Helping Haitian earthquake survivors becomes a complicated endeavor in the Dominican Republic
From January 29 to February 5, I spent a week in Barahona, Dominican Republic, helping Haitian earthquake victims with Acton resident Sarah Maria and Wayland resident Nancy Todd, both registered nurses, and Nancy’s daughter, Traci, a senior at Wayland High School. We found that, despite the need and despite our medical backgrounds, helping wasn’t as easy as we had expected.
On our Jet Air flight from Logan Airport to Santo Domingo, we carried with us $1,000 in donated medical supplies and suitcases of dresses and face towels that had been on sale at JC Penney. Among us we had about $5,000 in cash, representing donations from family, friends, friends of friends, and colleagues, as well as the coin contributions from the “Haiti donation jar” at the Concord prison, where Sarah, Nancy, and I work.
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| A young Haitian woman awaits medical treatment at a clinic in the Dominican Republic. (Courtesy photo) |
We were met by staff from the Grace and Peace Mission and taken to Barahona, a small city on the southwestern coast of the Dominican Republic about three and a half hours west of Santo Domingo and about two hours southeast of Jimani, a major border town with Haiti. The town of Jimani is about 30 minutes from Port-au-Prince and the earthquake’s epicenter. The Grace and Peace Mission has been based in Barahona for at least 10 years and conducts numerous service projects. Its home base is a large villa still under construction in Barrio Cassandra, a poor area of Barahona. This was our home for the next week.
Prior to our arrival we had heard from mission leadership that the city hospital in Barahona was having difficulty providing care for the Haitian earthquake victims. However, we were emotionally unprepared for what we saw when we first arrived there. After meeting with the hospital administrator and the nursing staff, we identified about 40 Haitian patients in the adult wards. Most of the medical problems we saw were directly attributable to the earthquake. Some patients had had limbs cut off as they were released from under the rubble. These had not yet been surgically repaired with a “flap” necessary for tissue healing, despite the fact that more than three weeks had elapsed since the quake. Many patients had infected open wounds, and there were many broken arms and legs, some having been repaired surgically, but many still awaiting treatment. There were several patients with broken pelvic bones. A majority of patients had not moved since they were first hospitalized right after the earthquake. As a result, decubitus (pressure) ulcers were a problem for several of the patients. The smell of infection, urine, filth, desperation and hopelessness was pervasive.
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| Patricia Ruze (right) poses with a girl with a spinal column injury and her father. (Courtesy photo) |
Most of these patients had arrived in the Dominican Republic immediately following the earthquake. Initially, they received some medical care at one of the hospitals at the Haitian border, but these hospitals were quickly overwhelmed and patients were transferred to other hospitals within the Dominican Republic. At the Barahona hospital Nancy, Sarah, and I were able to provide some care and comfort. We cleaned wounds and changed dressings, assessed medical needs, and addressed some of the needs described by the nurses and medical doctors. We were able to obtain crutches for about eight or nine of the patients. I used some of my donors’ money to pay for a CT scan for a young girl with back pain and leg weakness. We helped the patients’ families change their bloodied sheets and clothing. We brought in mops and pails to clean patients’ rooms and bathrooms. We distributed medication, shoes, and dresses. Several times we brought the most delicious mandarin oranges I have ever tasted to patients and their families.
Yet, more valuable than the care we provided, was patient advocacy. It is often difficult to get good medical care in a public hospital in a developing country. In many hospitals in Africa where I have worked, patients often don’t get even basic care unless they have some family connections and cash. Resources are limited and staffing is often inadequate. Generally, families provide most of the nursing care, including feeding, bathing, simple wound care, laundry, and management of urine and stool needs. Unfortunately, few of the Haitian earthquake victims had the resources to ensure good medical care. To make matters worse, they had difficulty communicating with their health care providers. While the Haitians spoke Creole, the Dominican nurses and doctors spoke Spanish.
Traci, who spoke Spanish pretty well, helped with translations, and was also our general all-around great organizer and logistician, helping to organize the acquisition of supplies, among other things.
