Milot's Forgotten "Tent City"

Jonna Knappenberger <jonna.knappenberger@gmail.com>:
*
Milot's Forgotten "Tent City"*
October 24, 2010
Originally published on Haiti Rewired
<http://haitirewired.wired.com/profiles/blogs/milots-forgotten-tent-city>

Cap-Haitien is Haiti's second largest city, and sits on the northern coast, six
hours' drive from Port-au-Prince. Ask anyone here where they would take a
sick or injured relative and they would tell you that the closest hospital
is the state-run Justinian, in the center of town. Just as likely, though,
they'll tell you that they would prefer to take a sick person to the Hôpital
Sacré-Coeur, a small, private hospital located less than one hour away in
the town of Milot.

It was this hospital that received hundreds of earthquake survivors in the
days, weeks, and months following Jan. 12. When I arrived in Cap, I kept
hearing stories about the survivors still bustling at the doors of the
Sacré-Coeur,
living in what people claimed was a huge, infested tent city overwhelming
Milot. I went to the hospital to see for myself on Oct. 9.

Sacré-Coeur, which opened its doors in 1987, is run by CRUDEM (Center for
the Rural Development of
Milot)<http://www.crudem.org/hopital-sacre-coeur/faq-2/>,
a private, non-profit Catholic organization based in Boston, Mass. A
permanent committee of five Haitian professionals runs the day-to-day
affairs, but the hospital is often host to groups of volunteer medical staff
from the U.S. The hospital at Milot has also worked in tandem with a group
of Catholic nuns since 2000.

*Responding to Disaster*

The Milot I saw was quiet and calm. I sat down with the Chief Medical
Officer, Dr. Harold Prévil and Chief Financial Officer Raymond Delnatus, who
told me that only 20 patients remained in Milot from the Port-au-Prince
earthquake, though at one point, they had served some 500.

The Sacré-Coeur started receiving earthquake survivors on Jan. 16, the first
three arriving by helicopter from the medical ship, USS Comfort. According
to Prévil, 90-95 percent of Sacré-Coeur's earthquake patients were
transferred from other
hospitals in Port-au-Prince, and even as far away as Jimaní in the DR. Upper
or lower limbs were amputated on 40-45 percent of the patients.

Prévil said that two functional operating rooms have been in continual use,
an additional third room opening for only a week. He estimated there were a
few weeks when surgery lasted from 8 a.m. to 10 p.m. every day. All amputees
were provided with prosthetic limbs, some of which came from a “prosthesis
lab” in a metal shipping container built by a doctor from Florida.

Before the earthquake, the Sacré-Coeur was a 64-bed hospital, Prévil told
me. They added 300 beds by borrowing space from a local school and by
setting up six donated tents, each holding 35-40 beds, across the street
from the main hospital campus.

Prévil insisted that the additions were not *abwi pwovizwa* (temporary
shelters) or a “tent city,” as I was told. Instead, he explained, the tents
were an extension of the hospital, treating and discharging patients.

The hospital normally charges for health services, but the care provided for
earthquake survivors was free. Upon discharge, CRUDEM provided one small
tent to each family, and the last 200 people to leave each received $100
(US) from Jesuits in Miami, Prévil said. A bus donated by the mayor of
Cap-Haitien transported the survivors back to the capital.

“It was hard for them to leave when they were discharged, but we have to
function as a hospital and not a refugee camp,” Prévil said. “We have to be
a police officer too, to carefully watch all of our supplies, because people
will take what they need.”

*An Uncountable Death Toll*

Prévil himself was a survivor of the earthquake in Port-au-Prince and
decried the lack of response to the crisis as it unfolded, something I
witnessed as well. He said he identified himself as a doctor to the Haitian
police, but was told they were not allowed to do anything.

He criticized foreign medical teams for ignoring what he called “the Haitian
context” of the disaster. He described Port-au-Prince as the scene of
rampant malpractice. Many of the triage decisions made there, he continued,
turned into infections, multiple surgeries, amputations, and unnecessary
deaths. “The death toll from a disaster can never be correct. It will always
be under-stated.”

*A Welcomed Response*

American medical teams made the work of the Sacré-Coeur possible, but the
most critical response, Prévil said, was that of the people of Milot.
Contrary to what many residents in Cap-Haitien believe, there was no
resentment among the residents of Milot. The town rallied around the wounded
– they brought food, held bedside services, and comforted the lonely.

Sister Maureen, a nun of the Sisters of Saint Joseph of Peace, spoke of the
generosity she witnessed from the Milot townspeople. Children would arrive
with pieces of tape on their foreheads, marked with their names and ages,
many of whom were separated from parents. The Milot people adopted these
children – and all patients – with open arms.

“We saw a woman washing a girl's hair, so we asked her, 'Is that your
daughter or sister?' She replied, 'No, she's from Port-au-Prince, and I'm
from Milot.'”

One child, Sister Maureen told me, had no name, but was given a name and
almost immediately taken in by a Haitian family. A few weeks later, a doctor
from Milot, visiting Port-au-Prince, happened to find the parents of the
child, and with the help of the International Red Cross, he was transported
back to his hometown, but not without tears from the residents of Milot.

Originally from England, Sister Maureen had been in Milot for only three
months when the earthquake struck. She and Sister Ann were previously
teaching English to local children, but volunteered to sort casts and
supplies, distribute donated clothing, and keep medical records of the
patients at the hospital. She told us that other groups, such as the Vincent
de Paul Society, Jesuit Refugee Services, and Project Hope, were also
integral to the hospital's work.

*Allocating Scarce Resources*

Both Sister Maureen and Dr. Prévil described the emotional trauma of limited
supplies and life or death decisions. Prévil described a situation in March
when only one ventilator (an anesthesia machine) was available, and keeping
a severely brain-damaged patient alive. At least ten other patients were
waiting to use the same equipment, and oxygen supplies were running low.

In line with the Catholic mission, the priests, nuns, and volunteers
believed that the top priority was not letting the man on the ventilator
die. But saving this life meant putting the others at risk. In the end, the
family chose to free the ventilator for use.

“Sometimes it was life or death, and other times it was life-saving versus
limb-saving,” Sister Maureen explained. “Everyone went through such
emotional trauma.”

This experience forced the staff to reevaluate the hospital's logistics and
supplies. They later acquired new ventilators and installed a machine that
produces oxygen across the street from the hospital.

*The Next Response*

Sacré-Coeur sees 56,000 to 57,000 patients every year, 50 percent of whom
come from the Cap-Haitien metropolitan area. Since most care is primary
care, Prévil said the hospital is planning to build a nursing school and
research center in the next few years, to train nurse practitioners to
provide these basic services.

As for future disasters, Prévil says the Sacré-Coeur is prepared to
immediately receive 60 to 100 people, and that they are prepared for the
first three weeks of a disaster comparable to the earthquake.

I tried to contact Dr. Prévil yesterday, and plan on getting in touch with
him in the next few days to ask about the cholera situation