Hi everybody:

I have not been able to write for several days. The team that dropped in unexpectedly a week ago (meeting me in church on Sunday morning) left on Thursday afternoon, while Drs. Jon Roberts (a yearly regular to Haiti who encourages both Rod Wray and myself in a big way, getting supplies, helping us with projects, bringing in mobile medical teams, etc) and Rick Honderick, both Family Doctors from Missouri, had left Wednesday after a week of help.  Thus I was then back to myself and the Haitian doctors I have been training between 1 and 6 years now. Trying to keep track of 80 patients is difficult. My Haitian doctors are doing well, but mega trauma is not what we usually do here; we get perhaps a couple a week, but not 65 inpatients and at least twice that many outpatients that require care. Understandably we all feel rather overwhelmed, though it is a good opportunity for the docs to learn from these new cases, whenever we get time for a “teaching moment.” Anyway Thursday and Friday were thus rather hectic, trying to keep up on all the patients, plus the Haitian doctors doing most of the outpatient clinic with supervision from me. We also did another 50 surgeries that week, including a bunch of amputations that we just couldn’t save, etc. Needless to say, nothing was done in the way of communication. 

I did answer an email from OMS, a missionary organization in Port, asking if I needed any extra help, as they thought they had a team coming to work in one of the tent hospitals that the location might not work out. Since about 50 emails and phone calls  per day are brought to my attention, and a lot of things end up to be shots in the dark, I answered the message and didn’t give it much thought. Saturday afternoon, however, a military helicopter landed with a team of 13 people, among them 2 orthopedics, a pediatrician, 1 ER doctor, 4 paramedics, a retired anesthesiologist who hadn’t “passed gas” in 20 years and a plastic surgeon who normally does only breast adjustments, plus a Haitian student and his wife to be a translator and a photographer.  They had been flown to Cap Hatian, in the north, by a private jet from Jackson, Mississippi, then the US military brought them to our doorstep “per my request?” [Many people have been making contacts/requests, and praying for the work here. This is no doubt an answer to prayer and a response to someone’s request. 

This was a pleasant surprise as I had not seen any response/feedback to the email response I had sent a week before. These people brought a ton [? literally] of welcome supplies. The breast surgeon has done very well despite the fact that he is doing everything but what he has been doing for the last 10 years, including adjusting to my necessarily simple supplies and techniques. He fixed a man this morning who had a machete chop to his face which had divided his cheek bone into 2 parts. He was not a quake victim, but needed help. I sent the peds, ortho, anesthesia person and 3 non medicals up to Bonne Fin Hospital, while the plastic surgeon will divide his between there and here. We seem to get along very well and I hope he comes back some day as this kind of plastic surgeon is a lot of help in Haiti for a week or two whenever he wishes. We have the paramedics doing dressing changes on 60 patients, twice daily on some of them. These are done with Epsom salts, something I learned back in Bangladesh; cheap, just boil and cool water so it is free of bugs, then add the Epsom salts per the instructions on the side of the container. You soak your dressings as you apply them, don’t need sterile gloves (which are in very short supply and need to be saved for surgeries, etc). This stimulates the tissues to help the open wounds prepare for skin grafting, etc. So, today was still a long day, but at least I had a couple hours tonight to work on trying to line up replacements for myself until I can come back again later in February. I am trying to make connections for flights back out through the Bahamas for this next weekend so that I can get home for Monday office hours on the 8th.  

Some of you may know that through connections of one of our church men, the local Meijers chain donated 3200 pairs of women’s shoes to Haiti on short notice, as the plans to send them elsewhere (? India) didn’t work out.  Through a team leader of one of our next building teams, he was able to arrange for these to be loaded on the container which we received just before Christmas. We gave some of the shoes to hospital employees as Christmas gifts, and we say thank you from them to Meijers, Nick Fennema, Dan Boerman, etc. The Wrays were able to give some to the poor children at Renault at Christmas and the rest we planned to give to the local Baptist church association with whom we work. I hadn’t been here since the arrival of the container and the Haitians felt I should personally make a formal gift notification to the association, so we still had the shoes. However, as we have been hauling hundreds of homeless and injured people as well as families from our churches in Port, I spoke about this to the President of the association when he stopped at the hospital. He then said he would take them that afternoon to the churches so badly hit in Leogane, as he was going there anyway. God’s timing was perfect. That morning I had asked Rod and the missionary ladies to arrange clearing out any storage spaces anywhere to put in more patient beds and we needed the room. I have never seen a dusty storage room scrubbed and made presentable in so short a time, the whole missionary team has really pulled together and done whatever needs to be done immediately. With the shoes gone, there was that much less to move to other storage space and they immediately went to good use. Thanks to all involved in helping provide for the hurting Haitians.

