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Dr. Katy Close, a clinical associate professor of the University of South Carolina School of Medicine, has returned to Haiti after a brief break. Dr. Close resumes her blog dispatches from the Hospital Albert Schweitzer in Des Chapelles in Western Haiti.The following excerpt is her sixth communiqué and is reprinted with her permission.

A 1988 graduate of the USC School of Medicine, she is the 2006 recipient of the university's Algernon Sydney Sullivan Award, which is given annually by the university to an alumna or alumnus whose service to his or her profession extends well beyond expectations.

Hospital Albert Schweitzer

Sunday, February 28

If you are basing results on how far the Hanger boys have come with the lab and how many happier amputees there are, we are winning.

I wish I could say the same for all medical problems, but I can't. I worked for a week at the government hospital run by PIH, and it was not good. They do not have glucometers, and they have way too many patients.

My diabetic patients are still getting gangrene and having amputations. Of course, now they get legs!  I guess I could look at the bright side.

My friend, the amputee and Haitian doc, Dianne Jean Francois, came to visit. She was amazed at the progress and boosted my spirits.


Friday, February 26

I have wanted to leave this place so many times this week. I opened the Albert Schweitzer book and found this:

"Anyone who proposes to do good must not expect people to roll stones out of his way, but must accept his lot calmly if they even roll a few more upon it.


"Thursday, February 25th. Up and DOWN, DOWN, DOWN...

Went with Frankie [translator] to river crossing. River was “swollen,” so he took bike around, and I climbed down bank, actually slid. Just as I was feeling really sorry for myself, I saw a woman behind me coming downhill who had one leg. I talked her into coming here next week. HIGH POINT.

The government-run clinic is a zoo. There are such archaic rules that you cannot practice medicine, if you do know how. It's the perfect example of why nothing ever gets done in this country.


Wednesday, February 24

I went to Petite Riviere, the Government hospital that Paul Farmer's group runs. I am going back daily this week, as all my diabetics have shown up. You have to cross the Artibonite river to get there.

Stephanie, my patient who is a quadriplegic and 17, is leaving us, but still smiling. I can't make myself call Asmek's brother because I think he is probably gone, too.

Harriett's burned little friend got skin grafts, and Alberto got his hand splinted.

Shawn & Dianne

On the positive side, the Hanger guys [prosthetics] are really into it. They have people coming from all over to look at what they are doing. The U.N. is having an “organizing” meeting tomorrow to discuss what they should consider!!! Can you imagine? We are already doing it.

PIH (Paul) is having a big party in Cange this weekend for all the Haitian docs. I am going to take the Hanger guys and we are going to fit their amputees so the guys can get a start on them, too.

At dinner Rosanna, the housekeeper, brought her granddaughter in because she had been hit in the eye with a ball. The eye doc saw it and wanted to look closer, but the kid resisted. Cynthia (my hero--the rehab doc) went in her room and got her acupuncture needles and anesthetized the kid- at the table!!!!

Life continues to amaze me.


Sunday, February 21

Lots of excitement. Things may be happening.

Alberte is a 6-year-old boy who was trapped under concrete for seven days after his house fell down. They are making him a hand. Harold sent him Spiderman. He was only person there with his mom. He really only wants to be Spiderman.

Juste Mackinee is an 8-year-old who was under concrete for one day.

Stephanie, the C4 quad is likely to die. She was following a teacher out of a school and got trapped, listening to screams from the others as they died. Her little girl sits on bed beside her. Trey and Jay finally arrived. Jay is staying 3 months. He says he is LUCKY to get to work with such brave people. Trey's story made me cry. We went to visit Verna, and they made me tell her that they came here because they saw her photo. I cried.


Saturday, February 20

I'm sitting here waiting for the Haitian surgeon to show. I have a 7-month-pregnant 18-year-old with sickle cell and 14,000 platelets. You are supposed to have 200,000 plus. She is spitting bright red blood at me. She has a syndrome called HELLP, and she needs to be delivered or the baby will die, and there is no OBGYN on call. If not delivered, she bleeds to death. Did I mention her hemoglobin is THREE (supposed to be 12-15)??? And we are low on blood.

