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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International Medical Corps to Lead PREPARE Team As Part of USAID Pandemic Threats Effort; Project to Focus on Improving Coordinated Emergency Managem

November 2, 2009, Los Angeles, Calif. – International Medical Corps is pleased to announce its participation in a three-year, $6.65 million contract awarded by the United States Agency for International Development (USAID) Bureau for Global Health to strengthen the human capacity of countries to identify and respond to outbreaks of pandemic diseases in a timely and sustainable manner. International Medical Corps leads a distinguished team including Global Deterrence Alternatives (GDA), TriMed Inc., MedPrep Consulting, and World Learning.

The project, called PREPARE, is part of the USAID Emerging Pandemic Threats Program – a specialized set of projects that build on the successes of the Agency’s 30 years of work in disease surveillance, training and outbreak response. The other projects in this USAID Program are PREDICT, IDENTIFY, RESPOND, and PREVENT.

PREPARE will focus on the provision of technical support for simulations and field tests of national, regional and local pandemic preparedness plans to ensure that countries have the capacity to implement response plans effectively during pandemic events. This agreement adds to USAID’s experience in the planning, design and implementation of tabletop and field drill simulations to enhance the preparedness of countries and regions against Avian and Pandemic Influenza.

PREPARE will employ a unique eight-step approach, combined with best practices and lessons-learned, to deliver training, simulation exercises, and evidence-based decision support. Its goal is to create capacities based on continuous refinement and enable countries and regions to reach higher levels of public health preparedness against infectious diseases with pandemic potential.

“International Medical Corps’ 25-year track record of response to large-scale emergencies in resource-challenged environments worldwide places us in a unique position to lead this kind of innovative initiative,” said Stephen Tomlin, Vice President of Program, Policy and Planning. “Staging pandemic simulation exercises that incorporate all sectors of society will enable us to create strengths upon which communities, counterparts and collaborating government ministries can offset the impact of pandemics through effective emergency management, and to take control of their own destinies by working together.”

International Medical Corps and its partners are well aware of the global health challenge presented by the spread of emerging infectious diseases and the potentially catastrophic direct and indirect human and economic consequences they bring. International Medical Corps has a long history in more than 50 countries around the world, responding to emergencies affecting large populations. In creating this PREPARE Simulation and Exercise Team, International Medical Corps complements its broad experience in international public health and emergency management with partners whose track records reflect state-of-the-art exercise development practices and tools for evidence-based decision support and strong experience in setting up field training exercises worldwide. The resulting PREPARE Team’s organizational capability provides USAID with a cycle of continuous refinement for “whole-of-society” approaches to pandemic preparedness at country, regional and international levels that is inclusive of U.S. government partners and U.N. agencies, civil society, host country governments, and international organizations and NGOs.

International Medical Corps is a global, humanitarian, nonprofit organization dedicated to saving lives and relieving suffering through health care training and relief and development programs. Established in 1984 by volunteer doctors and nurses, International Medical Corps is a private, voluntary, nonpolitical, nonsectarian organization. Its mission is to improve the quality of life through health interventions and related activities that build local capacity in underserved communities worldwide. For more information visit our website at www.imcworldwide.org.

International Medical Corps Aids Wounded in Deadliest Iraqi Bombings Since 2007

Responding to the deadliest coordinated attack in Iraq since 2007, Emergency Medical Technicians (EMTs) and physicians trained by International Medical Corps, provided life-saving assistance in central Baghdad. The two near-simultaneous suicide car bombings on Sunday caused massive destruction to the Ministry of Justice and surrounding buildings leaving more than 150 people dead and close to 600 wounded.

International Medical Corps-trained EMTs, working under the direction of the Ministry of Health, responded immediately to the scene to provide care within minutes. They administered emergency aid to patients scattered among the wreckage and transferred them to ambulances where they were rushed to local Baghdad hospitals.

Medical City hospital complex, which houses the closest hospital to the attack, received more than 150 of the wounded. Newly trained EMTs and their International Medical Corps trainers stopped in the middle of a certification ceremony, which was being held at the hospital, and rushed to aid the victims. Using the life-saving trauma techniques they had just learned, students resuscitated the wounded alongside International Medical Corps-trained doctors staffing the main receiving hospitals.

Madhafar Muhammad, one of the EMT trainees said, “We suddenly went from finishing the class to using our training on real injured people…they had blast wounds to the head, chest, and abdomen. The skills we learned in the International Medical Corps class were very, very helpful. We didn’t know [how] to do any of these things before.”

Despite a history of violence and trauma in the country, formal emergency care was previously very limited in Iraq. Over the last two years, International Medical Corps, with funding from Australian Agency for International Development and in cooperation with the Iraqi Ministry of Health, implemented a national emergency medical care development initiative for the country. This program is the first in-depth attempt to renovate the civilian emergency infrastructure. To date over 700 EMTs and 200 physicians have received training.

“This is a perfect example of how training and infrastructure strengthening can provide both immediate emergency response and sustainable health care improvement,” noted emergency medicine professor and program director Dr. Ross Donaldson. “Our hearts go out to the injured and their families.”

International Medical Corps has been working in Iraq for the past six years, creating sustainable initiatives focused on health care, humanitarian assistance, capacity building, and community engagement.



Since its inception 25 years ago, International Medical Corps’ mission has been to relieve the suffering of those impacted by war, natural disaster and disease, by delivering vital health care services that focus on training. This approach of helping people help themselves is critical to returning devastated populations to self-reliance. For more information visit our website at www.imcworldwide.org.

Facing Another Deadly Outbreak in Zimbabwe, International Medical Corps Launches Emergency Water and Sanitation Project to Prevent the Spread of Chol

International Medical Corps has launched an emergency water and sanitation campaign in Zimbabwe in anticipation of a cholera outbreak that is expected to strike in the coming weeks with the onset of the rainy season. The project, made possible by the generous support of the American people, benefits 150,000 people living in three districts in Mashonaland Central, and works to reduce the spread of cholera by improving access to clean water as well as personal hygiene practices.

“The six-month project aims to prevent cholera through a comprehensive package of water and sanitation activities,” says Miel Hendrickson, International Medical Corps coordinator for the region. “This includes repairing water systems and latrines, providing water filtration systems, and educating households about personal hygiene activities.”

At the community level, International Medical Corps plans to improve access to safe water by repairing or protecting household and community water points and constructing latrines. At the household level, the project calls for the distribution of hygiene kits and bio-sand filters to treat and safely store water at home. True to its mission to provide relief and enable self-reliance, International Medical Corps’ water and sanitation initiative will engage the community through education and training on personal hygiene activities, maintenance of the water systems, and the project at large.

Nearly 100,000 cases of cholera have been reported in Zimbabwe since August 2008, with approximately 4,300 deaths. Earlier this month, International Medical Corps investigated two confirmed cholera cases and distributed 2,000 hygiene kits provided by UNICEF. International Medical Corps is now working to acquire additional kits in order to ensure effective and timely response in case additional cases arise.