Teams Poll Haitians to Learn What They Need After Earthquake

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ComposeEdit HtmlTeams poll Haitians to learn what they need after earthquake
By David BrownWashington Post Staff WriterSunday, January 31, 2010;
PORT-AU-PRINCE, HAITI -- How do you find out what the Haitian people really need now, nearly three weeks after the earthquake? You ask them.
Three-person teams, each including at least one member who speaks Creole and French, are fanning out to 152 sites across the country this week, asking a long series of questions to "key informants." When they are done, they hope to have a clearer picture of the food, shelter, water, sanitation and health-sector needs of the Haitian population.
That's the intent of a week-long project run by the U.N. Office for the Coordination of Humanitarian Affairs, the World Health Organization and the U.S. Centers for Disease Control and Prevention.
It is an experiment in another way, too. The data are being collected on hand-held computers (PDAs) as well as on paper forms marked with pencils.
Much as truth is the first casualty of war, reliable information is one of the early casualties of natural disasters. Until fairly recently, disaster responders relied on their senses, and their common sense, to identify problems. The notion of measuring what you could see was viewed as an academic and slightly effete response to things such as earthquakes, hurricanes and tsunamis.
That view has changed.
The "evidence-based" paradigm slowly remaking medicine has crept into disaster medicine, too. So has the drive to make this field, like much of the rest of medical care, more democratic and responsive to the consumer and less paternalistic and responsive to the expert.
It is true, though, that time is of the essence, even a few weeks after a disaster such as this. Methodological rigor has to wrestle with the need to get things done.
The survey this week didn't ask questions of a random sample of Haitians in the way that a medical trial would. That would have been a huge and time-consuming undertaking. Instead, it sought out individuals expected to know what was happening to the people in their area: mayors, village directors, health officials. The places weren't chosen randomly either. The designers chose fairly evenly spaced sampling sites, with extra ones in the heavily damaged Port-au-Prince area.
There is also the matter of what to ask. Too little, and it's worthless. Too much, and it tries the patience of interviewer and informant. "This is a not-so-rapid rapid assessment," Carl Kincade, a CDC epidemiologist, said as he fluttered the 10-page questionnaire while waiting in the mid-morning heat for interviewers at a dusty lot in a centrally located neighborhood.
One of the teams went to Kenscoff, an administrative district of six villages south of Port-au-Prince. Reaching it took an hour of steady uphill driving. Part of the way, the road traveled the edge of a gorge-like valley, with lush terraced fields on its slopes. The destination was a village called Nouvelle Tourraine.
Relatively speaking, Nouvelle Tourraine was spared. Of its 7,981 residents, one person died in the earthquake and one was injured. Two Catholic churches and 64 houses were destroyed; nine other houses were damaged.
The chief interviewer was Jules Figaro, a 31-year-old graduate of Haiti's state university, where he studied ethnology. He lives in Cite Soleil, the capital's famous slum, with his parents, five brothers and three sisters. He has never had a job. Assisting him were Alex Guerrier, 24, a fourth-year student of administrative sciences, and Anne-Marie Saint-Victor, a 21-year-old medical student. The team leader got $50 for the day, the assistants $30.
They spoke with the appointed director-general of Kenscoff, a 40-year-old man whose crowded desk included a Haitian flag on a dowel that he had put at half-staff. He answered the questions with confidence.
The temporary housing's protection from weather: poor. Privacy: acceptable. Security: poor. Sheltering households with water purifying chemicals: less than 25 percent. Ones with necked water containers that make water storage safer: 50 to 75 percent.
Then it was around the corner to the Sanitary Bureau, where a public health doctor and infectious diseases specialist, Dorothy Posy, provided the information.
Number of births in Nouvelle Tourraine, in the last week: 10. Number with trained attendants: nine. Cases of diarrheal disease: one.
She was happy to report that the 10 people on antiretroviral therapy for HIV infection and the four under treatment for tuberculosis had no interruption of treatment.
There were some problems with the PDA, and Guerrier couldn't keep up with all the answers. So he would copy down the ones he'd missed from the paper form later on. Consequently, the analysis of how similar the two sets of data are -- paper vs. digital -- will be muddied for this team. And then there was the problem of running into another survey team as they descended the stairs from the Sanitary Bureau.
Scott Dowell, head of CDC's efforts here, speaks Creole and spent much of his childhood at the Albert Schweitzer Hospital, about 50 miles northeast of the capital, where his father worked as a pediatrician. He said the problem of bumping into other teams was bound to happen occasionally. If a team finds no reliable informant at the place it is assigned, it is instructed to go the nearest place there is one.
"So two teams are going to end up in the same place some of the time," he said.
It turns out, though, this duplication was intentional, a random test of the "reproducibility" of the data.
It will be into next week before the survey findings are compiled and considerably longer before the PDA experiment is judged a success or failure.
But there are some experts who think that the brief day of the PDA is over and that there's only one way to efficiently collect epidemiological data in the field. It's with a cellphone, the hand-held computer just about everyone in the world can afford.

Marijke and Baby Hazel

Marijke was in Haiti in October with Friends of Haiti Green Bay, and nursed baby Hazel back to life. She is now in Port au Prince trying to get adoption papers. Reports are mixed about how to expedite this process.

Every Day Is An Adventure for Nadia!

Every day is a new adventure for our Haitian friend, Nadia in the USA. The snow comes today as if to tell us it`s time to slow way down. We are going to have a baby soon!!! The c/section is scheduled for 9AM Tuesday. Every one has been made aware of the situation. The sonogram has been confirmed, the amnio has been arranged, the blood has been drawn and docs will be on standby for any situation that may arise. Luckily we live only a mile from GBMC hospital.

It`s hard to believe that just a short seven days ago we were invited to the Dominican Consulate which was instigated by a special Congressional Hearing, getting the long sought after visa to get Nadia to the States. This trans-national woman who speaks four languages fluently, who never left Haiti before the quake, whose high risk pregnancy would make most women bedridden with pain, whose 3 year old son and husband are living in a tent in Haiti with only $200 left, is the picture of calm and contentment of her stressful situation. She is a gift of grace in our lives and keeps us real.

