Last Night

As Gordo and I sit here with a couple delicious Haitian beers finishing up emails and merging contacts before I fly home tomorrow morning, I wanted to write some "last night thoughts" down to share with ya'll. But then I received a message from Chris, the reporter from the Santa Barbara Independent who was here with us for the first week, saying that his article came out today so I figured I'd have you read that while I reflect a bit more. I think it's a great article and captures what we've all kind of been feeling here.

Check it out at:
www.independent.com/news/2010/feb/18/bringing-hope-haiti

Other than that I'll just share this photo to show you that the 60 pallets of medicines we brought into the country and then into our warehouse two weeks ago have now all been distributed to 25 different hospitals and clinics in and around the earthquake affected areas of Haiti. And when I come back a week from Monday, my first task is to clear and distribute another 5o more!

Hanging Our Hats

I thought I'd take a little break from the work-themed emails and just give a brief update on our living situation here. After staying for a week in an extremely overpriced and unsturdy-looking hotel, we met a group who has been running a medical clinic in Jimani, a city right on the border of Haiti and the DR, for 5 years and have just recently opened another one in PaP. They came out to our warehouse to pick up some medicines for their clinics and overheard Gordo and I talking about potentially sleeping at the warehouse instead of the hotel. They immediately extended an offer to let us stay at a large house they have rented near the city; and we've been here ever since. It's a big house that's been set-up to specifically house a lot of people; there is just one massive room upstairs with a bunch of rolling cots. They are primarily using the place to house teams of medical personnel that are rotating down on a weekly basis to work at their new clinic here. When we moved in, there were four doctors (a pediatrician, OBGYN, orthopedist, and GP) and five nurses here from Tennessee. So with this unlikely connection, we have amongst us to ability to open, supply, and staff a medical clinic in a part of PaP where one hadn't been before.

The house is actually really nice and well-stocked with food, water, generators, and even the occasional internet connection. The best part is that, after primarily eating the tuna, beef jerky, and PB&J that we brought from home for the first week, we now are getting deliciously cooked meals from a couple amazing Haitian women who live, and sing, at the house. And, after the last group of doctors left and before the new group arrived, Gordo and I staked out the balcony and are now literally sleeping out under the stars high above the city. And we've only been woken up twice to gunshots coming from the surrounding valley! Check out the picture of our room...

On Sunday, since the city was even quieter than normal due to the memorial, we had a chance to drive up the coast a bit and see something outside of the city. The guys who own our warehouse, and the national water company they run out of it, had been inviting us to come up to their private beach for the last two weeks and we felt we could finally spare a couple hours on Sunday to check it out. It was a strange sensation. This beach house, just an hour outside the poorest and most violent city in the Western hemisphere, was an oasis. It could have been Malibu, except the water was much warmer, cleaner, and more turquoise in color. At one point, one of the guys waded out into the ocean to flag down a lobster boat and brought in a huge bag of crabs and lobsters that they cooked up straight away.

Obviously, there is economic disparity in every corner of the world, perhaps in the US more than anywhere, but it's hard to imagine a place where it would look more striking than this. And it's not to say these guys are greedy or selfish people. They came back to Haiti after living in the US for 20 years to start a business and have ended up employing about 500 people; many of whom they don't strictly need to run their business. Indeed, the small amount of money we are paying to rent the warehouse from them is going directly to hiring more staff to help us with the incoming and outgoing shipments when we need them. Other times, they are working for the water company. But it was a little hard to enjoy this place after seeing how most people live here. Like I said, you could say that about almost anywhere, but we have it on the forefront of our minds because we've been so immersed in it for the past two weeks.

Hospital Visits

Throughout this past week, Gordon and I have been trying to visit as many hospitals as we can. We've been averaging roughly four a day while still trying to manage the distribution of supplies to current partners from our warehouse. For a country like Haiti however, just getting the names and addresses of the hospitals in the area is a challenge. The UN is meant to be collecting data on all the hospitals and clinics in the country and providing that information to the public, but this report has gotten delayed. It seems like they are trying to create a ground-breaking study of health services in Haiti pre and post quake, which is great, but right now we just need to know where people are going to get medical services and what capabilities these sites have. So we are finding the sites mainly through word of mouth, GPS coordinates, and referrals.

