Konbit Sante: The Earthquake's Consequences for Cap Haitian

By Bryan Schaaf on Thursday, February 11, 2010.

While the impact of the earthquake was felt most acutely in Port au Prince, the entire country has been affected.  Hundreds of thousands of the displaced have returned to a long neglected countryside and to secondary cities like Cap Haitian.  Nate Nickerson, Director of Konbit Sante, provides an update on how Cap Haitian is dealing with the influx and what is being done to meet the health needs of returnees.  You can learn more about Konbit Sante's important work, and how you can support them, on their Website and Facebook Page

 

On behalf of Konbit Sante, a Portland-based health partnership on the ground in northern Haiti, I want to express our deep appreciation to the many individuals and organizations who have called, written, put on fundraisers, or donated to show their concern for the people in Haiti who find themselves in dire circumstances.  I will try to describe to you the situation in Cap Haitian, and the impact your generosity and efforts have had.

 

One morning I woke up to the earth shaking.  It was not dramatic; just enough to wake me up. It was not particular frightening, but my immediate thought was that something really terrifying was happening to someone in this country at that moment.  Indeed, it was the morning of the 6.0 aftershock, again centered in Port au Prince.  Working in Northern Haiti these past weeks has been a bit like that.  We are not at the epicenter of the earthquake.  The buildings here were not destroyed.  But there are constant reminders nearby.

 

Shortly after the earthquake, the displaced from Port au Prince began to arrive; some injured and maimed.  At first, they were transported by family and friends who were lucky enough to have access to cars.  Then the Cap Haitien mayor’s office began to send recently-donated busses on round-trip excursions to find people who needed evacuation, and brought them to the safety of the North.  Eventually, the Coast Guard began to helicopter injured people to an American-run facility nearby (Hopital Sacre Coeur).  All of the patients who came to the Haitian-run public Justinian Hospital that we partner with, arrived over-land.

 

After the largest tremor, there was a lot of concern from the medical residents, the major workforce in the hospital, that their living quarters were unsafe.  They live in a poorly constructed, unreinforced block building, in which new cracks and fissures appeared.  The anxiety level about all things related to the earthquake is understandably very high.  Most have been traumatized by loss of family and friends; by the collapse of just such buildings. I have now learned that subtle indications of earthquake damage to a building, that would not be evident to an untrained or casual observer, can portend very serious structural damage to a building, rendering it unsafe to enter, so we arranged to have structural engineers evaluate the building, through another local partner.  Fortunately, they were able to reassure the residents that the building is not at imminent risk.

 

I was struck, however, that the entire country is much like a building with hidden earthquake damage that is not yet obvious to many.  While there is understandably tremendous attention to Port au Prince, there are fissures and cracks in the systems and fabric of everyone’s life here that put an already-fragile place at great risk.  Port-au-Prince was in many ways the nerve center of the country.  Its destruction impacts the entire country; often in ways that are not so dramatically obvious or as visual, or sensational enough for significant media coverage, as the flattened buildings of Port au Prince.

 

There are an estimated 1.5 million people left homeless in the country who need to find a place to live.  There are over 200,000 seriously injured survivors who will need post-operative and wound care, re-setting of bones, treatment for infections, and psychological support.  Here in Cap Haitien; the displaced, strangers as well as friends, are being taken in by families everywhere.  Almost everyone I know has taken in six, seven, eight, or more people.  The Haitian people are demonstrating great compassion and care for one another, but that means that the household food and necessities have to stretch for two to three times as many people, without a commensurate increase in personal resources.  In fact, for most, Port-au-Prince was part of their economic lifeline.  The small items that poor women sell in the market, for instance, often originated in Port-au-Prince, and now they have nothing to sell.  The price of food, gas, water, and basic necessities, meanwhile, are increasing daily.

 

The medical residents who staff the Justinian Hospital were largely supported by their families in Port-au-Prince, and many have lost both family members and financial support.  The hospital, which received its small operational budget from Port-au-Prince, now receives nothing from there.

 

Konbit Sante has chosen to focus on what we know best; supporting our long-term Haitian partners in their efforts to maintain a level of care for the local vulnerable population, the growing population of the displaced, and the injured that have been evacuated from the south.  I was frankly concerned -terrified really- as I was preparing to come down shortly after the earthquake, that we would have little more to offer our friends than moral support.  But, because of the amazing mobilization of so many from our community and beyond, in support of our sister-city, we have been able to have a substantial impact.  I am humbled by the trust you have put in us to do the right thing with these resources, so I want to report back to you some examples of what we have been able to do with your support.

 

We have provided oxygen, medicine, and critical supplies to the Justinian Hospital, and other facilities accepting patients.  We have set up a purchasing logistics system from the Dominican Republic, to get urgent medicines and supplies quickly.  We were able to get the radiology service functional, and it has now taken hundreds of x-rays in the past weeks.  We have paid for fuel for hospital generators, as well as for busses to go to Port au Prince to bring back injured and stranded people.  We have supported food and water distribution by a trusted collaborating partner in areas of Port-au-Prince that were not being reached by large international organizations. We have been able to support a make-shift triage and primary care clinic set up at the returnee registration center established by the local authorities.

 

This effort, which was once completely staffed by American volunteers, now has Haitian medical leadership and integration.  We have purchased blood donation bags for the Haitian Red Cross, because they ran out of them in the North, and purchased proper refrigeration for blood storage at the hospital.  Hospital patient fees are now the only revenue the hospital has to function, and a large percentage of local patient fees are already waived because the patients are too poor to pay, so we have set up a fund to pay for the nominal normal hospital and clinic fees for the earthquake victims seeking care so that they do not further stress an already over-burdened system.  This is being done in two-week agreements, so that we can closely monitor the care and expenditures.

 

We are integrated into coordinating humanitarian efforts with the local authorities, the UN, and others. We are the coordinating body developing a medium to long-term supply chain for the hospital with several large international organizations, because as the acute phase ends, there will be long-term earthquake-related health care burdens for all of Haiti.  The International Committee of the Red Cross (ICRC) has agreed to let us store cargo containers in their secured area if too many come in at one time.  We’re expecting three containers of supplies to arrive soon from Hope International, and those supplies will be sent to where they are most needed in the area.  One of our Haitian staff has been deployed to work in Port-au-Prince with our close partner Direct Relief International to help them set up their base of operations for supply distribution there.  We are working to assure that vaccines and TB medication supply lines are not interrupted; which would further compound the effects of the earthquake.

 

We have had teams of seasoned volunteers coming down to work together with, and augment the capacity of, the public hospital.  We have provided funding to another Haitian partner organization, so that they can expand their feeding program for severely malnourished children to include displaced families with children.  This will provide bridge funding until the World Food Program (WFP) can restore food supplies next month.  Konbit Sante volunteers and staff are well-positioned to provide targeted and informed assistance, in a manner that strengthens the Haitian capacity to meet their own needs as much as possible.  Too often, I have seen well-intentioned people volunteers and basically announcing to their Haitian hosts, “get out of the way, we are here to do the job”.  For us, Haitians are never in the way.  They are the hope for their own future.

 

Clearly, there is so much work to do, and we are just a small part of what is needed.  There will be more stories to tell in the weeks and months ahead – stories about the challenges we haven’t even anticipated- stories of hope and recovery, in part, made possible by the kindness of our supporters.  Konbit Sante will continue providing updates and sharing our volunteers’ experiences in Haiti through our website, email news, and Facebook, and we invite you to stay engaged. 

 

Thank you!