World Relief Update for Haiti

Thank you friends for your support, for your sacrificial giving and for your prayers for the people of Haiti. World Relief and our partners could not do our work without you! Thank you so much. We are most grateful for your giving hearts.
Here is our World Relief UPDATE FOR HAITI -- January 29, 2010

Health Care, Food, Water, SanitationAcross sectors—health care, food, sanitation, etc., aid workers are expressing signs of transition from meeting the most basic emergency needs. While continuing to provide food, shelter and water, responders are moving into primary care support, nutrition and other rehabilitation and recovery activities.
· World Relief received 60 tons of food—beans, rice, oil and salt—from the World Food Program this week. We are grateful for the way that funds are able to be leveraged due to the World Food Program donation—and hope to continue to provide churches and communities food to serve more than 110,000 meals in their communities in the next few days.
· Even before the earthquake, roughly only half of Haitians had access to clean water. World Relief is working on a number of water projects as well as distributing packaged water. World Relief is working with partners to drill bore holes and planning water distribution points. Thanks to our team on the ground, you can watch a bore hole being drilled at an orphanage caring for over 130 children. Warren Wright, reflecting on the project, said “Without the local church this project could not be happening.” The hope is to establish five water points each serving around 500 people from the surrounding community in the coming weeks.
· More than 1 million people are still displaced in Haiti. 236,000 have left Port-au-Prince through a government sponsored program to move people out of the city. Internally displaced people camps have formed all around the city and outlying areas.
· World Relief plans to provide shelter in the coming weeks—initially working to get 5,000 temporary housing tarps or tents to distribute in communities.
· Unaccompanied children continue to be a huge concern. Child protection groups are working hard to ensure children are well-cared for and that every avenue to reunite them with their families is taken. There are considerable dangers of children being trafficked intentionally or accidentally separated from their families. Local and international authorities are scaling up efforts to ensure children do not become victims of trafficking. In Haiti, even before the earthquake, extreme poverty led some parents to take their children to orphanages for care. After the quake, the United States government is still requiring that all appropriate steps be taken to ensure children do not have living parents or close relatives in Haiti before adoption is considered. The long term goal is to strengthen and reunite families and enable them to care for their own children.
· In the coming days, we are hoping to begin providing emotional and psychosocial support to our staff in Haiti. Psychosocial support will continue to be a significant need in the coming months.
· Reports are estimating that the Port-au-Prince airport will open up to commercial flights sometime next week. For now, around 150 flights happen each day.
· Stories coming from our staff on the ground in Haiti are full of descriptions of resilience, determination and even optimism of the Haitian people as they face their future even in the face of such great devastation. Praise the Lord for hope in the midst of suffering.

Stories from the Field
Pastor Jean Baptiste Bataille, a partner of World Relief in Haiti, says "I pray: 'Lord, it is the time for change in Haiti! We've known so much sorrow, so much pain.... but I believe this is the time for a big change in our country."

Altona, a mother of three in an internally displaced people’s camp in Haiti, said ““We feel there’s no way we can resolve our problems on our own. But the church is our hope… we believe God and His people will help us in this situation.” Click here for more of her story.

Resources:
CNN: Haiti’s Children in the Quake’s Aftermath

Communications Team
The team has been in Haiti since Tuesday. They are gathering stories and photos featured on our homepage www.worldrelief.org
We encourage you to follow their progress on twitter. They are posting pictures and updates as they go. They are planning to return this weekend. Please pray for their travel plans, still being finalized, and safety as they travel.
· Julian: www.twitter.com/kookielukie
· Ray: www.twitter.com/pixelpooch
· Matt: www.twitter.com/worldreliefNEXT

One Minute 4 Haiti
World Relief is continuing One Minute 4 Haiti, designating one minute at 4:53 PM on Tuesday—the exact time the quake occurred—to pray for Haiti. Visit our homepage for more information. Encourage your friends, family members, Integral partners and churches to participate. Encourage them to visit www.worldrelief.org/1minute to find our more information and sign up for up-to-date prayer requests for Tuesday. We will continue to do this on Tuesdays for at least the next few weeks. The list of Prayer requests is available here.

FOR WORLD RELIEF STAFF POSITIONS OPEN
Communications Officer
· The job description for the Communications Officer is available at www.worldrelief.org/jobs.
Haiti Country Director
· The job description, visit www.worldrelief.org/jobs.


Blessings,
Nancy

Nancy Lanagan Regional Director Development
World Relief 7 East Baltimore Street ▪ Baltimore, MD 21202
nlanagan@wr.org / www.wr.org
410-236-4324
Empowering the local church to serve the most vulnerable

"And let us consider how we may spur one another on toward love and good deeds." Heb. 10:24

MedShare Financial Support From Our Yoga Friends

A letter to MedShare from our yoga friends. Thanks to all who participated in this event and were so generous.

Hello, Ms. Greene:

My name is Cheryl Catranbone and I am a yoga teacher in Maryland. Tom and Carol Ritter are dear friends as well as students of mine, and I have been hearing great things about you from them.

When the earthquake struck Haiti, I knew Tom and Carol would be making every attempt to offer as much help as possible to our brothers and sisters of Haiti. It was no surprise that they left immediately to offer support and their services. In appreciation to the Ritters for being such wonderful examples of what yoga truly means, I held a yoga event for Haiti with MedShare receiving the proceeds. I have sent you two online donations; one for $850 and another for $215. In addition, I am sending you checks to be added to my donation. The checks are coming by postal mail and the total for these checks is $1,705. I am including a copy of this e-mail with the checks so you know they come to you from the hard work and beautiful efforts of the Ritters. They are an inspiration to us all.

Thank you for your good works. It is an honor to help your organization.

Blessings of Peace,
Cheryl

Heartbreaking Forwards

Here is an example of e-mails we get all the time.

---------- Forwarded message ----------
George, people are dying in Cap Haitien hospitals after surgeries because there are no blood bags or blood typing equipment. Can someone helicopter some in? The contact there is John's "son", Benito Jasmine. He is still waiting for help. His phone # is 3824-7366.

Marijke's adoption papers are going to the Prime Minister for his signature. Thanks for keeping in touch.

Current Issues We Are Working On - Can You Help?

Currently we are hard at work on two major problems - and help is always appreciated.

1.) We have been wondering what we could do to help little Hazel in the forwarded message below, that Carol and I have held in our arms during the first couple days of her recovery from malnutrition. This is an experience I recommend to anyone before they leave this planet. To watch one starving infant (I mean a child with food insecurities) come back to life is ______. Fill in the blank with your own descriptive words. I will post a follow up e-mail with a progress report. Let's make the same miracle we did for Nadia happen for this child and her new parents.

