On the Same Page

Reflections on Haiti
Feb. 11, 2010

We may be about a thousand miles from Haiti, but the country and its people are closer than ever in our hearts.
The students, faculty, staff and alumni of the Health Science Center and Shands HealthCare have been touched
by the tragic earthquake that struck last month, and in recent weeks several have packed their bags, loaded up as
many medical supplies as they could marshal and headed to the island on various personal trips to help in
whatever way they could. In this issue of "On the Same Page," I'd like to share with you a glimpse of what they
experienced, of how they gave back, of how they have been touched, through their own eyes:

Mike Perri, Ph.D.
Dean, College of Public Health and Health Professions

Over the past year, faculty and staff from the UF Health Science
Center have been traveling to Haiti for work on several public
health initiatives. We were invited to start these projects by
Edsel Redden from the IFAS Extension Service, who over the
last decade has developed a demonstration farm in the
Christianville Community of Haiti. The farm feeds more than
1,500 children at two schools in the towns of Gressier and
Leogane (about 15 to 20 miles west of Port-au-Prince). On the
day following the earthquake, we learned that both schools had
collapsed.

We immediately initiated plans to travel Haiti. Getting there was not easy. After three days of false starts, we
flew to the Dominican Republic, where the U.S. Southern Command transported us via Blackhawk helicopters
to the Double Harvest Compound in Croix-de-Bouquets, Haiti (about 7 miles east of Port-au-Prince). Double
Harvest was selected because it had operating rooms that were underutilized.

We divided our group of 10 into two sub-teams: a "medical/surgical" group (Drs. Dave Meurer, David Risch,
Robert DeLaTorre and Bob Melosh, and Cindy Nelly, R.N.) and a "public health" group (Dr. John Gaines,
Sally Bethart, A.R.N.P., Slande Celeste, M.P.H., Edsel Redden and myself).

Our "medical/surgical" folks began immediately working with the Partners-in-Health medical team that had
recently arrived at Double Harvest. The group began triaging patients and operating on those who needed
surgery. For several days, the team worked with very few breaks treating lots of severe trauma cases, including
an overwhelming number of amputations. The team faced many heart-wrenching situations, such as parents
seeking medical care for their children who became overcome with grief when faced with deciding between
amputation or almost certain death.

As the news spread about the availability of medical care at Double Harvest, the numbers of patients brought to
the "Hospital" swelled exponentially. Throngs lined the road outside the compound each morning hoping for
treatment. The medical and surgical teams worked around the clock. The makeshift "recovery rooms" were
outdoor garages lined with mattresses on the floor. Behind the clinic, a fire burned constantly as a means of
disposing the amputated body parts.

Our "public health" team left Double Harvest on our second day in Haiti and we made our way to the
Gressier/Leogane area. We drove through Port-au-Prince and witnessed the massive devastation, including the

destruction to the Presidential Palace and the Cathedral. Building after building had collapsed, including homes,
shops, schools and government offices. In many places, the smell of death was unmistakable.

We drove through Port-au-Prince to Carrefour, the epicenter of the quake. We stopped there to search for
Slande Celeste's mother (who had not been heard from since the quake). Her home was destroyed, but she was
alive and well. It was a joyous moment!

We continued onto Leogane in search of Obinson Joseph, the principal of one of the local schools. Another
great moment! He was alive having survived the total collapse of the school, which housed his second floor
apartment. Luckily, the quake struck after school was out, sparing its 750 students. Obinson was grateful to see
us and immediately took us into the community to assist people injured in the quake. Slande served as
interpreter as Sally and John began treating the injured.

By nightfall, we made it into Christianville and found that the medical clinic, eye clinic, high school and
virtually all buildings in the compound had collapsed or had been damaged beyond repair. For that night and
several others, we slept outdoors. Each night we experienced multiple aftershocks. Following each shock, we
invariably heard the crying and wailing of people in the community. Parents subsequently told us of their
children experiencing nightmares and flashbacks to horror of the quake.

Each day our team set up an outdoor clinic in the courtyard of Obinson's collapsed school. As the word spread
that help was available, the stream of people with injuries and medical problems grew. Our team treated more
than 50 individuals each day. In some cases, we needed to transport people to other facilities that could provide
more extensive care. For example, we took a man with a gangrenous foot back to Double Harvest for a partial
amputation.

