Here in Haiti

Great Article about a Partner in Haiti

2011-07-07T17:07:00.000-07:00

Hello Out There,

Since my wife and I had our baby boy Finley just three weeks ago I'm taking a couple months off from traveling to Haiti. However, I'm still working hard from home and wanted to share a great article I came across today.

It's about one of Direct Relief's largest recipients of aid since the quake. They are basically the only full-scale trauma and surgical hospital, have one of the only neo-natal ICUs, and now have one of the only CT scanners in the country. They also have a full-scale prosthetics/orthotics fabrication center on-site and are in the process of building a teaching hospital on-site. They provide free care to everyone who walks in and now are able to perform surgeries for hundreds of hydrocephalus children (which are by far the hardest thing for me to see) thanks to the CT scanner and rotating teams of neurosurgeons.

The article states that this model needs to be replicated throughout Haiti--and it's true. What they don't mention is that a great organization called Project Medishare is spending around $200,000 per month to keep it running and unfortunately that will likely not be able to continue forever. Running a hospital in Haiti (or anywhere) for a population of people who cannot pay is about the most expensive undertaking there is.

Nonetheless, this place is doing amazing work--not only in the immediate aftermath of the quake, but even now 19 months on.

http://www.browardpalmbeach.com/2011-07-07/news/bernard-mevs-a-tiny-hospital-founded-by-floridians-may-be-haiti-s-best-hope/

Frustrations

2011-06-02T13:52:00.000-07:00

We arrived at the small medical clinic in Petit Trou de Nippes about five hours after we left Port au Prince that morning. The distance is only 75 miles but the unpaved roads, traffic, and small lakes and rivers we had to drive through to get there made the drive take quite a while. Halfway through the trip my Haitian colleague Catherine asked me if I felt like I was in a blender due to the jostling of the Land Cruiser we were driving in. We just pretended we were getting expensive lower back massages the whole way.

Like the other clinics I’ve visited on this trip, this is the only one serving the 25,000 people who live in the area. Unfortunately, this one currently does not have a doctor because he left for a training course in Port au Prince and they fear he’s not coming back due to the poor pay he’s receiving working at the small government clinic. So it’s currently being run by an extremely young but committed first year resident who just graduated from medical school last year. I asked her if she felt ready to be running a medical clinic just one year out of school. Before she answered yes, she hesitated and looked around at the two nurses, social worker, administrator, pharmacist, and lab technician who were sitting on the bench across from her waiting to hear what she’d say. It seemed like she wanted to reassure them that she could do it.

Like the doctor on the island of La Tortue who asked for a better boat to get his patients across the ocean to the larger hospital, the doctor at this clinic also asked for better transport. However, she wasn’t asking for it so she could send patients to other facilities, she was asking for it so they could have a way to get women into her clinic to deliver their babies. The only “ambulance” the clinic has is two broken down motorcycles and they said they wouldn’t want to transport pregnant women on motorcycles even if they were working. That made sense to me. Or I should say it made sense for a brief moment. They went on to say that pregnant women usually come in to deliver on horseback or are carried in a chair or lying down on a door carried by their neighbors like pallbearers.

At that moment, I flashed back the advice I received at the labor and delivery class my wife and I had attended a few weeks ago in preparation for our son’s birth. “Partners,” she said, “watch out for potholes when you’re driving to the hospital. They are a killer when you’re pregnant.”

There are some things about working in Haiti (and the developing world in general), that are consistently frustrating. Visiting this hospital reminded me of two of them.

Nearly 100 doctors and over a thousand nurses get their degrees every year in Haiti. However, because they are paid so little by the government to work in public facilities, most do not remain for long. It is not uncommon for a doctor to make $500USD a month while a nurse can make between $250 and $350 depending on her level of training. And these are pre-tax salaries. Imagine a doctor making $6,000 a year. It’s insulting. Therefore, most of them either leave the country or work for NGOs in Haiti who pay them a decent wage. So while plenty of doctors and nurses are trained every year, many rural areas are left without a way to care for their people.

But I would say that by far the thing that makes you feel the worst, is that most of the things they are requesting can be provided with a relatively very small amount of money and yet they’ve been dealing with these problems for years. The doctor on the island of I’le a Vache asked if we could fix the leaky roof in his exam room so when it rained he and his patients wouldn’t get wet anymore. The doctor on the island of La Tortue needed $1,000 to dig a well so he could put running water in his hospital. The doctor in Petite Trou de Nippes said her dream would be to have an actual ambulance but she’d be happy if they could have some gurneys or stretchers so women wouldn’t have to be carried in on doors. The medical director of Beraca Hospital wants a sterilizer so they wouldn’t have to disinfect their instruments in a pot of boiling water on the stovetop anymore. The nurse on I’le a Vache needs a raise from $300 a month to $350 a month because her parents spent all their money to send her to school and now she’s responsible for taking care of her three siblings. And the administrator in Nippes, who was extremely proud to show me the professional patient records and filing system he keeps on all the patients who come in, said he needed a new desk because the one he’s using is just a piece of plywood sitting on top of two oil drums. For some reason, that one made me feel the worst. This guy was working for almost no pay (and often goes months without even getting a paycheck) yet was very proud of his work. The least you could do is give him a desk.

You could raise enough money from a bake sale to solve most of these problems. In fact, the Haitian doctor I was travelling with who had been working in the states for the last 30 years promised to personally pay the $1,000 for the well because of the thought of working in a hospital without running water was unbearable to him.

I take some comfort from the fact that I work for an organization that can help respond to most, if not all, of these requests. However at the same time I know we’re just scratching the surface. There are thousands of health facilities all over Haiti that need wells dug, leaky roofs fixed, and new desks for their administrators.

Travelling North

2011-05-27T19:52:00.000-07:00

As I continue to travel around this country, I become more amazed and saddened that things actually seem to be more desperate once you leave Port au Prince. I came here to respond to the earthquake in Port au Prince but didn't imagine that things might actually be worse elsewhere.

Yesterday afternoon my colleagues and took the thirty minute flight from Port au Prince to Port de Paix in the far Northwest of the country. (A driver picked us up at the airport after driving up from the capital the day before and said it took him eight hours to get there due to the poor roads). We came to the north to visit two more hospitals in order to upgrade the conditions of their maternity wards and encourage more women to come to the hospital for pre-natal visits and delivery. As we drove down the long, bumpy and muddy road from the airport to the hospital I was struck by the fact that this town seemed to be the poorest I’d seen in Haiti. There were almost no other cars on the road (as compared to the constant traffic in Port au Prince) and the houses and roads looked to be in even worse shape than those in the capital. However, when we arrived at Beraca Hospital were greeted with a hot lunch of chicken, fish, plantains, rice and beans and a team of doctors and nurses who were eager to hear what we had come to offer.

Once again, I was struck by the eagerness and commitment of this medical staff to their jobs despite the fact that many of them had not been paid in months, their pharmacy had almost run out of stocks, and their sterilizer had broken so they had resorted to sterilizing their instruments in a pot of boiling water. This particular hospital had been funded by missionaries since it opened but funding has stopped and they haven’t received any outside support in over 10 years. Since they are not a government hospital, they do not receive any funding from the Ministry and thus have to rely on patient fees to support the hospital. That is almost unheard of in Haiti because it is simply not a model that can work here. Many patients cannot afford to pay for basic care. For example, ever since this hospital raised their fees for deliveries to 1,000GDS (roughly $25 USD), they only do 30 deliveries a month compared to the 100 they did before. So instead, the women have to deliver at home with the assistance of a matron who is often untrained and ill equipped to handle anything outside of a normal, perfectly smooth delivery.

This morning we left Port de Paix to head for La Tortue on a small boat with an outboard motor (that broke two times during the journey) and a purple velvet curtain attached to a PVC pipe that they used as a sail and boom. (The resourcefulness of Haitian people never ceases to amaze me).

When we reached the island of La Tortue I thought I might be at the end of the earth. This is an island of 40,000 people but only has 10 cars and a couple tiny boats to get supplies across. The steepness and bumpiness of the unpaved roads is astounding. A couple of times I thought for sure the Land Cruiser transporting us was going to tip over backwards due to the incline. And now, it’s 7pm and I’m sitting on the balcony of the only guesthouse in town overlooking the whole island that stretches nearly 50km long and 7km wide and there are no lights on as far as you can see in any direction. Indeed, the hospital we visited today only has power for 6 hours per day using a generator, does not have running water, and has to send patients to the hospital in Port de Paix (in that same velvet sail boat that takes nearly an hour—not to mention the trek to get to the water) if there is an emergency.

Today the doctor told us about a woman who came to deliver her baby at the hospital but he could not deliver the placenta no matter what he tried. So he sent her down the incredibly steep and bumpy road in the Land Cruiser and across the ocean in the velvet boat in order to be seen at the public hospital in Port de Paix. However, since this woman did not have the $30 for the procedure, they would not see her. So she waited outside the hospital for 4 days, meanwhile becoming infected, until finally her family was able to gather the money to get the hospital to perform the procedure.

This is an island where the hospital used to be the premier facility in the Caribbean and people traveled from all over the Caribbean to come for treatment. Today, I met the doctor at that same hospital on this same island and his first request was for a better boat so he could get patients away from his hospital and across the ocean to a different one.

This is an island where Napoleon’s sister once lived. Today, her house has been reduced to the foundation because the stones have been used to build dozens of other houses around the island by people who don’t have any other resources to use.

The sheer neglect of these areas over the past few decades has led to an astoundingly fast and extreme fall from decency.

