There's no denying it, these bloggers are bound to make you jealous. Whether it's their guts, their energy or their tan you admire, overseas volunteers have got plenty to share with you about their remarkable work in fascinating countries. Read on to find out what you could be missing.

All | Ashley | Natalie | David | Sheila | Jonathan | James | Abi | Fiona | Community_Action_International | Project Mongolia | Sarah | Emily | Dana | Selina | Lucy | Hannah | Sally | Lucille

Tuesday May 31, 2011

Personal Reflections: Religion

About 85% of the population claim Christian beliefs, the majority of whom are Catholic. Interestingly however, it is also reported that 50% of Haitians practice Voodoo, a religion deep rooted in Haitian tradition and culture.

Attending church is always a wonderful experience. No matter how little money people have, everyone is immaculately dressed for church. All the little girls wear beautiful, brightly coloured dresses with matching ribbons and ties in their hair. The choirs sing wonderfully, and they all wear gowns and hats that they make themselves. The churches are also very welcoming and will always introduce us to the congregation. The pastor at my regular church even translates the whole service into English just for me.

Although I normally attend one church in particular, I have had the opportunity to visit a few services across the region for different occasions. When I first arrived in Haiti I went to a very modest wedding in a school classroom. The room had been decorated with paper decorations of white doves and pink hearts. After the service they gave out juice and a sandwich to all the guests before leaving. Normally associating weddings with expense, it was a very humbling experience to see a wedding stripped down to highlight that the true importance is in the love, values and beliefs that the couple share.

Many people who are not Christian believe in Voodoo. In fact, it is so deep rooted in Haitian culture and tradition that many people who believe in God and choose not to "believe" in voodoo still regard it as a very real and powerful force. The practicing of voodoo has been a challenging cultural belief to understand. Friends have reported to me that their family members have been turned into zombies or cows as punishment for wrong-doings in their lives. This means they are effectively turned into immortal slaves for the person who requested the curse and are tasked to work the land. When people buy beef at the market they check carefully to see if it is actually human meat, killed as a cow. While this is a very laughable and distant concept to those of us brought up in Western Countries, these are very real concerns for many Haitians.

I attended a voodoo ceremony after the death of my friend's father. Because he had once been a grave digger, it was important for the family to have the ceremony so that he could rest in peace and other spirits from the graveyard would not haunt the family. The main part of the ceremony happened at midnight. A song was sung to voodoo drumming, and everyone had to stamp their feet to send the spirits away. After about fifteen minutes of this, the men lifted up the corpse and everyone walked with it in silence to the graveyard where the body was left. On our way out of the cemetery I was told not to look behind me, to make sure my spirit was not taken by the Lord, or 'Bahon' of the cemetery.

Learning more about voodoo and its influence on people's beliefs is also giving me better understanding of my patients and my work. Voodoo is blamed by many people for their illnesses or disabilities so it can be a big barrier for patients' engagement with rehab. For example, we were informed of a patient at the government hospital who had been stabbed in the neck and sustained a spinal cord injury. He discharged himself after a couple of days, with the help of his family, as he believed the only way he could get better was to go to a 'juju', (voodoo expert). Unfortunately after tracking him down and discussing the option of rehab he still declined to come to the rehab unit. Knowing that refusing all treatment will pose a severe risk to his health and life span, it was difficult to accept his choice. I have, however, witnessed some patients, initially very cynical about the benefits of rehab because of their 'juju' history, become very motivated with rehab after seeing the progress made by other patients at the unit.

Improving my understanding of these cultural and religious beliefs has been crucial for me when working as a healthcare professional in Haiti. Witnessing a heartbreaking case like I described above makes me advocate even more for Haitian-led educational and rehabilitation programs such as Community Based Rehab, which I described in a previous entry. This will be key in helping to bridge the gap in the understanding of what disability is, and how it is approached, so those that can really benefit from rehab have access to it.

Posted by Hannah ( 12:22 PM )
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Friday May 20, 2011

Personal reflections: basic needs

Many people ask me what it's like living in Haiti, and I always find it difficult to answer in a simple way. I thought I would take some time to reflect on my personal perspectives of life in Haiti, and my understanding of the influences that make life how it is.

Food, shelter and water. Arguably the three most basic needs of humans, all of which the majority of people struggle to find on a daily basis in Haiti. 80% of Haitians live below the poverty line and live in unsanitary conditions. 42% lack access to clean water.

As a relatively wealthy resident of Cap Haitien, I will always have access to clean water. Bottles and sachets are sold all over the streets and shops, and for 20 goudes (about 30p) I can refill our 5 gallon container. Then of course there's the transportation. Walking that 50 metres from the water shop through the busy market streets with a 5 gallon container is awkward, and I haven't learnt to balance it on my head. The options are to catch a moto, or, pay a man with a wheelbarrow to push it home. Quite a process when all you want to do is brush your teeth, but at least I have access. The majority of people living in the slum districts will never have the means to buy water, and those living in rural areas don't have access to bought water at all, so they are forced to drink the likely contaminated natural water. No wonder so many people are diagnosed as chronically dehydrated or have water borne infections when they come to see the visiting doctors.

