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SOLO instructors put their medical skills to work in Haiti

List of Valley residents who spent time aiding earthquake victims is long

Standing in front of the University of Miami Field Hospital’s ER tent in Port-au-Prince are, from left to right: translator/driver Midi, Frank Hubbell, D.O, Jon Eisenberg, Dr. Heidi Root, Rowan Lewis, Emily Beaulieu, and Dr. Jude St. Phard (Courtesy Rowan Lewis). (click for larger version)
April 01, 2010
The pair flew into the Dominican Republic, the more prosperous country with which Haiti shares the island of Hispaniola. They'd made their way over ground with a staffer from Housing Works, a New York-based group that provides services to homeless HIV and AIDS patients. Housing Works had a clinic in Port-au-Prince, which was SOLO's primary connection in Haiti. In a third-world country, in a region devastated by a natural disaster, it not only helps to have a connection in order to help out, it is necessary. Otherwise you are just another body getting in the way.

Neither Rowan or Eisenberg had been working alone, and often didn't work together. Rowan stayed in the country the longest, and the list of Mt. Washington Valley residents and SOLO staff who had joined him at various times during his stay is long, and not limited to familiar names such as SOLO co-founder Frank Hubbell, DO, Bill Aughton and Paul MacMillan.

Dr. Heidi Root and Nurse Practioner Emily Beaulieu, both of the Saco River Medical Group and Geomed, made it down, too, staying and working with local doctor Dr. Jude St. Phard. NGOs – non-governmental organizations – have a long history in Haiti, and many of those who came to Haiti to help in the wake of the disaster had been to Haiti before. Root and Beaulieu had been in Haiti as recently as January 2009, as part of the Madison Church's ongoing mission work, and Beaulieu was instrumental in supporting Dr. St. Phard through medical school.

SOLO's main campus is on Tasker Hill Road on the edge of the Conway-Madison border. A world-wide leader in wilderness emergency medicine instruction, SOLO has expanded since its beginnings in the 1970s in the living room of Hubbell's parents' house to include SOLO programs throughout the United States and in Africa, but up to this point hadn't expanded into Haiti. "We go to leave knowledge," Hubbell says of SOLO's primary mission.

Lewis, a native of Zimbabwe, became acquainted with SOLO through Overland Missions in Zambia, learning wilderness first aid through a SOLO course in 2007. He came to SOLO in New Hampshire that same year, took more courses and qualified as a WEMT and EMT-B, returning to Africa to teach courses in Zimbabwe, Zambia, Tanzania and Kenya. His family had been farmers in Zimbabwe, but had given up their vast acreage before they could be forcibly evicted by President Mugabe's government.

In December 2009 he came back to Conway to recertify as an EMT. He was getting ready to go back home to Africa when the earthquake struck Haiti. For Lewis, Hubbell said recently, it was a mission. Lewis was looking for greater challenges, not just mental, but spiritual.

" 'God,' " Hubbell remembered Lewis saying, " 'I really want you to stretch me.' "

When he first arrived in Haiti at the Housing Works' clinic, Lewis recounted, "I hung back the first two days to listen and see." In Haiti, "there were a lot of little frustrations," recounted Lewis, who last week sat for an interview along with Hubbell. Medical supplies needed to be better secured in the largely open-air clinic. Communication among the various medical facilities was a bit unorganized.

Lewis and the SOLO teams worked each day at the Housing Works clinic, which lasted until about two in the afternoon, after which they would look around to see where else they could be of assistance. At first that meant the University of Miami Field Hospital, but then the hospital stopped taking all but trauma patients. As the days passed it meant networking around the city with other health facilities, finding out the capacities of each place and where patients needing further care could be sent. For Lewis, working days routinely stretched out to 10 p.m. During that time SOLO volunteers also did outreach in a tent city, setting up a mobile clinic there.

Hubbell, who joined Lewis in Port-au-Prince in the middle of February, says Lewis's life in Haiti was "spectacularly fluid."