Nathan Nickerson

Executive Director

Konbit Sante

 

Konbit Sante Update (February 2014)

Dear friends, thank you all for your support of our recent Annual Appeal. I am in Cap-Haitien, where I am working with staff, partners, and volunteers on critical maternal and child projects that would not be possible without your generous contributions. Over the next two weeks, my colleagues and I will be:
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Conducting an assessment of newborn care at Justinian University Hospital (JUH). Although newborns are only 40% of all pediatric patients admitted to the hospital, they constitute 70% of all pediatric deaths. The assessment will attempt to identify factors contributing to these deaths and propose recommendations for change in the provision of care.
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Reviewing our community-based projects, including the prenatal mobile clinics, support for traditional birth attendants, and transportation for obstetrical emergencies, to ensure that we are providing high quality services. Stay tuned for an update on these projects. In the meantime, we encourage you to read the following posts about our work.
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Sincerely,
Tezita Negussie
Program Specialist
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P.S. Please take a moment and vote for Konbit Sante! Vote for us by visiting Community Matters More or stopping by any of the 57 branches statewide of Bangor Savings Bank and write in Konbit Sante. Your support can help us win a $1,000 grant.... or a $5,000 one if they hear from lots of our supporters!
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Malnourishment Study Presented to Health Professionals Across Haiti
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Konbit Sante was pleased to participate in the dissemination of the findings from a recently published study of the impact of provision of a ready-made food supplement on preventing malnourishment and growth stunting in very young children in an economically poor area of Cap Haitien. We collaborated on this study with Washington University and Meds & Food for Kids (MFK)....
The study presented found that supplementation with the nutrient dense, low calorie, peanut butter product- NutraButter- produced by Meds & Food for Kids (MFK) in their factory outside of Cap Haitian, had a positive effect on reducing stunting, but that effect may have not been as great as it might have been because of the continued incidence of diarrheal diseases in these children. More research is needed, especially combining this approach with improving sanitation efforts.
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Interview with Konbit Sante Executive Director, Nate Nickerson
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Recently on the Dr. Lisa Radio Hour, Dr Lisa Beslisle spoke to individuals who are contributing to world wellness by giving of themselves, both in Maine and abroad. From purifying hospital water supplies in Haiti, to providing homes in Central America, Dr. Nathan Nickerson and Mark Carter are making a difference one brick, and one patient, at a time. You can listen to the audio interview with Nate, who returned to Maine this weekend after four weeks in Cap-Haitien.

Konbit Sante Update (April 2013)

Dear friends,I just returned from five weeks of working with our Haitian staff and partners in Cap-Haitien. We recently bid a fond farewell to Dr. Youseline Télémaque, who very capably served as our Haiti program manager since 2010. She left to accept an appointment from the Ministry of Health to strengthen the maternity services at our close partner, the Justinian Hospital. We wish her luck and look forward to working closely with her in her new role.I hope you enjoy this brief report that covers changes in our management as well as updates on some of our programs.
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For those of you who live within driving distance of Portland, I hope to see you at our 4th Annual Maine Walks with Haiti and 4-Mile Run on May 11th !
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Peace,
Nate Nickerson, RN, DrPH, Executive Director
Expansion of Maternal & Child Services
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This winter we began to work with Unité de Lutte pour la Santé (ULS), a new and very promising Haitian organization based in Bande du Nord. ULS was founded in 2010 by a group of young Haitian doctors and nurses to bring basic health care to this underserved section of Cap-Haitien. With funding from Chemonics and USAID's Office of Transition Initiatives, Konbit Sante seeks to strengthen the capacity of ULS to provide maternal, child, and reproductive health services and information to this community. Director Maudelin Mesadieu, MD, (far left) is shown with his core staff. Congratulations!
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Congratulations are in order to Jose Ramour, who has been appointed as Acting County Manager for Konbit Sante’s Haiti office. Jose, who has a background in information technology and business, has served since 2010 as the administrator of Konbit Sante’s Haiti office. In this new role, Jose will oversee operations and programs for Konbit Sante in Haiti. The Cap-Haitien office employs 35 staff, ranging from other administrative staff to technicians and health professionals in a variety of roles embedded in the public healthcare system. We are also pleased to announce Clotilde Josaime St-Jean, RN, has been promoted to Program Manager for Community Programs. Ms. St-Jean, who joined Konbit Sante two years ago to coordinate outreach and the mobile clinics, has expertise and demonstrated leadership in community health. We wish both Jose and Ms. St-Jean the best in their new roles!
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Improvement of Hospital Financial Management:
The administration at the Justinian University Hospital, the 2nd largest public teaching hospital in Haiti, invited Konbit Sante to help them improve the accountability and transparency of their financial systems. Improvements to the financial systems will improve collections resulting in the hospital’s ability to improve patient care and treat more people. Another important outcome is the ability to better extend services to those without the ability to pay. In this photo, Konbit Sante staff and volunteers meet with Justinian Hospital executives to begin the first phase of the financial management study. At the far end of the table are hospital Executive Director, Jean Dubé, MD, (left) and Administrator, Fenel Etienne (right).
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ABOUT KONBIT SANTE: Since 2001, Konbit Sante staff and volunteers have worked in collaboration with the Haitian Ministry of Health and other partners to build local capacity in all aspects of the health system - from door-to-door community outreach programs, to strengthening community health centers, to improving care at the regional referral hospital. In Haitian Creole, a konbit is a partnership, a traditional Haitian method of working together to till your friends’ fields as well as your own. The word sante means health. For more information about Konbit Sante-supported programs, please visit our website.

Konbit Sante Update (3/8/2013)

The 4th Annual Maine Walks with Haiti and 4-Mile Run is set for May 11. Gather at 9:30 am at the Preble St. Parking lot across from Hannaford and walk or run around scenic back Cove. Register now! Enjoy a morning of entertainment including a Haitian RaRa band led by Boston-based Blem su Blem. Stay tuned for more details and let us know if you'd like to volunteer. We are pleased to announce that we just met our goal of raising $140,000 for our annual appeal. A sincere thanks to those who gave! Large or small, your support makes a difference in improving the health of our neighbors in northern Hait by helping them build a strong health system.
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The new year has been busy for Konbit Sante in Haiti. Our hardworking Haitian staff continue their essential work within the public health system in Cap-Haitien, and US staff and volunteers traveled to work on a number of projects. Back in Maine, staff and volunteers are busy planning our annual signature event, Maine Walks with Haiti and 4-Mile Run to be held on May 11, 2013. Join us to get some exercise, experience a Haitian festival and support Konbit Sante! I hope you enjoy this sampling of updates. Contact me with your comments anytime.
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ER Transport Project: One of the projects recently undertaken was to evaluate the program begun last year to help women experiencing complications in childbirth to obtain emergency transport to the nearest medical facility. Shown here is graduate student Jeff Caulfield (center) from Johns Hopkins interviewing a volunteer driver (right) who has been trained to participate in the program. On the left is Eddie Joseph, who often translates for Konbit Sante. Research such as this is important for improving our programs.
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Inauguration of Health Center: The year-long project to renovate and expand the Fort St Michel Health Center (FMS) is complete. US and Haitian staff were on hand at the inauguration on January 23rd to welcome dignitaries and guests including officials from USAID and MINUSTAH, which funded the project. Dr. Ernest Robert Jasmin, Regional Minister of Health, thanked Konbit Sante and the funders for the improvements to FSM, which is operated by the ministry. The building project expanded waiting and treatment areas and included a drainage system designed to eliminate the flooding of the facility grounds.
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Improved Surgeries:The infrastructure team of Hugh Tozer, Jeff Musich and Bob MacKinnon worked on a variety of projects at Justinian University Hospital. One mission accomplished – the autoclave, donated by Mercy Hospital in Portland, is now operational. Placed in the OR, this machine is a major upgrade, allowing more efficient and effective sterilization of surgical equipment. In this photo, volunteer Hugh Tozer trains two hospital technicians who are responsible for operating the autoclave

Update from Konbit Sante Director (2/12/2013)

Friends, first of all, I want to thank all of you who have supported our annual appeal. I just returned from a month working with our Haitian staff and partners, and can report progress on many fronts:
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An operating room sterilizer, installed by our volunteer Infrastructure Team, helps assure that surgical patients at Justinian Hospital undergo safe operations.
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Our new partnership with a community clinic will improve primary care to an underserved area on the outskirts of Cap-Haitien. At their invitation, we are joining with the administration of Justinian Hospital to help strengthen their financial management systems to improve their ability to support their own needs.
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It is your support that has made these and other initiatives that improve the health of our neighbors in northern Haiti possible.
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We set a goal of raising $140,000 to support existing salaries and programs, and are now about 85% of the way to meeting that. If you have not made a gift, would you consider helping us close the $20,000 gap? On behalf of our partnership with the Haitian people, I thank you for your consideration and generosity.
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Nate Nickerson, RN, DrPH
Executive Director

Update from Konbit Sante (4/7/2011)

