Tweets from Haiti

I had this series of tweets forwarded to my attention. I found the reflections and the reporting impressive--especially in consideration of how to communicate the vast and overwhelming tragedies via the Twitter media which requires such an economy of words. Also, some of the time stamps are pretty impressive:

Jan. 28

9:11 a.m. -  We are packing for Haiti

4:35 p.m. -  Loading the jet for Haiti

4:57 p.m. - We just loaded the trucks and are off to the airport

10:32 p.m. - What a great trip. Landed in wa dc. The crew and passengers were great Its cold here. Waiting 2hrs, refuel.

Jan. 29

4:27 a.m. - Just taking off from Miami for haiti. 9am landing slot. May need to circle pap 30-90min or go DR.

11:05 a.m. -  landed in Haiti no problem. Mayhem at airport. 200-1000 at hospital seeking care. Military will bring 300postop here

11:14 a.m. - we landed without probs. Hot & disorgaized here. About 1000 people waiting outside hospital. Military wants 300 postop in

6:17 p.m. - Nighttime now. Sleeping outside no rooms tents full hot anyway. Good thing we brought food.

Jan. 30

4:08 a.m. - Many fractures lots to do. 8 am mtg rounds then surgery all day tomorrow

8:39 p.m. - Relief workers encampment international experience. Italians made pizza pasta we had dehydrated meals but all ok.

8:47 p.m. - Sat nite. Operated till 22:30 8 cases. Kids c amps. Pregnant 18 yo girl c floating elbow open fx. children c femur & tibia frxs

8:52 p.m. - Derek did rounds on 25 pts then set up Ortho impant room. We set up equip we brought. Organizing daily schedule. OR. Clinic. ER

8:57 p.m. - Mary working to hard. Constant OR cases. No rest. make sure she has breaks need change her routine. We will kill her otherwise

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Jan. 31

4:23 a.m. - Bon jour. 75 @ 07:00. I'm on my second cup of tea. Sleeping outside. Can't stand the tents. Skeeters bad, bug nets good

4:33 a.m. - Plenty of difficult cases. Hospital ship full, they are sending overflow to us. All ages.

4:38 a.m. - Docs s boarders, French, Italian mobile hospitals sending open fxs here. Many ped femur frx. Using hip spica casts & exfix

5:07 a.m. -  Helicoptors are up again picking people up and distributing supplies

5:14 a.m. - Smoke in the air is better today. They have been pouring diesel fuel into the rubble to burn the decaying bodies making thick smoke

11:10 a.m. - OR functioning well. No Ortho implants avail except what we brought.

1:35 p.m. - Yahoo. Baptist hospital says they can provide exfixes and screw sets. They do not have a c-arm. I'll go there tomorrow to pickup.

7:45 p.m. - 8 cases today in 1OR. Turnover time 10-15 min.Doctors mopping floor. Teamwork prevails in our efforts for our fellowmen,women,kids

7:49 p.m. - Showers and cold beer tonite. God Bless, there are miracles.

Feb. 1

4:33 a.m. - Busy night. The wind shifted and the stench of death woke me. Sirens and yelling and 2 helicptrs. Thought we were under attack.

4:38 a.m. - Army flew in and set uptent wards in front drive of hosp. More injured arrive today. Just found out 6 femur frxs coming today

9:30 a.m. - Heading to Baptist Mission hosp.pick up more plates rods etc. Also will pu 2 adults c femur/hip frxs. That makes 8 femur frx today

10:21 a.m. - Just shook hands c Gen Keen. US Army. His impression of the situation is same. They are working hard logistcs of distibution hard

7:25 p.m. - Brought 22yo back from Baptist Hosp c severe femur frx in back of pu truck c impants. His whole family died. He Drawing pictures

8:18 p.m. - We were7 Ortho surgeons yesterday 5 today and4 tomorrow. Wed 2 more will come. All for one week except VM team. They are great

8:24 p.m. - We work as team. VM team working on routine Ortho model. establishing structure for future surgeons that rotate in.

8:32 p.m. - We are sharing rounds(4hr).clinic(6hr).OR(12-14hr)assist each other in OR. 20 cases on the schedule. ankle, forearm frxs, 9 femur frx

Feb. 2

3:35 a.m. - Quiet night.Good morning haiti.people still being injured working in unstable rubble trying to rebuild. forearm frx lastpm

4:50 a.m. - Hospital ship backed up 150 cases.we are backed up 20 now. The day is just beginning

6:56 a.m. - Headed back to Baptist Mission Hosp to pick up 76yo c femur frx. Other sugeons operating.