Still, we are all very excited about the rehab project. I brought a guy named Jim from Hanger with me, and he is getting machinery in place. It's a huge project, and the Hanger people have agreed to do it right. Of course, it requires $, but we will find it. I feel sure. They are sending a really high-level prosthetics specialist TOMORROW for THREE months! It's truly amazing that this all came together.


Friday, February 19

Am back at HAS [Hospital Albert Schweitzer]. Still lots of surgeons, these from South Dakota. I actually had to sleep on couch. But they left at 5 am. Harriett Miller is with me, thank God. Dr. Cynthia Racine joined us. She is a Haitian rehab doc sent by God to help us get it together.

I saw the paralyzed patient, Asmik, in Port-au-Prince on my way back here. He is at the University of Miami tent [hospital]. He has a better chance of getting to the US from there.

Legs WaitingI brought a patient here who lost her leg. Verna. She was smart enough to smile at Harold (the one-legged/5 plane guy from Hanger Orthopedic Group) a few weeks ago, and he is personally taking over her care (which means I am caring for her- which now means CYNTHIA is taking care of her!) She will be ONE OF THE FIRST patients to get a PROSTHESIS in Haiti post EARTHQUAKE!

Because..... the result of "the boys" showing up at HAS is that they are opening a center here NEXT WEEK!!!!!

Please see Or Google HAS / Hanger.

They are going to provide good-quality, sustainable prosthetics for everyone here. The hospital is helping with rehab and housing. It's a good deal for everyone.

I am going to continue raising money -- for Hanger, too. In fact, I have promised to. I hope teaching a Haitian staff member will be part of it. I appreciate EVERYONE helping and if you have not yet, you can choose to donate to the hospital or to Hanger. Both will get here.
Mark them Rehab/Haiti/ Katy Close.

The patients are still sick as stink. Thank God, Cynthia is here. She was trained in rehab and speaks fluent French and Creole. She is a godsend. However, the paralyzed patients are still getting septic and dying.

The lack of resources continues to limit patient care. There is a hospital in Petite Riviere, 45 minutes away, and they are very short on doctors. The hospital is run by PIH and Paul [Farmer] says they are all in Port working. Unfortunately, the patients in Petite Riviere need doctors. I am going there Tuesday.


Sunday, February 7 5 A.M.

I could not sleep because the rooster is going wild to my right and the on-call transportation person must be sleeping in Cay 5 next door because the TV is on full blast. I used to get mad, but I went to Frankie's [her translator] house yesterday before I went up the hill in the afternoon, and it was so sparse. About 40 x 20. Only 1/2 of it had a floor. Other half dirt. Cinder block. No furniture except a bed with a 2-inch mattress. Nothing else. And he has a "nice" house. I did not ask where he went to the bathroom or took a bath. It's all so unimaginable.

So complaining about a guy who probably lives like that and is on call once a week and sleeps in a chair and leaves the TV on. Well, maybe I'll keep my mouth shut. I just wish he'd turn the TV off when he falls asleep. I guess that is impossible.

I decided that everyone needs a bar code. Every doc who comes in at PaP airport, or Cap Haitian, Hinche, the border, wherever, give them a barcode and give the police those scanners and they can scan you and tell you where you need to go.


Saturday, February 6

I got three ladies with PPCM. I am not sure why. Last week was AIDS week, now its heart disease. Only one from Port[-au-Prince] who had run out. Rest just normal "fini les medicaments.' People here sometimes do not get the concept that some meds continue forever.

One patient has no BP and keeps grabbing me. She is so swollen her legs look like tree trunks and her forearms look like balloons. I think she will die. I put her on dopamine.

The new ortho[paedic] surgeons showed up. Atlanta.


Friday, February 5

Collateral damage continues to haunt. We have somehow run out of Aldactone (a drug that makes you pee). For some reason there is a super-high incidence of postpartum cardiomyopathy (PPCM) here. At home, when I worked at CMC, I saw three cases in eight years. Here I see a case a week. It's when postpartum patients get heart failure. If you can support them initially they get well, but they all have these tiny babies and they want to go home, and we have no oral medications.

I went to Genat Serlande's funeral. She is the 18-year-old who died because I could not check her sodium (that is a bit simplified). It was at the orphanage. The kids all cried a lot. Karen, the woman who runs the orphanage, has two kids she has adopted. I had never met them. They are both profoundly (I guess that is the term) developmentally delayed. I was overwhelmed.

