Haiti Journal: Shaken Again
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EDITOR'S NOTE: This is the third in a series of personal reports from Dr. Hyman in Haiti. Please note that there are some graphic descriptions.
Days 4 & 5
I slept through the aftershock this morning, a small 6.1 earthquake that has had no real impact because everything that could be destroyed was already destroyed. But the aftershocks that will ripple through the lives of the Haitian people will last for decades. They will for Mitch, who I met the first morning at the hospital grounds. He was laying in the back alley, unattended for four days except for a small bandage around his knee. He called out softly in English for me to stop, to help him. He had not eaten nor drank water since the quake and was still smiling at me. He lost his entire family -- a wife and three children -- and home. He was alone with no one to care for him, unlike some of the other patients who were tended to by their less-wounded family members, bringing what food and water they could.
I kneeled down and opened his dressing. A quart of foul pus spilled out from his knee, which was shattered and crushed. Pier, my wife, is an orthopedic surgeon. She came over and said he needed to be the next surgery case.
But the volume of trauma and mangled limbs is staggering.
I saw him a few days later, finally inside the make-shift pre-op area -- still with almost no water, food, antibiotics nor pain medication. He smiled again when he saw me and grabbed my hand.
I brought General Keen from U.S. Southern Command, who is leading the military relief and support effort for the Haitian people. I showed him the hospital which, seven days after the quake, still had no food or water for the patients (nor the doctors, nurses and staff). We still didn't have stable power and were operating in dark rooms, the batteries of our flashlights dimming or dead. We still operate with hacksaws. Supplies are trickling in, but we have more doctors and staff now than supplies. This morning surgeons were operating without gowns or gloves. And without lights, again.
Later, one of the patients we operated on the first day -- a woman with a beautiful smile, pony tail and an orange t-shirt -- was septic and having seizures that wouldn't stop. Maggots crawled out of the stump of her recently amputated leg. We (Partners in Health) are working to get the hospital up and functioning with food, water, supplies, power, sanitation, and security (we made significant progress after I emailed my contacts at the State Department -- General Keen showed up after), but we have no communications internally and little organization. I ran over to the Norwegian team's tent to find a bottle of seizure medication. They had finally set up after a week, getting their supplies and opening one mobile operating suit. The anesthesiologist gave me a bottle of phenobarbital. I looked down on the operating table and saw the surgeon cutting off a man's leg above the knee. I realized it was Mitch, my friend from my first day, who now -- seven days after the earthquake -- was finally in the operating room.
My heart cracked and the tears came all day. Through the exhaustion, a of lack sleep and food, I had spent four days of getting to know these extraordinary people. Their spirit is indefatigable despite 200 years of natural and political disaster. With each story, the tears came: the young man asking for a job so he could bring food to his wife and children, who hadn't eaten in a week; the well-known Haitian musician who, rather than escape a crumbing building, rushed up to the third floor to rescue a baby. He carried the baby in his arms, but lost most of his fingers as he protected the baby. George Boutin, my father-in-law, didn't have the heart to remove his mangled fingers and hand. He reconstructed them so the musician could, perhaps, play music again. Maybe. Perhaps. Hopefully one day.
Today, the local hospital staff (nurses and workers) came back, at least those who were alive. They came even though their families were dead, even though they still slept on the street because their homes were in rubble, and even though most hadn't eaten food for days. After 10 straight hours of operating in hot and dark rooms, the dark skinned nurses looked pale and weak. They worked without food or drink all day. In a back room of the main storage area I found a few cases of water meant for 5,000 people. I brought a few to the operating room to refuel the staff at 8 p.m. last night.
General Keen arrived to inspect the scene. The military are here to create life, support life, to save lives, to bring relief in a country where there is no local infrastructure. The NGO's (non-governmental organizations) and United Nations struggle to get organized in the chaos. Their kindness and compassion made me cry again. They are organized and willing and focused. They are not here to provide security or make us safe, because there has not been one incidence of violence. There are only those gently, graciously asking for water or food or supplies or shelter from the sun.
This hospital was a disaster before the disaster. The Americans built the national public hospital in the 1930's and there has been no support or funding from the Haitian government since then, except a small budget to pay salaries. I know we can raise the $30 million to rebuild the hospital, but wonder if it will be properly allocated because of the chaos in the government.
There is no remaining organization in Haiti to help us get the power back on or provide food and water for patients in the hospital. There is no one to get us medical supplies, or sanitation for the 4,000 people on the hospital compound, or get some of the overload of 1,000 surgical patients lifted to other sites. But General Keen's 82nd airborne is organized, compassionate and capable of helping us build the National Hospital into what it was meant to be -- the nation's center for caring for the poor.