Water for cooking, cleaning and bathing is also relatively accessible to me, although miles away from what I'm used to. The house I'm staying in used to have a pump connected to the well. Since it broke three months ago, we're obliged to physically carry the water straight from the well up one, two, or three flights of stairs. Fetching the water is an experience in itself: Squeezing through the gap between the stairs and the wall of the house with my phone as the only source of light, I fumble to unlock the padlock on the back door. Again, squeezing through the door which just fits the width of the bucket, I eventually reach the outside communal area of the house, shared with two other homes, with an historic French colonial-built water well dividing the land.

Retrieving the water from the well is pretty straight forward, although often the neighbours will take over to help me out. Carrying the water back through the dark and narrow hallway and up the stairs is the worst part, but normally shortly followed by a refreshing icy cold bucket shower to make up for it. Not as satisfying if all you wanted to do is flush the toilet. But this is normal life for most Haitians. Wells are not hard to come by in town, but in the country, people may have to walk a couple of miles just to get access to any water source. It's common to see people doing their laundry and bathing in rivers, in order to conserve the water they carry home.

Cooking is taken very seriously by Haitian women. Those who are better-off love to host guests. A fest of rice, beans, plantains, meat and legumes is typically served, sitting round the table. Those less well-off will still cook more than necessary, just in case a guest drops by, and left overs are eaten for tomorrow's breakfast. 

Preparing dinner is an all-day affair. Since I've been living with a Haitian family, I now see how much effort goes into just one meal. Food is bought fresh from the market each day. The meat is thoroughly cleaned, using oranges to disinfect chicken and seasoning is prepared using a pestle and mortar. Once the charcoal stove is ready, it takes several hours for the food to cook. Impressively, street sellers go to exactly the same lengths for people to buy 'fast food'. They spend all day cooking and selling food, and many sleep overnight in the streets so they can keep their vendor's spot.

Although the majority of people have a roof over their head, commonly it is not much more than that. Families and extended families may live in one home, with three or four people sharing a bed and others sleeping on the ground. Those in the slum district or in the country have just one tiny room to accommodate a whole family. Walls of old buildings are used for several homes, with ply wood dividing the properties.

Electricity is unpredictable, and scattered throughout town. Many people connect up to the electricity by physically climbing up the pole and connecting a cable themselves, thereby accessing the governmental electricity for free. Normally, in the centre of town we have electricity in the evenings but not throughout the day.

Another massive problem is waste disposal. With no land fill or way of recycling, people are forced to dump their rubbish which, ironically, is a criminal offence. Litter accumulates in massive piles, eventually collected by the council and dumped on the boulevard. Living in the middle of the food market, we get used to the daily routine of market traders collecting the rubbish in small piles and burning it every evening. Every so often residents will have to clean out the gutters of rubbish to allow the sewage to drain into the system properly. Last week, I saw a guy immerse himself into the sewage system and extract all the rubbish and dump it on the street.

To think of hot or drinkable water coming out of a tap, making a quick bacon sarnie or not have the incessant smell of sewage or burning plastic all sounds unreal, even to me now. I am really grateful to be working in the position I am, to help improve access to water and healthcare. However, Haiti has a very long road ahead of her to make sustainable improvements in the standard of living for everyone.

Posted by Hannah ( 11:14 AM )
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Friday Apr 08, 2011

Bon Bagay Yo (Good things)

The last time I wrote, I described the busy relief efforts our Network Team was engaged in to help contain the cholera outbreak.  I am glad to report that by the start of the New Year the number of cases all over the region (and across Haiti) dropped significantly.  This has given us some breathing space from getting daily reports from clinics and distributing supplies and allowed us to network further and broaden our work.
 
Coincidentally, it was around the same time that funding was finally secured for the rehabilitation unit at Haiti Hospital Appeal, so I have been able to support the staff to reopen the unit.  It officially opened in February as a general rehab unit, with specialist Spinal Injury care.

 
I have been providing a managerial and leadership role to help develop the service.  This includes providing theoretical and practical training to the therapists, new nurses and nursing students, helping the Haitian physio produce appropriate documentation, and attending weekly meetings with the multidisciplinary team to facilitate improvements to the service.
 
The service is now running with one physio and two therapy assistants, one psychologist, and a rehab physiatrist who visit from Port-au-Prince every fortnight.  The thirteen bedded-unit is full, mainly with Spinal Injury and Stroke patients. We are also receiving about 100 physio outpatients a month.  Work has just started on building the purpose built rehab centre, which will have a large physiotherapy gym, and a separate Occupational therapy treatment room.
 
