Clinic Day at SapaTrop Tent City March 12, 2010

Today we set up a mobile clinic and checked out a new area just a few miles down the road from our usual church clinic spot, at the request of the local Pastor, Vital. It was across from another tent city  here in Leogane called Sapatrop. I took a 5 min walk through it with my translator, the awesome young Mr.Innocent Stevenson, during a much needed water beak this afternoon.This tent city is newer and more organized. There are even latrines (tent latrines, but still) with private shower areas for people. There are some wooden constructed houses (the size of a large tent) as well, built by the Mennonites.

We saw a seemingly endless stream of patients in clinic, Matt the Paramedic doing triage and acting as a quasi-crowd control agent.Trish and I saw 50 or so pts each between 9 and 4. No one super sick but lots of babies and kids with fever, diarrhea, mild dehydration. Adults with stress symptoms, UTIs, stomach acid, asthma, and bronchitis stirred up by all the dust. Many complain of just weakness, body aches, headaches, and stomach discomfort daily since the Earthquake. Hard to treat sadness and poor nutrition. But I can say that in the tent city we saw people with food and produce, and they were cooking and appeared to be doing better in the way of nourishment. Some good looking coconuts lying around, too! We've got plans to buy one and chow down on it some afternoon before we leave. MM!

Just talked to Alli on the cell, and compared our days. They were quite busy in the Port au Prince clinic also. They have a little more staff and better crowd/flow management, and the added advantage of being in the same place daily where you can unpack once and leave it, establish a routine and stick with it. But I have to admit I do like being in more the rugged setting, with the mobile clinics traveling out to the remote, lesser served spots. It's adventurous! And, so, a little less comfortable. A block of concrete fell off the roof next to us during clinic today--didn't hit anyone, but just a little reminder that things are not stable and still shift. Be careful.

Alli tells me that Vivian (one of the nurses from MCDH/my hosp) ROCKED today in PaP! (props to ya Viv!)  And I can easily say that my guys, Trish and Matt, were just fantastic. They worked their butts off and handled so many things that they probably aren't used to doing--and they came and asked appropriate questions when needed. Occasionally they had me give a supervisory look at few people they were concerned about--and I really, really appreciate their work. We had no more than a 5 minute break through the whole day, and they handled it like troopers. Luckily we had some snacks that could be munched on the go or we might have gotten pretty run down by mid-afternoon.

Now that I've showered, I can see that the mosquitos had some fun with me last night. Not while I ws sleeping in my net, but when I was sitting up -like I am now- typing on the computer outside.
You bet I remembered the DEET this eve! Hoping the Chloroquine is working its magic.
There is huge wind tonight here, too. Came back to compound to find our large tent splattered to the ground as some of the critical poles were busted from the wind. I decided to can the tent and moved back into the good old gazebo where I'd stayed last time I was here. Tents are too much work! I am lucky I have the luxury of saying that, aren't I?..


As I sat and began this note, the people living nearby had one of many daily church services next door. That was around 5:30pm, and now it's 7 and it is quieting down. Last night they went until after 8pm. You can hear them singing, shouting testimonials and playing music-[real music-like, I heard some hyped up jazz just now]- in the church well into the night. I tell you --they work all day and go to church all night here. It keeps them going, I think. Keeps the community invested in the very daunting effort that lies ahead for the foreseeable future. Even if you aren't religious you can appreciate this, I think.

I will end here and go back and try to add some photos.
More tomorrow,

Jen

Back at last in Leogane

It's been almost exactly a 2 months since the earthquake now here, and a little less than that since I left.
 Returning directly to Leogane from the airport today, there was a lot going on. First, the airport is no longer under US Military operation.  No longer the Kafkaesque ghost port that is was when I left on the military flight in January! There was a live 'jug and drum' band playing at the bottom of the concourse as you entered the building,and there were throngs of people out front waiting to help you with your luggage, just like any other third world port. The traffic was actually not as bad as my last drive, and the most notable new thing was that there are large  groups of Haitian citizens out in the streets in bright yellow or baby blue t-shirts, working for the city--making repairs, clearing debris, hauling lumbar, and correcting drainage shoots. It was optimistic.

I arrived at about the same time as two other doctors, Janice from Memphis, and Linda from Boston.
We drove through town to the new (new to me) site of the Port au Prince Heart to Heart Clinic. Previously, we had worked out of the main soccer stadium along with many others giving aid, and it was hot, humid and less than ideal for anything other than disaster medicine. Now, it is in a 3-story church building that remained standing right in the middle of theBelAir district.Despite this, it is a little cramped, as the only places to set up patient exam areas are on the catwalk above the main floor where the pews still sit. People are of course sometimes still afraid to enter a building like this, and would rather not be seen than enter. But many, many people do come inside for help.  From here, we said quick hellos to those inside, dropped off Janice and Linda in the clinic, and 'took' Matt (Paramedic from Kansas City) and Tricia (nurse from MCDH with me) and jumped back in the truck toward Leogane.