The strange thing about going inside these hospitals is that there is no one in them. All the patients are outside in tents either waiting to be seen or recovering from some surgery they've just had in another tent. Whether it's because these buildings have been deemed unsafe or because the patients have been told not to go in them is unclear, but either way it's a terrible situation. Yesterday, we saw a woman recovering from a double amputation laying in a tent in 95 degree weather. I can't really imagine anything worse.

And yet you'll see kids like these who act like nothing has happened. We were being led around Hospital Bernard Mevs in Port-au-Prince and were followed the entire time by this group of kids begging for their picture to be taken over and over again. They couldn't have been happier. This girl above had a compund fracture and was sharing a bed in an outdoor tent with her mom and still looks like this!

Obviously this is not always the scene when we arrive at a hospital. This morning we visited the Grace Children's Hospital who specialize in treating kids with HIV and TB. I was too uncomfortable/shocked/saddened to take pictures of it, but the outdoor tents in this hospital were filled with cribs of the tiniest, skiniest babies I've ever seen and none of them had moms around to share their tent with. Unfortunately the medical director was not around to speak with (the president has declared yesterday, and indeed the entire weekend, a national day of mourning to remember those who died in the earthquake) but we are planning on going back first thing Monday morning to figure out how we can supply this facility.

And yet, the thing that has angered me most about being here is the absolute failure of the government to do anything positive. An official from the Ministry of Health approached us yesterday because he heard we were giving out free medicines to hospitals around the country and he basically asked us to stop doing it, at least until they decide how the new health system will be structured. He said that because hospitals have always been required to buy medicines from either government stocks or private pharmacies, giving out free medications will undermine that system and hurt the government and the businesses that sell these drugs.

While neither I nor Direct Relief wants to upset the capitalist system down in Haiti or cause sales in the local pharmaceutical industry to slump, we're going to keep doing what we're doing. Clearly none of these hospitals, who are all providing completely free services, can afford to buy anything. They can't even pay their own staff or rebuild their buildings.

So if you don't hear from me in a few days, check the basement in the Haitian government building...

UN Chopper Flight

Yesterday made me feel really good about what we're doing down here. It was just one of those days that the coordination came together to make something really cool happen.


A couple of days ago, a guy we met at the UN who has been helping us out told us that we can request UN Humanitarian Air Service (UNHAS) choppers to take medical supplies to the areas outside of Port-au-Prince that haven't been getting as much medical support. While these sites weren't hit nearly as hard by the earthquake, they have had a huge influx of people coming into their facilities due to the mass migration of people away from the capital. So they are working with the same resources but seeing hundreds more patients a day. Many of them on the west coast are also receiving post-operative patients coming off the USS Comfort and do not have the beds, supplies, or personnel to deal with them all.



So after receiving a request of supplies from Hospital Albert Schweitzer, a large hospital in the Artibonite region who are the only hospital in the region for roughly 400,000 people, we put in a request for on of these UNHAS choppers and they came through with it yesterday morning. At 10am we met the chopper at the UN airfield and they had already loaded it with the roughly 4,000lbs of product we had brought the night before. Gordo and I got to accompany the flight with four other folks from Channel 3 News in Bangkok.



After a short stop for refueling, we were off for the 30 minute flight to the hospital. The Russian pilots had the coordinates for the landing zone (a dirt soccer field 200m south of the hospital) and although they didn't understand me when I told them to look for the big yellow school bus to highlight the spot, they assured me they would find the site.

Either way, they found it easily and after spreading dirt from the soccer field for what seemed like miles, we landed to unload the supplies into the hospital's school bus.

