Haiti Earthquake

Most of our patients are women. I’d say they make up 80% of our most serious fractures. The earthquake struck at 16h50 (4:50 PM) on a Tuesday afternoon  and apparently the most vulnerable were adult women at home, preparing the evening meal.

Among our patients who have been with us the longest are a group of young women in their early twenties. The core group is four: two with femur fractures in traction, one with a tibia fracture just below the knee, and one in an external fixation set for her tibia-fibula fracture. Then there are a few others, of the same age, with similar traction sets or external fixations, who round out the group. But the four are inseparable: when we started moving patients from the orthopedic hospital to the rehab (physiotherapy) service, we had to move them as a unit.

I call them M’s girlfriends. Their eyes light up at the attention paid to them by M, the attractive trauma surgeon who was one of the first team members to arrive after the earthquake. He has been involved in their treatment from the start. He teases them about when they will be well enough to dance with him. And when they moved to Rehab and they saw him less often, they insisted to me, tell him to come visit us.

The ringleader is N, who has a tibia fracture just below (but not involving) the joint line, undisplaced. She gets dressing changes under anaesthesia about every 5 days for the wound behind the knee. She is overflowing with life: talkative, mischievous, shining eyes and luminous smile, who wears her emotions like banners. Last week M told me she refused to talk to him on his most recent round: I said, she’s playing hard-to-get so next time you come begging, and with flowers.

I think they spend their time chatting and gossiping. A few can get around on crutches (as opposed to those confined to bed because of their traction sets), so they sit under a tree outside and gossip. One has a baby of 6 months, who is passed around the room and fawned over. Last Sunday, a hairdresser stopped by and must have done a booming business, because when I saw M’s girlfriends on Monday morning, they all had new matching coiffures.

Last week I asked them if they would consider moving indoors from the tent. The rains are starting. The Haitian doctor said, sure, they won’t mind: the roof of our Rehab building is aluminum sheeting, not concrete. No! M’s girlfriends cried in a unified, horrified voice: there are still walls. The walls are concrete and they will fall on us.

Well, yesterday M said his goodbyes to the girlfriends. He is exhausted and heading home. I think it was emotional on both sides: from the hospital on the street and operating under a tree to, soon, being able to remove their traction and learn again to walk. But he couldn’t play favourites. One burst into tears: why must everyone leave? she asked. Wendy, are you leaving? (Yes, chérie, I’ll leave in two weeks, but new people are arriving with new energy to continue with you.) There was an individual photo with each of them; none of the core four were left out. And when he left, he said, Wendy, please look after my girlfriends.

Aujourd’hui, une organisation faisant des prothèses est venue voir une de nos patientes. Ils sont venus tester la prothèse qu’ils venaient de lui fabriquer. Cette patiente est dans la jeune vingtaine. Lors du séisme, elle a perdu son bras gauche et sa jambe droite. Elle voulait faire son cours d’infirmière…infirmière, comme moi. Cette organisation de fabrication de prothèses, touchée par son histoire, a décidé de lui offrir les 2 prothèses. Aujourd’hui, c’est vraiment le cœur gros que j’ai vu cette jeune fille enfiler pour la première fois sa prothèse de jambe. Je ne sais pas ce qui m’a touché le plus…son regard/ses yeux, son sourire, ou l’espoir qu’on ressentait tous dans ce geste d’offrir une nouvelle jambe. D’offrir une nouvelle chance de repartir dans la vie. Son regard, je l’ai immortalisé en prenant une photo…et comme ce moment ne s’explique pas (ou plutôt je n’arrive pas à trouver les mots pour le faire), je veux les partager avec vous …