 On the way there we stopped at La Catedral, the city's main church and one of the most symbolic landmarks. You can see why. It has taken a beating, but has not crumbled. Half-broken, formerly great stained glass window florettes seem to stand up of their own will against the sky. They are still beautiful, even with jagged edges and peeling iron. Next to it, a children's school and empty lots where men are clearing tangled rebar and rubble, and other men are coming up to ask you for work or water. We have no work to offer them right now.

Passing by the presidential palace on the way to Leogane, it remains alone in its green manicured lawn, surrounded by iron picket fence and still looking as if the crooked caps will come crashing down and spill onto the vast pretty lawn at any moment. Surrounding this, the tent city is even more expansive than before.

There are more white people, for sure. It almost looks like families touring in DC for a split second. Women in skirts and nice necklaces, carrying their oversized purses, with the teenage daughter slouching in her jean shorts and t shirt, and the middle-aged father tagging behind looking at the buildings. I am actually not sure who the people were I saw there or what they were doing. I wonder if they were missionaries or just curious people. Maybe they are here to adopt a child? Maybe they are providing food, or shelter or clothing somewhere. It was strange. But there are so many people here from all over, for so many different reasons. We are well beyond the need for medical care being foremost. It's time to rebuild.

So, no stop at the Port au Prince compound was in store for me today--whisked straight to Leogane--arrived about 4pm, where I met my friend Allison Trowbridge at the end of her stay as the only doc on the lot. Wish we could have had more time to catch up, but we spent the hour we did have doing an impromptu debriefing--trying to get updated on how things are going here, where we are holding clinics now, who we are paying for what work and how much, and just a whole lot of 'need to know' kind of info passing before she had to get in the car I just got out of and head back to the main compound in PAP.

Most of our info here in Leogane is on a collection of scraps of paper, and in people's heads. Installing and maintaining a system of operation here is difficult with such frequent turnover of staff and the ever-changing needs of the environment. Alli had clearly been working hard the whole time she was here, and I am so glad she was able to give me the run down. I would have liked to be at the main compound tonight before brining an all new team here; to sit at the evening meeting and transition over and take part in the discussions--to have a better idea what is working, how it is being organized, what is not working, and what the evolving goals are. But, not to be. Just have to wing it.

Walked through town before dinner, and I showed the guys the soccer stadium here where we'd worked on my last trip. The 'clinic' site had been at the corner of the giant stadium tent city, and after asking a couple people sitting around, some Creole chatter occured, and a phonecall was made to somewhere deep in the tent city we stood on the fringe of..and then one Miss France Remy, the Haitian nurse who has pretty much been the only medical provider to stay the duration here at this site, emerged from the sea of blue plastic to meet us. She lives there, too. We saw that where our trash-strewn site with blue tarps and smoking garbage hole in the ground had been, they had recently built a wooden structure to use as a real clinic. With 3 exam rooms, a pharmacy room, and real exam tables and chairs!
France is amazing with what she can accomplish. I don't know how she does it, really.

Then, dinner at camp, and the cold shower that I've never been so fond of before. Still staying here at the Mennonite compound, and there are large tents with cots set up for us already!
And, there is a wireless signal. YES!

So, tomorrow I will have more of substance to report, hopefully. But tonight we settle in for probably a week at least.

It's good to be back. Missing you all, but hopeful; and thankful for the opportunity to return to this haunted but magical place.

-Jen

Up, up and away

Myself, Vivian Daniels, Cyndy Woultee & Tricia Ferguson are boarded on
our flight to Miami, then on to PAP tomorrow. Feels good to be going
back. For my companions, it's their first go. I am excited and
apprehensive to see how things have progressed...

Jennifer Surber, M.D.

Sent from my iPhone

How to Give, Who to Work With?

I am no expert yet on which NGO (Non-Governmental Organization) does what, or who does the *best* work, etc. But what I do know is who I see at work when I'm on the ground, and which organizations my friends and colleagues are affiliated with out there doing some real good. So, as some have asked me to direct them in their effort to donate and volunteer, I am trying to compile for you a list of resources. On the left hand side bar here, you will see "Links Worth Visiting". The majority of them are medical aid-related. Some are just things I find really interesting personally. If you know of others that I have left out, email or post to me and I'll likely add them, too.
Keep asking me questions --it helps me focus my investigation when down there as to what the people back home want to know about. Which in turn makes an overwhelming desire to know everything about the situation a little more manageable for me.  Thanks again for reading.  Love,
Jen

Here is an Article I wrote that was published in Thursday's paper/Fort Bragg Advocate-News

