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Wednesday, 24 February 2010

Climate Change and Health - DOW's Annual Conference

Doctors of the World UK (Medecins du Monde UK) Annual Conference

 Climate Change and Health: understanding the impact before it’s too late.

 Friday 19th March 2010 - 10am-4pm

Join us to hear lead experts in the field, including Jonathon Porritt, Andrew Haines and Jean Lambert MEP, set out the consequences; from changing migration patterns and new conflicts to the impact on public health. Afternoon workshops will give you the chance to share your own ideas on how best to address the issues raised.

It promises to be an interesting, inspiring and interactive event.


How can we influence policy that impacts Health and Climate Change, right here in Europe?
The aim of the workshop is to explore the best ways of influencing policy by asking what we should focus on, what kinds of partnerships and coalitions are needed, and what lessons we can learn from what has been done so far.

Understanding the link between Climate Change and Health in the developing world.
The aim of the workshop is to understand the dramatic implications of climate change on health in many developing countries and to identify the impact and importance of investment in Disaster Risk Reduction (DRR). This workshop welcomes active participation from both NGO and non-NGO delegates to build a case supporting investment in healthrelated DRR in a developing country.

Read our finalized Agenda for the day
To register for this event please email: or call us on 020 7515 7534

Places are limited, so please do let Elinor know if you can no longer attend, equally, free to inform your friends or colleagues who have an interest in the topics we will be covering and ask them to contact Elinor asap to book their place. 

Hosted by Freshfields Bruckhaus Deringer LLP, Northcliffe House, 28 Tudor Street, London EC4Y 0AY

Professor Christopher Bulstrode, a British surgeon working with Doctors of the World in Haiti, has attracted significant media coverage since returning from the field. 

His moving commentary has received attention from national media, including Sky News, the BBC's Today Programme, along with regional radio channels and newspapers.

Christopher - Going home

Last few days…

My last few days in Haiti were difficult.  I was tired and one part of me was desperate to get home to my friends and family, to sleep in a real bed, and eat some healthy food. Another side of me was equally desperate to stay.

We now knew what we were doing and were working fast, as a tight team. Even my French was beginning to improve! But most importantly, we had got to know some of our patients very well and were very fond of them. We had looked after them through thick and thin, and they trusted us. I think we all wanted to see them through to the end of their treatment. But we were all exhausted.

We had been sprinting for three weeks. Working seven days a week, Michel and I between us had done just under 500 operations. We had been supported by a fantastic team of anaesthetists, nurses and logisticians who just kept the patients coming and made sure that we had everything we needed to do the best job possible under the circumstances.

The surge of open amputations and infected wounds was now under control. So, the surgical crisis was over. But now the long slow marathon of rehabilitation had to start.

Where now for Haiti?

It is estimated that there are now around 3000 new amputees in Haiti, so there is going to be an unprecedented demand for artificial limbs, limb fitters, and rehabilitation. Luckily two big charities Doctors of the World (Medecins du Monde) and ‘Handicap International’ have decided to join forces and are setting up a programme to get these amputees fitted with useful limbs.

In the first instance this work will have to be done by expatriate volunteers, but the task must be handed to the Haitians as soon as possible. It is their country and at the end of the day the solution must lie in their hands. So the workshops and the rehabilitation centres will be training Haitians to make and fit artificial limbs at the same time as treating amputees. It is going to be very difficult to fund, because already Haiti is beginning to slide into the media twilight, out of that bright spotlight which generates funds. 

Looking back

Looking back there are some things which stand out. There was a very small British input in the early stages. Oxfam have and still do a great job helping with water and sanitation. Merlin were one of the first to get a surgical team onto the ground. But for a country which I gather donated more money to help in this disaster than the rest of Europe put together, I do wonder if Britain’s footprint in any way represented our concern.

I just wonder if Britain needs a volunteer stabilisation force ready to deploy at a moment’s notice, to help in circumstances like this. The French have one and it is very good.

Back home 

Back in England it is cold and wet but it is lovely to be home. Walking into the John Radcliffe Hospital I am literally dazzled by the clean floors and the sense that everyone is quietly busy. There are no cracks running down the walls, no blue-bottle flies wobbling drunkenly over infected dressings, no patients lying in rows of stretchers laid out on the ground, sweating in the heat.

