Cholera in Haiti: A Message from Ian Rawson

"Last evening, the Center for Disease Control confirmed that the cases of diarrheal illness that HAS Haiti and other hospitals in the Artibonite region have been receiving have been identified as Cholera.

"HAS has instituted the World Health Organization Cholera treatment protocol, and redesigned the hospital's patient flow to keep the cholera patients in a separate area.

"All HAS staff have been provided with training on cholera and its effects, and its treatment.

"HAS remains in close contact with the CDC, whose efforts are now focused on localizing the source of the disease. A CDC team was at the hospital last night to study maps of the region and to review our patient data, especially the localities where the patients have been living during the previous week.

"Most patients appear to have contracted the disease from one or several sites at some distance from the hospital. We have received very few patients from the immediate area.

"Under the able direction of our newly-arived Medical Director, Dr. Silvia Ernst (who was formerly at the Schweitzer hospital in Lambarene), HAS has been able to manage the patient flow without undue stress. All of the staff have served long hours with great professionalism.
To a great extent, cholera is a nursing disease, requiring the establishment and maintenance of IV lines, education to the patients' families to remain hydrated, and the administration of antibiotics as appropriate. Most patients so far have been able to recuperate and return home within several days."

Ian Grant Rawson

Top Image: Dieu Nalio Chery/AP: "Cholera victims in Haiti receive treatment at the St. Nicholas hospital in Saint Marc, Haiti." Source: NPR.ORG
Bottom Image: Source: Doctorswithoutborders.org

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Update from HAS, Monday 1/18/10

The following is an update from the managing director of HAS, Ian Rawson.

The flow of urgent cases from Port au Prince continues as before except that they are more serious cases. It has been possible to treat and release many of the patients, so slowly the ones who remain are taken off the floor and put on cots, and then to beds.

A surgical team from Miami arrived yesterday evening on a military flight, started to work immediately, and had done a dozen cases by midnight. There is still a long row of surgical candidates in the hallway by the operating suite. The team has provided a welcome relief to the Haitian surgeons, and they are prepared to continue their work through today. They had been stalled in Miami for two days due to the confusion surrounding flights into the Port Au Prince airport.

We are learning every day about disaster medicine; we are a microcosm of what is happening throughout the country, especially in Port au Prince. The clinical demand is astounding; thousands of injured people are seeking care in Port au Prince, and for many it is a race against infection and systemic damages.

We had, and still have, a desperate need for clinical personnel; the surgical team which arrived yesterday has helped a great deal. Our OR nurses have worked as hard as the physicians, and are also in need of a break. More surgeons represent more demand for their services. The Surgery post-operative ward has spilled out into other spaces, but with only a few additional nurses, who are stretched thin.

I hope this comes across not as complaints, but as a description of what life is like on the ground here at Hôpital Albert Schweitzer, where the vast majority of our services have been provided by an exclusively local Haitian staff, and are only now getting support from international specialists.

Many of our patients have been in our hallways now for days, patiently waiting for help. We have become good friends and I appreciate their forbearance when I explain why they have not yet had their much-needed surgeries. Their pain is becoming more intense, and they must be frustrated, but they always respond with a smile and an assurance that they are doing all right, when it is obvious that they are not.

Several patients have brought radios. One of the early morning broadcasts play hymns. The patients turn up the volume a bit, and many people quietly join the songs, from both wards, the halls, the pediatric clinic, which is filled with beds, and the old horse parking lot, which is also filled. Many Haitians have lovely singing voices and the sound is angelic. For many, it is an inspiration that their faith will help them to endure the pain.

Your collective concern and support has helped to sustain us all in the face of an incomprehensible demand. I, and all of us here ion Deschapelles, send our sincere thanks.

Ian Rawson

Afternoon Report Wednesday, 13 Jan 2009

As we have all heard many reports of the terrible disaster---a 7.0 earthquake in Haiti, the worst in 200 years. Up to 3 million people may have been affected. So far, tens of thousands of people have died.

Hôpital Albert Schweitzer Haiti, located 40 miles NW of Port-Au-Prince was able to withstand the recent devastating earthquake and is currently operating with full staff helping victims. With mass casualty protocols in place, the medical staff is evaluating each patient, performing diagnostic tests and delivering life saving care. Due to the expertise developed over its 54 year history, Hôpital Albert Schweitzer Haiti (HAS) is one of the few institutions positioned to provide timely hospital care for the injured. As the flow of people urgently seeking care increases over the next few days and weeks, our resources will be pushed to the breaking point. It is critical that we receive support to help us continue with our mission.

Ever since early this morning, a steady stream of vehicles, mainly the open-back pickups which serve as public taxis on Haiti's roads, has come to the front of the hospital. In the back are one or two people, their legs or arms covered in bandages or clothes. HAS security staff rush out to the truck with a backboard or gurney, and bring the patient inside to be triaged by the emergency team.

Now, in early afternoon, a crowd of over 200 people are outside the hospital, friends or neighbors of injured patients. They rush to the arriving trucks and try to help to carry the new patients inside. Occasionally, the combination of the person's injuries and the truck ride are more than can be sustained by the patient, and the family members, with great wailing, adapt to the shock of the loss of a loved one. A sound system has been set up outside, so that family members may be called into the hospital to meet with doctors.

Each patient is brought into the Observation Unit and quickly evaluated. Some are sent to for an X-Ray or lab test while others are taken immediately to the holding area outside surgery, where both operating rooms are being used full time.

All beds have been pressed into use, and still there are patients on benches. Gradually, some of the early arrivals and less injured are prepared for discharge.

