Hôpital Albert Schweitzer Haiti

The HAS Blog is moving!

2010-11-08T11:49:00.000-05:00

As a part of a site-wide redesign, the HAS Blog is now located on the main website for Hôpital Albert Schweitzer Haiti, at http://hashaiti.org/blog. Please update your bookmarks, and follow the blog updates on our new website!

Business as Unusual

2010-11-03T13:36:00.001-04:00

At our 4 a.m. census this morning, we saw 20 adults and 18 children with cholera - a constant level for the past 4 days. As I walked though the hospital between the adult cholera section to the children's cholera section, both of which are isolated from the regular hospital, it was immediately apparent that there has been no change in the demand for clinical services at HAS.

The pediatrics ward had 63 patients, including 10 in the neonatal special care unit, and the medical and surgical ward had 31 patients. There were 38 patients in the Evaluation, Diagnostic and Stabilization unit, which is designed for about 20 patients, so the hallways were crowded with litters and cots as patients were stabilized pending the morning rounds and scheduling for lab tests and X-rays. This total of 132 inpatients does not include the several women who were in the high-risk pregnancy unit.

By mid-morning, referred patients and others with return appointments were filling the benches under the large mapou tree, waiting for the ambulatory clinics for medicine, surgery and pediatrics to open in the large donated tent.

While every disease outbreak or epidemic is unique, there appears to be strong indications that cholera will be found in Haiti for years to come, and that in the near future, we may continue to see new cases of the disease at HAS. However, the level of the future demand is unknown. At this time, and for the near term, we will have to plan on managing an institution with a total inpatient load of about 170, of which almost 40 will require special care as cholera patients.

Cholera Patients Continue to Arrive at HAS

2010-11-01T15:53:00.000-04:00

Today is a holiday – All Saints’ Day, as is tomorrow, the Day of the Dead. The hospital’s outpatient service is closed, but patients still arrive, either to the Cholera hospital, or to the regular hospital. Urgent cases are seen in the sal dijans (salle d’urgence, or emergency room), which is aptly named, because it is merely a room, off the primary care waiting area. If the patient’s condition appears to be serious, the patient is transferred to the Evaluation, Diagnostic and Treatment room, a bay of about 25 beds under the direct observation of several physician extenders, nurses and physicians on call.

Patients with the symptoms of cholera proceed directly to the cholera reception area, where they are evaluated and either started on an IV drip, or offered oral rehydration solution, depending on the intensity of their symptoms. According to our visiting CDC team, as many as 80% of the persons affected by cholera do not show serious symptoms, and do not require substantial rehydration, or do not come to the hospital at all.

We watch two trend lines every day; one is the daily census, as this indicates our work load for cholera patients, and the other is the new admissions for each day. The daily census reflects a stabilization at about 30 patients a day for the past three days. The new daily admissions also reflects a stable pattern at about 15 patients a day for the past 4 days, and there appears to be a balance between admissions and discharges. This pattern is apparently similar to that seen at the two other major cholera hospitals in this region, at St. Marc and Petite Riviere, although the total number of patients is higher at each of these facilities.

Many patients arrive with rather minor symptoms, receive oral rehydration and leave the same day (these do not show up on the admission or census figures). Several of the newly-arrived patients reflect a pattern which had caused us some concern, and they were the caregivers of a sick person, who were exposed to the patient’s effluents while caring for them. While I was translating for a writer from Newsweek today, we talked with a woman who had arrived with serious symptoms yesterday. She said that she had cared for her 16-year old daughter who had died on Thursday, and she had prepared the daughter’s body for her funeral. Now she apparently also has cholera. This person-to-person transmission of the disease is of great concern to the Ministry of Health, the CDC, and the Pan American Health Organization, all of whom are tracking the trends in our area with great attention. Their great fear is that the disease will spread in this way to the large camps of refugees in Port au Prince and nearby.

As if Haiti could not emerge quickly enough from one disaster to prepare for another, we are all watching the progress of Hurricane Tomas, as it drifts Westward just to the south of Haiti, with a forecast by the NOAA for it to turn sharply to the North on Thursday to connect with the southwest peninsula of Haiti, where the frequently-battered cities of Les Cayes and Jeremie are located.

2010-10-29T11:26:00.002-04:00

As we monitor the daily census at 5am each day, we are observing several trends; the number of adult cases has declined dramatically from the numbers on Sunday, but have essentially remained stable in recent days. The number of pediatrics cases has also declined, but appears to be stable, with a total population in the HAS Cholera Hospital about 35-40.

The CDC team has been visiting the courtyards of affected patients to evaluate the potential sources of the infection. Today they are visiting the health center in Petite Riviere, which received a large number of patients in the first days of the outbreak, but are now reporting a stabilization of the number of admissions. I was at the hospital in St. Marc yesterday, which had received the largest number of patients, but as of yesterday the numbers of cholera patients were reduced. In both the St. Marc facility and the Petitie Riviere heath center, primary support has been provided by Partners in Health. Now, each of the facilities has a staff from Medecins Sans Frontieres, which is caring for the cholera patients in an isolated area within the facility.

For all of us who are working with cholera patients, the demands for services remains high - HAS received a number of trauma patients last night from health care facilities in the region, and we also provide diagnostic services in the form of lab tests and X-rays for these facilities.

Today, our Community Health staff will meet with the Community Health workers, to provide current information about the spread of the disease, and also to thank them for their energetic pursuit of a public relations campaign for prevention of new cases. It is very probable that the decline in cases at HAS is related to these efforts.

Other visitors arrive daily at HAS - today we have a team from Massachusetts General Hospital's Diarrhea Treatment Center in Bangladesh, and additional members of the team will arrive tomorrow. They will serve as consultants to the Haitian Ministry of Health in planning for the management of the disease if it spreads beyond the Artibonite. Our experiences here will be of relevance to their efforts, in the event of the further expansion of the incidence of cholera.

Cholera Containment and Prevention Message Getting Out

2010-10-27T11:52:00.001-04:00

For the past several days, new cases of cholera came in, and an equal number of patients were discharged, and we are seeing a regular daily census of about 25 adults and 15 children. The public information program by the Ministry of Health, the local Rotary clubs, and by HAS field staff appear to have been effective, as patients come to the hospital early in the course of the disease.

In a dramatic technical innovation, yesterday morning all of us with Haiti cell phones (and who doesn’t have one these days), received a text message which said “to get more information about cholera, send a free SMS to “maladi" (illness). Shortly thereafter, we all received a voice message from the director of our local UCS, Dr. Willy Staco, with brief instructions on how to avoid cholera, and the need to come to a health center immediately if symptoms occur. We had been in discussions in the summer with local telephone carriers about the whole concept of MHealth (Mobile Health), but now we have a clear example of how effective such an approach can be.

Later today, a team from the US Centers for Disease Control will arrive at HAS to spend a week or more researching the sources of the disease, visiting the homes and courtyards of patients, and taking samples from water sources, wells, rivers and canals. The Mellon house has been converted to a research center, with map tables, a wi fi internet line, and a sample storage facility.

HAS field staff have visited many of the households from which our cases have come in the past several days, and have found concentrations of cases in courtyards where the water table is quite high (it is possible to dip water out of the well with a cup), and the wells are very near to latrines and canals. The wells are treated with chlorine powder, but it is apparent that continued exposure to the pathogen will continue in the absence of a dependable potable water source.

Our nursing staff, which has been working long hours the past ten days, has been supported by a group of nurses from Jacmel and Les Cayes (far from the current cases), and today a group of five nurses from Project Hope have arrived to provide more support for what is essentially a nursing disease. Most of the Hope nurses had been in Haiti previously during the earthquake.

The hospital (more appropriately “the hospitals” because of the separate facilities for the cholera patients) are quiet and orderly, the patterns of care have become systematized, and the work flow is becoming second nature. After a flurry of visits from various news agencies, their attention span appears to have waned, and we are able to return to our work undisturbed.

The forecast for the progress of the disease is at the moment unclear; we hope that the pattern of admissions will decline, but are afraid that it will remain steady, or even increase in the days ahead.
We send to you all our thanks for your concern and support…

New Patients Continue to Arrive

2010-10-25T09:52:00.002-04:00

HAS continues to receive new patients with cholera- at the same time, we are able to discharge approximately the same number, so our census of cholera patients remains fairly stable for the moment. Hand in hand with treatment, our focus has been on containment and prevention at the community level. We are fortunate to have well trained community health workers and volunteers - numbering over 1,500 - to bring a the crucial prevention message to people throughout the Artibonite Valley. HAS field staff are sharing educational materials with residents of their service areas, carrying the same messages which have been developed by the Ministry of Health. The local Verettes Rotary club, many of whose members are HAS staffers, has energized a community education and awareness campaign, including local radio stations, schools, and churches to pass messages about personal hygiene and water purification.

Over the weekend, the demand for services from our normal patients declined, and this provided us with the opportunity to review our current approach to managing the cholera patients. Initially, we had admitted cholera patients to the Observation Unit, and after stabilizing the patients for one or two days, transferred them to a transition and discharge unit in the courtyard. Children with cholera were cared for in the former physical therapy class rooms, next to the pediatrics unit, but many children were outside in the halls.

HAS designed a plan whereby all of the patients with cholera were assembled in the courtyard, and access to that space was restricted to clinical staff caring for these patients. The pediatric patients were transferred to a single large room in the annex, with closed access. Now, as Monday starts and we begin to receive the normal flow of outpatients and continue to care for the hospital's 130 inpatients, we are actually operating two hospitals - one for patients with cholera, and one for the remaining patients. The halls of the hospital have been cleared of the beds which had been filled with cholera patients, and the flow of medical personnel and patients has returned to normal. A large tent which was donated by the International Medical Corps has been set up outside the hospital as a triage and treatment center for non-cholera patients, in order to reduce the number of patients in the hospital.

Because of restriction in travel to and from Port-au-Prince makes it difficult for the amputees to get to HAS, the Hanger team of prostheticians and physical therapists has joined the hospital staff to provide patient support services, to allow the nurses to focus exclusively on clinical care. The technicians repaired a number of beds in order to make them available for the patients, prepared and distributed oral rehydration solutions, and providing logistics support.

The spirit of thoughtfulness, consideration, and respect which was so clear in the days following the January earthquake is in full view now, where patients and their caregivers have to find spaces to live and to accommodate to the demands of the disease. Despite the large number of people in the cholera areas, they are very quiet. Whenever possible, we teach as we provide care - we explain the ways in which the disease can spread, and provide information which they can share with others when they get home. We have been asked by the many media organizations about the panic about the outbreak, and they are surprised when we tell them that there is no panic; people are curious about how they got sick, and about how their neighbors can prevent, but they absorb that information, and begin to plan for what they will do when they get home.

The CDC team which is conducting epidemiological surveillance was at HAS yesterday, establishing a framework for mapping the geographic course of the disease. They will return next week and use HAS as a base for their analyses in this region. The origins of this outbreak are a mystery, but are not a primary question at this time. What is of most concern will be the modes of transmission. In our area, the initial cases were from men who were working in the rice fields in the lower Artibonite River, who traveled to HAS to receive care for the disease. More recently, cases have involved young children. These families, who live closer to the hospital and also near to the river and its canals, report that they had been drinking from wells in their courtyard or at their neighbors.

The coming week will be very instructive in terms of the broad direction of this disease, both in our area as well as in Port au Prince (where new cases have been reported) and in other parts of the country.

Week One of Cholera Epidemic

2010-10-23T09:29:00.002-04:00

This is the one-week anniversary for the cholera epidemic at HAS; it was last week on Saturday that we first saw the few cases of severe diarrhea, and without recognizing it for the relatively obscure disease that it was, treated the patients successfully. Several more patients arrived on Sunday and by Monday we began to recognize that there was a serious trend which connected them all. At the same, we were hearing from our partner facilities in St. Marc, Petite Riviere, and Verettes that they were seeing similar cases. When I visited St Nicolas hospital in St. Marc on Wednesday, it was overrun with patients, and they had to ask the numerous family members to stay outside so the nurses could get to the patients.

By Wednesday evening HAS had also begin to see an influx of new patients, and these numbers continued to grow through yesterday (Friday). We reorganized the patient care units so that the 25-bed observation unit was set aside for acute-level patients (by that time the disease had been confirmed by the CDC as cholera), and we set up a transitional unit of about 25 beds for patients who were evaluated for discharge. By the middle of the day today a pattern had emerged in which it was possible to discharge about 15 patients, who were then replaced by patients from the observation unit, who were in turn replaced by new, acutely ill patients. Currently, most patients seem to recover well within 2-3 days, and are discharged with an additional supply of oral rehydration powder.

The halls around the observation unit are an overflow area, from which we try to
bring patients into the unit as soon as possible.

The transitional unit is located on the former horse courtyard, where, when we first opened the hospital, patients tied their horses when they came to the outpatient clinics.

On Friday, when we had a large number of patients who were scheduled for return appointments, it was with some difficulty that we were able to separate the cholera patients from the normal patient group. By Monday, we will have acquired a tent which will be placed outside, where the outpatients will wait unitl they can see a physician in small offices in a formerly unused office building.

More than 30 children have to HAS with acute cholera; we opened up two rooms which had been used by the rehabilitation technician training program, which is now in vacation. The patients were interested to see the skeleton being carried out of the storage closet as we cleaned the rooms.

During the day today, several international relief agencies arrived with very useful resupplies of gloves, oral rehydration packets, antibiotics and buckets. We accompanied them to the Ministry of Health facility in nearby Verettes,, which is receiving a large number of cases, and which had used up their meager supplies. They were restocked, with a promise of another shipment tomorrow.

We are awaiting the arrival of the CDC epidemiological team which will continue the research to identify the source of the pathogen.Most of the early patients had reported drinking from the Artibonite river, and they clustered in an area where the rice fields now require a large number of day laborers. More recently, however, the cases are from a wider region, especially the children, and the incidence pattern no longer has a clear focus. The major concern, of course, is the potential spread of the disease more broadly in our area, but of even greater impact, into the urban areas, where so many people live in tent cities with poor hygiene and limited water supplies.

Ian G. Rawson

Cholera has been Confirmed in the Artibonite

2010-10-22T13:43:00.002-04:00

Last evening, the CDC confirmed that the cases of diarrheal illness that HAS and other hospitals in the Artibonite region have been receiving have been identified as Cholera. HAS has instituted the World Health Organization Cholera treatment protocol, and redesigned the hospital's patient flow to keep the cholera patients in a separate area.

All HAS staff have been provided with training on cholera and its effects and its treatment. HAS remains in close contact with the Center for Disease Control (CDC), whose efforts are now focused on localizing the source of the disease. A CDC team was at the hospital last night to study maps of the region and to review our patient data, especially the localities where the patients have been living during the previous week.

Most patients appear to have contracted the disease from one or several sites at some distance from the hospital. We have received very few patients from the immediate area.

