An Emotional and Unsatisfying Ending...

I guess one could make the argument that I shouldn't be posting this here in such a public forum. But I think with carefully chosen language I can say what needs to be said in a diplomatic enough way so as to tell what is an important story without offending anyone.

As those of you who have been following our travels here in Haiti during the cholera outbreak know... we have been escorting a team of experts from the ICDDR,B (a team from Bangladesh with years of cholera expertise). They arrived on November 15th and their commitment was that they would stay till the 7th of December. They would remain supported by our Project HOPE team of staff and volunteers in terms of lodging, meals, security and transportation throughout their entire stay. Their role was to assess the cholera situation on a number of country wide levels, perform training where needed and collect cholera sample for culture and sensitivity.

The trip was going very well even though our travels had been somewhat hampered by the election events and political unrest and the occasional riot due to the cholera epidemic. The team was making a huge impact with their training and expertise at every site they visited to include 5 major cholera treatments centers and hospitals. Their lab personnel had been accommodated at the national lab in Port Au Prince and were getting their necessary work done. All of the team's needs were being met and they seemed satisfied with their work and the outcomes of it. We all believed they were making an impact and were pleased.

Having been invited here by the Haitian Medical Association (AMH) one of the members of the AMH asked the ICDDR,B team to attend and help sponsor a conference for the AMH and other partnering organizations to review the team's findings and recommendations re the cholera epidemic... a much needed wrap up to the work they had done here. Without such a wrap up to bring closure to their visit and review there findings it negates one of the very purposes of them being here.

That said... the Project HOPE side of the team had started to hear rumblings that the team wanted to redeploy home early because of concerns about safety surrounding the Haitian elections... but the date of this important conference was in a state of flux due to the availability of an appropriate venue and having to work around election events. Without going into the minute details it became clear that the team was not only going to redeploy early but they were all going to leave without leaving appropriate representation from their team to present at the conference. Initially the team seemed unwilling or unable to articulate why this was. They were presented with a heartfelt and impassioned in person plea from a representative of the AMH but to no avail. They were unwilling to budge from their stance due in large part to their leader who seemed to lead by dictatorship and not democracy. I know if the individual members of the team, whom I liked very much, had felt like they had a voice there would have been more than one team member that would have stayed.

Each of these individuals is well thought of in their field, were well thought of as people and experts by the Project HOPE team and worked hard for Haiti while here. But to leave such a mission so prematurely without the appropriate closure having been asked by the AMH and others to stay I believe is an injustice. The leader of this team in my personal opinion, and it is only that, had his own agenda from the start and in the end didn't speak for the entire team.

Having worked this hard by their sides on behalf of helping Haiti navigate through this cholera crisis, their first ever, it is heart wrenching for this to be the end result. It was a slap in the face to the team that worked so hard to support them, it was a slap in the face to the AMH and to Haiti, and it was a slap in the face to Project HOPE. For an organization whose mission it is to help in times of cholera epidemics in the most austere environments world wide it was quite shocking to have them leave so abruptly without any well founded grounds to do so... shocking indeed...

Thanksgiving Guilt...

You can't spend much time in Haiti without feeling guilty for the things you are privileged enough to have in your own culture that aren't readily available here in Haiti. Most of all in this situation clean water and access to safe food sources that don't cause disease or illness. Being here in Haiti on Thanksgiving is all the more poignant  when everywhere you look there is need, there is suffering, there is poverty. On an American holiday where the emphasis is gratitude I cannot tell you how exponentially more grateful I am for everything I have in my life at home. Remind me never to complain about the strange taste of the water in DC, or the smallness of the living space Frederick and I share, or the "challenges" I face in my life. I don't know nor have I ever known the challenges the average Haitian suffers through on a daily basis. These pictures represent some of those challenges. On the top left is a Catholic brother we met on the cholera ward in Milot. He helps run a home for disabled orphans 10 of whom were admitted with cholera that day and one of whom died. He does his work in this austere environment happy, lacking resources and without complaint. There is truly a lesson there!

