Medical Relief Mission to Haiti
E. Jackson Allison, Jr. MD, MPH, FACEP
Professor of Emergency Medical Care
Western Carolina University
Past President, ACEP
Shortly after the earthquake, rated at 7.2 on the Richter Scale, hit near Port-au-Prince (PAP), Haiti, I was contacted by the CEO of the Greater Caribbean Energy and Environment Foundation (GCEEF) to ask if I were available to provide emergency care there. I jumped at the opportunity, yet had four firm needs in order for me to commit to going there, plus one definite wish: I wanted assurance of food, water, shelter, and safety; and I hoped for a satellite phone, or something comparable, in order to be able to communicate with the leadership of GCEEF in Miami, and with my wife, Sue, and other members of my family.
It took a week for GCEEF to make arrangements for me to go to PAP, and it took me that long to get my own affairs in order. Although I was originally scheduled to fly out of Miami, I was diverted to Chicago to catch United Airlines Flight 9902, which was a free flight from O’Hare for 165 healthcare workers. Since the flight left at 0700, I had to fly up the night before. What was amazing was that the Hilton O’Hare offered rooms at a discounted rate of $49.00 for this and similar flights to Haiti.
Once aboard the 767 craft, the bursar asked that I join her in the front of the cabin. She presented me with many boxes of infant formula, Pampers, medical supplies, teddy bears, and a box of get well cards that had been made by a children’s art class in Chicago for the children of Haiti — all of these things had been donated by members of the United crew. Furthermore, she informed me that a rather large pallet of medical supplies was in the cargo hold, and that that large assortment would be delivered to us at the airport. Needless to say, I was completely undone by their thoughtful generosity.
The scene at PAP airport was chaotic: it took us 2 1/2 hours to assemble all our bags, the extra donated boxes, the pallet of medical supplies, and to be picked up by our host, Dr. Christian Sanon, a prominent, well-respected Haitian physician. We were not required to go through passport control or customs at the airport.
The US military is in control of the PAP airport, and security is very tight. The horde of Haitians outside the fences could see the tons of food and water stockpiled there, and was eager to receive some. More about that later.
After a two-hour bumpy, dusty, harrowing van ride through the pervasive rubble of Port-au-Prince, we had dinner at the home of a Haitian nurse who is a close colleague of Dr. Sanon. It was a delicious meal of beans and rice, the staple of Haiti, and chicken. Little did we know that that was what we were going to be served every night during our weeklong stay in Haiti. The good news is that it was prepared differently each evening.
Our core group consisted of four people: myself, as Head of Mission; another emergency physician, George Poehlman from Fayetteville, NC; George Danenberg, a male nurse from Houston, Texas; and Livio Valenti, a young Italian chap with the UN/FAO, who flew in from Cambodia to join us as our coordinator. We joined up with a larger group from St. Louis, Missouri, which was composed of Haitian Americans led by Dr. Sanon’s brother, Franz, who is an architect in the states: three nurses, an imaging tech, a phlebotomist, a nurse’s aide, and a few other medical assistants. We were also melded with a Cuban physician from Miami, and two EMT-Paramedics from Miami and Ocala, Florida, respectively.
Since Dr. Sanon’s clinic and a contiguous 4-story hospital had been leveled by the earthquake, he had already established two makeshift clinics before our arrival. One was at the Sports Centre, in the small, dank concrete structure beneath the bleachers of an athletic field/soccer pitch, serving an impromptu tent city on the far side of the field. The other was at Grace Tabernacle, a large open-air facility where it was estimated that 30,000 souls had perished in the quake, and the recent home to another 20,000 Haitians who had set up home in another gigantic tent city. Most of these tents were constructed utilizing four saplings and five bed sheets for walls and the ceiling. People were living side by side in incredibly crowded conditions.
During our week in Haiti, we literally treated hundreds of patients: horrific fractures; challenging wounds; many with understandable anxiety; many with gastroenteritis because the three local wells were contaminated; and hordes of clinic patients who were seeking episodic and routine care because the city was paralyzed.