Giving Birth in Haiti

2011-04-15T11:02:00.000-07:00

Halfway through my trip to Haiti this week, my wife sent me an email saying that if our baby was born today, he would have a 90% chance of survival. I found that incredible given that Melissa literally just entered the third trimester last week. Obviously we hope that the baby will cook for the full 40 weeks and we won’t have to worry about an early delivery; but it is actually quite comforting to know that if he had to come out now for some reason, he’d probably be just fine.

The day she happened to send me that message I was visiting a hospital we’re supporting in a town called Marchand Dessalines, named after one of Haiti’s first leaders after independence, about two and a half hours north of Port au Prince in the mountains of the Artibonite. I learned from Dr. Fequirere, the young Haitian OB/GYN who works at the hospital, that if a child is born in Haiti at the start of the third trimester, there would be practically no chance of survival.

Haiti has the highest maternal and infant mortality rate in all of Latin America and the Caribbean. Pregnancy and its complications have become the leading cause of death and disabilities among women of childbearing age. Out of every 100,000 births, 630 women die giving birth. Roughly 77% of Haitian mothers give birth at home and nearly 100 babies out of 1,000 (10%) die during the first year after birth. The thought of my wife giving birth inside what’s become the typical home in Haiti, a battered tent or tarp help up by 4 sticks without any running water or sanitation, makes me queasy.

In this year after the earthquake, Direct Relief has been focusing on addressing the immediate medical needs of the population. We’ve supplied wound dressings, sutures, and wheelchairs after the earthquake; IV solutions, oral rehydration, and antibiotics after the cholera outbreak; and bleach, soap, shampoo, and toothpaste to address the poor hygienic conditions in the camps. However, now 15 months after the earthquake and 7 months since the outbreak of cholera, we’re taking a step back to look at the ongoing and ever-present medical issues facing the country. And the one that jumps out and takes your breath away is the number of women and babies who die unnecessarily every year in Haiti due to complications with childbirth.

The doctor at the hospital in Marchand Dessalines told me that day that they deliver roughly 80 babies per month, 10 of whom will die. While this hospital has 5 well-trained doctors, 18 nurses, and an anesthesiologist, they lack the material resources to save these babies. There is no blood bank in the hospital. Often times they do not have the medications needed to treat the women. And they do not have any incubators, let alone a neo-natal intensive care unit, to deal with premature deliveries. In fact, the doctor told me that they have to refer these pre-term labor cases to a hospital over an hour away. The road between the hospitals is impossibly bumpy and winding, and the woman is transported in the back of a truck. Imagine your wife or mother or daughter or sister having to endure that journey.

Bringing life into the world should not be a death sentence in 2011. As I know now, we have the technology and knowhow to treat babies who are born three months (or more) early. The eight hospitals we’ve selected throughout the country (that all have trained doctors, nurses, and midwives), will ideally become “centers of excellence” in Haiti with new equipment and supplies we’ll provide them to save more lives and encourage more women to come in for pre-natal care. My wife Melissa has now had nearly a dozen hospital visits and will double that by the time this baby is born; yet over 50% of women in Haiti don’t ever see a doctor before they give birth—partially because of the state of the medical facilities.

Sometimes it takes a personal experience, or just the ability to place yourself in someone else’s shoes, to relate to these issues that affect so many people on our planet. In fact, I think one of the biggest problems we face today is many people’s inability to walk a mile in another’s shoes. (Think healthcare for the poor and elderly, welfare for those who cannot find jobs, and the state we’re leaving our planet for our grandchildren. But that’s a topic for a totally different blog.) I remember when I broke my first major bone and couldn’t walk for over three months; I discovered a newfound respect for people with physical disabilities.

And now that I have a pregnant wife, a baby on the way, and know what we can do with complicated pregnancies in the United States, I’m shocked by what the majority of women in Haiti have to go through just to bring a new life into the world. But we’re doing what we can to help change that for the nearly 1 million women in Haiti who receive care at these facilities.

Working Together

2011-01-14T13:05:00.000-08:00

Once again, I'm blown away by the coordination effort that groups in Haiti are pulling off. Now it's in response to the cholera epidemic and not immediate earthquake response, but it's still happening nonetheless.

Direct Relief brought in an unprecedented amount of supplies to respond to the cholera outbreak thanks to the support of corporate donors who make these essential supplies. However, we were then stuck with the challenge of figuring out how to deliver these supplies to the over 100 hospitals and clinics we support in Haiti. Many of them are dozens of hours away along bumpy, unpaved roads and some of the clinics are actually on the islands off the coast of Haiti. Getting the supplies to these areas would require a huge logistical effort and would be extremely costly.

However, out of no where, we were put in contact with a group from Germany who provide helicopter ambulance transports for patients in the rural areas who need to get to a larger, more sophisticated hospital. Well with a sickness like cholera, patients don't necessarily need to be transported--they just need to receive immediate oral re-hydration and possibly an IV and antibiotics. So this group has been generously providing their helicopter for groups like DRI to use to get these supplies out to the rural areas where the people are being treated.

This past week we've made a number of deliveries and hope we can continue to do so in the future as this saves crucial time (and money).

So thanks to German Help One for providing this valuable service!

One Year Later

2011-01-10T06:08:00.000-08:00

I was talking to a reporter friend from a local paper last night who had been with me one year ago when I came to Haiti to help respond to the earthquake that killed nearly 250,000 people and left over 1 million people displaced. He asked me if things had improved since he was here last January. It’s the obvious question to ask as we approach the one year mark of the quake — and it’s one I ask myself every time I leave my home in Sacramento and arrive in Haiti (I’m now on my eighth trip) — but it still gave me pause. It is such a difficult question to fully answer.

Luckily I lost my phone signal soon after he asked the question so I had more time to think about it. What I decided to eventually tell him is if you look at the recovery effort at a macro level you’re going to get discouraged and assume the effort has failed. But if you spend some time in Haiti and squint your eyes a bit, you’ll see some amazing progress that has been made and you might meet a large number of people whose lives have actually improved.

On the surface, things look to be as bad as they were in the days immediately following the earthquake. Very little of the rubble that suffocates the city has been removed and the only homes that have been rebuilt are those owned by the very wealthy. The tent camps are ever present and have not gotten smaller. In fact, the first things you notice as you drive away from the airport are the huge tent cities that seem to grow every time you see them. The tents and tarps that the people are living under are completely exposed and there is no privacy to speak of. Bathing, cooking, and washing are done out in the open. Often times families of up to eight people share the same tent and have to rotate sleeping hours because there is not enough space on the bed or floor to allow everyone to sleep at the same time.

To add to the dire living conditions, there is a constant threat of post-election rioting. The riots are not only violent but they also end up blocking the city’s streets and cutting off essential services like water distribution and sewage removal.

And of course, now there is cholera. Roughly 12,000 people per week have contracted cholera since it broke out in late October and over 3,000 have died. There is not enough IV fluid or oral rehydration solution in the country to treat everyone properly. To make a complicated situation worse, there is a great deal of misunderstanding amongst the local population regarding how it is spread. Locals often do everything they can to keep the cholera treatment centers out of their towns because they fear these centers will bring the deadly disease into their communities. Reports of violence against NGO workers and UN troops have been on the rise and in the rural areas there have been lynching’s of people who are rumored to have brought the sickness. One aid worker I talked to encountered a barricade in the road comprised of dead bodies warning the international community to keep out.

In a disaster of this magnitude it is easy to look at these large glaring problems and say that nothing has been done and that money raised has been wasted. In an ideal recovery situation, nobody would be still living under a tent and everyone would be back in their homes. But it is unrealistic to think that such a feat could be accomplished within a year. Over a million people back inside newly rebuilt homes within a year? No one can realistically say that should have happened by now. More people died in Haiti after January 12^th than all the natural disasters that have occurred in the U.S. combined. It’s hard to even fathom the scale and scope of the destruction. Ninety-nine percent of all government buildings were destroyed and many of the government workers inside them were killed. How do you rebuild a country in these circumstances? What does success look like in this situation?

I would argue that on a micro level there has been a tremendous amount of success. Vital health services are available to segments of the population that lacked them before. The lives of many have changed for the better during the past year and should be taken into account when judging the overall results of the recovery effort.

Before the earthquake, the only organization providing services for the handicapped and amputees in Haiti was a small organization called Healing Hands for Haiti. There are now at least eight other organizations throughout the country that are providing these services, and Healing Hands has dramatically increased its ability to serve patients. In the past year, the Healing Hands team has fit over 900 patients with new prosthetics or orthotics and performed nearly 5,000 rehabilitation sessions for these patients. That’s more than any similar company in the U.S. would ever do in one year.

A year ago Hospital Bernard Mews in Port au Prince was a standard private hospital that could provide a limited number of surgeries and procedures for their paying patients. As a result of the support they’ve received over the past year from Project Medishare, they are now a state of the art facility with multiple sterile surgical theaters and an infant and pediatric intensive care unit. And the hospital can now provide all of its services free of charge. Thousands of people have now been served by this hospital that previously would not have been able to walk through the gates.

And Direct Relief International’s own $750,000 community grant program alone has given over 1,000 students the opportunity to go to school and receive lunch for free, provided care for 500 orphans (many of whom have special needs), trained community health workers to work in an area where there previously wasn’t any access to health care, rebuilt a library, and set up a community arts center for 150 children who were affected by the earthquake. We’ve set up seed banks for 4,000 farmers in the North, offered pre-natal care and safe deliveries to pregnant mothers in Jacmel, brought psychosocial support to the residents of Thomassin, and supplied funding for a hospital in Leogane to rebuild their surgical suite. We’ve been able to do this by tapping into the local talent and expertise of Haitian people who are working to rebuild their country. And Direct Relief is just one of the over 12,000 NGOs working in Haiti. And all of them are also doing amazing things.