About his own clinical work in Haiti, Hubbell says it was necessary to separate chronic health symptoms when examining patients. Hubbell said coughs are common because of the bad air; acid reflux, because of the bad diet, and dehydration because of the water situation. You get through all that, he said, and then ask the patient, "What's the matter?"

After about four or five weeks the trauma slowed down, and more volunteers, more doctors and other health professionals, Lewis said, were coming to Haiti. He spent time in two other clinics in Port-au-Prince, then visited one in St. Mark, two hours away. He also worked with the Quisqueya Christian School Relief Coordination Center. The school hadn't been touched by the quake, and had formed a partnership with Crisis Response International. The U.S. Army also used part of the school's campus for command and control of its local operations.

As time went on, residents of Haiti were able to get back to work at clinics as some of their situations stabilized, "so that was a good thing," Lewis said.

Hubbell — who recently ran the free SOLO course, "What to Know Before You Go" for Mt. Washington Valley area residents — said those who go down to Haiti to volunteer have to be prepared to be self-sustainable. That means providing your own food and shelter, among other things. He emphasized what he called the six s's: Safety, shelter, sustenance, sanitation, sanity, satisfaction.

Emergency medicine requires quick thinking and a thorough understanding of how to improvise with the resources at hand. In municipal emergency vehicles the standard equipment is all packed and ready for the EMT. Those venturing out into the wilderness for a hike or climb should always bring a basic first aid kit. In each case, advance preparation is the key, but in wilderness settings it isn't practical to carry every piece of medical equipment you might need. That's why wilderness medicine courses not only teach how to manage the usual emergencies, but how to make do with the resources the environment has to offer.

For over five weeks that resourcefulness came in handy as Lewis worked in various settings in Port-au-Prince. On the sixth week, after working at the clinic with a rural pastor in the mountains of Haiti, that make-do resourcefulness played a crucial role.

When Lewis and the others made their way back down to Port-au-Prince in two 4x4 vehicles, going over roads so rocky that they make New England's frost heaved highways seem smooth in comparison. While at the village clinic, they saw diseases "that would have blown a medical student's mind," Lewis said, clicking through the photos on his laptop to find a graphic picture of the sole of a boy's foot, bubbled with the pea-size eggs laid under the skin by sand fleas. Each egg had to be surgically removed, the resulting hole in the skin then packed with antibiotic cream. In the few days that the crew had been there, they had seen 300 patients with 450 conditions. Heading back on Wednesday, the front vehicle held the medical professionals, two EMTs, a doctor, and other volunteers. The Haitian team members were in the vehicle which followed. Among those was their translator.

Back in Conway this week, Lewis said as they went down the steep mountain road he'd kept an eye out for the second vehicle, frequently turning around to check its progress.

"They're in trouble," he said he'd thought at one point. Then he heard "Stop, stop, stop!" as the driver of the second vehicle, pressing down on ineffective brakes, fought to regain control of the vehicle. It spun a few times, then plunged 40 feet over the rocky bank into the river bed, coming to rest on its fiberglass top.

Within two minutes those in the lead vehicle were back at the accident scene where one of the Haitians was already crawling out of the wreck. The others were quickly out, some with help of the rescuers. Two accident victims appeared critical, one with a possible skull fracture and the other with a possible broken clavicle, and all had lacerations.

"Everyone was in a daze," Lewis said. "We were surprised to find everyone still alive."

The group had left trauma equipment at the clinic, but did have first aid emergency supplies, like stretch bandages. They made do, making splints into neck collars. Everyone was stabilized in ten minutes, but they were still three-and-a-half hours from home base. In the tight valley, they couldn't get communication signals.

Lewis said a local village boy showed him where there was a clear stream springing from the mountain side, and he had iodine tablets with him, so they would have clean water if they needed it. A villager gave them a door from his house to use as a stretcher. From out of nowhere someone produced a phone that had a greater ability to get a signal, but still it required a climb up the hillside.