Our other activities included meeting with community leaders to discuss immediate and long-term needs and to
begin planning for the rebuilding of the schools. We also began the first of a series of trips to the Dominican
Republic to purchase food supplies. On our first run, we secured two tons of rice and successfully managed to
keep it well-covered (i.e., out of plain sight) as we worked our way on our five-hour journey from the
Dominican Republic through Port-au-Prince to Christianville. On subsequent trips, Edsel obtained additional
supplies that are being saved for distribution in future weeks when the shortages of food are expected to be
more severe.

As the week progressed, we observed an increasing presence on the streets of Haitian police and troops from the
U.N., the U.S. and other countries. We did not witness any untoward incidents other than arguments at
gridlocked intersections. We saw large crowds standing in long lines waiting for food and water in Port-au-
Prince, but the people appeared to be waiting very patiently in the hot sun.

Throughout the town and countryside, most people seemed to be hard at work in clean-up efforts. Tent cities
seemed to be springing up all over, as most people were afraid to sleep indoors. In most cases, the "tents" were
simply tarps hoisted on wooden poles. When the rainy season arrives next month, the conditions will be ripe for
outbreaks of serious diseases with the potential for a public health disaster of a different kind.

As a group, we are very grateful for opportunity to be a small part of the relief effort. We are thankful to all who
provided us with assistance and support. The resilience of the people of Haiti impressed us immensely. We are
all determined to make this effort the start of a continued collaboration to improve the lives of our brothers and
sisters in Haiti.

Mark Atkinson, Ph.D.
Co-director, UF's Diabetes Center of Excellence
American Diabetes Association eminent scholar

On Sunday (Jan. 24), our small team of 10 that my wife, Carol, and
I put together in 36 hours returned from a nine-day medical mission
trip to Haiti. Many of us were also there from Dec. 26 through Jan.
5, with our having led a team of 30 individuals on that effort.
Hence, as of today (Jan. 29), I have spent more days in Haiti over
the last month than here in Gainesville.

Upon returning, the first question most people ask of me is along
the lines of, "What was it like?" It is a difficult one to address, as
there are so many stories to tell and pictures to share.

Days filled seeing the natural history of amputations (including the
youngest of children); consistent screaming throughout the medical
compound for procedures (e.g., debridements, moving patients) that
are performed with little to NO anesthesia nor pain medication, or
for grief related to the loss of loved ones; concerns about
aftershocks (many people are afraid to stay indoors, or run out of
buildings when they occur); natural fears for one's safety; going
SC into the ill-working, stench-filled morgue where we worked and
seeing bodies stacked like cordwood, three and four high; and the
faces of hope when carefully walking among the living laying on
any spare piece of space on the floors or hospital grounds. Of the
people in the ward I was part of, it was estimated that one in three
would die there, and of those left, half would leave with some form of amputation. Only a fraction will leave in
a means of physical ability similar to that before the earthquakes.

Last Saturday, Carol had a touching story. While conversing with a 13-year-old boy who was paralyzed below
the waist in the earthquake and who had lost three brothers as well as his mother to the quake (only a sister
remained), Carol began to cry. Throughout the week, she had developed a rapport with him that was not much
more than a smile. But, at that moment, he wiped the tears from her face, saying, "Don't worry, it will be OK."
That, and a comment suggesting he drew comfort from her in that when he looked into her eyes, he saw the
image of his mom. Amazing.

This trip showed me, once again, that Haiti is about life, or more appropriately, a primal attempt of the Haitian
people to stay alive and our feeble but sincere attempt to help them meet that goal. The one thing I keep telling
myself is that we were providing them hope. We met many interesting people during our trip, and I think that
even though it was not an official UF effort, we represented our university well.

Among those whom I met, supported or provided interviews: Former Senate Majority Leader Dr. Bill Frist (I
sent three physicians from North Carolina and Tampa his way, for which he was extremely grateful); Geraldo
Rivera (who, with the Fox News crew, became partners in our efforts at the Port-au-Prince airport); U.S. Rep.
Kendrick Meek, D-Miami, who was there to help groups like ours meet their goals, and so on, and so on.

Haitians now speak of Jan. 12 much in the way we in the U.S. spoke of 9/11. A day that will forever be etched
in the Haitian people's minds. For Haitians, among other things, it will be a day that rendered countless
numbers into the realm of life as an amputee; a day to start life over again because of the loss of all possessions;
and a day when it is now essentially unheard of to identify an individual who did not lose a friend or family
member to the quake.