2.) I just heard from my contacts at the dental school. I was supposed to visit there the Tuesday after the quake and stay in the Montana Hotel and give a lecture. That in itself tells you how desperate they are for faculty and how lucky I am! Anyway, the building is intact and has been checked out by engineers and declared safe. It is about four blocks from the palace that you see on the news. What they want to do is open the clinic to serve the people of Port au Prince. They need supplies - everything. The current thought is to ship in these supplies from a dental supply house similar to Sullivan-Schein from the Dominican Republic.

In October, 2009, Marijke van Roojen and I went with a group of medical people (http://www.friendsofhaiti-gb.com/) to Thomazeau in Haiti to work in a clinic for a week. Hazel was brought in to the clinic by her paternal aunt. She was severely malnourished (she weighed 11 pounds at nine months of age), dehydrated, and had a high fever. We treated her for pneumonia, gave her fluids and formula, and found out that her mother had died when Hazel was about four months old. Her father has four older children to take care of, and so gave her to his sister. The sister finally admitted that she was leaving Hazel on a bed by herself all day, and feeding maybe a couple of spoonfuls of something to her each day. She hadn't fed Hazel at all for three days before we first saw her. We finally asked her aunt if she would be willing to let an orphanage care for Hazel, and if Hazel could be adopted. She immediately said yes, and signed her over to a small orphanage in Thomazeau. We kept her with us until we left the country, and Marijke fell in love with her. Marijke started the adoption process as soon as she came home. Marijke visited Hazel again in December for a week, and had already planned that she would return for another week's visit in early February, when the earthquake hit. Marijke flew into Santa Domingo on Friday, February 22nd, which was the best American Airlines could do for her, and then hitchhiked her way into Haiti and to the orphanage. She has been at the U.S. Embassy in Port-au-Prince since early Monday morning with Hazel, and they have been sleeping on the floor of the embassy since then. Hazel is now quite sick, with diarrhea and fever. She heard this morning that her Humanitarian Parole papers are complete, and that all that is needed for her to return to the USA is for the Haitian government to allow them to leave. She is committed to staying at the embassy until she is allowed to leave the country. We are so anxious that they be allowed to leave Haiti, return to the US, and get medical care for Hazel. No one else wants this child, and Marijke does. Please help us in any way you can. Sincerely, Danae Steele, M.D.

Where to Donate

One of our goals before the earthquake was to bring a MedShare.org collection and distribution center to Baltimore, but we had to show we could raise money so we wouldn't be a drag on the first and second center. That is only reason we want money tagged somewhere on the giving page - I forget where (oh, okay - our ego is in there somewhere!).

Pass the word to keep giving to either MedShare.org or to imaonline.org, which is an organization run by good friends of ours who don't have time to go for five star rating like MedShare.

Medical Independence Day

Independence Day and Healthcare for all……………..

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.—That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, —That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.”

In the 21st century, chronic disease has become a major cause of death both here and abroad. The threats to our liberty are dramatically different in the 21st century, compared to those faced by our founding fathers over 200 years ago. Most countries recognize the charter set forth by the World Health Organization that mirrors this change, which mandates "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.". If one looks at our original Declaration of Independence, adopting a principle of universal health for all is consistent with our core American values that respects health not as a luxury, but rather as an essential and inalienable human right. If one looks closely at the hard fought liberties won by Americans over the centuries, it becomes apparent that life, liberty and the pursuit of happiness can not be achieved in this century without adequate health. Health is no more a luxury than freedom of speech, religion or any of the other freedoms outlined in our Constitution based on the premise that all individuals are endowed with certain inalienable rights.

Indeed our founding fathers set up a framework to challenge the government if these liberties are not being met, so as to make the Constitution a living document that changes with the times without changing its essential principles. In essence, access to adequate healthcare needs to be viewed through the lenses of our founding fathers as an inalienable right, not a political forum. In the most powerful and supposedly benevolent and generous country on the planet in the 21st century, it is as inexcusable and unconscionable for a diabetic individual to go without insulin, a stroke patient not have access to their blood pressure medications, or an asthmatic have their lifeline of oxygen and breathing treatments to breath, as sending a soldier into war without weapons or reinforcements to fight for our freedom.

On this 4th of July, I ask that as individuals and as Americans, old and young, women and men, from all racial and ethnic backgrounds, religions and diverse political views, we remember what our country was founded on, namely life, liberty and pursuit of happiness, and then consider how any American today can achieve that liberty without health. Once we are able to view healthcare in this light, we are able to find the path towards a more universal and caring approach to care for those in need. That is my wish on behalf of my patients for a 21st century Independence Day.

Ross Isaacs, M.D.
Charlottesville, VA
rbi9u@yahoo.com

A Letter From Tom's New Best Friend from Haiti

This is a missive from Tom's new best friend from Haiti, Ross Isaacs. Ross was a top liver transplant specialist but now practices internal medicine in rural Virginia.

"Just arrived safely back in Santo Domingo in the Dominican Republic. I spent the bulk of last week working in an orphanage that we turned into a hospital, right down the road from the real hospital where the surgeons did nonstop surgery. Saw lots of ortho trauma, neuro and spine trauma, open wounds, burns, blunt and open trauma to chests, abdomens, pelvises and extremities, crush injuries to just about every part of the body. I witnessed the despair of families split apart searching among the wounded for each other, etc. We put in 12-14 hour days and shifts. Teams from all over the world converged at our clinic and hospital which was right on the border of Haiti and the Dominican Republic. Yesterday we evacuated four patients in two ambulances - I was in one of them and an ob-gyn was in the other - to a hospital on the Dominican coast. They will make it, I hope...

It was a bumpy three hour ride for only 70 miles, but it felt even longer for the patients. All we had on board was a small supply of morphine and water to wash them down as the ambulances were not air conditioned and we were sitting by their sides. Although we spoke different languages, when we arrived they looked at us with appreciation even though I could not imagine a ride like that, let alone laying that way for days waiting for transport out. We were able to helicopter two kids out, one with a depressed skull fracture and one with an orbital fracture and head trauma. Our spine patients were still waiting for choppers to get them out when we left this morning.

