Haiti is a small country occupying the western side of the island of Hispaniola, with the Dominican Republic to the east. Widely recognized as the poorest nation in the Western Hemisphere, Haiti’s capital city of Port-au-Prince suffered a massive 7.0 magnitude earthquake on Tuesday, January 12, 2010, which left the capital city and surrounding areas in virtual ruin. Initial figures estimated that the death toll would reach 50,000, though on February, 3, 2010, Prime Minister Jean-Max Bellerive said in a press conference that the death toll had exceeded 200,000, with more than 300,000 treated for injuries (including over 4,000 amputations), and nearly 300,000 homes and businesses destroyed. Similarly, international humanitarian relief efforts, including water, food, medical supplies and urban search and rescue teams had been hampered in reaching the immediate victims as Haiti’s main international airport and largest seaport were severely damaged during the earthquake, coupled with the country’s pre-existing infrastructural challenges.
Trek Medics International was invited by Giving Children Hope, of Orange County, California, to assist in their medical relief efforts in the city of Carrefour, southwest of the capital, Port-au-Prince. These posts were written during our deployment.
At 8:30 am on January 19, 2010, I received a call from Jenise Steverding, Director of Projects and Advancement for Giving Children Hope in Buena Park, CA, asking me if I’d like to join their team to Haiti. The purpose of the trip would be to accompany a shipment of medical supplies and medicines to partner orphanages that had been affected by the 7.0 magnitude earthquake on January 12, including Grace International in the city of Carrefour. That night at 10:00pm we were on a flight from Los Angeles to Ft. Lauderdale, where we were scheduled to fly to Port-au-Prince.
Giving Children Hope is a faith-based nonprofit organization that specializes in Medical Excess Recovery, and donates their refurbished product to orphanages and other humanitarian organizations all over the world. Their facilities include a 43,000 square-foot warehouse from where they store, refurbish and ship most of their product, and at the time of our departure, had already shipped 20,000 lbs of product to their partners in Haiti since the earthquake struck.
As is common in most disaster relief efforts, our team encountered several delays and other obstacles which resulted in a one-night stay in Ft. Lauderdale, but on the following morning, January 21, we headed out to Opa-Locka Airport in Miami, FL, where we would board a charter flight arranged by the Medshare group, who was heading a large medical relief effort in Haiti.
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The World At Your Doorstep – Toussant Louverture International Airport
When we were finally given clearance to land at Toussant Louverture International Airport in Port-au-Prince, it was clear from even before the wheels hit the ground that the response effort was a truly massive operation: flags from all over the world flew over tents pitched just a 100 meters from the runaway; behemoth commercial and military transport planes were taxiing in and out; and palette after palette of supplies and materials were being hauled across the tarmac by local Haitians and the U.S. Army, who also worked with the Haitian police, UN peacekeeping forces, and French Gendarmerie to keep any opportunists off the tarmac away from the supplies.
One of the many problems complicating response efforts in Haiti had been the near instantaneous growth of hundreds of impromptu tent cities springing up across the affected disaster area. Aside from the complete destruction of hundreds of thousands of homes and buildings, the massive earthquake caused severe damage to countless other structures leaving them virtually uninhabitable. As a result, an estimated 1.5 million Haitians took up residence in the nearest open space, whether it was a park, a parking lot, a country club, the center divide of a main street, or even the street itself. By the time we arrived at the airport, it had already become dark, making the roads nearly impassable and reportedly unsafe to travel without a military convoy. Jenise, our intrepid leader, sought to obtain some type of military escort, but was unable to.
As as a result, we would spend the night on the airport tarmac. While the airport was safe, it was certainly not sound, with a constant stream of USAF C-17 transport planes continually arriving at the airport and dropping off supplies, only to leave with a plane full of evacuated US-passport-carrying Haitians. One of the staff members from the US Consulate told me that the US would evacuate anyone who had a US passport, but they would have to sign a promissory note to be charged at a later date – most likely when you went to renew your passport – and the charges could be anywhere from $300 – $1000, depending on where your final destination was. “If the government charges for a driver’s license, and a passport, you can be sure they’re going to charge you for a flight, too.” And then he added that all of the people who had been evacuated from Lebanon in the summer of ’06 during the Israeli airstrikes were charged too. Since he stated that they were running over a hundred flights into the Port-au-Prince all day and all night, it was clear that we would be spending the evening on the tarmac with the endless companion of the C-17s and their idling, apocalyptic jets, while a host of other international transport planes and private jets came in and out of the airport alongside them. Thankfully, the kind people manning the US Consulate desk supplied us with earplugs, and a few Army soldiers donated some MREs to eat, with a few baby-wipes to clean up with. Loud noise, bad food, and a lot of waiting – exactly as disaster response works.
