Notes on Haiti – Chris Van Gorder Journal, Scripps Health President and CEO

Sunday, January 31, 2010

This was a very busy day and the first day when our full team was able to operate together. We were up for breakfast at 6 a.m. and then off to the hospital. All of the churches in Port-au-Prince have been damaged or destroyed , so Sunday church services were held outside – and we saw several services taking place with large crowds during the morning.

As I have mentioned in previous reports, Saint Francois de Sales is in one of the areas that sustain ed significant damage from the earthquake. In fact, the hospital is only one mile from the epicenter. I was able to tour the areas adjacent to the hospital this morning and it is just too difficult to describe the damage . I suspect, however, that our patients could describe the earthquake – but in personal terms. A few minutes ago , I went on patient rounds with Dr. Eastman, Kelly Hardiman, and Deb McQuillen. We first stopped to see an 18 - year - old girl who had surgery yesterday on a crush injury to her leg. Normally, we keep the conversation to the medical issues , but now we are starting to ask questions about what happened. In the case of this 18 - year - old, she was crushed in her home where her father, mother, sister and brother were killed. She did have extended family with her , but her immediate family is gone.

The next patient we saw was a 56 - year - old man operated on yesterday by Dr. Drew Peterson. The patient had sustained a fractured femur when a staircase fell on him – his nephew was killed. Then we visited with a 58 - year - old man who , after the earthquake, is now a paraplegic. We are finding that many of the paraplegic patients are developing skin ulcers – and the special beds and tools we normally would use are just not available.

Earlier today, Dr. Eastman changed the bandages on a 100 - year - old woman suffering from an ankle injury . S he was in significant pain and being treated with the utmost care and compassion – even though many of the tools we would normally use in a hospital are not available here.

This morning, I traveled to the northeast part of Port-au-Prince with one of our b oarding school helpers – Patrick Monyinhan – to a region called Santos. It's pretty easy to know where you are because each street i s named “ Santos ” followed by a number, so we get “ Santos 1, Santos 2, etc. ”

The reason I traveled to the area was to visit a compound run by “ Father Joe ” (a different Father Joe than in San Diego ). He runs a large compound for seminarians that includes a large soccer field, large - scale kitchen, medical facility, etc. The thought was that , eventually, Hospital Saint Francois de Sales will have to be either closed or scaled back significantly , and the patients from not only “ our ” hospital but others will need a wound care facility. Father Joe's compound had been identified as a possible location , so I was asked to visit with one of our hosts to talk to the physician in charge – a doctor from Memphis. H e appeared to be interested in making his facility available for that purpose , so w e exchanged contact information and I will follow-up with him later.

I then visited Patrick's boarding school. Most of the children are not there right now as the government of Haiti has a 30-day moratorium on attending school due to the earthquake , but many of the children were at the school anyway. This was an opportunity to see many Haitians returning to some normalcy – something that ’ s difficult to see at the hospital.

Last night at dinner, a group of Catholic Bishops joined us – visiting from the Dominican Republic . T hey came by the hospital today to tour with the Nuncio , as well. During the dinner discussion last night (as I mentioned earlier), I found out that much of the Catholic Church in Haiti's infrastructure was destroyed in the earthquake , making the Nuncio ’ s job very difficult right now – yet he has been the perfect, gracious host. We were told that the Archbishop to Haiti was killed along with all of his senior staff and clergy. All of the churches in Port-au-Prince were damaged or destroyed and there are concerns about the loss of priceless historical documents and archaeological artifacts held by the church – more than 300 years of church history dating back to Christopher Columbus. The history of Haiti and the Catholic Church are very much synonymous.

Well, we have 67 inpatients at our hospital right now and we have become organized with supplies and an operating room schedule . T ents and beds are now labeled for patient tracking and , as of today, all patients are identified by a wrist band and number. Regular patient rounds are being conducted by multi-disciplinary teams – and we are making the difference we had hoped to make.