Dear Friends,
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I'm writing to you from Haiti with a very brief update and an invitation to join us on June 4 for the second annual Maine Walks for Haiti walk/run. While Haiti hasn't been in the news as much recently, people in Cap-Haitien are still struggling with wrenching poverty and shortages as well as the ongoing cholera epidemic. A substantial amount of the international funding that we read about has been delayed pending announcement of results of the runoff presidential election; the preliminary results for which were announced this week. It is too early to know the longer-term implications of it all, but there is at least a transient sense of hope for a better future. Through all of the ups and downs of recent times, our work continues, as always, unabated. This week, for instance, we have six volunteers from the U.S. here, including specialists in nursing, women's health, and public health, all working with their Haitian counterparts to strengthen different aspects of the health system. The nurses are giving lectures in the nursing school, and working on developing educational materials with hospital nurses. The women's health group is following up on past family planning and maternal mortality reduction work, and strategizing with the Ministry of Health and others on how to increase the impact. And the Public Health group is working on developing a referral resource guide of for use by our health agents. Here is a sampling of a few other things that are also currently happening. There will be much more to follow in the May newsletter.
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Cholera: While forecasts about the duration and severity of the epidemic vary, cholera is expected to be in the environment and threaten lives in Haiti for the foreseeable future. The good news is that the numbers and severity of new cases is down from the incredibly high levels even a couple of months ago. In Cap-Haitien where we work, the focus is shifting from treatment to prevention and the development of a backup plan in case there is a spike in severe cases again. Konbit Sante, with Haiti Hospital Appeal (HHA), is currently staffing 59 oral rehydration posts in the communities where we work, where health workers educate about hand washing, water testing and disinfection, and provide early intervention (oral rehydration) for symptomatic people. Responsibility for the ongoing management of these posts will soon be transitioned to the Ministry of Health "cholera brigades."
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Sanitation: We have two important sanitation projects underway at the Justinian Hospital. These have been on our wish list for a long time, as any of you who have been in Haiti with us will understand. The first is a project to improve collection and removal of solid waste (everything that comes out of the wards and the operating rooms). A $25,000 grant from MINUSTAH (United Nations Stabilization Mission in Haiti) will remove current debris, clean the area, build a structure to store the waste, and provide easy access by trucks to remove the waste rather than burning it. A second project, funded by the World Health Organization, will demolish the old pit latrines behind the hospital (the only facilities for many patients and families) and replace them with two, more hygienic, 4-stall latrines designed by some of our volunteer engineers. This $52,000 grant from WHO will also fund the building of two 4-stall showers for patients and families, and the laundry facility will be renovated and improved.
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Spinal Cord Rehab: Work has started on the building the Spinal Cord Rehab Center that we began working on with our partners Haiti Hospital Appeal after the earthquake, when the need became so evident. This will be the first and only such facility in Northern Haiti, and we hope that it will be open in a few months.
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Staff Changes: In Haiti, Dr. Youseline Telemaque, formerly head of our Women's Health team, has become our In-Country Program Manager. Upon assuming the new responsibilities, Dr. Telemaque had to deal immediately with the cholera epidemic in Cap-Haitien. She has been widely acknowledged for her superb leadership and early and aggressive action in addressing this scourge. We are very pleased and proud to have her be the face of Konbit Sante day-in and day-out in the community and with other partners here.
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In Maine, we are happy to welcome Victoria Broadbent, MBA, as our new Office Manager. Victoria comes to us with extensive financial and business background and skill-set, which will help strengthen our management as the scope and complexity of our work increases. This combined with an irrepressible enthusiasm for our work makes her a great addition to Konbit Sante.
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Members of Our Haitian Team Visit Maine in May: Several members of the Konbit Sante Haiti team - Dr. Youseline Telemaque (In-Country Program Manager), Dr. Marie-Carmelle Leconte (Haiti Board Member) , and Jose Raymour (Administrator) - will visit Maine in May to participate in strategic planning meetings. We look forward to their visit.
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All the best from Haiti,
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Nathan M. Nickerson, RN,DrPH
Executive Director
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MAINE WALKS FOR HAITI: June 4th, 2011: Mark your calendars and plan to join in the second MAINE WALKS FOR HAITI event on Saturday, June 4. This year's event will include a fun run as well as a walk around Portland's 3.4-mile Back Cove trail. This is an excellent opportunity to take a walk or run, enjoy Haitian music and entertainment, and help the people of Haiti at the same time! For more information please visit www.mainewalksforhaiti.org.
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About Konbit Sante: Since 2001, Konbit Sante staff and volunteers have worked in collaboration with the Haitian Ministry of Health and other partners to build local capacity in all aspects of the health system - from door-to-door community outreach programs, to strengthening community health centers, to improving care at the regional referral hospital. In Haitian Creole, a konbit is a traditional Haitian method of working together to till your friends' fields as well as your own - working together toward a common goal. The word sante means health. For more information about Konbit Sante-supported programs in community outreach and disease prevention, pediatrics, women's health, procurement and management of medical equipment and supplies, improvement of water quality at the regional referral hospital and more, please visit www.healthyhaiti.org. Konbit Sante is a 501(c)3 not-for-profit corporation organized in the State of Maine.

One Year After Haiti's Earthquake: Remembrance and Reflection

1/12/2011
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Dear Friends,
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Today in Haiti people are solemnly observing the anniversary of the earthquake that rocked the country one year ago. It is a sad day of remembrance and reflection. There will be much said and written today about the enormity of the calamity. There will be words of acknowledgement and congratulations about all that has been done by so many heroes, Haitian and foreign. And, there will be words of rebuke and blame about all that has not been accomplished in light of the great remaining need. In this year there have been times of guarded optimism for a new Haiti that is "rebuilt right," and there have been times of anger and despair over the missed opportunities, misguided efforts, and unfulfilled promises. In many ways everything has changed since that day, and many of us who are close to Haiti have been irrevocably changed by this past year. In other ways, things are very much the same as they were before the earthquake. The basic public health infrastructure remains so poor and insubstantial, for example, that cholera has been able to spread like wildfire throughout the entire country, sparing no remote corner. It is an epidemic that could have started and spread the same way before the earthquake.
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Thousands march along the waterfront boulevard in Cap-Haitien in January 2010 to honor those who died in the earthquake It is really not possible to capture what It is too complicated and it means too many different things to too many different people.this year has meant in a sound bite. It is too complicated and it means too many different things to too many different people. However, as I sit in Haiti today and reflect about the meaning of this day, there is one thing that stands out for me. There is a Haitian proverb that says, "Se le ou nan malè ou konnen si ou gen bon zanmi," which translates something like, "It is when you are in trouble that you know if you have good friends." This year Haiti was in particular trouble, and we had the opportunity and privilege to deepen and expand our friendships by standing sidebyside with the people in our sister city, to address the huge challenges they faced. We are not big, and our resources are not great compared to the need, but the generosity that has been shown to us by our home community and the support that we have been able to extend here have enriched us all.
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Konbit Sante is an organization, true, but the ideal of konbit sante- a group of people working together toward the common purpose of improving health- is bigger than we are, and is an ideal that we want to promote. The konbit sante that deepened over this past year includes all who made their personal or organizational agendas second to that common goal and put their shoulders to the wheel and resources on the table together. In this past year I have seen people rise to the occasion in extraordinary ways. I have been extremely proud of our staff here in Haiti for stepping up and working beyond their full capacity. I have seen rapid and effective outreach and engagement in the communities. Volunteers have contributed in extraordinary ways. I have heard a lot about NGOs being very competitive and insular in Haiti, but in the North I have seen an increasing willingness to collaborate and share and keep focused on the common mission. I have seen the health authorities and the international groups grow in respect for each other and what each contributes for the common good.
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Things are clearly not rosy here, and there is much that remains to be done, but the proverb is true; in this tragedy we have learned that we have good friends, for which we are deeply grateful, and we have learned that we can be good friends, and there is hardly a greater privilege or calling than that.
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Peace,
Nathan M. Nickerson, RN, DrPH
Executive Director

Cholera hits Cap Haitian Where Konbit Sante Works (11/1/2010)