I'm on call all weekend.


Monday, February 1

The "boys" arrived. The ones with all the fake limbs.

The cast of characters, vaguely:

Harold has one leg and 5 planes. It must be some equation that if you have more planes than legs you are just a good guy. He is a philanthropist. He is to die for!

Kevin is, by all accounts, the world's BEST prosthetist. He is delightful and woke up at 5:30 a.m. and scaled the hill with me, peppering me with intense questions the whole time. He made Harold's "bionic" leg.

His COO, Ron, just watched us all with bemusement and you could tell he was figuring out all the time. He must be the thinker.

Don owns Airedale terriers and carries flasks (plural) full of very good Scotch. He is the medical director of a large hospital in Atlanta.

When I first walked into the house, Harold was sitting on the porch trying to work three phones at once. I took the b-berry, fixed it, and handed it back to him. In retrospect, I should have left it broken.

He called his pilot, Kyle, and said:

"Kyle--you get me a helicopter. I ain't driving that road again, my butt's numb. I do not care if there are none in Haiti. Get me one in another country. And, Kyle- have it here at 6 am."

I started to tell him that was not gonna happen, but his friend Don grabbed me and said in a very nice voice:

"Honey, get him a beer, will you?"

I said, VERY nicely: "No, I won't. There aren't any here and don't call me 'honey.'"

He called me "doctor" (he had NO clue what my name was). I got the beer.

They had dinner at the house, by which time I had fixed all their gadgets and a lot of their problems.

Harold kept calling people and telling them to find a hospital in Port with amputees. He wanted to show ALL of them his leg. He says he will not see all these people fitted with plastic feet. He just will not hear of it! He is gonna get everyone a "classy" limb, if he has to pay for it himself. And he can. I convinced them Dianne Jean Francois was their person in PaP and solved another of their problems.

By then, they all knew my name.

In the morning, Kevin ran with me, and we went by L'escale and saw Asmel, who was doing well. His whole family from Port now lives there. After breakfast, we went to the soccer field to wait for the alleged helicopter.

After three hours, 55 phone calls (15 of them me calling Dianne to tell her to go or not go to the airport), a case of water, and the photo that ended up in the Pittsburgh paper, a helicopter actually showed up. So did 500 Haitians.

They disappeared into the dust, and I ran home and showered to go see Gena Serlande, aghast she was still alive.

By the time she died, two hours later, the 4 of them had emailed me 16 times.

I rode the bus into PaP. The boys had arranged to bring Shaun (a PT who used to be here and needed to come back and help figure this thing out) from Jamaica. I met them at the airport, and they dragged me onto the Tarmac and we waited for their plane. They told me they loved Dianne, as I knew they would. They PROMISED to come back. Somehow, between 7 a.m. and 9 a.m., Harold had fallen in love a second time and made more promises.

The boys pulled their wheels up, and Shaun and I headed out into the jungle that used to be Port-au-Prince. First we had to go locate the woman in the University of Miami hospital because Harold had told her he would get her a leg and then lost her identifying data. We found her. I asked the doc there where she would follow up. He stared at me blankly.

Tent City

We went to the CAT place and bought a battery. We drove past tent cities and huge fallen buildings. Reality came crashing down. The Episcopal church was particularly sad.

The nuns were good, though, and glad to see me. They have lots of boxes and were dividing up rations and cooking on a grill. Their generator worked. I never breathed through my nose, so I cannot account for the smell. There are tent cities in the next block, but they are not really visible.

After that, we went to the airport. A zillionaire from Pittsburgh brought a plane down and gave us lots of meds. When I asked him if I needed a luggage cart, he laughed (he was in a 737). I went outside and got the HAS school bus and drove it up to the gate. Lionel, the driver, opened the door and I showed some kid in a Marine uniform my passport and a HAS badge. He said, "Where you from?"

I said "South Carolina". He said "Me too! Go on in."

So we were driving a giant yellow school bus around on the Tarmac, Lionel and me, beside the mammoth planes from Charleston (it said "Charleston" on them). We filled up the bus, then the Bouchard guy who had been quizzing me the whole time about HAS says, "You know other hospitals are not showing up. Y'all are in this for the long haul. Just take all their stuff."

