Nursing Times’ resident Haiti-based nurse Fi Stephenson on the future for the survivors of the Haiti earthquake.
As time goes by, the future for our patients needs to be seriously addressed as they have, or have almost, reached their rehab potential. We have been sowing the seed gently over time. The ‘dripping tap’ principle I call it. They will have to face reality at some point and leave this comfortable bubble and return to Port Au Prince (PAP) and their own futures. What a scary thought.
Many of the patients are not out of the woods yet. They not only have to contend with their new physical, medical and psychological problems, but with the rainy season here, Malaria, Dengie Fever, plus other tropical diseases around such as Typhoid in epidemic proportions, there remains a real battle for survival. Even in a ‘clean’ environment, such as our unit, infection remains a real concern and flies avidly participate in the transference of disease. Flies love to socialise, and flit from person to person, food, waste - the smellier and more rank the better! In hindsight, I personally have been in contact with patients with Tetanus, Malaria, TB and Typhoid; thank goodness for our vaccination programme and anti-malarials.
In the third world it is known that most paraplegics die within 1-2 years of their injury. The main killers are urinary tract infections and pressure ulcers. When I look at my patients on the ward, I try not to think about this. What will happen to them in the future? This is a real dilemma. There is absolutely no health structure for these people at the moment. I have been reliably informed that before the earthquake, in Haiti, stroke patients were admitted for 2 days only, if they had indeed gone to hospital in the first place, and then discharged. Paraplegics were admitted for up to 2 weeks only and then discharged. These two conditions would have been a certain death sentence in the past from overwhelming infection. Tetraplegics just did not survive. Since the earthquake, and with outside foreign agencies now helping and discussing their uncertain future, this risk will surely lessen. Can you imagine the huge undertaking though? Over a million people are already displaced and homeless. How ridiculous it seems to say “million” – it seems to slip off the tongue so easily, yet in reality can you imagine what this really means? Living in tents or under tarpaulin, in utter poverty, during the rainy season, like sardines in a tin with the threat of hurricanes to destroy what little shelter they have.
I drove through Gonaive the other day on the long 10 hour drive back from Port Au Prince. This huge town had been destroyed by Hurricanes ‘Hannah’ and ‘Ike’ in 2008. We stopped to say hello to a family that Carwyn has been keeping tabs on for the past 18 months. They were a handful of thousands still living in makeshift tents, having been promised help with housing at the time of the two hurricanes destruction. With this in mind, how long is it going to take to ‘fix’ Port Au Prince and help its tent people?
There are now many, many people who will need adapted housing to help them manage with their new disability -Let alone sorting out wheelchair access, roads and pavements.
Starting from scratch to address disability, that has in Haiti’s past been seen as a weakness and ignored by almost everyone, would appear another impossible task. We cannot bring ourselves to knowingly discharge our patients who are complete paraplegics and wheelchair bound, to this harsh reality. Ethically it does not seem right. So what do you do? Having created a safe, nurturing and healing haven, it would seem inhumane to do anything but follow a new and safer path.
But who can create that path? What is the solution? We (Haiti Hospital Appeal) have been exploring possibilities that have included looking into acquiring land in or around Port Au Prince - building an adapted village for our 15 complete paraplegics and one tetraplegic plus their families.
But land is difficult to find and pricey because there has been an earthquake, every available plot of land is covered with tents, tarpaulins and makeshift housing and land available is either on a slope or too close to the sea with no available drinking water.
So is creating an adapted village the right thing to do? From a plus side it would provide adapted living conditions, even surfaces, ramps, widened doors etc, with a community centre for rehab, support group activity, SCI clinics, even micro-industry but on the negative side it segregates the disabled from the able bodied. Also how would it be sustained? Like many things, this would rely on money, which in reality means ongoing foreign aid. SCI care is one of those areas that readily takes money from the purse - especially as the specialised medication for neuropathic pain, for example, is so expensive and the high morbidity rate; infections, pressure sores, bladder and bowel problems, psychological needs, equipment and so on. Maybe social integration is the way to go? Adapting their own houses, keeping them amongst their families and friends, who remember them as they used to be.
Perhaps this is the way to change people’s ideas and beliefs about disability.