Off to Haiti

11 May, 2010

Tomorrow, Wed 12th May, 2010, I'm off to Haiti. I'll be volun- teering with Medical Teams International. I'll arrive exactly four months after the magnitude 7.3 earthquake of 12 January, 2010. It is estimated that a staggering 220,000 people were killed and over 300,000 injured.

I'm not sure what to expect--we're told that we may be sleeping in tents in a muddy field (it's the rainy season), or in a guest house with running water. We may be based in Port-au-Prince or in Léogâne, or possibly in Les Cayes, way out on the southern "claw" of which Port-au-Prince is at the base. We'll either have Internet access or we won't. (If the later, I guess this will be my only blog entry). Medical Teams says wisely that flexibility is key. I guess I'll start my stretching exercises on the red eye to Miami.

What I do know is that it will be hot--between 95 and 100 degrees during the day. And wet--the rainy season is in full swing, with thunderstorms daily. We'll be seeing lots of people still living in muddy fields after being displaced by the incredible destruction of the earthquake. And we'll have only very basic medicines and equipment. Much as I'd love to, I have no illusions about being able to make a large and lasting difference in the lives of these people. But I hope to help alleviate some pain and suffering, at least in the short term. And to give what comfort I can. That may be the most important thing I'll be able to do.

We Fly Into Port-au-Prince

12 May, 2010

The flight into Port-au-Prince told the story of Haiti: The land was almost uniformly brown and dry-looking. Then my seatmate pointed toward the horizon: "Look over there; that's the DR." The Dominican Republic, below the puffy clouds, was lush and deep green. The contrast was stunning. While The DR was verdant, Haiti had been clear cut.

As we soared above the big bay that divides the two clutching arms of Haiti we could see lots of buildings in Port-au-Prince, the capitol. At first it looked like a normal developing world city, with dense low structures, mostly the color of unpainted concrete, dusty roads, and a few green patches. But as we continued our descent there was a sudden shock--in scrubby fields flanking the runway were big splashes of bright blue, glinting in the sun: tarps of the enormous tent cities. The tarps were stitched together in tight squares and triangles, like crazy facets of a giant gemstone. It was hard to imagine that thousands of people were were living beneath them.

First Impressions on the Ground

13 May, 2010

The epicenter of the earthquake was in Léogâne, about 18 miles west of Port-au-Prince. Eighty percent of the buildings were totally destroyed, and virtually all of the ones left standing suffered at least some damage. Léogâne is where we were to spend most of our time in Haiti. Though only a short distance, the trip from Port-au-Prince takes from 1 1/2 to 3 hours, depending on traffic and road conditions.

The drive to Léogâne made clear that four months after the earthquake there’s still a post-apocalyptic feel to vast swaths of the country. There has been almost no serious reconstruction. Most buildings lie as they did minutes after the tremors subsided, with cement roofs, like soggy rugs, thickly draped over the underlying rubble. Many cinder block walls came down. They have been “repaired” simply by stacking salvaged blocks atop the remains of the wall. The slightest aftershock will shrug them off.

Where clearing has been done, the debris isn’t taken away but simply transferred to a big pile on the sidewalk, often with a gravelly gray-white tongue lapping out into the street. In fact, in some places huge rubble piles take up an entire lane, forcing vehicles going in opposite directions to take turns. The congested streets are also where most commerce now goes on. People have set up rickety wood tables, or simply tarps on the road, to display a few mangos or bottles of rum or dishwashing liquid for sale. Sometimes they've created an island by placing a ring of concrete chunks around them so that cars and trucks have to swerve rather than run over their merchandise (which they certainly would do).

People, looking dazed and weary, stand atop the ruins that were once their houses, They listlessly dig through the destruction, looking to salvage a few intact building materials or find something of value under the broken cement. Meanwhile, a man with a missing leg, supported by dusty crutches, stands in the very middle of a busy street with his hand out; cars swing wildly around him, but no one stops to give him money. Teenagers walk by the side of the road carrying pitiful tangles of salvaged rebar.

Tent cities are everywhere. Some are orderly rows of sturdy camping tents. More are rickety frames of wood swathed with plastic tarps—the predominant colors are gray, printed with “USAID," or bright blue, saying “Samaritan’s Purse.” Most pitiful are fragile structures of tree branches covered with plastic sheeting and frayed cloth. Sometimes the tents completely fill the tiny raised median that divides the larger roads (see photo). If a child rolled under the edge of the tent in her sleep she’d be lying in traffic.