Why did I go to Haiti?
I have to admit, though it may sound cheesy: I was called. For the first time in my life. It was just obvious to me that there was something I could really do to help the people there who had clearly suffered a devastation far beyond my imagination. I had waited all my medical career thus far to do something like this. I can't explain it any better. It wasn't completely selfless. I needed to go.
When I arrived on the island, we drove from Santo Domingo to Port-au-Prince by van in the middle of the night. When dawn came, we saw very gradually, the increasing destruction as we crossed over into Haiti. A house here, a broken house there. A pile of rubble.
As the miles fell away and we entered Port-au-Prince, the piles of rubble gradually began to outweigh the intact structures by far. Or, the homes were shifted on their ground, at half-mast, tilted, swaggering, as if unable to go on.
The people, however, were another story.
Though they lived on the streets, in former soccer stadiums, city parks, medians between major thoroughfares-- on any open piece of land available that did not fall in the shadow of a teetering building, in 4x4x4 tents made of anything available--corrugated tin, sheets, medical drapes, plywood, chalkboards from a school with the math lesson still visible--they were nothing other than RESILIENT. If there was one word that you will hear over and over again when discussing the survivors of this disaster in Haiti, that is it. I wondered how we, as Americans, would handle the same degree of devastation in our society. I don't see how we could. they never showed their suffering except on deep gaze into their eyes. They returned to work, they swept the streets, they moved the stones of rubble with their bare hands. They had nothing else to do but move forward into the unknown.
Medically, it was challenging. Resources were scarce. We worked in the same tent cities in which the people lived, under the same circumstances. It was hot. Humid. People were malnourished, even after only 2 weeks. Water was just beginning to be distributed in large quantity to areas outside the city, areas which, such as Leogane, where I worked, were closer to the epicenter and far more devastated than even the city.
Those who did not suffer acute loss of limb or serious injury suffered loss of family and friends; anxiety, depression, diarrhea, fever, stomach pain, and had nothing to eat or drink for days at a time. What could we do to fix them? Their hearts? There were wounds that had gone 2 weeks without care, infected, at risk of requiring amputation--teenagers, children and adults alike. There were long bone fractures that had yet to ever have eyes laid on them by a medical professional since the day of the "Tremblement du Terre", or "L''Evennement", as they referred to it. "The Event"... a recurring reference point in many interviews to come.
But despite the austere environment, the lack of any modern comforts that we here are used to and expect as patients, they were grateful, satisfied and able to persevere with just a little medicine and a little personal comfort.
What could we have used? Everything. Asthma medicine, baby formula (mothers had no milk) , better antibiotics, more wound care supplies, more hydration materials, any vitamins, iron, and even just local anesthetics. How much of my medical training did I employ? Depends. But do I feel I made a difference? Absolutely.
Should you try to help, even now at this 'late' date? By all means.
And if you can't go, and feel you've nothing to contribute, trust me when I say: Not true! You can help. Send money, send food, send love. Use your unique expertise to help rebuild this poor country in whatever way you are able. Support someone else who can help. This is a situation that will take years to improve. There is hardly a way NOT to help. Don't forget Haiti. I know I won't.


Jennifer Surber, MD
Mendocino Coast District Hospital
Emergency Department
2/12/2010

Time in Haiti: a short 7 days 1/23 - 1/31/2010
NGO: Heart to Heart International

Arrived in Haiti post Earthquake Jan 24 2010

End of 2 long days melted into one. Tired. Wounds abound, physical and mental, but the Haitian people are so stoic and resilient. Living on the streets, in tents, somehow still smiling from time to time. Hm.
January 24 at 6:44pm via Facebook for iPhon

From Haiti Jan 25 2010

There was a 'manifestation' today down the street where we were working in the tent city.(that's essentially a march or protest)
The people running through the street held signs saying they need food and water. They also said, "stop the corruption".

There actually is food and water getting in via several organizations, as is the medical care. But it does not reach everyone equally and quickly, because there is too much need and very widespread. The problem is more that transport and distribution of goods is slow and difficult- and there are just so very many displaced people to take care of.

We sat in traffic for 3hrs this morning en route to our site. It is normally only a 1 h ride. The dust and pollution is terrible.

But people had fruit and foods for sale on the roadside, clothing, and gasoline. There is an enormous gasoline tanker ship docked at the port. We have met Canadian medical people who've set up a mobile surgical hospital among the rubble. The Japanese set up an xray facility near that. There are docs from Israel everywhere. The other relief groups we've seen from various places have been generous in sharing meds and supplies, and we do the same. Things are really going quite well when you consider how many different people are here and that none had really communicated with the other before coming.

Tonight we are camped in a Mennonite compound in leogane. They fed us all, and opened their bathrooms and showers to us.
Every evening, they turn on their generator and are running a water purification system which then is accessible for free to the public for several hours.
One of the men here says ( when I asked him how long he forsees the rebuilding and recovery of the homes/ bldgs/ streets here) that it will likely be impossible. That people will have to just abandon and go to other parts of Haiti. Too much rubble- much of it huge chunks of concrete and rebar- no good way to remove or break it down easily. I don't know. I think many will stay and live around and among it.
But right now, no one will sleep indoors anyway, out of fear.

Including our hosts here--and us.
Understandable.
January 25 at 6:28pm via Facebook for iPhone