As political tension rises before the elections here Sunday and the cholera epidemic keeps a steady pace it is an interesting time to be here in Haiti. Thank you to all of my family and friends for supporting us being here. We love you all!

Love in a Time of Cholera

OK – I know it’s hokey but I couldn’t resist… I used it… G. G. Marquez would probably not be pleased but it really does apply here. There are many great privileges to working here in Haiti during the cholera outbreak most notably the capacity to feel like you are helping make strides towards even some minor improvement is wonderful… but an added benefit for me is being a witness to my husband Frederick at work. We are a great team and our skills complement each other well but Frederick is a master organizer and motivator and to watch him in action is inspiring. It inspires me to be better at my craft. I learn from him every day as he reaches out and makes contacts in this harsh and austere environment. At his hands we have reached more than 450 local staff for training on cholera diagnosis and treatment and when you consider how many people each of those people will be able to reach out to and impart the same information the impact is exponentially greater. We have done hands on training with doctors and nurses due to his planning and have been a witness to lives being saved directly because of these interventions. He is a wonderful, smart, hard working humanitarian and I am so lucky to be able to share my life and work with him! Truly love in a time of cholera…

Can You Blame Them for Being Scared

When you hear reports of family members and members of the community dropping off patients outside of health clinics or hospitals like this little guy and left to die for fear of contracting cholera your immediate reaction is judgement. How could they do that? Why would they do that? But as I reflect over these last several days I have softened a lot. The people of Haiti are truly scared. They have never had cholera before and have never had reason to know about how it is transmitted or how it is treated. They have never had any reason to know that it is easy to diagnose and treat if the proper treatment is started immediately. All they see is their loved ones and community members perishing rapidly before their eyes. They have never had any reason to know that you can only get cholera from contaminated food or water and so it is natural to assume all kinds of things about how you can get this treatable but deadly disease. The ICDDR,B team we are here with is hoping against hope that a little education about diagnosis, treatment and prevention will go a long way towards alleviating some of these fears.

With the presidential election approaching next weekend and tension mounting in Cap Haitien and Port Au Prince about who is potentially "responsible" for the cholera outbreak it is a tense and tenuous time for Haiti. One that I fear will get worse before it gets better. But the people of Haiti are strong and have withstood a lot over the last year and years previous so I can only hope they will come out on the other side of this disaster stronger for it.

ICDDR,B Saving Lives

After two full days of training in the Southern city of Jacmel the ICDDR,B team and Project HOPE volunteers moved West to the coastal town of Les Cayes. Their assistance was requested by Dr. Mbassi of the International Medical Corps (IMC). Although reports from Port Au Prince did not include Les Cayes on the map of cholera outbreaks the team found a very different scenario upon arrival bringing to light one of the greatest challenges of this cholera epidemic, under reporting. In a country that lacks the appropriate communications infrastructure for the reporting of morbidity and mortality statistics the true number of deaths due to cholera as well as the number sick or hospitalized is difficult to estimate.

The ICDDR,B and Project HOPE team spent the day in Les Cayes training doctors and nurses at the Hopital Immaculaee Conception Des Cayes (HIC Cayes) bringing their three day total of training sessions to a total of 11 classes and more than 150 participants. They have reached a wide audience thus far training people not only from local hospitals and clinics but from organizations that range from Save the Children and International Medical Corps in country staff to United Nations peace keepers and UN physicians.

After completing the training session at the hospital the team spent the day in the cholera ward led by Chief Medical Officer Dr. Jean Baptiste Glardimy to assess further training needs and treatment gaps, do hands on training with local staff and assess the patient care area for appropriate handling of cholera patients. The conditions the team found were startling to say the least. According to the medical director for the hospital, Dr. Marie-Josette Calixte, supplies and basic resources are in short supply creating unnecessary challenges for staff. Supplies such as Ringers Lactate, the primary intravenous fluid used to rehydrate the most severe cholera patients, Clorox and chorine used to disinfect patient care areas and drinking water, and the oral rehydration solution used to rehydrate all cholera patients are difficult to come by due to supply issues out of the capital Port Au Prince. An additional challenge is the lack of local staff able or willing to work in the cholera patient care areas. Throughout the day Dr. Glardimy was the only medical officer servicing all the hospitalized cholera patients and there was one ward nurse assigned to the area.

