Haití: ahora un desafío sanitario
Redacción
BBC Mundo
Según la OPS, 43 hospitales y 12 de campaña funcionan en P. Príncipe.
Casi dos semanas después del terremoto en Haití, que según los últimos datos ya dejó 150.000 muertos sólo en la capital, uno de los principales desafíos sigue siendo aumentar y coordinar la presencia de atención médica en las zonas afectadas por el sismo, advirtieron las autoridades sanitarias.
Varias agencias internacionales alertaron de que la ayuda internacional aún no pudo suplir toda la demanda de cirugías, medicinas y cuidados postoperatorios.
La Organización Panamericana para la Salud (OPS) dijo que por el momento no se desató ningún brote de enfermedades transmisibles como el cólera, el sarampión y la rubéola.
El programa de inmunización contra enfermedades no está funcionando, alertó la ONU.
Sin embargo, esta agencia de Naciones Unidas advirtió que el programa de inmunización contra otras enfermedades que sí podrían afectar pronto a la población, como el tétanos, no está funcionando.
Además, las autoridades sanitarias temen que el hacinamiento de personas en los improvisados campamentos de refugiados pueda acelerar la propagación de enfermedades.
clic Lea: 150.000 muertos en Puerto Príncipe
Hospitales de campaña
Una de las preocupaciones del Ministerio de Sanidad de Haití es el colapso de algunos hospitales y ambulatorios, donde la alta concentración de heridos impide a veces tratar a otras víctimas. Además, muchos curados no tienen casa a la que acudir cuando reciben el alta.
"Ahora lo que necesitamos es hospitales de campaña para ocuparnos de los postoperatorios y poder liberar así los hospitales, que tienen que retomar su actividad habitual", dijo a la agencia de noticias Efe el ministro de Salud haitiano, Alex Larsen.
Necesitamos hospitales de campaña para ocuparnos de los postoperatorios y poder liberar así los hospitales
Alex Larsen, ministro de Salud
Según el grupo de acción sanitaria de las Naciones Unidas en Haití, por el momento hay 43 hospitales que están funcionando en la zona de Puerto Príncipe, así como 12 hospitales de campaña.
"Los familiares de los heridos también quieren estar con los suyos en el hospital, porque así se sienten más protegidos: hay comida, hay agua... hay alguien a quien cuidar. Creo que el problema será organizar sitios temporales de cuidados ambulatorios, y convencer a toda esa gente de que se mueva a esos lugares", dijo la directora de la OPS, Mirta Roses.
clic Lea: ¿Cómo ayudar a Haití? Opinan los lectores
Coordinación
Las autoridades temen que el hacinamiento en campamentos acelere la propagación de enfermedades.
Roses, que visitó este domingo el país, le dijo al programa clic Conexión Haití de la BBC que la
organización está colaborando con el gobierno local en la elaboración de mapas que permitan localizar y analizar la situación de los distintos puntos de atención sanitaria en Haití.
Por su parte, el director gerente del Hospital General de Puerto Príncipe, Guy Laroche, advirtió de que hay dificultades en la coordinación de los equipos de numerosos países que trabajan en los hospitales y que llegaron a Haití en los primeros días tras el temblor.
"Cada vez nos resulta más difícil coordinar a los diferentes equipos que nos ayudan, cada uno tiene sus principios y su sensibilidad, todos quieren ser los primeros, se empujan entre ellos", relató Laroche.
Críticas a la ayuda
Por desgracia, aunque hay una presencia masiva (de equipos de rescate), no se están usando de la mejor manera
Guido Bertolaso, Protección Civil Italia
Precisamente, el jefe del servicio de Protección Civil italiano criticó la manera en que se están coordinando los esfuerzos humanitarios para asistir a las víctimas del sismo.
Guido Bertolaso, que supervisó la atención a los heridos durante el terremoto en la ciudad italiana de L'Aquila del año pasado, dijo que "por desgracia, aunque hay una presencia masiva (de equipos de rescate), no se están usando de la mejor manera".
Según Bertolaso, hay "demasiados egos" involucrados en las tareas de rescate.
El italiano también puso en duda la eficacia de la presencia militar estadounidense en el terreno. "Desde luego es una poderosa demostración de fuerza, pero está totalmente fuera de la realidad", dijo.
In Haiti, Many Amputees Have No Place to Go
Ruth Fremson/The New York Times
Jocelin François, 26, prayed Saturday under a tent outside University Hospital in Port-au-Prince. More Photos >
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By RAY RIVERA
Published: January 24, 2010
PORT-AU-PRINCE, Haiti — In a tent serving as an acute-care ward on the grounds of this city's biggest hospital, Jocelin François was sitting up in bed when a nurse went by, barking at him in French. Mr. François, whose left leg was amputated nearly to his knee after the earthquake on Jan. 12, threw out his arms and fell back on the mattress.
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Homeless Need Tents in Haiti
Interactive Feature
Perspectives on Haiti's Earthquake
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Haiti's Homeless Are Short Hundreds of Thousands of Tents, Aid Groups Say (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
"She said I have to go home," Mr. François, 26, said. "I don't want to leave until I can walk. I am weak. I have no place to go."
A doctor, sensing some confusion, intervened. "We're not telling him he has to go home," the doctor, Rose Antoine, 33, a native of Haiti who now lives in Pennsylvania, explained. "We're only telling him that this is an acute ward and we need the bed. We're trying to find a step-down unit where he can go to."
Nearly two weeks after the 7.0-magnitude earthquake that devastated Port-au-Prince, the immediate health crisis, which involved treating the injuries of people who were crushed by collapsing buildings and amputating damaged limbs, has begun to settle into a new phase.
This one is perhaps even more daunting: caring for thousands of post-operation trauma patients who are ready to leave the hospitals, but lack homes or families to go to. Many will require prosthetic limbs, frequent wound cleanings, bandage changes and months of rehabilitation.
As officials warn of possible outbreaks of infectious diseases from unsanitary conditions in hundreds of makeshift camps of people made homeless by the earthquake, they are also wondering where to send patients who have been treated for their injuries but require follow-up care.
"It's very hard to send people home when they don't have a house," said Dr. Surena Claude, who is coordinating a commission appointed by President René Préval to respond to the health emergency. "This situation is causing so many problems, because the hospitals are full, and if this continues we will have no room."
Early reports that there might be as many as 200,000 people who required amputations appear to have been exaggerated. At the University Hospital, Port-au-Prince's largest hospital, which received the brunt of the casualties after the quake, surgeons have performed about 225 amputations, mostly in the first few days. Doctors Without Borders estimated that its doctors had performed 125 amputations in 12 centers across the country. Hundreds more have been done in other clinics and hospitals elsewhere; the total is more likely to have been a few thousand.
Still, this is a country that, even before the earthquake created so much devastation, could barely cope with the healthy. There will be thousands more who will need rehabilitation for a range of injuries, from broken hips and femurs to neurological disorders from head injuries.
Health officials are still in the earliest stages of determining how to deal with post-operative patients, even as new patients are coming to the hospitals with secondary infections as well as the usual array of emergencies.
Dr. Mirta Roses, director of the World Health Organization's Pan-American region, said Sunday that all of the country's remaining 48 hospitals were at full capacity, including 11 in Port-au-Prince. That does not include the many clinics that aid groups have created.
Health officials are dealing with another problem. With aftershocks still rattling the city, including another on Sunday, many people are afraid to be inside the hospitals but are also unwilling to leave the grounds, where they can get food and water and have access to care.
"Even their relatives want to be with them in the hospitals," Dr. Roses said. She added that a solution would involve creating centers for ambulatory and post-operative care and persuading patients and their families to move there.
Even in the best of circumstances, it can take four to six months for a person who has had a traumatic amputation to function again, Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at N.Y.U. Langone Medical Center, said in a telephone interview. The Rusk Institute has a team in Haiti.
"What they really need to worry about in Haiti is infectious complication, so if you have an amputation of a leg or arm, that wound is subject to infection," Dr. Flanagan said. "And clearly they don't have all the medicines they need down there."
Dr. Claude, of the presidential commission, said the government was well aware of the situation.
"Unfortunately, a solution is not yet found," he said. Even when one is found, he said, logistics in this rubble-choked country will continue to be a problem.
The hope is that access to medicines and care will be eased greatly when the government carries out plans to build giant tent cities across Port-au-Prince and the vicinity, but that could take weeks.
At University Hospital, which is next to a nursing school that collapsed, killing about 50 students, Mr. François was relieved to learn that he did not have to leave immediately. He said he did not know if his relatives died in the earthquake, and that they did not know that he survived.
Outside the tent, a giant post-operative ward has been created in a grove of mango and oak trees, with low-slung tarps strung over patients' beds. The ward, known as "the forest," is filled with many patients who did not want to be inside the hospital. The doctors do not know how many patients are there, because they have been too busy to count.
In the United States, many of these patients would already be home, receiving outpatient care, said Dr. Michael Marin, chairman of surgery at Mount Sinai Hospital in New York, who is volunteering here with the International Medical Corps, the group coordinating relief efforts at the hospital.
Here, many of the patients cannot return home. "The only place they have to go is the forest," Dr. Marin said.
Ruth Fremson/The New York Times
Jocelin François, 26, prayed Saturday under a tent outside University Hospital in Port-au-Prince. More Photos >
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By RAY RIVERA
Published: January 24, 2010
PORT-AU-PRINCE, Haiti — In a tent serving as an acute-care ward on the grounds of this city's biggest hospital, Jocelin François was sitting up in bed when a nurse went by, barking at him in French. Mr. François, whose left leg was amputated nearly to his knee after the earthquake on Jan. 12, threw out his arms and fell back on the mattress.
Multimedia
Photographs
Homeless Need Tents in Haiti
Interactive Feature
Perspectives on Haiti's Earthquake
Related
Haiti's Homeless Are Short Hundreds of Thousands of Tents, Aid Groups Say (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
"She said I have to go home," Mr. François, 26, said. "I don't want to leave until I can walk. I am weak. I have no place to go."
A doctor, sensing some confusion, intervened. "We're not telling him he has to go home," the doctor, Rose Antoine, 33, a native of Haiti who now lives in Pennsylvania, explained. "We're only telling him that this is an acute ward and we need the bed. We're trying to find a step-down unit where he can go to."
Nearly two weeks after the 7.0-magnitude earthquake that devastated Port-au-Prince, the immediate health crisis, which involved treating the injuries of people who were crushed by collapsing buildings and amputating damaged limbs, has begun to settle into a new phase.
This one is perhaps even more daunting: caring for thousands of post-operation trauma patients who are ready to leave the hospitals, but lack homes or families to go to. Many will require prosthetic limbs, frequent wound cleanings, bandage changes and months of rehabilitation.
As officials warn of possible outbreaks of infectious diseases from unsanitary conditions in hundreds of makeshift camps of people made homeless by the earthquake, they are also wondering where to send patients who have been treated for their injuries but require follow-up care.