But today, when I got back to the hospital, all the patients that we had moved into the hospital's remaining buildings were outside -- strewn all over the hospital grounds. The aftershock shook them and frightened them. Those who had just had their legs cut off jumped on one foot out of the buildings. Others had their families drag them out for fear of getting caught in another collapsed building. The trauma is so deep and vast that even after we had the buildings cleared by the U.S. Army Corps of Engineers and announced it to all the patients, most were still to afraid to enter the buildings. As a result, many died from dehydration in the heat and sun. After five days of trying to rebuild the hospital, we had to start all over again.
But we did, and the people kept smiling back at me as I walked by.
• • • • • • • • • • • • • • • • • • •
Please donate to Partners in Health at www.pih.org. They are integrated with the Haitian health care system and can create a sustainable system from the ashes and sorrow.
Cruise industry leader: Royal Caribbean was right to return to Haiti
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One of the cruise industry's leading voices spoke out Wednesday in defense of Royal Caribbean's controversial decision to resume cruises to Haiti in the wake of last week's devastating earthquake.
Seatrade Insider reports Rick Sasso, president and CEO of MSC Cruises USA, offered a passionate rebuttal to criticism of Royal Caribbean's move during a cruise industry event in New York.
"What they're doing is humanitarian," the news outlet reports Sasso as saying. "For anybody to criticize or portray this as 'ghoulish,' as I saw one newspaper report, makes me sick."
RELATED: Royal Caribbean's quick return to Haiti draws mixed reaction
RELATED: Royal Caribbean to resume calls in Haiti
RELATED: Full text of Royal Caribbean's announcement on Haiti
Royal Caribbean operates a private beach area for its cruise ships called Labadee on Haiti's north coast -- an area relatively unaffected by the earthquake. It is far from Port-au-Prince and the epicenter of the disaster.
Royal Caribbean's 3,654-passenger Independence of the Seas -- one of the world's largest cruise ships -- went ahead with a scheduled call at Labadee on Friday, just three days after the earthquake devastated the southern part of the country. More Royal Caribbean ships arrived on Monday and Tuesday, and Royal Caribbean's sister line, Celebrity Cruises, has a ship visiting Friday.
In addition to vacationers, the vessels are bringing relief supplies to be distributed to more seriously affected parts of the country by Food for the Poor. The company also has promised $1 million in humanitarian relief for Haiti and says it will donate 100% of its net revenue from the visits to relief efforts.
Royal Caribbean executives, in defending their decision to resume calls in Haiti so soon after the quake, also have noted that Labadee employs hundreds of Haitians and is an important contributor to the country's economy.
"There were a lot of discussions about (going ahead with calls), but in the end, Labadee is critical to Haiti's recovery and hundreds of people rely on Labadee for their livelihood," Royal Caribbean associate vice president John Weis wrote last week on a Royal Caribbean company blog.
AP Photo/J. Pat Carter
Comments 22 | Recommend 3
Buzz up!
Like this story? Share it with Yahoo! Buzz
JUST POSTED: Silversea christens new ship in Florida. Click HERE for details.
One of the cruise industry's leading voices spoke out Wednesday in defense of Royal Caribbean's controversial decision to resume cruises to Haiti in the wake of last week's devastating earthquake.
Seatrade Insider reports Rick Sasso, president and CEO of MSC Cruises USA, offered a passionate rebuttal to criticism of Royal Caribbean's move during a cruise industry event in New York.
"What they're doing is humanitarian," the news outlet reports Sasso as saying. "For anybody to criticize or portray this as 'ghoulish,' as I saw one newspaper report, makes me sick."
RELATED: Royal Caribbean's quick return to Haiti draws mixed reaction
RELATED: Royal Caribbean to resume calls in Haiti
RELATED: Full text of Royal Caribbean's announcement on Haiti
Royal Caribbean operates a private beach area for its cruise ships called Labadee on Haiti's north coast -- an area relatively unaffected by the earthquake. It is far from Port-au-Prince and the epicenter of the disaster.
Royal Caribbean's 3,654-passenger Independence of the Seas -- one of the world's largest cruise ships -- went ahead with a scheduled call at Labadee on Friday, just three days after the earthquake devastated the southern part of the country. More Royal Caribbean ships arrived on Monday and Tuesday, and Royal Caribbean's sister line, Celebrity Cruises, has a ship visiting Friday.
In addition to vacationers, the vessels are bringing relief supplies to be distributed to more seriously affected parts of the country by Food for the Poor. The company also has promised $1 million in humanitarian relief for Haiti and says it will donate 100% of its net revenue from the visits to relief efforts.
Royal Caribbean executives, in defending their decision to resume calls in Haiti so soon after the quake, also have noted that Labadee employs hundreds of Haitians and is an important contributor to the country's economy.