Under the able direction of our newly-arrived Medical Director, Dr. Silvia Ernst (who was formerly at the Schweitzer hospital in Lambarene), HAS has been able to manage the patient flow without undue stress. All of the staff have served long hours with great professionalism.

To a great extent, cholera is a nursing disease, requiring the establishment and maintenance of IV lines, education to the patients' families to remain hydrated, and the administration of antibiotics as appropriate. Most patients so far have been able to recuperate and return home within several days.

Disease Outbreak in Haiti's Artibonite Region

2010-10-20T23:00:00.005-04:00

During the day yesterday, reports came in to us at HAS that there was a suspected outbreak of severe diarrhea and vomiting, with most of the cases in the Artibonite region. By the late afternoon, HAS began to accept an influx of such cases, all with similar symptoms, and we reviewed charts from Monday and Sunday to identify possible earlier cases. A total of 30 patients had been received by the middle of the night on Wednesday, mostly adults and primarily male. The patients came from localities near the Artibonite River, and many reported that they had drunk water from the river. The regional director of our Unite Communautaire de Sante, Dr. Willy Staco, came to HAS and reported that there were many cases in Petite Riviere. HAS staff who had been to the hospital in St. Marc reported that there was a large crowd outside the hospital, with an estimated 60 patients there.

As more patients came in during the afternoon and evening, the HAS mass casualty protocol was implemented, and patients started to line the halls and crowd the inpatient bays. Patients in the hospital’s Evaluation, Stabilization and Treatment unit were either discharged or admitted to the ward, and this unit became the intensive management site for the diarrheal patients.

The causative organism has not been identified and initial suspicions have focused on typhoid. Dr. Bien Aime, the epidemiologist in Integrated Community Services, began to take oral histories and identify where the patients were living when the fell ill.

All through the night, we maintained contact with HAS board member Scott Dowell, of the CDC, who updated us on reports from the CDC field staff in Haiti. Scott sent us very useful references for patient care.

This morning, we collected relevant specimens between 2am and 4am and sent them to the National Lab for evaluation by midday. In the meantime, we are pushing hydration and maintaining hygiene. No new cases came to HAS after midnight, and we are waiting to see what the morning brings.

HAS Observes World Mental Health Day

2010-10-16T10:26:00.001-04:00

Sunday, October 10th was World Mental Health Day, which HAS observed the following Monday with a presentation by a psychologist who discussed the long-term effects of traumatic events such as natural disasters. As he talked, I, and I am sure others in the room, were carried back to the days after the January earthquake.

Several weeks after the earthquake, we visited several churches and schools which had welcomed people from Port au Prince, and provided them with temporary shelter before they could be placed with generous families. The pastor asked me to look in on a young woman who had moved her cot to a corner and lay on it in a fetal position with her face to the wall. Unresponsive to any overtures, she huddled in her bright Chinese blanket.

I asked if she was like this all of the time, and the pastor said that no, she had terrible nightmares whenever she tried to sleep, and appeared to be reliving her experience in the falling houses. He asked for help for her, saying that he was worried about her and the other refugees in the church.

The pastor’s wife then introduced me to several other people who were suffering from flashbacks and nightmares, and then told me that her husband was also waking up every night, reliving the experiences of the people who were in the church and who had shared their stories with him. She asked if the hospital could help them. I explained that in most cases the reactions of the people at the church were understandable, and common following traumatic events. I told her that I would see what we could do for her guests.

Before the earthquake, HAS had been fortunate to find a young Haitian psychologist to work with the AIDS program. Her contract was coming to a close with the transition of the AIDS patients to Partners in Health, and she had stayed on the staff to support that transition. During the earthquake, she had come into the hospital for long hours every day. Initially she supported the acute needs of patients and their families, and then offered counseling to the physicians and nurses (and occasionally administrators) who had been caring for the crush of patients.

I found the psychologist in her office, which was the hallways of the crowded hospital, calmly listening to a patient whose terrible memories were now accompanied by the fear of the unknown in an operation on her leg later that day.

She agreed to come to visit the people in the church, and another group which had been housed temporarily in an empty rice warehouse (all of these groups were placed with families within weeks of their arrival in the region, and most remain today). She was able to provide immediate support to several patients, and to the families who were with them.

On the way back to the hospital, we talked about what she had been able to achieve in the past weeks, and her heroism and professionalism poured through her simple reports of types of cases she had seen. We discussed what we could do in the coming days, recognizing that everyone on the staff had been stretched beyond their limits of endurance. She sat in her seat, looking out the window, obviously reflecting deeply, and suggested that we could talk about it the next day.

When I saw her, she shared with me that she had been on the phone with several of her classmates from the psychology program who had suffered personal losses in the city. She asked if it would be possible for her to host them in her small house on campus. Of course, I assured her, and asked if there would be a chance that they might wish to work here. One step at a time, she said with a sly smile.

Today, HAS has three psychologists, which represents approximately one-quarter of the professional psychologists in Haiti. They offer individual, as well as group counseling, and their schedule is fully booked all day and into the early evening. Their residence has been converted into an office, and signs guiding people there are dotted throughout the campus and hospital.

With the good fortune which seems to been gifted to HAS in recent months, Rolf Maibach contracted with AMURT, an international emergency aid organization, to support this program, and we have come to recognize that, as is the case with physical therapy and prosthetics, that this will be a permanent element of our service package.

At the Monday conference, the psychologist presented statistics of our service volumes, with an estimate of the current need for counseling services throughout the country, as well as the small resources available to meet these needs. As with many other clinical services in Haiti, there is a tragic mismatch between the demand and the resources, and in this case, HAS is fortunate to be able to serve many of those who come to us in need.

High School Student's Visit to HAS

2010-09-10T16:02:00.002-04:00

My name is Robin Brody and I am a high school student in Colorado who had the incredible opportunity to spend nine days at HAS. The experience was one I will never forget.

My appreciation for everything we have access to here in the United States grew exponentially since my visit to Haiti. It amazes how abundant our resources are, and it troubles me greatly. We waste too much of everything here; but the one thing that now troubles me most of all is our waste of food. While at HAS I worked with the children and families in the Annex (the malnutrition unit) whose major challenge has been to get enough food to eat.

While at HAS, I worked with the kids and families in the Nutrition Annex. I visited and painted with them many afternoons during my stay. I noticed how closed off and sad all the patients and their families were. After only a few minutes of interaction, they opened up and started laughing and smiling.

I became very curious as to how these children became malnourished in the first place. The hospital’s community-based workers, Animatrices, had collected data to find which areas have the highest risk households for having a malnourished child. I helped to enter the data from these surveys into a register, and once the data was compiled and the areas with the most risk factors identified, we headed up to the mountains (where there were the most household with high risk factors) to see where the children who came to the Annex came from.

We went to house after house with four or five risk factors. The established risk factors are simple; If a family has a metal roof rather than thatched they are at less of a risk. If they have a latrine they are at less a risk then those without. If the family uses a method of family planning then they are at less of a risk of having a malnourished child. If they cook on some sort of elevated “stove” they are at less of a risk then if they cook on three stones on the ground. If a family has a pump near their house they are much better off then if they have to walk miles to a stream and if they have a filtration device for the water their children are less likely to be mal-nourished.

At the houses with high risk factors, we found malnourished kids by measuring their arm circumference (less then 12cm indicates a malnourished child. 12cm shows the child needs to be watched carefully and over 12cm means they are OK).

Robin Brody

On the positive side not every high-risk home had a malnourished child. In the houses with malnourished children we gave the families pre-packaged bags of dried rice, bean, vegetables and vitamins in hopes that the children could gain a little weight each week, and the other children could be kept from becoming malnourished.

It was fascinating and devastating to see the relationship between the high-risk factor houses and the children who had dipped to low and ended up in the Annex at HAS. The experience made me incredibly grateful and eager to do something more to help!

ALFA Program

2010-09-08T14:28:00.008-04:00

One of the great tragedies in Haiti today is the large number of adults who are analfabete; illiterate, and not able to participate in the normal exchanges which are the foundation of contemporary society. For example, the majority of HAS’ animatrices, who are the front lines of the hospital’s connection with the residents of the HAS region, cannot read or write. For that reason, when we conducted a Risk Factor Analysis for infant malnutrition, we used a graphic check sheet so that all of the animatrices could participate.

The HAS alphabetization project has been operating for two years with the generous support of the Hummingbird Foundation, and has graduated more than 200 participants in a 2-year program of 3 afternoons per week.

Last Thursday, the 2010 graduating class invited Dawn Johnson and me to join them for their graduation ceremony in a shady church yard in Marin. More than 123 people from 8 mountain communities arrived for the ceremony, dressed in their finest, and quite proud of their achievement. Each of the community groups contributed something to the ceremony; a short theatre piece, a song, a dance, or speeches of welcome or gratitude, all of which involved reading.

One of the skits involved a small group walking to their Alfa class, and greeting a farmer in a field, inviting him to join them. “Too busy” he grunted. As the students walked back and forth each day, they told the farmer what they had learned. “I can measure my field and calculate my corn harvest” one said. Another said that she can read the label on a can of fertilizer. Another said that he will make a list of everything he will buy in the Verettes market. Eventually, the farmer’s restraint dissolved, and he followed the students off stage with his hoe on his shoulder, stimulating a standing ovation.

Agathe Geneus, our animated project coordinator, asked several participants what they could do now, that they could not do before the class. “I can read my child’s vaccination card” one said. “I can read my prescription, and now I don’t miss my medications” said another. One woman reported that now she can read with her children when they come home from school. An older farmer stated formally “Alfabetizaston se lavantage nou!”; being able to read and write gives us an advantage.

One group arrived in white shirts with a handwritten message on the back “ABA TI +”. All through the ceremony, I stewed over what this word meant. As the final act, they came to the microphone and sang a song about how they finally have learned to write their own names on documents, and don’t have to be embarrassed by having to make an X mark. Thus the motto on their shirt; “No more small cross”, sung with great pride.

Periodically during the ceremony, Dawn Johnson, who supports the literacy project, and I were invited to join the groups who were performing dances. Dawn is graceful, and I am less so. At a quiet moment, a young woman went to the microphone and, reading from a paper, announced that she wanted to ask me a question. She asked “How did you learn to dance, M. Jean?” The audience was teetering on the edge of open laughter, so, in as much of a deadpan I could muster, I said “I learned to dance from a book”, which gave everyone permission to give full vent to their laughter.

It’s possible that our culture has lost the gift of ritual in ceremonies; we have much to learn from Haitians, for whom ceremonies hold a vital function, to celebrate, to honor transitions, or to mark the beginning or end of important life stages. For the participants in this ceremony, their two years of effort were capped by a memorable, happy and important event. The flowery certificates which they took home with them will, long into the future, trigger memories of a morning in which they were honored for their commitment to self-development, and recognized for achievements. And I will long remember it also.

HAS Welcomes New Medical Director, Dr. Silvia Ernst

2010-09-07T09:50:00.000-04:00

Hôpital Albert Schweitzer Haiti (HAS) wishes to thank and bid a fond farewell to Rolf Maibach, MD. Dr. Maibach has served at HAS as medical director for 2 ½ years, pediatrician for 1 ½ years and as a board member of HAS for 10 1/2 years, as well as 14 years of short term volunteering. He is returning to his home in Switzerland but will remain on the HAS board. Dr. Maibach wrote the following touching letter to express his deep attachment to HAS and to introduce the new Medical Director, Dr. Silvia Ernst:

Dear Friends and Colleagues:
Today is my last day as Medical Director at Hôpital Albert Schweitzer Haiti (HAS). Dr. Silvia Ernst will arrive in Haiti this morning, welcomed by Ian at the airport, briefed about the news at HAS and will immediately take over as Medical Director. Silvia and I had the opportunity of brainstorming for 10 days in Switzerland and for an additional day in Ilanz and from those meetings, it is clear that Silvia is very well prepared for her important and difficult task at HAS. Silvia brings with her a wide range of professional and personal experience from her excellent work in Switzerland, India, Belgium and Africa. HAS is very fortunate to have Silvia as its new “Directrice Medicale”. Along with Silvia, HAS is privileged to have two outstanding Haitian physicians who have served as Acting Medical Directors, Dr. Harryo Sannon, Chief of Internal Medicine, and Dr. Maurice P. Toussaint, Chief of Pediatrics. Another important member of the team is Ms. Eda Sam who will succeed my wife Raphaela as Haitian Chief of Laboratory.

Raphaela and I are not leaving Haiti or HAS at all. In fact, we will be in Haiti several times a year assisting with the supervision of the Swiss Pediatric Transition Project and the Social Service and Laboratory Projects. I will also remain as a Member of the HAS Board.

Now it is time for me to express my thanks. The farewell party that the employees of HAS arranged for me was wonderful and touching and I thank you for putting it together for me and for the years of your service with me. I wish to thank the patients of HAS as well. I would also like to extend my thanks to the Board of Directors and the Senior Management, especially Ian and Nevin and Jimmie and Dawn; and of course, the team at the Pittsburgh office. Thanks to all of you for your help during the last few years. As you all know, my heart will always be with HAS as I share with you a deep concern for its future and the health and well being of the people of the Artibonite Valley.

Raphaela and I are thankful for the privilege of being a part of the wonderful HAS team.

Sincerely,
Rolf Maibach

Hôpital Albert Schweitzer Haiti wishes to welcome Dr. Silvia Ernst as HAS Medical Director!

A little bit about Silvia Ernst, MD:

Silvia Ernst, MD, Internal Medicine (FMH), General Medicine(FMH)Diploma in Tropical Medicine and International Health.

Silvia was born in Switzerland and is fluent in German, French and English. She studied at the University of Zurich, the University of Lausanne, the University of Basel and the Tropical Institute of Antwerp, Belgium. Her specialty is Internal Medicine and General Medicine with a post graduate certificate in Tropical Medicine and International Health. During her training, Silvia has worked in gynecology/obstetrics, surgery, anesthesiology, emergency medicine, intensive care, pediatrics, radiology and infectiology.

Silvia is a member of the Swiss Medical Association, the Swiss Association of Residents and Consultants and the Swiss Association of Internal Medicine.

Silvia’s work in the developing world, and in particular her recent work at the Albert Schweitzer Hospital in Lambarene, Gabon immediately identified her as the top candidate for medical director of Hôpital Albert Schweitzer Haiti. She has served on the board of directors of the hospital in Lambarene, and is well acquainted with the Schweitzer philosophy that is central to HAS.

She also has been very involved with humanitarian activities at the Leprosy Hospital in Kothara, India. Hôpital Albert Schweitzer Haiti is very pleased to welcome Dr. Silvia Ernst to our team.

Silvia Ernst, M.D.

