Report from Cap-Haitien, Dr Andre Vulcain Feb 15, 2010

Report from Cap-Haitien

February 15, 2010

Humanitarian Situation in the North • Crisis Response

After a lag period in regard to the events in Port au Prince , Cap Haitien is currently experiencing the “contre-coup “ effect  of the earthquake. A couple of days after the earthquake, the mayor of the city had sent busses to Port au Prince to evacuate people originally from the North Department who wanted to leave Port au Prince. Also some people started to move toward the north on their own, heading toward their hometowns. The capital city is quickly emptying. There is right now a drastic reduction of the population in Port au Prince due to the combined effect of losses of life in the earthquake , internal migration to other towns and emigration to foreign countries.  It is estimated that around 30000 to 50000 people have moved   in the north department  during the first 3 weeks following the earthquake  and the number is increasing on a daily basis.

A refugees center has been established in the gymnasium   next to the hospital offering various  services : medical exam and triaging of sick patients, clothing, psychological support. We had some meetings with the leadership of the hospital to assess the situation and I worked for about one week as a volunteer with a family medicine resident at the refugees center. We are also contributing in the coordination of the refugees center with a focus on the health care needs of the refugees and victims. We have encouraged the Internal Medicine and Pediatrics residents of hospital Justinien ( HUJ ) to join in the effort and a more structured medical presence has been set up in this facility providing much needed first contact basic medical care and proper referral on existing health care facilities .   The family practice center at HUJ plans to maintain a daily medical presence with other groups  of health care personnel at the refugees center as its functioning will last.

The hospital has received some important support during the first three weeks post earthquake from various groups of assistance including teams of surgeons and orthopedists . Other groups have help in providing some supplies and equipments as well as assistance in managing the overload of surgical patients. Over 150 patients requiring major limbs surgery have been admitted in the hospital with a rate of about 8 to 10 procedures a day. The situation is stabilizing in term of the surgical and orthopedist cases referred to the hospital. However major limbs injuries are still being treated , particularly ORIF of fractures. There is now a need to optimize the care of the those patients  particularly during the first 2 to 3 post-op months.

During my  work at the Refugee Center, the most striking  (dominating) issue was and is still   the need for food. Small amounts of food were distributed during the first 2 weeks in the center but this initiative has stopped 2 weeks ago.  Hunger is rampant in the group of refugees . Patients were telling me one after another that they had practically no access to food during the past three weeks and the loss of weight and the overall state of poor nutrition  were obvious in adults as in children  . Family or acquaintances in Cap Haitien cannot really help them . The donated food by religious organizations  is in short supply with a dysfunctional distribution process . From various conversations  I had with knowledgeable people ,  I understand that  the World Food Program sent  large quantities of  food stored in Cap to Port au Prince. Basically the food that is badly needed here in the north went south to Port au Prince as the refugees were moving North.

The health  problems  of the refugees are not as spectacular as the situation in Port au Prince during the first week post earthquake. It’s  less visible in pattern and content but still with a large amount of suffering, heavy burden  on the weak health care system and potential far reaching  public health consequences.

Infectious diseases (including HIV and TB ), nutritional issues, psychological traumas , infected wounds and  other common  chronic illnesses like diabetes and high blood pressure  ,  are on the list of prominent health problems  .An increase in the load of patients at the family practice center is already noticeable as this is one of the  major  referral services for the refugees. Health education,  counseling  and screening  for prevalent infectious diseases and nutritional problems are performed as needed.   The bio psychosocial approach  at the Family Practice Center at HUJ  is  very suitable to address comprehensively the health needs of these patients /victims.

Some critical medical assistance components being  planned  or already initiated included :

  • Strengthening of  of an embryonic program for psychoemotional support at Hopital Justinien  for the personnel and the victims. Dr Genna, the co-director of the residency program at the family practice center has led this initiative during the second and the third week post earthquake . The program  will need to be strengthened
  • Implement the surveillance system designed by the MOH and its partners
  • Contribute in  optimizating the coordination of the response at HUJ
  • Provide long term ( at least one year ) comprehensive medical care at the Family Practice Center to the victims / refugees
  • Assist HUJ in establishing a step down ( long term integrated  post op unit ) providing  an array of services to the patients: nutrition , wound care , psychoemotional support and physical therapy.

The center of the crisis is being displaced from Portau Prince to the major provincial towns and their surroundings. The crisis is now on the multipolar mode and Cap Haitien is progressively feeling  part of the brunt of the redistribution  of this human catastrophy . What is happening now in Cap is probably happening also in Gonaives , Les Cayes and other major cities of the country . The string of events is a very dynamic one with a changing nature and geography  of the needs to be promptly addressed to prevent further deterioration ( physical , mental and social ) in the victims condition.

We currently need volunteers physical therapists (technicians and physicians) and post trauma and post surgical counselors for psycho-emotional support for 1 to 2 weeks stints. We will provide room, meals and transportation in Cap-Haitien.

Please contact Dr. Andre Vulcain at 305-243-2764 ( office in Miami ) • 305-799-0276 (cell phone ) for arrangements.

Andre Vulcain , MD

Faculty Liaison of the Haiti Project

Department of Family Medicine

University of Miami Miller School of Medicine