Medical needs in Haiti remain high as MSF moves into next crucial phase

HIGHLIGHTS Ten weeks after the January 12 earthquake that left up to 300,000 people injured, medical needs remain immense in Haiti, and they continue to grow. A crucial phase has begun with thousands of injured people requiring long term medical care just as some of the health providers who responded to the initial emergency phase have begun to discharge patients and leave the country . ?MSF is expanding its capacity to care for the many wounded requiring extensive postoperative care - including secondary surgeries, physical therapy, rehabilitation, and mental healthcare - for at least the next year. In recent weeks, more than 200 patients have been referred to MSF medical facilities by other medical teams leaving the country. ? MSF is also focusing on primary health care, with the opening of new out-patient departments and the creation of additional capacity for secondary health services, including emergency obstetrics, intensive care for malnourished children, and inpatient care for paediatrics and adults. In response to the dire situation confronting people living in makeshift camps or on the street ten weeks after the quake, MSF is stepping up the distribution of tents and plastic sheeting, as well as blankets and hygiene and cooking kits. MSF activity specific to locations across Haiti HOSPITALS – SURGERY – POST OPERATIVE CARE Port au Prince - Saint-Louis Hospital: Surgical activities are ongoing in a 200-bed capacity inflatable hospital, which includes two operating theaters. An additional operating room is planned for treating treat patients suffering from burns. At the moment, around 200 patients are hospitalized and 770 surgical operations have been performed since setup. The hospital provides complete post-operative care: medical and surgical follow up, physiotherapy, psychological and social care. The hospital aims to treat the same cases that were treated at the now destroyed facility of La Trinité: major traumas (road accident, gunshots, burn victims, etc.) and health care for victims of sexual violence. Port au Prince - Choscal Hospital in Cité Soleil: MSF intervened in this Ministry of Health hospital initially focusing on earthquake-related trauma. There are two operating theaters for major surgery, one for minor surgery. MSF also works in the emergency room and the maternity ward. The hospital has a 100 bed capacity, all under tents as the building has been slightly damaged by the earthquake and patients are still afraid to get in. The team has rearranged the hospital into a general hospital serving an extremely precarious population. Psychological care continues for all patients and caretakers. Since the earthquake, 2705 (1852 new cases and 853 dressing) emergency cases treated in the emergency room, 874 trauma (trauma, wounds and burns), 201 trauma due to violence (57 gun shot, other aggressions by knife, machete, stone, bottle,...), 718 surgical interventions, 91 major orthopedic interventions including 37 amputations and 222 wounds operations; 363 deliveries including 39 cesarean section. Still a daily average of about 2/3 violence-related injuries, including gunshot and machete wounds. Port au Prince- Site Office du Tourisme: Site functional since February 22. At present, 40 patients are hospitalized and receiving post operative and medical care, mental health care, and physiotherapy. Port au Prince- Site « Mickey », Crèche angle rue Christ Roi et Bourdon Site opened on January 19. Currently, 61 patients are hospitalized and receiving post operative and medical care, mental health care and physiotherapy. For the immediate term: maintaining the maximum post operative care capacity, following up minor surgery cases, reinforcement of mental health rehabilitation Port au Prince - site Lycée with its 80 beds of post operative care, was closed. Patients were transferred to the OCB facilities. Port-au-Prince - Bicentenaire: Post-op, emergency and surgical facility with two operating theaters and pediatric and obstetric services. Presently 41 patients hospitalized in the 77-bed structure. A total of 90 beds foreseen. Mental health services are also provided. Carrefour Arts et Metiers orthopedic hospital:  Around 40 surgical interventions are performed every day in this 135-bed trauma and post-op hospital, which houses two operating theaters, and one of the few x-ray machines in the city. Orthopedic surgery, skin grafts, and muscle flaps are being performed and post-op care and rehabilitation are provided. Currently, 80 patients are hospitalized. Rehabilitation care is offered to patients in collaboration with Handicap International. Psychological care is offered to patients and families. Léogâne: 90-bed hospital. Maternity activities are increasing; 50 deliveries and three C-sections performed in the past week. . Jacmel: Full outpatient and inpatient services are available under tents (81 beds) as the main hospital was badly damaged. Surgery is ongoing in the hospital’s operating theater (services offered; internal medicine, surgery, maternity, pediatrics, emergency). Mental health services are also provided. POST-OPERATIVE CARE Although a full range of post-operative care is offered in all MSF supported structures where