Several new teams came yesterday to replace us and last night there was another severe aftershock so strong that we actually felt it in the mountains. Patients panicked and ran out of the orphanage, and one jumped from the second story and luckily only broke his arm. There was no way to convince the patients to go back. Lots of moving and tender and sad experiences. I'm still processing it. We helped babies with severe burns, and had the joy of several healthy childbirths at the clinic. Kids with horrendous wounds and fractures were calmed by other victims who were total strangers and either sang to them or helped translate to calm them. We inserted a chest tube using a Foley catheter for someone with impending tension pneumothorax, made splints out of all sorts of stuff, cleaned wounds with not only the basics but with new tricks learned from other docs here and abroad, hydrated severely dehydrated patients, helped cast, laughed with people when we could and cried when we couldn't help it, witnessed thousands of acts of courage and kindness by the beautiful Haitian people - and I was basically just lucky to be part of such a large effort to help them via an amazing group of docs, nurses, and other volunteers.

Had to miss my morning flight as the copilot for Stan is sick. I am looking after him tonight and will get home by another route tomorrow morning. I wish I could stay longer but I miss my kids and need to get back to work. These beautiful people are truly amazing despite the devastation of their country, and they have a silent dignity that I can not do justice to by trying to describe with mere words. The survivors were mothers, fathers, sons and daughters, aunts, uncles, brothers and sisters, etc., and from all walks of life - from carpenters and ship captains to lawyers, doctors, poets, authors, masons, and business owners all left with nothing at home but complete devastation. There is so much to describe which I will by via a blog later, but for now I am grateful to have had the opportunity to help and be on my way back.

I tore a ligament in my right ankle goofing around the other evening playing soccer with some kids, while waiting for our bus taking us back to where we stay in another village on the frontier/border which only helped make them laugh. All I could do was reflect that unlike many of those kids' friends and families, my ankle, albeit sore, is still attatched to my own leg and I will recover without a trace, while they are left with the physical and emotional scars of being a survivor that will last a lifetime. Thanks for the well wishes. Once I get pics, I will post them and forward them on. Please pray for the healing of the people of Haiti and their families." Ross Isaacs

Start Helping Haiti in Ten Minutes With No Cash

Robert Wray, the tech guy behind Tom & Carol's blog, went down on Saturday to check out the Crisis Commons. The event was a mind blowing collaboration of over 1,000 technical volunteers from three continents. Crowd-sourced community-generated maps have become the official on the ground map resource in Haiti. In this video, Fortiusone's CTO Andrew Turner explains how you can start helping Haiti in 10 minutes with no cash ... just some of your time. Links talked about in the video are ushahidi - Haiti SMS disaster relief collaboration, Crisis Commons ,and ImapHaiti. How you get started in less than 10 minutes: http://imaphaiti.com/ The event was also covered by internal media organizations such as CNN, BBC, Washington Post, LA Times, Wired and O'Reilly Media.

Lessons Learned From Haiti

This is a letter forwarded from Tom to me, to be shared with all of you:


Here are a few ideas gleaned from our experiences at Dr. Marc Pinard's Le Bon Samaritan Hospital in Jimani. They are in no particular order. If you have any questions or would like us to expand upon any of these concepts or ideas per our experiences, please contact Tom Ritter at (410)215-9426 when he returns to the US tomorrow, or you can contact him via his country phone today at (809)989-0284. He will be leaving the DR at 7:00 AM tomorrow, Monday, January 25, 2010. If you prefer, we can meet in person anytime this afternoon or evening over dinner.

We realize you have tremendous expertise in this area and are not trying to reinvent the wheel, but rather we are making suggestions from how we have experienced it before the wheel was invented. Either way, if any of our ideas can help save one more life or help the despair these wonderful people are suffering, it will all be worth it. Thanks for all of your help and support for the people of Haiti and the Dominican Republic.


1. Utilize local "organic" organizations that have been created out of the chaos of this disaster and praise them for what they have done right, under these impossible circumstances. Help them by asking them what they need to improve the crude but somewhat effective systems they already put in place, and resist the temptation to replace it quickly with a Western model.

2. Move patients down to the appropriate level of care with a person they trust. The idea is that when patients are moved, a Haitian nurse and/or trusted family member should evaluate the new location for safety, etc., in order to prevent them from feeling even more isolated and displaced.

3. Let everyone blow off steam once in a while - both from the patient and family side as well as providers. Note: The Haitians believe if they lose their temper once in awhile, it helps them calm down to get things done rather than keeping it inside and staying frustrated.

4. We need to stop wasting, to reuse resources and recycle, because Haitians believe strongly that wasting anything is sinful and they do not respect those who do waste. Be culturally sensitive, as you already are. Again, this is what we have heard from the front lines in taking care of a displaced population.

5. Develop an adequate registration mechanism. Earlier methods of registration during the initial phases of the disaster, although very imperfect, still should be incorporated into the newer systems as they evolve, and labeled as primitive in the field assessments and registration.

6. Recognize that electricity is very expensive and find better ways to minimize waste. Excess use of electricity at relief centers takes electricity away from local Dominicans which might lead to resentment and anger from the local population.

7. Dr. Marc Pinard is most concerned with the fact that his regular Haitian and Dominican patients have been suffering without his care, and need the same access to our facilities as those other trauma patients from the earthquake and disaster areas. He was hesitant to open his clinic for this reason, but opened it purely on a humanitarian basis and should be recognized for this role. Marc is also recognized as a Mother Teresa-like figure who has trained all over the world. He could practice anywhere, but he chose to return to serve the people along the border shared by both countries. He also suffers with his own medical issues, but put the needs of his patients before his own.

8. Develop better communication mechanisms for Haitians. Their main frustration is that they still don't know whether loved ones are still alive, suffering, displaced, dying or dead. Therefore, utilize all and any means to improve their communication with one another. For example, give them phone cards and/or cell phones with the right country codes to call others. Contrary to popular misconception, many of the patients we saw had e-mail addresses and need some form of access to the internet at the hospitals and throughout Haiti as well as the border areas, such as churches, stores, etc. A conference on this concept has already been convened on yesterday in Washington DC. For details, contact Tom Ritter.

