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It is three weeks after Haiti’s devastating earthquake and time for Isabelle Jeanson, MSF Operational Communications Support, to depart. Saddened to leave the many patients she has met, Isabelle is touched by the dignity and solidarity the Haitians have shown in the face of the disaster. She is, however, heartened to know that while her personal time in Haiti has come to an end, MSF’s medical teams work on to provide much needed healthcare.
I’ve been dreading this day because there is no easy way to say goodbye. I have developed so much affection and respect for Haitians, who carry such dignity in the face of this crippling adversity.
Isabelle Jeanson
By this time next week I’ll be working in the comfort of my office, worrying about the people I met who made a particularly deep impression. Like my little Gabrielle, who is hanging in there for her life. Or lovely 19-year old Sinthia, who has a fever and is lying in our hospital bed with her wounded leg. She gave birth to her baby on January 4, but her little girl died a few days after the earthquake because, she tells me, they were cold sleeping in the street at night. I’ll be thinking about Ste-Amise and her four-month-old baby. She also waits in her hospital bed, her leg in a fixation apparatus, while her other four children live under a bed sheet in the street. I have the option of leaving Haiti, but the patients I met will wake up every morning confronting their grim reality.
Christobal © MSF
In any tragedy there are always miraculous moments. A couple of those moments occurred today.
The first was a privileged and lengthy discussion with the young man who works for us as a driver. We’ve been on the road for the last two days towards the northeast part of the country, to assess the health needs of Haitians who escaped Port-au-Prince. The exodus from Port-au-Prince happened in the days following the earthquake, as thousands of people fled to rural hospitals in search of the healthcare which the overwhelmed capital could no longer offer.
Our driver Christobal and I had a moment to chat this morning before we got back on the road. I asked him – as I asked all our staff – about his experience during the earthquake. He explained that although his house had been destroyed, his wife and two young sons survived, and they now sleep in the street like everyone else. But he went on to tell me an incredible story.
Things are slowly changing. In fact everyday when I walk into our office and our hospitals there are small noticeable changes and supplies are finally piling up in our storage, there is some order to the madness. MSF’s program is also evolving. I was speaking to a mental health expert who was explaining that this phase of counselling is mostly about information sharing: making sure people know where to get healthcare, explaining what are earthquakes, etc. Only when people are ready, will they begin to talk about what they’ve been through. Most have not fully absorbed the impact of what they have experienced. It may happen in a few days or a few weeks, when they realize what it means to lose their house, their family member, their belongings, their job, or all the references to their old life.
We’re also entering a new phase medically speaking, where the injured who have not gotten care yet are entering a critical phase of septicemia, or those who have received treatment are now being followed up with fresh wound dressing and bandages. The teams are still working hard to treat as many as possible, always trying to save what they can on so many injured bodies. The decision to amputate a limb is never easy. Our doctors prefer to save limbs whenever possible and will treat the patient first to do this. But gangrenous tissue puts the patient’s life at risk, as the infection spreads to the rest of the body. Amputations can be a shock for our patients. But the decision, as difficult as it, is always done to ultimately save their lives. A doctor told me yesterday that despite the decision to amputate a young boy’s foot, the youngster sought her out to thank her for helping him.
I had the scare of my life this morning. I had hoped I could sleep in an extra 10 minutes because I’ve been working on 5 hours a night for the last week and am hitting the bottom of the barrel.
No such luck. I suddenly felt my sleeping bag on the bedroom floor rocking back and forth. For about a second I thought maybe I was dizzy from being tired. But that thought didn’t last long when the rocking
got stronger.
I jumped up, scrambled to the door in the dim morning light in my pyjamas and ran downstairs to the locked front door. I didn’t have the key, but fortunately my colleague caught up to me to unlock it and we both got out.
I was shaking and on the verge of crying, and so was he. He had survived the quake last week, but he still had the courage to run back inside the house to get our two other colleagues out. My heart was racing. I finally understood the meaning of vulnerable, to be so exposed to this overwhelming force.
That was the start to this day.
The newly established hospital in the Carrefour district. © Julie Remy/MSF
This afternoon I spent a few hours at our field hospital in Carrefour. The entrance is through grey thick plastic sheeting, which is attached to two trees, spanning across a street in the middle of the town. This is the triage area, a wound-dressing area, and an inpatient ward.
It hurts to see so many injured children and adults, some screaming in pain as their dressing gets changed by a nurse. They have serious burns, wounds that are infected, broken arms, deep cuts in the skull, gangrened limbs, and the list goes on.
