Friday, March 16, 2007
Haiti on the Brink
Haiti on the Brink
By Dr. John A. Carroll
January 25th, 2007
Each Wednesday our mobile medical team piles into a nice new truck that has URGENCE brightly painted on the front. We work in two slums in Port-au-Prince. The first slum is called La Saline and the second is Cite Soleil. Both slums are on the water front. Cite Soleil is known for its gang warfare with the UN troops and miserable poverty. La Saline is known for its miserable poverty.
The population of these slums is guessed at around 300,000. Port-au-Prince has a population of approximately 2,000,000.
There were five of us in the truck today as we coursed through a slum called Pele. We stopped at a house in Pele and filled the back of the truck with medication in large picnic coolers that we hand carry into the slum when the streets become too narrow to continue in the truck. As usual, Pele’s streets were full of pedestrians this morning. However, as we approached Route 1, which runs by Cite Soleil, five United Nations tanks were positioned up and down this street and an a UN soldier stood in front of our vehicle, put his hand up, and motioned for us to stop.
There are almost 9,000 UN troops in Haiti now. The UN has been here since July, 2004. The UN commander in Haiti is Brazilian as are the majority of the troops.The UN had been shooting inside Cite Soleil early this morning and now had the entire slum entrance and exit blocked off with their white tanks that menacingly sat on Route 1.
UN troops had traded gunfire with armed gangs while the UN was taking control of an abandoned school that the gangs had used to fire upon UN troops. The UN is doing all they can to kill gang members and take over their bases, so that Soleil can be turned over to the Haitian National Police.
Route National 1, which is usually fairly busy, was empty of traffic. Pedestrians and their bags and wheelbarrows, were searched before they could continue walking past the slum. The white UN tanks and their machine guns were aimed directly into the slum.
We have a clinic about one mile inside Cite Soleil. We work here in the afternoons after finishing clinic in La Saline. It didn’t appear we were going to be able to enter Soleil in the afternoon or even head down Route 1 towards La Saline.
The UN soldiers had patches on their soldiers from Bolivia and from Peru. I got out of our vehicle and told them we were a medical team headed for La Saline and we needed to be allowed to pass.
In Haiti, I have found out that everything is possible.
The UN soldier in charge was very polite and had another soldier search the back of our vehicle to see what we had in the containers. The commander called a mile down the road to let the other soldiers know that we were going to be allowed to use the road. He told us we could proceed down Route 1.
A large crowd of people stood on the corner and watched our interaction. I felt bad for them because I am sure some of them live inside the fetid slum of Soleil which is currently full of tragedy and most likely many had family members trapped inside.
A UN soldier took a picture of us as I took a picture of him.
We headed down Route 1 and our driver, who is very well versed in local slum politics, told me that the gangs from Soleil probably had escaped and would be in La Saline where we were headed. There are no UN soldiers in La Saline and the Haitian police will not go into either slum because the gangs have bigger guns than they do. Our goal was to triage the sickest patients from the clinic in La Saline to different hospitals and hand out bags of rice to mothers with children.
La Saline looked as fine as La Saline can look when we arrived. We heard no gunshots and everything looked normal.
The clinic was full, so we ran a full clinic. We sent two very ill pediatric patients to the hospital that supports us. The big problem was an 18 year old girl lying on an army cot on the dirt floor in the middle of the clinic. The other patients stared at her from their wooden benches.
She was very weak and said that she had vaginal bleeding for nine days and couldn’t stand due to weakness since she had lost so much blood.
Her exam showed that her sclera were very pale, she had a fast heart rate, and a bounding, dynamic pulse consistent with blood loss.
So when clinic was over, she was drug to our truck and loaded in back. We headed out of La Saline. I had a plan for her and hoped it would work.
Last weekend my wife and I visited a three story building that was turned into a high risk maternity hospital in PAP. It is staffed by Medecins Sans Frontiers with a skeleton crew of physicians and nurses. Last month 1,200 deliveries were done at this hospital including 200 C-sections. There is an incredibly high number of women with toxemia of pregnancy admitted. The maternal mortality rate in Haiti is one of the very highest in the world.
So I asked our driver to go this maternity hospital with our young anemic lady hoping they would accept her. Women in all sorts of obstetric conditions were literally everywhere— filling every hallway, bed, and stretcher. Many were in labor about to deliver and crying out with their contractions. No epidurals are done here. Some women deliver on the street in front of the hospital. And these are the fortunate Haitian women who do not deliver at home alone or with a midwife from the village.
We drug and carried our girl in and a quick sonogram revealed that she did not appear pregnant or appear like she had an ectopic pregnancy. However, her hemoglobin returned at 4.6 which is about one-third of what it should be. Her sister, who accompanied us, went to the lab to donate her blood.
An excellent German MSF doctor asked me if I would accept a 7 lb. baby boy who was born an hour ago. His 20 year old mother went into labor last night but arrived only an hour before she delivered. Her water had broken hours before. And the little guy was in respiratory distress and had to have some temporary CPR after he was delivered.
We climbed the narrow steps to the second floor to check him out. This newborn was definitely in respiratory distress and his lungs sounded terrible. He was on oxygen by prongs leading into the nose. He still hadn’t cried and wasn’t moving. However, his vitals were reasonable aside from his rapid respirations.
I accepted the baby because if I didn’t they were going to send the baby to the public hospital in Port-au-Prince which really doesn’t function well, and the staff is frequently on strike. Port-au-Prince offers no great alternatives for babies like this and accepting him was the only thing we could do.
The hospital had no portable oxygen to send with us. So we gave him two injections of antibiotics to cover him for infection that he may have acquired perinatally, wrapped him in a towel, and took off his oxygen.
We went down the steps quickly and I hoped he would keep breathing. We pushed through the crowd on the sidewalk, climbed up into the vehicle and went tearing across this nutty city with no traffic lights or stop signs that anyone respects. The trip took one half hour and the baby actually started moving his legs as we neared the pediatric hospital. In the ED, he pinked up with oxygen, opened his eyes, and looked around.
When civil disorder is great in a country, and there is no meaningful infrastructure, and Spanish and Portuguese speaking soldiers are trying to kill Creole speaking Haitian gangs in the kidnapping industry, innocent people are injured in everyway. They are locked in their slums and their mothers are lucky to get to any hospital to deliver their babies. Everybody suffers and everyone is pushed to the brink including one hour old baby boys.
John A. Carroll, M.D.