We Settle in to Our Base in Léogâne

14 May, 2010

Destruction is everywhere. In fact, seeing an intact building is such a novelty that you really notice it, just as I myself am noticed as a rare white person. Very little rubble has been cleared. Thus much of the landscape is frozen in time, exactly as it was on January 12th in the first few minutes after the shaking subsided. Except that the dust has mostly settled. But even the dust gets stirred up when the wind blows or when traffic goes by on the crowded streets. The night we arrived, our headlights picked out a man walking towards us on the side of the road. Despite the heat he was wearing a suit coat, white shirt and tie. In his hand he held an old misshapen leather briefcase. He was framed by swirling clouds of dust; when a big truck passed he was lost from sight, as if in a snowstorm.

Tent cities are omnipresent. Because the seasonal rains have just begun the collections of tents seem like huge and somewhat sinister flowers. Or mushrooms. Some encampments are orderly, with reasonably-spaced sturdy camping tents. But most are haphazardly arranged combinations of scraps of tarps and palm fronds and cloth cobbled together over branches and old lumber.

One of the biggest hospitals in the city of Léogâne, where we’re working, is (or, perhaps more appropriately, was) Hopital St Croix. It was partially destroyed in the earthquake. Parts of the structure left standing are severely cracked. The laboratory was destroyed, so the salvageable lab equipment was moved into the chapel. The pews had been piled up by the raised platform in the front. So the dirt and gravel floor was freed up to accommodate old wooden tables on which microscopes, centrifuges, and primitive analytical equipment sit. The doors gape open—they can’t be closed because the metal door frames were twisted by the tremors. As the lab techs do their analyses chickens wander in and out and peck amid the debris.

> A fancy European car, which somehow escaped damage, sits nearby a raggedy tent. A series of torn tarps extends from the tent to the car roof, combining them into a single structure. The owners of the car had obviously come way down in the world after the earthquake.

> Occasionally a person could be seen on top of the pile of rubble that was once his home. He slowly fills a small bucket with chunks of concrete and carry it out to the street, where he dumps it. Some streets are almost impassable because of the accumulating debris.

> In some clearings and empty lots are big tangles of rusty rebar, like giant lurching spiders. Clinging to the legs, like poorly strung gray pearls, are clumps of concrete, testifying that the rebar wasn’t nearly strong enough to withstand the awful force of the earthquake.

> We pass a large cemetery. Most of the gravestones have toppled over and the mausoleums are severely damaged, some flattened, others leaning at crazy angles. A second indignity to the already-dead.

> In a bitter irony, in one village we drove through virtually the only building left standing was a funeral home and morgue.

> I saw an 11-year old girl at our first mobile clinics who had a stomach ache. For how long, I asked. I correctly anticipated her answer. "Since the earthquake." Did you lose anyone you knew? She was very quiet. "I lost my best friend." Repeat this story, with variations, about 8 million times and you have the story of Haiti after January 12, 2010. Healing will not come from medicines, and will take a very, very long time.

First Mobile Clinics

15 May, 2010

The old one-two punch of the tropics, heat and humidity, is inescapable. Most days it’s between 95 and 100; even at night it cools down only a few degrees. I take a shower before I go to bed so I can get under the mosquito netting feeling slightly clean, but by morning I’m drenched in sweat.

Today we did our first two mobile clinics, both of them at orphanages. “New Voice House of Life” got its name through a clerical error. The director, Gesner Nozil, told me that when he received the papers after registering his orphanage he noticed that the name on the certificate wasn’t the one he’d filed. So he went back to the government office to request a correction. “That’s impossible,” the official said, “the correct name is the name that has been officially registered. Your orphanage is called ‘New Voice House of Life.’” This was my first taste of Haitian government bureaucracy—it is no surprise that the government has been so ineffectual in coordinating recovery efforts after the earthquake.

Mr Nozil told me that his children were outside playing when the earthquake struck. Miraculously, all 37 survived. But the orphanage was totally destroyed. The children slept in a garden under the stars for two days, then an aid agency appeared with tents, and they moved to the current location, in a field. Aid workers dug shallow pits for a three-seater toilet. When we arrived for the clinic the pits were almost full; new ones were being slowly dug.

