fdmts

06:50 am: From space
I have to admit that I'm totally blown away by the capabilities of Google maps. Just a few years ago, this level of overhead imagery was the stuff of high level clearances and Tom Clancy novels. Now, I can click around through the entire world.

We took a SPOT Personal Locator device to Haiti with us. This is a little GPS with a way of talking to space. It's got an "I'm OK" button, and an "I'm screwed" button. If you push "I'm OK," your friends get an email with a link to google maps showing where you were when you pushed the button. In the other case, for a $99 annual subscription, they will inform the appropriate local authorities (Coast Guard, Police, Embassy, NASA) that you're requesting help.

Here's the Jimanai border crossing: I clicked the button after we parked to negotiate customs and immigration. We're on the Dominican side.


View Larger Map

Here's what the border looked like on the ground:



Here's the compound where we stayed in Blanchard AKA Terre Noir. The longer building is the church, and the smaller one to the North with the rounded front is where we slept:


View Larger Map

Finally, here's the ruined church in Cite Soleil:


View Larger Map

See the writing on the roof? Here's what it looks like from the ground:



Tags: haiti

06:41 pm: Pictures from Haiti
Here are some pictures of Haiti:

Elizabeth's pictures
Our pictures

Totally unorganized for the moment.

Here's one I find poignant:



This man comes each day to the technical school where he lost at least 10 of his friends in the earthquake. He comes because his home is destroyed, his workplace is destroyed, and most of his friends are dead. He escaped through pure luck. He comes to tell people about his friends.

Tags: haiti

06:07 pm: Skynet symphonic

09:43 am: Haitians
There is a lot of writing about Haiti. I want to write for a moment about Haitians.

The reason that I keep going to Haiti is not that I care so much for the nation. It's that I'm deeply in love with its people.

Haitians have the most brilliant and unexpected smiles I've ever seen. For the most part, they go about their day with a rather closed expression on their faces. This can lead you to think, from candid pictures, that they are a dour or unhappy people. If you wave or smile at a person on the road in Haiti, 9 times out of ten you will be rewarded with a smile like a sudden sunrise. The eyes light, the face brightens, and they return your wave. Similarly, they are guarded and careful at first. Anyone who lives with such hardship would be. However, when you talk openly with them, they are a joyful people. Poor, downtrodden, cautious, misused by the world - but at core joyful like no others I've met.

It is no exaggeration to say that the average Haitian I've met is happier, in a very real sense, than the average American that I know. That should tell you something about both sides of the equation.

Haitian children sit quietly like no others that I've seen. I've watched a bench filled with twenty 5 year olds sit quietly, waiting to be seen by the doctor, for hours at a time. Again, when I took a hand or looked into the eyes, that smile would light up the room.

Alan, the architect traveling with us, shared a story: While evaluating buildings, he was standing on one wall, looking at an adjacent wall that was in the process of falling over. Under that wall was a pile of trash. While he watched, a little girl, perhaps 8 years old, wormed her way out from the hole she had dug herself for shelter - in the trash - under the wall that would inevitably fall and would certainly kill her when it did. She flashed him that open, honest Haitian smile. As he put it "my shit was lost."

redmed's translator, living in the street himself, discretely gave what little money he had in his pockets to the poorest patients who passed through her room. "Hide this," he would say. "Don't let anyone take it from you."

Haitians are a clean people. They dressed in their best to see the doctors (to see our motley crew), and to come to church. To see people living in the streets, bathing in shared water in the open - you might think that cleanliness would go. Somehow, from that dusty, dirty, smashed city - impeccably pressed shirts emerge. Blinding whites and colors, shined shoes. Ribbons in children's hair. I remarked on this in 2006 and it's still true in 2010.

Haitians are a people of deep, deep faith and strength.

Haitians are a crafty, resourceful people who can make almost anything work.

Haitians have long, long memories. Children in the orphanage in Fondwa remember my name and ask after team members who came in years past.

Of course, no nation is homogeneous. As someone who tries hard to avoid being a stereotypical American traveler (overweight, badly dressed, loud, rude, clueless, culturally insensitive) - I hesitate to make generalizations about any group of people. Obviously, Haiti has suffered from brutal dictators and vicious local gangsters. However - these are my observations of the people I've met - and I would share them with you.