The work is very tiring in hot (9O degree) heat with increasing humidity. We try to keep cool with fans , but that seems to be a losing battle. We all look forward to the evening when the weather starts to cool.

I'm pleased to see that the University of Maryland ’ s “ Shock and Trauma ” team members are rounding and operating with our team – i t makes for better care. It ’ s easy to spot the University of Maryland staff , as they all wear “ pink ” scrubs.

Dr. M ike Capozza provided the anesthesia for Haitian doctors today on at least two cases , and both the Haitian physicians and Dr. Capozza were pleased with the outcomes.

Thanks again for all the notes. Some of you have asked what you can send the Haitians to help – shoes, blankets, clothes, etc. The truth of the matter is that those types of things are still too hard to distribute. If you want to provide that type of assistance, it ’ s b est to donate to one of the non-governmental organizations that are established here in Haiti. One NGO which has been a big help to us (they are currently putting up screens to keep the flies and mosquitoes out of the operating rooms) is Catholic Relief Services. Their cars and people are all over the island.

Also, if you want to directly help support Scripps ’ mission in Haiti and the Hospital Saint Francois de Sales , a Scripps Health Foundation fund has been established for this purpose. If you work at Scripps, y ou can find a donation form on the ScrippsNet “ Haiti ” page: http://scrippsnet/haiti.htm.

Talk to you soon.

Chris

Saturday, January 30, 2010

This morning, Dr. Brent Eastman’s team of six physicians and nurses went to the Hospital Saint Francois de Sale and met their five counterparts from the University of Maryland. The physician leaders met and worked out a coordinated plan for the day. The University of Maryland has been involved in Haiti for years, mostly working with HIV/AIDS patients. Several members of their team went into the tent camps during the day and identified several patients with fractures and other injuries caused by the earthquake who had not yet received treatment. Our team also made rounds within the hospital, so we already have 15 cases scheduled for tomorrow – and that’s before the walk-ins who are sure to fill the triage area.

I’m told we had a couple of issues during the day. First, the Haitian nurses were feeling left out of this recovery effort. They always seemed to be standing back and appeared to not to want to get too involved with us and the surgical cases we had been assigned or identified. Apparently, though, that was a false assumption. So this afternoon, Dr. Eastman met with them and, through an interpreter, worked the situation out – diplomat that he is. From now on, the Haitian nurses will be an active part of the care teams – a cultural learning for all of us.

The second issue related to my team coming into Haiti. We had a schedule glitch and arrived one hour sooner than expected – so no pick-up of supplies, nor did we have a ride to the hospital. Fortunately, we were able to connect by e-mail and a small pick-up truck was dispatched to get us. The Air Force and TSA staff running the airport were very cooperative and told us our driver would be given access to the airport tarmac when he arrived. The airport was very busy today – much busier than when we arrived last week. Then again, when Brent and I arrived last time, it was 2:30 a.m.

Anyway, the pick-up finally arrived and that’s when we ran into another problem. The truck was not big enough to take five adults with bags and the 14 boxes and bags of supplies we had brought along. So we decided to temporarily split the team. Deb McQuillen and I went with our driver to deliver the supplies - first to the hospital and then up to the Nuncio’s compound where we could later sort, organize and prepare to work full time on patients. Meanwhile, Kelly Hardiman and Rob Sills were good sports and stayed at the airport with our precious supplies for several hours before we could get back to them.

Rob will have a new job tomorrow. We only have one sterilizer at the hospital, so instruments have been getting cleaned and sterilized at too slow a pace. So tomorrow, Rob will take that on – most likely supported by me.

The environment is changing here in Port-au-Prince – major changes in just the few days we were gone. Traffic is picking up; I saw the first heavy equipment removing debris from streets and some badly damaged areas. Law enforcement, U.N. and military presence has picked up significantly. While we were at the airport, a United Airlines passenger jet came in and picked up many people who had been waiting for transportation off the island. That appeared to startle some people. Kelly and I were approached by one Haitian man who asked us in a very agitated way “why are all the American citizens leaving – is there something your not telling us? Why are you all trying to get out of here?” Kelly just spoke briefly to him and he calmed down and walked away.