And perhaps most importantly, it seems that people are beginning to invest in Haiti and provide the desperately needed jobs so that people can begin to fend for themselves. We rent a warehouse space inside a local factory run by two Haitian businessmen and since we arrived here last year, three private companies — a lumber company, a plastics company, and company making fiberglass domes —have moved in and are now employing hundreds of people. And the owner has told me he has investment plans from other companies for the rest of the 30 acres he owns.

It’s easy to come here and say that things have not improved in Haiti and that the aid is not working. But had aid groups not responded in the immediate aftermath of the quake a much greater number of people would have died. Fewer would now have access to healthcare, schooling, and water. Of course more needs to be done and done better. But I think the people who have been fitted for new limbs at Healing Hands, the patients who have received life-saving surgical procedures at Hospital Bernard Mews, and the kids who are now getting to go to school would say that at least some things have improved.

Desperate Needs

2010-11-22T10:13:00.000-08:00

Soon after I arrived in Haiti to coordinate Direct Relief International’s cholera response efforts, I had a conversation with some doctors, nurses, and a pharmacist who had been working in country when the outbreak started. They told me that when they heard there was cholera in the country, they all felt a tinge of excitement. At first I chalked this up to some kind of strange humor that medical professionals have been known to have. I’ve worked with enough doctors and have enough paramedic friends to know that they can get strangely excited about seeing a new kind of illness or a particularly gruesome injury. So I assumed they were excited because they would now get to treat cholera patients; something they wouldn’t likely get do in the States. But when I began to question them, I found out that wasn’t the case at all.

As I have traveled throughout Haiti over the past ten months visiting hospitals and clinics, I’ve realized that resources in the country are extremely limited. Many medical facilities lack fundamental items such as latex gloves, generic antibiotics, and soap--not to mention surgical equipment, x-ray machines, and basic lab supplies.

On Tuesday I met with an aid organization called Management Sciences for Health (MSH) to discuss developing a maternal-child health program in the rural areas in Haiti. They asked Direct Relief to help raise the standard level of care in these rural clinics by donating supplies and equipment so that when there is a complication during childbirth, the mother and baby might have a chance for survival. (Currently Haiti has the highest maternal and infant mortality rates in the western hemisphere). I told them that we might not have the resources to donate high tech obstetric equipment to the 150 facilities they were talking about. However, they reminded me it’s not high tech obstetric equipment they need. In many of these clinics, there are no surgical instruments for the doctor to use to perform a cesarean section. Many don’t have birthing beds so mothers are required to lay on a piece of wood set on top of concrete blocks or tires during labor. What they were asking for was not high tech at all. To raise the standard of care in these places, all you need to do is provide an exam table, some basic instruments, a sterilizer, a bit of soap, and some gloves. These items would save lives.

After the earthquake in January, there were some very serious injuries that would have been difficult to deal with even in the most advanced medical facilities. Thousands of people needed amputations. Many were paralyzed. People were trapped under the rubble for days and required advanced care for long periods of time. Medical staff did amazing work but there were patients who had sustained such extreme injuries that they could not be saved.

But cholera is easy to treat. That’s why the medical staff was excited. They felt like they would really be able to save the lives of the people who contracted it and could easily stop the spread to other people. All that’s needed to contain the illness is access to clean water and soap. And if a person does get cholera, it can be treated in the early stages with a simple oral rehydration solution made with water, sugar, and salt. If it’s progressed to the later stages, all that’s required is a simple IV drip that a nurse can administer and possibly a few doses of a generic antibiotic—things you would find in any small clinic in the US.

Cholera is no longer a serious concern for most areas of the world. In fact, just this week officials announced that cholera has been confirmed in the Dominican Republic and in Florida—both were found in people who had traveled to Haiti. However, health officials aren’t concerned about it in these areas because when the population has access to soap and clean drinking water cholera does not become an issue.

In Haiti though, where there is not enough soap, water, IV solutions, or antibiotics to go around, there are now over 15,000 confirmed cholera cases, over 1,100 deaths, and it has spread from one department (equivalent to a county in the US) to all ten. And bio surveillance teams in Haiti say these numbers are probably 400% under reported due to the fact that the Center for Disease Control only counts cases that have been confirmed by lab tests. As I’ve mentioned, lab equipment in Haiti is largely non-existent outside of the private hospitals and those treatment centers that have sent their samples off for testing often receive inconclusive results due to problems with the sample.

Haiti has endured through years of terrible hurricanes, an HIV epidemic, and most recently of course the January 12^th earthquake that’s been called the worst natural disaster in the western hemisphere. But cholera is different. Cholera should be easy. The medical staff I talked to made the same mistake I did when talking about upgrading the rural medical facilities to help save pregnant mothers. We assumed that the most basic things that we take for granted like having enough soap and water and being able to give birth on an exam table are available in Haiti. But often they are not. And they need all the help they can get.

60 Minutes

2010-11-17T10:28:00.002-08:00

This is a really good story that aired Sunday on 60 Minutes. It touches on many of the issues that people are really frustrated with. Government says its a lack of money. NGOs say its the government interference or worse. And the international community is too nervous to make good on their commitments.

I've driven past those tents on the road to Carrefour many times and have distributed medicines in that tent city. We've also donated to that Partners in Health Hospital.

It's a bad sign that it takes seeing it on film to make me remember how bad it is down there. It has all started to become the new reality for people in Haiti and it's not hard to imagine a future where those tents and those camps just become the norm.

Dr. Charles

2010-11-15T19:11:00.000-08:00

An hour and a half after leaving the crowded streets of Port au Prince, we arrived at the gates of the new Camejo Hospital in Leogane, a town only 20 miles outside the capital city where the January 12^th earthquake was centered. After honking our car horn at the gate, an older man dressed in nurse scrubs and holding a machete opens the gate and waves us in. Like every time I pass through one of the large metal gates in Haiti, I have no idea what I’m going to find on the other side. In this case, what we see is a lush piece of land, two football fields in length, with a wooden building standing in front of a larger, mostly collapsed, concrete building. This is the site of the new Camejo Hospital that is being run by Doctor Joseph Charles and the Camejo Group, a group of Haitian doctors of various specialties.

Working in Haiti over the past ten months, I’ve constantly found myself wondering what the country looked like before the earthquake. Like so many other aid workers I’ve meet here, I had never been to Haiti prior to January of this year so I have no personal reference for the state of the country before “the twelfth,” as they say here. However, what I can do is compare what it looks like now to what I witnessed when I first arrived at the end of January. Unfortunately not much has changed. Although the rubble is finally beginning to be cleared from the streets, very few homes or businesses have been rebuilt and all of the tent camps that sprung up in the immediate aftermath remain. The cramped conditions of the tent cities are unsanitary, unsafe, and provide no real shelter from the brutal sun and constant rain. And as we all are well aware of now, these are the conditions where cholera thrives.

Depending on who you talk to, you’ll get a different answer for the reason behind the slow recovery effort. Some say the government is underequipped and unprepared to deal with a recovery effort of this size. Some say that the non-governmental organizations (NGOs), which have received most of the aid money that’s been given for Haiti thus far, are short-sighted and unable to work within the government’s reconstruction plan. And some say that the Haitian people have become so dependent on foreign aid (it’s said that Haiti has more aid groups per capita than any other nation) that they often rely on outsiders to help solve their problems for them instead of taking the initiative. Clearly, there are aspects of all three at play. But Dr. Joseph isn’t using any of these excuses – and he is going to prove that Haiti can be rebuilt better than it was before the earthquake.

Dr. Joseph is a Haitian surgeon and his wife Dr. Marie is a pediatrician, however between them they have about a dozen different medical degrees and certificates. Although he couldn’t tell me for sure, Dr. Joseph thinks there are probably only one or two other Haitian surgeons working in Leogane, a town of over 250,000 people. I first went to see their clinic back in February to see if Direct Relief could help supply them with medicines and supplies because there were almost no other medical facilities that survived the earthquake--although by that time numerous NGOs and foreign armies (including the US, Canadian, and Japanese) had come into town and set up field hospitals and clinics. When I arrived at the clinic, there were roughly 20 mothers with their babies waiting to see Dr. Marie and another handful of patients waiting to see Dr. Joseph. I remember feeling badly that I was taking their time away from their patients just to show me around their clinic.

Joseph and Marie were extremely grateful for the medical support that foreign groups were providing but they knew that in time, the foreigners would leave and it would be up to the Haitian people to figure out how to care for their own people. So shortly after the earthquake hit, Joseph and Marie’s son and daughter in law, Jodel and Sulfrance Charles, started an NGO called Renewal 4 Haiti in their hometown of Aurora, Colorado. They planned to raise funds to build a new surgical, referral hospital in Leogane. They already had the land, a parcel that was acquired from a patient who Dr. Joseph treated for free in 1988, but now there was a small wooden hospital on the site that the Canadian Army had built and operated out of when they were working in Leogane. Dr. Joseph let the Canadian Army use his land for free because they were helping the people in his town. In return, they left behind the brand new wooden building that was perfect for a temporary hospital because it is not made of concrete. People are wary of concrete in Haiti.

While there are plans in the works to build a permanent hospital on the site, for now there is no rush. Dr. Joseph has capacity for 20 beds, and while we were there about half of them were filled. Two people had typhoid. One patient had malaria. But thankfully there were no cholera patients yet. Recently they built another room which will serve as the operating theater, and Direct Relief has provided them with the funds to outfit it. Because the site is on a major highway that connects Port au Prince to the Western departments, Dr. Joseph expects to see many patients who have been injured in traffic accidents.