Maine Today
By Beth Quimby
bquimby@mainetoday.com
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Cholera has spread to Cap Haitien, the city in Haiti where a Portland-based group works to improve health conditions. DONATIONS to Konbit Sante may be made by check made out to Konbit Sante and mailed to Konbit Sante, Box 11281, Portland ME 04104, or online at the Konbit Sante website at www.konbitsante.org. Nate Nickerson, executive director of the nonprofit Konbit Sante, said five cases of the deadly disease were confirmed Thursday night in Cap Haitien, the nation's second largest city. Nickerson wrote in an e-mail Friday that a triage site had been set up outside Justinian University Hospital in Cap Haitien, where Konbit Sante has focused its health efforts in the poverty-stricken country during the past decade.
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"The gymnasium near the hospital will be used for a treatment and isolation center," he wrote. Until Thursday, Cap Haitien had been spared any cases of the cholera. The Rev. Marc Boisvert, a Lewiston native who operates an orphanage and school outside Les Cayes, reported on his blog a week ago that no cases of the deadly disease had been documented in his region. It appears the situation in Les Cayes has not changed since. Cap Haitien is located in the north and Les Cayes in the south. Almost all of the cholera cases since the outbreak was confirmed on Oct. 21 have been in the central part of the country, but late last week they began to surface in the northern region.
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As of Thursday, 303 people out of 4,722 confirmed cases had died, according to the latest report by the United Nations Office for the Coordination of Humanitarian Affairs. Speaking earlier in the week by cell phone, Nickerson said there was some guarded optimism that the epidemic was slowing. "But the course of such things is not entirely predictable and it is best to work hard to be prepared for the worst," he said. Nickerson said in his e-mail Friday that volunteers are still optimistic that a major education campaign and response has slowed the epidemic. Other Mainers with ties to Haiti have been checking on the status of friends and relatives in the poverty-stricken country. Pam Lee, who has opened her Kennebunkport home to two Haitian men wounded and displaced in the Jan. 12 earthquake, said so far everyone she is in touch with seems to be alright. "They are right in the line of fire, but so far everyone we have close contact with has been safe," she said.
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Nickerson, who has been in the country for the past four weeks, said Konbit Sante has been working hard with the government and public health organizations to prevent the spread of the disease. They've been helping to alert and educate people about cholera and procure the supplies needed to respond quickly. Now that the epidemic has arrived, said Nickerson, Konbit Sante is providing logistics support. He said the hospital leadership and its partners have a good plan in place going forward. Cholera is an acute inflammation of the intestines that causes diarrhea and vomiting. Untreated, it can kill within hours. It is transmitted largely by feces-contaminated water and is one of the leading causes of death, sickening 3 million to 5 million people and killing 100,000 worldwide annually. Nickerson said that although the public education campaign to alert Haitians to the cholera outbreak has been effective, the poorest Haitians have no access to clean water. "This is one more tragedy in a whole litany of them," he said.
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Boisvert, a Roman Catholic priest, wrote on his blog a week ago that the wells at Hope Village compound, which houses 600 orphans and educates 1,300 students, are tested regularly and children are taught not to drink from other sources. "To be safe, we are treating our drinking water for the children with AquaTabs," he wrote. AquaTabs are water purification tablets. Nickerson says the outbreak highlights the water quality issues in Haiti. He said only a third of the residents of Cap Haitien have the use of some sort of toilet, and most residents live without running water, sewers or electricity. "Obviously, if everyone had access to clean water, cholera couldn't take hold," he said.
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Nickerson said the complete deforestation of Haiti has resulted in the contamination of underground aquifers by sewage and salt water. When Konbit Sante first arrived in Cap Haitien a decade ago, the Justinian Hospital's own water supply was unsafe. "All the water coming through the faucets was contaminated," he said. Volunteer engineers from Maine fixed the problem. Now his organization is trying to improve water quality in the surrounding community, which would help end much of the illness. The supplies Konbit Sante has obtained will be useful even if no more cases surface, said Nickerson. "All of the supplies that we are bringing in are badly needed anyway for the baseline diarrheal illnesses that routinely take the lives of many children here, day in and day out," he said.

Wound Care Capacity Strengthened at Justinian Hospital

10/29/2010
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Shortly after the January 12 earthquake, the Justinian University Hospital in Cap-Haitien received a dramatic increase in the numbers of severely injured patients. A team of volunteer surgical nurses from Maine Medical Center and Orthopaedic Associates in Portland came to provide direct assistance in caring for these patients. Although it was the first visit for all of them, new relationships were formed during that difficult time, and a new partnership was born. Working together during that crisis period led to a longer-term goal of improving the capacity of the hospital to provide the highest level of wound care and recovery from such injuries that are not uncommon in Haiti.
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Consistent with Maine-based Konbit Sante Cap-Haitien Health Partnership's approach of investing in, and supporting, Haitians who have great potential to contribute to the strengthening of the health system, Konbit Sante hired Nurse Manuchca Marc Alcime to expand capacity in wound care and to provide training on an ongoing basis. Wound care nurse, Manuchca Alcieme, treats a patient at Justinian Hospital in Cap-Haitian. Ms. Alcime completed her basic nursing training at the Ecole des Infermières Notre Dame de la Sagesse in Cap-Haitien and, prior to joining Konbit Sante, worked as an operating room nurse at Justinian Hospital and as a nurse teacher in basic nursing and surgery nursing.
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After spending four weeks at Maine Medical Center in Portland training on a variety of subjects including wound care, burn care, and ostomy care, Ms. Alcime is now at the Justinian Hospital working full time as a resource for the entire hospital, providing patient care and cross-training nurses. "I am really impressed with Manuchca's skills, dedication, and desire to provide excellent care," says Konbit Sante Executive Director, Nate Nickerson. "She has a wonderful way with both colleagues and patients, and is eager to learn and share new skills. We are committed to supporting her to be successful in her role, by providing technical, moral, and material support. It is such a great example of how we can work together to make sustainable changes in the care of patients that will multiply in effect."
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Konbit Sante wishes to thank wound care nurses Susan Reeder, RN, MS, DWCN, burn/wound resource nurse at Maine Medical Center's Center for Clinical and Professional Development, who planned Manuchca's program; and to Nicole A. Shaffer, RN, BSN, DWOCN; Tricia Foley, RN, BSN, DWOCN; and Sue Delisle, CWCN and Clinical Nurse for their generosity with their time and knowledge. A very special thank you to Mariette Atienza, RN at Maine Medical Center who provided hands-on wound care to patients with debilitating injuries in Cap-Haitien after the January earthquake and who hosted Ms. Alcime in Maine, and to Dr. Sam Broaddus who sponsored Ms. Alcime's visit. Finally, our profound gratitude to all who donated to Konbit Sante's earthquake response fund which allows us to endow Ms. Alcime's position.
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About Konbit Sante: Started in 2000, Konbit Sante Cap-Haitien Health Partnership's mission is to save lives and improve health care by building local capacity for Haitians to care for Haitians. Konbit Sante believes the key to improving health care in northern Haiti involves making long-term improvements to the public health system. To that end, Konbit Sante volunteers and staff work in collaboration with Haitian clinicians and administrators to build local capacity in all aspects of the health system - from door-to-door community outreach programs, to strengthening community health centers, to improving care at the regional referral hospital.
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In Haitian Creole, a konbit is a traditional Haitian method of working together to till your friends' fields as well as your own - working together toward a common goal. The word sante means health. For more information about Konbit Sante, please visit www.healthyhaiti.org. Konbit Sante is a 501(c)3 not-for-profit corporation organized in the State of Maine

Konbit Sante Surgeon Honored (Portland Express - 10/1/2010)

By Ann S. Kim
akim@mainetoday.com
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PORTLAND - The efforts of Dr. Samuel Broaddus to improve surgical care in Haiti are being recognized by the American College of Surgeons. Broaddus, a urologist who works with Portland-based Konbit Sante, is the recipient of the college's annual Surgical Volunteerism Award for international outreach. He will be honored Tuesday at a dinner in Washington, D.C. With 77,000 members, the college is the world's largest surgeons organization. Broaddus, 59, said Thursday that he was glad for the chance to draw attention to the needs of Haiti, a country where he began volunteering in 1995. "This is a way that the story of Haiti can be told. It's a forum for telling the story of Haitians and Haiti that they can't tell themselves on the international stage. I'm happy to play that role," said Broaddus, a senior partner at Maine Medical Partners Urology.
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Broaddus is the volunteer surgical team leader and a board member of Konbit Sante, which works with Haitian partners to improve the public health-care system in Cap-Haitien, Haiti's second-largest city. The aim, he said, is to improve the capacity of Haitians to care for Haitians. It's work that often revolves around infrastructure needs and always involves long-term relationships with Haitian counterparts. Broaddus' work with Konbit Sante can involve any aspect of improving surgical care. He sometimes gives urology presentations to Dr. Jean Geto Dube and his residents at Justinian Hospital. He may also work toward that goal by searching for more affordable sources of anesthesia for the hospital or arranging rotations at Maine Medical Center for Haitian colleagues.
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In 2008, Broaddus co-wrote a surgical needs assessment for Justinian Hospital. The review was the first of its kind in the area and is seen as a model that can be applied elsewhere. Nate Nickerson, Konbit Sante's executive director, said the nonprofit depends on high-level volunteerism that doesn't end when a brief mission comes to a close. Broaddus has been a core member in terms of leadership and the roll-up-your-sleeves-and-do-the-work component, Nickerson said. "That level of commitment is unusual. I think Sam exemplifies that," he said. Broaddus' international work began early in his career. His notion of bringing his skills to places that don't have urologists solidified when he was a surgery resident.
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Broaddus developed his own program to serve as a volunteer urologist in five countries -- Egypt, Sri Lanka, Pakistan, Thailand and St. Lucia. He taught prostate surgery to general surgeons, who were doing open surgery decades after their American counterparts had widely adopted endoscopic surgery. Broaddus also provided fiber-optic equipment to each location. He has volunteered in Vietnam, Zimbabwe and Kenya. His experience in Haiti during the 1990s, when he made four trips a year to Deschapelles, helped him connect to Konbit Sante.