Our guide today pointed out at least a half-dozen schools that were totally destroyed by the earthquake. It still is not clear to us why so many schools here on Haiti collapsed. Our driver pointed out one school where he said 500 school children were killed. He said none survived.

Tonight, our complete team had dinner together for the first time. We had dinner with the Nuncio at 7:30 p.m.. Tomorrow, I’m told there will be a BBQ for us – but we will be paying for it (and I’m happy about that). And we have identified an American man who will provide transportation for our team during the week. He has lived on Haiti for 22 years and runs a few schools. Fortunately, none of his schools were badly damaged. One of his schools is a boarding school and several of the older students will be working as interpreters for our team.

In discussion before dinner, Dr. Eastman told the group about a woman with some bad wound infections on her legs. When Brent asked her how she was feeling, she explained she had no pain from the wounds, but that she was scared. Brent asked her what she was scared about. “I’m scared about what’s going to happen to me," she said. This woman, very bright and in her mid-20s, has lost everything. She no longer has a home to go back to, even if she does get physically better. One does start to wonder what will happen to all of these patients after we leave.

So, we have arrived. One half of the team did several surgical cases today – mostly dealing with old wounds and secondary issues from initial traumas. Tomorrow, our full team will go to work at 6 a.m. and we will try to bring our World of Healing to a few patients who truly need our care and compassion.

Thanks again to each of you at home for your support. I’ll talk to you again tomorrow.

Chris

Friday, January 29, 2010 [End of Day]

Hello to everyone back home. My team left San Diego this morning (Friday) in a bit of a whirlwind. We gathered supplies to take with us this time so we will be able to take better care of our patients and make them more comfortable - antibiotics, pain and anesthesia medications, along with some surgical supplies and surgical tools. Also needed in these circumstances, we took communication devices, personal items, food and water purification systems and personal medications prescribed for each member to protect against typhoid, hepatitis, gastrointestinal illnesses and malaria. We also brought gloves, masks and other gear.

We had at least four television stations covering our departure this morning from Campus Point, with several requests for live and taped interviews. It was interesting to watch the reaction of several of these hardened news reporters as I told them of our recent Haiti experience. The more stories I told, the longer the interviews. After each interview, the reporter and camera operator offered their sincere well wishes for a successful mission. All the stations remained until we pulled out of the parking lot in two large vehicles - each filled with medical personnel and supplies destined for Haiti.

So, imagine showing up at the airport ticket counter with several crates, boxes and bags to be shipped with us, along with all of our personal gear, and with medications and liquids not permitted through airport screening. Fortunately, we were supported by several members of the pharmacy, supply chain and SHAS teams, who helped us with the boxes and assisted with the medications.

When staff at the ticket counter heard about our mission, the Continental Airlines staff did what they could to help. They tried to help us upgrade some tickets (in return for a couple of muffins we had brought), and also helped with the large number of boxes. We had already prioritized our supplies and left much at home because of limited cargo space on the aircraft that will bring us into Haiti. But now we needed to break the boxes down again so no individual box or bag weighed more than 50 pounds. That work fell to Rob Sills - our logistics and communications team member. He broke everything up into 14 different bag or box groupings. Of course, these days, we have to pay for baggage, right? Well the answer was yes and no. The computer said we had to pay $1300 for the bags, and there was no way the ticket counter staff or supervisor could change that - but we were given military discounts and told that Continental would write-off the cost for this mission - upon request. So, I have something to do when I get home.

Now for the medications - DEA to the rescue, yes, the DEA. Earlier, our pharmacy team had made contact with the DEA, which had an agent meet us at the ticket counter. They supplied us with a letter authorizing us to transport the medications on an aircraft and out of the country. We had some challenges obtaining the letter, but everything worked out and TSA walked us through the screening process.

