ARTICLE - 'MERLIN MAGIC'

AID TEAM WORKING ITS MAGIC AS HAITI'S HOMELESS FACE CHOLERA HORROR
(The Times) - By Martin Fletcher

Port-au-Prince - From the hilltop tent that houses his clinic a young doctor named Jackson Fleuranvil solemnly surveys a sea of rudimentary shelters in which 12,500 Haitians made homeless by January’s earthquake have somehow survived for the past 11 months.

“Whatever we do we will have cholera here, and it will be catastrophic because of the way people are living,” he says of Acra camp, which covers several acres of former wasteland overhung by pylons and power lines near the centre of Port-au-Prince.

Dr Fleuranvil, 33, leads a team of two doctors, five nurses and a midwife, all of them Haitian, which works for Merlin, a British charity that provides health care in disaster zones, and runs daily clinics in the camp.

They are doing all in their power to prevent the cholera epidemic that is rapidly spreading across Haiti from ravaging their camp. If it does arrive here, they will be out there battling to save the lives of every camp dweller.

Staff hold almost continual sessions with Acra’s 2,700 struggling families to emphasise the paramount need for hygiene. They have six paid community health workers, recruited mainly from within the camp, going from tarpaulin shelter to shelter with megaphones and cartoon leaflets and giving hand-washing demonstrations to the children. They are frantically distributing soap and aquatabs to people far too poor to afford their own.

The odds are stacked against them. The shelters are so densely packed that there is scarcely room to walk between them. Streams of filthy water trickle down the hillsides to stagnant pools that are breeding grounds for flies and mosquitoes.

Clean water has to be trucked in, but there is not enough of it, and the few latrines are a “nightmare”, says Dr Fleuranvil. They are rarely cleaned. The floors are covered in piles of excrement, making a mockery of the hygiene notices on the doors. The stench is overpowering. Most inhabitants prefer to defecate into plastic bags which they then throw on to the piles of rotting refuse scattered around the camp.

In short, Merlin’s staff here, and in a dozen other urban and rural locations in Haiti where they run clinics, find themselves on the front line, battling another impending crisis.

But there is nothing new about that.

Merlin was formed in London in 1993 by three friends — a doctor, a manager and a logistician — who wanted to send medical teams into disaster zones, and its first mission was to truck £1 million worth of food and medicines into war-torn Bosnia.

From this modest beginning it has grown into Britain’s foremost overseas emergency medical relief charity, still small and agile and first on the front line where there is conflict or natural disaster.

It sent teams to Rwanda as soon as news of the genocide emerged, to Iraq after the US invasion, to Burma after Cyclone Nargis, and to South-East Asia after the tsunami. It works in Afghanistan, Darfur, the Swat Valley in Pakistan and the Democratic Republic of Congo. Danger is no deterrent.

A Merlin team reached Haiti four days after the earthquake in January that killed 230,000 people and left 1.3 million homeless — the worst urban disaster in modern times. Within nine days it had set up a fully operational medical centre in tents pitched on a couple of old tennis courts, earning it the nickname “Wimbledon”, and staffed it with a plastic surgeon, two accident and emergency consulants, two theatre operators and an anaesthetist, all from Britain.

It was “Wimbledon” that caught the attention of this reporter in March when I went out to cover the aftermath of the earthquake. Literally thousands of aid groups, big and small, had poured in to Haiti’s ruined capital in the weeks after the disaster.

They were a mixed blessing. Many duplicated each other’s work. A few saw the catastrophe as a fundraising or promotional opportunity. Others simply got in the way, or appeared to have come simply to make themselves feel good. I remember hesitating when my wife called me in Port-au-Prince and asked who to give money to, because so little of the vast sums being donated seemed to be reaching the victims.

Merlin, by contrast, stood out. It offered direct, practical and eminently measurable help to Haitians who had been brought in off the streets and were in desperate need, and often the charity found itself repairing the carelessness of others.

Its surgeons, some of them retired consultants from the UK, amputated gangrenous limbs, relieved the suffering of people who had, amazingly, lived for weeks with broken legs or dislocated joints, and helped to reset bones whose broken ends had crossed and fused. In a city of scarcely believable chaos and destruction it was a real haven of order and salvation for those fortunate enough to reach it.

A 14-year-old boy named Evans Veti, for example, was found wandering through the slums with a cumbersome metal scaffold called an external fixator on his shattered left leg.