To provide a little shade, we strung a USAID tarp between the big tent where the children slept and our Land Cruiser. Crude tables and chairs were set up as examining stations—each table had three chairs, one for the treater, one for the patient, and one for the translator. The children quietly lined up to be seen. There were lots of skin infections, diarrhea, coughs and headaches. And stomach aches. At the second orphanage I saw a seven-year old girl who had been trapped under earthquake rubble for four days. She’d had a stomach ache ever since.

After the clinic the children sang songs for us and one of our team members handed out little presents from his daughters, which were gratefully received. Then the children had lunch--small bowls of corn meal which had been cooked in boiling water. The big sack which held the corn meal said, "Donated by the American people."

After dinner at the guest house where our team was staying I took a walk with a team member and Lissa, a Haitian nurse who was working with us. Right across the little dirt road a telephone pole leaned against an iron fence it had partially knocked down. Behind the fence black goats were frisking in the rubble of what on January 11th had been a very substantial house. We strolled in the pink twilight past ruin after ruin, our shoes kicking up earthquake dust. Most of the houses had been flattened so that the concrete roof was draped over the first floor, which in turn was humped up over a central mound of rubble. Occasionally we saw clothes lying on the fallen roofs to dry.

We rounded a corner and saw a long row of destruction on either side of the road. Suddenly, totally unexpectedly, I began to cry. I hardly ever cry. I apologized to Lissa: “I’m really sorry, this isn’t my country, these aren’t my people; I have no right to cry.” Lissa smiled. “I’m glad you cried,” she said softly.

Earthquake Stories

16 May, 2010

It’s hard to think of many other disasters, natural or man-made, that can cause as much widespread and instantaneous destruction as that of an earthquake. In the decisive few seconds around the event, your precise location determines whether you live or die. A Haitian physician I met told me stories of incredibly good—and bad--timing.

His cousin was supposed to begin college courses on January 12th in an 8-story classroom building in Port-au-Prince. But much to his chagrin he missed the registration deadline by one day, so he wasn’t permitted to attend classes. This lapse saved his life: The building totally collapsed, so that all eight floors ended up smashed together in a terrible pancake stacked on the ground. Well over a hundred students were killed instantly. A single survivor was pulled from the rubble 17 days later. He had been in the men’s room on the ground floor and survived by drinking toilet water. The worst part of his ordeal, he said, was the smell of decaying flesh, which surrounded him for more than two weeks.

The sister of one of the physician’s friends needed a single credit to complete her nursing degree. She chose a course that was to meet precisely when the earthquake occurred. Even though she was sitting right next to the exit, the first shock was so strong it instantly brought down the building. Her brother found her body half in and half out the door. Our lives are infinitely more fragile than we like to think.

Later in the day Elise, a volunteer nurse, Lissa, the Haitian nurse, and I were sent to work for a week at a hospital in the tiny village of LaColline, considerably to the west of Léogâne. As we bounced along in the Land Cruiser, mile after mile of destruction reeled past. In some towns not a single building was left standing. Cracks in the road were sometimes so big that we had to drive entirely off the pavement to get around them. In several places huge pieces of the adjacent cliffs—some with trees still desperately clinging to them--had chunked off and entirely blocked our way. A few stretches of the highway had been so badly damaged that a new road had been plowed through fields, sometimes right next to indignant little wood houses that were used to being way out in the country.

In the thickening dusk, far out on the lower claw of Haiti, we turned off the main road. Quickly, darkness took over. We bumped along a rutty dirt road for miles into the jungle. Our bobbing headlights caused people to materialize out of nothing by the side of the road, then vanish. Occasionally we saw a kerosene lamp faintly lighting up a few things for sale. Finally we arrived at the hospital compound, a somewhat shabby collection of turquoise and white buildings. We set up our mosquito nets and were soon asleep.

An Uncomfortable Week in LaColline

17 May, 2010

I was awakened at 4 am by what sounded like a spliced- together sound track from every barnyard movie that had ever been made: a massed chorus of dogs, donkeys, cows, pigs, goats, and (of course) roosters was enthusiastically welcoming us to LaColline.

I zipped myself out of the mosquito netting and saw a man with a big basket of buns patiently standing at the front door. We bought some for a sunrise breakfast.

The grounds of the mission compound include not only the hospita where we were to work,l but a church, school, and a cannery. There was also a prenatal care and feeding program, where corn meal, flour, and cooking oil donated by the US government are distributed.

