A New Step for Ania, A New Step For HAS



During the earthquake of 12 January, many people suffered crushing injuries to their extremities; primary care for the injured often required amputations of injured or infected limbs. An estimated 2-4,000 amputatins were performed in the first week after the earthquake, many of them under rudimentary field conditions.

Patients who arrived at HAS with crushing injuries to the extremities were managed by a specialized nursing wound care team, and the surgeons were very conservative in their management of these cases, exercising limb salvage strategies to the greatest extent possible. Only 15 long-bone amputations were required for the patients at HAS, but soon after the earthquake, we began to receive referrals from other hospitals for patients who required revisins of thei original amputaions.

Soon after the earthquake, at the encouragement of the Peachtree Orthopedic Group, which had sent two teams to HAS, we received a visit from Harold Anderson, an amputee, who brought with in representatives of the Hanger Corporation (a national leader in prosthetics and orthotics), and of the Shepherd Rehabilitation Hospital in Atlanta. This group offered to HAS the opportunity to establish a prosthetics laboratory on a turnkey basis, in order to address a national demand in Haiti. Both opf the prosthetics services in Port au Prince were taken out of service as a result of the quake, and the demand for artificial limbs was becoming more apparent daily.

Technicians from the Hanger group arrived with several pallets of equipment and supplies, and set up an operating laboratory in three days. Yesterday three of the 8 patients currently housed at HAS l'Escale village were fitted with new legs and given the opportunity to try them out. Ania, shown in this picture, is a teenager with a beguiling smile and a doting father, the only surviving members of their family. She has made firm friendships with other young patients in the village, where they assist each other to accommodate to their physical losses with a strengthening of emotional bonds and mutual support.

Ania's first steps were difficult, but she kept at it for almost a half-hour, wanting to master the new technique of walking with an unfamiliar appendage. Perseverance, the watchword of the Haitian people, is never more evident than in the new prosthetics facility.

For HAS, this also represents.new steps; starting from a commitment in 2007 to develop a training program for Rehabilitation Technicians, which has been supported by the Friends of HAS, and which is guided by Health Volunteers Overseas. The 2009 class graduated three students, one of whom is in the hospital, and the other two of whom are assigned to the dispensaries. The current class has six students, who arrived a week before the earthquake. A full-time Haitian PT (a rare commodity in Haiti) has been added to the staff, thanks to support from the Friends. Now, with the arrival of the Prosthetics lab, HAS is emerging into a new clinical arena, and also in a new role within Haiti. All of the current patients are victims of the Port au Prince earthquake, and have been cared for by HAS and several PIH-related facilities in Cange and St. Marc. Additional patients are awaiting transfer to HAS in the near future.

HAS was honored by the selection of Shaun Cleaver, the Canadian PT who started the Rehabilitation Technician training program, as a member of the national council which is charged with developing policies for the care of persons with disabilities, and specifically for the provision of resources to support persons with amputations. This places HAS in the center of planing for one aspect of medical care in Haiti, which in the future will of necessity be more decentralized away from the devastation in the capital. Parallel planning processes will be developed for the acute health care system as well, and the HAS experience will contribute to those plans.

Ian Rawson

Managing Director

Since the beginning of post-earthquake recovery effort, the United Nations has provided logistical support for patient evacuation and the delivery of essential medicines and materials. HAS' efforts to get replacement supplies during the first weeks were somewhat convoluted, involving the arrival of samll planes onto grass airfields about 4 hours north of Deschapelles, or land transport through th Dominican Republic. One of our suppliers, Direct Relief International, had a large shipment of materials for HAS today and requested a helicopter airlift from the Ukrainian squadron.

The sound of the helicopter's engine brought a quick end to the day's schedule at all of the local schools, and the soccer field was surrounded by young people who were astounded at the huge machine, and who then were shocked by the clouds of dust as the helicopter landed.

The large yellow school bus, which has been our workhorse vehicle for transporting materials to the hospital. was backed up to the back of the helicopter and a group of volunteers transferred the boxes from the helicopter. Several volunteers from Thailand who were working with the World Food Program hopped a ride on the helicopter, and took advantage of the photo op with all of the kids who were lining the soccer field.

In about 15 minutes the aircraft was unloaded, and took off in another dust storm, and all of the kids went home for lunch, having witnessed a piece of history which will not show up in their textbooks.

The materials which were delivered by the helicopter came from a shopping list which was part of a complex supply chain for HAS which has been maintained by Nellie Player working from her home in Pittsurgh. Lists of needs from the hospital, which changed almost hourly in the first weeks after the quake, were matched with list of donated goods which were offered from a variety of agencies, and also with the list of volunteer air flights, to come up with a timely delivery to HAS. Today's shipment as a first, as a helicopter delivery by the United Nations, and it has opened a door for further deliveries in the future.

