February 9, 2010

Port-au-Prince :

We’ve arrived at Port-au-Prince international airport, which was managed by American military and still not accessible to long carriers at the time. As we were descending towards our destination in the 10-seater bi-propeller plane that took us there from Santo Domingo, the pilot said: "Welcome to Haiti, here it's survival of the fittest, good luck in your mission..." The tone was set. The atmosphere was one of a country at war with military helicopters (mostly Americans) taking off and landing on an overheated tarmac in a continuous ballet.

Formalities to enter Haiti were brief for NGO’s and journalists. Three vehicles were waiting to take us to our respective HQ (MSF-Switzerland, MSF-France, MSF-Belgium). The atmosphere was chaotic in town, the areas we drove through were partially destroyed, and numerous vehicles were lined up in traffic jams. The heat, the omnipresence of the military, the surrounding desolation and chaos all contributed to a very particular atmosphere, heavy and filled with adrenaline. However, the desire to jump right in was irresistible, and every single one of us was anxious to start his/her mission...

The MSF-Switzerland HQ is located in the higher parts of Port-au-Prince in the middle of a residential area that was somewhat spared by the earthquake. It's a 3-story house with a terrace on the roof, which offers a breathtaking view of the whole city. The inside courtyard serves as a parking lot for about fifteen MSF vehicles. The main lobby is equipped with radio and communication devices, charts of arrivals and departures, map of the city, etc... The first floor is a central station where all the volunteers bump into each other in an organized chaos. Every single square inch is used, and I see about 20 computer stations set up for all the different resources used by MSF.

After introducing myself with my traveling companions (the others had been directed to other national HQs of MSF), we were told about the destinations of our missions. My companions will stay in Port-au-Prince, while I was assigned to the Sainte Croix hospital in Leogane...

During my bumpy ride here, I became aware of the way things work with MSF. It’s an unusual NGO, one that uses local resources and has the will to break the rules to make things move faster. There’s little inertia in MSF’s functionality. It reacts in urgent situation and evolves in terrains where other organizations waste time evaluating situations that require immediate actions, as needed here in Haiti.

MSF-Switzerland manages several hospitals in Haiti: Lycée (a hospital established in a old high school), Mickey in Port-au-Prince, and Sainte Croix Hospital in Leogane, to name a few... Other hospitals like Cité-Soleil or Saint Louis are managed by MSF-France and MSF-Belgium. Every national MSF HQ manages its own infrastructures and teams.

LEOGANE:

During the two hours that took us to drive the 30 kilometers between Port-au-Prince and Leogane, I got to realize the magnitude of the catastrophe. Entire blocks of the city were destroyed, and the road was lined up with debris and refugees without shelter. The odor and shadow of Death were oppressive. I arrived in a field hospital set up in the middle of a destroyed schoolyard in Leogane. The entrance was guarded and there was a sign on the front gate with MSF’s initials. About 10 big tents constituted the hospitalization units, surrounded by 10 others that served as lodging for the volunteers in the camp. Part of the school building was still standing and served as a stock room for supplies, and also held the surgical ward.

This facility could hold about 100 hospitalized patients. The outpatient department (OPD)  handled over 150 consultations daily. There was about 35 volunteers and 50 Haitian employees (drivers, nurses, etc...). This place also managed the distribution of food and tents to the population, as well as the set up for water and sanitation in neighboring areas.

The medical unit was made of 2 surgeons (1 orthopaedist and 1 abdominal/general surgeon), and 7 first aid doctors (urgent care specialists and one pediatrician). The medical team was made of about 15 nurses and one physical therapist. The amenities allowed us to perform urgent orthopeadic care procedures such as casts, external fixators, as well as tractions. There was no x-ray unit or radiology. The sanitary conditions didn’t allow internal fixations (plates, screws, nails, etc...).

The majority of injuries caused by the earthquake affected the musculoskeletal system: open wounds, fractures, etc... Diseases like Dengue Fever, Malaria, diarrhea and other chronic pathologies were also handled in Leogane. The hospital had a maternity ward, with an average of one birth per day.

I arrived there with only my backpack, as my luggage was still lost somewhere between Geneva and Santo Domingo... The camp’s administrator, Pierluigi, as well as the medical manager, Nadia, wished me welcome and introduced me to the rest of the team. There was Benjamin, the general/abdominal surgeon from Switzerland, and Manoli, a physical therapist from Greece, who were both very happy to see the arrival of an orthopaedic surgeon. I picked a tent next to Benjamin as my quarters, and after a brief visit of the facilities, Pierluigi started to brief me on my mission and the local situation. During our conversation, another 10-second aftershock shook the ground and knocked down a couple of walls from the ruins of school... Pierluigi shook my hand and told me “welcome to Leogane”...