Diary from cbm co-worker based in Haiti

Report 1 by Michiel Steenbeek and Marieke Dreise, CBM co-workers.

Present situation

Valerie, the emergency coordinator of CBM has been here in Haiti since 4 days after the earthquake. She has done an incredible amount of work. Visited some of the CBM partner organizations and coordinated with different NGO's the emergency response.

The city of Port-Au-Prince is in a mess. About 50% of the buildings have collapsed or are severely damaged and beyond repair. Some parts of the capital look like Berlin at the end of WW II. In Leogane about 90% of the buildings collapsed. In most cases the ground floor of multi storey buildings has completely disappeared while the concrete slabs of the higher levels are sandwiched on top of each other. Indeed you had a higher chance of survival if you were on the top floor. Some streets smell like an abattoir. The pain that the people who lost relatives, their houses, and all their property go through is beyond our understanding. Walking or driving in some areas and seeing all the damage clearly does affect us too.

The acute phase is now kind of over, the people who are still under the rubble are dead, the injured have had their emergency treatment and most surgical teams are pulling out this week. Now the phase of recovery and rehabilitation starts. An incredible amount of work ahead.

The International Community response

“Emergency” is not something that we have experienced before to this extent. But it is amazing to see, and we are starting to understand a bit, the enormous effort by the international community of the UN, government donors, INGO‟s, which actually creates a lot of order and system in this chaos (although in some cases also more chaos). At the UN Logistical compound (the 'logbase' at MINUSTAH) an operations centre was created. I don‟t know where to start to describe this and I won‟t because it goes beyond the scope of this report. Just a few key words: big white tents, clusters of health, logistics, communication, water, PHC, shelter, protection, nutrition, food distribution, blitz meetings of 45 minutes, action points and implementation, about 300 hundred orgs represented, airplanes landing, helicopters, noise, wind and steaming hot, wireless internet, canteen, coffee and meals, boxes-pallets and crates, tankers with water, trucks with food, blue helmets and camouflage uniforms, sweat and plastic water bottles.

CBM is in the Health cluster and also participates in the Protection Cluster (child protection, especially for disabled kids is a big issue). WHO and the Ministry of Health have asked Handicap International and CBM, together with the Secretariat d'Etat de integration de personnes handicapees, to lead a special working group on injury, rehabilitation and disability, which is now operational. Within this group another working group for prostheses and orthoses has been organized, bringing together organizations making orthoses and prostheses and organizations needing those for their patients. Valerie and Michiel have regular coordination meetings with the clusters and the working groups. Those meetings are very short, to the point and aim at quick and effective solutions and implementation. And that is what we are trying to do with our small CBM team in collaboration with Handicap International. Next week we will open the CBM country office and the first short-time expat physio's will arrive.

Hospital snap-shot

Many patients have lost limbs; we have an estimation of around 2000 – 4000. Not the hundreds of thousands the media was mentioning but still lots of people are affected. Many more patients have fractures. As there were not enough plates and screws for internal fixation, many patients have external fixators. Michiel went a few times to the Hopital de la Communaute Haitienne for a few hours to mobilize patients there. In two weeks time more than 250 doctors and surgeons rotated through this hospital. Post-op rooms and stores were changed into operating rooms and the conditions under which the surgeons had to do their work were very poor. You probably don't want to know the details. More than 100 surgeries per day weredone and they worked 24 hrs around the clock. The hospital is full of patients who need post operative treatment. The hospital needed to create space inside and many patients are now in tents outside on the parking and driveway waiting to be discharged. But where can they go? Many have lost their house and they can only go back to a heap of rubble. Before discharge they need wheelchairs, crutches and other walking aids, of which we do not have enough. And physiotherapy! There are hardly physiotherapists in the country, so they need to be recruited from outside. Handicap International and CBM are doing that. The first physio for CBM will arrive on Sunday and hopefully soon more will follow.

In the meantime we can expect problems like non-unions when patients (in p.o.p. or external fixators) have been discharged without proper walking appliances and instructions for weight bearing. This is essential for good bone healing. We will also see infected stumps, and stumps that need to undergo surgery again at a higher level. We can only do so much….

