Haiti, the second country in the New World to gain their freedom from a European colonial power has never had it easy.  Thousands were brought to the New World by France as slaves to work the sugar plantations.  A revolt lasting over ten years finally gave them their independence and freedom.  The French demanded that reparations be paid to the former slave owners amounting to 60 million Francs.  Haitian economy has never recovered from this debt which was not satisfied until the 1940’s.  Life in Haiti is very difficult even into the 21^st century.  As the poorest country in the Western Hemisphere they have been neglected for almost two centuries.  The land there is more mountainous than most Americans realize with the capital city of Port-au-Prince bordered on three sides by steep hills and on the forth by the ocean.  The mountains are almost devoid of trees.  The rich tropical forests were cut for fuel and to pay debts to other countries.  The soil is rocky and scarred by years of erosion.  The average Haitian earns only $500 per year.  Their government, by all accounts is one of the most ineffectual and corrupt in the world.

Tuberculosis, Hepatitis, HIV and a host of other illness abound in Haiti along with diabetes, hypertension, anemia, malnutrition and malaria.  Only one Haitian in 10,000 has ever seen a doctor.  A mostly Christian country, the church is the center of most life there, after just staying alive.  Haiti is the dirty little secret of the Western World; tolerated, minimally assisted and ignored for the most part.  The people there are almost all descendents of the slaves that made Haiti the richest of the French colonies.  Most speak Creole, a language with its roots in the French of more than 200 years ago, and West African languages.   After the Haitian slave revolt and the loss of their rich colony, France offered to sell the Louisiana Territory to the U.S.  The French packed up and left.  Haiti has struggled ever since.

January 12, 2010.

It was life as usual until the earth shook violently for about 40 seconds.  The epicenter of this 7.1 seismic event was centered just a few miles southwest of the heart of Port-au-Prince.  The buildings in the cities and villages are almost all of concrete and mortar.  There is little regard for building codes.  Most have concrete slab floors and roofs with block walls.  Large areas of the rambling city collapsed.    In less than a minute of shaking, thousands were killed.  Many more were trapped beneath the rubble to die over time.  The streets were blocked by rubble making any transportation impossible.  What few hospitals there are in Port-au-Prince were mostly ruined.  Life, as bad as it was for most Haitians, suddenly became the ultimate horror.  The damage far surpassed any capability of their government to take charge.  People tried, mostly in vain, to free their family members and neighbors from huge piles of twisted re-bar and concrete.  There was no electricity, no water, and little food.  All rescue work was done by hand at first, there was no heavy equipment.   Bodies littered the street.  Horrendous injuries were common.   An estimated 280,000 people died as a result of this 40 second slip of the earth’s crust.

Within hours relief efforts by the rest of the world were started.  The scale and logistics of the task were unprecedented.  Just getting to Haiti was not easy.  Their airport has a single runway, without adjacent taxiways.  Any plane landing must taxi to the “terminal” on the only runway.  Only a couple of planes could land each hour.  The airport tower was destroyed.  Water and food were almost impossible to find.  There was essentially no medical equipment or supplies for this city of 2.5 million.  Chaos reigned.

The first serious relief effort from the outside world arrived to an unbelievable scenario. The call went out to the world for a massive rescue effort.  To rescue as many trapped people as possible and to care for the staggering amount of trauma was the immediate goal.  Efforts to supply food, water and shelter to the survivors rapidly accelerated.  The call for surgeons, physicians and medical personnel went out across the globe.  Medical teams streamed into the city from the U.S., Europe, Mexico, even as far as Pakistan, Japan, Korea and Australia.  U.N. forces were sent to Port-au-Prince for security.

At first, only a few planes could land at the Port-au-Prince airport.  The airport facilities and ground transportation were a constant problem.  The injuries were more like those seen in battle.  Severe crush trauma, open fractures, and internal injuries.  So many amputations were done to save the lives of the victims that I doubt anyone will ever have an exact count.  Many medical teams landed in the neighboring Dominican Republic and loaded into trucks for the grueling normally seven hour trip to PAP.  The trip took more than one day at times.  The road is so bad only daylight travel is possible. The influx of medical teams outpaced the arrival and distribution of supplies and equipment.  International medical teams did what they could, but the needs were staggering.  Vivid news coverage kept American glued to their TVs.  Many millions of dollars were donated by individuals, governments and corporations to assist in relief and recovery.

