Hôpital Albert Schweitzer Haiti

Saving Lives, Changing Lives

Sunday, January 31, 2010

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

Ian Rawson


Thursday, January 28, 2010

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

Tuesday, January 26, 2010

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

Monday, January 25, 2010

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.

Sunday, January 24, 2010

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:

Saturday, January 23, 2010

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.

Friday, January 22, 2010

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.

Thursday, January 21, 2010

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.

Wednesday, January 20, 2010

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

Tuesday, January 19, 2010

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

Monday, January 18, 2010

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

Sunday, January 17, 2010

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

Saturday, January 16, 2010

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.


Friday, January 15, 2010

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.

Thursday, January 14, 2010

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.
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

Wednesday, January 13, 2010

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

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.