Systems at HAS are working well; preparation and practice have paid off. The greatest resource, however, is the dignity and grace of people who have suffered a great shock and sometimes tragedy, and remain calm and show concern not just for the people with whom they have come here, but for others as well.

This is the most serious challenge ever faced by HAS in its 54-year history, and while we are currently coping with the onslaught of the injured, we urgently need support.

At this moment, we don't have the capability to accept material goods or personnel. Our greatest and most urgent need is for funds to pay overtime wages to our dedicated staff, and to buy replacement medicines and supplies.

We will update the www.hashaiti.org website with news of relief efforts. To make a donation that will have immediate impact, please go to www.hashaiti.org.

Thank you again for the many expressions of help and caring that are coming from around the globe.

Happy Belated Birthday, RTTP!

September 5th was the one-year anniversary of our Rehabilitation Technician Training Program (RTTP), which is perhaps the only program of its kind in Haiti. Ok, are you ready for all these acronyms? Let's see: RTTP was designed by the Friends of HAS Haiti (FHASH) as a way to professionalize Hôpital Albert Schweitzer Haiti's (HAS) rehabilitation service with its limited resources. Health Volunteers Overseas (HVO) came on board as a partner, as HVO affiliated teachers had been seeking a site in Haiti to operate. This collaboration between FHASH, HAS, and HVO set a platform in place to allow each of the partners to achieve their goals.

That said, we'd like to introduce you to the individuals that have made this program into the fledgling success story that it is today!


Meet Shaun Cleaver –
Coordinator of Rehabilitation Services Development

Shaun Cleaver is a Canadian physical therapist who has spent more than a year in Haiti. Shaun moved back to the country in April 2008 to work as the Coordinator of Rehabilitation Services Development for the RTTP. In this role he was responsible for establishing the framework of the training program and the system for providing rehabilitation services.

Shaun fulfilled numerous roles for the RTTP. When the training program started in January, Shaun was first and foremost the onsite contact for the training program, orienting teachers to life in Deschapelles and being a consistent face for students amid the constant changes seen with the teacher rotation. This role also makes him the interface with the RTTP and other political and independent social institutions in Haiti, including HAS of course, but also the Haitian government and local Disabled Persons’ Organizations. Shaun also works with the HAS staff to improve the current provision of rehabilitation services and facilitates the expansion of services and hiring of new employees. This included traveling to outlying areas where he stays at and works out of small health centers, seeing patients and collaborating with local employees to integrate rehabilitation. Besides this field work, he also spent a good deal of time with his hands on the keyboard and eyes on the screen, communicating with RTTP stakeholders, drafting documents to help the program raise funds and planning budgets and schedules.

Focusing on immediate needs, though, Shaun’s biggest job at RTTP's inception was to select the students and the local translator. The RTTP searched for the best candidates in these roles and engaged in a rigorous process to identify these people. For Shaun, this was a new and interesting challenge that at the time required better knowledge of the Haitian education and labor systems.

Outside of work, Shaun is known locally for his morning 3 mile runs and Kreyol fluency, allowing for animated banter and joking with the area’s residents. He is also fluent in French and often fulfills ad-hoc translation duties in HAS. He enjoys gardening, hiking and the wide variety of personalities, both visitors and local, that frequent Deschapelles.

Shaun has stayed in Deschapelles for over a year at this point. While he is currently facilitating his own transition away from his position in Haiti, he has already put systems in place which have allowed this to happen on its own. Despite the challenges, RTTP is a success after one year, and you will be sure to hear of some of the trials & triumphs of this project both in real-time and retrospectively. Shaun plans to complete his PhD in order to seek an academic appointment integrating teaching, research and service. More generally, Shaun’s career focus is integrating rehabilitation therapy in resource-poor environments and across cultures. It is likely that he will return to South America or Sub-Saharan Africa where he has traveled, worked and lived previously. Nonetheless, with a record that includes substantial, and repetitive, time living in Haiti, it is likely he will stop by here again too…

Meet Denise English – Program Director

Haiti has been an important part of Denise’s life for over 12 years. She has fulfilled a variety of commitments in Port-au-Prince, Lacroix (near Gonaives), St-Louis du Nord and now Deschapelles. In her role as Program Director, Denise is responsible for all of the educational aspects of the RTTP. It was really through Denise's efforts that RTTP was founded as an official program of the Friends of HAS. Denise established the vision for the training program, led the curriculum development, recruited teachers and oriented them to the program and providing guidance for important decisions regarding student selection, evaluation and discipline.

Denise’s affiliation in the RTTP partnership is with Health Volunteers Overseas (HVO). HVO is based in Washington, DC, and its mission is to create opportunities for health professionals from high-income countries to build health and human resources in low-income countries. (Whoa – that’s a mouthful.) Now, what does this all really mean? At the most basic level, HVO programs are rooted in teaching. Professional volunteers from the United States and Canada travel to international sites to collaborate with locals to train health care workers. In this way, HVO’s work should serve to strengthen health care systems at their local program sites. All RTTP teachers are HVO volunteers with previous experience in Haiti.

HVO has a strong physical therapy component, currently with programs in Bhutan, India, Nicaragua, Peru, St. Lucia, Suriname and Vietnam. According to Denise, “Working with HVO provides us with a wealth of international expertise and important contacts.” Denise is in regular contact with the Program Directors from the other sites, enabling exchanges regarding experiences and lessons learned.

HVO is sponsored by the American Physical Therapy Association (APTA) and has a reputation among physical therapists as offering a very organized volunteer experiences. The RTTP is proud to have HVO as part of our team and excited about the opportunities this provides.

We are also lucky to have friends like Denise and Shaun on our side.

Read an Article from the Pittsburgh Post-Gazette about Denise English and her work with the RTTP.