"There were a lot of discussions about (going ahead with calls), but in the end, Labadee is critical to Haiti's recovery and hundreds of people rely on Labadee for their livelihood," Royal Caribbean associate vice president John Weis wrote last week on a Royal Caribbean company blog.
AP Photo/J. Pat Carter
More go online or text to donate for Haiti's quake victims
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By Kevin McCoy, USA TODAY
Online contributions for Haiti earthquake-relief efforts are setting giving records, topping early totals for other major disasters and opening new support sources for humanitarian groups.
Electronic donations for the first five days after the Jan. 12 disaster totaled 19% more than during the same time frame after the 2004 Asian tsunami and 109% higher than the equivalent following Hurricane Katrina in 2005, according to Blackbaud, a software and services provider for 22,000 non-profit groups.
Similarly, users of the online-payment system PayPal raised more than $1.8 million for Haiti relief efforts in the first five days of fundraising after the tragedy. That surpassed the $1.5 million contributed via PayPal in the month after the devastating 2008 earthquake in China.
"The Haiti disaster is yet another example that when major disasters strike, it's online where givers increasingly turn first," said Steven MacLaughlin, Blackbaud's Internet solutions director.
Especially since online often means mobile.
VOLUNTEERS: Thousands made helping in Haiti a habit
MORE: U.S. prepares Gitmo for Haitian migrants
VENDORS: Some commerce returns in Haiti
As part of an American Red Cross campaign supported by first lady Michelle Obama, celebrities and athletes, cellular phone users who texted the word Haiti to 90999 could donate $10 to the relief agency's Haiti effort. The amount is charged to the user's phone bill.
As of Wednesday evening, the campaign had raised roughly $25 million in pledges. That dwarfs the $250,000 the American Red Cross got via texts for 2008 hurricane season aid. It also represents almost a fifth of the $137 million in total Haiti-related pledges the agency said it had received.
Verizon is speeding delivery by forwarding customers' mobile donations before they pay their bills, said Jonathan Aiken, an American Red Cross spokesman.
"We're blown away," he said. "None of us anticipated anything like this."
SEA HOSPITAL: 'Comfort' starts its healing mission
HOW TO HELP: Ways to donate to Haiti earthquake victims
ADOPTIONS: Americans eager to embrace Haitian orphans
Other relief agencies, including CARE and AmeriCares, reported millions in Haiti-related online giving, though less than after the tsunami. "Haiti is not tracking quite as high. But it's definitely in second place," said Karen Robbins, CARE's director of resource development communication.
Relief agencies said the message in the numbers is that the old formula of contributing by the U.S. Postal Service— or even by calling an 800 number — is too slow for what's becoming an always-online nation.
"You have technology expanding the opportunity for giving, and a broader population base taking advantage of that," Aiken said. "This is how people who predominately use these new mediums prefer to do business."
Updated 5h 4m ago | Comments 11 | Recommend 2 E-mail | Save | Print | Reprints & Permissions |
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By Kevin McCoy, USA TODAY
Online contributions for Haiti earthquake-relief efforts are setting giving records, topping early totals for other major disasters and opening new support sources for humanitarian groups.
Electronic donations for the first five days after the Jan. 12 disaster totaled 19% more than during the same time frame after the 2004 Asian tsunami and 109% higher than the equivalent following Hurricane Katrina in 2005, according to Blackbaud, a software and services provider for 22,000 non-profit groups.
Similarly, users of the online-payment system PayPal raised more than $1.8 million for Haiti relief efforts in the first five days of fundraising after the tragedy. That surpassed the $1.5 million contributed via PayPal in the month after the devastating 2008 earthquake in China.
"The Haiti disaster is yet another example that when major disasters strike, it's online where givers increasingly turn first," said Steven MacLaughlin, Blackbaud's Internet solutions director.
Especially since online often means mobile.
VOLUNTEERS: Thousands made helping in Haiti a habit
MORE: U.S. prepares Gitmo for Haitian migrants
VENDORS: Some commerce returns in Haiti
As part of an American Red Cross campaign supported by first lady Michelle Obama, celebrities and athletes, cellular phone users who texted the word Haiti to 90999 could donate $10 to the relief agency's Haiti effort. The amount is charged to the user's phone bill.
As of Wednesday evening, the campaign had raised roughly $25 million in pledges. That dwarfs the $250,000 the American Red Cross got via texts for 2008 hurricane season aid. It also represents almost a fifth of the $137 million in total Haiti-related pledges the agency said it had received.
Verizon is speeding delivery by forwarding customers' mobile donations before they pay their bills, said Jonathan Aiken, an American Red Cross spokesman.
"We're blown away," he said. "None of us anticipated anything like this."
