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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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