Haiti Hurricane

     Another installment of my very intermittent series of blogs.  Tropical storms have always been a threat to Haiti.  Even ones without the strong winds have caused much misery.  I was in Haiti in 1994 for (then) Tropical Storm Georges.  Maximum sustained winds were only 40-50 miles per hour but the 12-18 inches of rain were devastating.  Initial reports had only a few killed, but the dead don't give report.  Eventually, someplace between 2 and 5,000 were felt to have died.  Bridges were washed out, hill sides crumbled and water borne disease was rampant.  Hurricane Matthew has the potential to be worse.  Even bridges built since the earthquake have been destroyed.  Waves as high as 50 feet high and a storm surge of 10-12 feet high must have devastated the shoreline.  We will see today as we fly from Santo Domingo into Haiti.

     In the developing world, beachfront property is not particularly valuable,  Because of the threat of storms, the areas closest to the water are the most vulnerable.  This leads to a clustering of the poorest people closest to the water.  I saw this in Tacloban with Typhoon Hyian in the Philippines.  The poorest were the closest to the shore and they suffered the greatest loss.  Often, they wouldn't leave their homes for fear of looting.  Often they left too late.  We have already received similar reports from the southwest of Haiti.  

     The entire situation brings back my military memories (and requires similar skills). I deployed as part of the HHI advanced team with two experienced HHI Haitian hands (Wes Comfort and Steve Weber) but I am the most experienced disaster responder.  So I get to look at not only the medical aspects of our deployment, but at logistical aspects (fuel, lodging, food, re supply etc), administrative aspects (MoH and WHO coordination etc) as well as treating patients.  Even flying in by helicopter brought back military memories.  This also brought back memories of when I entered Haiti during the first few days after the earthquake.  We entered then from the Dominican Republic, again because the airport was closed.  

      The flight into Santo Domingo was also interesting as the storms from Hurricane Matthew were still active.  We had one last minute aborting of a landing and an very rough time second successful attempt at landing.  That evening we meet with Charlie, who has a helicopter company.  We have worked with him in the past and he graciously agreed to fly us into Haiti from Santo Domingo allowing us to see some of our medical sites en route.  We had already registered with the Haitian Ministry of Health and the World Health Organization as an Emergency Medical Team.  We are in, for us, a unique situation.  We already have Haitian medical teams that we can deploy to our regular sites in the southeast and an expat medical team that can be used in the MoH/WHO system.  

     As we fly along, even in the Dominican Republic, the shore is quite eroded and the rivers are out of their banks.  There is no rain now but the cloud level is too low to get to some of the places that we wanted to scout.  We will have to bypass some of the places we wished to see and fly to Port au Prince.  We saw a lot of damage.  Many metal roofs missing and fields and rivers were flooded as we enter Port au Prince.  This demonstrated  the advantage of concrete roofs (as long as there is no earthquake).  As the plans started coming together, I felt a sort of peace.  I guess this is where I am supposed to be.  

     After formalizing plans for the deployment of our Haitian medical teams and a few more coordination meetings, we ran out of work day and energy.  Tomorrow, I am off to connect with the World Health Organization and the Haitian Ministry of Health.  At least as long as I am in Port au Prince, I will be able to blog.  Thanks for following along on this with me.  Keep the Haitian people in your prayers.

Heading to Malawi

     It has been a while since I have posted a blog and this seems like an appropriate time to resume.  I am now flying from Kansas City to Atlanta en route to Malawi in southeastern Africa.  As the Chief Medical Officer for Heart to Heart International, Julie Hefner (Heart to Heart's Director of International Programs) and I will explore partnering with the Church of the Resurrection in their primary care and nutrition programs.  It is a new role for me (at least since my last blog), developing programs and partnerships.  It is a change because I was used to taking care of patients in the developing world and disasters.  Now, while I get to do that some, My main focus is on how others can provide that care.  I won't deny that there are some regrets in the change because  I have always enjoyed taking care of patients.  But there is a challenge and a greater good that I can help usher in by developing avenues through which others can help.  Certainly there is much more that needs to be done than I could ever do.  By developing these programs, many others will have the opportunity to help give those without adequate medical care, be they in the developing world or even in the U.S..  

     On this trip, I will spend almost two weeks in Malawi.  This is a small county wedged between Zambia and Mozambique in southeastern Africa.  It was already in the bottom tier of least developed countries before 3 straight years of poor harvests.  Since the majority of people are subsistence farmers, this has lead to widespread hunger and the President of Malawi has since declared a state of emergency.  One aspect of famine is that most who die due to malnutrition don't die of a lack of calories.  90% of those who die, due so because of infection.  The immune system is the second most energy requiring tissue in the body after the brain.  In malnutrition, many don't have enough calories to expend to fight what would be otherwise survivable infections.  We have brought a large supply of antibiotics with us, but the immune system still needs energy to work.  Malawi has been importing food, but there are still several months before the next harvest.  

     Hopefully, the situation isn't so dire.  I look forward to learning more about the people of Malawi.  However, please keep us and the people of Malawi in prayer.