Progress in Cap-Haitien (Nate Nickerson - 7/14/2010)

Dear Friends,
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As I'm sure you are aware, Monday was the six month anniversary of the earthquake in Haiti. In light of this, I thought you would be interested to hear of our progress on a number of programs and initiatives. I returned home after four weeks in Cap-Haitien in mid-June and will be heading back to Haiti next week. It is a very busy time as we embark on many new projects to help our Haitian neighbors during this incredibly challenging period.
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All public systems, including the health system, continue to struggle as funds have not yet begun to flow from Port-au-Prince or from the international donors that have pledged support for the rebuilding of Haiti. Lacking critical materials, and lacking funds to purchase them, has many implications. For instance, when I arrived in Cap-Haitien, I learned that the TB Clinic at Fort St. Michel had run out of sputum specimen containers, which meant that their ability to screen for TB had ground to a halt. Thankfully we were able to quickly procure more with the help of new friends from the St. Francois de Sales Clinic in Cap-Haitien.
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Working together with many partners and friends to improve the supply chain and ensure that the most essential and commonly-used medications and supplies are available and accessible to patients in need, at the time of need, continues to be one of our priorities. Following the earthquake, the Justinian Hospital and other public medical facilities provided so many medications free of charge to patients that the hospital pharmacy lacked the revenue usually generated to replenish their stock. With generous support from Direct Relief International, Konbit Sante is providing temporary assistance to help the hospital pharmacy restock, and we are working with the hospital to improve the hospital pharmacy's fee system so that patients who can't pay are exonerated while those who are able to pay do so. (Of course, all medications that are donated by Konbit Sante and other outside groups are not sold, but rather given free to people who need them.)
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We have secured funds from MINUSTAH (United Nations Stabilization Mission in Haiti) for the basic renovation of the emergency services facility at Justinian Hospital to make the space better suited for provision of clinical care. Structural engineers are now evaluating the structural integrity of the existing building, and and additional funding will be sought if structural improvements are needed.
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Industrial sterilizer for the OR at the hospital
The container of equipment and supplies that left Portland in May arrived in Haiti in early June and just cleared customs. As one can imagine, there is a long backlog of containers coming in, which slowed down the clearance process. Packed on the container, among many other things, was a large sterilizer donated by Mercy Hospital in Portland, that will more than double amount of surgical instruments the Justinian Hospital's operating rooms can sterilize at any given time. This will represent a very important improvement the hospital's ability to provide surgeries safely and efficiently. A team of Konbit Sante infrastructure volunteers will travel to Haiti in October to install the sterilizer, and clinical volunteers will train OR staff on its use.
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As part of our commitment to support psycho-social services for earthquake victims, we are working with an established Haitian organization called Action Sanitaire (Health Action). They are a group of volunteer psychologists, medical residents and interns, and others who are doing outreach in Cap-Haitien, using mobile clinics, to care for earthquake victims and others who have been displaced from Port-au-Prince and now live in the area. They have developed a well-thought-out and ambitious plan to impact care at the community level, and we are planning to become a partner with them rather than starting a different, separate effort. We agreed to provide some support for their work by paying for their lease for a headquarters, some medical supplies, some transportation fees, and other high-priority things that they need to operate.
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We are making great progress on two projects that we committed to assist with as part of the post-earthquake Health Commission plan in the North. First, we are spearheading development of a guide to all support services in Cap-Haitien. This guide will provide information such as where to enroll in micro-commerce programs, where to receive malnutrition support, get eye glasses, etc. and will be used as a resource by community health workers. Twenty nursing students from the nursing school at the Justinian Hospital have already collected detailed information about more than 80 services in the area. Six of those nursing students are continuing to work on the project with the help of two of Dr. Renee King's (Konbit Sante emergency medicine committee volunteer) medical students from the University of Colorado School of Medicine. While in Cap-Haitien, the medical students are also conducting a detailed survey of all ambulances in the area in order to guide us in our work with the Ministry of Health to improve the coordination of emergency response using available resources.
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During my recent visit I had the privilege of visiting the first community-based women's clinic, set up in a church in the Bas Aviasyon neighborhood. Our Konbit Health worker checks blood pressure at community clinic Sante-sponsored staff organized the clinic and saw thirty-four pregnant women that day! The community health workers took vital signs (weight, temperature, blood pressure) and the women then consulted with Dr. Youseline Telemaque, Konbit Sante-sponsored OB/GYN, or another physician, received basic medications, vaccinations, and HIV counseling and testing. During that one clinic, doctors and health workers identified three women with serious risks who were referred to the Fort St. Michel Health Center for follow up. This is a very promising advance in providing access to maternal health care at the community level and in improving maternal outcomes.
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The plan is to run these clinics in each neighborhood every three to four months in order to reach the majority of pregnant women in the communities. Dr. Eva Lathrop of Emory University, chair of Konbit Sante's women's health committee, was in Haiti during the second week of June working with colleagues who are training clinicians to provide postpartum family planning counseling.
Dr. Charles, chief of Pediatrics at the Justinian Hospital, and Konbit Sante-sponsored pediatricians, Dr. Paul Toussaint and Dr. Rony St. Fleur, are making great progress developing a plan to improve dispensing adherence for medications that were ordered for the children.
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After reviewing the results of a joint study conducted in March indicating this is a challenge area, they devised an approach that will greatly improve the situation, and we are committed to re-measuring the outcome in six months to see if their plans have had the desired impact. This is a great step forward in supporting sustainable change.
As those of you who have been to Haiti know, the tropical climate, power surges, and shortage of maintenance and repair support make it difficult to keep x-ray equipment operational.
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With the determination of Dr. François Joseph (Chief of Radiology) and his team of x-ray technicians, combined with generous donations of x-ray equipment and supplies, the x-ray unit at Justinian Hospital has been operational every day since it opened after the earthquake. In addition, a place for the on-call technician to sleep has been created on site so staff can be available 24/7. Konbit Sante staff and volunteers have been working closely with the hospital administrator, Mr. Rody Gauthier, over the past year to design a revenue management plan for radiology. Not only is the service now self-funding, but it also provides a critical source of funds for the hospital during this difficult time. The success of this collaboration has encouraged us to try to develop a similar model together with Dr. Marie Leconte and the OR.
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In response to increased population and health needs in the communities on the outskirts of Cap-Haitien, we are adding three outreach workers to our existing staff of ten, based at Fort St. Michel. Ms. Jeanne Bright, RN, who worked on our women's health study, is now a member of our community health program and will work alongside Dr. Telemaque and Miguelle Antenor, RN. She will be joined by two new agents de santé (community health workers).
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There is actually so much more going on, but I hope that this gives you a glimpse of the breadth and depth of the ever-evolving and growing konbit. Thank you as always for your interest and support.
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Sincerely,
Nate Nickerson
Executive Director
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About Konbit Sante: Started in 2000, Konbit Sante Cap-Haitien Health Partnership's mission is to save lives and improve health care by building local capacity for Haitians to care for Haitians. To that end, Konbit Sante volunteers and staff work in collaboration with Haitian clinicians and administrators to build local capacity in all aspects of the health system - from door-to-door community outreach programs, to strengthening community health centers, to improving care at the regional referral hospital. In Haitian Creole, a konbit is a traditional Haitian method of working together to till your friends' fields as well as your own - working together toward a common goal. The word sante means health.
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To learn more about Konbit Sante-supported partnerships and programs in disease prevention, pediatrics, women's health, procurement and management of medical equipment and supplies, improvement of water quality at the regional hospital, community collaborations and more, please visit www.healthyhaiti.org.