So we flew to Houston and then to Fort Lauderdale, arriving around 10 p.m. EST. We will be spending one night in a hotel and then off to the airport for our trip to Haiti.

Our first team, led by Dr. Brent Eastman, had some challenges, as well. Getting to the East Coast on Thursday was difficult due to weather, but they eventually made it and also made it to Haiti today. We are in regular contact and will meet up with them tomorrow - most likely taking our supplies and team directly to the hospital from the airport. There are people who need us and there is no time to delay.

You might also like to know that we are supported by a large and well-trained team at home. First of all - each of you who remain to carry on our core mission. But we also have a team of administrators, supply/logistics and communications experts who maintain a command post and process to make sure we are always safe and in contact with home. We have at least three satellite phones, and no team on the ground will ever be without communications capability. We also have people and systems set up to watch out for team member safety and security. That was part of the reason Dr. Eastman and I made the advance trip to Haiti last week.

Thanks also go to the many people who helped us leave on time today and yesterday, and with the right gear. Members of the Office of the President, Pharmacy, Supply Chain, Information Services, Project Management Office, Disaster Management and others. Thanks also to the family members of the deployed teams for without their support, we would not have a team deployed.

And finally, thanks to all of you who have volunteered to serve or have written letters of support. I do share your letters with the team and I promise to respond to all of you - but probably not until I return home, as we will be pretty busy. I wish we could take every volunteer, but this is a mission that requires specific expertise - and it is a limited mission in terms of size - mostly because of air transportation into Haiti. But this could go on for a while and I suspect we will be needing many of you in the future.

So, next message - from Haiti.

Chris

Monday, January 25, 2010

This morning (Monday) we started our day early with a trip to the Mission Baptiste Hospital, which is up in the mountain above Port-au-Prince. On the way to the hospital in the Papal Nuncio's diplomatic car, the police officer driver asked us to stop to see his cousin, who had injured her foot in the earthquake. Dr. Edward Gamboa made a quick check, cleaned the wound, and sent her on her way.

Our driver was a very interesting man. As we were driving, he told us he was a policeman during the week and, on the weekends he played and sang in a piano bar. He actually studied music for three years in Germany. When he was told I was a former police officer, he jumped in his seat, and yelled, "Sallud, you're fine now, I like you,"  and we continued to the hospital.

The Haitian mountain above Port-au-Prince was beautiful, with small farms across the valley. Along the entire length of road we saw more people just walking up or down the road, or selling food or other mostly used products, anything to make a living or survive.

We finally arrived at the Baptiste Hospital. It had approximately 80–100 patients, and the hospital was in much better shape than the hospital we had been working in. All patients were indoors. Surgery was conducted in two operating rooms with full general anesthesia, and there were many volunteers: chaplains, physicians, and nurses from the Billy Graham organization. We were given a tour, and we discussed patient cases with the medical staff, but it was clear that they did not require any additional support.

So we drove back to the Papal Nuncio's compound to pick up supplies that Dr. Gamboa had arranged to have delivered, and we loaded up to return to Hospital Saint Francis de Sales in the most heavily damaged part of the city.

On arrival at the hospital, we found it much busier than on Sunday. The outside triage area was full, and it appeared as if there were even more patients than the day before.

Dr. Eastman was pulled immediately to triage/pre-op to check three patients: a boy who had a crush injury to his foot, a woman who had an old injury to both of her lower legs, and another woman with a leg injury. This last woman had been eight months pregnant, but she lost the baby when she was trapped for eight hours under the rubble of her house.

We also learned that the young boy we had cared for yesterday had lost the battle to save his foot and it had ultimately been amputated. But he was going to survive.

So we started our work. Dr. Eastman began with the boy with the foot injury. His wounds were surgically cleaned and two toes removed that were not salvageable. I was able to assist on these cases. We were also fortunate to meet a surgical tech who had just arrived from Boston. She agreed to work with us, and, frankly, that was a big relief for me. But I did get to be the "circulating nurse" (in name only), pulling supplies and assisting wherever I could.