7:02 a.m. - Army will resupply our implant and equip needs. Thank you General Keen.

7:13 a.m. - FatherRick working to set up St Camile Hosp nearby as rehab facility for amputees. Need CADCAM prosthetic fitting machine program

7:45 p.m. - Busy day today. The USA Ortho team did 17 operations today in one OR. 6 were femur frxs, as many as the comfort ship did today

7:52 p.m. - Medishare sent 7 more pts c femur frxs. 2 had hip socket frx dislocations. We will fix them in AM.maybe 1.5 d surgery backed up.

7:56 p.m. - Medishare is backed up with frxs. Sent 7 femur frx wants to send 15 more. I asked them to wait 1.5 days till we clear backlog.

8:05 p.m. - Two more Orthosurgeons coming from US tomorrow.We need the help.Hospital ship sending pts mostly postops.Ortho rounds 50 in house

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Feb. 3

4:22 a.m. - Gd morn Haiti 2 femurs 1 severe pelvic crush came last noc. Need to send pelvis & L2 burst frx to ship helicop land @0800

4:25 a.m. - Surgeon from ship coming to evaluate our program & capacity on first copter 2USAsurgeons arrive today c sign nails. War Zone Haiti

4:53 a.m. - Lew Zirkle from Richland Wa & partners devel Sign nail for long bone frxs in underdeveloped contries. I get my first lesson today

5:07 a.m. - 71 patients to round on today for USA Ortho. Uncovering postoperative infections and loss of fixation or metabolic probs important

Feb. 4

2:07 p.m. - USA Ortho operated on 12 pts today. All went well. We recieved two severe pelvic dissociations that need to go to USS Comfort.

5:25 p.m. - We are fine. The tweets have slowed with the volume of work and the incidental mtgs and offers of help. Everyone wants to do something

5:34 p.m. - I lost a day thought this was Wed. We lost a lady to tetanus today. I have pts to discharge but they have nowhere to go and their family died

5:39 p.m.- A 3yo c Abov knee amp blames her older sister for her amp. Her sister threw herself on her to protect her during equake and died

5:43 p.m. - We need crutches and REI dome like tents to give to people on discharge so they have somewhere to stay

5:46 p.m. - Father Rick spent the day burying the dead like he does every Thurs. There were many in all stages of decomp. they had last rites

Feb. 5

7:47 a.m. - Docs s borders is sending us 12 femur frx tomorrow.They will take care of them postoperative. Still revising amputations daily.

7:59 a.m. - The coastgaurd brought 50 sets of crutches and dressing supplies today. Keeping us going. 7cases on the sched today. 10 yesterday.

8:06 a.m. - Took a rock shard out of a childs head today. Been there 3 weeks. Comfort ship may be leaving and Italian hosp ship coming

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Feb. 6

3:42 a.m. - Slower surgical day. Italians had the OR till 2pm. Tom&I went to st francis hosp today. Close to palace most buildings leveled.

4:29 a.m. - Dr in charge @ st francis said 120 staff &pts perished in hospital. They could not get them out of rubble. could hear them 10 days

4:59 a.m. - A WHO supply truck just outside the hosp just got mobbed and pallets of food stollen. The people are trying to get what they need#vminhaiti

5:07 a.m. - St camille hosp sending us 5 pts. Humerus, femur tibia frxs. Surgeons are coming and going. Tom Mary Derek& I are stability.

Feb. 7

4:58 a.m. - Slow day inOR. 3cases.Toured the city worstareas.Devastationof biblical proportions.People scavenging anything. Homeless families

5:03 a.m. - Mass burials continued this week. 20 babies to a coffin. 4 adults to a coffin. Sadness. Rebuilding is continuing.