The entrance into the hospital courtyard is through a small door in a gate. This is the surgical ward, which is basically a series of beds under two blue tarps and a tree. On one side, there are pregnant women who are giving birth, or who need c-sections. On the other side, there are three beds for more serious surgery, such as amputations.
Our teams are performing surgeries outdoors mostly because the staff are too traumatized to work inside the hospital building. Despite these conditions, in the five hours I was there, the team did at least three amputations, two for young children. They removed necrotic tissue on a young woman’s thigh, and did a c-section.
Our team is tired. They have been working long long hours in the heat, in crowded, noisy, demanding and stressful conditions. Fortunately, we’ve located a brand new spacious school building that was not affected by the earthquake, just down the street from our hospital. We hope to move to this new location in the coming days.
The one shining light in all this physical and emotional suffering is the birth of healthy little babies. Eight healthy little new ones arrived today under the blue tarp of our hospital. We all need them to breathe new life and hope into this torn country.
Contributor: Isabelle Jeanson has worked in communications with Médecins Sans Frontières (MSF), also known as Doctors Without Borders, since 2003. She has visited several MSF missions over the years, including working as an emergency press officer during the 2004 tsunami in Sri Lanka. Her latest work with MSF has taken her to Colombia, Russia, Nigeria and Papua New Guinea. She joined the emergency team in Haiti 48 hours after the earthquake struck.
Makeshift tents. The team was able to gather supplies and have set up a tented clinic using the grounds of the pharmacy. The plan is to keep the first tented sites for basic first aid and care and use the a new site for the many patients who need surgery. © Julie Remy/MSF
Yesterday I visited Trinité Hospital. There was a small baby, about one-and-a-half months old, lying on her side in her bed because her right arm had been amputated and was covered in bandages. The auxiliary nurse told me her story — sad and miraculous. She was in the hospital when the earthquake partially destroyed it. Somehow this tiny little girl survived after falling through concrete floors and walls and was rescued from the rubble, though we have no idea where her mother is. Chances are she doesn’t have a family anymore.
Some people are now selling food in makeshift markets, and there is more traffic in the streets. There’s also the regular sound of helicopters hovering. More and more aid organizations are showing up and trucks and some cranes are steadily working through buildings in the city, though who knows how long it will take to dig through all the rubble to find those missing.
A man with a gunshot wound was carried in on a stretcher. Two doctors jumped into action, first checking to see if he was conscious, then seeing if he could feel his arms and legs. Even though the gunshot had punctured his neck they determined he was “operable” i.e. that under the limited conditions of our operating theatre (in this case, in a shipment container), the team could still save his life. We’re not sure where he got the gunshot from.
The patients we are treating will end up leaving our hospital as different people. Many must undergo amputations because their limbs are so badly crushed there’s no way of saving them. A colleague, who is on his fourth mission, told me he was amazed because had no idea MSF had the capability to implement the human resources, the logistics, the setup that is required for this kind of emergency.
Most amazingly though, is that everyone here, including our Haitian staff, are so singly focused these days on the one common intention: to save as many people as we can.
Contributor: Isabelle Jeanson has worked in communications with Médecins Sans Frontières (MSF), also known as Doctors Without Borders, since 2003. She has visited several MSF missions over the years, including working as an emergency press officer during the 2004 tsunami in Sri Lanka. Her latest work with MSF has taken her to Colombia, Russia, Nigeria and Papua New Guinea. She joined the emergency team in Haiti 48 hours after the earthquake struck.
Port-au-Prince, Haiti
Medical care under tents continues in front of what was La Trinité trauma hospital and rehabilitation center Pacot. More than a thousands patients have received primary medical care here.© Julie Remy/MSF
The situation remains critical, few aid agencies in place, still hundreds of bodies stuck in buildings. I’ve only seen about 4 or 5 trucks and cranes trying to remove buildings to get people out, in the entire city!!! The smell can be overwhelming in some areas, where corpses are rotting in the heat, and near Internal Displaced Persons gatherings, because there is no sanitation, no showers, no latrines, and people are gathering in the hundreds anywhere where there is open space in the city. At night, we must be careful not to run over people who are sleeping on the roads. I saw one person sleep in the middle of an intersection, just to avoid any buildings that may fall if there is another earthquake.
Yesterday, we experienced two more tremors. When the medical team starting doing their work in the Carrefour operational theatre, the national staff stayed working when the first tremor hit. But when the second one happened, the nurses ran away, dropping everything they were doing on the spot!!! People are very edgy still and afraid of sleeping indoors. I am a bit worried myself and I didn’t even go through the earthquake (we’re sleeping in a trigano tent in a hotel courtyard because there is not enough room for all the expats at the office).