My colleagues in the hospital are all very kind and supportive. I know that they would have gone to Haiti like a flash in my place, and would certainly have done a better job too, but whatever they were thinking they were kind enough to keep to themselves.

Facing the press at home

The media still want interview after interview, and of course this suits the NGOs very well. This is their oxygen. This is how they raise funds to do what they do, so I must do it, but actually it is quite harrowing talking about some of the things I have seen, and of course those are the parts they most want to hear. The interviewers are very gentle but my knees are shaking at the start of each interview as I pray that I don’t say something stupid. But their questions are sensible, and they are all very well briefed.

They genuinely seem interested in what I have to say. I am rather touched because they must have to deal with this sort of thing all day every day, and it is nice to realise that they are humans too, albeit doing a tough job.

“Will I go back?” they ask me. Of course I will, if I am asked. I so want to see what happens. I would just love to see Haiti break the downward spiral of poverty, drugs, HIV and violence which has gripped it for years. Perhaps only an earthquake can do that, but it is difficult to see how.

Our entente cordiale

So really this blog ends now. I have to thank Harry Beer at Radio Oxford for giving me so much moral support in those first interviews with the lovely Malcolm Boyden. Then there is Vicky my partner, the rock in the system, always there at the end of Skype when the going gets tough and there at the end of the day to pick up the bits when I get home.

Last but not least my thanks go out to Phillipe Cottin, the artist and photographer who took wonderful photographs, translated these blogs into French, improving them at the same time, and gave me a wonderful insight into French military history. And all these years I had thought that we won against Napoleon!. Thank you for reading this all and ‘au revoir’ or ‘a bientot’.

Thursday, 18 February 2010

HEALTHlink - Challenging the barriers to access to healthcare in the UK

The treatment of migrant workers, asylum seekers and refugees is a matter which concerns us all. They experience common, reoccurring problems when trying to access the services they are entitled to. They are a group that is nearly invisible; they live alongside us but are not able to visit a doctor or a dentist when they need it the most.

On the health care frontline, health professionals and their staff are strongly relied on by this section of the community when the iron curtain of language barriers and tortuous bureaucracy falls between them and health care.

Doctors of the World UK (Médecins du Monde UK) has launched MDM HEALTHlink, a new online forum to improve access to healthcare services for migrant workers, asylum seekers and refugees.

This new network will provide a forum for healthcare professionals as well as activists, lawyers and academics to improve information and best-practice exchange by enhancing communication, pooling the most recent information around patient registration, legislation, reports and articles, as well as providing a platform to launch campaigns to lobby policy makers and regulatory bodies.

This is a call to action

Through this new network, we link up healthcare professionals who are determined to challenge these restrictions. We all work together to provide access today and urge the government to take steps to ensure access tomorrow.

Join now if you want to make a difference.

Emily, Darfur - Birth in a toilet

Later that week I tend to a lady who has just given birth to a premature baby at about 30 weeks, in the toilet. And when I say toilet, I mean an outside pit. The baby was rescued and brought to the delivery room. The mother is poorly, suffering from a serious infection. The baby seemed to be in good health, although it is having problems sucking. We administer antibiotic injections just to be safe.

That night, I’m awoken at 2am by the guard who is pointing towards the clinic. As we arrive, we find a lady in labour with the baby’s foot sticking out. I have never delivered a breech baby before. I wonder if the baby is still alive. I thought I heard a heartbeat, but then see that that the cord is next to the foot. This baby definitely isn't alive.

Battle of suvival

Even with the baby close to delivery, the woman's bump is still big. She must be having twins. I hope the second one survives. Please let it survive! This is her first pregnancy. When the first baby finally comes out, it is a relief but also heartbreaking. Some patches of the baby's skin have already started breaking down. There is no point in trying to resuscitate it.

All of us in the room are pushing with the mother and praying that the second baby makes it. It is a boy and he comes out crying! He weighs just two kilos, but that’s normal with twins, and they were born early. We are all filled with tears of relief.

Despite the high stress levels, I love this job; it is just amazing.

Tuesday, 16 February 2010

Emily, Darfur - October

 I always wake up at around 6am, even without an alarm clock. Being the first one up I get the first of the hot water, heated up by the guards in an old fashioned cauldron with a tap on the side.