We asked him how he expects to fund and sustain a hospital in Haiti. The majority of Haitian people cannot pay for medical services, even at a place like Camejo Hospital where the supplies and medications are often given away for free. “There are ways to do it,” he said with a smile. “If someone comes in for a surgery and he cannot pay, we ask the family what they can do to help. Maybe they can work around the hospital for a week.” “Another way,” he says, “is if we have ten patients and only two can pay, they help pay for the others.” We found out later that the man with the machete who opened the gate for us will be the first one to have surgery when the new surgical suite opens. He has a hydrocele (an accumulation of fluid in a body cavity) that needs to be removed and is working there now to pay for it.

If only donors and NGOs can do more to encourage and support these kinds of activities instead of thinking about how to spend their money in the short term, Haiti can harness the talents of people like Drs Joseph and Marie Charles and indeed rebuild better.

End of Another Trip

2010-07-02T11:45:00.000-07:00

Once again I find myself sitting in a Florida airport contemplating the trip I've just returned from. This one-week trip absolutely flew by as compared to the past few where I've spent three weeks down there and usually had at least a bit of down time to process some the things that I'd been through and experienced.

First off, and on a totally different note, I should say that it's extremely unfortunate that Brazil just lost to the Netherlands 2-1 in the World Cup. Haitian people are completely obsessed with Brazilian football and the country has been in a fervor as they've been winning over their past games. It really seemed like it was one of the few things keeping many of those people upbeat. The first night we got there, we almost couldn't get to our house because of the parades and parties in the streets that thronged late into the evening. The past wins and future predictions were on everyone's lips and I'm sure the country feels like they've just suffered another huge letdown. It sounds strange to say but anyone who has experienced the World Cup outside of the Unites States will know what I mean.

Ok, back to my contemplation in the airport...

The big question on all of our minds during this trip now that we are nearing the 6 month anniversary of the earthquake was, "are things any better now than they were 5 months ago when we first got down there?" On the surface, it appears that they really are not. The tent cities seem to have grown even bigger since the last time I was there. Actually, a 'tent city' doesn't really describe it very well but I'm not sure what else to call it. Basically any open space the city has to offer, from the park in front of the collapsed presidential palace, to the median in the center of the highway, to ravines where the rain water flushes thru after any heavy rain, has turned into a place where people have either put up a tent or a tarp so they can have a place to sleep. For the first few months, there often weren't toilets or running water for these people to use so the hygiene was appalling. Typhoid has now broken out in many camps, as has outbreaks of scabies and TB. Violence and rapes are on the rise and families have taken to sleeping in shifts so they can keep watch for each other.

Six months on, the larger of these camps are much more organized and sanitary now because most of the larger tent camps have been taken over my at least one NGO that usually provides water, toilets, and possibly a health clinic. However, the fact remains that it has been 6 months and people are still living in appalling conditions.

Food provisions have been cut off so as to limit dependency yet there are almost no options for employment (aside from the "cash for work" programs for which the lucky few Haitians can earn $5 a day cleaning the streets, piling rubble, or cleaning the latrines in the camps). Schools are back in session but they are asking parents to pay for the 5 months that they weren't operating. And hospitals are functioning again yet many facilities are so poor that patients are required to not only buy their medicines and pay the doctor visit, but also buy the latex gloves the doctor uses to examine you with or the needle and syringe he uses to treat you with.

Rubble removal throughout the city is almost non existent, and since the government has been so slow to provide any help or guidance on rebuilding people's homes, people have begun to do it on their own using whatever wood, concrete, and bent rebar they can find.

So yes, things are still quite bad and it's both appalling and tragic that the government remains basically silent in the aftermath of this tragedy when they possibly could have galvanized the support of the entire world to rebuild Port au Prince and encourage decentralization by upgrading the infrastructure of the outlying cities. As it is, the opposite is occurring. People who initially left the city to live with family or friends around the country are now moving back into this city that was built for 500,000 that now hosts over 2 million people and counting. It seems that no matter how bad the outlook is in Port au Prince, prospects for jobs outside the city are worse.

However, despite all of this, I truly don't leave Haiti discouraged. To be quite honest, I don't think you can expect that after the largest natural disaster in the Western Hemisphere in the poorest country in the same region that things will be better, or even back to normal, within 6 months. I'm fairly certain that some people in New Orleans were still living in asbestos filled FEMA trailers years after Katrina hit and it took almost four years to start clearing out and rebuilding the Lower 9th Ward. It might be overly optimistic to think that Haiti, with the host of problems the country was already facing, should be able to move people back into their homes in that amount of time.

And at the risk of sounding like a broken record, I've gotten to meet and spend time with some incredible and dedicated Haitian people who are absolutely committed to lifting their country up from it's current state. These doctors, politicians, philanthropists, and activists have not given up on their people or their hopes for a better Haiti. They are frustrated by the Haitian leadership and by the soaring budgets of many of the large international NGOs in Haiti who are not focused on sustainability or empowering the Haitian people. But they are encouraged by the sad fact that as a result of this event, many of their hospitals are now better equipped, their schools are being rebuilt better, and the world may actually remain focused on Haiti for years to come.

Sacramento Bee Article

2010-06-27T07:42:00.000-07:00

Hello out there,

I'm heading back to Haiti today for a week to visit sites and start putting together a six-month post earthquake assessment. I'll try to send out a couple notes while I'm there but in the meantime, here's an article that I wrote for the Sacramento Bee, my new hometown paper, that was published today.

http://www.sacbee.com/2010/06/27/2850473/future-remains-uncertain-in-quake.html#none

Violence in Haiti

2010-05-17T09:01:00.000-07:00

During the past four months that I’ve spent in Haiti, I’ve gotten lots of questions from friends and family (mostly from my loving and worried mother) about how safe it is for her child to be staying in the outskirts of Cite Soleil in Port au Prince. And I’ve had a difficult time answering that question. It turns out; Haiti is a hard country to stereotype.

Haiti has long been declared the poorest and most violent country in the Western Hemisphere; with Cite Soleil the largest and most dangerous slum in this country. Cite Soleil borders the city of Port au Prince on Route 9, which is next door to where my colleagues and I have been staying over the past four months. However, during the time we’ve been down here, we never been attacked or really even felt threatened in any way. We’ve seen some fairly violent fights break out at food distributions and gas lines. We’ve driven behind a truck filled with food that got hijacked by young men who jumped inside the trailer (unbeknownst to the driver) and emptied all the food to their friends waiting in the street. True, we are rarely greeted with smiling faces as we drive past the newly erected shanty towns on our way to our apartment. And yes, people do get quite upset when you take a picture while driving past in a speeding car. But how can you blame them? They are living in the poorest city in the western hemisphere; have just been through the worst natural disaster for the area in history; are aware of the $1 billion has been raised on their behalf yet are still living in tents (if they’re lucky) without any hopes for immediate improvement.

However, while we didn’t ever experience it firsthand, we have heard many stories of kidnappings and shootings during our time here. There was a well-publicized case of the two Medicines sans Frontiers workers who were kidnapped (and later released) upon leaving their clinic. And we also heard from a colleague at St. Damien’s Children’s Hospital that two U.S. aid workers were shot outside their facility near the U.S. Embassy earlier this month, although I have yet to find any documentation of it. And many of the NGOs that we work with in Haiti wouldn’t even venture over to our office/apartment off Route 9 because of the violence and widespread reports of shootings and robberies during the Aristide years five years ago. Indeed, a couple Haitian citizents who had come from the states to work with us for a short time were unwilling to even come with us to our office.

I’m sure that Haiti can be and has been a violent place over the years but I’m always puzzled by these accounts because I just have not seen it during my time here. I’ve seen small acts of aggression due to unimaginable desperation. But those acts pale in comparison to my interactions with some of the kindest people I’ve ever met in my life. In fact, on the same day I heard that the two people were shot outside the Embassy, a Haitian man I didn’t even know literally gave me the shirt off his back because I said I liked it.

Like I said, it’s a hard country to stereotype.

Where does the Money go?

2010-05-14T14:16:00.001-07:00

The Chronicle of Philanthropy announced yesterday that over $1.1 billion has been donated to support relief efforts in Haiti. The largest recipients include the American Red Cross ($444 million), Catholic Relief Services ($135.7 million) and Oxfam International (over $100 million). This outpouring of generosity on the part of the world community is unprecedented and should be applauded and (hopefully) repeated. And for the most part, from what is possible to observe in Haiti, these organizations have been good stewards of this money, doing as much as they can as efficiently as possible to assist those who have been affected by the earthquake.

However, all of this money that has been raised on behalf of the Haitian people begs the question of whether or how the Haitian people will actually benefit from it. Of course, the money is being spent on Haitians' behalf by the NGOs that received it, but that's different from allowing them to spend it themselves. How much do their voices count in allocating this money or even giving it to them to empower their communities, rebuild their schools and hospitals, or provide education to their children? How much of the money will actually remain in Haiti for the decades that it will take to rebuild?

A few months ago, the students at the University of California at Santa Barbara held a fundraiser for Haiti and decided to donate the $25,000 they raised to Direct Relief International, the organization I work for that has been providing medication and medical supplies to hospitals in Haiti since 1964.

Among the speakers that evening was Professor Claudine Michel, a dynamic accomplished member of the Haitian Diaspora who edits the only peer-reviewed Journal of Haitian Studies in the world. Another speaker was Dr. Nadege Cilatandre, also Haitian, a brilliant young scholar who engaged in post-doc studies as a University of California post-doc Fellow. Nadege provided a rich retrospective on Haitian history and also showed the 600 attendees photographs of a community center, complete with a library and computer lab, in Carrefour-Feuilles that she personally had helped create with small-scale contributions and volunteer labor though Haiti Soleil, a small nonprofit she had established. The center was destroyed in the earthquake but the staff had self-organized and begun providing emergency help to the families and community that it serves. They lost nearly everything, spent what little financial cushion existed to help pull the community together, and continue doing this work as the months tick by.