Thanks for listening.

Tags: haiti

05:31 pm: Safely back in the Dominican
Cross posting from the work blog again:

To the below, I will add:

Our drivers on the Dominican side met us with huge smiles, and it was a massive relief to once again commit ourselves into the armed hands of men paid to take care of us. We stopped off at the same gas station from before, declared it the safest place in the entire world, and bought beers for the road. I had some of the best sleep I've had all week, face pressed up against the window glass.

We said our goodbyes this morning, gave away most of our supplies (blankets, sleeping pads, spare clothing, water bottles, etc) to the families still sleeping outdoors in the neighborhood near the clinic, and made our way to the border with the Dominican.

We drove the FHM vans all the way through to the Dominican Republic, stopped only once by an armed guard. He banged on the window and demanded to know what we thought we were doing just driving 17 people across an international border. “Medicos,” we replied. “Andele con Dios,” he said as he waved us through.

Of course, it wasn’t really that simple. We guessed that we needed to get our passports stamped to get past customs at the airport tomorrow. Hardy and I collected all 15 passports and took them to the Dominican authorities. There was a $10 per passport fee to get the entry visa into the Dominican. They took that (cash, no receipt) and demanded some sort of “medical identification.” He showed them his military ID, which seemed to suffice.

They then revealed that we would need to get an exit visa from Haiti before they could stamp the passport. So we walked back across the border (ignoring a couple of offers to hire a moped for the 200 yard trip), around the exhausted looking guards who waved us through, and to the Haitian authorities. We set a stack of 15 passports on the counter, explained ourselves, and watched them get stamped through.

Back to the Dominican side (hello again to the exhausted guards), received 15 more passport stamps, and returned to the group.

At no point did anyone seem to think that it would be important to see these 15 individuals who were notionally crossing the border. It’s also worth noting that the border crossing is a geographically stunning place, a high mountain lake with chalk cliffs plunging directly into greenish blue water. It was a surreal experience.

This was substantially different than the trip into Haiti, since we bothered to stop at immigration at all. We have neither exit nor entry visas from that trip.

Summary: We’re safely back at the Marriott in Santo Domingo – substantially lighter – and planning to get on a plane home tomorrow.

Tags: haiti

05:46 pm: Another cross post
From the work blog again:

We just returned from a drive around Cite Soleil and downtown. The devastation there is much, much worse than what we’ve been seeing around the clinic. We’ve basically been in a suburb – the houses are spaced a bit further apart and two story buildings were rare. Therefore, while the devastation is very real – it’s not as packed together and overwhelming. People have space to sleep on the ground on in simple shelters next to their (former) homes.

We did clinic this morning, seeing a mere ~150 people. This brings our total for the week to the high 800’s. Honestly, we could be plus or minus fifty. We try to track patients with a rudimentary chart (piece of paper with name, vitals, chief complaint, evaluation by the doctor, treatment administered, drugs prescribed, and so on) but urgent cases pre-empt that process. I’ve also lost count of how many people have been carried past me in a fireman’s (two man) carry as I worked filling small containers with our limited drug supply.

Google maps and Google Earth have remarkable overhead imagery of the city, updated after the quake. I would encourage everyone to take a look at the national palace, the cathedral, and Cite Soleil for reference on what I’m writing here.

Cite Soleil is built on top of the former garbage dump of the city. Not the most stable of foundations – but it’s also explicitly intended for some of the poorest people in the Hemisphere. The poverty there was intense prior to the quake. When it rains, the sewage from the city flows through Cite Soleil on its way to the sea. We stopped at a church supported by the group I’m with (Family Health Ministries). It would normally seat about 2,000 people, but it is unusable due to many cracks through the foundation and walls.

The architect traveling with our team picked up a fist sized piece of concrete from the foundation and crushed it to powder between his hands. “You couldn’t build a doghouse on this foundation anymore,” were his exact words. Apparently once concrete has set, subjecting it to severe compression and strain will weaken it structurally.

We then drove to the national cathedral and the palace. Frankly, I’ve never felt so safe in Port Au Prince before. You can find footage of those buildings on CNN and so on. It’s a lot more intense up close. A city builds a cathedral as an expression of their hopes and dreams – the architectural pinnacle of what they can accomplish. Seeing that reduced to rubble took a lot out of me.