Three memorable patients: (1) an emergency C-Section performed sans anesthesia by an OB/GYN from the Dominican Republic who just happened to be serving with a group we had joined on our first afternoon of providing medical care. Mother and baby did well, save that we had to pack the mother’s uterus and belly with padding and 4X4s and refer her to an overcrowded maternity hospital to be sutured appropriately; (2) a floppy, septic 1-year-old boy who was brought to us immediately after having been dug out of the rubble one week after the quake. We resuscitated him with IVFs via two tibial plateau IOs, IV antibiosis, and an ETT. Were I a betting man that afternoon, I would have wagered that he would not make it; however, after he was delivered by van to an awaiting US Navy helicopter, he miraculously recovered on the US Navy hospital ship in the harbor (the USS Comfort), and was reunited with his family before we departed for the States; (3) a 57-year-old woman with an SBO: again, she was referred to the good ship Comfort, was operated successfully, and rejoined to her family.
Our clinics were crowded, hot, and demanding. Too many patients, not enough staff, and a dearth of appropriate supplies. I sutured a young man’s knee with 4-0 nylon sans a needle driver or even a mosquito clamp. Although we had rehydration packets for the infants and children with dehydration, we didn’t have adequate clean water to assure that the kids would improve. And although it was in the 90s during the day, it got down to ~ 60 during the night; subsequently, we treated many children with URIs and LRIs. We had not one splint, so we fashioned makeshift splints out of cardboard boxes. We also trained the two paramedics to perform wound care so that we physicians would see many more patients.
Although I’ve been a physician for 35 years, I had never experienced the penetrating odor of rotting human corpses before: definitely memorable, decidedly disgusting.
It became readily obvious to us that all the people we treated were in need of food and clean water. When we arranged a meeting with the US military to beg for food and water, we were offered anything and everything medical, yet were flatly refused our impassioned request for the food and water… We were told that distributing the latter would just foment riots. We pleaded that we were working with trusted Haitians, and assured the officers that we were willing to take those risks. However, the persistent answer became “Hell no!”
We were able to pry 5,250 tents and enough rice to feed the entire population of the district of Gressier, 30 miles west of PAP, the actual epicenter of the quake, and an area that had yet to receive anything except a modest delivery of fresh water. When we attended a community meeting of Gressier to set up medical clinics there, we announced how proud we were that enough tents to serve 17,000 people had been delivered the day before. However, a mini riot ensued, for we became acutely aware that the tents had been intercepted, and were already for sale on the black market for 200.00 USD. Then a young Haitian announced that although the truckloads of rice had been signed off by the local mayor’s office, the rice was now being sold openly in the local market. Our spirits were crushed; corruption is indeed rampant throughout Haiti…
Lessons learned: Corruption is part of the fabric of Haitian culture. Although the US military is in control of the PAP airport, no one is in charge of the city. Downtown Port-au-Prince was damaged the most, and it’s where the unchecked looting has taken place. The Haitian government officials are in hiding, refusing to make announcements on TV or radio of what exactly has occurred, and what to expect in the immediate future. The estimated 500,000 people living in makeshift tent cities are experiencing widespread diarrhea, dehydration, and respiratory diseases, including pneumonia. The city is set up for a cholera epidemic. Our medical supplies did not include any tetanus toxoid, splints, or adequate suturing materials. The populace is in dire need of food and clean water. They are also in need of adequate shelter, for the rainy season usually begins at the end of February — one can only imagine what will become of the flimsy tents once the rains begin. And the people are also in need of established, ongoing medical care. Foreigners cannot hope to get much done sans connections to the Haitian government, no matter how corrupt the latter might be — that’s why working with and through Dr. Sanon was so meaningful; however, because he was nobly trying to be all things to all people, our mission was rather unfocused and diluted, over all.
Now that the acute phase of the disaster has ended, my major concern is who will be there for the long haul of pulling Haiti out of financial and physical rubble?