Haiti

When Stanford Hospital staff members volunteered to participate in a relief mission to post-earthquake Haiti last year, they were stunned over the number of deaths that could have been prevented had emergency medical services been available just a few days sooner. As highlighted in the video above, their initial shock led to the creation of the Stanford Emergency Medicine Program for Emergency Response, a team that will be able to mobilize immediately in response to a global disaster.

Previously: Treating the injured amid the apocalypse of Haiti, Reports from Stanford medical team in Haiti and Stanford sends medical team to Haiti

At Hospital Albert Schweitzer (where I traveled last February to write about the hospital’s struggle to care for the wounded in the quake’s aftermath), the staff paused today to “honor what Haitians have lost,” according to Ian Rawson, managing director of the hospital in Deschapelles.

In the past year, the hospital has treated thousands struck by the cholera epidemic, and served tens of thousands of displaced persons in addition to their daily work of caring for some of the poorest patients in the Western Hemisphere. Rawson writes on the hospital blog:

Despite all this, the Haitians never give up. Therefore never can we. We draw strength from their forbearance and resilience. Everyday we learn again about the reservoirs of strength which come from hope.

The hospital has planned a prayer of remembrance, followed by presentations from caregivers who were on the front lines treating the victims of the quake. The hospital will also pause to celebrate Hanger Klinik, the clinic built virtually over night and where new limbs for more than 800 earthquake victims have been built and fitted.

Photos will be posted on Flickr throughout the day.

Previously: Haiti day 4: Life after the quake, Haiti: In pictures, Haiti day 3: Amputees, Haiti day 2: At the hospital, and Haiti day 1: Arrival
More entries can also be found in the Haiti category.

From plug-and-play hospital tents to the water-disinfecting SteriPEN, physicians and aid workers have used a number of simple yet innovative technologies in treating earthquake survivors in Haiti.

Another such interesting tool, which I learned about today, is a $3 wound-therapy device designed to speed up the healing process.

The device was designed by MIT mechanical engineering students and originally scheduled to be field tested in Rwanda. But Partners in Health requested prototypes of the tool be brought to Haiti, according to a release.

MIT doctoral student Danielle Zurovcik demonstrates how the device is applied to wounds in the above video.

Lukas Biewald discusses the crowdsourced relief efforts in Haiti:

The advantages of a flexible crowdsourcing workflow to managing disaster relief are huge. Businesses like crowdsourced work because they don’t have to plan unknown work capacity in advance, and managing a crisis is an extreme version of this problem. There would be no practical way to have thousands of trained Kreyol speakers ready to handle emergency text messages, but through viral channels and a microtask framework it was possible to have thousands of people around the world doing mission-critical work within days.

Of note, FrontlineSMS: Medic is mentioned in the piece, which was co-founded by Stanford medical student Nadim Mahmud.

Previously: Using cell phones to save lives

On a workbench in the backroom at the new rehabilitation facility is a brown plastic foot, about a woman’s size 6, with a carefully carved notch between the big toe and its neighbor.

It’s about 7 p.m. on March 1. Ania Antoine, a pretty 15-year-old in a short denim skirt, who is waiting for her turn with the physical therapist, likes to wear flip-flops. Right now, she’s only wearing one.

She smiles when she hears the new foot will fit nicely into a flip-flop. And has toenails to paint as well.

Ania (pictured above) lost her right leg - and most of her family - in the Jan. 12 earthquake that nearly leveled the capital city of Port-au-Prince and killed more than 200,000 people. She and her father alone survived.

Sitting along the walls of the rehab room in white plastic chairs are five young adult amputees, all healthy enough to leave the hospital but housed near the Hospital Albert Schweitzer at L’Escale, a former tuberculosis village, a short walk from the rehab facility. They are among the first of Haiti’s estimated 4,000 amputees to get prosthetic legs and begin the difficult process of learning to walk all over again.

They need a week or two of practice before they go off on their own, navigating the difficult Haitian terrain. Most are from Port-au-Prince and have lost their homes or schools and don’t know where they’ll go from here.

“Two people were dead next to me in the rubble,” Ania (shown again, right) explained earlier in the afternoon, speaking through a Creole interpreter. She was walking around on crutches in L’Escale, a desolate place of scattered cinderblock homes housing about eight amputees. The grounds are dirt, the residents wash laundry in a pump at the center of the village. The smell of burning piles of garbage drift through the air. A Haitian community group, led by Luquece Belizire along with the help of the hospital, provides bottled water, and members come by to cook meals at an outdoor barbecue. Belizire’s mother and sister often cook the meals. Belizire drives the amputees back and forth to the hospital for rehab where the physical therapists work long days that continue late into the night.

