February 16, 2010

Letter from Dr. Eva Lathrop Describes the Impact of the January 12 Earthquake on a Poor Neighborhood in Cap-Haitien, Haiti

 

Through a note from Cap-Haitien, we begin to understand the impact of the January 12 earthquake in an already underserved and impoverished neighborhood 85 miles from the epicenter. In this note to Dr. Michael Taylor, founder of Konbit Sante, Dr. Eva Lathrop, an OB/GYN, MPH currently living in Atlanta, shares some of what she saw and what she did during her recent working visit in Cap-Haitien.

Dr. Lathrop has been part of Konbit Sante since the group's first visit to Haiti in November 2001. She is an assistant professor in the Department of Gynecology and Obstetrics at Emory University School of Medicine. As chair of Konbit Sante's women's health team, she visits Haiti frequently to teach and to work with her Haitian counterpart, Dr. Youseline Telemaque, on programs to improve maternal outcomes. Her daughter, Bella, was born in May 2009.

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[January 27, 2010]

Dear Michael,

I have been in Cap-Haitien for several days, and as we pass the two week post-quake mark, it is ever evident that it was the right thing to do to come and to come here, away from the epicenter of the disaster, to a place where we, as trusted partners of the public health system here, can be immediately effective in response to the collateral damage the quake has caused to the community and the displaced victims from Port-au-Prince seeking refuge here.

	Dr. Eva Lathrop (second from right) talks with women in the Petit Anse neighborhood of Cap-Haitien about reproductive health needs.

We have been asked to coordinate all visiting volunteers at the hospital and organize all of the donated materials and supplies so that they can be used effectively. I am not very good at it but it was what was needed most, that and moral support, when we first got here. The rest of the time has been spent working closely with Dr.Telemaque on reproductive health related issues. Obstetrical emergencies, gender based violence, unintended pregnancies, HIV transmission, to name a few, can all increase during complex emergencies so we have been assessing the displaced population arriving in Cap-Haitien for their experiences and potential risk for these complications since the earthquake. We're in a unique position to help women new to the area access available healthcare services, and we've been trying to extend our assessment and coordination of care to as many women as possible. Remarkably, most of the women we've worked with have really wanted to talk about what they've been through, reproductive health related or not. Everyone is exhausted, hungry, thirsty and afraid and answer "Koman ou ye? (How are you?) with "M'vivant" (I'm alive). Everybody has their own story of tragic loss, near misses, survivor guilt, sheer, raw grief. The sadness is palpable, and the losses are unimaginable.

	Children play in the Petit Anse community on the outskirts of Cap-Haitien, Haiti. This neighborhood is one of several served by Konbit Sante-sponsored community health workers.

So many of the women we talked to are finding it difficult to hang on to any hope for the future. The ones who were in Port-au-Prince getting an education, for example, know that that was their chance, and now there is nowhere to go to complete it, and they are moving out to rural towns with a friend of a friend who has agreed to take them in. They have nothing, own nothing but what they had on at the moment the earthquake struck. No money, no documents, no photos. Others are staying with family in Cap in a household likely already stretched beyond what they could bear. Households that had eight people and enough food for five now may have 15 people and no additional support with the arrival of earthquake victims. Some people have lost everyone they know...and multiply what I heard by two million...it is just too much, really.

That said, I feel like one of the reasons I came down was to help keep our core mission going and our core programs going in the face of this catastrophe, so I
have spent some time out at Fort St. Michel community center and with the agents sante [community health workers] in their zones trying to figure out what the impact of the earthquake has been on them and their communities. Have they accepted displaced people? Have they seen their populations growing? We did a couple of focus groups in Petit Anse and, as you know, it is a community of the poorest of the poor, and they are really struggling with the increased price of food and the lack of even the teeny tiny money that some were receiving from family in Port-au-Prince. The saddest part is that they KNOW that no aid will be coming their way and that the little support they received as a community, whether it was food aid or vaccine campaigns, will all be shifted to the south. Somehow they still manage to smile, share small moments of hope, and find strength to persevere. It is remarkable and humbling. It is a privilege to be among them.

Fort St. Michel [health center] is okay now, but one big concern is the interruption of the ever-fragile supply chain. For example, the World Food Program is diverting all of their food stores in Cap to Port-au-Prince, and we don't know when they will resume food shipments to Fort St. Michel for the TB patients, pregnant and lactating women, and malnourished babies. Vaccines will also be diverted to Port-au-Prince, and again, the timing of resumption of services is anybody's guess. Assessing the community for these potentially harmful losses now will allow us to try and figure out how to continue to support these programs in the immediate aftermath of the earthquake and avoid adding to the already staggering number of victims.

I am pumping breast milk and donating it to feed two little malnourished babies in pediatrics, so that is making me feel better about leaving Bella and missing her. Coming here was the absolute right thing to do, I have no ambivalence about that, but leaving a breast feeding baby has been hard. I struggle with missing her, with whether or not I have to right to miss her...how can I miss her and feel sad about that when I HAVE her and li vivant, li manje, li secure (she's alive, she eats, she's safe)? It is all very complex and intense and a bit of a roller coaster - one part business as usual, one part nothing will ever be the same. Business as usual laced with catastrophe and a wounded nation.

But truly, the most compelling part for me has been witnessing the generosity of Haitians towards Haitians - the beautiful young volunteer spoon feeding a displaced girl her age who was nearly catatonic with shock and grief, cradling her head and rubbing her cheek slowly encouraging her to chew. It took her an hour to get her to eat a plate of rice and beans, but she stayed with her and provided her the only comfort she has had in weeks. It made me cry, the tenderness, the shared innocence. So, there is so much more, but this gives you the picture for now.

Miss you, and your wisdom, as always.

Love to both, Eva