Listen to Professor Chris Bulstrode and Dr Oda Mukkuaka discussing Haiti on BBC Radio Oxford and BBC Radio 4

Doctors of the World's Professor Chris Bulstrode, and Haitian surgeon Dr Oda Mukkuaka worked alongside each other in Haiti after the devastating earthquake that struck in January 2011.  Doctors of the World invited the surgeon over to the UK to help train him in surgical techniques, so that he in turn can help his colleagues back home.   The two explain their work with Doctors of the World's emergency mission and discuss how things are now in Haiti in these interviews.  Listen here to BBC Radio Oxford's interview and here to the Radio 4 interview.

Surgeon Chris Bulstrode on his work with Doctors of the World

Listen to surgeon, Professor Chris Bulstrode, as he talks to BBC Radio Oxford's Malcolm Boyden about his work with us in Haiti and his forthcoming project in Bangladesh.

 http://www.doctorsoftheworld.org.uk/resources/surgeonchrisbulstrodeonhisworkwithdowuk.asp

Haiti: 1 Year After the Earthquake

5th January 2011
To pull through this emergency, keep the promises made to the Haitians.

Since the earthquake on 12th January 2010, Haitians have been surviving essentially thanks to the mobilisation of international assistance. On the ground, conditions for survival remain extremely precarious and the UN & member states are far from meeting their commitments. Reconstruction work is stalling and the Haitian people continue to wait for promises to be fulfilled.

Mobilising the funds promised by the international community

For one year, the majority of donations received from all over the world - almost 3 billion dollars, much of which has come from private donors - have financed the massive humanitarian operation that is continuing today. The Haitian population has endured disasters, frustration and disillusionment for several months. It is therefore not surprising to see, during this extremely sensitive electoral period, an upsurge of sometimes fierce criticism of the United Nations, other states and, occasionally, humanitarian organisations.
While Haitian and international emergency teams have enabled vital needs to be addressed, states themselves are far from meeting their commitments in terms of reconstruction. Of the 10 billion dollars pledged in March 2010 during the international donor conference of the United Nations and Member States in New York, only a few hundred million dollars has been paid out. If the promises made to Haiti on reconstruction are not kept, the country risks another disaster: economically, socially and politically.

Medical action taken by Doctors of the World over the past year
The earthquake completely destroyed an already very fragile and inequitable health system. To deal with this, the Haitian Ministry of Health established an intermediate reconstruction plan. Yet one year later, in spite of efforts, the plan has made too little progress. It is principally the NGOs who are managing the cholera emergency. The Haitian government, paralysed by the lack of funds promised by Member States, is having trouble getting back on its feet and initiating a sustainable reconstruction of the heath system.
For the past year the Doctors of the World teams have been offering multidisciplinary access to healthcare: treatment of cholera cases, medical consultations, reproductive health, vaccinations, nutritional screening, specific follow-up of women and children, assistance to victims of violence and post-traumatic psychological follow-up:
* More than 580 000 medical consultations, including 800 surgical procedures, carried out since the earthquake. On average, about 9 250 medical consultations were carried out each week of which 20% were for children under 5 years and 12% were for pregnant women.
* To address the cholera epidemic: 5 Cholera Treatment Centres with a capacity of 40 to 50 beds each and 11 Cholera Treatment Units dedicated to oral and intravenous re-hydration.
* 4 operational areas: Port au Prince, the Goâvienne region Grande Anse and Nippes
In Port au Prince: 8 permanent tented clinics in the displaced persons camps and slums
: 4 mobile clinics operating on 16 sites of Cité-Soleil
In the Goâvienne region: Supporting the Petit Goâve hospital and 10 health care centres
In Grande Anse: Supporting the provincial hospital in Jérémie and 11 health care centres
* 1 268 staff working for Doctors of the World of whom 95% are Haitians.

To find out more read our Doctors of the World 1 Year After the Earthquake Press Kit

Six Months after the earthquake that shook Haiti, help is still desperatly needed.

12th July 2010

                    © Stéphanie Lelong

Six months after the earthquake, as the hurricane season begins, the timing for Haiti's reconstruction remains critical. Doctors of the World calls for the funds promised by the international community to be used to provide a truly equitable healthcare system

Our work has helped to limit the effect of the disaster on health, but the living conditions for the 1.3 million disaster victims in Port-au-Prince and the surrounding region are extremely difficult.

For many, the daily situation is not improving but getting worse as food distribution comes to an end. We still have our teams in Haiti and with the emergency phase over we continue to work to ease the desperate situation the Haitians face caused by epidemics and malnutrition. However, to date, only a few hundred million dollars of the $10 billion pledged has actually been paid by various countries and donors. It is high time that these promises were kept; things need to move faster.

