REPORT OF MY RELIEF EFFORTS IN PORT- AU- PRINCE, General Hospital Dr Herve Boucard In the early morning hours of March 27, I headed to JFK airport in New York, anxious, not knowing what to expect from my homeland that I haven’t seen for 15 years. Though the American Airlines airfare was exorbitantly expensive, the plane was packed and overbooked. Up to 800 dollars were being offered to passengers to give up their seats resulting in a good 2-hour delay. The flight was uneventful until the crew ran out of warm food and offered cereal in compensation; it was already close to 1PM. The passenger next to me got furious and started to scream despite my efforts to calm him down, another passenger added to the chaos and on. The chief hostess threatened to divert the flight to Miami to release the instigators of the chaos... Luckily, calm was reinstated. Finally, 2 hours beyond schedule we landed at the Toussaint Louverture International Airport, in Port au prince and of course our ride had left... Our group of which I was the team leader only included was projected to be 12 healthcare professional strong; instead because of some re-arrangement via Partner In Health (PIH) only we were only 2. The other member, Mrs J. Laroche was a pharmacist from Long Island, NY. On Sunday morning at 7:30 the first stop was the General Hospital campus. The buildings looked grossly intact but many tents were noted in the yard. I visited several of them looking for the most suitable one where my medical training would help and settled for the (Intensive Care Unit) ICU tent. This was a large tent tightly packed with over 20 patients without air conditioning. Many infectious cases including malaria, tuberculosis were noted. Several young patients in their 30’s had cardiomegaly and heart failure and several others renal failure. There were an internal medicine and a family practitioner from the United States working as intensivists, as well as an American nurse. The only local health care providers were nurses aides and later on 2 Haitian nurses. I got a quick orientation and started gastro-intestinal/liver consultations. GI tuberculosis, unexplained diarrhea, stomach pains and ascites were the most common cases encountered. Soon, the temperature under the tent was getting unbearable barely altered by the few floor fans blowing at full capacity. You wonder if the heat does not hurt the patients more than their documented illnesses. I was humbled to see those foreign volunteers working tirelessly to attend to those ICU patients. As the hours pass you could see the dehydration and the exhaustion on their faces. I would serve as interpreter every now and then when the young Haitian translators could not tackle some intricate medical issues. I could not determine why the local doctors were missing; were they absent because volunteers were here? Where they hurt or emotionally distraught by the earthquake? I also visited the medical floor that some other volunteers were calling 'the catacombes' because of its blatant neglect. There were over 50 pts, one resident in a remote corner, no visible nurse. Patients’ families were pulling me in hallway sensing that I am new. ‘dok tanpri al we man-manm pou mwen...’ (‘doc please take a look a my mom’) said one of them. I followed a young guy to an elderly lady in the hallway. Her oxygen saturation was 80% (normal over 90%), her blood pressure also 80 , her pulse 135 beats per minute (normal 60 to 100) and she had high fevers; she had been there for 3 days for confusion and suddenly she stopped talking. I realized that she probably would not survive the evening; therefore, I personally helped to transfer her to the ICU. Her condition slightly improved over the next 3 days with broad spectrum antibiotics, fluids and pulmonary care but on the next morning I did not find her. She had passed away during the night. I had a chance to perform over 15 endoscopy procedures. Unfortunately, sedation beyond oral spraying was not readily available. The equipment was a fairly modern Olympus system but I noted only one that was working; meaning that with any malfunction the endoscopy unit would shut down. In fact, no endoscopy service was being provided for over a year recently because of technical issues. There was an obvious lack of accessories, that in the US are considered standard. The outpatient clinic easily had 120 patients scheduled for 2 docs. The doctors would see as many as they can and the rest was just sent away. I examined many patients with anemia, headaches, epigastric pains, body aches, palpitations, anxiety. Bilateral breast pain was noticeably frequent in young females. Luckily, basic labs seemed to be readily available and results returned in 1 to 2 days apparently free of charge. Basic radiology seemed to be easy as well. But there was a fee for ultrasound. I saw a girl in her 20's with facial muscles weakness (unable to smile or grimace), slurred speech since head trauma from January 12th , unfortunately no neurologist was available at the General Hospital to see her. The pharmacy was packed to the roof with medications, but many of the boxes were not even open while patients were turned away with unfilled prescriptions. There was a computer available but inventory was still being done on paper. There were employees there but not excitement to do anything. The AMHE volunteer pharmacist updated the drug list the best she could, picked up requests for medications from several sections of the hospital and delivered them herself throughout the day. Her help was greatly appreciated by doctors and nurses. Haiti disaster has been on the TV screens of the world but unless you go the street you will not be able to grasp the magnitude of the tragedy ‘tande ak we se de’. I noticed that people will not spontaneously speak of the seism, it's like a bad dream everyone is trying to drown. The first few days after the earthquake days were especially dramatic, and there was no where to turn; no church to pray, no hospital for the wounded, no morgue for the dead. The road sides were lined with dead bodies that were left there to be picked up by the trucks. Many report about a loud deep noise that seem to emanate from the heart of the earth like a thunder. Many agree that the 215,000 death toll is an underestimation. We stayed at the Quiqueya Crisis Relief center. This is a English Christian school in Delmas 75 transformed to crisis relief center in the aftermath of the earthquake. The staff was courteous and helpful. You live in a classrooms (the structures were intact) on air mattresses or in tents depending on how brave you are. Two warm meals provided daily and basic amenities for shower etc are available in a gated, safe and well lit campus. Transportation and wireless internet connection were also provided. A fee is expected to cover the expenses. I did not feel unsafe at any time while in Port au Prince, I even ventured in a tap-tap (local public transportation) at some point. On the hills of Petion-Ville nocturnal life with fancy restaurants, dance clubs etc seemed to be intact. The enthusiam and dedication of the volunteers especially those who have no tie whatsoever with Haitians were impressive and humbling. A group from Alberta/CN took 3 flights to Dominican Republic then an 8-hour bus ride to Port au Prince. The trip lasted 2 days! Haiti needs us all especially those who can help relieve suffering right now; the needs are huge but together we are even bigger. If every Haitian professional would devote 1 week of his/her time weekly, assuming 10% of the diaspora is a trained professional (modest estimate) this would guarantee 2 thousands professionals weekly, it’s easy to imagine to impact. Considering the popularity of the health field among Haitians in the diaspora, the absence of Haitian volunteers from the US is noticeable. The Haitian diaspora needs a more visible presence in Haiti. With the language and the culture the yield of our work may be even greater. As the foreigners start leaving we need to take over. I saw a lot of optimism, Haitians have been toughened by their tribulations over the last decades; Mentally, they have impressively bounced back already. But the task is herculean, thousands of schools flattened taking with them many students and teachers, public buildings destroyed with employees, documentations and computers; the middle class hardly hit with the capital's main street resembling a post-war zone. I will never forget someone who told me ‘doc make sure you save your pictures because you will never see Haiti in this bad shape again’. I thought I would leave Port-au-Prince crying instead the strength of the Haitians inspired me. I can’t wait to go back…
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