Initially it was only staff from the hospital who were there to meet us but once people heard the helicopter coming down to land we were immediately surrounded by thousands of people who gathered to see the chopper. I initially assumed the people had gathered because they expected a food distribution to take place but the Director of the hospital told us that they had been trying to get supplies airlifted to them ever since the day after the quake and hadn't managed to get anything there. So they were just there to check out the helicopter that had landed on their soccer field.

With help from the hospital staff, we got the chopper unloaded into the bus and we're back off as quick as we came. We're definitely going to try to get some more supplies into this facility as they are one of the largest in the country, providing free services, not supported by the government, and buying all their own medicines and supplies. We're also going to try and re-focus our search on groups outside the capital city as they seem to be the ones who are being largely left out of the aid supply chain.

It was overall a great experience in coordination. The UN were able to provide the logistical support to us so that we could distribute our medicines to a hospital that was doing great work. That's what it's about, really.

If you want to read more about this, the hospital posted it on their blog yesterday:
http://hashaiti.blogspot.com/

Cite-Soleil

Yesterday Gordon and I drove through Cite-Soleil while we were en route to Leogane, a city about an hour outside Port-au-Prince that was hit as hard by the earthquake as PAP was. The two main hospitals in Leogane have collapsed so we were there trying to find out where people were going to get medical services. Essentially, the nursing school in Leogane has turned into the hospital for the city, which is a slightly scary thought as these nurses come into the school with no medical knowledge and are now seeing patients on a daily basis.

But what was more devastating seeing than that, was seeing Cite-Soliel, the largest slum in the Northern Hemisphere. This tent city was set-up to house laborers in the 1990s and has turned into a slum of over 300,000 people. There is no clean water, electricity, or sewage system and police haven't been able to patrol it in years due to the armed gangs. Life expectancy is 50 for people living there.

Cite-Soleil was one of the most alarming sights I've seen since I've been here and they were hardly even affected by the earthquake. Because there weren't many concrete structures in this area to begin with, most people in the city survived the earthquake and are now receiving the much needed aid alongside those who were affected. In fact, as we were driving through, USAID was doing a food distribution and they clearly did not have enough security as a massive fight broke out between a group of women trying to get their share of the food.

As we've been driving through this earthquake-affected area of Haiti, I keep find myself wondering what things looked like before. Obviously the rubble and collapsed buildings are new, but some people have always been living outside in these squalid conditions. The difference is that the world hasn't been paying any attention to it until this happened. It's sad to think that it took something this devastating for us all to realize something equally as devastating may have already existed.

It also makes you think about these foreign, usually missionary groups, who are coming over looking to adopt or bring children back to orphanages in another country. Obviously the group who tried to do it without any paperwork and are now in Haitian jail made the wrong decision. (On a side note, the thought of spending 9 years in a Haitian jail makes makes me feel kind of queasy). But I'm not sure that their intentions were bad or they were doing anything malicious. Bringing an orphan (or even a child with a parent who has made the unimaginable decision to send them away for something better) out of a place like Cite-Soleil to give them a better shot at life cannot be intrinsically bad. Exploiting the situation by coming down here to adopt a child now that the country is in chaos is the wrong way to do it but the end result may be the same.

5am Karaoke

Every morning at 5am the massive tent city on the other side of the hotel walls comes to life. It usually starts with some sort of hour-long drum circle, chanting, and possibly a Congo line. From there, it turns into a karaoke party. Different people step-up to whatever voice amplification system they have set-up and take turns rapping, singing, and performing what could only be described as a religious operetta.

