Reflections on Haiti

The Need to Save CDTI Hospital

I arrived with Julie Manly and Roger R. Jean-Charles, both M.D.'s, at CDTI Hospital in Port-au-Prince five days after the earthquake to find a busy hospital that had been running at full throttle since the disaster had struck on the afternoon of January 12. Two modern operating rooms and a GI suite upstairs and five tables in the emergency room downstairs were all occupied with surgeons and anesthesiologists busily working away...They had modern x-rays and ultrasound!... I had never seen such a modern hospital in Haiti.

So how did it come to be there?... when we had a chance to catch our breath, I accompanied the principle owner, Dr. Reynold Savain on a tour of the hospital with a structural engineer who was inspecting its damage. Dr. Savain told me that he and his colleagues had wanted to do something for the first time in Haiti: To build a modern hospital that could be found in any country, but built by Haitians and run by Haitians. It was obvious that they had accomplished this. Very impressive. Soon after opening a couple of years ago the hospital had become the favorite of the embassy staffs and foreign nationals in the country.

Then complete dsiaster hit. Dr. Savain, his colleagues, and his CDTI Hospital (stands for Center for Diagnosis, Treatment and Imaging) were suddenly one of the only resources left in the city that could handle severely injured patients from this massive casualty of biblical proportions. It had survived essentially intact largely because of its recent construction to modern building standards. Due to safety concerns from some small damage to the foundation of the bed tower no patients were put in the rooms. Instead a tent ward was set up in front of and behind the hospital. Likewise, the CT Scan and Interventional Radiology equipment were not known to be safe to use without damaging them, but the modern OR's, X-ray department and emergency room were fully functional.

As the magnitude of the disaster began to unfold it became quite clear that the hospital would soon run out of fuel for the generators, along with supplies, medicines and X-ray films. Dr. Savain knew he had to keep the hospital doors open. Literally hundreds of doctors, nurses and paramedics from the U.S., France, and elsewhere kept the surgeries going. It fast became known amongst us arriving surgeons and anesthesiologists as THE place to be in the city -- if you wanted to use the skills that you brought to help, that is.

Dr. Savain has worked day and night. He has now managed to keep CDTI open for over a month, and is going broke. (It is suspected by most of us that he is borrowing to keep the hospital open.) He is also paying for the concrete and steel repairs for the foundation of the bed tower himself, to get patients inside and out of the sweltering tents.

This hospital, CDTI, is a precious resource for Port-au-Prince, (as is Dr. Savain) and cannot be allowed to close its doors!... All of us who have worked at CDTI over the past month know this to be true... If it survives, Dr. Savain plans to open a public wing for patients who can't pay. This would be another first-of-a-kind for Haiti I suspect.

Many of us know people (and companies) of means. Perhaps a hospital where you work would like to do what my hospital (St Mary-Corwin Hospital in Pueblo and Catholic Health Initiatives, its parent company) did for me five years ago to help the hospital in Gonaives (Haiti's third largest city) and form a partnership (sister relationship, if you will) with CDTI in Haiti. The possibilities for U.S. and Haitian staff exchanges for training and continuing medical education purposes, and an ongoing mutually enriching relationship would be endless!.

I challenge anyone who has a spark to continue what we have started in Haiti as a result of this disaster to embrace the need now to keep CDTI Hospital alive!

Sprung up and fell down to the floor
Watching the floor I’ve fallen on tilt and collapse.
I knew this was real.
I try to run and escape

But am paralyzed by the fear of falling through the gaping floor
Thinking this was the end of my life, the end of mankind.
Thinking this was the apocalypse.
Clawing my hands on the floor to save my life.

When its over, I try to call my parents. NO RESPONSE.
Then shimmied my way under and over ruble.

Thoughts unwillingly invaded my head.
Could I be an only child? Could I be an orphan?
Fear and anxiety and panic infested my mind.
Walked home to find my parents walking in the opposite direction looking for me.

Dad yelling VERO!!!!!! Ran into his arms crying
Got weak in the knees from emotions.
First time I saw my father weep.
Hearing my mother yell! Benisoi l’eternel. Tears running down her face.

Caro running to be with open arms, tears in her eyes.
Her not letting me go.
Holding on to me with her dear life.
Finally safe. But the uncertainty about my other family still within.

48 hours straight with no sleep,
Hardly any food. Emotions uncontrollable.
Still this uncertainty remains.
Camping outside. Still this fear resides.

The countless aftershocks
The fear, the dread, the apprehension, the trauma.
Still today it follows me.
Loud noises cause my heart to race, my body to tremble.
Nightmares invade my sleep. The trauma.

The thought of my possible death invades my mind. But the gratitude of being spared this misery screams louder. God bless the souls that have passed.

Already the Dominican Republic, for very laudable reasons, is curtailing its efforts to reach out to Haitians.  Daily, busloads of Haitian refugees, some recently post-operative patients, are being returned to border missions and camps (2 of which I worked at personally)...The ongoing coordination of the disaster-relief focused NGOs and local, long-term mission-driven organizations (such as Partners in Health) will be critical as we move from this acute/subacute phase to redevelopment. To that end, I implore you to stay vigilant and engaged long after the cameras are gone, and this story is no longer front page news. Lives are at stake. Lives like those of the 4-year-old girl who I took care of who lost her leg due to the earthquake after a building collapse on her and her mother, who also suffered devastating injuries to her own legs... These families will need rehab -- both physically and psychologically -- for months, if not years. This country will need to be rehabilitated -- not only the healthcare system -- but the educational system, the transportation infrastructure, housing, water/sewage, employment and the government itself. If we are truly to call ourselves a nation that helps others in need, we cannot simply do it when its convenient, when there are no consequences for ourselves, or when its popular to do so. The time to prove of commitment to our neighbors in need will come not now, but 6 to 12 months from now when the hard work begins out of earshot of a reporter or without the aid of a video camera to tell the story... There are certainly more who have done more, lost more and dedicated more of their lives to this cause than me.  I'd like to acknowledge them for all of their amazing work and enabling me to be a part of their efforts both now and those that will extend indefinitely.

