Marcelo Venegas-Pizarro, M.D. arrived to Port-Au-Prince amidst the ruins and people out in the streets. Makeshift signs that read "We Need Help..food, water, medications," could be seen every couple of blocks. Makeshift tents of sheets strung across wooden poles dotted the streets.
We drove through the dust and colorful "tap-tap" buses that still provided a means of transportation. The presence of U.S. Marines and UN "blue helmets" was felt from the airport to the main hospital.
Edner Boucicoult received us in Port-Au-Prince.
Edner is on the Haitian National AIDS Coordinating Committee, ("CCM") and works as the Communications Director for Cecosida, a small Haitian organization that promotes HIV issues in the Haitian media. Edner would become our guide and liaison to the makeshift clinic of PHAP+ that we would help set up and work out of. PHAP+ is a coalition of Haiti-based AIDS groups led by people living with HIV/AIDS. The open-air clinic had awnings that would help cover the waiting areas and consult rooms and house the many medications we carried with us.
I arrived with friend and fellow physician, Jen Kasper, M.D., who works as a pediatrician out of Massachusetts General Hospital and also is vice president of Doctors for Global Health. As an adult doctor I was very glad to have her around.
It seems as if "life went on" in relative ease and calm as people lined up for food rations, water or money from relatives abroad at Western Unio
n offices. And yet hunger was building and tensions rising as it quickly became evident that the food and supplies were not getting out to people quickly enough. The resilience and perseverance of the Haitian people was evident as they set up their "homes" in newly formed tent cities alongside roads, in parks, golf courses or plazas. Tremors were felt daily reminding everyone what had caused the many calamities.
We came from New York with a group called Housing Works, the largest AIDS based community organization in the United States, who has a long and arduous AIDS advocacy history and has been working for more than two years with PHAP+. Charles King, president of Housing Works had arrived in Haiti four days after the earthquake with Dr. Vaty Poitevien, a Haitian HIV doctor, with whom I had practiced. Dr. Poitevien had lost both of her parents in the earthquake. The two of them had brought suitcases of medications and supplies that helped stock the PHAP+ clinic.
On the afternoon we arrived Dr. Kasper and I made an inventory of all the medications and prepared the outlay of the HIV/AIDS clinic with fellow Haitians from PHAP+.
That evening we set up our tent alongside Edner's family in the rear of an HIV/AIDS associated government building. With no electricity or running water conditions were tough but Edner's mother, Simone, made sure we had some coffee every morning before leaving to see patients. We arrived at the clinic with over 50 patients waiting to be seen and that number would grow as the word spread of the PHAP+ clinic.
I worked with several interpreter
s, as I do not speak Creole. The first of which was a young man named Carlton, who, I later learned, was from Miami and had lost an uncle and a younger nephew. This was his way of giving back. We saw all kinds of patients: children and adults, many with trauma injuries from the first hours of the earthquake that not been attended to or had not received follow-up care. We saw many people with fractures including children with fractures that had not received medical attention either because of lack of transportation or because of the hospitals over-capacity with traumatic injuries and amputations.
Many of the patients we saw had wound infections from lacerations or abrasions from debris falling on them during the earthquake. We attended to many patients with more common primary care problems, from gastritis to headaches, to hypertension. We also saw many people with diarrhea, upper respiratory infections, vaginitis, urinary tract infections and general malaise. We sent many people with trauma injuries to the main hospital with a small note either requesting an x ray or follow-up care. Many would return to us the next day with x rays in hand or bandaged up. Many patients had a dazed look from recently losing family members and loved ones. The grief was vivid and sometimes overwhelming.
We would have patients triaged by the nurses and then we would write out a brief note in makeshift medical records via paper stapled to manila folders. The day would go by so quickly. Hunger was real and prevalent, emotions were raw. I saw one young woman whom I recommended she take an antibiotic with food, she quietly stated she had not eaten in two days as tears rolled down her eyes. My translator became emotional as well and I had to get up as I felt my eyes swell up with tears. I went to get the antibiotic and also went into my bag to grab whatever power bars I had left to give to her. I looked into the waiting area and everyone looked thirsty and hungry. How could we feed them all? And the hungry children
? I thought of my own children back in the States.
The next day
we started bringing in some snacks and water to the patients that were waiting, although that quickly went away. The few power bars and food that Dr. Kasper and I had brought did not last.
We saw many patients belonging to the HIV associations who were there for medical reasons besides HIV. They had gone more than a week without their anti-retroviral therapy, mostly first line therapy of an NRTI plus NNRTI. We gave what little we had of Lamivudine, AZT, Nevirapine and Efavirenz to hold patients over from two weeks to a month. The concern was when would these patients eventually get their regular supply of medications? And if not, how quickly would resistance mount particularly to the NNRTI's? We dispensed as much Bactrim as we could to patients with CD4's less than 200. Madam Marie Rose, an adherence counselor with the HIV associations seemed to personally know all the HIV positive patients and also identify all those who had an AIDS diagnosis.
In treating all these patients we were never alone. We counted on the support of all the translators: Pierre Paul, Sophie, Carlton and Clara. We counted on the support of the nurses Saitha and Kerline, and the assistance of Sourel, helping us take patients to the clinic. Last but not least were the other doctors: Dr. Petit Frere, working out of the sister clinic sponsored by Diaspora Community Services, NYC and Dr. Gerson Sergio Jeudi, from Promoteurs Objectif ZeroSIDA. They stayed working at the clinic in Haiti, eventually Dr. Kasper and I left. We were replaced by Dr. Marie Nomil an internist from Maimonides Hospital in Brooklyn and many other medical providers that since I left have led the call of duty to help out those in most need in Haiti.
To this date the PHAP+
clinic continues. We continue to support it with medications and anti-retrovirals from groups such as AID for AIDS in New York as well as support from local HIV pharmacies in NYC who have kindly donated much needed antibiotics and medical supplies.
The experience I had in Haiti was by far one of my toughest, even though I have worked in many places including Guatemala, El Salvador and Mexico. I am still amazed by the resolve and strength of the Haitian people.
I became good friends with Edner Boucicoult, who described the first minutes after the earthquake as he ran like a "madman" down the street to the house where his baby daughter was staying and after finding her in safety, broke down in tears. By the time I had left, he stated in a Housing Works blog that he was "completely out of tears," from all the suffering he had seen from his people – from piled up bodies to the total devastation of his city. He plans to help in the reconstruction and is currently administering the PHAP+ clinic and coordinating all the relief and support effort.
This article is dedicated to Edner and his beautiful family along with all the Haitian people that continue the day to day struggle for survival and dignity. If anyone is interested in donating money or volunteering their time in Haiti please sign up at www.housingworks.org
Marcelo Venegas-Pizarro, M.D. is medical director for the Designated AIDS Clinic at LFHC. He is an HIV specialist and an AAHIVM member. He previously worked for Housing Works as the Chief Medical Officer.