Terrain Acra Port au Prince

HAITI
Today is Day 3 of my visit here.
The first thing you notice when you arrive here is how hot it is! I have never sweat so much in my life, not even in Africa.
After a slight wrinkle at the airport on Sunday I made my way to the “group house” that is shared with 5 other people. It is actually a beautiful house in a ‘safe’, gated community. I sleep in a tent on the ‘balcony’ which fortunately is inside. Fortunate because this is the rainy season. It rains every afternoon, sometimes it is a thunderstorm with a deluge and sometimes it is lighter.
On the drive from the airport there were obvious piles of rubble and destruction and a fair amount of traffic.
I met my house mates and forced myself to stay awake until after we went out to dinner, getting to the restaurant took 40 minutes. The traffic in Port au Prince is really bad and I was to discover just how bad the following day. A large part of my time is spent sitting in traffic, after a stop at the main office and a security and camp briefing I finally got to the “Tent city” where I will be practicing for 2 weeks. It is called Terrain Acra.
Terrain Acra has to be seen to be believed, it is a community of 28,000 people displaced by the earthquake all living under pieces of plastic sheets. There is no running water or electricity, the temperature outside is between 97 and 103 degrees, this is magnified by the plastic sheeting and lack of air circulation. Children, goats and pigs rummage freely in trash piles that are everywhere. What is it about pigs that makes them smell so bad?
Terrain is a squatter settlement on the waste dump of a factory owned by 3 brothers with the last name Acra (I understand they are of Lebanese origin). The brothers have agreed to allow these people to stay on the land until January 11 2011 at which time they want their land back. The police have agreed to forcefully remove the people at that time.
The ‘clinic’ is a large tent donated by Unicef, it has been divided up into 5 examination cubicles and a table which represents the pharmacy. I was only there for a few hours on my first day and then I was told to return to the office. Once there no one seemed to know what I was there for so I guess I should have gone in the ‘mobile clinic’. In the office I was given a disc on key by the data entry guy. I tried to open it later on my own computer. There was nothing on it but viruses, my computer went crazy!
DAY TWO
My second day began with a quick breakfast and then the long car ride to the camp, on the way in, I could tell my stomach was starting to rebel. I had the dreaded thought that I might have to use one of the latrines (a hole in the ground which is used as a toilet). Try as I might I couldnt ignore it and the cramps got worse. Just in time to start the daily meeting ! Great, why didn’t it start before I left the house so I could take something? I checked in at the pharmacy table, No, they didn’t have any diarrhea medicines! I decided I had no choice but to bite the bullet and go to the latrine.
The latrines stand proudly with their graffiti covered plastic flapping whenever there is a suspicion of a breeze. I am not too proud and I do need to hurry up before I run out of options, I thought. Let me check them out.
I went back and got some gloves, I didn’t like the idea of toughing the plastic not even for the second it would take me to get into position. OK, now I’m ready! I picked up the plastic and the smell was overwhelming, I reeled back and rethought my strategy, Nah! I can wait!
Unfortunately my stomach had other ideas. The cramping got worse, I was dodging in and out of the meeting trying to look very busy without doubling over. I thought perhaps I could wear a mask and that might make it tolerable (“does anyone have a hazmat suit, I’m going in!”) but I couldn’t find one. Finally on my third attempt I stepped inside the latrine and held my breath. It sounded like everyone in there had similar problems! I tried to hold the plastic ‘cover’ with one gloved hand a failed attempt at some modesty and prayed it would soon be over. Added to this was the fact that the latrine temperature is a good 10 degrees hotter than the outside. Now, you can understand why in 3minutes you lose almost a litre of sweat and exit with near syncope (that means fainting). I recalled one of my colleagues had mentioned he was about to pass out the day before doing the same thing. I returned to the clinic tent sweating buckets and seriously nauseous just in time to hear the medical director announce “I would like to introduce Dr Tuakli, our new visiting doctor!” Showtime!
So why do I tell this graphic tale you wonder? Because it really brings home how these people are living on a day to day basis with zero options, it’s a wonder a massive epidemic of cholera or dysentery hasn’t wiped the whole camp out or that people don’t become despondent in the face of such living conditions. Compared to this the rest of the day was less traumatic. I saw patients in the clinic including an 82 year old resident of the camp and several children. There was some mention of me organizing the women and child care system for the camp , we’ll see how that pans out. I guess every little bit helps and I am glad to make my contribution.
Around 3pm I went with the medical administrator to a ‘cluster meeting’. This is where all the organizations that have health programs helping out in the various camps get together and decide on strategy. There are Aid organizations from all over the world mostly Europe and the US. They decided with the WHO to call on the Haitian government to stop forceful removal of squatters in camps. By the time I spoke to my husband on skype my voice was gone and I was wiped out, I thought it was just dehydration and a stomach virus, but No, this morning I woke up with a full blown cold.
DAY THREE
I have spent the day with a nose dripping like a faucet but in addition to that I worked in the clinic in the morning. I am discovering creative talents I did not know I possessed. Yesterday a lady brought a child in with a fever of 40 degrees centrigrade (normal is 36) and said the baby had begun to have seizures, requests for Tylenol were not working and after insisting I was told there was none in drops. The child had already been stripped and sponged but was still hot (big surprise in that tent!). Brain wave! I asked for a tablet then crushed the end with my otoscope and poured the powder into the child’s mouth. He didn’t like that and started to whine, next I grabbed my water bottle and dripped some water into his mouth, Voila! All washed down.
Today, a lady came in with a child with Hydrocephalus (a big head from too much water on the brain) the child is 15 months old and has a fresh scar on the head where some surgery has been done to relieve the pressure in the brain. A sad case, the child cant walk or talk, legs are paralyzed. Apparently the doctor she saw had given her a prescription for Amoxicillin liquid, which was not available so she was told to go and buy the prescription elsewhere. The child’s caretaker came to me and asked me to help. She said the child’s mother had died and she had no money. I spoke with the doctor, “well she can come back tomorrow and she can see if we have some then” she said. Ahh, I don’t think so! I went to the pharmacy and told them to take an adult pill and have them crush half of it three times a day.
I have treated four staff people so far!
A middle aged lady came in with a 3 day old baby, apparently it had been delivered ‘at home’ in a tent, the mother was not there. Unfortunately, this opportunity to intervene was missed, the clinic staff cleaned the umbilicus and sent the baby ‘home’.
This plus several other issues prompted me to send a long email to the program director. I’m not sure how popular I am going to be after this!
My mind is racing with ideas of things we can do to help the community at Terrain Acra .
I will keep you posted!