SEA HOSPITAL: 'Comfort' starts its healing mission
HOW TO HELP: Ways to donate to Haiti earthquake victims
ADOPTIONS: Americans eager to embrace Haitian orphans
Other relief agencies, including CARE and AmeriCares, reported millions in Haiti-related online giving, though less than after the tsunami. "Haiti is not tracking quite as high. But it's definitely in second place," said Karen Robbins, CARE's director of resource development communication.
Relief agencies said the message in the numbers is that the old formula of contributing by the U.S. Postal Service— or even by calling an 800 number — is too slow for what's becoming an always-online nation.
"You have technology expanding the opportunity for giving, and a broader population base taking advantage of that," Aiken said. "This is how people who predominately use these new mediums prefer to do business."
Nightmare in Haiti: Untreated Illness and Injury
Ruth Fremson/The New York Times
Haitians waited for medical care in a makeshift ambulance in Port-au-Prince on Wednesday.
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By MARC LACEY
Published: January 20, 2010
PORT-AU-PRINCE, Haiti — A strong aftershock rattled Haiti once again on Wednesday, causing even more physical damage and further traumatizing the jittery population. But the authorities said the biggest dangers now facing survivors of last week's major earthquake were untreated wounds and rising disease, not falling debris.
Multimedia
Interactive Feature
Perspectives on Haiti's Earthquake
Video
Haiti Quake Day 9: Hospital Ship Arrives
Audio Slide Show
Exodus from Port-au-Prince
Related
Exodus to Countryside Reverses Long Trend (January 21, 2010)
Vows to Move Fast for Haitian Immigrants in U.S. (January 21, 2010)
Teaching Americans What Haiti Needs: Money (January 21, 2010)
Our Towns: Haitians and Hasidim Find Common Cause (January 21, 2010)
Haiti Disaster Relief: How to Contribute | Tips on Donating
Interactive: The Missing | Connecting to Those Affected
More Multimedia on the Haiti Earthquake
Enlarge This Image
Damon Winter/The New York Times
Produce vendors in Port-au-Prince were a sign that some measure of normalcy was returning.
Enlarge This Image
Damon Winter/The New York Times
A narrow tent city has sprung up in the median of a main roadway leading out of Port-au-Prince.
Enlarge This Image
Ruth Fremson/The New York Times
A woman pushed her way into a factory where U.S. Marines were distributing food in Léogâne.
Readers' Comments
Readers shared their thoughts on this article.
Read All Comments (271) »
Because of untreated injuries, infectious diseases and dismal sanitary conditions, health workers said that the natural disaster that struck Haiti more than a week ago remained a major medical crisis and that, unless quickly controlled, it would continue to take large numbers of lives in the days and weeks ahead.
"There are still thousands of patients with major fractures, major wounds, that have not been treated yet," said Dr. Eduardo de Marchena, a University of Miami cardiologist who oversaw a tent hospital near the airport where hundreds of severely injured people were being tended. "There are people, many people, who are going to die unless they're treated."
For the seriously ill, the chances of surviving may depend on leaving Haiti entirely. On Wednesday morning, a paramedic rushed up to Dr. de Marchena with news of a newborn who had arrived at another clinic in dire condition. After hearing that the baby could barely breathe, Dr. de Marchena said, "Should I get him airlifted to the United States?"
The paramedic hesitated for a moment, and the doctor said, "Do it." The baby was soon boarded for medical care in Miami.
In the squatter camps now scattered across this capital, there are still people writhing in pain, their injuries bound up by relatives but not yet seen by a doctor eight days after the quake struck. On top of that, the many bodies still in the wreckage increase the risk of diseases spreading, especially, experts say, if there is rain.
Getting food and water to displaced people is also crucial to staving off more deaths, relief workers said. As of Wednesday, the World Food Program reported that it had distributed food to more than 200,000 people, but it acknowledged that it could take as long as a month for relief food to get to the two million or more people in need.
At some of the hospitals and clinics now treating survivors, the conditions are as basic as can be, with vodka to sterilize instruments and health workers going to the market to buy hacksaws for amputations.
At General Hospital in here Port-au-Prince, the water and power are both out, medical supplies are running low and fuel for generators is hard to come by, doctors reported. Other hospitals are even worse off, though, with patients moved outside into the open air.
Still, health experts were arriving in Haiti from Israel, Cuba, Portugal and other countries, many with stocks of medicine and supplies as well as extensive experience in disaster conditions.
And the United States Navy hospital ship Comfort pulled up off the Haitian coast to handle the worst-off patients. A helicopter landing pad was cleared near General Hospital to evacuate the critically injured there.
But integrating all the health professionals into a coherent system will take time. "Nobody knows how many doctors, how many nurses have come to Haiti," said Dr. Henriette Chamouillet, head of the World Health Organization in Haiti. "No one is providing the government with the data it needs."