Mickey, cette garderie transformée en hôpital, m’apporte chaque jour un peu plus que la veille. Ces derniers jours, j’ai eu la chance de partager les premiers pas de plusieurs patients. Un pas, ça ne signifie quasi rien pour nous tous. Chaque jour, on marche d’un point à l’autre, pour y revenir, y retourner…on ne se rend jamais compte de la chance que nous avons chaque fois de pouvoir mettre un pied devant l’autre. Ces derniers jours pourtant, j’ai vu plusieurs pas qui veulent dire beaucoup plus. Des patients alités pendant 1 mois, ayant perdu leur maison et plusieurs de leurs proches, recommencent tranquillement à marcher. Certains me disent même « enfin », enfin ils peuvent marcher de nouveau. Réapprendre, avec des béquilles, des marchettes, des cannes…mais marcher. Toujours avec ce grand sourire aux lèvres, cette fierté d’avancer. Tout le monde a vécu de durs moments ici, des pertes, de la souffrance, des questionnements face à cet inconnu soudain. Mais aujourd’hui, tout le monde partage ces premiers pas. Je n’aurai jamais ressenti autant d’émotions qu’aujourd’hui face à ce nom, qui prend une toute autre signification pour moi : Mickey.

The other night I was in charge of the getaway car. So there I was, at three in the morning, sitting in the moonlight,  swatting at mosquitoes, with three cars pointed in the right direction. The keys were in the ignition. I was trying to keep the drivers awake in case we needed to get going in a hurry.

No, not a robbery! We were doing a distribution of ‘non-food items’, meaning various things that someone who has lost their house might need to live: tent, blankets, bucket, soap, cooking pots, etc. This is a city of refugees, now. (Technically, not refugees because they have not crossed an international border. They are more accurately called ‘internally-displaced persons’, or IDPs.)

And because these are now valuable items in desperate times, distributions are difficult because of the security risks. We want the things to reach those who most urgently need them, not others who might sell them or steal them. And the stock you bring is limited in number, so you need to limit somehow the people who receive, despite nearly infinite need. Rioting and stampedes are a real possibility.

So it’s delicate. There is some discussion and planning with community leaders. But secrecy as well, with some element of surprise so that the crowds don’t swell out of control. Tight security. Strict lines. And this one was done at night so as to reach those who would leave in early morning for their jobs.

And me: the lone medical person on the team in case someone gets hurt. And in charge of the evacuation cars. I joke that it’s the opposite of a hospital project, where the medical staff get all the glory and logistics’ role is forgotten, as long as the lights are on and the water is running. In this case, logistics has all the action, and I’m just support staff.

In the end, then, I saw nothing. Four hundred households received their kit, no one was hurt, and we left efficiently but not with tires squealing.

It’s hard to sleep because of the aftershocks.

There were two tonight, both fairly strong, in quick succession. Very much not cradle-like, they shudder and rock one out of sleep. In darkness, heart beating, wondering, *now*, should I panic’ But it’s over before any answer comes.

There was another big one last night, which was a jolting, falling sensation. And one this morning while we were doing rounds at the hospital, which caused one of our patients, an amputee on crutches, to lose his balance and fall.

It’s not quite a daily occurrence, but certainly it has been  happening several times weekly. The feeling of helplessness and unpredictability is petrifying. But precisely because there is nothing much to do, one just carries on.

Marie-Michèle Houle et Jerry ... quelques jours après mon arrivée! Nous regardions les photos qu'il avait prises avec mon appareil photo.

Je travaille actuellement dans un centre de prise en charge de soins post-opératoires. Les patients ont besoin d’un suivi pour différents  problèmes opératoires. Par contre, nous devons parfois garder des patients en observation dans le centre pour d’autres raisons de santé…ou parfois même les référer. Nous avons environ continuellement 60 patients de tous âges. Des enfants, des ados, des jeunes adultes, des adultes, des personnes âgées… c’est vraiment beau de voir cette cohabitation. Car même si leurs histoires sont différentes, j’ai l’impression de voir se construire une petite famille, tous unis face à une même tragédie. Notre unité d’hospitalisation est installée dans une garderie qui s’appelle Mickey Mouse. C’est divisé en plusieurs sections, mais dans chacune de ces sections, il y a un petit quelque chose qui la rend unique…

J’ai plusieurs amis dans cet hôpital… beaucoup de gens adorables et surtout forts…plusieurs héros. L’hôpital prend tranquillement de la couleur, de la joie…