Another big project I have been working on is helping other NGOs provide access to clean water.  The main reason that cholera hit Haiti so hard is the incredibly poor water access and sanitisation in both rural and urban areas.  With several NGOs recently coming to the region interested in working on improving access to clean water, the network has been able to support this work to improve it's effectiveness.  We have put together a 'water network' consisting of NGOs who purify water; fix broken hand pumps on wells; and others which have access to rigs to dig wells.  

We are partnering with them all to put a proposal together to provide access for over 400,000 people in the North of Haiti.  Our main role as the Network is to get a basic idea of where the priority areas are and establish what type of help the location needs.  We are feeding this back to the NGOs so that they can make informed decisions as to where to target, and not have to 'go blind' which is how it so often works.  The water network also gives the NGOs an opportunity to communicate between themselves so they can hopefully flag up areas of need more quickly.

 
 Working with water and sanitisation and hygiene (WASH) is not what I thought I would be, or want to be doing when I came out to Haiti.  However, after living here for even a couple of months, its clear to see what the priorities are of the communities I'm working in.  The network gives us the flexibility to direct our help where we feel it is most beneficial.  Working on such a broad range of projects is a really rewarding and engaging, and an educational experience too.  One massive thing I have learned from my time here so far is that to best help a low-income country, the work that is done must be 'driven from' the community, not 'driven into' the community, which is again the ethos of Haiti Hospital Appeal. We must always listen to the people we are helping.

Posted by Hannah ( 9:18 AM )
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Thursday Dec 16, 2010

Personal experience of cholera

10:30pm on the night before my birthday I was relaxing at home with a couple of friends.  A close friend of mine, Manette received a call from her sister to say their father, Jacques has been vomiting.  Asking a few more questions I was almost certain this gentleman had cholera.  Without immediate treatment cholera can dehydrate people so quickly that they can die within hours of onset of symptoms. We needed to get him to a cholera treatment centre immediately:  The difficulty was, that he lived in Labadee, a remote fishing village: a 1 hour drive and 15minute water taxi ride away from the nearest treatment centre.

Amazingly, Manette's family had managed to get Jacques onto a water taxi, in the pitch dark and were waiting for a 'tap tap' (shared taxi) to ride into town. At this time however, even in town the streets are deserted and there is certainly no public transport.

After half an hour of roaming the streets, asking anyone and everyone including the police we eventually found someone who was willing to drive us there to collect him.  As we jumped in the car and charged off I realised there was an almost finished litre bottle of rum rolling around on the passenger seat.  With the driver treating the mountain roads as a racing track I have never been so scared for my safety.  At one point we skidded off the road headed towards a ditch, but the driver somehow managed to pull the car back onto the road as we span into a 180 degree turn.

As soon as we arrived at Jacques it was clear to see time was running out fast.  He was severely dehydrated, and had only drunk half a litre of the rehydration solution I had asked his family to make for him.  His body was shutting down: he couldn't speak or stand and needed to be carried into the car.
2 ½ hours after that phone call he finally arrived at the treatment centre. The biggest treatment centre in the region, the MSF are working out of the public gymnasium. 300 patients are being treated in the main hall, with another 300 in tents outside.

6 litres of special IV fluid was pumped into him within the first hour and he continued to have IV fluid running into him through the night whilst his wife stayed with him. When we visited him the next day he was much more stable.  He was talking and able to sit on the bucket to go to the toilet.
When we returned that evening the doctors handed over that he had nearly died a couple of hours before as he had not been drinking enough oral rehydration. With his wife having stayed with him for 24 hours I decided to stay with him whilst Manette took her mum home for a shower and some sleep.  However, things started getting worse again.

After being made to drink such a lot of fluid to save his life, he was now refusing to drink.  As the minutes wore on he became more and more agitated, distressed and delirious, and was still refusing to drink.  After almost an hour the doctor decided to put a second IV line in, but because he was so agitated, it took four men to restrain him to insert the IV. I was trying to get hold of Manette, worried that Jacques did not have long to go, but she wasn't answering her phone. By this point we had collected a crowd of other patients' visitors, curiously watching the only agitated patient in the room being treated by several members of staff, and cared for by a 'blanc' or white person, who, by this time was getting quite distressed herself.  I eventually managed to get hold of Manette and luckily by the time she and her mother arrived Jacques had stabilised again.

I was desperate to stay with Jacques for the rest of the night as I knew he needed to be monitored very closely, but Manette quite rightly wanted her mother to stay with him.  Manette and her sisters stayed at my flat that night, close to the treatment centre.  We got a call at 5am to say that Jacques had started becoming agitated again, but within ten minutes, on our way to the centre we got a call to say he had passed away.

As we approached the centre, we could hear his wife screaming with heartache, and a journalist lining his camera up to take a shot.  I walked her back to my flat whilst Manette went to see her father's body.