Seasonal Malnutrition in Rural Haiti

2010-08-31T08:20:00.000-04:00

The SCI team visits the home of a household with high risk factors for malnutrition

The Nutrition Rehabilitation Unit at the hospital has the most severely malnourished children in the region; most of them have been sent to the hospital from the mountain dispensaries in Tienne and Bastien. The surveys by HAS of households of risk factors for malnutrition indicated that the area served by the Tienne dispensary included the highest proportion of high-risk households. This was corroborated by the most recent monthly weigh-ins which showed an inordinately high rate of Low and Very Low Weight for age children.

A community health worker shows off the
normal weight record of a child in a high-risk household

            In order to better understand the actual conditions of households in this region, a team of four members of the SCI team went to Tienne and accompanied animatrices in home visits to selected houses. In many of these houses, we found children who had been admitted to the hospital's Nutrition Rehabilitation Unit, which validated the survey findings. However, in the locality where my son Edward and I were visiting, we also encountered a number of homes which had high risk factor ratings, but the children's weight charts showed normal growth. This raises the question as to why households with extremely limited resources do not have malnourished children. Part of the answer to this question lies in the concept of Positive Deviance, in which the expected negative conditions are not found. An understanding of the strategies which are deployed to avoid the hazards and health consequences of poverty can help to shape an effective intervention strategy, to help other families to discover approaches to preventing malnutrition and illness.
            Our discussions with the mothers of PD children brought out some of the steps taken by mothers to ensure that their children were well provided for.
            When we complimented one mother on her child's obvious good health, and noted that surely life was difficult in the mountains, she explained "nou pa chita"; we don't sit down. Very animatedly, she told how during that week, she had bought limes from neighbors, loaded them in straw bags on her donkey, and took them down to the Verettes market to sell. She took the money which she earned from the limes, and bought toothpaste and imported foods from the Dominican Republic (which are not available in the mountains) and sold them to her neighbors. With her small profits, she bought rice, which only grows in the irrigated lowlands, for several nutritious meals for her family.
            Her energy and creativity, as well as her concern for her family, combine in the design of her work week to add income to the household and to protect her children.

The strategic plan for HAS’ nutrition services include the establishment of nutrition rehabilitation services at the two mountain dispensaries, which will reduce the need for the children and mothers to spend several weeks far from home, and will provide a base for community-based education in nutrition. One of the key resources for this effort will be the mothers who have developed strategies to protect their children. These shining examples of Positive Deviance will be folded into the educational programs as local experts, to share their success stories with their neighbors.

Ian Rawson

A conversation with Carsten Stauf

2010-08-23T10:42:00.004-04:00

The patients at the HAS Hanger prosthetics lab have appreciated the gift of new mobility which comes with the prosthetics device. Recently, they have been able to benefit from a new device, the

Haiti

Knee, which was designed by the Medi corporation in

Germany

to address the specific needs of Haitian patients. Recently, Rebecca Rawson had the chance to talk in Deschapelles with the engineer who designed the

Haiti

Knee.

Carsten Stauf shows the Haiti Knee
to HAS Managing Director Ian Rawson

Carsten Stauf is the chief project engineer and inventor of the “Haiti Knee.” He and his colleagues at Medi, a German company headquartered in Bayreuth, Bavaria, have been providing prostheses to the Hanger Corporation for decades. When Hanger opened the prosthetics lab at HAS, Medi sent them the first prosthetics systems for Haiti. These have been life-altering for over 500 Haitians.

Carsten developed the “Haiti Knee” to respond to the unique challenges in Haiti, such as the uneven terrain and the gait of the people. The “Haiti Knee” is lighter and more durable with a titanium head that features greaseless Teflon to make it easy to articulate, and therefore to walk. The head attaches to 2 carbon rods that can be adjusted to the individual’s height. It is a neat and efficient system. Medi has given HAS 300 of these units as well as 300 pairs of shoes, made in Austria, which will cover the hospital’s needs until next summer.

Long term plans between these collaborators include 2-week rotations at the Hanger lab of Medi-related personnel, such as certified prosthetic orthoticians and physical therapists, to alternate with the Hanger personnel. Medi is also making a 15-minute documentary by a German film crew that will premiere in Orlando, Florida at the upcoming World Congress meeting of Orthotics and Prostheticians. It will then be sent all over Europe during the holidays with the aim of creating a registry of doctors, CPOs and physical therapists who would come to volunteer at HAS.

As each patient puts on a new leg at the Hanger Clinic, they may not understand that this prosthesis is the result of an international collaboration which reaches from Germany to the United States to Haiti, but they are overjoyed to have this new mobility, and to be able to look forward to a future which includes the possibility of employment, going to market, and being with family.

Prevention of Water-borne Diseases in Flood Zones

2010-08-14T09:14:00.018-04:00

Following the floods in the Deschapelles and neighboring areas earlier this month, volunteer animatrices visited all of the households to which they are assigned to assess the risk factors for disease. A graphic chart was designed to allow the mostly illiterate animatrices to report damage to latrines, well-heads, water storage, or household materials which might contribute to gastrointestinal and other diseases.

More than 1,000 households were surveyed in the three major flood zones, and the results were synthesized in order to identify regions and households where the damage was the most extensive and severe.

I, along with the director of the HAS Wells and Water team, and the senior community relations manager, visited over 50 high-priority households to validate the findings of the survey, and to establish our priorities for reconstruction. We selected three localities with a total of 8 separate households, and over 65 residents in total. In each of these 8 households, we will build a latrine to replace the ones which had been damaged beyond repair. At the same time, we will decontaminate wells and evaluate the need for repair of the well heads.

Work begins Monday on this strategy, with the purchase of cement and hiring a bos mason who will oversee the construction of the latrines at three central sites. Each latrine costs approximately $300, the funds for which have been received from generous and concerned donors.

As the work proceeds on these latrines, we will go to several other nearby localities which have been identified by the surveys to have been seriously damaged. There, our priorities will be latrine construction and well decontamination, plus possible construction of flood-proof wellheads.

In some communities, we have identified the need for biosand water filters; water is accessible through shallow wells, but the water is consistently polluted, so a household water filter will remove coliform bacteria to render the water potable.

The flooding and its aftermath have shown us how vulnerable the local families can be to environmental impacts; as we visit households, we are invited into neighboring courtyards which did not suffer flood damage, but still need latrines, wellheads and water filters. As a result, this work will extend beyond the present urgent state into the near future.

With the encouragement and support of an NGO which is active in the north of Haiti, we will construct several multi-user composting latrines, to be located in several clusters of large compounds of extended families (20 or more residents).

Ian Rawson
Managing Director

Responding to the Deschapelles Floods

2010-08-02T17:11:00.000-04:00

Immediately after the floods, volunteers spread out to the most affected households in our region to assist in cleaning and trash removal. By the end of the week, our volunteer community-based workers conducted household visits in these stricken areas to assess other damage from the flooding. They reported on destroyed latrines, contaminated wells, and the loss of animals and property. It was evident that immediate action should be taken to reduce the possible incidence of typhoid, oral-fecal contamination and other water-borne diseases.

The planning team from HAS Integrated Community Services determined that the most important intervention at this time would be to ensure that each household in the most affected areas would have access to a decontaminated well, water filter and a functioning latrine. Each of these involves the construction of the filter, a toilet base and seat, or collar for the well to keep out ground water.

Today, the emergency response team will go to areas where there are clusters of houses with these needs and identify locations where we can set up a small production plant for these items. Because of the weight and the lack of road access, our experience shows that it is easier to set up the fabrication as close as possible to the location where they will be installed.

So far, we have identified 4 priority fabrication sites and we expect that number to increase to 10 sites. Each site will receive 10 latrines at a cost of $3,575 and 10 well covers costing $1,500. We have been assured by World Vision that they will offer food for work support for the people who provide labor at the fabricating sites.

We are fortunate that donors have already made contributions that cover almost all the funds needed for 2 sites. These and other emergency requests that we make are due to extraordinary circumstances and are not covered by our budget. A gift designated for emergency relief will allow us to address this crisis and future ones in a timely and effective manner.

The community is appreciative of the rapid response which HAS has been able to mount in response to this urgent situation, and we are hopeful with your help that the entire program can be funded and implemented by the middle of August.

Ian Rawson, Managing Director

Measuring the Flood Impact in Deschapelles

2010-07-24T15:10:00.002-04:00

In the days after the Sunday flood of the Ca Charles watershed, volunteers and part-time workers with the UN project went to all of the affected homes and assisted in clearing away mud, rocks, trees, and trash, helping the residents to gain some sense of order, and to cope with their losses.

Many of us joined the volunteers, and we were shocked by the extent of the damage to the homes and the crops. In a team meeting of the staff of Integrated Community Services (all of HAS’ activities outside the hospital), it was suggested that we would conduct a survey of homes which were in the flood cone, to determine the extent of the damage, and to identify priority families for assistance in rebuilding. We had hoped to immunize 3,000-4,000 people in the area of worst flooding against typhoid. Sadly the vaccines were not available in our area, so instead our health workers provided education about typhoid prevention.

We activated the animatrices, community volunteers who work with HAS as contacts with the community, reporting on births and deaths, finding cases of illness and referring them to the dispensary or hospital, and providing health education. Most of the women (and a few men) had previously participated in the survey of risk factors for malnutrition, so we used the same concept of a graphic survey, so that the mostly-illiterate women could mark the objects which they saw.

Today, most of the surveys have come into the office, and we are compiling them to cluster by sub-zones within the immediate hospital area. Over the weekend, we will compile the results and identify the highest-priority households to be visited and support with whatever resources we can find. We appreciate the responses which have come in after the first blogs in this series, and we have already seen that the needs are greater than we had imagined.

Ian and the Integrated Community Services team.

In the Aftermath of the Flood

2010-07-20T13:35:00.000-04:00

On Monday morning following the rains and the flood, the HAS managers of the UN Cash-for-Work project allocated more than 100 workers, who had been cleaning local canals or fixing roads, to the flooded areas. Using wheelbarrows, shovels, and other tools from the project, they joined the people in the mud filled courtyards to clear out the piles of trees and branches, and to clear the mud from the house floors.

Some of the women collected the clothes from the houses and washed them, putting them out to dry on fence lines and bushes. By the end of the day, most of the large debris had been cleared, and the houses had been emptied of the furniture to be assessed for future use. Many households had mattresses, but few had bed frames, and thus were soaked with muddy water. When they are dry, most of them will be burned.

The physical, visible, effects of the flood have started to disappear, but the sense of loss and having been invaded by a powerful force will remain for a long time. The HAS team of psychologists, who have been supporting the needs of the earthquake victims who live in this region, will go to the flood areas tomorrow to conduct group therapy sessions, and to try to help them to deal with the sense of insecurity which comes from such a powerful event and it losses.

While the force of the flood was greatest as it passed by the narrow channel behind the market, it gained strength from a web of small watersheds, each of which contributed a rapid flow of water, mud and debris into the main channel. This morning, one of our security guards, who had volunteered to help other families the day before, shared with me that he cannot get into or out of his house, because one of the upstream feeder channels, which is usually a small stream, had flooded and swerved, washing away the gentle slope to his front door. Now there is a steep ravine in front of his gate. Later today he will cut a new gate in the back fence, and negotiate with his neighbor the rights to pass through his courtyard to get to his house."

As always in Haiti, volunteers came from all over the community, to assist the people in the flooded zones, and to show solidarity with them, in the face of a tragedy which might have affected any of them.

Weather forecasters have been predicting for months that a punishing hurricane season is on the horizon. We are watchful and hoping for the best for all of the people of Haiti.

Ian Rawson
Managing Director

Torrential Downpours Flood Artibonite Valley

2010-07-19T13:27:00.002-04:00

Five years ago on this date, a short but powerful rain created a flood which rushed down the Les Forges ravine and washed out the Deschapelles market and most of the houses below the bridge which leads to L'Escale, a residential village belonging to HAS.

On Sunday, in the late afternoon, a similar rain created a flood of the same magnitude. Trees are piled up around the houses below the canal, cars and motorcycles are covered with mud, and the interiors of many houses are flooded to a height of about 3-4 feet.

By Sunday evening, it was still raining, and the floods had receded, but it was impossible to walk very far without slipping in the mud and tripping over trees and branches. Thus far, there are no reports of physical injuries or losses, but we can see a substantial impact on the residences, courtyards and fields of food crops. Also, we have not heard from the upland communities, which will have endured the same rains.

Our extended family here at HAS has suffered losses. Manite, employed at HAS since the very early days, found her house was flooded to the height of her waist, washing away many of her treasured herbal plants. Another long-time HAS employee, Tyranie, also lives in that lacour, a small cluster of homes, and her house was flooded as well. The children from that lacour were brought over here to my house, and we had a bit of a camp party there with hot chocolate and blankets.... Fortunately, guests left yesterday, so we have space for the temporary visitors.

In Haiti, we live very close to nature, and its vagaries impose themselves without warning or selection. But the poor suffer more, because they are less well protected, and the margins on which their lives are led are so narrow. The miracle is the resilience of Haitian people, and their ability to carry on in the face of disaster, and to be able to visualize a better situation even in the face of disaster.

Our role is clear; to be considerate and concerned, to share resources as they may be available, but to share with them the experience of loss and also of recovery, hand in hand and shoulder to shoulder.

This incident may not be carried on your national or regional TV shows; the media who were here last week to mark the 6-month anniversary of the earthquake left before this new challenge emerged. Our son Edward came back from Port au Prince yesterday evening along the coastal road, and he reports that the devastation is remarkable all along the road, with flooded rivers and mudslides down from the steep mountains, and people wandering out to and into the road in a state of shock. Today will bring a broader perspective, one of loss and disaster, but ultimately of perseverance and hope.

Ian Rawson

Managing Director

HAS 6 Months After the Quake

2010-07-12T13:12:00.002-04:00

Six months ago, a powerful earthquake shook Haiti’s capital city and other crowded residential areas to the south west. Only estimates are available of the number killed or injured, who have endured life in tarp cities, or who have migrated to rural areas.

HAS, unscathed by the tremblors, accepted over one thousand patients, most of whom were admitted to the hospital and received advanced care, most frequently orthopedic interventions. With time, most of the patients were discharged, some to an uncertain future, and HAS began to return to a semblance of its former status as a regional referral center.

However, the earthquake has changed everything in Haiti. The country’s healthcare infrastructure has been severely disrupted, and leaving a significant shortage in surgical and specialty services in the main city. Almost a million refugees are estimated to have left the capital to stay with relatives or acquaintances in rural areas, and approximately half of them came to the Department of the Artibonite, where HAS is located. Many of the refugees in the Artibonite have located in the major towns, but we estimate that our population in the HAS district has increased by 15%, with many of these residents needing primary health care and immunizations.\

The earthquake has also changed everything at HAS. The hospital, normally a 80-bed facility, now has more than half again as many inpatients. Most of the added inpatients are scheduled for surgery, and many of these are orthopedics cases who have been injured in motorbike accidents. The pediatrics ward has also expanded, with children with gastrointestinal and respiratory diseases, often complicated with malnutrition. As the patient population expands, so do the diagnostic services in the laboratory and radiology.

