Haiti After the Earthquake (12 page)

Haiti is probably the only country in the world where a Martin Luther King Avenue runs into a John Brown Avenue, and we soon turned right on John Brown, down the hill towards the federal buildings. For twenty years, we'd traced this route to attend meetings at the Ministry of Health; now it led through empty streets lined by a new nightmare landscape. Could that really be the National Palace? The Ministry of Finance? The Cathedral? Even in the dark, it looked as if the heart of Port-au-Prince had been carpet bombed. People were already camped out in the broad open space in front of the palace, surrounding the famous statue of a marooned slave, broken fetters at his feet. Now his descendants were marooned under sheets pitched close by the symbol of Haiti's resistance to slavery.

The Ministry of Health was one of the first federal buildings on the street leading from the palace to the hospital. The heart of the nation's health system lay in a compact but messy pile of plaster, office
furniture, and papers. Although I couldn't see much in the dark, I soon learned that not even a corner of the venerable building was standing.

We pulled up at last to the General Hospital. It looked the same as it had before the quake, and the gate was open. The rest of the neighborhood was clearly a mess. Echoing Dr. Lassègue, Loune and Nancy told me that the nursing school had been flattened, its students and faculty crushed. And once through the gates, we saw that like the neighborhoods and public spaces we'd just traversed, the once-familiar hospital campus was transformed. It was mostly dark: a few small generators were sputtering power into a couple of the main wards. Every open space on the campus was occupied by people who should've been inside the buildings, not outside. Even in the dark, we could make out people huddled around beds and cots and makeshift tents. Everywhere hung the same overwhelming stench that pervaded the entire city. I felt disoriented, and counted on Loune and Nancy to lead me to Lassègue, to the team I'd traveled with (none of them Haiti veterans except for the Haitian-American doctor who had trained there years ago), and to Byron Pitts, with whom I'd promised to sit and speak somewhere in this wreck and ruin.

In a disaster, shortages of personnel and supplies were to be expected. One didn't have to be an expert in disaster relief to know that. But the director of the hospital was there, as was the chief of nursing—even though it was after ten at night before we arrived. We found Dr. Lassègue and Marlaine Thompson tucked into a small office in the middle of the darkened complex, pouring over their own grim lists in the dim light—lists of what was needed but also lists of personnel unaccounted for. Outside the office, a handful of people were moving stacks of boxes and doing inventory; some of the tools of the trade, surgical and first-aid supplies, were coming in.

It was in this room, filled with stacked boxes of supplies, in the heart of a hospital that could not possibly provide the kind of care needed most—trauma care, much of it surgical—even if it had not been crippled by the quake, that I sat down with Pitts to discuss
what was unfolding around us. I have little memory of our conversation, although one of Pitts's questions stayed with me: “Haiti was already in dire straits prior to the quake. Do you believe it's possible for it to recover?” I am paraphrasing here, because I've never had the courage to watch the piece through in one sitting, nor the reserve it would take to read the transcript of the interview and report.
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Although weary, Lassègue and Thompson were clearly happy to see us. We'd been last together a month previously to cut the ribbon on a kitchen we'd helped build for the hospital. It was something we should have done years ago because our avowed philosophy—to make a preferential option for the poor—always led us back to dilapidated public institutions, whether in Haiti or elsewhere in Latin America or in Africa. After all, what institutions confer the right to health care? Not NGOs, universities, or patients and their families; not aid agencies or the UN. The government confers rights, and this was supposed to be the premier public hospital in the country. Our tardy and overmodest contribution to build a proper kitchen in the General Hospital was intended to help the hospital live up to its obligations. Feeding the patients was one such obligation, but as elsewhere in Haiti, patients' family members were expected to bring their meals to them. This practice had been extolled by some as community participation but had never been lauded by the poor, the sick, and the injured who found themselves in these institutions. (It reminded me of nothing so much as the fiction of community health “volunteers.”)

If there had not been enough food for inpatients in Haiti's referral hospital a month before the earthquake, it wasn't hard to imagine what it would be like in its aftermath (in spite of the growing piles of medicines and supplies that served as the backdrop for my interview with Pitts). The hospital would also need food, fuel, and cash; it would need salary support. But very few of the Good Samaritans now pouring into Haiti were seeking to provide these basics. We wouldn't have been able to help much in those first days if family
and friends, including a well-respected nun from Miami, hadn't given us thousands of dollars in cash to meet those needs.