Yesterday Saturday, we did several surgical interventions, this was only 24 hours after setting up the operational theatre!!! This is totally amazing considering that the team went to Carrefour on Friday afternoon to start the setup, only 2 hours after the head of mission, myself and a nurse visited the empty hospital on Friday morning to do the assessment. I am in awe of the work and the speed of our teams to set up this new functional operational theatrein less than 24 hours!!
On my way back from an assessment in Legoane (about 1 hour from PaP) in the dark around 6 pm yesterday, we crossed some check points set up by civilians. They were jumping on a pick-up truck, that was carrying a load of corpses. They were very angry because the driver was going to dump the corpses in their town. So there were check points set up from that point on, all the way to PaP, about 10 km. People were angry about this but i would be too, if someone was dumping corpses in my town! When we crossed the checkpoints they let us through no problem and show respect for us. Small fires are burning in the street, the air is smoky and smelly, and buildings, concrete, wires, and debris are strewn everywhere onto the streets. There are not so many crowds where we are based in Petionville, although on the laneway going up to our other house, there are people sleeping in the street, blocking their road access. And last night we could smell that horrible smell, because the windows are open in the house. That team is under a lot of stress because they have extremely limited surgical capabilities. I spoke to a surgeon yesterday, and he was so frustrated and stressed about the fact that 5 patients he saw yesterday needed immediate surgery!! But he can’t save their lives because they don’t have a proper operational theatre. We need more space to perform surgeries, which the inflatable hospital will provide if it ever arrives!!
So, it’s getting worse because the patients who were not critical only 3 days ago, are now in critical phases : this means that people will die from preventable infections. It’s horrible, it’s really so terrible that people are begging for help and we can’t help them all to save their lives!
Contributor: Isabelle Jeanson has worked in communications with Médecins Sans Frontières (MSF), also known as Doctors Without Borders, since 2003. She has visited several MSF missions over the years, including working as an emergency press officer during the 2004 tsunami in Sri Lanka. Her latest work with MSF has taken her to Colombia, Russia, Nigeria and Papua New Guinea. She joined the emergency team in Haiti 48 hours after the earthquake struck.
The last day in the field is a blur: some final handover of reports and evaluations and lessons learned the hard way before I forget; a sumptuous lunch followed by a grand afternoon tea organised respectively by the wonderful staff in my two departments; pictures and hand-shakes and exchanging contact details…
I do not like saying goodbye. I would prefer to slip away quietly in the night, but to do so would not allow me the chance to say thank you to all the people who have worked so hard during my time here: the drivers and watchmen who have helped to keep me safe, the office and support teams for making so many things happen in the background so that I didn’t have to worry, our chef and house staff for taking such good care of us and the excellent clinical team for delivering the true purpose of our project: high quality patient care. Thank you to all of you, without your ongoing efforts, my presence in North-West Frontier Province in Pakistan would have been without value or result.
I spend my last evening in the field quietly: warm and watching a movie – a simple and unexpectedly special end to what has been at times an incredibly challenging period in my life. The next day I am up far too early for my liking. It is cold and all I want to do is stay in bed, but my transport to the capital is leaving. I say some final goodbyes to my expat team (my family away from home) and suddenly after weeks of being ready, I no longer want to leave…but all in a moment and a cloud of dust, Dargai is behind me.
My last days in Pakistan are spent debriefing and writing reports in Islamabad. On my last night, two of my expat team arrive unexpectedly from the field and I am treated to an impromptu farewell party including home made sushi, beautiful decorations and entertainment by a local musical duo. The packing I had planned to do is postponed and I enjoy another very special evening. On the final morning it takes all my will power to leave the warmth of my bed. The distinctive smell of 4am greets my nose as the driver and I shift through the deserted streets on the way to the airport. Silent for most of the way he eventually turns to me and asks: “Is your mission complete?” and, despite some reports to finish, despite the never-ending work that I leave behind, I am able to say “Yes”. I have done what I came here to do.
We go through one last security check-point on the road: one last slalom between concrete barriers; one last pass in the firing line of the machine-gunner in his sand-bagged bunker; and I am reminded that I have just spent six months in Pakistan and it is the end of what has been a very long and difficult year for that country and myself.
The firm fleshy hand of the driver is my final farewell and then, I am gone.
I want to thank those of you who have followed this blog. The work of MSF relies on the support of people all around the world who recognise the need for what we do and agree to help us, whether through a period of work with the organisation or financially. Please spread the word about MSF to everyone you know. The more people who know about us and the efforts we make to bring healthcare and other services to populations in need, the greater the impact we will be able to have and the more projects (like our current ones in Pakistan) we will be able to operate.
