Team Sinai - Operation Rainbow Plans Haiti Return

From the day we returned this past June from Port au Prince, we have been planning our return. Our experience at Adventiste Hospital was for all of our team members, uniformly, life changing. It didn’t matter if we were veterans of many international relief missions, or if we were first timers. None of us will ever forget the children and adults that we treated that week.  Scott Nelson put it aptly, “Haiti messes with your head.” Well it is certainly a point in fact that Haiti messed with Scott’s head. He was back earlier this month for a two week volunteer stint at Adventiste. (Read more about Scott and Marni Nelson at http://www.caribbeanortho.com/caribbeanortho/Nelson.html). As you may recall, Scott had been in Haiti for a full 6 months after the January 12 earthquake, and did amazing work organizing what has become the top rated orthopedic facility in Haiti.  He left shortly after our June mission, to start his new life and career at Loma Linda University in California. Scott returned in early December to help orient Terry, and provide his inimitable expertise and enthusiastic, boundless reserves of energy to serve the Haitian underserved population. In his place, Dr. Terry Dietrich, from Appleton, Wisconsin has now arrived, as of November, along with his wife Jeannie Dietrich, R.N. for a year-long commitment. (Read more about the Dietrichs at http://www.caribbeanortho.com/caribbeanortho/Dietrich.html).

Team Sinai / Operation Rainbow all packed and ready to go. 

Our plans were to return for a week of service on December 26, at which time we would be the only expatriate medical team present, with the long term volunteers being scheduled out for the Christmas/New Year holidays. We were ready to welcome some new team members, including Drs. Ron Delanois, Dr. Rishi Thakral, Dr. Julia Ramberg, and Dr. Jossie Abraham. Unfortunately, fate intervened, and we have had to cancel our trip.  Here’s the story…

Over the past 6 weeks, the political situation in Haiti began heating up considerably. Nationwide elections took place on November 28, plagued by controversy, with accusations of ballot rigging, and other irregularities. Haitian electoral law requires that the winning candidate capture at least 50% of the casted ballots. With over 20 candidates to choose from, no single candidate took a majority, which leads by Haitian law to a run-off election (scheduled for January 16^th, 2011) between the top two candidates. The third place candidate, who by the official count, trailed by a mere few thousand votes, cried foul, along with many other candidates. This lead to mobilization of various supporters in the form of street demonstrations that turned violent, and essentially shut down the city for the better part of a week. HAH was on lock-down, and all volunteers present were forbidden to leave the hospital compound. Things got so bad that American Airlines stopped flying to Port au Prince for about a week.  New reports showed street barricades, gunshot victims, and burning tires. Tap-taps stopped running, and the general populace hunkered down, waiting for the political game to play itself out. Unfortunately, things are at an uneasy stalemate, with many of the stake holders still negotiating and posturing. Even today, no one knows if there will be a recount (unlikely), a re-election (more unlikely), or a continuation of the current government as a provisional government (who knows?). The US and Canadian embassy shut down, and forbade their staff to go to downtown PAP.

Street riots and barricades in downtown PAP

The enthusiasm of the rabble to create mayhem has died down over the past two weeks, given the paralysis of the government and the electoral board.  This past Monday, the final election tallies were to have been announced, and everyone feared that this would provoke yet another round of unrest. Fortunately, the government decided to postpone any further election announcements until the entire mess can be worked out by a combination of the government, the Organization of American States, Bill Clinton, the candidates, and the UN. Don’t expect anything to be decided too soon. Once there is a decision, it is feared that the losing party/parties will be unhappy, to say the least.  According to Haitian law, the run-off elections should take place on January 16^th and the new government installed on February 7^th.  It is doubtful that this time line can be maintained, given the current impasse that has become, in effect, a political Gordian knot. Rumors of renewed civil strife, unrest, and even civil war are floated. Given the volatile nature of Haitian political history, with numerous past coups, military takeovers, and dictatorships, these possibilities are not far fetched.  For an insiders view of Haitian politics, see the Haitian news site www.haitilibre.com  which has an English version as well as a French version.