Being the day of elections there was again no public transport to take Manette's family back to Labadee.  Expecting riots and road blocks all over town later in the day I knew we had to act quickly. Taking a moto to the other side of town to pick up our work car I was then able to drive them home. The journey was an incredibly vivid experience for me.  Culturally, Haitians are very open about grieving. Manette, two of her sisters and her mother were crying, shouting and wailing throughout the journey.  A strange experience for me, but it enabled them to release their emotions and share their grieving process.

These few days have been an incredible shock to my system. Just as I do with work at home, it's very easy, and important, to keep a professional outlook on the healthcare work I do.  But having a personal experience on the effects of cholera to individuals and their families has really hit home how much pain and grief this epidemic is causing to so many families.

Posted by Hannah ( 4:25 PM )
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Friday Nov 26, 2010

Riots in Cap Hatien

As some of you may have heard there were some very violent demonstrations and riots in Cap Haitien this week.  Elections are looming, but there is also heightened rage as people are blaming the Nepalise UN for bringing Cholera to Haiti.  This report describes what was happening at the start of this week.
 
Cacooned inside my downtown apartment I had a very acute awareness of what was going on.  By 10am the streets were crowded.  People running in hoards through the nearby square towards the MINUSTAH.  Shouting was constant, chanting and gunfire every few minutes throughout the day until about 10pm.
 
When the odd mob would pass my apartment  I would see my curious Haitien neighbours quickly close their doors and return inside for safety.

 
Vehicles would occasionally charge up the road, must have been about 40-50mph: very fast given the state of the roads and the amount of people on the streets.
 
There were many reports of rocks and other missiles being thrown with no specific target.  Barricades have been put up all over the town, with no access to enter or leave the town other than by foot up until recently.  I was also informed that the MINUSTAH eventually made the decision to evacuate themselves from town last night.
 
Reports by Al Jazeera and BBC Latin America say that at least one man was shot dead as an act of defense by the UN.  At least 10 others were injured and are being treated at Justinien Hospital, as was reported on the local news last night.
 
Today everything seems to be much quieter.  There was an eerie atmosphere driving around Cap Haitien this morning.  The streets were almost empty except for a few passersby.  A dead body half wrapped in a sheet had been abandoned near the town square.  Tires have been left burning in the middle of the roads and barricades are still in place all over the town.

 
As the day draws on the streets seems a little busier.  I can hear more gunfire every couple of minutes, but nothing too violent has passed close to me.
 
This situation is obviously having a detrimental effect to what can be provided to the Cholera victims.  MSF have been unable to receive their latest supplies or reach out to those clinics in the rest of the region so desperately needing support.  With one truck and a warehouse looted, many supplies are being wasted.  The network is still waiting on deliveries, but with the situation as it is, it poses many security concerns with regards to storing and distributing supplies.

Posted by Hannah ( 10:52 AM )
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Monday Nov 22, 2010

The start of the cholera epidemic

I apologise for the late reporting of the events that cholera has brought to Haiti.  The last three weeks since the start of the outbreak have been extremely hectic as I do the best I can to work against it.

 
My change of job role certainly could not have come at a better time.  Working for the Cap Haitien Health Network has enabled me to provide support for many health services across the north of Haiti, as well as providing direct patient care.

The diarrhoea outbreak in the region about 30miles north of Port-au-Prince was confirmed as the start of a cholera epidemic on 22nd October, a few days before starting my new role.  With no one yet diagnosed with cholera in the north region, I spent most of my first week focusing on health promotion to educate local people about the importance of vigilant hand washing, drinking clean water, and what to do if they get diarrhoea.
 
At the start of my second week we received a team of medical volunteers to work at a clinic in a small fishing village 2 hours west of Cap Haitien.  Little did we know that amongst many ailments we came across, we would discover the first of many cases of cholera in northern Haiti.  In the two days that I was there we received 5 cases of cholera.  Working out of a school building (pictured) the team was forced to create a temporary ward to provide intensive and isolated care to these patients.  The most severe case was a 25 year old male, carried for 2 hours to the clinic by his family in his own bed.  The Ministry of Health was immediately informed who sent transport to take him to the government Hospital in Cap Haitien.  Unfortunately, despite all the treatment he received he died on transit to the hospital.
 
The rest of the week I had planned to visit many other clinics with the visiting team, however the severe weather warning of Hurricane Tomas ground us to a halt.  Waiting for the incoming cyclone was at first tense and worrying, but soon became tedious and frustrating.  Fortunately, neither Port-au-Prince or Cap Haitien were directly hit: the weather, if anything, reminded me of England – cloudy with the odd drizzle of rain!  However, it still meant that the visiting team’s flights were delayed by two days.  
 
Since then we have had an explosion of cholera cases in the north.  A gymnasium is being used as a temporary ward in the centre of town, and many other clinics around the region are also taking cases.  I and the rest of the network team worked hard to distribute relevant medical supplies to various clinics, but our aid soon ran out.