I got, maybe, 100K worth of drugs. Lots of narcotics. I promised Bouchard I would share with other clinics here and I would watch the narcotics like a hawk. So we finally got it all loaded. I was supposed to send the bus back to DesChapelle, with Shaun, and go to dinner and spend the night. I was not worried about the drugs being stolen. But the Bouchard guy had made me sign and give my DEA #, so I did not want to be responsible for the population of some town getting addicted to Oxycontin. I stayed with the bus. It was almost nine, so my dinner plans were ruined anyway. I was not exactly happy. But it isn't good form to whine too much when you're at the epicenter of a disaster.

We left and didn't stop until we rounded a curve outside Mirabalais and came -literally- one inch from a very large cow. We had already killed a small goat, but we did not slow down for that. It was close to midnight before they unloaded and we inventoried the loot.

My "boys" take their proposal to the Board of their company Tuesday. Harold is going with them. I hope they get it passed. If they do, we will be able to make the best prosthetics here and take care of them. Like forever, not for two years. At HAS they now have the $, or at least a start to it, to support the rehab initiatives, even if the boys do not help us or their board votes against it (highly unlikely).

Since nobody can figure out how "the boys" got here, and they all fell in love with the place, I think maybe it's beyond my control.

Or maybe it's just that I could find cold beer, fix phones and had a friend named Dianne.



Friday, January 29

Been a week since I got here and it feels like a year. Some big wigs came in to talk rehabilitation, but I don't know if they'll do it here or in Port[au-Prince]. They decided the drive out here (3 hours) was too long so they ordered up a helicopter. Well-- the helicopter was 3 hours late, and they were surprised. Even helicopters run on Haitian time.


I spoke with one of their wives on the phone, and she was irate that all the aid and all the money could not get to where it was needed. I feel her pain. This has been going on for a while. I put in a photo of a guy who works here in his "wheelchair." He doesn't have legs and has used the chair for years. It shows you how different it is here from there.

It isn't as hectic here as in Port. That's why a person can stay here longer and feel safe and do things other than be a doctor.

At least, I hope things get back to normal. The fact that Port is 90 km down the road is sort of haunting.

My patient with diabetes died. All my AIDs patients went home. Asmek, the paralyzed man, is down the road in a house at the TB village. His whole family seems to be there. I do not think that was the point, but who cares?

I'm tired and gonna sleep all weekend.


Wednesday, January 27

Today sucked.

There was a woman who was paralyzed and had lain in the middle of the "salle observation" for two weeks. Yesterday she went to the OR so they could look at her neck and see if it was stable. They said it was, so she sat up. And died. Sort of just like that. Her kids had been around her for two weeks. No bed sores on her. Just sat up. And died.

My paraplegic patient with the bed sores is spiking temps, but he still smiles all the time.

My young diabetic with either a high or low sodium is fading, and I do not know what to do. Neither does the Belgian nephrologist, so I don't feel as guilty. Still wish we had lab reagent.

Its better here than in Port-au-Prince.

Buck [Dr. Closes's brother, who is volunteering in Port-au-Prince] writes about our nun friends:
There are about 120 families living around the house, and none of them have any shelter and aren't expecting to get any soon. The appeal is for tents. We need 120 to 150 two person tents.

So if anybody has any NEW or good as new tents (nobody wants your old clothes or an old tent. Think: old mattress!) Send them to my sister Francie at 2430 Terrace Way in Columbia, S.C. (29205).

I'm on call. Awaiting the dreaded knock on the door. I bet my diabetic girl dies. Collateral damage. I do not want to die as collateral damage.


[Dr. Close added a postscript a short while later.]

And ...I'm sitting here on my 18 year-old diabetic's bed. I have treated her for 4 years. She is dying and I'm typing on a b(lack)berry. To you, a thousand miles away. The world has the capability to let me do that. However, I cannot check the sodium (or the ABG or the cre or the LFTs) on this child dying in front of me, and I have no clue why she is dying. And it's 100 degrees and there are 100 Haitians staring at the "blancs." Gena's "mom" is the woman who runs the orphanage. Karen happens to have the same color skin as me.

Anyway, now I am as bad as the Canadians who filmed the girl dying Sunday. Narrating a death. It just seems so weird I can be on a bberry and I can't get a sodium.