"It's very hard to send people home when they don't have a house," said Dr. Surena Claude, who is coordinating a commission appointed by President René Préval to respond to the health emergency. "This situation is causing so many problems, because the hospitals are full, and if this continues we will have no room."
Early reports that there might be as many as 200,000 people who required amputations appear to have been exaggerated. At the University Hospital, Port-au-Prince's largest hospital, which received the brunt of the casualties after the quake, surgeons have performed about 225 amputations, mostly in the first few days. Doctors Without Borders estimated that its doctors had performed 125 amputations in 12 centers across the country. Hundreds more have been done in other clinics and hospitals elsewhere; the total is more likely to have been a few thousand.
Still, this is a country that, even before the earthquake created so much devastation, could barely cope with the healthy. There will be thousands more who will need rehabilitation for a range of injuries, from broken hips and femurs to neurological disorders from head injuries.
Health officials are still in the earliest stages of determining how to deal with post-operative patients, even as new patients are coming to the hospitals with secondary infections as well as the usual array of emergencies.
Dr. Mirta Roses, director of the World Health Organization's Pan-American region, said Sunday that all of the country's remaining 48 hospitals were at full capacity, including 11 in Port-au-Prince. That does not include the many clinics that aid groups have created.
Health officials are dealing with another problem. With aftershocks still rattling the city, including another on Sunday, many people are afraid to be inside the hospitals but are also unwilling to leave the grounds, where they can get food and water and have access to care.
"Even their relatives want to be with them in the hospitals," Dr. Roses said. She added that a solution would involve creating centers for ambulatory and post-operative care and persuading patients and their families to move there.
Even in the best of circumstances, it can take four to six months for a person who has had a traumatic amputation to function again, Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at N.Y.U. Langone Medical Center, said in a telephone interview. The Rusk Institute has a team in Haiti.
"What they really need to worry about in Haiti is infectious complication, so if you have an amputation of a leg or arm, that wound is subject to infection," Dr. Flanagan said. "And clearly they don't have all the medicines they need down there."
Dr. Claude, of the presidential commission, said the government was well aware of the situation.
"Unfortunately, a solution is not yet found," he said. Even when one is found, he said, logistics in this rubble-choked country will continue to be a problem.
The hope is that access to medicines and care will be eased greatly when the government carries out plans to build giant tent cities across Port-au-Prince and the vicinity, but that could take weeks.
At University Hospital, which is next to a nursing school that collapsed, killing about 50 students, Mr. François was relieved to learn that he did not have to leave immediately. He said he did not know if his relatives died in the earthquake, and that they did not know that he survived.
Outside the tent, a giant post-operative ward has been created in a grove of mango and oak trees, with low-slung tarps strung over patients' beds. The ward, known as "the forest," is filled with many patients who did not want to be inside the hospital. The doctors do not know how many patients are there, because they have been too busy to count.
In the United States, many of these patients would already be home, receiving outpatient care, said Dr. Michael Marin, chairman of surgery at Mount Sinai Hospital in New York, who is volunteering here with the International Medical Corps, the group coordinating relief efforts at the hospital.
Here, many of the patients cannot return home. "The only place they have to go is the forest," Dr. Marin said.
As Haiti's Focus Turns to Shelter, Families Press Search for Missing
Michael Appleton for The New York Times
A woman rested under a sheet in a makeshift tent village near the airport in Port-au-Prince. The call for aid groups to focus on shelter came 12 days after the quake. More Photos >
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By GINGER THOMPSON
Published: January 24, 2010
PORT-AU-PRINCE, Haiti — As officials focused Sunday on the Herculean task of this nation's physical recovery — clearing the wreckage and setting up housing for the hundreds of thousands left homeless by an earthquake — desperate relatives of those still missing pleaded with the authorities not to give up the search.
Multimedia
Interactive Feature
Perspectives on Haiti's Earthquake
Photographs
Homeless Need Tents in Haiti
Related
In Haiti, Many Amputees Have No Place to Go (January 25, 2010)
On Street Tracing Haiti's Pain, Survival Goes On (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
With so many of this city's buildings left in ruins and a public health crisis brewing from a failed sanitation system and a shortage of clean water, search and rescue efforts were winding down.
Across this devastated capital, demolition crews were razing buildings teetering dangerously close to collapse, and teams of American surveyors were expected to begin examining the stability of those structures left intact so that people whose homes were spared can move off the streets and businesses can go back to work.
International aid organizations said they had identified three sites to temporarily resettle the homeless. Brazilian teams have begun clearing a field in the Croix des Bouquets neighborhood for a tent city for some 10,000 people, according to Niurka Piñeiro, a spokeswoman for the International Organization for Migration, but it estimates the need at 100,000 tents for families of five, to assist 500,000 people.
Another temporary settlement will be established on Rue de Tabarre for the estimated 4,000 people now camped in squalid conditions on the grounds of the prime minister's home. A third settlement will be built in the city of Léogâne. And French authorities have said that they will begin efforts to provide water and sanitation to several thousand people crowded in the Champ de Mars plaza downtown.
"Tents, tents, tents," Ms. Piñeiro said. "That's the word we want to get out. We need tents."
The call for aid organizations to focus on shelter came 12 days after the quake, when an estimated 250,000 people were still living under pieces of scavenged tarpaulins, tin and bedsheets. With so many people lacking access to clean water and sanitation, illnesses are running rampant.
"We're getting a lot of kids with diarrhea," said Yveline Auguste, who is working at a Haitian hospital on behalf of Catholic Relief Services. So far the cases are generally mild enough to be treated with medicine at home, she said.
But Rick Bauer, a shelter expert for the international aid agency Oxfam, said that the temporary camps would work only if they were secure, their residents were working and the government offered a clear exit strategy.
"The camps must not become warehouses of people waiting for permanent homes that never materialize," he said.
The Inter-American Development Bank has committed to building 10,000 houses in Léogâne, Ms. Piñeiro said, and further plans for permanent housing will be the focus of a United Nations donors' conference in Montreal on Monday.
Still, the pivot from rescue to recovery met resistance from relatives of the missing, whose pleas not to give up hope were heard at funerals, demolition sites and displacement camps across the city.
Bulldozers were halted at the Collège du Canapé-Vert when one of the teachers reported getting a telephone message from someone believed trapped in the school's ruins.
Capt. Christian Morel, leader of a French search team, said that four other teams had searched the school and found no signs of life. He said search teams had received frequent reports of texts or messages from those believed to be dead. But he speculated that either the messages were just now being transmitted as cellphone towers came back on line, or that they were the work of wishful thinking.
Nonetheless, he unleashed search dogs to go over the ruins of the school again. And again he came up with nothing.
That was not enough, however, to convince Madeline Dorville, whose husband, Oriol Randiche, was attending a teacher training program at the school when it collapsed. Tears wetting her cheeks, she said she would be tempted to throw herself in front of the waiting orange bulldozer if it resumed demolition work.
"How can we trust these kinds of decisions to a dog?" she said. "Dogs are not detectives or magicians."
For others, the thought of starting a new chapter was all the more excruciating because they had not been able to properly close the last one.
"Can you imagine trying to say goodbye to your brother with his body still in the concrete?" asked Lindsay Soliman, 24, a law student who was conducting a funeral service with her family for her brother, Mikenley Soliman, 21. His body lay somewhere under the rubble of a home in the Carrefour district.
Ms. Soliman's family decided that it was time for his funeral, which they held Sunday at a badly damaged house owned by the Roman Catholic Church, using a photo of him instead of his body.
Mikenley, a computer science student, "dreamed of America like no one," his sister said. He was a Los Angeles Lakers fan and an aspiring computer programmer who planned to move to Maryland this year after attaining a United States residence visa.
He was watching a soccer game with three friends when the earth shook and the walls of the house fell in. None of the men made it out.
Steeve Hilaire, 27, a police officer and a cousin of Mr. Soliman's, said he could not understand why the government was in such a hurry to begin clearing away the debris before recovering all who were lost.
"The bulldozers would not be roaring if a government minister's body or his relatives were under there," he said. "But when it's just a regular person, no one cares."
Reporting was contributed by Simon Romero, Deborah Sontag, Damien Cave, Marc Lacey and Ray Rivera.
Michael Appleton for The New York Times
A woman rested under a sheet in a makeshift tent village near the airport in Port-au-Prince. The call for aid groups to focus on shelter came 12 days after the quake. More Photos >
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Reprints
By GINGER THOMPSON
Published: January 24, 2010
PORT-AU-PRINCE, Haiti — As officials focused Sunday on the Herculean task of this nation's physical recovery — clearing the wreckage and setting up housing for the hundreds of thousands left homeless by an earthquake — desperate relatives of those still missing pleaded with the authorities not to give up the search.
Multimedia
Interactive Feature
Perspectives on Haiti's Earthquake
Photographs
Homeless Need Tents in Haiti
Related
In Haiti, Many Amputees Have No Place to Go (January 25, 2010)
On Street Tracing Haiti's Pain, Survival Goes On (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
With so many of this city's buildings left in ruins and a public health crisis brewing from a failed sanitation system and a shortage of clean water, search and rescue efforts were winding down.
Across this devastated capital, demolition crews were razing buildings teetering dangerously close to collapse, and teams of American surveyors were expected to begin examining the stability of those structures left intact so that people whose homes were spared can move off the streets and businesses can go back to work.
International aid organizations said they had identified three sites to temporarily resettle the homeless. Brazilian teams have begun clearing a field in the Croix des Bouquets neighborhood for a tent city for some 10,000 people, according to Niurka Piñeiro, a spokeswoman for the International Organization for Migration, but it estimates the need at 100,000 tents for families of five, to assist 500,000 people.
Another temporary settlement will be established on Rue de Tabarre for the estimated 4,000 people now camped in squalid conditions on the grounds of the prime minister's home. A third settlement will be built in the city of Léogâne. And French authorities have said that they will begin efforts to provide water and sanitation to several thousand people crowded in the Champ de Mars plaza downtown.
"Tents, tents, tents," Ms. Piñeiro said. "That's the word we want to get out. We need tents."
The call for aid organizations to focus on shelter came 12 days after the quake, when an estimated 250,000 people were still living under pieces of scavenged tarpaulins, tin and bedsheets. With so many people lacking access to clean water and sanitation, illnesses are running rampant.
"We're getting a lot of kids with diarrhea," said Yveline Auguste, who is working at a Haitian hospital on behalf of Catholic Relief Services. So far the cases are generally mild enough to be treated with medicine at home, she said.
But Rick Bauer, a shelter expert for the international aid agency Oxfam, said that the temporary camps would work only if they were secure, their residents were working and the government offered a clear exit strategy.
"The camps must not become warehouses of people waiting for permanent homes that never materialize," he said.
The Inter-American Development Bank has committed to building 10,000 houses in Léogâne, Ms. Piñeiro said, and further plans for permanent housing will be the focus of a United Nations donors' conference in Montreal on Monday.