Pour la première fois cette semaine, mon ami Tom a pu marcher avec des béquilles depuis son amputation. Tom a 7 ans. Il a été amputé de la jambe droite et il reste à l’hôpital avec sa petite soeur de 12 ans. Chaque jour, sa maman qui a 1 enfant de 1 mois vient passer la journée avec eux. Tom a été mon premier coup de foudre en Haïti. Souriant et coquin, on se fait toujours des clins d’oeil et des “good” (pouces en l’air!). Cette journée là, quand il s’est déplacé avec ses béquilles multicolores, tous les gens l’applaudissaient dans l’hôpital. Les malades dans leur lit qui ne sont pas encore rendus à reprendre la marche, mais qui encourage beaucoup ce petit bonhomme plein de vie! Il souriait tellement, les bras lui tremblaient, et je dois avouer que je n’ai pas souvent vu Tom dans son lit cette journée-là… maintenant qu’il pouvait se déplacer.

Il y a une dame aussi qui me touche beaucoup (tout le monde me touche, mais…). Elle est depuis 3 semaines dans le lit 1. Elle ne sort jamais de son lit autre que pour aller en salle d’opération pour faire son pansement sous anesthésie ou pour changer les draps de son lit. Cette femme est une des quelques personnes amputées qui se trouve dans notre centre. Elle est âgée, elle doit avoir près de 70 ans. Il y a toujours une odeur nauséabonde quand on passe au côté de son lit parce que sa plaie est infectée. Malgré tout ce que nous avons essayé, la plaie de l’amputation ne guérit pas du tout. Son pansement a toujours un écoulement…senteur de chair pourrie. C’est difficile à expliquer. Elle ne veut à peine manger…ses enfants doivent la faire manger, car elle est trop découragée et dépressive. Et vendredi passé, les médecins lui ont appris que nous allons devoir la réopérer pour couper un peu plus haut, au-dessus de son genou. Samedi, je n’en pouvais plus de voir son regard désespéré, son regard d’appel à l’aide. J’ai donc décidé que nous allions la sortir dehors. Qu’il était temps qu’elle voit le soleil, qu’elle change d’air. Elle ne disait pas grand chose, mais elle a accepté. Donc en chaise roulante, nous sommes sortis, devant la garderie et nous y avons passé 10 minutes au soleil. Elle m’a parlé un peu finalement…et même les silences de ce moment étaient précieux. Son visage a repris un peu de vie et elle s’est mise à s’étirer un peu le cou pour voir les gens dans la rue. Aujourd’hui, elle a accepté de faire l’opération et elle a repris le sourire…

J’ai aussi une petite princesse!!! La jolie! Jessie doit avoir environ 10 ou 12 ans. Elle reçoit de la visite de sa famille, cousins et cousines, mais je n’ai jamais vu sa mère ni son père. Elle a une fracture de la jambe et une grosse plaie. Elle aussi a une petite infection de la plaie…au début, elle ne parlait pas beaucoup, mais tranquillement, elle s’est ouverte. On lui a donné une barbie qu’elle tresse. Elle est tellement gênée…

Il y a aussi une dame de 31 ans, Marie-Soleil. Lors du tremblement de terre, elle a perdu sa petite fille de 11 ans. C’était sa seule enfant, car elle et son conjoint avaient beaucoup de difficulté à réussir à faire un enfant. Sa fille était pour elle un miracle. Et le jour du tremblement, elle était à la maison avec sa fille. La maison s’est écroulée sur elles, mais des voisins ont sorti la maman des décombres…mais on n’a pas retrouvé sa fille. Elle avait des abrasions partout sur le corps, un peu défigurée même et une fracture du bassin. Au début, elle était seule…seule, car son mari n’arrivait pas à venir la voir. Il l’aimait tellement que de la voir dans cette situation le torturait, en plus de la douleur de la perte de sa fille unique. Tranquillement, l’équipe a travaillé avec elle et son mari pour les aider à se retrouver. Aujourd’hui, ils sont ensemble dans cette épreuve… elle n’a plus rien. Elle a perdu toute sa famille… il ne lui reste qu’un oncle, un frère et une soeur…

La nature humaine est ainsi faite que nous sommes portés à oublier… nous finissons souvent par oublier. Et ici, nous sommes portés à oublier que la maladie et les accidents continuent de se produire. Que tous les soins ne sont pas nécessairement reliés au tremblement de terre. Du moins, j’avais un peu oublié que les accidents continuaient.