To my surprise there's a proper gas oven in the kitchen, equipped with other utensils. I usually have cornflakes with powdered milk or a locally made bread, with marmite that I brought, or nutella or honey that are brought on trucks along with medical supplies. After breakfast we have the security briefing, although this area is quiet at the moment.

This morning, a lady who had been in labour since Sunday needs assistance. Meanwhile, so does another lady who is in agony after giving birth to a big baby five days ago but hasn't been passing urine since the birth. The baby, apparently her ninth infant, was stillborn. We fit a catheter and manage to drain almost two litres instantly.

Another miscarriage

We attend to another lady who has had a miscarriage, and put her on a drip to stop her bleeding before sending her home.

After lunch I am called back into the clinic to help a woman whose baby, believed to be her sixth, is transverse at 36 weeks. Luckily, she hasn’t been contracting. We complete a referral form to send her to the hospital in Nyala, but there are no trucks available until next week.

Another lady arrives at the clinic saying that she is 20 weeks pregnant, but looks ready for labour now. There is no foetal heart and she is in pain, obviously from the expansion. We don’t know what is wrong with her and no trucks are available to take her to a hospital.

Paying rebel groups

It’s expensive to hire trucks because we would have to pay rebel groups to let the truck pass. We give her IV antibiotics and pain relief as a precautionary measure.

In the evening I go back to clinic in the pitch black. The 20-week pregnant lady is still in a bad way, but her husband knows of a truck that is leaving tonight or tomorrow morning. This means that we’ll be able to get her to El Fasher. The journey takes eight hours, but it’s better than waiting a week.

We arrange the cash and paperwork for the truck and prepare everything in case it plans to leave straight away. It’s a relief to know that she will soon get the medical attention that she needs, ending the evening on a positive note.

Emily Denness - Laborious times for a midwife in Darfur

Emily Denness, a trained midwife from Richmond, London, decided that she wanted to experience new cultures while giving something back to local communities. At the end of summer she left her job in Lymington, Hampshire, to board a plane heading towards Cairo, Egypt, before finally arriving at Deribat, in Darfur, Sudan.

Doctors of the World has been in Deribat since February 2008 to reinforce the primary health care services and improve the capacity of the population to maintain its own health status. With the nearest hospital eight hours away, Emily faces a challenging six months ahead. However, her enthusiasm and excitement outweigh her nervousness as she shares her experiences at the project.

Christopher - Day 8 Finishing Off: A Personal View

The media and its coverage in a disaster

It seems like yesterday that I arrived in Haiti, but nearly three weeks later a lot of water has gone under the bridge. By all accounts the initial phase before I arrived was absolute chaos, as people struggled to escape from under the rubble and to understand what had happened to the world around them.

Haiti is not famed for its earthquakes. It has had the odd tremor like many places in the world, but this disaster came like a bolt from the blue. The buildings were not designed to resist an earthquake. There was no contingency plan if one did occur.

But quite literally, within hours, the media were here in Haiti. Reporters are always ready. They are professionals whose bags are packed ready to leave at a moment’s notice. Some of them have at their disposal the resources of multi-national news agencies, that know how to get an airline ticket when the plane is full, and how to charter a helicopter which is already assigned to go elsewhere. Quite literally their cameras are running before their feet touch the ground.

Behind-the-scenes in a rescue operation

It is a little unfair but within hours of arriving they are demanding to know why the medical assistance still has not arrived. After all they have been here for what feels like ages in news time.

Well, we medical workers are all volunteers with day jobs. Our bags are not packed and we have to be invited by a Non-Government Organisation to help. They can hardly ask us to help until they know what is needed. Then they have to put together the team and equipment to support that job.

Perhaps it would give a more realistic picture if the media interspersed the pictures of people being rescued from the rubble with pictures of the Doctors of the World (Médecins du Monde) offices in Paris, London, Montreal, Madrid etc with their lights on all night as the staff work flat out to prepare and equip an emergency team?

Then they might want to come into some of our homes to film the conversations that we were having with our partners about whether we could/should go? That might give a more balanced picture of what was going on behind the scenes in those first days.

At first the surgeons coming in and the local surgeons who had survived, were often amputating ruined limbs (about 10% of the surgery we made) as well as trying to relieve the terrible pressure that develops in limbs which have been crushed.