Still, the pivot from rescue to recovery met resistance from relatives of the missing, whose pleas not to give up hope were heard at funerals, demolition sites and displacement camps across the city.
Bulldozers were halted at the Collège du Canapé-Vert when one of the teachers reported getting a telephone message from someone believed trapped in the school's ruins.
Capt. Christian Morel, leader of a French search team, said that four other teams had searched the school and found no signs of life. He said search teams had received frequent reports of texts or messages from those believed to be dead. But he speculated that either the messages were just now being transmitted as cellphone towers came back on line, or that they were the work of wishful thinking.
Nonetheless, he unleashed search dogs to go over the ruins of the school again. And again he came up with nothing.
That was not enough, however, to convince Madeline Dorville, whose husband, Oriol Randiche, was attending a teacher training program at the school when it collapsed. Tears wetting her cheeks, she said she would be tempted to throw herself in front of the waiting orange bulldozer if it resumed demolition work.
"How can we trust these kinds of decisions to a dog?" she said. "Dogs are not detectives or magicians."
For others, the thought of starting a new chapter was all the more excruciating because they had not been able to properly close the last one.
"Can you imagine trying to say goodbye to your brother with his body still in the concrete?" asked Lindsay Soliman, 24, a law student who was conducting a funeral service with her family for her brother, Mikenley Soliman, 21. His body lay somewhere under the rubble of a home in the Carrefour district.
Ms. Soliman's family decided that it was time for his funeral, which they held Sunday at a badly damaged house owned by the Roman Catholic Church, using a photo of him instead of his body.
Mikenley, a computer science student, "dreamed of America like no one," his sister said. He was a Los Angeles Lakers fan and an aspiring computer programmer who planned to move to Maryland this year after attaining a United States residence visa.
He was watching a soccer game with three friends when the earth shook and the walls of the house fell in. None of the men made it out.
Steeve Hilaire, 27, a police officer and a cousin of Mr. Soliman's, said he could not understand why the government was in such a hurry to begin clearing away the debris before recovering all who were lost.
"The bulldozers would not be roaring if a government minister's body or his relatives were under there," he said. "But when it's just a regular person, no one cares."
Reporting was contributed by Simon Romero, Deborah Sontag, Damien Cave, Marc Lacey and Ray Rivera.
On Street Tracing Haiti's Pain, Survival Goes On
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By DEBORAH SONTAG and GINGER THOMPSON
Published: January 24, 2010
PORT-AU-PRINCE, Haiti — Avenue Poupelard in the center of this devastated city pulses with life and reeks of death almost two weeks after the earthquake.
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Ozier Muhammad/The New York Times
Rolienne Verrier, 42, opened a restaurant in a rusty railroad car on Avenue Poupelard about a week after the quake.
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Devastation and Survival Along Avenue Poupelard
Interactive Feature
Perspectives on Haiti's Earthquake
Related
Haiti's Homeless Are Short Hundreds of Thousands of Tents, Aid Groups Say (January 25, 2010)
In Haiti, Many Amputees Have No Place to Go (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
Enlarge This Image
Ozier Muhammad/The New York Times
Jeaney Hypolite helped his son Jeanan, 23, walk back to their temporary shelter on Thursday after Jeanan was treated at a clinic.
Before what Haitians call "the event," it was a chaotically bustling street of lottery kiosks and cybercafes, gated homes and shacks, churches and schools.
Now, a coffin maker spends the day hammering wood as fast as he can get it, while the body of a 6-year-old boy decomposes in the ruins of a school. Hundreds of displaced residents squat in the junked cars of a mechanic's lot as a lawyer, writing briefs, camps under the bougainvillea of her uninhabitable villa. A fiery pastor preaches outside the ruins of his church; street vendors hawk small plastic bags of water; an AIDS clinic reopens briefly each day for patients who survived the earthquake but ran out of essential pills.
And, bound in muslin like a mummy, a cadaver lies beneath a sign that screams "S O S," deposited there by neighbors as if to underscore their cry for help as they struggle to reconstitute some semblance of community and move forward.
"We are not blood relatives but we are all the dispossessed of Avenue Poupelard," said Franc Danjou, gesturing at those around him in one encampment. "We must pool our resources — and get help! — or in a year this community will be dead."
Over a quarter-mile stretch, Avenue Poupelard, a residential and commercial strip in the area called Nazon, offers a panorama of life in the ruins of the Haitian capital where a stricken heart still beats.
A complete damage assessment is impossible without tax and property records, which are not available. But of 53 buildings examined on Avenue Poupelard, only six appeared to be intact. Twenty-three are completely or partially collapsed. And the remaining 24 show damage ranging from cracks to crumbled walls, with daily aftershocks presenting a continuing threat.
Despite such widespread destruction — and an incalculable number of deaths — almost no one on Avenue Poupelard seems to let himself cry, not even the children. Grief is still buried under shock, and there is a stoic determination to face the future because, no matter how tenuous, it is far less frightening than the immediate past. It is daunting to imagine the recovery that lies ahead. But in this one pocket of the city, as elsewhere, life of a survivalist sort goes on.
Some small businesses — a barbershop here, a tiny food stand there — are stirring back to life. Political debate, a sign of normalcy, is resurfacing, with many openly cursing President René Préval for making few forays into hard-hit areas.
Food, water, shelter, sickness and death: these continue to be urgent problems even as some help is finally arriving. For many on Avenue Poupelard, the trauma of loss has created an almost existential vertigo. Nora Jean Phillipe, an office worker who sat beside a tent with a box of Pop Tarts in her lap, was keenly, almost obsessively, focused on one thing: excavating her family's birth certificates from their destroyed house.
"Please understand," she said. "I lost my home. I lost my son. Somehow, I have to find a way to salvage our identity."
Determined to Stay
The Legros family settled into their villa on Avenue Poupelard over a half-century ago when the area was affluent and surrounded by farmland. As he grew up, Michel Legros, 53, owner of a popular radio station, Radio Maximum, watched the neighborhood grow denser and more socioeconomically mixed.
Late last week, Mr. Legros and his sister Gladys Legros, a lawyer, opened their gates, ushering visitors onto the patio in the shadow of their elegant house, which is still standing but badly damaged.
Mr. Legros is a well-known political activist. "Politics sticks to him like a disease," his sister said. His patio, shaded by palm and banana trees, used to serve as a meeting place for the Democratic Convergence, a largely elite political coalition opposed to former President Jean-Bertrand Aristide, a champion of the poor. Now the Legros family sleeps there alongside the many less privileged, displaced neighbors they have invited in.
Most of his friends, Mr. Legros said, have abandoned the country, but he refuses to go. "If you hear there is one person left standing in Haiti," he said, "you can be sure it's me."
Despite his bravado, Mr. Legros, unlike many of his neighbors who have repressed the horror of the earthquake itself, keeps reliving it.
After the earthquake struck, he said, he rushed downtown, where his cousins owned a small hotel and found it a pile of heavy concrete slabs. After learning that his cousins were buried inside, he saw an employee, whom he knew only as Rudy, lodged in the rubble, crying for help. He ran to search for equipment to help get Rudy out. But with Port-au-Prince wrecked from one end to the other, Mr. Legros found that his political connections did not help — not on the day of the earthquake, or for the two days after that.
By the time Mr. Legros secured a bulldozer, Rudy was dead.
"I feel impotent, and that impotence bothers me a lot," he said. "But what bothers me even more, is that my country is impotent.
"My God," he added, "what has happened to Haiti?"
Crossroads of Need
Avenue Poupelard crosses a major north-south thoroughfare, Avenue Martin Luther King. At their intersection, a sign in English — "We need help. Food. Water." — has arrows pointing both east and west.
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By DEBORAH SONTAG and GINGER THOMPSON
Published: January 24, 2010
PORT-AU-PRINCE, Haiti — Avenue Poupelard in the center of this devastated city pulses with life and reeks of death almost two weeks after the earthquake.
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Ozier Muhammad/The New York Times
Rolienne Verrier, 42, opened a restaurant in a rusty railroad car on Avenue Poupelard about a week after the quake.
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Devastation and Survival Along Avenue Poupelard
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Perspectives on Haiti's Earthquake
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Haiti's Homeless Are Short Hundreds of Thousands of Tents, Aid Groups Say (January 25, 2010)
In Haiti, Many Amputees Have No Place to Go (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
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Ozier Muhammad/The New York Times
Jeaney Hypolite helped his son Jeanan, 23, walk back to their temporary shelter on Thursday after Jeanan was treated at a clinic.
Before what Haitians call "the event," it was a chaotically bustling street of lottery kiosks and cybercafes, gated homes and shacks, churches and schools.
Now, a coffin maker spends the day hammering wood as fast as he can get it, while the body of a 6-year-old boy decomposes in the ruins of a school. Hundreds of displaced residents squat in the junked cars of a mechanic's lot as a lawyer, writing briefs, camps under the bougainvillea of her uninhabitable villa. A fiery pastor preaches outside the ruins of his church; street vendors hawk small plastic bags of water; an AIDS clinic reopens briefly each day for patients who survived the earthquake but ran out of essential pills.
And, bound in muslin like a mummy, a cadaver lies beneath a sign that screams "S O S," deposited there by neighbors as if to underscore their cry for help as they struggle to reconstitute some semblance of community and move forward.
"We are not blood relatives but we are all the dispossessed of Avenue Poupelard," said Franc Danjou, gesturing at those around him in one encampment. "We must pool our resources — and get help! — or in a year this community will be dead."
Over a quarter-mile stretch, Avenue Poupelard, a residential and commercial strip in the area called Nazon, offers a panorama of life in the ruins of the Haitian capital where a stricken heart still beats.
A complete damage assessment is impossible without tax and property records, which are not available. But of 53 buildings examined on Avenue Poupelard, only six appeared to be intact. Twenty-three are completely or partially collapsed. And the remaining 24 show damage ranging from cracks to crumbled walls, with daily aftershocks presenting a continuing threat.
Despite such widespread destruction — and an incalculable number of deaths — almost no one on Avenue Poupelard seems to let himself cry, not even the children. Grief is still buried under shock, and there is a stoic determination to face the future because, no matter how tenuous, it is far less frightening than the immediate past. It is daunting to imagine the recovery that lies ahead. But in this one pocket of the city, as elsewhere, life of a survivalist sort goes on.
Some small businesses — a barbershop here, a tiny food stand there — are stirring back to life. Political debate, a sign of normalcy, is resurfacing, with many openly cursing President René Préval for making few forays into hard-hit areas.
Food, water, shelter, sickness and death: these continue to be urgent problems even as some help is finally arriving. For many on Avenue Poupelard, the trauma of loss has created an almost existential vertigo. Nora Jean Phillipe, an office worker who sat beside a tent with a box of Pop Tarts in her lap, was keenly, almost obsessively, focused on one thing: excavating her family's birth certificates from their destroyed house.
