PIH
Executive Director Ophelia Dahl has been visiting PIH’s sister
organization in Haiti, Zanmi Lasante (“Partners In Health” in Haitian
Creole). She recently sent the following note reflecting on her first
48 hours in Haiti, where she visited the University Hospital in
Port-au-Prince and the Zanmi Lasante (ZL) hospital in Cange:
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PIH Executive Director Ophelia Dahl with a patient in Haiti.
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Haiti’s catastrophe will forever divide its history into before earthquake and after.
Dust has not settled. Flying towards Port-au-Prince, you can see a
thick layer of smog lingering above the city. The air is acrid, stings
the eyes, and makes you cough. The airport is its own world: a spread
of tents large and small, containers, supplies, boxes, vehicles,
bicycles, and people wandering about—both in and out of uniform.
We bumped into Jens, the UN engineer who had worked with us on the
bridge we helped build in Boucan Carré last year. He was the last
person to be pulled out alive from the UN meeting building. He had been
under rubble for 6-8 days. Needless to say, he looked like a walking
skeleton and sounded very jittery. “I had a lot of luck,” he put it
simply
We drove to the University Hospital (HUEH). The scene there is
truly impressive in so many ways. Much progress has been made. Medical
tents are lined up in a row. Inside, beds and stretchers lie close
together. Most patients are post surgery, bandaged, or in casts. They
are now receiving narcotics. Operating rooms are up and running—now 24
hours a day. Patients are lying down, most with haunted eyes, but
always responding to a greeting, often waving a slow hand. I had to
stop myself from greeting them so they wouldn’t have to wave back in
pain.
Last night, I sat outside the main tent at HUEH on a bench talking
to Dr. Evan Lyon and Dr. David Walton, both have worked with PIH in
Haiti for many years. With the lights on inside the tent, I could see
the silhouettes of relatives tending to the patients, washing them with
a rag, feeding or massaging them. The sadness everywhere is so
palpable. Haitians are usually very expressive in their mourning.
Before the quake occurred, wakes would typically last all night, with
women wailing and shouting in agony outside on the ground. People often
fainted during funerals. I can’t imagine that happening here now. The
wailing would never stop. There is no energy for weeping. Everything
is marked by the quiet. Nearly everyone—adults and children—wear the
same flat, sad expression on their faces.
Volunteers run about. Some nurses, both Haitian and American are
around, but there is a lack of nursing care everywhere. The nursing
school collapsed in the quake, flattened between two buildings that
still stand. Its rubble holds the remains of the entire second-year
nursing class. You can smell the bodies when you walk past. It seems
so arbitrary which buildings crumbled; maybe that’s why no one feels
safe in any concrete structure.
Outside in the courtyards at HUEH, the patients who were evacuated
from the ward after the second wave of aftershocks have constructed
makeshift tents over their beds. It is starting to look like people are
staying – where else can they go? The main buildings are mostly still
standing on the HUEH campus, but several have major cracks. Patients
are afraid to be inside. Evan told me that when people felt aftershock
tremors last week, they pulled out their IVs and just scrambled out as
fast they could.
Polo [PIH co-founder Dr. Paul Farmer] described a 35-year-old woman
who had come to the hospital from the south. She was also attached to
oxygen and afraid. He asked her whether anyone was with her. She said
no one. She lost all her family and was brought to the hospital by a
neighbor.
We also saw a woman who had been brought back to the hospital with
tetanus. She was fine and had been discharged after the initial surgery
on her foot. But now her neck was stiff, her head tilted back. She
looked rigid and very sick. There will be medical challenges for many
months and years to come. Other challenges remain too, including
sanitation (there are no real toilets). You can imagine.
So many people are doing such a stellar job. Obviously, I know it is
the effort of many, many folks, but Evan and David are shining stars.
Old news, I know, but Evan reinforced how life-saving it has been to
have Jim Ansara [founder of Shawmut Design and Construction Company]
help get the electricity going. A lack of power was responsible for a
lot of deaths in the first few days.
My first night, after touring parts of the city, Evan, David, Jim
Ansara, Chris Strock [an engineer from Virginia Tech], and I stayed
with a family in Port-au-Prince. We slept on the floor inside their
house. The family slept on the ground outside—still too unsure to go in.
Yesterday, we had a leadership meeting with Zanmi Lasante (ZL)
Director of Operations Loune Viaud, ZL Director of HIV/TB Dr. Fernet
Leandre, PIH Clinical Director Dr. Louise Ivers, ZL Director of
Monitoring and Evaluation Dr. Wesler Lambert and PIH Medical Director
Dr. Joia Mukherjee and Polo to talk about the mid- and long-term
response, particularly a community-based outreach movement. We spoke of
ten specific communities, with a massive training of Community Health
Workers for follow-up wound care and chronic care. We discussed key
partnerships with food and water organizations. Joia also returned
yesterday and has a plethora of details to be shared and refined.
Polo and I headed to Cange following our meeting. Silence was
everywhere, as was a sort of stoicism I had not seen here before. It is
impossible to greet colleagues and friends and not see that their
hearts are broken.
We went first to visit the church, which has probably 70 patients
lying on mattresses in rows on the ground. All of them have casts on
their limbs or white bandages over their stumps. Haitian staff and
volunteers change dressings every day, and this need will endure for
weeks to come. In the corner of the church is an overflow pharmacy,
where the piano has become a workbench and meds cover the altar. Docs
round on the patients. Lovely Dr. Jon Crocker [formerly the clinical
director of PIH’s project in Malawi] was seeing patients with a team of
volunteers. And, as always, relatives help their loved ones with simple
tasks. There is mostly quiet, no one is talking much, but there is a
sense of community. Apparently, some patients moved to other wards have
asked to come back to the church. We will have mass today in the
Clinic Externe.
In the hospital, all wards are taken up with amputees, patients with
fractures, and some in need of spinal care. Probably 200 patients
altogether. The team reported having done 1,150 x-rays. The x-ray room
is a miserable place to be for those who have made the long trek,
because their limbs must be repositioned to get a good film, and it is
painful. But the films help ensure that their surgeries go smoothly.
There is a long road ahead for plastics, including skin grafts and
wound care. We are planning for all that. We’ll need a big infusion of
prosthetics in a few months. There will be perhaps tens of thousands of
amputees, but it’s hard to count. Dr. Koji Nakashima, who has been
working with Zanmi Lasante in Cange, says there are some NGOs with good
experience helping landmine victims that we should reach out to because
it is clear that expertise is required, as is steady, dedicated
funding. Also, there loads of physical therapists will be needed. It is
so hilly in Haiti that it’s hard to imagine life here without both legs.
I’m deeply moved by our staff. Many are suffering huge losses, but
are still here. One of our lab technicians lost her husband, and her
son suffered head trauma and kidney failure, yet she keeps coming to
work. Having volunteer teams working with our staff is going well . The
lovely team from California here right now. The operating rooms are
working hard; we’re able to do roughly 16 surgeries per day. There are
three rooms available, but one is kept for emergencies and C-sections.
I am struck by many things, but the silence is deafening. The road
from Cange to Hinche used to be a busy thoroughfare with trucks
hurtling back and forth all day and blasting their horns. Yesterday, I
counted only a handful of trucks. The trucks used to be loaded with
food and things for market. Now there is just quiet—a sign that we are
far from any sort of economic normalcy.
I’m heading to Hinche and, hopefully, to St Marc tomorrow.
-Ophelia Dahl
The above letter was used without permission. However, Ms. Dahl's letter is so powerful, it would be a shame not to share it with you. I trust PIH and its ED will forgive me for sharing my passion with you.
Dee
