Haiti Earthquake

Overnight call at the hospital yesterday. Tranquil. Felt hot and sticky, braised in sweat and mosquito repellent. Was wondering if have ever been quite so dirty.

But near morning, rain. Heavy for 2 hours or so. Rain like that, after a hot, oppressive night, is usually a relief. Here, it’s hard to feel refreshed when you think about people in the bedsheet tents. They would have been drenched, tents flooded, streams and mud along the footpaths.

It had stopped by daylight. The clouds had cleared. Our patients and their caregivers opened up the tents that had been shut tight against the rain, and started their morning routines: toothbrushes and hairbrushes in hand, trips to the latrines, smoothing sheets. Our staff were sweeping water away from the corridors where water had collected.

I, too, went to brush my teeth and use the bathroom in that pale, scrubbed-clean light. I got smiles and “bonjours” along the way. Some people were singing, as a habitual way to give thanks in this very Christian-religious country. The elderly woman’s “bonjour” was part of her song as we passed.

There is both beauty and tragedy in a morning like that. Beauty in sharing daybreak and its mundane intimacies with our patients. I marvel at their smiles, still. They have suffered; their injuries are serious. On this morning, though, they were dry and safe.

The tragedy is in fearing for those in the refugee camps. I have seen some camped by the side of the road, but I have not visited any of the bigger gatherings. Apparently they are impressive; tens of thousands of people, packed like sardines without a single square inch of extra space. Many of the shelters are sticks and bedsheets. During the predawn rain yesterday, I got up from my cot to watch it fall in the darkness, my heart breaking for the additional misery it will bring to the too-many homeless. It was a hint of the beginning of rainy season. And rainy season is followed by hurricane season.

I have not seen much of the physical damage of the earthquake, strangely. I passed through a few parts of the city that I knew, on my arrival through Dominican Republic. A busy road near the airport, with a few buildings shaken to the ground. The police headquarters, now on a lawn because all the bricks have been carted away. The refugee camp on the grounds of a school, where MSF has the inflatable hospital, not far from Hospital de la Paix. Delmas, still a very busy street, where some buildings are a pile of indistinguishable rubble, others compressed like layer cakes, others still totally untouched. The  Caribbean supermarket is  half-collapsed and leaning dangerously. The public squares are bedsheet-tent cities. Traffic is worse than it used to be. And this is still a very loud place.

What I see daily, though, is the change in some of our Haitian staff that I know from before. I am overjoyed to see them, in one piece, still working with MSF though in a different location and often in different capacities. I haven’t seen everyone since some have left town, and others are working in other projects throughout the city. But here are some of the drivers I know. The receptionists and my favourite archivist. The guys who carry stretchers. A few nurses and midwives. The logisticians.  They are still here. The ones I think are wonderful are still wonderful.

But they are thinner. I see just a little bit less exuberance, and a bit more melancholy. They have lost sisters, uncles, a child. One left the pharmacy today with a flattened cardboard box under her arm: this is my bed, she said.  Yes, most if not all have lost their homes. Life and limb are still intact, though so many others were lost. Still, the impact on family and foyer is devastating: with that in account, I can see that life for everyone in Port-au-Prince has changed.

J’ai lu un livre qui m’a énormément touché, comme il l’a sûrement d’ailleurs fait pour plusieurs milliers de personnes dans le monde, “l’alchimiste”. Je ne rentrerai pas dans les détails du livre, mais on y raconte que chaque personne possède sa propre “légende personnelle”.

Vous savez, cette chose pour laquelle nous sommes tous individuellement. Et pour savoir ce en quoi elle consiste, il suffit de se rappeler nos rêves ‘enfants, ce que nous désirions. Moi, ma légende personnelle c’était de soigner, d’aider les gens dans le besoin, démunis, à travers le monde.

C’est ainsi qu’un jour j’ai décidé de foncer et de la réaliser. Je travaillais dans un grand höpital pédiatrique, Ste-Justine, que j’adorais et respecte énormément; j’avais un bel appartement à moi; j’avais ma voiture; j’avais mon amoureux depuis 2 ans; une vie familliale formidable avec même un adorable filleul, William; des amis super… mais j’ai osé. Osé me lancer vers l’inconnu avec la confiance que peu importait l’issu, je n’allais pas regretter, car j’allais avoir écouté mon coeur. J’ai vendu ma voiture; quitté mon travail; brisé mon bail d’appartement; même quitté mon amoureux…

Et me voilà aujourd’hui devant cet ordinateur, vivant ma légende personnelle, pour vous écrire ce que moi-même j’ai parfois de la difficulté à comprendre, mais que je vis pleinement. J’espère que je saurai vous faire comprendre ou réaliser au moins une chose…personnelle à chaque personne. Car ce que j’écrirai proviendra de mes yeux, de mon interprétation, très subjectivement. Ces mêmes choses pourraient vous paraîtrent totalement différentes si vous les viviez. Par contre, je m’efforcerai de vous les faire vivre en utilisant les meilleurs mots possibles…car les écrits restent et les paroles partent.

