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The WHO's International Ear Care Day was set on 3 march as the date 3.3 looks like the shape of two ears

2010 Haiti earthquake

Haiti Earthquake - CBM in Port-au-Prince

Occupational and physiotherapy work with patients in Port-au-Prince, CBM Emergency team.

CBM together with international partners supports activities to assist persons with disabilities affected by the earthquake in Haiti and its aftermath.

The following report was produced by Michiel Steenbeek and Marieke Dreise, co-workers active in emergency response for CBM in Haiti. In it, they talk about the situation of persons with disabilities affected by the earthquake and its aftermath.

The situation

On January 28, we arrived safely in Port au Prince, the capital of Haiti. It was a long journey with little sleep, but it actually went fairly smoothly. We had a stopover in Santo Domingo and spent a night at the guesthouse of the CBM-supported Eye Hospital. Here in Port-Au-Prince we are staying with a very nice Haitian family who have offered the top floor of their house to us and other co-workers.
CBM’s emergency coordinator has been here in Haiti since 4 days after the earthquake. She has done an incredible amount of work, visiting some of the CBM partner organisations and coordinating the emergency response with different NGOs.
The city of Port-au-Prince is in a mess. About 50 per cent of the buildings have collapsed or are severely damaged and beyond repair. Some parts of the capital look like Berlin at the end of World War II. In nearby Leogane, about 90 per cent of the buildings collapsed. In most cases, the ground floor of multi-storey buildings has completely disappeared while the concrete slabs of the higher levels are sandwiched on top of each other. Indeed, you had a higher chance of survival if you were on the top floor. Some streets smell like an abattoir. Walking or driving in some areas and seeing all the damage clearly affects us, too.
The acute phase is now all but over: the people who are still under the rubble are dead, the injured have had their emergency treatment and most surgical teams are pulling out. Now the phase of recovery and rehabilitation starts. An incredible amount of work lies ahead.

The International Community’s response

“Emergency” is not something that we have experienced before to this extent. But we are starting to understand the enormous effort by the international community to impose order on the chaos.

At the UN Logistical compound, an operations centre has been created. I don’t know where to start to describe this.

Just a few key words: big white tents, clusters of health, logistics, communication, water, shelter, protection, nutrition, food distribution, ‘blitz’ meetings of 45 minutes, action points and implementation, about 300 hundred organisations represented, aeroplanes landing, helicopters, noise, wind and steaming hot, wireless internet, canteen, coffee and meals, boxes-pallets and crates, tankers with water, trucks with food, blue helmets and camouflage uniforms, sweat and plastic water bottles.

CBM is in the Health cluster and also participates in the Protection Cluster (child protection).

The WHO and the Ministry of Health have asked Handicap International and CBM, together with the 'Secretariat d’état de integration de personnes handicapees', to lead a special working group on injury, rehabilitation and disability, which is now operational. Within this group another working group for prostheses and orthoses has been organised, bringing together organisations making orthotic aids and prostheses and organisations needing those for their patients.

CBM has regular coordination meetings with the clusters and the working groups. These meetings are very short, to the point and aim at quick and effective solutions and implementation. Next week we will open the CBM country office and the first short-time expatriate physiotherapists will arrive.

Hospital snapshot

Many patients have lost limbs; we have an estimation of around 2000 – 4000. Many more patients have fractures. As there were not enough plates and screws for internal fixation, many patients have external fixators. Several times, CBM went to the Hopital de la Communaute Haitienne for a few hours to mobilise patients there. In two weeks time more than 250 doctors and surgeons rotated through this hospital. Post-operation rooms and stores were changed into operating rooms and the conditions under which the surgeons had to do their work were very poor. More than 100 surgeries per day were done and they worked around the clock.