About a week after the earthquake I received an email from Dr. Susan Caldwell of Lansing, MI.  I knew her from her mission work in Honduras.  She asked if I would go with her to Haiti, she was putting a medical team together.    I had been planning to go to Honduras during that time period on a medical mission team with AHMEN (Alabama Honduras Medical Education Network) based in Jasper, Alabama.  Things had not worked out for that trip, and I had already arranged for time off from my work at Urgent Care Northwest is Jasper.  It was obvious to me that I was destined to go to Haiti.  God has a way of closing one door while opening another if you watch for it.  Sometimes, He gets your attention with a bang, not just a whisper.

I called Dr. Caldwell and said I would be proud to go and do what I could in Haiti.  I had made several trips to Honduras, but I knew this would be much rougher duty.  Dr. Caldwell was pulling all the strings she could to gather donations to buy medications and supplies through her foundation at Limonaid.org.  We had to buy commercial airline tickets to PAP.  The airlines were not cutting their fares at all for relief workers.  We even had to pay full baggage rate for all of our medical supplies we carried.  Before departure, we had accumulated over $250,000 worth of medicine and supplies, thirty eight large plastic containers similar to foot lockers.  The team paid an additional $1700 in extra baggage charges.

We were first booked into Port-au-Prince airport.  All commercial flights into PAP were cancelled a few days prior to our departure.  We quickly changed our destination to Santo Domingo is the Dominican Republic.   This involved an extra day of travel as night arrival precluded travel across the mountains into Haiti.  We arrived in Santo Domingo on February 11^th expecting our previously arranged transportation to take us to Port-au-Prince that day.  Alas, the vehicles they provided would not carry the large amount of supplies we had brought with us.  We had to spend an extra night in the D.R. while suitable transport was found.  Early on the morning on the 22^nd we were all packed like sardines with thirty eight large containers, into a small bus for the six hour trip to Port-au-Prince..  The closer we got to Haiti, the more inhospitable the terrain became.  When we finally crossed into Haiti we were told to close the curtains on the bus.  Bandits might want what we were carrying.  After another hour or so, we began to see a few collapsed buildings as we traveled up and down the steep hill surrounding PAP.  We were all awed at the mountains, poverty and the traffic on the roads.  Haitian drivers can turn a two lane road into four lanes and do it at 60 mph.  Damaged buildings lined the roads in places.  Our road was on the very edge of steep drop-offs into the deep valleys below.  The views were impressive, but a little disconcerting.

The last portion of our journey was to the GCOM orphanage about 15 miles southeast of PAP in an area called Calabasse.  We traveled up a winding dirt road for several miles.  I was amazed that our bus was able to negotiate the sharp turns and deep holes.  We ascended to almost 5000 feet above sea level and there were taller mountains around us.  The weather was very cool and the air was clean instead of the smog in PAP.  There were several destroyed buildings nearby, but the large orphanage had withstood the quake.  We felt safe there and spent our first night sleeping wherever we found space.

We were unsure where we would go to work the following days.  The next morning, we traveled down to PAP across the roughest dirt road I have ever been on.  Sixteen of us in a small “Tap-Tap” truck with what we hoped would be a day’s needed medication.  We ended up at a hospital in the Pernier section, the Centre de Sante de Pernier in Pétion-Ville, a suburb in PAP.  The hospital serves 100,000 people with hardly any supplies or medications.  Despite all the foreign doctors now in Haiti, none had been to Pernier.  We were greeted with open arms and given the entire second floor to set up our clinics.  Our group of three physicians, one PA, one CRNA, several nurses, pharmacy techs, volunteers and translators evaluated and treated well over 200 people the first day.

We treated patients with diabetes, hypertension, diarrhea, infections, stomach ailments, worms, malaria, and much more.  Because the hospital had no surgical facilities, our surgeon and anesthetist did general medicine this day.  We saw a small number of patients with injuries directly related to the earthquake.  Most of the severe injuries had been treated over the past weeks and were now recovering in the tent cities.  At the end of the day, we piled back in the truck for the long uncomfortable drive back up the mountain to Calabasse.