9. We realize there is a desperate need to depopulate Port au Prince, but do it in a way that does not frighten or dehumanize their homes. They need to know when they return - if they return - it will be to a better place, not worse. Perhaps even have different ideas developed to show them as an example how it may look when they return. Every Haitian we have spoken with has conveyed fears that their home will become a place where garbage is dumped and bodies are buried, as has always happened in the past. Significant reassurance needs to be used to help them overcome these fears if Haiti is to be rebuilt correctly again.
10. Give Haitians the means to make their own food to their own tastes, cooked using their own methods and own ingredients, i.e. rice, beans, goat and chicken. This will also free up your own scarce resources to be used elsewhere while simultaneously empowering the victims of the disaster. Although efforts have been made to provide adequate food and nutrition under difficult if not impossible circumstances, the food that is served is perceived as somewhat less in quality than what an animal is fed, and could be counterproductive.

11. Develop a job corps for Haitians run by Haitians with Haitian management and focus. In other words, they need cash but want to earn it themselves by rebuilding both their own country and internal dignity and self worth.

12. Ask the local communities in Haiti who have helped in the past, and work those relationships (i.e. IMA, Partners in Health via Paul Farmer, Remote Area Medical, Friends of Haiti Green Bay) - both secular and religious, medical and non. These relationships are important because they know who the community leaders are, who often are not the most obvious or official leaders. Possibly ask technology experts like Bill Gates to help develop a Google map to educate people about the already existing infrastructure in those villages so that they can better help those populations. Not all villages have the same access to outside help, and not all outsiders access the same leaders within the different villages. Centralizing this via the internet and modern techology will simplify and advance this.

13. Ask people about their own priority list, not what is perceived by outsiders as their need. You have a priority list - and so do the Haitians. We need to ask them up front what their needs and priorities are.

14. We are nothing without good translators. We need translators fluent in Spanish, English, and Creole. Treat them like the precious resource they are by praising, paying and respecting them as one of the most important members of your team. Without them you are blind, deaf, and dumb, and will not enact any of the wonderful ideas that you have already developed. That said, pay them what is acceptable so as not to poison the well from which we all draw upon with a potential devastation of their economy.

15. How do we develop better relationships and communication with a central command and all those involved? We need facile, easy and reproduceable communications.

Nadia Got a Visa, And a Five Year One, At That!

Nadia got a five year visa! Here is the photo that was used for her documentation.

From Lack of Supplies to Overabundance - and Nadia's Visa

From Dr. Thomas Ritter: UNEDITED VIA SMS/TXT: Sorry - have not posted in awhile, but it is almost all over for us. We will come back Sunday if we get Nadia's visa, which there is still hope that there will be some bureaucratic miracle.

Things have completely changed - from where there was a lack of things and now to a overabundance of volunteers and supplies. Now much time will be needed to try to direct the flow of abundance to where there is lack. Sounds philosophical, doesn't it?

Just heard this blog got to be a big deal. We love you all, too. Thanks for all your comments and words of support. If it hasn't already been said, we will try to stay quiet and catch up on processing all that we saw and did - thanks for understanding.

Please send this to Mary Zendak to all visa working group members. We have Nadia on a bus headed to a special interview with the US Embassy. Her appointment is as soon as we get there. She should get a visa if all your efforts pan out - and it's highly probable at this point. If we encounter trouble, we have a team of Harvard immigration lawyers standing by, and politicians who are on standby should have contact info texted to Carol's phone now.

Crisis Commons

Robert Wray is at a Haiti relief technology event at the NPR headquarters with 150 regional technology gurus. The purpose of the gathering is to use technology to make relief efforts more efficient. Some of the projects in progress have helped already in several areas:
Translation apps for mobile devices, Mapping, Long range wifi systems ~30 miles and coordination of relief efforts. The director of the event was on NPR this AM (link to 2 minute audio clip) If you know any technology gurus that want to help, have them check out this website. http://crisiscommons.org/

Huge Bill from AT&T

From Dr. Thomas Ritter: UNEDITED VIA SMS/TXT: AT&T just sent a text to Carol - said her phone is running up a huge bill, and worried her phone may not work at a critical moment. Oops - false alarm! They were just trying to sell her a new wireless plan to save money for us!

BlackHawk Picks Up Burn Victim

From Dr. Carol Ritter: UNEDITED VIA SMS/TXT: Got back from my five hour cruise to Barharon Hospital, only to find the Internet had arrived to La Bonne Samaritan (that is the name of Marc's clinic before this all began). The upstairs area was filled with laptops gone wild. People intensely downloading pix and e-mailing like mad. And OMG!!! FB is here!!!

With this new Internet addition to the compound, expect a plethora of
photos, guys. I hope this means those C arms that are waiting in the
warehouse in the US will be arriving today, and that we can have that teleradiology that the new management promised yesterday.

To all of you working so diligently to get Nadia home ... Thank you, thank you, thank you!!! These connections have actually lead us to the USS Comfort people, and our first US helicopter is expected to land at first light today to pick up one patient. That "lucky" patient has burns over most of his body. His story: He was at the gas station pumping gas when the quake hit. A fire ignited from the tank and set him alight. He dragged himself to a hospital where he sat outside with masses of quake victims for five days. He got to us three days ago now and is laying with bandages covering him like a mummy.

"Critical" does not seem like an appropriate level to describe his condition - that painfully acute level between life and death. He gets the first ride on our US BlackHawk.

No pix on this from me. I'm sure one of those upstairs laptops set one out, though.

Glimmer of Hope for Nadia's Visa

I received a call this evening from George Sarmiento, a gentleman from the US Consulate in the DR. He told me that due to a congressional hearing today, he would meet with Nadia tomorrow even though the office was closed for the weekend, and accept her application for an emergency medical visa.

Many of us have been working very hard to see this happen, with letters and phone calls and prayer. Sometimes you encounter situations in life that seem as if they have insurmountable odds, but sometimes ... you just have to believe.

Much Needed Rest for the Ritters

Just imagine the sheer magnitude of tragedy the Ritters are encountering in Haiti right now. Try to imagine being there yourself - in the heat, running on sheer adrenaline with little sleep, and being immersed in patient trauma that never seems to end. If that were you, wouldn't you be physically and emotionally drained?

It is for that reason that the Ritters have requested not to be contacted for press interviews for several weeks. They need to spend some quality time with their friends and family to decompress and re-energize. Please understand this and respect their wishes.

Tremor in Haiti - 1/22/10, 5:45 p.m.

From Dr. Carol Ritter: UNEDITED VIA SMS/TXT: We just had a little tremor down here in Haiti. Everyone is okay. except for a patient who panicked and jumped out of the second floor.