Direct Relief’s CEO, Thomas Tighe, was at the meeting too. He told me he afterwards he was both humbled and puzzled after hearing these presentations that the funds collected from UCSB’s students would come to Direct Relief instead of Haiti Soleil to rebuild the library. But it gave him the idea to have Direct Relief serve as a conduit for channeling funds to well run, local, Haitian-run NGOs that have been working in their communities for many years and simply do not have access to funds that the international NGO community has.
The hallmark of Direct Relief’s approach is that we look for the local leaders who invariably do all the important work where the rubber hits the road. We look for the people who are plugged in, deeply committed, very smart, and with credibility and trust earned over many years. In any community (think of who you’d want to hear from in a local emergency in your own town) these are the people whose ear to the ground and ability to make things happen is essential.

But, as we’ve learned over many years (and is clear to me again after the past several months in Haiti), these great local leaders are often so busy doing great work for the people in poverty areas that they they’re invisible to individual donors and the large funding streams. For whatever reasons, funding tends to find its way only to large groups steeped in the arcane bureaucracies of government funding or have world-class, rapid-response marketing that can galvanize attention and resources when a high-profile emergency occurs and people are inspired to give.
Since then, Direct Relief has allocated an initial $500,000 from the Haiti contributions received to serve as a ‘community grant fund’ that offers local groups the ability to access grants for up to $25,000. So far, we’ve received over 40 requests and have provided $125,000 to five local groups to: begin rebuilding the library and community center in Carrerfour-Feuilles, keep free medical services open at a community hospital for three more months, re-open a medical clinic in Delmas, provide psychosocial support to youths who have left Port au Prince for the northern district, and start a feeding and therapeutic support program in the devastated Carrefour-Feuilles area. Those funds will be spent in, and reinvested in Haiti, directly. We’re hoping that our support, and listing these groups on our website, may give them some profile and help them attract other resources, including directly from others who might learn about them in this way.

All of these groups that we are fortunate enough to be able to provide grants to have been working in Haiti long before many of the rest of us came in to help and have a great sense of what their communities need. No one has a bigger stake in making sure these resources make a difference. We just don’t always think to give them the resources to do it.

Meeting a Supreme Master

2010-05-05T07:11:00.000-07:00

I'm spending the week traveling with Claudine Michele, a professor of Haitian studies at UCSB and the editor of the only scholarly Haitian journal in the U.S. She and former student named Nico Pascal a have come to Haiti to help Direct Relief select Haitian NGOs to fund. As I've mentioned in the past we have established a $500,000 community grant fund to let Haitian groups who have been working here long before the earthquake get access to the money that has been raised for their country. So far we've selected five groups and are hoping to fund at least 15 more.

So after picking Claudine and Nico up from the airport, we drove an hour north to Mirebalais to visit a K-6 school modeled after the Montessori system. The place was like a paradise. It was peaceful, serene, and best of all, every single kid had a smile on their face. It is something that you do not see very often in Port au Prince and it was extremely refreshing.

From there we drove to Gressier, about 3 hours SW, to visit with Max Beauvoir Haiti's high priest of the voodoo religion. It was an honor to meet this man as I've read a lot about him and his work as I've tried to gobble up all the information I can about the voodoo religion. The man is a personal friend of Bill Clinton, has met Ban Ki-moon, fled the country during Aristide's rule, and got voodoo recognized as an official religion in the states. I could have spent all day listening to him speak but unfortunately, believe it or not, some Scientoligists showed up to speak to him about opening up a medical clinic across the street from his house.

Essentially, Mr. Beauvoir is concerned that the earthquake will erase the voodoo culture in Haiti because it knocked down some of the main temples in the country and nobody is paying to rebuild them. He says most of the churches will get rebuilt but nobody wants to pay to fix the temples and the majority of Haitians who practice the religion aren't wealthy people. It's a tough situation. Clearly these places of worship should be preserved but there aren't many NGOs are going to want to get behind a project like this.

Again, another aspect of this earthquake that you'd never think about but has fairly devastating consequences for the history and culture of Haiti. For me, it was an honor to meet a man who has dedicated his life to preserving it.

What a Day!

2010-04-27T20:03:00.000-07:00

Yesterday, the CEO of Direct Relief International, Thomas Tighe, arrived into Haiti with his 16 year-old son Travis. I don't know whether it was just good timing or kismet, or just fantastic (Plandrew-ing) but in the first five hours of his arrival, we had met with the Minister of Health for Haiti, Paul Farmer of Partners in Health, and the head of health services for USAID Haiti. Because his arrival coincided with a large meeting of ministry and health care officials who were discussing the interim plan for health care in Haiti, we were able to get them all down together at one time to discuss ways we can assist the country recover from the damaging health-related effects of the earthquake. They were all grateful to hear what we've done and we have plans to meet with the head of pharmaceutical services tomorrow to discuss what medicines are needed and how we can best communicate and deliver the products we are bringing into the country.
And to top it all off, Paul Farmer, who I've never met, recognized my name from a Huffington Post blog I wrote about Partners in Health. He said that although he never reads blogs because of all the bad information that circulates out there, he really thought my post on the long-term health services in Haiti had captured the nuances that many people miss. And to show his sincerity, he personally signed and sent me a copy of his new book.
It feels like Direct Relief is genuinely starting to get some traction in this country and people are beginning to take notice of who we are and what we're doing.

Getting Ahead in Haiti

2010-04-26T17:56:00.000-07:00

A few days ago, my colleague and I were scheduled to drive up to Hospital Albert Schweitzer to assess their medical supply needs and determine what more we could supply them from our medical supply inventory. Unfortunately, as we soon found out, we wouldn’t be able to make the three hour drive to Deshapelles because our car was out of gas and our local staff member had been unable to purchase gasoline for pretty much the entire week before we arrived. When he was able to get fuel, it was only after waiting in line at the pumps from noon until 5:30pm because he didn’t want to risk purchasing it from the street vendors who often mix it with water. So unfortunately, we had to cancel the trip and turn it into a work-from-home day. We are now on constant alert for gas stations carrying fuel so we don’t get stuck again.

But a gas shortage in Haiti doesn’t just mean fewer cars on the streets. It means that houses, hospitals, schools, and businesses can’t run their generators to keep their lights on or the equipment running. Now that many hospitals in Port au Prince are working out of tents using generator-powered equipment, a fuel shortage can have devastating consequences.

And a gas shortage cripples businesses as well. The warehouse we rent as a storage and distribution site for medical supplies is actually in a factory where they process and bag clean drinking water and make huge blocks of ice so people can have cold drinks. A lot of people do not own ice makers, but even if they did, they would also need constant electricity for the units to function. So this business distributes bags of water and blocks of ice get via truck to local vendors who sell them on the streets. And a gas shortage means that they cannot make clean drinking water.

The barrier for entry for businesses in Haiti is extremely high, and this is a huge contributing factor for the high unemployment rate.Things we completely take for granted in the US are not so in Haiti. To open a business, you not only have to provide your own security, but you also have to ensure that you have your own constant fuel supply (or, rather, a reliable source electricity, like solar.) The entrepreneur-owner of this water and ice factory spent eight years lining up all the necessary pieces, and when he finally did open, he had 10,000 people come in to apply for 500 jobs.

People want to work; they just don’t have the opportunity to. A fuel shortage affects every step in the commercial processes of manufacturing, distribution, and sales. And a fuel shortage doesn’t inspire much confidence for entrepreneurs here, who, like everywhere else drive economic activity.

Haitian Hospitals in a Catch-22

2010-04-21T06:17:00.000-07:00

Since the devastating earthquake on January 12th, hospital services in Haiti have been provided to patients for free. No matter what your status or ability to pay, for three months after the earthquake you could feel certain that you could see a doctor and (hopefully acquire medications) for free. This was a fantastic service and was a great idea because it enabled the poor to have access to the health care services that they often go without.
However, the free service in many facilities has now ended because these hospitals have only been guaranteed reimbursement for their services until April 12th. Many hospitals are now struggling with what to do next.
If they begin charging people to see the doctor, the majority of Haitian people will not be able to afford it. Thus, the follow-up treatment that is so essential for people who are newly handicapped and people with chronic conditions will go untreated. However, if they do not charge, many hospitals will be forced to shut their doors. In fact, one of the premier hospitals in the country, Hospital Sacre Coeur (CDTI), recently shut its doors because they sustained a great deal of damage to the hospital building and had to spend so much of their own money treating patients for free while (still) waiting for the reimbursement monies. Like any other business, a hospital must have income to finance their operations. Even the non-profit hospitals, of which there are many fantastic ones in Haiti, have to generate income somehow to pay the staff and the buy the diesel for the generator.
However, there is another devastating aspect of this story. As we all know, there was an incredible number of doctors and nurses who came to Haiti in the aftermath of the quake to assist in these facilities and the work they have done in the past three months has saved countless lives. It has been easy for these medical personnel to work in any of the hospitals and clinics in the area because everyone was providing services for free. These overseas medical personnel don’t want to make the patients pay for services they are providing out of the goodness of their hearts. However, now that some hospitals are beginning to charge again, these doctors and nurses are avoiding those facilities that are forced to take fees. These hospitals are now losing the expertise of the overseas medical personnel who do not want to work in a place that is charging the patients for the work they are doing for free.
Unfortunately there is no easy solution to this problem. The health care system in Haiti has been set up as a fee-for-service model. To change that now would take a lot of money that Haiti does not currently have. Unfortunately, if it doesn’t change, the hospitals will have to begin charging patients, overseas medical personnel will not want to work in these facilities, and the Haitian people will suffer as a result.
An efficient, self-sustaining and self-financing system for health care is very attractive but also very hard to achieve. Even the United States, the richest country in the history of the world, is trying to figure out how to do it. Significant resources have been donated for Haiti in recognition of the immense scale of loss and much of these resources have been used in part to subsidize the most basic goods and services (including health care) that people need but simply do not have the ability to pay for. Pulling this subsidy out now, three months after the worst disaster in the Western Hemisphere seems too abrupt. If there was a gradual lessening, rather than a complete elimination of the subsidy, perhaps there would be time for the market forces to kick in without kicking out all the people who lost everything.

