Only days after the catastrophic earthquake in Haiti on January 12, 2010, Clinical Engineer Diogenes Hernandez accepted a call from the Washington, DC-based Pan American Health Organization (PAHO) to go into the country and use his skills to assess damage to equipment and the physical infrastructure of health care facilities. Hernandez traveled overland from his home in the Dominican Republic to his destination of Port-au-Prince, Haiti’s capital.
The PAHO representative in the Dominican Republic gave Hernandez a double cab pickup with a driver, as well as everything needed for an independent 2-week stay. With no possibility of obtaining a hotel, the organization equipped Hernandez and his driver with a tent, sleeping bags, and rations of water, milk, juices, and canned and dry food.
“The mission was not clear, and it seemed a trip into the unknown,” Hernandez says. “By the nature of the mission, I carried a set of tools for electromechanical works and a digital clamp meter (EM266F) for measuring electrical parameters such as voltage, current, and resistance/continuity. I admit I had some apprehension because of all the news I had heard about the magnitude of the disaster and the insecurity prevailing. We also heard that the earthquake had affected telecommunications in the neighboring country.”
Hernandez and his team followed the directive to travel to General Melenciano—a small hospital in Jimaní and the last town in the Dominican Republic before the Haitian border—where they would receive vaccinations against diphtheria, tetanus, and malaria. When they arrived at the hospital, Hernandez was shocked by what he saw. A large crowd had gathered in front of the hospital where several soldiers tried in vain to maintain order. Inside, patients choked the hallways and rooms to the point where one could hardly walk. Cries of despair and pain were everywhere, and, according to one of the physicians, more than 500 trauma victims from various Haitian cities, including Port-au-Prince, waited for a bed in the 20-bed hospital.
Hernandez sought out the director of the hospital, but found he was at a meeting in the town of Fond Parisien in Haiti but would return shortly.
“The secretary told us that the director wanted to talk with me to explore the possibility of recovering a sterilizer, a stationary x-ray unit, and an anesthesia machine.”
The director arrived shortly before 4 pm, but while waiting to speak with the director, Hernandez did not realize the Haitian border would close after 4 pm. Because of the delay, he had to stay another day in Jimaní.
“The director said some essential equipment had damage,” Hernandez said. “He said the hospital had exceeded its ability to care for patients. The Dominican people really opened their doors to Haiti and to human solidarity, and hosted large numbers of injured persons as a result of the earthquake. At about 5:30 pm, I received a call from the two coordinators of the mission, based in the United States. I explained that I needed to verify the status of three important pieces of equipment that were out of service. They agreed I should offer support if the problems were simple to solve, but reminded me my mission was in Port-au-Prince.”
At the PAHO, reports coming in from international aid groups and rescue teams were often unclear or inconsistent with one another in terms of damage to the city, but they all told of damage to infrastructure and equipment in major health facilities.
“A new day started. At 7:30 am, I went with the available tools to the x-ray equipment first,” Hernandez said. “I measured the voltage on the machine’s control panel, which measured within normal parameters. From a recognized American brand, the measurements were single phase, 300 mA, 220 volts AC, and manufactured in 2000. I requested a radiology technician, and I told him to prepare a chassis measuring 14 inches by 17 inches. The machine showed the presence of high voltage, which led me to believe that it was generating x-rays. I attempted to get an x-ray, but it was not possible to generate enough concentrated radiation to develop an x-ray film. The technician prepared all and made a shot from the control panel. The processed film showed nothing, as evidence that there was radiation. A deeper conversation with the radiological technologist convinced me that the tube had suffered overheating from overwork. I concluded that the technical problem was in the x-ray tube.
“Next, I went to the operating room, which contained the anesthesia machine. I dressed in surgical clothing and footwear. With support from an anesthesiologist I checked the supply of anesthetics and its blend with oxygen and nitrous oxide. The apparatus was out of control. We proceeded with a written procedure and some careful calibrations. The anesthesiologist was satisfied and said that he would use the machine at the next surgery.”
