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'I need some good news, but this is Haiti and the reality is stark'

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I know it has been ages since I sat and reflected on what has been happening in Haiti. I have been thinking about sitting down and typing but I never seem to have managed to stop and do it.

It is not that I haven’t wanted to. Just other things have cropped up I guess. I suppose I have some difficult stuff to face too – but more on that later. The past month has been filled with comings and goings; More visitors to our unit to see what we have been up to. Patients being discharged ‘home’. Volunteers coming to help sort out the containers (thank you Guylee and Cara!), and so on.

We now have another physiotherapist (Hannah) who has come out for six months or so and will be working with the children, the spinal and rehab unit as well as setting up a community rehab service locally with Haitian employees. Great stuff.

I managed to fly to Florida and help with the fabulous Friends of Haiti fund raising event in Palm Beach. I had the easy bit really and cannot thank my friends there enough for all their very hard work. It made headlines locally as it was the largest out of season gathering in Palm Beach for years. I then flew on home to England for a whirlwind visit to see my family and friends, catch up with everyone, empty my house, rent it out and do my tax return (oh, the realities of life).

Some really exciting news is that we have been asked to be part of filling a much needed healthcare gap. There has never been any fully blown rehabilitation facility in North Haiti to care for patients and we are now working closely with some big NGO’s to build a 10 bed dedicated unit.. So I think Hannah is going to be very busy!

Some very sad news is that one of our patients recently died of typhoid and encephalitis back in Port au Prince. It is so frustrating to think that she had survived the earthquake and although a complete paraplegic and wheelchair bound, she was totally independent with all her care, bladder and bowel management and mobility. She even washed her own clothes and sheets.

The one good thing was that she was with her family, whom she had not seen for eight months. I guess it just brings home the fact that we are in a tropical, post earthquake, poverty stricken country. I still think of her so much. She was one of our first admissions on our very first day as a functioning unit, way back in early February. She had such a gorgeous smile, very kind eyes and beautiful skin. She used to get very hot and I would go and find a piece of cardboard for her to use as a fan.

In all the time she was with us, she had no visitors but managed to talk occasionally on the phone to her family. She was a very courageous woman who never complained. When asked “Kòman ou ye?” (how are you?) She would always reply; “Pa blèmal mèsi“ (not that bad thank you!). I do miss her.

Bad things still happen here in Haiti. It is still a country with its own rules. A two and a half year old little girl was found by the police in Quartier Morin (where I am) the other day. Her eyes, heart and genitals had been gouged out, she’d been decapitated and her limbs severed. She had been missing for three days. The word on the street is that her family had done something viewed as wrong by the voodoo chief and this was their punishment. The mother was found murdered a week later. Life can appear very cheap and is easily extinguished in Haiti. To hear the voodoo drums at night sounds more sinister to me now, that is for sure.

Cap Haitien NGO’s have been under a curfew for the past couple of months due to the increased incidence of kidnapping. We have been confined to barracks, so to speak. It begins at 7 pm, so we are firmly in situ by 6.30 pm every night. This has been due to a notorious criminal gang that has been taking locals and foreigners as hostages. Thankfully its leader has recently been captured and is awaiting trial and the kidnappings seem to have stopped in the area. I am looking forward to the curfew being lifted by an hour, which will make all the difference. Interestingly the curfew for NGO’s in Port au Prince is around 10.00 pm. Are we more hardcore here?

The local people take the law into their hands on many occasions. Some of the police officers appear to let this happen, others are unable to do anything about it as they would be turned upon too. If a driver is involved in a road traffic accident and another person is killed, even though it might not be his fault, he will be sought out and killed by the grieving family, then burnt. I guess it explains why there are so many hit-and-run incidents. To be put in prison here in Haiti sounds a lot worse than mob justice. I have heard that the conditions prisoners are forced to endure are beyond barbaric.

I need some good news again, but this Is Haiti. And at the Haitian people face a stark reality. It’s something we need to face. I just wish Haiti (with foreign help if needed) would do something constructive about it. There are some things here that have got to change – for the sake of humanity.

I am really thrilled as our nurses and ambulance driver have finally had training in emergency first aid response. The three-day education programme was delivered by an American medical emergency response team we have been liaising with, which is a fantastic step forward in the immediate care of sick and injured people here.

Our unit is a buzz of activity these days. Everyone who can, is independently getting up, washing, going to physio classes and so on. What a contrast to their total dependence on us in January. Miranda has taken on the task of feeding Ernest. I am so pleased that this has naturally occurred: she identified a need and has taken on this important role. Ernest has not only broken his back but has also sustained a traumatic brain injury, and unfortunately has no family members here (he has been abandoned). I guess this has given her a purpose and makes her feel useful.

