On January 10, 2012, the Chicago Tribune published the following article, written by Dawn Turner Trice:
This was the email Dr. Evan Lyon sent Jan. 17, 2010, five days after Haiti's devastating earthquake:
drove past the main central park in (Port-au-Prince) where at least 50K people must be sleeping and it was almost silent.
people cooking, talking, some singing and crying.
people are kind, calm, generous to us and others. even with hundreds lying on the ground, open fractures, massive injuries of all kinds.
there are few dead bodies on the street.
stench is everywhere.
the city is changed forever
Thursday is the second anniversary of the earthquake, and Lyon returned to Haiti last week to check on patients he hopes to bring back to this country for care, to help launch a new residency program for Haitian doctors, and to mark the anniversary.
Lyon, 40, is a Harvard-trained physician and assistant professor of medicine at the University of Chicago. He's also the medical director of the Right to Health Care Program for the international medical and social services organization Partners in Health.
When he arrived in Port-au-Prince last Friday, he headed to a hospital in Carrefour, the neighborhood that was near the epicenter of the earthquake. He was on his way to meet a 20-year-old woman whose bone cancer had metastasized.
Lyon had been working with the woman's doctors from his office in Chicago since last fall and they had asked him to explain to her why she was no longer a candidate for treatment in the United States, as her condition was terminal.
Although the woman's cancer had nothing to do with the earthquake, she and her mother had been living in a tent since the disaster.
"I'll be checking in with other patients who will be able to come to the States for care," said Lyon. "But unfortunately, this young woman isn't one of them."
On the way to the hospital, he said, the first thing that struck him was how quiet the streets of Port-au-Prince were. And that's a big difference even since September, the last time he was in the capital.
"We drove through the downtown in the middle of the city near the presidential palace and there's a massive refugee camp" around the site, said Lyon. "There are about 15,000 people in that part of town. But things are eerily quiet and it almost felt better when more was happening in the streets and there was more activity."
Tens of thousands of people lost their lives in the earthquake, and about 1.5 million were displaced. About 500,000 still live in temporary housing, according to Partners In Health.
Lyon said that though most of the residents have moved out of the capital and into long-term settlement camps, he fears that some people may not have immediate access to health care or other services.
"There's been more engagement, more work and, in some ways, more progress over the last two years than in years before," he told me. "But it still doesn't come close to meeting the size of the need."
As he rode through the city, he said that though the main roads have been cleared of debris and makeshift tents, none of the buildings housing the ministries of health and interior or the Supreme Court have been rebuilt. The landscape has gaping holes and, for miles, bears little resemblance to the Haiti he remembers back when he first arrived in 1996 as a music teacher.
Much work remains in Haiti, including stemming a cholera epidemic that began in October 2010, and continues with about 600 new cases a day. Lyon has been working with a human rights organization that's investigating the cause of the epidemic, which, as of Dec. 25, had killed at least 7,001 Haitians, according to the Haitian Ministry of Health.
Despite all of this, there are signs of hope.
Lyon said one example is a new residency program that was launched this week at a hospital Partners In Health runs with its Haitian sister organization Zanmi Lasante in St. Marc, about 50 miles north of Port-au-Prince.
"Of all the work that needs to be done here, this is entirely optimistic," Lyon said.
He said the program will teach Haitian doctors how to be family practice physicians.
As part of the program, Lyon and other physicians will conduct classes over the Internet and travel to Haiti to teach. The University of Chicago also will start a one- to two-year fellowship in which trained doctors will work and teach in Haiti for about six months a year.
"Two years after the complete destruction of the main hospital and medical school, we're making progress, although it never feels fast enough," he said. "Within a year, a new national teaching hospital (built by Partners in Health and Haiti's Ministry of Health) will open. It's a nice way to think about the anniversary. Despite the many challenges ahead, we're moving forward."
The construction of this new hospital in Mirebalais, Haiti, will bring to bear all that Partners In Health and Zanmi Lasante have learned over the past 25 years about hospital design that serves health care delivery, provides a dignified setting for patients in very poor settings, and allows health professionals to train and develop new skills. Workers broke ground on the facility on July 3, 2010. When completed it will house 320 beds, serve an estimated 450 - 500 patients a day, and help to train Haiti's next generation of doctors, nurses and medical workers.