Huffington Post

2010-03-25T14:44:00.001-07:00

Hi out there,

Check out The Huffington Post's new blogger!

Mine is the one directly above Sienna Miller's post...

Another Airlift

2010-03-19T12:37:00.000-07:00

Every so often something happens down here that makes you think that some of the coordination effort between the UN, aid organizations, and the government is actually working. The UN has the tremendously difficult task of trying to coordinate and oversee the over 900 foreign NGOs in the area to avoid duplication and ensure that everyone in the earthquake-affected area is receiving aid. As you can imagine, this often looks a lot like herding cats (or maybe even wind).

NGOs are autonomous agencies and have their own ideas on what they want to accomplish and how they want to accomplish it. However, one of the bright spots in this whole effort is the UN logistics cluster that provides supply-chain and transportation support to groups like us who are providing essential medicines and supplies to hospitals and clinics so that patients can receive the kind of care they deserve.

Like many other organizations currently working in Haiti, we are primarily focused on distributing these medical supplies to the earthquake affected areas of Port au Prince and Leogane. However, medical facilities all over the country are now over-burdened by the thousands of Haitians who have relocated from these areas to go live with family and friends.

The effects on the outlying health facilities are intense. They are receiving additional patients into their already tenuous medical system (511,405 people as of February 17^th) but generally not receiving any of the aid that the hospitals in affected areas are. Indeed, after meeting with the WHO last week I found out that they too are focusing their medical relief efforts specifically in these few cities.

So we have made a concerted effort to try and get medical relief supplies to hospitals and clinics distributed throughout the rest of the country. However as anyone who has been to Haiti can attest, the roads are in tough shape and the traffic within Port au Prince can turn a one kilometer drive into a two hour sweaty standstill. So when we heard that the UN was offering helicopters to move humanitarian cargo to areas that could not easily be reached by roads, and that the service was actually being underutilized, we thought it was too good to be true.

So after receiving a request of medicine from an organization called the Haiti Hospital Appeal, who are supporting the influx of patients (many of whom are amputees and quadriplegics who have come off the USS Comfort) at the Baptist hospital in Cap Morin, we loaded up a truck with two tons of antibiotics, oral rehydration, and pain medication for children and brought them to the UN airfield to fill up the Mi-8 chopper. The entire flight and unloading time was only two hours (as compared to the roughly 20 it would have taken by road) and before we knew it we were back at the airfield and they were packing it up for the next trip.

After spending six weeks down in Haiti, I’ve realized the most important part of effective aid delivery is planning and coordination. Planning your route so you don’t sit in the traffic. Planning what services you are going to provide so you don’t dump any useless items on the recipients. Coordinating your efforts with other NGOs to ensure that all the facilities here are being looked after. And in this case, utilizing the coordination efforts of others so that the support for Haitian people can stretch far and wide.

Support for the locals...

2010-03-17T19:54:00.000-07:00

I've been thinking a lot lately about the money that's been pouring into aid groups to support the people in Haiti. Almost 1 billion has been raised in the US alone by private charities. Of course, it's not yet close to the 14 billion the government says it's going to take to rebuild, but it's pretty damn good.

However, as I've mentioned before, I wonder how much of that money will actually be seen or directly contribute to the well-being of the Haitian people? I've read that groups who receive money from USAID to assist in the recovery effort only have to spend 30% of that money within the country they are assisting. The rest can be spent on hiring staff, procuring (American made) equipment, and whatever else they choose to spend it on really. So that's why I'm really glad to be doing the kind of work we are doing here.

Today for example, Scott (a new DRI-Haiti staff member) and I filled up Pino's truck with pallets of medical supplies for four hospitals around Port au Prince. Not only are all of these hospitals providing free services to every patient who comes in, but they are all completely run by Haitian doctors, nurses, and administrators. While they are all currently receiving support from overseas medical personnel, the fact that they have been around since before the quake means that they are not going to be gone in a few weeks or months down the line. And that means that the medical supplies we are providing them directly support their infrastructure and long-term capabilities because they can take the money away from buying costly medicines and use it to rebuild their hospitals.

One of the hospitals we went to today was Grace Children's Hospital. They are a non-profit hospital that before the earthquake was providing free treatment and medications for children with HIV and TB. Before the quake, they had a multi-story facility with multiple wards but now that the their hospital is destroyed the children who stayed there are now sleeping in tents outside. And at this moment, it's pouring down rain. When we went to drop off the medicines today, the medical director thanked us profusely for the supplies, but then proceeded to ask us if we could provide any money so they could start to rebuild the facility and continue to run their generator. Since their is no electricity in PaP without one, it essentially means they need money to keep the hospital open.

And this brings me to the other aspect of our work down here. Direct Relief has decided to fund locally-run organizations so that we can ensure at least some of the money raised for Haitian people is actually getting to them. After hearing this request from the director, I knew exactly why a fund like this is so important. Even if groups like DRI provide them with free medicines and other groups provide them with medical personnel, they cannot continue to run their hospital without raising the money to pay staff, buy diesel fuel, or repair the buildings.

Likewise, yesterday Brett and I met with a woman named Nadege (who is actually a professor at UCSB and was born in Haiti) and her father to discuss the possibility of providing funding for him to rebuild his library and community center in Carrefour-feuilles, a city just outside of PaP. This library served a population of 250,000 people and provided parents with a safe place to send their kids where they could use computers, go swimming, or read one of the 8,000 books from the collection. The library was completely destroyed as a result of the quake so they basically need to start over from scratch.

And while we were there, another group came in to request that we fund them to provide food for the 16,000 residents of this city who haven't gotten any support from any other organizations since the quake. This group had spent the last two months canvassing the city to ascertain who had perished in the quake, what families had moved, and what the immediate needs for people were. Unfortunately, once they had completed the survey, they had no funding to provide the most destitute of these people the food, water, shelter, and medical attention that they so need.

I think we all have to remember that the money raised to help the people of Haiti should go to the people of Haiti. Clearly not every penny is able to make it down here, but I think too often we get bogged down with doing what we think the people need and don't usually take the time to ask them. Or provide them with the resources to do it for themselves.

Highs and Lows, Strikes and Gutters

2010-03-15T20:11:00.000-07:00

I've noticed lately that my outlook on things here change by the minute. Every time I think things are going well and some positive may eventually come out of this tragedy, something brings me back down to earth.

A few examples...

On Friday we spent the whole day in the warehouse distributing medicines and supplies to the various hospitals and clinics who we are now working with. Everything they received was specifically requested and can be used to treat the patients in their facilities no matter what their capacities are. These partners vary in the services they provide (one group of doctors from the Tzu Chi Foundation are doing acupuncture in a displaced persons camp) and the numbers of patients they see, but they are all providing their services and the medicines for free. One of these groups was telling us that they are going to ship in these pre-fabricated houses and set them up in a camp so that people will eventually be able to get out of these tent and tarp shelters. People seemed to be doing really good work and at the end of the day, we felt like we had done something to improve the health care of the people being treated by these types of groups. The outlook seemed bright.

Later that night however, we had a long talk with Pino, the owner of the water purification and bottling factory that our warehouse is located in. He has crews in here 24 hours a day, every day except Sunday, making over 10,000 bags of drinking water a day. And in doing so, he directly employs thousands of people. And I had never seen Pino get angry until he heard that overseas groups were going to ship in and build houses for the people in Haiti. What Haiti needs, he said, are jobs. And industry. And investment. And infrastructure. People need to work and they don't need houses built for them. He said when he opened the factory, he had 10,000 people lined up for a job and at the time, only had 500 available.

Hearing this makes me think of the old "give a man a fish" saying. So far, the international community has raised almost $2 billion for Haiti and with that, the immediate needs of shelter, water, food, health, and sanitation are being addressed as best as anyone could have hoped for. But you can see the picture of Haiti in a year from now. That money will be gone and there won't be any more opportunities than there are now except for the few who still have jobs working for the remaining NGOs. If even a fraction of the money raised was spent just to improve the roads (an obviously unglamorous proposition for how to spend aid money) it might be possible for some industry and trade to develop. So needless to say, after the talk with Pino, depression set in...

But alas, today was a new day and we were able to load up a truck with 12 pallets of supplies (mostly Pedialyte for kits who need fluids replaced) to the Petionville Country Club--former golf course and current site of the largest tent city (70,000 people at last count) in PaP. The four medical clinics inside the city see an average of 3,000 patients per day and just as we were walking into one today a baby was being delivered and was eventually named after Alison, the American nurse who delivered her.

When it came time to unload the truck, since there was no forklift we rounded up a team of about 30 people to bucket brigade the supplies into the storage tent. In the line with us, was a guy from the Center for Disease Control who has been studying the health infrastructure in Haiti since April and has now been tasked to study the possibilities for outbreaks in these camps. He said that because of the unsanitary conditions in the camps, they are predicting huge problems of diarrhea and dehydration and the Pedialyte we were unloading would literally serve to "quell the outbreak." It made unloading this truck for four hours in the 90-something degree heat feel pretty good. And afterwords, Sean Penn thanked us for what we are doing because his group is the one running all the medical tents in the city!

