Author: cdwan

Mid Week Update

Cross posted from the work blog:

This will be a quick update, because I suspect that I would be asleep long before I could even summarize our entire trip.

We’re in the ‘Blanchard’ or ‘Terre Noir’ neighborhood, perhaps a mile north of Cite Soleil – in Port au Prince. The clinic building where we are working survived the earthquake in remarkably good shape. It’s in a walled compound that also contains a 1,000+ seat church and a small school. The school is basically a loss, and the church has a large crack from floor to ceiling on the two side walls. The tower that holds both the satellite dish and the water tank is badly damaged, but standing. We suspect that re-filling the water tank would push it over the edge.

Our clinic is providing mostly ambulatory care. Everyone here is in tremendous emotional stress. The majority of the city are sleeping on the streets, and anyone who we can get talking has lost friends and family just a couple of weeks ago. For perhaps 75% of the patients, we’re really providing a friendly face, some painkillers, mild sedatives (benadryl) to help with the nightmares, and so on. A chance to get out of the sun for a few hours and have a couple of cups of clean water is probably a bit of help in and of itself.

That said, we’ve unequivocally saved several lives. We had a man collapse and begin to seize with what was most likely meningitis on Sunday. The doctors started IVs, maintained his airway, and managed to stabilize him. The hospitals refused him, so we wound up having him driven to his house. He came back the next day, walking and talking – and thanking us.

We’ve been working our orthopedic doctor to the bone – in some cases re-breaking and setting limbs that had begun to heal incorrectly. For these folks, we have conscious sedation, which is a real benefit. Still, the screams are quite something.

For my part, I spent a couple of hours yesterday giving two liters of water with rehydration salts to a severely dehydrated girl. One tiny sip per minute, so she wouldn’t vomit it back up. I spend most of my time working in the pharmacy – dispensing medicines and running the few lab tests that we can do (urinalysis, glucose, hemoglobin, and pregnancy).
dwan_clinic.jpg
At the clinic
I sleep on the roof of the compound with about half the team. A ridge-rest on bare concrete is remarkably comfortable – once you’re tired enough. We generally wake around 6am (to roosters, dogs, and sunrise). Clinic starts at 8am and runs (today) to about 5:30. Like I said, early day. Electricity from the city is nonexistent – but we have both solar and generated power.

Rooftop Satellite Internet Terminal

We’ve seen perhaps 720 people in three days, starting out slow and ramping up to about 270 per day, today and yesterday.

Perhaps a future post can describe the incessant helicopters, and how we’re clearly on the edge of a massively devastated city. For now, food has arrived.

Santo Domingo

We’re safely in the Dominican Republic, happily nestled in the Marriott hotel. The rest of our team is arriving sometime tonight. We’re meeting them at 7am in the lobby. Hoo-ah.

I felt like I was in the company of heroes on the plane today. There were at least two other groups of medical folks represented: The New York Medics (perhaps 10 doctors, nurses, and PAs) were pretty serious looking folks – with nametags and everything. They’re going into Cite Soleil. We also interacted with a couple from Niamayah Vision Ministries. They have a clinic, much like ours, but further out of town. These are seriously the people who went to help New York dig out, and also New Orleans. I don’t feel much like a hero – but at least I’m on the same plane with them.

When the plane landed, the flight attendant asked the passengers for a round of applause for those of us going to Haiti to help out. We were in the very butt end of the plane, and while we were hanging out back there she pressed a handful of bandages and ointments into our hands. “You’ll cut yourself,” she said.

Perhaps even more remarkably – the customs agents in the DR waived our “visitors card” fee. “You’re going to Haiti? When? Tomorrow? Go. God Bless You.”

For the moment, I feel like I’m staying in the nice hotel just outside the gates of hell. Hopefully that’s hyperbole – but I’m getting a good night’s sleep, just in case.

Supplies

Cross posted from my work blog.

I write this from JFK airport in New York, having successfully gotten out of the house at 5am carrying four duffel bags containing just under 200lbs of (mostly) donated supplies. Our clothing and personal gear are in our carry on luggage.

I remain overwhelmed by the deep vein of compassion and generosity we have tapped. We decided to make this trip less than a week ago, on Sunday the 24th. In the ensuing five days we’ve amassed enough gear and supplies that we spent last night in a sort of triage party.