A lot of buildings looked fairly normal, until you realized that you were looking at a second floor resting at street level.

On the other hand, we passed US, Brazilian, and French military and construction convoys. We chatted with several members of other groups who were getting on with the business of building infrastructure.

People are living in clusters of strangely homogenous tents. Here, a hundred from Coleman. There, 200 from the Rotary.

With that, I will again close and let someone else notify family and friends that they are doing okay.

Tags: haiti

05:23 pm: Mid week update
Cross posted from the work blog:

This will be a quick update, because I suspect that I would be asleep long before I could even summarize our entire trip.

We’re in the ‘Blanchard’ or ‘Terre Noir’ neighborhood, perhaps a mile north of Cite Soleil – in Port au Prince. The clinic building where we are working survived the earthquake in remarkably good shape. It’s in a walled compound that also contains a 1,000+ seat church and a small school. The school is basically a loss, and the church has a large crack from floor to ceiling on the two side walls. The tower that holds both the satellite dish and the water tank is badly damaged, but standing. We suspect that re-filling the water tank would push it over the edge.

Our clinic is providing mostly ambulatory care. Everyone here is in tremendous emotional stress. The majority of the city are sleeping on the streets, and anyone who we can get talking has lost friends and family just a couple of weeks ago. For perhaps 75% of the patients, we’re really providing a friendly face, some painkillers, mild sedatives (benadryl) to help with the nightmares, and so on. A chance to get out of the sun for a few hours and have a couple of cups of clean water is probably a bit of help in and of itself.

That said, we’ve unequivocally saved several lives. We had a man collapse and begin to seize with what was most likely meningitis on Sunday. The doctors started IVs, maintained his airway, and managed to stabilize him. The hospitals refused him, so we wound up having him driven to his house. He came back the next day, walking and talking – and thanking us.

We’ve been working our orthopedic doctor to the bone – in some cases re-breaking and setting limbs that had begun to heal incorrectly. For these folks, we have conscious sedation, which is a real benefit. Still, the screams are quite something.

For my part, I spent a couple of hours yesterday giving two liters of water with rehydration salts to a severely dehydrated girl. One tiny sip per minute, so she wouldn’t vomit it back up. I spend most of my time working in the pharmacy – dispensing medicines and running the few lab tests that we can do (urinalysis, glucose, hemoglobin, and pregnancy).
dwan_clinic.jpg
At the clinic
I sleep on the roof of the compound with about half the team. A ridge-rest on bare concrete is remarkably comfortable – once you’re tired enough. We generally wake around 6am (to roosters, dogs, and sunrise). Clinic starts at 8am and runs (today) to about 5:30. Like I said, early day. Electricity from the city is nonexistent – but we have both solar and generated power.
sat-term.jpg
Rooftop Satelite Internet Terminal

We’ve seen perhaps 720 people in three days, starting out slow and ramping up to about 270 per day, today and yesterday.

Perhaps a future post can describe the incessant helicopters, and how we’re clearly on the edge of a massively devastated city. For now, food has arrived.

Tags: haiti

10:12 pm: Santo Domingo
We're safely in the Dominican Republic, happily nestled in the Marriott hotel. The rest of our team is arriving sometime tonight. We're meeting them at 7am in the lobby. Hoo-ah.

I felt like I was in the company of heroes on the plane today. There were at least two other groups of medical folks represented: The New York Medics (perhaps 10 doctors, nurses, and PAs) were pretty serious looking folks - with nametags and everything. They're going into Cite Soleil. We also interacted with a couple from Niamayah Vision Ministries. They have a clinic, much like ours, but further out of town. These are seriously the people who went to help New York dig out, and also New Orleans. I don't feel much like a hero - but at least I'm on the same plane with them.

When the plane landed, the flight attendant asked the passengers for a round of applause for those of us going to Haiti to help out. We were in the very butt end of the plane, and while we were hanging out back there she pressed a handful of bandages and ointments into our hands. "You'll cut yourself," she said.

Perhaps even more remarkably - the customs agents in the DR waived our "visitors card" fee. "You're going to Haiti? When? Tomorrow? Go. God Bless You."

For the moment, I feel like I'm staying in the nice hotel just outside the gates of hell. Hopefully that's hyperbole - but I'm getting a good night's sleep, just in case.