surgery is performed, some sites are specifically dedicated to welcome patients after surgery. Promesse: Post-op structure with an initial capacity of 50 beds. Handicap International physiotherapists are working in collaboration with MSF. 46 patients are currently hospitalised. Mental health care provided. Delmas 30: The first 70 patients and their caretakers have been transferred to this new post-op tented center, from the inflatable hospital structure in Saint Louis. The center will have more than 100 beds for people needing physiotherapy and mental health support. They will be transferred in the middle of March to the MSF facility in the Port-au-Prince neighbourhood of Tabarre (capacity: 140 beds) Sarthe: On February 23 MSF opened a new, a 203-bed post-operative center in a converted soft drink factory in the Sarthe area of Port-au-Prince (potential capacity of 300 beds). All patients from Chancerelle and Choscal who need further post-operative care (wound care, more specialised orthopaedic surgery, reconstruction surgery) were referred to this new structure. Up to now 150 patients were admitted. Handicap International physiotherapists are working in collaboration with MSF to optimize reeducation (including prosthesis for the amputee) and mental health support is provided as well. SPECIALISED CARE : NEPHRO NUTRITION EMERGENCY OBSTETRICS Port au Prince - General Hospital The nephrology team did an initial handover to the Ministry of Health, with donations of materials and three dialysis machines to the nephrology unit in the general hospital. Currently, 30 chronic patients are receiving dialysis. Another five dialysis machines has been installed recently to increase capacity of the unit. A nephrologist came for one week to give specific trainings. Carrefour stabilisation center for malnutrition: Stabilization center and ambulatory feeding center for severely malnourished children. There are currently 22 children hospitalized. Carrefour Maternity Hospital: MSF supports this Ministry of Health structure with staff, fuel and supplies to run 24hr maternity/emergency obstetrics services. Isaie Jeanty, Emergency Obstetrics Hospital: MSF is working in collaboration with the Ministry of health for the maternity and emergency obstetric care in this 85-bed Ministry of Health hospital. This is the main referral hospital for Port-au-Prince for complicated and eclampsia cases. PRIMARY CARE Port au Prince - Martissant: This MSF structure provides an emergency and stabilization center through an outpatient department and a 30-bed inpatient department. There is also a 15-bed maternity service. The center has seen more than 3892 consultations since the earthquake and 1967 dressings. More than 1000 trauma had been treated including 100 by violence.The team is preparing to move some patients back into the undamaged structure. Port au Prince - Delmas 24: A new health center opened on February 15 in the Delmas area of Port-au-Prince. About 150 consultations are offered every day. MSF plans to open five out patient departments in total in the Delmas area (including in Saint Louis Hospital and Delmas 24). Saint-Louis OPD and ambulatory: Opened February 27; 120 consultations/day. Follow up of post op in ambulatory ( dressing, physio, mental health...) Les Collines: OPD will open March 10. Fort National/poste Marchand: OPD will open March 15. Port-au-Prince - Site "Mickey", Crèche angle rue Christ Roi et Bourdon: Outpatient structure performing between 120 and 170 consultations per day. Port-au-Prince – “Tourism", in front of the Champ de Mars: Outpatient activities began February 15; average of 160 consultations per day. Leogane, Dufort and region: OPD is operational in the city of Leogane on the site of Hopital Sainte Croix. At the Dufort fixed clinic site, approximately 250 consultations are carried out each day, with referrals to Leogane when required. In addition, MSF teams are operating mobile clinic activities in 20 locations, between Gressier and Petit Goave. In total, 2,130 consultations were carried out last week. Carrefour Feuille: A team of one nurse, three doctors and one midwife is running a tent clinic in a camp for 9,000 homeless people in the area. Main pathologies are now diarrhea, skin diseases, upper respiratory infections, fever, gyneco cases, traumas and increasing requests for psychological counseling. An average of 130 consultations are carried out per day. The team is performing dressing changes and providing vaccinations. Mental health services are also provided. Carrefour, Village Grace IDP camp:  The basic health care unit includes an outpatient department, antenatal and post natal care and a mental health component in a site that is home to 15,000 displaced persons. 150 patients are seen daily.  