Haiti’s New Normal

The day started like a typical Haitian Sunday. Relaxed. I had made plans the  day before with Junior to catch a ride to St Damien’s hospital in Tabarre.  Fr  Rick lives there and I wanted to meet up with him and to go to mass. He’s been  agreat mentor and friend for me in my Haitian journey. Whne I spoke with Fr  Rick by phone the night before, he told me that Mass would be in the evening,  unusual for him to have a Sunday evening Mass St Damien’s to have it at night.  I knew things must have been busy.  “Can I give you a hand tomorrow?” “Sure, we  could use the help. Come on by and speak to Conan.” I awoke early, as is my  norm there, sleeping and arising in sync with the sun, particularly when there  is no electricity. I have often been struck by how quickly I do so wene there  is no power. It makes perfect sense of course, and yet in 2010 the injustice of  that scenario is not lost on me. The news reports about how electricity  shortages in Baghdad make life tough. In Haiti that’s the norm.

How can people study when there is no light?  As a kid I remember hearing once that Abe Lincoln knew the importance of studying, and so he would do so by candlelight, but how many Honest Abe’s ought we expect?  As we were  getting ready to go, Junior went out to the truck and found the front passenger  side tire flat. The day before I had paid to have the same tire repaired. It  was impressive to watch the guy jack up the truck, remove the tire, then using  what looked like a tire jack from my parents old Country Squire station wagon,  ala 1969, manually remove the tire from the wheel. Except he didn’t use the  jack part.

He would swing the pole, and lodge the base of it between the rubber tire and the rim. It can’t be too good for either part, but such is the common way it’s done.  Next the tube is removed and the the hole located   by squeezing the inner tube and listening for the hissing leak. The hole is patched using rubber, heated over a wood fire and allowed to cool.  The process is vintage Haitian-simple, logical, right out of my first  year physics textbook. The result is too, unfortunately. Cheap materials,  cheaply repaired on the street just don’t have a great track record.   Junior  told me that we would not be able to repair the tire until the next day.  I was  not happy, and the familiar frustration of Haiti washed over me like an  unwelcomed kiss planted by an ancient aunt on an eight year old boy.

The trick in navigating Haiti without having a stroke is to stay cool when the inevitable happens – like getting a flat on the worst roads you’ve ever seen – and to know to  get pissed off when you need to, not  settling for the status quo when better results are within reach.   It’s a  delicate balance that I struggle with on a regular basis.  I asked Junior how  we could fix the problem and he looked behind me.  As luck would have it, his  own vehicle , a Montero SUV, is the same make that Lamp uses.  Junior’s truck  has four flat tires not because he keeps going back to the same tire repair  guy, but because he hasn’t driven the vehicle in months. He simply swapped out  the wheels, pumped it up and we were in business. We arrived in Tabarre a  little later than I had planned, but not too far off the mark.  When I walked  onto the grounds of  hospital,

I was told by the guard that Fr Rick was in church. I walked the 100 yards toward the chapel, but did an about face after seeing a coffin in the center aisle, and hearing sobs exude outside.  I walked to the side of the  chapel and ran into my friend Conan. Conan   should be in a movie. He is an American, with eight kids, and divorced.   (Many of my American friends who work a lot in Haiti seem to be divorced. It’s something a stay very aware of, as I don’t want to be among their numbers).

