Rehabilitation in Rural Haiti: Dreading Discharge

Sunday, March 21, 2010 - 10:55 AM

The street in front of the hospital on Sunday morning The street in front of the hospital on Sunday morning (Anna Sale/The Takeaway)

We arrived Saturday afternoon on a charter flight to the north Haitian town of Cap-Haitien – after a stopover on a Bahamian island, because it's difficult to get gas in Haiti. The airport was bustling, filled with aid workers coming and going on top of the already steady flow of local traffic. A guard stood in the lobby to manage the crowds, it took a minute before I realized the flag on his shoulder wasn't the Haitian flag. It was from Jordan. He's here on a UN Security mission to maintain airport security – just the first of many signs of the continuing international presence here.

We stuffed our luggage, boxes of supplies and ourselves into a few SUVs and made the 45-minute drive here. These imported volunteers bring their own stories with them: One of the nurses was laid off from her job last month, after she'd signed up to make this trip. She asked her church to help cover her costs, and they donated twice what she asked. There's an orthopedic resident, who's using one of his rare vacations from his 80-hour work week to work down here. He arrived with thousands of dollars of supplies from his hospital at the University of Iowa, including a box full of prostheses. Heather, the charge nurse at the earthquake tent has been here for seven weeks. She came here from Liverpool, England, after her job at home lost grant funding in January. Her husband's paying the bills back home while she's here.

The immediate challenge for the new volunteer medical staff was to get oriented. The initial tour included the locations of the bathrooms and beds, but also how instruments get sterilized and where the last round of doctors left off with patient treatment. The main hospital building houses the intensive care unit and the operating rooms, as well as the maternity ward, which continues to serve the local Haitian community.

The patients with earthquake-related injuries are all in one place across the street. The adults stay in tents separated by gender. The children are all together in a building that used to be the hospital's nutrition education center. All of them have been here a long time, because unlike other hospitals, all of their injuries date back to a single day. Some of them were transferred from the USS Comfort and a hospital at the Port-au-Prince airport.

Their numbers are slowly decreasing. Some have moved to other speciality units, like a spinal cord clinic in a nearby town. Other patients have healed and recovered to the point where they're ready for discharge. That presents another set of challenges. Some of these patients and their families have nowhere to go. So, Crudem, the nonprofit that runs this hospital in Milot, has just added another service to its list of local programs: moving assistance. So far, about 100 discharged patients have made the trip back to Port-au-Prince, where they will live in tents that Crudem located for them.

But there's a lingering question about whether that's the best option for all the former Port-au-Prince residents, like 17 year-old Joseph. His house in Port-au-Prince collapsed in the earthquake, and his whole family was killed – both parents and his sister. Rescue crews pulled him out of the rubble, though he doesn't remember that. When he woke up, he was here at the hospital in Milot. Since mid-January, he's had surgery to fix a broken leg and broken arm, and he's now walking short distances without crutches. He's getting better – but he doesn't know what's next. When I asked him what he thinks will happen when he leaves, he says he has no clue. He may search out his mother's relatives in the rural town where she grew up. The New York Times reported last week that the earthquake has reversed decades of migration from the Haitian countryside to Port-au-Prince, and Joseph could become part of that phenomenon. But he's never met those relatives or been there before. Another option is to return to Port-au-Prince alone.

It's stories like his that get to Heather, the charge nurse. She calls this the worst job here, because it's her responsibility to draw up the list of patients who are medically discharged and ready to leave. That brings with it a quiet dread of wondering what will happen once they leave the hospital's three daily meals and constant care. That's another way this hospital is totally different than any other. “The better they get, the worse you feel,” she says.

17 year-old Joseph (left), whose  whole family in Port-au-Prince was killed in the earthquake.
Anna Sale/The Takeaway
17 year-old Joseph, left, whose whole family in Port-au-Prince was killed in the earthquake. At right, his translator Patrick, a local Haitian.
Joseph on the left, with his translator Patrick, a local Haitian
Anna Sale/The Takeaway
Physical therapy dance party, in the courtyard in front of the earthquake tents.
Orthopedic resident Bob Volz, with some of the prosthetics he brought from Iowa.
Anna Sale/The Takeaway
Orthopedic resident Bob Volz, with some of the prosthetics he brought from Iowa.
Doctors and medical staff planning their day.
Anna Sale/The Takeaway
Doctors and medical staff planning their day.
Tent covering boxes of donated supplies on the hospital grounds.
Anna Sale/The Takeaway
Tent covering boxes of donated supplies on the hospital grounds.
The street in front of the hospital on Sunday morning
Anna Sale/The Takeaway
The street in front of the hospital on Sunday morning

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