The hospital used almost three month's supply of medications and surgical materials in the first ten days after the quake, and it has been a challenge to get back up to a full stock. After the initial flood of patients directly from the quake zone, HAS is now receiving referrals of patients which have received primary care at tent hospitals in the capital, but who require more advanced surgical intervention. A series of one-week rotations of surgeons, primarily orthopods, has responded to these requests, and has been able to stay current with this increased demand. Attlanta's Peachtree Orthopedic group sent down two teams, the second of which is here this week, and they have done a good job of reducing our stocks again.

Ian Rawson

Managing Director

Exerpt from 2/9/2010 blog by Edward Rawson
http://www.edwardrawson.com/

Before I came to Haiti after the quake, I was hearing the numbers on the news. Before I arrived the estimated death toll was already over 160,000. By the time I got settled in to the Hôpital Albert Schweitzer campus I was reading over 200,000 dead. The statistics were saying over a million directly affected by the quake. All these numbers were so abstract to me. Sure it sounded like a lot of people. I could imagine my home city of Pittsburgh, has a population of around 300,000 people, so that means around two thirds of the Pittsburgh's population would have died over the course of 30 seconds and over the next few hours and days. But still that was so abstract an idea I could hardly wrap my mind around it.

Now it has been nearly a month since Haiti has been reduced to rubble and broken hearts. The initial crisis of getting people to hospitals and in the care of doctors is slowing down. Most of the life saving has been done and rescue work is nearly over.

Now the hundreds of thousands of patients with broken bones, amputated legs, horrible scrapes and bruises will wait patiently for their wounds to heal. More surgeries will happen, but now we will be fixing the rough field hospital amputations and other procedures, reducing infections, skin grafts, and removing of external fixing devices. Though HAS is still overcrowded and filled with major procedures yet to be preformed, it looks less full than it did a few weeks ago. Now we are seeing many injuries NOT related to the earthquake. Taptap (taxis) and motorcycle crashes are very common as well as cases of TB, Malaria and other illnesses.

There is a new emergency emerging and growing every day. Because of the unthinkable destruction in the south of the country, a massive migration of displaced people is coming our way. Their numbers too are sounding abstract at the moment, but in the region of the Artibonite the numbers are the largest. An estimated 162,000 people moving to this region. To compare that to Pittsburgh again... half of Pittsburgh just moved in our back yard.

Hôpital Albert Schweitzer now has a massive new population to care for. We are one of the only hospitals in our region and already have a large population within our 610 square mile service area that depends on us for their healthcare. That means that a large portion of this new immigrant population will now need vaccinations, to be recorded in our systems, treated for illnesses and given care when needed. This will put an additional burden on the already weak economy. Most of the illnesses we treated before the quake were illnesses that are the result of poverty. So, if the economy goes down more, the illnesses will go up. Our region will need more care.

We are here, and have been here, for over fifty years in the Artibonite finding ways to provide care to the people of Haiti who we love and know deserve a helping hand.

We need your help. Your donations will save lives today, tomorrow, and for years to come. PLEASE VISIT www.hashaiti.org TO MAKE A DONATION NOW!

Sunday, February7th 2010_____________________________________________________________


By Edward Rawson


Time.

Time is the distance between being here and being there.

Time is the thirty years of my life.

Time is the space between the day my grandparents opened HAS and now.

Time is the moment a baby's departure from a mother's womb gives way to its first breath

Time is a fleeting moment, a single breath, and a life time of breathing.

It is eternal and it is momentary.

Time is an instant as much as it is a lifetime.

Time is the essence of life.

Time is passing right now.

Time is one hundred thirty heart beats a minute; twelve breaths per minute.

Time is an hour; its sixty minutes; its three thousand six hundred seconds.

How many foot steps every hour?

That is time in various measurements.

It can be measured in a million ways and quantified in a million more.

Multiply that by another million more, and that is how many ways time can be felt.

Some would say its been a long time since the Jan 12th earthquake rumbled the earth of Haiti.

Others would say its only been four weeks since it destroyed the lives of millions.

How do you measure the time since you had your leg? How do you measure the time since you saw your child for the last time? How you measure the time it will take for skin to grow over the exposed muscles in your arms? How do you measure the time since you saw your house crush your leg and killed your son? The house that you cherished. The house you built with your own hands. The place you raised and nurtured your family. The house that took all that from you when it fell. How do you measure the time a country will take to heal?