Our next case was the woman who had sustained injuries to both legs. Dr. Eastman opened and cleaned both wounds and we packed them with material that will aid in healing over time.

The Belgian physicians and most of the German physicians were leaving. What we did not know is that they were taking their anesthesiologist with them, along with all of their surgical instruments. After some negotiations, we convinced them to leave their instruments. Dr. Eastman also went into one area of the hospital not being used anymore due to earthquake damage and found more surgical instruments. So we were still in business.

We also had a patient with Tetanus (rarely seen in the United States). Unfortunately, this boy will probably not survive.

At the end of a busy day, we met with the Papal Nuncio who had come to pick us up, as well as the leadership of the hospital. They met and then approached me to ask if we could come back, with a few more Scripps doctors and staff. Apparently they liked our style, quality, and work ethic, and, despite the fact that some other physicians are coming to work at the hospital on Wednesday, they also wanted a Scripps team to return as soon as possible. They told me it was their hospital and they could invite who they wanted to help, and when they wanted the help. (This reminded us of Houston after Hurricane Katrina. At that time, Mayor Bill White invited us back after Hurricane Rita.) The Papal Nuncio also said he would help our team with lodging and transportation when we are there, all within their capabilities, of course.

After our shift today, we returned to the Papal Nuncio's home and had dinner with the Nuncio and Father Rick, a priest with a DO degree who operates an orphanage and a children's hospital.

During dinner, he told us what it was like in the days right after the earthquake. He said there were so many dead outside the National Hospital that the line of dead was more than a half mile long. He said people would bring their family members who had died to the National Hospital, but the hospital would not take the responsibility to bury them. So, in this case, several front-end loaders picked them up and put them into trucks for mass burials. He told us that he and several volunteers came to pray for the souls of the departed when they were being removed in the trucks.

During the dinner, Father Rick told us how difficult it was to operate a hospital and orphanage in Haiti. He said that to operate in Haiti, you had to be able to provide your own power, water, and electricity. He also said you needed to make sure your medications were pure and from a reputable dealer. He told us some horror stories and said you even had to be careful with labs because some used poor equipment, etc. Father Rick told us that they would sometimes send lab work to two outside labs, only to receive "wildly different results" due to bad equipment and expired reagents used in the testing.

So, in summary, in just a couple of days, Dr. Eastman and I came to Haiti on an information gathering mission and found ourselves caring for patients for two days in addition to our information gathering. And based on the request to come back to help the Haitians recover, we might be back relatively soon.

As to my story of the day, well, I found out that the number of dead under the collapsed part of the hospital is much larger than previously thought. It is now estimated to be somewhere between 50 and 200 — 25 babies and more children, parents, and staff members — very sad and a constant reminder of the tragedy. In addition, we found flies, lots of flies. I found it interesting to care for patients while flies were constantly in your operating room and all around. I wondered many times today that if we were in California, would the State DHS licensing people let us continue taking care of patients? But this was not California, and these patients needed our help, even if there were flies all around. We did what we had to do, and what we could do.

So we will soon end a short stay in Haiti, but it appears as if we will be back with other Scripps doctors, nurses, and support people, because they want us, and they need us.

See you soon.

Chris & Brent

Sunday, January 24, 2010

On Saturday, Dr. Brent Eastman and I spent the day in Atlanta with the CEO of MedAssets. During the day, we made contact with many physicians in Haiti or physicians who had already been there to plan our mission. We made several contacts in dozens of emails and calls during the day. We finally made arrangements with Dr. Edward Gamboa — a former trauma surgeon at Scripps La Jolla — to initially see and possibly work at Hospital Saint Francois de Sales in Port-au-Prince.