It was held in place by six pins drilled into the bone, and the boy had been discharged by US naval surgeons without any idea of how or when to take it off. He might have worn it all his life, or until an infection set in that could have necessitated amputation. A Merlin surgeon removed it and ensured a full recovery for the teenager.

Unlike some of its counterparts Merlin was nimble. It did not have fleets of Land Cruisers clogging up the rubble-strewn streets of Port-au-Prince, or hordes of administrators with clipboards, or public relations people trumpeting its work. It prides itself on spending only about 4p of every donated pound on administration and promotion, and of having 98 per cent of its 3,870 staff out in the field.

Merlin’s “Wimbledon” clinic performed nearly 400 complex surgical operations in the three months after the earthquake, and treated more than 7,000 people in its outpatient department.
But another crucial part of Merlin’s approach is that it does not leave the moment an immediate humanitarian emergency is over and the television crews have left. It stays on to help to rebuild shattered health systems, and nowhere is that more important than in Haiti, the poorest and most wretched country in the western hemisphere.

Even before the earthquake 40 per cent of Haiti’s population lacked access to health care, barely a quarter of births were supervised by a trained medic, and the infant mortality rate of 86 per thousand was by far the highest in the Americas. Life expectancy was just 60. The quake then destroyed 73 of the country’s 373 hospitals, clinics and medical training facilities, and killed or injured countless doctors and nurses. The health ministry alone lost 200 staff when its headquarters collapsed.

Apart from Acra, Merlin now runs primary health care clinics in seven other camps in and around Port-au-Prince, in two more camps in the town of Petit Goave, which was also hit by the earthquake, and in seven remote mountain villages which previously had practically no access to health care at all.

It is now rushing to open half-a-dozen cholera treatment units. It treats roughly 13,000 patients a month, works closely with the health ministry, and is helping to train workers and rebuild health centres against the day it finally withdraws. Of its 160-odd employees in the country 140 are Haitian.

The nature of Merlin’s services may have changed from emergency surgery to primary health care, but they are no less valuable for that because the crisis in Haiti continues, albeit in a less obvious form. Some 1.3 million men, women and children who lost their homes are still living in a thousand overcrowded, desperately insanitary and downright dangerous camps like Acra, and remain intensely vulnerable.

In the past 11 months they and their flimsy shelters have been battered by torrential rain, floods, and Hurricane Tomas.

Dr Fleuranvil and his team routinely treat Acra’s inhabitants for ailments that result directly from their terrible living conditions — malnutrition, anaemia, diarrhoea, a lot of malaria, worms, scabies, fevers, respiratory diseases like bronchitis, asthma and pneumonia, intestinal infections and plenty of sexually transmitted diseases.

One week they are vaccinating children against diphtheria and tetanus, the next they are handing out mosquito nets. On the day The Times visited Acra they treated 104 patients.

That is just the start. Dr Fleuranvil said that rape cases were common in the early days after the earthquake, and still persist, and that the number of HIV cases was increasing. He also treats several victims of fights each week, some of them with knife wounds. “As a human being I’m sometimes shocked, but I must stay calm,” he said.

Rona Andre, 34, the Acra team’s midwife, said that sexual violence was common in the camp, though the victims were afraid to report it for fear of reprisals. Merlin gives out free contraceptives to try to address the soaring number of teenage pregnancies. Most of the women now giving birth in the camp are single. Indeed, a recent UN survey found that women in the camps were three times more likely to be pregnant.

Ms Andre said the number of dangerous “street” abortions had also increased, the preferred method being to swallow large quantities of a certain ulcer drug to try to kill the foetus. “Women are not secure enough here,” she said. “When there’s a lot of young men and women living right next to each other there is a high risk of rape.”

On top of all that, the camp now faces the scourge of cholera, and its inhabitants are understandably terrified. “It really stresses me. Every time they talk about it I shiver,” said Marie Lourdes Pikard as she sat in the clinic with her feverish three-year-old daughter.
“Everyone’s talking about cholera, cholera,” complained another woman, Samedi Rose Venite.

Dr Fleuranvil has a simple message for the outside world as his benighted country’s year of almost biblical disasters — earthquakes, floods and tempests — ends with a dreadful pestilence. “We thank you for your help, but we need more,” he pleads. “Please continue what you started because the situation here is still very, very difficult.”