How do you measure that time laying in a bed staring at the ceiling, listening to the screams across the room as the nurse removes the dressings on other patients wounds? How do you measure the next patients barking, crying, wailing? By the scream? By the tear? By the prayer?

How do you measure the time until its your turn? Until the anticipation gives way to your own reality? How do you measure the time that it will take for the skin around your amputated leg to grow together closing the wound; Closing the chapter in your life when you walked; When you skipped?

How do you measure the time until you learn to walk again? How do you measure the time until you will never learn to walk again; Never see him again; Never hug her again; Never know where they are? How do you measure the time it takes to stop crying? How do you measure the time it takes to take your last breath? How do you measure the time you will spend watching until they take theirs?

Today I walked the halls of Hopital Albert Schweitzer with a team of orthopedic surgeons who just arrived from Atlanta. I thought of the time since I had last seen Dr. Guy. I thought of what he must have done since I had last seen him. I thought about the time he and his team will be here. One week. What will they do? What will they be able to accomplish? I saw determination in their eyes. I saw confidence. I could see the sight of blood and open skin was no stranger to them. The dozens of external fixations posted through skin into setting bones, the x-rays, the gauze, the, fear and hope in their patients souls, their trauma.... This was where they lived. This was their territory. They spent their lives honing in on their ability to see this, and know just what to do, and how to do it. They were embarking on a week of healing.

As many times as I have walked the halls of HAS, the sight of injuries is never something I have totally gotten used to. Or maybe I've gotten used to it, but it still makes me uncomfortable. In the last weeks I've seen all too much of it. Every time I see a woman's pink muscle exposed again, and cleaned again, while she winces in pain; every time I see large metal posts sticking through the flesh, clutching to healing bones, I feel it inside me. It hurts me to watch. I feel pain inside of me because I can't grasp the pain they feel inside of them.

Today I became all to conscious of my own feet. I have stood on them billions of times. I have walked so many steps, ran so many more. All moments. Millions of moments that string together, and in the cluster of them... I can't remember a single one of them. They are lost in a sea of countless seconds, minutes, years and decades. Today I felt my feet like I never felt them before. I watched as the Atlanta team of orthopedic surgeons pulled the skin together around the place where a woman's leg once was. They talked calmly about a strategy to get the skin to close around the stump. To heal. To permanently close. Her foot was not there. she could not and will not feel it ever again.

I stood there staring blankly, at this calm group of doctors, and I began to feel my feet. I wanted to hold on to that feeling and never forget it. I had never been more thankful to feel myself standing.

I looked at the face of the woman. She had gotten over it to some extent. She had morned her leg by now. She was coming to terms with it. As thankful as I was for feeling my foot at that moment, she was more, because she knew she was breathing. She was alive. She made it. Not everyone did and she was being cared for by people who knew what to do. She had been cared for over the last few weeks now. Weeks which must have felt like an eternity. Weeks where she has still not healed but has begun to. Weeks where she stared at the ceiling and waited. Waited the time it takes to get better and to accept ones new reality. A reality which was delivered in a few short seconds. A reality you share with a nation of people.



She wasn't alone. In that same room still laying in their cots were others with broken legs, broken arms broken cheeks... broken spirits. The sight of blood was becoming familiar to all of them in this room. Sounds of pain were becoming as regular as their own breath. And it is the same in the next room, and in the halls, and in the courtyards where families watch and heal together.

The sight of doctors was even more familiar. What does it feel like to be in good hands? How do you balance the fear of the unknown with the faith, that this man and this woman standing over you, know you have nothing to fear but fear its self? How do you measure the time it will take to accept that? How do you measure the time it will take you to realize that these people saved your life? They saved all these lives, and they were here for you when you needed them most. How do you measure a lifetime of gratitude?

Time.....

The time is now to help. Visit www.hashaiti.org and make a donation and join us in helping the Haitian people

Sunday morning is usually rather calm in the pediatric and adult wards at the hospital: Few urgent cases, pediatricians, internists and surgeons doing rounds quietly and visiting all their patients, walking from bed to bed, talking with patients and parents, explaining, calming. Not so today: Six orthopedic surgeons, general surgeons and anesthesia doctors from Atlanta were busy checking all surgical patients, X-Rays and medical histories, planning upcoming treatment and operations. They are the second orthopedic team from the well known and renowned Peachtree Clinic in Atlanta coming down to HAS since the earthquake and doing hundreds of difficult orthopedic operations for our victims. They are operating simultaneously in all three operating theatres. Peachtree Orthopedic Clinic, founded by Dr. Bob Wells, former Chair of our Board and lifelong volunteering orthopedic surgeon in Haiti, has a more than 50 year tradition of sending high skill orthopedic surgical teams to HAS. Following the first Peachtree team, a highly efficient nine member team from Sherbrooke University hospital in Canada, consisting of OR nurses, orthopedic surgeons and anesthesia doctors filled the gap between the two Peachtree teams.