Konbit Sante puts focus on hiring people to aid Cap Haitien

7/7/2010
Maine Today
By Matt Wickenheiser
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Though progress has been made in the six months since an earthquake devastated Haiti, challenges persist, says the executive director of a Portland-based nonprofit that works in Haiti's second-largest city.
Photographer Gregory Rec of The Portland Press Herald/Maine Sunday Telegram, standing, hangs photographs from his trip to Haiti at Starbucks in Portland’s Old Port with the help of Malcolm Rogers of Konbit Sante on Tuesday.
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Nate Nickerson of Konbit Sante returned recently from almost five weeks in Cap Haitien, one of Portland's sister cities. Konbit Sante has worked for about a decade to improve the public health care system in Cap Haitien, in partnership with local officials. The earthquake on Jan. 12 caused widespread destruction in the Haitian capital, Port-au-Prince. Cap Haitien, about 90 miles north of the capital, wasn't damaged, but thousands of refugees made their way there, many with serious injuries.
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Konbit Sante's work was documented by The Portland Press Herald/Maine Sunday Telegram immediately after the earthquake. Pictures taken by photographer Gregory Rec are on display at the Starbucks coffee shop in Portland's Old Port, at the corner of Exchange and Middle streets. Nickerson said many Cap Haitien residents have taken in family members who fled Port-au-Prince. That extra population has stressed the city, Nickerson said.
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After the earthquake, Konbit Sante raised about $450,000. The nonprofit has used the money to support the Justinian Hospital, the teaching hospital where Konbit Sante has focused its work over the years. Konbit Sante provided critical medical equipment, such as X-ray films, and necessities such as fuel for generators, and helped pay for supplies at the hospital pharmacy. Nickerson said the earthquake has made the political and funding landscapes more difficult to navigate in Cap Haitien.
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A shipping container full of medical supplies left Maine in May, and has yet to be taken from the docks in Cap Haitien. Funds that were promised to rebuild the Justinian Hospital's orthopedics/rehabilitation center have dried up, Nickerson said. In response, Konbit Sante has focused on hiring human resources instead of working on capital projects, Nickerson said. The nonprofit has hired health workers and a nurse to work with an obstetrician in Cap Haitien's poorest neighborhoods.
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It has brought on another person to help manage supplies and purchases. It has started a diabetes project, with a nurse and two health care workers. And Konbit Sante is hiring a full-time wound care nurse to address continuing care of some of the earthquake victims. The nonprofit is also trying to plan for future needs, with the uncertainty of continued fundraising efforts, Nickerson said.
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Staff Writer Matt Wickenheiser can be contacted at 791-6316 or at mwickenheiser@pressherald.com

Addressing the Long-Term Effects of the Earthquake

4/6/2010
Update from Cap-Haitien
Konbit Sante
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Dear Friends,our profound thanks to all of you who have given us encouragement and support following the January 12 earthquake in Haiti. To date, donations to Konbit Sante's earthquake response funds total more than $400,000.
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The facilities where we work, on the northern coast of Haiti, are about 85 miles from the epicenter and were not directly physically affected by the earthquake. However, the devastation is still being felt throughout the country. For weeks after the earthquake, hundreds of critically injured patients came to Cap-Haitien to receive care, and an estimated 40-50,000 people have migrated to the area. Many came to stay with friends or family, but many others were taken in by total strangers who opened their homes to help. The already-fragile and under-resourced health system is being stretched even further by this influx of people.
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Immediately after the earthquake, the Haitian public health system's regular governmental support from Port-au-Prince was cut off. Because of your donations, Konbit Sante was able to address urgent needs by setting up a rapid purchasing capability through the Dominican Republic. Fuel for generators, x-ray film and radiology supplies, orthopedic materials for urgent surgeries, blood donation bags for the blood transfusion system, and essential medicines were all quickly provided with these funds. The funds also helped transport injured people from Port-au-Prince and supported local authorities' efforts to provide triage and minor treatment at a center for earthquake victims.
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Public medical facilities were required to provide free care for all earthquake victims, during the time all governmental support from Port-au-Prince was cut off. Konbit Sante was able to replace this lost patient fee income which allowed the facilities to have some basic cash flow and keep functioning.
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As World Food Program food supplies were redirected to the earthquake zone, Konbit Sante provided food for 500 earthquake-affected people in the north each day through a partner organization. Funds are also being used to provide a hot meal each day for 140 medical interns and residents who provide a great deal of the medical care at the Justinian Hospital but who have not received their government salaries since January. Most of them have also lost the financial support from their families in Port-au-Prince.
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Many Konbit Sante volunteers have already helped in areas of great impact - orthopedic trauma and wound care, psychiatry, pediatrics, women's health, and public health. In addition, these volunteers and our staff are working with their Haitian colleagues and community leaders to assess longer-term impacts on health. Because of our long-term relationship and knowledge of its needs, the administration of the Justinian Hospital asked us to help coordinate the non-governmental agencies who were providing materials and volunteers. We were also asked by local authorities to assist the Ministry of Health in the north to coordinate the earthquake response in the area through a newly formed Health Commission.
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Now we are beginning to address the longer-term priorities identified by the Health Commission, our Haiti board, our Haitian staff and colleagues, as well as our U.S. staff, volunteers and board by committing earthquake funds to the following projects:
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Building an orthopedic and rehabilitation facility at the Justinian Hospital. Rehabilitation and orthopedic needs will be a priority of many years, so we are committing a significant level of funds to leverage a much larger grant.
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Lack of sterilization capacity currently causes serious delays in surgical care at Justinian Hospital. Konbit Sante's infrastructure team will more than double the sterilization capacity in the operating rooms at the hospital within the next few months, and we are working on longer-term plans to build surgical capacity through surgical/orthopedic partnerships.
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Sending a donated mobile medical unit to Haiti to be used by a partner organization to provide rehab services in outlying areas.
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Hiring a full-time nurse to be trained in wound care who will serve as a resource for the entire hospital. With support from colleagues in the U.S., this nurse specialist will provide patient care and also cross-train other surgical and emergency nurses.
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We have already leveraged more than $40,000 worth of donated medical supplies and will devote some earthquake funds to expand the system for management and distribution of these valuable resources.
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Adding a nurse and additional community health workers to our existing eight to provide community outreach, education, vaccinations, and disease control and to help address the public health issues that come with a dramatic increase in displaced people moving into the area,
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Collecting community-based data in Haiti has always been problematic. A small investment of earthquake funds will allow us to provide the technology and training to survey internally displaced persons, assess needs, and track diseases.
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We are committing funds to support psychological care and support for people experiencing post-traumatic syndromes, and are seeking additional grant funds to supplement ours,
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We have committed some resources to building latrines in the camps in Port-au-Prince. Whenever possible, we are collaborating and leveraging other resources to get the maximum impact for our investment of earthquake funds.
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Our deep appreciation to all of you who have contributed to our earthquake fund as well as supporting our ongoing programs. We are grateful to the many businesses and employees, individual donors, foundations, students, teachers, story tellers, musicians, dancers, hockey players, restaurateurs, and many others who have responded to the needs of our brothers and sisters in Haiti.
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To all of you who have given us your support, we promise we will be good stewards. We have deep respect for the people of Haiti and we're committed to being there for the long haul.

Belfast doctor finds humility, optimism in Haiti experience

3/31/2010
Mideast Beacon
By Abigail Curtis
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Dr. Carol Kuhn may be better known in Waldo County as a family physician at Seaport Family Practice — but lately she has been developing a reputation in Haiti as the doctor from Maine who always comes back to help the impoverished island nation. Kuhn recently returned from her ninth trip since 2006 to Cap Haitien, where she volunteers with the Portland-based nonprofit Konbit Sante. Seaport Family Practice raised $3,803 for Konbit Sante at its annual Charity Saturday Clinic in January.
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"You get sort of hooked," she said recently. "There’s something about the optimism of the Haitian people. They’re very, very resilient. It’s not a naivete, either, how they can find some reason to be joyful and optimistic." Although the city of 180,000 people which lies 85 miles north of Port-au-Prince was not damaged by the Jan. 12 earthquake, the doctor said that effects of the massive natural disaster were immediately clear. "The earthquake has affected everyone’s lives, whether it’s physically apparent or not,” she said.
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Immediately after her Jan. 31 arrival in Cap Haitien, Kuhn was greeted by a moving sight while on her way to the Haitian Ministry of Health's Justinian Hospital — a parade of Haitians clad all in white, singing as they walked. "It was an homage ... for the memory of those who had died," she said. "We also heard it was to give thanks because Cap Haitien residents felt they had been spared."
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The flowing river of people stretched as far as Kuhn could see and lasted for hours. "It was beautiful, with everybody singing and waving their arms," she recalled. Because of the earthquake and its aftermath, Kuhn initially started her week of work doing direct health care. "We weren’t sure what we were going to find," she said. At a triage and food center set up by the hospital, she and other medical staff found hundreds of earthquake refugees lined up for food vouchers and for mostly minor emergency care. By the middle of the week, more international medical volunteers arrived to help with direct care, and Kuhn decided that it made more sense for her to do what she originally planned to do — give educational lectures to nursing students and help train agents sante, or community health workers.
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Kuhn said increases in tuberculosis, malaria, diarrhea and reproductive complications are expected in the earthquake’s aftermath and with the displacement of large numbers of Haitians from the capital to other parts of the country. The doctor chose to volunteer for Konbit Sante because she wanted an organization where she could develop a long-term relationship with a country — and she’s glad she did.
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"It’s all about building a partnership," Kuhn said, adding that she, too, benefits from her affiliation with Konbit Sante and Haitians like the agents sante. "I really do feel very humbled and energized when I’m working with them."
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For more information about Konbit Sante, visit www.konbitsante.org.