"Please understand," she said. "I lost my home. I lost my son. Somehow, I have to find a way to salvage our identity."
Determined to Stay
The Legros family settled into their villa on Avenue Poupelard over a half-century ago when the area was affluent and surrounded by farmland. As he grew up, Michel Legros, 53, owner of a popular radio station, Radio Maximum, watched the neighborhood grow denser and more socioeconomically mixed.
Late last week, Mr. Legros and his sister Gladys Legros, a lawyer, opened their gates, ushering visitors onto the patio in the shadow of their elegant house, which is still standing but badly damaged.
Mr. Legros is a well-known political activist. "Politics sticks to him like a disease," his sister said. His patio, shaded by palm and banana trees, used to serve as a meeting place for the Democratic Convergence, a largely elite political coalition opposed to former President Jean-Bertrand Aristide, a champion of the poor. Now the Legros family sleeps there alongside the many less privileged, displaced neighbors they have invited in.
Most of his friends, Mr. Legros said, have abandoned the country, but he refuses to go. "If you hear there is one person left standing in Haiti," he said, "you can be sure it's me."
Despite his bravado, Mr. Legros, unlike many of his neighbors who have repressed the horror of the earthquake itself, keeps reliving it.
After the earthquake struck, he said, he rushed downtown, where his cousins owned a small hotel and found it a pile of heavy concrete slabs. After learning that his cousins were buried inside, he saw an employee, whom he knew only as Rudy, lodged in the rubble, crying for help. He ran to search for equipment to help get Rudy out. But with Port-au-Prince wrecked from one end to the other, Mr. Legros found that his political connections did not help — not on the day of the earthquake, or for the two days after that.
By the time Mr. Legros secured a bulldozer, Rudy was dead.
"I feel impotent, and that impotence bothers me a lot," he said. "But what bothers me even more, is that my country is impotent.
"My God," he added, "what has happened to Haiti?"
Crossroads of Need
Avenue Poupelard crosses a major north-south thoroughfare, Avenue Martin Luther King. At their intersection, a sign in English — "We need help. Food. Water." — has arrows pointing both east and west.
To the immediate west lies the AIDS clinic opposite the car repair lot; to the immediate east, the coffin maker — who is charging his neighbors $125 per plywood box, about a quarter of the average yearly income — and a cybercafe offering free phone calls to the United States. Among those thronging the PMS Cyber Café late last week, one caller was recounting how a cousin had died at the hospital: "They cut off his leg," he said into the phone, "so I don't think he wanted to live after that."
Multimedia
Interactive Graphic
Devastation and Survival Along Avenue Poupelard
Interactive Feature
Perspectives on Haiti's Earthquake
Related
Haiti's Homeless Are Short Hundreds of Thousands of Tents, Aid Groups Say (January 25, 2010)
In Haiti, Many Amputees Have No Place to Go (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
Across the street from the cafe last Thursday, a community center was converted into a triage unit by American doctors, volunteers with a Catholic missionary group who tended dozens of survivors with crush injuries and fractures. The patients included Linda Saint Alain, 27, who had languished in pain with a broken back on the patio of a family home since being dragged from its wreckage during the quake.
The American doctors quickly determined that Ms. Saint Alain needed to be transferred to a hospital, and helped her brother put her onto a flatbed. Before leaving, the brother jumped down to hug Gaston Jeaneddy, a voodoo priest and community leader who had arranged for the rescue team to visit the neighborhood.
"No one person can fix all of Haiti," said Mr. Jeaneddy, a short, muscular man with the bark of a drill sergeant. "Each has to fix his own piece."
Earthquake injuries are not the only urgent medical problems on Avenue Poupelard. The quake has left many thousands of Haitians who have H.I.V./AIDS without the antiretroviral medication that they need to stay healthy. On Thursday, scores of newly homeless Haitians managed to make their way to a dermatology clinic on Avenue Poupelard, where a guard let them wait for assistance on the wooden benches of the open-air waiting room.
The clinic, which used to focus on leprosy and now treats many AIDS patients, is damaged but standing. Its staff members, many of them also homeless, have been showing up for a couple of hours a day to dispense pills.
One patient, Yvose Descosse, 38, wore a turquoise flower in her hair, and twisted her beaded necklace as she spoke in a soft sing-song. She had walked three hours to the clinic from her tent city in the sprawling slum of Cité Soleil. Having missed an appointment the day after the earthquake, she had run out of pills and found herself racked by diarrhea and vomiting — on the streets, no less.
Further, she added, patting her very small belly, she was eight months pregnant and the father of her baby had been killed during the earthquake.
"I needed to come to Poupelard, where they will help me," she said, covering her face with her hands.
Seated near her, Claude Chevalier, 24, a medical student who has H.I.V., said the earthquake had killed his mother, father and sister and left him completely alone. "Everyone in Haiti is in the same situation," he said, closing his eyes briefly, then shrugging.
Not everyone can shrug. For some, the dispiriting reality inspires grim thoughts. Florence Mabeau, a former Red Cross janitor, said she almost envies her teenage daughter for lying unconscious at the General Hospital: "I wish I could sleep through this nightmare," she said.
Ms. Mabeau was squatting in the mechanic's yard opposite the dermatology clinic, where about 300 people have taken shelter in junked cars. It is one of the largest encampments in the neighborhood, with extended families crowding into broken-down vans and painted jitneys. At night, they reserve the best car seats — where there are seats — for the babies, and sleep in the open air.
Multimedia
Interactive Graphic
Devastation and Survival Along Avenue Poupelard
Interactive Feature
Perspectives on Haiti's Earthquake
Related
Haiti's Homeless Are Short Hundreds of Thousands of Tents, Aid Groups Say (January 25, 2010)
In Haiti, Many Amputees Have No Place to Go (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
Across the street from the cafe last Thursday, a community center was converted into a triage unit by American doctors, volunteers with a Catholic missionary group who tended dozens of survivors with crush injuries and fractures. The patients included Linda Saint Alain, 27, who had languished in pain with a broken back on the patio of a family home since being dragged from its wreckage during the quake.
The American doctors quickly determined that Ms. Saint Alain needed to be transferred to a hospital, and helped her brother put her onto a flatbed. Before leaving, the brother jumped down to hug Gaston Jeaneddy, a voodoo priest and community leader who had arranged for the rescue team to visit the neighborhood.
"No one person can fix all of Haiti," said Mr. Jeaneddy, a short, muscular man with the bark of a drill sergeant. "Each has to fix his own piece."
Earthquake injuries are not the only urgent medical problems on Avenue Poupelard. The quake has left many thousands of Haitians who have H.I.V./AIDS without the antiretroviral medication that they need to stay healthy. On Thursday, scores of newly homeless Haitians managed to make their way to a dermatology clinic on Avenue Poupelard, where a guard let them wait for assistance on the wooden benches of the open-air waiting room.
The clinic, which used to focus on leprosy and now treats many AIDS patients, is damaged but standing. Its staff members, many of them also homeless, have been showing up for a couple of hours a day to dispense pills.
One patient, Yvose Descosse, 38, wore a turquoise flower in her hair, and twisted her beaded necklace as she spoke in a soft sing-song. She had walked three hours to the clinic from her tent city in the sprawling slum of Cité Soleil. Having missed an appointment the day after the earthquake, she had run out of pills and found herself racked by diarrhea and vomiting — on the streets, no less.
Further, she added, patting her very small belly, she was eight months pregnant and the father of her baby had been killed during the earthquake.
"I needed to come to Poupelard, where they will help me," she said, covering her face with her hands.
Seated near her, Claude Chevalier, 24, a medical student who has H.I.V., said the earthquake had killed his mother, father and sister and left him completely alone. "Everyone in Haiti is in the same situation," he said, closing his eyes briefly, then shrugging.
Not everyone can shrug. For some, the dispiriting reality inspires grim thoughts. Florence Mabeau, a former Red Cross janitor, said she almost envies her teenage daughter for lying unconscious at the General Hospital: "I wish I could sleep through this nightmare," she said.
Ms. Mabeau was squatting in the mechanic's yard opposite the dermatology clinic, where about 300 people have taken shelter in junked cars. It is one of the largest encampments in the neighborhood, with extended families crowding into broken-down vans and painted jitneys. At night, they reserve the best car seats — where there are seats — for the babies, and sleep in the open air.
Huguette Joseph, 53, who shares a yellow Nissan bus with 10 children and grandchildren, said she did not have much before the earthquake, living in a leaky, one-room house. Still, she said, "I had my own house. I had my own kitchen. I had my own pots for cooking. I had shoes on my feet."
Multimedia
Interactive Graphic
Devastation and Survival Along Avenue Poupelard
Interactive Feature
Perspectives on Haiti's Earthquake
Related
Haiti's Homeless Are Short Hundreds of Thousands of Tents, Aid Groups Say (January 25, 2010)
In Haiti, Many Amputees Have No Place to Go (January 25, 2010)
Times Topics: Haiti
Haiti Disaster Relief: How to Contribute | Tips on Donating
More Multimedia on the Haiti Earthquake
Sermon Amid the Ruins
Before the earthquake battered the large Evangelie de la Grâce Church, Pastor Enso Sylvert said he routinely drew hundreds of worshipers who spilled out onto the sidewalk for Sunday services. Now he has a gravel lot and a circle of folding chairs, but during a morning service last Thursday, his faith was on fire. He wore a salmon shirt, bounced on the balls of his feet and thrust his Bible in the air, working a crowd of displaced residents into a good-spirited frenzy.
"We call the president 'Onion,' " he said in a chant, using a Creole insult. "We call the ministers 'Onion.' We call the government 'Onion.' Our only hope lies with God."
For a couple of hours, the service enlivened the camp beside the church, a ragtag assemblage of working-class and poor neighbors who once coexisted in the various structures — main house, cottage, shacks — on an old villa property with an empty, cracked swimming pool. Jean-Claude Gouboth, 36, a thin, serious man in an Italian soccer shirt whose small store was crushed in the earthquake, lived in the main house, now damaged.
That made him the de facto leader of the impromptu refugee camp, a post that he did not appear to relish. Life was not easy before the earthquake, he said, with three children to put through school and mounting debt to the bank underwriting his business. But now his 3-year-old girl had been killed by the quake, his wife and other children had fled to the countryside, and he was sleeping with the neighbors in his rocky backyard.
"We are trying to stay on friendly terms, but sometimes there are disputes," he said, citing not a squabble over scant resources, but a theological debate about exactly what God was trying to say when he shook Haiti to its core.
Jesumelle Gustave, 44, who lives in the rubble of the church, does not participate in such esoteric conversation. She thanks God, she said, for leaving $4 in her husband's pocket when the earthquake killed him, money that she has needed to sustain her family of five, including a son with a broken back and an amputated finger.
"How merciful is God!" she said, as the little boys in the encampment kicked a soccer ball onto Avenue Poupelard and across the street to a schoolyard where some friends are living.