While many are worrying about the possibility of violence or rioting or security, we encountered Haitians steeped in religious belief, faith and resilience. Singing at 3 a.m. every night, I discovered that they were singing their prayers. Singing them because it is thought to be soothing to sing and comforting to pray... Well, my prayers were answered when Pastor Prophet agreed to drive me from the border of Haiti and DR to Port-au-Prince in order to attempt to leave the country on a military evacuation plane...I arrived there with only my driver's license and medical license.  We saw the devastation that occurred in Port-au-Prince, but also the return to everyday life as markets were open and banks had lines that extended for hundreds of yards. I did not want to leave. But I knew my best opportunity to return to the USA was while evacuation flights still were going. After help from local Haitian charter pilots, the U.S. Military, State Dept. officials and the U.S. Embassy, I made it onto a C-130 that arrived in Orlando... Truly life-changing!  And I will go back...I've already gotten my new passport...

We encountered patients who had breast masses, prostate hypertrophy temporized by foley placement, abdominal masses in cachetic men--a potential harbinger for undiagnosed cancer, diabetes, hypertension, complications of pregnancy and on and on... This combinations of progessive pathology and untreated complications are only made worse by the complete lack of a healthcare infrastructure that exists.  The presence of multinational NGOs providing "acute" care services has and will continue to need to be the provision of chronic care. Certainly organizations such as Partners in Health have been in Haiti for years and provide amazing care, but in some of these outer areas near the border between Haiti and Dominican Republic, we saw desparate need as the care that did exist was disrupted by the earthquake... One example is a 75 y.o. man who arrived with a foley.  He asked for help with getting rid of it.  He did not recall why he had it...  After taking as detailed a history as possible through a translator (and using the mediocre French that I have retained from grade school), examining him, and reviewing his paperwork, it was obvious he had prostatic hypertrophy and had a foley placed for bladder obstruction.  His condition is one we see in the United States and can repair easily. Nonetheless, in that austere environment, this man will be relegated to managing a foley, while living in a tent with 5 others (at best) or without shelter (at worst)... The time for action will be ongoing. The response currently is astounding; however, in the coming weeks and months ahead, all institutions need to come together to design ways that medical students, physicians, nurses, physical therapists and other allied health professions can aid in rebuilding this nation ravaged by natural disaster made worse by inadequate social systems.

I wish to start by thanking each and every one of you who care, pray, wrote, and took action for us Haitians. I will not relate in detail the horrors I’ve witnessed, nor the feelings of despair, hopelessness and fear one experiences in such a situation. I was lucky enough to survive with little damage occurred -- in comparison to most -- so now I choose to talk about the beauty I’ve discovered in all of this.

***
I was sick in bed when it happened. I did not realize the magnitude of the disaster at first but within an hour, after hearing from my immediate family members, I put on my tennis shoes and walked to a nearby maternity to offer my help. What I saw there cannot be put in words… the despair of kids dying in the hallways and of people with open wounds I had only seen in war movies. I left the clinic at midnight, went to my parents’ home so we could all be together. The next morning, I went to volunteer in another hospital in the neighborhood and quickly realized that the horror of the night before was just a preview of what was to come. With the lack of staff, a friend and I found ourselves acting as an assistant/nurse in the O.R. for an amputation and for a liver operation! How did I get there, you ask???. But at that point, I chose to see the beauty in the midst of the chaos, as I learned that some choose life over all… The woman whose operation I assisted had one leg chopped off. When I stopped for a while and decided to compliment her on her strength, she answered: “I choose life over legs, I have 2 daughters to raise.” How could she smile and actually thank the team who took away this big piece of her body? She simply chose life, she said… I spent 5 long days at the community hospital and many long nights hosting visiting surgeons. What films and pictures do not show are the emotions, the pain in the voices, and the agonizing smell of bodies slowly decomposing on the grounds. But on the other side of the slide, I saw beauty… Indeed, in the midst of it all, I saw everyone giving a hand in a way or another; I saw foreigners whose names I will never know save lives of people whose names they will never know; I saw a nation devastated, but its citizens taking the next step by simply choosing to survive and helping others do the same. I saw young, not so young, rich, not so rich, poor, black, white, literate and illiterate, Haitians and foreigners acting as one! I saw the universal language of hope, survival, love, strength, determination and solidarity. THIS, I choose to remember and learn from.
***
Many days later, I thank the Lord for my blessings. My worries are the same as everyone else’s: What comes next? What will we do? Where will we start? But I said to a friend, we already started. Now it is for us to decide on the type of Haiti we want, the type of nation we will become, and the kind of individuals we will be. It took me the same 35 seconds to be reminded that no matter where we stand from, no matter how different our journeys are, LIFE and LOVE are what matters the most... Again, I thank each and every one of you for the support. In these tough times, knowing one cares is enough to keep another going in the right direction. Your messages arrived from all over the world and my wish is that you keep praying for Haiti and its citizens as we have never been so vulnerable.
Again, thank you.

Rachel Coupaud

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