Since we can't see over the walls, we usually lie in bed for these hours just imagining the scene on the other side. Is everyone up at 5am participating in this Congo-line drum-circle? Are some people also trying to sleep and saying, 'shut the heck up it's 5am for God's sake?' Do they actually have a microphone plugged in somewhere over there or do some people have superhuman voice boxes? Your guess is as good as mine. But for now, my day starts at 5am.
'

Making Progress

As I think I alluded to before, everything you do here takes more time than you think. The country lacked a strong infrastructure even before the earthquake, and now the influx of people, cars, and trucks has completely clogged the city. Driving a mile takes 30 minutes at least. So when we went to pick up our 60 pallets of medicine from the PAP airport yesterday, we didn't expect anything different. Although they had arrived on-time and were off-loaded onto the tarmac by 8am sharp, it took another eight hours to get them through customs and onto our trucks. That was partly due to the fact that Bill Clinton and Paul Farmer arrived in their private jet at the airport at 10am, thus closing down the whole airport, and partly because the customs official who has to sign the paperwork decided to not show up for work. We were dealing with a volunteer agent who said that since the quake, government officials have often stopped coming in to work because they are not only overwhelmed, but they also got used to not working very hard in the days (and years) before it happened.

In the end though, we got it all safely to the warehouse and unloaded. And having the 24 hour security at this warehouse cannot be overstated because today, as we picked up 6 more trucks to deliver to Partners in Health and St. Damien's Childrens Hospital, we were told that we couldn't bring any of them to St. Damien's because just that morning a truck was looted while it was outside waiting to come in. People are just trying to get their hands on whatever they can, and unfortunately these were medical items (from another organization) for this hospital that the people who stole it probably couldn't do much with anyway.

We're seeing more and more here that while there is a huge amount of supplies coming in, the distribution process is incredibly slow. This is partly to do with the infrastructure problems I've been talking about, but also has to do with the fact that groups are simply overwhelmed with the amount of supplies coming in. We went to a warehouse today that was packed full of stuff (food, water, medicine, clothes, etc.) but the group running it didn't have the manpower or trucking/logistical capabilities to get any of it out. It's a terrible thing to have a warehouse full of products and then see a sign just outside their doors reading, "Please help us. We need food and water." But that distribution process is not easy. You need tons of manpower, you need to be able to spread it out amongst the people, and you need to maintain your own safety. And when it comes to medicines, you have to ensure that it's getting into the hands of the people who can properly prescribe it. So while there is justified anger on the part of the Haitian people with the speed in which aid is being delivered, you have to be here and understand the situation to fully grasp the challenges and complexities.

So with all that being said, tomorrow (yes, SuperBowl Sunday) we're spending the day getting everything we can out of our own warehouse and distributed to the hospitals. This amazing guy who owns our warehouse has offered us a truck and a driver to make deliveries within PAP, and we are working with the WHO and World Food Program to get items helicoptered out to the surrounding areas that have also been devastated.

Phase 1, as I call it, is mostly complete down here. And, so far, only 2 of 4 of us have gotten sick! Guess which weak-stomached person you know was the first to come down with it...

"Come se, neg pa!"

"What's up my man!" That's the extent of my Haitian Creole so far...and I'm not even sure that's correct. But whenver we start to draw attention from large groups of serious looking Haitian dudes, that's what I say and it can almost always draw some smiles. Some of the other standard words are just the same as French and so we can at least say hello, thank you, and goodbye but that's about it.

2 Days in Port-au-Prince

Sorry about the gap-day yesterday. We’ve had a couple of big days recently and internet isn’t available until we get back to the hotel at night.

It’s hard to describe the devastation that has hit this city. We’ve all been in earthquakes before but the buildings here look like bombs have gone off inside each one of them. It’s not just that concrete has fallen over. It’s like the concrete was made with the shatter-proof glass that you put in your car window that shatters into a million pieces when broken. It’s unreal. And the result is that the streets are completely covered in rubble and temporary roads have been cleared just to allow a single lane for cars to drive through. The presidential palace (the grounds of which actually look like the white house) has collapsed, as have all the ministry buildings nearby. You can see the desks that people were working on that day sticking out of the rubble.

And the tent cities that have sprung up all over the city are reminiscent of Soweto in South Africa. People are starting to build settlements anywhere that there is space. Most are using tents but some are gathering wood and sheet metal from wherever they can in order to rebuild their homes. Obviously there is no plumbing, running water, toilets, or electricity going on in these areas so issues of sanitation and disease are a serious concern.

