January 02, 2012

Fourteen Months in Carrefour

Mary Jo Frawley, a registered nurse from Vermont, went to Haiti days after the earthquake in January 2010. She thought she’d stay a few weeks, but wound up staying for 14 months.

Haiti 2011 © Francois Servranckx/MSF

MSF's orthopedic center in Carrefour.

USA © Joshua Lutz

MSF nurse Mary Jo Frawley.

Having previously completed MSF assignments in Somalia, Pakistan, Sierre Leone, Zimbabwe, and other nations, Mary Jo Frawley, a registered nurse from Vermont, went to Haiti days after the earthquake in January 2010. She thought she’d stay a few weeks, but wound up staying for 14 months.

On January 12, 2010, I was in Vermont when I heard that an earthquake had hit Haiti. It was ten o’clock at night and 20 below zero. I called my colleague Jane, who I had worked with over the last ten years on MSF missions. We quickly emailed the emergency team coordinator to let him know that we were available if they needed us. I got a call at seven the next morning from MSF in Amsterdam. They wanted me to go as soon as possible. Within an hour, my bag was packed.

The first night was in Miami, where we had a team meeting in the hotel. While communication out of Haiti was limited, we heard that MSF teams on the ground had basically lost everything but the clothes on their backs. The next morning, we went to a department store and collected food, water, underwear, deodorant, cell phones, and anything else we thought they would need.

We landed in the country less than 48 hours after the earthquake, as one of the first emergency response teams on ground. Nothing in my wildest dreams could have prepared me for what we saw. If you can imagine one of the worst snowstorms in New York City’s history, and what the middle of the street looks like after the snow plough passes through, that was what the streets of Haiti looked like, but instead of snow it was parts of people’s homes. The streets were covered with rubble people had carried out by hand or wheelbarrow so they could try to set up shelters where their homes once stood.

I was assigned to a scout team. Our initial assessment showed the greatest needs were in Carrefour, a very poor community of one million people in Port-au-Prince. The neighborhood’s sole hospital had been badly damaged, and patients were on the street, so we spent our first night working there. Though it had been off-limits to aid workers before the earthquake due to security concerns, and I was expecting to stay in Haiti for only four weeks, Carrefour became my home for the next fourteen months.

Assessing the Needs

Initially, I was the front scout of a very experienced Rapid Surveillance and Response team that consisted of an emergency room doctor, an emergency team coordinator, and an MSF driver. After one night in Carrefour, we moved down the coast to Leogane and set up in a nursing school and focused on trauma surgery. Our work was community based and surveillance-based and involved constant reassessments of what the needs were and whether they were being met. We’d treat patients and talk to community members to learn how we could best assist them, then report back to our coordination team about the supplies and specialists needed in a given location. When other MSF groups and NGOs that could take over the activities came to the area, we moved on to places that had not yet received substantial medical support.

Even towns not directly damaged by the earthquake felt the impact. In Le Cayes, for example, hundredsof people who fled Port-au-Prince had ended up at the town’s 300-bed hospital. We assisted by providing pediatric orthopedic support until other organizations began establishing
themselves in the area, allowing us to hand over our work and return to Carrefour. The community had been underserved even before the earthquake—in addition to the insecurity, it was difficult to reach due to its diverse terrain—and had now sustained a lot of damage.

We decided to set up programs that could take care of both the orthopedic emergencies caused by the earthquake and the ongoing needs in the neighborhood. That meant establishing an orthopedic surgical unit, a pediatric hospital, two primary care clinics, and a feeding center. Setting up the clinics was my responsibility. We recruited a team of 20 people from the community to help us let others know who we were and what we were doing and to conduct medical surveillance. With their assistance, our team surveyed the health needs, conducted health education sessions, and, in collaboration with MSF’s epidemiological research arm, Epicentre, developed a surveillance system that would inform us of any sudden demographic changes—deaths, births, movements, and so on.

Each team had 600 families that they would visit once a week. We surveyed 60,000 to 100,000 people on a regular basis. This also helped us establish connections in the community, something we tried to reinforce in Carrefour by walking through the neighborhood and asking people about their lives, families, and health.

One of our community outreach workers, Paula, was especially effective when it came to explaining the services we offered and why we couldn’t provide others. A powerful, dynamic woman who was a social worker before the earthquake, Paula was passionate about helping women and children and assisted with a local NGO for women’s health. When we walked down the street she had a friendly, “Commo yea?”—“how are you?” in Creole—for everyone, and she could both explain to the residents what we were doing as an organization and help us see how we could better serve the community. She was also able to answer people’s questions, letting them know why MSF wasn’t going to put a clinic in every campsite but was going to meet people once a week for consultations. I am confident that our acceptance and safety in this community can largely be attributed to people like Paula who worked so diligently to bring MSF to the people of Carrefour.

Haiti © Kadir van Lohuizen/NOOR

An MSF worker treats an injured patient in the Carrefour orthopedic center, in June 2010.

A New Emergency

As the months wore on and other NGOs began leaving, we made sure gaps were filled. People started making progress, finding better places to live and seeing schools open again. By early October, we were phasing down some of our projects.

Then cholera hit, and in less than four days, we converted the orthopedic hospital in Carrefour into a cholera treatment center. My team started tracking the first cases of cholera using our existing surveillance system and established Oral Rehydration Solution (ORS) points. MSF treats many cholera patients using ORS, a mixture of glucose and electrolytes (such as sodium and potassium). The solution is stirred into a liter of water and provides the correct balance of electrolytes to rehydrate someone who has contracted the disease.

Haiti had not seen cholera for over a century. In order to help educate the public, we distributed information at the ORS points and through community outreach teams. By the following spring, cholera had spread throughout the country, but so too had knowledge of how to prevent and treat it.

We Are Guests

I extended my time in Haiti three times before I finally left in March of this past year. My time in the country was different than any other mission I have gone on with MSF. I think the difference was how close I was able to get to the community, something that made the experience especially rewarding on both professional and personal levels. I really haven’t had that before. Carrefour became my neighborhood. In the time I lived there, I was able to gain an appreciation for what that community had gone through and the struggles they were continuing to have. I used to eat at this food stand on the street, for example, and when cholera hit I continued to eat there because I knew the woman that ran the stand, and I knew that she was trying the best she could when everyone was afraid of water and food contamination. I was willing to continue eating there in order to help support her and the community. I’m not sure I would have done that on a shorter mission.

MSF can’t always provide all the solutions, but in this emergency I think we provided a great deal of medical care, as well a caring presence for the community. One of my patients was a young boy who had heart problems. He was not long for this world, but I spent time dancing with him. I think what we provided this boy was a sense of stability, a sense of support, and some palliative care. What I’ve had to learn with MSF is that sometimes you can dig as deep as you can and find out as much as you can, clinically speaking, only to learn that all you can do is hang out and provide a moment of fun for your patient.

I left knowing that the community outreach and local staff I had trained were well prepared to continue caring for their own community. My goal at each MSF project I am a part of is to work myself out of a job because I know the national staff can take care of it. We are guests in these settings.