Je travaille actuellement avec Médecins sans Frontières section Suisse, en tant qu’infirmière. Je suis basée dans l’équipe à Port-au-Prince. Je travaillais dans une clinique ambulatoire où les gens viennent consulter pour différents problèmes. Que ce soit pour des troubles psychosomatiques (insomnie, céphalées, etc), des plaies infectées, des diarrhées, des problèmes respoiratoires, des suivis de maladie ou de pansements…

Depuis une journée, je suis maintenant superviseur d’une unité d’hospitalisation de soins post-opératoires. Nous avons autour de 50 patients. Tout au long de votre lecture, vous comprendrez sûrement mieux ce que je fais ici…

I am an Australian nurse and have been working for MSF for about a year. Before that I was an emergency nurse in Melbourne and had also spent some time working in a remote Australian Aboriginal community.

Haiti is my third mission with MSF and like the first two, this experience is just as different in nature. My first mission was for a massive emergency vaccination campaign against an epidemic of meningococcal meningitis, where we vaccinated 1.2 million people in Niger in just over 2 months. That mission took me out into the remote depths of the sub saharan desert in the worst heat I have ever experienced, visiting some amazing villages. My second mission was in the northern part of the Democratic Republic of Congo, establishing the projects pharmacy and supervising the running of our paediatric and surgical interventions in the hospital. Most of the Congolese people in the area were displaced through war and the terror inflicted by frequent violent attacks of the Lords resistance Army.

When the earthquake happened in Haiti I had been home in Melbourne just a month after returning from nearly five months in the Congo, and was about to embark on a 6 month break from missions. Like most of you, I also saw the same footage on TV and felt shocked at the scale of the devastation. Only this time, working for an organisation like MSF made me feel more close to the tragedy, as I knew MSF would be playing a huge and immediate role in the aftermath. It was clear MSF needed people to go to Haiti quickly, and after some days of deliberation I decided to put my break on hold and set off again. Within just a few days I found myself in Port au Prince. I already knew many people in the team, and they seemed very tired, and totally immersed in setting up hospital beds quickly for the wounded in the city. The demand for post operative places in the city is huge and will become more pressured soon as the spot light turns away and other aid organisations move out.

I have been here now for just over a week and I have completely lost track of time. We have all worked very long hours building an 80 bed hospital from scratch in the grounds of a damaged school and all within just a few days. It has been an absolutely awe inspiring experience to witness how quickly things can be done here by MSF for the Haitian people. We have set up a fully equipped inflatable operating tent inside the school stadium, and 6 large tents outside that very quickly were inundated with patients. We have set up a recovery room, a hospital kitchen, laundry, sterilisation area, physiotherapy and psychologists area, bathrooms, hospital laundry, pharmacy etc. all within a matter of days. We have used carpenters, plumbers, electricians, etc. to pull it all together and we are now almost full. We have been receiving patients while construction has been going on. Patients keep arriving on stretchers, many of them amputees or with badly broken legs, backs, head injuries. One nine year old patient was having his appendix taken out on the day of the earthquake and in the chaos that followed received no post operative care. He has become very unwell since and extremely emaciated. One patient has a large part of her skull missing. But most are recovering amputees, struggling to get used to the idea of a disabled life. Being disabled in Haiti is not easy. And a mind blowing number of the population will be left disabled after this.

One patient that stands out for me is a six year old girl called Jenna who has a badly broken leg, and is all alone with no family support because she lost everyone in the earthquake. She often becomes hysterical and inconsolable.
I spend most of my time working with the group of Haitian staff we have employed to work at the hospital. They are amazingly motivated and a pleasure to work with.

I have enjoyed overseeing and setting up the services in our hospital so it can operate to a high standard. It is great to see it all coming together so efficiently given the difficult context. The logistics of putting it all together has been incredible.

As soon as we can MSF is going to find another space to build another hospital to accept more wounded. Space is tight in Port au Prince, as so many groups are competing for space. From what I have seen we wont have any trouble doing it again with such a great team.