 All three teams were not only very professional but created an excellent working atmosphere together with our Haitian physicians, nurses and technicians, in the OR as well as in the wards. HAS which utilizes our high tech C-Arm (fluoroscopy controlled reposition of fractures) has been able to perform difficult operations of open and closed fractures, unlike at some other small hospitals or field clinics, where often only preliminary interventions could be done, exposing patients to secondary operations or even infections or consolidation in false positions.

One week after the quake we ran out of strong pain relief medications and antibiotics. It was an incredibly hard day for our patients, many with severe fractures, which had not yet been operated on. We walked from bed to bed, from mattress to mattress on the floors, talking, trying to console our patients, ending up with a deep admiration for our patient victims, the real heroes of this drama, and their supportive and caring relatives….By the end of the evening the first medical shipment arrived and we were able to do much more than console. I never in my life have been waiting so anxiously for the arrival of a medical supply delivery. Since this crisis we have received tons of medical, surgical and laboratory supply by planes and large trucks, from US, Canada and Switzerland. Every shipment has been a big relief to all of us. We still will need more, but apparently the hardest time is past.



Looking back more than three weeks after the catastrophe, I feel a strong sentiment of immense and deep gratitude; first of all for our very competent and persistent Haitian Medical, Nursing and Technical staff at HAS, who were alone managing the incredible workload during the first days and thereafter, handling 66% of all victims without foreign help! I am grateful as well for all the volunteer doctors and nurses, rushing from many countries to help Haiti in this incredible tragedy. We still have a list of over 60 volunteer doctors and nurses ready to join us immediately. Due to limited ORs we only could take a few volutnteers with special skills that could be utilized for the immediate treatment of our patients. For those very well meaning volunteers that we could not accommodate, please forgive us. I am sure there will be a time we will need your help in many ways. Haiti and HAS have great support currently, but this support needs to go on!

HAS has an obligation towards the victims, not only now but for a the long term. First estimates show that hundreds of thousands of refugees from the Port-au-Prince area will settle in the Artibonite Valley and the Haitian government will prevent them from returning to the capital for good reasons. Support of HAS will be necessary for many years. So, we ask that you please help us and our wonderful patients!



Rolf Maibach, Medical Director

Today's Blog from Deschapelles is being sent to you all by Ian Rawson’s son, Edward who was working in New Orleans and immediately made plans to travel to Haiti upon receiving news of the Earthquake.

I was able to arrange transportation just shy of two weeks after the massive 7.0 earthquake that shook the country to the ground. I flew in on a private plane which was bringing doctors, reporters, much needed medical supplies, and me. I spent my first night sleeping with one eye open on the tarmac at the Port au Prince airport. I watched as massive military planes unloaded tons of supplies. Most of them looked more like buildings with wings than airplanes. Trucks Marked UN, US, France, Turkey, and hundreds of other country's authorities raced around coordinating plans and supplies for the following day. It was surreal. I've been to this airport many times in my life often greeted upon arriving with the sounds of a band playing as I walk towards customs. This time the building was cracked and the only sounds were jets and sirens. The reason we slept on the runway the first night was that we were not allowed to leave the airport until dawn due to concerns about security.

When I got to the hospital the next day it was a really nice feeling. I hung on the side of a trailer filled with boxes of pain killers, antibiotics, and surgical supplies. I passed the big mural near the hospital entrance that we did in November still in perfect condition. It was a great feeling to be back to my home away from home. I was happy to be bringing these supplies and I was happy to see my dad.

Once the truck was all unloaded I got to sit down with my pops and reflect on the weeks before. It had been hard on him, I could see it in his eyes, and I could tell by how quick he would well up, and how little he wanted to talk about the tragedies he witnessed. I could tell he hadn't been sleeping much and he was becoming very attached to many patients from spending so much time in the halls doing what he could to make them feel better.

Albert Schweitzer Hospital is in the center of the country in the Artibonite Valley, in a town called Deschapelles. It was far enough from the center of the quake that it did not sustain much structural damage which is great news for all those I love here, and great for the hospital my grandparents built in the 50's. It was even better news for the victims 2.5 hours away in Port au Prince. Many of the hospitals in the city had been leveled or were severely damaged by the quake and were not in use immediately after. HAS was the first response in many cases.