And finally, whoever and wherever you may be, take time to appreciate the good things, the special things that you have in your life. If the last six months has taught me anything, it is that to be here (in this life) is an amazing opportunity, don’t waste it!
My six month mission with MSF in Pakistan is rapidly drawing to a close. My replacement, Fahad, another South African, has arrived and I have the time to look back over what I have done here. Certainly I have not managed to get finished all the things I had (with unrestrained idealism) hoped for at the outset, but some small progress has been made. Some further links with the local community. Some treatment success stories. Perhaps even some lasting influence on the way medicine is practiced here in NWFP. And if that is all, then it is enough for me. There is much more that still needs to be done, but it will be done by other hands than mine.
As the last few days wind down, despite my tiredness and my readiness to move on, I am torn. There are things here with the power to make me want to stay: places, opportunities to use and share my knowledge and experience but most of all, people. I have had the chance to meet and work with an incredible group of dedicated and talented people from Pakistan and from all around the world. Thank you to all of you for your commitment and hard work. Though it may not always seem so, it does make a difference.
Moving through town and at work, my brain records snippets of what is going on around me, filing them away. I see a small boy, running alongside the railway track; he is wearing a bright purple woolly hat against the early morning chill. He turns and smiles at me and I wonder: in this place where I have seen the tragic consequences of so much violence, when exactly that innocence will be lost? My bed and desk are covered with slips of paper that I pore over: lists, and list of lists of the things I need to get done before I leave, things I need to hand-over to my replacement, reports and summaries and protocols I need to write – a mountain of words to climb that seems impossible in the time I have left and yet it is essential, to ensure continuity, to ensure that any worthwhile momentum I may have generated in our work will not be lost.
The images of patients stays with me: the wizened, gaunt face of a man on his death bed, dwarfed by the size of his own white beard, his lungs severely scared by TB; the history in the eyes and hands of a woman with joint pain, who I am unable to help in the way I would like, partly because of the languages which divide us.
And other scenes from this other world that I have been part of for a while that refuse to be overlooked: heavily armed soldiers on guard duty outside the fort with the sweeping panorama of the mountain rising above them in the distance; the menagerie of sheep and goats, cows and chickens, donkeys and buffalo, walking and grazing and toiling in the narrow streets; the sun setting to the sound of the evening prayer as I walk on the roof, learning some basic Spanish with the help of a new colleague.
All these things will stay with me. For though I will soon leave Pakistan, it will never leave me as I find myself profoundly changed by having been here. Wherever I go in the world after this, whatever I do, I will carry these images, these snapshots of how life is in this other place. I will be forever grateful for the perspective I have gained, for the things I have learned, and I know that they will help me to be more appreciative of just how fortunate I am in life. Holding onto this, perhaps I can go on to take full advantage of the many opportunities I have with renewed vigour, in the sound knowledge that there are many who cannot even imagine such chances. A worthwhile goal I think, and a responsibility I now accept with profound gratitude.
Being a doctor entails now and then (and sometimes more often than that) dealing with strange situations at unusual hours. I have worked in emergency medicine on and off for nearly 10 years and some of the most interesting cases I have been involved with have needed help at some of the most cruel and dark times of the night.
Throughout my time here in Pakistan, the emergency room is regularly busy into the wee hours and I am frequently on the phone at those times helping the on-site staff make decisions about patient care. As a result of our recent withdrawal from the field due to security concerns, I am not able to be on site in the hospital at all at the moment, and I am now spending more time on the phone that ever.
I am not a 1am person. Sleep in all its essential deliciousness is very important to me and my brain shuts down somewhere round ten thirty in the evening. But here I have had to adapt to a different routine: the phone rings sometime after I have fallen asleep. Initially, the noise is incorporated as an aspect of my dream, but eventually I wake up. With scratchy eyes and croaky voice I answer. Frequently the line drops or the connection is too bad to make out the story on the other end (frustration!) and a little cycle of call-backs from both sides begins until finally we can hear one another clearly. It will be one of the MSF ER nurses. Perhaps there is a patient with a bad head injury after a road accident or assault. Maybe it is a known cardiac patient with severe chest pain and low blood pressure or a tiny newborn who is struggling to breath. What to do?