The plastic surgeon helped me do skin grafts until after 9 pm Saturday. I have lined up several more for him to do tomorrow as well as a few other cases. We will be able to run both ORs and are so thankful for the extra help. He wants to take my dermatome and skin mesher up and do grafts at Bonne Fin but I have the only one around so I am a bit hesitant to part with it. It will be easier for him to go and do the grafts up at Bonne Fin than to move the patients down here, but they were not cheap, even getting it from my good friend, Mark Heydenberg at International Aid in their pre bankruptcy days. With prayer I will probably let him take them up there for the 3 days he will be up there this week prior to his departure. 

In the midst of all these earthquake disasters, I had a lady come in with a large amount of vaginal bleeding from her placenta separating, so severe risk of death for both mom and baby and I had no good equipment to diagnose this, just clinical judgment. She had bled so much that I didn’t dare do the C- section without blood, something we don’t have much to spare these days at the Red Cross, as they no longer will let us do our own blood banking (I think sometimes we try to mimic the US too much, and haven’t the capacity to do things as well as they are done there with more resources, etc). She had lost too much blood to operate safely, yet each hour we waited Friday night she lost more blood. Praise the Lord, we got some blood in the wee hours and have a live boy and a healthy, though weak, mom at this state, 24 hr later.  

On December 2, a 49 yr old lady had abdominal pain was horrible, per her history. She had spent time in two reputable hospitals and had received some help, she said (no records come with the patient). Nevertheless, her abdomen just kept getting larger and more painful, and she transferred herself to me 4 days ago. The ultrasound showed that she most likely had inoperable uterine cancer, nothing could be done for her. I admitted her here and evaluated her over the next 24 hr. With the 79 other patients we had last Thursday, admittedly, didn’t sort things out well in my head, but on Friday morning, her husband told me her pain was much worse, couldn’t I just operate on her.  Turns out she had had a ruptured appendix for probably the better part of 2 months, had 3 quarts plus of pus in her abdomen. Her case kept me up much of Friday night, however, she is sitting upright and wanting to eat this evening (not quite ready to allow that, for she is far from out of the woods, but thank the Lord, she is doing much better than I could have hoped). I share this to show the resiliency of some of these people, most of whom have lost several relatives or close family members, as has the lady in the bed right next to the door. She came in with a crushed leg and has lost 3 of her 4 children, yet can now smile back at me each time I pass her bed and try to give her my best smile and share tracts with her and her grieving husband. 

Time to go to bed, but wanted to bring you up to date. I know Karen has shared how I am trying to get home by the weekend, but want to have my guys here to have adequate coverage, both in volume of volunteer medical help and quality, so they won’t be overwhelmed by the severity of the 80 patients we have in our little hospital, as well as the outpatient work which continues. 

Thanks for all your prayers, support and encouragement.

In His service,

Bill and Karen Ten Haaf

There has been some great news. I talked to William last night about the container which was feared possibly lost (as some did fall into the ocean), or irretrievable since we had totally lost track of Herbie, the agent the missionaries had sent to PaP to arrange paying customs and trucking the container to Les Cayes. We have found out that HERBIE IS SAFE, THE CONTAINER IS FOUND AND COMING TO LES CAYES, possibly even today. Sorry for the shouting, but this is fabulous news and how we thank all of you who prayed, and the Lord for keeping His hand over this large amount of supplies, donated by many people, paid for with the Lords funds, and now able to come and be used. I just saw a note Wm sent to someone last night and will include this in case anyone who receives this may hear of a possibility of med personnel:

“This is Bill Ten Haaf, general surgeon at Cite Lumiere. Nurses are always desirable under the present work load, as are general physicians/ internists/general surgeons who are willing to do a bit more simplistic work, like skin grafting, wound debridements, etc. We don’t have anesthesia at CSL, Bonne Fin does, we just do our own spinals with Ketamine, and thus keep the cost down. At present, it appears that Brenda Hospital has 6 Brazilian Orthos with NOTHING to do???? I asked if they might want to take some of my case load, do wound care, abscess drainage, cleaning of ortho wounds, NO, just clean ortho. Sorry, at 16 days, there is not a lot of the fun stuff left, just hard work.”

We are praying for those God will enable to come.” Bill

Here is some more information Wm sent last night:

Want to say hi to everybody as at present, it is just quieting down at the hospital.

