Australian midwife Margaret Bell shares her diary from Haiti

Australian midwife Margaret Bell conducting a prenatal consultation at Médecins Sans Frontières' Health Centre in Champ de Mars. © Benoit Finck /MSF

Margaret Bell is a nurse and midwife from the Blue Mountains in New South Wales who has just returned from Haiti. Based in Port-au-Prince, Margaret worked providing antenatal care. Margaret was in Haiti for 6 weeks. In a diary she kept during her field placement in Haiti, she details her experience treating Haitians in the aftermath of one of the biggest natural disasters of recent times.

27/02/10

There have been one million people displaced by the quake and around 200,000 people died (or missing, assumed dead).

Most of the displaced people are living in tent camps scattered on any spare piece of land around the city. One of the largest camps is in front of the Presidential Palace (part of which was destroyed) in a place called The Champs de Mars. It is like a huge park area, I guess a bit like Hyde Park in Sydney, but larger. There are now 20,000 people living here in tents and makeshift shelters. Our outpatient department is directly opposite and Médecins Sans Frontières has also set up an inpatient department and operating theatre about 500 metres away in a school ground. There are around 120 beds and all have people with injuries from the quake. We are seeing a lot of broken bones, legs, spines – hence paralysed people. There are people with wounds that have become infected and there are many people needing mental healthcare.

I have to say I have never seen so much rubbish in a city. The piles just keep getting bigger as the city struggles without services. There is so much rubble and debris from the damaged buildings piled on each side of the streets – then rubbish just being piled around, that it could potentially have a medical impact in the future if it is not cleaned up.

There seems to be some cleaning up of damaged buildings beginning. In the housing areas, you see people picking up rubble piece by piece to move it into another pile, or to a truck if they are lucky. Sadly, you see people picking through the piles of rubbish also looking for food I’d imagine – or perhaps they’re after things that could be useful when you have lost everything.

I can hear the rain starting to fall outside. It’s 10pm and sounds like the rain will settle for the night. Going to sleep with the sound of rain is always a nice feeling but somehow tonight when I think of all those people under their plastic shelters, it has lost some of its beauty.

4/3/10

I think I was surprised to see how much activity has resumed in the city amid the damage and destruction. For some reason I had in my mind there would be no retail or commerce at all – but like anywhere else in the world, life goes on and people get back to some type of normality as soon as they can. I arrived five weeks after the quake, and by then the roads were clear so traffic could pass. Shops are open again, markets are set up and the hustle and bustle of life goes on. Obviously very different to before.

There seems to be food around (a plethora of fruit and veg) if you can afford it! I think that is the problem, people who have lost homes cannot. Some were possibly quite poor to start with and now even poorer. Water is also a problem with damage to pipes etc. There are water bladders set up around the city where the water is pumped or trucked to but there are not enough it seems. You sometimes see people lined up at distribution points collecting bottled water for drinking. Food distributions are also being done.

14/3/10

It has become busier each week. Fifty percent of the women we are seeing are having problems in early pregnancy such as miscarriages and other gynaecological problems.

A lovely woman I saw the other day came to us because she had been sexually assaulted. She is now pregnant as a result of the attack and is desperate to keep the baby despite the situation as she hasn’t seen her husband since the earthquake. She assumes he is dead and she lost both her children a few years ago. Her first child died a day after birth and the second died one five days after birth. She now visits us every few days for reassurance that the baby is ok and will be well after birth. Not knowing the circumstances of how the other children died, I can only hope this will be the case. Another woman came and was so happy and overwhelmed to be pregnant, as both her children were killed in the quake.

A national staff colleague told me a story of her neighbour whose daughter was trapped in the house after the quake. She had her mobile phone and managed to call a relative in the US as she didn’t know who to call in Haiti. That relative then tried to contact someone, anyone in Haiti who could help rescue her. The girl’s mother managed to find where she was in the rubble and pass a small amount of food to her. She kept in touch with her friend but after five days they didn’t hear from her again and no one had come to her rescue. There are so many stories like this.

19/3/10

We have a lovely team, both international and national staff. I have been living comfortably in a house with ten other people - doctors, nurses, administrators and logisticians. There is another house nearby with twenty people so I’m probably lucky to be in the smaller one as we have more living space and only have to share a room with two others. We eat well here, and we have water to wash with so I cannot complain about my time here.

It rained all through the night and this morning whilst driving to work we passed one of the camps. We had to stop for a few minutes in the traffic and there was a young boy standing at the door of his shelter. The shelter was made from plastic sheeting and I could see the floor all muddy and wet. I can only imagine what kind of night he and his family would have had. He saw me watching him and his face broke into a huge smile and he gave me a “thumbs up” sign. It absolutely made my day, if not my week, and is evidence to the strength and constitution of the people.

There are many skilled medical staff in Port-au-Prince so it has been quite easy to find doctors, nurses and midwives to work with us. Here in the outpatient department, we have four doctors and nurses. Nadia, a midwife, works with me.  I am about to employ a nurse to help with the organisation of urine tests and vaccinations. In the first week of the clinic, we saw forty women and this week we have seen 120 so far (there is one more day to go). We work Monday to Saturday and the clinic is about a 30 minute drive from our base and houses. I don’t mind the drive - it’s quite beautiful driving through and down the mountain. It does get a little disturbing when we get to the worst-affected area of the city, near our clinic. The worst-affected is now completely blocked off as the buildings are hanging quite precariously and are starting to be demolished. The stench from the rubbish and bodies still trapped is becoming quite bad.

We also have a big mental health component in our clinic and many of the other Médecins Sans Frontières facilities. It is always busy and the communities are very happy to be referred and often seek it out themselves. I imagine this will be a long term thing, as will be the need for physiotherapy and help to get people back on their feet. We have both facilities here in our outpatient department.

A young man came in today with a plaster cast on his arm. He had broken his humerus (upper arm) in November. He was due to have the plaster removed the day of the quake. That didn’t happen and since then he hasn’t been able to afford to go to a private clinic or anywhere to see a doctor. So my colleague removed it – the fracture had completely healed. He was so happy. He now needs some intense physio so he can straighten his elbow again as having his arm in that position for nine weeks longer than necessary left him with quite an immobile limb. It’s just another example of indirect effects of a disaster such as this.