In the clinic area we met one of the two staff Haitian doctors. A tour of the hospital showed that not a single one of the 19 inpatient beds was occupied. The OR was stacked with boxes and supplies, and a somewhat dubious obstetrics suite was still filthy from the last delivery. In the pharmacy bottles of pills were arranged on raw wood shelves, and trash lurked in the corners. An iron-barred window to the outside was sealed with a heavy wood shutter; later we saw that the pharmacist opened it from time to time to dispense medicines.

People started slowly arriving for the outpatient clinic that Elise and I were to staff. From past experience in Uganda and Kenya, I expected a huge influx of patients. But they never materialized. Soon enough I found out why: This hospital charges fees.

A consultation with a doctor costs the equivalent of $1. Then if lab tests are ordered the patient must pay for them in advance –the rather daunting cashier, who sits in a little booth like a ticket seller in a movie theater, collects the money then stamps the lab slip. After the lab results are available, the patient sees the doctor again. If the doctor orders medications, these too must be paid for in advance. The people living in the villages near the hospital are very poor; in several cases I saw patients who had already paid for the consultation and lab tests being sent home because they had no money left to pay for their medicines. Elise and I made it a policy to give our patients medicines that we’d brought with us from Léogâne, if we had the right ones. And in several cases we paid for both lab tests and medicines, which unaccountably displeased the cashier.

That a hospital in such a poor area, particularly a mission-sponsored one, would charge patients was of course quite upsetting. I asked if there were provisions to give free care to those who simply could not pay. The answer was an evasive shrug, which I took to mean ‘no, not really.’ Why did this hospital seem so dysfunctional? Was the support of this project so limited that it wasn’t possible to make services available for free? Couldn’t a special fund be established so that the very poor could be served? Were cultural issues or unknown government regulations involved? Unfortunately there was no one who could give us answers. This was an uncomfortable week.

Later I spoke with several Haitian doctors and NGO representatives who told me a very sobering story: The presence of so many NGOs providing free care may perversely impair the health of Haitians in the long run. Many private as well as government-sponsored hospitals and clinics charge a small amount to pay staff and meet operating expenses. But when the NGOs poured into Haiti after the earthquake, poor people naturally went to them for free care rather than to the established hospitals which charge. This has resulted in the bankruptcy and closure of a number of these hospitals; such losses compound those of hospitals destroyed in the earthquake. Thus when the NGOs drift off to the next disaster, Haiti is likely to be worse off than before. Somehow, the more desperate people are the harder it seems to be able to help them.

The Rhythm of Mobile Clinics

22 May, 2010

The week in LaColline passed quickly. Though the clinic wasn’t terribly busy we saw some very sick patients and, I’d like to think, did some good. Between patients there was time for us to do a little teaching. Lissa asked me to explain antibodies. After I did she asked, “So why do we need antibiotics when we have antibodies?” A good question indeed.

On Friday we returned to Léogâne and joined the rest of the team for the daily mobile clinics. This was the routine: After breakfast we helped load up the Land Cruiser with supplies and drove out into the countryside. No matter where we were headed we soon left the paved road and bounced along rutty dirt tracks flanked by scrappy fields of sugar cane, banana and cassava. Beyond the fields, brown and green hills rose up to kiss the clouds. Periodically, the idyll was broken by reminders of why we were here: out of nowhere we’d pass a tight collection of tarp tents, ten or a hundred, jammed together in a field that should have been planted with crops. Then, in a sobering echo, we’d come to a collection of destroyed houses as if they’d been smashed by a giant fist.

One day we went to a tiny village called Duplaisir. Gilles, the driver, drove the Land Cruiser down the steep dirt road to a shallow river. But instead of fording across, he suddenly turned right—we were driving upstream! Gilles explained that as long as the previous evening’s rains hadn’t been too heavy this semi-aquatic route was the best way to get to Duplaisir. Around a bend we came to the village bath tub: people of all ages were soaping themselves in the brown water. A little further on was the Laundromat, with clothes being pounded clean on the rocks and put out to dry on fallen tree limbs. Around another bend was the local bike and motorcycle wash. Though I felt quite conspicuous in a huge vehicle lumbering up a muddy river bed, people barely looked up. And when Gilles beeped, they only grudgingly moved aside to let us pass.