5:12 a.m. - Fa Rick held mass yesterday on the rubble of the old hospital where Molly Hightower and others died

12:56 p.m. - Worked in clinic till noon. Rounds as well. Cancelled all surgery today,nothing urgent.Haitians deserve Sunday off. Church,family

Feb. 8

3:24 p.m. - Things are more sane today. Pts are being admitted at a steady pace rather than 3-6 at a time. Maybe I am just getting used to it

5:21 p.m. - earthquake has caused destruction and suffering. The world maythen recognize the need for rebuilding, basic sanitation sewer garbage

5:25 p.m. - These people deserve help no drunkeness. No obvious drug problem. Hard working resilient. Haven't met a Haitian that I don't like.

5:28 p.m. - Lots of poitics happening in the Catholic heirarchy. We are staying out of it. Focusing on excellence in pt care

5:32 p.m. - Frxs coming in now show significant early healing. Many in bad position. We take them to the OR and rebrake the frx and straighten out

6:16 p.m. - 9:15pm and the helicopters are up. That is unusual and some cause for concern

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Feb. 9

4:36 a.m. - I saw children climbing into a building that was ready to collapse...scavenging. There will be ongoing injuries.

4:55 a.m. - Haiti needs public sanitation and garbage services. The streets are covered with plastic bottles and garbage...stench, foul water

9:31 a.m. - spent the morning straightening out frx sent to us some of ours. Adjusting the exfixs some children are terrified, screamers

9:35 a.m. - catholic archdioceseis organising 7outposts for medicalaid food distribution healtheducation. Helicoptorpads forItalian military.

2:27 p.m. - Ran out of cast padding today,frustrating. Containers with donated material offloading tonite hoping for plaster, fiberglass etc

2:52 p.m. - Sun is going down. Red sunset. Enjoying a cold beer. Pleasant breeze. Hoping for Haitian recovery. Think positively,for healing

5:10 p.m. - Tom is going to assiston a surgery for a kid with an incarcerated hernia tonite. It is 8pm. Ortho is branching out. New territory

Feb. 10 (exact times not yet available for the following posts)

2:01 p.m. - New scenario. Italians report that there was a mass exodus from PaP including injured. Now rural clinics overloaded c injuries

2:06 p.m. - Rural clinics maytransfer pts back to city(us) for surgery and frx care. Our present lull maybe short lived.150K dead, 20Kinjured

2:11 p.m. - 80% injured Ortho problems. Multiple extremity injuries.Many crush injuries, frxs&nerve injuries. Many skin grafts, amp revisions

2:17 p.m. - Many helicopters coming & going bringing new pts.USAComfort decided to stay.Taking a few days to reorganize.glad they are staying

2:58 p.m. - Italians bringing 6 more helicopters. More pt transport. Italians are committed disaster relief responders. Great people.

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Feb. 11 (updated at 8:22 a.m.)

3:44 a.m. - It rained hard last nite. Mary and I had to move inside.We are fortunate.The mothers with babies and no tents just get wet

3:46 a.m. - We have one volunteer with Malaria.She has been here since the quake.She refuses to leave.

3:48 a.m. - The hurricaines come in 4 months.

1:32 p.m. - Tomorrow is 4 weeks since the quake. Many pts are coming in with frxs partially healed in a poor position.More difficult surgery.

3:04 p.m. - The Haitian Govt has declared the next three days for mourning.We will stop operating until Monday unless it is an emergency

3:08 p.m. - We were contacted by another community medical clinic today that will send us another 3-4 pts c femur/hip frxs Monday.

3:10 p.m. - We have been doing 6-8 surgeries a day.

7:04 p.m. - We had dinner with the Italian rescue workers tonite. Great pasta. Mary was stunning c red hair.We now have friends in Florence.

7:09 p.m. - Peter Ackerman MD from VM anesthesia will arrive in DR tonite and travel overland; be here in AM. We need anesthesia experts.

Feb. 12

4:18 a.m. - Peter Ackerman arrived safely this morning. New anesthesia blood.

9:21 a.m. - Today is a day of mourning and reflection. Mass was conducted at the mass burial site. All the churches are full today.

9:25 a.m. - Just had a starving kid come in to the kitchen here. Gave him some of our food. He told me his whole family died. Looked 13 yo.

9:33 a.m. - I spend hrs a day on email networking with Ortho surgeons coming down to resupply our equipment and implants.

9:37 a.m. - NPH has 3 containers of donated hospital supplies arriving. Ortho surgeons from US networking getting specalty items, effective.

9:43 a.m. - Implant companies told us there would be plenty onground onarrival. We have not found any equip except Synthes from Baptist hosp.