On the drive through downtown, we passed countless destroyed buildings.  On a few occasions we could smell the unmistakable stench of rotting corpses, but only rarely.  People were working on the piles of rubble, looking for possessions or for loved ones.  Who knows?  We passed many smaller tent cities.  Any place that was open and flat seemed to have sprouted closely packed shelters.  Some were real tents, some just blue tarps or sheets of tin roofing or bed sheets.  Anything that would give some shelter was put into use.  The street were lined with people selling whatever they could; vegetables, water, shoe-shines, phone cards, even DVDs.  The traffic was as bad as anywhere you’ve seen.  Exhaust fumes, crazy drivers, honking horns, weaving motorcycles and brave pedestrians.   People seemed not to notice the surrounding devastation.  I guess it was now commonplace.  We were all too tired when we arrived back at our base.  We ate a light supper, took uncomfortably cold showers and crashed for the short night’s sleep.

The next morning we split into several groups and left the orphanage at dawn.  One group set up a clinic near the orphanage and saw over 200 patients.  I spent another day at the Pernier hospital, and the surgical team was sent to a functioning surgical hospital to work. In all we saw in excess of 400 patients.  On the third day, we again split up our forces to care for as many persons as possible.  We had decided to form a relationship with the Pernier hospital and their staff, to continue to provide supplies after we returned home.  We planned to leave them all unused medications remaining when we left Haiti.  We probably had 50 times as much medicine with us as they had in their whole pharmacy.  We worked closely with their staff of Haitian and Cuban trained doctors who enjoyed having sufficient medications at their disposal and a chance to practice real medicine.  Word had spread in the neighborhood that there were American doctors at Pernier.  Hundreds of people were waiting for us.  We treated several very sick patients.  One had typhoid fever, several with severe dehydration from diarrhea, even one with chicken pox.  Visions of epidemics of any of these diseases were frightening to us all.

On the third day we went again to the hospital.  I had been lax in drinking enough water in the heat and became ill requiring IV fluids.  We continued to see as many people as we could.  The line to see us seemed to never shorten.  Everyone wanted to see the American doctors.  After another long, long day we returned to the orphanage where our anesthetist fell and dislocated his shoulder.  We were able to reduce his shoulder and realized that he may have to return home in the morning.  One of us would have to go with him back to Santo Domingo.  We made plans to catch a bus in the AM.  The next morning Randy was more comfortable so the team stayed together in Haiti.

Several members of the team went into the center of Port-au-Prince to one of the larger tent cities; concentrated poverty with only minimal health care, sanitation and food.  All these tent cities are ripe for the violence seeded by the condition there.  We held several clinics in tent cities.  We saw many patients that had been cared for right after the earthquake and had been returned to their tents to recuperate.  We supplied medications and supplies to the local camp leaders and nurses.

We had a chance to see the heavily damaged area in PAP.  The beautiful Presidential Palace in ruins.  The Palace of Justice totally collapsed while in full session.  These are the seats of government in Haiti.  All the records for the nation were destroyed.  The Haitians, despite their distrust of their government and its lack of effectiveness are very patriotic.  Seeing the destruction of their government seat affected them deeply.   The tent cities in the heart of Port-au-Prince were shocking.  Against the background of the collapsed Palace, to see acres of tents and masses of displaced people was a sight I will never forget.  We saw many Haitians just standing, staring at the ruins of what were once the showplaces of their country.  There were many America Soldiers and Marines in the city.  We always felt better when we saw them, knowing there had a special eye on us as Americans.  We always took time to greet them and thank them for their service to the people of Haiti, and to us.

By Thursday, we were reasonably certain that the Port-au-Prince airport would be open.  This meant we would not have to return home via Santo Domingo.  This was great news. We spent that day in more tent cities.  The hospital in Pernier apparently had been shipped a load of supplies and equipment from a relief organization in the States.  It was being held until “taxes” were paid to customs.  Donated equipment is supposed to be tax free.  These demanded taxes were most likely bribes.  When money was found to pay customs, the amount required suddenly was increased!  Dr. Caldwell; no meek individual, made a couple of phone calls to a local major relief group and the full shipment was delivered to Pernier in two days…. with no taxes due.  Rumor has it that the President of Haiti was called and he had a word with the Customs officials.  On Friday, we made brief visits to one more tent city and saw another 200 or so patients.  We then returned the Pernier Hospital to deliver all our leftover medications.  The truck from Customs was there.  It was a great last day for us and for the Hospital.   There was now the real possibility that this small hospital will have the materials, equipment and supplies to make a real difference in the lives of the people they serve.  Plans were made to form an ongoing relationship between an American hospital and the CENSHOP hospital in Pernier.  Because of the efforts of our team, Pernier Hospital will now be a site for foreign healthcare providers to work as long as the relief effort continues in Haiti.

