Month in Focus, February 2010: Haiti and Zimbabwe

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HAITI
On January 12, Haiti was struck by major a earthquake and its devastating consequences &#– the loss of 200 000 lives, and 300,000 wounded. MSF, already running several projects on the island, was able to respond immediately, providing emergency medical care to victims of the disaster. Within hours, hundreds of wounded had arrived to MSF health facilities in search of help.

Working conditions were difficult. Many members of staff were missing and several of the buildings where MSF had been working were damaged&#… Despite the shock and turmoil, MSF's Haitian staff turned up to the health centres, determined to be of assistance.

Pierre Wagner, MSF doctor The first tremors were very strong. Afterwards, when I stepped out of the house, I was told that the MSF hospital had collapsed. And what I saw when I got there was catastrophic. The people in front of the hospital were either dead or wounded.

In the first two days after the earthquake, MSF staff already present, managed to treat nearly 1,000 injured. Initially, all efforts were focused on emergency care, with priority given to the most serious casualties. Additional staff arrived quickly, but with thousands of injured in need of urgent treatment, MSF teams were overwhelmed.

Marie Lucie was at home, on the 3rd floor, when the building collapsed.

Marie-Lucie, patient My arm is broken. And I've got other injuries too. We've got nothing, not even a place to sleep. So we just stay here.

MSF sent out mobile clinics and quickly set about finding new facilities where it could operate further activities. Assessments were carried out in Jacmel, Leogane and in several neighborhoods in Port-au-Prince.

By this stage, surgical teams were working in 7 hospitals : Saint-Louis, Cité Soleil, Chancerelle, the gerenal hospital and Carrefour in Port-au-Prince, and Leogane and Jacmel, further west. In total MSF now has a hospitalisation capacity of 900 beds. Other medical facilities are focusing on providing primary and secondary healthcare.

Pip Millard, MSF Field Coordinator, Carrefour (in English)
Over the last few days we've seen roughly on average around five hundred people that have been coming through the door a day.
We have a surgical team here, who are doing surgery, We have got some really severe wounds, lots of fractured limbs, both arms, legs, many different kinds of crush injuries.

A few days after the earthquake, a team of MSF psychologists also arrived in Haiti. They are there to help the people cope with the traumatic events, and the fear of further tremors.
The needs of the Haitian people have gradually begun to change. A month after the earthquake, more than 13,000 people have received medical treatment from MSF, including surgical teams performing 1,400 operations.
Thousands of patients require extensive post-operative care, including dressing and physiotherapy.

Amilcar Contreras, MSF surgeon (Lycée Health Centre)
For example, this lady, our first patient today, had a skin graft 8 days ago. We need to change her dressing but it's very painful so to avoid unnecessary pain we'll do it under anaesthetic.

At Isae Janty hospital MSF is providing gynaecology and obstetrics care. The organisation has also set up a trauma and post-operative care unit

Aurélie Ponthieur, medical hospital director "So we treat patients who have been operated in other MSF facilities, patients who've had major orthopedic surgery. So we provide all the follow-up care. We operate on open fractures too and use external fixators for traction

In addition to earthquake injuries, medical staff are seeing patients with pre-existing medical conditions like AIDS or diabetes, whose health have detiorated because of the situation.

Marie-Michelle Houle, MSF nurse, Mickey health centre "Of course, we also have patients for example who are diabetic and need regular treatment. They need to find a doctor or a nurse because the clinics where they used to be treated are gone."

But needs go beyond medical care. MSF teams have been working on water supply and hygiene facilities, as well as organising the distribution of essential non-food items to Haitian families

Etienne Gignoux, MSF logitician Hygiene conditions were very bad. There were lots of people living in a small area and they didn't have access to latrines, so we wanted to set up a project to tackle that. And then there were people living, and some still are living under sheets having lost everything they had in the earthquake. So we wanted to respond to those two aspects very quickly : latrines &#– to provide minimal hygiene conditions - and shelter

By the beginning of February, more than 1 500 national and international staff members were on the ground, striving to help the people of.
After the initial emergency phase, they are now helping the population to overcome the trauma and heal their wounds

Zimbabwe - Giving life without Aids

Priscilla watches over her two daughters, who are playing with their cousins in the courtyard of a house in Bulawayo. Like 1.3 million Zimbabweans, Priscilla is HIV-positive. Thanks to MSF's program for the prevention of mother-to-child transmission, she did not infect her daughters.

Priscilla Mugota "I went to Luveve Clinic for registration of my second pregnancy. I was six months pregnant. I was tested and the result was positive. I wasn't ready for testing but at the clinic, they told me it was compulsory for all pregnant woman. I was frightened, I didn't know what to do.
I was worried about what my family would say But I convinced myself it was better to go through with it, and God guided me."

Without treatment, 40% of children born to HIV-positive mothers will be infected.

In the prevention program, mothers receive a triple therapy regimen during and after pregnancy and the infant is monitored. In developed countries, HIV transmission from mother to child is extremely rare.

In Bulawayo, the country's second-largest city, 3,000 children are registered in MSF's program - that is the highest concentration of HIV-positive children throughout MSF's projects.

This is why it is so critical to screen pregnant women and help them participate in the prevention of mother to child transmission program

Jean-François SAINT-SAUVEUR. MSF medical coordinator in Zimbabwe
"We know that when children are born with the virus &#– because the mother was not receiving appropraite treatment &#– approximately 50% of these children will die before their second birthday. This is unacceptable in a world where there are effective ways to prevent transmission."

However, there are many obstacles. The program requires women to wean their babies as soon as they reach six months. Often mothers don't complete the monitoring period, which must be conducted for more than one year. And many pregnant women, afraid of how their entourage will react, refuse to take part in the program.

To help them cope with their family's reaction, Carole discusses the issue in her support groups. Sharing their experiences and encouraging each other help these women to deal with their illness.