Two slim teenage girls ran past them in flip-flops, mattresses on their heads. The school, its roof knocked off, has one wall chiseled away to reveal a blackboard chalked with the chemistry homework assigned the night the earthquake struck.
"We don't have school anymore in Haiti," Sophonie Daniel, 17, said. "Can we come to your country to study?"
Her friend Danuela Bayard, a 21-year-old marketing student, chimed in: "We are young, and we don't want to waste our time in life. This earthquake just paralyzes our lives."
Conditions are harsh. The people pool their pennies to buy small packets of water and spaghetti, they have no running water or electrical generator and diarrhea is rampant. And now, most have little patience for questions about where they were when the earthquake struck. What's gone is gone, some say, slapping their hands. But others cannot help but yearn for what they lost.
In Haiti, children are the most vulnerable
Updated 3h 21m ago | Comment | Recommend E-mail | Save | Print | Reprints & Permissions |
Enlarge By Jack Gruber, USA TODAY
Seven-month-old Lei Auralis waits for food Saturday from his mother, Roseline Auralis, right, on a sheet with his cousin Migerson Centhilaire, 2, at the Brothers School in Port-au-Prince, Haiti.
EARLIER HAITI COVERAGE
Interactives: Photos from Haiti | Map of earthquake zone | Timeline of deadly quakes
Haiti: Country's outlook had been improving | Geology points to big quakes
Washington: Obama pledges starter of $100M in relief | Status halts deportations | Clinton, Bush combine efforts
Reaction: Churches offer solace | News slow to reach loved ones | Facebook becomes 'lifeline'
Aid: Donations may break records | Private donors critical | U.S. agencies coordinate rescues | World mobilizes relief
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By Donna Leinwand, Marisol Bello and Martha T. Moore, USA TODAY
PORT-AU-PRINCE, Haiti — In the night, the children wake up crying.
"They always ask for someone to be with them. They ask why it happened. They think God is mad at them," says Marie Louise Woel-Michel, a hospital volunteer in the shattered Carrefour neighborhood of the Haitian capital. "They don't play."
The lawn of Adventist Hospital has become a camp for patients and their families, many of whom are among the 2 million people displaced by the earthquake that destroyed this city. Last week, residents found a little boy, 4 years old at most, in the bushes. He was chilled, dehydrated and silent.
"Either the parents are dead or abandoned him. We don't know his name," says Woel-Michel, a school principal whose husband is an Adventist radiologist. "We talk and talk and talk, but he doesn't answer."
BACKGROUND: Marines studied their own history in Haiti
GOVERNMENT: 150K quake victims buried in Haiti
MORE COVERAGE: Haiti calls off search and rescue
PHOTOS: Devastating earthquake hits Haiti
In the devastation left after the Haiti earthquake, the heaviest blow is falling on the weakest: children. Already poor, underfed and underschooled, tens of thousands of Haiti's children now face the cruelest catastrophe: They are alone. Their parents are dead or have disappeared in the chaos. They have lost their homes, their friends, their sense of security. They are hungry, bleeding and afraid — of the present and of the future.
Kathiana Joseph, 9, is having nightmares. Her family's house in Cité Soleil, Haiti's worst slum, fell into the water during the earthquake. The family, including a brother and a sister, are living in the street.
"I am afraid it will happen again," she says. "I had a puppet. It's missing." It was her only toy.
Even before the Jan. 12 earthquake, 380,000 Haitian children, out of 4.2 million in the whole country, lived in orphanages or group homes, according to UNICEF. Whatever the final death toll of the Haiti quake — 150,000 are confirmed dead so far, Haiti's government says — thousands more children will join them.
The destruction presents an enormous challenge for UNICEF and other relief groups that focus on children, as they confront both the immediate crisis and the question of who will care for the children in the future.
"I think we'll be facing one of the most horrific disasters for children in memory," says Irwin Redlener of Columbia University, whose Children's Health Fund responded to Hurricane Katrina. Few events could compare to the "extraordinary loss of life and the potential for such psychological harm to children."
Nearly two weeks after the earthquake, children continue to arrive at hospitals gravely injured, with serious infections and broken bones. Few have had medical care, and many are suffering without painkillers. Many children have been in pain for so long they have stopped crying.
Doctors at Adventist were forced to amputate the gangrenous hand of a 12-year-old girl without proper anesthetic because of a shortage of drugs, says Mike Howatt, a Canadian surgeon volunteering with Global Medic. Otherwise, he says, they feared the infection would spread and kill her.
During the excruciating surgery, the girl seemed to be singing. "It was only at the end that I realized she wasn't singing," Howatt says. "She was praying."
'I'm not living well'
The needs of Haiti's children were vast even before the quake took away what little they had. Nearly half of Haiti's nearly 10 million people are younger than 18. Only half of Haitian children ever attend school, and only 2% finish high school, UNICEF says. Haiti's infant mortality rate and the rate of death for children younger than 5 are the highest in the Western Hemisphere.
Now, "we're in that kind of search and rescue operation ... for these unaccompanied children," says Patrick McCormick, spokesman for UNICEF. "Feed them, give them water, take care of them, protect them, and then start the process of registration and tracing to see if they have any family members left."
Once relief workers have tended to children's physical needs, they will have to help Haitian children face the psychological scars and tremendous upheaval caused by the disaster.
Stability is so important for children, Redlener says, that studies of kids displaced by Katrina show that even five years later, they still struggle in school. Rebuilding efforts often focus too heavily on infrastructure instead of communities and schools, he says. "What really matters is rebuilding the lives and the stability of children. That's what I'm hoping will be the biggest lesson that we can learn from Katrina that we can apply to Haiti."
While Kevin Brito, a relief coordinator for Adventist Development and Relief Agency Spain, tried to distribute energy biscuits at a tent camp this week, three little boys, about 5 years old, tugged at his shirt.
"They were jumping and playful, and they wanted to help with the boxes. They asked, 'Are you my friend?' " says Brito, a psychologist from Madrid. "That touched me. But as I thought about it, I realized how needy they are for affection. They wanted to know someone was caring for them." So Brito gave them small tasks, hugged them and rubbed their heads as they vied for his attention.
The risk of post-traumatic stress is high, specialists say, if children aren't helped. Children have to sort out what they've been through, says Carolyn Miles, chief operating officer of Save the Children. "There's the shock, then there's the 'I just want to hang on to something,' then there's the anger."
As powerful, often conflicting emotions emerge, children need solace and support, says Caryl Stern, head of the U.S. Committee for UNICEF.
"There are kids who are just wandering the streets right now. We need to find them. We need to hug them. We need to give them blankets. We need to tend to their health problems," Stern says. Even in Haiti, which has been racked by hurricanes, floods, riots and mudslides, "for many children, this will be their first major disaster. They don't know that tomorrow may be a better day. They need to be convinced of that."
Jenika Seveur, 10, was playing soccer when the quake struck. She fell down. "I feel bad. I'm not living well. I'm hungry," she says. "We have no place to live. We are living in tents. I don't like it."
If she could make one wish, it would be "for the Americans to help us."
'Angry and nervous'
At Adventist, Woel-Michel says children are clingy and fearful of straying far from family. An 11-year-old girl whose leg was amputated cries all the time.
"She thinks she will never be a mother," Woel-Michel says. "We keep telling her it won't keep her from doing what she wants. I just invent stories about people with similar injuries with happy endings to make them feel better."
Woel-Michel sees the effects of the disaster in her own son. "I wanted him to come here as a volunteer, but he couldn't," she says. "He cannot cope yet. He's angry and nervous."
Aid groups including UNICEF and Save the Children are setting up special tents for children in camps of displaced residents, to start what they call "psychological first aid." Mercy Corps is handing out "comfort kits," including a blanket and stuffed animal. The children's tent "gives kids a place to go. It starts some sort of normal routine," says Miles, of Save the Children.
The tents also will be places where relief workers can register children who are alone, in hopes of reuniting families. UNICEF is worried about unaccompanied children being abused and exploited.
Mercy Corpswill begin training teachers, church groups and community leaders in Haiti to recognize signs of post-traumatic stress in children: clinging, crying, and sleep and toilet-training problems. The group also is translating into Creole a workbook it gave children after 9/11 and Katrina. It asks children to draw pictures of what they lost, fear and hope for.
Lesly Luc, 11, already has recorded his experience. In two pages of neat script, he recounts running out of his house with his brother and wandering around the city. He wrote about his mother screaming when they couldn't find his father, and their joy when they saw him run toward them covered in dust. He wrote it to remember the day his town in Léogâne, about 20 miles west of Port-au-Prince, became the epicenter of the earthquake.
"If I have children, I have that to share with them," he says. "I'm hoping that never happens again. Too many people died."
Lesly's family now lives in a shack of corrugated tin in a tent city in a park. The shack has an adjoining area enclosed by blankets tied to wooden poles.
Sixteen people cram into the space. He sleeps on a mattress on the ground. When it gets too crowded or hot, they take turns sitting up so the others can lie more comfortably. He has no toys or television. He spends his days sleeping, drawing and writing with a pen on a notebook that his parents found in rubble. Always, he is looking for food: One day last week, his only meal was wheat mashed in water.
Since the quake, he says, he has been feeling weak. His head hurts, and his stomach is upset.
"Before, I had a house, I went to school," he says as his parents watch and nod. "Life was good before, but right now, it's not."
Seven-year-old Schneider Michele hasn't been able to walk since a block of concrete fell on his leg. His right shin is bandaged, and blood seeps through the cloth. His mother, Anny, carries him on her back.
They sleep in a yard without blankets or tents, just a pad to lie on. "After the earthquake, we went to another family to live with them, but their house fell, too," Schneider says. "I have no home to go to."
Rather than describe what he has seen, Schneider looks down, picking at lint on his mother's T-shirt. He cries all the time, Anny Michele says.
"Before, I always found a way to feed my son and send him to school," she says. "I don't see a future for him."
In the desperate international effort to help Haiti's children, relief workers hope to restore not only their physical and mental health but also their ability to endure — and even to dream.
Schneider wants to be an engineer. "If I made houses with metal roofs instead of using cement," he says, "maybe so many houses would not fall down, and people would not die."
Updated 3h 21m ago | Comment | Recommend E-mail | Save | Print | Reprints & Permissions |
Enlarge By Jack Gruber, USA TODAY
Seven-month-old Lei Auralis waits for food Saturday from his mother, Roseline Auralis, right, on a sheet with his cousin Migerson Centhilaire, 2, at the Brothers School in Port-au-Prince, Haiti.
EARLIER HAITI COVERAGE
Interactives: Photos from Haiti | Map of earthquake zone | Timeline of deadly quakes
Haiti: Country's outlook had been improving | Geology points to big quakes
Washington: Obama pledges starter of $100M in relief | Status halts deportations | Clinton, Bush combine efforts
Reaction: Churches offer solace | News slow to reach loved ones | Facebook becomes 'lifeline'
Aid: Donations may break records | Private donors critical | U.S. agencies coordinate rescues | World mobilizes relief
Share
Yahoo! Buzz
Add to Mixx
More
By Donna Leinwand, Marisol Bello and Martha T. Moore, USA TODAY
PORT-AU-PRINCE, Haiti — In the night, the children wake up crying.
