Thursday, November 11, 2010
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.
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
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.
Sunday, June 20, 2010
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...
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
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.
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.
Thursday, May 13, 2010
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
Wednesday, March 31, 2010
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.)
Wednesday, March 3, 2010
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.
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.
Tuesday, March 2, 2010
Saturday, February 20, 2010
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.
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.
Mouvaux has become her sidekick (and mine) and it is changing her life.
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.
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.
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 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.
Thursday, February 18, 2010
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.
Who is caring for who?
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.
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.)
Mud is being tracked into and through the hospital tents. More flies and mosquitoes will follow.
Monday, February 15, 2010
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.