Latin America & the Caribbean

By Genevieve Bitter, Direct Relief's director of international operations. Genny is traveling in St. Vincent & the Grenadines on assessment visits, where she has met with Mr. Lanceford Weekes, Permanent Secretary for the Ministry of Health, and several of his associates.

Kingstown, St. Vincent
May 5, 2010
I am so impressed with the health system implemented in this tiny country. There are 39 health centers which offer basic primary care services; these centers are regional and are no more than three miles apart. There are five district hospitals in addition to Milton Cato Hospital, which is the largest and acts as the referral facility. The Ministry of Health is in the process of opening three polyclinics to ease the pressure on the emergency room and trauma center at Milton Cato (visibly labeled as “Fresh Wounds”).

Milton Cato Hospital offers a wide range of services including surgeries, lab tests, radiology, dental, ophthalmology, maternity, and geriatrics. It is equipped with three operating theaters, but it is by no means a state-of-the-art facility. These are the tropics, so things are rusty and dilapidated but the services the hospital provides are consistent. The fact that there is always a radiologist available impressed me when so many facilities only offer part-time access to such services.

Another unique component of the hospital is its commitment to and treatment of asthma patients, which is how Direct Relief first came to know the facility. The hospital holds an asthma clinic once a week where the staff can see returning patients--mostly children--and adjust their medication if necessary. In the emergency area, there’s a bench with built-in nebulizer stations where patients can sit and receive treatment when having a respiratory attack.

Mr. Emmanuel Jones is a trained nurse and pharmacy technician who now manages the inventory system at the Central Stores. He showed me how he logs and distributes our product and pointed out our supplies in the hospital. From his nursing perspective, he knows how desperate they can become for hospital necessities, so he works very hard to get the goods out swiftly and accurately. Our donations not only go to Milton Cato, directly across the street from the main Central Store, but they are delivered to all of the hospitals and health centers as needed, so we are really helping to equip the entire country. Emmanuel also showed me in their log records that they were down to just five IV sets when our donation was received, boosting the stock to more than 2,000.

What I like best about Direct Relief’s relationship with St. Vincent and the Grenadines is that we are the primary source of medical donations for them, they know the quality of our goods on a personal level, and our donations have literally saved lives and also enabled them to use their budget for drugs for chronic conditions--diabetes and hypertension are widespread here. Allowing people to have piped water in their homes is a good thing but also took away daily exercise. The shift away from backyard farms to eating more convenient refined foods has clearly contributed as well.

From the clerks in the Medical Stores to the nurses to the Ministry level, all were deeply grateful for our relationship and are eager to continue. I am leaving here very proud of our work and have seen direct results of the quality donations we provide...and with a list of what they'd like to see in the future. 

Saturday, January 23, 2010 at St. Damien Hospital, Haiti

Working in Port-au-Prince to facilitate logistics in Haiti and help our partners there, Brett Williams took this photo at St. Damien Hospital, a pediatric facility that has been treating a large number of adults and children injured in the January 12 earthquake. “The staff is treating patients under tarps,” Williams reported today. “They had so many patients the only place they could treat them was in the courtyard.”

Listen to a radio interview with Brett Williams from Haiti, broadcast this morning on KGO-AM, San Francisco

January 18, 2010 - 2 pm

Direct Relief staff members Brett Williams and Nate Brock are in Haiti coordinating logistics and relief efforts there. Williams' comments from Port-au-Prince follow:

We have been able to organize the piles of medical supplies for the tent hospital that has been established in two large tents at the UN compound, where dozens of volunteer physicians from the States and several from France are working nonstop. Staff from the University of Miami, and a team from New Jersey were among the many who had been at it for days – sleeping onsite on crates.

Sunday evening, patients with serious injuries, including open compound fractures, were still arriving to be seen for the first time.

As we work to organize the resources already here, we are receiving site level assessments and reports from our partner health facilities – all of them are draining supplies fast and need replenishment. The in-country logistics for distribution, essentially from the airport outward, are pinched. We are focusing on the medical-supply channels, but food, water, fuel, patient transport, and every other type of transport and distribution function also is urgent.