"They always ask for someone to be with them. They ask why it happened. They think God is mad at them," says Marie Louise Woel-Michel, a hospital volunteer in the shattered Carrefour neighborhood of the Haitian capital. "They don't play."
The lawn of Adventist Hospital has become a camp for patients and their families, many of whom are among the 2 million people displaced by the earthquake that destroyed this city. Last week, residents found a little boy, 4 years old at most, in the bushes. He was chilled, dehydrated and silent.
"Either the parents are dead or abandoned him. We don't know his name," says Woel-Michel, a school principal whose husband is an Adventist radiologist. "We talk and talk and talk, but he doesn't answer."
BACKGROUND: Marines studied their own history in Haiti
GOVERNMENT: 150K quake victims buried in Haiti
MORE COVERAGE: Haiti calls off search and rescue
PHOTOS: Devastating earthquake hits Haiti
In the devastation left after the Haiti earthquake, the heaviest blow is falling on the weakest: children. Already poor, underfed and underschooled, tens of thousands of Haiti's children now face the cruelest catastrophe: They are alone. Their parents are dead or have disappeared in the chaos. They have lost their homes, their friends, their sense of security. They are hungry, bleeding and afraid — of the present and of the future.
Kathiana Joseph, 9, is having nightmares. Her family's house in Cité Soleil, Haiti's worst slum, fell into the water during the earthquake. The family, including a brother and a sister, are living in the street.
"I am afraid it will happen again," she says. "I had a puppet. It's missing." It was her only toy.
Even before the Jan. 12 earthquake, 380,000 Haitian children, out of 4.2 million in the whole country, lived in orphanages or group homes, according to UNICEF. Whatever the final death toll of the Haiti quake — 150,000 are confirmed dead so far, Haiti's government says — thousands more children will join them.
The destruction presents an enormous challenge for UNICEF and other relief groups that focus on children, as they confront both the immediate crisis and the question of who will care for the children in the future.
"I think we'll be facing one of the most horrific disasters for children in memory," says Irwin Redlener of Columbia University, whose Children's Health Fund responded to Hurricane Katrina. Few events could compare to the "extraordinary loss of life and the potential for such psychological harm to children."
Nearly two weeks after the earthquake, children continue to arrive at hospitals gravely injured, with serious infections and broken bones. Few have had medical care, and many are suffering without painkillers. Many children have been in pain for so long they have stopped crying.
Doctors at Adventist were forced to amputate the gangrenous hand of a 12-year-old girl without proper anesthetic because of a shortage of drugs, says Mike Howatt, a Canadian surgeon volunteering with Global Medic. Otherwise, he says, they feared the infection would spread and kill her.
During the excruciating surgery, the girl seemed to be singing. "It was only at the end that I realized she wasn't singing," Howatt says. "She was praying."
'I'm not living well'
The needs of Haiti's children were vast even before the quake took away what little they had. Nearly half of Haiti's nearly 10 million people are younger than 18. Only half of Haitian children ever attend school, and only 2% finish high school, UNICEF says. Haiti's infant mortality rate and the rate of death for children younger than 5 are the highest in the Western Hemisphere.
Now, "we're in that kind of search and rescue operation ... for these unaccompanied children," says Patrick McCormick, spokesman for UNICEF. "Feed them, give them water, take care of them, protect them, and then start the process of registration and tracing to see if they have any family members left."
Once relief workers have tended to children's physical needs, they will have to help Haitian children face the psychological scars and tremendous upheaval caused by the disaster.
Stability is so important for children, Redlener says, that studies of kids displaced by Katrina show that even five years later, they still struggle in school. Rebuilding efforts often focus too heavily on infrastructure instead of communities and schools, he says. "What really matters is rebuilding the lives and the stability of children. That's what I'm hoping will be the biggest lesson that we can learn from Katrina that we can apply to Haiti."
While Kevin Brito, a relief coordinator for Adventist Development and Relief Agency Spain, tried to distribute energy biscuits at a tent camp this week, three little boys, about 5 years old, tugged at his shirt.
"They were jumping and playful, and they wanted to help with the boxes. They asked, 'Are you my friend?' " says Brito, a psychologist from Madrid. "That touched me. But as I thought about it, I realized how needy they are for affection. They wanted to know someone was caring for them." So Brito gave them small tasks, hugged them and rubbed their heads as they vied for his attention.
The risk of post-traumatic stress is high, specialists say, if children aren't helped. Children have to sort out what they've been through, says Carolyn Miles, chief operating officer of Save the Children. "There's the shock, then there's the 'I just want to hang on to something,' then there's the anger."
As powerful, often conflicting emotions emerge, children need solace and support, says Caryl Stern, head of the U.S. Committee for UNICEF.
"There are kids who are just wandering the streets right now. We need to find them. We need to hug them. We need to give them blankets. We need to tend to their health problems," Stern says. Even in Haiti, which has been racked by hurricanes, floods, riots and mudslides, "for many children, this will be their first major disaster. They don't know that tomorrow may be a better day. They need to be convinced of that."
Jenika Seveur, 10, was playing soccer when the quake struck. She fell down. "I feel bad. I'm not living well. I'm hungry," she says. "We have no place to live. We are living in tents. I don't like it."
If she could make one wish, it would be "for the Americans to help us."
'Angry and nervous'
At Adventist, Woel-Michel says children are clingy and fearful of straying far from family. An 11-year-old girl whose leg was amputated cries all the time.
"She thinks she will never be a mother," Woel-Michel says. "We keep telling her it won't keep her from doing what she wants. I just invent stories about people with similar injuries with happy endings to make them feel better."
Woel-Michel sees the effects of the disaster in her own son. "I wanted him to come here as a volunteer, but he couldn't," she says. "He cannot cope yet. He's angry and nervous."
Aid groups including UNICEF and Save the Children are setting up special tents for children in camps of displaced residents, to start what they call "psychological first aid." Mercy Corps is handing out "comfort kits," including a blanket and stuffed animal. The children's tent "gives kids a place to go. It starts some sort of normal routine," says Miles, of Save the Children.
The tents also will be places where relief workers can register children who are alone, in hopes of reuniting families. UNICEF is worried about unaccompanied children being abused and exploited.
Mercy Corpswill begin training teachers, church groups and community leaders in Haiti to recognize signs of post-traumatic stress in children: clinging, crying, and sleep and toilet-training problems. The group also is translating into Creole a workbook it gave children after 9/11 and Katrina. It asks children to draw pictures of what they lost, fear and hope for.
Lesly Luc, 11, already has recorded his experience. In two pages of neat script, he recounts running out of his house with his brother and wandering around the city. He wrote about his mother screaming when they couldn't find his father, and their joy when they saw him run toward them covered in dust. He wrote it to remember the day his town in Léogâne, about 20 miles west of Port-au-Prince, became the epicenter of the earthquake.
"If I have children, I have that to share with them," he says. "I'm hoping that never happens again. Too many people died."
Lesly's family now lives in a shack of corrugated tin in a tent city in a park. The shack has an adjoining area enclosed by blankets tied to wooden poles.
Sixteen people cram into the space. He sleeps on a mattress on the ground. When it gets too crowded or hot, they take turns sitting up so the others can lie more comfortably. He has no toys or television. He spends his days sleeping, drawing and writing with a pen on a notebook that his parents found in rubble. Always, he is looking for food: One day last week, his only meal was wheat mashed in water.
Since the quake, he says, he has been feeling weak. His head hurts, and his stomach is upset.
"Before, I had a house, I went to school," he says as his parents watch and nod. "Life was good before, but right now, it's not."
Seven-year-old Schneider Michele hasn't been able to walk since a block of concrete fell on his leg. His right shin is bandaged, and blood seeps through the cloth. His mother, Anny, carries him on her back.
They sleep in a yard without blankets or tents, just a pad to lie on. "After the earthquake, we went to another family to live with them, but their house fell, too," Schneider says. "I have no home to go to."
Rather than describe what he has seen, Schneider looks down, picking at lint on his mother's T-shirt. He cries all the time, Anny Michele says.
"Before, I always found a way to feed my son and send him to school," she says. "I don't see a future for him."
In the desperate international effort to help Haiti's children, relief workers hope to restore not only their physical and mental health but also their ability to endure — and even to dream.
Schneider wants to be an engineer. "If I made houses with metal roofs instead of using cement," he says, "maybe so many houses would not fall down, and people would not die."
Haití llora 150,000 muertos
MICHELLE FAUL y PAUL HAVEN | 2010-01-25 | El Diario NY
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Hombres construyen ataúdes en el vecindario de Delmar, en Puerto Príncipe, para las decenas de miles de muertos que dejó el terremoto del 12 de enero pasado. AP
1/3
Haití llora a sus muertos
Controversia por envío de soldados a Haití
Avidos de adoptar huérfanos
PUERTO PRINCIPE/AP — El terremoto devastador que asoló Haití causó más de 150,000 muertes confirmadas sólo en la zona metropolitana de Puerto Príncipe, dijo ayer la ministra haitiana de Comunicaciones, y se estima que muchos miles más murieron en el resto del país o aún no fueron recogidos entre los escombros de la capital.
La cifra se basa en un conteo de cadáveres en la capital y zonas vecinas hecho por CNE, una compañía estatal que recolectó y enterró restos humanos en una fosa común al norte de la ciudad, dijo a la AP la ministra Marie-Laurence Jocelyn Lassegue. La suma no incluye otras ciudades afectadas, como Jacmel, donde se cree que murieron miles de personas, ni los cuerpos que han sido quemados por los deudos.
Las cifras de víctimas han variado y el domingo Naciones Unidas dijo que seguía dando por válido su total anterior de 111,481 cadáveres, a pesar de la declaración de la ministra. En total, las autoridades calculan que el sismo de magnitud 7 causó 200,000 muertes, según cifras del gobierno haitiano citadas por la Comisión Europea.
"Nadie sabe cuántos cuerpos están enterrados entre los escombros: ¿200,000; 300,000?", dijo Lassegue. "¿Quién sabe el total de muertos?"
Los expertos dicen que hay pocas posibilidades de que aún haya sobrevivientes entre los escombros, aunque los socorristas cavaron un túnel en una verdulería destruida el sábado para rescatar a un hombre que estuvo enterrado 11 días.
El gobierno haitiano declaró el fin de la búsqueda de sobrevivientes atrapados entre los restos para concentrarse en asistir a miles de personas que viven en campamentos improvisados.