Big Kenny

From Dr. Carol Ritter: UNEDITED VIA SMS/TXT: Just sat next to Big Kenny from Nashville. (Big Kenny on Wikipedia) He keeps a blog and website. He's on a search and rescue mission to find a friend. Interesting person to share stories with. Can't wait to look up his web site.

Which, by the way, I hope AT&T will give me a break on my phone bill this month like T-Mobile did for other Haiti relief workers.

Transport Duty

From Dr. Carol Ritter: UNEDITED VIA SMS/TXT: Doing transport today. On my way to Batciella Hospital in the Dominican Republic (DR), where we found 4 open beds. Cadet, age 26, with a ruptured liver. Jean Francois with sepsis after right leg amputation. Madet with sepsis and probable PE. Roger, who I operated on three days ago with multiple crush injuries and probably in renal failure. Their stoicism is unimaginable. Family members are not allowed through the check points but I have sneaked in a brother of one and a cousin of another. This is the longest two hour drive of their lives, hopefully to make their lives longer with a brighter future.

Gratitude For a Bath

From Dr. Carol Ritter: UNEDITED VIA SMS/TXT: The influx of new patients slowed yesterday, allowing my friend Carey to give the first bath to our post-op patients. The gratitude of the 18 year old patient with one arm was heart breaking.

Could the Comfort come to Nadia's rescue? Its arrival is anticipated in three days. They will need top notch translators.

Photos From Thursday

Awash In Volunteers

Desperate to Leave

Desperate to Stay

Friday Updates

I have a bunch of photo and text updates to post from the Ritters. They might not go live until later tonight. Everyone is doing okay. They are ready to come home and have a day off. There will be no more press interviews for several weeks until they have time to recharge. - Robert Wray

Thursday Updates from Dr. Carol Ritter in Jimani

From Dr. Carol Ritter: {UNEDITED VIA SMS/TXT} In eight short days starting with eight people, we've become the defacto Johns Hopkins of the isle of Hispanola. We are awash with volunteers all looking for the adrenaline of a few days ago. Now we have post op care , follow up and patient transportation to somewhere out of here. The patients either want to get back home to loved ones, or want to stay here with their loved ones and get food and lodging. Less glorious care for this energetic new bunch of fresh volunteers. We first eight are exhausted and looking after each other. Some of as manic persists. Others are geting a taste of post traumatic stress. I work frantically for Nadia 's visa. Plans to leave in two days with my friend hopefully at my side.  Here is a picture of Nadia with Haiti in the background.

GBMC Haiti Press Conference - January 18th

Jump to 1 minute to get to the conference call.

This event generated some of the following awareness: Baltimore Sun, 2nd Baltimore Sun Article, WBAL TV, WBAL Radio,  Baltimore Business Journal, Towson Times, Channel 13, Channel 2, WTOP, WJZ/ Associated Press, Fox45, Baltimore Examiner
Thanks for your help @gbmcmedia

3 Year Old Found After 8 Days in Haitian Rubble

From Dr. Carol Ritter VIA SMS/TXT/MMS: 3 year old found in the rubble today, 8 days after the quake. Doing well tonight after IV hydration. Most difficult IV stick by our wonderful pediatric docs! Good work, guys!!!

New Life In Haiti!

Dr. Carol Ritter Reports:  New Life!!!  Healthy baby and mom is doing well.

Echo of Haiti

A Story from a friend - By George Wills (from citybizlist)

I'd like to share a memory of a young soldier 52 years ago in Haiti, the small country at the center of 2010's first natural catastrophe. Last week's magnitude-7 earthquake killed an estimated 200,000 people, left 250,000 injured and 1.5 million homeless.
My first trip as a newly commissioned naval officer 52 years ago included Haiti, where the USS Aldebaran entered Port au Prince in 1958. We were stationed there due to the threat of violence from dictator Duvalier whose control over this small impoverished island was absolute. As a small group of young officers walking along a street, we were confronted by a young woman shrieking as she carried a tiny baby: "For sale! No money! " Shaken, we all opened our pockets and handed over what must have totaled $50. Our words: "Keep your baby! Promise! Please!"
We never knew the outcome, but hope was that we may have helped a ravished mother and child stay together.
Now over five decades later,

Dr. Carol Ritter - Tuesday Fox 45 Interview

Dr. Carol Ritter just finished an interview with Fox45 News. She and her husband, Dr. Tom Ritter, are both safe after the most recent earthquake. They are working in an area which is about a 2 hour drive from the epicenter. Shock was limited or non-existent in their current location.

When Fox45 posts the video we will link it in to the blog.

Dr. Carol Ritter's Photos and Report From Monday

UNEDITED VIA /SMS/TXT/MMS - A day filled with many fresh orphans. children losing parents and parents losing children all day. No one wants to stop working. Would give us time to think about it.

7 OR's going full force yesterday with a NY team, the Rainbow team, German, Japanese, Puerto Rican, Dominican, French. So many kids. Volunteers are all working together today in solidarity.

The photo shows blessings given by Padre with our Fatima holy water to a one year old about to have her hand amputated.

The woman in pink is waiting in line for her periorbital abscess debridement.

End of Day Updates for Monday

Carol and Tom tried to send me several pictures today. The mobile network has been terrible. I have gotten no updates. Hopefully we will have some text and pictures tomorrow.

I had a 15 minute phone call with Tom tonight. He has been made the "chief of staff" at the hospital. There are a lot of amazing efforts happening here in Baltimore to raise money. Tom hopes to get a chief of technology at the hospital tomorrow to handle communications issues.

A lot of you have been asking what to do. The answer is send money to professional disaster relief organizations, such as imaonline.org. Just flying to Haiti and saying "I am here to help" is not a good idea.

UPS has also shut down all shipments in and out of Haiti until further notice, so 'care packages' are not an option.

Attempting to Get a Visa for Nadia

I have been working most of the day, writing letters and attempting to contact our state senators and representatives about bringing Nadia home with Tom and Carol to deliver her baby and to receive some much needed post-op surgery. Nadia is the Haitian interpreter that has been an integral part of missions for Friends of Haiti. Due to the high risk condition associated with her pregnancy, it is imperative that she be delivered of this child here, among modern medical technology.

Nadia is currently with Carol and Tom in the DR. She has a husband and a three year old son. If you have any ideas or links to someone who can help with a visa, please let me know!