The prosthetics services, provided by the Hanger Corporation and Foundation, is racing to keep pace with the demand for new limbs for amputees. Over 400 patients have received prostheses, and more are on the waiting list. Today, there were more than 40 patients at the clinic; some are living at l’Escale, a temporary residential space just off the campus, and the others were brought up from Port au Prince by bus.

HAS, which prior to the earthquake, was a regional referral hospital for the 300,000 residents of three communes, now serves as a vital resource for the population of the destroyed capital as well, with patients coming from that area for surgery and diagnostic services. The national plan for prosthestics calls for the establishment of 8 laboratories, with four in the capital and four in the periphery. Not all of these services have yet come on line, and HAS appears to be one of the major provider for the entire country of Haiti. HAS now has a new, expanded role in the total scope of health services in Haiti.

The malnutrition ward always expands during the rainy season, while crops are growing and there is little food in the house. Almost half of the patients in the ward today are from two mountain communities, and we are making plans to develop nutrition rehabilitation units at these two dispensaries, to be more convenient for the mothers. In the long run, it is our hope to be able to substantially eliminate malnutrition in the mountain region through preventive intervention, especially among the most vulnerable children, those who are going through weaning to a transitional diet, and those who live in resource-poor mountain communities during the rainy season.

Just as more international aid agencies arrive in Haiti to set up long-term recovery projects, there appears to be a sense of malaise and frustration among many young Haitian professionals about the slow pace of change and the lack of a coherent recovery model. HAS, along with other healthcare organizations, has noted the departure of physicians to Canada and Europe, probably on a permanent basis. Several of our all-Haitian permanent staff positions are vacant, and will have to be filled by short-term clinical volunteers.

HAS was very fortunate to have been generously supported in the weeks following the earthquake, and the funds which were sent to assist HAS in that crisis have been expended in addressing the need for resupplying the hospital, accommodating volunteers, Now, the increased demand for our services, and the resource-intensive nature of the surgical and other services, have placed pressures on the planned expense budget for 2010. While cost reductions have been instituted, the redefined mission of HAS represents a challenge for the organization.

We appreciate the concern and support for HAS and for Haiti which our supporters have expressed in so many ways, and we look forward to our new challenges with confidence, and with appreciation.

As we sit together today in Haiti, making plans for the near term and longer term at HAS, we appreciate the concern and support for HAS and for Haiti which have been expressed in so many ways, by so many people. Some have known HAS for a half century, but countless others are new friends. We look forward to our new challenges with confidence, and with appreciation.

Ian Rawson, Managing Director & John Walton, Board Chair

2010-07-01T12:59:00.000-04:00

This year marks a centennial of a sort for HAS; it is the 100th birthday of Larry Mellon, and it was observed here in Deschapelles with several days of celebration, along with the 54th anniversary of the hospital.

In the past several years, the locus of the HAS birthday events has shifted from being held inside the hospital to out in the community, in order to ensure that both employees and local residents can share in the reflections about the hospital’s achievements. Our closest partners at the community level, the Organization for Economic and Social Development (ODES) has served as the official host and coordinator of the events, with the active support each year by Mme LeGrand Mellon, the widow of Billy Mellon.

The day-long celebration on the 26th was preceded by a week of evening musical events in the outdoor pavilion of the Belizaire-Mellon boutique, which exhibited models of new products emerging from the crafts shops in ceramics (brilliant new colors), cotton rugs, and furniture (new, contemporary designs, along with the antique reproductions).

On the day of the birthday, a large crowd convened in the Catholic Church at the end of the corridor, in a ceremony which was led by the lay pastor, Vanes Dutreuil, who is also our surveyor. This was followed by a parade up the corridor, led by the Fanfare brass band, and the brightly-uniformed young coordinated marchers. After circling the hospital, the crowd returned to the ODES site, where they were welcomed with a prayer from Pastor Sonnal (returning from New York for the event), and several musical selections interspersed with reflections from the oldest HAS alumnus, a community leader, Mme Billy (LeGrand, in her Deschapelles persona), and your Managing Director.

Special guests of the day’s celebrations were a large number of people who were in the process of receiving and using new limbs from the Hanger Clinic. Many of them walked down the road from their residence in l’Escale, on their new prostheses or crutches. This is almost the half-year marker since the January earthquake, which caused the injuries suffered by many of the patients. The day, however, was a day of celebration and liberation, led at the end of the program by a rap which was written and performed by two of the patients.

In observing the 100th birthday of Larry Mellon, the point was made that when he was young, his mother always read to him from the Bible at night, and one of the passages which she frequently chose was the one which notes that it is easier for a camel to pass through the eye of a needle than it is for a rich man to enter Heaven. Larry recalled those verses when, later in life, he was presented with the opportunity to establish a hospital in Haiti.

The formal events were followed by several popular soccer matches on the HAS field; in the first one, an inexperienced but disciplined team of girls from Deschapelles beat a well-equipped team from Petite Riviere, and the under-13 boys from Deschapelles battled an older-looking team from Verettes to a 1-1 tie. The large screen TV on the basketball court which was showing World Cup games went virtually ignored as the feisty locals were cheered on by their neighbors.

A long day came to an end, having covered the gamut of emotions from celebration, thoughtful reflection on the losses which have been sustained recently, and the joy which comes with a return to mobility.

If the hospital and the community can pause at the half-way marker of the Year of the Earthquake with such grace and humor, it bodes well for many joyful celebrations to come.

2010-06-18T15:00:00.000-04:00

”Tipa tipa, ti zwazo fe nish li”. Bit by bit, the tiny bird makes her nest, says the Kreyol proverb, and in this season it is truer than ever. At the start of the rainy season, birds make their nests to prepare for the safe hatching of their young.

One type of bird, a tiny yellow bird, converges in flocks into a single tree, screeching in a volume totally out of proportion to their small size, as they fly back and forth from the palmier trees, where they pluck the slender fibrous leaves to build their nests. They are called "Madame Sara” birds, because they make as much noise as the ladies at the Verettes market, calling out to each other to advertise their wares and to belittle the meager offerings of their neighbors.

One can almost imagine what the tiny birds are saying, as they hover next to their nests, which hang from branches, gradually becoming a gourd-like structure with a side entry. They fly to the nest with leaves, and pound them into the next row, using ther beaks almost like nail hammers. “Come on, girls, time’s a-wasting, the rains are coming, we have to get our chicks under shelter.”

The rainy season also brings out the maternal instincts of the women of the mountains, who come to the hospital with their sick and malnourished children, where they are admitted first to the pediatrics ward for initial treatment and then to the Nutrition Rehabilitation Unit to regain some of their lost weight, and to receive psychosocial intervention.

Since May, the population of the NRU has doubled, reflecting the dire conditions in the upland communities. The year’s food supply comes from a single planting season; last summer’s crops have all been consumed, and hungry families watch the slender green shoots of corn and millet emerge from the rocky soil, knowing that it will be weeks before they can be harvested. They watch hopelessly as their children lose weight, and their stomachs become distended with parasites. Then they bring them to the health centers in Bastien or Tienne, or directly to the hospital, where the children will be treated and given life-saving food.

For many years, HAS has weighed all children under 5 years old, and have treated children whose weights are below normal either in community-based 2 –week nutrition sessions (ti foyers), or at the hospital if the condition is more severe. This year, HAS has embarked on an innovative approach; women volunteers who support approximately 15 households each (called animatrices), go to each of their assigned families to conduct a Risk Factor Assessment to identify households where children are at a high risk for malnutrition or diseases. Because many of the animatrices are illiterate, the assessment form is a series of graphics, which the visitor checks off when they see them. They report on the condition of the house and courtyard, where the family cooks, whether they have a latrine, and how they access water.

The categories were defined in focus groups with animatrices, and field tested and revised before the campaign started. With support from the UN OCHA program, every household in the HAS service area with a child under 5 years will be assessed, and children in these households will be offered supplemental foods to try to prevent the annual increase in cases of severe malnutrition. Our hope is to be able to prevent malnutrition in the highest-risk households, and to be able to show, over several years, a decreasing trend in severe malnutrition and a reduction in referrals to the hospital during the rainy season.

With tiny steps, the hospital continues to build a system which addresses the immediate needs of the people in the Artibonite Valley, and to establish a foundation to change the major patterns of disease, particularly in the most vulnerable of the mountain communities.

Ian Rawson,

17 June 2010.

Haiti Water for Life Celebrates Drilling 200 Wells!

2010-06-07T09:13:00.002-04:00

Over 15 years ago Canadian Rotarian Roy Sheldrick and his wife, Norma visited Hôpital Albert Schweitzer Haiti. The trip became a life changing experience for Roy who wrote of this experience, “Many Haitians live in conditions that have changed little from a century ago. Many Haitians have no electricity, no running water, and no telephones. To visit Haiti is like going back in time. Potable (drinkable water) wells are life savers. In Haiti, one out of every five children die before the age of five, mostly from curable diseases. Contaminated water gives children (and adults) infections, typhoid and diarrhea which in turn can lead to malnutrition”. So, with the help of Sheldrick’s Rotary, The Rotary of Ancaster Ontario, he developed the Haiti Water for Life Program whose goal was to put 200 wells in the Artibonite Valley of Haiti, first by buying a well and subsequently over the years by building and installing many many more.

Since that time, wells have been installed in school yards, church yards, medical centers and on the Hôpital Albert Schweitzer Haiti’s campus. In April the Haiti Water for Life program announced the drilling, capping and installation of the 200^th well in the Artibonite Valley of Haiti. Since its inception in 1995, Haiti Water For Life has raised over $1.3 million dollars for Haiti Water development. Major donations have come from individuals, church groups, Rotary Clubs in over 70 communities in Ontario and Western New York State. There is also a fund raising Walk for Water Event which is sponsored by the City of Hamilton Ontario’s Public Works Department along with additional funds from private foundations, the Ryan’s Well Foundation and the Foundation of Rotary International.

Hôpital Albert Schweitzer’s own Dawn Johnson and Renold Estime administer the program and are the key program leaders in Haiti. There are countless people to thank for the success of this program including the drilling crews and others who carry out the difficult construction and implementation of these wells often traveling over barely passable mountain roads to do so. There are also 3 partner Haitian Rotary Clubs that have been vital to the program, the Petite Riviere, Saint Marc and Verrettes. At a recent dinner in Canada to celebrate the drilling and opening of the 200^th well Renold Estime was presented with a Paul Harris Fellowship Award to recognize his dedication and efforts in supervising the crews, training community committees and managing the work program. Sheldrick was also presented with awards at this celebration for his life’s work with the program. In his comments that evening, Sheldrick thanked all of the hundreds of people who have made the Water for Life Program possible. With its recent expansion into sanitation facilities it has become even more critical to the communities being served in the Artibonite Valley. Roy said that one of his life’s dreams had been realized with the completion of the 200^th well; however he acknowledged that the work is not complete until all of the people in the Artibonite Valley (now estimated at up to 400,000) have access to clean safe water.

Hôpital Albert Schweitzer Haiti wishes to thank everyone involved with Haiti Water For Life.

“Giving clean water to the Haitian people brings hope for tomorrow”. –Roy Sheldrick

Improving Literacy in Haiti

2010-05-26T19:22:00.001-04:00

Today I learned how to read on, an, en, and ou. Then I learned to write 1,2, 3, and 4.

I was in a classroom in Les Forges behind the Deschapelles market, with 25 adults who were learning to read and write for the first time. When we arrived at the school, the regular students were leaving in their crisp uniforms, and the adults filed in to one of the classrooms while the teachers closed the rest of the school. The adult learners, most of whom were women, wore the clothes they were wearing in the market or the fields.

Agathe, our animated education coordinator, took over from the teaching assistant who has been leading the daily classes, and led the group in a rousing song in celebration of literacy. Then, writing on a section of the class wall which had been painted a matte black, she started to write, one at a time, the two-letter dipthongs, pausing to invite a student to the board to say the word and then to write it. Each achievement was celebrated with wild applause.

The afternoon rains have started, and they came today in a torrential flood, beating on the tin roof, making it impossible to hear anyone but Agathe, whose experience has brought her through more challenging situations.

The hard part of the day dealt with numbers - writing them, and then adding two of them at a time, with the class calling out the numbers and the answers.

This class, one of four being conducted in Deschapelles, is intended to strengthen the domestic economies of households of earthquake refugees and their host families.

Gozde Avci, the project sponsor, explains that these classes are essential to the participants to allow them to become full participants in the cash economy, allowing them to read labels and to calculate prices. The educational model is the same as the alphabetization program now being implemented for the HTRIP project, which has been proven to be an effective approach to rapid learning of basic writing and calculation.

Ian Rawson

Managing Director

HAS Managing Director Speaks at Carnegie-Mellon

2010-05-24T11:02:00.004-04:00

Ian Rawson, who is now serving as Managing Director of HAS in Deschapelles, and who was at HAS when the earthquake hit Haiti on January 12th, was invited to be the commencement speaker at this year’s graduation at Carnegie-Mellon University. Many of the CMU students had joined together in a number of fundraising efforts for Haiti and for HAS after the earthquake, and the incident was a signal event in their final semester.

In his letter of invitation to Ian, President Jared Cohon noted the relevance of the earthquake experience to this year’s graduates:

“In this time of devastation, Hôpital Albert Schweitzer Haiti has surely faced many challenges, and you have continued to manage each issue with poise, determination and innovative problem solving. Your work reflects the essence of what we strive for in a CarnegieMellon education: dedication to solving the world’s biggest problems. For these reasons, we would be honored if you would be available to deliver the university’s Commencement address this year. I am certain your talk would be motivating to our graduates, impressing upon them the importance of sharing their education and talent to make the world a better place, just as you have done for Hôpital Albert Schweitzer Haiti and the surrounding community.”

In his address Ian shared a message about the perseverance and hope of the people of Haiti, which will serve the graduates well as they move ahead in their professional and lives of service.

http://www.youtube.com/watch?v=XyG3KB7aw48

2010-03-05T13:24:00.001-05:00

As we continue the long term work to recover from the earthquake, events are moving rapidly forward to help those folks who have suffered from this devastation. Perhaps no injury is more life changing than the loss of a limb. Tracie White is a contributing reporter for the Stanford Medical School publication Scope, and is currently in Haiti to document the earthquake relief efforts. Please follow her recent account that describes HAS efforts to treat amputees at:

ttp://scopeblog.stanford.edu/archives/2010/03/haiti-day-3-amp.html

John Walton
Board Chair

2010-02-25T10:27:00.000-05:00

A New Step for Ania, A New Step For HAS

During the earthquake of 12 January, many people suffered crushing injuries to their extremities; primary care for the injured often required amputations of injured or infected limbs. An estimated 2-4,000 amputatins were performed in the first week after the earthquake, many of them under rudimentary field conditions.

