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SANDWICH, MA – Matthew Keilty, Nora Kenneway and Gordon Smith are no strangers to health care crises in Third World countries. The therapists from the Rehabilitation Hospital of the Cape and Islands (RHCI) have worked in Africa, Central and South America.

           

But conditions in Haiti were the worst they’ve seen. 

 

“Haiti was already struggling with poverty and lack of basic necessities -- water, shelter, food,” says Matt, inpatient occupational therapist, who was in Haiti several years ago. “Add a major earthquake and it’s totally devastating.”

 

“You’re basically working in battlefield conditions,” added Nora, outpatient occupational therapy supervisor.

 

“The first thing you notice when you come in from the airport is the rubble,” says Gordon, outpatient physical therapist. “Four months after the earthquake and it’s still everywhere. There’s just this mass of humanity with no place to go.”

                       

The three recently returned to RHCI after treating earthquake survivors in the capital city of Port-au-Prince. On January 12, a 7.0-magnitude earthquake killed 250,000 and leveled parts of the island, leaving millions homeless. The three joined colleagues from the Spaulding Rehabilitation Network to volunteer in Haiti through Partners in Health, a Boston-based non-profit health care organization which provides care in areas of extreme poverty. In all, 14 occupational and physical therapists from RHCI, Spaulding Rehabilitation Hospital, Shaughnessey-Kaplan Rehabilitation Hospital and Spaulding Hospital-Cambridge have traveled to Haiti since March 1. All were based at Hopital de l’Universite d’etat d’Haiti, the capital’s main public hospital.

           

 

“Whatever need arose we tried to meet as best we could with the supplies we had,” Matt said.   “It became a mantra: We will do the best we can, with what we have, to try and meet the needs of the patients.”  In one case, Matt and the other therapists in his team improvised an ankle-foot brace out of duct tape, Velcro, an Ace bandage and some basic splinting material.

           

“Many patients had no clothes and no shoes,” he added. “Essentially, we were working as therapists, nurses, doctors, transportation aides, whatever was needed.”

 

Conditions were challenging.  The earthquake destroyed or damaged most of the hospital buildings, so many patients were treated in tents. Patient records were scarce, incomplete and written in Creole or French, or a combination of both.  At one point the team shared one wheelchair and a few walkers for 60 patients. Electricity was supplied by extension cords threaded through the tents. Toilets were outside port-o-potties, otherwise buckets kept under the patient’s beds. 

 

“At night when it would rain, rivers of water would flow through the tents and people would be scrambling to take up the extension cords,” says Gordon.

 

And the heat was oppressive  – 95 to 100 degrees – and humid. “We didn’t have hot water. We had cold-water drip showers on the roof of the hospital,” said Nora. 

 

Another difference from American hospitals: families provided most of the hands-on care, including feeding and washing.  “It’s part of the culture, but it also reflects the lack of nursing and aide staff,” says Nora. “Also, families would stay in the tents with the patients because they literally had no homes to go back to.”

 

The lack of medicine and unsterile conditions meant patients who should have lived, died. Tuberculosis, tetanus, diphtheria and infections were common.

 

 

One of Gordon’s patients was an 18-day old baby who developed tetanus after his umbilical cord was cut with a rusty utensil. “When I first saw him his limbs were rigid. Fortunately, they got antibiotics into him. I did some basic range of motion with him and he improved. By the time I left I knew he would be fine.”

 

Despite the terrible devastation, the therapists were impressed by the resiliency and hopefulness of the Haitian people. “The patients were incredibly grateful for anything we could do,” said Nora. “Making a small improvement could have a major impact. If we could make someone more comfortable, that was a success.” 

 

In the midst of the rubble and suffering, moments of great beauty occurred too. Matt recalls a woman who was paralyzed on one side and couldn’t speak because of a stroke. “This patient’s friend told me she had loved to sing, and I encouraged her to sing to her friend. She started a beautiful hymn that was evidently very popular, and all the other patients and families started singing too. And this patient, who couldn’t speak, started to sing. It was fabulous.”