Haiti After the Earthquake (54 page)

As the patients grew stronger and were able to leave the hospital, we moved them into the house and hired three Haitian home health aides to help with bandage changes, to supervise medications, to cook and clean, and to navigate the washing machine, grocery store, and bus system. As the months passed, we had become a family. We spend many nights eating together and many weekends in one another's homes celebrating birthdays and anniversaries or simply passing the time. When there was a death in my own family last year, my Haitian family attended the funeral. They wouldn't have it any other way.

It is hard to know what will come next for these families. Some were given an “indefinite” stamp to stay in the United States. Others were granted two years. Some will be healthy enough by then that they could go back to Haiti. Two of the children will need years of follow-up that would be best provided in a country with abundant tertiary care. But physicians in Haiti would certainly do their best with physical therapy and additional surgeries if necessary.

As an organization, we are facing difficult decisions about the future of these patients. PIH brings patients here for treatment and, when that treatment is complete, helps them get home—healthy and often with social supports such as school fees, a new house, and clothes for the other children in the family. This “turnover” allows us to continue bringing new patients to the United States for care while spending the bulk of our resources in the countries in which we work. Should these cases be any different? We grapple with the ways in which we could continue to provide support. PIH often struggles with how to allocate money between needs in Haiti and organizational or patient needs in the United States. These patients are no exception. As difficult decisions arise, we do our best to make them mindfully. And I watch carefully to see how Sherline negotiates difficult terrain in her wheelchair, knowing that sidewalk quality on a Philadelphia street is light-years away from the roads and rocky terrain of rural or even urban Haiti.

In August, I spent a week with my family in the Outer Banks in North Carolina, a spot we visit each year. It is a sacred time away from the daily grind of work and school. This year, three of the children from Haiti—Given, Bettina, and Lolo—came with me. I hoped to give their parents a break for the first time in six months, and to give the kids a chance to leave the house and experience a week at the beach. When we arrived, the kids eyed my family and our surroundings with suspicion and wonder. They stayed close those first few hours, clinging to me and refusing even to go to the bathroom by themselves. By the end of the week, the kids were playing in the sand with my young cousins while I read upstairs. They were willing to interrupt their time outdoors only to yell “cornflakes please” to the closest adult and then sprint into the house in their wet bathing suits for a quick refueling.

Given sprinted in his walking cast and tenderly put sunscreen on his mountain of scar tissue. Bettina waited twice a day for her medications. The kids wanted to shower multiple times each day, marveling and giggling at the free-flowing warm water and the fact that they weren't in Haiti anymore; there weren't hundreds of others waiting, jostling, and yelling for them to hurry up so others could share in the limited resource. Lolo, the fifteen-month-old who had lost his mother in the earthquake, had nightmares, screaming and inconsolable at 3 A.M. The four of us shared a king-size bed decorated with a seashell comforter.

Nine months after the earthquake, we reviewed the numbers: more than two hundred thousand dead; more than twenty thousand amputations; a million injured; more than a million homeless. Enormous effort has gone into saving the lives of the small number of people who arrived in Philadelphia. In this we see both the mission of Partners In Health and, more generally, the heart of medicine. Although we are always allocating limited resources based on the greatest good for the greatest number, we never consider a single effort to be “a drop in the bucket” or energy wasted. If we did, our organization would have stopped the moment we were spending ten thousand
dollars to treat a single AIDS patient in rural Haiti or in our first effort to make life-saving chemotherapy available to a young woman afflicted by breast cancer there. Now we are proud to say that both treatments, both tools of modern medicine widely accessible in the “developed” world, are available to patients in Haiti. Moreover, their use is no longer truly extraordinary or expensive there. We, the world's wealthy, must have the courage to dream big for the communities we serve and to take on the challenge of turning high hopes into reality. Today, in early 2011, it is devastating to realize that “dreaming big” for families in Haiti may consist of clean water for a household wracked by cholera, or a new home for a family living under a tarp in Port-au-Prince. But the patients here in Philadelphia are living testimony to what is not only possible but
required
if we are to fulfill our mission of providing comprehensive, high-quality health care to the destitute sick.

I am proud to declare that these twenty-one lives are worth extraordinary effort. Some people have asked: “Couldn't you have used that money to help even more people in Haiti?” Medicine cannot stop to argue when there is a patient suffering on the ground. The great joy of a life in medicine is that ability and that mandate: to do whatever it takes for the patient in front of you. No matter how deep the tragedy, or how expansive, we continue our work—one patient at a time.