Former President Clinton is here today, and we were with him at the hospital in Port-au-Prince. We have connected with Partners in Health and will work together to assist St. Damien Children’s Hospital. The pre-positioned emergency medical supplies we provided to St. Damien months ago in anticipation of an emergency (which we thought would be a hurricane), was a good call. But they need more, as do other partners, just to keep up.

Report From Haiti -
By Brett Williams, Director of Emergency Response
January 18, 2010

We have been able to organize the piles of medical supplies for the tent hospital that has been established in two large tents at the UN compound, where dozens of volunteer physicians from the States and several from France are working nonstop. Staff from the University of Miami and a team from New Jersey were among the many who had been at it for days – sleeping on-site on crates.

Sunday evening, patients with serious injuries, including open compound fractures, were still arriving to be seen for the first time.

As we work to organize the resources already here, we are receiving site level assessments and reports from our partner health facilities – all of them are draining supplies fast and need replenishment. The incountry logistics for distribution, essentially from the airport outward, are pinched. We are focusing on the medical-supply channels, but food, water, fuel, patient transport, and every other type of transport and distribution function also is urgent.

President Clinton is here today, and we were with him at the hospital in Port-au-Prince (right). We have connected with Partners in Health and will work together to assist St. Damien Children’s Hospital. The pre-positioned emergency medical supplies we provided to St. Damien months ago in anticipation of an emergency (which we thought would be a hurricane), was a good call. But they need more, as do other partners, just to keep up.

Haiti: Babies Don't Stop for Hurricanes
Traveling through Haiti to finalize plans for Direct Relief’s Third Annual Hurricane Prepositioning Project, Senior Program Officer Dan Smith and Emergency Response Coordinator Brett Williams discovered that in the north, new mothers and their babies are most affected by last year’s hurricanes.

March 24, 2008
On Haiti’s northern coast there has been a spike in premature births—a trend you wouldn’t immediately attribute to the storms that struck six months earlier. Those disasters are long forgotten by everyone except those still struggling with their lasting effects.

Haiti’s northern departments are the country’s poorest and most vulnerable, where about 75 percent of people live on less than $2 a day. The northern departments are dependent on commodities from the capital, Port-au-Prince, and are linked by one low-lying road on the coast that passes through Gonaives. It repeatedly bears the brunt of hurricane damage.

In St. Louis du Nord, we visited North West Haiti Christian Mission’s Birthing Center, which averages about 85 births a month. The clinic receives nutritional products from Abbott, which are critical for these mothers and babies.

At the clinic we met Rose Cardene. Rose had recently given birth to a beautiful baby boy, Standley, days before we arrived. Standley was premature, born weighing less than 3 pounds.

Premature birth is increasingly common in northern Haiti, where a food crisis lead to violent protests last spring and hurricane damage to crops caused the price of food to skyrocket. This left adequate nutrition out of reach for many pregnant women, placing additional stress on their already stressed bodies. Donated nutritional products become a lifeline for these women and their babies to be.

Adding insult to injury, aid delivery was severely hampered following last year’s four consecutive storms in as many weeks that killed more than 800 people, causing massive flooding and damage in their wake. With roads and bridges completely washed out, people in the north were forced to fend for themselves.

Now, in late March, a full month before the start of the rainy season, daily rains are making people in the north very nervous; memories of last year’s storms are all too vivid. It’s hard to image life in rural Haiti getting harder than it already is, but all you need to do is add water.

We are here planning our Hurricane Module distribution for the 2009 season, which will include Haiti. Clearly the need here is great.

Last year, hurricane modules were prepositioned in Texas, Louisiana, Mississippi, and Alabama in the U.S., and in Jamaica and the Dominican Republic in the Caribbean. The modules contain essential antibiotics; nutritional products for children and adults; oral rehydration solutions; and supplies for wound-care and water purification, all selected to help local healthcare providers meet the surge of additional patients while also caring for existing patients.

Having these modules in place before hurricane season starts will help protect vulnerable populations like pregnant women and their babies should a hurricane strike. Nutritional products give premature babies a chance at survival, despite challenging circumstances. 