We go through the standard checklist of presenting problems, examination findings and vital signs. Are there any blood results available? What is the chronic medication? What treatment has been given so far? My team is well practiced and they know what I need to hear to grasp what is happening. We discuss the case until a plan can be made. Perhaps a dose of an emergency drug is needed, sometimes additional tests must be requested first. On difficult days it is a discussion about whether to terminate resuscitation for a patient that has collapsed and shows no signs of life despite a long and concerted effort at revival. We have faced all these scenarios together many times and I have come to rely on the sound judgement and dedicated efforts that my team makes for all our patients. Sometimes there will just be one phone call in a night and on rare occasions none at all – how I cherish those uninterrupted hours of sleep! But usually it is necessary to discuss a case several times before a final decision is made. These are often rushed conversations in urgent tones, there is no time to waste and the tired brains on both ends of the phone are urged into a higher gear. We do what we can, watch closely always ready to respond and hope for the best outcome. Sometimes all goes well, sometimes not and we know that tomorrow night we can expect more of the same.
I don’t think I will ever get quite used to the penetrating sound of the late night phone. It will probably remain an alien and unnatural thing. But, certainly here and now, it is a reality I must continue to face.
As a result of the excellent standard of care MSF staff continue to provide in our emergency room despite limited resources, more and more patients are presenting with emergency problems at all hours. Whilst before they would have bypassed our little hospital in (sometimes blind) hopes of better treatment in a bigger city, now they know to stop and let us help them. And so, to be woken a few times at night is really just part of the job, as it is for doctors all around the world. Though the rings under my eyes are darker than they were a few months ago, I am happy to be able to support a service that is there for people who really need it. So I better get off to bed and get a few hours in while I can!
Sleep well all of you who are able and, for those of you who, like me, are sometimes called on to guard the night, know that you are not alone and your efforts are not forgotten or in vain.
Patients with chronic diseases need regular follow-up, ongoing education about their illnesses and access to a reliable supply of quality medication. Unfortunately here in North West Frontier Province, this ideal is seldom if ever achieved. Due to many factors, including poverty and difficulties in regularly accessing healthcare facilities, many patients who should have close monitoring and support instead suffer through a confusion of haphazard and sporadic treatment. As a result, they progress through an inevitable and tragic deterioration.
Type 2 Diabetes is very common here and so are its complications, including problems like gangrene, kidney failure, blindness and metabolic derangement leading to coma and death. Because of the devastating damage it causes throughout the body, it is an important example of a disease that needs well-regulated control. But, most of the diabetic patients who come to the MSF emergency room and in-patient department have been denied this in the past and consequently they are often in very bad shape.
Ziarat Gul, a man currently admitted in our ward is no exception. Blind in one eye and with a long white beard he is a hunched, frail old man who has become well known to us over the past few months. He guesses his age is somewhere between 60 and 80, but he looks closer to 90 to me – the weathering of a life harder than it needed to be.
When he first presented he had a carbuncle – a large area of infected skin similar to an abscess – on his back that had been festering for some time. He had been unable to get proper treatment for the wound or afford to purchase his vital medication, and his blood sugar was dangerously high. Infections are a real problem for patients like this: the uncontrolled diabetes (caused by the missed medication) weakens immunity, increasing the likelihood of infection and, once an infection takes hold, it pushes the diabetes further out of control – a vicious cycle in which this man was trapped.
Luckily, once identified, the problem was simple enough to treat: a special diet, daily doses of the right tablets and dedicated wound care. Though it has taken a lot of patience on the part of the MSF nurses and several debridements by the MSF surgeon to remove the infected tissue, this previously neglected wound is dramatically improved. From a painful crater in his back, it is now a healthy, neat surgical wound after a successful operative closure today.
A success story like this is very gratifying for us because this man is one of the lucky ones. He managed to get to the MSF hospital while there was still time for us to help him. Others are not as fortunate. Over the months that I have been here, we have admitted many diabetics with infections whose disease is out of control because of chronically poor management. For most this means an extended stay in our hospital until things improve, for others it ends with the amputation of a foot or leg with all the long-term impairment that can bring. And for a few, it is their last illness in this world.
It is not easy having to accept that a person has suffered or died from a preventable cause, from something that, had it been seen to earlier, would have been completely treatable. And so we hope that the story of this old man who is now on the mend will be told, and will spread in the community and that others in need of similar help will come sooner to the hospital. Soon enough for us to nurse them and their neglected wounds back to health. Inshah-Allah.
| First steps to recovery foryoung boy Jerry in Haiti whose leg had to be amputated. http://bit.ly/cYcDQV |
| http://bit.ly/9pcwTE |
| I uploaded a YouTube video -- Slideshow: Emergency Surgery in Haiti http://youtu.be/Nw6rmP4OT90?a |
| I uploaded a YouTube video -- Haiti: SABC2 Interview with MSF Dr Kathryn Chu http://youtu.be/5WB-vjXiu30?a |
| Haiti: Emerging trends in patient care. http://bit.ly/aXWHgu |
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