Patients who arrived at HAS with crushing injuries to the extremities were managed by a specialized nursing wound care team, and the surgeons were very conservative in their management of these cases, exercising limb salvage strategies to the greatest extent possible. Only 15 long-bone amputations were required for the patients at HAS, but soon after the earthquake, we began to receive referrals from other hospitals for patients who required revisins of thei original amputaions.

Soon after the earthquake, at the encouragement of the Peachtree Orthopedic Group, which had sent two teams to HAS, we received a visit from Harold Anderson, an amputee, who brought with in representatives of the Hanger Corporation (a national leader in prosthetics and orthotics), and of the Shepherd Rehabilitation Hospital in Atlanta. This group offered to HAS the opportunity to establish a prosthetics laboratory on a turnkey basis, in order to address a national demand in Haiti. Both opf the prosthetics services in Port au Prince were taken out of service as a result of the quake, and the demand for artificial limbs was becoming more apparent daily.

Technicians from the Hanger group arrived with several pallets of equipment and supplies, and set up an operating laboratory in three days. Yesterday three of the 8 patients currently housed at HAS l'Escale village were fitted with new legs and given the opportunity to try them out. Ania, shown in this picture, is a teenager with a beguiling smile and a doting father, the only surviving members of their family. She has made firm friendships with other young patients in the village, where they assist each other to accommodate to their physical losses with a strengthening of emotional bonds and mutual support.

Ania's first steps were difficult, but she kept at it for almost a half-hour, wanting to master the new technique of walking with an unfamiliar appendage. Perseverance, the watchword of the Haitian people, is never more evident than in the new prosthetics facility.

For HAS, this also represents.new steps; starting from a commitment in 2007 to develop a training program for Rehabilitation Technicians, which has been supported by the Friends of HAS, and which is guided by Health Volunteers Overseas. The 2009 class graduated three students, one of whom is in the hospital, and the other two of whom are assigned to the dispensaries. The current class has six students, who arrived a week before the earthquake. A full-time Haitian PT (a rare commodity in Haiti) has been added to the staff, thanks to support from the Friends. Now, with the arrival of the Prosthetics lab, HAS is emerging into a new clinical arena, and also in a new role within Haiti. All of the current patients are victims of the Port au Prince earthquake, and have been cared for by HAS and several PIH-related facilities in Cange and St. Marc. Additional patients are awaiting transfer to HAS in the near future.

HAS was honored by the selection of Shaun Cleaver, the Canadian PT who started the Rehabilitation Technician training program, as a member of the national council which is charged with developing policies for the care of persons with disabilities, and specifically for the provision of resources to support persons with amputations. This places HAS in the center of planing for one aspect of medical care in Haiti, which in the future will of necessity be more decentralized away from the devastation in the capital. Parallel planning processes will be developed for the acute health care system as well, and the HAS experience will contribute to those plans.

Ian Rawson

Managing Director

2010-02-11T20:12:00.000-05:00

Since the beginning of post-earthquake recovery effort, the United Nations has provided logistical support for patient evacuation and the delivery of essential medicines and materials. HAS' efforts to get replacement supplies during the first weeks were somewhat convoluted, involving the arrival of samll planes onto grass airfields about 4 hours north of Deschapelles, or land transport through th Dominican Republic. One of our suppliers, Direct Relief International, had a large shipment of materials for HAS today and requested a helicopter airlift from the Ukrainian squadron.

The sound of the helicopter's engine brought a quick end to the day's schedule at all of the local schools, and the soccer field was surrounded by young people who were astounded at the huge machine, and who then were shocked by the clouds of dust as the helicopter landed.

The large yellow school bus, which has been our workhorse vehicle for transporting materials to the hospital. was backed up to the back of the helicopter and a group of volunteers transferred the boxes from the helicopter. Several volunteers from Thailand who were working with the World Food Program hopped a ride on the helicopter, and took advantage of the photo op with all of the kids who were lining the soccer field.

In about 15 minutes the aircraft was unloaded, and took off in another dust storm, and all of the kids went home for lunch, having witnessed a piece of history which will not show up in their textbooks.

The materials which were delivered by the helicopter came from a shopping list which was part of a complex supply chain for HAS which has been maintained by Nellie Player working from her home in Pittsurgh. Lists of needs from the hospital, which changed almost hourly in the first weeks after the quake, were matched with list of donated goods which were offered from a variety of agencies, and also with the list of volunteer air flights, to come up with a timely delivery to HAS. Today's shipment as a first, as a helicopter delivery by the United Nations, and it has opened a door for further deliveries in the future.

The hospital used almost three month's supply of medications and surgical materials in the first ten days after the quake, and it has been a challenge to get back up to a full stock. After the initial flood of patients directly from the quake zone, HAS is now receiving referrals of patients which have received primary care at tent hospitals in the capital, but who require more advanced surgical intervention. A series of one-week rotations of surgeons, primarily orthopods, has responded to these requests, and has been able to stay current with this increased demand. Attlanta's Peachtree Orthopedic group sent down two teams, the second of which is here this week, and they have done a good job of reducing our stocks again.

Ian Rawson

Managing Director

2010-02-09T16:39:00.002-05:00

Exerpt from 2/9/2010 blog by Edward Rawson
http://www.edwardrawson.com/

Before I came to Haiti after the quake, I was hearing the numbers on the news. Before I arrived the estimated death toll was already over 160,000. By the time I got settled in to the Hôpital Albert Schweitzer campus I was reading over 200,000 dead. The statistics were saying over a million directly affected by the quake. All these numbers were so abstract to me. Sure it sounded like a lot of people. I could imagine my home city of Pittsburgh, has a population of around 300,000 people, so that means around two thirds of the Pittsburgh's population would have died over the course of 30 seconds and over the next few hours and days. But still that was so abstract an idea I could hardly wrap my mind around it.

Now it has been nearly a month since Haiti has been reduced to rubble and broken hearts. The initial crisis of getting people to hospitals and in the care of doctors is slowing down. Most of the life saving has been done and rescue work is nearly over.

Now the hundreds of thousands of patients with broken bones, amputated legs, horrible scrapes and bruises will wait patiently for their wounds to heal. More surgeries will happen, but now we will be fixing the rough field hospital amputations and other procedures, reducing infections, skin grafts, and removing of external fixing devices. Though HAS is still overcrowded and filled with major procedures yet to be preformed, it looks less full than it did a few weeks ago. Now we are seeing many injuries NOT related to the earthquake. Taptap (taxis) and motorcycle crashes are very common as well as cases of TB, Malaria and other illnesses.

There is a new emergency emerging and growing every day. Because of the unthinkable destruction in the south of the country, a massive migration of displaced people is coming our way. Their numbers too are sounding abstract at the moment, but in the region of the Artibonite the numbers are the largest. An estimated 162,000 people moving to this region. To compare that to Pittsburgh again... half of Pittsburgh just moved in our back yard.

Hôpital Albert Schweitzer now has a massive new population to care for. We are one of the only hospitals in our region and already have a large population within our 610 square mile service area that depends on us for their healthcare. That means that a large portion of this new immigrant population will now need vaccinations, to be recorded in our systems, treated for illnesses and given care when needed. This will put an additional burden on the already weak economy. Most of the illnesses we treated before the quake were illnesses that are the result of poverty. So, if the economy goes down more, the illnesses will go up. Our region will need more care.

We are here, and have been here, for over fifty years in the Artibonite finding ways to provide care to the people of Haiti who we love and know deserve a helping hand.

We need your help. Your donations will save lives today, tomorrow, and for years to come. PLEASE VISIT www.hashaiti.org TO MAKE A DONATION NOW!

2010-02-08T16:37:00.001-05:00

Sunday, February7th 2010_____________________________________________________________

By Edward Rawson

Time.

Time is the distance between being here and being there.

Time is the thirty years of my life.

Time is the space between the day my grandparents opened HAS and now.

Time is the moment a baby's departure from a mother's womb gives way to its first breath

Time is a fleeting moment, a single breath, and a life time of breathing.

It is eternal and it is momentary.

Time is an instant as much as it is a lifetime.

Time is the essence of life.

Time is passing right now.

Time is one hundred thirty heart beats a minute; twelve breaths per minute.

Time is an hour; its sixty minutes; its three thousand six hundred seconds.

How many foot steps every hour?

That is time in various measurements.

It can be measured in a million ways and quantified in a million more.

Multiply that by another million more, and that is how many ways time can be felt.

Some would say its been a long time since the Jan 12th earthquake rumbled the earth of Haiti.

Others would say its only been four weeks since it destroyed the lives of millions.

How do you measure the time since you had your leg? How do you measure the time since you saw your child for the last time? How you measure the time it will take for skin to grow over the exposed muscles in your arms? How do you measure the time since you saw your house crush your leg and killed your son? The house that you cherished. The house you built with your own hands. The place you raised and nurtured your family. The house that took all that from you when it fell. How do you measure the time a country will take to heal?

How do you measure that time laying in a bed staring at the ceiling, listening to the screams across the room as the nurse removes the dressings on other patients wounds? How do you measure the next patients barking, crying, wailing? By the scream? By the tear? By the prayer?

How do you measure the time until its your turn? Until the anticipation gives way to your own reality? How do you measure the time that it will take for the skin around your amputated leg to grow together closing the wound; Closing the chapter in your life when you walked; When you skipped?

How do you measure the time until you learn to walk again? How do you measure the time until you will never learn to walk again; Never see him again; Never hug her again; Never know where they are? How do you measure the time it takes to stop crying? How do you measure the time it takes to take your last breath? How do you measure the time you will spend watching until they take theirs?

Today I walked the halls of Hopital Albert Schweitzer with a team of orthopedic surgeons who just arrived from Atlanta. I thought of the time since I had last seen Dr. Guy. I thought of what he must have done since I had last seen him. I thought about the time he and his team will be here. One week. What will they do? What will they be able to accomplish? I saw determination in their eyes. I saw confidence. I could see the sight of blood and open skin was no stranger to them. The dozens of external fixations posted through skin into setting bones, the x-rays, the gauze, the, fear and hope in their patients souls, their trauma.... This was where they lived. This was their territory. They spent their lives honing in on their ability to see this, and know just what to do, and how to do it. They were embarking on a week of healing.

As many times as I have walked the halls of HAS, the sight of injuries is never something I have totally gotten used to. Or maybe I've gotten used to it, but it still makes me uncomfortable. In the last weeks I've seen all too much of it. Every time I see a woman's pink muscle exposed again, and cleaned again, while she winces in pain; every time I see large metal posts sticking through the flesh, clutching to healing bones, I feel it inside me. It hurts me to watch. I feel pain inside of me because I can't grasp the pain they feel inside of them.

Today I became all to conscious of my own feet. I have stood on them billions of times. I have walked so many steps, ran so many more. All moments. Millions of moments that string together, and in the cluster of them... I can't remember a single one of them. They are lost in a sea of countless seconds, minutes, years and decades. Today I felt my feet like I never felt them before. I watched as the Atlanta team of orthopedic surgeons pulled the skin together around the place where a woman's leg once was. They talked calmly about a strategy to get the skin to close around the stump. To heal. To permanently close. Her foot was not there. she could not and will not feel it ever again.

I stood there staring blankly, at this calm group of doctors, and I began to feel my feet. I wanted to hold on to that feeling and never forget it. I had never been more thankful to feel myself standing.

I looked at the face of the woman. She had gotten over it to some extent. She had morned her leg by now. She was coming to terms with it. As thankful as I was for feeling my foot at that moment, she was more, because she knew she was breathing. She was alive. She made it. Not everyone did and she was being cared for by people who knew what to do. She had been cared for over the last few weeks now. Weeks which must have felt like an eternity. Weeks where she has still not healed but has begun to. Weeks where she stared at the ceiling and waited. Waited the time it takes to get better and to accept ones new reality. A reality which was delivered in a few short seconds. A reality you share with a nation of people.

She wasn't alone. In that same room still laying in their cots were others with broken legs, broken arms broken cheeks... broken spirits. The sight of blood was becoming familiar to all of them in this room. Sounds of pain were becoming as regular as their own breath. And it is the same in the next room, and in the halls, and in the courtyards where families watch and heal together.

The sight of doctors was even more familiar. What does it feel like to be in good hands? How do you balance the fear of the unknown with the faith, that this man and this woman standing over you, know you have nothing to fear but fear its self? How do you measure the time it will take to accept that? How do you measure the time it will take you to realize that these people saved your life? They saved all these lives, and they were here for you when you needed them most. How do you measure a lifetime of gratitude?

Time.....

The time is now to help. Visit www.hashaiti.org and make a donation and join us in helping the Haitian people

2010-02-07T20:50:00.000-05:00

Sunday morning is usually rather calm in the pediatric and adult wards at the hospital: Few urgent cases, pediatricians, internists and surgeons doing rounds quietly and visiting all their patients, walking from bed to bed, talking with patients and parents, explaining, calming. Not so today: Six orthopedic surgeons, general surgeons and anesthesia doctors from Atlanta were busy checking all surgical patients, X-Rays and medical histories, planning upcoming treatment and operations. They are the second orthopedic team from the well known and renowned Peachtree Clinic in Atlanta coming down to HAS since the earthquake and doing hundreds of difficult orthopedic operations for our victims. They are operating simultaneously in all three operating theatres. Peachtree Orthopedic Clinic, founded by Dr. Bob Wells, former Chair of our Board and lifelong volunteering orthopedic surgeon in Haiti, has a more than 50 year tradition of sending high skill orthopedic surgical teams to HAS. Following the first Peachtree team, a highly efficient nine member team from Sherbrooke University hospital in Canada, consisting of OR nurses, orthopedic surgeons and anesthesia doctors filled the gap between the two Peachtree teams.

All three teams were not only very professional but created an excellent working atmosphere together with our Haitian physicians, nurses and technicians, in the OR as well as in the wards. HAS which utilizes our high tech C-Arm (fluoroscopy controlled reposition of fractures) has been able to perform difficult operations of open and closed fractures, unlike at some other small hospitals or field clinics, where often only preliminary interventions could be done, exposing patients to secondary operations or even infections or consolidation in false positions.

One week after the quake we ran out of strong pain relief medications and antibiotics. It was an incredibly hard day for our patients, many with severe fractures, which had not yet been operated on. We walked from bed to bed, from mattress to mattress on the floors, talking, trying to console our patients, ending up with a deep admiration for our patient victims, the real heroes of this drama, and their supportive and caring relatives….By the end of the evening the first medical shipment arrived and we were able to do much more than console. I never in my life have been waiting so anxiously for the arrival of a medical supply delivery. Since this crisis we have received tons of medical, surgical and laboratory supply by planes and large trucks, from US, Canada and Switzerland. Every shipment has been a big relief to all of us. We still will need more, but apparently the hardest time is past.

