Haiti: Aftershocks

"Immediately after the shaking stopped, it was deathly silent. You couldn’t hear anything. Then, about three or four seconds later, the entire city erupted in screams. It was something I’ll never forget," says Jordan Wiley of Médicins Sans Frontières (MSF) recalling the moment that would test Haitian resolve yet again.

Over a month has passed and Haiti still remains shattered by an earthquake that is estimated to have killed over 230,000 people. Having treated over 18,000 patients and carried out nearly 2,000 surgical operations, MSF has been an integral part of the medical response to the natural disaster.

Although the situation in Haiti is moving from an emergency phase to a recovery phase, the needs are still incredibly dire. This is especially evident in the psychological wounds the earthquake has caused, and MSF is extending support activities to the many Haitians left traumatised by the horrific events of 12 January.

MSF has been working in Haiti since 1991, maintaining four health centres, 30 international staff and 800 national staff in Port-au-Prince and the surrounding area. In the immediate aftermath of the quake, MSF had to respond in unimaginable circumstances.

Mr Wiley was the logistics manager for La Trinité hospital—the only emergency medical facility in Port-au-Prince—when the earthquake hit: "I don’t know how long it lasted, maybe ten or fifteen seconds. What had been the first floor of a three-storey building was completely destroyed, it was just rubble. There had been an emergency ward, a waiting area, an intensive care unit, and a blood bank there. And in all of those areas there were patients and MSF staff."

Within 25 minutes of the earthquake, MSF staff were treating patients. Additional staff were quickly dispatched from abroad to address the emergency needs that had arisen. MSF maintains a list of approved potential volunteers, and in the aftermath of the quake, MSF responded to requests for specific medical specialisations required in Haiti. A month later, MSF has increased its presence in Haiti to 375 international staff and 1,450 national staff.

MSF also maintains an Emergency Team, whose job it is to remain available at all times to respond to emergencies. Volunteers from this team can typically be deployed in as little as 24 hours from the time of the disaster. Paul McMaster, a surgeon based in Amsterdam, was one of the first MSF volunteers to be sent to Haiti after the earthquake, as it became evident that additional surgical capacity would be sorely needed.

He described his experience working under extremely difficult circumstances in Port-au-Prince: "When we first went into Haiti we were just working round the clock dealing with the casualties with very little interruption, just with perhaps a few hours break in the night to rest.

"We were working off two makeshift operating tables in the courtyard and we just went from one patient to the next. We then did some resuscitation outside in the road and then came back in and went into the surgery, so it was a continuous process."

In the immediate aftermath of the earthquake, severe traumas such as head injuries and fractures were the most common cases staff were seeing, and so surgeons, anaesthetists, and theatre nurses were among the most sought-after volunteers to be sent to Haiti.

Dr Jane Cabeza was working at the MSF Pacot rehabilitation centre in the capital when the quake hit. Dr Cabeza describes the horrific injuries inflicted on patients and the task of trying to aid one victim at a time: "I see some people and can't believe they are alive. A mother helped me bandage her infant, whose left hand was gone.

"It took an hour, but once the baby was bandaged, she was more calm. I can't imagine what the mother is going through. I changed the bandages on a little girl and it took me a while to see the wound, but part of her skull was missing. She needs immediate reconstructive surgery."

As the crisis developed, crush injuries and gangrene also became prevalent and these problems require additional resources such as dialysis machines and adequate facilities for post-operative care. The lack of supplies quickly became one of the most pressing concerns for aid agencies and medical teams on the ground.

Delays were rife because of the gridlocked airport in Port-au-Prince, as supplies would then have to be brought into Haiti by truck along a single narrow and often dangerous route. Loris de Filippi, one of MSF’s emergency co-ordinators, admitted that lives were lost for lack of medical supplies which should have been available.

MSF’s inflatable hospital, specifically designed for situations where adequate medical facilities are lacking but desperately needed, took over a week to fully set up, due largely to logistical issues with getting both parts of the hospital to the selected location in Port-au-Prince.

Living conditions for people who lost their homes and are now in camps under makeshift shelter are also atrocious, with water and sanitation desperately needed. Etienne Gignoux, an MSF logistician in Port-au-Prince, explained the huge need for water and sanitation: “There were people living, and some are still living, under sheets, having lost everything they had in the earthquake. So we wanted to respond to those two aspects very quickly: latrines to provide minimal hygiene conditions, and shelter.”

Currently, MSF are planning to supply the water and sanitation needs of over 7,000 people living in the camps near the St. Louis Hospital, and improve access to water and sanitation for around 40,000 people in the Port-au-Prince and Léogâne areas.

The healthcare situation in Haiti is likely to remain extremely serious for the foreseeable future. There has been an enormously generous and active response by the international community to the earthquake in Haiti, and we are committed to continuing our assistance to the Haitian people as long as there are unmet medical needs.