11:30 a.m. - Had lunch c navy officer here.Comfort interested in oursite. Took themto OR and Italiancamp. They will takeus to comfort for tour

2:31 p.m. Just drained an infected hip in a 8 yo boy.Sick for 3wks.In severe pain. He'll be OK now.Brought to us from another tent hospital.

Feb. 13

6:18 a.m. - Visiting u of Miami tent hosp called medishare. have surgical capability but no sterilizers. not doing internal fixation

6:22 a.m. - U Miami will send us pts Monday

9:38 a.m. - Have been touring different hospitals and the PaP devastaion area c a Haitian Ortho surgeon. He is in tears at times.

9:42 a.m. - searched the airport drop area for plate and screw sets.There are none. Talked with the army.Best source is our Ortho doc network

9:44 a.m. - U Miami not doing internal fixation due to sterilization problem. They will supply us with some implants

3:46 p.m. - Feeling good. Just heard from Dr Guidera Shriners Minniapolis. Phili Shriners may take the 14 yo boy c TB of spine

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Feb. 14

6:03 a.m. - Happy valentines day! Another day of mourning in Haiti. Going to USS Comfort for tour. Father Rick will give Mass this evening

6:06 a.m. - Visiting Ortho docs yesterday brought 6 screw sets and plates. We are in business.

6:12 a.m. - Ever seen "Good Morning Vietnam" Robin Williams. Every morning and all day helicopters are ever present overhead till after dark.

6:17 a.m. - Working on Haitian govt permission to transfer14yo boy c spinal TB to states for surgery.Need to send Mother and interpreter also

7:01 p.m. - Toured the USSComfort today.Very capable, very interesting.Here is Dr Ackerman on shuttle to the comfort

8:07 p.m. - I think we are all feeling a bit tired and lonely tonite. Three days of mourning has taken it's toll. Love, Faith,& Hope endure.

Feb. 15

4:28 p.m. - Surgery is ramping up again.After the 3 days of mourning we were hit hard today.Admitted 6pts with 5 femur fxs and one pelvic frx

4:41 p.m. - Volunteer workerscoming and going. Consistency ofcare Rsuffering.Nurses and ORstaff at a premium.Crisis is evolving.Late stage

Feb. 16

3:29 p.m. - Still working on transferof boy with TB ofspine.Shriners in philidelphia is bestchoice.Working onflights family stay in phili etc

3:34 p.m. - Today is carnival or Madi Gras. Haitian nurses in OR took the day off. We worked anyway and did 5 surgeries.

3:37 p.m. - Lew ZirkleMD Ortho surgeon from Washington Sign Nail program and hisyy

6:02 p.m. - Lee Zirkle MDand his asst Jeanne were here today toteach us howto use the Sign intredullary nail.Invented for disasters like this

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Feb. 17

4:01 a.m. - It rained hard last night. Homeless mothers children were lucky if they had tents. Many do not. Rainy season coming

4:05 a.m. - We are sharing our operating room with U of Miami today. They have 3 open upper extremity fractures to fix

4:08 a.m. - Drained a thigh abcess in a 4yo emergently last night. He had it for 3 weeks. He will be alright now.

Feb. 18

3:15 p.m. - When it rains at night in Haiti,do people lie down in the mud and sewage or do they stand all night or crouch in doorways.

3:48 p.m. - They stand all night and there are not very many safe places to crouch. Unless the are lucky enough to have a tent.

3:59 p.m. - The rice came in today and the staff was excited and happy.

4:25 p.m. - Many hospital staff are homeless or living with relatives. Fa Rick's following. artists for social responsiblity sent truckloads of rice

Feb. 19

5:02 a.m. - The rain is coming. Another concern is for the emergence of a cholera epidemic. We haven't seen it yet.

Feb. 20

4:08 p.m. - Tom and I cleaned out a 15 yo kids knee of caseating granulomatous material....looks like TB for sure. No ability to culture it.

4:12 p.m. - We did 7cases today. Thought it would be light...Saturday. Plenty to do. U of Miami wants to send more pts. We will take them.

4:17 p.m. - The US Embassy is 1/4 mile away. They have a swimming pool. We are taxpayers. We are going there tomorrow afternoon, asking for a swim

4:20 p.m. - One week to go. Happy and Sad. Need to tie things up for surgeons that follow us. We have set up a quality Ortho program here.