Miami seemed like one obvious place to store other supplies we would need in the weeks ahead: medications, generators, anesthesia machines, water, tarps, portable ultrasound machines. (The lists went on and on.) Jennie Block's sister Laurie Nuell, a close friend of mine who lived there, helped organize such efforts. Before long, our teams in Miami and Boston had amassed hundreds of truckloads of supplies. The next issue was where to put them, and how to get them to Haiti. A New York–based supporter helped overcome this hurdle by donating a plane and a private airport hangar. (A number of our supporters in the business community, including Denis O'Brien and Rolando Gonzales-Bunster, also lent us planes.) Thanks to the logistical wizardry of the Partners In Health procurement team, which coordinated the entire process, private jets were soon flying in around the clock, picking up supplies and bringing them to Haiti. Laurie described it well:

Many others made herculean efforts to help. But it was hard, even in the first days, to link the goodwill offers to the critical needs in Haiti because so much of what was needed and expected by medical volunteers was unavailable.
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After decades of inattention and unwitting sabotage of Haiti's health system—too little foreign aid flowed to the public sector—there was suddenly a great deal of interest in helping Port-au-Prince's public hospitals. But helping is difficult in a broken and underfunded system. This is why many Good Samaritans simply erected their own MASH hospitals or worked in private facilities. Many lives were saved by such efforts, but what would happen when these Good Samaritans left, taking their temporary hospitals with them? What would happen if Haiti's for-profit hospitals continued to prove unable or unwilling to provide care for the destitute? Was there a way to help Haiti's dysfunctional health system function better in the long term?

The frustration of many volunteers and disaster relief experts was rooted in their inability to find a system capable of effectively using their resources and goodwill. “We were unprepared for what we saw in Haiti—the vast amount of human devastation, the complete lack of medical infrastructure, the lack of support from the Haitian medical community, the lack of organization on the ground,” wrote three New York surgeons after a mission to the quake zone.
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They first showed up at the General Hospital (where my colleagues had directed them) but felt that their efforts to help were futile: “This facility could not nearly accommodate our equipment nor our expertise to treat the volume of injuries we saw.” A number of visiting medical teams felt similar frustrations well before they packed up and left. They had encountered, for the first time, the profound weakness of the underdeveloped public hospitals that should have been the frontline in the fight to save lives after the quake. From day one, friction grew between teams with much-needed skills and those, mostly Haitian, who had for years tried to keep such facilities from collapsing.

Most of this friction did not stem from cultural barriers. Some of the complaints came from Haitian-American professionals who spoke Creole and French just fine. (Many were happy to question, in these
languages, the competence of their fellow Haitian professionals. It was a combustible mix, and a conversation to which non-Haitians contributed at their own peril.) These were, rather,
structural
problems. The urban public health delivery system, long weakened, was now all but destroyed. Beyond saving lives, medical practitioners faced a choice between giving up on the public system and seeking to rebuild it. It was for this reason we sought to direct expertise, skills, and goodwill toward the public-sector institutions still standing.

These frustrations were not new. In previous decades, we had encountered the same deficits and dysfunction while trying to provide health care to Haiti's poor. We learned early on about the friction between the diaspora and the Haitians we worked with—those who had never left. But such friction was not a given, nor did it prevent young Haitian-Americans from providing some of the best, most patient care in the days after the earthquake. I was lucky to count some of them as students. Natasha Archer, a young Haitian-American resident physician from Harvard, was one of the many volunteers based at the General Hospital. One night, after a long day of service, she wrote about the lifesaving work of a makeshift surgical team from Haiti, Boston, New York, and New Jersey. When a young girl presented with a rigid abdomen late one evening, and an x-ray suggested a perforated small intestine, she was immediately taken to the OR. The cause was likely typhoid. Natasha warned, correctly, that a lack of proper sanitation would lead to more such cases—and other waterborne illness.

I had reviewed the scant literature on typhoid in Haiti a decade before (it revealed the same high prevalence) and came to the same conclusion.
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I'd issued the same warnings. A few years before the earthquake, Haiti was declared the most water-insecure country in the hemisphere.
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After the temblor, sanitary conditions only magnified the threat of waterborne pathogens, including cholera—the most dreaded consequence of disaster and displacement. This was, again, what doctors termed an acute-on-chronic problem: one that should have been dealt with long ago, and one crying out for attention in the weeks after the quake. The good news was that, with proper surgical care, this girl's life could be saved, and it was. Young
doctors like Natasha were often the glue that held together people from what seemed like different worlds, people with the best of intentions.