Friday, January 29, 2010

Correspondence from Jennifer Kasper, MD, MPH

Sent Jan.29 3:55 pmI volunteered to work with Dr. Marcelo Venegas-Pizarro (a former DGH board member) through a New York NGO called Housing Works, a branch of Act Up. Housing Works has ties with a number of HIV associations in Port-au-Prince and St. Marc. When the earthquake hit, they were asked by their Haitian colleagues – Dr. Esther B Stanislaus, and Mr. Edner Boucicant, a Haitian journalist - to send physicians to address the needs of people living with HIV/AIDS, help reestablish access to HIV treatment, and provide general care.

At least half of the AIDS clinics in Port-au-Prince were destroyed in the earthquake. PHAP+, a coalition of AIDS service organizations in Haiti, proposed opening a clinic, and this was endorsed by the Haitian Ministry of Health.

I didn’t know what to expect. Yes, I’d been following the news, but nonetheless was in a state of suspended animation. The one thing I was sure of was that I wanted to be of service to the Haitians and assist in anyway they needed. Marcelo and I traveled via the Dominican Republic and were warmly greeted by Edner, our Haitian contact person who led us to meet a group of Haitian health professionals on the grounds of ASON, a grassroots AIDS service organization. We had Haitian nurses, a Haitian physician, translators, people to give water and food to the patients, and a driver to take people to the Central Hospital if necessary. After a group discussion, we set up a makeshift outdoor clinic under an awning, organized the medication inventory and developed simple medical charts. A local family health clinic, Centre Medico-Social de Port-au-Prince (supported by Brooklyn, NY-based Diaspora Community Services), had collapsed during the earthquake, and their clinicians brought what supplies they could retrieve to include with the essential donated medications that had been collected by Housing Works.

In the first three days of operation, with our Haitian colleagues, we cared for 130 patients, providing primary care and HIV care. We also triaged a number of adults and children with earthquake-related injuries to the Central Hospital. Some people presented with headaches, dizziness, poor sleep, abdominal pain, and cough (nearly everyone we saw lost their home and were having trouble securing enough food). After confirming that they didn’t have any serious ailments, we did our best to reassure them and comfort them. These symptoms will linger for the foreseeable future. We need to bring in resources to address individual, family and community mental health issues. Thankfully Housing Works is committed to obtaining safe housing, food and community-based social workers and psychologists for these families. One child I will not forget is Matthieu, a 3-year-old whose right leg was struck by a cinder block wall. His family had taken him to a local hospital the following day, and his ankle was casted. His brother carried him to our clinic. After a thorough assessment, I diagnosed him with a femur fracture. We gave him pain medications, splinted his leg and took him by car to the Central Hospital for orthopedic care. All I could think of was how much pain this little child must have experienced over these last two weeks.

During my time there, we planned a needs assessment to document the amount of damage suffered by all of the HIV clinics throughout the city, note which ones lost staff and ARVs and other supplies. We discussed how to organize all of the HIV associations so that they could advocate as one voice for equitable treatment for all. And we talked about how to secure housing and food for the families in need. I wrote up a list of essential pediatric medications, using the WHO Essential Drug List as my guide. I also wrote up guidelines for the use of PlumpyNut, a ready-to-use food for children with moderate and severe malnutrition, and gave them the name of the doctor in charge of pediatric nutrition within the Ministry of Health.

At night, we slept outdoors with Edner’s family. Thankfully his entire family survived the earthquake but they lost their home. They had lost all of their material goods, but did not lose their intangible wealth. I was overwhelmed by their kindness as they shared their sleeping space and food with us.

The breath of life of the Haitian people is so palpable. It is strong enough to dispel the stench of death. It was very peaceful in Port-au-Prince. The Haitian people with whom I came in contact were warm, generous, and vibrant, with a desire to help those in need. People were carrying on, doing the best they could to restore a sense of dignity and normalcy to their lives.

It was important to me that Housing Works already had an established relationship with organizations in Haiti and that we were invited to help. And we had a cohesive, flexible team that responded to whatever the Haitians felt was needed. I hope to return in the future to work in the clinic and help with more long-term efforts to re-establish health, human rights, and a dignified life for all in Haiti.

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