Haiti Status Update From a Friend

From: JDA4Him
Sent: Mon Jan 18 20:52:00 2010
Subject: Haïti Update 18 January 2010
Hello Everyone! - Here are some neat things we’ve been finding:

• I’ve never seen the Haitian people more united than right now. Folks that still have a resource are freely sharing it with others. All my neighbors have folks staying with them; and both Odelin and Samuel are housing people in their courtyards—even though Samuel no longer has a house!
• Food aid is arriving to the needy but still rather slowly as they continue to clear roads and establish a system to get to some rather remote spots. BUT local people are helping! A number are preparing food from their own homes to share with those who do not have—even though markets are just beginning to open and none of us has much cash to restock supplies (this is a cash-based economy and the banks remain closed).
  
  
  

E-mail from Paul Farmer

{UNEDITED} Email/SMS Forwarding an e-mail that one of our team just received from Paul Farmer:  Dear Joia:

Tried to get more information on referrals to US military surgical capacity in Haiti, or just off-shore or on the island in the DR. Am assuming these are surgical referrals (but our phones are not working in Port au Prince so don't have info). Some info:

1.) The USS Carl Vinson has 30 beds but only a general surgeon; no neurosurgeon. You will hear that it is their mission to treat US citizens only but they have already operated on non-US citizens. Sanjay Gupta did a procedure there this morning on a child. I have the names of the medical officer (Dr. Lee Harvis, with whom I spoke at length; cell xxx-xxx-xxxx) and the commanding officer (Capt. John Kirby xxx-xxx-xxxx) and their e-mails too. The USS Comfort is coming in on Thursday and will have a lot more capacity by report.

Forgot to Thank Some People on the Media Interviews

{UNEDITED} From Dr Thomas Ritter VIA SMS -

I forgot to plug the most important helper and problem solver on our press conference call:
Robert Wray, who is the owner of Innovative Technology and a great friend for setting up our blog and jumping in whenever we needed his help. He has been our press secretary for our state side communications. He and Debbie Streeter, one of my dental staff who has been to Haiti on past trips, and all those who we may never know - thanks! We can feel the love.

Thanks For All the Media Support

Thanks for all the media support: Baltimore Sun, 2nd Baltimore Sun Article, WBAL TV, WBAL Radio,  Baltimore Business Journal, Towson Times, Channel 13, Channel 2, WTOP, WJZ/ Associated Press, Fox45, Baltimore Examiner and GBMC's media group. You all have really helped spread the word. A press conference was just taped at the GBMC hospital at 8:00PM on Monday with the Ritters connected live in Haiti. Expect links to the above articles, media and audio clips to be linked as they become available. If you haven't made a donation yet, please consider imaonline.org

Such Sad Stories

VIA TXT/SMS From Dr. Carol Ritter.  Such Sad Stories - They keep coming.  We are crazy but functioning.  The coast guard, Japanese and Canadians arrived today.   See some pictures from 3:15 pm:

Current Photo of Tom and Carol from Haiti

We took a quick break because several people wanted to see a current picture.  This was taken at 11AM Monday morning. 

Baby Delivered & Friend/Translator is Safe in Dominican Republic

From Dr. Carol Ritter VIA SMS/TXT message: Nadia is safe with us and stoic. Came over with French journalists. Her husband and 3 year old are in Haiti without passports. Tears in her eyes about what's happening to her country. Waiting for immigration to open tomorrow. Making plans to deliver in DR if unable to get to US. The clinic is awash in trauma patients. Only 3 deaths input post op patients. WHO intel set up down the street . They see our organizational abilities relative to other facilities, and are sending more and more patients our way.

Oh - by the way, I did deliver a healthy baby girl yesterday in the middle of all the amputations. They named her Carol! Life is bittersweet .

Late PM Update From Tom - Two Aid Workers Killed. We Are Safe and Okay.

From Dr. Tom Ritter / Late Sunday night via SMS/TXT: All surgeons from Puerto Rico have quieted down, and what was once a 7 operating room hospital is now closed for night. Three to four hundred patients and post-op patients will hopefully make it through the night, then we go to regroup.

I am told two aid workers were killed. Rest assured -we are safe and security is not a problem. Gonna nap till 5:30 - yahoo! Please do not be in hurry to come here - there will be work for med teams like Katrina for years and years. Nite nite. Carol delivered baby that was named...Carol.

4pm Sunday TXT/SMS Update from Haiti

Things slow down to a crawl while the experts decide who is in charge. There are people here from every alphabet soup trying to mess with our mess. Made it all the way to top of the chain of command - now just sitting. What we came for was that medivac with the military - now we sit.

Coming to Haiti to Help? What Do I Bring?

From Twitter: Some people direct messaged the Ritters @CarolTomHaiti and wanted to know what they can bring. Here is a response from Tom & Carol .
From Dr. Carol Ritter: VIA /TXT/SMS
IV antibiotics
Anesthesiologist
Sonogramas
Regional anesthesia
Laryngoscopes
Spinal needles
Narcotics

Machines for the operating rooms and recovery rooms. We have 8
operating rooms.

Dr. Tom Ritter mentioned on another post: " Please do not be in a
hurry to come here - there will be work for med teams like Katrina for
years and years."

Several Sunday Morning Updates

Update From Dr. Tom Ritter VIA SMS/TXT 7:32AM Good Morning: Slept in comfort. Team fed. Heading to hospital to see what the night has done to our systems. Carol and I feel today is the day to try to move Nadia across the border to the Dominican Republic. Film crew to follow us all day. I knew I should have put mousse in my hair this morning.

9:25AM Did morning assessments. Food is no longer a problem for relief workers in this area. Housing is camping only - maybe sleeping on the floor inside. Doing medical supply run - there are no IV antibiotics. About 100 crush injuries now, with old infections everywhere. Many amputations needed and done. Our crew is mostly coordinating docs and problem solving. Infection control - there are no autoclaves, no bleach, no Cidex, nothing. Hope to get boiling water disinfection up soon, but clean instruments - they are not. I hate this phone but love all the support.

10:39 AM: Just ran into our friend, the senator. We are staying at his house which is very comfy. Called meeting of all powers that be - U.S. Army, Dominican Republic army, and all the chiefs wish us luck. They assume we know something they don't.

