Friday, November 11, 2016

Rehabilitation medicine in Haiti

Rachel Lampros, PT, DPT, SCS, of the Sports Medicine Center in the MGH Department of Orthopaedics, was awarded the Durant Fellowship to work with STAND Haiti, which provides care in Port de Paix, Haiti. Here Lampros shares her first-hand experience during Hurricane Matthew.

At 7 am, the air in Port de Paix is heavy and still. It is already 82 degrees and humid. As clinicians walk through the entrance of the clinic, they are greeted with a sea of somber faces, both young and old. We see babies crying while mothers combat mounting fevers, fragile fathers – too weak to walk – carried in their sons’ arms and children bent in spastic postures on the ground. Many have travelled days to be treated. Many haven’t eaten in days to afford the travel.

Haiti is the poorest country in the western hemisphere, where 80 percent of Haitians live below the poverty line and 54 percent live in abject poverty. There is no public health infrastructure, making access to basic health care impossible for the majority. Half of the children in Haiti are unvaccinated and more than 10 percent die before the age of 5. Mothers provide two numbers when asked how many children they have: how many born, and how many living.

This October, I embarked on my third trip to Haiti to work in a small home repurposed as a rehab clinic. We provide multiple services including general medicine, orthopedics, pediatrics, neurology, women’s health, wound care and prosthetics. We sleep, eat and treat in the community. Our presence is tangible. This marked my first trip as a Durant Fellow, revitalizing my purpose and polishing my practice. Unbeknownst to me, Hurricane Matthew would craft a different narrative.

When we arrived early Saturday morning, Matthew was still a tropical storm warning. Our team anticipated some rain, road closures and flooding; a recipe for inconvenient travel days at worst. Located in the northwest region of Haiti, our clinic boasts “beachfront property,” a coveted luxury during oppressive days but a dangerous site before a storm surge. 

As Matthew manifested into a Category 4 hurricane, we were shocked to learn many of our neighbors were unaware of the storm’s imminent arrival. Unlike in the United States where we were inundated with the latest satellite imagery on Matthew’s trajectory, there was little to no awareness that we were on the threshold of possible disaster.

Despite closing the clinic for the day, we were swarmed with patients seeking medical attention. We triaged the patients that required emergent care and sent the remainder home emphasizing the severity of the storm. Projected winds of 145 mph and 25 inches of rain meant our neighbors living in tin sheds and tents could literally be swept away. The forecast was devastating.

After Matthew decimated the southern peninsula, it took a hard westward turn away from our clinic. We sustained little to no damage and minimal surge. Our community was spared and our clinic reopened. It is the “disease of poverty” that has chronically enveloped this struggling nation. The lack of indigenous resources, integrated resource management and emergency medical response magnifies the impact of natural disasters and facilitates the spread of illness. In the wake of Hurricane Matthew, this devastated country will become even more vulnerable to disease outbreaks and less equipped to manage its long-term sequelae.  



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