Tags: haiti

10:09 am: Supplies
Cross posted from my work blog.

I write this from JFK airport in New York, having successfully gotten out of the house at 5am carrying four duffel bags containing just under 200lbs of (mostly) donated supplies. Our clothing and personal gear are in our carry on luggage.

I remain overwhelmed by the deep vein of compassion and generosity we have tapped. We decided to make this trip less than a week ago, on Sunday the 24th. In the ensuing five days we’ve amassed enough gear and supplies that we spent last night in a sort of triage party.

The 200lb number is far from arbitrary. Not for love or money can you check more than two bags on an international flight. Further, if you’re flying to the Dominican Republic – not for love or money can those bags exceed 50lbs. At the airline’s discretion they may allow overweight bags, for a substantial fee. Since I did not want to see the fruits of people’s generosity thrown out at the gate to make weight, we decided to pre-weigh all of our bags and make a separate shipment of what would not fit.

In terms of shipping, there is still no really coherent way to ship to Port Au Prince. Fedex and UPS will each take packages to the Dominican Republic – but the cost to overnight a 50lb bag was nearly $500. At that price point, I’m sure that there are more useful things to do with the money than spend it on expedited burning of jet fuel. With an additional week’s notice, we could have dropped the cost substantially. So, the remaining supplies are being shipped out this week (by still further friends, with keys to our house), not only out of weight, we were also out of time.

Based on what we see on the news, as well as reports from colleagues and friends in country, we are focusing on pain management, wound care, antibiotics, and postoperative care for the lucky souls who have already received treatment. I have no idea what to do about what is being described as an emerging mental health catastrophe. The hospitals who employ the physicians on the team have been singularly generous. Just the two of us are carrying nearly 50lbs of drugs. We’re also shipping nearly 7,000 over the counter pain pills. The other physicians on the team are similarly laden.

My wife’s hospital came through with a wide assortment of surgical equipment. Apparently in the United States this is considered single-use. Stainless steel implements are simply thrown away. In the rest of the developed world they are sterilized and re-used. We have one bag that is small but dense with retractors, forceps, scalpels, and other things whose names I do not know.

On Wed, we were also allowed into a basement room filled with pallets of donated supplies. “Take what you need, and God bless you,” them man said. We selected an “ambu” breathing bag, as well as lots and lots of gloves and gauze, among other things.

My colleagues at Bioteam, as well as other friends, delivered a total of three boxes of emergency gear (emergency rations, a folding solar power source, tarps, stoves, water purification supplies, and so on) as well as four boxes of home health care supplies. The latter included critical supplies for wound care, splinting, and pain management.

We decided early on that all our clothing would fit in the carry on bags, as well as my communications gear. So, my clothing for the week (including church duds for Sunday) consists of half a duffel bag’s worth of space – crushed next to a satellite internet terminal and a 12″ G4 Apple laptop that will probably live out its days as a clinic computer in Haiti, and a GPS locator beacon.

Food was the hardest compromise. We’re carrying everything we need for a week. That took up critical space – but we decided that it would be unacceptable to make the trip only to become a burden and take supplies that the Haitians need. Perhaps half of one of our larger bags is heat-and-serve pouches of pre-cooked food, trail mix, and so on.

I brought each bag up to nearly 50lbs with the emergency ration bricks – intending to make something of a show of having to leave behind food for the hungry. Fortunately, it was not necessary. In fact, the JetBlue employee who checked us in surprised us by waiving our baggage fees entirely. “You’re doing a good thing,” she said.

Thanks again to all of you who opened your hearts, closets, and supply room doors to us. This is truly humbling. Between the 15 members of our team, we’re bringing 30 bags – 1,500lbs of supplies.

With that, I board a plane bound for the Dominican Republic. Our drivers meet us at the hotel at 7am tomorrow to begin the trip into Port Au Prince.

We have pictures of the guest house where I’ve stayed in the past. If you click the link, you’ll see why we’re sleeping at the clinic this time.

Tags: haiti

12:16 am: Bags are packed
In something less than five hours, a cab will show up (hopefully) to take us to the airport. From there we proceed to JFK, and thence to the island resort town of SDQ (Santo Domingo, in the Dominican Republic). I have told various folks in the group that I will be the white guy lounging by the pool with a beer and a laptop. Yes indeed, perhaps four hours of blissful Caribbean vacation. Then the rest of the group shows up and we have to get serious.