Tuesday, January 26

The thing about being here at HAS (Hospital Albert Schweitzer) is that every time you start to throw in the towel and go home, something happens to make you never want to leave.

This morning I got up at 4:30 a.m. and ran to the top of the hill behind the hospital. I do it a lot when I am not on call. I forgot to ask when the sun comes up. Of course, no one would know. The answer would be "when the sun comes up". It was really dark as the moon had set. It's a sort of scary path. You go through fields and by houses with mean dogs and through dense thickets that make you think of lurking trolls. At the foot of the big hill you come into an open field and even in the pitch black dark you can see the outline of it. Making your way up the rocks is tricky, but I have become accustomed to it. This morning it was so dark I barely realized I was at the top. I had my iPod on and "Glory Days" at max volume obscured any noise.

All of a sudden, I realized there were people all around me. I pulled my earphones out and realized they were all singing. The top of the hill has a tree and a prayer flag. Usually there are 2 or 3 Haitian women sitting or standing, praying out loud. This time there must have been a dozen. When I first witnessed the ritual, I would stand back and try not to have them see me. As I had run right into the middle of them in the dark, I couldn't really back up, so I just sat down and bowed my head like a good Episcopalian. They prayed for Port-au-Prince; they prayed for the dead; they prayed for the Hospital, and then they prayed for the people who could not walk. I don't know how they knew I was freaking out about rehabilitation, but God must have told them. They pray until the sun comes up, and while I did not have the luxury of that much time, I stayed as long as I could. They sing about "mon deio" (God) and "papa" (God). I got back down in time to wolf down breakfast and get to morning report.

On rounds today I discovered another kind of victim. The collateral damage kind. Gena is an 18- year- old insulin-dependent diabetic. I have been caring for her for 4 years. Sometimes she takes her insulin, sometimes not. I got her some new insulin in a pen and she does better. She was hospitalized the day after the EQ, but they had to hurry her out to make room. She came back about 4 days ago, somnolent (out of it). We treated her for an infection and, initially, she got better. Yesterday, though, she got all swollen, and now she is confused. We don't know if it's her sugar (which is basically normal) or her kidneys failing or her electrolytes because we don't have the reagents to test these. I am told that the entire country is out. Everybody checked so many labs for the last two weeks that there aren't any. Add to that, Haiti is a very centralized place as far as distribution goes. Everything comes through PaP. I guess that will be part of the next wave. Can't wait to see what's after that! ####


Saturday, January 23

Friday night was quiet, and Saturday morning I sorted out the patients who had come in overnight. My morning was long and frequently interrupted to greet old friends. I had spent 12 weeks in Haiti in 2009, and in December I was there for 10 days. I usually go in January, but the hospital, short on funds, was expecting to lay off a few dozen employees. Sanon had told me he expected manifestations (riots) and asked that I come in February instead so he could take vacation. I had witnessed a previous manifestation and while NEVER EVER in any danger, I did not want to be a spectator again. So my Haitian friends did not expect me, and despite the onslaught of SV's, they were delighted to see me. Even a nurse who literally hates me had tears in her eyes. With each "bienvenue"(welcome) comes the kiss on each cheek, the questions about MY FAMILY, followed by inquiries and their recitation of the cousin or the brother or the uncle who died. Then they smile and say "m'contant we ou"- glad to see you and move, deliberately, down the hallway.

On afternoon of my day two and their day 12 I came head to head with what I feel is going to be the next phase. I'm trying to remember the phases of disasters. There is the acute, or the CNN, phase, replete with SV's and Anderson Cooper. You have to raise money then before people forget. I know that.

Then the chronic phase, which is certainly less dramatic and longer and stabilizes the community. I say I went to public health school, and I did. But I wasn't very good at it. I did memorize from EK Noji that there are things that contribute to disaster severity -- rapid population growth through rapid urbanization, human vulnerabilty due to poverty and social inequality, and environmental degradation. Port au Prince was a TRIFECTA! I don't think anyone ever did a study on what a totally decentralized society does in disasters. If you think about our federal government's response to Katrina, maybe you think it isn't important. But in Haiti the lack of any central authority, deeply rooted in its voodoo religion, leads to massive noncooperation and duplication of services.