However, within ten days we were able to start reconstructing people’s limbs. In a few weeks from now the long slog will start of fitting artificial limbs and getting people mobile again so that they can start living their lives as independent individuals once more.

The battle for one young patient

It is a sad time. Yesterday we finally lost the battle for another young patient. The muscle death was slowly creeping up the limb poisoning his kidneys. Up till then I had tried to be optimistic with him as he struggled with the pain and the hallucinations produced by the anaesthetics.

I had to sit down and tell him what I had known in my heart for several days. He is only 22 years old and must lose his leg above the knee. The family are heart broken and asked if one of them could be present when we did the final assessment under anaesthetic, just to be sure that it was absolutely necessary.

They sent his 16 year cousin. Brave girl, she had to stand there as I explained and showed her what we were fighting. In my halting French I tried to tell enough but not too much. When she bowed her head, I knew that she had seen as much as she could take, and a nurse led her away.

The team is winding down its work

We now need to start running down our surgical initiative, not because the demand for surgery has vanished - it certainly has not - but because a surgical team was put in place to deal with a special need i.e. to help with the injuries caused by the earthquake. That task is now finishing.

We are now handing all our patients back to the Haitian orthopaedic surgeons and very good surgeons they are too. Their problem is that even without an earthquake, there is far too much work for them.
What is the future for Haiti?

The big question for all of us is what the future holds for Haiti. Is this earthquake going to be a further nail in a coffin already riddled with problems, or could it be used to be the  catalyst for some kind of radical change, which would start Haiti on the road to becoming a developed country? Great idea.

Great sentiments, but what could the earthquake catalyse?
Photos by Giorgos Moutafis

Monday, 8 February 2010

Christopher - Day 7 Port-au-Prince through the looking glass

We drive through Port-au-Prince each day on the way to and from the hospital. So, we get snap-shots of what is happening in the city as each day goes by.  In the first days there was just a mad rushing about as everyone simply tried to survive and find out who else was still alive.

But today, a different movement is visible. Everyone is busy doing something, and there is a sense of purpose in everyone’s actions. Sure, there are still people pushing the remains of their belongings along in wheelbarrows, but now they are going somewhere. Others are carrying beams of wood, or sheets of corrugated iron.

But everyone you see has now got a plan, and they are starting to make it happen. The resilience of the human race is something to behold, and I suppose bodes well whatever ghastly Armageddon we finally visit on ourselves, whether it be global warming or an exchange of nuclear warfare.

The local mobile phone distributor has a gigantic digger in their forecourt clearing the site. Clearly they are going to be one of the first to have a brand new building standing in the ruins of this city. I am sure that their Board of Directors have justified this expense as symbolising their dynamism and their ‘futuristic’ culture. It seems a pity that they have not decided to invest in their customers by building some housing, but there we go. Hooray for capitalism!

Port-au-Prince the capital and its comparisons with the UK

Port-au-Prince is a tiny city in our western consciousness. I think I had heard of it before this earthquake, but I don’t think that I could have told you that it was the capital of Haiti. I certainly could not have told you that the population of Port-au-Prince is over 3 million, the same as Birmingham, one of Britain’s principle cities.

The authorities still have no idea how many people have died here but we do know that the atom bomb dropped on Hiroshima killed forty thousand. This earthquake has killed somewhere between five and ten times as many. I find the numbers involved in this disaster hard to grasp.

Wounds, dressings and maggots

Today we accepted from the emergency service a sweet lady in her forties. She was as light as a feather and I wonder if she has eaten since the earthquake three weeks ago? It seems likely from what we can gather that she has lost every single member of her family - children, husband, parents, brothers and sisters. Her foot had been crushed and the wound had been dressed some weeks ago, and this is why she came to us.  My heart went out to this patient.

What kind of misery had this poor lady been through for the past three weeks with no close family and with a crushed foot which was being slowly eaten by maggots?  Actually, the larvae only eat dead tissue so they had probably done good rather than harm over this time, but I just cannot envisage the mental and physical torture that she must have been through.