Saturday morning we made our final trip down the mountain into Port-au-Prince.  This time to board our planes back to the United States.  There were sad goodbyes and promises to return as we walked the long road to the terminal.  In total, our teams treated well over 2000 patients while in Haiti.  We were all emotionally moved by what we had seen there.

What will become of Haiti?  Where will all the displaced people end up?  How long will the tent cities be required there?  Where will the money to rebuild Haiti come from?  News today tells that people are being told to leave the tent cities and return to their homes.  The rains are coming and the authorities are likely afraid of the epidemics that will certainly accompany the floods, landslides and seas of polluted mud.  Where do you go when your home is now no more than a pile of broken concrete?

This country is poor beyond belief.  There is no money from within this nation to rebuild Port-au-Prince.  Is there money enough in the world to rebuild?   I would like to return to Haiti in a few months to see what changes have been made.  This catastrophe has been quickly moved off the front pages of the world’s news papers.  There were already more relief organizations and NGOs in Haiti than anywhere else in the world, and that was before the earthquake.  Will Haiti slide back into the shadows of the world?

Can and will the world do what will be required to repair 200 years of poverty and neglect compounded by this natural disaster?  Only time will tell.  No one can answer this question with any certainty..

Bruce McFadden, PA-C

Birmingham, AL

February 25, 2010

Dr. Susan Caldwell posing with Dr. Casimir of Hopital De Prenier Censhop.

I want to give a diary/memento of some of our work in Haiti.  We appreciate so deeply your loving support, good wishes and prayers.  I am deeply humbled by our experiences.  We were blessed far beyond our expectations and feel that we accomplished more than we could have ever hoped for – though it is less than a drop in the ocean of the needs of our beloved Haitian friends.  We are all safely home, but our hearts are still in Haiti – I wish I could have stayed indefinitely – it was hard to go where there was so much need – but we had used all our resources and needed to come home.  We will never forget.  Many of us were permanently changed by what we saw and experienced there.

Wed 10 – With our 38 (50#) crates we left from Detroit in a snowstorm, $1400 went to the airlines for the extra crates.  We met some of our group in Miami, and stayed the night there – we had to store the 38 bins as the airlines would not check them through, which cost $200.

Thurs 11 – Arrived in Santo Domingo (Dominican Republic) and met up with our last team member – 3 doctors, 4 nurses, 1 PA, 1 EMT, 1 physical therapist, 2 pharmacy workers.  The airport waved us through passport and customs without even looking at our documents when they found we were doctors going to Haiti.  Were met by Bobby of GCOM (a wonderful man who was raised in House of Blessings orphanage near PAP where we were staying).  We had a couple of vans – but there was not enough room for all the bins of supplies, so ended up having to spend the night in Santo Domingo and renting a small bus the next day.

Fri 12 – We left at 6 AM, making the seven-hour drive to PAP.  Again at the Haitian border we were waived through without stopping for passport clearance.   There is a shocking change in landscape at the Haitian border.  Sadly all the trees have been cut down to pay off debts to the French (after the slave revolt in 1809) and to burn wood for cooking.  It is dry, dusty and barren compared to the lushness of the DR.  In PAP we drove directly up the mountain to our little orphanage (15 miles but another hour and a half due to road and traffic conditions).  We made this drive twice a day the entire time we stayed there – but it was nearly impossible to find somewhere safe to stay in PAP.  The orphanage was built by an American and housed currently 14 orphans of all ages.  They and the staff welcomed us into their little home.  We picked places to sleep – some in tents outside, some in bunk beds in the orphan’s rooms, some on the floor – and I chose to sleep on the 2nd flood patio.  We spent several hours organizing our massive amounts of supplies and medications and packing for the next day.

Most nights we had an orientation/debriefing meeting that sometimes included airing our frustrations and a song and prayer.  We slept OK except for the dogfights in the garbage, the crowing roosters, the hard floor, and the cold nights (the temp dropped precipitously at sundown in the mountain).

Sat 13 – We packed 25 people plus about 10 bins into the Tap-Tap (an indescribable sort of truck that is the endemic form of public transportation in PAP), leaving around 6:30AM.  We drove the hour and a half down an incredibly rough dirt road into PAP – where we had our first glimpses of flattened houses and buildings and smaller “tent” cities.  Many tent cities consisted merely of sheets hung up over poles, or cardboard boxes.  Every little encampment had a sign saying “We need food, water, medical care”.