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Feb. 21 

2:37 p.m. - Sunday in Haiti. Rounds, clinic, cleanup. Walked down to US Embassy, went for swim in their pool, heaven.

Feb. 22

5:43 p.m. - Lost our first pt today on USA Ortho.Tears.Benita Delva diabetic ketoacidosis septic c multiple washouts BKA--AKA today lost her.

5:47 p.m. - Got killed today c new pts and problems.200 people trying to get into the hospital. clinics bringing pts. doing good work

5:20 p.m. - Other Doctors coming from other clinics and hospitals wanting to use our facilities. Difficult because we are at full bore.

5:52 p.m. - New Ortho Docs have arrived, thank God. Maintaining work load

6:15 p.m. - The wind is blowing. It muffles the sounds of crying children in the hospital. Can we relieve their pain? Phantom limb pain?

Feb. 23 (exact times not yet available for some tweets)

4:45 a.m. - The ground shook last nite and people were scared. The hospital was emptied. The children and adults are sleeping on the lawn.

4:48 a.m. - We are alright. There will be more injured from the unstable rubble downtown.St Damien hospital is unharmed from last nite quake.

About 17 hours ago - Patients in courtyard outside hospital. Scared to go back inside.

About 16 hours ago - The mothers with premies don't want their babies inside because earthquake risk. It will get to cold tonite, too cold for babies.

Feb. 24

About 3 hours ago - The children are back inside the hospital. It was a quiet night. We did 6 cases yesterday. Will do 4 today

Haiti Earthquake Relief: Help

The Haitians that know how to write jot down their prayers and cries for help. They place these in an empty water jug that looks like it has been dry for too long. The jug sits in the middle of an unfinished and crumbling sanctuary that should have stood three stories tall and should have been built to metaphorically burst with the shouts of sermons and the reverberations of a community coming together in choir. Where will these prayers go? What will happen to that water jug?

How do families handle the still missing loved ones? Do survivors consider the missing ones as buried in rubble or as buried in the communal graves?

Why do we bother putting estimates like 100,000 fatalities when we only overturn them for double that amount two weeks later? When will the estimates stop rising?

Do the impending deaths in displaced person camps during the rainy season fall into the death toll for the earthquake?

Haiti has never been known to have a strong sense of leadership. Recently, many articles and blog-posts have been written expressing socio-political solutions for Haiti. I have read about how Haiti's debts need to be forgiven; furthermore, the world (read "The West") is in debt to Haiti for slavery, coups, deforestation, and the general destruction of the socio-economic viability of the nation.

But beyond the economic situation, Haiti is desperate for a leader who is just uncorrupted enough to symbolize stability, vision, solidarity, and strength. Based on opinions on the ground, Rene Preval is not that man. The Haitian president was widely criticized for coming into the limelight to deliver a public message far too late after the quake: “He made us focus on the dead, how much we have lost and what sorry shape this country is in...And he interrupted us right in the middle of our own prayer service, which was actually joyous.”

But Haitians are still uniting. Typically this unity and this strength in solidarity happens in faith-based communities. There is buzz around JR Bataille, a pastor and an articulate US University alum who is writing a position paper for the United Nations on how to rebuild a more sustainable Port-au-Prince.

P-a-P, Haiti, and the Haitians need optimistic and ambitious visionaries with pragmatic conceptions of how to proceed. Leaders with knowledge (of how to proceed sustainably and about living as a Haitian) need to assume leadership positions--regardless of whether these positions are political or not. And these leaders are doing so. These are the leaders that need international support as liaisons: These leaders need to demand sustained support in at least the strength (if not stronger) that the initial earthquake response elicited.

These leaders need to continue sponsoring youth development in a country with a suddenly diminished capacity to serve their own future.

These leaders need to continue the strictly supervised distribution of resources to the women, children, and families that need food, water, and shelter. Something needs to happen to ensure that 55 tons of rice that can create over 300,000 meals does not slip into the black market.

Haiti has the spirit and strength in its peoples to create a responsible nation. Even if leaders (like the Batailles) struggle to monitor every facet of being a liaison between international support and local communities, there are educated individuals with the heart to help their own people.