250 dressings are done per week. Vaccination campaign for DTP and measles was carried out last week. Psychological care is offered to patients and families. Carrefour, International Grace Hospital: A new hospital, located next to Grace camp, will offer out-patient services by the end of this month. Other planned activities include pediatric care and emergency services. Carrefour, Shikina clinic, Waney 87. An out-patient health center offering basic health care, antenatal and post natal care, as well as mental health services. This is an urban area with many displaced are living in small groups. Carrefour, outreach activities: A MSF team is working in a number of sites in the Carrefour area, including in displaced persons camps, homes for the elderly, clinics and orphanages. Petionville Golf Club Camp (Golf course): A health care clinic offering basic health care and ante-natal care to pregnant women, referral services and psycho social counseling in this camp where 40,000 people are estimated to live. About 150 consultations have been provided every day (ANC, PNC as well as mental health). MENTAL HEALTH Psychological care is routinely offered to patients who have been through major surgery in MSF supported structures. But there are other mental health activities targetting specific groups. Sarthe Choscal Martissant : A team of psychologists is still focusing on the patients and the caretakers inside the three hospitals, but as also shifted towards providing counseling to  displaced people living in makeshift camps around the structures. Carrefour, Grace Village IDP camp: Psychological care (individual and group sessions) is offered in the camp, through the clinic and through outreach workers who work in the camp as well as in the surrounding neigborhoods. Carrefour, MSF Field hospital: A team of psychologists is supporting the patients. Delmas, Petion Ville Club IDP camp: Psychological care is offered in the camp through individual sessions and group councelling. Bicentenaire, Promess, Jacmel and Carrefour Feuille: Mental health activites taking place in MSF facilities in all these locations. A team of Payasos sin Fronteras (Clowns Without Borders) worked in collaboration with MSF – their project has now finished. NON FOOD ITEM DISTRIBUTIONS Port au Prince – Ecole Saint Louis: 1,800 tents distributed in the camp near the inflatable hospital to an estimated 8,500 people. NFI (hygiene and cooking sets) will be distributed in the coming days to the same population. Grand Goàve: 2,638 complete family kits distributed. Petit Goave: complete family kits and tents for 364 families Grace Village IDP camp: NFI kits distributed to 3,000 families (kit = 2 jerrycans, bucket, hygiene kit, plastic sheeting or tent, 6 pieces of soap and a hygiene kit) Carrefour: 1,800 NFI kits to IDPs at different sites. Port au Prince – Delmas 33: 200 NFI kits to IDPs at Solidarity site and 200 NFI kits to Delmas 33 “future hospital” site. Leogane: Distribution of 1,550 NFI kits in rural areas in the periphery of Leogane. 5,000 additional NFI distributions planned for next week (plastic sheeting instead of tents), accompanying mobile clinics. Jacmel:Distribution of kits to more than 1,800 families. Cité Soleil: 2954 tents were distributed in several camps spread within Cité Soleil slums. Still ongoing with additional NFI kits distribution to come. WATER AND SANITATION Marrtissant, Cite Soleil, Chancerelle: Water distribution is continuing via 15 bladders, including one in Martissant, 11 around Cité Soleil, one in Chancerelles, and three in Sarthe,  focusing on IDPS close to the medical facilities. MSF has also undertaken the cleaning and emptying of community latrines inside the slum of Cité Soleil, which had been backed up for a prolonged period. Carrefour, Grace Village Camp: MSF is providing 76m3/day water for 15,000 IDPs and constructing 45 latrines.  Additionally, 45 showers will be constructed and 15 Portocabs have been installed.. Chancerelle, Aviation camp: 50 latrines, 50 showers and 20 washing places under construction. Water provided by MSF to part of camp. Installing 30,000 liter tank. Carrefour, Child detention center: Ten latrines and showers under construction; eight portocabs installed in the meantime. Carrefour, Joseph Janvier camp: maintenance of 20 existing latrines for 1,500 IDPs. Carrefour, various sites: chlorination treatment of tanks/wells and small interventions in other areas. Chancerelle, Aviation camp: 50 latrines, 50 showers and 20 washing places under construction. Water provided by MSF to part of camp. Installing 30,000 liter tank. Leogane (periphery): Water distribution: target of 200,000 litres per day. Will install two latrine blocks in gathering spots, and, if used, will increase numbers. Again, water and sanitation activities will be in support of mobile clinics and around MSF hospital structures. Port au Prince - Mickey: Water distribution of 80,000L/day Port au Prince – Ecole Saint Louis: Water and sanitation work (latrines) for estimated 7,000 IDPs. Jacmel: MSF installed a water bladder, drinking points, and ten latrines in St. Michel Hospital. Grand Goave: Sanitation facilities established in four camps: Lifeline, Park Ferrus, Servants et Tit Paradise: 4-6 latrines per block, showers, bladders, and seven water distribution sites for a total of 7,000 beneficiaries. Port au Prince – In Petionville and Carrefour Feuille: portable or fixed latrines, portable showers, waste areas and water bladders were installed for a total population of 31,800 people. MSF has carried out out water storage and distribution, constructed washing areas, showers, latrines, waste areas and hygiene promotion in the following camps : Place Boyer, Place St. Pierre, Marie Therese, Hospital Sanatorium, Campeche, Tapis Rouge, Pinchinat (Jacmel).