MICHELLE FAUL y PAUL HAVEN | 2010-01-25 | El Diario NY
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Imprimir Enviar Comentar Guardar Vincular a
Hombres construyen ataúdes en el vecindario de Delmar, en Puerto Príncipe, para las decenas de miles de muertos que dejó el terremoto del 12 de enero pasado. AP
1/3
Haití llora a sus muertos
Controversia por envío de soldados a Haití
Avidos de adoptar huérfanos
PUERTO PRINCIPE/AP — El terremoto devastador que asoló Haití causó más de 150,000 muertes confirmadas sólo en la zona metropolitana de Puerto Príncipe, dijo ayer la ministra haitiana de Comunicaciones, y se estima que muchos miles más murieron en el resto del país o aún no fueron recogidos entre los escombros de la capital.
La cifra se basa en un conteo de cadáveres en la capital y zonas vecinas hecho por CNE, una compañía estatal que recolectó y enterró restos humanos en una fosa común al norte de la ciudad, dijo a la AP la ministra Marie-Laurence Jocelyn Lassegue. La suma no incluye otras ciudades afectadas, como Jacmel, donde se cree que murieron miles de personas, ni los cuerpos que han sido quemados por los deudos.
Las cifras de víctimas han variado y el domingo Naciones Unidas dijo que seguía dando por válido su total anterior de 111,481 cadáveres, a pesar de la declaración de la ministra. En total, las autoridades calculan que el sismo de magnitud 7 causó 200,000 muertes, según cifras del gobierno haitiano citadas por la Comisión Europea.
"Nadie sabe cuántos cuerpos están enterrados entre los escombros: ¿200,000; 300,000?", dijo Lassegue. "¿Quién sabe el total de muertos?"
Los expertos dicen que hay pocas posibilidades de que aún haya sobrevivientes entre los escombros, aunque los socorristas cavaron un túnel en una verdulería destruida el sábado para rescatar a un hombre que estuvo enterrado 11 días.
El gobierno haitiano declaró el fin de la búsqueda de sobrevivientes atrapados entre los restos para concentrarse en asistir a miles de personas que viven en campamentos improvisados.
Trabajadores humanitarios de la ONU dijeron que el cambio de enfoque es crucial pues, aunque la entrega de alimentos, medicina y agua ha comenzado a mejorar tras los problemas iniciales, la necesidad todavía es apremiante y los doctores temen que haya brotes de enfermedades en los campamentos.
Médicos sin Fronteras dijo que sus equipos comenzaban a ver más pacientes con "infecciones o complicaciones luego de intentos de tratamiento básicos o hechos por aficionados en los primeros días" luego del terremoto.
En la populosa barriada de Cité Soleil, donde hubo algunos saqueos y violencia desde el sismo, soldados estadounidenses y brasileños repartieron comida y agua ayer a miles de hombres, mujeres y niños que hicieron fila frente a un centro de salud.
Los estadounidenses llevaron 2,000 raciones de comida, 75,000 galletas energéticas y 9,000 botellas de agua, mientras que los brasileños tenían ocho toneladas de comida en pequeñas bolsas con frijoles, sal, azúcar y sardinas, además de 15,000 litros de agua.
Lunie Marcelin, de 57 años, dijo que su familia sobrevivió al terremoto, incluidos sus seis hijos adultos, pero que no tenían dinero para comida.
Las raciones "nos ayudarán, pero no es suficiente", dijo. "Necesitamos más", apuntó.
Médicos sin Fronteras dijo que sus equipos comenzaban a ver más pacientes con "infecciones o complicaciones luego de intentos de tratamiento básicos o hechos por aficionados en los primeros días" luego del terremoto.
En la populosa barriada de Cité Soleil, donde hubo algunos saqueos y violencia desde el sismo, soldados estadounidenses y brasileños repartieron comida y agua ayer a miles de hombres, mujeres y niños que hicieron fila frente a un centro de salud.
Los estadounidenses llevaron 2,000 raciones de comida, 75,000 galletas energéticas y 9,000 botellas de agua, mientras que los brasileños tenían ocho toneladas de comida en pequeñas bolsas con frijoles, sal, azúcar y sardinas, además de 15,000 litros de agua.
Lunie Marcelin, de 57 años, dijo que su familia sobrevivió al terremoto, incluidos sus seis hijos adultos, pero que no tenían dinero para comida.
Las raciones "nos ayudarán, pero no es suficiente", dijo. "Necesitamos más", apuntó.
Haiti Journal Day 8: The Tsunami Coming -- Riding the Waves of Rescue, Rebuilding and Resurrection
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EDITOR'S NOTE: Two photo slideshows appear in this post. The first one is not graphic. The second one includes extremely graphic depictions of surgery and wounds. Viewer discretion is strongly advised.
How can we measure the resiliency of the Haitian people who are the poorest in the western hemisphere with 55% living below the extreme poverty line of $1 a day? On a good day in Haiti, nearly half the population doesn't know when or where the next meal will come; in good times, 47% don't have any access to the most basic health care; 45% of the population doesn't have clean water and 80% are without basic sanitation. People fear going to the nation's main hospital, which we have worked to bring to life over the last week, because at its best, it provided inadequate care in facilities with marginal electricity and water, and received no funding. When we arrived there, we found no basic medical supplies to restock the meager supplies we could fit into our bags and our small plane.
How can we measure the resiliency and capacity to endure of these people who have endured for 200 years? Perhaps it is in the strength of the 85-year-old woman found yesterday in the rubble 10 days after the quake still breathing, with a pulse and blood pressure and who after some intravenous fluids, started producing urine again. Or the little boy who a day after being found in the rubble after a week was running around our medical camp hugging the nurses and doctors who brought him back from near death? Or the 13-year-old who ran to the top of the 3-story building as it collapsed under her, riding it down to the ground suffering "only" a massive laceration to her thigh that her mother attempted to stitch without anesthesia with a needle and thread. There is barely a whimper from the hospital campus where we reduced fractures with only a little pain medication and where gaping, infected and necrotic wounds are re-bandaged daily without sedation. There is only the occasional wailing from a broken heart.
Yesterday was the first day the coordination and supplies came together on the hospital campus -- with nine hospital and 3-4 NGO operating rooms working 24 hours a day now, with X-ray and ultrasound and proper surgical instruments and supplies, and medical personnel, with food, water, and tents to house the patients who crawled with broken pelvises and hopped with the newly amputated stumps dangling from the hospital wards to the open air with each shake of the ground. Finally after days of transporting patients in and out of buildings, after the U.S. Army Corp of Engineers repeated inspections, it was clear that patients were more afraid of being inside than outside. But it is very difficult to run surgical intensive care units in the open air or sweltering tents without electricity or water. And patients die.
But what we see inside the walls of the hospital, which has concentrated resources, NGOs, food, water, supplies, people, however inadequate they may be, however limited our abilities to care for patients, however strained our ability to track medical records, to know which patient had which treatment and when, however great our need for better communication and coordination, the General Hospital is the most well-organized run health care facility in Port-au-Prince right now. Compared to the needs and demands of those outside its walls, those in tent cities, or lying in the streets who bathe, eat, drink and defecate all in the same few square feet, and are at risk of tetanus, or diseases of overcrowding such as meningitis, diarrhea, typhoid, hepatitis, measles, diphtheria, whooping cough or tuberculosis, or the millions displaced or whose lives are upside down, General Hospital is the now the Mayo Clinic of Haiti. But the load of new surgical cases at the General is diminishing though we still have to clean and eventually close the hundreds of stumps and wounds we have treated already. Local doctors at the hospital express concern that we have seen all the patients to be seen, and are worried about sending patients off the USS Comfort or other mobile hospitals coming in. But they have not accounted for the second wave.
• • • • • • • • • • • • • • • • • • •
The Second Wave: The Forgotten Thousands
There will be a second wave, there must be a second wave and it must come now or it will be too late. There have already been too many tragic deaths in the immediate aftermath of the quake, but now there will be thousands of unnecessary, preventable deaths from the consequences of the lack of medical care from infection, gangrene and tetanus. There is simply a lack of infrastructure.
There are few ambulances or EMTs in Haiti and I have only seen one or two in the streets. There is barely fuel, with prices shooting up to $800 USD a gallon at one point, in a country where a good wage is $100 a month, where 900 gallons of diesel to run the hospital generators were stolen from the back gate before the military arrived. The initial effort by FEMA providing $36 million for search and rescue was critical to save lives. Now 11 days later, there is a need for emergency medical response teams to find and scoop and transport the thousands remaining strewn about the city. According the USAID daily report, there was only $50,000 spent on emergency medical response to date.
It is dire, even the dogs are hungry. They chewed to the bone a leg of a dead man sticking out of the rubble.
Last night flying back on a C 17 Air Force transport, I spoke to Miami firefighters who surveyed the city and reported that they saw no search and rescue teams any longer, only two ambulances and two pieces of heavy equipment. But when they walked through tent cities and streets and they found hundreds of patients who needed to get to a hospital for emergency care but had no way of getting there, now way of being identified and were not aware of available resources or hospitals. Cell phones work only occasionally, there is a breakdown of communication infrastructure. One hospital they visited remained nearly empty with doctors roaming the streets looking for patients.
The immediate burden on the hospital campus has been addressed, but there are thousands tucked in corners of alleyways, under tarps, in tent cities all over Port-au-Prince and surrounding areas that have not had medical care, still with open fractures, gaping wounds, crush injuries that are stuck without knowledge of where medical facilities are, or any way to get transported and afraid to leave their meager belongings unattended on the sidewalk or by their tent or tarp.
Yesterday I heard about Jackmel, a nearby city, where 30 critical victims needing amputations or emergency surgical care have been trapped by damaged roads and isolated since the quake with no food, water, and medical care waiting for 11 days to get evacuated. I worked yesterday with General Keen to find a way to get those patients mobilized. And those are only the ones I have heard about, how many more are there? There are thousands more unattended who now are at risk of unnecessary death from gangrene and infection and tetanus, thousands more who could have their limbs or lives saved if we can get to them in time.
Coordination between the military, government and volunteer resources is happening but slowly. A clear plan needs to be developed immediately to deploy volunteer EMT's, translators and security and transport with a map of all existing medical resources, functioning communication to immediately find and bring those patients to medical care. Fliers, radio announcements, trucks with loudspeakers can be deployed through the city to flush out the patients needing care.
Third Wave: Discharge Planning, PTSD, and Rehab
Then there is the third wave. Once we treat and stabilize the patients, there is nowhere for them to go. Their homes are piles dust and rust, their families gone. Who can tend to them, feed them, change their bandages? Where can they live, who will transport them back to the doctor or hospital for follow up visits? We can't send them back to the street. I spent two hours yesterday with Navy doctors Richard Sharpe and Larry Ronan from the USS Comfort to find an open space to put post-operative patients. We are at capacity. And all the hospitals in the country are full.
Soon, very soon, there is the need for rehabilitation, helping the thousands with lost or broken limbs get back on their feet or foot again. There are no physical therapists, no facilities, and no place for them to go for care. As the immediate surgical needs are slowly addressed, the psychological needs explode magnified by each minor aftershock. There are no psychologists here. The Center for Mind Body Medicine that has worked on PTSD in Kosovo, Gaza and New Orleans is mobilizing a team of 500 to go to Haiti over the next months coordinated with Partners in Health. But more will be needed.