The hospital is full of patients who need postoperative treatment. The hospital needed to create space inside and many patients are now in tents outside on the parking and driveway waiting to be discharged. But where can they go? Many have lost their house and they can only go back to a heap of rubble. Before discharge they need wheelchairs, crutches and other walking aids, of which we do not have enough. There are hardly physiotherapists in the country, so they need to be recruited from outside. Handicap International and CBM are doing that. The first physiotherapist for CBM will arrive on Sunday and soon more will follow.
We have seen situations where patients have been discharged without proper walking appliances and instructions for weight bearing, essential for good bone healing. We also see infected stumps, and stumps that need to undergo surgery again at a higher level. We can only do so much. It is a desperate situation for many of these patients. But the few that did get some attention appreciate it if you spend some time with them, exercise with them, and make them actually stand up and walk with crutches or a walking frame. A glimmer of hope and a smile to say “see you tomorrow”.

I think that is what we have to focus on and get our satisfaction from, not look too much at the overwhelming numbers of injured people, which is too depressing. We need to look at the ones that we can help, that one individual. That person who we can make smile, because suddenly, after days laying on a mat on the floor in a boiling hot tent, realizes that he can walk with crutches and sit outside on a chair in the shade of a tree.

Community snapshot

CBM went out with a group of community workers to assess the situation of patients who were discharged. We went to Bourdon, a slum area where many houses were destroyed. The people who lived in the destroyed houses were either still in hospital or had moved to tent camps or to the rural areas to join their families there. So we found very few injured people there. In the tent camps, we found more patients, who were often discharged too early, still having wounds and plaster casts.

There are around 590 camps now in town. CBM has been to several of them. Some camps are quite organised, for example in a mission compound, while other camps have sprung up completely spontaneously, with people making tents out of any material they could find. The smell around one of the biggest camps near the collapsed presidential palace is almost unbearable, with refuse hardly collected and very few portable latrines.

It is unimaginable what a task it is to clear all the rubble. More and more you see groups of youngsters trying to move rubble, in a food or cash-for-work program of USAID and other organizations, but they hardly have tools. Everyday again we look in amazement at the destruction; big concrete buildings collapsed as if they were made of cardboard.

CBM Partners

CBM went to assess some of the existing Partner organisations. One of them is the Eye Clinic in the University Hospital. The head of department, Dr. Cadet, showed them around the building. A big part needs to be destroyed, as it has structural cracks in the walls and it is not safe anymore. The doctor described how, during the earthquake, a patient who was in surgery rolled off the table. The nursing school collapsed completely. He and a colleague managed to pull two students out of the rubble, but 200 of them died.

Another CBM partner, the School for Special Education, also had their buildings damaged and declared unsafe and equipment was looted. Fortunately the children were not in the buildings at the time of the earthquake, but one staff member lost both her legs while she was at home. The other staff members want to get back to work, but cannot as there is no building anymore. They almost begged whether they could be involved in some projects that CBM is now setting up. They will be involved in working in the Day Care Centres and the Antennes. It will help them to get over their trauma. Also, for the lady with the amputated legs, there will be a job somewhere in the program.

The way forward

To respond to the enormous need for follow up in the community, CBM and Handicap International, together with the 'Secretariat d’état pour l’integration des personnes handicapees', are setting up nine focal points for patients, providing information about services, simple wound treatment, mobilisation advice/physiotherapy and mobility devices (crutches, wheelchairs, prostheses etc). These centres are called ‘Antenne Handicap’. Tents will be placed in the compounds of hospitals that have treated many injured patients in the emergency period after the earthquake. At a later stage they will be moved to the communities. Expatriate physiotherapists will move from centre to centre.

These will also work in about 20 different hospitals in the city to meet the needs for post-operative treatment and follow-up. Local staff will be employed; some 42 community workers have already been recruited by Handicap International and CBM will interview groups of nurses for the Antennes.

CBM has been going to some hospitals to discuss whether they agree to have our big tents in their compound for the Antenne. Some hospitals however still have their compounds full with tents with patients, so there we will have to wait. Two Antennes have been opened and next week more will follow. Besides that we are starting with Child Day Care centres for children with disabilities, who are especially vulnerable in emergency situations. Their parents do not have time to look after them because they are looking for food, water, shelter and work, so the children are in danger of being neglected. If the parents can bring them to the Day Care Centre they will have their hands free during the day to try and care for the family.

Your support

Your support will help reach more persons with disabilities in the poorest parts of the world. To make a general donation to CBM's work, please go to our 'donate' page.


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