Many tent cities had not received any assistance since the earthquake (which the Haitians call “the event” or “that thing that happened”).  We headed for a small hospital in the Pernier district (a 15 minute drive from the hard hit downtown area).  The hospital was called Censhop.  As soon as we drove up some doctors came out and warmly greeted us.  They had received no international help or medications since the Event and were absolutely thrilled to see us.  This hospital was built 8 years ago by Dr. Casimir from his own money that he got by selling a piece of land.  It is a non-profit hospital that until a few months ago was getting some support from the government, but that had dried up.  They serve an area of 100,000 people with 12 part time doctors and a handful of nurses.  Their pharmacy was not much bigger or well stocked than my medicine cabinet at home, and they had no surgical equipment.  After the Event they saw 5000 people, 500 of whom had to be shipped to other hospitals for major surgeries.   It is by Haitian standards a nice facility with multiple bathrooms, patient rooms, waiting areas.  Many rooms were not being used since they had no way to care for the patients.  We set up our pharmacy, triage area, and began seeing patients – seeing 150 patients that first day.  Some were very ill, some were mildly ill – but all were appreciative.  We saw some severe malaria cases, diarrheal illnesses, and severe uncontrolled asthmatics, as well as many hernias we were unable to operate due to a lack of an autoclave.

Memorable cases – a 50 year-old man who nearly died of acute asthma our ER doc was able to save, a man shaking severely from malaria, a dehydrated baby.

Memorable people – Jean (a 20 year old man who had taught English until his school collapsed) showed up at the hospital to see if he could translate for us.  He worked with us all day and we learned his story.  Not only had his school been demolished and many of his students killed – but his entire family was dead – mother, father, sister, brothers and some cousins.  He was the only one left.  He was sleeping on the ground with no shelter in a park, heard we were at the hospital and came to try to help.  I hugged him and expressed my sorrow.  He said he was grateful to God to be alive.  We offered to sponsor him in the US if he can find a way to get a visa and Peter gave him some money to try to get a visa.  He was so sweet.

Memorable scenes – a grocery store completely flattened – great slabs of cement and rubble – hundreds of bodies still buried and the smell of decaying flesh.  A feeling of being in a morgue – yet the city streets pulsating with life everywhere around – pigs and dogs rooting in the rubble – street markets with fresh produce everywhere – mounds of burning trash in every street – dust and rubble everywhere.

The drive back up to the orphanage was somber, we arrived at 7 PM, they fed us and we felt so lucky to have food and water, cold showers for some.

Sunday 14 – We divided into two teams.  Half stayed in the mountain to run local clinics (after church – Haitians are very devout and in fact were in the middle of a national 3 day fast for the dead and injured).  The other half went back to the hospital where we set up our pharmacy again – today news had spread there were American doctors and we saw 200 people (plus 120 in the mountain).  Many churches were flattened and 90% of the schools were unusable, yet people were worshipping everywhere.  The remaining churches were packed to the brim (they say Haiti is 50% protestant, 40% catholic, 10% other – and 100% voodoo).  All the Tap Taps are painted brightly like circus trucks with slogans such as “Jesus Saves”  “Thanks be to God”  – all in Creole of course.

Memorable patient – a 19 year-old young lady with a rectal abscess that had to be surgically drained.  She was so shy we had to put the male translator in the bathroom and we shouted back and forth during the procedure.

Memorable scenes – Haitians everywhere dressed and clean in their Sunday finery – looking much better than us hot, sweaty Americans – with little water, no homes, most of their belongings gone.

Monday 15 – Again divided into two teams as the mountain clinic was overwhelmed with need.  Today the mountain team saw 240 patients, and the hospital team nearly 200.  We were mostly seeing non-acute things.  The worst of the earthquake victims were being cared for in the field and city hospitals that had surgical capacities, although we saw quite a bit of wound infections, lacerations, and a lot of uncontrolled asthma – partly because of the dust but also because there is no preventative medical care for the asthmatics in Haiti.  Our surgeon was frustrated by a number of surgical cases we had to refer due to lack of an autoclave.  Dr. Casimir told me he had a large crate of medical equipment tied up in the port but they could not get it out because they wanted $2000 and the hospital simply did not have it.  They were paying their doctors $300 a month and their nurses $100.  The cost of living in PAP is high.  Gasoline is $7 a gallon.  We gave vitamins with iron because nearly everyone was anemic due to poor nutrition and untreated tropical diseases.   At this point having seen around 900 patients things were becoming a bit of a blur.  Our surgeon and nurse anesthetic went to Quisqueya (a school that had become a command center for dispensing medical teams to various hospitals).  They ended up doing some surgeries and wound debridements and dressing changes.

