S. cities, it is hard to see here, and hard to see now.

Last night's rain weakened some structures and a school wall collapsed this afternoon.  We received the news and readied the O.R. and cleared the Emergency Area.  And waited.  Four children died at the scene.  There was nothing for us to do but shudder.

We still don't have enough ICU nurses, so I am again getting up at 2 a.m. to relieve another R.N.  I tried to go to bed early enough to do this, but some of the new nurses think they're at camp, and are pretty fucking loud for 11:30 at night.  I can still hear them over my noise-cancelling headset.

But I am happier to whine about this than about no O2, no water to cleanse wounds, and no anesthesia.  I guess this will have to pass for normal tonight.

An Amazing Post From Another Aid Worker

http://www.oursoil.org/content/jounen-jèn-days-remembrance-letters-port-au-prince

Jounen jèn -- Days of remembrance: Letters from Port au Prince

Friday February 12, one month after the earthquake, the first day of Jounen jèn, the days of mourning and remembrance, and we walked through the twisted iron and dusty shards of glass of the shattered National Cathedral. As we crossed through the open door and stared down the length of the cathedral it was as though the world had ended and even the wind had disappeared into the silence of the rubble. Just blocks away, in front of the crumbling palace, thousands of people dressed in white were singing songs of grief and praise, but inside the National Cathedral, on this national day of remembrance there was only the sky and the crumpled flowers from the alter scattered across the floor where so many feet once tread. 

As we stepped gingerly through the cement dust, climbing towards where the alter once stood, I remembered the last time that I walked down this aisle, through the sunbeams and the wailing, walking to pay my last respects to Father Gerard Jean Juste in June 2009. This place has always broken my heart. So many voices that once sang in this church have been swallowed by the earthquake and I longed to hear Father Gerry’s voice, but I knew what he would have told me. He would tell me that those of us who survived have to sing louder, to work harder and to love each other more.  As we left the cathedral and passed the crowd on Champ de Mars I could hear the crowd of thousands singing their sadness into salvation.  I knew that Father Gerry was with them, under the tarp churches, marching through the streets, watering the parks of the city with their tears. 

When we got home in the evening on Friday everyone at Matthew 25, where we are staying, gathered to read aloud a prayer for Haiti.  Three quarters of the way through the prayer the tears began rolling down my cheeks, I could see the cathedral as they carried Father Gerry’s body down the aisle and the flowers buried in dust that we had walked through earlier.  I cried for hours that night for the first time since coming to Port au Prince.  Mine were only drops in the lake of tears that flowed through Haiti this weekend as people said goodbye to their loved ones and their lost city.
I end with an excerpt from the prayer that we read on the 12th.

“Raise up your people from the ash heap of destruction and give them strong hearts and hands, shore up their minds and spirits.  Help them to bear this new burden”

This week with your donations we were able to provide a week’s worth of food to over 350 families, deliver 24,000 gallons of water to 5 communities, provide medicines to several mobile clinics, give over 4000 water sachets in churches during Jounen jèn and purchase 140 tarps, reaching over 5,000 people in Port au Prince.  In Cap Haitien the SOL team provided food and medicines to victims of the earthquake that have been relocated out of the capital. SOIL is still small and though we cannot rebuild the National Cathedral, with your support we can help thousands of families in Port au Prince to bear this new burden.

It is the strength of the Haitian people that has helped me to rise from the ashes of my own fear and sadness, today on this final day of mourning I pray that I can treat the victims of this tragedy as they have treated me, with compassion, respect and dignity.  I am so grateful to all of you who have helped to lighten Haiti’s load, this experience has helped us all to remember our humanity. 

With love from Port au Prince,
Sasha