After a long day of transporting patients to different hospitals around P-a-P and reallocating baby formula to hospitals surrounded by thousands of starving tent city dwellers, a dehydrated and exhausted translator expects nothing more than a bottle of water, a handful of beef jerky, and a picture. He draws a doodle in my personal journal: Though it looks like any stick figure, he labels it as "Ron" (his name). He does not ask for my contact information in the ominous or guilt-inducing way that many contacts in "developing countries" would so that they can work on their escape routes. He is proud to be a Haitian helping other Haitians he knows, loves, and lives with.

And we need to continue pressuring our leaders to support the recovery, rebuilding, and restructuring of a more sustainable, livable, and healthy Haiti.

We need to continue enduring the difficulties of traveling to P-a-P because we have the knowledge that every day of delay compares not to every minute of hands-on help we can offer.

We must work with Haitians and not for them.

Though our team, donned in scrubs, worked to serve a specific, specialized need amongst the Haitians, no one needed a degree to understand how to move baby formula, organize patient flow, or even understand the basics of triage.

Just because you do not have a degree does not mean that you will not be able to help with recovery. Haiti will need childcare workers, teachers, movers, organizers, supporters, hand-holders, idea-generators, innovators, frugal initiative takers, etc.

But adjusting standards of living is not so easy.

And I am not entirely sure about how to treat my experience in Haiti. How am I to do the people justice? How am I to pay adequate tribute? How am I to incorporate the knowledge of the tragedies in P-a-P into my life? 

I am not sure, really, what to take from our team's experience. I find myself feeling so pessimistic about the dire situation in P-a-P: The Haitians were in a tough spot before the quake, and now they are facing what seem to be insurmountable obstacles--economically, politically, health-wise, community-wise, on an infrastructural level, etc. I tell stories and praise the impressive University of Miami hospital and the strength and graciousness of the Haitian people, but I find I always return to the tragic elements that I witnessed:

Divided families

Homelessness

Displacement

Misdirection

Futility

Filth

Disease

Insufficient support

Inadequate relief

Disorganized relief

Reduction in relief workers (by the time we left)

Fading of media coverage

Hunger

Destruction

Lack of leadership

And so on. I go about my daily life conscious of the experience but always wondering what I am supposed to take from it, what I am to learn, how I am to integrate Haiti into my life. 

I do not have a link to a website or a cause that you should support with direct intent of donating to Haiti.

Go.

Help fix the mess.

Even if you are like me and without any specialized training, there is a storage facility at a hospital that needs your help with organizing so that the doctors do not waste five minutes looking for a specific size scalpel while a patient waits in pain. There is no good reason why the tons of donated food in that storage facility is rotting in the sun.

I met a 22-year-old Harvard alum who was starting an N.G.O. with the aim of assisting community centers in creating child development courses (e.g. art, karate, dance, soccer, etc.) during and after earthquake recovery.

I met two young men who started an N.G.O. with the aim of scouting out communities that had yet to receive aid, the aim of finding aid and relief workers, and the aim of connecting the two.

And I met a 26-year-old college drop-out who spent his days struggling to learn Haitian Creole while he drove trucks around P-a-P pursuing rumors of water and food aid so that he could claim it for a particular orphanage.

There are still buildings down throughout P-a-P, and I can only imagine what the rest of the country looks like. A man swinging a pickaxe at a fallen slab of concrete catches his son's head on the back-swing; though the child retains the majority of his motor functions, his father now has another emotional burden and physical restriction to uncovering whatever is underneath that concrete slab.

Find a way to get there.

Here was mine.

And just because Haiti is not the news' top story and just because many relief workers are returning (if not returned) does not mean the country does not remain cracked and broken.

Haiti Earthquake Relief: Commemoration, Faces, Health

While we were in Haiti, the first days of public markets since the earthquake began. Some praised how "commerce" had resumed; if you call thousands of heads of rotting lettuce deluged in the smell of feces "commerce," then, yes, "commerce" had resumed. 

Regardless of the conditions under which Haitians were resuming their markets, the fact that the Haitians were doing what they could to continue their livelihoods was undoubtedly uplifting.

Still, the national dish of Haiti seemed to be rice and beans. While staying at a church run by pastors named Bataille, we enjoyed a daily meal of rice and beans with the members of the congregation. Pockets within Port-au-Prince course with an undeniable sense of community. While news reports about looting and civil disruption had amplified my paranoia before arriving in P-a-P, I quickly came to appreciate the unifying forces in Haiti: a common will to recover, a desperation to survive, and a need for community interaction. Often times, these unifying forces prevailed because of faith-based communities.

