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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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Monday Nov 08, 2010

The time of our lives!

Wow...there's no other way to put it – this trip to Ghana was without doubt the best month of my life. Anyway I realise we've been a bit slack on the blog entries so here is a summary of what we got up to during our month-long trip.

 

Mama Viak's Orphanage and Preparatory School

 

In the mornings five of us (Marcey, Tom, Josh, Laura and Becca) would work with Mama Viak and what seemed like ALL of Ho's children! During the afternoon the remainder of us would do so (Katie, Ruth, Liz, Maisie and Amy). The orphanage/school provides a home and an education for a small number of children in Ho, although being the summer holidays Mama Viak's was open to all local children as a safe place to come and play. Run by Mama herself, alongside some teaching staff, the orphanage is a fantastic place for the children to be – the daily laughter, smiles and singing made this clear! We provided the children with activities – both fun and educational – to ensure that chaos was kept to a minimum! All the activities were planned by us to incorporate fun and learning for the children, and we were also able to bring our own personal expertise (including football and karate lessons!). We dabbled in:

 

Arts and crafts

 

 

Science lessons (the body)

 

 

 

Geography

 

 

Sports

 

 

... and this is just a taster!

 

The orphanage relies on donations and Mama Viak has set up a sewing centre to help raise funds by selling clothing to the local community. Several of us walked away from Mama Viak's looking much more African than before and knowing the money we paid was going to a fantastic place.

  

I think it's safe to say that we were all touched by Mama Viak's. We are certainly all keen to continue donating to Dave Squared to help them to help Mama Viak keep the orphanage running. The warmth we received from the staff and the children was incredible and I hope that returning one day is a certainty, not just a dream.

 

 

Painting

 

Painting St Cecilla's School had its challenges – the biggest actually getting there when no taxi drivers appeared to understand what we were saying! Painting in Ghana was hot work and the sweaty look is one that we simply had to embrace. Armed with an Ipod and speakers we had lots of fun painting, dancing and singing with two local painters and few helpers! We learnt that 'Love Shack' is enjoyed by Ghanaians as much as us and Sean Paul always went down a storm! We worked hard to finish in time but still had a panic at the end that it would not be done in time for school to start and before we had to leave. Fortunately we made it!

 

 

 

 

Reading

 

Between 4pm and 6pm (often 7.30pm... we enjoyed ourselves too much to want to stop!) was the time for reading classes with a number of local boys. Our house in Ho was transformed into a library for a short period every day when the boys would descend armed with a smile and eagerness to learn (something that pleasantly surprised us right the way through the project). We all assigned ourselves set children to work with to ensure consistency in their learning and the children chose books they were interested in... and simply read! Where comprehension was low the children were encouraged to take an active role in finding out the meanings of words they did not understand and we would take the time to discuss what they found challenging. Towards the end of the project we encouraged children to write their own stories and received some fantastic ones, covering themes of bank robbery, magic children and talking stones! The children's dedication to learning was evident and it was a pleasure to be able to assist them in reading and writing – hopefully having one-to-one help, even for just two weeks, will have helped in some small way and if anything, given at least one child a passion for reading and writing.

 

 

 

Football

 

The boys football teams had just returned from a successful tournament so their coach had given them time to rest instead of training so five of the volunteers (the other five ran the reading classes described above) were asked to help head coach Fosta with the coaching of the women's team, Ghatel Ladies Volta FC! The girls were preparing for a series of qualifying matches for a regional tournament at the end of the two week placement so our task was to get them to the tournament. Becca, our FA qualified coach, took the lead on this and as a team of five volunteers we set about organising the girls into daily training sessions focusing on all different aspects of their game including passing drills, counter-attacking football and in particular better communication between players on the pitch, something Ghanaian ladies teams in general weren't very good at! The squad of girls were very motivated to play and improve and came to training regardless of how much it was raining. This was very inspiring for us volunteers to see and we made sure to work just as hard in return, organising useful sessions for them. Despite setbacks of injuries to key players and a loss during the qualifying rounds, in the end Ghatel Ladies triumphed and successfully qualified for their regional tournament! The team gave us the warmest welcome imaginable during the two weeks and we were made to feel like an integral part of the team as well as becoming good friends with many of the players. During our ten days travelling we went on tour with the team to their tournament in Cape Coast, staying with them in the hotel and supporting them in their matches throughout the tournament. COME ON YOU REEEEEEEEEEEEDS!

