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January 22, 2010

Haiti: From Chronic Despair to Catastrophe

They came to Haiti to research interventions for iodine deficiency, and found themselves helping those wounded in the catastrophic earthquake. They had little more than Band-Aids, cardboard and ibuprofen.  

The four researchers, masters’ students at the Johns Hopkins Bloomberg School of Public Health, had planned to spend three weeks gathering data on the country’s endemic iodine deficiency. (Its prevalence among school-age children reaches 50 percent  in urban areas and 75 percent in rural areas. (Iodine deficiency causes goiter and mental impairment, congenital retardation, and stillborn births.)  Then, on January 12, the earthquake that razed Port-au-Prince left the city teeming with injured adults and children. The students— Jane Andrews, Remle Stubbs-Dame, Laalitha Surapaneni and Andrew Tyan—then improvised supplies and invented practices that could wring more efficient aid from a strained system.

laalitha surapaneni in haiti

Bloomberg School student Laalitha Surapaneni splints an injured hand using cardboard.
Photo by Demeter Russafov (AMURT).

When the earthquake hit, at about 5 p.m., the four students were stationed in the Artibonite département (province). Surapaneni and Stubbs-Dame had been surveying citizens in Pont Sonde about their knowledge of iodine, while Andrews and Tyan had been interviewing salt producers in Anse-Rouge about the challenges to salt purification and iodine supplementation. Soon after the earthquake, all four were traveling by car with an American journalist, NGO volunteers and others headed to Port-au-Prince, where they would spend their first night on the driveway of a house that had collapsed completely, providing what aid they could muster with limited supplies.

Between Joy and Agony

Andrews describes approaching the city in total darkness, as the quake had knocked out all electricity: “First we began to see bonfires on the sides of the road, then the collapsed buildings. People were singing together—spiritual songs—and there were songs coming from both sides of the street, people were filling the streets.” Organized around bonfires, Haitians were singing, doing call and response prayer, shrouding their dead.

Throughout that first night, the students heard shouts as people searched for their friends and families and found each other, dead and alive. “The visceral cries we heard from women on the street all sounded the same, whether from finding alive a relative thought lost, or from finding a child dead in the rubble,” said Stubbs-Dame. In the uncharacteristically cold night, they heard people yelling themselves hoarse to be rescued from rubble. Said Surapaneni, “All night long, people were wailing,”—“Keening,” said Stubbs-Dame—“Nobody slept.”

Old-Time Medicine

With almost no resources, the students did what they could to provide stop-gap medical care for the wounded. Using candles and headlamps for light, they provided basic wound care. Some of the injured—such as the young woman with a fractured pelvis—were beyond their capability, but the students were able to clean wounds and fashion makeshift splints for many others. For disinfectant, they used Dominican rum; for bandages, they used a cloth flag purchased as a souvenir.

For the next two days, the students stayed at an orphanage run by Ananda Marga, a nonprofit service organization, and by Friday they moved to Matthew 25 House in the Delmas district. They worked with doctors and nurses to provide aid in relief camps set up on soccer fields and on the Prime Minister’s lawn. Without sufficient antibiotics, pain medication, casting or gauze, they used what they had: tabs of ibuprofen, Cipro (a travelers’ diarrhea antibiotic), lidocaine (a topical anesthetic) and Band-Aids from first aid kits. “Every doctor and every nurse put on gloves and didn’t leave,” said Andrews. “With humble tenacity,” said Tyan, the Haitian doctors and nurses labored without rest, day and night.

Ad Hoc Research and Practice

In addition to the sheer volume of the suffering, the city’s impaired communications systems further challenged the situation. In order to create and organize data, Stubbs-Dame helped with a “crack survey” effort to quantify the needs, rates of injury and death, chronic illness, status of food and water and the percentage of children in camps in one of the most impoverished neighborhoods in the hard-hit Delmas district. On Friday, she worked on a list of pharmaceutical needs that could be directed to organizations wishing to bring in supplies.

Surapaneni, who has a medical degree, Andrews and Tyan and continued to work with patients in the camps and created patient information sheets in English in order to save translation time and improve care; these case sheets, carried by the patients themselves, could be given to care providers in hospitals and to emergency personnel arriving from other locations.

The daytime temperatures were in the 90s, and by the third day, people kept cloths over their noses against the corpses’ smell. They began to see wounds that were infected and festering. One of Surapaneni’s patients revealed a severe foot wound with live maggots embedded in the flesh. But along with the futility of treating fractures with ibuprofen and treating wounds impossible to fully clean, Tyan says, “there were also some victories,” some infections treated or staved off with the barest of supplies.

The dead were organized and shrouded on the streets. Surapaneni describes walking on the street and encountering a shrouded child, tied to a plank. “It totally caught me off guard,” she said. A week later, “I still don’t know how to respond to that.”

On Saturday, the four students went home. From Baltimore, they are working to raise funds to buy supplies for relief efforts and to meet long-term needs. With chronic, long-term public health challenges, such as the iodine deficiency the students had begun to research, one in five Haitians dies before reaching age 40. Iodine supplementation is one of the most cost-effective public health interventions in the world, and it has not reached Haiti. Andrews, Stubbs-Dame, Surapaneni and Tyan want to see that the country gets more than just short-term aid.

—Christine Grillo

Watch presentation by the students as they recount their experience in Haiti

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