We've got 200.00lbs of baggage distributed perfectly evenly between four duffel bags. redmed has her surgical tools. She has her antibiotics. She has her stuff. Me? I found my hat. Actually, we're a little over weight. In each bag, I have several of Dag's food bricks - intended for feeding starving people. If they give me crap about my bags being over weight, I intend to throw away food for poor people. In front of them. Slowly. I'm not ditching antibiotics. Hell with that.

I have located my hat. redmed has located her hat. Our hats are ready to go. Us? We're completely weirded out by the fact that people are praying for us - not in a bad way - but in a "go team" sort of way. That is well and truly odd.

And with that, to bed. Perhaps to sleep. More likely to scheme and plot and play scenarios - the better to be effective.

Tags: haiti

01:07 pm: Reality sets in
Well, the rubber is hitting the road already on this trip. We've got more donations than we can take directly. Apparently for international flights, you're allowed two pieces of checked luggage. Nobody on the Jetblue support lines could do anything to alter or modify that. Further, when going to the Dominican Republic - each of those checked bags can be no more than 50lbs. They have an option to allow overweight bags - sometimes - but since we'll be taking a taxi to the airport at 5am - I have no interest in having my stuff turned away and having to leave it at the curb. "No guarantee" means "no."

Plus, with two 50lb bags apiece - plus a stuffed carry on - redmed and I will already be the sort of vulnerable - unable to run with our own stuff - losers that I make fun of. So no - no more bags - even if I could.

capital_l came over last night and we had a little packing party. We made 3 duffel bags that each weigh about 50lbs. One is solid drugs. The next two are a mix of medical supplies. I spent this morning un-boxing and bundling our pre-cooked Indian lunches and dinners (foil packs that you heat up in boiling water, or eat cold) - and with just our food for a week, our sleeping bags, and a couple of other essentials (water bottles, camp stove, etc) that last duffel bag is full full full. I still need to look at the clothing situation. I'm thinking underwear, socks, undershirts, and two pairs of cargo pants. I can fit a week's worth of that - plus a laptop, plus a satellite uplink (heh) in my carry on (AKA gym bag).

Therefore, I'll be shipping a couple of decent sized boxes to RDU, and donating a couple more decent sized boxes to Partners in Health. Rest assured, it's all going down there - just not in my checked luggage. Triage order goes something like (a) serious drugs (b) medical equipment (c) my food (d) ... well ... um ... 'd' is getting shipped.

With another couple of days of warning, I could have done better. Pisses me off that I *had* those days and didn't start moving faster - although I had no idea that we would have so much stuff - and it all arrived yesterday. Fedex and UPS both ship to Santo Domingo. Right now, I could drop a 50lb box and have it at the hotel by the time we arrive there tomorrow. Price for that privilege? $450. If I had a spare week, it drops below $100.

No, it's not worth the money. This is the hard calculus. Throwing money in the wrong direction is just as much of a mistake as not giving at all. If you feel tempted to spend that kind of money, please pause and consider what $450 might be able to do in a month or so - once the real reconstruction begins. We've got all the hardcore stuff. What we're slow-boating is nearly 10,000 over the counter pain pills. Tylenol, Ibuprofen, Aspirin, etc. ... plus stuff that will still be valuable once the amputations are done and the infections have run their course.

This is the part where I look at what I'm doing and say "people will suffer, and possibly die, who did not need to - because of my lack of omniscient knowledge of the future." If I had played this one *perfectly*, there were better moves - and that would have meant less suffering in the world.

Live and learn. Self flagellation done. Back in motion.

Oh yeah, and looking out my window, I see snow. What's *that* about?

Tags: haiti

01:30 pm: Supplies for Haiti
Once again, I am incredibly humbled by the lengths that people will go to in support of this crazy idea of going down to help the people of Haiti.

I'm being intentionally a bit vague here - in case anyone is bending the rules on our behalf.

After a few phone calls, redmed and I were led into the basement of her hospital. Deep in the bowels - where blue smocked cooks move steaming vats of soup - and pallets of gauze and surgical supplies share the halls with crash carts and so on. We met The Man In Charge in his basement corner office. He had strong hands with a firm grip - looked us in the eyes and said "so you're going to Haiti? We've got a room full of donated supplies. Come with me."