Instead of spending the entire night on the tarmac with our arms crossed and our ears bleeding, however, a few of us ventured out to locate the University of Miami (Miller School of Medicine) field hospital which had been set up just west of us on the airport grounds. While we didn’t make it all the way there another Trek Medics volunteer, Paul Maxwell would spend a lot of time there the next week. While walking around, we met with several different groups including FEMA’s NY Task Force 1, the US Army 82nd Airborne, and a South African USAR Team, who were waiting to return home after nearly a week on the ground. The airfield was covered in SAR teams from all over the world. Talking with some of the South Africans, they remarked that among the many disasters they had been deployed to (Turkey ‘99, Iran ‘03/’05, Algeria ’03, India ’05 and Pakistan ‘08), most considered this deployment to be the worst they had been to, but were quick to note that it had “fortunately” happened in the middle of the day.
Because the airport terminal had suffered considerable damage, it was unsafe to try and find anywhere inside to sleep, so the remainder of the night was left to watching the transport planes come in and out, and the host of foreign nations and other NGOs that were present: the UN, Russia, Spain, Cuba, France, Belgium, the Netherlands, Doctors Without Borders, UNICEF, WHO, and PAHO, among many, many others. Later that morning, as we were sitting with our bags awaiting our ride, a new line of Haitians were quietly waiting to board a C-17 when we felt what would be the first of many aftershocks throughout the week. The Haitians had been seated along a line of folding chairs only a few feet from the airport terminal, and as soon as the aftershocks hit, most all of them leapt over the row of chairs and away from the walls before we even knew what was going on. Many of them stared at the terminal wall for a little while after, with the fear and sheer terror in their eyes spoke volumes – who knew what horrors these unfortunate people had lived through for the past week?
The Aftermath: Port-au-Prince to Carrefour
At around 9am we were informed that our ride had arrived at the airport, so we piled our 12 duffel bags onto a carriage and brought them out to the front of the airport terminal. Everywhere you looked people were bustling and pushing and trying to carry your bags for you, and though we handed them off to some Haitians who were there to help us, few of us really had any idea if we were handing them off to the right people. Fortunately, it turned out we had. Our drivers had come in a pickup and another SUV along with three helpers, and after piling all of our bags into the bed of the pickup we set out to our destination.
As soon as we stepped out into the sun we were immediately taken over by the heat and chaos – a relentless Caribbean sun and soaking humidity, coupled with throngs of people walking, standing, pushing and driving with little apparent order. To make matters more claustrophobic, the heat and humidity were exacerbated by the overwhelming exhaust from trucks and motorbikes, and accentuated by persistent, ear-ringing horns. Crowds of people had gathered outside the airport terminal to wait in hopes of getting some food or water, or just to watch, and once out onto the main road, the traffic became so congested you had to roll up the window to keep from choking on the dust, smog and smoke from burning trash piles along the roadside. When the traffic did move, it was often hard to tell if you were on the right side of the road as the cars and trucks drove wherever there was an opening, and the motorbikes weaved in and out between the bigger vehicles.
Once out onto the open road you could see lines of Haitians standing behind the airfield wall staring at all the planes and helicopters and military convoys patrolling their airstrip. Not far along across the road, we could see what would be one of the larger refugee camps in all of Haiti, the Daihatsu Camp (named after the adjoining car dealership), which looked like a vast sea of blankets and sheets and tarps all crowded together, struggling to claim whatever space they could on a rocky hillside.
