Notes From Our Partner in Haiti

Ophelia Dahl, Executive Director of Partners in Health, arrived in
Haiti on Friday, January 22 to meet with staff and volunteers and to
assess Zanmi Lasante's needs for the coming weeks and months.

MADRE is providing emergency support to Zanmi Lasante, a Haitian healthcare initiative founded by Partners in Health.

These are some notes we received from Ophelia after her first two days in Haiti.

Haiti's catastrophe will forever divide its history into before earthquake and after.

Dust
has not settled. Flying towards pap you could 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 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 Carre, who 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. He simply said, "I had a lot of luck".

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, and, inside, beds and stretchers lie close together, most
patients are post surgery, bandaged or in casts. They are now receiving
narcotics. Operating rooms up and running now 24 hours a day. Patients
are lying mostly with haunted eyes but always respond to a greeting,
often waving slow hand. I had to try to stop 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 Evan [Dr. Evan
Lyon] and David [Dr. David Walton]. With the lights on inside the tent,
I could see the silhouettes of the relatives tending to the patients,
washing with a rag, feeding or massaging them. The sadness everywhere
is so palpable. Haitians are usually very expressive in their mourning.
Before quake, a wake would take place all night with women outside on
the ground wailing and shouting in agony. 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 have the same
expression of flat sadness.

Volunteers run about and some
nurses both Haitian and American are around though everywhere a lack of
nursing care. On the campus, the nursing school has collapsed,
pancaked in 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. Yet people do still walk past because there
is no choice but to get other places. It seems so feckless which
buildings crumbled which is why no one feels safe in a concrete
structure.

Outside in the courtyards at HUEH, the patients
who 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 described the days that
have been lost to bringing 80 patients in and out of the wards. When
people felt the tremors, they pulled out their IVs and just scrambled
out the best, fastest way they could. Polo [Dr. Paul Farmer] described
a woman about 35 years old 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 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 help get the electricity
going. No power was responsible for a lot of deaths in the first few
days.

The first night, after touring parts of the city, I
stayed with Evan, David, Jim Ansara, and Chris Strock 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 Loune [Loune Viaud], Fernet [Dr.
Fernet Leandre], Joia [Dr. Joia Mukherjee], Louise [Dr. Louise Ivers],
Lambert [Dr. Gregory Lambert] 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.

Paul
and I headed to Cange following our meeting. Silence everywhere and 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 limbs or
white bandages over their stumps. Dressings are changed every day by
Haitian staff and volunteers and need to continue to be changed for
weeks to come. In the corner of the church is an overflow pharmacy, the
piano has become a work top and meds cover the altar. Docs round on the
patients. Lovely Dr. Jon Crocker 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 some back to the church. We will have mass today in the Clinic
Externe.

In the hospital all wards taken up with amputees,
fractures, some in need of spinal care. Probably 200 patients. The team
reported having done 1150 x-rays in Cange. The x-ray room is a
miserable place to be for those who have made the long trek, limbs must
be placed in best position to get a good film and it is painful. But
the films help ensure surgeries go smoothly.

There is a
long road ahead for plastics with skin grafts and wound care. We are
planning for all that. We'll need a big infusion of prosthetics in a
few months. Perhaps tens of thousands of amputees - hard to count. Koji
[Dr. Koji Nakashima] says there are some landmine NGOs with good
experience (Cambodia etc.) - we should reach out because it is clear it
can't be done cottage industry style, with donations here and there.
Also, there is loads of PT needed - it is so hilly, hard to imagine
life here without both legs.

I'm deeply moved by our staff
- many are suffering huge loss but are still here. One of our lab techs
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 - team from CA here right now are lovely people.
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, which of course still go on.

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.

Patients are still arriving in a steady stream from Port-au-Prince. I'm heading to Hinche and, hopefully, to St Marc tomorrow.