Everyday we drive through the busy streets of Port au Prince. We pass a lot of rubble and completely crushed buildings. The ones left standing are balancing precariously and I feel vulnerable even driving past them. I am unable to fathom how long it will take to rebuild a place like this.

It seems nearly everyone is living on the streets under makeshift tents. The city is full of camps. Most people are still too afraid to sleep inside. When you drive through the city you see people bathing with a bucket on the side of the crowded streets, and just a few meters away people are defecating. The environment is ripe for an epidemic… and the wet season is fast approaching, bringing with it the possibility of hurricanes and rain that will surely weaken the already fragile foundations of the structures that are only just still standing.

This evening just as we were rounding up another long and challenging day we received word that a building had collapsed trapping or crushing people underneath it. Even almost a month after the earthquake, it is clear that the danger is not over. MSF was at the scene quickly ready to treat and refer the wounded.

Part of the area we drive past every day on our way to work winds down a hill that has a view over the township on the other side. It looks like a hill of smashed concrete, everything has been completely obliterated. The original houses are barely discernible in the mess that is left. The dimensions of the destruction still catches my breath, even though I have driven past about 15 times now.

Bodies have all been removed from the streets. Unlike my predecessors here in Port au Prince, I have luckily not had to face the horror of seeing death. One day whilst stagnant in the car at a traffic light, we were right next to the crushed mess of a collapsed building in the midday sun. The stench was strong and I dont like to think about what it was I could smell. I am sure there are so many bodies just meters away from me at any time of the day. Out of sight, out of mind. Yet people are carrying on as normal.

My work in the pharmacy is a mess. We received so much stock to use so quickly that it is difficult to keep track of where it is going and how much we have left to use. I am in the process of putting systems in place at our hospital to help our other pharmacists who manage our big warehouse of stock. The bigger the scale of mission we are dealing with, the bigger the demands are on our pharmacy resources, and the scale of this mission in Haiti is huge. My previous mission was a small one, where a small number of expats worked hard to achieve things on a much smaller scale. Here we have so many expats living under one roof (currently almost 50). This means that what we are achieving is happening at a mind numbing pace, we are all working in a whirlwind of fervour. We all stumble up off our mattresses on the terrace roof of our building at around 6:30 am, and even now as I type this at 11pm there are still people working around me.

Achieving so much against the odds, seeing such direct benefits for the many many wounded people here and realising first hand MSF’s capabilities is a wonderful experience for me. Working on the edge of exhaustion everyday has a certain pleasure to it because what we are achieving feel so satisfying. I wouldn’t want to be anywhere else.

Isabelle Jeanson has returned to MSF’s office in Toronto, Canada. However, there is a long journey ahead as MSF’s work continues in Haiti, treating and rehabilitating our patients and project infrastructures. This blog will be continued by Marie-Michèle Houle (in french), a nurse from Montréal who has worked with MSF in Niger on infant malnutrition; and Louise Johnston (in english), an Australian emergency room nurse who has worked with MSF in Niger on a mass vaccination campaign against meningitis, and in the Democratic Republic of Congo establishing a pharmacy and supervising pediatric and surgical interventions in a hospital serving people displaced through ongoing conflict. Their first entries will be posted shortly!

Isabelle Jeanson est de retour au bureau de MSF Canada à Toronto. Toutefois, le parcours reste encore long pour les équipes de MSF présentes en Haïti qui continuent de fournir des traitements et des soins de rééducation aux patients et remettre en état les infrastructures médicales. Ayant travaillé dans un projet de malnutrition infantile au Niger, Marie-Michèle Houle, infirmière à Montréal, rédigera un blog en français, tandis que Louise Johnston en écrira un en anglais. Cette infirmière-urgentiste australienne a œuvré au Niger dans une campagne de vaccination de masse contre la méningite. Elle a aussi mis sur pied une pharmacie en République démocratique du Congo et supervisé les interventions pédiatriques et chirurgicales dans un hôpital traitant les personnes déplacées par le conflit constant. Leurs premiers articles seront prochainement en ligne!

Right after the earthquake, the first set of surgeries were done under a tree. Then there was a sort of hospital on the road, in front of the ruined Carrefour Hospital: blocked off to traffic , mattresses practically amid the garbage. A week before I arrived (meaning two weeks after the earthquake), the hospital was moved onto the grounds of a school.

On my arrival, activities were much more calm and controlled than I expected. Of course, also the injuries were fewer and generally less acute. Most patients arriving are for follow-up: redress a wound, recheck a fracture. A few are recent accidents and assaults. Some?for reasons I don?t totally understand?have had a three-week delay to seeking care, since the earthquake.

