Thursday, February 18, 2010

Reflections on Haiti...a Must Read

My friend David Volk sent me this e mail written by Rob Chamberlin.

From: Rob Chamberlin
Sent: Sat, Feb 13, 2010 8:38 am
Subject: Reflections on Haiti

Hi Friends and Family,

I hope that this email finds you all well, and that you all had a good week.

I've returned from my trip to Haiti, and thought I'd share some of my thoughts. Overall, I'm so grateful that I got down to Haiti, but it was hard to see and, as much as I try to fight against being overwhelmed, it was at times overwhelming.

This email is rather long, so I'll put in little section heads so you can just read the parts that may be of interest to you.

Briefly about what I was doing - I was sent down to mainly support another Brigham resident who is working with Partners in Health, Natasha Archer. Natasha's role has been to be the PIH representative at the University Hospital (general hospital) in Port-au-Prince. The hospital is the city's biggest hospital, and is right in the center of town where there was so much damage. PIH was called in to support the hospital administration, and help be a liason between all the other medical NGO's working at the hospital and the hospital administration. We are also supplying volunteer physicians to the hospital. One of my projects was working with a hospital administrator to develop a system to track all the foreign volunteers working at the hospital. Another project was to help the hospital statistician develop a system for recording epidemiological information about patients. They already have such a system in place, but they just needed to adjust it to the new situation of staffing/physical structure. I also helped schedule and manage our volunteers. The PIH team stayed in tents in the courtyard of a school about 30 minutes away. We had medical and nursing teams from Philadelphia, Boston, NYC, and Miami, for a total of about 25 medical volunteers. And finally I did clinical work on a couple of nights. It was quite a challenge to try to make clinical decisions with limited tests (only a cbc is available at night, and no imaging) and limited medications. The patients themselves were amazingly grateful and tolerant.

Current hospital set-up
Only 1 hospital building, of about 10, is stable enough for patients. So most of the patients are being cared for in about 20 tents set up on the hospital grounds. There are medical teams there from Norway, Switzerland, Denmark, Canada, Spain, Peru, the US, Israel, and Belgium. People are divided up among functions - the Swiss managed pediatrics, the Norwegians were doing surgery, the Belgiums ran the dialysis unit (very important as crush injuries can lead to kidney failure), the Americans did ED/surgery/medical care, the Israelis did surgery, etc. There was also a strong US military presence at the hospital, which provided good security but often with unnecessary verbal aggression.

The physical damage from the earthquake
The University Hospital is right downtown, where there is a lot of destruction. Not to dramatize things, but just to give a sense of the damage I'll share a few stories. Driving into the hospital, I would say that 30% of houses/buildings had crumbled flat, and another 50% were damaged enough to be uninhabitable. I reflected one morning that, as long as you had survived the earthquake, it would be better for your house to have crumbled flat than to be cracked and too unstable to inhabit. Even before rebuilding their homes, I wonder how these people will find the money/equipment to even tear down their homes.
Some streets had almost no one on them as the whole street was full of destroyed houses. Some roads had rubble fallen into them so much that the street became a 1-lane road. One of the hardest parts of working at the University Hospital was that the nursing school was destroyed with over 100 nursing students killed under the rubble. In the heat of the day, the stench from the nursing school was horrible. In a country so in need of medical care, it was a wrenching reminder of the long-term devastating effects of the earthquake. Outside of another building I saw 2 partially decayed dead bodies recently uncovered from the rubble. It was just so sad.

Jimmy's experience of the earthquake
Jimmy (Bos's son, with whom I lived when I was a Peace Corps volunteer) told me about his experience of the earthquake. He was outside the hospital because he was accompanying his friend and his friend's pregnant wife who was going to get a c-section. His friend's wife went in to the OR, and Jimmy went out to buy medicines for them. Then the earthquake hit. Jimmy saw the building across from the hospital crumble. He saw cars and trucks that couldn't stear getting tossed left and right, hitting pedestrians. He saw people fall to the ground. After the 30-seconds of quake, Jimmy ran to find his friend. His wife had luckily not had her c-section, although another woman was in the middle of her c-section and died during the earthquake. They then walked for hours, looking for family and friends, as there was no cell phone service. He assumed his 2 younger brothers were dead, as well as his step-mother and others back in his hometown of Vialet. There were frequent after shocks, causing continued destruction and loosening of unstable cement blocks. Jimmy saw one man get killed when an aftershock caused a cinder block to fall 2 stories and hit the man. They walked down the center of the street as best as they could, as to avoid further tumbling of debris from buildings. Eventually, he and his siblings all found each other, and by some miracle all were alive and well. However, friends of theirs who went to their apartment house presumed that they were dead because the house was ruined. Jimmy's youngest brother ran down the stairs of their apartment during the earthquake, with the stairs literally crumbling behind him. The next day there were thousands of people who had all slept in the public plaza. Yet everyone was terrified all night because they heard that the earthquake had caused the earth to split and create caverns in some places. So, they couldn't go into building because they might fall, and they didn't want to stay on the ground out of fear it would open up beneath them. The next day, waves of rumors would spread through this crowd that a tsunami was coming, so there would be a stampede up to higher ground, with badly injured people left behind. After a second night of sleeping outside, Jimmy and his siblings gathered up their remaining money to buy a bus ticket back to their hometown of Vialet.