With more independence and time on their hands, it has been important to establish some future projects and skills for our patients to learn. I guess everyone needs a goal or aim in life to keep us going and it is especially important for these people who have had almost everything taken away from them.

This month has been the most incredible one for establishing independence and a more normal life style. With hand cranked sewing machines arriving in one of three containers recently, our patients are now having haberdashery lessons. It is wonderful to see them doing their sewing homework, sat on their beds with pencils, rulers and paper, quietly concentrating and creating clothing. The men seem just as keen as the women. Both genders have crafted wooden transfer boards, rounding the edges and smoothing the surfaces with sandpaper and then carefully varnishing them – they have already been put into use. We have also introduced some English lessons for patients to attend in between their micro-industry lessons and physiotherapy, although these have been a little bit hit and miss.

Visits to the Maison de Benediction Children’s Home continue to be a fantastic success, not only to our patients but also to the children there. Many of the patients take it in turns to wheel themselves down the bumpy dirt track to the children’s home. Not only does this do wonders for their fitness and wheelchair skills, but it also gives them an aim for the day and takes them into another environment. I guess it is their chance to hold and care for another person in need. The Maison de Benediction is a place that would lift anyone’s spirit, especially as the main ingredients are children’s smiling faces, singing, music and the sound of young laughter.

Visits in the ambulance to the city of Cap Haitien, as a social outing, have been a good way to introduce the crazy, noisy, bustling, environment again to our patients due to go home. Having been so long in a quiet green bubble, this exposure can be quite daunting, so I have made it a priority as part of the discharge planning process. If you can imagine driving down a hugely pot holed dusty road with cars passing you on the left and the right - at the same time - with other vehicles heading towards you doing the exact same thing, with every type of tune blasting via their horns, motorbikes, bicycles and jay walking pedestrians. That is a normal Haitian street! I expect an aerial view would be like watching a line of busy focused worker ants going to and from their nest. It is no wonder there are so many road traffic accidents here. Driving in London, Buenos Aires or anywhere else for that matter will be a piece of cake for me.

The other day I walked down the road to buy some fresh local rice bread from a street stall with one of the other volunteers. While waiting for the bread to arrive, I watched a Tap Tap taxi hurtle round a bend, but their momentum was so great that five people sitting in the open back were thrown out onto the road right in front of us. Thankfully no one was seriously hurt, but there were lots of grazes and bumped heads/limbs and I am sure they would have felt very sore later on that day.

Bizarrely, they all got up, dusted each other off, and got back into the same Tap Tap. No shouting or yelling. No anger. Almost total acceptance of the situation being a totally normal event! It was shocked, to say the least.

With the three more containers arriving we have received more food aid to give out to the displaced earthquake victims, Global Link and SMILE donations, more beds for the maternity unit, six neonatal incubators and a rescuscitaire for the neonatal unit, which is fantastic! The ridiculous thing is that even in 2010, our hospital will be the only one in the north of Haiti with usable incubators.

This will mean that small, sick babies will have a better chance of survival. I really can’t wait to see the maternity and paediatric wings open. What a joyous occasion that will be and hopefully before Christmas. The buildings are taking shape, and now have painted walls and tiled floors. (The frustrating news is that more than $2,000 has to be paid for Port storage charges. Two thousand dollars would have bought at least one prefab hut for one of our displaced families.)

I guess all good things have to come to an end at some stage. In my case, my part of this project is nearing completion. I have achieved what I set out to achieve. Was I really part of that incredible task? I feel so privileged. We have an amazing team of people working here together. Each and every one here has been a vital cog in the wheel. I suppose it just goes to show that if you have a team full of willingness, enthusiasm, communication, positive reinforcement, guidance, patience, initiative, adaptability, flexibility, oh and more communication. Anything is possible! That is life – right?

When I returned from my UK whirlwind tour, I brought back Fob watches for all the nurses and physio assistants, and a silver heart necklace for each patient as a present. I didn’t know whether to wait until I left the hospital for pastures new, but am glad I gave them out as gifts from home. I was very touched to see my patients wearing their necklaces on their day of discharge home. They looked beautiful in their smart clean clothes that they had stashed away. The women with make up subtly applied, and with their hair freshly and neatly braided. The men cleanly shaven. Wow.

Since my return to Haiti, I have escorted five patients home in the past 10 days (all with their own sewing machines amongst other unusual discharge items compared to the Western world.) So, out of the 25 SCI patients we are now down to 10. An unrepeatable, incredible, tragic, courageous, frightening and emotional journey for each and every one of them since the 12 January 2010, when their lives changed so drastically and so completely.

The last person I escorted home was Elsie, and to be honest; she was the most difficult person to escort home to date. She lives in a house at the top of the side of an extremely steep hill. We carried her up on a camp bed, as we had no stretcher. The terrain was too much for her rough terrain wheelchair. So steep, so bumpy and so slippery. (This unfortunately will mean that she is not only be wheelchair bound but also housebound too for the time being.) Her friends and family were there to meet her – flocking from their adjacent homes to greet her.