He buzzed us into the back room, where pallets of boxes stood. He handed us a box cutter, and introduced us to one of his employees. "Take what you need, anything in here. It's mixed, but all good. It's being shipped once we can arrange it - but you need it now. God bless you for what you're doing. This fellow will get it straightened up after you're done."

The thing that got me was that he was the one doing us a favor - and he was also the one thanking us. Somehow, the opportunity to help us was - for him - a big thing.

This is not how I usually live - but I think I like it here.



Tags: haiti

06:56 pm: Publication
A positive post, not about Haiti.

One of the groups with whom I work just published a paper. It's interesting in that it may be the first paper to describe the whole genome sequencing and analysis of an entire genus. Maybe. Or not. I can't keep up with big science anymore. It's the genus that includes plague.

Anyway, I helped out with this at the very end of the process - when a reviewer pointed out (correctly) that a couple of the strains in the paper were not yet in the public repositories. I.e: The data wasn't *actually* available to the public yet.

We went digging, the lead author and I, and finally located the files based on what can be best described as "the dog shit connection." He noted that this strain had been isolated from dog feces, in Germany, in the 70s. I ran a search in the wiki on "feces," and there was the data. The rest is history.

Lest you think I'm making this up - here's a table from the publication. I love my job.

09:38 am: Donations and suchlike
I'm getting a lot of offers of support. You humble me. Here's the deal:

First: Thank you.

Second: This is both a sprint and a marathon. While we're going down to bandage wounds and set bones, this must be a much longer term project. I actively leaning on all of you to make a long term commitment to helping the Haitian people. I don't yet know how best to implement that help. It may be some sort of Marshall plan from the US. It may include merely keeping the eye of world attention on our Caribbean neighbor once the bodies are buried and the starving people once again out of sight of the cameras.

If you want to do the right thing over the long term, please plan a little support every month for the next few years.

I will know a lot more about how to be useful in that context once I've been down there and seen the situation with my own eyes.

Third: I appreciate the donations of money and goods. If you want to support us with money, the best way is probably to send donations to Family Health Ministries, earmarked in some way for "Chris and Jen Dwan". They're a tax deductible, charitable organization - you'll get a receipt - etc. I understand that if the money shows up sometime soon, you'll even be able to take it off your 2009 taxes instead of 2010. We're keeping receipts for our expenses related to the Haitian people. We'll probably pick up a substantial amount of antibiotic, gauze, tegaderm, etc. at cost. FHM has committed to reimbursing us for that - and you can specify that you would like your funds used for that reimbursement.

We will not ask for reimbursement of the airfare or hotel in the DR, nor for our own food.

Fourth: If you have contacts who can get medical supplies to us by Thursday evening (donated, or at cost), that would be a huge help. Drop me a note or an IM and we can talk on the phone. We've got limited space in our carry ons, but if I could take a whole 50lb bag of powerful antibiotics, plus local and general anesthetics, plus ways to get them into people's veins, I totally would. Hell - I would leave up to half of my food behind for retractable syringes.

Tags: haiti

09:40 pm: Support
One additional thing, in a smaller package:

To all of you who have, both with words and deeds, offered support to Jen and I: Thank you.

09:30 pm: Preparations
Okay, so the trip is real. Tickets have been purchased. I'm totally confident that I can work the clutch and the brakes on this machine until about noon on Saturday. That's a good 36 hours about which I have confidence. Better than usual.

On Friday we take a plane from Boston to Santo Domingo in the DR. We're staying at a Quality Inn near the airport overnight - meeting the rest of the team there. 15 of us. 5 physicians, 2 nurses, and the rest of us. Most have been to Haiti before. In the morning, we're hiring a driver (or two ...) to get us from Santo Domingo to the Jimani (pronounced "Jimminy") border crossing.

That that point we hit one of the truly major make or break points on the trip: We expect that the Family Health Ministries van will meet us at the border crossing. They're also bringing a truck for the supplies - as well as guards. Okay, they're probably just bringing guys we know. That's better than nothing.

I fully expect that we'll get to sit and stare at the border crossing for a couple of hours, hoping that our transport shows up. It's gonna be an awesome period during which I learn a lot about the moral constitution of my teammates.