Memorable scenes – blocks of women and children waiting in line for the World Food Organization trucks.  ID badges are only issues to women, as they are known to also feed the children and they don’t fight in the hours long lines.  The result of this is mostly beneficial but some of the men went hungry if they did not have women feeding them and anger towards women sometimes broke out.

Tuesday 16 – Half of team to the hospital – half to our first tent city.  The mobile people arrived first in Las Vegas (large tent cities all have names and numbers – and the UN keeps track of how many people are there.  Las Vegas was a tent city of 4012.  A US army detachment was there with a first lieutenant who told us he was heading up an investigation into 14 rapes that had occurred there recently.  There was a Doctors Without Borders hospital relatively close so we headed to a larger tent city with 7,000 and set up under a canopy.  I was impressed to see the women schooling the children and we shared the space with the school.  We again saw around 200 patients, treating multiple infections – including a leg osteomyelitis (bone infection).  We were afraid of tetanus – most of the population has not been immunized and many hospitals have already had people die of this dreaded and difficult to treat disease.  We had no tetanus vaccination with us and were unable to locate any.  Between the two teams we again saw around 400 patients.  A Hiatian nurse who lived in a nearby tent city saw us and brought her nursing license over and asked if she could help us.  I think her name was Mireille.  She didn’t speak much English.  She was awesome and helped the pharmacy people (Kyle and Peter).  She had no job because her hospital was destroyed (like most of the rest of the city – one of the worst things was noone had a job and they were all subsisting on handouts).  She came and helped us every day.

Most memorable patient – part way through the day someone brought a 6 year-old boy named Davidson to the tent clinic.  He had a fever of 103, machete cuts on his feet, and looked yellow.  He seemed to be a street kid and told us his parents were dead and he lived with his aunt.  We treated him for malaria, pneumonia and cuts and rehydrated him.  We gave a tent to one of the men and told him to keep him there that night and see he got his medications and we would come back in the morning.

Wednesday 17 – The whole team set up in a larger tent city in one of the roughest downtown areas, next to the city Soleil (the notorious slum area where 4 and 5 year olds carry guns to protect themselves).  This was definitely a harsher environment; we treated lots of sexually transmitted diseases and some really nasty infections that needed surgical drainage in addition to the usual.  Part of our team set up just to clean and dress wounds.  I spent the day driving around PAP with Dr. Casimir trying to buy medications (we went to 4 different pharmacies to get some of what we were running out of).  We also tried to find an Autoclave (or a pressure cooker) to sterilize instruments – but there were no department stores – everything was demolished – in a city of 2 million – we couldn’t find anything to sterilize.  I offered to pay the $2000 to get the crate out of the port and we found a bank but they would not take my charge card so Dr. Casimir borrowed the money from his friend and I agreed to pay it back as soon as the bank president OK’s the transaction.  We then took the check to the Port – only to find that they wanted an additional $1500.  That is how things work in PAP.  We took the $2000 back and I decided to work on the problem from another angle.

It took us most of the day to locate Davidson because some of the men had taken him in hopes of extracting money from us.  I told them we would be back with the US army if they didn’t produce him by 2 PM.  We eventually found him, talked to a blind older brother who confirmed he lived with his aunt in a cardboard tent with 10 children she was raising.  We were able to find the place he lived – and it made the other tent cities look like upper middle class.  There were literally thousands of box and sheet tents packed in next to each other – it was incredibly crowded, noisy and demoralizing.  His aunt introduced us to his siblings and cousins she was taking care of, we told her we respected her, told Davidson not to run off (his parents had died of tuberculosis when he was 2) and left her with some supplies – which probably got distributed among all her neighbors.  We offered to take Davidson to an orphanage but both the boy and his aunt declined.

Most memorable patient – a 5 year-old girl with congenital cataracts, almost blind.  Her mother told us she had been all over Haiti looking for a doctor to help her but they said nothing could be done.  She had the most beautiful blind eyes.  We took her contact information and told her we would see what we could do.  She expressed great fear we would take her daughter from her, but we reassured her we would not.