But then, just as we were on a high from the day, on the way home we saw a relief truck in front of us carrying boxes of food get hijacked. Basically, a few guys jumped into the back of the truck, opened up the gate, and just started throwing all the boxes out to their buddies waiting on the street. The driver was in the tractor part of the truck and had no idea what was going on. I guess as long as the food is getting to the people it's not a big deal but unfortunately this will probably get sold.

We'll see what happens next...

Deliveries Begin Again

2010-03-11T19:27:00.000-08:00

Hey out there. I have a couple pieces of great news to report.

First, my colleague and good friend Brett came down on Tuesday morning so I'm not flying solo here anymore. I have to say however, that while it's great to have him back, it actually wasn't bad being here alone since I was rarely truly alone. Most days I spent at least 17 hours (or what felt like it) in the car with my boy Pascal (see him and I below at this amazing beach in Jacmel on our Sunday beach day) and the rest of the time I was in meetings, visiting hospitals, or spending time with the doctors in the house. But either way, it's great to have Brett back down here.
The other great news is that we got our own little office and apartment set-up above our warehouse. Now we have a place to work from, we can be here when people come to pick up products, and we have a place to stay that is already set-up whenever we come down. And it's actually turning into a real-life apartment. When we first came in it was totally barren because they had just finished building it when the earthquake hit. But on Tuesday they put in the shower, yesterday we got the stove hooked up, and today we even got a kitchen sink installed! And because this place is actually a water factory, I'm convinced that we have the best bathroom/water pressure in all of Haiti.

And yesterday, after a couple small customs issues, we collected the shipment of 53 pallets from the airport and delivered them securely into our warehouse. (All the cuts are from customs officers inspecting the products to make sure we're actually sending medicines). After spending time today organizing and inventorying the products, we sent out a list of what we have here to the over 30 new hospitals and clinics that we've identified and have already received requests for all of it! These items include everything from standard painkillers, to asthma medicines, to antibiotics, and re-hydration formula for babies.

Tomorrow we'll spend the day distributing these products to the partners and will hopefully collect more info on their specific needs. For example, one of our largest new partners is a group called the Jenkins/Penn Haiti Relief Organization (as in Sean Penn) and they are running the largest tent city in Port-au-Prince where roughly 80,000 people are people living, bathing, receiving medical attention, going to school, and trying to make a new life. Our plan is to continue to support them in the future with hygiene kits that contain basic items like toothpaste, soap, and diapers that are so desperately needed in these camp settings where sanitation and hygiene remain one of the highest priorities.

Finding the Cure for What Ails You

2010-03-09T03:49:00.000-08:00

A few people have written to me asking about my mental and psychological well-being after seeing the devastation and spending so much time in hospitals here. First, let me say thank you for thinking about that aspect in all this. And second, the only word I can really think of to describe the way I feel every day is overwhelmed; and that doesn't even really do it justice.

But I think those who had been to Haiti before the earthquake would say the same thing. Life here in general, is overwhelming. The anger over government corruption and ineptitude, the absolute poverty (especially on an island where the other half is doing just fine), the crowds, the noise, the constant feeling of claustrophobia, the crappy roads that turn what should be an hour drive into a five hour drive, the number of kids begging on the streets, the lack of any kind of infrastructure to create schools or hospitals, and the general feeling of hopelessness that things will get better soon; it's all overwhelming. And then the earthquake hit.

It's typical to hear stories from people who were walking through the streets minutes after the quake hit and could hear people yelling from underneath the rubble and were not able to do anything about it. Parents with their kids underneath. Brothers with their sisters. And students with their classmates. The far too casual manner in which these stories are told make you think that these people have not fully processed what has happened and I know for sure that there aren't enough therapists in Haiti (read: zero) to deal with these long-term mental health issues.

As for me, I have no doubt that some of these things will stay with me for the long-term, but in hopes of gleaning something positive out it, I'd say that it will help me keep perspective in life. For the time being, the thing that's been beneficial for my own mental health has been staying in this house with people who are working in a medical clinic down here. We are all seeing things that don't leave you very easily and it's been great to come back from the day and discuss the things we went through that day.

That, and the fact that last night a new person came down with a two-day old Dashound/Yorkie puppy and after spending some time with that little guy I was ready to go out and fight the world again. I think you just need to figure out your own cure and last night, this was mine.

You Tube Video

2010-03-08T10:26:00.000-08:00

Just noticed a video has been posted on Direct Relief's You Tube page of me updating the situation on the ground. We recorded this when I was back home after the first trip.

Watch it here on: You Tube

Hello out there?

2010-03-07T18:43:00.000-08:00

So I have this Google Tracker device telling me that I have a fair number of people out there in multiple different countries reading this blog. I keep telling myself there must be a glitch, but if not, two things come to mind:
1. I'm stressed to know that there are people out there actually looking at this thing
2. Where are all the questions and comments from the readers? Am I answering everything you want to know about Haiti? I must not be.

So please feel free to write in and ask a question, let me know something you want to hear about, or just tell me a funny story so I can have a laugh when I come home at the end of the day. I'd love to hear from you and I hope you'll continue to follow along with the story.

Cheers.

Just when I thought I was doing pretty good work...

2010-03-06T17:50:00.000-08:00

I'm spending the weekend down in Jacmel; a large city in the south coast that was severely affected by the earthquake. It is the largest city in the region and in the past has served as one of the (few) tourist destinations in the country. The town reminds of me New Orleans or Puerto Rico. It has narrow streets lined with high-walled houses and balconies where people can drink local rum and survey the goings-on in the town below. And the beaches that run along the south coast of the city are as clear and blue as anywhere you'd see in the world.

We have been working on a plan with a few other organizations to start up a medical depot here so that all the medical facilities in the area (from east to the ocean and west t0 the border of the Dominican Republic) could access the medicines and supplies they need. We had a great meeting yesterday with all the organizations involved and I really think that we might be able to supply the medical needs of entire the region. Already, our medicines are reaching over five major hospitals and over 30 clinics and dispensaries in the region.

Today I went to visit some of these sites and became even more pumped about the plan. We first stopped by Bumi Sehat; an organization of nurse midwives from the States who are setting up a birthing clinic in Jacmel that will serve as the only free birthing clinic in the area. (This picture is me with one of the local workers helping to set-up their clinic on newly acquired land.)

Then I went by two of the largest hospitals in the region who have also accessed the medicines in the depot. Being a Saturday, many of the doctors were not around (7th Day Adventists are big in the area) but we were able to see the facilities and the numerous patients staying in tents outside the buildings. As I have mentioned earlier, in addition to the fact that Haitians are extremely scared of earthquakes, the government is also telling people not to sleep indoors so even structures that remain intact after the quake are not being utilized. For example, I'm currently staying in a guesthouse with a few other aid workers and when I asked my driver Pascal to sleep inside the house, he politely refused saying that he's too afraid to sleep under the concrete.

So anyway, I was feeling pretty good about the way things were progressing down here and, given that it was about 5pm on a Saturday, I felt like I might be ready to stop working for the day and have a beer. So me and by buddy Ceasar, another guy I recently met who is working with us on the depot, decided to swing by and pick up his friend Sarah Wallace and go have a beer at a local spot. Since the local beer factory, Prestige, collapsed in the earthquake, you can only find foreign imports now but I was lucky enough to stumble upon a place that was fully stocked with icy-cold Guinness!

As it turned out, Sarah (listed here between Scott Brown, Barack Obama, and Tim Tebow on CNN's most intriguing people for January 2010) is a 24 year-old Canadian midwife who moved down here 18 months ago to start an orphanage completely on her own. After realizing that many of the kids in orphanages down here actually have parents who just can't take care of them, she decided to change courses and open a birthing clinic for pregnant mothers so she could help reduce maternal/infant mortality and educate the moms about the need to keep birth rates in Haiti low. (She's pictured below with two of the kids she's birthed and subsequently named.)

After already being completely blown away by the work she was doing, on the way home we stopped by her house that she has been living in for over a year and saw that she's surviving on $200USD per month in a house with no electricity or running water. Being the founder and CEO of her organization, she decided on her rate of pay and is using these funds to pay local staff as well!

And to top it off, she has begun making micro-loans to local folks who need some money to start a small business of their own. To my great pleasure, the first guy she funded is a sandal maker. After hearing this, I immediately asked to meet this sandal-smith and asked if he would possibly be willing to make a sandal for my (size 16) foot. He said he would gladly do it, but he would need to buy extra material a new wooden mold because he didn't have any that would work for my foot. Sarah tried to convince him that he might not be able to find a mold my size in Haiti and that he might have to just measure my foot free-hand. He eventually relented and measured my foot on a large piece of cardboard (to the great amusement of his parents, sisters, cousins, and children) and agreed to have my new sandals completed within two weeks. I have no idea what they are going to look like, what the price will be, or if they will fit without the mold to guide him, but I'm pretty excited to find out!

Thoughts on past few days

2010-03-04T19:26:00.000-08:00

I think taking a week off to get out of Haiti was a good idea. Without knowing it, I had started to get used to things down here and accepted things that I saw as normal when they really shouldn't be.

Buildings (this one being a school) should not look like this.

People shouldn't be living in the center divider of a major highway in 'houses' like these.

And you should definitely not have to wait in a line like this to see a doctor.