Nervous? Me? Nah.

Assuming that the truck shows, we're planning to arrive in Blanchard (AKA Terre Noir), just North West of the Port Au Prince airport on Saturday evening. We'll go to church on Sunday. Yes yes, I know. I'm an atheist. However, perhaps (in the words of the New York Times) "a God who never answers is better than nothing." Also, the faith of the people I've met in Haiti is real, applied, and useful to them. Better than most anything I saw growing up in the suburbs.

Either Sunday afternoon or Monday morning we'll start seeing patients. At that point, things go totally off the map. I received a forwarded email (via my dad) from a man who was in country last week. Here's a representative chunk:

spent the bulk of last week working in an orphanage that we turned into a hospital down the road from the real hospital where the surgeons did non stop surgery. lots of ortho trauma, neuro and spine trauma, open wounds, burns, blunt and open trauma to chest, abdomen, pelvis and extremities, crush injuries to just about every part of the body,despair of families split apart searching among the wounded for each other etc.....we put in 12-14 hr days and shifts. teams from all over the world converged at our clinic and hospital which was right on the border of haiti and the dom rep.

He continues, after a bit more detail:

these beautiful people are truly amazing despite the devastation of their country and have a silent dignity that i can not do justice to by trying to describe with mere words. the survivors were mothers, fathers, sons and daughters, aunts, uncles, brothers and sisters, etc and from all walks of life from carpenters and ship captains to lawyers, doctors, poets, authors, masons, bussiness owners all left with nothing at home but complete devastation.

He was at the border. We're headed for the core. On the other hand, we're a week later. We may well be able to run an ambulatory care clinic and refer off to the hospital ship. Who knows? I just really hope to not have to do amputations with no sedation. Hell, I would really like to maintain my lifetime record of "zero" instances where I had to take a knife to human flesh.

Nervous? Me? Nah.

What I do know is that we're packing food for a week, clothing for 90 degree weather, and all the supplies we can fit into our two x fifty pound checked luggages. I'm treating this as a BYO medical practice. It's gonna be awesome. In addition to bandages, splints, pain meds, and so on - I'm adding things like knives, basic sets of tools, tarps, and so on.

We'll work as long as we can, through Friday, and then make our way back to the part that I'm actually the most nervous about: Getting from the border back to Santo Domingo.

I'm looking for a Satellite Internet connection. Seems to be a mere matter of about $100 bucks to rent the gear for two weeks, and then something like $8 per MB. Yikes. Still, I would very much like to be able to post while I'm out there.

I'm also looking for ideas. If you have ideas on topics ranging from personal security, to useful tools to bring, to how to best help these people: I would love to hear them.

Tags: haiti

04:03 pm: Autobots, roll out
I just bought tickets to go to the Dominican Republic on Friday the 29th. On Saturday, we intend to go overland via hired vehicle to the border crossing with Haiti. Hopefully, the Family Health Ministries van will meet us there and take us to the clinic where we've worked before, in the Blanchard neighborhood of Port Au Prince. It's about two miles from Cite-Soleil, and I've seen pictures that show it still standing after the most recent aftershocks.

From Sunday through Friday we'll be running a medical clinic, focusing on trauma, wound care, setting bones, and so on. Our supply list includes local and general anesthetics, bandages, basic splints and so on, gloves, suture, and the other extreme basics. If things go well, we'll be able to triage the worst off people over to the hospitals (fine, the hospital parking lots. We'll take what we can get).

We'll be going with a group: family health ministries, http://familyhm.org (FHM) with whom we've traveled before. Jen and I have been down there with them three times over the past few years, working with small medical clinics, smuggling in supplies, and generally trying to directly help people in whatever small ways we can.

It's worth noting that we're not the big boys. Partners in Health (PIH) and Doctors Without Borders (MSF) are the ones with the real facilities and the real funding. Ours has historically been a much smaller effort to catch people who fall through the cracks - and so it remains. If you have a few bucks to donate, I highly recommend PIH and MSF. Of course, we'll take what we can get.

FHM has built four clinics and two schools over the years - and we had just broken ground on a new hospital in Leogane - which was approximately the epicenter of the earthquakes. Two of the clinics (in Cite Soleil and in the rural village of Fondwa) are described as a total loss. The other two (Leogane and Blanchard) are apparently usable - though damaged. Our oldest school (500+ students) is rubble, as is every guest house and hotel that I ever stayed in while I was down there.

