04-JUL-B-3
OUR OPENING DAY IN JIMANI NEAR THE
HAITIAN BORDER
IN THE MONTAINS OF THE
OUR TOUR OF THE
OF THE MAY 5 FLOOD VICTIMS AT
JIMANI
We are in
the hospital at Jimani, a town that is on a steep hillside within sight of the
border with
In the middle of the night, most people were still asleep when the wall of water and rock hit them. They often did not wake up, if at all, until they were far away from where they had gone to bed. Boulders larger than trucks and full trees came sweeping down the course of the old dried stream bed, and the force of the blows wiped out all before it like a scythe mowing down everything, The road on the bridge pilings disappeared, and the houses along the way were pushed through a cemetery, and it was resurrection day for those who had been buried in vaults in well plotted out lines of tombs. The long dead bodies and the parts of them that had been recovered later were not a high priority compared with the new ones, but eventually all such parts were put into a common mass grave at the edge of the old washed out cemetery.
The living
were not as lucky. Almost everyone has a
story of what happened “when the waters hit them.” It was not so much drowning as trauma, as the
force of the blow perforated eardrums.
We discovered young men who had foreign bodies like nails or twigs driven
into there hands or skin and subcutaneous tissue. We had at least two children who had lost
both parents. The cook here at the
hospital was hired and began work on May 4, the day before the disaster. He was
Haitian and brought here by his
The wall of water and debris slid down the side of the hill where we are staying in a large house with a few guest rooms into which we have been packed by none too hospitable caretakers who view our appearance here as an intrusion that is nettlesome. The hospital is downhill to our right, but still on terrain that I would have called level rather then valley or lowland. That did not save it. The front of water mud and car-sized rocks came through the locked double doors of the hospital and wiped it out, with a slurry of mud and debris that was up to the ceilings in the hospital on water lines seen after it subsided to just a meter or more of gook in the rooms. All the patients’ archives were lost, and the business administration of this hospital had 24 computers—no more The OR’s and all the special areas were destroyed, including the laboratory. They have been diligently cleaning and repainting the rooms and trying to rehabilitate the empty shell of the hospital that is left with a World Bank emergency loan of two million dollars. The majority of this seems to have gone for an earthen levy along the course of the scoured stream bed to prevent this from happening again, but the pitiful barrier that remains is studded with items of colorful cloth that was clothing at some time recently with body parts inside.
The Director of the hospital took me around and showed me several areas, but then took me outside in a small area of a parking lot alongside the malaria standards laboratory. There is a space for maybe a dozen cars. He said that all this area was stacked in cadavers that had been recovered from the immediate are, stacked up to a level he marked on the building walls, a total of more than 450 cadavers from those killed in the disaster—a large percentage of the immediate regions population. But, he added, that this would not include any of those bodies recovered from the higher mountain areas or along the washout of the stream bed, and that certainly the majority that were never recovered, since they would have been buried under unmovable rocks the size of a couple he pointed to in a now vacant lot, with trees wrapped around them.