Turf wars and the British ‘stiff upper lip’

Last night as darkness fell, gunfire started as it does most evenings in Port-au-Prince. However, last night it was in the wood immediately behind the house. I was delighted to see that no-one flinched at all.  All of us have worked in war zones. The shooting then got louder and a bit more frantic and those of us on the veranda decided to move inside. I explained to my French colleagues the concept of the ‘stiff upper lip’. They responded by opening another bottle of wine!

It appears that drug dealing is big, in the way it is everywhere in this part of the world, and that this was probably part of a turf war.  An hour later the Police arrived armed with Martini rifles. I kid you not! Each weapon was a veritable collectors piece and no match for whatever the dealers were using this year. They were clearly deeply embarrassed by the incident and very unwilling to go any closer to the scene of the dispute with their ancient weapons.

Plans afoot to create a Rehabilitation Centre

In the hospital there is a plan to create a rehabilitation centre for all those who have been injured in this disaster.  It is depressingly rare that NGOs agree to work together but in this case Doctors of the World (Médecins du Monde) and Handicap International have agreed to collaborate to try to create a huge integrated service providing both physical and psychological support for the thousands left damaged by this earthquake. There are actually great synergies between the two organisations and if this works it should be a quite wonderful initiative, which should make a real difference for thousands of people.

My son who is studying Aid to the Third World has just introduced me to a new phrase ‘Pink collar workers’ which I had never encountered before. If I have understood this concept correctly, pink collar workers are people in Third World countries trained to provide an international service such as Call Centres etc. You and I may sneer at them, but it is work like this which may provide some kind of future to those who have been disabled by this earthquake and so lost any other chance of earning a living.

Keeping pace with a heavy workload & the patients who need help

In the hospital itself there is still no sign that we are really keeping pace with the workload. Each morning there is a queue of several hundred waiting for the Emergency Department to open, and each evening the queue is just as long.

The waiting time along the side of the main road in the hot sun must be around 8 hours before you even get logged into the system, and these patients are really very ill indeed. It makes our efforts to see, treat and discharge patients within 4 hours at the John Radcliffe 2 Hospital in Oxford very creditable indeed.  I just wonder whether after all that waiting, we are providing what they really want.

Thursday, 4 February 2010

Christopher - Day 6 Early Morning

We have now been working at the hospital here in Haiti for over a week and life is settling into a rhythm. Sleep is difficult without ear plugs because dozens of dogs bark all night. Then if there is an after-tremor, there is a veritable peal of barking and howling. We are all living in tents next to a house. It has only one bathroom. The secret is to get up before 5am so that you can beat the queue. Otherwise, it feels like boarding school all over again.

Quite suddenly at 5.30am the cicadas in the trees start their monotonous buzz just like a faulty fluorescent light being switched on. It is just a hundred times louder. Then at 6.15am sharp they stop again just as suddenly and presumably get on with what cicadas do for the rest of the day. Their chain-saw whine wakes all but the soundest sleepers who are sprawled on the sofas and on camp beds in the open trying to find some cool breeze.

Breakfast is quite leisurely and civilised; a chance for all thirty of us to touch base and hear what everyone else is doing and thinking. At this time of day there is never any electricity so I have difficulty understanding the French as I cannot see their faces clearly in the half light and I need every cue that I can get to follow the meaning of what they are saying.

The hospital set up

Then we all pile into an old Land Cruiser for the bumpy ride to the hospital. We weave between rubble, and crushed cars, past lines of people carrying water back to wherever they are currently sheltering. As we pass the Presidential palace with its ornate domes tilted at crazy angles, we enter a large park with the statue of some national hero in the centre.

This is one of the largest refugee camps, a kaleidoscope of clothes drying and tarpaulins covering families. Hundreds and hundreds of people are milling around talking, selling things, trying to feed their children, find water and get some kind of more durable shelter before the rains come.

Around the corner is the Hospital. Its gates are guarded by American troops. They have to be. Even at this time of the morning, there is a queue of hundreds of people waiting for treatment, pushing to be let in. We set up the operating tables as quickly as we can. The Haitian doctors will not arrive for a while. They do not have transport to bring them in, so will get in later.

My first job is to walk around the wards and find the patients booked for today. We write on the dressings when the next operation is due, because although the patients are supposed to keep their notes under their pillows they get wet, torn and lost. So I go from leg to leg, arm to arm searching for the Doctors of the World (Médecins du Monde) logo and today’s date.