The $10 billion dollars in aid pledged by the international community at a conference in New York in March would provide for and allow the implementation of a health care system which is more equitable in terms of cost and carried out in the poorest and least accessible districts. The clinics set up by us in the emergency context could then make a permanent commitment to providing a new quality of health care for the poorest Haitians.

Our actions have helped limit the effects of the disaster on health.

There has been no spread of contagious diseases. There have been few cases of malaria and typhoid diagnosed. There has been mass vaccination of children and infants. We have also tracked and managed cases of moderate or severe malnutrition. We have also made it possible for thousands of Haitians to have their first real access to care. Before the earthquake, more than 60% of the population had no access to care. Today, 5,000 free medical consultations are conducted each week by our teams in 10 clinics in tents set up in the poorest districts. Sadly, it remains difficult to refer a patient for treatment at a hospital and transfers between hospital services are very complicated.

Six months after the earthquake hit, the psychological effects are still felt, the Haitians are still suffering. People are having trouble overcoming the trauma, as Dr Emanuela explains:

"Every morning people come to see me for imaginery illnesses, there seems to be nothing wrong but if you ask questions they say they can'ty sleep, can't eat, that they are constantly reliving the 52 seconds during the earthquake."

For this reason psychological support must continue beyong the emergency phase. Mental health support must be fully integrated into the Haitian healthcare reconstruction plan.

We aren't just working in the capital Port-au-Prince; here is a recap of our international network projects across the country:

In Port au Prince

Doctors of the World is active in 10 locations in Port au Prince: St Michel, Carrefour Feuille, Cité Georges, Canapé Vert, Automeca, Delmas, Solino, Saint-Marc, Miron and the Mahotière, covering a population of about 123,000 people. The teams provide primary health care, reproductive health (antenatal, postnatal, family planning, gynaecology), detection of malnutrition, immunization and psychosocial activities. Since the beginning of the emergency, more than 71,000 primary health care consultations have been provided.

In Cité Soleil

We set up three mobile clinics in 16 displaced persons camps and we support the Choscal hospital. Since January, more than 21,000 patient consultations and 4,800 psychosocial counselling sessions have been provided and more than 18,000 people have been immunized. Meanwhile, individual and group interviews, community and prevention activities have been offered: adults have already held 75 discussion groups and 725 workshops have welcomed Cité Soleil children. 20,000 people have also participated in educational and health risk awareness activities and 90,000 condoms have been distributed.

In Sonapi

We ran a clinic in the Sonapi camp that saw 200 patients per day, and two clinics in the Croix de Bouquettes and the Lycée Jacques Premier camps. This facility closed in June.

            © Stéphanie Lelong

In Carrefour Feuille

We ran a clinic which provided nearly 300 consultations per week: healthcare and maternal-child health, health education, immunizations etc. This closed in June.

In Petit Goâve

At Hôpital Notre Dame of Petit Goâve we have been supporting maternity and paediatric units through a sexual and reproductive health programme which includes: healthcare personnel (gynaecologists, midwives, healthcare assistants) training and capacity building, providing medicines, modern medical equipment and gynaecology equipment, reconstructing buildings and assistinh in antenatal preparation for childbirth.

In addition, we have six dispensaries in the remote region of Petit Goâve to ensure the most isolated people are cared for, particularly children under five years of age and pregnant women. Our programme focussed on: family planning, antenatal and postnatal consultations, health education, family planning, training of staff etc.

In Grand and Petit Goâve, we are providing a primary healthcare and nutrition programme as well as supporting four dispensaries located in rural areas of Grand Goâve and in Petit and Grand Goâve. We also giving support for different levels of acute severe malnutrition. Between January and May, 714 children were registered at this centre. Meanwhile, advocacy and prevention are offered to communities, particularly focussing on maternal and child health.

In Grande Anse

With the influx of new comers to the area after the earthquake, Doctors of the World France strengthened its existing programme and currently offers free treatment at 12 health centres in the region. Since February, these centres have provided an average of 8,730 consultations per month; nearly three times more than in the months before the earthquake. All services provided are free to all. We had more than 2,000 consultations for children under five years old. Furthermore, in order to relieve the dispensaries and reach isolated populations, two mobile clinics visit the most remote areas. On average 630 consultations are provided per week; 16% of the patients are displaced persons. Finally, special attention is given to screening and treatment for malnutrition.

Our work would simply not be possible without your support. Thank you for helping us to react quickly in a crisis and care for the most vulnerable.

Fred, Haiti - 6 months on, the reconstruction of Haiti continues

Fred Costa arrived in Haiti to help with the clear up operation after the devastating earthquake hit the country in January.  Fred has been working as a Logistician in Haiti for the past 4 months for Doctors of the World (DOW). 