 

 

 

W
hat do they do?
I am in Léogâne, epicenter of the earthquake, ten days after it struck. I am addressing the question to Joseph (not his real name).

Few people on earth could be better qualified to answer the question. Joseph is an American foreign service officer who has spent his thirty-two-year career in some of the poorest, disaster-wrenched countries on earth: Congo, Rwanda, Nigeria, Angola, Sudan, and now, for the past four years, Haiti.

The people I am asking him about are two officials from DART, the United States Disaster Assistance Response Team. Who could be more qualified to organize logistics than an organization with a name like that? They are some forty feet away, doing the same thing that Joseph already did: interviewing a pair of paramedics from the United States.

The paramedics are two among hundreds of people who got tired of seeing the thousands of untreated Haitians on television, packed into clinics, sitting in streets and empty lots waiting for medical attention. And so they got off their couches, bought plane tickets, and came to Haiti to do something about it. For three days, they have been treating hundreds of patients a day.

The DART officers are scribbling in notebooks; the paramedics are talking and surely saying the same things they said to me and Joseph. Next, the DART officers will interview the Cuban doctors and a half dozen German paramedics from another independent aid
agency, all of whom Joseph and a series of other officials—Canadian, U.S. Navy, UN—have interviewed, and all of whom are tired of being asked the same questions—most importantly, “What can we do to help you?”—and receiving no help in return.

“I don't know what the hell they do,” Joseph replies, squinting at them. “They usually don't even leave the office.”

After the DART officers have visited all the other doctors and paramedics, Joseph and I are huddled with them. Joseph has introduced me, explaining that I am an anthropologist who has worked in Haiti for the past twenty years and that I have volunteered. The two DART officers, a man and a woman in their mid-thirties, are stone-faced. As we talk, I am imagining that, after ten days of rescue chaos, this is finally the beginning of a coordinated aid effort. These people, I am thinking, are the real thing. They're feeling out the zone, taking notes, and in another couple days, the United States will come in here and put everything in order.

For the sake of efficiency, I volunteer to visit all the other aid agencies in town and gather information. The DART officers think that would be a big help. They can go on to the next town with Joseph; I will stay here and get the data. This way they can maximize their time out here in the field. It's agreed.

Léogâne is a small town, covering less than a square mile. And it's starting to fill up with NGOs and medical agencies.

Daphne Mervil, a student at Léogâne Université Episcopal d'Haïti nursing school, tells me, “Within hours after the earthquake struck, we had more than five hundred injured people.” The nursing students and their two instructors did the best they could to care for the injured. They stacked the dead behind the building and laid the wounded back out in the field. The first doctor, an American, arrived Friday, three days after the earthquake. But significant help did not begin arriving until the following Monday, seven days after
the quake, when Joseph and I visited the first time. Now the help seems massive.

I am standing next to a large Canadian flag listening to the public relations representative of a Canadian field hospital. They have twenty beds, meds, and can see two hundred patients per day. Next, I am with the director of the Medécins Sans Frontières (MSF). Around us men are carrying poles. A bed goes by. Tents are going up. I'm jotting it all down. Lists of doctors, psychologists, surgeons, nurses.

In all, eight medical groups and twenty-eight aid organizations are in Léogâne. All but the Cubans, who were here when the earthquake struck, have arrived in the past couple days. In a few more days, about the time most of the field hospitals get finished, the flow of gangrenous survivors will abruptly abate. Those that didn't get help will be dead. Some of those who did will be missing limbs. A lucky minority will have been treated and returned to a relatively normal, if traumatized, life. Then a new avalanche of patients will begin, what the doctors call primary care patients, the many Haitians who were already suffering from chronic diseases, worms, and infections before the earthquake. They will come to take advantage of the opportunity to get high-quality medical care, for Léogâne is turning into a massive hospital.

But for now, hundreds of wounded are pouring in and Léogâne has all these organizations with different capacities and supplies. The Spanish Red Cross has water makers. The Austrian Red Cross has latrines and pumps. The French at MSF have meds and a laboratory for blood work. The Japanese are the only ones with an X-ray machine, but the Germans are bringing another. The Cubans have four surgery rooms, twenty general practitioners, and five orthopedic surgeons. Heart to Heart at the Nazarene Church has pharmaceuticals, vaccines, and disposable medical supplies; and on and on.