It is a desperate situation for many of these patients. But the few that did get some attention appreciate it if you spend some time with them, exercise with them, and make them actually stand up and walk with crutches or a walking frame. A glimmer of hope and a smile to say “see you tomorrow”.

I think that is what we have to focus on and get our satisfaction from, not look too much at the overwhelming numbers of injured people, that is too depressing. We need to look at the ones that we can help, that one individual. That person who we can make smile, because suddenly, after days laying on a mat on the floor in a boiling-hot tent, realizes that he can walk with crutches and sit outside on a chair in the shade of a tree.

Community snap-shot

Marieke went out with a group of community workers to assess the situation of patients who were discharged. She went to Bourdon, a slum area where many houses were destroyed. It was literally climbing over the rubble with pieces of metal sticking out to get from house to house. The people who lived in the destroyed houses were either still in hospital or had moved to tent camps or to the rural areas to join their families there. So she found very few injured people in the slum. In the tent camps she found more patients, who were often discharged too early, still had wounds and plaster casts.

There are around 590 camps now in town. Marieke has been to several of them. Some camps are quite organized, for example in a mission compound, while other camps have sprung up completely spontaneous with people making tents of any material they could find. Thank God, it is not raining yet! The smell around one of the biggest camps near the collapsed presidential palace is almost unbearable, with refuse hardly collected and very few portable latrines.

The first days we could sometimes still smell the dead bodies buried under the rubble. Awful. It is unimaginable what a task it is to clear all the rubble. More and more you see groups of youngsters trying to move rubble, in a food or cash for work program of USAID and other organizations, but they hardly have tools. Where to start... Everyday again we look in amazement at the destruction, big concrete buildings collapsed as if they were made of cardboard.

The way forward

To respond to the enormous need for follow up in the community CBM and Handicap International, together with the Secretariat d'Etat (pour l'integration des personnes handicapees), are setting up 9 focal points for patients, providing information about services, simple wound treatment, mobilization advice/physiotherapy and mobility devices (crutches, wheelchairs, prostheses etc). These centres are called Antenne Handicap. Tents will be placed in the compounds of hospitals that have treated many injured patients in the emergency period after the earthquake. At a later stage they will be moved to the communities. Expatriate physio's will move from centre to centre. These physio‟s will also work in about 20 different hospitals in the city to meet the needs for post-operative treatment and follow-up. Local staff will be employed, some 42 community workers have already been recruited by Handicap International and Marieke and a colleague from HI will interview groups of nurses tomorrow for the Antennes.

Marieke has been going to some hospitals to discuss whether they agree to have our big tents in their compound for the Antenne. Some hospitals however still have their compounds full with tents with patients, so there we will have to wait. 2 antenne have been opened and next week more will follow. Besides that we are starting with Child Day Care centres for disabled children. Disabled children are especially vulnerable in emergency situations. The parents do not have time to look after them, they are looking for food, water, shelter and work, so the children are in danger of being neglected. If the parents can bring them to the Day Care Centre they will have their hands free during the day to try and cater for the family.

CBM Partners

Ulrike and Marieke went to assess some of the existing partners of CBM. One of them is the Eye Clinic in the University Hospital. The head of department, Dr Cadet showed them around the buildings. A big part needs to be destroyed, as it has structural cracks in the walls and it is not safe anymore.

The doctor was telling how during the quake the patient who was in surgery rolled off the table. It was total chaos. The nursing school collapsed completely. He and a colleague managed to pull 2 students out of the rubble, but 200 of them died.

Another CBM partner, the School for Special education also had their buildings damaged and declared unsafe and the equipment was looted. Fortunately the children were not in the buildings at the time of the quake, but one staff member lost both her legs while she was at home. As the other staff members want to get back to work, but can‟t as there is no building anymore, they almost begged whether they could be involved in some projects that CBM is now setting up. They will be involved in working in the Day Care Centres and the Antennes. It will help them to get over their trauma. Also for the lady with the amputated legs there will be a job somewhere in the program.

So far our first report. We have delayed sending it, because every day there is something new that we wanted to include.

Regards,
Michiel Steenbeek and
Marieke Dreise
Port-Au-Prince
Haiti
5th February 2010