I also remember that "only skills NOT available in the country are needed." Oh well, that's all of them. And another - "Epidemics rarely occur after a disaster." I kept reminding myself of that. Dead bodies do not cause disease. Bacteria don't mutate. But in the back of my mind were the stages. What were we supposed to be preparing for?

Then there he was. A sweet-smiling Haitian man, probably in his 20s, lying still on a stretcher. Too still. Ian, the CEO, who has been at the hospital 24/7 for 12 days at this point, is sitting beside him speaking in Creole (he speaks like 11 languages). A physical therapist, Denise English, who started a school for physical therapists here at HAS, has summoned me. They want me to look at his belly.

The man was paralyzed from the neck down 12 days previously when smashed by a building in PaP (Port au Prince). He came to HAS that first night and was told no one was able to operate on him. His spinal injury was not reversible, and he was sent home with his brothers. At that point, in the initial phase, physical therapy, understandably, was not a priority. Now, 12 days later he had a distended abdomen and his brothers wanted it looked at. They brought him all the way from PaP in a tap-tap.

I examined him and he had an ilius--his bowels weren't moving. We took him into a clinic room and disimpacted his bowel. I will not explain that, but it's not a pleasant thing. Add to this that he had a 6-8 cm sacral ulcer (bedsore) that felt like it was abscessed. Thank God this man feels no pain.

Then I was told to discharge him, there was nothing we could do. We did not have any Duoderm or Tegaderm, or any other derm for dressing his wound. I did what I was told, but it left me sick to my stomach. Fortunately, this man had two strong brothers, and even more fortuitous, they ran into Ian again.


Friday, January 22

Flying in you could tell something was amiss. The beautiful Presidential Palace was not visible against the blue sky and the roads were unusually crowded with pedestrians.

PaP  Airport

But when the plane touched the Tarmac, the site was unmistakable. It sort of screamed "disaster" and "military" and "chaos." It was like ants at a picnic. An organized chaos without an organizer. No one questioned our pilot or asked for any ID. It was pre 9/11. It was pre-historic. There were 5 of us: 2 pilots, 2 friends and me. But I knew the others were not there for long because they were picking up two others and taking off and the military was "in charge." I had 1,300 pounds of medicines, lots of it cold, and I had to get it through the airport and into a vehicle that I prayed was waiting. As usual, my cell phone did not work.

Fortunately, the two guys who were waiting for us on the Tarmac had corralled three luggage carts. We loaded them up, sort of waiting to be inspected, but no one even looked our way.

It was eerie, walking through the airport. Haiti has been relatively stable since 2004, and the airport was being renovated. The last time I was there, in December, they were putting up ornamental wrought iron in a new grand salon.

On January 22, there was no band playing at the airport door, and no customs agents in starched white uniforms with epaulettes. You walked under the fallen ceiling and out into the driveway.

While I have never been to a disaster, I did go to public health school. In one of the endless disaster classes they teach you about violence. I think riding in the back of a pickup with valuable medicines was in the "HOW NOT TO DO IT" category.

Having been through those streets many, many times, the thought of building codes was ALWAYS a joke. But seeing one block demolished and another intact did make you wonder.

It was close to 3 when we reached the hospital, and my allegiance was divided between getting the cold meds to the fridge and getting to rounds. With lots of help and lots of hugs, I did both.

The hospital was chuggyjam. Wall to wall there were people with external fixators (the steel things that stick out after you fix a broken bone), abrasions, and bandages obscuring their faces. The worst were the ones who had tape on their heads labeled NPO (for NOT BY MOUTH) meaning they had yet to be operated on. It was 11 days almost to the hour since the earthquake. They were the lucky ones- still alive to wait their turn.