Father Bataille has reportedly sent over 25 children to universities and colleges--only a small fraction of these being his own kin and the remainder being members of his congregation. He shelters displaced families in the church's walled compound, and he offers the church's grounds as a station for United Nations food distribution. He is active in organizing relief based at his church. 

For three days, this relief included our team; we camped in tents, in the church's yard, next to the displaced families, leashed goats, and dysfunctional roosters that cock-a-doodled every five minutes starting at 2 a.m. The communal toilets had the flushing handles removed to preserve what little water was supplied to the church. But, many echoed: "At least there are toilets."

And that seems to be one of the motifs resonating in Haitian minds: "at least." They embrace what they still have, and, as I mentioned in the last post, they may even have a tragically heightened awareness to what truly matters in life: family, friends, love, survival, faith, community, etc. 

After a day assisting with a pharmacy for a medical clinic run out of an alley behind a cracked-but-survived orphanage, our team returns to the Bataille's church during a memorial service for the congregation members lost in the quake. Amongst the tents, a small children's orchestra of violins and recorders practice a piece for the service: "Hatikvah," the Israeli national anthem that echoes with tones of sorrow but translates to mean "The Hope."

Pastor Bataille's Creole shouts resonate out of the church--the church is roofless and was unfinished before the quake. The earthquake undoubtedly has cracked the church's walls without quite bringing down the community center that erupts with a solidarity backboned by faith. I am curious about what the pastor is shouting, but the fifty-or-fewer French words that I do know do nothing to decipher Haitian Creole.

And though I am tired from a physically trying and emotionally taxing day, I know well-and-good that I am not nearly as exhausted as the survivors grieving those they have lost, worrying about their homelessness, and contemplating their struggles for food and water. And, I know that I am not nearly as exhausted as the translators who follow our team each day and do all that I do but often do it twice: once in English for our team's sake, and once in Creole for the Haitian patients' sakes.

By the time our team arrives in Haiti (about fourteen days after the quake), most of the severe trauma (that our surgeon, our E.R. doc, and our nurses were preparing themselves to face) had already been treated. There were still a few patients with broken limbs and deep abrasions trickling into clinics and hospitals; these patients lacked access to emergency care or lacked the access to transportation to emergency care.

Being somewhat uneducated in local traditions and voodoo practices, I also speculate at whether a cultural justification has precluded individuals from seeking proper medical care.

The patients are gracious. They have no qualms about subjecting themselves to a privacy-compromised medical process. Whether at clinics in the communities or at hospitals, the vast influx of patients implies overcrowding and volunteers' improvisation to accommodate as many people in pain as possible. In an open-air and poorly curtained auditorium (probably a religious center), a man removes his pants for a doctor to inspect a severe intestinal hernia that has engorged his testicles; a woman hikes up her skirt to reveal puss in an abrasion the width of a pumpkin on the back of her thigh. These patients clearly understand that this medical setting is not suited for modesty.

The handful of translators abidingly respond to the doctors and nurses. An issue of not knowing how to express in Creole or in English never arises; the team is ever-thankful and praising of the translators. Still, translators occasionally "disappear" for much-needed breaks or to help with crowd control of the hundreds of Haitians who have flooded-in from their tent city  to wait on broiling benches for the opportunity to see these pale skinned foreigners who may or may not have the "cure" for a malady. 

One man creates a fuss in the clinic area because he wants the doctors to come to his half-crumbled house to pay a call to his family; with security threats and the inability to transport, no one on our team can accommodate--the translators tell the man to bring his family to the clinic, but we never see the man again.

My father, a surgeon on our team, points out a stark truth about the situation: "I always wonder what these patients must think. Despite what we bring, they must think: 'They get to leave.'" He means that we, Americans, are only amidst the chaotic suffering for but a brief week, two weeks, month, or however long until we can use our precious U.S. Passports to bring us back to our lives with roofs, central heating, and outlets in weather-proofed walls. 