He works like a dog seven days a week. His red hair and fair eyes belie   a propensity for skin cancer that makes my dermatologist wife cringeven  talking about him. On this day he is wearing mirrored wrap-around shades, and a  blue bandana as a head cover.  “Hi Jim, can you work tonight?” Is his greeting.  He disposed of the formalities like “Hi how have you been?” and “Good to see  you” long ago. I am happy to be on that level of comradeship with him. Conan is  about the work. His work ethic is impressive. It’s an elite group that is co  dedicated to a cause. In that group is also Fr Rick, a physician and Catholic  priest, who works even more nonstop on behalf of the poor.  Among   other hats he wears at the hospital, Conan is responsible for staffing the cholera tents with doctors, nurses, and ancillary workers.  We share  stories about the cholera patients we have seen over the last few days, and he  is exhausted in his rendition.  “Sure I can work tonite.” “How long? When can  you start?” “I have to be at our clinic tomorrow at 7am. I’ll work all day and  night if you want. You tell me  where.”  “Ok   good.”  That’s all you get. No “wow, you are so kind, thanks.” No these   guys work like that all the time. I neither expect nor want the kudos.  The  funeral has ended in the chapel, and the mother of the boy who died is running  around , sobbing uncontrollably. Fr Rick is headed towards us, but is stopped  by the mother, who literally throws herself into his arms.

She asks him where her son will be buried, since he died from cholera and the general hospital morgue won’t accept the body. He speaks softly to her  in Creole, but I can’t hear what he tells her.  Speaking in his  Canadian-Connecticut-Haitian accent, Pere Rick says to me “Oh Jim. Nice to see  you. Are you seeing a lot of cholera at your clinic? We have to bring this body  over to be cremated. Can you give us a hand?” He too does not waste his words.  The three of us load the cheap plywood casket onto a truck and drive to the  crematorium. We unload the cargo, and I hold open the iron gates as they  deliver the coffin.  The all too familiar smell of death is present. The oven  is working on one body already, but other lifeless ones await on tables nearby.  The smell, I know it as that of anaerobes, bacteria that grow well in nonliving  or poorly oxygenated tissue. It is akin to the smell of  dirty socks from a  bunch of teenage boys, left in a pile for a week. I am instantly transported  back to a side street i walked down after the earthquake ten  months ago. Then,  as now bodies we decomposing, and the odor was harsh.  I recall reading  somewhere that  scent memories are some of the most difficult to forget.  Unfortunately I am finding this all too accurate.

After   dropping off the body, we go over to a storage area to collect some wooden pallets. We have to build a tower to put a water tank on.  The plastic container, about 1000 gallons in capacity, is being used to supply  water for cleaning in the cholera treatment area. Gravity will allow the water  to be distributed to several different places. Water is key on a normal day in  Haiti. During a cholera epidemic, it becomes the Rosetta stone.  We load the  pallets onto the truck. I try not to let on that the giant bugs really do gross  me out, and we drove to the cholera treatment area about  four football fields  away.  Conan tells me that I will be working triage, and also the treatment  tents. Currently  there are three large tents, like the kind my parents rented for my sister’s wedding reception in our backyard. The only dancing though, is by the nurses who are working their butts off, trying to keep up with the volume of patients and their needs.  “Ok, no problem” I tell him, even  though I have never taken care of a cholera patient in my life before this  week. I   read a lot about the disease in the past two weeks, and attended a meeting with my Lamp team the day before, sponsored by the Ministry of Health, for NGO’s working , so I guess I’m as good as they’re going to get,  today at least.  Conan tells me that I’ll work until about 11pm. That will give  the American guy, Jeff, an ER physician from Ohio, a few extra hours of rest.  No problem. It’s just past noon.  I relieve a young and very pleasant Haitian  doctor, a woman, who gives me a detailed sign out. “this   man has diarrhea and vomiting.  We are hydrating him with IV fluids, and we will give him antibiotics – just one dose.  This woman has diarrhea and vomiting. We are giving her IV hydration and antibiotics- just one dose of antibiotics, you understand? This baby is vomiting and has  diarrhea. Baby needs hydration and antibiotics, just one dose, you understand  .”

And so on went the sign out. After about the tenth patient I asked her to point out the ones who were not vomiting with diarrhea. Of the 40 or so  patients, none fit that description. Tout moun genye diarya ak vomis. We cut to  the chase, and she bade me bon chance. After a few hours, I had my mojo on.  Working as a doctor in a level I trauma center in New York City for six years  has some advantages to it, and one is confidence.