When we arrived at a village we usually set up under the shade of a big mango tree. Sometimes the villagers produced fancy dining room chairs for us to sit on at our folding tables, sometimes crude handmade ones. Usually the scattered concrete houses were no longer fit to be occupied—their rubbled remains seemed to have only two uses: a place on which to drape clothes to dry, and a playground for frisking goats. As the word got around that “American doctors” were having a clinic, people streamed in. Skin infections were common. There were fevers, diarrhea, pneumonia, high blood pressure, tooth aches and worms. Lots of men had hernias and lots of women had sexually-transmitted diseases. Many complained of poor vision. And the majority also had headaches and stomach aches, very often originating just after the earthquake.

Some patients were quite spunky. I shook the hand of a seventy year-old women and asked her what her problem was. “I’m not telling you, doctor” she said with a twinkle in her eye, “it’s up to you to figure it out!” A young woman sat down in the chair next to me, crossed her arms, and announced “If you aren’t going to give me some medicine, I‘m going to leave now!”  I told another women, who had a sexually-transmitted disease, that the antibiotics I was giving her would treat her infection. But to be sure she was healed and wouldn’t pass the infection on, she must not have sex for a week. My translator, Whistler, gave her this instruction. She said something back to him and they both burst into hysterics. I asked to be let in on the joke. Whistler dried his eyes and said, “She said she was going to tell her husband that the doctor said she couldn’t have sex for a month.”

A Sobering Meeting With the WHO

25 May, 2010

Ever since I arrived in Haiti I’d wondered how the medical efforts of all the NGOs and Haitian hospitals were being coordinated. After spending the morning seeing patients at a clinic at the Ste. Croix “tent hospital” I found out.

The wall of the Ste Croix Hospital
 SOS: 180 Dead

We were invited to go to the biweekly meeting of the Léogâne area WHO “health cluster.” It was held in a big tent on the grounds of the regional UN headquarters. The big UN site was bordered by cinder block walls topped with several layers of razor wire. Very serious looking UN soldiers from Sri Lanka wearing blue helmets, combat fatigues, and machine guns stood at the entrance. We exchanged our IDs for UN badges and walked through the compound. The grounds were filled with tents of various sizes and little pre-fab offices. A row of white satellite dishes pointed up to the sky like huge, gaping mouths. We found the tent, and settled in on folding chairs arranged in a rough circle. There were 10 or 15 other people.

The head of the Léogâne Health Cluster, a Haitian physician and new WHO employee, welcomed everyone and took a quick poll which established that more people spoke English than French. So the meeting was conducted in English. He began by apologizing for the absence of the representative of the Haitian Health Ministry, who was supposed to be conducting the meeting. (The next day he told me that he’d called the man daily over the previous few days to remind him, most recently at 11 am that morning for the 3 pm meeting. When he called the representative afterwards to see why he hadn’t shown up the man said something like, “Oh, sorry, I guess I forgot.”)

We learned that about half the medical NGOs registered in Léogâne were represented at the meeting; the other half were unaccounted for. Furthermore, it was estimated that no more than half the NGOs working in the area had registered with the WHO at all--maybe they weren’t even aware of the existence of the Health Cluster. It didn’t take a rocket scientist to figure out that under these circumstances, meaningful coordination of health care resources wasn’t going to happen. The truth is, each NGO was operating semi-autonomously.

The WHO doctor summarized the current state of play: The seasonal rains were just starting, making it impossible to run mobile clinics in some remote locations. Not a single facility was providing dental care in all of Léogâne. Virtually none of the NGO field hospitals, and almost none of the few standing Haitian hospitals had working laboratories, and the very few that did were charging for their services. Many patients who had had emergency surgery for fractures following the earthquake had not achieved satisfactory bone union and would need new surgery for internal fixation. But the nearest facility able to provide this surgery was many miles away and waiting lists were very long. In fact, there was only a single X-ray machine in the entire region, operated by the Japanese Red Cross. They could only accept emergency cases.

Then each NGO gave an update on its activities. Some were focused exclusively on reproductive health and domestic violence, others on childhood nutrition, still others on lymphatic filariasis. Several doing mobile clinics had already run out of key medicines.

The WHO doctor summarized the combined epidemiology report based on information supplied by some of the NGOs. Unfortunately, he said, he had data for only five medical categories—several key diagnoses such as sexually transmitted diseases and PTSD could not be collected. Why? Because WHO was not allowed to change the collection forms without the approval of the Health Ministry. He had sent the Ministry a proposed revised epidemiology form many weeks ago but they hadn’t yet approved it. Not surprisingly, the current statistics were not particularly useful—almost 60% of the cases fell in the category, “Other.”