Another grievance among some health professionals was that the American military was not giving enough of a priority to humanitarian aid. Doctors Without Borders has complained that more than one of its planes carrying vital medical equipment has been kept from landing at the airport here, costing lives.
Despite all the incoming help, Partners in Health, an organization that has been providing health care in Haiti for two decades, estimated that 20,000 Haitians were dying daily from lack of surgery. But that figure was not backed up by other aid organizations in Haiti and appeared to be much higher than other estimates of the continuing death toll from injuries. The W.H.O. said it was just beginning to gather epidemiological data to assess how much the quake's toll, which is still uncertain, might rise.
One of the keys to bolstering the response, said Dr. Paul Farmer, a co-founder of Partners in Health and deputy United Nations envoy to Haiti, was to unify the disparate aid efforts. "Everyone's doing their own thing, and we need to bring them together," he said in an interview.
The continued tremors were not helping the situation. The latest aftershock, which had a magnitude of 6.1, came around 6 a.m. on Wednesday and was centered on Gressier, a village west of Port-au-Prince. The most powerful tremor to hit Haiti since the initial earthquake on Jan. 12, it caused some additional damage to the ravaged capital and surrounding areas, although the United Nations said it was still assessing how much.
At the tented hospital run by Miami doctors, patients were shrieking and trying to squirm out of their cots when the aftershock came. The situation was still more dire at University Hospital, where patients and staff members evacuated the building and many traumatized Haitians feared going back in.
Squatting on the sidewalk in central Port-au-Prince, her thigh bandaged from an injury suffered during the main quake, Ange Toussaint, 55, smiled broadly. "I'm here," she said. "It happened again, and I'm still here. Wow!"
There were some early efforts to address the psychological toll of the earthquake.
At the University of Haiti, which hardly showed any damage, Jean Robert Cheri, a professor of psychology, sent a team of student trauma counselors into the streets.
"We are sending them out with basic instructions," he said. "First, listen to people, let them verbalize their feelings. Second, don't promise them any material aid, because you can't deliver."
Mr. Cheri said that the students' studies had been interrupted for the foreseeable future and that putting their lessons to work would help both them and the country.
"Look, it's not going to be easy because they're traumatized themselves," he said of his students. "I myself am a psychologist who needs therapy. When I go to sleep, I dream of houses falling down."
Deborah Sontag contributed reporting.
Ruth Fremson/The New York Times
Haitians waited for medical care in a makeshift ambulance in Port-au-Prince on Wednesday.
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(271)
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By MARC LACEY
Published: January 20, 2010
PORT-AU-PRINCE, Haiti — A strong aftershock rattled Haiti once again on Wednesday, causing even more physical damage and further traumatizing the jittery population. But the authorities said the biggest dangers now facing survivors of last week's major earthquake were untreated wounds and rising disease, not falling debris.
Multimedia
Interactive Feature
Perspectives on Haiti's Earthquake
Video
Haiti Quake Day 9: Hospital Ship Arrives
Audio Slide Show
Exodus from Port-au-Prince
Related
Exodus to Countryside Reverses Long Trend (January 21, 2010)
Vows to Move Fast for Haitian Immigrants in U.S. (January 21, 2010)
Teaching Americans What Haiti Needs: Money (January 21, 2010)
Our Towns: Haitians and Hasidim Find Common Cause (January 21, 2010)
Haiti Disaster Relief: How to Contribute | Tips on Donating
Interactive: The Missing | Connecting to Those Affected
More Multimedia on the Haiti Earthquake
Enlarge This Image
Damon Winter/The New York Times
Produce vendors in Port-au-Prince were a sign that some measure of normalcy was returning.
Enlarge This Image
Damon Winter/The New York Times
A narrow tent city has sprung up in the median of a main roadway leading out of Port-au-Prince.
Enlarge This Image
Ruth Fremson/The New York Times
A woman pushed her way into a factory where U.S. Marines were distributing food in Léogâne.
Readers' Comments
Readers shared their thoughts on this article.
Read All Comments (271) »
Because of untreated injuries, infectious diseases and dismal sanitary conditions, health workers said that the natural disaster that struck Haiti more than a week ago remained a major medical crisis and that, unless quickly controlled, it would continue to take large numbers of lives in the days and weeks ahead.
"There are still thousands of patients with major fractures, major wounds, that have not been treated yet," said Dr. Eduardo de Marchena, a University of Miami cardiologist who oversaw a tent hospital near the airport where hundreds of severely injured people were being tended. "There are people, many people, who are going to die unless they're treated."
For the seriously ill, the chances of surviving may depend on leaving Haiti entirely. On Wednesday morning, a paramedic rushed up to Dr. de Marchena with news of a newborn who had arrived at another clinic in dire condition. After hearing that the baby could barely breathe, Dr. de Marchena said, "Should I get him airlifted to the United States?"