Despite the desolate surroundings, the young people find comfort with each other. They flirt and answer cell phones and laugh and joke.

Denise Jacques, 16, said it’s not very difficult learning to walk on the new leg. She described the horrible pain of suffering with a crushed leg for four days before a team of foreign doctors set up a tent at a nearby town where she finally had it amputated. She lives in one of the cinderblock homes with her brother. Jean McKinley, 19, lost his leg and four fingers in the earthquake. He also lost his school where he was learning to be a mechanic.

“He’s really good,” said Cynthia Racine, MD, a Haitian-born physiatrist from the United States who came to Hospital Albert Schweitzer to volunteer after the earthquake. She points out that McKinley can’t use one of his hands because of the amputated fingers where skin grafts are healing. “He’s trained as a mechanic and understands when we talk about center of gravity and vectors.”

At the end of the day about 10 p.m., the young amputees finish their 40-minute rehab by kicking a soccer ball with their new legs, and even attempt to dance with each other.

It’s just one small room in one small town way out in the Haitian countryside, but it’s an amazing sight and a sign of hope for the future of Haiti.

On March 2, I headed back to the airport in Port-au-Prince from the hospital in Deschapelles, driving 80 miles through some of the poorest communities in the Western Hemisphere. Trucks overloaded with Haitian passengers and piled high with mattresses rumble past, heading away from the tent cities and destruction of the capital, looking for new homes in the country.

My traveling companion, an American hydrologist who has worked and lived at the hospital for more than a decade, describes how the Haitian people have organized themselves to survive this earthquake. In the tent cities they provide community patrols to keep the women safe. They share whatever food they can find.

She says there are rumblings among the Haitians about how the much-stronger 8.0 earthquake in Chile on Feb. 27 caused fewer deaths and less destruction than the 7.0 earthquake here. And she talks about a fierce determination to rebuild the country better than before.

“It’s not, ‘We have to rebuild Haiti,’” said Ian Rawson, the heart and soul behind this hospital, whose mother and stepfather, Larimer and Gwen Mellon of Pittsburgh, founded it more than 50 years ago. “We have to build Haiti. Together, with the Haitian people.”

Tracie White is a Scope contributor and writer in the medical school’s communication office. She just returned from Haiti, where she wrote about the situation there. You can see all of her updates in our Global Health category. More details on Stanford’s Haiti relief effort are available here.

This is David Charles, one of just a dozen Haitian physical therapists in the entire country. David works at Hospital Albert Schweitzer. He trained in the Dominican Republic.

This child is one of 132 people staying at a refugee center near the hospital. The center is a half-built hotel.

This is Ania Antoine, age 15, an amputee who was one of the first refugees to get a new leg.

These are Deschapelles schoolgirls walking past the hospital.

This is a girl collecting water from a stream that runs between the hospital and L’Escale, a former tuberculosis village.

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Global Health category. More details on Stanford’s Haiti relief effort are available here.

This new video from Lucile Packard Children’s Hospital shows footage shot by a team of doctors and nurses who went to Haiti Feb. 2 - 16 as part of the earthquake relief efforts. The caregivers traveled by boat to a remote village where most people had never been seen by a Western physician. They established a clinic now being run by other volunteers in the international relief effort.

The team, led by pediatric hospitalist physician Daniel Imler, MD, also included pediatric hospitalist Joseph Kim, MD, and nurses Rich Ramos, RN; Katie Purdy, RN; and Elena Hopkins, RN.

More coverage of the team’s trip to Haiti is available here.

Bel Jean still hopes to be a priest. But there is a problem. “You need two arms to elevate the mass,” explains the 29-year-old, raising his stump in the air.

The young man (pictured above, left) was in Port-au-Prince studying for the priesthood when the earthquake struck on Jan. 12. During the night that he spent trapped beneath the roof of his school, he mostly cried. Then he prayed. The loss of his arm has him devastated. What he wants, though, is to replace his missing right arm with a new one so that he can hold high the sacrament during Sunday mass.

I’m in a ward at Paul Farmer’s hospital in Cange, a 2.5-hour bumpy car ride further north deep into the island nation from Hospital Albert Schweitzer in Deschapelles, where I have been staying the past few days. I’m traveling with members of the newly-formed rehabilitation team from HAS, to fit prosthetics for four of five of the amputees at Farmer’s hospital, which is similar in size and mission to HAS.

In a mad dash to begin to meet the overwhelming demand for artificial limbs in this country, where amputations have become the defining injury of the quake, HAS has quickly built a prosthetics lab, working with the Bethesda, Md.,-based Hanger Orthopedic Group Inc., a provider of prosthetic and orthotic products and services. The effort began 10 days ago. Within five days they had made 10 prosthetic limbs, and had five amputee patients up and walking.