By the time that I return with my list, the smiling Spanish firemen and women have also found some patients too, and they are added to the list. In the hospital there are now ten tents with between ten and twenty patients in each just for trauma.

Then there is the ‘Jungle’. This is the hospital garden, which has been filled with old beds while tarpaulins are draped between the trees. It is full of patients who could not find a bed anywhere else. The hospital is trying to close this open ward as it is becoming a bit of a refugee camp for those patients who have no home to go to. But as fast as they empty it, more patients arrive. Meanwhile lorries are arriving at the Triage tent travelling down from ‘up-country’ loaded with more patients to be seen.

The working day

We operate for eight hours. I am part of the Doctors of the World (Médecins du Monde) French team and being French they bring wonderful tasty things for lunch, and if there is a chance we stop around midday to eat sardines on biscuits and drink tea.

This is clearly a sacred moment for the French and they always look upset if we don’t manage to stop for this little oasis of peace. As soon as the last case is finished there is an hour’s work tidying up and restocking for the following day, then it is back down to the gates to meet our transport to take us home.

Beneath the rubble

Yesterday the building outside the gates was being cleared with a large digger and dozens of Haitians were digging through the rubble salvaging what they could. The smell was terrible as bodies tumbled out.

To me the horror was the thought that some of the people must have been trapped there for hours or even days hoping for rescue which never came. They are presumably some of the parents of the orphans who are causing so much distress for everyone. They would have been at work when the earthquake struck, and it is the big buildings in the centre of the city which seem to have been worst damaged.

I try to relate this whole situation to Oxford where I live. What if the Cornmarket and the High Street were just piles of rubble with electricity cables trailed across the road? The Westgate would be a pile of rubble with over a thousand people buried in it. What if patients from Beckley and Eynsham were still coming in by the lorry load three weeks after the disaster their wounds covered with maggots?

What if there was a crèche of one hundred children on the Marston road, another on the Abingdon road and another in Botley full of orphans of every age, brought together into camps because of the fears about child traffickers, but with no facilities to look after them?  I know that it is hard to imagine, but this is what we are living now.

The next stage for Haiti: Reconstruction

This is going to be really difficult. Actually this city now needs to be completely razed to the ground and built again. Those buildings still standing are mostly unsafe while the rest are rubble already. But if you do that, who is going to pay for the rebuilding? This country was bankrupt before the earthquake. It is now homeless too.

Wednesday, 3 February 2010

Christopher - Day 5 Living in the field

When you go on a medical mission to provide emergency aid, you might imagine that you just jump onto a plane and get on with it. Nothing could be further from the truth. Even if you don’t find yourself turned away by Immigration on arrival there are many questions.

How are you going to find anywhere to stay? How do you stop all your kit from being stolen? Where will you find food? How do you get to the hospital or wherever you propose to work, and what are you going to do about language?

These little problems can occupy so much of your time that you wont be able to do anything, however much you want to. Worse still you may find yourself a drain on desperately needed resources of shelter, food and water.

In contrast, if you are invited by a Non-government organisation (NGO), they handle all of this for you. The big ones have a huge team of very experienced staff who manage the ongoing programmes, who drop everything and work day and night when a disaster like the earthquake in Haiti occurs.

They quickly work out what they think is needed and then they build the team that they want for the job that needs to be done. It is a great honour to be asked to represent them.

And of course, with the honour comes the responsibility. They have to trust you to do the best you possibly can for the injured and at the same time act as an ambassador for them in that country.

In return the NGOs do what they can to make life as pleasant as possible for their team in the field. All the staff at their head-office have  worked in the field themselves so they know how lonely and uncomfortable it can be.

Here in Haiti, Doctors of the World (Médecins du Monde) have lost their office (the building collapsed) but have managed to borrow a beautiful house from a local businessman who has turned it over to the charity for the duration of the emergency.

The house itself is in a forested suburb and is built from a lattice of concrete reinforcing steel rods without the concrete in between. It gives a whole new meaning to the concept of “open plan’ and is ideal in this tropical climate.

Its design must be one of the reasons that it is relatively undamaged as there was very little to fall down! We are all sleeping in tents in the garden firstly to give us enough space and secondly, to stay out of doors in case there are more after-shocks and tremors. The house has a toilet, a shower and a kitchen so really we are in ‘Fat City’, although there must be more than thirty of us here at the moment.