General reflections
nothing too profound, just some thoughts that I had while down there

Good intentions - It's such a tough thing, sometimes, figuring out how best to serve. Every foreigner I saw at the University Hospital had good intentions for being there. Sometimes it seems evident to me that someone's attitude about helping is not necessarily based in principles of respect and solidarity - such as the soldier who was explaining to another how you have to aim above someone's head when you are shooting into a car because the bullet will get deflected down by the windshield, but you have to aim low when you shoot from a car because the bullet will get deflected up. Or the guy American doctor doing medical care at the hospital, who explained to me that we can't provide too good of care while we were there because then the Haitians would get too "used to" good care. Or the guy from Boston who wants to be helpful so he works with a statistician on a project that perhaps the statistician knows how to do already, or perhaps take him away from something that is more important. And yes, the army guy is providing security, which really is needed. And the NGO guy is helping to provide medical care to the sick. And the Boston guy (that's me), well he's a lost cause. Yet, while good intentions are important, they aren't enough. I think we do have to be critical of 'hero's', and we do have to take a stand that certain approaches to helping are harmful. And it seems that certain principles should guide our efforts of service, so that we don't live out that saying of roads paved with good intentions.

Hard working Haitians - I was amazed at how hard some of the Haitians were working, in the face of such a catastrophe. Someone made the comparison that this was the equivalent in life-lost to about one hundred 9/11's. In the face of that, it's sometimes impressive that anyone can come into work at all. The overall director of the hospital and the administrative director both slept at the hospital, and would often wake up at 2am to continue doing work. The statistician slept in his car, awakened every morning around 4am by relentless mosquito bites. I'm sure that every Haitian working at that hospital had some family member or friend who died, yet they were still coming in to work. And not to glorify the Haitians, because there were still some struggles - getting nurses to record medications that were given, beaurocracy that sometimes delayed access to needed equipment, etc. But, in the face of such tragedy, I was impressed.

PIH - It was a real privilege to work with Partners in Health. I got to spend time with a number of PIH folks - some Brigham residents who work with PIH, a young guy doing logistics for PIH, Joia Mukherjee, the medical director for PIH, Paul Farmer, one of the founders of PIH. I just found myself inspired and challenged by these people. Joia has an amazing fire and passion for living out one of PIH's moto's - "Providing a preferential option for the poor in healthcare". In conversations I often found myself saying "yah, that's right", and getting fired up about inequalities, or beliefs, or approaches to addressing issues of poverty. And there was a combination of respect for Haitians, a belief that things (not just related to the earthquake, but related to inequalities in the world) can get a better, and a commitment to forever working on this, that just felt right.

Trying not to be overwhelmed - In the face of all of this destruction, I found myself often feeling totally overwhelmed. However, while I do not know how Haiti will recover from this, I think that despair is a luxury that Haitians can't afford, and neither can we. Because despair and being overwhelmed can just lead to paralysis and inaction. I had a moment of clarity around this one night when I went to the hospital and got a sign-out for patients in one of the tents. A sign-out is the brief patient notes that one doctor leaves for a next doctor who coming in for the next shift. I looked at the sign-out: 54 year old man with pneumonia; 36 year old woman who had a lower leg amputation; 23 year old woman with extremely elevated blood sugar levels; 66 year old man with high blood pressure, right lower arm amputation and infected wound; 65 year old woman with altered mental status and a tender abdomen. Somehow, reading this sign-out reduced these problems to things we know how to take care of. We know how to treat pneumonia, we know how to treat wound infections, we know how to treat high blood sugars. The context may seem overwhelming, the logistics daunting, the scope immense, but we know what to do. It was a moment of hope, in a sense. These are not unsolveable problems. It takes resources, time, investment, and knowledge, but there are solutions.

Those are some of my thoughts. I hope you are all well.


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