On the Ground in Port-au-Prince, Haiti

Bonjou fanmi ak zanmi! (Hello family and friends! in Haitian Creole)

As some of you already heard, I have been granted the privilege to volunteer for two straight weeks as a field clinic physician for Heart To Heart International as part of an elective rotation for my Rural Family Medicine residency training. It's exciting to be here! I am now settling in at the Nazarene Seminary compound in Port-au-Prince, Haiti after arriving here yesterday evening. It took 2 days of flying and a long minibus journey from Santo Domingo through a very porous and crazy/congested border to get here. Check out the photos from the 8-hour bus trip over. The surrounding mountains are beautiful. The city here is busy and filthy. I have yet to see the major destruction of downtown (tomorrow I will), but the people look exhausted, dirty and hungry.

Today is exactly one month after the earthquake that devastated the Port-au-Prince area of Haiti, killing over 230,000, injuring over 300,000, creating over a million homeless, forever disrupting and traumatizing the already impoverished nation. As we found out last night, the Haitian president designated today a national Day of Mourning. Everything was basically shut down today and the Haitians have been in white & black (if they have the clothes) and singing/praying/mourning in streets, shelters and churches. Initially I thought we'd be out seeing patients today, but last night we were advised to stay in our compound today to avoid running into any possible riots and disrespecting the Day of Mourning by being out and about. So today we spent time planning and organizing our work and medications/supplies for the coming days and weeks. Throughout the day we've been able to hear a distant but haunting sound of people singing hymns in the churches and streets.

Since the president has also requested the country continue mourning for the rest of the weekend, the Heart To Heart advisors here feel we should wait until Sunday afternoon to open up our little clinics again. So we providers are feeling quite antsy, wanting to just go out there and help people anywhere. Tomorrow morning we will go into downtown Port-au-Prince and see what help we can offer at some of the larger field hospitals that are still having an influx of patients despite the continued days of mourning. Sunday the plan is to run a clinic at the front of our compound after announcing it at church, which brought over 250 patients to be seen when they did it like this last Sunday.

On Monday we start back full-force running the multiple urgent care field clinics that Heart To Heart has been running for weeks now in the Bel Air neighborhood of Port-au-Prince and a couple somewhat outlying cities including Léogâne, the epicenter where mild tremors can still be felt on a daily basis. There is one town the group serves, Grossier, where the only building left standing is the Voodoo temple. Another two towns, Jacmel and Fondwa, will no longer be part of this project for a while because the only road out there is frequently impassable due to ongoing landslides.

In these field clinics, each provider (doc/nurse/PA/paramedic) is seeing 60-100 patients a day, functioning as doctor, nurse, pharmacist, and counselor all at once. Cases include wound infections, sepsis, dysentery, fractures, stomach pain, dehydration, asthma, anxiety, abscesses, hypertensive crisis, STDs, etc. Diarrhea and respiratory infections are really starting to mount. The dust is a major irritant. Malaria, TB, HIV, scabies, worms, and other 3rd-world diseases are quite prominent. Typhoid, dengue fever, measles, meningococcal meningitis, and H1N1 influenza are all starting to spread. Tetanus is starting to show up, not surprising with the hundreds of thousands of dirty injuries and lack of immunizations here. Our charting consists of one line for each patient: age, sex, diagnosis and treatment, which we report to the UN for biosurveillance. There are daily UN Health Cluster meetings/forums that one of us attends downtown, which minutes are posted among lots of other various information that agencies are sharing with each other online.

At a debriefing with the 8 providers who just left here, I heard amazing stories. Some have experience helping in Africa, Katrina, 9/11, and the Asian tsunami, and they say they've never seen anything like this and are seeing cases they've never seen before exc. And they say the people are incredibly resilient and determined to survive and recover.

The providers here have some amazing photos and stories. I look forward to accumulating and sharing my own with you, but here's a sample story from one of the doctors who just finished here last night. A high school girl came up complaining of stomach pains and inability to sleep. She was on her high school roof terrace when the quake hit. Its several floors collapsed like pancakes, dropping her and catching her repeatedly on the way down as each floor broke through, while her classmates and teachers were crushed below her, left screaming and dying. She and millions here now have PTSD (since their stress reaction has lasted a month now), and their anxiety is literally wrenching their stomachs in pain. She got an acid blocker for her belly, debridement and antibiotics for a couple infected wounds, and Benadryl to help her fall asleep on the hard street. (Hopefully soon they will get mats and tents too, which they did protest for downtown yesterday!) These sort of things are very common here right now. We have tons of certain meds and supplies, but we still need many others, which we expect to be able to get soon from some cooperating sources here, plus the group I'm with, Heart To Heart is one of the most efficient aid agencies I've researched and has brought in 3 jumbo jets full of supplies already and will be bringing more.

There are seven of us providers here at the moment (9 just went home in the last few days, so the need these next couple weeks is great), and 8 more arrive over the next 3 days, but there is still so much need. I'm thrilled to hear my dear med school friends Aaron and Maryclaire (also broad-scope family medicine residents) will be joining me in this great work in a few days. My on-site Heart To Heart field director says we could accommodate 50 providers here, and the international agencies say the medical needs are only growing, so hopefully more providers will come soon. The two main physician attendings I will be working with are Dr. James Dickie, an FP/ER doc from near Kansas City, and Dr. Duane Spalding, a retired internist/hospitalist from Colorado Springs, both very experienced and quite interesting and nice, as are the nurses, paramedic, and logistics staff who are here.

The facility I'm at currently is a very sturdy and nice home complete with electricity, wireless, cell reception (for certain phones, not mine), and hot showers, though all are spotty. The men and women volunteers sleep separately, each with 9 cots to a room. The water is filtered, the toilets and washer work great. We have a motherly woman cook/helper Elise who speaks English and makes the most delicious breakfasts & dinners, complete with fresh papayas, bananas and breadfruit grown here on the compound. She lost her home and in staying in a tent in our driveway.

When we go out on field clinic trips to outlying communities the conditions aren't as nice but are still secure. For instance, we get to camp in a secure Mennonite compound in Léogâne with a few hours of water and electricity a day and eat great breakfasts and dinners with very good people, but the surroundings are infested with tarantulas, centipedes, fleas, scabies, bats, and of course mosquitoes. Especially there our DEET, Malarone, tents, mats and mosquito netting will be our great friends.

I'm excited finally to start seeing patients soon and feel honored to be a part of this amazing relief effort. Please do send your thoughts, prayers, and support to these suffering people, to those of us trying to do what we can for them at ground zero, and to our own dear families back home. Thank you/Mèsi/Merci!

God bless and much love,
Lincoln :)