What to pack on an emergency mission?

Before we set off from Europe each of us had to think what we are going to pack in our rucksacks to be able to live comfortably and to be able to do the work we need to do, yet travel light.

It is a game of guessing. Yes you need a good head-torch both to see in the tent and to operate. Yes you need wet-wipes in case there is no shower and no toilet. But do you need a lap-top?  How many books are you going to bring? (They are heavy). And what surgical kit do you need?  We all get it wrong of course. I forgot talcum powder, and in this heat with sweaty hands I cannot get my surgical gloves on without a hell of a struggle.

Being a French team of course little luxuries keep on appearing. For example, Camembert cheese, a bottle of lovely wine. I don’t know how the French do it but they get a special expression of suppressed glee on their faces as they reach deep into their rucksacks and draw out some rare delicacy perfectly preserved.

All around there are deep Gallic groans of appreciation and anticipated pleasure, then they cut it into tiny pieces and everyone savours a morsel, each of them looking like a free range chicken drinking from a water trough as they savour every bit. It is a great bonding exercise.

Working as a team

In the hospital we have been given a part of Outpatients to have as our operating theatres.

We have two tables side by side so we can share work, advice and resources. Each person has a multitude of tasks to perform but there is very little talking or arguing. We all know what needs to be done so we just get on with it.

You are primarily responsible for your own work, but everyone appreciates a bit of help lifting a patient or adjusting a light. There does not seem to be any leader of the team which surprises me as the task we are doing is complex and continually changing in response to conditions.

I find the concept of a tight but leaderless team rather fun. The game for all of us is to anticipate what the team needs and to do it if you have a spare moment, without having to be asked. The result is an almost completely silent room with people moving around very little.

When we go next door to the American ward there is a cacophony of noise, orders being issued, challenged and revised. People are running around in a riot of activity. Are they getting more done? I don’t think so.

The next step for the patients

The work has now changed.

There are no more amputations (or almost none) and those who are going to survive are mostly through the worst. We are getting rid of the infection in the wounds and amputation stumps.

Now we need to get these patients out of hospital and back to being human beings. That means plastic surgery to close the horrendous wounds, and it also means somewhere for them to go. That will be phase two (creating human beings).

Then comes a third phase. Those people with leg amputations need artificial limbs. There are none in Haiti.

So the final phase must be to share knowledge with the Haitians on how to make and fit artificial limbs. Without this the survivors have no chance of independent life nor of finding work. This is going to be a long slog. The next bit is not going to be half so exciting, but it is going to be just as important.

Tuesday, 2 February 2010

Christopher - Day 4 Tectonic Plates

Haiti has suffered an unimaginable disaster. Today the Land Rover bringing us back from the hospital cut through the centre of town. It is a scene of utter destruction and dereliction. Hundreds of people are still picking over the ruins trying to salvage wood and anything valuable. Fires burn lazily throwing up plumes of black smoke which pervade everything with the horrid smell of burning human flesh. It is now 2 weeks since the earthquake but they are still burning the bodies where they find them. 100,000 dead and that is only the bodies which they have found! Who knows how many more are under the untouched piles of rubble?

The earthquake in Haiti is the result of a gigantic geological accident. Tectonic plates from different continents are colliding. Local medical professionals and international medical professionals are trying to work together but are also learning that we have a completely different approach to patients and their injuries.

Lots of work to do

Today the cases poured in again. There are patients with amputated limbs. Then there are crush and burn wounds.  I cannot conceive how these poor people have survived with the pain that they must have been in these last two weeks. Certainly I am completely obsessed with the thought of what agony these patients must have been in for the last two weeks. And they are the tip of the iceberg. They survived. Some died at once, others slowly and in agony.

Sustainable medical care is needed 

Tonight we had a meeting of the Doctors of the World (Medecins du Monde) staff back at the house where we are camped. At the meeting it was discussed how the effort we are making now must be the beginning of an even bigger sustained programme, not the end of an emergency response. We now need teams to re-fashion the stumps of patients so that they are closed properly. Then we need limb-fitters and physiotherapists to get these patients going.

I cannot imagine where the money is going to come from to reconstruct this poor and terribly damaged country, but ideas and concepts come free.