Haiti: A hospital adapts during a crisis

Nicolas Broca was the head nurse at MSF's trauma and burns hospital in Tabarre, Port-au-Prince, during multiple crises in the city from August to November. He describes how hospital staff responded to the challenges.

10 Dec 21

In Haiti, the context is constantly changing. One of the major things that struck me is that there's always something that you don't expect. You have to adapt continually. 

Resting area in the middle of Tabarre hospital. (September, 2021).

Earthquake

Three days after I arrived, the August 14 earthquake struck southern Haiti.

The capital was not directly affected, but our Tabarre hospital soon filled with patients from the South. 

Patients waiting in triage area outside MSF's Turgeau emergency centre (CDTI) (September, 2021).

These were patients with complex injuries from the earthquake. 

Transporation problems

Some reached our hospital three or four days late because of transportation problems following the earthquake, and their wounds had become infected. 

Some had even developed antibiotic-resistant infections, which are particularly difficult to treat. 

Morning traffic jams in the Port-Au-Prince. (September, 2021).

Violence resumed

In the week after the earthquake, the level of violence in Port-au-Prince was much lower than usual, as the city's various armed groups let people move more freely.

Woman injured by several gun shot wounds the day before now in the recovery room after an operation. (October, 2021).

But by the following week, a high level of violence resumed in the city, and we started to receive as many wounded patients as we usually do, while our hospital was already full with earthquake survivors. 

Wounded patients

As head nurse, I was managing the supervisors of nurses, nurse aides and hygienists in each hospital unit. 

The hospital specializes in treating people with severe traumatic injuries or burns. (October, 2021).

The hospital includes the only specialized ward for patients with severe burns in Haiti, which MSF relocated from the Cité Soleil neighborhood earlier this year because of armed clashes there

.

Staff making a splint after taking off an external fixator. (October, 2021).

Caring for burns patients requires a great number of staff because their health is very fragile.

You always have to have someone monitor their vital signs, and the smallest problem can become a very big problem for a person's body. 

External fixator on the leg of a patient. (October, 2021).

The patients need a lot of protein and other nutrients to help them heal, and they need to compensate for the loss of fluids. 

Mental health workers in demand

There is also a huge demand on the staff to provide clean linens and sterilize medical instruments, because of the patients' repeated dressing changes and vulnerability to infections. 

MSF staff cleaning a skin graft for a patient who suffered a severe burn on her leg. (October, 2021).

In addition, there is a big need for mental health workers to help patients face the challenges. 

Political tensions, strikes and fuel shortages

Staffing the hospital became more difficult when transportation was shut down in Port-au-Prince.

Political tensions, strikes and a fuel shortage prevented hundreds of staff members from commuting to work as they normally do. 

MSF cars parked in front of MSF's Turgeau emergency centre (CDTI) (September, 2021).

The city was completely blocked, and even though strikers allowed MSF vehicles to pass through their demonstrations, it was very stressful for staff members to be out in this environment.  

A gas station in Port-au-Prince is closed because of a lack of fuel. (October, 2021).

Our logistics team told us they were struggling to obtain more fuel for our vehicles and generators, and we had only a 15-day supply at the hospital, so we had to do everything we could to limit our consumption while maintaining vital medical services. 

Staff reductions

Our staff all started working 24-hour shifts, to reduce everyone's movement in vehicles. 

We reduced the number of administrative and logistical staff, and at one point we reduced our criteria for admission, accepting only patients who would not survive if they were referred elsewhere. 

Pharmacist at MSF's Turgeau emergency centre (CDTI) (September, 2021).

Severe burns

However, people continued to arrive in grave condition, and there was generally nowhere else to refer patients with severe burns. 

A traffic accident victim arrives at MSF's Tabarre hospital in Port-au-Prince. (October, 2021).

In times of fuel shortages, people would stockpile fuel at home in unsafe containers, such as plastic bottles, and this led to accidental burns.

Woman injured by several gun shot wounds the day before now in the recovery room after an operation. (October, 2021).

Sometimes an armed group would attack people by setting their house on fire. 

You don't hear a lot about COVID-19 in Haiti, but it creates challenges too. 

At MSF's Tabarre hospital in Port-au-Prince, Osmé, 3 years old, plays with a physiotherapist in order to rehabilitate his arm, which was injured in the August 14 earthquake in southern Haiti. (October, 2021).

We test all new patients, and we have a very strict limit on people visiting the hospital to limit COVID-19 transmission, but we must still allow children to have a family member present, for example. 

Challenges due to COVID-19

And this creates risks for patients and staff.

When a staff member tests positive, they must stay home, and when a patient tests positive, they must be housed in a separate area of the hospital, and given oxygen therapy if needed. 

Health Promoter talking to patients in the triage area of MSF's Turgeau emergency centre (CDTI) (September, 2021).

So far, we have not seen COVID-19 deaths among our patients there, fortunately. 

I found my assignment in Haiti to be exhausting but rewarding. The staff are very competent and committed, and the level of medical care we provide is something to be proud of. It is very intense work in the midst of a crisis. 

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