He also repeated a previous request that NGOs conducting mobile clinics provide the GPS coordinates of each of their sites so that a map could be constructed that would reveal both unnecessary overlap and gaps in coverage. To date almost no one had complied, and at this meeting not a single NGO could supply the requested information.

Copies of an undated and unsigned letter from the Ministry of Health were passed out which ordered all medical NGOs to register with the Ministry or leave Haiti within 30 days. Several NGOs reported trying to meet all the requirements of the letter, but said it was virtually impossible because the relevant office was often closed, and even when it was open, when they went to  register they were told to come back in a month. As I understood it, most NGOs were in fact operating without having satisfied the Health Ministry’s requirements. Nevertheless, it seemed unlikely that they would be kicked out of Haiti, if for no other reason than bureaucratic inertia. It also emerged that the government had recently imposed an import tax on many items being brought into the country by health-related NGOs, such as computers and medical equipment. The tax specifically included medicines that were to be distributed without charge.

Finally, plans were announced for a big health fair to be held on Haitian Mothers’ Day. The theme was pregnancy prevention--there would be talks on birth control, and lots of condoms would be distributed. Though the plans were presented very seriously, I chose to think that the organizers recognized the irony of holding a pregnancy prevention fair on Mothers’ Day. I had to find something to laugh about!

Last Clinics

26 May, 2010

We went on mobile clinics to pretty little villages—Mellier, Casale, Mattieu, K Simillien. As with the previous clinics, there were wounds, fevers, and lots of chronic disease. Most disturbingly, there were so many patients with symptoms dating from the earthquake. The stomach ache or palpitations or dizziness or headache was almost always associated with horrific loss—of property, family, friends. Gently I tried to help the patients establish a connection between the losses and the symptoms. I said that these were normal, didn’t mean there was necessarily anything wrong with their bodies, and encouraged them to talk about their feelings with family and trusted friends. I referred many to a new post-traumatic stress disorder clinic at the Doctors Without Borders hospital.

Haitian health care workers will need to learn a lot about how to care for these patients, and Haitians will need to learn to be mutually supportive to help deal with the incredible trauma that was collectively experienced. This isn’t a problem that will go away any time soon. Children who lived through the earthquake, many of whom lost parents and siblings, all of whom suffered psychological if not physical trauma, will be affected for the rest of their lives. Perhaps they will come to be known as “the earthquake generation.”

Back to Port-au-Prince

29 May, 2010

The drive from Léogâne took over three hours because of traffic, earthquake damage to the roads, and the rains which have begun in earnest.


Here are two photos of the presidential palace, which we passed by on the way to the guest house in Port-au-Prince. A Haitian physician friend, who now works for the WHO in Leogone, said he was in the Dominican Republic when the earthquake occurred. He got a call from the US about an hour later, and went on Facebook where he saw pictures similar to these. He said he thought the pictures had been “Photoshopped”—he didn’t believe they were real. Then he saw the same photos on CNN, and raced across the boarder to Haiti to see his family, and to help out.

As is evident, absolutely nothing has been done to clear away the rubble, much less reconstruct the palace--it stands exactly as it did on January 12th. This is a poignant metaphor for the discouraging situation in Haiti, now approaching five months after the earthquake.

Two days ago was our last mobile clinic. We drove over muddy roads (the rains have finally begun in earnest) and across swollen rivers to a tiny village near the base of a mountain. We set up in the dirt under a big mango tree, next to a sugar cane field and across from a raggedy banana grove. Little bleating goats clambered over our equipment as we unloaded it and small jet-black pigs, like self-guided torpedoes, cruised around the periphery, grubbing for food.

Part way through the clinic it began to rain hard, and everyone rushed into a tiny single-roomed building with a tin roof, rousting the alarmed goats who had taken cover there. We managed to set up our interview tables and chairs and relocate the three big rolling bags of medicines that made up our pharmacy and began treating patients again while those waiting to be seen huddled under cover of the roof. In a low-budget imitation of a three-ring circus, we listened to hearts and lungs, pulled men into a slightly secluded corner to examine hernias, dressed wounds, gave babies ORS (oral rehydration solution) and handed out pills and condoms while children cried and goats bleated in time to the rain on the roof.

