February 9th, 2010
Slande flew out of Miami two days after the Haitian earthquake struck. She is a nurse at a Ft Lauderdale nursing home, and her home country was devastated. “Well, I had to come” she explained. Slande went immediately to work at the HUEH or public General Hospital in downtown Port au Prince, as it is known by most.
The hospital was in as bad a shape as the surrounding neighbourhood. The five story nursing school annex collapsed, killing many – reports of between 100 – 500 nursing students died. Inside the hospital, many sections were damaged. “But the courtyard was intact, and that is where the injured and the dead were brought. It was too much! We had nothing then. People were lying outside in the boiling sun during the day. The entrance to the X-ray department was crowded – because it had shade”.
“Yeah, we treated them of course. People came in with open fractures, dirty, flies, untreated. It was really bad”, Slande says wearily. “There were no tents. People were dying too”.
Over the last few weeks, the destroyed hospital has turned into a functional hospital with large 10 -20 bed size tents serving as specialized wards crowded in the courtyard, there is a mixture of HUEH staff and international organizations providing health care. Food is minimal for the patients, and none for the staff, but there is plenty of drinking water. Essential pain medications, antibiotics and wound dressing supplies are generally in adequate supply. The operating room is functioning, and the x ray department has two machines running.
Three weeks later, Slande is now running between 50 patients in three trauma tents. She cleans their wounds and changes their dressings; make sure they get their pain medications and antibiotics, and puts out fires. She coordinates with the irregular and rapidly changing staff. Slande is of course very popular, not just because she is a friendly, excellent, dedicated nurse, but because she is speaks the three languages that operate here: Creole, French and English. Her past experience as an Emergency Room nurse prepared Slande “only a little bit” she confesses, to the overwhelming demands here.
Jeanne is 26, pretty and has a large shoulder bandage at her shoulder where her right arm used to be. Being tended by her younger sister, and two children she survived the traumatic crush injury to her arm, but now finds herself among the hundreds of amputees.
She has a note from her surgeon dated Jan. 30th, stating she needs to return for surgery February 10th, and her wound needs to be cleaned and dressed daily. But Jeanne can’t read much English, so when I approached her on Feb 2nd, she is convinced that the doctor wrote that her wound dressing will be changed next on Feb. 10th. My French is good enough to explain to her what the note says, and to warn her that wounds like hers’ must be cleaned daily to prevent deadly infections. Her French is good enough to understand me. Jeanne refused nevertheless.
I asked a Haitian doctor to lay it out for her. If Jeanne gets a serious wound infection, she will die. He did. She refused. The next day, Slande made it clear to her what the deal was, and reassured her that we would give her pain medications before doing the dressing change. Fear of pain, we thought, might be the underlying reason for her obstinacy. Jeanne agreed. But Slande got caught up with other patient’s wounds and needs, so Jeanne who lies at the far end of the ward, didn’t get her dressing changed that day.
When Slande cleaned Jeanne’s wound of Feb. 4th, she said it looked “really bad”. “Really bad” means it’s infected. We made sure Jeanne was on appropriate antibiotics. I asked Slande if the dressing change was painful, and she said, not really.
The next day, Slande changed the dressing again- Jeanne readily agreed- and the wound improved significantly. This is more a testament to Jeanne’s age, than our treatments. Young people can heal that much quicker. (Photo is from Feb 7th, after 3 dressing changes).
Our wards are little communities. There is no privacy between the beds or cots. Most of the patients have family members staying with them all the time, there is a buzz of conversations and activity throughout the day. The families are essential – feeding, cleaning their kin, and advocating for them. They clean the mess on the grounds too.
Occasionally the cacophony of various evangelical preachers and prayers. By my second day, enough patients or family members know me by name to call for me. Usually their needs are basic: pain medications (which they rarely ask for); when will I get around to changing their wound dressings; but mostly it is to say Hello. In fact, all the foreign staff are shaking their heads about how little we are asked to treat anything – especially the pain which must be considerable. Bone pain from fractures, even amputations, are considerable. But most of our patients are getting by with the occasional Tylenol or ibuprophen. We use narcotics for a few.
C.M. and E.F. are two Haitian nurses who come in for the night shift. They work for the HUEH hospital, yet like all the medical staff, haven’t been paid in four months. “The government is broke”, they explain. Pierre, a Miami accountant who is back in Haiti helping with logistics after being gone for 25 years, is like me, astounded. “Why do you come to work then?” he asks. “This is typical for Haiti” replies E.F., “no one gets paid here”.
