Haiti: “this disaster is so, so far from over”

Dr Birgit Hauffe, a GP registrar at Grange Medical Group, Edinburgh, describes the challenges of responding to the Haiti earthquake. Hauffe has been working for the medical charity Medicins Sans Frontieres (MSF) in Choscal Hospital in the Cite Soleil slum area of Port-Au-Prince and is now in Santo Domingo dealing with medical referrals. She has previously worked with MSF in Angola and Liberia.

1. What is your experience of the scale this disaster, compared with other disasters?

“Haiti was a poor and underdeveloped country even before this tragedy, and had suffered badly from natural disasters such as hurricanes in the last few years. But the level of devastation here is beyond any I have ever seen before- beyond any I could really imagine. The streets of Port-Au-Prince are literally like bomb sites. I imagine people in the UK who remember the war might have something similar in their minds - but this is everywhere - not just single buildings…there is no street or area untouched. 

“The odd house still stands (often precariously) but people still feel uncomfortable about going inside - so life continues outdoors for almost all. The lucky ones in camps, some 400,000 or so voluntarily moved to the countryside, but an estimated 300,000 are still living in the streets with nothing. Ironically for the very poorest of the poor in the slums many buildings have remained upright (as they were made of wood and other lighter materials) but what is really striking is that there doesn’t seem to be a single person who you meet who hasn’t been affected: lost a family member, lost their house, lost everything.”

2. What have working conditions been like?

“I have been working in a tented hospital called CHOSCAL in an area of Port-Au-Prince which historically was the site of very significant and brutal gang warfare (apparently this is well depicted in the film of the same name - Ghosts of Cite Soleil - the name of the area). MSF had been using this hospital in the past, and MSF’s name was known and trusted in the area, which allowed them quick access to the structure, and they began the first life saving operations in the quickly rehabilitated operating theatres within a few days of the earthquake.

“The tents are the same as the ones I have worked under in cholera epidemics in the past - a good compromise - but really hot in the day despite the shade netting. The surgical, anesthetic and scrub team have been working pretty much flat out 24/7 trying to get the 80 or so patients sorted. The majority have amputations, mostly lower limb.

“Unfortunately as you might imagine the initial operations were often done in a hurry (I spoke to the surgeon who was here before, during and after the quake and he spoke of literally hundreds of people crammed into the tiny hospital grounds all begging for help. He himself did many, many, amputations in his first 72 hour non-stop shift) and there is now quite a lot of problems with infection. 

“The initial amputations were often conservative - trying to preserve as much of a stump as possible - but it seems that many of the patients who were already malnourished and whose tissues has spent some time squashed and hence oxygen starved have not been healing well despite debridement to what looked like good healthy bleeding tissue. It is that fight against necrotic and infected stumps with frequent further debridement and dressing changes under anesthetic which is keeping the surgeons so busy. 

“As I am not a surgeon I was working in the tents trying to organize the patient flow through the operating theatres, supervise the national staff, and also man the ’salle d’urgences’. We were working 8am-6pm which meant leaving the house at 7 and coming back at 7 or so. My French has been sorely tested!

“In the ’salle d’urgences’ we had some general medical cases - LRTI, exac asthma, cardiac failure - but also some tropical stuff such as typhoid fever, malaria, and dengue in some expats. We were also receiving trauma - mainly in the form of gunshot wounds - both using shot type bullets which pepper the patients with shallow wounds, and also the type of bullet I imagine is normal (I have little experience with this!). Fortunately the surgical team is always at hand to help!

“After a week or so in Haiti, I was asked to move to Dominican Republic to follow the care of the patients who have been transferred here for definitive care as I speak Spanish (a lot better than my French). Working conditions here are much easier in the sense that I have my own room to sleep in at night (in Port-Au-Prince I was sleeping on the office floor) and we have a phone network which actually works!”

3. Have enough supplies, equipment and drugs been available?

“For the medical side we have sufficient supplies - actually we are mainly using dressings and simple antibiotics. What we are desperately in need of is crutches, which have come from our close association with handicap international who have sent physios to work in our structures but they had run out…without these the important phase of rehab simply can’t happen.”

4. What have been the successes of, and satisfaction in, your work?

“Since I have been in Santo Domingo I have been able to get to know the patients we have here and their families really well, and am constantly struck by the strength of will and hope and incredible dedication the carers show to the patients, and the overwhelming gratitude they show.

“There is one young woman as a patient, and her father as a carer. They have lost absolutely everything in their world, and are now living in a world of different languages and habits. Every time I come to visit the father tells me he feels strong when I’m there - he knows someone is looking after them (as I have to ‘encourage’ the staff to do things for the patient) and he thanks me so effusively I want to cry. 

“I tell him this is my job - that he doesn’t need to thank me - but he always replies the same: you have given me my world and my hope…enough to bring a wee lump to anyone’s throat I think.”

5. What have been the frustrations and heartbreaks?

“Too many to count. The sheer scale of disaster. The fact that even when you make these patients ‘well’ from a medical point of view - you may have saved their life - but they are destined to a live in a world of so few opportunities. 

“The thing that worries me most for the near future is the coming wet season, hurricanes often devastate this part of the world. What happens to all those hundreds of thousands living in the streets when the rains come? And if we don’t manage to organise the water and sanitation systems before then, then we may be looking at huge outbreaks of diarrhoeal disease, etc. With all the standing water there is also the increased risk of mosquito breeding sites, so a possible rise in malaria and dengue etc…and how can you fix all that in a few short months? 

“This disaster is so, so far from over - even if we do get folks walking again.”

6. Do you feel you have been able to do enough?

“My job in the hospital in Choscal was really mainly one of organisation, although I really enjoyed working in the salle d’urgences (I was previously an A&E trainee before defecting to GP). So in many ways I didn’t feel that my medical skills were so important. 

“As often seems to be the case in these types of situations you need someone who can take a step back, see the big picture and then try to organise the use of resources most efficiently. You can never do ‘enough’ - there is always more to do!!”

7. Is there anything that could have been done better?

“Speaking as a pedantic list maker and organisational freak, who arrived after the main chaos had died down a bit, I think co-ordination and organisation could have been better, but then I wasn’t faced with literally hundreds of people with mangled limbs standing at deaths door tugging at my clothes asking me to help…”

8. How easy is it to slot back into, and readjust to, everyday practice after working in a disaster zone like Haiti? Do the mental images ever go away? 

“I’ve worked in developing worlds since 1995, living in Cuba for a year before I started medicine, so I am quite used to the stark differences between the two worlds. It doesn’t stop you being angry at the injustices, and frustrated by the apparent narrow mindedness of so many people in the UK who seem to choose not to be interested in a world that is not their own. 

“The best you can do is share your stories with people and hope to instill in them at least some level of awareness and interest in the world around them. I don’t believe we will ever live in a world where people are truly egalitarian and considerate - but I do believe we can all do a little to get a bit closer to that ideal.”

Read more about MSF.

Tags: Disaster relief, Haiti