 
In order to work towards a coordinated approach I have been attending meetings with the Ministry of Health; other NGOs already working in Haiti; and the water & sanitization and health NGOs who have come here specifically because of the cholera.  As part of the Health Cluster Group, formed by the Ministry of Health, Ministry of Planning, WHO and MSF, I have been working closely with the lead co-coordinators of each organisation.
 
I am also a member of the Cholera Epidemic Advisory System, an email network inputted by people working throughout Haiti and America.  A large aspect of my role is to match the needs with the availability of staff and supplies, by responding to urgent pleas of help at clinics, and immediately linking them with the correct people or organisations to support them.
 
MSF (Doctors Without Borders) have been working in Cap Haitien for a week now, and it has been a real experience to observe how they are dealing with the situation.  Working directly with Helmi, the MSF coordinator, has taught me a huge amount about how to deal with an epidemic.  They have come with enough supplies and expertise to be able to set up Cholera Treatment Centres (CTCs) to eventually accommodate over 1000 patients.  They set up their own water supplies, strict cleaning and hygiene protocols and manage the dead bodies in a specific way according to the Cholera Guidelines.
 
Due to the extremely poor access to clean water and sanitization throughout Haiti (see picture of outskirts of shanti town in Cap Haitien as an example) it is estimated that this epidemic may last for at least nine months – affecting a higher percentage of people than is normally expected.  Working in this environment is tough, but I am glad to be in a position to make a direct impact to the responsiveness of the health service.

Posted by Hannah ( 4:49 PM )
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Wednesday Nov 10, 2010

Community based re-hab

Alongside working on the spinal unit I have also been helping to set up a new project called 'Community-Based Rehab' (CBR).  Going from knowing nothing about this initiative to researching it well enough to provide a training course, I very quickly became a strong believer in this program.  I'd like to share this with you as an example of a way in which organisations can contribute to the development of countries such as Haiti in a sustainable way.

CBR is an initiative led by WHO with the broad aim of enhancing the quality of life for people with disabilities and their families through means which are low cost and easy to access.  The program has been used in communities in low-income countries all over the world for a long time, and there are some well-known examples of CBR working very successfully in India and Mexico.

The goals of the program are always to:

To enhance activities of daily life of disabled people

To create awareness in the disabled person's environment to achieve barrier free situations around them and help them attain equal human rights

To create a situation in which the community of the disabled person participates fully and takes ownership of their integration into his society.

Using the 'train the trainer' principle, CBR hopes to empower the local community to manage disabilities themselves, without the need for 'western standard' healthcare.

The way that Haiti Hospital Appeal have decided to start the program is to employ four Haitian professionals, including a pastor and a school teacher, to work at the level of the people with disabilities and their families; the community and ultimately at the governmental level.

The training I have led has been broad: explaining the concepts of the program; facilitating discussions on understanding the community culture and initiating change; providing an introduction to the physical and environmental problems they may be faced with; and basic principles of rehabilitation.  The aim of the training is not to provide western explanations, but to equip them with the skills needed to identify a problem, and then find a solution: whether this is with regards to someone's physical ability, how they are able to move around their home, or accessing their local community.  A fantastic resource has been a series of books written by a group of village health and rehabilitation workers in Mexico.  They have not been professionally trained, but instead use their own experience of working with villagers with disabilities to explain rehabilitation in lay-persons terms, giving examples of low-cost, culturally sensitive ways of providing rehab (see David Werner links at bottom of entry).

The discussions with the new employees around the community culture were incredibly interesting, and they also helped me to better understand typical Haitian beliefs. For example, there is mixed understanding about what causes disability, and how people respond to it.  Those who are Christian are taught to have mercy on those with disabilities and many Christians see it as their duty to support families around them.  However voodoo followers are taught that disability is the work of Satan as a punishment for something they or their family have done wrong.  Many people who believe this will choose to stay away from families of people with disabilities to ensure they are also not 'inflicted' with a 'curse' themselves. 

The disabled community the new employees will be working with initially will be the children and families who use the HHA children's respite home, and the spinally injured patients who will continue to reside in the region.  The specific objectives will largely be set as a result of working closely with these communities to ensure the needs of the disabled are being identified and met.

Unfortunately, at present HHA are waiting for the funding of the project to come through, so the employees are not able to commence their roles just yet.  With this, and the spinal unit slowly closing for the time being, my work with HHA is drawing to a natural close.  Next week I will start working for the 'Cap Haitien Health Network': a Non-Governmental Organisation (NGO) set up to co-ordinate and improve communication between the health services in the north of Haiti, and to distribute medical supplies equitability.  Alongside this, I hope to explore the discrepancy between the need and availability of therapy services; to provide advice and education to health workers in the communities, clinics and hospitals where there is no therapy input, and to distribute rehab supplies equitably.