Looking back more than three weeks after the catastrophe, I feel a strong sentiment of immense and deep gratitude; first of all for our very competent and persistent Haitian Medical, Nursing and Technical staff at HAS, who were alone managing the incredible workload during the first days and thereafter, handling 66% of all victims without foreign help! I am grateful as well for all the volunteer doctors and nurses, rushing from many countries to help Haiti in this incredible tragedy. We still have a list of over 60 volunteer doctors and nurses ready to join us immediately. Due to limited ORs we only could take a few volutnteers with special skills that could be utilized for the immediate treatment of our patients. For those very well meaning volunteers that we could not accommodate, please forgive us. I am sure there will be a time we will need your help in many ways. Haiti and HAS have great support currently, but this support needs to go on!

HAS has an obligation towards the victims, not only now but for a the long term. First estimates show that hundreds of thousands of refugees from the Port-au-Prince area will settle in the Artibonite Valley and the Haitian government will prevent them from returning to the capital for good reasons. Support of HAS will be necessary for many years. So, we ask that you please help us and our wonderful patients!

Rolf Maibach, Medical Director

2010-02-06T12:25:00.001-05:00

Today's Blog from Deschapelles is being sent to you all by Ian Rawson’s son, Edward who was working in New Orleans and immediately made plans to travel to Haiti upon receiving news of the Earthquake.

I was able to arrange transportation just shy of two weeks after the massive 7.0 earthquake that shook the country to the ground. I flew in on a private plane which was bringing doctors, reporters, much needed medical supplies, and me. I spent my first night sleeping with one eye open on the tarmac at the Port au Prince airport. I watched as massive military planes unloaded tons of supplies. Most of them looked more like buildings with wings than airplanes. Trucks Marked UN, US, France, Turkey, and hundreds of other country's authorities raced around coordinating plans and supplies for the following day. It was surreal. I've been to this airport many times in my life often greeted upon arriving with the sounds of a band playing as I walk towards customs. This time the building was cracked and the only sounds were jets and sirens. The reason we slept on the runway the first night was that we were not allowed to leave the airport until dawn due to concerns about security.

When I got to the hospital the next day it was a really nice feeling. I hung on the side of a trailer filled with boxes of pain killers, antibiotics, and surgical supplies. I passed the big mural near the hospital entrance that we did in November still in perfect condition. It was a great feeling to be back to my home away from home. I was happy to be bringing these supplies and I was happy to see my dad.

Once the truck was all unloaded I got to sit down with my pops and reflect on the weeks before. It had been hard on him, I could see it in his eyes, and I could tell by how quick he would well up, and how little he wanted to talk about the tragedies he witnessed. I could tell he hadn't been sleeping much and he was becoming very attached to many patients from spending so much time in the halls doing what he could to make them feel better.

Albert Schweitzer Hospital is in the center of the country in the Artibonite Valley, in a town called Deschapelles. It was far enough from the center of the quake that it did not sustain much structural damage which is great news for all those I love here, and great for the hospital my grandparents built in the 50's. It was even better news for the victims 2.5 hours away in Port au Prince. Many of the hospitals in the city had been leveled or were severely damaged by the quake and were not in use immediately after. HAS was the first response in many cases.

Because of the severity of the quake, whole buildings fell on people. Hundreds of thousands of people died all so fast their bodies were just piled up in the streets in the days after. Those who did survive largely had bad traumatic injuries caused by concrete chunks hitting them and breaking their bones. They were in massive amounts of pain and needed treatment ASAP or they too would join their fellow Haitians dead in the streets. It was a very scary reality for many to face. I'm so thankful I was not here when it happened because hearing the stories from so many people was more than I could take much less to have to witness or be a victim of the horrors myself. Thankfully hundreds made it to Hopital Albert Schweitzer on time for life saving treatment despite having to travel up bumpy roads in the back of pickup trucks for hours.

Even when I got here two weeks after the big shake, I saw the hospital filled way beyond capacity. I had never in my life seen so many people at this hospital. Many patients were placed in the halls and their loved ones slept under their cots on the ground.

It was a trying first week as many faced surgery, while others got bandages changed and began the healing process. Thankfully there were finally some pain killers here. Even with them, some patients wailed in agony. If I close my eyes I can still picture one man screaming on my first day here as a nurse peeled away blood soaked bandages to reveal exposed muscle on his arm. Across the hall a few feet away a man sat quietly watching with his left leg wretchedly broken in several places and yet the surgeons so overloaded still did not have time to operate yet, so he sat and waited patiently for his turn.

All in all you could see the hope in the eyes of all people here. Every patient seemed relieved they made it this far, and knowing they were in good hands with the doctors and care HAS was providing. They were gonna make it through this and they knew it.

The patients were also relieved to know that regardless of how much care was required, it wouldn't even cost them a penny because HAS is supported by generous donations from all over the world.

Edward Rawson is a mural artist who has been creating public art designed and painted by disadvantaged youth in Pittsburgh, Atlanta, Miami, New Orleans, Brazil and recently in Haiti. Follow other images and video clips at www.edwardrawson.com .

2010-02-04T13:33:00.001-05:00

The past three weeks have seemed like an eternity, from the time late in the evening of the 12th of January, when the first patients began to arrive in tap-taps from Port- au-Prince, and the true scope of the disaster was not yet understood, until today. Now many of the quake-related patients have been discharged, and the many crises, joys, heartbreaks and celebrations which filled our moments are fading into memories. Time, which extended out through the many waking hours of the day, is slowly returning to normal cycles with meals at tables with team members and guests, the occasional visit to the Verettes market, and even trips to Port-au-Prince to meet with relief agencies. For me, it has brought a return to my office in the Community Services building, with the daily agendas filled with the concerns of the residents of this region.

I still go through the hospital several times each day, checking on the special friends whom we got to know so well. Yesterday, the lady who offered to be my Mami, who had spent several weeks in bed with her leg in traction, was sitting up, her hair done by her daughter, and wearing a spiffy nightgown. She had been cleared for discharge at last, and her sons were cleaning out their car which had been their home for several weeks. We shared a last moment together before we wheeled her to the exit.

For me it was a symbolic statement of a closing of an intense era in the hospital’s history. From these days forward, Haiti will never be the same, and HAS will also never be the same. We have all been redefined by this tragedy, as we have been redefined by the heroic response to it by the clinical staff, by the community, and by the patients and their families. We have emerged with greater confidence in our abilities to respond great challenges, and with a greater trust in each other and our professional and personal commitments.

Now, we are entering into a different phase of the disaster – when we have to confront the reality of the changes which have been wrought by the earthquake, including the devastation of the capital city and its infrastructure, and the massive population shifts which have brought people to the countryside, fleeing the destruction and insecurity of the city. We have to plan for the registration of many new residents in this area, and to prepare to provide immunizations, food support, primary care, and even shelter for many of them.

HAS is part of the formal planning process for a post-earthquake reality in Haiti, and for the design of a health care delivery structure which will be decentralized away from a concentration in the center of the country. Each day, clusters of activity groups meet in the tents which have sprouted next to the tarmac in the airport, conducing needs assessments, forecasting demands, and planning services. While most of the affected services and populations are in the city, HAS presents a voice for the institutions and populations beyond the immediate impact area, which are also affected, and which offer valuable services to the overall situation. As the new reality becomes clearer, we will be asked to accept new roles as one of the few substantial health facilities outside of the capital, and to help o design models for health and human services which will address the current critical state as well as the longer-term future.

Many of you have been kind enough to let me know that the information in these postings have been informative and appreciated. To a certain extent, they have also been therapeutic for me, and I have enjoyed the opportunity to share these experiences.

Ian Rawson

2010-01-31T13:41:00.000-05:00

During the past several days, we have helped more earthquake patients to leave the hospital; others remain, recovering from surgery, and benefiting from rehabilitation services. Almost all have been bed-ridden for almost 3 weeks, and for some of them, learning to walk again is precarious challenge.

It has also become possible to travel to Port-au-Prince to establish personal relationships with the international aid agencies which have established offices in tents on the grounds of the airport. HAS is now represented in the Health Cluster, with daily briefings to the more than 130 participating health-related organizations, and a rich opportunity for networking. In addition, through the good offices of Dr. AJ Neusy, who has been at HAS this week, we have established links with senior officials at the United Nations and several European aid organizations. Also visiting HAS now is Gozde Akci, a Turkish veteran of many UNDP postings in troubled areas, and now a consultant to UNDP in economic development. She has arranged for a meeting with UNDP staff next week, to discuss long-term economic development strategies in Haiti.

Dr. Erlantz Hyppolite and Shaun Cleaver (the Canadian physical therapist who implemented the Friends’ Rehabilitation Technician Training Program here) attended a special meeting yesterday of the rehabilitation section of the Health cluster. There is a growing concern about the long-term needs of the many persons who endured traumatic amputations of limbs, or whose injuries resulted in therapeutic amputations. At HAS, among the many surgeries performed in the past weeks, some were amputations, and a proportionally greater number of other amputations have been performed in field hospitals in Port au Prince. The planning group forecasts a significant need for follow-up services for these patients, as their amputations were done by visiting teams under field conditions and a number will require revisions.

The loss of a limb is devastating to any person, but the challenge is compounded in the case of subsistence farmers or laborers whose independence and economic survival requires physical labor. The demand for prostheses will be significant during the coming months, and discussions have begun with several entities which could establish a fabricating plant in Haiti.

These needs are being considered in the context of a growing realization of the true scope of the devastation which the earth quake has wrought on Haiti. In a recent news conference, Edmond Mulet, acting head of the UN mission in Haiti, warned that emergency relief efforts were the start of a commitment that would be much longer than the international community might realize. "I think this is going to take many more decades … this is an enormous backwards step in Haiti's development," he told the BBC. "We will not have to start from zero but from below zero."

One of the major impacts of the earthquake has been the internal migration of many residents of Port au Prince to outlying regions. All estimates of these patterns are unconfirmed, however according to the Government of Haiti (GoH) Minister of the Interior, as of January 29, more than 482,000 people had departed Port-au-Prince for secondary cities, including at least 162,500 people displaced to Artibonite.

We have started to see the impact in our immediate area; at our monthly meeting of the community health workers (CHW) on Friday, Dr Heyliger and I learned that people from Port au Prince had been arriving and settling with distant relatives or acquaintances. How many is unclear at this time, however we asked our CHW team to provide an estimate based on thier field work during the coming week. All of the children in these groups will have to be immunized, and many of them will require medical attention. The CHW’s will register them as new residents in our census, and give them identification numbers for the Electronic Medical Record system, so that they will be easily registered at our dispensaries or at the hospital.

Our son Edward, Gozde and Starry Sprinkle (HTRIP Coordinator) visited several families in the Deschapelles area. Some of them had untreated injuries and were referred to the Deschapelles dispensary, and almost all needed food and financial help. Edward and Gozde went to the Verettes market to buy rice and beans, and are now revisiting the houses to distribute these supplies. These emergency efforts will have to be replaced by a more structured relief effort soon, as their hosts may not be able to provide shelter for them over an extended period.

One of our visitors this week has been Dennis Roddy, a reporter from the Pittsburgh Post-Gazette, who made his way to Deschapelles and has written several thoughtful pieces about HAS and Pittsburghers who have joined our efforts recently. Today’s newspaper carries a front-page article at
http://www.post-gazette.com/pg/10031/1032453-82.stm

Ian Rawson

Deschapelles.

2010-01-28T17:28:00.001-05:00

Ian is off campus today in Port Au Prince meeting with officials at the US Embassy. At this time we are trying to improve coordination efforts with other organizations providing aid to the people of Haiti.

As this disaster unfolds we are confronted with very significant problems. Because of the widespread devastation inflicted on Port Au Prince, large numbers of people are migrating away from the damaged areas, and in many cases are returning to their childhood homes or to live with relatives. Recent estimates show that up to 1 million people are leaving Port Au Prince and that approximately 70,000 are projected to return to the Artibonite Valley near our hospital. We expect that many of these people will require medical attention as they may have untreated injuries. As we brace for this next wave, we are continuing to strengthen supply lines and treat the hundreds of patients already admitted to the hospital.

A second issue that we are facing is the need for rehabilitation services. This is best described by Dr. Katy Close, a volunteer internist who is currently serving at HAS:

I’m writing to you from the Hopital Albert Schweitzer (HAS) in Haiti. I consider myself blessed to be here, but if you saw what I have seen these last few days, you might well feel otherwise. I have been coming to Haiti to work at the hospital here for years, but never have I seen such wretchedness, misery and despair. It is difficult to describe.

The essence of it is that, in the wake of the terrible earthquake, the hospital now has many amputees, quadriplegics and paraplegics.We deal here with every kind of misery there is – and Haiti is never in short supply of that.

Currently HAS is simply not set up to accommodate the large numbers of patients who need services to recuperate and retrain so that they can cope with the challenges of everyday life in Haiti. In 2007 HAS initiated a Rehabilitation Technician Training Program which has now graduated the first group of students, but the demand will be far greater as a result of the earthquake. We are currently reaching out to our community of medical professionals, volunteers and donors to assist in creating a solution for this very critical need.

John Walton

2010-01-26T12:09:00.002-05:00

Each day I try to go through the hospital several times in the early morning, during the day and in the evening. I try to encourage the people who are waiting for surgery and their families, and then to check on the progress of those who are recovering from their procedures. I have become quite close to several of these strong people, and our visits buoy the spirits of both of us.

We have never asked people about their experiences in the earth quake, but some now want to be able to express themselves about the disaster. One of my special friends is an elderly lady who has required two surgical procedures, with her leg in traction between them. She has endured pain and discomfort with strong perseverance (that's the word she used). She has a beautiful smile, which she usually shares with me each time I visit. If not, I know that she is suffering.

Once, when I went to see her, the bed was gone, but her son, who has not left her side, indicated that he wanted to talk, so we went out the ward door to a breezeway, and sat on a concrete bench. His mother comes from a small community on the north side of the Artibonite River. She had come in to Port Au Prince with her family to prepare for the daughter's wedding. When the quake hit his mother was buried in the rubble of a 3-story apartment building.

Miraculously, her sons found her and carried her to a nearby house. One of the sons drove to three hospitals to seek help for her broken leg, but he only found bodies of people which had been carried there by distraught families. The son returned to report to his mother, who was coming out of the initial shock of the quake. She told her children to take her home. Why? They asked, and she told them about the hospital across the river where she had gone when they were young, to have an operation.

The sons drove around buying gasoline, for which the price had doubled, and started on the road to Deschapelles and Hôpital Albert Schweitzer. On the way, she told them about the hospital and the American woman who visited her every day.

I met her the day after she arrived, when she stopped me to ask me when she would have her operation. We talked a while, and she asked if the American lady was still there and I explained that she was not, but as the American lady was my mother, she had taught me how to care for our patients. That earned me the first of her beatific smiles.