The paramedic hesitated for a moment, and the doctor said, "Do it." The baby was soon boarded for medical care in Miami.
In the squatter camps now scattered across this capital, there are still people writhing in pain, their injuries bound up by relatives but not yet seen by a doctor eight days after the quake struck. On top of that, the many bodies still in the wreckage increase the risk of diseases spreading, especially, experts say, if there is rain.
Getting food and water to displaced people is also crucial to staving off more deaths, relief workers said. As of Wednesday, the World Food Program reported that it had distributed food to more than 200,000 people, but it acknowledged that it could take as long as a month for relief food to get to the two million or more people in need.
At some of the hospitals and clinics now treating survivors, the conditions are as basic as can be, with vodka to sterilize instruments and health workers going to the market to buy hacksaws for amputations.
At General Hospital in here Port-au-Prince, the water and power are both out, medical supplies are running low and fuel for generators is hard to come by, doctors reported. Other hospitals are even worse off, though, with patients moved outside into the open air.
Still, health experts were arriving in Haiti from Israel, Cuba, Portugal and other countries, many with stocks of medicine and supplies as well as extensive experience in disaster conditions.
And the United States Navy hospital ship Comfort pulled up off the Haitian coast to handle the worst-off patients. A helicopter landing pad was cleared near General Hospital to evacuate the critically injured there.
But integrating all the health professionals into a coherent system will take time. "Nobody knows how many doctors, how many nurses have come to Haiti," said Dr. Henriette Chamouillet, head of the World Health Organization in Haiti. "No one is providing the government with the data it needs."
Another grievance among some health professionals was that the American military was not giving enough of a priority to humanitarian aid. Doctors Without Borders has complained that more than one of its planes carrying vital medical equipment has been kept from landing at the airport here, costing lives.
Despite all the incoming help, Partners in Health, an organization that has been providing health care in Haiti for two decades, estimated that 20,000 Haitians were dying daily from lack of surgery. But that figure was not backed up by other aid organizations in Haiti and appeared to be much higher than other estimates of the continuing death toll from injuries. The W.H.O. said it was just beginning to gather epidemiological data to assess how much the quake's toll, which is still uncertain, might rise.
One of the keys to bolstering the response, said Dr. Paul Farmer, a co-founder of Partners in Health and deputy United Nations envoy to Haiti, was to unify the disparate aid efforts. "Everyone's doing their own thing, and we need to bring them together," he said in an interview.
The continued tremors were not helping the situation. The latest aftershock, which had a magnitude of 6.1, came around 6 a.m. on Wednesday and was centered on Gressier, a village west of Port-au-Prince. The most powerful tremor to hit Haiti since the initial earthquake on Jan. 12, it caused some additional damage to the ravaged capital and surrounding areas, although the United Nations said it was still assessing how much.
At the tented hospital run by Miami doctors, patients were shrieking and trying to squirm out of their cots when the aftershock came. The situation was still more dire at University Hospital, where patients and staff members evacuated the building and many traumatized Haitians feared going back in.
Squatting on the sidewalk in central Port-au-Prince, her thigh bandaged from an injury suffered during the main quake, Ange Toussaint, 55, smiled broadly. "I'm here," she said. "It happened again, and I'm still here. Wow!"
There were some early efforts to address the psychological toll of the earthquake.
At the University of Haiti, which hardly showed any damage, Jean Robert Cheri, a professor of psychology, sent a team of student trauma counselors into the streets.
"We are sending them out with basic instructions," he said. "First, listen to people, let them verbalize their feelings. Second, don't promise them any material aid, because you can't deliver."
Mr. Cheri said that the students' studies had been interrupted for the foreseeable future and that putting their lessons to work would help both them and the country.
"Look, it's not going to be easy because they're traumatized themselves," he said of his students. "I myself am a psychologist who needs therapy. When I go to sleep, I dream of houses falling down."
Deborah Sontag contributed reporting.
Haiti's Many Troubles Keep Bodies Uncounted
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By SIMON ROMERO and NEIL MacFARQUHAR
Published: January 20, 2010
PORT-AU-PRINCE, Haiti — Dr. Alix Lassegue, the physician who runs this city's largest hospital, including its morgue, has been trying to figure out how many people died after the earth buckled so violently last week.
Multimedia
Interactive Feature
Perspectives on Haiti's Earthquake
Video
Haiti Quake Day 9: Hospital Ship Arrives
Related
Nightmare in Haiti: Untreated Illness and Injury (January 21, 2010)
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
Unlike most of the rough figures bandied about, Dr. Lassegue's are based on actual calculations. Standing amid the frenzy of patients being treated in every direction, he jotted down a few numbers with a pen.