After two full days on the hospital wards, we were all feeling heartbroken and hopeless. Already one of the Haitian women on the ward had died from gangrene, a serious, sometimes fatal infection. So on Monday we piled into the mission pickup and headed west to the border and over into Haiti to visit the Love a Child rehabilitation camp. Love a Child is a large refugee center that was established by foreign donors to address the post-operative needs of earthquake victims. Here, patients receive high-quality wound care, oral antibiotics and pain medications, good nutrition, and physical and occupational therapy. The facility was mandated to provide care for up to six months for seriously injured earthquake survivors.
The order within the facility, the abundance of supplies, and the cleanliness took us by surprise. Hundreds of identical, perfectly spaced, new blue-domed tents were lined up within the security walls. Each tent housed a family with at least one injured Haitian. We heard that more than 200 refugees were living in the medical part of the camp. There seemed to be almost as many volunteer staff. Groups of sporty, tanned Americans in clean scrubs were milling around chatting and drinking Gatorade from Nalgene bottles.
Here, the patients’ casts and dressings were slick and immaculate. Several well-equipped operating rooms were set up in Quonset-style tents. In a “M.A.S.H.” moment, a helicopter bringing in injured patients set many of these medical providers running. In another area of the camp, a pretty Caucasian woman was giving a lesson to a Haitian family about the importance of having patients get out of bed and walk. We met an Asian-American woman whose job in the tented camp was to facilitate the use of electronic medical records.
Nancy, Sarah, and I were invited to volunteer at Love a Child. In fact, they were looking for nurses who could help get patients out of bed and teach self care. An internist like me, they said, would be useful for coordinating antibiotic administration in a particular unit of the camp. While each one of us would have loved to be useful as part of an organized and efficient humanitarian effort, our Haitian patients in Barahona were the ones who really needed us. We got back into the truck and headed back over the border.
Our next stop was the U.S.-funded surgical hospital, the Good Samaritan, based in Jimani, on the Dominican side of the border. Again, we were impressed with American-style efficiency, cleanliness, and the abundance of supplies. This is a trauma hospital with X-ray equipment, multiple operating rooms, and several floors of patient wards. It is designed to handle the initial assessment of the injured patient, surgery, and immediate post-op care.
There were American plastic surgeons, orthopedic surgeons, and ob-gyns from Harvard Medical School Hospitals and the Mayo Clinic. There was also a helicopter that provided transport to the USS Comfort for neurosurgery or intensive care, as well as transport to Love a Child for post-op patients needing rehabilitation.
For at least its first two weeks following the earthquake, the Good Samaritan was teeming with patients, and systems evolved for handling patients efficiently. By the time we visited, patient flow seemed well under control; in fact, they seemed to have even more doctors than they could use.
Just prior to our arrival, 22 volunteer doctors had arrived by bus unexpectedly. It wasn’t clear how and whether they could be put to work. Then, as we toured the facility, a luxury tour bus pulled in with 39 medical providers from the Virginia College of Osteopathic Medicine. These included medical students, many of whom were EMTs or paramedics, as well as their professors. They had come all the way from the U.S., driving 13 hours that day from the east coast of the Dominican Republic to volunteer. As they were being turned away by the director at Good Samaritan, we pleaded with them to join us in Barahona for the night. We had been searching for some orthopedic medical expertise to assess and prioritize the Haitian patients in Barahona in order to get them to medical facilities where they could get the care they needed.
The Virginia team spent the next 72 hours wrestling with the regional director of health, the provincial director of health, hospital administrators, the Haitian consulate, and the chief orthopedic surgeon, attempting to facilitate transport of the Haitian trauma patients to the international facilities at the border. It was difficult to understand the reluctance to release these patients. Clearly, the Barahona hospital staff was already very busy with their usual work with Dominican patients. The hospital had limited resources and no expertise in trauma surgery. Further, some of the Haitian patients had already been discharged by their doctors, so it seemed they should at least be free to leave.