Because of the severity of the quake, whole buildings fell on people. Hundreds of thousands of people died all so fast their bodies were just piled up in the streets in the days after. Those who did survive largely had bad traumatic injuries caused by concrete chunks hitting them and breaking their bones. They were in massive amounts of pain and needed treatment ASAP or they too would join their fellow Haitians dead in the streets. It was a very scary reality for many to face. I'm so thankful I was not here when it happened because hearing the stories from so many people was more than I could take much less to have to witness or be a victim of the horrors myself. Thankfully hundreds made it to Hopital Albert Schweitzer on time for life saving treatment despite having to travel up bumpy roads in the back of pickup trucks for hours.

Even when I got here two weeks after the big shake, I saw the hospital filled way beyond capacity. I had never in my life seen so many people at this hospital. Many patients were placed in the halls and their loved ones slept under their cots on the ground.

It was a trying first week as many faced surgery, while others got bandages changed and began the healing process. Thankfully there were finally some pain killers here. Even with them, some patients wailed in agony. If I close my eyes I can still picture one man screaming on my first day here as a nurse peeled away blood soaked bandages to reveal exposed muscle on his arm. Across the hall a few feet away a man sat quietly watching with his left leg wretchedly broken in several places and yet the surgeons so overloaded still did not have time to operate yet, so he sat and waited patiently for his turn.

All in all you could see the hope in the eyes of all people here. Every patient seemed relieved they made it this far, and knowing they were in good hands with the doctors and care HAS was providing. They were gonna make it through this and they knew it.

The patients were also relieved to know that regardless of how much care was required, it wouldn't even cost them a penny because HAS is supported by generous donations from all over the world.



Edward Rawson is a mural artist who has been creating public art designed and painted by disadvantaged youth in Pittsburgh, Atlanta, Miami, New Orleans, Brazil and recently in Haiti. Follow other images and video clips at www.edwardrawson.com .

The past three weeks have seemed like an eternity, from the time late in the evening of the 12th of January, when the first patients began to arrive in tap-taps from Port- au-Prince, and the true scope of the disaster was not yet understood, until today. Now many of the quake-related patients have been discharged, and the many crises, joys, heartbreaks and celebrations which filled our moments are fading into memories. Time, which extended out through the many waking hours of the day, is slowly returning to normal cycles with meals at tables with team members and guests, the occasional visit to the Verettes market, and even trips to Port-au-Prince to meet with relief agencies. For me, it has brought a return to my office in the Community Services building, with the daily agendas filled with the concerns of the residents of this region.

I still go through the hospital several times each day, checking on the special friends whom we got to know so well. Yesterday, the lady who offered to be my Mami, who had spent several weeks in bed with her leg in traction, was sitting up, her hair done by her daughter, and wearing a spiffy nightgown. She had been cleared for discharge at last, and her sons were cleaning out their car which had been their home for several weeks. We shared a last moment together before we wheeled her to the exit.


For me it was a symbolic statement of a closing of an intense era in the hospital’s history. From these days forward, Haiti will never be the same, and HAS will also never be the same. We have all been redefined by this tragedy, as we have been redefined by the heroic response to it by the clinical staff, by the community, and by the patients and their families. We have emerged with greater confidence in our abilities to respond great challenges, and with a greater trust in each other and our professional and personal commitments.

Now, we are entering into a different phase of the disaster – when we have to confront the reality of the changes which have been wrought by the earthquake, including the devastation of the capital city and its infrastructure, and the massive population shifts which have brought people to the countryside, fleeing the destruction and insecurity of the city. We have to plan for the registration of many new residents in this area, and to prepare to provide immunizations, food support, primary care, and even shelter for many of them.

HAS is part of the formal planning process for a post-earthquake reality in Haiti, and for the design of a health care delivery structure which will be decentralized away from a concentration in the center of the country. Each day, clusters of activity groups meet in the tents which have sprouted next to the tarmac in the airport, conducing needs assessments, forecasting demands, and planning services. While most of the affected services and populations are in the city, HAS presents a voice for the institutions and populations beyond the immediate impact area, which are also affected, and which offer valuable services to the overall situation. As the new reality becomes clearer, we will be asked to accept new roles as one of the few substantial health facilities outside of the capital, and to help o design models for health and human services which will address the current critical state as well as the longer-term future.

Many of you have been kind enough to let me know that the information in these postings have been informative and appreciated. To a certain extent, they have also been therapeutic for me, and I have enjoyed the opportunity to share these experiences.

Ian Rawson