Fred is part of a team of more than 450 people working in Haiti, comprising of national and international staff.  DOW is providing health care in clinics and hospitals around the capital Port-au-Prince as well as in the towns and surrounding areas of Petit Goave and Grand Goave.

Here Fred shares his experiences:

The city of Port-au-Prince is still pretty much the same as when I got here. There is a lot of rubble.  Many buildings which were destroyed remain as they were when I arrived.  There are now thousands and thousands of makeshift shelters and tents too.

  

Pictures of Port-au-Prince.

A lot of the Haitians don’t have a house or any access to water but they always look well–presented at work - clean, tidy and shaved. They always have a smile and can have a laugh and a joke. They are always so polite and respectful too.  

 












No matter what, they always believe in better days, in a better life, in a better country, and a better tomorrow.  They believe this so that gives me the extra strength to work every day a bit better than before in order to give them the best I have.

Fred and the carpenters building a medical clinic in Miron - Port-au-Prince.

Half of my time is spent solving problems as a Logistician.  This role is largely spent building, fixing and maintaining everything so our operations can run smoothly.  

  

One of our mobile clinics in St Marc - Carrefour.

If a generator breaks down or if a clinic is at risk of being flooded I am on hand to fix these things.  The other half of my time is spent working on how to expand our programme by calculating the budget and working out what things need to be bought to continue our work efficiently.  The work is very intense.  It is fulfilling to feel that what I am doing here helps and will provide a better life for the Haitians.  I am realistic though – due to the incredible devastation caused by the earthquake, providing that better life will be difficult to achieve. 

Fred and the Logistics team.

No matter how much of a bad time they have endured, the Haitians always see a better future.  I will finish my mission here in August.  I am starting to miss this place even before I have left it.  It seems to me that life in Europe is more complicated.  People have more problems there and they are not happy.   But in Europe we have everything yet here in Haiti they don’t have anything. 

Donate now to Doctors of the World UK to help support our work. 

Haiti, 3 months after the earthquake: a continuing emergency

The situation remains urgent. 1.3 million people are without shelter and the rainy season will make their living conditions even worse.

Humanitarian and health needs remain huge, especially for those without shelter and for the thousands of people displaced within the country. With a health system that has been completely destroyed, aid for reconstruction and healthcare will be a long term commitment.

The earthquake on the 12th January hit a country with more than half the population living on less than $1.25 a day, 65% unemployed, and a life expectancy not beyond the age of 61.

Doctors of the World (DOW), has had a presence in the country for 25 years, is committed to the people of Haiti in the long term and is continuing its work with the disaster victims of Port-au-Prince, Petit Goâve and in Grande Anse.

700,000 people are without shelter in Port-au-Prince.

Sheltered in 400 camps the earthquake victims cram into them and remain extremely vulnerable. There is limited access to water, food and sanitation. Three months after the earthquake, Doctors of the World is still providing daily health care daily in 8 of the districts of Port-au-Prince, based in clinics covering the emergency camp and surrounding area where there are around 10000 - 15000 people.

In large tents erected in the heart of the camps, each team is made up of 10 Haitian staff, everyday they provide:

- General medical consultations : More than 5500 basic health consultations are carried out each week
- Vaccinations for pregnant women and young children.
- Screening for malnutrition in 7 of the clinics. This affects many children: for many the situation was bad before the earthquake, now it is even worse.
- Reproductive health activity (family planning, gynaecological consultations, pre- and post-natal consultations) which make up 20% of the consultations.

"Fok Nou Pale!" - We've got to talk!

A team of some 50 Haitian community workers go to one or two camps every day. They provide a link between the mobile sites and the health care structures. They organise games at workshops for the children but also provide discussion and support groups for the adults.
Doctors of the World staff walk through the camps with megaphone to let everyone know about the free clinics. At the same time it is an opportunity to inform people about disease prevention, hygiene, contraception, as well as about violence and psychosocial support.
"Fok Nou Pale!" In the local patois Magna says, "we've got to talk! It does you good, come and see us at our clinics." Armed with her megaphone, she makes her way, with difficulty, between the tents. "Don't overlook your health! DOW clinics are not only for the injured but for everyone, boy and girl, young and old, and for expectant mothers as well! "
The people of Haiti are affected and will be affected for a very long time. Aftershocks provoke renewed fear, sleeplessness and anxiety attacks. The earthquake has also revealed important psychoses, especially amongst adolescents. After 3 months, certain cases prove the need for psychiatric help but at the moment healthcare provision for this is almost non-existent.

For information more on the following aspects of our work there, please visit our website:

An upsurge in cases of sexual violence.

Rebuilding a health system with free access for those who need it. 

Doctors of the World's call for the continuation of free healthcare, at least initially, for pregnant women and children under 5.

Fundraising and funds spent.

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

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.