Haiti: Looking Back at MSF's Response, Looking Forward to the Work Ahead

July 29, 2010

This article is part of the Spring 2010 issue of the MSF Alert newsletter.

The first reports that trickled out contained only the slightest hint of the destruction that had occurred, or the massive response that would follow. Soon, though, the immediate consequences of the earthquake that struck Haiti on the evening of January 12 were made devastatingly clear, and Doctors Without Borders/Médecins Sans Frontières (MSF) launched what would quickly become one of the largest emergency efforts in the organization’s history.

From those first, vague bits of news that something had happened in Haiti, however, MSF operations and emergency desk personnel knew that the situation needed to be watched closely. MSF already had a long history in Haiti. It was, at that moment, running three programs in the country—a maternity
project, a trauma and rehabilitation center, and an emergency stabilization program—all necessitated by the cumulative impact of decades of violence and instability in a place with limited medical and governmental capacity.

In the best of times, life in Haiti was precarious. Much of the capital, Port-au-Prince, was built haphazardly, structure stacked atop structure or hurriedly erected with little regard for the few building codes that existed. Thousands upon thousands of people lived in shanty-filled slums that were often rendered all but inaccessible by the mud flows that followed heavy rains. Economic opportunities were few, unemployment was widespread, and underemployment evenmore so, but residents were well accustomed to spasms of organized violence and political upheaval. Outside Port-au-Prince, seasonal storms, hurricanes, and cyclones regularly disrupted everyday routines and, in some instances, cost people their homes and their lives. The earthquake, therefore, hit in just the right place, and with more than enough power, to throw Haiti into a period of turmoil that went beyond anythingeven its most beleaguered residents had known.

The toll was staggering. Hundreds of thousands lay dead and injured. Millions were suddenly homeless. The headquartersof Haiti’s few functioning institutions were strewn with debris and rendered nearly inoperable. The organizations that would ostensibly coordinate a disaster response—the Haitian government, the United Nations—were themselves badly hit as well. The resulting authority vacuum severely hampered the ability of outside actors to get people and equipment into the country. There was no staging ground for the response and no one on the ground who could manage it.

A Flood Of Casualties

There were, however, great swathes of the population in desperate need of help, and MSF, because it already had teams on the ground, began providing lifesaving emergency medical care immediately. Dr. Jeanne Cabeza, the medical coordinator for MSF’s operations in Haiti, wrote in The Wall Street Journal that even though she thought she was going to die when the earth started to shake, “five minutes after the quake, people were banging on our door in need of help.” She was at MSF’s rehabilitation center in the Pacot neighborhood and had, like some of her colleagues, sustained minor injuries. Nonetheless, they got started right away and worked through the night, attending to the crush wounds, fractures, concussions, and other injuries that had been visited upon men, women, and children in the surrounding area. What began as a trickle of patients quickly became a limping, bloodied deluge. “Within a few hours, there were hundreds of people in need of surgery,” Cabeza recounted.

Similar situations were unfolding at other MSF facilities in Port-au-Prince. Since the buildings had been damaged, much of the work took place outdoors, in courtyards or in the streets in front of MSF structures. Car headlights were used to illuminate procedures. A janitor helped Cabeza apply bandages. Medicines and supplies were collected from MSF medical and storage facilities, sheeting was hung from trees to create ad hoc operating theaters, and mattresses were spread out to fashion areas where patients could wait for treatment or recover from care they had received. Before long, an operating theater had been set up in a shipping container that had previously served as the hospital’s pharmacy. “In the first 24 hours, you need everything at once,” said Jordan Wiley, an MSF logistician who’d been in the country for five months before the earthquake hit. Given the conditions—several veteran MSF staffers likened it to doing surgery in a war zone in which everyone is injured at the same time—it was impossible to meet all those needs. “The patients kept demanding your attention,” said Dr. Philippe Brouard, a Haitian surgeon who has worked with MSF since 2006. “You do all you can, but there are always so many people calling you.”

MSF offices around the world were mobilizing their resources, assembling new teams to buttress those on the ground and loading cargo planes with desperately needed supplies—including a 200-bed inflatable hospital that had been deployed to Pakistan following the earthquake there in 2005. Dr. Greg Elder, MSF’s Deputy Operations Manager, later said that in those early hours, “we knew the team on the ground, if anything was still standing, would be able to do a couple of days work.” But with the perspective afforded by distance and past experience, he also knew that they would soon need reinforcement and, after that, relief.

