Dispatch from Carrefour, 2/26/10
As I get ready to leave Haiti, I want to write for the first time. Before this, I have felt unwilling to talk or write very much about what is happening here. The immensity of the disaster makes words seem trivial.
First, I’d like to describe the daily routine of our Relief International team. We can hear (among the barking dogs and crowing roosters) people lining up as early as 3:30 a.m. for the clinic. There is a soft murmuring outside the wall of our compound, and an occasional baby crying. We get up between 5:30 and 6:30 and have a wonderful breakfast of Haitian coffee, hard-boiled eggs, and fresh fruit, and every other day we also had some oatmeal with cinnamon. We sit for a few minutes and then get ready for clinic, which begins at 8.
Yesterday morning, our routine was interrupted at 7:15 a.m. by a mother carrying her unresponsive 4-year-old son to our gates. One of the security guards rushed her in and the docs and nurses started working, along with our cook, Guerline, who acted as translator. We got the history that this child had had a seizure 2 hours previously and our fabulous ED nurses got an IV started and discovered his blood sugar of 41 (low) within minutes. He was immediately arousable after IV glucose and was swiftly packed into one of our cars (transport to a local hospital had been arranged during resuscitation).
We then got back to readying the grounds and our tents for morning clinic. At 8 a.m. a few of the nurses and MDs “walked the line” to number the patients according to the acuity of their illness. The rest are taken in order. The rest of our day was relatively quiet with one mobile clinic going to Grassier while the “fixed” clinic continued to operate.
The Grassier site was in the courtyard of a school that was heavily damaged in the earthquake, while some children were in attendance. We sat under the trees with the breeze blowing off the ocean while we saw our patients. I asked a lot of patients to tell me about what happened to them during the earthquake. We are seeing a huge amount of post-traumatic stress disorder. The mother of a 5-year-old girl who had scratched herself to the point of bleeding from head to toe, told me that the girl’s twin brother had died. The team has seen suspected malaria, pneumonia, pyelonephritis, lots of diarrheal illnesses, malnourishment and a variety of problems related to a lack of chronic care for hypertension, diabetes, seizures, etc. I have spoken to parents who are starving themselves out of their feeling of responsibility to feed their children.
The clinics run smoothly from morning through afternoon, even though the humidity has everyone running for water breaks – they’re never enough. Most don’t take adequate time to drink and there have been several episodes of dehydration among staff members. The late afternoon can be used for resting, or, more recently, emailing and calling from our “dining room table” since an NGO called NetHope came and installed these services for us. They even work most of the time, depending on the available of city power or our generator. We wash our clothes, haul water from the cistern into the bathrooms for bucket baths and toilet flushing, stock the tents and chat. Sometimes a few of the team members help Guerline prepare dinner in the kitchen. Cooking is done over a small propane stove, or over charcoal. The suppers are very tasty and consist of Haitian rice and beans, or spaghetti, often with a chicken or vegetable stew.
The cohesiveness of our team is the best of any of the medical mission teams with which I have worked. After dinner, we have lots to do. We wash dishes, clean up and collect ourselves around the table for pill counting to restock for the next day’s mobile and fixed clinics. We pack the mobile clinic duffel bag and some of us work on guidelines for malnutrition, commonly encountered local clinical conditions, and nursing guidelines for incoming staff — RI or national. For me, it’s 10:30- 11 p.m. by the time I finally crawl into my “bug hut” and end my day.
The days have been busy and instructive, heat notwithstanding. I love working with the Haitians. The people are courageous and gracious. The team has helped me look after my broken foot (from a hiking accident two days before I left for Haiti). I was given an ACE wrap and lots of instruction to keep my foot elevated (forget about ice!), which of course I did not do. I’m moving pretty quickly now.
The young Haitian men who serve as the primary source for our drivers, translators and security are very willing to talk about the situation here. They are sensitive and very protective of us. I hope Americans know that we are seen as a source of hope for the Haitian people. As Garry, a translator, said to me yesterday: “For Haitians, first God, then the U.S.”
Debra Cohen, MD, aka “Dr. Deb”
Kaiser Permanente Santa Clara Medical Center