September 2011 Update:
Work is moving along quickly at the Mirebalais National Teaching Hospital. Hurricane Irene passed by with little more disturbance than rain luckily. The electrical crew has arrived and is making impressive progress.
Wiring in major parts of the new facility is now in place.
This week the crew completed running conduit and pulling wire in the Outpatient, Women’s Clinic, Community Health, Endoscopy and Pharmacy buildings. Furthermore, they have finished the Main Electrical Room switchgear in building 4.1 (mechanical, kitchen and laundry) and have begun running conduit and installing panel boxes in building 2.1 (labor and delivery).
All this was done in less than three weeks. Also, thanks to the National Rural Electric Cooperative Association (NRECA) we will have permanent power to the site within 10 days!
The wall tile in the kitchen is complete and the crew can now start on the floor tile. Once the tile is complete, they will be able to start installing cabinetry and equipment. The tile work is almost complete in multiple bathrooms, including those of Outpatient, Women’s Clinic and Community Health.
In late August, Paul Farmer made a visit to the site. This was a very exciting day for everyone as they were happy to be able to show him the progress that has been made.
With tiles up, the walls begin to look more like a hospital.
Following the January 12, 2010 earthquake in Haiti, Partners In Health (PIH) and our Haitian sister organization Zanmi Lasante (ZL) immediately began to both respond to immediate medical needs and plan for the long-term recovery and rebuilding of Haiti's public health system. Now, nearly 15 months after the earthquake, PIH/ZL's focus is on these long-term programs, including our community-based rehabilitative medicine program.
In general, patients have sustained one of four types of injuries: a closed fracture which will need follow-up x-rays and cast changes; an open fracture, which requires wound care in addition to typical fracture care; an amputated limb, which often requires additional surgical procedures for prosthesis fittings; or permanent neurological disabilities, which include spine fractures, spinal cord injuries or paralysis. No matter what the injury, these patients require specialized rehabilitation. Recovering from a fracture means not only learning how to walk with a crutch, but also retraining muscles, ligaments and tendons to walk again. Patients who have had limbs amputated or who have been permanently disabled will need occupational therapy to learn how to live with their disability, in addition to ongoing physical therapy to strengthen their muscles. Patients who underwent life-saving surgeries in the aftermath of the earthquake will require months, and in some cases years, of follow-up and aftercare.
PIH/ZL’s Community-Based Rehabilitative Medicine Program has two main components: Clinical Care and Community-Based Care. When an injured patient first comes to one of PIH/ZL's hospitals or clinics, they are seen by a clinician, who then refers appropriate patients to the rehabilitative team. A doctor of rehabilitative medicine handles all medical issues related to this disability. After a complete evaluation, the rehab doctor develops a care plan, 90% of which takes places outside of the hospital with PIH/ZL's team of community health workers. In cases of extreme injury, patients are reffered as inpatients to PIH/ZL's rehabilitation clinic (currently in Cange, while a state-of-the-art rehab center is being planned and constructed in St. Marc).
Back in the community, each patient is visited regularly by a home visit team, a three-member unit: a rehab doctor and/or nurse (for clinical support), a rehab technician (for physical and other rehab therapies), and a rehabilitation educator, who is a community health worker (CHW) who has been specially trained to tend to the needs of people with disabilities. Throughout this time, the patient's CHW visits him or her daily to monitor the patient’s state, providing in-home support and accompaniment throughout the healing process.
Thank you so much for your support of Partners In Health's earthquake relief and recovery programs. If you wish to continue supporting these types of programs, be sure to take advantage of the GlobalGiving Bonus Day on March 16! All donations made on 3/16 will be matched at 30% (up to $1,000 per donor)!
For video on our rehab program, click below:
When the earthquake struck Haiti on January 12, Zanmi Lasante was uniquely positioned both to provide emergency care and to help develop and implement plans for long-term reconstruction. ZL provided life-saving care to thousands of injured people, opened clinics to serve more than 100,000 people in four spontaneous settlement camps, and launched a $125-million plan to help rebuild Haiti's public health and health education systems.
Highlights from the response:
In the first hours after the earthquake, Zanmi Lasante took immediate action to provide emergency medical care to earthquake victims both in Port-au-Prince and at our facilities in the Central Plateau and Lower Artibonite. ZL medical and engineering staff arrived at the badly damaged general hospital in Port-au-Prince just after the quake, where they helped restore electricity, deployed volunteer surgical teams and urgently needed supplies, and worked with partners to get 12 operating rooms up and running around the clock.