We have been leading medical mission trips to that country since the 1990s. Moving forward, however, the
situation is bleaker than ever. The airport is a loss, the one place with jobs and technology (Port-au-Prince) is a
disaster area, and the few with resources or an education are fleeing the country for the U.S. (round-the-clock
U.S. military flights out of Port-au-Prince airport) ... perhaps never to return. We know, having spent two days
living on the airport tarmac in Haiti, trying to meet up with our supplies and find a safe means out. And, let's
not forget that the threat of infectious disease like cholera and dengue fever loom like a storm on the horizon.
Food and water remain scarce in and around the area of Port-au-Prince. Many of the governmental officials in
this already ill-working country were killed in the quake, making a bad situation worse (an almost
unconceivable thought).

Thankfully, our team had much in the way of strength and an amazing ability to move forward each day. People
like those on this team have, and always will remain, true heroes in my life. Experiences like this also remind
me that I truly am a blessed man.

That, and despite of all of the above, there is no place, NO place in the world I would rather have been last
week, than in Haiti.

Again, despite ours not being part of a UF effort, hopefully, it will help make our institution look like leaders ...
if not a caring people ... in the eyes of others.

Indeed, I hope UF takes an active role in that country's future. Which leads to the second most-asked question,
"What can Ido to help?" Here, I would encourage people to stay active in hearing of events in Haiti (i.e., keep
the story alive and do not get weary hearing of it). Beyond this, I would ask that UF and other organizations
develop plans to become involved. The needs are many and will not be going away any time soon. Whether it
be provision of a donation or providing direct (on-site) assistance, I truly believe everyone can find a way to
help.

Eloise Harman, M.D.
Professor of medicine
Pulmonary and Critical Care Medicine

In 1996, I was asked by a second-year medical
student, Serge Geffrard, if I would be interested in
.. accompanying a group of first- and second-year
students to Haiti on a spring break medical mission
trip. I went along with the students and Dr. Parker
Small in March 1997, and we visited several locations
in Haiti administering vaccines and seeing sick
adults and children in orphanages and makeshift
clinics in and around Port-au-Prince and Laogon.
Serge called this Project Haiti and it has continued and
M flourished as a spring break volunteer activity for
students since then. I have been fortunate enough to be
Sable to accompany the students each year.
Picture taken in Haiti by UF student photojournalist Karina Gonzalez.
Project Haiti was the inspiration for other similar
activities and now a large proportion of the second-year medical student class participates in a service mission
in a foreign country during spring break. In some years, the Project Haiti group has been unable to enter Haiti
because of political instability. In those years we have been able to work in Jimani, a border town in the

Dominican Republic. Haitians in the Dominican Republic often lack access to medical care and are living in
poor conditions, so we can still fulfill our mission in the Dominican Republic.

Prior to the "tremblement de terre" on Jan. 12, people in Haiti had many challenges high unemployment,
high infant mortality, lack of access to education, poor roads, among many others. Now they are facing death of
loved ones, injuries, loss of basic necessities shelter, food and water. On Jan. 29, I traveled to Haiti, again
with Dr. Serge Geffrard, now a cardiologist in Atlanta. Serge founded a new organization, "Operation Haiti
Heart," centered in a small clinic and hospital in Fonds Parisien, which is about 15 miles from Port-au-Prince.

We were with a group of 15 physicians and nurses (primarily from Atlanta), all carrying gathered drugs and
medical supplies. I had 150 pounds of drugs and supplies donated and purchased. So many people who heard
that I was going to Haiti gave me supplies or money in all almost $1,000. We flew to Santo Domingo and
then traveled by bus to Fonds Parisien. Prior to leaving Santo Domingo, we bought $6,000 worth of food,
including 50 80-pound bags of rice, and transported it with a rented truck and our bus into Haiti. We had no
problems and were not stopped at the border. The food was distributed to 400 people living in tents behind a
Catholic church by the local priest without disorder.

We worked at the clinic in Fonds Parisien, where we saw a lot of people with minor injuries, coughs related to
the dust, inability to sleep and dehydration. There were babies who were underweight and lethargic because of
their mothers' inability to provide adequate breast milk with the stress and lack of food and water. We heard so
many stories of loss. One of the women in the hospital had been holding her twin babies when the earthquake
struck and they died in her arms. She was trapped for two days during which people threw bottles of water to
her. She was asked if she was angry and she said "No, I know God kept me alive for a purpose." Most people
escaped with literally just the clothes on their backs.

