one year ago today...January 18th

I remember my first days in Haiti with pretty vivid clarity. I think it is a combination of being part of something very intense, plus having my journal and many pictures to remind me of specific things that happened and specific patients we treated.

One year ago today, on January 18th, 2010, Heartline clinic opened. It was 6 days after the earthquake. A few days prior to the clinic opening, a couple of our guards who reside in a neighborhood called Simon Pele had asked us to help the people who live there. Various Heartline people visited Simon Pele to get a sense of exactly what the needs were. The medical needs were huge before the earthquake. After the quake they were even bigger. Family members of the injured placed many of them in big open areas (such as church courtyards) because there was no where else for them to go. Many people had tried to seek care at various hospitals and clinics, but most medical facilities were already overwhelmed and nothing could be done.

On that first day, we saw patient after patient who had had no care until that point except very basic first aid. And these patients didn't have cuts and bruises--they had open fractures, major closed fractures (such as pelvic and vertebral fractures), traumatic amputations, major lacerations, gangrenous open wounds, crush injuries, and open skull fractures. I've said this 100s of times in the past year, but I'll say it again--I can not imagine living for 6 days (and for some people, much longer) with these types of injuries, with little food or water, no pain medicine, likely living under a tarp (if you're lucky) or more likely sleeping under the sun and stars. Can you imagine? Up until January 2010, I'd rarely (if ever) seen traumatic wounds that had been left untreated for days or weeks. Since then, it's been a different story.

Heartline had purchased a large Canter-type truck just before the earthquake, with the idea that it would be used to transport teams and other big things. Little did everyone know that it would be used to transport hundreds and hundreds of patients injured in the earthquake. Because Hearline is located about 4 miles from Simon Pele (and many other neighborhoods in which the injured were in need of care), we went to the injured (instead of expecting the injured to come to us). We were lucky, in a way, because this allowed us to operate out of a relatively safe neighborhood that had sustained less damage than many other areas (though still had many houses that had fallen down completely). Working within Simon Pele and Cite Soleil and Aviation (Sou Piste) and other places would have been much harder logistically than working out of Heartline's various houses in Tabarre. That truck went back and forth, several times a day, picking up new patients and dropping off previously-treated patients, over and over again, starting early in the morning and finishing after dark. The drivers never got much recognition for what they were doing, but their role in our clinic was just as important as the medical providers.

You can read what I wrote on January 17th, 2010, here and what I wrote on January 18th, 2010 here.

Yesterday in Cazale I'm pretty sure we saw a guy with cutaneous leishmaniasis. As far as I know, there isn't any leishmaniasis in Haiti, but there have been cases in the Dominican Republic, and this man had (interestingly) traveled to French Guyana. There is actually a strain of cutaneous leishmaniasis that was (I believe, but don't quote me on this) initially discovered French Guyana, called Leishmania guyanensis. Treatment is typically with medications that are very difficult to track down, but after talking with P.J., an awesome pharmacist who's been working with Project Medishare for the past year, I think we figured out a way to treat him here using heat therapy. We'll see.

There is a 10 year old girl here with severe burns. With the guidance of Mary, another awesome pharmacist who works at Children's in St. Paul, we've been sedating her with "Ketafol" (ketamine plus propofol) and it's been working great. Prior to this they were using plain ketamine which was also working well. Being able to use anesthesia meds is such a blessing, as they are not always available here, and her daily dressing changes are extremely painful. It is a really tough situation for this brave girl but she is being taken care of so well here.

It's old news by now that Duvalier was arrested at Hotel Karibe today, brought to a courthouse, then released again. I'm not in Port au Prince so aside from what the updates I'm reading on Twitter and Facebook, I don't really know what's going on there. Politically-speaking, everything is quiet here in Cazale.

On a totally unrelated note, I've been listening to a lot of U2 recently. They are hands-down one of the best bands ever. And on that note, good night.