Various reasons were offered as to why these patients were being held. One was that the Good Samaritan was overwhelmed with patients and couldn’t take any more. We knew that was untrue because we were in constant communication with the chief surgeon there. We also were told that transfer of the patients would reflect badly on the Dominican Republic. Moving these patients acknowledged suboptimal care and somehow demonstrated a lack of appreciation for the Dominican government, which had generously opened up the border to care for Haitians in crisis. We also were told that it was just “against policy” to transfer patients to a hospital that was outside of the state hospital system.
Other rumors involved the two million pesos that this region had accepted from international relief organizations to care for the Haitians. Perhaps even more important were plans to build a rehabilitation hospital in this region of the Dominican Republic to serve the needs of the Haitian earthquake victims. Apparently $150,000 had been advanced by charitable groups with more to come, but this was dependent on keeping handicapped patients in this area of the Dominican Republic.
Eventually, four patients were given authorization to travel to Santo Domingo with the Virginia medical team. Their tour bus was outfitted for patient transport, with black garbage bags over the seat backs to protect them from wound drainage. One of the patients that we had been taking care of was part of this group. She was about 20 years old, with an upper arm open fracture that had not yet been surgically repaired. The other three patients were in another hospital, but when the bus went to pick them up, all three patients had somehow disappeared. Apparently another bus had already taken them somewhere, but it was unclear where they had gone. The medical team continued on to Santo Domingo with their sole patient.
It was about this time that Daniel came on the scene. A tall, dark, and charming Haitian-American human rights advocate and the international coordinator for Heart to Heart Caribbean Ministry, Daniel joined us at the hospital for the next couple of days. After hearing the patients’ stories, he, too, became determined to get them to a facility where their medical needs could be better met. He spent hours negotiating with the hospital administration, officials from the public health department, and the Haitian consulate. Cash changed hands. Still it seemed that those in power would not permit these patients to leave the hospital.
Daniel then found a brilliant solution. He arranged to meet the Haitian consular officer at the hospital. Daniel got there first, and began asking patients and their families a few questions. “Why are you still here?” “Aren’t you free citizens here legally, free to leave when you want?” “Where would you like to be?”
When the Haitian consular officer arrived, emotions were at the boiling point. The patient families nearly rioted, and the consular officer literally ran in fear from the wards. She solicited help from Daniel, who advised her to assist her countrymen with transport to a place where they could get better care. She promptly obtained the required paperwork and organized several ambulances, including one donated by the military. The majority of the patients were transferred immediately to the Good Samaritan Hospital. Once there, they were immediately surrounded by eager medical professionals who were ready to assess and provide care.
Later, I heard that the Haitian consular officer followed the ambulances to the border that night. After Daniel had left, she entered the facility and told these patients that they were there illegally and that they had to return to Barahona. Fortunately, the American medical professionals refused to release these very ill patients.
There were still about 10 patients remaining in the Barahona hospital when we left. One was a lively woman, Martine, who had become special to me. Her right leg had been cut off, guillotine-style, to release her from the rubble of the earthquake. Sarah, Nancy, and I had dressed and cleaned her stump all week, and the infection there had improved significantly. I admired her incredible strength and sense of humor. I noticed the nail polish on her left foot was precisely painted, so shiny and peachy-pink. I told her that I was impressed with her fine pedicure despite the circumstances. She explained to me that she had painted her nails on Monday for her university classes on Tuesday. On Wednesday the earthquake buried her. Yet, the toenail polish on her left foot was somehow still almost perfect. This symbol of resilience brought tears to my eyes.
While I understand that these 10 remaining patients were finally moved to adequate medical care on the border, I fear for the many forgotten patients in other hospitals nearby in Barahona, and possibly throughout the Dominican Republic. Perhaps they are still there.
I have been inspired by the incredible generosity from individuals and from organizations around the world, especially the U.S. The financial resources donated to Haiti have been immense. However, while relief aid is being delivered to the medically needy in Haiti, the distribution is uneven and the motives that drive the various efforts are complex, and sometimes difficult to understand. There remains a great need for assistance, and it will last for a long time.
I am extremely grateful for the donations I received from my community in Harvard, including the Harvard Lions Club. This trip, more than other humanitarian efforts I have been involved with, brought home the value of direct in-person support to those in need.
Dr. Patricia Ruze lives on Willow Road.