Relief Work in Jimani

I will not pretend that I understood everything or even most of what was going on in my time at Good Samaritan Hospital, a relief hospital on the Dominican side of the border in Jimani. I arrived nearly two weeks after the earthquake on January 25, hoping to be of use but imagining that most of the hard work was over. I expected to do some Spanish to English translation and offer support where needed. As it turned out, the other Peace Corps volunteers and I were presented with so much work and problem solving, I had a hard time leaving on February 2. I was feeling unfinished, like I could have done so much more. We were faced with the administrative challenges of organizing volunteers and patient records as well as a responsibility to advocate for patients and families.

Good Samaritan Hospital is an incredible operation offering high quality medical treatment crucial to the lives of these victims, yet inevitably faces huge organizational challenges on every level. Every worker is dedicating time, energy and resources for the victims of the disaster and while thinking about improvements, this should still be acknowledged and appreciated. Beginning as an emergent crisis scene, it is bound to be chaotic. The health of the patient should always be the first priority and in the beginning, everything else could and had to wait. In time, however, it became more important to keep records, collect data, and focus on the logistical aspects of the program. Without this, the sustainability of the program is very vulnerable. With a frequent turnover of management and no one person clearly responsible for organization of Good Samaritan Hospital, the road from chaos to order is rough.

Progress

In the nine days I was there, the evolution of the hospital was impressive. We went from records written only on paper to electronic logs of patients, volunteers, evacuations and medical procedures. It went from patients barely receiving consistent food to steady meals for every patient and family member. There was great confusion about patient names with language barriers and misunderstandings in naming norms. This presented the task of finding all of the medical information for each person written with various names to assure correct patient records. Now, every patient has an ID number and bracelet functioning to safely track their condition and location. The hospital implemented a track of patients within the wards as well as those transported to more appropriate care facilities to be given to their families.

Medical volunteers are now obligated to register with their license and passport. In the beginning, there was little time or attention given to volunteer credibility. In the nine days, the security of the center went from almost non-existent, with threatening raids and other safety difficulties to a fairly well controlled system. The coordination of all volunteers became a priority and responsibilities are now more appropriately delegated. There has been a huge effort of organizing Haitian and Dominican volunteers and treating them fairly.

Volunteer Commitment

The volunteer commitment is an incredible demonstration of dedication and generosity. There is a group of expertly trained medical professionals from Spain who are committing three months of consistent support running three wards of the hospital day and night. Medical volunteers are showing up after days of travel, ready to work any necessary position and shift. They work with limited equipment and supplies in an environment very different from their home hospital. They serve patients outdoors on ground mattresses and still do everything they can to provide care and contamination management. Non-medical volunteers are willing to exert themselves carrying patients and supplies for long hours in the hot sun and take on tasks such as security and transportation with little prior experience. With limited volunteer accommodations, many stay in tents or on floor mats, adjusting to the conditions as necessary.

Volunteers are not just visitors from developed countries. Haitian families are doing an incredible amount of volunteer work without which, the hospital would not function. Families feed their patient, help them readjust positions, go to the bathroom and advocate for their care. When patients need to be moved short distances, it is usually family members carefully transporting their loved ones. Haitian as well as Dominican nationals distribute food and supplies, assemble and transport donated items such as beds and tents and carry out many of the maintenance tasks. The translators, Creole to English or Creole to Spanish, are some of the most important people in this effort. With a medical volunteer population almost entirely speaking only English or Spanish, they play a crucial role in the communication between patients and families and medical professionals.

Difficulties of the Operation

While interpreters played a vital role in the hospital, the disorganization of this group of volunteers became a difficult and sensitive problem. The whole operation began as a frantic effort, the patients needing to be treated immediately. Time for organization was limited if not nonexistent. At this time, anyone with an understanding of English and Creole was of emergent use. This became a group of an undefined number, with varying language proficiency and no management. With a lack of security and coordination, the delineation between official volunteer and family helper was difficult to establish. The equality of treatment and accommodations provided for volunteer doctors versus an English speaking family member was impossible. The food provided for the volunteers was, at times, refused to translators or unintentionally given to non-volunteers. The appointment of these volunteers was unclear and resulted in inconsistent availability of translators in the hospital. All of the confusion resulted in many volunteer interpreters who felt unappreciated and discriminated against. This challenge eventually led to a translator strike that was resolved with more structure, official uniforms and appropriate benefits for these positions.