She exaggerates; clearly, some Haitians are getting paid very well. They drive nice cars, and live in big houses, with servants and gardeners. But one aspect is clear about this extremely poor country, there is little money for public services like health care or education. Which is why the patients appear very happy to have this foreign health care all of a sudden?
Not only are the staff here because we want to be, but we bring in tons of free medications and supplies that previously, they would have had to pay for, even at the public hospital. Yet, this is creating a black market too – the supplies and medicines disappear. Desperate people may be taking them, or common criminals. The patients go without, as their donated supplies are now for sale on the streets. Haiti has long been a country where the poor are grievously exploited – and this influx of relief aid without accountability and justice, is not going to change the corrupt economic system.
Emanuel is a young man with wounds on all four limbs, including a high right arm amputation has not been having much relief in the last two days. Three nights ago, one of his sisters assisted me with the wound dressing changes, while I instruct the other squeamish sister to “not look”. Previously, her natural reaction to her brother’s pain during a wound cleaning forced the doctor to stop. I told him I was going to medicate him well with analgesics before I began. Emanuel got 10 mg of morphine, but to my surprise, he was wide awake when I began the dressing change. So I sprayed lidocaine anaesthetic on his wound, and even injected a few cc’s into the necrotic area. It worked fine. The squeamish sister stayed calm, the other sister assisted with holding E.S. leg up and unwrapping dressing supplies, and Emanuel felt nothing as I removed a patch of dead tissue from his calf. Last night when I did his dressings, he refused extra medication, took deep breaths, and did fine.
One consequence of 1 million homeless is that a bed in a hospital tent is a bed for someone without a home. I have had to play the bad sheriff, this morning telling a man with a finger wound and a limp, to leave, because he snuck in and spent the night in one of our beds, despite his children pleading. But our beds are for people much worse off than him. Where can he go? To a crowded camp with a mixture of homemade tents and fancy Red Cross tents. The situation was difficult before, and now it is just overwhelming. We all hope that the Haitian people will be able to take over the services the international volunteers are providing, and rebuild a better country.
Scott Weinstein, RN
February 4, 2010
Hi, Very quick message because I’m borrowing a computer. I’ve been working the post op ‘ward’ of 3 tents w 50 people at the very busy HUEH hospital in Port au Prince – mostly fractures and amputations. There are probably several hundred in patients and just as many ‘out patients’. We are trying to save their limbs and lives with the materials and medications we have. It is very busy, and not as coordinated as I hoped it would be. Part of the problem is that there are teams from everywhere who don’t have similar systems and styles. Lots of turnover, unreliable transport, etc… But folks are trying hard and doing good work. The Haitian nurses and staff are invaluable to the rest of us, especially the non-French or Creole speakers. I would say that Haitian and French or Creole speaking RNs and MDs are still very much needed. We are seeing still a lot of trauma, plus acute and chronic medical issues, and peds. Babies are being born and, yes, patients are also dying. I can’t say everyone is getting adequate care because of the holes in our supplies personnel and equipment. X-ray is now available. MSF just opened a 200 bed rehab hospital. We are mostly in tents, it’s hot humid, but plenty of drinking water. The patients have their families with them which is the only way they will get most of their daily care. Again, I am choked up about how little the people here expect from us. They rarely ask for pain meds, despite their fractures and amputations. The people are very resilient.
Jan 31, 2010
Roger & I walked around for an hour today in crowded Pietonville which has the rich and lots of poor, and 4 hours in crowded downtown which is all poor in tents and shanties. We went by the port, the national palace camps and by Cite de Soleil. The worst thing that happened to me was a sunburn. Downtown which is flat is really pummeled by the earthquake, a lot of houses down. Shanties on hills collapsed too.
But everyone was very nice. Very busy, but safe all around. No fights, no yelling, other than hailing ‘tap-taps’. It helps to be white guys. Very little hustling even – less than a NYC street. In a shanty town, an orange wholesaler gave us free oranges, because it was too complicated to sell individual ones. This was so unlike the fear propaganda that is drummed into our heads, which is why we didn’t see any other white person on foot the whole time, except one guy with his young Haitian girlfriend. We didn’t see much in the way of soldiers or police either.