Today Rod and I made the decision to put up the 5 tents we had been using for the last years at the Sunday School Feeding Program at Renault. They are not needed for that now as we have a permanent building completed thanks to the Faith United Reformed, Byron Center Bible Church, Jamestown Baptist and several other people associated with them. As many of your know from Rod’s letters which you may receive or which Karen has included in these updates (the ones with the pictures), they have opened up the camp site to 200 of the homeless people from Port from our churches there. The plan is to let them live there for like 3 months, then hopefully they can find a place to stay, but the big question then is, where will they go in 3 months? Squatters are a constant situation in this country of no ice and snow and the houses are made from cement (weak though it may be per recent earthquake testing). People normally add on to the house as they have money available and may take 20 years to finish a house. During these years, squatters take up semi permanent residence, somewhat like the homeless do at times in empty buildings in the US. However, these people have lost everything. They brought literally all their worldly wealth along with them when we got the group from Port Monday morning and it was a pitiful amount, but we had a short prayer service with them and the pastor of the church where they had gathered and they were just so thankful that the Lord had kept them from death.

As I have pondered what Rod and Debbie may be facing in 3 months, I am considering a problem of my own, space in the hospital. As you know, we made the decision to give totally free care to victims of the earthquake. My first concern was how to come up with funds to care for them, as they are very ill, have complicated treatments/surgeries, etc, with lots of dressings, medications, etc. By the grace of God and the generosity of His people, a fantastic amount of funds is coming in, enough to cover the first week of treatment, etc. Thanks to the wonderful transportation service of groups like Methodist Habitat for the Bahamas and Agape, we have had enough supplies to cover these first weeks of treatment, food, etc. so that is a great relief. People are also gathering supplies which we will try to get down to Bluffton after I get back in order for them to go on the next container. Praise the Lord, as Karen said, we just heard from Herbie. (He is our agent to clear containers through the maze of red tape of the government; the French seem to exceed the U.S. capacity for bureaucracy, they did the same for us in Togo.) A number of buildings were damaged at the port and several containers were lost at sea as they were tossed there by the quake is what we were told. But, the second container is scheduled to arrive tomorrow at the camp and the medical supplies will be brought here.

Anyway, as we have provided a roof over our patients heads a given fair amount of attention to their physical ailments and hunger, it appears that 30 or so have made a definite commitment to turn to Christ during this turbulent time. Many have seen family members lost for eternity, so we have tried hard to tend to both their physical/medical and emotional/spiritual needs. The feeding program provided includes a rotation of 5 area church groups working every day to make huge amounts of mainly beans and rice. But I now have availed myself of every inch of space in the hospital, as some patients are discharged but don’t leave, having no family left, etc. There is understandable reluctance to go out into the cold, unfriendly world. Because of this, Rod put up tents outside with some cots in them and we literally move the patients out the door onto the veranda/porch. That may seem to be a harsh step, but I have no more place to put patients who continue to arrive daily at our door, again with neglected wounds for which they were unable to find care, or for which they need extended care. In addition, some people prefer being outside in the open air (“under the stars” is their term) these days as they fear another quake. Allegedly we had an aftershock while I was making rounds this morning, which I didn’t notice, at least my writing didn’t get any worse to my knowledge.

Pray for wisdom as to how to resolve this situation. With the increased flow of neglected patients coming, I believe we need some more help to cover the wards and surgeries needed after my scheduled departure on the 6th of February. Added to that is the fact that patients with all sorts of other ailments are coming in as in most hospitals they let them in and make them lie on the floor until they can be seen a week or so later (the Haitian form of socialized medicine?). Thus, I am looking for some flexible general surgeons and internists/general or family practice docs to be here, at least one of each, to work here during the 3 weeks I will be back in the states. There is a lot of pressure on my guys during these trying times. We know the government is keeping an eye on what they do since while they are now legal doctors, they are not allowed to do more than simple things without my presence. Normally, this works pretty well, but right now, people cannot wait until I return for skin grafts, etc. It appears I am the only one here who can do this at present, at least this is what is said when they send me the patients to do grafts on. So, I would love to find some flexible people who can work under less than perfect conditions, with more primitive equipment, etc and keep things on an even keel. I have no anesthetist, you do your own, via the Haitian nurses and doctors giving spinal and/or Ketamine. It works very well and is inexpensive but requires flexibility in adapting to somewhat different anesthesia administration.

Praise the Lord, it appears we do have a portable X-ray unit donated! We anxiously await its arrival via the Bahamas Methodist people, whose planes have so wonderfully helpful in getting us here and flying in medical supplies. I actually was able to meet a group of them over the last few days, including the president today.

Will get to bed as I have another long surgery day tomorrow and at present have no outside help. We are doing well, but I have 80 patients or so to keep an eye on, to round on with my Haitian doctors’ help, and about 12 surgeries to do tomorrow. At this point at least there are no amputations to do, thank the Lord. These dear patients are always so sad as their outlook is bleak; so many are young and now face a crippled future. Pray for continued wisdom, compassion and patience under stretching conditions for us all.

In His Service, with thanksgiving for you all, your help and your prayers, Bill