The asphalt grounds in front of the morgue are roughly 1,000 square yards, with each body occupying about one square meter. Trucks have carted away the dead 10 times, which means about 10,000 bodies removed for burial.
"This, too, is not a perfect count," Dr. Lassegue said. "But it is the best that I can arrive at given our current limitations. We must not attach ourselves to wild estimates, but try to get at the best figures possible."
Wild estimates are not hard to find. Steps away, where morgue employees were cleaning the asphalt with hoses and brooms, one employee said 75,000 bodies had passed through; a second said 50,000; a third, 25,000.
The simple truth is that no accurate figure exists. In disasters like Hurricane Katrina, the 2004 Asian tsunami and the 2003 earthquake in Bam, Iran, the toll habitually swings way up at first, taking a couple of weeks to settle at a final, accepted number.
In countries like the United States or China, with vast resources to handle and count the dead, the numbers are likely to be more accurate than in a poor nation like Haiti, experts said.
The fact that the earthquake, with a magnitude of 7, devastated Port-au-Prince, Haiti's capital, virtually paralyzing a government that was hard-pressed to count the living in normal times, only compounded the problem.
"There are a lot of similarities with war here," said Dr. Frederick M. Burkle, an expert on disaster response. "When you have poor countries, poor governance and poor baseline demographics, things can vary quite a bit."
It is also virtually impossible to extrapolate the toll from an earthquake in one country to another. Factors like building materials and population density vary too much to make any such comparison scientific.
The adobe material in Bam, for example, was much more likely to suffocate people than the concrete in Haiti. The earthquake that virtually leveled Bam was a magnitude 6.3. The first government estimates pointed to more than 41,000 dead among an area population of 142,000. Eventually, the number settled at 26,271.
Round numbers are a sure sign that nobody knows, said Dr. Claude de Ville de Goyet, a Belgian expert on disaster emergency medicine. It takes a real count to establish a better figure. But in Haiti, where estimates of the dead now run from 50,000 to 200,000 or more, no one is sure that will ever happen.
"I don't think we will ever know what the death toll is from this earthquake," said Edmond Mulet, the newly appointed head of United Nations operations in Haiti. People are burying bodies by themselves, many have been thrown into dumps outside the city and an untold number still lie under the rubble, he said.
On Wednesday, United Nations officials began quoting an estimated number of bodies buried at 75,000, which they called the Haitian government figure. But the most common reaction among both United Nations and Haitian officials is that there are too many problems coping with the dire needs of the living to worry about the dead.
"We pass through the bodies, we saw the bodies, we don't have time to count them right now," said Guiteau Jean-Pierre, the director of the Haitian Red Cross.
Usually the death toll in earthquakes emerges as a subset of the number of missing persons reported, with some of them turning up later alive and some buried in the rubble. Haitians are being encouraged to report all the missing to the mayor's office or branches of the Department of Civil Protection, but again it is not clear how representative their lists may be at this point, Mr. Jean-Pierre said, with so many focused on survival or escaping Port-au-Prince.
Experts in disaster management say that if they know the population density of an area as well as the number of buildings destroyed, it is sometimes possible to produce an estimate.
In Haitian neighborhoods hit by the quake, the number of buildings knocked over varies from about 50 percent to less than 10 percent. The fact that some areas escaped relatively unscathed suggests a less-than-catastrophic toll as a percentage of the overall population of Port-au-Prince, which is estimated at about four million when temporary residents are included.
In Geneva, experts at the United Nations Operational Satellite Applications Program first calculated the level of destruction by looking at satellite images. They just received clearer aerial photos that will allow them to catalog the damage house by house.
But those experts have not yet correlated damage estimates from satellite photos with prequake data on population density in different parts of the city, making it difficult to estimate a probable range of casualties.
In the lower-middle-class area of Edmond Paul in southern Port-au-Prince, Isaac Jean Widner, a lawyer and community leader, said about 3,000 people lived there before the quake. He and his neighbors had begun compiling a list of the dead.
"We have nothing else to do since we are living under the sun and the stars," he said. He estimated that as many as 1,000 people had died, but between the exodus and those still trapped it was impossible to confirm.
Experts said that after the people of Port-au-Prince and the surrounding areas returned, it might be feasible to discern the toll by interviewing survivors about the number of relatives lost.
"It could be that 10 percent of our neighbors have perished, maybe more, maybe less," said Jean-Paul Duperval, 57, a geologist who lives in Edmond Paul. "Really, no one knows."
Simon Romero reported from Port-au-Prince, and Neil MacFarquhar from the United Nations.
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By SIMON ROMERO and NEIL MacFARQUHAR
Published: January 20, 2010
PORT-AU-PRINCE, Haiti — Dr. Alix Lassegue, the physician who runs this city's largest hospital, including its morgue, has been trying to figure out how many people died after the earth buckled so violently last week.
