Monday, February 15, 2010

Refugee Camp in Port-au-Prince

(Photo by John Carroll)

From The New England Journal of Medicine

Published at
February 12, 2010

(GHESKIO is the acronym of a medical center in Port-au-Prince that has treated AIDS and tuberculosis patients for many years. Many scientific papers have been written from GHESKIO. jc)

The GHESKIO Refugee Camp after the Earthquake in Haiti — Dispatch 2 from Port-au-Prince

The first phase of the disaster in Haiti is now ending, with hundreds of thousands of people having died from trauma. But the second phase promises to be as cruel as the first, with deaths due to exposure, starvation, and infectious diseases. Millions of Haitians are homeless and have no food, clean water, sanitation, or primary health care. And the rainy season is coming.

The Port-au-Prince clinic of the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) has become a refugee camp and an emergency field hospital, even as we continue to run our clinic for thousands of patients with AIDS or tuberculosis. Despite our own losses (4 GHESKIO staff members died, 4 were critically injured, 28 lost an immediate family member, and 90 are homeless), we continue to provide medical care around the clock, working with international partners.

The number of people living in the GHESKIO refugee camp has swelled, and members of our community advisory board and faculty members from neighboring Quisqueya University have organized the camp into 38 "quartiers." A census counted 6109 people, including 1046 children under 5 years of age, crowded into 1162 makeshift shelters. The Danish Red Cross visited our camp and noted that it was the most densely populated one they had seen in Port-au-Prince. Most of the refugees come from two large nearby slums. Family leaders were identified and given an identification card.

Refugees receive water from a GHESKIO well and from water-delivery trucks. We have not yet received United Nations (UN) food tickets to provide refugees access to food at the city's 16 distribution sites. Sanitation improved recently, when we received 12 portable toilets from Oxfam, but we need more. We have distributed UN sanitation kits with commode buckets and toilet paper and have hired refugees to pick up garbage and a large truck to haul it away. We also hired people from the camp to dig trenches to drain standing water and reduce mosquito reservoirs.

We are providing primary health care and conducting disease surveillance in the camp. Every day, a team visits each camp resident and asks about fever, diarrhea, cough, and rash; those with symptoms are seen by a physician. We have launched a vaccination campaign to protect the refugees from diphtheria, measles, mumps, pertussis, rubella, and tetanus. All children and pregnant women and more than 2000 other adults have been vaccinated. We have established primary care clinics, which also receive people from the surrounding slums. To date, there have been two deaths in the camp: a homicide and a suicide.

Security remains problematic. There are several armed criminals in our camp. We have finally received barbed wire to secure the camp's perimeter; we have 10 solar-powered street lights, but we need more.

Obtaining essential supplies has been difficult — the bureaucracy is overwhelming. The UN has 14 "clusters" that we must contact to receive supplies. Each cluster (e.g., for shelter, water, food, sanitation, and so forth) has its own daily meetings at the UN base — an hour's drive away. Some clusters now have subclusters with meetings. We have been referred to centralized Web sites where we can order emergency supplies. One of these sites required a 2-hour online training session. Being forced to choose between attending meetings or navigating Web sites and providing care, we are providing care. The supply chain needs to be more accessible for care providers. We have purchased some supplies and received some from partner organizations, and former President Bill Clinton personally delivered supplies to our clinic last week.

The rainy season arrives next month. Port-au-Prince is a basin surrounded by deforested mountains; our clinic and many of the city's poorest neighborhoods are at the bottom of the basin, below sea level, and routinely flood. The established canals and drainage system are now disrupted or blocked by the earthquake's debris. Heavy rain cascading down the bare mountains will hit the lower city like a tidal wave and flood many refugee camps, including ours. The city's drainage system urgently needs repairs, and refugees must be moved to higher ground and provided shelter before the rains come.

Jean William Pape, M.D.
Port-au-Prince, Haiti
Center for Global Health, Weill Cornell Medical College
New York, NY

Marie Marcelle Deschamps, M.D.
Port-au-Prince, Haiti

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