Although I am sad to leave HHA and the wonderful friends I have made there, I am excited about the new challenges that await me.  Working for an overarching support service should also give me a better perspective on the availability of health services and what barriers there are to people accessing the care and education they need.

Links:

WHO website: http://www.who.int/disabilities/cbr/en/
Joint Position Paper, WHO, UNESCO and ILO (2004): http://whqlibdoc.who.int/publications/2004/9241592389_eng.pdf
 
'Disabled Village Children'; and 'Where There is no Doctor', David Werner (2009): http://www.hesperian.org/publications_download.php#DVC
 
'Helping Health Workers Learn: A Book of Methods, Aids, and Ideas for Instructors at the Village Level', David Werner (2009): http://www.hesperian.org/mm5/merchant.mvc?Store_Code=HB&Screen=PROD&Product_Code=B020

Posted by Hannah ( 4:57 PM )
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Thursday Nov 04, 2010

Home sweet home

On my return to Cap Haitien it was time to discharge some of the patients, the first of whom was Nancy.  With her hair freshly braided, make-up done, and a special outfit saved for this very occasion, she looked so beautiful and so happy.  Nancy, her brother, and Fiona (the volunteer nurse who has been leading the unit since it opened) were spectacularly waved off on their way by all the other patients.  With the flight and transportation organised by one NGO, and therapy and equipment provision organised by another, the discharge went well.  Fiona escorted them safely to their new home, and another of Nadia's brothers even made a surprise trip to greet her.

Four other patients were also discharged safely within the next couple of weeks.  One patient was discharged to a temporary shelter, and another had to be carried in a stretcher up a rocky hill because it was too steep for vehicles to climb.  

These situations are far from ideal, but the wonderful reception these patients received by their family and friends on returning to their communities shone through.  It struck me that despite the many barriers to accessing everything we may take for granted, the simple love and support of the neighbouring community gives these patients a lot to live for.

I witnessed another example of this community spirit when I did a 'home visit' for another patient, Lenny.  Although ambulant, he has been one of the worst affected by the earthquake. 

His wife, ten children and his home were all taken from him.  Fortunately, he has extended family who live near the border of the Dominican Republic, and his cousin had kindly agreed for him to live with her.  We took a trip out to her home to assess how suitable the conditions are for Lenny, and to see if he could benefit from any equipment to make life easier for him.

Visiting her home was a humbling experience: A wooden shack about 9x5foot and a small yard was all she owned (see the pink building in photo).  By the time Lenny had walked with his crutches from the truck to her home, we had collected over 30 curious village children and adults!  Lenny was really put to the test as I asked him to perform various tasks in front of this fascinated audience.  Lenny's determination shone through as despite the extreme heat he completed everything successfully.  He even managed to fill a bucket of water from the community well, wheel it to the house and lift it onto the table. 

Driving out of the village on our way home we were still being approached by people wanting to greet Lenny.  Even our interpreter was amazed at the response he got, and explained that to receive such a greeting from a place where he hasn't been living, Lenny must be a very well-loved and admired individual.

Although living in such a basic and rural community will be hard work for him, I was satisfied that Lenny would be able to live there. However, on our way back to the hospital Lenny wanted to pop to his aunt's in the next town to say hello. Visiting her home and neighbourhood was a complete contrast to the village we had just come from.   

She had a large, very clean and beautifully decorated concrete house.  We were warmly welcomed into her home and she was delighted to see Lenny.  By the end of the visit she and Lenny had agreed that he would live with her instead of returning to his cousin's village, which they were both very excited about.

This example highlights how the earthquake has devastated many families.  Some of the patients still at the hospital may well have family willing to help them, but with no method of contacting them, they may be lost forever.  However, for the patients I have seen being discharged; it is wonderful to witness the families and friends reunite with their loved ones, and being a part of these new beginnings is a real privilege.

 

Posted by Hannah ( 11:12 AM )
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Tuesday Oct 05, 2010

The stark reality

With over 1.5 million people in Port-au-Prince still displaced, it was hard to imagine what I was about to face as I flew into Haiti's capital.

Driving through Port-au-Prince the stark reality of how people are struggling to live 9 months on really hit home.  Some buildings have been fully demolished, with the remaining rubble piled high at the side of the roads and nowhere for it to go.  Many other devastated buildings have been left untouched; tents fixed as best they can against remaining walls of what used to be people's houses, and every piece of spare land is now someone's tent home.

The set up of the spinal ward I spent most of my time at was a complete contrast to the unit I've been working at in Cap Haitien.  This organisation has been working out of tents since the earthquake to provide acute medical and surgical care and rehabilitation.  They have recently moved into a building, but space is very limited and the wards are extremely basic:  Patients are provided just one meal a day, staff have to leave the ward to wash their hands; and many of the patients are sleeping on camp beds: all of which are particularly concerning issues when caring for spinal patients.

