Haiti After the Earthquake (3 page)

There was so much to be done. But by day three, when we finally reached Port-au-Prince, we'd already missed two days to help save lives. Now we were surrounded by thousands of survivors—but many wouldn't be with us long without the right care. The only gratifying moments in those first few days came from two sources: pulling people alive from under the rubble (there were far too few of these “saves”) and making sure that the injured received proper medical care (this occurred much more often).

As doctors and nurses, we were grateful to offer services to the injured, perhaps in part because the extent of the destruction made other needed activities, such as clearing debris or housing the homeless, seem overwhelming. Surely those tasks might be postponed for a few days at least, while we attended to the injured and tried to save lives? But from the beginning, we knew there were no simple answers. We could tend to the injured, but what about the homeless? We could treat the sick, but what about burying the dead? We could
insert intravenous lines, but what about slaking, with clean water, the thirst of millions?

In those first few days after the quake, it seemed almost sacrilege to think about anything other than succor; the hard and inevitable work of reconstruction was difficult to even contemplate. And so we focused on alleviating the suffering right in front of us.

But for those not new to Haiti, the big picture of rebuilding was always in the back of our minds, even as we tended to the injured and the dying. This had been our modus operandi at Partners In Health and Zanmi Lasante for decades: to struggle to serve those right in front of us even as we struggled to think about the big picture. We sought to provide modern medical care and social services—schooling, housing, food and water, security, jobs—to neglected rural areas. But the temblor had struck the heart of the city. Although we wanted to help, where in the city should we go? Spontaneous settlements were springing up in every open space, and the sick and wounded were everywhere. We had little time to think.

Dr. Claire Pierre and I, and soon other reinforcements, were left to keep a promise: one place where help was clearly needed was Haiti's largest hospital. We weren't the only ones to reach this same conclusion. Already cluttered on day three with the injured and dying, the General Hospital was a scene of enormous confusion. Relief workers arrived by the dozens and casualties by the hundreds. With no electricity in the morgue or anywhere else, the entire place smelled like a charnel house.

There was never enough time, in those first days, to take stock, but we soon knew that both relief and recovery would be hampered by losses in the medical community. As Dr. Lassègue had said, the nursing school had collapsed during class, killing students and faculty alike. The Ministry of Health had been destroyed, too. Many clinics and hospitals in the city were down. The state medical school and hospital, the country's chief teaching facility, were badly damaged. Even for seasoned physicians, the quake zone was a horrifying scene. But more and more volunteers were streaming in to help.

Three days after the quake, the General Hospital campus was unrecognizable: the central courtyard, like the other open spaces in the city, was covered (or being covered) with tents and makeshift lean-tos fashioned from sheets and pieces of plastic, under which lay the injured and (if they were lucky) surviving family members and friends. Also there, although I was too dazed to see them, were almost fifty children with disabilities: the hospital's unaccompanied minors, most of them orphaned in every sense of the word. We'd been trying to relocate them to a safe haven outside the city for weeks, but the quake found them still in the General Hospital. (I remembered these children only many hours later, at three or four in the morning, and could only hope that someone else on our team had a plan to get them all to safe haven.)

We soon learned that simply keeping track of patients within a single hospital was a full-time job. Although the courtyards were packed, most of the wards were half-full: patients and staff were afraid to go into even ostensibly undamaged buildings. They had their reasons. For days, aftershocks had rolled through the city.
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Rumors of approaching aftershocks emptied several of the wards as terrified and sick patients ripped IVs out of their arms in a rush for open space. The anxiety hung over the hospital, like the smell, and made delivery of medical care even more difficult.

This infectious anxiety endured for weeks, as did the aftershocks. To offer an example: late one evening, about a week after the quake, I spent the better part of an hour trying to convince a gasping, skeletal young woman, her lungs half-consumed by tuberculosis, not to join the exodus that had emptied the wards after yet another aftershock. We were both inside when the shaking began, and I remember putting a hand out to steady her oxygen tank, which weighed almost as much as she did. Never had I imagined such a scene: grasping the top of a heavy tank inside a trembling building and trying to comfort a patient, while wondering whether the whole place was about to come down.

The patient's name was Natasha, and she was alone except for a young man sitting on the bed next to her. I assumed he was a family member, or perhaps a nurse's aide. It turned out that he was a Good
Samaritan who'd never met Natasha before. He had just traveled from a town south of Port-au-Prince with his own sister, badly injured when the quake destroyed their modest house. His sister had died a few hours before, he said, and he'd not yet decided where to go. So he lay down, alone in a fog of grief, in an empty hospital bed.