As thousands of injured people fled the ruined capital, ZL opened up new emergency wards and brought in volunteer orthopedic teams to help perform emergency surgeries at four of our largest facilities in central Haiti. In the first four weeks after the earthquake, these facilities delivered life-saving medical care to 2,961 patients with earthquake-related injuries.
Just two weeks after the earthquake, ZL set up health clinics to serve over 100,000 displaced people living in four spontaneous settlement camps around Port-au-Prince. ZL's clinics provide comprehensive primary health care and social support services — including maternal and child health, reproductive care, HIV and TB testing, mental health care, and malnutrition treatment — to roughly 10,000 people each week.
Each clinic is staffed by a team of Haitian physicians, nurses, psychologists, pharmacists, and lab technicians. ZL also trained and hired local residents to serve as community health workers at each location, improving outreach into the settlements and providing jobs and income.
Many of the more than 300,000 people wounded by the earthquake suffered crush wounds, compound fractures, spinal injuries and other severe injuries that will require ongoing and specialized rehabilitation. Tens of thousands more were scarred emotionally by the loss of family members and friends, homes and livelihoods. To meet their needs, ZL more than doubled the size of our rehabilitative medicine and mental health teams. By the end of June, the physical therapy team had distributed 400 wheelchairs and was providing care to 50 people with amputations. The mental health and psychosocial support team had offered more than 4,200 support services in spontaneous settlements, including psycho-education, counseling, and individual and group therapy.
In partnership with the Haitian Ministry of Health, PIH/ZL is building a world-class, 320-bed teaching hospital in Mirebalais. The new hospital will train the next generation of Haitian doctors, nurses, and lab technicians, equipping them to take on the challenges of rebuilding and strengthening the Haitian health care system. When its doors open in late 2011, the Mirebalais hospital will be Haiti's largest public hospital outside Port-au-Prince. It will house clinical facilities not currently available in Haiti, including an intensive care unit and six operating rooms, and will contribute to the national goal of decentralizing services, including both clinical care and education for health professionals.
A cholera epidemic has broken out in the Lower Artibonite region of Haiti. As of Friday morning, October 22, more than 2,000 cases and 140 deaths had been reported. PIH has rushed clinical reinforcements and supplies to the region and has mounted a massive community education and mobilization campaign. Community health workers are fanning out throughout the area to distribute oral rehydration salts and soap and to warn people of the need to drink only clean or purified water and wash their hands frequently—the two keys to preventing further spread of the disease.
Starting on Tuesday evening, patients suffering from acute watery diarrhea began arriving at Hôpital Saint Nicolas in St. Marc, which PIH operates in partnership with the Haitian Ministry of Health. By Thursday evening the hospital in St. Marc was overflowing with over 500 patients, of whom 12 had died. Another 437 patients were taken in between 6:00 Thursday evening and 5:00 Friday morning. Other hospitals in the Lower Artibonite region—including PIH facilities in Petite Riviere and Verettes—also reported large numbers of patients with similar symptoms and high mortality rates.
Although the diagnosis of cholera was not confirmed until Friday morning, PIH, the Ministry of Health, and other partner organizations had already launched urgent treatment and prevention efforts. The most effective treatment for both cholera and other acute diarrheal diseases is oral rehydration; and prevention hinges on providing access to clean water.
Zanmi Lasante dispatched reinforcements for both the clinical and community outreach efforts from our team in Port au Prince and our facilities in the Central Plateau. And several longstanding partner organizations have rallied to support PIH and the Ministry of Health on both fronts. Operation Blessing, which has worked closely with PIH to provide clean water in settlements around Port-au-Prince, rushed to St. Marc to help. Two branches of Médecins Sans Frontières (MSF-Spain and MSF-Belgium) deployed clinical team reinforcements to St. Marc and Petite Riviere, where they are taking the lead in setting up systems to separate cholera cases from non-cholera cases.
Lack of access to clean water has long been a major threat to public health throughout Haiti. Zanmi Lasante has worked with partner organizations to combat the problem on many fronts:
As we work urgently to treat cholera patients and halt the epidemic before it can spread to the crowded settlements around Port au Prince, PIH will continue to emphasize that strengthening public infrastructure, especially the water supply, must be a top priority in post-earthquake reconstruction efforts.
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