It was, Elder said, “the single most concentrated response I can remember,” an effort fueled by the energy and commitment of MSF field personnel and staffers in numerous country offices. When the delivery of shipments was stalled by congestion at the Port-au-Prince airport, and MSF planes were not allowed to land, the organization not only re-routed cargo through the Dominican Republic but also spoke out to demand that aircraft carrying lifesaving emergency medical equipment be given priority by the Haitian and American authorities coordinating incoming air traffic. “We cannot accept that planes carrying lifesaving medical supplies and equipment continue to be turned away while our patients die,” said Rosa Crostini, one of MSF’s medical coordinators in Haiti, at the time. Thanks to MSF’s reputation, we insured that this message was widely broadcast both by the mainstream media and also on newer channels of communication, such as Twitter and Facebook.

Reinforcements Begin To Arrive

Despite the coordination issues at the airport, MSF nonetheless sent more than 250 metric tons of medical and material equipment to Haiti in the week after the earthquake. The next week, the tally was 260 metric tons. All told, over the first seven weeks, nearly 1,200 metric tons of supplies were flown, driven, and carried by boat into Haiti. Among other things, the shipments contained medications, bandages, dialysis machines, tents, blankets, tarps, plastic sheeting, nutritional supplements, non-food items for distribution to displaced families, water and sanitation equipment, and vehicles.

Accompanying them, and finding their own way into the country—and then working day and night in extremely challenging conditions—were hundreds of international staff members who rotated in at intervals designed to keep the teams sharp and to spare them the assumed trauma that can affect people working in disaster areas. And serving as both the foundation and the inspiration for the entire effort was the national staff, all of whom had been directly impacted by the catastrophe but who continued providing emergency care for other Haitians, even when they themselves had no home to return to at night. “I have to come to work because this is a disaster and it is my business,” said social worker Charles Joseph, who lost his home in the earthquake. “If people from other countries can risk their lives and come here to cure people, me, as a Haitian, I must do the same.” Before the earthquake, there were some 800 people working in MSF’s projects in Haiti, the vast majority of them Haitian. By the end of the February, that number had climbed above 3,300

The Work Ahead

Other organizations chipped in as well, recalls Jane Boggini, a nurse who has been on 17 MSF missions and who arrived in Haiti days after the earthquake hit. Whether it was the missionaries who donated supplies, the Haitian nuns who brought water for the patients, or the individuals who had collected items in their home communities and brought them into the country themselves, the unexpected contributions were greatly appreciated. Likewise, MSF teams were aided by Haitian volunteers who offered their skills and expertise in a host of different ways.

Collectively, by March 25, MSF staff had established 26 medical care facilities, with a total of more than 1,300 beds. They were able to create several mobile clinics. They were running 14 operating theaters and were planning to open more. They had tended to some 53,000 patients and performed
more than 4,000 surgeries. Additionally, they had distributed roughly 14,000 tents and more than 20,000 hygiene and kitchen kits. They carried out more than 10,000 mental health consultations. They set up water and sanitation facilities for displaced peoples living in ad hoc camps in and around the capital, and in outlying villages such as Jacmel and Léogâne. And, crucially, as other medical organizations began packing up to leave the country, they set up several sites specifically dedicated to post-operative care, rehabilitation, physiotherapy, and ongoing mental health services, while also resuming maternity programs and care for patients with chronic conditions—such as tuberculosis, hypertension, HIV-AIDS, and diabetes—whose treatment regimens were interrupted by the earthquake.

There are still patients who need surgery, either as a follow-up to a procedure first performed in the immediate aftermath of the earthquake or for wounds that went untreated and subsequently got infected. But the emphasis has shifted from emergency intervention to post-operative care. Additionally, MSF expanded its efforts to provide relief for displaced individuals
and families, recognizing that the crowded, unsanitary living conditions, the rainy season that will arrive early this summer, and rising tensions within the population could all have dramatic public health ramifications.

Estimates put the number of wounded between 200,000 and 300,000. A quarter of those suffered fractures. Several thousand needed to have limbs amputated. “Our response to this point has been driven by an emergency logic, by emergency needs,” said Greg Elder one month after the earthquake. “But looking forward at those reconstruction needs, they go back, in fact, to the root a little bit of why we were in Haiti before the quake.”

The healthcare system was a shambles, and now it’s worse off. The economic picture was dire, and now it’s shattered. The nation’s psyche had endured numerous struggles. Now it must reconcile this cataclysm. For its part, after losing the three facilities it had been operating, MSF is now situated in a number of fixed structures and is looking for ways to make some of the temporary structures permanent, or semi-permanent. In early March, the organization announced that it would keep several of the new sites open for at least a year.

The recovery period, as is often the case, could be as grueling as the disaster itself, as the adrenaline fades and the world’s attention wanes. In many ways, the work is just beginning.

MSF had already been present and active in the country for the past 19 years. It was therefore ready to respond when the disaster struck. And it is now prepared to do the work that will remain as necessary as ever in the days, months, and years to come.

 

Tags: Haiti, Natural Disaster, Haiti Earthquake 2010, Physician, Field Coordinator, Surgery, Surgeon