Aid Lags as Evacuees Strain Cap Haitian (3/8/2010)

The Miami Herald
By Jim Wynn
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CAP-HAITIEN, HAITI -- Dabel-Eliana Laforet returned to the place of her birth, and Haiti's second-largest city, determined to remake her life in this port town that was virtually untouched by the Jan. 12 earthquake. Instead, she listens to the news from Port-au-Prince and yearns to be back in the shattered capital she called home for 20 years. Even as it lay in ruins, Port-au-Prince continues to starve the rest of the nation of attention and resources. In this northern city of about 180,000, residents say the central government has largely been absent and international aid barely trickles in. Despite Cap-Haitien's functioning harbor and rubble-free streets, residents say they are reliant on the capital's crumbled institutions to get anything done.
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Unable to find work, Laforet said it frustrates her to hear about aid agencies doling out food and jobs in the capital. ``No one has done anything for us here,'' she said, standing outside a pink, one-room shack on the outskirts of town. ``Everything is happening in Port-au-Prince.'' Some call Haiti ``the Republic of Port-au-Prince'' because no other city seems to matter, said Jean-Robert Lafortune, the president of the Haitian-American Grassroots Coalition, a Miami-based organization that has been advocating for greater decentralization. ``There has been an unbalanced development of Haiti, and that has an impact in terms of commerce and industrialization in other parts of the country,'' he said.
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If decentralization was an issue before the disaster, in some ways it has only been exacerbated as the world's relief agencies have focused their efforts in hard-hit Port-au-Prince. Three weeks after the earthquake, Tim Traynor, the emergency coordinator of the CRUDEM Foundation hospital, on the outskirts of Cap-Haitien, toured a field clinic with about 400 patients -- almost all flown in from Port-au-Prince.
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While the hospital has been surviving on donations and volunteers, in the weeks immediately after the earthquake it had not received the full support of the United Nations or the International Red Cross, he said.``We have not received a thing from the U.N. We are being completely ignored,'' Traynor said, as he surveyed a tent full of patients with shattered limbs and missing legs. When he asked the Red Cross and the U.N. about getting food or shelter for the hundreds of family members who have followed the patients to the hospital, he was told, ``We're busy in Port-au-Prince.'' ``Well, what about us?''
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The World Food Program has been bringing in rice through the Cap-Haitien port, but much of it has been destined for the capital, local officials said. Making matters worse, the region has been plagued recently by heavy rains that have been deadly in some cases. In fact, all schools in Cap-Haitien and neighboring cities to the north have been closed since Feb. 16 -- ever since four children were killed when the rains triggered a landslide that sent a boulder crashing into their classroom. One of the problems hindering aid has been lack of communication, said Valente Perry, the team leader of a U.S. Army Civil Affairs group that recently toured Cap-Haitien.
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``There has been a disconnect between [the United Nations], the government and the NGOs [nongovernmental organizations]here,'' Perry said. ``Much of that coordination is just starting to come on line.'' In the days after the earthquake, more than 400,000 people fled Port-au-Prince, according to the International Organization on Migration. The government encouraged the exodus, packing people on buses and calling ``decentralization'' a national imperative. No one's sure how many ended up in Cap-Haitien, but Mayor Michel St. Croix estimates at least 50,000 have sought refuge here.
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While evacuees have come, the aid they need has not followed, he said.``We need housing, sanitation, security -- we need everything,'' said St. Croix, who worked for the Red Cross before becoming mayor in 2007.Most importantly, the city needs to able to put them to work, he said. ``We didn't have enough jobs before the earthquake. And we certainly don't have enough jobs now.'' With the seat of government and the nation's principal harbor in Port-au-Prince, industry has traditionally clustered around the capital pulling the labor force with it. When the earthquake struck, about one-third of the nation, or more than 3 million people, were crowded into the capital.
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Cap-Haitien has always had a complicated relationship with Port-au-Prince. After independence from France in 1804, Henri Christophe, a key leader in the revolution, declared himself emperor of the Kingdom of Northern Haiti, with Cap-Haitien as its capital. The ruins of that era -- the Sans-Souci Palace, once considered the Versailles of the Caribbean; and the hilltop Laferrire citadel -- still loom on the outskirts of the city and are among the nation's top tourist draws.
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In 2004, anti-government forces under the command of renegade police chief Guy Philippe took Cap-Haitien and launched a putsch that ultimately led to the ouster of President Jean-Bertrand Aristide. Although it sits less than 100 miles from the capital, Cap-Haitien is also isolated by poor roads that can make the journey an eight-hour odyssey. And yet it's still dependent on Port-au-Prince. Getting a birth certificate, a driver's license or a passport requires a trip to the capital.
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Even the fact that the city has its own port -- which never ceased to function even as the main harbor in Port-au-Prince was crippled -- means little, said Jimmy Marzouka, who owns the Super Mart grocery store in downtown Cap-Haitien. Corruption at the installation makes it too costly to bring in merchandise, so he is forced to send trucks every week to the capital to pick up goods. ``When you try to bring goods in through the [Cap-Haitien] port, they can sit there for months and months and you lose money,'' he said, echoing a common gripe in the business community. ``All the distributors are in Port-au-Prince. Everything is in Port-au-Prince.''
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There are efforts to shift the balance of power. Georges Sassine, the president of the Manufacturers' Association of Haiti, said there are plans to build a garment-manufacturing plant near Cap-Haitien that could employ 10,000 to 20,000 people; there are also projects to expand the city's undersized airport and improve the roads that lead to tourist attractions.
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``There is no reason not to continue with these plans,'' he said.
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While decentralization may be good government policy, it's not always seen as a sound business decision, said Robert Krech, an operations officer at the International Finance Corporation who promotes foreign investment in Haiti. Investors want to be close to the central government and other industries, he said. ``Like attracts like,'' he said. ``Most of the [foreign] investors we have been speaking to don't want to locate outside of Port-au-Prince even after the earthquake.'' That sentiment is not limited to investors. The lure of a bustling Port-au-Prince may continue to be too enticing for average Haitians to ignore.
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Cradling her week-old grandson, Laforet said she planned to raise the boy in the capital as soon as she collects enough money for the trip.``It's very pretty and quiet here,'' she said looking at the row of mountains in the background. ``But I miss the noise and the traffic. Port-au-Prince is home.''

Letter from Cap Haitian: Dr. Eva Lathrop (2/16/2010)

