The 9 days I spent in Haiti working at the State University Hospital (HUEH) were the most powerful experience I've had in over 20 years. Landing in Port au Prince, the first thing I noticed was that the terminal was severely damaged, and that no effort had been made to repair it. A bus took us to passport control: it was like the Egyptian border checkpoint at Taba, but with less hassle. The baggage terminal was an open room (a warehouse) with bags strewn everywhere. Once outside, the chaos began. Port au Prince looks like Gaza after an air raid, but worse. The streets teeming, rubble and shattered homes everywhere, the acrid stench of burning garbage, packed mopeds and cars and buses all painted in gaudy bright colors. Tent cities made of tarps and plastic bags tightly packed. The only differences I could see were the signs in Creole and not Arabic, no minarets, no sheep or donkeys. The roads and quality of driving are worse than Gaza.
The hospital looks like a dilapidated Israeli army base originally built by the British. We were housed in the former ICU building which was clean. We ate in a tent left by the first Israeli team (I learned this on my second day here after feeling this really odd déjà vu every time I went in). There were dozens of groups working there, not always in coordination with each other.
Electricity and running water were intermittent. We bathed with buckets (though a few days we had tropical downpours and one of the other docs and I showered under the run off from a roof, which was great). The food was really good (I'd never had Haitian food before, and it's very tasty), we had lots of bottled water, and it was VERY hot. I was probably drinking 2 L/hour.
At the hospital we were doing all sorts of things, from helping evaluate and care for kids in the ED (including trivial things such as removing a pebble lodged deep inside some kid's nose), in the pediatric intensive care tent, helping with transports, etc. One evening I had to evacuate a kid with a head injury to another hospital (run by MSF Spain) after the house he was in and two others collapsed after the heavy rain and trapped 12 people inside. He and his father were the only ones pulled out of the rubble. The drive was an experience unto itself: no streetlights, no traffic lights, bricks and rubble and potholes everywhere, feral dogs, prostitutes, other crazy drivers...
The Haitians are a very nice, quiet, friendly people. The patients and their families did not complain, did not shout, did not insist, did not demand, and were grateful for whatever we were able to provide, even though the outcomes were often not good. I have never seen this degree of submission and acceptance in Israel or the US.
The other docs, nurses and admin people I met were a really cool bunch. Lots of them are people who seem to have signed on for the adventure. Our group was comprised of 18 people from Children's Hospital Boston, and included physicians, nurses, respiratory, occupational and physical therapists, a biomedical engineer, a pharmacist and a translator. I had not worked with any of them before, though I could not have chosen better team mates had I tried. My colleagues were incredibly dedicated, supportive, compassionate and kind people. Likewise, the staff of Partners in Health, who coordinated our stay, was a fantastic group of people, real life superheroes.
The hospital has 4 pediatric tents. The pediatric intensive care tent is probably 30 feet by 10 and had at one point 28 infants and children and between 1-3 family members for EACH CHILD (except for one who was abandoned) who slept in chairs/under the rusty cribs on pieces of cardboard. The heat inside is unbearable, the smell overpowering, and the flaps kept down to keep mosquitoes out. When there was electricity, there were fans which worked, though it remained very hot; when not it was hard to be inside without becoming drenched after 3 minutes. When it rained, there was a 3 foot river flowing through the middle of the tent. Many of the kids were malnourished in a way I'd only read about. Supplies were erratic and hard to find. One evening the ICU ran out of oxygen and a tank had to be found emergently at another hospital and brought over: if not for that, the ICU staff would have had to decide who would live and who would die. On another evening, a 30 week baby weighing 2 pounds three ounces was born in the ED. We had no incubator, and no other facility could take the baby, so we built one out of a cardboard box, blankets, and a desk lamp.
The Haitian medical staff is dedicated beyond belief, and maintains high professional standards of care despite the awful physical conditions. Even thought they had not been paid in over 9 months, and had sustained great personal losses of friends and family killed in the earthquake (not to mention their own living quarters), they continued to come to work day after day, and cared for the sick with a passion that inspired awe.
The tragedies kept on coming, even during the last hour we were there. About 40 minutes before we left for the airport to come back home, another physician and I were approached by a man with a 5 hour old newborn who was pulseless, cold, and dying. We worked on her for over 20 minutes, and were able to get her perfused and her heart beat back, but not to breathe on her own, and had to stop. It was such a stupid, pointless death: the father had apparently taken the baby to another clinic where he was told they could not help him because there were no pediatricians available. By the time he hitched a ride on a motorcycle and got to HUEH it was too late to save her.
The posting above is the author's own and does not necessarily represent the positions or opinions of Partners in Health. Please consider donating to Partners in Health www.pih.org
Dennis Rosen, M.D.
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