The 200lb number is far from arbitrary. Not for love or money can you check more than two bags on an international flight. Further, if you’re flying to the Dominican Republic – not for love or money can those bags exceed 50lbs. At the airline’s discretion they may allow overweight bags, for a substantial fee. Since I did not want to see the fruits of people’s generosity thrown out at the gate to make weight, we decided to pre-weigh all of our bags and make a separate shipment of what would not fit.

In terms of shipping, there is still no really coherent way to ship to Port Au Prince. Fedex and UPS will each take packages to the Dominican Republic – but the cost to overnight a 50lb bag was nearly $500. At that price point, I’m sure that there are more useful things to do with the money than spend it on expedited burning of jet fuel. With an additional week’s notice, we could have dropped the cost substantially. So, the remaining supplies are being shipped out this week (by still further friends, with keys to our house), not only out of weight, we were also out of time.

Based on what we see on the news, as well as reports from colleagues and friends in country, we are focusing on pain management, wound care, antibiotics, and postoperative care for the lucky souls who have already received treatment. I have no idea what to do about what is being described as an emerging mental health catastrophe. The hospitals who employ the physicians on the team have been singularly generous. Just the two of us are carrying nearly 50lbs of drugs. We’re also shipping nearly 7,000 over the counter pain pills. The other physicians on the team are similarly laden.

My wife’s hospital came through with a wide assortment of surgical equipment. Apparently in the United States this is considered single-use. Stainless steel implements are simply thrown away. In the rest of the developed world they are sterilized and re-used. We have one bag that is small but dense with retractors, forceps, scalpels, and other things whose names I do not know.

On Wed, we were also allowed into a basement room filled with pallets of donated supplies. “Take what you need, and God bless you,” them man said. We selected an “ambu” breathing bag, as well as lots and lots of gloves and gauze, among other things.

My colleagues at Bioteam, as well as other friends, delivered a total of three boxes of emergency gear (emergency rations, a folding solar power source, tarps, stoves, water purification supplies, and so on) as well as four boxes of home health care supplies. The latter included critical supplies for wound care, splinting, and pain management.

We decided early on that all our clothing would fit in the carry on bags, as well as my communications gear. So, my clothing for the week (including church duds for Sunday) consists of half a duffel bag’s worth of space – crushed next to a satellite internet terminal and a 12″ G4 Apple laptop that will probably live out its days as a clinic computer in Haiti, and a GPS locator beacon.

Food was the hardest compromise. We’re carrying everything we need for a week. That took up critical space – but we decided that it would be unacceptable to make the trip only to become a burden and take supplies that the Haitians need. Perhaps half of one of our larger bags is heat-and-serve pouches of pre-cooked food, trail mix, and so on.

I brought each bag up to nearly 50lbs with the emergency ration bricks – intending to make something of a show of having to leave behind food for the hungry. Fortunately, it was not necessary. In fact, the JetBlue employee who checked us in surprised us by waiving our baggage fees entirely. “You’re doing a good thing,” she said.

Thanks again to all of you who opened your hearts, closets, and supply room doors to us. This is truly humbling. Between the 15 members of our team, we’re bringing 30 bags – 1,500lbs of supplies.

With that, I board a plane bound for the Dominican Republic. Our drivers meet us at the hotel at 7am tomorrow to begin the trip into Port Au Prince.

We have pictures of the guest house where I’ve stayed in the past. If you click the link, you’ll see why we’re sleeping at the clinic this time.

Bags are Packed

In something less than five hours, a cab will show up (hopefully) to take us to the airport. From there we proceed to JFK, and thence to the island resort town of SDQ (Santo Domingo, in the Dominican Republic). I have told various folks in the group that I will be the white guy lounging by the pool with a beer and a laptop. Yes indeed, perhaps four hours of blissful Caribbean vacation. Then the rest of the group shows up and we have to get serious.

We’ve got 200.00lbs of baggage distributed perfectly evenly between four duffel bags. redmed has her surgical tools. She has her antibiotics. She has her stuff. Me? I found my hat. Actually, we’re a little over weight. In each bag, I have several of Dag’s food bricks – intended for feeding starving people. If they give me crap about my bags being over weight, I intend to throw away food for poor people. In front of them. Slowly. I’m not ditching antibiotics. Hell with that.

I have located my hat. redmed has located her hat. Our hats are ready to go. Us? We’re completely weirded out by the fact that people are praying for us – not in a bad way – but in a “go team” sort of way. That is well and truly odd.