There appears to be a lot of food for sale in the streets & sidewalks, but most is non caloric, most is fruit. I saw very little rice, no corn, some potatoes, sugar cane, a little wheat, some beans & oil. I saw no one actually eating…, and not a lot of people buying. We saw no food aid at all, on the streets or in the camps. We hear rumors of food aid now for sale in the stores…
In the camps, we put a sling on a young girl with a possible fractured arm and gave her some Tylenol. She was afraid to go to the hospital because she thought it would cost, and they would amputate… So we had to dispel that myth.
At the hospital, I took a photo of 4 guys with the US 82nd Airborne armed with M16s guarding a cart of patient’s food being distributed! It was so ridiculous, because others were distributing food by themselves.
Certainly, the Haitians are resilient, and also self sufficient. I imagine they don’t expect people to help them.
Jan 30, 2010
I can only write about my very limited impressions over 2 days here, so take what I write as having an very narrow perspective.
Port au Prince in the four neighbourhoods including downtown that I’ve been through is teeming with people, buses and cars. It really seems like any crowded city in an under-developed country. Unlike abandoned New Orleans when Americans were barred from returning to their damaged neighbourhoods, and also they felt unable to return without electricity, water and sewage, this is not the case here.
People appear very industrious, and a lot of small businesses and street vendors are operating. I am aware that small business, schools and churches are now functioning in a public relief mode – helping people with food, water, medical and other essentials. Everyone I have spoken too has been polite and friendly. Haitian French is very easy to understand, and many Creole speakers understand my French.
Most of the streets are cleared of rubble. I would estimate that about 5 – 10% of the buildings have collapsed, but a lot more are structurally damaged to the point that people do not feel safe to live in them.
Every town square and park is teeming with the new homeless, thousands. There are also people camped out on the sides of streets. Yet, I was prepared for the odor of decomposing bodies or food, and it is no longer present in the areas I have been.
The airport is down to 40 flights a day from 120 last week according to an Air Force soldier I spoke to there upon arriving. The Air Force and the FAA control it. Immigration did not even ask me any questions or stop me before I left the building.
I visited and spoke with the director of the main hospital yesterday (HUEH/General), a very kind and welcoming Dr. Lassegue. He notes that the trauma period of medical care is over, and medical needs are post op care, wound care, and chronic illnesses.
There are still shortages of essential medical materials and medicines on the ground – analgesics, anesthetics, antibiotics, and regular meds for the usual chronic diseases. (I sent in another email, their staff and material/medicine needs).
The hospital itself is a combination of medical tents outside, and some services inside. There are many Haitians working and volunteering there, plus a good compliment of international teams. It appears very well organized and staffed. I note a busy, but focused and calm atmosphere, despite the improvisational nature of the services. They are doing it all from Labour and Delivery, neo-natal, pediatrics, trauma, OR, medical, ER, mental health and triage.
Many patients are on simple beds or cots. Few have running IV’s, and probably few have pain meds. Remarkably, people seem awfully stoic and quiet. I heard no complaining or yelling (less so than our hospitals!). Patients often had their family there – especially the kids. Everyone was polite who I spoke with and let me take their photo when I asked.
Outside the hospital, the medical needs are wound care, and regular illness. I noticed very few internationals medical people besides my acquaintances from the US and Medecins Sans Frontiers. Of course, sanitation, drinking water and food in the new homeless camps is essential.
Food, water, money & armed troops.
Food is simply not being distributed adequately to those who need it the most. Yet there is both food in the restaurants and stores for sale, and I believe food in the warehouses that the UN and the International bodies are controlling. I was in a store today to change money and the shelves were full. It seems horrible to think that many are going hungry or even starving, but across the street, if they had money, they could eat their fill. Food in Haiti is expensive because most of the essentials are imported. Their agriculture is more geared for export crops like fruit.
I keep hearing about security concerns for the teams distributing food, but my strong impression is that there is a lot of ill prepared teams and paranoia about crushes & violence. If food can be distributed safely around the world in other emergencies, it could be done here too. Frankly, the streets are busy, but I have yet to notice any threatening behavior. Like the hospital, people seemed focused and calm. A business association I was visiting today was busy distributing water, and there are no armed guards with their operation.
Because of the class divisions in Haiti, those that have money will not go hungry unlike those without who are dependent of food aid and distribution.
Drinking water is in short supply like food.
There are pockets of US soldiers around the downtown that are noticeable, and I have heard comments from Haitians about them. Since there seems to be no general security threats, people are wondering why they are here. My lame answer is that is what the US does best; send troops, because it has no civilian emergency corps. But they would be more helpful if they were not carrying around M-16s, but had medical supplies or food.