Fortunately, the only deaths of people I know (so far) were a nun who was full time at one of the clinics, and one of the translators with whom I worked the last time I was down there.

In addition, the CDC and WHO are organizing public health efforts for the rest of the country - and basing those efforts near the facility in Leogane. The director of FHM will be on a CDC plane on Thursday, landing on the highway outside of Leogane. We may try to sneak into that effort - since I think that we might be more useful there.

We've got as safe a place to sleep down there as anyone (the clinic floors). Word is that there is gasoline to power the generators, that the well is working, and that there is sufficient food for that part of the city. Honestly, getting there will be the biggest challenge.

That's a long way of saying that I don't really know many details.

Those of you who have known me long enough have heard me refer to situations like this as "naked skydiving." Here's what I mean by that - sometimes you just gotta jump.

Or, as it was once put by the indomitable _earthshine_: "You gotta commit."

Tags: haiti

11:31 pm: Look, damn you.
Look at this.

It's not far away. This is an hour by plane from Miami - and it's happening now.

They are not unknown people. That's the town where I was helping, in my very, very small way, to built a hospital. That nascent hospital is rubble. Rubble that includes corpses.

Look, damn you. Look. See the underlying nature of your reality and mine. Look for as long as you can.

Then think what you can do to help.

Fuck democrats, fuck republicans. Fuck Massachusetts and fuck your politics.

Look.

Tags: haiti

08:20 pm: Insights
I'm riding a clear, smooth yoga high. Went to the heated vinyassa class at Thrive, where I've been dropping in on the occasional class for the last three years. A really good session will yield at least one good insight that I can ponder through dinner. This one provided two:

1) In Judo training there are usually two roles: The Uke and the Tori. The tori does the technique, and the uke allows himself to be used for the technique. Being a good uke takes a lot of practice. You need to give yourself to the tori, but also protect yourself. You need to be flexible and go where you are put, but not simply flop or jump. You need to anticipate the technique to protect yourself, but not anticipate it so much that the tori learns bad habits.

In yoga, you are your own Uke. You relax and give yourself to yourself for the practice. All of this in a context where there is no fundamental "self" to point at. It's tricky.

And the second is a bit odd, even for me:

2) During savastana (complete relaxation), one lays on the mat with eyes closed and releases the energy and tension from their body. I took the opportunity to do a mental exercise in which one dedicates any "merit" (whatever that might mean) to other people. I was specifically thinking of the folks in Haiti - but my mind broadened to a few people from work - to people suffering in other places - and generally to the world in a compassionate sort of way. At the same time I went through one of my preferred mantras:

So long as time and space remain
So long as sentient beings remain
So too may I remain
To ease the suffering of the world

As I settled into that mindset I felt, very distinctly, soft and ephemeral hands cradling the top of my head. It was an immensely comforting and reassuring feeling. I found that I could increase the sensation by broadening my mental gaze - which I did.

Realistically, it was probably just my hair drying out or something - but let me tell you - it was odd.

12:27 am: Facts
I was going to go all philosophical and write about justice. Instead, I find myself tired and needing to get up early for work (here in Maryland - hooray for business trips). So instead I will share some facts about Haiti. I know, I know - it's been a whole week. Forgive me, I care.



The quick and dirty summary is that every building in which I ever slept on my three trips to Haiti is now rubble - but the people I met seem to have survived. St. Joseph's hospice in Port Au Prince fell down entirely. In Fondwa, both the guest house and the school are "a loss." Fortunately, the orphanage sustained "minor damage," and only one child was killed.



It's becoming clear that while Port au Prince is in really rough shape - the rest of the country is going to quietly get the worse of it. The World Health Organization has designated Partners in Health to lead major portions of the medical response (hey, you've been here 25 years, you wanna drive?). The CDC is stepping in to provide some level of advice and support for the public health nightmare that is about to happen.

I'm still looking into whether it makes any sense at all to go down there. We've got a few contacts, and the consensus appears to be that unless you're a trained emergency responder, a trauma surgeon, or someone with major construction skills - you might want to hold off for a few weeks.

Hell: Paul Farmer says it better than me.

Tags: haiti