Ce matin, un accident m’a fait rappeler… rappeler que d’autres évènements continuent de se produire, mais aussi que la vie est fragile. Ce matin, je me suis rendue à la base (bureau) d’où je quitte chaque matin. à mon arrivée, je dûs partir d’urgence, car il y avait eu un accident sur la route et des blessés se dirigeaient vers l’hôpital. Je ne sais pas exactement ce qui s’est passé sur la route, mais je sais ce que j’ai retrouvé à l’hôpital… environ 8 patients étendus sur de petits matelas sur le sol, des cris, des pleurs, du sang, beaucoup de sang. Des médicaux qui courent… les patients étaient vraiment graves. Un homme avait toute la jambe ouverte, on pouvait y voir la chair et les os…l’autre avait du sang qui sortait par l’oreille, il vomissait du sang par le nez et la bouche et avait des coupures ici et là, il était semi-conscient et répétait toujours son nom… une femme ayant plusieurs abrasions avec son bébé de 1 an à ses côtés qui pleure… je ne peux pas me souvenir de tous ces gens, mais quand je referme les yeux je vois du sang, beaucoup de sang. Je revois cet homme qui vomissait du sang… j’ai quitté avec lui en voiture pour faire le transfert dans un hôpital plus spécialisé pour ce type de trauma, ce type d’urgence. Le trajet a duré environ 30 minutes, la circulation était dense. J’avais l’impression qu’on allait jamais arriver… je continuais de répéter à cet homme que nous étions là, avec lui, ensemble. Que nous allions arriver, de ne pas lâcher. Quand nous sommes arrivés à destination, je lui ai dit que nous y étions, il a ouvert les yeux et m’a regardée… cet homme, il avait mon âge. Je ne sais pas si demain il aura encore mon âge, car le fil de sa vie était encore plus mince que jamais quand je l’ai quitté.

Des expériences comme celle-ci n’arrivent pas tous les jours…

Some of the injured children are quite clearly emotionally traumatized, too. One is an 8-year-old boy who had a left leg compartment syndrome. We will call him Bobby.

(Compartment syndrome is swelling in a relatively closed ‘compartment’ in the leg, enclosed by tough membrane called fascia causes increased pressure in that space and therefore reduced blood flow, as well as nerve damage. The treatment is to surgically open the compartment to relieve the pressure a fasciotomy).

He still needs dressings done under anaesthesia every five days. His foot does not move well. He is pale with anemia. Sullen most of the time. Moans and swats away at anyone who tries to touch his leg or foot. Resistant to trying to move his knee or ankle.

The physiotherapists have not been able to make much progress with him. Our mental health team has been trying, too.

One person only has gained Bobby’s confidence. He is a very experienced now-retired orthopedics/trauma nurse, who functions here like a doctor. He is certainly better qualified than I am for a lot of these patients with complex fractures, external fixations, traction sets, and ugly open wounds. Bobby asks for him constantly. I came across them yesterday afternoon.

There they were in the late afternoon sun: a gruff French-Canadian orthopedics nurse and a traumatized little boy, Bobby’s weight on the nurse’s arm clumsily manipulating his new crutches and touching his good leg to the ground. No moaning. They did half the length of the tent and back again. I think everyone in the tent was paying attention. It was momentous and moving.

It seemed brief but draining, his first time away from his bed in weeks, perhaps. And back in bed, the nurse then coaxed him into a few range-of-motion exercises: raising and straightening the injured leg, which are important for regaining muscle strength and preventing contractures (deforming shortening of ligaments). Again, there was no moaning and no swatting. No words either: but Bobby’s acquiescence spoke volumes.