When the team first arrived on the cholera ward there was a cholera patient who had died and was wrapped in a sheet on the floor of the ward waiting to be taken to the morgue. In addition, there was severely ill young woman with an IV that was not infusing who according to the ICDDR,B staff was within minutes of dying had nothing been done. A severely ill cholera patient can die within hours if they don’t seek and receive the right treatment. The team was able to start a new IV and after 3 liters of IV fluids the young woman was able to sit up and start sipping on oral rehydration solution.

Later that afternoon as the team continued treating cholera patients a young woman rushed into the ward with a 3 year old Haitian boy wrapped in a blanket. She was the child’s neighbor and while watching him had witnessed his rapid decline so she rushed him to the hospital. When the boy was placed on the cholera cot for rapid assessment he was unresponsive to stimuli and his eyes were sunken in from dehydration. Within minutes the team had placed an IV in the young boy and were infusing the first of the life saving Ringers Lactate solution. By the end of their shift there at the hospital the team witnessed the little boy sitting up and laughing and sipping on oral rehydration solution. This only further reinforces how easy to diagnose and treat cholera disease is and how rapidly a patient at the brink of death from dehydration can make a turn around. With the proper resources and staffing hospitals and cholera treatment centers like Hopital Immaculee Conception Des Cayes can save every life that walks through their doors.

Fear, Confusion and Suspicion...

This lovely slide was given to me by one of our Bangladesh team members. Hard to believe this microscopic little bugger can kill someone who is untreated in a matter of hours.

Two days into our mission and things have gotten interesting... When the team from Bangladesh landed Monday to lend us their expertise our original plan was to head north to one of the hardest hit areas in Haiti. Cap Haitien is a city on the Northern coast of Haiti that has the highest death rate of any region currently at 7.5% with more than 1,500 hospitalized and 119 deaths thus far. However this plan was foiled by the outbreak of violence and protests in Cap Haitien. Ground traffic was halted by road blockades and commercial and private airline traffic canceled flights in and out of the city. The residents there are angry because they believe that the outbreak of cholera can be blamed on a Nepalese contingent of the UN that has an installation there. Cap Haitiens claim the Nepalese UN peace keepers dumped untreated sewage into the water supply there. The UN denies this claim. Lack of understanding of spread and transmission of cholera impair the capacity of Haiti to appropriately treat those most severely affected by the disease leading to the high death rates. There are reports of families and even physicians and nurses not wanting to touch cholera patients for fear of transmission delaying or even preventing life saving treatment.

Catching a break...

Okay, so it's high time Haiti caught a break. Earthquake, hurricane Tomas and now a cholera epidemic... The latest from CNN says the death toll has risen to more than 900. I feel very fortunate to be able to join my husband Frederick there to help out. He is there trying to coordinate the efforts of a team from the International Center for Diarrheal Disease Research from Bangladesh (ICDDR,B). Hopefully with their expertise along with the help of USAID and the CDC the Haitian people can get some much needed hope and relief.

Update on Jonny D!

So those of you who have heard anything about my time in Haiti you all know what an impact our little patient Jonny D had on all of us. Thanks to my photojournalist friend who sent me this link (I have attached to his name above) I have finally gotten the most recent update on his status. It is an inspirational read for sure. I had known that he was adopted by a family in Texas but this article brings even better news about his condition. As Haiti struggles with even more trauma with the recent cholera outbreak - it's hard not to think back on all the folks we met there and how they might be struggling through... Hold a good though for Haiti once again!