I think that certain things have become accepted here and the problem is so huge that it's hard to focus on anything more than tomorrow. There are naturally so many immediate concerns (food, water, health care, temporary shelter) so the larger issues that have been plaguing the country for years (government corruption, unemployment, lack of infrastructure) are naturally falling by the wayside.

What concerns me is that most of the groups that I got used to seeing during my last three weeks here have now gone home. There was a huge international presence initially and that was incredibly refreshing. But there are very few left. And that leaves the prospects for rebuilding this country and addressing the long-term problems seem incredibly slim.

Today I visited two completely different types of medical facilities but the great thing about both of them is that they are committed to staying in Haiti and figuring out a way to treat the people for the long term. Since the earthquake, Partners in Health (a group started by a Harvard Doctor named Paul Farmer in the 80's) have set up four 'mobile clinics' in different tent cities around PaP. These clinics are set-up in very rough conditions and they are essentially operating out of tents (I was reminded of M.A.S.H) in large fields without any running water, medical equipment aside from stethescopes and blood pressure cuffs, or computerized record system. But they services they provide are absolutely essential. They are doing everything from re hydrating kids to treating STDs to testing pregnant moms for HIV. All of this out of a small army tent. (Incidentally, many of the supplies and medicines they are using to do this came from Direct Relief).

From there I went to the University of Miami field hospital that is set-up in four gigantic tents on the airport grounds. While they are also operating out of tents, they have the most state of the art hospital I've ever seen in a field setting. They have everything from surgical theaters (they have operated and amputated roughly 1,000 people) to a neonatal ICU which held the smallest babies you've ever seen. That being said, this is still Haiti, a country without a single incinerator, so all the hospital waste (think about it) is all dumped 1oo yards away under a mango tree. Yikes.

But at least they're staying...

Back to Haiti for Phase Two

2010-03-01T14:09:00.000-08:00

Hey People,
So we've all had a week off. Me from living in Port-au-Prince and you from my incessant blogging. But now I'm back and I hope you'll continue to join me.

I'm kind of thinking as these next three weeks as Phase 2 of the operation. Last time down we did basically what we wanted to do in a hurried frenzy. We got ourselves linked in with the UN, got a warehouse, distributed the first wave of supplies to the roughly 25 new hospitals and clinics we met, and got started thinking about our long-term strategy. Essentially though, we were running around with our heads cut off for 3 weeks trying to get the products out as quickly as possible and didn't have much time for reflection or long-term planning.

This time around I'm hoping to have some time to get out of Port-au-Prince to potentially assist some of the large hospitals around the country that have been inundated with patients who fled from PaP. I'd like to head out on Thursday to visit some of Partner in Health's facilities in and around the central plateau and then head east to visit a hospital called St. Bonifice who are receiving a great deal of post-op patients coming off the USS Comfort (the Navy ship off the coast where they are bringing people who need major operations). From there, I hope to head north, possibly up to Cap Haitian on the far north coast to see some large hospitals in that area. Me and my driver Pascal will bring a tent and some food and have our own little road-trip.

I'm also going to try to connect up with other non-profit groups who are working to provide shelter and water to all the people living in these tent cities all over the capital city. Direct Relief has received a great deal of products like: toothpaste, soap, shampoo, lotion, diapers, sheets, and towels and these items would be perfect for distribution within these camps to people who are literally without any possessions besides their clothes on their backs and tarps over their heads. So we may look to work with groups like Oxfam and Save the Children if to see if we can't assemble and distribute these personal hygiene kits to the hundreds of thousands of people who need these items.

And finally, we've been invited by the government to be a part of their working group to create a strategy for caring for the handicapped and disabled. There were already a large number of handicapped people in Haiti and the earthquake has made amputees out of countless more. This New York Times article spells out the dire situation for these individuals. It is a great honor that they invited us to play a role in the five-year plan and I'm going to represent us at these meetings in the upcoming weeks.

After spending an amazing week back in California splitting time between Tahoe, Sacramento, Santa Barbara, and Ojai, I can't say it's good to be back in Haiti but I'm not bummed about it either. Between the guys at the warehouse, the new office and apartment we are setting up, the house I'm staying at (and the food the women here cook), my awesome driver Pascual, and the variety of interesting people I'm meeting, I'd say that overall it's not that uncomfortable. Of course, every day you get gigantic pangs of sadness and guilt for the absolute poverty and dire conditions that you see. The kids are the hardest to deal with but today I saw a woman on the sidewalk trying to sell her few pieces of fruit and she had her head buried in her arms and you could just understand the hopelessness she was feeling. And when she looked straight at me and held out both her arms with her palms upturned it was all I could do to not give her all that I had on me.

But every so often you feel great about the work people are doing down here and feel hopeful that the conditions might improve. I was looking back at my pictures from last time and remembered this school that had been set up right in the middle of this gigantic tent city. All the kids were uniformed and smiling and there was a huge line of parents trying to sign their kids up. It wasn't much, but it was clearly a beginning.

Last Night

2010-02-18T17:48:00.000-08:00

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

2010-02-16T04:39:00.000-08:00

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

2010-02-13T12:36:00.001-08:00

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

2010-02-12T04:59:00.000-08:00

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

2010-02-11T05:21:00.000-08:00

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

2010-02-08T06:24:00.000-08:00

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

2010-02-06T18:12:00.000-08:00

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!"

2010-02-06T18:00:00.000-08:00

"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

2010-02-03T20:07:00.000-08:00

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

2010-02-01T18:26:00.000-08:00

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.

Almost There...

2010-01-31T19:02:00.000-08:00

Hi there,
We've made it most of the way. After an overnight flight to Miami and then another short flight to Santo Domingo, we are staying overnight at the "Fiesta Hotel" in the capital of the Dominican Republic because the UN flight into Port-au-Prince (PAP) doesn't fly on Sundays. So we are booked on the 1pm flight tomorrow which will get us into PAP at 1pm (something about a one hour flight and going back in time by an hour).

We are lucky to have a guy named Chris from the Santa Barbara Independent with us for the first week to write his own blog and then a feature story when he gets back to SB. So now there are 4 of us and we're actually going to meet a photographer tomorrow who is going to document some of the shipments arriving into the hospitals.

At dinner tonight, we met a group called "Firefighters for Christ" who have been down in Haiti for 10 days in a city just south of PAP. They had some interesting stories to tell about their time down there but the gist was:

1. This experience is going to change our lives
2. The need down there is tremendous and everything helps
3. They got into a couple of tough spots with some rowdy crowds (who may or may not have been carrying machetes) but in the end their prayers made them get through it.

I guess I'll take all the advice I can get...

Underway

2010-01-30T17:49:00.000-08:00

Hello out there. Thank you for visiting my blog. Just before I go into my thoughts and feelings as I sit here in the Los Angeles International Airport awaiting my flight to the Dominican Republic (the airport in Port-au-Prince is still closed to civilians), I should make a few things clear:

1. I have never been entirely sure what a blog actually was until my wife recently forced me to watch "Julia and Julia" and I got a better understanding of the idea.
2. I've never known why anyone would read a blog from some unproven and un-credentialed writer blathering about their feelings on a new technology or the state of the world.
3. Hitherto, I'm not entirely sure what to write or how long to blog for. I just figured that this was the best way to give people an idea of what is happening on the ground in Haiti in the aftermath of this tragedy.

With all that said, off we go...

To provide some context for anyone out there who I don't know, I've been asked by my former employer, Direct Relief International, to travel to Haiti with two other guys to establish a warehouse, office space, and provide logistical support to the hospitals and clinics that we support. Actually, let me take a step back.

Direct Relief International is a non-profit organization that donates medical supplies, pharmaceuticals, and equipment to hospitals and clinics all over the world. For the past 60 years, they have been providing these essential medical items (that are donated by large medical and pharmaceutical companies) to locally-run health facilities to enable the doctors and nurses to do their jobs better. They don't send doctors or start their own hospitals like other organizations. They simply provide the supplies to the people on the ground who are treating the sick in their communities. They do it in over 60 countries worldwide and have recently begun a large program to provide this same kind of assistance to free clinics in the USA.

When the earthquake struck in Haiti, a unique opportunity presented itself. Since Direct Relief International (DRI), has been supporting a number of hospitals in Port-au-Prince and the surrounding areas for many years, they were in a unique position to send large amounts of medicines and supplies to these partners very rapidly. Air-freight shipments were flown in and delivered in the days following the disaster. However, as many of you have seen, this event has struck a nerve with people and the support from both private individuals and the medical industry has been overwhelming. DRI has opened up two more warehouses just to store all the products that have come in for Haiti. Therefore, a decision was made to open up our own warehouse and office in Haiti (something DRI has never done) to receive and store all of these products and deliver them to our partners as they request it. This will take the burden off them and enable us to get the products they need much more quickly. Since my background with DRI has been both in the logistics side and the program side, (and since I have just gotten my Master's Degree and am currently unemployed) I am in the unique position to help them accomplish this.

At this moment I feel a mixture of excitement and trepidation. I am glad to be able to help the people of Haiti in a way few others can. I understand the goals, think they are achievable, and know what success will look like. However, there are so many unknown variables that make me slightly anxious. For example:

1. None of us speak French or Haitian/Creole
2. None of us are doctors
3. We don't have a place to stay (but are stocked with camping gear)
4. We don't have any security (as of yet)
5. We don't have a warehouse or any trucks

As with anything in life, we'll just do our best, play it by ear, and go with the flow. I'm hopeful that soon after we arrive, we will make contacts with other NGOs and local Haitians who can help connect us to what we need. We don't have long to figure out however, as numerous trucks and planes are arriving loaded with supplies on February 4th. We have to make sure they can get to the people who need it as quickly and safely as possible. Should be a piece of cake...right?