A PhD student in public health was there, whose area of interest is cholera. Perfect. You can do discharge training of patients. We need to educate them on eating and cleaning and toileting.  I schmoozed a couple of  nurses early on. My ER experience had taught me that if you don’t do that early  on, you’re dead.  The nurses are the hub of the wheel in the ER. Doctors maybe  driving the car, but the want to go.  A nursing friend once told me that I  could charm the skin off a snake when it came to those situations,   a talent I am happy to have, because the team has to get along to have a   chance at being effective, especially in the face of catastrophe.   The  cholera  epidemic in Haiti is a catastrophe. Patients coming in were being  triaged and  treated appropriately. I even was able to discharge a few  patients, and they received discharge instructions, in Creole.  About 4pm, Fr  Rick asked if I could head out to Warf Jeremie. I have been there a few times  before. It a place in Cite Soleil, not far from where our Lamp clinic is  located.  It is poor, densely packed with people. There is a clinic there, run  by an Italian nun, he told me. “The clinic needs to send some patients to St  Damien’s , and they need a doctor to tell which ones are the worst. Bring the  generator and some gas, since they don’t have electricity and it’ll be dark  soon. Win can drive, and he’ll bring Allain with him too.”  And off we went.

There were five of us, all blan, the Creole expression for white people. We  drove along Route Nationale,   on the outskirts of Cite Soleil. Win was kind enough to bring along a plate of food for me, and I ate in the back seat. The food tasted delicious, and after the first bite I remembered I had not eaten all day. I was hungry, and practically ate the plate on which it was served.  After  about 20 minutes in the truck we turned right onto the road leading to Warf  Jeremie.

It was dark now, and the way was lit up by headlights from the occasional vehicle, and by the small cooking fires on the side of the road. Tin shacks, held together by rust, dogs barking, smoke spewing from in  front of homes, children sitting naked on the ground. Horns honking.  I was  looking for Mel Gibson in Road Warrior garb to come racing by on his  motorcycle, but this scene was even more distressing than anything Hollywood  had yet offered.  I asked myself “what could be worse than to live like this?”

We arrived at the front of the clinic in silence. On entering the dark  building, we were greeted by Sr Michaella, an Italian nun, maybe 50 years old.  She was happy to see us for sure. The clinic was officially to open in about 2  weeks. She had arranged for medical staff to start at that time, but then came  the epidemic of cholera. Like most disasters, this one didn’t read the schedule  and came inconveniently early.   People in the neighborhood began coming to the  clinic   looking for help. “I could not turn them away” she told me, and soon the beds were full.  There was a team from Doctors without Borders who   were awaiting clearance from the Haitian Ministry of Health, and fortunately they would be able to assist. “But they told me yesterday they would not come today since it is Sunday and they needed a day off.

So it is just me and my boys. We have been working nonstop since very early  this morning. I have no energy left. What do you think I should do?” Win   and I looked at each other. We came to take the worst of the patients and so we started to go around triaging patients. Very quickly, I had to   assess each one, and decide who would be transferred back to the hospital in Tabarre.  Sister Michaella had a tap-tap available ,and so we  figured we could transport five patients. Someone started the generator, and  there was a dim light throughout the building. It was worse than I could have  imagined. People were crowded into that place. Vomiting and diarrhea was  rampant. It   was a horrible sight to see such suffering. An old woman was sitting on   a red bucket, her dress pulled up around her waist, with diarrhea. She hadn’t  the strength to sit up, and she rested her head on an adjacent cot.  Babies not  crying, dry mouthed. Young men ,   obviously from the community, moved about with purpose, looking for IV’s not functioning, assisting new patients to cots or open floor space.  I asked Sister Michaella if she needed me to stay. “If you would, yes.