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Unlike most of the rough figures bandied about, Dr. Lassegue's are based on actual calculations. Standing amid the frenzy of patients being treated in every direction, he jotted down a few numbers with a pen.
The asphalt grounds in front of the morgue are roughly 1,000 square yards, with each body occupying about one square meter. Trucks have carted away the dead 10 times, which means about 10,000 bodies removed for burial.
"This, too, is not a perfect count," Dr. Lassegue said. "But it is the best that I can arrive at given our current limitations. We must not attach ourselves to wild estimates, but try to get at the best figures possible."
Wild estimates are not hard to find. Steps away, where morgue employees were cleaning the asphalt with hoses and brooms, one employee said 75,000 bodies had passed through; a second said 50,000; a third, 25,000.
The simple truth is that no accurate figure exists. In disasters like Hurricane Katrina, the 2004 Asian tsunami and the 2003 earthquake in Bam, Iran, the toll habitually swings way up at first, taking a couple of weeks to settle at a final, accepted number.
In countries like the United States or China, with vast resources to handle and count the dead, the numbers are likely to be more accurate than in a poor nation like Haiti, experts said.
The fact that the earthquake, with a magnitude of 7, devastated Port-au-Prince, Haiti's capital, virtually paralyzing a government that was hard-pressed to count the living in normal times, only compounded the problem.
"There are a lot of similarities with war here," said Dr. Frederick M. Burkle, an expert on disaster response. "When you have poor countries, poor governance and poor baseline demographics, things can vary quite a bit."
It is also virtually impossible to extrapolate the toll from an earthquake in one country to another. Factors like building materials and population density vary too much to make any such comparison scientific.
The adobe material in Bam, for example, was much more likely to suffocate people than the concrete in Haiti. The earthquake that virtually leveled Bam was a magnitude 6.3. The first government estimates pointed to more than 41,000 dead among an area population of 142,000. Eventually, the number settled at 26,271.
Round numbers are a sure sign that nobody knows, said Dr. Claude de Ville de Goyet, a Belgian expert on disaster emergency medicine. It takes a real count to establish a better figure. But in Haiti, where estimates of the dead now run from 50,000 to 200,000 or more, no one is sure that will ever happen.
"I don't think we will ever know what the death toll is from this earthquake," said Edmond Mulet, the newly appointed head of United Nations operations in Haiti. People are burying bodies by themselves, many have been thrown into dumps outside the city and an untold number still lie under the rubble, he said.
On Wednesday, United Nations officials began quoting an estimated number of bodies buried at 75,000, which they called the Haitian government figure. But the most common reaction among both United Nations and Haitian officials is that there are too many problems coping with the dire needs of the living to worry about the dead.
"We pass through the bodies, we saw the bodies, we don't have time to count them right now," said Guiteau Jean-Pierre, the director of the Haitian Red Cross.
Usually the death toll in earthquakes emerges as a subset of the number of missing persons reported, with some of them turning up later alive and some buried in the rubble. Haitians are being encouraged to report all the missing to the mayor's office or branches of the Department of Civil Protection, but again it is not clear how representative their lists may be at this point, Mr. Jean-Pierre said, with so many focused on survival or escaping Port-au-Prince.
Experts in disaster management say that if they know the population density of an area as well as the number of buildings destroyed, it is sometimes possible to produce an estimate.
In Haitian neighborhoods hit by the quake, the number of buildings knocked over varies from about 50 percent to less than 10 percent. The fact that some areas escaped relatively unscathed suggests a less-than-catastrophic toll as a percentage of the overall population of Port-au-Prince, which is estimated at about four million when temporary residents are included.
In Geneva, experts at the United Nations Operational Satellite Applications Program first calculated the level of destruction by looking at satellite images. They just received clearer aerial photos that will allow them to catalog the damage house by house.
But those experts have not yet correlated damage estimates from satellite photos with prequake data on population density in different parts of the city, making it difficult to estimate a probable range of casualties.
In the lower-middle-class area of Edmond Paul in southern Port-au-Prince, Isaac Jean Widner, a lawyer and community leader, said about 3,000 people lived there before the quake. He and his neighbors had begun compiling a list of the dead.
"We have nothing else to do since we are living under the sun and the stars," he said. He estimated that as many as 1,000 people had died, but between the exodus and those still trapped it was impossible to confirm.
Experts said that after the people of Port-au-Prince and the surrounding areas returned, it might be feasible to discern the toll by interviewing survivors about the number of relatives lost.
"It could be that 10 percent of our neighbors have perished, maybe more, maybe less," said Jean-Paul Duperval, 57, a geologist who lives in Edmond Paul. "Really, no one knows."
Simon Romero reported from Port-au-Prince, and Neil MacFarquhar from the United Nations.
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