Wednesday evening the doctors and nurses decided to stay at Quisqueya and go out to hospitals the next day, the rest of the team went back up the mountain.  At the Quisqueya meeting I told the staff about our little hospital and they agreed to start sending medical teams the next day.  I also told them about our problems with the medical crate – they got a look of fire in their eyes and assigned someone to look into it the next day.  We slept in a tent, no roosters but the traffic and horn blares went on all night.  It rained pretty hard and we got sort of wet.  We worried about all the people in tents and boxes, and heard there were many floods.  Rainy season starts in a month.

Thursday 18 – 5 of us went to a large hospital where they were treating amputees, and other post-traumatic surgical patients.  The hospital was partially destroyed and all the patients were in tents outside the building, but they were doing the surgeries inside the OR’s.  The surgeon and ER doc did a lot of wound debridements, flap revisions and other surgical cases.  The nurses worked in triage and ER and came back telling us our team was better organized and supplied than the hospital ER.  I made the mistake of agreeing to run a street clinic outside the city.  I had to collect my own medications and supplies – and while I was in the medication tent overheard an eye doctor asking for medications.  He agreed to treat our little blind girl, and we contacted her and had her go with her mom to the University General Hospital where the eye team was for two days.  We hope she got her surgery.  My street clinic was incredibly disorganized and poorly run and the nurse midwife who was in charge did not seem interested in actually seeing patients and giving appropriate treatment.  She spent most of the time praying with the patients and measuring pregnant women’s bellies.  I saw about 70 patients on my own and had to dispense my own medications.  I opened and drained an osteomyelitis, treated a lot of malaria and sent one very sick infant (who clearly was multiply infected with either HIV or malaria or both) to the hospital.  I tried to get the nurse to help me and train her how to identify and treat malaria but she was clearly uninterested.  I did not get back to the compound until 7:30 and decided to go back up to the orphanage that night.

The remainder of our team that day ran some wound care clinics and street clinics and drove through some of the hard hit areas – they visited the Presidential Palace (collapsed) and a Baptist mission that had a small Haitian museum and zoo.

Most memorable patient - My translator in the street clinic was a lovely young woman named Ruth.  She was a schoolteacher.  Her school and 23 of her students were destroyed.  During the event Ruth was on the 3rd floor of her house and her two sisters were on the bottom floor.  They both died.  She had a look of horror in her eyes when she told how they looked when they were dug out with their heads pushed down their necks.  “I will never forget it – never!” she said.  She showed me the remains of her house.  I hugged her but there was little I could say.  She did not cry.  She told me all her schoolbooks, personal papers, and money were gone.  I cannot forget her.

One of my other patients told me her two children were dead in the quake.  I prayed with her.  It was all I could do.  In a city of 2 million – one out of 10 dead, one out of 4 seriously injured, nearly everyone homeless – it is not possible to truly grasp the magnitude of this tragedy.

Friday 19 – Our surgeon and ER doc continued treating surgical patients through Quisqueya.  The remainder of our team ran a short tent clinic in Davidson’s city.  We saw 100 patients in an hour and a half, including a young boy with a rectal abscess, and a 15 day old pair of identical twin girls – they were so little and so beautiful.  Getting diapers was a terrible problem and many babies had sores.  Some of the moms had diminished milk supply since the Event and were feeding their babies with food that was too harsh for their little systems and they were getting diarrhea.  We did a lot of education.  The tent city of 5000 begged us to stay longer but we were almost out of medications, and had other commitments.  The head of another 1500 person tent city came over and begged us to go there, said they had had no care.  We were sorrowful, but it was our last day and we had things we had to finish up and it was already 2 PM.  We tried to leave boxes of wound care supplies, tylenol and food snacks – but right at the end a doctor and some workers from Partners in Health came over and tried to confiscate the supplies from the tent city leaders.  An ugly fight ensued with shoving, jerking and yelling.  I tried to intervene but no one listened to me!  Some marines were watching from outside the city but did not come in.  Finally I just hopped on the Tap Tap and we left them there to work it out themselves.  Violence in the tent cities is a growing problem – frustration, desperation, lack of work – there have been gun shot and knife fights and rape – but these are isolated incidences and most of the people are patient, resilient and kindly.