It is true that people have a lot of fear that a limb will be amputated. Maybe it?s justified: there are rumours that I can neither confirm or deny, that some groups who responded to the disaster were indeed to quick to sacrifice a limb. Our Haitian doctors have done some public education on the radio to explain the medical reasoning.

I have not seen any amputation done since I arrived this week. There are some terrible fractures, though. Many are comminuted (multiple fragments), many are open (go through skin). Healing will be long and difficult.

My role is actually not so different than the last time I was here, despite that we are doing orthopedics instead of obstetrics. Ensure the quality of care of each of the services: triage, dressings, casting. (The operating room is self-sufficient.) Also?to expand our services to include more physiotherapy and rehabilitation. This also will increase our capacity, possibly up to 40 more admitted patients.

This is indeed the next phase of care, and an important one. This is a city of hills, with poor roads full of potholes, puddles, and piles of garbage. Injured people need to regain as much function as possible, because in this setting, being disabled makes daily survival extremely challenging.

Pour la version française, cliquez ici.

It is three weeks after Haiti’s devastating earthquake and time for Isabelle Jeanson, MSF Operational Communications Support, to depart. Saddened to leave the many patients she has met, Isabelle is touched by the dignity and solidarity the Haitians have shown in the face of the disaster. She is, however, heartened to know that while her personal time in Haiti has come to an end, MSF’s medical teams work on to provide much needed healthcare.

I’ve been dreading this day because there is no easy way to say goodbye. I have developed so much affection and respect for Haitians, who carry such dignity in the face of this crippling adversity.

By this time next week I’ll be working in the comfort of my office, worrying about the people I met who made a particularly deep impression. Like my little Gabrielle, who is hanging in there for her life. Or lovely 19-year old Sinthia, who has a fever and is lying in our hospital bed with her wounded leg. She gave birth to her baby on January 4, but her little girl died a few days after the earthquake because, she tells me, they were cold sleeping in the street at night. I’ll be thinking about Ste-Amise and her four-month-old baby. She also waits in her hospital bed, her leg in a fixation apparatus, while her other four children live under a bed sheet in the street. I have the option of leaving Haiti, but the patients I met will wake up every morning confronting their grim reality.

Our teams are expanding our medical programs. We now have several sites in Port-au-Prince, Léogâne and Jacmel to provide not only surgical care for the wounded, but rehabilitation, skin grafting soon, therapeutic feeding for malnourished children, obstetrics, counseling and long-term care to hundreds of patients. Body wounds will heal over time, but the wounds in their heart will also need special care.

Many people tell me they don’t want to think about what happened, because they don’t want to relive the terror. I spoke to a patient today, Elizabeth, who was gravely wounded but also depressed. She was quiet and withdrawn and crying at times. The shock of her condition, of losing the few things she owned including her home, are too much for her to bear. What will be her future? Where will she live?

I resent the limitations of the support I can offer. Once the physical healing has started, people will need jobs and homes to live in security.

The assessment we did last week made us realize that there is hope for the people who have left Port-au-Prince. It was amazing to discover the solidarity in these smalls town. Free care is provided to the earthquake survivors, in both the Dominican Republic and in Haiti; doctors have offered to volunteer their services and town mayors organized buses to pick people up from Port-au-Prince to bring them back to their home towns.

In fact, the most beautiful thing I have observed in this disaster is the solidarity of the people. Haitians helping each other, risking their lives to pull friends and strangers from the rubble, sharing the bit of food they have, hosting dozens of homeless people in their homes in the rural areas and looking out for each other when they sleep at night in the streets of Port-au-Prince. There is also hope now in the form of dozens of organizations who want to help in whatever way they can. Town mayors have hired hundreds of people to sweep the debris in the streets, to bring back some order and cleanliness. And people are setting up small stands to sell foodstuffs in the homeless camps around the city. Life must go on.

My last wish is that long after the media have turned off their cameras, that we, the lucky ones, don’t forget about Elizabeth, Synthia, Ste-Amise and Gabrielle. Because they will continue to bear the brunt of this disaster. The only way I can accept to leave them behind is to know that at the very least our medical care will continue for as long as people will need it.