 

When the two weeks of project were up we said a very sad goodbye to everybody in Ho and the ten of us volunteers plus Ol' Man Dave Coles commandeered a tro from Ho to Big Milly's backyard, via Accra which took approximately 9 million years (ok more like 9 hours...it felt longer at the time) in the heat of the Ghanaian sun with nothing to eat but sweet bread, plantain chips and FanYogo ice creams and warm bag water to keep us going! We spent two nights at the incredible Big Millie's, including my birthday 20^th celebration on Saturday night which is the best birthday part I've ever had by a long chalk! Thank you player! The food and drink is top quality and the setting amongst the palm trees and right next to the beach is great. The rastas from the nearby community spend most of their time hanging around and making friends with the visitors. The whole resort is eco-friendly with bucket showers and solar panels on all the rooms.

 

From there we travelled from town to town along the coast. Our next stop was Hans Cottage Botel famous for its crocodile sanctuary where you can feed the crocs from the walkways. Most of the group went to Kakum national park for the afternoon where you can walk on the walkways high up in the forest canopy offering some spectacular views over the area. A must see! From there we moved on to Cape Coast where Ghatel Ladies FC (the team we had been coaching on placement in Ho) was playing in their regional tournament. The team generously let us stay in one of the dorms they had rented for the tournament for free which was a massive bonus. On top of watching their matches, we found time to visit the Cape Coast Castle (a sobering reminder of the Colonial History of Ghana), play football against the local children on one of the cleaner beaches in Cape Coast and have supper overlooking the beach. The next day a small number of us had a go at Ghanaian drumming lessons (suffice to say we won't be forming a band anytime soon!).

 

From there, three of us made an overnight round trip to Kumasi to visit the second largest market in Africa and the gold mines in nearby Obuasi, before meeting up with the rest of the group in Green Turtle Lodge. There is no other way to talk about GTL then simply to say it is paradise on earth. Watch the Leo DiCaprio film 'The Beach' and you'll get a feel for the sort of place it is. The last four days of the trip was spent unwinding here and getting to meet all the other guests, including Big Phil, the most legendary 80 year old ever who had been living there in a tent for 6 months and the owners, Tom and Jo, who we found out were Exeter Alumni (Jiff and Lukie respectively...I think). Our final night in Ghana was a low key, four of us ended up getting taken to a random club and snooker bar in central Accra and dancing the night away by a guy who turned out to be a drug dealer. Why not!

 

Anyway this in a nutshell was our ten days travel in Ghana. I couldn't count how many little details and events I haven't included which made the trip the time of my life and how close friends everyone became who were involved on this trip. I can't recommend DaveSquared highly enough (www.davesquared.org). Everywhere we went our volunteering contribution was made to feel hugely important and we were treated as family by everyone we met. We could not have been made to feel more welcomed and this helped us all to deal with the feeling of uncertainty we had when we first arrived in Ghana. The Ghanaian way of life has stuck with all of the volunteers and we have all adopted a much more open and relaxed stance on life. Our motto of the trip became 'Why Not?' and this will live with me for many years to come. We still talk to one another using all the Ghanain catchphrases that we picked up and play some of the games that the Kids at Mama Viak's taught us including 'Bambambambalika'! As Daniel would say, THANK YOU PLAYER!

 

 

Akpe kakaka,

 

Tom and Katie (on behalf of everyone!)

 

Posted by Community Action International ( 4:34 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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