Whether or not this actually crosses the minds of the mothers, fathers, brothers, sisters, sons, daughters, cousins, aunts, uncles, or any other relative is unknown. But, the Haitian people all wait patiently for their chance to be seen for a severe injury, for intestinal worms, for diarrhea, or for a headache. The Haitian people tend to have stern facial expressions that imply mourning, fear, and anxiety.

Dehydration and hunger being the origin of most maladies, we run out of Pedialyte and Enfamil for kids within hours. We are told not to share what little water we have for fear of instigating a situation that could easily escalate into a riot amongst those who plead for water.

Unfortunately, the Haitian people must wait for help to come from somewhere. They are driven to help themselves, to rebuild, to preserve their strength of conviction. But the problems are so momentous that the Haitian graciousness needs to meet adequate and organized international support. Unfortunately, the earthquake response seems to be following a similar disaster relief pattern: too little relief too late is too disorganized. There is no central body registering what relief (private and governmental) goes where, and there is no central body creating a list of locational needs. Of course, this may be another development in what is already too beureaucratic of a relief process.

The times I find myself thinking about all the issues and all the obstructions to appropriate relief (including those outside of our control, like geography and time) are the only times that I find myself tearing-up about the tragedy in Haiti. Yesterday (2/11/2010) the first rains of the rainy season fell, promising a difficult battle to protect the displaced persons from inevitable mudslides, floods, and the onslaught of waterborne diseases. There is much to be done, still, and I fear the implications of the marginalization of news coverage.

What must the Haitian patients think when they are placed in a ward housed in a pop-up tent that shelters nearly 100 people at a time? It is void of privacy and there is constant foot-traffic in the narrow aisles: visitors carrying loved-ones' bedpans out of the tent and to wherever the disposal area is. Is there any dignity in these places? How terrifying must it be for these people to wake to a tube connected to their arms? Do they have an understanding of this process? Do they question the paler-skinned men and women wearing blue and claiming to have the answers? What do the patients think when they hear regular screams from compatriots who have never received a tetanus shot before or who just received an amputation a day earlier? Do they fear the doctors and nurses when "G-27," their bed number, is called to the wound care table for a procedure involving ketamine as anaesthesia and saline solution to irrigate a deep tissue wound? Do the patients have any idea what anaesthesia or tetanus are?

So few eyes reveal the answers to these questions. The Haitians generally remain stoic or smile appreciatively. But my heart brakes every time I hear a baby scream over the grinding from a plastering machine while his leg is being casted. And my heart breaks when I see that patient, one in every hundred, with fear in his or her eyes. That is why I can never become a doctor and why I will probably never become a nurse.

But the undeniable necessity for healthcare and human rights workers compels me to continue doing all that I can to help: to teardrop away from the flood that is the problems facing Haitians and others who suffer from marginalization, ignorance, and injustice only amplified by a tragically placed natural disaster.

Reflections on Relief

My readership,

I am sorry, again, for the hiatus. For the past two-weeks-or-so, I have been assisting a Haiti disaster relief team sponsored by International Medical Relief.

Needless to say, this was a trying, eye-opening, enlightening, and upsetting experience. I have many thoughts about my time in Haiti, my team of doctors and nurses, other relief workers with whom I interacted, the Haitian people with whom I worked, relief efforts, Haitian infrastructure, obstacles to recovery, and the sponsors of relief efforts. I was diligent in journaling and taking photos. I wrote nearly 30 pages in just 11 days, and I snapped over 300 photos--undoubtedly, I will steal some photos from my team as said photos surface.

I would love to share some of these thoughts and photos, but I request time. I know many of you are eager to hear a first-hand perspective from someone who was in Haiti (or my particular perspective), but I need some time to process and recover. I have come down with a small cold and am dealing with inconsistent sleep as a consequence of waking-up regularly from the anxiety-laden dreams that are side-effects of taking Malarone.

I will share thoughts, reflections, and photographs in the near future. Until then, here's a brief anecdote:

One morning, I was interviewed by an NBC correspondent in Port-au-Prince. He asked me questions about what I was doing (while I was looking for supplies for my dad and other doctors at the University of Miami pop-up hospital) and my thoughts on the scientologists who were in Haiti en masse. I was not completely honest with the correspondent because a scientologist volunteer was standing close-by, but I generally found the scientologists to be unqualified and inappropriately stationed at the hospital. Anyways, bless Hubbard that I wasn't included in the news piece promoting those who study scient.