Konbit Sante
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Through a note from Cap-Haitien, we begin to understand the impact of the January 12 earthquake in an already underserved and impoverished neighborhood 85 miles from the epicenter. In this note to Dr. Michael Taylor, founder of Konbit Sante, Dr. Eva Lathrop, an OB/GYN, MPH currently living in Atlanta, shares some of what she saw and what she did during her recent working visit in Cap-Haitien.
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Dr. Lathrop has been part of Konbit Sante since the group's first visit to Haiti in November 2001. She is an assistant professor in the Department of Gynecology and Obstetrics at Emory University School of Medicine. As chair of Konbit Sante's women's health team, she visits Haiti frequently to teach and to work with her Haitian counterpart, Dr. Youseline Telemaque, on programs to improve maternal outcomes. Her daughter, Bella, was born in May 2009.
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Dear Michael,
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I have been in Cap-Haitien for several days, and as we pass the two week post-quake mark, it is ever evident that it was the right thing to do to come and to come here, away from the epicenter of the disaster, to a place where we, as trusted partners of the public health system here, can be immediately effective in response to the collateral damage the quake has caused to the community and the displaced victims from Port-au-Prince seeking refuge here.
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We have been asked to coordinate all visiting volunteers at the hospital and organize all of the donated materials and supplies so that they can be used effectively. I am not very good at it but it was what was needed most, that and moral support, when we first got here. The rest of the time has been spent working closely with Dr.Telemaque on reproductive health related issues.
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Obstetrical emergencies, gender based violence, unintended pregnancies, HIV transmission, to name a few, can all increase during complex emergencies so we have been assessing the displaced population arriving in Cap-Haitien for their experiences and potential risk for these complications since the earthquake.
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We're in a unique position to help women new to the area access available healthcare services, and we've been trying to extend our assessment and coordination of care to as many women as possible. Remarkably, most of the women we've worked with have really wanted to talk about what they've been through, reproductive health related or not.
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Everyone is exhausted, hungry, thirsty and afraid and answer "Koman ou ye? (How are you?) with "M'vivant" (I'm alive). Everybody has their own story of tragic loss, near misses, survivor guilt, sheer, raw grief. The sadness is palpable, and the losses are unimaginable.
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So many of the women we talked to are finding it difficult to hang on to any hope for the future. The ones who were in Port-au-Prince getting an education, for example, know that that was their chance, and now there is nowhere to go to complete it, and they are moving out to rural towns with a friend of a friend who has agreed to take them in. They have nothing, own nothing but what they had on at the moment the earthquake struck. No money, no documents, no photos.
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Others are staying with family in Cap in a household likely already stretched beyond what they could bear. Households that had eight people and enough food for five now may have 15 people and no additional support with the arrival of earthquake victims. Some people have lost everyone they know...and multiply what I heard by two million...it is just too much, really.
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That said, I feel like one of the reasons I came down was to help keep our core mission going and our core programs going in the face of this catastrophe, so I have spent some time out at Fort St. Michel community center and with the agents sante [community health workers] in their zones trying to figure out what the impact of the earthquake has been on them and their communities. Have they accepted displaced people? Have they seen their populations growing?
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We did a couple of focus groups in Petit Anse and, as you know, it is a community of the poorest of the poor, and they are really struggling with the increased price of food and the lack of even the teeny tiny money that some were receiving from family in Port-au-Prince. The saddest part is that they KNOW that no aid will be coming their way and that the little support they received as a community, whether it was food aid or vaccine campaigns, will all be shifted to the south. Somehow they still manage to smile, share small moments of hope, and find strength to persevere. It is remarkable and humbling. It is a privilege to be among them.
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Fort St. Michel [health center] is okay now, but one big concern is the interruption of the ever-fragile supply chain. For example, the World Food Program is diverting all of their food stores in Cap to Port-au-Prince, and we don't know when they will resume food shipments to Fort St. Michel for the TB patients, pregnant and lactating women, and malnourished babies. Vaccines will also be diverted to Port-au-Prince, and again, the timing of resumption of services is anybody's guess. Assessing the community for these potentially harmful losses now will allow us to try and figure out how to continue to support these programs in the immediate aftermath of the earthquake and avoid adding to the already staggering number of victims.
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I am pumping breast milk and donating it to feed two little malnourished babies in pediatrics, so that is making me feel better about leaving Bella and missing her. Coming here was the absolute right thing to do, I have no ambivalence about that, but leaving a breast feeding baby has been hard. I struggle with missing her, with whether or not I have to right to miss her...how can I miss her and feel sad about that when I HAVE her and li vivant, li manje, li secure (she's alive, she eats, she's safe)? It is all very complex and intense and a bit of a roller coaster - one part business as usual, one part nothing will ever be the same. Business as usual laced with catastrophe and a wounded nation.
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But truly, the most compelling part for me has been witnessing the generosity of Haitians towards Haitians - the beautiful young volunteer spoon feeding a displaced girl her age who was nearly catatonic with shock and grief, cradling her head and rubbing her cheek slowly encouraging her to chew. It took her an hour to get her to eat a plate of rice and beans, but she stayed with her and provided her the only comfort she has had in weeks. It made me cry, the tenderness, the shared innocence. So, there is so much more, but this gives you the picture for now.
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Miss you, and your wisdom, as always.
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Love to both,
Eva
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About Konbit Sante
Based in Portland, Maine, Konbit Sante's mission is to save lives and improve health care for the people of northern Haiti through collaboration and empowerment. In Haitian Creole, a konbit is a traditional Haitian method of working together to till your friends' fields as well as your own. The word sante means health. For more information about Konbit Sante's programs in women's health, pediatrics, disease prevention, procurement and management of medical equipment and supplies, improvement of water quality at the regional hospital, community collaborations, and more, please visit www.healthyhaiti.org.
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Konbit Sante is a 501(c)3 not-for-profit corporation organized in the State of Maine.

Thank you from Konbit Sante (2/12/2010)

Since the devastating earthquake of January 12, referred to in Haiti simply as jou a (the day), we have been deeply moved and gratified by the outpouring of support from individuals, businesses, and other non-profit organizations from Maine and beyond. We are in the process of thanking people individually, but we also want to make a public thank you and recognize some of the many people who have reached out to help.
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Our friends at the Portland branch of the NAACP, under the leadership of Rachel Talbot Ross, generously donated proceeds from their Martin Luther King, Jr. events - including an uplifting gospel music concert on January 17 and its annual Martin Luther King, Jr. breakfast. Our thanks to all who organized and participated in these events.
With co-host, WGME 13, The City of Portland conducted an emotional and highly successful telethon January 21 to address health needs in its sister city of Cap-Haitien. For this we are indebted to Mayor Nicholas Mavadones, City Manager Joe Gray, former mayors Jill Duson and Peter O'Donnell as well as many other city councilors and employees who helped with publicity, volunteered to answer phones and work in the back room, spoke on camera, cooked for the volunteers, and who set up and took down the room. This event, which was organized on very short notice, brought in $66,000 to help the people of Haiti.
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We can't talk about the telethon without giving special recognition to Will Thomas of Tri-Maine Productions, who ordinarily organizes multisport events, but who volunteered his time and talent to make the January 21 non-athletic event an extraordinary success. And our own Emily Gilkinson who would probably say this is part of her job, but we know that she volunteered a lot of extra time and energy to make this event happen.
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To WGME 13, we can't thank them enough. They co-hosted and broadcast a telethon that was energetic, fresh, and effective. We're so impressed that when Kim Block and Erin Ovalle ask people to pick up their phones - they do it! Our thanks to general manager Tom Humpage, news director Robb Atkinson, anchor Gregg Lagerquist, camera operators Jason Nelson and Matt Perry and all the others behind the scenes who make a remote broadcast like this happen.
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On January 24, the Portland Symphony Orchestra opened its dress rehearsal for a concert that included the Portland premiere of a composition called "Headcase" about the crisis of suffering a stroke and then the slow process of healing - very apropos to the situation in Haiti. Our thanks to music director Robert Moody, executive director Ari Solotoff, and all the symphony staff for their generosity and for the gift of music.
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For an entire week, the Portland Press Herald brought stories of Haiti to life through their on-the-ground reports. Our thanks to editor and publisher Richard Connor, reporter Matt Wickenheiser and photographer Gregory Rec for telling the story of the bond between two communities and about the people in both communities who are working very hard to improve the lives of our Haitian brothers and sisters.
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Our thanks to the other groups - including the African Cultural Foundation, schools, musicians, restaurants, gymnasts and media - for their generosity and for spreading the word about the needs in Haiti.
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Konbit Sante's roots in Maine and beyond run deep, and we are grateful for the support of many organizations and businesses including Carestream Health, Dermatology Associates, Direct Relief International, GOJO Industries, Hope International, InterMed, J.B. Brown/Fore River Distribution, Maine Medical Center, Martin's Point, Mercy Hospital, Northern Data Systems, Orthopaedic Associates, Partners for World Health, Penmor Lithographers, the Portland Regional Chamber of Commerce, Rotary Clubs from Maine and New Hampshire, the University of New England, USM School of Nursing, United Way of Greater Portland, and Woodard & Curran, to name just a few. And our appreciation to the Maine congressional delegation for their encouragement.
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Individual donors are too numerous to name here, but our profound gratitude to the many donors - some are old friends who helped get us started and have supported us over the years, and some are new friends - who have donated funds to respond to the needs caused by the January 12 earthquake as well as to support our ongoing programs to improve health care in northern Haiti.
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Like the rest of the world, we are still trying to understand the magnitude of the losses and what the eventual outcome will be in Haiti. Some of the needs related to this disaster will be immediate and some will be long-term. We are committed to helping our partners address the immediate needs - the broken bones, the emotional trauma - and also to addressing the long-term needs created by even greater demands on an already fragile health care system. To all of you who have given us your support, we promise we will be good stewards. We have deep respect for the people of Haiti and we're committed to being there for the long haul. Our ability to do this has been boosted substantially by the outpouring of support from all of you.
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In future email news, through our website, and Facebook we will provide updates about the situation in Haiti, our work, and our volunteers' experiences.
About Konbit Sante
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Note: Based in Portland, Maine, Konbit Sante's mission is to save lives and improve health care for the people of northern Haiti through collaboration and empowerment. In Haitian Creole, a konbit is a traditional Haitian method of working together to till your friends' fields as well as your own. The word sante means health. For more information about Konbit Sante's programs in women's health, pediatrics, disease prevention, procurement and management of medical equipment and supplies, improvement of water quality at the regional hospital, community collaborations, and more, please visit www.healthyhaiti.org.
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Konbit Sante is a 501(c)3 not-for-profit corporation organized in the State of Maine.

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