And with that, to bed. Perhaps to sleep. More likely to scheme and plot and play scenarios – the better to be effective.

Reality Sets In

Well, the rubber is hitting the road already on this trip. We’ve got more donations than we can take directly. Apparently for international flights, you’re allowed two pieces of checked luggage. Nobody on the Jetblue support lines could do anything to alter or modify that. Further, when going to the Dominican Republic – each of those checked bags can be no more than 50lbs. They have an option to allow overweight bags – sometimes – but since we’ll be taking a taxi to the airport at 5am – I have no interest in having my stuff turned away and having to leave it at the curb. “No guarantee” means “no.”

Plus, with two 50lb bags apiece – plus a stuffed carry on – and I will already be the sort of vulnerable – unable to run with our own stuff – losers that I make fun of. So no – no more bags – even if I could.

capital_l came over last night and we had a little packing party. We made 3 duffel bags that each weigh about 50lbs. One is solid drugs. The next two are a mix of medical supplies. I spent this morning un-boxing and bundling our pre-cooked Indian lunches and dinners (foil packs that you heat up in boiling water, or eat cold) – and with just our food for a week, our sleeping bags, and a couple of other essentials (water bottles, camp stove, etc) that last duffel bag is full full full. I still need to look at the clothing situation. I’m thinking underwear, socks, undershirts, and two pairs of cargo pants. I can fit a week’s worth of that – plus a laptop, plus a satellite uplink (heh) in my carry on (AKA gym bag).

Therefore, I’ll be shipping a couple of decent sized boxes to RDU, and donating a couple more decent sized boxes to Partners in Health. Rest assured, it’s all going down there – just not in my checked luggage. Triage order goes something like (a) serious drugs (b) medical equipment (c) my food (d) … well … um … ‘d’ is getting shipped.

With another couple of days of warning, I could have done better. Pisses me off that I *had* those days and didn’t start moving faster – although I had no idea that we would have so much stuff – and it all arrived yesterday. Fedex and UPS both ship to Santo Domingo. Right now, I could drop a 50lb box and have it at the hotel by the time we arrive there tomorrow. Price for that privilege? $450. If I had a spare week, it drops below $100.

No, it’s not worth the money. This is the hard calculus. Throwing money in the wrong direction is just as much of a mistake as not giving at all. If you feel tempted to spend that kind of money, please pause and consider what $450 might be able to do in a month or so – once the real reconstruction begins. We’ve got all the hardcore stuff. What we’re slow-boating is nearly 10,000 over the counter pain pills. Tylenol, Ibuprofen, Aspirin, etc. … plus stuff that will still be valuable once the amputations are done and the infections have run their course.

This is the part where I look at what I’m doing and say “people will suffer, and possibly die, who did not need to – because of my lack of omniscient knowledge of the future.” If I had played this one *perfectly*, there were better moves – and that would have meant less suffering in the world.

Live and learn. Self flagellation done. Back in motion.

Oh yeah, and looking out my window, I see snow. What’s *that* about?

Publication

A positive post, not about Haiti.

One of the groups with whom I work just published a paper. It’s interesting in that it may be the first paper to describe the whole genome sequencing and analysis of an entire genus. Maybe. Or not. I can’t keep up with big science anymore. It’s the genus that includes plague.

Anyway, I helped out with this at the very end of the process – when a reviewer pointed out (correctly) that a couple of the strains in the paper were not yet in the public repositories. I.e: The data wasn’t *actually* available to the public yet.

We went digging, the lead author and I, and finally located the files based on what can be best described as “the dog shit connection.” He noted that this strain had been isolated from dog feces, in Germany, in the 70s. I ran a search in the wiki on “feces,” and there was the data. The rest is history.

Lest you think I’m making this up – here’s a table from the publication. I love my job.

Donations and Suchlike

I’m getting a lot of offers of support. You humble me. Here’s the deal:

First: Thank you.

Second: This is both a sprint and a marathon. While we’re going down to bandage wounds and set bones, this must be a much longer term project. I actively leaning on all of you to make a long term commitment to helping the Haitian people. I don’t yet know how best to implement that help. It may be some sort of Marshall plan from the US. It may include merely keeping the eye of world attention on our Caribbean neighbor once the bodies are buried and the starving people once again out of sight of the cameras.

If you want to do the right thing over the long term, please plan a little support every month for the next few years.