The last patient I saw in the increasingly steamy little room was a 53 year-old man who complained of three years of headache and belly pain, the two most common complaints of Haitian patients. I got the details, did my examination, and began to explain to the patient (via my translator, Conception) that I didn’t think these represented anything serious, but that I’d give him some medicine that might help, as well as worm medicine which we give routinely. The opaque discussion in Creole between translator and patient took a lot longer than usual. At one point Conception’s face lit up and he said something like, “oh, aha!” More discussion, then in answer to an apparent question, he showed visible disappointment.

"OK, Conception, I said, let me in on what’s going on!"  He smiled a little self-consciously. “Well. This man told me that the cause of his stomach ache is that a woman who doesn’t like him put a charm on him three years ago.” What? “You know, a charm. What she did was take some of her poop, put it out in the sun to dry, then ground it up. Then she sprinkled some of the poop powder into his food or into something he drank, he’s not sure which. That started his stomach aches.” Really? “Of course! But it’s so sad, this man’s mother is dead.” Yes, I said, that is sad. But why did you mention it just now? “Well only a person’s mother can counteract the charm. If she were alive she would give her son some of her urine. Or wash her vagina with a little water. And give it to him to drink. That would make the charm go away.” It would? “Of course!” Is it only the mother who can supply the urine or the washings? “Of course.” Oh, I guess that’s because they are from where he came from when he was born? “Of course.” Wow. Do you really believe this stuff? “Of course.” I finished writing the prescription for antacids, with very little hope that they would make a difference.

Goodbye to Haiti...For Now

30 May, 2010


As I mentioned in an earlier post, almost all commerce occurs on the streets, sometimes right under severely damaged buildings. On one busy road I saw a big chunk of concrete hang threaten-ingly from a twisted rebar, right over crowds of passing people. This seemed to be a metaphor for the tropical sword of Damocles that has been hanging over the heads of the Haitian people ever since the earthquake. Sadly, it won't disappear any time soon.

The waiting room at the airport was a milling rainbow of T-shirted volunteers. There were the gray HODR people, the yellow Baptists, and the green “Mission Adventures 2010” folks. The back of the green shirts listed the locations of all the mission trips planned for 2010; they were an exact echo of  those rock band “World Tour” T-shirts. We talked to a few of the rainbow people: they had generally been in Haiti for a week and their experience had been ‘awesome.’ They had cleared rubble or built a church or repaired a school. Some were texting on their iPhones.


There were some free-ranging volunteers too. A well-dressed woman went around introducing her 13 year-old son as well as an apparently famous rap singer (Haitian or American, I wasn’t sure which) who I’d never heard of. She said her son’s bar mitzvah was in a few weeks and she wanted to give him a taste of "the real world" before then. She handed out little rubber “I support Haiti” bracelets and offered to take people’s pictures with the rapper. I declined.

Finally there was a boarding call for our flight. As we trundled down the aisle of our plane we passed the rapper and the mother and the bar mitzvah boy all sitting in first class.

As uncomfortable as the airport scene made me, I don’t pass judgment on any of these people who had come to help the Haitian people. Our mere two and a half week stay seemed barely long enough to allow us to learn the ropes and become at all effective; a single week seemed almost pointless. But who was I to say? Even if the bar mitzvah boy didn’t singlehandedly change Haiti, he may have himself been changed. Or he at least might raise the consciousnesses of some of his friends as he described what he saw in Haiti during his bar mitzvah speech. Maybe the gray-shirted girl texting on her iPhone was telling her boyfriend that she’d decided to get a degree in public health rather than go to business school. And surely there’s value for the Haitian people to know that people care about their plight. Haitians had written on one of the green T-shirts with a black marker: “Good Travel, Miyou,” God bless you, Yves,” and “I love you.” This connection has got to be worth something.

In Miami we cleared customs and boarded a flight to Orlando. Then there was a long layover before the next flight to Seattle so Elise and I decided to treat ourselves to lunch. At Ruby Tuesday the cheerful waiter asked, “So you folks on vacation?” No, not exactly, Elise said.



The plane from Orlando to Seattle was full. Many of the passengers, of course, had been to Disney World so the overhead racks were crammed full of Disney booty. As the plane rose into the clear blue sky a little girl a few rows behind us hugged her stuffed Simba tight and said, almost in a trance, “bye bye Mickey ...bye bye Goofy...bye bye Bambi...bye bye Ariel...”

I closed my eyes, and felt the weariness of the last few weeks settle in. As the engines roared, all I could think about were the people I’d met and the patients I’d tried to help. I took a deep breath and thought, bye bye Chanté...bye bye Lissa...bye bye Azacca...bye bye Wilkenson.”