Ian Rawson, who runs HAS, describes the situation during the earthquake on his blog:

Patients who arrived at HAS with crushing injuries to the extremities were managed by a specialized nursing wound care team, and the surgeons were very conservative in their management of these cases, exercising limb salvage strategies to the greatest extent possible. Only 15 long-bone amputations were required for the patients at HAS, but soon after the earthquake, we began to receive referrals from other hospitals for patients who required revisions of their original amputations.

HAS is an 80-bed hospital with an all-Haitian staff of 16 doctors and about 50 nurses. Today’s patient count hovers around 120 patients. Most of the amputees at the hospital are newly homeless. They’ll need to stay at least a week for fitting of prosthetics and then rehabilitation therapy to teach them to walk or to use their new prosthetic arms. Since most have no home to return to, the hospital is housing them at a place called L’Escale, a former tuberculosis village, a short walk past a village market from the hospital. Where they’ll go from there, no one really knows, but at least they’ll be able to walk away when they leave. Most will try to return to jobs in the fields or as laborers.

Estimates of crushing injuries that resulted in the emergency removal of limbs within the week after the quake range from 2,000 to 4,000. Eleven patients at the hospital are at some step of the limb making process right now. Today, the HAS rehabilitation team will add four more from Farmer’s hospital.

As the news gets out that HAS has perhaps the only functional prosthetics laboratory in the country - two were destroyed in Port-au-Prince during the earthquake - the demand is likely to spiral out of control. “Soon we’ll start to get people showing up at the hospital doors,” said Shaun Cleaver, one of two foreign-trained physical therapists in the entire country. He works at HAS. “It could get a little crazy.”
The rehabilitation team, including Cleaver and John “Jay” Tu, a prosthetist with the Hanger company, measure Bel Jean’s stump, then examine how well the stump has healed to determine if he’s ready for the casting process. That’s the first step. The cast will be taken back to the lab to create a mold that can be used to design a limb to fit the patient. Often the stumps of the earthquake victims have to be repaired surgically before being fitted because the initial operation was done under emergency situations in tents in the first few days after the quake.

“It was my last year in college to be a priest,” Bel Jean says. He shrugs. Now he doesn’t know what his future will hold. “You have to able to write if you’re a priest in Haiti, to run schools,” he explains. He lost the hand he writes with. His amputation is described as “above elbow.” The girl beside him is a double amputee, both “BK,” or below knee. The girl in the bed next to her is a single amputee, below knee. The plan is to transfer all three to HAS after their new limbs have been fabricated. They’ll stay there for the weeklong rehab process. After that, no one’s sure.

“I’m Roman Catholic,” Bel Jean says. “I used to love to see the Priest celebrate the mass when I was a child. I had one year left of school to become a priest.” He shrugs again and smiles. “Now, I don’t know.”

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Haiti category. More details on Stanford’s Haiti relief effort are available here.

I can bear the adult patients with amputated limbs, red and raw stumps oozing, waiting stoically on cots spilling out into the hallways. The toes missing from diabetes. The necks broken in motorbike accidents. But as the afternoon ticks by, the ages of the suffering in the Hospital Albert Schweitzer seem to get progressively younger, and the air grows increasingly heavy with heat and humidity and mosquitoes and despair. And my knees grow weaker.

It’s been a month and a half since the Jan. 12 earthquake killed 200,000 in Haiti and the initial trauma has passed, allowing the hospital staff to catch their breath as the thousands of refugees who rushed here from Port-au-Prince begin to disperse. The number of patients has dwindled from the peak of 800 down to 160, which is still twice the hospital’s normal capacity.

The families of the patients fill all the empty spaces of the hospital. They sleep on pads beneath the hospital beds. They wait in rows on hallway benches. In the courtyard outside the patient’s windows you can see them washing laundry and hanging it to dry on bushes and over railings. In the corridors, the smell of bouillon and Haitian stews further thicken the air. Mothers and grandmothers prepare lunch for their damaged children and their husbands and sisters and brothers.

It’s the questions of what to do with the amputees, and the paralyzed, and the homeless, that now hang heaviest in the air.

I’d been told repeatedly the Haitians are a resilient people. They’ve survivors. Some refused pain relievers in the operating tents in Port-au-Prince in the days following the earthquake. They don’t complain. “They’ve had so much thrown at them, they just get up and go,” explains one of the hospital doctors.

On my afternoon tour of the hospital on Friday, from the post-op ward to the pre-op ward to pediatrics, as the tragedies multiply, it’s this strength of the Haitian people that weakens me most.