Otherwise we will have to send people home. For the last two days we arrived in  the morning and found four dead bodies on the steps, waiting for us.  ” Win   heard my conversation, and said “Jim, if we take the worst cases back then you wouldn’t have to stay. ” He sensed my nervousness in making the   offer.  Cite Soleil is a notoriously tough place under the best of circumstances. With the upcoming elections, it had become a   lot more risky, as local gangs backed by different candidates, tussled.

The wrong comment could be big trouble. He went on. “We don’t know how long the gas will last in the generator. You won’t have any nurses. I don’t know how long the IV fluids will last.”  “You’re right.” It was a bad  idea. After all, we’ll be taking   the five worst cases, right? Then with a little luck people can go home   and come back tomorrow morning for more treatment. Also, God knows I didn’t want to spend the night in Cite Soleil alone. Though I’d worked regularly in Bwa Nef, another neighborhood in the slum, for years, it was  always during the daylight hours, and always with close confidants.  I   told Sister my reasoning. She understood my reasoning, and said Okay.

She squeezed my hand and thanked me for coming to help those people we would be  taking back to St Damien’s. She turned to continue her work, and I went about  helping to load up the patients.  As we were getting the last patient ready, I  turned to Win. “I’m staying. I can’t leave these people. Look at them. There’s  no one else to do it.”  He called on his cellphone back to Fr Rick, and we got  the OK. I spoke to Sr Micahella   again, and I thought she would kiss me. I knew all along it was the right decision. I didn’t know how I would make it through the night. In a   weird way, I was reminded of  when   I used to be an ER doctor in the West Village of Manhattan, starting a shift on the night of the Halloween parade. You knew it would be crazy and  exhausting, but   you would get through it. I didn’t linger on the obvious — in the ER we had lights, professional nurses and doctors, and practically every modern medical test at our fingertips. As Win and the others were readying to  leave, Sr Michaella   told me that I would have some help. There was a group of five nuns and   priests who happened to be living in some tents nearby. They had come recently to minister to the poor. She introduced me to Sister Cacilda.  Sister  Cacilda smiled so radiantly and gently, it was a gift from above.  She   told me in broken English that she and the others would help me, and that together with the help from the young men from the community, and  most  important  – she pointed up – with His help. We will do this.  I felt lifted up  by her courage. Here I was,   a relative veteran of the streets of Cite Soleil and no stranger to working in disasters and a nun who was living in a tent in one of the worst places one could imagine became a conduit of holiness and strength.  As the night wore on, the vomiting and diarrhea continued, and more  patients came. I had no idea how long the gas would keep the  generator   going.  Most patients needed intravenous hydration, and lots of it.

Finding a vein in a dehydrated body can be really tough. I was particularly happy when I finally was able to get a line in the old woman with the flower dress. She was close to death.  Sister Cacilda   never stopped smiling. She asked me if I would like something to eat, and though I hadn’t thought of it, I answered yes.  She spoke in Portugese   to one of the young priests, and he brought me a mango and a chunk of peanut butter. I think it’s one of the best things I have ever tasted.  At  about four in the morning, I was completely exhausted. I told Sr Cacilda   that I had to lie down for one hour. I crawled into a cot in the back, and lay down. The room started spinning, and I thought I would puke. “Oh   shit. I can’t get sick.” I said aloud. I got up and used the bathroom, and didn’t vomit. I crawled back into the cot and somehow woke up exactly one hour later.  At six o’clock I was had just finished putting in a  line into a child who was severely dehydrated.  As   I looked up, the sun was just coming up above the horizon. On cue, the generator started to sputter, the familiar sound it makes when running out of gas.  It had lasted all night as we needed it to do. The daytime medical  team began arriving, doctors, and nurses and the others. Sister Cacilda and I  exchanged numbers and email. I am sure we will work together again, and again  it will be my privilege.  We proudly noted, zero dead that night.  A driver  came to pick me and the generator up, to go back to St Damien’s . I needed a  shower, and some sleep. Getting out of the truck the first person I saw was  Conan. “Oh good. Jim. Can you work tonight?”