Our private aircraft, owned by MedAssets CEO John Bardis, left Atlanta at 10 p.m. Saturday night with an initial destination of Fort Lauderdale, where we picked up six physicians and the CEO of Virginia’s Inova Health System. Mr. Bardis has donated his private jet to shuttle physicians and healthcare personnel back and forth to Haiti for the past several weeks.

The CEO of Inova is Mr. Knox Singleton, and his small health system has been supporting a medical mission in Haiti for some time. We arrived in Florida at midnight and met our partners in this mission and took off again at 1:30 a.m. so that we could get to Haiti and land in our scheduled time slot at 3 a.m.

9:13 p.m.

Not sure how to even describe today, but I will never forget it either.

Dr. Brent Eastman — our chief medical officer — and I are being hosted by the Vatican Nuncio, the official representative of the pope to Haiti, so we woke up today in a beautiful facility that overlooks much of Port-au-Prince. As we looked out over the city this morning, we could see a few areas that were badly impacted by the earthquake, but, frankly, the view from a distance was actually very pretty. We did see military helicopters flying and large military aircraft from many countries flying in and out of the airport in the distance, so there was a constant reminder of the disaster that hit this country more than a week ago, with many after-shakes since that time.

Dr. Edward Gamboa (former Scripps La Jolla trauma surgeon) helped us make arrangements with the Papal Nuncio for lodging and transportation in Port-au-Prince while we are here.

As we started our day, we observed Sunday Mass being conducted by the Archbishop — our host. The songs from the parishioners were beautiful as they met on the lawn overlooking the city. Even though the sound was beautiful, we had been told that many on the staff and many attending the mass had lost family members to the earthquake. You would not know it from the sound of joyful song. But maybe that is because Haitians have a difficult life. We have been told there are up to 40 percent of Haitians with HIV/AIDs, that up to 52 percent had never attended school, and the average annual salary is about $1,300 in a country where gasoline is $5 a gallon and food is more expensive than in California. Unemployment is 70 percent, and the average life expectancy for a woman is about 57 and a man about 52. Tough lives.

Anyway, we headed down to the main city in daylight. We arrived in Haiti at about 3 a.m., so we saw little of the city and the damage when we arrived.

The early part of our drive was easy and little damage was seen, but as we entered the flat areas we saw damage that exceeded our expectations. Nothing seen on CNN or Fox News prepares one for the scene of building after building destroyed, or the smell of death still very much in the air. We came upon camp after camp of tent cities, every park and open area was filled with tents, and thousands upon thousands of people were walking the streets or standing on the corners. Yes, everyday life was returning but in a country virtually destroyed by a major earthquake.

After about a half-hour drive, we arrived at the hospital where we were to work today, the Hospital Saint Francois Sales. This hospital was one of the original hospitals in Haiti, built in the 1880s, and not upgraded much since.

Large steel gates were opened after our driver honked. I looked around the neighborhood, which was teaming with people, and almost every building had collapsed or sustained major damage. We entered the hospital, and I was immediately struck by the sight: all patients outside, either in the open on mattresses thrown on the ground or in tents and make-shift tents.

Privacy? No way. I saw patients literally side-by side in beds, cots, gurneys, and chairs. I saw an examination of a woman in the open without any clothes or sheet cover, and men and women, boys and girls were all together. Most, if not all, of the injuries were trauma- and crush-related, and many amputations.

We were met by German and Belgian physicians who had been volunteering at the hospital for several days. Most were leaving in the next few days. The lead Belgian physician (an ED physician) was very direct, but we warmed to him immediately, and I think he did to us. He took us on a quick tour. Triage was outside under a canopy — no gurneys, only chairs. The hospital surrounded a courtyard where all patients were in tents or the open — some being attended to by staff or volunteers but most by family members. Half of the hospital had collapsed. As our guide took us into the building next to the collapsed section, the smell of death was overwhelming. Even Dr. Eastman and I were impacted. Source of the smell: 50 children and adults were under the collapse. Nobody was even thinking, at this point, in trying to recover the bodies. We were told we could operate in the building adjacent to the collapse “if” we could handle the odor. I don’t think so.

