Tuesday, June 15, 2010

Heading home


I'm heading home now after a very short visit. Most people warn you that Haiti gets under your skin. I think it's because you immediately feel at home because of the people, and probably because there is no end to the addictive emotional whomp...

And I love the little reminders to check your semi-automatic machine gun at the door...


Sunday, June 13, 2010

Returning to their homes


Steps are being taken by various NGOs to assist families in moving from the camp to something more permanent. Housing has been classified as red (needs to come down), yellow (repairable), and green (safe to move back in). Families can be categorized into three groups: never had decent housing in the first place, has a house somewhere but are too afraid to move back into it, and those who have a green house but who receive greater benefit in the camp (security, food, healthcare, NGO work) than at their home. There is also the question of how to determine land ownership, removal of rubble, finding empty spaces to settle people in the mean time...'transitional housing' is a tent and this is considered the step up from a tarp. Transitional housing is the housing plan for the next two years.

Needless to say, the camp experienced outburst of domestic violence. Today, I was working with Andy, the team physician for the New York Rangers. A woman arrived with her head wrapped in a towel and she was covered in blood from the top of her head down to her knees. It's Sunday, and we're seeing emergencies only (it's noon and we've already had one 2 year old with severe burns from falling into a pot of boiling beans, one 11 year old with a head injury who fell two floor from a roof onto a pile of rubble, a semi-drunk 21 year man passing kidney stones, a woman in labour who has an eclamptic seizure with a blood pressure of 190/120, and a 9 month old baby with some sort of diffused pneumonia cooking a fever of 41C).

Hubert, a very kind 24 year old translator, explains to Andy that this woman was hit in the head with an iron rod. She's in shock and leans against the guy who helped her walk up to the tent hospital. We unravel the cloth around her head, pick through her hair, and cut some of it off to find the superficial slices on her scalp. Hubert gently coaxes her to tell him what happened. "She said her husband did this, they fought when he wouldn't give her money to buy food for their children." Andy starts to suture her head, and I get out the Domestic Violence Checklist from the hospital protocol binder. I start taking notes, and explain to them that we'll need to call the UN Police. Then this oddly surreal moment unfolds in which Sean Penn arrives with his Glock pistol in the back of his pants, and asks me to ask her for directions to their tent - as of last Thursday, his crew has now been put in charge of security in the camp. I efficiently cross out "Call UN Police" on the checklist and replace it with "Call Sean Penn - head of camp security".

Sean (an American actor) and Bulldog (a Haitian ex-supermarket security guard) leave. Hubert tells me that she won't tell him what she did to deserve this because in his opinion, Haitian men don't hit women. "Hubert," I sigh like an old, tired feminist, "Zanmi, she did nothing to deserve this...don't go there, you'll lose." Andy backs me up. "It's never ok," he confirms.

Later on, we're sending the 9 month old baby by jeep to St. Damien's Hospital, with Bulldog riding shotgun. Whenever the jeep gets slowed down in traffic, 6'6" Bulldog jumps out and starts banging on the hoods of cars to clear a path for the jeep. He got the eclamptic women to hospital through the worst church traffic. Hubert arrives at my side as I wave the jeep off. "Okay, I just have to tell you, she stabbed her husband first - she just told me." I don't know what to say..."See? It was self-defence." "Perhaps, but it's still messed up, don't you agree - why isn't there enough money for food?" He pauses, and then says slowly "I know this probably isn't the right answer, but maybe she spent it on her hair extensions that you just cut off?"

Saturday, June 12, 2010

Petionville Hospital at the Golf Course



This is baby number 116 to be born in the 12 bed tent hospital since they started counting January 27 2010...and 110 of them have been girls. This is a natural experiment in demonstrating excess male fetal loss that was published in BMC Public Health in May. These authors used 9/11 to show that it was not a decrease in conception of male fetuses, but an increase in miscarriage of male fetuses, since they looked at deliveries of infants who were conceived before 9/11. One hypothesis is that male fetuses are more sensitive to the mother's increase in corticosteroids released in response to extreme stress.

Baby Julie's proud father is holding his second daughter in a blanket donated with funds from Canadian friends. A short time later, baby Ann, number 117 arrived (err, the temperature inside the tent is 46C...Rachel from Montana and I didn't just shower, we always look that glowing).


Thursday, June 10, 2010

Haitian Pharmacy



This is a Haitian pharmacy. It's blister packs of meds arranged by colour.

In the women's clinic today, a woman arrived visibly pregnant and asked for a check up. She looked a little pale. I asked her a few questions and learned that she was 6 months pregnant and had spent the night in writhing pain. She had taken cytotec purchased for $2 from a pharmacy such as this. Abortion is illegal in Haiti - but cytotec, like in Latin America, is a medical means for early abortion available to anyone. It is sold in readily available homebirth kits for the prevention of postpartum hemorrhage. If it only partially works for abortion, a woman can come into hospital reporting complications from a miscarriage and receive a D&C.

This woman wanted an abortion after learning she was pregnant a month ago. She thought she was pregnant earlier but a foreign health worker told her that it was normal to not have your period after the stress of the earthquake, but the worker didn't provide her with a pregnancy test. She lives in a tent with her three children, and her husband is dead under the rubble.

