HAITI

treat the injured and to look for somewhere to set up an obstetric unit. Nothing we had seen on TV prepared us for what we found, the heat, the noise of aircraft and helicopters; the gridlock of traffic in the streets partially blocked by massive piles of concrete, the overpowering smell of death, the screams of the children and adults as lacerations were stitched, massive, infected soft tissue injuries cleaned and debrided, and fractured limbs stabilised; the shooting at night.

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The sisters have a large feeding programme, based in their compound at Delmas 31, and at a number of out stations, as well as a nursery with around 50 orphans. Two of the buildings in the compound have been badly damaged, the three story children's house and nursery and the volunteers house. They established a make shift first aid station in the open soon after the earthquake which quickly became a mini hospital where some of the severely injured, who had lost their homes, were being cared for. We joined two American doctors, one an internist and the other an emergency room physician, a physician's assistant and a social worker also from the USA and later by a Haitian medical student and treated severe head injuries, compound limb fractures of all types and lacerations. The Sisters normally have a large feeding programme, for 400 families each day, in their compound and this has been expanded to outstations.

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We were housed in a small bungalow, three to a room, sleeping on mattresses. The lady volunteers preferred to sleep outside because of the frequent after shocks which could occur at any moment, some at embarrassing times and one then had to collect ones dignity fast and head for the door. Food was in short supply for everyone but the sisters managed to feed us volunteers and also the many sisters drafted from their other houses untouched by the earthquake, to help with the emergency.

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Downtown Port au Prince has been so destroyed that for the locals, assigned to guide us around the city, it was difficult to get their bearings as the streets are unrecognisable. We spent some time exploring for possible sites for the obstetrics unit. The first place we looked was in the Cite Soleil, one of the largest slum areas in the Western hemisphere and a no go area for outsiders. However, the possible buildings - schools, churches a large dispensary have been destroyed. There was a functioning hospital nearby but it was very overcrowded and two other international medical agencies were already providing trauma care and first aid but no obstetrical care. There was really no room for another agency.

On another day we ventured into the downtown area past the destroyed Cathedral and the badly damaged White Palace. Travelling through the streets was extremely difficult, a bit like here in Canada after a snowstorm, when a plough will make one cut for at least one car to be able pass. Here that cut was between concrete on both sides.

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With some difficulty we found the hospital of St Francis de Sales, the Archdiocesan Hospital now being administered by the Apostolic Nuncio, Msgr Bernardito Auza. This too was crowded with patients, some on camp beds others lying on the mattresses, underneath strips of plastic, filling what looked like the garden and car park. They were being attended by Haitian and overseas doctors and nurses. The tragedy at this hospital was that the three storey building that housed the maternity ward, the delivery rooms and nursery had collapsed during the quake, trapping everybody inside. The smell of death was overpowering. To retrieve the bodies would be an enormous job and require heavy lifting gear which would be very difficult to bring down because the road around the hospital is so narrow. We found in this hospital an area that could be turned into an operating and delivery rooms and labour ward but would require renovation or a mobile field hospital. We were told that there was an urgent need for obstetrical specialists at this hospital. It was the best opportunity at this point.

Another day we visited a very large paediatric hospital near the airport. The hospital had not been too badly damaged where Italian and Belgian surgeons were providing emergency trauma care for both children and adults. The volunteer health administrator, a paediatrician from Venice indicated that there was an urgent need for obstetricians and gynaecologists (ob/gyns) and welcomed MCI as our intention was to stay for the long term, and we wanted to work with Haitian specialists and midwives. Another Obstetrics and Gynaecology team had just arrived from Milan and we were introduced to the department Professor and found we had the same ideas. We learned that the Italian troops had established a field hospital and would be vacating it on Feb.10th which we could then use as a self contained obstetrical unit. Three mobile clinics had been established to provide ante-natal care in the large makeshift camps with as many as 20 to 30 thousand, established for those who had lost their homes. It was agreed that we would work in partnership to develop this unit. Now we have to serve the two hospitals. We have enough volunteers to start, but will need more to increase the out clinics.

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Following any natural disaster such as this earthquake, the first requirement understandably is for search and rescue and emergency trauma surgery, water, food and shelter which are provided by the large international relief and medical agencies with teams from all over the world. However, from previous experience in East Timor after the occupation forces left, and during the Kosovo crisis back in 1999, it seems that the needs of women during pregnancy and childbirth are forgotten as if pregnancy and birth can be put on hold. Mothers-to-be, in Haiti, have experienced everything; they have lost children, loved ones, homes, all their possession and suffered severe injuries - crush fractures to limbs and pelvises. However, they have special need during pregnancy for care of high risk conditions which can't wait for treatment and neither can labour when it starts. Having lost their homes and as most hospitals have been badly damaged, there are few opportunities for them to have safe, clean, deliveries and there are few doctors or midwives to help them. They deliver where they are lying in the camps or in the street, alone and without dignity.

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To ignore these needs is a form of violence caused by omission (neglect). The World Health Organization has recently stated that the most neglected health problem in the world is women's health. Haiti already had one of the highest maternal mortality ratios in the world and given this catastrophe will become even worse. The international community has admitted that the 5th Millennium Development Goal (MDG), to improve women's health by reducing maternal mortality by 75% by 2015, is the most neglected of the eight MDGs. In fact at the present rate of progress it will take 275 years to reach that goal. But as the former Director General of WHO, Dr. Halfdan Mahler, commented at the first Safe Motherhood Conference in Nairobi back in 1987,

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"We know enough to act now, it could be done; it ought to be done; and in the name of social justice and human solidarity, it must be done."

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Pregnant women are optimistic and are not expecting to die and frequently they have no way to voice their needs for proper care and when they are dead they have no voice only ours.

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The reconstruction of Haiti is going to take decades. MCI's mission is to help mothers and to work with Haitian doctors and midwives, over the long term, to re-establish maternity services perhaps in two centres. The large, well-known, international relief agencies have the profile and the resources to easily attract your financial support for their work. We hope you see that the work of MCI also deserves your financial support.

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Thank you.

Dr Rob Walley
Executive Director,  MaterCare International
Emeritus Professor of Obstetrics and Gynaecology
Memorial University of Newfoundland
04/02/10