We have been at full capacity at our hospital in Port au Prince for a day or two now but there is no shortage of patients here who need hospital care.

We are all still packed into the one large house which doubles as a base for MSF Switzerland in Port au Prince. It is on a hill with great views over the city, but for the 50 or so expats we have here it is quite squashed. Most of us are still sleeping on the roof (partly out of fear of another quake, but also because the roof is a large terrace and we can put many beds on it!). We all get tangled up in the web of makeshift washing lines, with mosquito nets and clothes drying which zig zag across all of our mattresses. The very few bathrooms we have are barely functional, with an unreliable water supply and toilets that don’t flush well. I enjoy sleeping on the roof; the sunlight wakes me up naturally in time for work.

Very soon many of us will be moving into another house which should make things more hospitable. But when you compare our lifestyle with the tens of thousands of Haitians right now, there is absolutely nothing I feel comfortable complaining about.

(…)

My staff have been asking me if I can provide them tents as they are also living under ‘la belle étoile’ (the beautiful stars) as they call them in the typically positive Haitian way. It is difficult to imagine that nearly all of our staff is also living without water, sanitation and protection from the rain, in camps around the city.

(…)

We have had a few mini earthquakes and tremors over the last few days that have caused things to shake occasionally, but not severely. So many buildings are about to topple that it won’t take much. Things feel very precarious.

However despite all this, the ambiance at our hospital gets better and better each day as people settle in. We have a team of physiotherapists that are getting people up to walk, whether they have legs amputated or external fixation still in place. We have parallel bars, wheelchairs, crutches etc. and it is great to see people smiling as they can learn to move around again. To see a man smiling with pride as he negotiates going up a ramp on crutches, just one month after losing his leg gives me a sense of purpose and motivation all day to do all I can for these people.

Our psychologists are doing a great job with consultations, and especially with the children who are all starting to play with balls, teddy bears and draw with crayons. Every day there is laughter and games and more and more interaction between staff and patients as things are coming together and settling into a nice rhythm. It is starting to have a homely feel. We are also providing great quality food which makes a big difference to the lives of our patients.

We have been at full capacity at our hospital in Port au Prince for a day or two now but there is no shortage of patients here who need hospital care.

We are waiting to hear if we can use a large location not far from here which we could turn into a large hospital (perhaps with a capacity for 400 beds)  so I am looking forward to see if we can get the go ahead to start.

We are all still packed into the one large house which doubles as a base for MSF Swiss in Port au Prince.  It is on a hill with great views over the city, but for the 50 or so expats we have here it is quite squashed. Most of us are still sleeping on the roof (partly out of fear of another quake, but also because the roof is a large terrace and we can put many beds on it!  We all get tangled up in the web of makeshift washing lines, with mosquito nets and clothes drying which zig zag across all of our mattresses.  The very few bathrooms we have are barely functional, with an unreliable water supply and toilets that don?t flush well.  Yesterday evening for the first time it started to rain, and we all quickly had to take our beds into the indoor passageway until it passed. Luckily it did not rain while we were trying to sleep.  I enjoy sleeping on the roof; the sunlight wakes me up naturally in time for work. Very soon many of us will be moving into another house which should make things more hospitable.  But when you compare our lifestyle with the tens comfortable complaining about.

The recently orphaned girl called Jenna who i was talking about in my last blog is still an unhappy looking little thing, and yesterday had one of her screaming fits again because the plaster was making her leg itch.  We managed to wheel her around the hospital in a wheelchair to give her a change of scenery from inside her tent.  When I look at her I try to imagine what it would be like for her, one month now without her mother or anyone familiar, her leg in a cast and stuck in a hospital tent with construction happening all around her.  How quickly her life changed.  We have not been able to make her smile much yet, she is not very interactive.  But we have alerted her to the psychologists who will encourage her to start playing again when she is ready.  I can see small improvements in her sense of security.