Lewis called Quisqueya, asking them to see if they could send a military helicopter for evacuation. The person on the other end reported that there were no helicopters available, but that they would keep trying. There was still the further challenge of getting the exact location to helicopter, if one was found. That meant knowing the GPS.

Lewis said they canvassed the crew to see if anyone had a Blackberry with GPS, but came up empty. One person, however, had an IPhone, but unfortunately it had no power left. Rowan went through his supplies and came up with a cable. He was then able to charge the phone off the vehicle's battery, but only got a five minute charge.

That charge was enough, though, to call Quisqueya back and get connected to the Internet. It was enough, too, to sign up and download Google Earth and get the GPS co-ordinates, which Lewis passed on to Quisqueya personnel. Quisqueya in turn said help was on the way by motorized vehicles, which included two military personnel.

Lewis got back to the river bed, where the doctor was suturing a deep gash in the arm of one of the injured. Lewis said during the phone call from the U.S. Embassy, the person on the other end repeatedly asked of any of the injured were Americans. Lewis kept saying no, they are Haitians, but later thought the Embassy personnel was half-hoping that he would fudge the truth and say that Americans were involved so that they could send a U.S. helicopter immediately.

Hardly a minute later, Lewis said he heard, "The helicopters are here, the helicopters are here!"

Two Navy helicopters had been in the area, had been on their way back to base and only had two minutes to locate the accident victims. Thanks to those GPS co-ordinates, they did. The villagers in the area helped carry the injured to the helicopter, which then went on to the University of Miami Field Hospital. The door went back to the villagers.

Everyone else got into the support vehicles, and made it back to Port-au-Prince later that night.

In the morning they got up, expecting to visit their Haitian team in the hospital that morning, and not knowing the extent of the injuries.

"'All of them are at home with me now; they're alright now,'" Lewis said, quoting Pastor David, whose church supported the rural clinic. The accident victims and their families were celebrating. Their family members who had been propelled down the 40 feet over the river bank into the thin flowing water were safe, unlike the hundreds of thousands of their fellow countrymen and women who just weeks before had been crushed, without warning, when the earth shook and flattened much of the city.

Lewis and others went to the church and celebrated with them, joining in with the joyous praying, singing, dancing. For these families, what had almost been lost was found.

Several weeks later an earthquake hit Chile, grabbing the headlines for a couple of days. The earthquake was stronger, but farther away from the main population center.

Chile has had earthquakes before, and many of their taller buildings were built to sway, not buckle. Haiti, that land of hard luck, had no advance warning, and the buildings slipped and slid away like sand castles in the tide.

Hubbell says he'd like to start up a SOLO Haiti to train locals in emergency medicine. He would also like to run another "What to Know Before You Go" course at the River Church in Center Conway, so that those who wish to volunteer in a disaster zone will have some of the skills necessary. The mission of that church, of which he is an active member, he says, is not to reach inward, but to reach outward.

"Lots of people," Hubbell said, "have the heart to be there, but no skills." Life in Haiti, Hubbell noted, is starting to get back to what passes for normal in the economically depressed country, with services such as electricity coming back on line. "It's just if you were living in a place, you're now living outside a place."

That living outside will bring further challenges to the people of Haiti, particularly for those who are living in one of the estimated 460 tent cities in and around Port-au-Prince The country is just entering the rainy season, and the threat of disease spreading in the crowded, wet conditions is very real.

International aid to Haiti continues, and a donor meeting was taking place Wednesday at a U.N. conference, where more than $2.7 billion in aid was expected to be pledged by the European Union and a coalition of U.S.-based humanitarian groups.

That large figure shouldn't overshadow the efforts of small groups and individuals, who keep volunteering to help out.

"You can make a huge difference," said Lewis. As to his time in the country, he'll remember the laughing and the singing, the joy among the people at the church the day after the mountain accident.

"It does affect you," he said, "it absolutely transforms the way you look at life." s

Littleton Chmber
Varney Smith
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