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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.

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