Only a few minutes out of the airport and it became quite apparent the level of destruction that had been left behind. While much has been said of the construction methods employed in Haiti – no uniform building codes, too much sand in the cement, improper construction supervision, and faulty materials, among others – few buildings seemed to have fallen in the same way, save the ones that had fallen completely. Some had collapsed from the edges only, giving them a pyramid-like appearance. Others fell only where there was no beam to support them underneath, so that the balcony or overhang was now perpendicular to the ground where it was once horizontal. Other buildings had all four outer walls intact, while the “innards” of the building had collapsed in on itself, and all the contents within the structure – beds, rebar, wires, desks – were now thrown together in a salad of demolition. Sometimes it was the complete opposite, where the center of the structure had collapsed, yet the side walls remained, making them look like a giant, concrete “V”.
Many buildings were completely obliterated, as though some cosmic foot had stepped on them and left them in a giant pile of rubble, like they were nothing more than over-sized sandcastles; while some of the larger, multi-story buildings had collapsed into neat stacks of pancakes, with a thin sprinkling of dust and rubble surrounding the perimeter of the separate floors like excess jelly seeping out of a PB&J sandwich. Still other buildings were both half-standing, and half-destroyed, like condemned buildings that had been sentenced to the wrecking ball, with their ruined walls and roof spilling into the middle of the street and obstructing traffic. Even where there were no buildings, a thick line of rubble and rebar lined the street, creating a snow drift of concrete and steel that had been plowed to the sides. Entire walls were flattened, lying on their sides though still intact save the top row of cinderblocks which were shattered and sprayed into the street, making them look like someone had just pushed them with only minimal effort. Needless to say, the entire area looked as if it was in the midst of a complete and total demolition, and the Presidential Palace as though it had been brought to its knees.
As we made our way out of the capital, we passed a large market where life seemed to be carrying on as usual, with the exception of a corpse or two pushed off to the side of the road, still waiting to be collected. The market was filled with people walking, shopping, and jostling along the crowded pathways, in between women seated beside piles of fresh produce and fruits and sacks of grain, selling whatever goods they had as pigs ate what had been left from the day before or scrummaged through other piles of smoldering trash. Interestingly, the corrugated metal shanties that lined the eastern end of the market seemed to have faired somewhat better in the quake than the larger concrete structures, which may have been the result of a “better” ability to move and sway as the earth shook. Nonetheless, one expert with the Haitian government involved in assessing the damage estimated in the Wall Street Journal that “as much as 75% of [Port-au-Prince’s] combined commercial and residential structures will eventually have to be torn down.” And that’s just in Port-au-Prince; we hadn’t even arrived to Carrefour, which was still closer to the earthquake’s epicenter.
Farther along, we passed more tent camps. The term “Tent City,” however, is a bit of a misnomer itself, as the tents are little more than whatever cloth big enough to create a barrier could be found: bed sheets, blankets, table cloths, rugs, tarps and even flags were strung up and pinned to sticks or poles or rebar which had been pulled from the concrete that once constituted the walls of a home. “IDP Camps” (internally displaced persons) was the official nomenclature.
Tents, camps and people were everywhere. Many sat in front of what used to be their homes, but were now little more than non-descript piles of rubble, selling food and other goods as they would be if their house were still standing. Oftentimes, you’d see people rummaging through the rubble, trying to salvage whatever they could, or breaking down a wall which still had the potential – and likelihood – of falling apart and causing more injury.
After passing a center divide which had become the site for a long, single-file row of tents between two main roads, we came to the coast, where you could see a number of naval ships, Coast Guard Cutters and other vessels including the USNS Comfort, a naval hospital ship with a 1,000-bed capacity and 12 fully-equipped ORs. We also drove past the oil refinery, and you could see where the long pipeline had collapsed as it stretched out into the sea. But no matter what we passed, and how creative the different forms of destruction seemed to be, there were two common realities: the destruction and the dust. It was a unique type of dust though, not comprised of only the kicked-up dirt from the trodden ground and pock-marked streets, but also from the ashes of burning trash piles, and from the rubble of collapsed buildings. The rubble is probably the biggest contributor to this dust and it created a thick white film that layered everything, as though someone had taken all the schoolhouse erasers in the world and beaten them together at once over all the city. And throughout, the Haitians carried on with another day.
