The greatest number of deaths and injuries from Haiti’s 14 August earthquake occurred in the country’s southernmost region, the Sud department. Prior to this disaster, hospitals and clinics were already scarce in remote areas of Sud, and the earthquake damaged or destroyed many health facilities and roadways, making it difficult for survivors in rural areas to reach care quickly.

At the Immaculate Conception Hospital (HIC) in Les Cayes, the capital of the Sud department, our medical team is providing surgical and post-operative care to more than 90 patients through a collaboration with the ministry of health (MoH).

“We arrived in Les Cayes on 23 August,” says Prunau Mimose, MSF emergency nurse supervisor. “The hospital was overwhelmed. Children and adults were together. People were arriving at the hospital after several days with infected wounds.”

Surgery and post-operative care

Our teams began providing surgical, post-operative and psychosocial care at the hospital and installed seven tents with a total of 62 additional patient beds. The hospital’s post-operative care room, where Prunau Mimose works, has been full almost continuously since the earthquake. As soon as a patient leaves a bed, another patient arrives.

Mimose manages the nursing activity and the coming and going of patients. She praises the local volunteers who have stepped up to work in the hospital as well as the staff. “If it weren’t for the volunteers, our job would be harder,” she says. “They’re great people – they work nonstop.”

Many of the patients, especially those in the region’s mountainous countryside, had a difficult, long journey to Les Cayes.

“I was off to tend the cattle when suddenly the earth shook,” says Jean Nader Joseph, who goes by Dèdè. “I was with a friend, and he was the first to see the landslide. No sooner had he shouted, ‘Dèdè rocks are tumbling toward us!’ when a boulder hit him on the head,” says Dèdè. 

“He died instantly, and the same boulder struck my leg. I spent the night in the bush, and it was not until the next morning that my wife and neighbours came to free me.”

Dèdè says he first sought treatment from a traditional healer for his injuries, but when he learned that the HIC was providing care for earthquake survivors free of charge, he went there.
 
After 12 days in the hospital he was discharged and was about to return to his village in the mountains beyond the town of Camp Perrin. However, like many trauma patients, he will still need follow-up care. As more patients progress in their treatment, we have started providing physiotherapy at the hospital.

“Once the acute phase of taking charge of the injuries has passed, we have a lot of work to do on post-operative care, in particular to avoid the risk of infection and ensure proper rehabilitation, ” says Carla Melki, MSF emergency coordinator. “The idea is to avoid post-operative infections, which could have quite serious consequences for their long-term mobility.”

Mobile medical teams

Many patients' homes were destroyed, making it more challenging to provide follow-up care once they are discharged. We are working to ensure that discharged patients have shelter, Melki says.

In order to reach patients who cannot make it to Les Cayes on their own, on 23 August, we began running two to three mobile clinics per day to rural and remote areas severely affected by the earthquake. To travel to some areas, the teams have to use motorcycles or travel on foot with donkeys to carry supplies. Other areas are only accessible by air or sea. 

“Most areas close to the epicentre, especially near Maniche or Aquin, are difficult to reach,” says Bram Keijzer, MSF emergency medical coordinator. “We have made exploratory visits to identify villages where we can provide care. We have also visited camps for displaced people in the centre of Les Cayes, some of which have been there since the 2010 earthquake.”

The mobile clinics provide primary and mental health care services, and each clinic can see up to 100 patients a day. In the first week, the mobile clinics saw nearly 1,000 patients. Patients in need of specialised care are transported to functioning medical facilities, such as HIC in Les Cayes, when possible. 

In addition to injuries from the earthquake and related wounds and infections, mobile clinic patients often have respiratory and vaginal infections, skin conditions, signs of malnutrition and other illnesses associated with poor living conditions and a lack of clean water and hygiene facilities. 

Our teams have also worked, along with other organisations, to improve access to clean water and sanitation in these communities and have supported local health facilities with medical supplies and temporary structures since the earthquake.  

We will continue to seek ways to reach the most remote villages affected by the earthquake. Meanwhile, our regular project for maternal and sexual and reproductive health care in the Sud town of Port-a-Piment also continues to function, even though our building was severely damaged by the earthquake.