Direct Relief provided more than $2.3 million (wholesale) in aid to Haiti following last year’s hurricanes. The organization is committed to providing essential medicines and nutritional supplies as long as needed following an emergency—because pregnancy doesn’t stop for hurricanes.  

Senior Program Officer for Latin America and the Caribbean Dan Smith and Emergency Response Coordinator Brett Williams are traveling throughout Haiti to visit clinics and hospitals Direct Relief International currently supports as well as potential new partners. Smith and Williams are also finalizing plans on expanding Direct Relief’s Hurricane Preparedness Program, which will include Haiti this year.  

Wednesday, March 18, 2009
We got on the road early this morning to avoid the daily traffic jam that so painfully congests Port-au-Prince, Haiti’s capital. Port-au-Prince is a sprawling city of winding roads, green foothills, and shanty towns along what must have once been a beautiful coastline. As Haitians move from rural areas to the capital in search of work and a more prosperous life, the true poverty of this nation becomes apparent. Although the numbers are different in each district, roughly 80 percent of Haiti’s population lives on less that $2 a day.

The slums, such as the infamous Cite Soleil, are bursting at the seams with people and the byproducts of human life. Rivers that empty into the sea have become collections of every kind of plastic imaginable, and with the slightest rain the streets are a soggy collection of trash and mud. Our car slips through the streets of Carrefour, another downtrodden district south of Port-au-Prince, as we try to avoid the lively collection of vendors selling sodas, fried plantains, charcoal, and used clothes on our journey south.

We are heading along Haiti’s southern arm to the city of Petite Riviere de Nippes, where a very determined group has built the Visitation Clinic. As the name suggests, the hope is to have visiting doctors come and share their expertise with the Haitian staff, building the knowledge base of local doctors, providing specialized services, and helping to expand the services the clinic can provide. 

Arriving from the U.S. more than 10 years ago, a group of volunteers from the Parish Twining Program, which connects parishes from the U.S. with those in the Caribbean, visited Petite Riviere. They soon realized the immense need for health services, and under the leadership of one volunteer, Teresa Patterson, a foundation was created to help address the problem. The Visitation Foundation was born; regular trips of medical professionals to Petite Riviere were established with the goal of building a permanent clinic run by a Haitian medical staff and available five days a week all year long.

For the past five years, Direct Relief has supported the efforts of the Visitation Foundation with donated medicine and medical supplies hand-carried to Haiti during medical missions. More recently, with the clinic fully functioning, Direct Relief has provided the first of many large-scale donations of specifically requested products.      

After a bumpy four-hour journey along dirt and semi-paved roads, we arrived to see the beautiful clinic perched on a hill above the town. The clinic was completed in January 2008 and has already seen over 15,000 patients. When we arrived, the waiting area was full of people, mostly women and children, who start lining up for service at 4:30 a.m. The medical staff is usually able to treat 80 or 90 people a day, and is on-call 24 hours in case of an emergency.

The Visitation Clinic has another unique quality: It’s 100 percent sustainable. The clinic is powered by solar panels on the roof and thus saves a massive amount of money on energy costs and the use of fossil fuels to operate generators. It also has a backup generator in case of an emergency.

Its remote location brings the challenge of referring patients with specialized needs. The clinic has worked very hard to establish relationships with specialists throughout the south and as far as Port-au-Prince, creating a billing service that allows patients to be seen elsewhere without having to pay on the spot because the Visitation Clinic pays the bill at a later date. The Foundation’s long-term goals include building a full hospital on their five acres of fenced land to keep up with expanding patient needs and to avoid having to refer patients to health facilities in Port-au-Prince.

After a short walk to the center of town with the clinic administrator, it’s obvious to us that the community supports the clinic’s work. We were unable to get 100 feet from the gate of the clinic without kids and parents offering their hellos and kids wanting to hold hands and walk with us. By the time we returned to the clinic, it looked as if a small parade had taken place. The clinic has brought healthcare to Petite Riviere, but also hope.