When we got to the top of the hill to catch our breath, I turned around to see that she had silent tears rolling down her cheeks – she had just spotted her family for the first time in nine months. Her mother openly sobbed. This was the first time they had seen and held each other since the earthquake. It was all too much for them all. What an emotional roller-coaster. To be home. Husband and wife reunited. Her mother. Her children. Her friends. And we must not forget her sister Clarisa too, who has spent months with Elsie as her main carer.

To be home again with her own friends and family. Yes, she is lucky to be able bodied. But she too has experienced a catastrophic event, lost loved ones, been displaced, is grieving the loss of her sister’s health and has seen the day to day battle that her sister has had to make. They have all had experiences that they will need to come to terms with; individually and as a family.

So how do you end a mission here in Haiti? In my situation, I have been sewing the seed for some time now, as I know the patients have relied heavily on my being here. I know I am not indispensable, and that every person here has played - and continues to play - a vitally important part in their road to recovery. I suppose, to our patients, I am part of their daily routine, the greetings, the questions about their pain, eating habits, drinking and sleeping habits, our jokes together, practicing my Creole. I guess I have been the only ‘foreign constant’ in their lives having been the only person here right from the start.

They have known me as their manager and educator, nurse, and friend. We have shared happy times as well as sad times. We have together faced the reality of walking and not walking. We have gone through living conditions and disability. We have spoken about the death of loved ones; babies, children, brothers, sisters, mothers, fathers, grandparents, friends, colleagues. We have discussed the loss of housing, jobs, careers, money, clothing, possessions and what the future holds. Yes. I would say we have been through a lot together.

And what is on the horizon for me? In a nutshell, I will be staying in Haiti for the foreseeable future. I have been asked to do more of the same but in another place. I guess I have mixed feelings – good normal ones though I think. I suppose it is like starting anywhere new: the unknown, the uncertainty, new people, leaving the fabulous small Haiti Hospital Appeal NGO for new pastures, facing new challenges, wondering whether I am up to it, will I succeed or fail? Saying goodbye to the patients and staff here. That sort of stuff. I will still be involved with HHA as a volunteer and will be popping up to see everyone on a regular basis so it is not a goodbye, just a cheerio. And I am thrilled because I will be able to see the patients who are now at home in Port au Prince when they come back to clinic.

I know that the journey that I have taken this year has been life changing. I have been very fortunate to have met and worked with some incredible people from all over the world, and particularly the Haitians. If I didn’t know before, I now know that whatever is thrown at me – I can survive. It is in places like this, and playing a part in experiences such as this, that really bring out a persons’ inner strengths and true character. Sometimes I have got it right. Sometimes I have got it wrong. I know that I still enjoy the ‘nice things in life but I also know what it is like to have and live with the bare minimum and still be happy.

Some food for thought

The President of the Haiti Nursing Foundation recently pointed out: “Before the earthquake, there was only one nurse for every 10,000 Haitians, compared to 94 nurses for every 10,000 people in the United States. Sadly, nurses, nursing students and nursing schools were lost in the earthquake, making the ratio even worse at a time when nurses were most needed”. (As you may or may not remember, the whole of the second year of student nurses, for example, was wiped out in the earthquake).

The streets of Port au Prince are pretty much exactly the same as when I first laid eyes on them in January. Rubble everywhere in the streets where houses used to be. Tents in and on top of mounds of stone and on top of collapsed buildings. Market stalls perched on top, erected to the side and even under precariously pitched buildings. Thousands of tents and tarpaulins – everywhere you look. From the air, it resembles a patchwork quilt of grey, blue and white squares. Some randomly positioned. Others in regimental rows. The rough official estimate is a 2% clearance and rebuild. How on earth does one build new houses when all the land is covered in makeshift temporary dwellings? The other problem is how do you prove land ownership when many documents have been lost and destroyed in the earthquake? It’s a serious headache and one that will not go away.

This headache has developed into a migraine recently - last week there was a sudden unexpected severe storm with horizontal winds blowing trees and debris as though they were leaves. More than 2000 tents were destroyed with many people injured and an uncertain number killed. I do not want to think what the death toll would have been if a hurricane had ploughed its way through the Haitian capital.

Why does mother nature have to pick on this country again? It really does seem so cruel. More displaced, homeless people, who have lost what little items they had managed to gain to create some semblance of life after the earthquake. I just cannot believe it. All washed away in a matter of hours. It just does not seem fair. Haiti has had more than her far share of bad luck and misery. Why more?

Yes, there is a lot to do here. Haiti still remains in desperate need of help. We cannot forget her and her people.

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