Well, I'm back. I apologize for the lack of posts but the communications were sporadic and spotty, at best. It might actually be better to post after I get back anyway as it gives me a chance to organize my thoughts and pics instead of a daily log.

I will start with an overview of the mission and in the future posts discuss more including the injuries and surgeries we managed, the people of Jimani, the political situation, the volunteers and other topics.

I'll start with the IMA (International Medical Alliance). IMA long preceded the earthquake in Haiti, but their role drastically and immediately changed when the quake hit. In general and historically, the International Medical Alliance(IMA) is a nonprofit organization that provides medical relief and care to under-served and vulnerable people around the world through medical mission trips. They run medical mission trips to the Dominican Republic and Kenya (among others)and revisit each of the villages once a year to establish long term relationships. In the Dominican Republic, they provide care through day trips to remote villages termed Batays.
These are communities that surround the sugar cane plantations and were created by the Dominicans who populated them with haitians. The Haitains who live there are not Dominican citizens and any Haitian child born there is not given a Dominican birth certificate nor considered a dominican citizen. basically these people are stuck there and will never get out unless they go back to Haiti. These people live in abject poverty and may not receive any medical care other than that provided by IMA. The general medical mission for which IMA is known continues and happened to coincide with the week I was there. I am grateful for the opportunity to see that side of the organization and work with IMA's regular volunteers caring for the native population of Haitians.

Part of the mission of IMA included a new facility in the town of Jimani that was to be used as an outpatient clinic and another new building that is to be an orphanage. When the earthquake hit Haiti, the "clinic" was inundated with victims. They arrived by car, foot, helicopter, any way they could get there. Within days the facility at Jimani, DR was transformed into a hospital. The volunteers set up 4 operating rooms, patients were housed in large tents and some of the rooms in the clinic were designated as an intensive care unit. My fellow colleagues who were there in those frenetic weeks tell me of endless amputations, wound repairs and fracture fixations.
It was reported that they had approximately 500 patients, 25% of which became amputee´s, they hosted about 1000 volunteers both medical and non-medical, had 14-15 deaths and at one point had over 2000 people living on the compound.


The clinic turned Hospital at Jimani


Patient Tents


Pt tent in foreground, the foundation of a warehouse, and in the background a new orphanage building used to house early victims.

By the time I arrived it was 4 weeks after the earthquake and most victims had either begun to make a true recovery or had lost limbs or died. As a result, most of my work dealt with open, difficult and/or infected wounds and general medical and supportive care. Each day we were bused from our lodging in the nearby town of La Descubierta.

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Typically, we would operate in the mornings and see patients in the tents in the afternoons. During our rounds we treated wounds, coordinated care with the medical doctors, review their antibiotics and medications and arrange the next days operating schedule. We had ample time to interact with our patients and really get to know them. At the end of the workday, we returned to La Descubierta and had time to share experiences with the primary care teams returning from the Batays.


Inside the Pediatric patient tent


A part of the medical team heading out to a Batay

Our accommodations were simple but sufficient. One of the officials in the D.R. had opened his house in La Descubiata for the teams, but there were many more volunteers than this house could hold. Additional beds were found in the two hotels in town. No hot water, food was good but predictably rice and beans with occasional chicken or goat, and fruit. The officials at IMA had hired locals to cook and maintain the house.




Images of the town of La Descubiata


The Chow Line...he looks perplexed !!


Our Cooks and Caretakers

The next post will discuss the "hospital" and how it was set up and organized.

BRK

Finally in Jimani, 1AM Monday

One thing I won't miss!

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Thanks to all those who have stepped up to help, including vendors with supplies, my colleagues covering while I am gone and all the nurses at MetroHealth who have organized equipment. A special thanks to Miggy in the OR.
BRK

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Thanks to all those who have stepped up to help, including vendors with supplies, my colleagues covering while I am gone and all the nurses at MetroHealth who have organized equipment. A special thanks to Miggy in the OR.
BRK

Preparations continue for my trip. I spoke with the director of the clinic, Dr. Jeffries about some of the specifics. Apparently, between ground zero in Haiti and Santo Domingo there is little else that has any sophistication. As a result some of the more complicated cases are being referred in, while many others less acute moving out. Most of the work now seems to be wound care, revision and reconstructive surgeries.

The clinic/hospital is located in Jimani, DR and is due east from Port au Prince.


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I spoke with Dr. Benjamin Lind, a vascular fellow at Rush University in Chicago who came back from Haiti last week. He reported that conditions in Port-au-Prince were still quite severe and that, although critically important, the surgical care they could provide was limited by the conditions. His hope is that our situation, being a little removed and still able to maintain some organization will be most productive.

I also have been collecting materials and supplies needed for our efforts and for the IMA facilities. This is a fascinating social situation, and I heard about this recently on an NPR radio report. The outpouring of support has resulted in an influx of supplies, often so much that facilities are literally buried in materials. As a result, they can often not find the needed instrument or medication because it is buried somewhere beneath so much other stuff. Dr. Jeffries reported that they are only now finding some of the surgical instruments needed and that they are flush with sutures, dressing supplies, etc (at least for now). It seems that the most efficient way of contributing is money so your relief effort of choice can purchase what they really need, when they need it.

I have been on medical missions before and many of our colleagues volunteer regularly. There is a routine of leaving boxes around the hospital and OR where supplies that would normally be discarded are collected and delivered to the mission. While effective, I've learned this is not always the most efficient for the reasons I described above. I want to give recognition and congratulations to Medwish (www.medwish.org) a cleveland organization that collects these items, inventories them and will deliver the needed supplies upon request. I called them yesterday and they are truly a professionally arranged organization, very efficient and a pleasure to deal with. They fulfill a serious need and I thank them.

More to come.

Please visit the International Medical Alliance website: www.imaonline.org


BRK

It is with a combination of sadness and anxious anticipation that I set up this blog. The earthquake in Haiti has resulted in devastation and personal tragedy beyond compare in recent history. We all watch the events and aftermath unfold before us with a sense of deep frustration that we can not help more.

The purpose of this blog is two-fold. First and foremost to help spread the word about a wonderful organization that IS helping, the International Medical Alliance. I have only recently been introduced to the organization but already see that they are genuine. They have been in the area on the border of Haiti and the Dominican Republic for several years providing basic medical care and hosting routine medical missions. Their commitment started long before the earthquake!

They are in dire need of support. You can find them at www.imaonline.org.


Next, I hope to be able to chronicle the experience of helping the IMA. If the communications are sufficient I will send updates during our trip starting February 13th.

Thank you for any support.

Bram R. Kaufman, MD