Update

Sunday, January 31st   I think I've missed a couple of days but hope I can catch you up tonight.   Our operations are still continuing and expanding.  Yesterday I met with Plan International that have operations in Haiti.  They were interested in hearing more about our work in the region and how we can partner on specific activities.  At the meeting was Mme Germaine of the Red Cross and Larry Walker of Community Coalition for Haiti, one of my partners representing Hospital St Michel.  Haiti Village Health and CCH are presently working to support the biomedical depot in the city.  It is stocked with donated meds which are distributed to partners within our network.  Plan may be able to assist with some funding to keep the facility going.   We also had a Health Cluster meeting.  Many issues were discussed, including updates from the more remote clinics in the region.  A health assessment was done in Cotes de Feres by ACDI VOCA a USAID funded organization.  Among the greatest needs were a refugee camp with 3500 people and only one latrine, lack of medications and the need for a special care home.  Twenty people with physical and mental handicaps are now living in a small school as their home was destroyed.    One of the greatest barriers to helping this village is that it takes 5 1/2 hours to drive the 130 km due to poor roads.  In discussions with the Canadian DART team, I am hoping that they may be able to go in to assist in the quick construction of latrines in the area.  Working closely with  Base Jacmel Airport gives me several good connections regarding the possibility of flying teams in by helicopter to the region.   Back to the health cluster, we also encountered another snag.  There was a suspected case of measles in one of our refugee camps (Pechinat, over 7000 people).  UNICEF sent vaccines and the process began Friday.  Unfortunately the government building where vaccines were stored in Jacmel was damaged.  The group seemed a little confused as to how to proceed so I offered up the fridge at our guest house.  It still seemed a little shocking to me that the vaccines were loaded up into the back of our truck and then delivered to the fridge in my kitchen.  I know...you public health advocates out there are saying "cold chain"  which to lay people means ensuring that the vaccines are kept under specific temperature control.  Well, in times of disaster you do what you have to do.  In speaking with Mme Germaine of the Health Office yesterday, she did inform me that UNICEF was donating a fridge and that it should arrive by Monday.  I brought this subject up at the logistics meeting yesterday morning, and WFP said there would not be a problem placing the fridge in their storage facility.   Haiti...improvisation.   So, today I went to Cayes Jacmel which is about 20 minutes east of the city.  I had vsited the hospital once before in the spring while I was doing my health assessment.  How it has grown in the past several weeks.  As I knew of the potential capacity of the center, i directed several physicians to augment the services there.  We moved doctors from lavallee de Jacmel in the mountains to assist in Cayes Jacmel.  It is currently our best hospital in the city.  It has two functionnal operating rooms and a brand new, mobile OR donated by a Swiss Humanitarian agency.   (I'm sorry I just have to stop for a moment now.  The rain is pounding down overhead.  It has been dry here for so long, which is what we need.  I can only think of the thousands now who are sleeping outside with little shelter or cover......I think too of Cayes jacmel that I visited today.  They have 40 inpatients well outpatients as they have very little space.  when I was there today I saw the simple tarps that were placed over the patients.  I looked up and discussed with one of the surgeons as to what would happen if the rains came.  A young boy sleeping outside with an external fixator on his leg from a broken bone.....rain falling around him....little pain medications and fear in his eyes.  I think of him now as I recall his mother comforting him today.  Trying to keep him calm when he was in pain.......rain......and we simply need a few large tents to provide shelter for these patients.....please don't forget Haiti....this crisis is anywhere from over)   So, back to the Mobile OR unit.  They performed their first surgery today.  Skin grafting of wounds on a woman's hand and foot.  The tendons in her left hand were exposed from a crush injury during the earthquake.  A skin graft was taken from her left thigh and placed on her hand and foot.  The surgery went well medically, slight problems with the electricity in that they had a power outage half way through.  Luckily the secondary generator kicked in.  As I mentioned with this third functional OR, Cayes Jacmel has the best facility in the south at present.   After the OR evaluation I had a look at the current OR and staff accommodations.  There is room for over 20 doctors and nurses.  That facility will get a lot of use in the next 3 months.  