So, during the check up, I listened with the doppler, and for the first time in my career, I said "sorry madame, but your baby is still alive." She just laid on the cot with her hands over her eyes. I blathered on about options, don't do anything drastic, referrals....Then, gradually, she got up and arranged herself, thanked me with a tired smile, then left.

Wednesday, June 09, 2010

The Beach


We headed out of Port-au-Prince to ejoy a swim on Saturday with our host Nickel and Soneide, Carl and kids...under a hut on the edge of the concrete pier, young folks hung out together and played competeing music with the next hut. Guys in boats would sell cocout to drink and spear fisherman surfaced with a catch of 4 crab and various fish to sell. Out beyond the edge where the kids play, there was always a dozen couple, spearated by a few metres, grinding and sexing (apparently you put the condom on before you enter the water) where they could get relative privacy compared to their home (?)...our hosts shrugged like 'what the big deal'and Sue and I agreed that we were raised by our mother afterall and why were we so pruddish? So for the NGOs that are focussing their HIV prevention efforts in the camps, they should really do a turn at "the beach".

Sunday, June 06, 2010

Golf Camp




This is the Petionville Golf Course before the earthquake on the left, and after the earthquake on the right.




I'm staying in the neighbourhood of Delmas 40B, which is one block from the largest camp in Port-au-Prince Camp Golf where right after the earthquake, people just started setting up shelters on the private golf course. 60 000 people have settled in, set up shops in front of their tent or in their tent.





Most interesting are the beauty shops since they are run by young women, and they provide the not-necessary-for-life hair cuts/extensions/wash and set as well as manicures and pedicures. Many set up right after the earthquake and are struggling with a 3x higher price in supplies and a clientele that has little money. And in the four hours it takes to do extensions, they share a lot of info on birth control, safe sex and sexually transmitted diseases. June's salon now has a box of "Huge" condoms (really, that's what they're called) to hand out to customers, courtesy of an American NGO of course...

Camp Dadadou


Sue’s friend Carl lives in Camp Dadadou, one of the comparatively smaller camps in Port-au-Prince. After the earthquake, people living in the middle-class neighbourhood Delmas 3 moved across the street to the soccer stadium and set up tents…10 000 people. The houses remain under the rubble, along with the deed to their properties and their loved-ones who have passed. Relatively speaking, it is one of the nicer camps since it is surrounded by a high stone wall and barbed wire providing memory of a previous Haitian era when Haiti was represented in the World Cup in 1978. There is a volleyball and basketball court, and folks have started businesses, like cell phone charging stations, Skype phones service to Canada and US, and shops stocked with the Cheetos, beer, cigarettes, rice and beans.


However, being small means it has been overlooked by the larger NGOs in infrastructure management. They haven’t had drinking water for two months and they have 126 toilets for 10 000 residents. They have 24 orphans who are housed by a tent provided by USAID but are fed by the residents of the camp. A mobile clinic is run by Partners in Health and a Haitian nurse provides emergency care and delivery attendance 24/7. This nurse has attended 126 deliveries in the tents, 3 of which were transported for cesarean. There were no maternal deaths and 5 neonatal deaths.
The camp has security that residents provide. Though fighting between residents is managed as any mob would, without the back up if police and ambulance to disperse the crowd. Last night, while Sue and I were at Dadadou, having a beer and visiting with Carl’s family, a fight broke out between two teenage girls. Everything stopped – the volleyball game, the basketball game, bathing children, cooking on the coal pit – everyone rushed to see two girls lunge at each other with batons and back away and taunt one another. They were cheered on by the crowd. Entering into the circle of the fight, came a young man who raised a thick baton – it happened quickly, one of the girls stumbled and collapse unconscious. The crowd didn’t disperse but some men were able to carry her to the clinic which is surrounded by barb wire. She was laid on a camp cot in the clearing of the clinic and observed by the mob from the edge of the barb wire. Carl led me through the wire. The girl continued seizing for the next two hours while there were these Lord of the Flies moments of cheering and calls of justice served. A middle age woman appeared and said she was a friend of the girl’s mother, she asked if the girl could be taken to a tent for a rest? Would she wake up? I pointed to the girl’s seizing right hand, stiff legs and jaw, non-response to pain, and fixed pupils – her brain is bruised, she needs to go to the hospital. My limited experience in resource-poor countries (or who come from resource-poor countries and are receiving care in Canada) is when you tell someone they are sick or injured – the default pathway is death, and it only once you explain that there is treatment do they consider life a possibility. Whereas in Canada – our default is life, and we’re shocked to learn that medicine can’t rescue everyone from death. When I said she had to go to the hospital, the mob at the barb wire, and those who had managed entry and were now surrounding us in the clearing, said she’s as good as dead. It didn’t help that the girl when collapse on the cot, stiffened and start seizing again…in Haiti, voodoo beliefs are stronger than rational belief. And no explanation of brain bruising and bleeding vessels would dissuade the mob from pointing out that she was changing into a cat or a dog, and she was about to leave. Finally, our friend Nickel appeared with his jeep and we loaded her into the back, her head resting on the lap of the woman accompanying her to the hospital. We arrived at the National hospital, and knowing that she wouldn’t be assessed until the morning, we left them. The next day, we were told she was discharged, having progressed from seizing and unconscious to a headache…