My staff have been asking me if I can provide them tents as they are also living under ‘la belle étoile’ (the beautiful stars) as they call them in the typically positive Haitian way.  It is difficult to imagine that nearly all of our staff is also living without water, sanitation and protection from the rain, in camps around the city.  It rained last night quite heavily for the first time… when we arrived at the hospital this morning we had to remove all our damaged stock that got wet accidentally when the makeshift roof let the rain in.  The patients tents needed a good mopping but all in all the hospital survived ok. It is the beginning of a huge crisis here now the rains are starting and tens of thousands of people are living on the streets.

We have had heavy machinery and earth moving trucks operating next door to our hospital.  The noise of crumbling buildings reverberates all day around our hospital which is disconcerting for many.  We even feel the earth tremor because of them which is not conducive for a therapeutic environment but I guess this will be the norm in Haiti for a long time. We have had a few mini earthquakes and tremors over the last few days that have caused things to shake occasionally, but not severely.  So many buildings are about to topple that it won?t take much.  Things feel very precarious.

However despite all this, the ambience at our hospital gets better and better each day as people settle in.  We have a team of physiotherapists that are getting people up to walk, whether they have legs amputated or external fixation still in place.  We have parallel bars, wheelchairs, crutches etc. and it is great to see people smiling as they can learn to move around again.  To see a man smiling with pride as he negotiates going up a ramp on crutches, just one month after losing his leg gives me a sense of purpose and motivation all day to do all I can for these people.

Our psychologists are doing a great job with consultations, and especially with the children who are all starting to play with balls, teddy bears and draw with crayons.  Every day there is laughter and games and more and more interaction between staff and patients as things are coming together and settling into a nice rhythm.  It is starting to have a homely feel. We are also providing great quality food which makes a big difference to the lives of our patients.

But it feels like a bubble.  As soon as we leave the gates we are confronted by a desperate situation that seems mammoth.  The living conditions in some other hospitals are terrible, yet sometimes the patients in these places are too afraid to leave where they are to come to our hospital because it is unknown to them and they don?t want to give up their beds and risk being stranded.

Today there were some men in a car who called out to us to ask if there was hope for Haiti… we replied that there was certainly hope, but they responded that they didn?t think so as they drove on by. Time will tell.

Plans are being made to relocate large patches of the population who are living in camps in town.  It is interesting where the strategies are going in terms of deciding to either rebuild Port au Prince, or re-establish another capital city entirely.  I have been here almost two weeks and the magnitude of all this still hasn’t really sunk in because I have been so pre-occupied with the task at hand.  In terms of loss of human lives, it has surpassed the Asian Tsunami which effected a huge stretch of land in many countries.  This was one city.  Destroyed in 30 seconds, and the aftermath is still barely manageable.

We have no idea how we will ever be able to discharge most of our patients, as we can?t send someone out to the streets with one leg and no house, job or family.  At the moment though, we are focussing on just providing the post operative care so many need.

Carneval is normally next Tuesday, February 16. It’s unclear what will happen. But certainly no pre-Carneval buzz: no loud neighbourhood parties, no mini-défilés (parades) with costumes and papier-mâché masks. Today I asked “E” — now on the mental health team, but formerly our strongest agent de terrain (community health worker) — what buzz she has heard about Carneval and security in general.

She says Carneval will not happen. No one is interested. The money and effort will go to reconstruction. Everyone is in mourning.

Indeed, Friday was proclaimed a national day of mourning (deuil). The bustle and daily noise on the street was absent on our drive in to the hospital. Instead, we had to detour around the crowd gathered on the street in front of the local cathedral. We passed a few other more modest places of worship in courtyards and storefronts. Many women were dressed all in white, with white kerchiefs around their heads, Bibles in hand.

At the hospital, you could hear the preacher expostulating at the church behind us. There was more fire and brimstone on the ubiquitous portable radios. Some of our patients were lying in their beds, eyes closed, waving their hands in rapture (with external fixations or traction sets in place). It seemed everywhere I turned, I came across someone praying. The guard let me in through the gate to our Rehabilitation Centre, and returned to his praying.

With so much loss and so many limitations, there is much to mourn.