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Grace International Orphanage
Two walls once surrounded the grounds of Grace International: the exterior wall, which enclosed a medical clinic, an open-air church, a school, and the unfinished, two-story Grace Haiti Children’s Hospital; and the inner wall that surrounded the girls’ orphanage. But after the 7.0 earthquake shook the country, only the inner wall remained standing.
The orphanage is home to 54 girls, ages 3-26, but since the earthquake, it has also become home to the families of orphanage employees, as well as the camping grounds for relief workers with Grace International. The orphanage itself had suffered some structural damage, but was still intact, and the grounds surrounding the orphanage were scattered across the grounds as the aftershocks discouraged anyone from staying within the visibly cracked walls. The girls were safe within the inner wall, and most of them slept with their “maman” in a few of the empty shipping containers leftover from the hospital construction project – a reliable structure, as it turns out, that is both earthquake- and hurricane-proof.
But what was once the spacious, green lawn of the compound, became home to a dusty, teeming tent city of approximately 17,000 displaced Haitians, too afraid to return to their homes – if they even had a home to return to. For many, these tents were now their permanent residences for the foreseeable future, with whatever material possessions they could salvage taken along with them. TVs, radios, toaster ovens and other home appliances were stacked inside the tents, some intact and some not. Beside the appliances lay mattresses, makeshift grills, wash basins and piles of clothes. Outside the tents, along the narrow, trash-strewn corridors that wind through the camp, other signs of a burgeoning economic zone had popped up, with vendors selling food and other goods. Some sold deep-fried vegetables and chicken, while others sold candy or produce or MREs that they’d gotten from the US Army. And still others set up small stands with power strips connected to car batteries to charge your cell phone or iPods for a few coins.
And while the bedsheets that were used as walls were hung in hopes of providing some privacy and protection, nothing is able to escape the elements. No matter how well-built the tent is, the heat and humidity still penetrated, and the dust covered everything. This fight against the elements went on all day, trying to keep the sun off their backs and the dust out of their lungs, and it continued through the night, trying to keep warm. But above all else, no one could keep their minds of the rains that were less than a month away. At all times, the elements continue to drag them down.
Yet the elements aren’t the only thing the Haitians were fighting – they were fighting each other, too, and not necessarily with violence: they were fighting for space to live, food to eat, water to drink, and dignity to preserve. They fight the constant threat of infection and sickness from the building trash and excrement; they fight the depression and sadness of having lost their loved ones; the hopelessness of having nowhere to go and of having little way to help themselve; and they fight the humiliation of having to turn their country over to foreigners, no matter how well-intentioned they may have been. There are many, too, who are now fighting to provide for the thousands of orphans left by the earthquake, whether they are the neighbor’s children, or children they found just roaming the streets alone. Children are proving to be one of their most difficult fights, too, as it is the children who are most vulnerable to sickness, dehydration, starvation and even abduction.
At night the tent camp becomes another place, and the relief workers remain behind the inner walls of the girls’ home. Still, we could hear what was going on outside the walls, and were often awoken at night. Without fail there would be some type of worship service coming from near the church, and it was common to hear the population break out in spontaneous ritual, praying, chanting and singing songs in French and Creole. Other times, the sounds were of a different kind of adulation: one night it was the raucous cheers coming from a nearby tent which had hooked up a TV to watch the Arsenal soccer match, while another night it was a loud dance party that a different tent had put on. But still other nights, the sounds were less uplifting: from time to time there was the deep rumbling of an aftershock which could shake you right out of bed, leaving the camp in an eerie silence, interrupted only by hushed sobs and the muffled cries of children coming from distant corners.
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The Medical Clinic at Grace Int’l
Though it is only a few miles from the capital, the tent city in Carrefour had been slow to find much relief or assistance – most of the urgently-needed supplies were used up by the populations and camps closest to the airport where they came in through.
When we finally arrived at Grace International, the medical personnel in our team were given barely enough time to drink some water and wash our faces before we were rushed off to a makeshift medical clinic which had been set up in a 25,000 sq. ft. open-air church. While much of the church’s concrete perimeter had been damaged, the inside sanctuary had been deemed “safe” by relief workers because of its steel beams and aluminum roof, so it was turned into a temporary clinic, with its benches and pews used for supplies and examinations, and its wooden tables used for exam beds and even operating tables – only a couple days before our arrival, doctors had successfully performed an emergency c-section on a rickety wooden pew. Initially, a group of doctors and nurses from Hospitals for Humanity had been manning the clinic, along with a few others who had been sent by other organizations.