Coordinated planning is needed to provide food, water, sanitation, dressing changes and skilled nursing care, and it is needed now in large temporary tents properly staffed by local Haitians providing jobs and care, closing the ecosystem of health and recovery. Plans are being developed to move people out of Port-au-Prince to begin to rebuild and restore the city infrastructure, utilities, and housing. The local Haitian medical community has to be supported and restored to care for the traumatized for the long term. The partnership model of Partners in Health training and employing local community health workers providing jobs and bolstering the Haitian economy, which they have done now in a dozen locations in Haiti, employing 5000 Haitians is essential if we are to avoid a hit and run NGO disaster relief that will only leave another disaster. Last night we scrambled to find a way to take over the Israeli field hospital and care for the 150 patients still there when they leave on Wednesday.
The Silver Lining: Empowering the Haitian People
EDITOR'S NOTE: Two photo slideshows appear in this post. The first one is not graphic. The second one includes extremely graphic depictions of surgery and wounds. Viewer discretion is strongly advised.
They have done their job, but rebuilding Haiti will not take a week or a month or a year, but decades of sustained and coordinated effort needed when the disaster relief is over. Haitians must be empowered to take back their country and create what they have always deserved. They were the first liberated from slavery in the early 1800s but yet to be lifted from extreme poverty.
Aside from my day job, I am a volunteer for Partners In Health (PIH), which has been working on the ground in Haiti for over 20 years. The organization works to bring modern medical care to poor communities in nine countries around the world. The work of PIH has three goals: to care for patients, to alleviate the root causes of disease in their communities, and to share lessons learned around the world. Based in Boston, PIH employs more than 11,000 people worldwide, including doctors, nurses, and community health workers. The vast majority of PIH staff is local nationals based in the communities they serve. They can partner with other organizations and the local Haitian government and communities to effectively and for the long-term support the emergence of the enduring, resilient and openhearted people from two centuries of darkness. Donate at www.pih.org.
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Comments 95
EDITOR'S NOTE: Two photo slideshows appear in this post. The first one is not graphic. The second one includes extremely graphic depictions of surgery and wounds. Viewer discretion is strongly advised.
How can we measure the resiliency of the Haitian people who are the poorest in the western hemisphere with 55% living below the extreme poverty line of $1 a day? On a good day in Haiti, nearly half the population doesn't know when or where the next meal will come; in good times, 47% don't have any access to the most basic health care; 45% of the population doesn't have clean water and 80% are without basic sanitation. People fear going to the nation's main hospital, which we have worked to bring to life over the last week, because at its best, it provided inadequate care in facilities with marginal electricity and water, and received no funding. When we arrived there, we found no basic medical supplies to restock the meager supplies we could fit into our bags and our small plane.
How can we measure the resiliency and capacity to endure of these people who have endured for 200 years? Perhaps it is in the strength of the 85-year-old woman found yesterday in the rubble 10 days after the quake still breathing, with a pulse and blood pressure and who after some intravenous fluids, started producing urine again. Or the little boy who a day after being found in the rubble after a week was running around our medical camp hugging the nurses and doctors who brought him back from near death? Or the 13-year-old who ran to the top of the 3-story building as it collapsed under her, riding it down to the ground suffering "only" a massive laceration to her thigh that her mother attempted to stitch without anesthesia with a needle and thread. There is barely a whimper from the hospital campus where we reduced fractures with only a little pain medication and where gaping, infected and necrotic wounds are re-bandaged daily without sedation. There is only the occasional wailing from a broken heart.
Yesterday was the first day the coordination and supplies came together on the hospital campus -- with nine hospital and 3-4 NGO operating rooms working 24 hours a day now, with X-ray and ultrasound and proper surgical instruments and supplies, and medical personnel, with food, water, and tents to house the patients who crawled with broken pelvises and hopped with the newly amputated stumps dangling from the hospital wards to the open air with each shake of the ground. Finally after days of transporting patients in and out of buildings, after the U.S. Army Corp of Engineers repeated inspections, it was clear that patients were more afraid of being inside than outside. But it is very difficult to run surgical intensive care units in the open air or sweltering tents without electricity or water. And patients die.
But what we see inside the walls of the hospital, which has concentrated resources, NGOs, food, water, supplies, people, however inadequate they may be, however limited our abilities to care for patients, however strained our ability to track medical records, to know which patient had which treatment and when, however great our need for better communication and coordination, the General Hospital is the most well-organized run health care facility in Port-au-Prince right now. Compared to the needs and demands of those outside its walls, those in tent cities, or lying in the streets who bathe, eat, drink and defecate all in the same few square feet, and are at risk of tetanus, or diseases of overcrowding such as meningitis, diarrhea, typhoid, hepatitis, measles, diphtheria, whooping cough or tuberculosis, or the millions displaced or whose lives are upside down, General Hospital is the now the Mayo Clinic of Haiti. But the load of new surgical cases at the General is diminishing though we still have to clean and eventually close the hundreds of stumps and wounds we have treated already. Local doctors at the hospital express concern that we have seen all the patients to be seen, and are worried about sending patients off the USS Comfort or other mobile hospitals coming in. But they have not accounted for the second wave.
• • • • • • • • • • • • • • • • • • •
The Second Wave: The Forgotten Thousands
There will be a second wave, there must be a second wave and it must come now or it will be too late. There have already been too many tragic deaths in the immediate aftermath of the quake, but now there will be thousands of unnecessary, preventable deaths from the consequences of the lack of medical care from infection, gangrene and tetanus. There is simply a lack of infrastructure.
There are few ambulances or EMTs in Haiti and I have only seen one or two in the streets. There is barely fuel, with prices shooting up to $800 USD a gallon at one point, in a country where a good wage is $100 a month, where 900 gallons of diesel to run the hospital generators were stolen from the back gate before the military arrived. The initial effort by FEMA providing $36 million for search and rescue was critical to save lives. Now 11 days later, there is a need for emergency medical response teams to find and scoop and transport the thousands remaining strewn about the city. According the USAID daily report, there was only $50,000 spent on emergency medical response to date.
It is dire, even the dogs are hungry. They chewed to the bone a leg of a dead man sticking out of the rubble.
Last night flying back on a C 17 Air Force transport, I spoke to Miami firefighters who surveyed the city and reported that they saw no search and rescue teams any longer, only two ambulances and two pieces of heavy equipment. But when they walked through tent cities and streets and they found hundreds of patients who needed to get to a hospital for emergency care but had no way of getting there, now way of being identified and were not aware of available resources or hospitals. Cell phones work only occasionally, there is a breakdown of communication infrastructure. One hospital they visited remained nearly empty with doctors roaming the streets looking for patients.
The immediate burden on the hospital campus has been addressed, but there are thousands tucked in corners of alleyways, under tarps, in tent cities all over Port-au-Prince and surrounding areas that have not had medical care, still with open fractures, gaping wounds, crush injuries that are stuck without knowledge of where medical facilities are, or any way to get transported and afraid to leave their meager belongings unattended on the sidewalk or by their tent or tarp.
Yesterday I heard about Jackmel, a nearby city, where 30 critical victims needing amputations or emergency surgical care have been trapped by damaged roads and isolated since the quake with no food, water, and medical care waiting for 11 days to get evacuated. I worked yesterday with General Keen to find a way to get those patients mobilized. And those are only the ones I have heard about, how many more are there? There are thousands more unattended who now are at risk of unnecessary death from gangrene and infection and tetanus, thousands more who could have their limbs or lives saved if we can get to them in time.
Coordination between the military, government and volunteer resources is happening but slowly. A clear plan needs to be developed immediately to deploy volunteer EMT's, translators and security and transport with a map of all existing medical resources, functioning communication to immediately find and bring those patients to medical care. Fliers, radio announcements, trucks with loudspeakers can be deployed through the city to flush out the patients needing care.
Third Wave: Discharge Planning, PTSD, and Rehab
Then there is the third wave. Once we treat and stabilize the patients, there is nowhere for them to go. Their homes are piles dust and rust, their families gone. Who can tend to them, feed them, change their bandages? Where can they live, who will transport them back to the doctor or hospital for follow up visits? We can't send them back to the street. I spent two hours yesterday with Navy doctors Richard Sharpe and Larry Ronan from the USS Comfort to find an open space to put post-operative patients. We are at capacity. And all the hospitals in the country are full.
Soon, very soon, there is the need for rehabilitation, helping the thousands with lost or broken limbs get back on their feet or foot again. There are no physical therapists, no facilities, and no place for them to go for care. As the immediate surgical needs are slowly addressed, the psychological needs explode magnified by each minor aftershock. There are no psychologists here. The Center for Mind Body Medicine that has worked on PTSD in Kosovo, Gaza and New Orleans is mobilizing a team of 500 to go to Haiti over the next months coordinated with Partners in Health. But more will be needed.
Coordinated planning is needed to provide food, water, sanitation, dressing changes and skilled nursing care, and it is needed now in large temporary tents properly staffed by local Haitians providing jobs and care, closing the ecosystem of health and recovery. Plans are being developed to move people out of Port-au-Prince to begin to rebuild and restore the city infrastructure, utilities, and housing. The local Haitian medical community has to be supported and restored to care for the traumatized for the long term. The partnership model of Partners in Health training and employing local community health workers providing jobs and bolstering the Haitian economy, which they have done now in a dozen locations in Haiti, employing 5000 Haitians is essential if we are to avoid a hit and run NGO disaster relief that will only leave another disaster. Last night we scrambled to find a way to take over the Israeli field hospital and care for the 150 patients still there when they leave on Wednesday.
The Silver Lining: Empowering the Haitian People
EDITOR'S NOTE: Two photo slideshows appear in this post. The first one is not graphic. The second one includes extremely graphic depictions of surgery and wounds. Viewer discretion is strongly advised.
They have done their job, but rebuilding Haiti will not take a week or a month or a year, but decades of sustained and coordinated effort needed when the disaster relief is over. Haitians must be empowered to take back their country and create what they have always deserved. They were the first liberated from slavery in the early 1800s but yet to be lifted from extreme poverty.
Aside from my day job, I am a volunteer for Partners In Health (PIH), which has been working on the ground in Haiti for over 20 years. The organization works to bring modern medical care to poor communities in nine countries around the world. The work of PIH has three goals: to care for patients, to alleviate the root causes of disease in their communities, and to share lessons learned around the world. Based in Boston, PIH employs more than 11,000 people worldwide, including doctors, nurses, and community health workers. The vast majority of PIH staff is local nationals based in the communities they serve. They can partner with other organizations and the local Haitian government and communities to effectively and for the long-term support the emergence of the enduring, resilient and openhearted people from two centuries of darkness. Donate at www.pih.org.
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