We then drove to the Hospital.  When we got there to our great joy there was a huge 18wheeler with an immense crate full of medical supplies on the back.  Our Quisqueya people had got on the phone to the Haitian president and got the port to deliver the supplies – and no money changed hands.  The hospital president came bounding down the stairs and there were tears of joy on his cheeks – he kissed and hugged me again and again.  It was one of the most joyous moments I have ever had.  Included in the shipment were operating tables and lights, TWO autoclaves, anesthesia machines, many ultrasound machines, computers and copiers, hospital beds, and stacks of ancillary supplies – a three page single spaced list.  Dr. Casimir said we had added 10 years to his life.  I introduced our little Haitian nurse to Dr. Casimir and gave her my highest recommendation.  He did a two-minute job interview on the spot (which we have on video in Creole), then hired her based on my recommendation.  She starts Monday.  We dopped off the 10 remaining crates full of supplies and medications we had brought from the states – leaving this little hospital with the ability to treat all the things we had treated, plus perform surgeries.  We had the blessing of helping to transform this little starving and dying hospital into a well-stocked and energetic hospital, able to provide at least basic medical care to the people in their district.  Dr. Casimir plied our whole team with coca cola and fruit drinks.  We were sorry to have to say goodbye but it was getting late.

We did a quick run to the Baptist mission, took a tour of the hospital where there were a lot of amputees and bad wounds, saw the museum and did a little street shopping – the Haitians are fantastic artists.

Our team had been there a week - Kyle and Peter had spent most of the time in the pharmacy or mobile pharmacy (back of the truck) – dispensing over 4000 prescriptions to the almost 2500 patients we had seen.  Some of us had not showered.  Our PA Bruce got dehydrated and our CRNA Randy pumped him full of IV fluid, the next day Randy dislocated his shoulder and Bruce popped it back into place and despite his pain he stayed and did as much he could – two nurses (OK I won’t tell their names) got some diarrheal illness.  We were all sleep deprived.  Don our surgeon and Monica our ER doc made an impressive OR team, Kathy and Katie were masters of triage, Rocephin shots, IV fluids, and generalized nursing care, Liz bless her heart extended our providers by seeing patients – she particularly enjoyed treating the pregnant women, Phoenix rotated between the pharmacy, triage, wound care and taking care of children, Mary also did wound care, triage and loved the orphans (she is a PT and should return and help with rehab of some of the amputees in the future).  Additionally we were joined by 3 young men and 1 young lady from UTAH who were truly awesome and did everything and more we asked them, two young men from Chicago (great at crowd control), and Martha and her mother Ellen (70+) who were the hardest working and greatest hearted people you could ever meet.

We made a lot of connections, learned so much, tried to help a little.  Mostly we learned to love Haiti and the Haitian people.  Ronald (our main translator and team leader) was truly amazing.  He was studying to be a pastor, but his school was destroyed along with 37 of his classmates.  He ran home to find his two sisters trapped in the rubble of their home.  He spent hours digging them out by himself because everyone else was digging out their own family members, but thankfully they were both survivors.  We love him so much.

What we learned about the Haitian people is – they are resilient, they are tough, they are hard working, they are intelligent, they are creative, they are beautiful, they have great hearts – they have tremendous potential.  Our hope and prayer is that out of this terrible Event a new Haiti can arise – one that allows the amazing Haitian people to develop their abilities, to govern themselves, to make a place that is safe, welcoming, prosperous, full of opportunity for all.

Sat 20 – Left our little orphanage at 6 AM, spent a couple of hours trying to get to the airport in PAP (which thankfully had opened up the day before), finally ended up walking the last mile or so to the airport because the UN had blocked all the access.  We saw soldiers and teams from all over the world – US army/air force – blue helments of the UN – Canada, Germany, Swiss, Israel, France, Cuba, even Pakistan had soldiers and medical teams in Haiti.  We were scanned and patted down twice at the airport – the plane left on time.  A medical emergency midflight turned out to be a Haitian woman with – an acute asthma attack.  We managed to stabilize her despite the fact she refused an IV (she said it would kill her), refused to use the oxygen, and even refused to use the inhaler as much as we wanted her to.  When we landed they hauled her off to the hospital.  I’m telling you – Haitians are tough!

Although we are happy to be home – our hearts are still in Haiti.  We hope to make an ongoing partnership with the hospital to help them provide improved care to their 100,000 Haitians.  We hope to return soon and often.  We hope the international community can assist the Haitians with helping hands, but not try to solve their problems – only the Haitians can solve their problems.

Thank you all so very much for your amazing support – we could not have done it without every one of you.  We will be making a blog with more stories and pictures and videos of our trip. We will keep you updated.

Bless you all,

Susan and Team

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