It was typically run by a local doctor Philippe who performed surgery once weekly there.  Now they are performed several ORs daily and have 40 inpatients (within only one nurse....don't worry I may have two volunteer Haitian RNs to assist them tomorrow) So after Cayes it was back to the airport.  It was actually strange to be out of the city even such a short distance as the airport has become almost my first home.  I am lucky to have my secretary Ruth, Fredo and now my good friend Jo Barbosa to act as manager of Airport Operations for NGOs while I coordinate logistics and attend meetings.   This afternoon Sarah Wallace and I were invited to the family home of a friend of mine from Bermuda, Mrs. Frigga Simmons.  Frigga was born in Jacmel and moved to the US as a teen and then Bermuda.  We were able to spend time with her Aunt and Uncle and discussed the earthquake, its effects in Jacmel and potential future of the region.   Sarah and I returned to the airport and I packed up for transfer to my new accommodations at Haitian Children's Home, under the care of Danny Pye.  We are renting the top level of the home for the next 3 months.  En route, we saw a large amount of traffic on the road.  It looked like there had been an accident, so being the Emerg doc that I am I ran over to see if I could help.  There was a young man lying on the road with none other that the Canadian RCMP by his side.  (Yes, they are in Haiti and have been here for several years.).  We were unsure if he was hit by a car or simply just fell off his motorbike, but he had decreased level of consciousness and was bleeding from the mouth and head.  So we did what one would do....call the UN for the ambulance.  The RCMP, bless their souls, did have a first aid kit with them.  Unfortunately I didn't find the gloves until my hands were already streaked with blood.  And sorry to all my EMT friends, I was unable to do c-spine precautions as I knew there would be no c-collar, and if he did have a neck fracture, we would have little ability to deal with that injury.  So I bandaged him up (again my EMT friends I have the ultimate respect for what you do in the field) and awaited the ambulance.  I called my partners on the ground as I was planning to take him to the General Hospital.  I was instructed to go to Cayes Jacmel.  My friends took my bags to the guest house and I went with the patient (accompanied by his friend) with lights and sirens to cayes Jacmel.  I tried to call the facility to give report.   No laughing EMTs, I really did want to give them a heads up.  Unfortuantely cell coverage isn't the best at that hospital so I texted one of the docs that works there.  The text didn't go through, but they were quickly able to deal with the patient when he arrived.  We moved him by stretcher to the bed.  The orthopedic surgery was attending to him, had one look and said ?maybe we should start mannitol.  I suggested that we get him cleaned up, stitched up, treated for pain and then observe him for the night.   In any North American institution this young 24 year old would have immediate xrays of his neck and a cat scan of his head.   But this is Haiti and we must learn to work with what we have.   So, from the hospital to the airport.  It was funny but as I finally had time to speak with the ambulance driver and told him I was Tiffany, he said oh  "Dokte Tiffany".  My name seems to be catching on.  At least now I have his direct number, though all ambulance transfers must be approved by the hospital administrator.   Tonight was a special feature at the airport.  We were entertained by the boys and young men of Trinity House.  It is affiliated with St.Joseph's home for boys in PAP which some of you may have seen before.  AS St Jo's was demolished in the earthquake, many boys have come to live here and the capacity of Trinity House has grown from 20-40.  It was a very entertaining show with drums, dance and even fire.  A welcome break from our gruelling schedule.   So, here I am now, 11pm, probably time for bed but I really want to be able to share my stories with you.  One of my team members writes articles for health magazines and follows the news closely.  He says that Haiti is dying out in the media.  Please, remember that there are thousands of people still in great need.   Almost 200,000 have died but there are another 200,000 displaced without shelter.   My other concern as well, is the predictions that we are hearing regarding another large quake.  3% chance of >7 on the Richter scale, 25% of >6 and 90% change of >5.0  (which could still cause severe damage).  Tremors are expected as well. Please keep my team and Haiti in your thoughts and prayers. Goodnight. Tiffany   Tiffany Keenan, MD CCFP Haiti Village Health www.haitivillagehealth.ca www.haitivillagehealth.blogspot.com "Sustainable Health Care in Haiti"   7 Marley Beach Drive Warwick WK08 Bermuda. 441-599-7709 Canada. 506-474-2429 skype.  tiffany.keenan.1971

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