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PIH: Hope and Responsibility in the Darkest of Times

By Lucy Belnora
News | January 25, 2010

PORT-AU-PRINCE, Haiti - Founded in 1987 by Dr. Paul Farmer, Partners In Health (PIH) is an international health care organization that has providing vital health care services in Haiti for more than 20 years and is one of the largest health care providers in the country, working with the Haitian Ministry of Health to deliver comprehensive health care services to a catchment area of 1.2 million across the Central Plateau and the Lower Artibonite Valley.

PIH Medical Director Joia Mukherjee has been working around the clock in Haiti since 48 hours after the earthquake. In a late-night email from Port-au-Prince, Dr. Mukherjee reported an inspiring example of lifesaving international collaboration from the night before. The case of a baby suffering from severe blood loss and in shock was discovered by the Haitian nurse who serves as chief administrator at HUEH, who was rounding by flashlight, with two Haitian doctors who had returned from their pediatric residencies in Cuba to help. Dr. Mukherjee described what happened next...

"On a routine post-operative check on a woman who had undergone a C-section, the residents noticed that her baby was pale. Upon unwrapping the baby, they found that she had a huge amount of blood pouring out of her rectum. They ran to the operating room asking for a surgeon. While the team had orthopedic surgeons, a plastic surgeon, four anesthesiologists, six pediatric nurses and me, a pediatrician, we had no general surgeons.

"Because the blood bank that the Haitian Red Cross was a day or two away, an orthopedic trauma surgeon from Grand Rapids, MI, stepped up to the plate and drew 60 cc of his own O negative blood into a regular syringe. Plastic surgeon John Meara [from Boston] put a needle into the baby's tibial bone marrow (an intraosseus line) and we moved the baby to the operating room where anesthesiologists from Boston and Grand Rapids went into full code mode finally securing a line and giving the direct whole blood transfusion and nearly one liter of fluid (half the baby's body weight), oxygen and antibiotics.

"The cause of the bleeding was likely an intestinal obstruction. When the baby was stabilized, we began trying to transport the baby to one of the U.S. military facilities. Even with the excellent collaboration with U.S. military personnel stationed at the hospital, it took hours to get confirmation of the location.

"By 3 am, the baby had stabilized and was actually sleeping. Some of us slept on gurneys close by--abruptly jumping up for two aftershock tremors. At 5:30 am, as the sun was rising, I again called the military and finally got confirmation on the location of the hospital. After waiting 2 hours for military-approved transport, our own PIH/Zanmi Lasante driver took us to the facility. By 8 am, the baby was stable and in the hands of a competent pediatric surgeon.

"My brief rest was made more peaceful by this one miraculous example of collaborative spirit between Haiti and nurses, doctors, drivers, and soldiers from around the world, on behalf of a tiny baby, whose life, like those of all babies, is our collective human responsibility."

PIH had more than 100 doctors, 600 nurse and 4,000 employees on the ground in Haiti working from 12 existing PIH medical facilities in Haiti before the earthquake struck on January 12th.

In the hours immediately following the earthquake, PIH quickly established field hospitals in Port-au-Prince, and currently has 20 operating rooms up and running, with 12 functioning 24-hours a day. Because it was already on the ground and acquainted with the country, PIH quickly established a relief transfer system to transfer patients from Port-au-Prince (HUEH) to PIH sites in the Central Plateau and Lower Artibonite Valley, which includes 12 clinical facilities already treating patients.

It was one of the first NGOs to evacuate patients in critical condition to hospitals in the United States and Dominican Republic and is now coordinating the evacuation of patients in critical condition to the United States Naval Ship, the U.S.S. Comfort.

So far, PIH has sent 22 plane loads with more than 140 medical volunteers - orthopedic surgeons, anesthesiologists, surgical nurses and other medical professionals - and several thousand pounds of medical supplies to support the more than 4,500 PIH health care providers already in Haiti.