Despite the austere working conditions, the doctors and nurses had been successful in setting up a well-functioning clinic. By using the wooden benches in the church sanctuary, they had blocked off a number of “wards” where they would treat patients after they had checked in at the triage desk: “Acute/Critical”, “Chronic”, “OB/GYN”, and “Pharmacy”. For patients who needed beds, a number of wooden palettes and a few mattresses from the orphanage had been set up along the perimeter of the clinic. Otherwise, most procedures were done on a folding table, or right on the cement floor with only a couple of chux laid beneath the patient. Similarly, the triage desk was effective in both keeping account of which patients were in the “waiting room” outside the church, as well as “fast-tracking” any moderate-to-acute patients who came in. While there were always many patients waiting to be seen, it was important to have someone determine if their needs were acute, or if they were there merely there to see a foreign doctor, as many had not had any type of medical care in a very long time. Unfortunately, a significant percentage of the patients did in fact need medical attention.
Of the many patients we treated, one of the first was a woman in her mid-forties who had lost four of her five children in the earthquake. She had suffered what looked like a broken wrist and a broken ulna, but was currently there for a laceration that ran along her left groin. It was probably 8-inches long, 1-inch wide, and 1-inch deep, and basically looked like someone had taken a fork and burrowed out a long strip of flesh from her groin. The woman clearly needed staples to close up the wound, but that wasn’t an option, so I was left to do some debridement – a procedure undoubtedly repeated thousands of times in the past week. The bigger challenge turned out to be explaining to her and her family that she would need to remain in bed as much as possible, and for a long time, so as to let the wound heal, but moreso to prevent it from getting infected. The family had been very insistent about visiting an “Army doctor,” but I tried to explain to them how difficult it would be for her to get to the Army doctors.
When I stood up, I saw that the doctors had just laid down a 32-yr old male who looked as though he were 8-months pregnant. “I’m a musician,” he explained. “Of course, I drink.” While it was clear that he had had a serious liver problem, the immediate issue was that the ascites buildup in his abdominal cavity had gotten to be so severe that it was now pushing up on his diaphragm and compromising his breathing. While there was no question that he, too, would need more definitive treatment, the best that could do for him right then was to lay him down on a few chux and insert a large-bore IV catheter into the side of his abdomen so that they could at least drain out enough to improve his breathing. Once they had inserted the IV catheter into his abdomen, they placed a small trash bin beside him to collect the drainage, and after about 20 minutes they removed it and shook his hand as he stood up. “I can breathe much better,” he said. “Thank you.” And he walked off, back to the tent city.
There were several other patients we treated that morning, including a woman who had had a broken left tib-fib that was showing early signs of infection. Using several medications available, we stuck the poor woman with at least three different injections. I then spent the next five minutes injecting another antibiotic, and the whole time the woman was as confused as could be. “This is the first time she’s seen a doctor since she was a child,” a translator explained to me for her.
From a public health perspective, it was interesting to consider the types of patients we were seeing. Since it was already a week since the earthquake had struck, most of the patients who had suffered injuries resulting directly from the earthquake – including thousands of amputations – had either been treated or were dead, though every now and again a patient from a distant corner of the city would arrive with untreated injuries. Of course, there were untold scores of patients whose wounds had become infected, but now, however, we were seeing more patients with chronic problems, like untreated hypertension and diabetes, as well as several pediatrics who had gotten sick from spending a week in the elements with little water and nourishment. Consequently, the clinic had been running out of the very supplies necessary to treat these conditions, and this became particularly worrisome when we got down to our last liter of normal saline. One woman had brought a child in (she didn’t know him or who his parents were, and he hadn’t seen his parents since the earthquake), who was obviously dehydrated. But because we had only one liter of normal saline left, we could only spare a 200cc bolus, then disconnecting the tubing from the bag and clamping it off in case another, more acute patient might need it.
That patient would take less than 5 minutes to arrive. [Read more]