And then the ground started to shake again. He leapt up to join the general exodus, but saw Natasha straining against her lifesaving contraptions, including the oxygen tank. He stayed in the building and did his best to calm her. Blood was seeping from around the IV catheter in her arm; panicked, she was also tugging against the tube that piped oxygen into her nose. Claire Pierre and I arrived just then and begged him to stay with her until we could find a staff member to assume these duties. They were both there the next day, still unassisted, but by then he was sitting next to her, reading from a wellthumbed Bible. He had also gone out into the fractured streets and found her something to eat.

Staff shortages at the General Hospital and elsewhere in the quake zone led some to assume that Haitian doctors and nurses had fled after the quake, unwilling to help. Our experiences suggested a different conclusion. Despite nursing their own wounds and losses, many Haitian health professionals were, in fact, back on the job within days or even hours. One assessment by an emergency medical aid group suggested that 95 percent of public-sector health workers had returned within one week of the quake.
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What was missing, in addition to the hospitals and clinics in which they worked, was decent pay. How could they take care of their families, or purchase and maintain the equipment they needed to do their jobs?

The consequences of a longstanding lack of investment in medical infrastructure and training were obvious: manifesting, for example, in quarrels about who would take care of the sick and wounded at night. Many relief workers blamed security protocols: they couldn't stay at the General Hospital at night without proper security, they said. But the hospital had never had funds for security. Most Haitian employees were not as concerned about security as they were about
salaries. We all gave thanks for the Good Samaritans who struggled to save lives after the quake, even as we struggled with chronic problems such as low public-sector wages and lack of supplies.

Giving thanks for Good Samaritans was one thing; coordinating them, quite another. On day four after the quake, it was clear that the wounded city was mobbed with rescue and relief workers. More medical care was available in urban Haiti than ever before. The coalition brought together by the disruptive force of January 12 included a veritable horde of highly trained health professionals, most from North America (including hundreds of Haitian-Americans) and Europe but also many from Cuba and across Latin America and from countries as far away as Israel, Japan, and China; Haitian health providers who had never or rarely left Haiti, most of them touched directly by the quake and already teetering between gratitude for and resentment of better trained and better equipped teams who, while volunteering in Haiti, had paying jobs at home; the recently injured, some minority of them long spared the risks of premature disease and death endured by Haitians living in poverty; the UN survivors (the peacekeepers in their barracks were largely spared the fate of the civilians in the UN headquarters, which had collapsed in the quake); and of course the people and patients we knew best, the rural and urban poor. There were also sudden appearances by celebrities, including some, like Sean Penn, who came with cash and supplies and settled in to stay. Never in my wildest dreams could I have imagined being smack in the middle of such a life-and-death mix, much less in a post expected to bridge such disparate worlds. (Isn't that what envoys do?)

But such was our role and so were our tasks. As Dr. Lassègue predicted, one of the biggest problems was where to send patients in need of advanced surgical care. Some could be sent to the Partners In Health–affiliated hospitals in central Haiti, although our surgical capacity was limited; some could go to the new MASH units
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in the city, such as those erected near the airport by the University of Miami and the Israeli Defense Forces, although nursing and follow-up
care there was limited. But for many, we didn't yet have a plan. Even though thousands of relief workers were on hand, we were all waiting anxiously for the arrival of reinforcements.

What passed for Haiti's most important teaching hospital was still, despite the destroyed buildings around it, receiving more and more of the injured: people from south of the city and those lucky few rescued after days under rubble. We knew some reinforcements would soon be steaming into harbor in the form of a giant floating hospital. A week and a day after the quake, the USNS
Comfort
arrived, an oil tanker refitted with one thousand beds (including almost a hundred intensive care beds), twelve operating rooms, a large and well-trained staff assisted by scores of volunteers, and diagnostic equipment (including CAT scanners).
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Even before the
Comfort
was stationed in the Bay of Port-au-Prince, helicopters wheeled overhead, some of them starting to ferry patients from on-land hospitals and other staging areas to the ship.

The
Comfort
towered over an armada of craft from a dozen or so countries in the harbor, including the USS
Carl Vinson
. It wasn't the English channel before Normandy, but Haitian waters hadn't seen such traffic since Napoleon's failed attempt to retake Haiti in 1803.

Using the
Comfort
effectively, however, posed problems. The difficulties of coordination were clear enough within the General Hospital; now its leaders also had to manage the surfeit of goodwill offshore. Everyone wanted to help, but no one knew exactly what to do. Each of the many tents erected by NGOs in the hospital courtyards became its own semi-autonomous world.