Au revoir Haïti

Click here for English version

Il y a trois semaines que le séisme a dévasté Haïti et il est temps pour Isabelle Jeanson, Conseillère en communication sur le terrain pour MSF, de partir. Triste de quitter tous les patients qu’elle a rencontrés, Isabelle est émue de voir la dignité et la solidarité dont les Haïtiens ont fait preuve face au désastre. Elle est cependant soulagée de savoir que même si sa mission en Haïti s’achève, les équipes médicales de MSF continuent à fournir les soins médicaux indispensables.

Je redoutais ce jour parce qu’il n’est jamais facile de dire au revoir. Une telle affection et un tel respect ont grandi en moi pour ces Haïtiens qui font montre de tant de dignité face à cette adversité paralysante.

Dans une semaine exactement, c’est dans le confort de mon bureau que je songerai avec inquiétude aux personnes que j’ai rencontrées ici et qui m’ont profondément marquée. Je penserai à ma petite Gabrielle qui se bat pour survivre. Mes pensées iront aussi à la ravissante Synthia qui, du haut de ses 19 ans, est couchée sur un lit d’hôpital, une blessure à la jambe et lutte contre la fièvre. Elle a donné naissance à un bébé le 4 janvier. Sa petite fille est morte quelques jours après le séisme parce que, comme elle le raconte, il faisait trop froid dans la rue pour dormir. Je n’oublierai pas non plus Ste-Amise et son bébé de quatre mois. Elle aussi attend sur son lit d’hôpital, la jambe immobilisée dans un appareil de contention, alors que ses quatre autres enfants dorment juste sous un drap, dans la rue. Moi, j’ai la possibilité de quitter Haïti, mais les patients que j’ai rencontrés continueront de se réveiller tous les matins à la vue d’une réalité sinistre.

Nos équipes étendent les programmes médicaux. Nous avons désormais plusieurs sites à Port-au-Prince, Léogâne et Jacmel où nous offrons non seulement des soins chirurgicaux pour les blessés mais également de la rééducation, bientôt des greffes de peau, de l’alimentation thérapeutique pour les enfants malnutris, des soins obstétriques, du counselling et des soins à long terme à des centaines de patients. Les blessures physiques finiront par guérir, mais celles de l’âme nécessiteront aussi des soins spéciaux.

Beaucoup me disent qu’ils ne veulent pas penser à ce qu’il s’est passé, de peur de revivre la terreur. J’ai parlé à Élizabeth aujourd’hui, une patiente qui a été très gravement blessée mais qui fait aussi une dépression. Elle était silencieuse et renfermée et se mettait parfois à pleurer. Le poids de sa situation, la perte des quelques biens qu’elle possédait, y compris sa maison, est plus qu’elle ne peut supporter. Qu’est-ce qui l’attend? Où vivra-t-elle?

Je ne ressens que trop les limites de l’aide que je peux apporter. Une fois que la guérison physique s’amorcera, les gens auront besoin de travail et de logement pour vivre en sécurité.

L’évaluation que nous avons conduite la semaine dernière nous a permis de conclure qu’il y avait de l’espoir pour ceux qui avaient quitté Port-au-Prince. La solidarité dans les petites villes nous a impressionnés. Des soins gratuits sont offerts aux survivants du séisme en République dominicaine et en Haïti. Des médecins se portent volontaires et les maires des villes ont mis en place un service de bus pour venir chercher les personnes à Port-au-Prince et les ramener dans leur ville d’origine.

En fait, la plus belle chose que j’ai pu observer lors de ce désastre est la solidarité entre les gens. Les Haïtiens s’offraient une aide mutuelle, risquaient leur vie pour sortir des décombres des amis et même des inconnus, partageaient leur peu de nourriture. Ils offraient le gîte à des dizaines de sans-abri dans leur maison en zone rurale et se surveillaient les uns les autres lorsqu’ils dormaient dehors dans les rues de Port-au-Prince. L’espoir naît aussi de la présence de dizaines d’organisations qui veulent les aider le plus possible. Les maires des villes ont engagé des centaines de personnes pour balayer les débris dans les rues et ramener ainsi un semblant d’ordre et de propreté. Certaines personnes installent de petits stands pour vendre des denrées alimentaires dans les camps de sans-abri tout autour de la ville. La vie doit continuer.

Mon dernier souhait serait que, lorsque les médias auront posé leurs caméras, nous, les chanceux, continuions à penser à Élizabeth, Synthia, Ste-Amise et Gabrielle. Parce qu’elles n’auront d’autres choix que de continuer à porter le poids du désastre. La seule chose qui rend mon départ moins pénible est de savoir qu’au moins, nos équipes continueront de fournir des soins médicaux aussi longtemps que les gens en auront besoin.