The journey to the Visitation Clinic made us extremely proud to know that the long-term commitment Direct Relief has to helping the people who just need a little boost pays off. The hard work is done by those on the ground, and we feel grateful to be a part of such a wonderful program. The project has grown into one of the best we have seen in Haiti and is completely run by Haitians with the exception of one staff member. Access to health services has been improved in Petite Riviere de Nippes and the goal of equal access to health services for everyone—no matter where you are born—is a little closer.

August 19, 2007
By Dr. Julio Sotelo

[NOTE: Dr. Sotelo is a physician with Direct Relief partner Peruvian American Medical Society and chairman of their Missions Committee.]

I was in Lima the 19th of August, returning from Abancay when Mariel Pineda for APCU invited me to collaborate on a trip to Southern Peru to visit the earthquake victims.  The Civil Defense Institute (INDECI) was stationed in Pisco, the most damaged town.

There have been many donations of medicine, food and other things from many countries.  I saw planes from Colombia, Brazil, the United States and Spain, which left at any moment of the day without interruption.  I helped organize the donations and register them in the computer.

The Commandant, Carlos Barandiaran, who is in charge of the base, offered me a flight to Pisco.  I immediately accepted and flew down with the Colombian Air Force with 15 other people on top of a shipment of Gloria milk cartons.  In Pisco, James Atkins of INDECI was in charge.  He assigned me to Angel Montesinos to help me inspect the town, the hospital and the emergency room.

We took a 20 minute drive to the town of Pisco in a MINSA truck.  During the drive I saw that at least 50% of the brick houses were destroyed and those that were still standing could not be used for the risk that they might collapse.  Due to this, many people are in the streets, some underneath plastic.  I saw no tents.  The driver and my companions advised me not to travel with the windows down and to lock the car door because in the past few days people had been approaching vehicles looking for water and food.  No one approached us this time.  All the streets were filled with people.  There was no water or plumbing, nor were any restaurants or hotels open.  All the stores were closed and many streets were impassable due to the debris.  There were no taxis or buses. 

We arrived at the hospital, which was completely destroyed.  A taxi driver told me that, a few days ago, a group from NBC reported seeing bodies lying in the debris with a stench in the air.  I did not see or smell this, only people wearing masks.  I was told a group of Spanish volunteers had removed the bodies.  No one could tell me if survivors were found after the earthquake among the rubble.  The emergency wing was recently finished and was to be inaugurated the week of the earthquake and it had to be used as the only site to attend to the people with head injuries, broken bones, and anxiety attacks.

After the hurt were stabilized, they were helicoptered to Lima.  Dr. Rosa Vicuna was in charge of the hospital wing.  There were five doctors working in shifts of 12 hours, leaving between two and three doctors in charge of the emergency wing. Dr. Vicuna said that the center had four stretchers, that they needed a well equipped ambulance, first aid supplies, and antibiotics.  I reiterate the need for an ambulance.  It was relatively calm in the emergency wing, with patients in stretchers.  There were coffins on top of each other in the entrance.  I estimate that there were about 100 coffins.

Dr. Vicuna said that the volunteer Cuban doctors had coordinated 34 shelters in the town.  She asked me that no blood be sent to the emergency wing because there was no way to store it.

It seemed that all the emergencies had been attended to in the first few days following the earthquake that occurred on Wednesday, August 22 at 6pm. The differences between the destroyed hospital and the intact emergency wing is a reflection on the differences between some of the houses in the town being completely destroyed and others left untouched.  Civil engineer Lourde Gomez of the INDECI explained to me that this occurred partly to the subsoil in Pisco and to the faulty construction by many people, who did not follow the building codes, instead building “a la criolla”—on their own.  The poorest people suffered the most.

The base of operations is located in the Pisco airport, which is receiving flights from Lima day and night.  There are free flights to Lima but the waiting list is very long.  The nights are cold.  Many families with children were going to Lima, but the majority of the population does not have family or the means to leave the town.  It reminded me of New Orleans and Hurricane Katrina when many of the poor people could not evacuate the city due to similar reasons.

I ran into Carlos Vallejos Sologuen, the Minister of Health, who has been working in Pisco at the airport.  He offered me his driver to return to Lima, but the trip usually taking four hours, has extended to more than six due to road damage.