With such a high rate of volunteer turnover and very few people committing more than one week to the effort, the consistency of every aspect of the operation is vulnerable. In the beginning, patients and families went periods of time without receiving dependable food because of a lack of management and order. The consistency of meals faltered because while volunteers would commit to food supply, common donations lasted short periods of time, leaving an important responsibility without a guaranteed substitute volunteer. For example, there was a mission group taking the responsibility of providing meals to patients and families who filled this important position for several days and then left without finding a replacement group.

With an uncoordinated volunteer population and little management, there was also a misallocation of labor and attention. We ran out of bottled water while a storage room sat full. Ambulances would run out of gas and there would be no working vehicle to fill up the tanks. This left volunteers to transport patients while a functioning ambulance sat empty. The systems of supply, food, transportation, and communication between the wards are completely dependent on volunteer work. While everyone does their best to maintain and improve the organization of these processes, the departure of volunteers with these roles is not always smooth.

The medical volunteers also faced challenges with their volunteer turnover. Many arrived in groups and stayed less than one week. While the medical care at Good Samaritan is very high quality, a completely new group of nurses and doctors have to take over wards on a regular basis. These staff members may not have the knowledge of the patients essential to providing the best possible care. Even the appointed medical directors were cycled through the center quickly, impeding their efforts for organization of the whole operation.

Similar to the inconsistency of volunteers, there was an inconsistency of supplies. While there were items needed, many organizations and volunteers came with supplies to equip the operation. The priority of resources of all types was not organized by any one person. The effort could benefit from someone identifying the most crucial needs whether it is transportation, shelters, food, water or medical. Many people want to help, yet do not know what is most needed or most urgent. Without someone on the ground with this information and perspective, the supply and volunteer solicitation and input is inefficient and chaotic.

Potential Improvements

It appears that one huge improvement to the Haitian relief effort could be a centralized management group dedicated to the large scale logistics. If there was someone with a handle on the needs of the operations, as well as the contributions ready to be given, they could solicit to meet the needs as well as redirect money, supplies and expertise. Specifying and redirecting materials is extremely important to the greater relief effort as resource allocation is still very chaotic. A lot of this comes down to communication on every level- locally in each operation, between the operating relief centers, and with all of the supporting organizations donating resources. An institution acting as a control center, gathering information from all the specific programs could drastically improve the efficiency of the relief efforts.

For example, US military helicopters transported patients from Good Samaritan hospital in Jimani, Dominican Republic to Sacred Heart Hospital in Milot, Haiti. Most family members were not transported with the patient and therefore left on foot to reunite with their loved ones in Milot. The distance and route of the trip is incredibly difficult and there was little knowledge in Jimani of the resources in Milot. While the medical care at Sacred Heart is strong, they do not provide any accommodations for family members such as food or tent shelter. As organizations such as USAID were unclear on resource needs in Good Samaritan, asking for solicitations, more transparency and communication could have redirected resources for patients and families to Milot.

Another illustration of needs for communication about allocation of resources was a visit from a Dominican foundation to Good Samaritan. They had come to advocate for the patients at the public hospital in Azua, another Dominican location taking in earthquake victims. They reported that the hospital in Azua did not have enough medical supplies, doctors, or space to care for their patients. There were patients who needed operations such as amputations and had been waiting for two weeks being treated for pain only. If there was more transparency and knowledge of situations like these among regional medical coordinators, those patients could have been treated in other facilities. Because space and transportation proves to be difficult, doctors and supplies could also be reallocated. As far as I know, this specific situation has not been resolved.

People travel long distances visiting hospitals to find out if their family member is in there in that hospital. Each hospital can check their database and, if the patient is not in the records, inform them of other possible locations or give advice about using the websites set up to look for loved ones. The truth, however, is that we, like many programs, are not contributing our database to these websites resulting in what is a very limited function. Like so many other aspects, each program does not have a great understanding or knowledge of other programs available to people leaving our facility.

There are many hospitals and clinics, refugee camps and food distribution centers that could be contacted. The information about services, accommodations, capacity and current availability could become organized and available. These programs could also contact the centralized location with resources that are needed as well as specialized volunteers. If this system was functioning, maybe groups or institutions wanting to donate aid or serve could be directed toward the most appropriate center. In reality, I know so little about relief efforts as well as the expanse of programs involved in Haiti that maybe this system already exists. It became clear at Good Samaritan that if it does exist, it is not being utilized to its full potential.