Another difficulty is that the hospital is largely staffed by volunteers who change every week.  With minimal documentation to show what therapy treatments and outcomes the patients have had, it makes it very difficult to provide smooth continuity of care.  I therefore introduced some documentation to improve the handover between therapists, and to provide a clear way of measuring patients' progress with their rehabilitation.

The hospital has also been receiving patients with spinal injuries who have been admitted to manage their large pressure ulcers.  It is very easy for these to develop, especially if patients have not been well educated on how to relieve pressure on vulnerable parts of their bodies, and how to move without damaging their skin.  Working with these individuals really made me appreciate how crucial it is that patients truly understand the importance of the advice we give them, and the reality that if they don't, they could be back in hospital within weeks.

Some of the patients in Cap Haitien are due to be discharged in a couple of weeks, and talking to them about the reality of going home is a difficult conversation to have.  On one hand, they are desperate to leave the hospital to move on with their lives, however, on the other hand they are all clearly scared about what the future will hold for them.  Thankfully, a Haitian psychologist has started working with the patients this week; which should offer them some support with this huge transition.

Whilst in Port-au-Prince I took the opportunity to visit some of the patients' properties before they are discharged.  I was fortunate to arrange joint visits with the physiotherapist and occupational therapist working in the spinal injury community team, who will follow our patients up once they are home.

The first visit we did was very successful.  'Nancy' will be returning to her family and a newly built house.  With the community team able to provide a bed and a commode she will have the potential to live very independently.  The house is situated at the top of a very steep mountain, which although gives her spectacular views across the city, means she will not be able to leave her property alone.  Fortunately her family own a 4x4 vehicle, so she has a safe way of accessing the community.

The second visit we did was very different.  'Lydia' doesn't have a house; her mother is living in a tent.  A neighbour has offered for the family to use their land, and now we have the papers to prove his ownership of the land, we are able to organise for a temporary shelter to be built for her.  These shelters are basic – a room made of ply wood and canvas, but it's a step above living in a tent.

Spending time in Port-au-Prince has really given me perspective on the way Haiti has been affected by this horrific natural disaster.  With news just yesterday of another sudden storm hitting the capital and destroying whole tent villages, it highlights just how vulnerable Haiti is, and the relentless battles it has to fight to even have a chance of development.

 

Posted by Hannah ( 2:17 PM )
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Thursday Sep 16, 2010

Sew, a needle pulling thread

One of the many concerns with regards to discharging our wheelchair-using patients is whether they will be able to return to employment.  Accessing ‘public transport’ is almost out of the question, and wheeling around the community to the local markets will be extremely difficult given the state of the streets in Port-au-Prince.  

Amazingly, in the last container that was sent from the UK, we received a load of hand-powered sewing machines and fabric, which will be perfect for the patients to take home, to tailor clothes to sell.  Not only that, but whilst interviewing for the Community Based Rehab jobs, we came across a seamstress!

So, as of Thursday, Madame Josline has been employed to teach the patients to tailor, and so far, the classes have been extremely successful.  All the patients are keen to learn a new skill and have attended the 2 hour-long daily sessions.

I was also really pleased that the physio assistants have now started running the exercise classes by themselves.  Another challenge has been that the assistants have tended to use little initiative.  Therefore I was delighted that after the assistants observed how the class can be run, how the patients responded, and being given really clear instructions; they have been successfully leading the classes for the last couple of days.

I will be spending the next ten days in Port-au-Prince, mainly to work at the spinal unit there.  I also hope to visit some of my patients’ homes to assess whether anything can be done to make using a wheelchair easier.  It’s difficult to imagine what the set-up will be when the patients return home, and I don’t think many of the patients know what to expect either having not been in Port-au-Prince since the earthquake, so this should help prepare for as smooth a discharge as possible.

Posted by Hannah ( 3:51 PM )
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Monday Sep 06, 2010

Fun and games

I, along with the physio assistants ran the patients’ first ‘wheelchair skills/sports’ class today.  Although it wasn’t quite as structured as I would have liked it to been(!), it was great to see the patients getting really into it, and they loved competing with one another!  I am aiming for the class to happen once a day, led by the physio assistants.  We will then start incorporating other classes into the day to start giving the patients more of a routine and reason to be in their chairs.  Currently, when the patients have nothing to do they tend to return to bed.  Therefore, by providing them with activities and enjoyable ways to increase their rehab time, their abilities and fitness will improve, and they will be kept occupied!

Here are a few pictures of today’s events!

Posted by Hannah ( 3:04 PM )
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Saturday Sep 04, 2010

First impressions

It is certainly a huge cultural transformation completing the three day journey from England to Haiti.  Flying over the beautiful islands of Bermuda and the Bahamas; reaching the flat and very developed land of Miami; swimming in the crystal clear Caribbean Sea, and salsaing in the bar of an all inclusive hotel all was an enjoyable and fearless adventure.