The tour continued and we went to the pharmacy — now under a collapsed building. Our guide said he could get to the pharmacy by crawling into the building, so he did and I followed. But when we got to the pharmacy, he found the gate locked. He was surprised, but we just climbed back out again. Not much of a search and rescue moment.

The radiology viewing room was outside against a wall, and the one X-ray machine was shut down when the tech said it got too hot. He just left and went home.

Then we were taken to see the patients. Our Belgian physician guide introduced us to some German physicians and we discussed a patient in his late 20s who had received crush injuries to his arm and leg. Dr. Eastman diagnosed a “compartment syndrome,” so our guide said: “Well, take him to surgery,” and we did.

The operating rooms were in a dirty and damaged building, but it appeared safe. There were four areas where surgeries were taking place and three were busy, so we got the large room. Dr. Eastman “scrubbed” at an outside water faucet used normally for attaching a lawn hose. We put on what surgical gear was available and did the case. While there was an anesthesia machine in the room, it did not work. We only had a pulse oximeter, no blood pressure. No oxygen, as there was only one O2 tank in the entire hospital. No surgical cautery, only medium-sized gloves, only the Kerlex and 4X4s we brought with us — and Dr. Gamboa brought his own surgical instruments.

While we had a small surgical light, it was insufficient, so I pulled out my search-and-rescue headlamp and put it on Dr. Eastman’s head, which did the trick.

To make a long story short, I think Dr. Eastman saved that man’s arm and leg today. Given the number of amputations at the hospital, they could have used a Dr. Brent Eastman a lot earlier.

Several more cases were done during the day as well as post-op care, and, at the end of the day, our Belgian guide asked Dr. Eastman to check on a small boy with a crushed foot. Brent operated. He removed much of the dead tissue, amputated a toe, but did the best he could to try to save this boy’s life and foot. And all the while — 30 yards away — 50 dead children and the constant smell of death.

At the end of a long day, we met with the hospital’s director and discussed future days and their needs. On the way home we saw even more destruction: the cathedral, gone; the Ministry of Health, gone; the Haitian Palace, gone; and mile after mile of rubble, collapsed buildings, dust, and people, people everywhere.

We saw a water/food distribution center where the line of people was hundreds of yards long, and every person was chest-to-back, no space between anyone in line. That struck me. We drove by the airport and saw many large cargo planes taking off and landing — a huge United Nations presence — traffic jams like I have never seen before, and driving that would make a New York cabbie scared to death.

This country has been virtually destroyed and, yet, there are people everywhere and most are acting as if this was just another day. I have never smelled such smells or observed such devastation close up. Yet people acted like it was just another day in Haiti.

Two final stories today: We took our driver’s son to get an X-ray today as a ceiling had fallen on him during the quake and he had been having trouble walking ever since. A friend had given me a small Teddy Bear to pack, to give to an injured child. So I gave the bear to him. The bear was holding a heart that said, “Hug me.” This little four-year-old clutched the bear and looked at me and smiled — the first smile I had seen from him. He simply said “merci” as his dad held him as any worried dad would. Given the way he clutched the toy, I suspect that Teddy Bear will be his friend until he is an adult many years from now.

And one more: When I was working at the hospital today, a little girl grabbed my arm and pulled me into a tent to see her injured sister. I could not understand her and she could not understand me, but I could tell that she wanted me to talk to her sister — or do something for her — so I talked. As I did, I could see her sister relax and, eventually, close her eyes and go to sleep. The girl who had pulled me into the tent just looked at me eye-to-eye and smiled. We did understand each other after all.

Scripps made a difference to a few people in a small foreign country today, and I feel very good about that. Before we left San Diego, we placed an American flag on our Scripps Disaster Team “badges.” Many people saw that today, Scripps and the American flag.

Until tomorrow.

Chris Van Gorder