Earlier Post

Sunday, January 24

It's like a damn war zone. There are helicopters for no exact reason and people's nerves are frayed. There are those old army stretchers everywhere. I got two more paralyzed people. What am I supposed to say? Go home, get rehab? They have no homes. There is no rehab. I guess they will lie there until they die. At least they have no sensation. I can't quite figure out why - or how -they came all the way here. I'd give my right arm for a rehab doc. And a bunch of wheelchairs. I realized at some point yesterday nobody had post -op orders. But on many levels, I bet HAS is as organized as anyone here. I talked to Paul Farmer* who is in same position with same problems in Cange. Lord only knows who is running the General Hospital in Port. I wish I could say I thought I had helped the patients, but I am not sure that's true. At least the internists have had some sleep

. ...just as I sent the last note a nurse came running in to get me to see a kid. By the time I saw her, she was obviously dead. I let the nurses try to resuscitate her for a while, but it was not happening.The mother was so sweet and told me the whole story. The girl was in school in Port. She had been discharged from here last week after having a crush injury in the EQ.(Her brother died too.) She was 14. From what the mom said, I think she had a pulmonary embolus.The woman was so nice, she actually thanked ME (I did NOTHING). OMG. And then... I realized the Canadian TV crew filmed the whole episode. I want to scream. Going swimming

* Paul Farmer and his organization, Partners In Health, are the subject of "Mountains Beyond Mountains" by Tracy Kidder, Carolina's Freshman Reading Experience book in 2006.


Saturday, January 23

The Port-au-Prince airport was surreal. There was one of those convertible jeeps in the grass and it had an American flag stuck in it. There were huge cargo jets unloading huge pallets and it was TOTAL chaos. It was like an ant farm, nobody seemed to know what anyone was doing. I got off, and saw our friend TJ standing on the tarmac like he worked there. We gathered my stuff and walked right through the very damaged building and out a door. The area was guarded by a military guy--one of ours. He made all my guy friends leave me and go back to plane. That caused a brief bout of anxiety. But I was too busy guarding my stuff to worry for long. I saw Buck and started handing him bags and boxes. We put them all in his truck with the help of our (homeless) Haitian driver, Dieuseul. The HAS truck wasn't there when we finished and we were surrounded by a mob, so Buck climbed on top of the luggage and we drove off.

It was somewhat a sight and probably not in the "How to transport meds in Emergencies" handbook. We drove straight through Port, by the Palace, through the slums. It looks like a bomb went off on one block, then there is a perfect playground on the next. We went to the nuns' house. They are an unbelievable bunch, camped in their driveway, the oldest ones in rocking chairs. Their Provincial house was spared but their house in Petionville and their school in downtown Port were destroyed. We left there quickly because I caught the bus here. Once the drugs were safe on the bus and we were out of Port I fell sound asleep.

Dr. Sannon, my partner, handed me a chart, hugged me and said "See ya later, I am going to sleep". I told all the medicine docs (mostly interns) to go home and I have taken over for the weekend. The medicine ward isn't that bad and it's not like I came here to sit by the pool. Ian (the CEO) came and found me and was gracious. All the doctors hugged me; one cried. Even a nurse who hates me came up and smiled. There are visiting surgeons everywhere and patients everywhere. There are still open fractures and people screaming. But the Haitians haven't changed. They smile and welcome me,

Then they relate which of their family members died--two sisters for one, a cousin or an uncle for another. These people know disaster. They live it. They did 400 X-rays in one day. They had 600 patients one night. The stories continue. I saw my first victim this afternoon and it gives me the willies because it is so prescient of the next wave. It was a young healthy man who was paralyzed in the "trembleman de te" [earthquake] and now has horrible skin lesions. There is no Tegaderm -- the stuff we take for granted for bedsores. I am trying to figure that one out right now. When I pulled in the drive, I got that feeling you get when you come after a long trip and knew I had made the right decision.


Thursday, January 21

Tonight we go to Marsh Harbor and spend the evening with the 1700 pounds of meds Harriett, Glenn et al have organized. THEY ARE saints. Tomorrow Ted will take me to PAP (Port-Au-Prince). Supposedly my brother Buck and my usual driver Dieuseul will be there. Also, a truck from the hospital (Hospital Albert Schweitzer- HAS). I hope to be able to help Buck triage the nuns and sick and new orphans BEFORE going to HAS, but this will likely not occur because I need to get to HAS urgently. When I get there I am sure I will be occupied but I will try to keep all informed. HAS runs on generators and when they run out of gas, that will be the end of communications.

One thing I have gotten SO many requests for is methods to help. Please know that I am 100 percent sure I will be able to answer that question soon. I also hope to be able to get other docs down. While they desperately need more help, they cannot handle it right now. But soon I hope to help change that.