"Amazingly the streets are pulsing with life"

PIH Director of Communications Andrew Marx wrote this diary.

I landed in Port-au-Prince early on Wednesday morning along with our Chief Program Officer, Ted Constan, and a film crew who are making a documentary about PIH. We were met on the tarmac by Loune Viaud, our long-time head of operations and planning and all-around wizard of logistics in Haiti. From there, we drove directly to the Fondation Aristide, where we have about 20 tents pitched in the concrete courtyard, housing PIH staff and volunteer medical teams who have joined us to work in Port-au-Prince. Nobody wants to sleep indoors since the quake.

After we had stashed our belongings in tents, we drove through the city to the Hospital of the National University of Haiti, the main public hospital in Port-au-Prince. Looking out the window on the way to the hospital was like looking at a city that had been systematically carpet bombed. Almost every large building has been flattened or badly broken, with pieces tilted at odd angles like the work of a deranged Frank Gehry.

Amazingly, the streets are also pulsing with life. Markets have sprung up at intersections; tent settlements have sprouted in parks, courtyards and right in the middle of some streets; people industriously sort through the rubble, salvaging intact cinder blocks, crumpled pieces of furniture and equipment, scraps of metal, anything that might be useful in patching together a new home and a new life.

	Volunteers walk by wreckage of nursing school.

The scene at the University Hospital is both nightmarish and inspiring. The buildings have been largely abandoned for fear they might collapse in the next aftershock. Engineers have determined that some of them are structurally sound. But patients and staff are all terrified. Not surprising. The nursing school on the hospital campus collapsed, killing 200 students from the second-year class.

So most patients are housed and most medical procedures are performed in tents pitched throughout the grounds and the surrounding streets.

The pediatric ward at University Hospital.
Waiting to be triaged at the hospital gate.		In one room, two amputations were going on simultaneously.

By the time I arrived, the first wave of emergency surgeries had mostly passed. But operating rooms were still running around the clock. Patients were still arriving at the hospital gates on stretchers, in wheelbarrows, in the arms of family members, and being triaged and admitted for treatment, mostly in tents with banners declaring the country and organization that was working there. PIH had helped get 12 operating rooms up and running at the hospital, including several in one building that had been declared safe.

The next morning a team of about 50 doctors, nurses, pharmacists, and lab technicians from Zanmi Lasante (Partners In Health in Haitian Creole) arrived at Fondation Aristide to map out plans for mobile clinics that would bring medical care to two large tent settlements of people who had lost their homes in the quake. Between them, the two settlements have a population of 50-60,000 people. Calling them tent cities is highly euphemistic. When we arrived, there was hardly a tent to be seen. Most families are living in patchwork shelters cobbled together from tattered sheets of cloth and plastic, scraps of metal and wood, and pieces of cardboard.

Estimated population - over 40,000 people.		A boy in front of his temporary home.

Since the quake they have had no access to health care, little food, and almost no clean water. In open patches of ground within and around the periphery of the settlements, the reeking air and suspiciously squishy soil testify to the total lack of sanitation facilities. Our medical staff fears deadly outbreaks of diarrheal diseases, measles, pneumonia and other diseases.

Yet in the midst of it all children play soccer and fly makeshift kites fashioned from scraps of cloth. Women wash clothes in basins of precious water.

And families work with heartwrenching assiduousness to improve makeshift living spaces that provide almost no shelter from the weather but do afford a scant measure of privacy and domesticity. As I watched one wobbly structure fashioned from threadbare scraps of cloth that looked as if it would blow or melt away with the first storm, a woman emerged with a battered broom to sweep the barren patch of dirt beside her home.

Committees have emerged to organize and advocate for these settlements, exemplifying the spirit of solidarity and community that has enabled the Haitian people to survive and surmount every manner of adversity – from slavery to military occupation, from ruthless dictatorships to apocalyptic hurricanes and floods.

Zanmi Lasante has worked with these committees to find places to set up our clinics and to notify people we would be there to examine and treat patients.

Within 45 minutes of when we arrived on the first day, the team had erected a large open-sided tent, filled most of it with tables and chairs for 20 consulting stations, and established an orderly system for checking patients in and sending them to the next available doctor.

In one corner of the tent, they had set up a pharmacy area and a small laboratory to perform urine, pregnancy and HIV tests.

Within six hours, they saw more than 500 patients -- everybody who had come to the clinic.

And the next day they did it all over again, only bigger and better. At the larger of the two camps, with an estimated population of over 40,000, we had arranged for food to be distributed by the World Food Program and for a water purification system to be installed the day before.

The next day we drove up to PIH's flagship hospital in Cange. The hospital sustained damage, but is fully operational. Wards are overflowing with refugees from Port-au-Prince, many with families who live in the area, others who came simply because they knew there is a hospital in Cange that provides quality care free of charge. In almost every bed, a patient lies with a fracture held together with external metal rods and pins or with heavily bandaged wounds or amputations, usually accompanied by a family member.

A large room that normally serves as a pharmacy warehouse has been converted into a ward for 20 post-operative surgery patients.

The church that I last saw filled to the rafters with parishioners and the soaring sound of the church choir and band is now hushed, with all the seating removed. 50 patients lie on mattresses spread on the floor, with nurses, doctors and family members by their sides or quietly wending their way among the beds and IV poles. The room is uncannily quiet and has acquired an oddly domestic atmosphere. Everybody speaks quietly as parents help injured children wash their faces and brush their teeth, as a teenage girl gently helps her wounded mother use a bedpan and then sits close beside her, arms interwoven, each with a hand resting on the other.

In the evening, the Zanmi Lasante medical team gathered for lengthy discussions about how we can prepare for the next big challenge — how we can approach discharging patients who have no homes or jobs to go back to, who may have lost most of their families, who have injuries that will require months or years of rehabilitation and physical therapy, who will have to cope with paralyzed or missing limbs and other disabilities.

The next morning we observed the discharge of one patient who is fortunate enough to have a home in this area. Zanmi Lasante had already assigned a community health worker who will visit her every day, had already worked out a plan for physical therapy, had already developed plans for psychological support services, had assessed her need for food and other economic assistance.

Before she was released from the hospital, a doctor, physical therapist, and ajan sante (community health agent) went to check out the home where she will be recuperating. With one leg and one arm badly injured, she will need a wheelchair to move around for several months at least. Her home could hardly be called accessible for the handicapped. It can only be reached by clambering up a steep hill on a narrow, dirt path.

Inspecting the home of a patient to be discharged.		Family members await a discharged patient.

But she is one of the lucky ones. She lives in the Zanmi Lasante catchment area, where she will get daily visits from the ajan sante, regular physical therapy appointments, and follow-up wound treatment at the Cange Hospital. That's what we do and have been doing in Cange for almost 25 years. Now we have to figure out how to do it on a massive scale for tens of thousands of people who have fled to the areas where we work. And we also have to help the Haitian Ministry of Health obtain the resources and develop and implement plans to provide similar services in Port-au-Prince and other parts of the country.

We have a lot of work to do. But I feel confident that Zanmi Lasante and PIH can play an important part. And to the extent that I can contribute, I felt extraordinarily fortunate not to be an impotent witness to catastrophe but to be part of an organization that is working with Haitian communities, the Haitian government, and other partners to save lives, to relieve suffering, and to give Haiti a chance to reclaim its place as a beacon of hope and true heir to the banner they wrested from the French with their freedom -- liberté, égalité, fraternité.

Andrew Marx is Director of Communications for Partners In Health.

[published February 2010]