Amazingly, the markets have started back up and people are working hard to clean up areas of the city bit by bit. Brett (a DRI colleague who came here immediately after the quake) took us past the site of the old post office today on our way to a hospital and the lot was completely empty. Two weeks ago it was a completely flattened building. On another main street there was earth moving equipment and probably 25 people working to clear the area of rubble. The incredibly sad part is that there are still people buried under this debris all over the city (if you couldn’t reason this out you could smell it distinctly) and as they clear each building they will slowly start to uncover these people.

On a positive side, there are a huge number of people here doing incredible work. We visited 3 hospitals who we haven’t worked with before and they are completely dialed in. We met a surgeon from Kentucky who seemed as though his specialty wasn’t even needed anymore now that most of the people who needed it have undergone their surgeries. We also met with a Haitian pharmacist at a local hospital that had seen over 2,000 patients and performed surgery on over half of them since the earthquake, and he could immediately rattle off every medication and piece of equipment they needed. The great thing is that our list of supplies matched up with their needs and we can provide them with a large number of items.

The sad thing about these hospitals is that while they have enough doctors, they don’t have enough beds for all the patients. That means that patients who go in for surgery in the hospital have to undergo their post-operative treatment in tents outside. If that doesn’t sound bad, imagine getting a rod implanted into your leg to fix your femur and then getting wheeled outside to a cot in a tent in 95 degree weather with 10 other people who you have never met for the next 4 weeks of your life.

Another great thing about today is that we think we found a secure warehouse that we can store our products in and send them out to these groups as they need it. We are now connected with about six of the roughly 18 hospitals operating on PAP. Many of them are mobile/tent clinics that have been set-up by foreign governments and aid groups that may leave in the coming weeks and months.

The fact is that there are an amazing number of people who are down here trying to help. It’s an incredible feeling to see (and try to talk to) groups from basically six different continents. The other day as we were unloading a truck into a hospital I was doing my best to try and speak Spanish to the truck driver, French to the hospital staff, and so when a new guy walked in the door I said, “Hola,” then “Bonjour,” and ultimately he turned out to be Italian. At that point I was out of greetings.

Arrived in Port-au-Prince

We've arrived safe and sound in Port-au-Prince this afternoon thanks to the UN's World Food Program flight they are providing daily for aid workers. After arrival, we spent the majority of the day at the UN compound where they hold their daily cluster meetings. The goal is to coordinate the actions of all the local and international groups who a performing a specific function here. So for example, there are cluster meetings for: health, logisitics, food and water, construction, etc. At the health cluster today we met a ton of overseas doctors who are working at these various field hospitals and a variety of other medical NGOs like Partners in Health and Doctors Without Borders. We also made a great contact at the WHO who can arrange for us to transport our supplies to facilities outside of PAP via truck and/or helicoptor.

From there we left the compound and got our first taste of real PAP. A couple things stood out initially:

1. Traffic is insane.
2. Locals seem to be fairly used to all the foreigners in their city and somewhat in a daze. We got neither waves nor incredulation from them.
3. Lots of people are here who truly seem to want to help but the overall coordination, at least in the health cluster, seems poor. Doctors are here and working but they don't have nearly enough supplies. The WHO is supposed to provide this and say they have 16 containers full of products (we have 6 on the way right now) but don't have the manpower to organize the distribution or assess the needs of each facility. The doctors made no bones about their anger over this.
4. There are an enormous number of injured people. They announced today that there is a phone number that hospitals can call to properly dispose of limbs.

We're now back at our hotel that we'll be staying at for the next 3 nights. The place is packed with people and many of them are sleeping outside in tents. However the majority of the people here are either from NBC news or the private security firm that they hired to protect them. Needless to say, we are safe here.

Tomorrow the four of us will split up and two will go meet some trucks full of supplies at the border to delver to a hospital and two will go try to find the warehouse. When we told the head of the logistics cluster that our plan was to find a warehouse, all he said was, "Good luck with that." Doesn't inspire much confidence.