The smile of the horribly burned teenage girl who we repeatedly pass in the hallway. The patient eyes of the young man holding the stump of his right leg in the air for the doctor to examine. The single mother of the young woman lying paralyzed in a hospital bed, holding her fifth child, a baby boy, in her lap and singing soft lullabies. And I can’t catch my breath.

The little girl with the orange ribbon in her hair that matches her orange socks. The teenage boy turning his back in a hospital corner to apply deodorant. Injured mothers nursing babies. A 5-year-old boy helping his horribly burned 2-year-old sister do her physical therapy.

The heat becomes nearly unbearable.

Finally at the end of the hallway, an adolescent boy, near my son’s age, allows the therapist to move his burned arm up and down, up and down, while smiling bravely to hide the guttural moans of pain that fill the room. And I turn away to hide my tears.

The patient above lost his leg and four fingers in the earthquake - he was studying at a professional school that collapsed and was one of the few survivors. His photo is published with his permission.

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Haiti category. More details on Stanford’s Haiti relief effort are available here.

I took American Airlines flight #18 from JFK airport to Port-au-Prince on Feb. 24, only the second such commercial flight to land in post-earthquake Haiti since the Jan. 12 “Tremblement” that killed more than 200,000 Haitians.

My destination was Albert Schweitzer Hospital in Deschapelles, undamaged by the quake. It was overrun with refugees fleeing the 80 miles from the city of Port-au-Prince seeking medical help. They came by the hundreds, carrying their injured loved ones on the front doors from their fallen homes into the backs of pickup trucks to make the three-hour journey north into the mountains.

At its most crowded, the 80-bed hospital swelled to 800 patients - two days post-earthquake.

The passengers on the flight were, by far, of Haitian origin, with a few rescue workers dotting the aisles. Many were flying to Haiti for funerals. My seatmate’s brother-in-law was killed in Port-au-Prince. The man waiting in front of me to enter the plane was going to the funeral of a relative’s sister and her children. As we taxied out, a soft snow began to fall from the storm hitting the East Coast.

It was a quiet, somber crowd.

“It’s horrible, just gray,” said the Haitian flight attendant Monique, describing the view of Port-au-Prince from the air. She worked on the first New York to Haiti flight on American Airlines into the city. The airport had been closed to commercial air traffic for about a month after the earthquake left cracks in the walls of the main terminal building and toppled the control tower. It reopened after the U.S. military had taken over and repairs could be made.

Into the fourth hour of the flight, the mountains beyond mountains began to appear out the window - wave after wave of them, looking like the namesake of Tracy Kidder’s book Mountains Beyond Mountains, the biography of Paul Farmer. Then the city of 3 million, stretching from the harbors, covered the mountainsides. The damaged national cathedral and national palace jutted out from what must have been miles of brown and gray rubble. The USS Comfort, a massive ship where many earthquake victims were taken for surgery, stuck out like a white flag in the harbor.

My traveling companion, LeGrand Mellon, a 73-year-old New Yorker and sister-in-law of the hospital administrator at Albert Schweitzer Hospital, had traveled to Haiti on and off for years and was anxious to arrive, hoping to see Jackson, the armless porter who always carried her bags for a few bucks, and the Haitian band that routinely greets visitors as they step off the planes.

Part of the terminal was functioning when we arrived. The small Haitian band was playing when we stepped off the plane. Military trucks, soldiers with machine guns, crowds of white aid tents filled much of the airport grounds. We were shuttled to what was formerly a cargo hold, now temporarily a customs station. Luggage appeared, papers were stamped, all was orderly and well-mannered. Jackson, the porter, grabbed our bags with his good hand.

And then, there was Haiti.

Behind the bars that barricaded the airport, throngs of Haitians clamored, arms waving, teeth flashing, the native Creole filling the air (pictured at the top of this entry). The gates opened and Haiti rushed in.

Women with chickens in baskets on their heads, lines of white U.N. trucks, Tap-taps (the brightly colored, overfilled Haitian taxis) bounced by. In bumper-to-bumper traffic and in the tropical heat, we navigated the streets on the outskirts of Port-au-Prince heading to the mountains, away from the tent cities made of sheets and tarps that lined the outskirts of town. Away from the vendors marketing bicycle pumps and juice boxes from wheelbarrows.

Soldiers with machine guns directed traffic (above, right). Sirens blared. A nun dashed by. An American tank rumbled by. Small boys with bundles of sugar cane to sell waved. Garbage littered the streets. The smell of charcoal from open fires filled the air.
“Isn’t this the greatest country in the world?,” said Mellon, grinning widely. “Oh, I’m so happy to be back.”

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Haiti category. More details on Stanford’s Haiti relief effort are available here.