I will know a lot more about how to be useful in that context once I’ve been down there and seen the situation with my own eyes.

Third: I appreciate the donations of money and goods. If you want to support us with money, the best way is probably to send donations to Family Health Ministries, earmarked in some way for “Chris and Jen Dwan”. They’re a tax deductible, charitable organization – you’ll get a receipt – etc. I understand that if the money shows up sometime soon, you’ll even be able to take it off your 2009 taxes instead of 2010. We’re keeping receipts for our expenses related to the Haitian people. We’ll probably pick up a substantial amount of antibiotic, gauze, tegaderm, etc. at cost. FHM has committed to reimbursing us for that – and you can specify that you would like your funds used for that reimbursement.

We will not ask for reimbursement of the airfare or hotel in the DR, nor for our own food.

Fourth: If you have contacts who can get medical supplies to us by Thursday evening (donated, or at cost), that would be a huge help. Drop me a note or an IM and we can talk on the phone. We’ve got limited space in our carry ons, but if I could take a whole 50lb bag of powerful antibiotics, plus local and general anesthetics, plus ways to get them into people’s veins, I totally would. Hell – I would leave up to half of my food behind for retractable syringes.

Support

One additional thing, in a smaller package:

To all of you who have, both with words and deeds, offered support to Jen and I: Thank you.

Autobots, Roll Out

I just bought tickets to go to the Dominican Republic on Friday the 29th. On Saturday, we intend to go overland via hired vehicle to the border crossing with Haiti. Hopefully, the Family Health Ministries van will meet us there and take us to the clinic where we’ve worked before, in the Blanchard neighborhood of Port Au Prince. It’s about two miles from Cite-Soleil, and I’ve seen pictures that show it still standing after the most recent aftershocks.

From Sunday through Friday we’ll be running a medical clinic, focusing on trauma, wound care, setting bones, and so on. Our supply list includes local and general anesthetics, bandages, basic splints and so on, gloves, suture, and the other extreme basics. If things go well, we’ll be able to triage the worst off people over to the hospitals (fine, the hospital parking lots. We’ll take what we can get).

We’ll be going with a group: family health ministries, http://familyhm.org (FHM) with whom we’ve traveled before. Jen and I have been down there with them three times over the past few years, working with small medical clinics, smuggling in supplies, and generally trying to directly help people in whatever small ways we can.

It’s worth noting that we’re not the big boys. Partners in Health (PIH) and Doctors Without Borders (MSF) are the ones with the real facilities and the real funding. Ours has historically been a much smaller effort to catch people who fall through the cracks – and so it remains. If you have a few bucks to donate, I highly recommend PIH and MSF. Of course, we’ll take what we can get.

FHM has built four clinics and two schools over the years – and we had just broken ground on a new hospital in Leogane – which was approximately the epicenter of the earthquakes. Two of the clinics (in Cite Soleil and in the rural village of Fondwa) are described as a total loss. The other two (Leogane and Blanchard) are apparently usable – though damaged. Our oldest school (500+ students) is rubble, as is every guest house and hotel that I ever stayed in while I was down there.

Fortunately, the only deaths of people I know (so far) were a nun who was full time at one of the clinics, and one of the translators with whom I worked the last time I was down there.

In addition, the CDC and WHO are organizing public health efforts for the rest of the country – and basing those efforts near the facility in Leogane. The director of FHM will be on a CDC plane on Thursday, landing on the highway outside of Leogane. We may try to sneak into that effort – since I think that we might be more useful there.

We’ve got as safe a place to sleep down there as anyone (the clinic floors). Word is that there is gasoline to power the generators, that the well is working, and that there is sufficient food for that part of the city. Honestly, getting there will be the biggest challenge.

That’s a long way of saying that I don’t really know many details.

Those of you who have known me long enough have heard me refer to situations like this as “naked skydiving.” Here’s what I mean by that – sometimes you just gotta jump.

Or, as it was once put by the indomitable _earthshine_: “You gotta commit.”

Look Damn You

Look at this.

It’s not far away. This is an hour by plane from Miami – and it’s happening now.

They are not unknown people. That’s the town where I was helping, in my very, very small way, to built a hospital. That nascent hospital is rubble. Rubble that includes corpses.

Look, damn you. Look. See the underlying nature of your reality and mine. Look for as long as you can.

Then think what you can do to help.

Fuck democrats, fuck republicans. Fuck Massachusetts and fuck your politics.

Look.