On top of the political strife, Haiti is enduring a nationwide epidemic of cholera, that has now infected, by official count, at least 120,000 people and killed 2,500.  See an epidemiologic analysis at http://www.reliefweb.int/rw/fullmaps_am.nsf/luFullMap/2D9992968E894422852577F2007C2B3E/$File/map.pdf?OpenElement . It should be noted that these figures are widely believed to be underestimates. See this recent posting from Haitilibre….  http://www.haitilibre.com/en/news-1972-haiti-cholera-epidemic-the-mspp-hides-the-truth-to-the-people.html .  In yet another twist, the Nepalese soldiers from the MINUSTAH (United Nations Mission for Stabilization in Haiti), have been accused of being the source of the outbreak of cholera, though in the boiling cauldron of Haitian culture, at least 45 voodoo practitoners have been lynched by street mobs who are convinced that the cholera epidemic is being promulgated by the voodoo priest casting spells on the unfortunate victims. For details of this bizarre aspect of the epidemic, see http://www.haitilibre.com/en/news-1975-haiti-social-lynchings-at-least-45-dead-cholera-or-religious-war.html

Given this volatile mix of civil, political, and electoral unrest, with a dollop of a deadly cholera epidemic thrown in, and intermittent cessation of airline flights, the Adventist Health International (AHI) has decided to suspend the short tern volunteer program at HAH. Two weeks ago, with only a few days notice, they officially evacuated the short term volunteers who happened to be at HAH at the time, plus the five long term volunteers, which included the Dietrich’s, the Russell’s (assistant administrators), and nurse Lynn Byers. Scott Nelson, and his Dominicana nurse Lucilla and anesthesiologist Dra Adrian were also there when the order came to evacuate. Predictably, he and his crew placed patient safety above the orders from the AHI home office, and chose to stay a few extra days beyond the AHI ordered evacuation deadline to make sure that the recent post-operative patients were stable. Scott even managed to squeeze in an emergency open reduction of an unstable pelvic fracture that had been told by MSF  doctors to stay in bed for three months. For a description of the last few hectic days of the evacuation, read accounts from Terry Dietrich and Scott Nelson from December 16,17,18 on the www.haitibones.org  website.

Rishi, Ella Joy, Amy and Merrill packing duffles.

The current situation over the holidays is that all expatriates are now gone from HAH, and the hospital continues functioning with a Haitian only staff. Obviously, the orthopedic capacity has been reduced dramatically. On a hopeful note, AHI is considering giving the permanent expats (Terry and Nathan) a tentative go-ahead to return in January. The fate of the short term volunteer program (that’s us) remains in limbo.

Up until two weeks ago, when we were notified of the evacuation order, we were busily preparing for a December 26 departure. Dr. Rishi Thakral, orthopedic fellow at Sinai Hospital, and Nurses Amy Monitillano and Ella Joy Napoles Brown came to our house to prepare more than a dozen duffle bags stuffed with hospital supplies that had been requested by HAH, including sterile OR drapes, gowns, and towels, bandages, as well as ex-fix components and various and other assorted sundries that have been donated for this mission. Amy and Ella Joy worked with Sinai surgical techs Hassan Hooper and Jenel Slonaker to collect discarded but otherwise unused drapes and gowns from surgical packs that would have been sent to trash. Instead, they reprocessed/resterilized them for our mission.  Another packing party had been planned for the following week, but we cancelled once we had the official word from our sponsoring agency, AHI, that we were no longer allowed to volunteer at HAH until such time, indeterminate, that AHI declares the situation safe.

Palisades, NJ Rotarians donate to our mission after hearing my PowerPoint.

All of us were sorely disappointed, but we have regrouped, and are planning to use our American Airlines tickets (minus a change fee…) to reschedule our trip for later in 2011. We will be in close contact with AHI and the permanent volunteers at HAH to determine the safest and earliest date.  When we went to Haiti last June, we were representing Sinai Hospital. This time, we are proud to be co-sponsored by Operation Rainbow.

John and I have been long associated with Operation Rainbow, going on yearly trips to Nicaragua or Ecuador. Thanks to the vision and generosity of Laura Escobosa, executive director of Operation Rainbow (www.operationrainbow.com), we have the additional logistic support that promises to make this mission (when it actually happens…) even bigger and better than our previous trip. We've been fundraising to help buy medicines and Medika Mamba (Plumpy Nut) for our patients. Special thanks to the Palisades, New Jersey Rotarians for enduring my Power Point of our June mission, and for their kind donation. Additional thanks to the Rubin Institute for Advanced Orthopedics (RIAO) at Sinai Hospital for their Save-a-Limb Fund which helps support our mission plans. Each year, Sinai has an annual Save-a-Limb Bike Ride http://savealimbride.org, and this year's October 2010 ride brought over 600 participants. 

Save-a-Limb Ride and Team RIAO

One thing for certain, Haiti is still suffering from the destabilizing effects of the January 12 earthquake, the agonizingly slow rebuilding phase, and the confounding factors of political unrest and a cholera epidemic. Clearly, there is a continued need for volunteer groups such as Team Sinai / Operation Rainbow to provide orthopedic care for the masses of Haitian adults and children that cannot afford to pay for what might be considered even the basic necessities of life. The overall theme that AHI has planned for HAH is to increase the Haitian national medical presence, with a goal towards sustainability. For the foreseeable future, however, volunteers are still desperately needed.

--Merrill Chaus, RN