The second day we went into Port-au-Prince. The streets were packed with trucks and cars carrying aid
personnel. It seemed that all the tall buildings were flattened. Each block there would some buildings standing
and many just rubble. Some had signs in front indicating how many people were still buried inside. There were
many signs asking for help. We saw some tent cities with all manufactured tents but more commonly sheets
stretched over pieces of wood or tree limbs. There had been no rain since the earthquake and we worried what
would happen to these meager shelters when it did rain.

We went to a medical command center, which assigned us to work at the tent city across from the Presidential
Palace. There were 30,000 people there living in makeshift tents. After assessing the situation there, we were
unable to stay as there was no security. However, we did go to a nearby elementary school that had collapsed,
entombing 30 children. You could see the broken blackboard and desks inside and the air was full of the smell
of death and large black flies. Many people there had not received medical care since the quake, some because
they feared they would be forced to undergo amputation. We saw about 170 patients. There were infected
wounds which we cleaned and dressed, and we administered IM ceftriaxone. We did not have tetanus toxoid,
and later the same day saw two children in the hospital with tetanus.

Some of our group also went to The Port-au-Prince General Hospital, which was housed entirely in tents. The
nurses' residence had collapsed and there was concern about the stability of the main hospital building. The
nurses and doctors there had not been paid since the earthquake, but were still working. There was no food for
the patients or staff. The outside physicians working there left at 7 p.m. Serge volunteered our group to cover
the hospital at night. Security was good as the hospital was surrounded by Marines. Equipment and supplies
were scarce one tank of oxygen and one nasal cannula in the medical ward, no food or formula in the
pediatric ward. Serge returned the next day and distributed food at the hospital. Again, all was orderly. My
overall impression was that the distribution system for medical personnel and supplies lacked organization.

The people in Haiti are desperate for help. Despite this, I never felt unsafe or witnessed any unruly crowds or
mobs. Every person I treated thanked me for my help and was grateful for what we could give. Since 1997,

Project Haiti has allowed scores of eager and enthusiastic medical and pharmacy students the opportunity to
help the people of Haiti and the Dominican Republic while learning invaluable lessons about grace in the face
of deprivation. I always return humbled by what I have seen and grateful for what I have. In the future, we hope
to develop a permanent site in Haiti to allow year-round trips and development of public health and educational
projects.

Drs. Atkinson, Harman and Perri are just a few of several UF faculty physicians who headed to Haiti, along
with Shands nurses and others. Dr. Michael Moser, an assistant professor at the UF Orthopaedics and Sports
Medicine Institute and a UF team physician, led a UF group that included physician assistant Matt Walser,
registered nurse Terri Hodgson and medical doctors Michael Mac Millan, Mark Rice, Tim Morey, Ben Miller
and Jay Clugston. They worked from The H6pital Sacre Coeur in Milot, near the north coast of Haiti, about 80
miles from Port-au-Prince. Pediatric dentist Dr. Tim Garvey, meanwhile, worked in a makeshift hospital at the
airport in Port-au-Prince.

Closer to home, on Jan. 28, a patient who survived Haiti's earthquake was admitted to Shands at UF. The
ShandsCair flight team transported the patient by helicopter from Tampa to Gainesville. Shands at UF and
Shands Jacksonville are "first-receiver" medical centers. Each has a state-designated Level I trauma center and
Shands at UF has a regional bum center. UF College of Medicine and Shands teams have been on standby since
the earthquakes to support state emergency-response efforts. Shands HealthCare officials have also worked with
the state and donated medical supplies, hospital equipment, surgical instruments, diverse tools and other
materials. Shands also purchased and donated broad-spectrum antibiotics for medical relief efforts.

Faculty, staff and students interested in UF's official policies with regard to participating in Haiti relief efforts
should go to www.aa.ufl.edu/haiti/resources.htm for more information. In the days ahead, we are heartened that
so many plan to commit their personal time to continuing these important humanitarian efforts.

Warmest wishes,

David S. Guzick, M.D., Ph.D.
Senior Vice President, Health Affairs
President, UF&Shands Health System