After being told (once I booked my flight) that the route I had chosen to take: crossing the Dominican Republic/Haiti boarder by land was unsafe, I was not looking forward to the rest of the journey.  Clutching desperately to my bags I caught the two coaches with no problems.  Once on the second coach I even started to find the whole situation quite amusing; wondering how I ended up with the responsibility of yanking open the door to the onboard toilet whist passengers clambered over luggage splayed all over the passageway.  It was unfortunate that there were a lot of older Haitians onboard with the need for very frequent trips to the toilet!

I was met by the warm faces of Reninca and Fiona at the Cap Haitien bus station, shortly followed by the rest of the team who we met at a lovely Haitian restaurant in town: a relaxed lull into a false sense of security of what was to come!

It’s amazing to see such driven and versatile people working at Haiti Hospital Appeal.  There are about 5 or 6 different projects going on at one time, which are all led by Carwyn and Reninca – the couple who head up the charity.  One minute they’re unloading containers of aid and distributing it to Port-au-Prince, the next they’re interviewing for new posts to set up a brand new community-based rehab service.

I’m thriving in helping out with as many aspects as I can get my hands on!  I’ve been invited to lead the training for the new posts: which, as much as the Disability Options Team (for those of you who know) may have given me some skills, will be a real challenge.  These case manager-type roles will need to be taught everything from the basics of what a disability is, and the importance of social inclusion (in a country where those with disabilities are commonly thought of as an act of the devil), to hands-on assessment, advice and education which families of those with disabilities so desperately need.

I completed my first day at the spinal unit today and I am completely astounded by what has already been achieved.  Many patients have gone from having foot-long  grade 4 pressure sores to being completely healed which is nothing short of a miracle.  This means that they are now able to get into their wheelchairs, making them much more independent.  The Haitian physio assistants have been brilliantly trained by staff from ‘Healing Hands’ who are a group of spinal injury specialists who have visited several times throughout the last six months to give training and advice to the permanent staff.

That’s not to say my job doesn’t come without its challenges!  Culturally, the Haitians take illness and disability to mean that they will be dependent on others.  This can be frustrating to observe as a therapist, as you want to empower the patients to lead as normal and independent lives as possible.  Nonetheless, some of the patients are highly motivated: The work they have put into their rehab, and the encouragement and help from their family members really shows.

Working in a unit where you don’t speak the language of either the patients or the staff is a very daunting task, but as the patients have already started mocking my Creole knowledge (or lack thereof), it will only make me more determined to master it!

My third major challenge is coping with the heat.  Those of you that work at RLH – leaving the heating on full blast until May is nothing compared to this!!  The heat seems to affect some patients more than others, but they definitely all seem to cope better than me at the moment.

One final note with regards to the fundraising – amazingly we flew past the target, and have so far raised over £12,500, with money still coming in.  Thank you again to all those who contributed/donated/participated/fundraised.  I will keep you posted on how the money will be used, as there are some exciting plans in the pipeline.

Lots of love

Hannah

Posted by Hannah ( 1:12 PM )
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Friday Aug 20, 2010

From London Hospital to Haiti Hospital

I am a physiotherapist working in a London Hospital with patients who have suffered neurological problems (brain and spinal cord injuries). I have now embarked on a trip to Haiti to use my specialist skills to treat some of the many patients that suffered injuries from the January earthquake.  I will initially be working with the charity 'Haiti Hospital Appeal' who set up a spinal injury ward at their hospital following this earthquake.  I envisage my main role will be around training the Haitian staff in caring and providing rehabilitation to the patients, and exploring the long-term options for the patients.

I am planning to be away for 7 months, and have taken a career break from work.  I hope to work with Haiti Hosptial Appeal for at least the first 3 months, but my work after that is yet to be decided!

I have wanted to volunteer overseas ever since I went to Ghana after I first qualified as a physiotherapist in 2006.  I worked in Ghana for two months as a volunteer physio through a structured program with a UK based charity.

Working in Ghana certainly exposed to me the challenges you are faced with when working in a developing country.  However, I am expecting the work and environment in Haiti to be a lot tougher: being one of the poorest countries in the world, it is open to a lot of violence and corruption, and it is still very much in shock from the earthquake this hit in January.

In preparation for my trip, I have been fundraising, with the aim of raising £10,000 to kit out the spinal unit with rehabilitation equipment.  My fundraising events included organising a salsa night; 'Cycle to Haiti' sports event, and a couple of 'swishing' (clothes-swapping) parties. Friends and family have also got involved : they have helped fundraise through a sponsored walk; holding a quiz night; and selling homemade cakes, cards and jewellery. So far I have raised over £9,000, but I am hoping this will reach the £10,000 target by the time I leave: I will keep you posted!

Here is my Just Giving page and the website for the charity: http://www.justgiving.com/Hannah-Steadman and http://haitihospitalappeal.org/.

 

Posted by Hannah ( 3:48 PM )
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