Joseline Marhone is the face of Haitian optimism.

By Tyler Marshall

On Jan. 12th, the day of the earthquake, she lost loved ones and a comfortable home. Her prestigious job as Director of Nutrition in Haiti’s Ministry of Health quite literally dropped out from under her when the ministry itself collapsed. In short, her world turned upside down.

A respected physician who also teaches as the National University Hospital, Marhone didn’t dwell on her loss. She didn’t hesitate a day.

The morning after the quake, she opened an emergency clinic under a grove of trees adjacent to the wreckage of the Church of St. Pierre in the St. Louis area of Port au Prince, just a few miles from downtown and began treating the injured. Several of her medical students quickly joined her. A tent was erected, canvas sheets were put up to added more shade and mattresses were hauled in to create a 13-bed in-patient section to the clinic.

Now International Medical Corps is supporting the clinic with a volunteer physician, medications and food for those who now reside in the makeshift neighborhood in and around the clinic.

Talking animatedly with a big smile, Marhone’s body language alone conveys the message that (1) the only response to the earthquake is to get on with rebuilding and (2) there’s no time to waste.

“We don’t have homes, we don’t have offices and we sleep right here at night and I’m practicing general medicine again,” she said with a big smile. “I’m available for anyone who comes here and we’ll stay for as long as we’re needed.”

Monday, the clinic treated about 60 patients—roughly half of them with earthquake-related wounds that require cleaning and new dressings. Physicians report a growing number of skin rashes, stomach problems and diarrhea—complaints that reflect the stress of maintaining good hygiene while living in the streets or in makeshift tent camps.

International Medical Corps’s support began just over a week ago when it provided a volunteer physician and badly needed medicines. Volunteer physician My-Charllins Vilsaint who is Haitian American, currently serves at the clinic along side Haitian physicians. Sunday, International Medical Corps delivered 2.5 metric tons of rice, beans, maise and vegetable oil to the residents of the little community—an action that clearly lifted Marhone’s spirits.

After treating the injured and sick for much of the day, at night, her commute is short: she sleeps under the stars at her clinic.

“It’s satisfying to be tending to patients,” she said.

Two Separate Cities

Nearly three weeks after the Jan 12th earthquake, Port au Prince has become two separate cities. In one, the bustle of daily life slowly resumes. In the other an endless swath of rubble, partially collapsed buildings, with roofs awkwardly canted, remains frozen in the moment of Haiti’s worst nightmare. It is dead.

In the living Port au Prince, petty traders have returned to the streets, selling just about everything from sugar cane to cell phone batteries. In the morning freshness, before the heat sets in, women carry buckets filled with the day’s supply of water on their heads back to makeshift shelters that have sprung up on sidewalks, in parks, football fields and other once-open spaces in the city. Men carry wooden poles, doors, and slabs of corrugated metal rescued from the rubble to build new, temporary homes.

At the main university hospital in downtown Port au Prince where International Medical Corps volunteer doctors and nurses tend the injured each day and the seven mobile clinics in outlying areas where our volunteers also work, earthquake-related wound care is now mixed with more mundane complaints of everyday medicine. Patients awaiting aftercare of earthquake-related wounds wait patiently next to head-ache sufferers.

Rubble has been cleared from most of the streets, traffic moves—or doesn’t. The influx of international aid groups, United Nations agencies and a small army of media has only added to a gridlock in central Port au Prince that was notorious before the earthquake. As darkness falls, the streets narrow further as city residents use white cinder blocks and chunks of concrete rubble to carve out their sleeping spots for the night.

And all around them the dead city of Port au Prince remains. Schools, hospitals, office-buildings, hotels and endless private homes squat lifeless and quiet--flattened into a fraction of their former size. That many are mass graves only magnifies their stillness.

Sometimes the two cities meet. Sunday morning a couple of house wives living in a tent camp across the street from the collapsed Presidential palace, found a practical use for iron rods of the formidable green-painted metal fence erected to protect the now-destroyed palace: they used it as a clothes line.

In medical parlance it’s called “revising”

In medical parlance it’s called “revising” – adjusting--and hopefully improving—an original treatment. Two and one-half weeks after the earthquake there is a spike in the number of revisions in clinics and hospitals in the Haitian capital as medical practitioners work in calm conditions to smooth out or repair procedures undertaken in the chaotic first hours and days following the quake, sometimes by people with little or no medical experience.

Perhaps the most unusual cases was a woman who came into an International Medical Corps mobile clinic during the past few days, with a severe head laceration bound together with her hair hair wrapped into a knot at the time and sealed with Super Glue.

“A perfect solution in emergency conditions,” said Emilie Calvello, who teaches Austere Medicine at Johns Hopkins Department of Emergency Medicine. The revision included cleaning and stitching the laceration closed—and removal of the Super Glue.

A middle-aged man at the same clinic underwent a revision procedure to remove an inch square chuck of concrete that was sown up into his scalp on the first night after the quake.

Work is also required to revise what one physician called guillotine amputations--where the leg is taken just above the ankle rather than below the knee--because it is faster and easier to perform. Often more of leg must be taken in order to facilitate cleaner healing.

Petionville

Port au Prince, Haiti -- On a small hill in the hard-hit Petionville area of the Haitian capital, International Medical Corps operates a mobile clinic to treat residents of a provisional tent and plastic-shelter community of 20,000 that has sprouted up in the days since the Jan 12th earthquake.

Residents are mainly those who lost their homes in the earthquake.

Saturday, International Medical Corps volunteer physician Marie-Alixe Kima and volunteer critical care nurse Simone de Brosse Adelugba worked with Haitian physician Charles Watson and a team of Haitian nurses to treat about one hundred residents of the new community. Both Kima and de Brosse Adelugba are Haitian American.

Working with their local counterparts, they conducted basic wound care to keep injuries sustained during the giant quake on the mend and other, more routine treatments. By the time the clinic opened, a large crowd of about 60 or 70 people, primarily women and children, had formed at the entry way waiting their turn.

The mother of a month-old, for example, expressed concern about her infant’s cough while an older woman completed of shoulder pain in what may have resulted from sleeping on the bare pavement of the streets.

As at other International Medical Corps facilities, two trends were visible that underscored the gradual but reduction in acute cases with the rise of more routine complaints:

- an increasing percentage of those seen were seeking treatment for non-urgent ailments.
- an increasing number of Haitian health professionals showing up in ever greater numbers.

The goal, said both International Medical Corps volunteers, was to work closely with local Haitian health care professionals so that it could eventually transition to take on greater responsibility.

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