After our hospital
tour and the idea that we would be setting up shortly in a set of rooms that
had been cleaned up for us, with one of them still being covered in mud and
debris, which was later all cleaned when we came by for stacking our medicines
in it. We have been very inefficiently
received, with our long periods of standing around while nothing happened, and
then a series of conflicting orders (”empty the bus of all medicines, then
re-pack the bus and carry it all over to the hospital where it is unpacked
again so the bus can leave,") but this would mean that the medicines are
assumed to all remain here, and none would be available to go on with us to
Haiti. We also were deployed in the
hospital then told we would go out to the refugee camps, then reversed again,
and finally when all set up with our med stock in the hospital and the teams
assigned, we were scooped up in an old bus and with two incomplete boxes of MAP
medicines hurriedly put aboard the bus, we went to Refugee Camp Number Two—a
tented enclave surrounded by barbed wire fence and containing about thirty
white tents and another dozen olive drab tents on a gravel base baking in the
hot sun. There was a
We will repeat this operation tomorrow, getting up earlier, allegedly, and starting with a breakfast at seven, begin at the hospital for our first clinic and the Refugee Camp Number One for the afternoon. A lot of improvement will have to happen in our operations before then, but the supporting infrastructure is absent in several areas. For example, the support facilities where we are staying are not very helpful. Somehow, these arrangements were a last minute change from a Jimani Hotel reservation which was closer, cleaner, had running water, was more capacious and had longer periods of electricity than this "Guest House," but for reasons unknown, this very much more expensive non-facility was the one switched to for all but Serge Geffraud who arrived later and had found out how much better the facilities were in the Jimani Hotel, particularly when he recognized the unsavory past history of the proprietress who runs the one we were staying in. We were each assigned a roommate and a bed I a room, and then we find that the same room would have been assigned three or more times. There is a shower in the room, as well as a commode, between tow rooms, one of which houses four women, and my room in which Mike Williams and I are roommates, but at least one other ‘drop-in” from other rooms is usually falling in as well. The door to the single bathroom does not even close, let alone lock, so there is no way to protect between the two rooms using the same bathroom. And, then, there is no water. There is a pump run by a generator which needs to be turned on to function and the secret of how this works was well guarded. We tried to get a bucket of water to be used as a bucket bath, but even that was a struggle. And our “breakfast at seven” is not very likely, since the caretaker and her two workers do not even get up until an hour or more later, regardless of our schedule. It seems that the BRA had had four relief groups here and has an ophthalmology group coming in September, so they are all eager that this goes well. But the CEO named Ulrick is out fund-raising for which reason he would be eager to have good digital pictures of our operation, and Maria is his liaison with me. It at least exercises my latent Spanish, learned here forty years ago in the same DR, as I act as translator from her to the group, but the others seem to be only half heartedly involved, and would get paid whether or not any services from us were forthcoming. So, our accommodation and facilities are much less than they can or should be, given the resources available, and the passive noncompliance of the third order staff. WE are getting to the point that the team may be working as well as it might be able to given the good will and motivation of the group, but we have a mixed group that is not medically sophisticated, and that means we have a lot of explaining to do at each turn.
That, it turns out, is the most successful part so far: we had two briefings so far and the medical education component has been the most valuable. The case presentations last night had occurred with two patients each presented from the four teams worked fairly well in exploring the pathophysiology of the conditions seen and also the little notes about the sociocultural phenomena of a captive group of refugees in a tent camp. So, we are underway, with the first day’s mixed results already discussed with a session involved in how we can make this better, and each of these successive days should be better run than the last one.
JIMANI = 18* 29.26 N, 71* 51.04
W
WHAT IS THE DIFFERENCE BETWEEN A “BATEY” AND A “BARRIO”
A Batey is
a plantation unit of indentured servants grouped to cut and process cane. They are not much removed from slaves, with
most of their pay coming from the plantation store in credits that make them
indebted for virtually ever. There are
Bateys in the DR, in
THE NIGHTLY DIDACTIC INTENSIVE MEDICAL
COURSE
IS A DEBRIEFING WITH PATIENT PRESENTATIONS:
I WILL SUMMARIZE THOSE OF EACH SESSION—
THIS ONE MAKNG TWO ROUDNS OF OUR FOUR
TEAMS
A: Lindsay: presented a woman with a tympanic membrane perforation, a result of the explosive underwater sounds during the flood in which she was submerged. We talked of the open middle ear and the possibility of otitis and suppurative osteomyelitis of the ears conduction bones and the eventual outcome of a “cholesteatoma” or mastoiditis.
B. Sombol: presented a woman with reflux esophagitis (common) but this one also had weight loss and a problem passing urine; we discussed gastric carcinoma and the Krukenberg tumor, or rectal shelf, that might link the two symptoms together.
C Duc: a man with abdominal pain, which on an exaggerated sit-up showed the diastasis rectus, and epigastric ventral hernia.
D Adam: presented a
11/2 year old girl who looks to have
A Zeb: a man with a hand laceration during the turmoil of events when he as caught up in the flood: I had shown a serous packet with an extruding foreign body being expelled along with drainage; encouraged to soak until the process had completely expelled the FB
B
C Anisha a two-year-old with emesis and distension—the first of multiple later discussions of parasitic versus nutritional abdominal distension from hypoproteinemia; this one was wormed
D Siayvash: a small boy with swollen scrotum: the
differential between hernia and communicating hydrocele—this was a hydrocele
that did not communicate nor reduce.