Trying to Get Help From the Air Force

A friend and newspaper reports that there is an empty hospital ship off shore who can take care of the critically wounded. They can only receive patients by order of the air force. see more in this article

Update via VIA TXT/SMS from Tom Ritter:
Will send Air Force to both Harv and Thomazeau. Can you confirm needs by the 8 am meeting and we will do what we can. Let Bobby of Thomazeau know we have abundance of docs and we could send them to him.

Initial Assessment From Tom

Initial assessment VIA TXT/SMS: Wow - we've got our work cut out for us! No one should come here unless they can feed and house themselves. 100 fully equipped docs just came with no way to feed themselves, and their hotel is 3 hours away. The public hospital is not a nice place to be. Chaos is the order of the day, but good things come in every hour to help ease the suffering.

An Update from the Haiti Embassy

________

Update on Nadia: (Embassy info below): We met a retired special forces guy who is transporting patients from Port ay Prince to Jimimi. I'm hoping he can bring Nadia to the border with us. From here we can work on her visa.

________

An email from our friend at the embassy: Saturday 10pm.

From: Joseph Vorgetts - US Embassy - Port-au-Prince, Haiti

Attaché--USDA APHIS--International Services

These are the facts that I have.

At this time, the situation is a search and rescue operation. This is
a type of triage. That means that the focus has been on getting
emergency teams in here who can pull people out of collapsed
buildings, and provide the severely injured survivors with emergency
medical treatment. These rescue teams began arriving at least 48
hours ago and there are many from all over the US. Most, if not all
of them have deployed in the city by now, and are headquartered at the
embassy compound. The embassy compound is a sea of tents for
providing accommodations as well as emergency medical attention. Thus,
they may not be so visible to people in town. They are in the
compound because there is no security in the city.

If the Belgians have been here for three days before yesterday
(Friday), then they actually arrived before the quake, so just

106 Docs, 11 Anesthesiologists & Mobile Hospital Arrived!

106 docs from Puerto Rico arrived with a mobile hospital. We will be doing real surgery tomorrow. 11 anesthesiologists! No pain!!!

In Jimani, Dominican Republic

VIA SMS Carol: At the hospital on Jimani, Dominican Republic. Hundreds of patients, broken bones, burns. Haven't found Dr. Marc. Local docs and a few Red Cross.

Update from Tom and Message to Yoga Friends

From Tom Ritter VIA SMS: "I smile just thinking of you all doing your yoga fund raisers this Sunday. I wish I could be there - my back is out of alignment, to say the least. If you have been following the blog, we have shifted our cash flow to imaonline.org (Dale and Dorothy of Katrina fame). MedShare has been over the top, successful at least - $20,000 at last check. Supplies now being flown in on Wednesday instead of by boat, thanks to everyone's generosity. Many, many lives will be saved. Stan Brock has also volunteered to fly in a load in to us in his DC3 plane. It is over 50 years old. From his group remote area medical read book al him called "All the Cowboys Were Indians". People continue to stop us and offer us supplies - I'm not sure what I am sitting on, but all the seats full."

VISA Needed For Translator

This was written prior to the earthquake. A medical VISA request is now even more urgent.

"Carol and I are very concerned about Nadia, one of our translators, who was due to come to Baltimore this week to deliver her baby. Nadia is 8 months pregnant and is a very high risk OB patient. Her visa was denied last week probably due to the Detroit bomber and tightening of visas. If anyone has a US senator in their pocket, that might be helpful. We have not yet heard from Nadia - she lives just west of Port au Prince."

Photos of Supplies. On the Road

Text update:  "On the road with Supplies.  Strangers are donating food to us in the parking lot.  Expect the American Refugee Committee with food on Monday. "

Donate to imaonline.org

Text at 11:01 AM - We are requesting that all donations now be directed to Dale & Dorothy at imaonline.org. They are with us now and running on negative cash flow. Donate here.

How Can You Help Right Now?

How can you help right now? Visit http://www.medshare.org/ and donate. Carol and I will match dollar for dollar up to $5000. Mark donation Haiti/Ritter as "Honoree's First Name". Get updates on this blog or Twitter.

Saturday AM updates

Update from Carol @ 6am: Awake and waiting to get to the border. Reading "Pathology of Power" by Paul Farmer. This earthquake is the epicenter of social inequities. Chaos is the end result of consistent social injustice. We are all people - flesh and blood, and they are like us, with a soul, who cannot even count on the earth under their feet for support. We need to rethink the definition of civilization. The gift of mankind is recognizing the genius of our weakness.

Update as of 9 am: Made contact with Nadia!!! I heard her voice but she could not hear me.

Other notes: The team has bought 5 Dominican Republic phones to lower communications costs and to stay in touch. The team is taking a 5 hour bus ride to the border.

10 Min frm Airport-Amputees only get 200mg of Ibuprofen, lacking sutures & antibiotics

A report from friends of the Ritter's - Matthew 25 - As of 6:25 PM Friday night - 10 minutes from the airport. Doctors availabl,e but amputees only getting 200 mg Ibuprofen - they are lacking suture materials and antibiotics. "Our garbage is growing and we are out of plastic bags; bodies are still on the streets." Belgium MDs have been on site for several days. Matthew 25 notes there have been few Americans. They have been begging for supplies. Read more to see the full e-mail chain:

Text Message From Tom - 4 AM, Saturday Morning

The crew all snug in their snuggies.

We have always known we would have our own jet and snuggies someday. Many private jets loading here - our plane has flown to Port au Prince twice today. Pilot says it is ok. Airport tower operations are up and running. One of the ground crew went to KMart and got us all backpacks filled with snuggies and other goodies. On approach to Santo Domingo, where we will spend night in usual hotel then head to the border in the morning.

Message from Carol: 11:21 PM, Friday night

We're on the ground in Santa domingo 12 docs and nurses. Reports from the clinic are grim . People dieing waiting in line. No food or medicine or doctors. Our Haitian Dr Marc overwhelmed and wondering where we are. Some one on the airport wanting to set up a food bank but can't get approvals to cross the border. Our clinic is on the Dominican Republic side. People networking on the airport like crazy. Naive goodwillers expecting to walk across the border onto downtown PAP. Tomorrow will come fast. Continuing to show Nadia's picture to all.

Final Photos from Miami Plane departed at 5:30

Final photo inside the plane prior to departure & the search begins for Nadia