She said that she will be my Mami, and I am honored with the relationship.

Later today, she will have her second operation and will be on her way to recuperation, and I am certain to be graced with another of her smiles.

Ian Rawson

2010-01-25T09:31:00.001-05:00

Volunteers have fueled our efforts during the past week. They have brought respite to the Haitian staff which has labored such long hours during the first days after the earthquake, and they have brought valuable skills which are needed by the patients.

Yesterday I drove to Pignon, a small town to the north of Deschapelles, with two trucks. In one, we had the six-person orthopedics team from Peachtree Orthopedics in Atlanta, which, in various configurations of its members, has supported HAS since its first years. They had come as an autonomous group, with two surgeons, two nurses and an anesthesiologist, and they operated for several days in one of the ORs, addressing the needs of our most serious cases.

They had come in to Haiti through Cap Haitian in the north of the country, on a private plane, carrying all of the equipment and materials which they would need. The ride to HAS from Cap Haitian is a bone-jarring five hours. Our goal yesterday was to evaluate a different method of getting passengers and medical without trying to go through the Port au Prince airport, which has limited access.

The plane which had brought the team to Haiti was piloted by a volunteer from Atlanta, and he was returning to bring the team back. He had identified an airfield in Pignon which looked appropriate, and which was only 3 ½ hours away from Deschapelles, over better roads. We arrived at Pignon, and as one of the doctors noted, it was possible to understand why they were called airfields. The two turboprops landed on a 3700-foot grass field, following a low sweep by the lead plane, which scared the goats away. We offloaded the two planes which had been stuffed to gills with medical supplies and medicines, and the surgical team went aboard to return home.

As we loaded the materials on our trucks, several other small planes arrived with volunteers; a Rotary group from the US, an orthopedic surgeon from New Zealand, and others who had come to assist in reconstruction effort. Each was met by a different group from the affected areas, and taken back to Port-au-Prince to start their work.

Another supplpy flight arrived last night at Port Au Prince. This Boeing 737 had been chartered by the Bouchard family from Pittsburgh and was filled with personnel as well as medical supplies for HAS and other Pittsburgh-related health care organizations that operate in Haiti. This was just one of several flights which have made huimanitarian trips to Haiti this week, and an example of both the generosity but also the logistic expertise of the Bouchards. The plane arrived after dark, and the airport was closed, so the teams remained in the arrival lounge until dawn, and they are making theor way out to their respective work sites in rented trucks.

While much has been seen in the media about the massive airlifts of supplies and personnel in Port-au-Prince by major international relief organizations, there is another parallel, and less well known, process through which volunteers have come in to Haiti, made a significant difference, and returned home, unheralded by the public, but essential to the overall effort.

When we got back to the hospital and off loaded and inventoried the supplies, I went to the Alumni House, which has served as the residence and dining hall for volunteers, I had dinner with three doctors who had served at HAS a number of times in the past, and who have been supporting the care of patients before and after surgeries, two trauma surgeons and an anesthesiologist, who had found their way here on their own, supported by a New York-based group which organizes disaster response teams, an Army medic from Pittsburgh who had recently retired and who hitchhiked in from the Dominican Republic, and who was assisting the surgical teams in the ORs, and a long-term internal medicine doctor who has been supporting the needs of our regular patients, who continue to come for diagnoses and for return visits, scheduled before the quake. In the next house, a team of surgeons from Sherbrooke University in Montreal were taking a break before returning to complete several more cases.

All of these clinicians have melded almost seamlessly with the Haitian staff; many have been here before, and know how to fit in. Others are adaptable and flexible, and adjust their activities to the existing patterns. All of them work long hours, and make substantial contributions to the hospital’s efforts to manage the surge of unexpected patients. In a future blog we will list all of their names and affiliations, with an attempt to thanks them adequately for their good will and concern.

After dinner I went back to the hospital to visit the patients; I have come to know them well, and they joshed me about not having been to see them all day, and told me how they were recovering from their surgery, or shared their pain as they wait for their turn. They are confident that they will recover; they have seen many of their roommates go home, and they know that they will be able to do so also. In the meantime, they offer a beautiful smile and a word of encouragement to those of us who work to serve their needs.

2010-01-24T19:39:00.000-05:00

As Ian is off campus today, I will fill in with an update on some of the other activities surrounding HAS response to this crisis.

Today, we were able to bring in another supply flight with desperately needed supplies and medical personnel. We feel we have turned the corner on the acute shortages of badly needed antibiotics and analgesics. As you know, following the earthquake, we had record numbers of patients. We were using a month's worth of supplies for each day of operation. The USA based team quickly went to work on the challenges in procuring and transporting medical supplies as well as medical teams specializing in the treatment of trauma injuries. There were many nail-biting days as our regular supply lines using commercial shipping and airlines into Port Au Prince had been interrupted by damage to the port facilities as well as restrictions flying into Port Au Prince.

As people around the world began to grasp the impact of this catastrophe, it has been incredibly gratifying to see the almost instant and generous response of individuals, corporations and foundations offering to help the people of Haiti through HAS. Donations of money, medical supplies, surgical teams and even private aircraft to fly in people and supplies quickly surfaced. We are very pleased to be recognized by the Rockefeller Philanthropy Advisors http://rockpa.org/haiti-relief/ as a recommended organization providing relief to Haiti.

Despite the complications of matching up the right supplies, medical team skills with the aircraft capabilities and ground vehicles in Haiti, we are now able to deliver supplies utilizing airstrips at Cape Haitian and Pignon. We were also able to squeeze in a couple of flights into Port Au Prince amid the heavy traffic of the international aid organizations.

John Walton
Board Chair HAS

The following pictures are of todays flight into Pignon:

2010-01-23T09:49:00.002-05:00

For this morning's update I want to report on how the surrounding community has pulled together to help in this emergency.

During the period since the earthquake, community organization ODES has organized volunteers to come o the hospital to support the crush of patients and their families. Some of them have cleaned the hallways, so that despite the large number of people, the floors are clean, and the trash cans are emptied. Others have prepared and served food for the families of the patients, many of whom have arrived at HAS with no money. Others carry beds and cots from the halls to the operating rooms, or back to the surgery ward. They all are immediately recognizable by their white t-shirts with the ODES logo.

As they have helped patients to prepare to go home following treatment, they discovered that many do not have homes left to go to in Port au Prince, and in some cases, they have been scheduled to return to HAS to have casts removed, or to check for infections. It would not be possible to go back and forth to Port au Prince, and they would not be able to find follow-up care there. So, ODES volunteers have taken over the former TB village, l’Escale, have cleaned the houses, and have begun to install patients and their families in these houses, so they can remain close to HAS and will be able to make plans for a return to Port au Prince when their injuries have healed.

Another group has worked with a local entrepreneur who was building a small hotel, to help to advance the project to make the rooms habitable, and have begun to house families, who have some connection with Deschapelles, and who have joined the crowds of people who are migrating out of Port au Prince. That facility will be filled soon, and the volunteers are scouting for other places where these people can be accommodated.

Many families have been leaving the capital, trying to get back to where they have some connections, so they can find shelter and the chance to regroup in order to try to make future plans. Near Port-au-Prince, aid agencies are setting up tent cities, but these may not be adequate. From our perspective, it is hard to estimate what the impact will be in this region, or on HAS, but it seems probable that the pattern of outmigration from Port au Prince will continue, and that more demands will be placed on HAS and on the community. We are fortunate to have a strong and flexible community organization such as ODES as a partner.

2010-01-22T09:14:00.002-05:00

Morning report 22 January 2010, Day 11 of the earthquake emergency

In today’s Medical staff conference, Dr. Maibach led a discussion with the physicians of the state of transition at the hospital, from the emergency situation, with more than 500 patients, to the conditions of today, where many of the corridors have been cleared of cots and gurneys. Patients who arrive at HAS now are almost exclusively from this region, and present with the expected health conditions for this season. Normal procedures are being followed for the diagnosis and treatment of these patients in pediatrics and adult medicine, with the exception that admissions to the wards will be restricted, due to the large number of post-operative patients who fill the inpatient bays.

In surgery, new patients are primarily local, with motorbike injuries or other accidents. However, the daily workload for the surgery teams is still quake-related. A large number of major cases were processed overnight and into the morning, and as of 7 AM, the hall to the OR was re-stocked with patients in the queue for procedures. All 3 rooms are in full use, staffed by the Atlanta orthopedics group, the NYMed trauma surgeons, and the Sherbrooke University team, along with the HAS surgical staff.

The Haitian medical staff reported on what they were hearing from their colleagues in Port-au-Prince; there is an awareness that the actual resources, especially for surgical care, are limited, and they are dependent on the temporary services of the international agencies which have set up tent cities to manage the immediate crisis, and will soon pack up the tents to go home. What will happen then is unknown, but we assume that people in need of surgical care will continue to seek services here.

One member of the staff likened this to a wave, which crashes to the shore, and then retreats, but builds strength and returns to crash on the shore again. HAS board member Scott Dowell will be in Port-au-Prince with a governmental delegation to assess the future needs of the health system in Haiti, and we look forward to being able to contribute to that assessment and the planning process which will follow.

2010-01-21T17:31:00.002-05:00

Last night, the Orthopedics team from Atlanta arrived at 7 PM, following a bone-jarring, 5-hour truck ride from Cap Haitin, the only airport which is open to civilian airplanes. After a quick shower, they did rounds in the hospital and set up a schedule for operations today. This morning, they sey up in one of the operating rooms - the team had a complete staff, with surgeons, anesthesiologists, and and OR nurses, and they brought a large number of bags with surgical supplies, pain medicines and antibiotics. The Haitian surgical team is in the other operating room.

Also, late last night, a surgical team arrived from Sherbrooke University in Montreal. The surgeons attended surgical rounds and then settled in the third operating room, and were joined by their anesthesiologist and nurses. Each of the visiting teams represent an ideal model for post-disaster medical care; they can operate autonomously, in parallel with our permanent staff, and under the overall direction of the HAS chief of surgery, Dr. Exe, they can cooperate in clearing the remaining backlog of surgical cases from the erthquake of a week ago. Later in the morning, a young Canadian anesthesiologist showed up, having hitchhiked from Port au Prince, and was quickly installed in the operating suite.

With this complement of permanent and visiting medical and nursing staff, it will be possible to complete the clinical management of almost all of the patients from the earthquake that have arrived at our location. By the weekend, we assume that the hospital will return to its normal, busy level of activity, and the visiting teams can begin to return, or in several cases, to go into Port au Prince to support several of the international clinical efforts there. Although we continue to receive offers of help from surgeons and other clinicians, for the moment, Dr. Maibach has suggested that we will not accommodate these offers until it is possible to assess the remaining needs, both at HAS and also in the capital.

With the support of the visiting specialist teams, a small degree of normalcy has returned to the wards, and the fulltime staff can invest more of their time on the needs of our patients who are unrelated to the earthquake. Care was provided to all patients by all doctors, with out regard to specialization. Now, the pediatric team can convene to plan the care of their patients, as can the adult medicine group, and the social residents, who arrived several days before the quake, can be reallocated to specific services.

Drs. Hyppolite and Heyliger, whose normal assignment has been with the Community Health service, are in Port au Prince, visiting the storehouses of donated materials and pharmaceuticals which have been sent from around the world, with a check list of our current needs. There does not appear to be a central point of coordination, so they run into representatives of other health organizations as they make their rounds. As Haitians, when they arrived on foot to the depots, the multinational UN guards which are stationed at all of the depots refused to let them in. Once we were able to send them a HAS car, they are waved through graciously, and have been able to address some of our most acute shortages.

For the patients who have been waiting so patiently for more than a week, the additional clinical activity has given them strength, knowing that soon it will also be their turn to proceed down the hall to the operating suite.

Going Home: All through the day, patients leave their beds in the post-operative unit or the wards, cleared for travel home. Family members collect the bedding and clothes and follow the patients as they are wheeled to the exit. They are pleased to be finished with this ordeal, but also face what awaits them with trepidation - they don't know if they have a home, or who will be there when they arrive. As their bodies heal, their lives also will require a healing process.

2010-01-20T14:52:00.002-05:00

2010-01-20T12:51:00.000-05:00

Morning Report 20 January 2010, day 8 of the earthquake emergency

We were awakened at 6:30 this morning by what seemed to be another aftershock. It was a nice way to meet the neighbors, as we all bolted out the doors together. There was no impact in this area, and we hear from colleagues in Port au Prince that there was no effect in their immediate areas.

All through the afternoon, the exits saw a steady stream of patients with casts, on crutches, and on stretchers, passing out of our doors to return home. The issue for many is where they will go – their homes in many cases were destroyed. A community group, ODES, has asked to take over L’Escale, the TB village, and are placing patients and families there in order to offer them shelter while they have the chance to sort out their lives. For some patients, who have had emergency treatment but are still fragile, this is an extremely helpful service. It is intended to be temporary….

Several of the hospital corridors are completely clear, and others only have a row of cots along only one side, so it is easier to get gurneys down the halls to the operating suite. The visiting team of trauma specialists teamed with Drs. Exe and Pierrelus in a seamless group and were able to function in two operating rooms at a time in a 13-hour marathon of procedures. Those patients who are still waiting were given hope as they saw patients being rolled into and out of the Ors.

A number of patients with complex conditions are awaiting the arrival today of a team of orthopods from Atlanta, who will be able to perform procedures on hands, ankles, and femurs which require the more technical equipment and materials which the team will be bringing with them. During the several days that this group will be here, they will assist the HAS team to clear a number of patients from the earthquake, and to support additional patients who have come in after the earthquake with injuries from farming and vehicular incidents. Gradually, the ratio of patients between earthquake victims and patients from this region is coming into balance, and perhaps by the weekend we will have returned to a census which more closely resembles the pre-quake levels.

Here at Deschapelles, we appreciated the concern shown by the team from ABC news, the first major national news entity to make it beyond the urban areas. We have heard kind comments about the program, which may also be shown on GMA and other ABC programs today. Some media leaves the impression that there are no functioning hospitals in Haiti, and that the entire country is embroiled in violence and desperation. This is not the case at Hopital Albert Schweitzer.

A regularly-scheduled delivery of food for the malnutrition program in the mountains arrived yesterday with a contingent of Argentinean soldiers in full battle dress, expecting a riot such as have occurred in Port au Prince. They established a security perimeter, automatic rifles in the ready position, surrounded by young men, some of whom were ominously armed with tennis racquets. We suggested that they might lower the rifles, and the tension cleared. Some of the young men showed up with cold colas, and others with ice for their water bottles. Soon it became clear that this was a different environment, and the young men explained that they were there to volunteer to off load the trucks into our depot. We finished the exercise with photos of the UN soldiers surrounded by their new friends.