Its founder, Dr. Paul Farmer, wrote last week:

"The scale of the disaster is coming into view. All of the clichés born of extremity came to mind as I saw the city of Port-au-Prince in the dark after this huge earthquake. Symbols of authority and some sort of civility were flattened or tottering. The National Palace looked like a meringue pie that had been sat on. A foul smell hung over the General Hospital, which had just run out of diesel fuel and was surrounded by the injured, the sick, and, of course, piles of those who did not make it. But contrary to rumors of looting and mayhem, the city of two million was quiet, which in itself was unusual. I had never experienced Port-au-Prince without the blaring of radios and car horns. And I expect it will remain this way -- calm, as long as people are offered dignity and respect and the necessities of daily survival: food, water, sanitation and shelter.

"The public open spaces of the city (there are few of these) and many streets have been closed off by the citizenry seeking protection from both aftershocks and troublemakers (there have been more of the former than of the latter). What strikes me from Port-au-Prince, apart from the enormity of the disaster, has been the magnitude of the response among those unaffected, whether within Haiti or without -- the simple desire to help -- and the difficulty we will face in seeking to match that goodness with the surpassingly enormous need. So far the desire to help has not been matched to the need, and there are several things to keep in mind as the situation on the ground changes rapidly. ...

"I was reminded last night that rescuers will get tired. I went to see my hardy colleagues -- Haitian, Americans from Boston and Miami, Irish, and Cuban. A couple of them had been in Port-au-Prince before the quake -- attending, ironically, a meeting on disaster preparedness -- and had spent every waking moment attempting to assuage suffering the scale of which most of us have never seen. Here again, coordination and cash are king. Just like everyone else, they will need food and a safe place to sleep. Two of my medical colleagues have been sleeping in a jeep. Another two have spent the past two nights without any sleep at all. One of my Haitian colleagues had a dressing on her hand but did not comment on it. She was looking for water and food for the rescuers and, of course, worrying about her own family, some of whom were still unaccounted for.

"Like so many of my Haitian colleagues, she represents what is best about that country: an inextinguishable spirit of resistance that represents hope even in the darkest of times."

PIH medical personnel on the ground in Haiti report continuing progress in ramping up surgical care, but warn that equal or greater attention, resources, and urgency are needed to address other dimensions of a humanitarian crisis affecting more than 3 million people - shelter, food, water, sanitation, primary medical care.

"The reality now is medics are not the main issue in terms of care. It's still a problem of supplies, coordination, post-operative care and the problem of internally displaced people. There will be more than one million people that need shelter - maybe many more - some with acute medical needs, some without. All in need of care, shelter, food, water, beds, etc. This is the next crisis. It's happening now and I think it will get much worse very, very fast," said Dr. Mukherjee.

Large tents, x-rays, and heparin (to prevent blood clotting) top the current list of urgently needed supplies, along with rapid HIV tests and prophylaxis to protect against infection from needle-sticks and cuts for medical staff and patients.

The PIH team also reports that life is returning in Port-au-Prince with street markets opening and Haitians courageously rebuilding their lives and demonstrating inspiring resilience in the face of such tragedy and loss.

PIH's Haitian doctors are expanding their reach into neighborhoods across Port-au-Prince, bringing medical care and other vital services to people who have set up encampments in parks, streets, and courtyards. PIH regards these self-organized communities as the best foundation for our medical response and calls on the international community to do the same by joining us in efforts to distribute food, water, shelter, sanitation and other essential services equitably and efficiently.

Partners In Health was one of seven organizations benefiting from the most widely distributed telethon in history, Hope for Haiti Now: A Global Benefit for Earthquake Relief hosted by MTV Friday night and aired on all the major networks. James Taylor also raised funds for Partners In Health's relief work in Haiti Friday night at a sold-out concert in Great Barrington, Massachusetts.

As part of PIH's long-term commitment to relief and reconstruction efforts in Haiti, PIH has greatly expanded its procurement and supply operation to include a 27,000 square foot warehouse space in Miami. The warehouse will serve as a primary storage and shipment point for PIH for medicines, medical equipment, and supplies, as well as vehicles and other equipment needed to rebuild and expand the public health infrastructure.

The long-term ramifications in Haiti are going to be significant and far-reaching with a new, large group of vulnerable and displaced people. PIH seems to have the experience and commitment to help Haitians for many years to come.

Anyone interested in donating to Partners in Health can click here.

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