Hernandez continued his quest to repair the third item. “I went to a nearby room that had been installed with a sterilizer from a known American brand,” he says. “I checked the water inlet to the boiler, and there was enough pressure. I measured some resistors (electronic devices) one by one, meaning continuity from both ends. I connected everything again, and I tried to make a sterilization cycle. The final problem: a microswitch was not working and I could not repair the piece, but I took note of the brand, model, etc, of the equipment. From this point, my job only consisted of technical assistance. Despite the emergency situation caused by the earthquake, the maintenance service department was not functioning and there were no biomedical technicians.”
Hernandez left Jimaní later that day and crossed the border without any difficulty. The entrance to Port-au-Prince was clogged by traffic chaos as United Nations guards armed with automatic weapons tried unsuccessfully to restore order. Eventually, Hernandez arrived at the precincts of PAHO, which contained more than a dozen tents as a center for the international staff.
“Under considerable limitations, we prepared to begin our work for the next day,” Hernandez says. “Because of security issues we needed to be back at headquarters by 4 pm. Our coordinator promised to deliver to us a list of the hospitals most affected.”
Early the next morning, Hernandez left for the city’s general hospital, HUEH, also called Haiti’s University and Educational Hospital. It has about 100 beds and practices the five basic specialties. Despite studying routes to the hospital in the heart of the city, his driver had to take several detours and became lost. The air conditioning in the car kept them from the smells of the destroyed city, but outside the car pedestrians watched them pass with hands closed over their noses or covered their faces with breathing masks. Most of the smells came from decomposing bodies.
Hernandez eventually arrived at the facility, where he was temporarily halted by guards before they were given entry. The facility was close to the presidential palace, and the grounds were filled with people. Hernandez explains his task:
We determined that the major damage was concentrated in both the surgical block and the administration building. No health worker was at his workplace, many of them feared to enter the buildings for fear of another earthquake. I entered the affected areas and, as part of the mission, had papers to fill out with information on the damage. International institutions for relief and first aid had tents erected as mobile hospitals with patients everywhere. Some Haitians were acting as interpreters. There was no electricity, and many of those sites were in darkness. The lack of medical equipment in quantity and quality was obvious because the rooms were almost empty. I found similar patterns in other hospitals, a total abandonment situation.
Sometimes I asked myself, ‘Is this a hospital or a death house?’ We did a crosscheck of the health services, the number of beds, and the equipment. The results indicated that the provision of medical and institutional equipment was very poor. The radiology area was not affected by the quake and was composed of a waiting room with wooden seats and a darkroom with a very old automatic developer. Two fixed x-ray units were damaged and only one machine was functioning, despite being quite old. Technical characteristics were that it was an American brand, 300 mA, 1 phase, and 220 volts AC, which was being powered by an electrical generator.
In the following days, we continued with the assessment work of other hospitals in Port-au-Prince. However, we were presented with an unforeseen problem. Visiting some areas was considered highly dangerous by the UN, and it was necessary to apply several days in advance via the official media to obtain security clearance. For example, one of those areas identified as “red” in the city was Carrefour. It had a maternity hospital, and it was one of the country’s most marginalized neighborhoods that had suffered the ravages of the earthquake.
We evaluated five hospitals in total, with four in Port-au-Prince and one in the city of Leogane. All health care facilities were underequipped in relation to the services offered. A constant of Port-au-Prince was the lack of basic sanitation. Everywhere there were piles of trash and debris. The city of Leogane, on the southwest side, was full of sewage. The sewers were not working, there was sewage among the people, and high contamination from the sewage.
Hernandez successfully finished his mission for PAHO and served many hospitals during his trip. What he saw left a lasting impression on him, from destroyed houses and facilities to dead bodies and streets filled with shacks housing the newly homeless. Haiti had been severely damaged by the earthquake, but its needs went far deeper and further back than the natural disaster. Old and failing medical equipment was brought to light by the earthquake, and much needed aid had finally come to Haiti.
Matthew Draper is a contributing writer for 24×7. For more information, contact .