All of us here send our thanks for your concern and the generous outpouring of support during the past week. It lets us know that the work which we are privileged to do here is not unnoticed, and it gives us strength as we look forward to final stretch.

Ian Rawson

2010-01-19T12:01:00.004-05:00

A new day starts, and in addition to patients arriving from PauP, not to be forgotten are our usual patients from the district, arriving with motorbike accidents, suspected malaria and such. The halls still have beds with quake victims, waiting to continue with the process of caring for their wounds and going in to surgery, followed by post-operative care, rehabilitation and discharge.

Yesterday, an orthopedics team came from Miami for two days to support the Haitian surgeons. Today they have been replaced by several trauma surgeons from University Sherbrooke, Canada, who will stay for several weeks.

On Wednesday, an orthopedics team from Atlanta’s Peachtree Orthopedics, who have worked with HAS since it opened, will be coming with surgeons, anesthetists, and operating room nurses. One of the key points that we have learned is that in cases like this, when many physicians volunteer, it is most useful if they come with a team, which includes nurses, and which can function autonomously next to the existing teams, or in place of them on a temporary basis.

There are more international groups coming in to Port au Prince each day, some will come out to HAS today.

What is unclear for us here is the future demand from Port-au-Prince – several patients arrived yesterday with conditions which are not earthquake-related, and it is not clear if this is the first of many which will seek out HAS as the preferred hospital which is closest to town. We are communicating with Partners in Health about what the implications of this disaster are for the national health system, and what is the appropriate role for larger US-sponsored organizations in managing the demand for care when the major facilities are destroyed.

The tired nurses and doctors take heart in the arrival of reinforcements. However, we will never forget the magnificent response which emerged from everyone at HAS. No one paid any attention to shifts or hours, and remained at their posts to be able to serve the flood of patients. The spirit of the hospital has been positive and caring, and there is a recognition that we can respond to an extreme challenge with professionalism and human concern.

Each day when I go into the hospital, I pass under the metal plaque which spells out, in French and Creole, Albert Schweitzer’s concept “Reverence for Life”. Never, in my history of association with his writings and his work, has the meaning of that phrase been more clear.

Ian Rawson

2010-01-18T12:28:00.003-05:00

2010-01-18T08:40:00.002-05:00

The flow of urgent cases from Port au Prince continues as before except that they are more serious cases. It has been possible to treat and release many of the patients, so slowly the ones who remain are taken off the floor and put on cots, and then to beds.

A surgical team from Miami arrived yesterday evening on a military flight, started to work immediately, and had done a dozen cases by midnight. There is still a long row of surgical candidates in the hallway by the operating suite. The team has provided a welcome relief to the Haitian surgeons, and they are prepared to continue their work through today. They had been stalled in Miami for two days due to the confusion surrounding flights into the Port Au Prince airport.
We are learning every day about disaster medicine; we are a microcosm of what is happening throughout the country, especially in Port au Prince. The clinical demand is astounding; thousands of injured people are seeking care in Port au Prince, and for many it is a race against infection and systemic damages.
We had, and still have, a desperate need for clinical personnel; the surgical team which arrived yesterday has helped a great deal. Our OR nurses have worked as hard as the physicians, and are also in need of a break. More surgeons represent more demand for their services. The Surgery post-operative ward has spilled out into other spaces, but with only a few additional nurses, who are stretched thin.

I hope this comes across not as complaints, but as a description of what life is like on the ground here at Hôpital Albert Schweitzer, where the vast majority of our services have been provided by an exclusively local Haitian staff, and are only now getting support from international specialists.

Many of our patients have been in our hallways now for days, patiently waiting for help. We have become good friends and I appreciate their forbearance when I explain why they have not yet had their much-needed surgeries. Their pain is becoming more intense, and they must be frustrated, but they always respond with a smile and an assurance that they are doing all right, when it is obvious that they are not.

Several patients have brought radios. One of the early morning broadcasts play hymns. The patients turn up the volume a bit, amd many people quietly join the songs, from both wards, the halls, the pediatric clinic, which is filled with beds, and the old horse parking lot, which is also filled. Many Haitiams have lovely singing voices and the sound is angelic. For many, it is an inspiration that their faith will help them to endure the pain.
Your collective concern and support has helped to sustain us all in the face of an incomprehensible demand. I, and all of us here ion Deschapelles, send our sincere thanks.

Ian Rawson

2010-01-17T12:33:00.000-05:00

2010-01-17T11:32:00.000-05:00

Overnight, several patients have died, of a combination of their injuries and sepsis; we have run out of antibiotics We have never had enough pain medicine, and the usually stoic patients are now succumbing to days of unrelieved pain.

There is a gap between the images of the national news media of incoming flights and media moments with senior visiting dignitaries, and our reality here. Our surgical and nursing team is overwhelmed by the need.

Their days of non-stop work will not end today or tomorrow. At the same time, teams of qualified surgeons and other specialists are at airports in Miami and the Dominican republic, trying to get here to help. For many, it will be too late. We must find a way to speed up arrivals for these key people to come in.

We still do not have cell phone connections inside Haiti, and the few international cellular systems are overloaded, so we can speak by phone to the US only at night. The Internet has been a great help - our new satellite connection was installed the day before the earthquake, and we have good contact through that system. But it doesn't do much good, if all we can talk about is how it is impossible to get here.

This afternoon, a small group of surgoens might arrive overland through the Dominican Republic, which will be a great help, but we are also hoping for several specialists in orthopedics and neurosurgery who are waiting to get here, will be able to arrive soon.

This is only the second phase of a 3-phase disaster; after next week it will be clear that the quake has destroyed the capital's health infrastructure, and the emergency tent hospitals will not be a long-term solution. HAS will need to be able to make substantial changes in order to assist in the design and management of a decentralized hospital system for the future.

Ian Rawson

2010-01-16T15:32:00.002-05:00

The earthquake struck Haiti almost four full days ago.

Here in the Valley, we had little idea of what that entailed; all of the cell phone towers were out, and only later did radio programs begin to tell of the disaster. And then we began to get patients from near the quake zone - all through Tuesday night, they came in a steady stream. And then the same through Wednesday and Thursday. Yesterday, Friday, the number of new patients began to decline slightly, and some of the patients were discharged with new crutches and bandages.

But still, patents lie on makeshift beds along all of our hallways, with some families setting up camps in corners and closets to have some privacy. They wait, with great patience and endurance, for their turn to go to the laboratory or the Xray, and then for the operating suite.

Local churches have come through the halls with basic warm meals. The local bank sent fresh water sachets, and the large community organization, ODES, is bringing food for lunch now. No crowding or bickering, just quiet appreciation for the gifts of unknown friends.

Our surgical team has finally been able to take a break as they are replaced by other HAS surgeons who have arrived on campus.

Slowly, the backlog of cases is being reduced, but new cases still come, some of whom were recently taken from the rubble of collapsed buildings, still covered with the dust of dissolving concrete blocks.

Two volunteer teams are trying to get here; the airport is controlled by the US military, and only large humanitarian flights are allowed in. The bottleneck is an increasing source of frustration.

Our medical director, Dr Toussaint, shares with me that we are getting fewer patients, but they are more serious. They have received some care in other medical facilities and then are transferred here because of the lack of materials, electricity and other basics.

We suspect that this may be a future trend, as we have heard from doctors in PauP that there are many patients and few resources.

The clinical team here is heroic; they do not pay any attention to shift times or hours, but are here all through the day and night. I try to tell them how much this means to the patients and to thank them.

One nurse who came in from a distant dispensary shrugged and said "of course, I am here - these are my brothers and sisters."

I am proud to be part of this family which cares so much for each other.
We have heard that news of the disaster and of the work of the hospital has spread, and we are very grateful for the generous support and encouragement which has come from all over the world. It means a great deal to all of us here.

Ian

2010-01-15T10:08:00.002-05:00

During the night, additional patients have arrived - some have been carried in on doors, and as we don't have any more beds, they stay on the door to keep them off the floor.

We sent a truck to buy beds in St. Marc yesterday, and the mattresses and box springs are separated so that more people can have some comfort. Nighttime temperatures are cold at our location in the Artibonite Valley of Haiti at this time of the year. We have placed most of the patients on cots and beds around the corridors, but with the new influx overnight, about 40 were put in the outside clinic areas. They are wrapped in bedcovers which they brought with them, but still are very cold.

As the hospital begins its day, there are lines at the bathrooms and at the outside faucets. Sheets and blankets are carefully rearranged by family members, so that they look neat and clean when the nurses and doctors begin the early-morning rounds.

The hospital was quite full before the earthquake; while some of the patients were discharged, more than 60 patients still remain, and are cared for at the same time as quake victims.

The effort has begun to wear on the surgeons (one is a resident), and on the other physicians and nursing staff. We are searching for local support from doctors whose hospital facilities were destroyed in the quake. A team of surgeons will arrive from Montreal this weekend, but they have to make their way through the Dominican Republic by bus. Later, surgeons from the Peachtree Orthopedic Group from Atlanta will arrive to address some of the more complex cases.

As we sort through the range of medical conditions, we begin to see emerging several patients with special needs, with suspected spinal cord injuries or head trauma, and we hope that one of the members of the groups which are coming will be able to help to set up appropriate treatment plans for these patients.

Our goal for the day is to begin to complete the processing of a number of patients so that they may be discharged. As one of our nurses noted, however, it's not clear that they will have homes to go to.

As we go about our work, I did take a few minutes to reflect on the fact that yesterday, Jan. 14th, was the birthday of the great humanitarian, Albert Schweitzer, whose mission to bring health care to those in greatest need, provided the inspiration to establish this hospital more than 50 years ago. We are fulfilling the promise to provide care for those who are in the most desperate need.

2010-01-14T18:48:00.000-05:00

Throughout the day more vehicles arrive, more people seeking care.

Two school buses filled with patients just came to the door. We sent to St. Marc to buy a dozen more beds and mattresses in the market.

We are all exhausted - I haven't left the hospital for two days except to take a shower and change. And I have been lucky -others have just stayed through, like Toussaint.

All for now.

2010-01-14T08:59:00.003-05:00

At 6 AM, the hospital is stirring to life. More than 100 people are on cots or makeshift beds along the wall of every hallway. Family members are straightening out the sheets and coverlets, helping the patients to wash and to get ready for the day. About 30 of the patients have tape with NPO on their forehead, indicating that they are on the surgery schedule. The surgery team worked past midnight, and will be coming in again for morning rounds. About 25 of the patients are in the Observation unit, where they can be monitored closely by nursing and medical staff. The parking space in front of the hospital has thinned out to 6-8, in place of the more than 40 which were there at midnight.

Our immediate need is for replacement physicians. A key problem is long time required to arrive here from the US and Europe and the difficulty of transiting Port au Prince. I have been trying to contact other medical organizations here in Haiti as we understand that they have surgeons but no ORs. Dr. John Judson and the Ortho team are setting up teams which could be here within a week, which will help the HAS doctors to take a break, and to attend to the needs of their families in PauP. We will schedule these teams when Dr. Rolf Maibach, HAS Medical Director arrives later today with an official Swiss delegation to asses recovery needs.

We still do not have phone service. The internet is really our only means of communication..
It would be hard to adequately reflect the enormous effort which has been extended by every member of the HAS staff during the past days; always available, always helpful and supportive, and always supremely professional. Disasters often bring out both the best and the worst in people; in our case, we have only seen the best.

The halls are clean, despite the large numbers of patients and visitors. the flow of patients and their family seems chaotic but is well managed by the security staff. The lab and X-ray services are open, and the ORs are being prepared for another full day.

There are many heros here, most unsung; over time, it will be possible to identify and thank each one, but for the moment, a special recognition goes to the medical staff, especially Dr. Toussaint, a young neonatologist whom Rolf was wise enough to name as acting Medical Director in his absence. Quiet, kind, pleasant, and professional, he has led a team of physicians who have followed his lead of competent and caring service. Several physicians went to PauP to support their families, and the rest coalesced to ensure that all services were provided. The young social residents have also been extremely helpful.

Thanks to all who have offered assistance and support. It helps more than you can know.

Ian G. Rawson

2010-01-13T20:04:00.005-05:00

Ian Rawson, HAS Managing Director on the ground in Deschapelles, provided this snapshot of conditions:
Ever since early this morning, a steady stream of vehicles, mainly the open-back pickups which serve as public taxis on Haiti's roads, has come to the front of the hospital. In the back are one or two people, their legs or arms covered in bandages or clothes. HAS security staff rush out to the truck with a backboard or gurney, and bring the patient inside to be triaged by the emergency team.

Now, in early afternoon, a crowd of over 200 people are outside the hospital, friends or neighbors of injured patients. They rush to the arriving trucks and try to help to carry the new patients inside. Occasionally, the combination of the person's injuries and the truck ride are more than can be sustained by the patient, and the family members, with great wailing, adapt to the shock of the loss of a loved one. A sound system has been set up outside, so that family members may be called into the hospital to meet with doctors.

Each patient is brought into the Observation Unit and quickly evaluated. Some are sent to for an X-Ray or lab test while others are taken immediately to the holding area outside surgery, where both operating rooms are being used full time.

All beds have been pressed into use, and still there are patients on benches. Gradually, some of the early arrivals and less injured are prepared for discharge.

Systems at HAS are working well; preparation and practice have paid off. The greatest resource, however, is the dignity and grace of people who have suffered a great shock and sometimes tragedy, and remain calm and show concern not just for the people with whom they have come here, but for others as well.

This is the most serious challenge ever faced by HAS in its 54-year history, and while we are currently coping with the onslaught of the injured, we urgently need support.

At this moment, we don’t have the capability to accept material goods or personnel. Our greatest and most urgent need is for funds to pay wages to our dedicated staff, and to buy replacement medicines and supplies.

We will update the www.hashaiti.org website with news of relief efforts. To make a donation that will have immediate impact, please go to www.hashaiti.org.

HAS deeply appreciates the many expressions of help and caring that are coming from around the globe.

Jan 12 - Earthquake in Haiti

2010-01-13T20:01:00.001-05:00

Hôpital Albert Schweitzer Haiti Is Making a Difference

DESCHAPELLES, HAITI – January 13, 2010 – Haiti has sustained a terrible disaster: a 7.0 earthquake in Haiti, the worst in 200 years. As many as 3 million people may have been affected. So far, tens of thousands of people have died.

Hôpital Albert Schweitzer Haiti (HAS), located 40 miles NW of Port-Au-Prince, was able to withstand the recent devastating earthquake and is currently operating with full staff helping victims. With mass casualty protocols in place, the medical staff is evaluating each patient, performing diagnostic tests and delivering life saving care. Due to the expertise developed over its 54 year history, Hôpital Albert Schweitzer Haiti (HAS) is one of the few institutions positioned to provide timely hospital care for the injured. As the flow of people urgently seeking care increases over the next few days and weeks, our resources will be pushed to the breaking point. It is critical that we receive support to help us continue with our mission.