Haiti After the Earthquake Read online

  Clinton’s words haunted me. I considered myself experienced in tough situations, but here was someone who had, for decades, dealt with flood and fire and quakes and every sort of misfortune, as public officials must. For eight years, he had done so as leader of a nation with a long history of responding to disasters beyond its borders. If Clinton hadn’t seen anything like this, why was he confident that Haiti would claw its way back? I resolved to ask him when we were next alone.

  It was a relief to move on to the next stop, even if only to think and breathe in the car. It was hot and crowded in the hospital, and the place still reeked. Some of the clinicians present, tired and irritable, didn’t want to be disturbed. Small generators were adding to the general din; few places could have accommodated larger generators, had they been available, because the quake had scrambled the city’s grid. (Rolando Gonzalez-Bunster, who had shipped the big generator overland from the Dominican Republic, was there that day with some of his Dominican friends, and Dr. Lassègue thanked him for his generosity.)

  I was still lost in my own dark thoughts when Clinton’s top aide pointed discreetly to a pile of bags on the ground in front of the pediatrics unit. “Some toys for the kids,” he said, “from me and my wife.” (The supplies on the plane had already been transferred to the appropriate officials.) With some pleasure I brought the bags into the ward, spilling them open in front of the tired nurses and children. All but the more heavily sedated kids looked on with excitement, triggering some of the few smiles I saw in days.

  I left Haiti that night with President Clinton and had a chance to ask him why he was confident that Haiti could recover. His daughter was close by, but no one else was listening to our exchange. “Haitians have fought adversity for centuries. There’s so much talent here, and perhaps they can turn this reversal into some new opportunities. And think about Rwanda.” I did so all the way back to Florida and drew on this reflection in the days that followed.

  After two days of rest (and restlessness), Louise Ivers and I found a ride back to Haiti on January 20 with a planeload of volunteers and supplies from the University of Miami. Who was going to coordinate them when they landed in Port-au-Prince? While waiting for hours in a small, unfamiliar airport while the plane was loaded with supplies, I asked Louise for help on an opinion piece that Claire Pierre and I had drafted for the Miami Herald. Finishing an op-ed was one way to kill time and to sharpen our thinking about the coordination of goodwill efforts pouring into Haiti as the enormous team of physicians and helpers loaded up.

  Because the airport lounge was small and crowded, Louise finished it sitting in Jennie Block’s car, which was idling in the parking lot:If any kind of chronology can be imposed on a disaster of this magnitude, we are moving into the next phase, where rescue and relief operations continue—miraculous rescues of those trapped are still occurring, with one young girl and her brother pulled from rubble the other day and now recovering at the largest urban hospital—and are complemented by slowly coordinated efforts to bring food, drink, shelter, and basic medical services to the millions affected by the quake.

  Some of the aid is starting to move, as repeat visits to the General Hospital of Port-au-Prince reveal: In the space of less than a week, the hospital, run by local staff, has been assisted by scores of surgical and medical volunteers and has moved from no functioning operating rooms to a dozen that are busy all day, every day, and throughout the night, too.

  This disaster has brought together goodwill and interest in Haiti such that for the first time in the country’s history, there may soon be enough surgeons and trauma specialists. There are, of course, many kinds of trauma, and even those who escaped unscathed physically have lost friends and loved ones, to say nothing of material possessions.

  Across the country, as people continue to search for missing family members and friends, a kind of numbness is giving way to grief. Rescue workers and medical personnel and ad hoc logisticians, most of them Haitians, will need a break, as some of them have been working nonstop for over a week. One of our collaborators is still in the clothes in which she escaped with her life from her home.

  To close the op-ed, we also took President Clinton’s suggestion and started thinking about what lessons Rwanda’s experience might offer Haiti. The tone may have been overly sharp:One potential model of recovery for Haiti is the nation of Rwanda. After the 1994 genocide, Rwanda was overwhelmed by the international helping class, which included, in addition to many people of good will, a flock of trauma vultures, consultants, and carpetbaggers. Under the strong leadership of the nascent government, including now-President Paul Kagame, leaders insisted that recovery and reconstruction aid be coordinated by the central and district governments. A number of nongovernmental organizations left Rwanda, but most would argue the decisions made then have helped to create a new model of collaboration between public and private actors, and contributed to Rwanda’s remarkable post-genocide stability and growth.13

  Louise looked rested, but we both knew that tough conversations were in order. The last time I’d seen her, five days before at the UN log base, we’d been enveloped by the stench. She had been through hell and now faced, along with all our colleagues, some difficult decisions. One of the biggest concerned the massive concentration of damage and injury in Port-au-Prince. Our medical work had always been based in rural areas outside the quake zone. It would have been easier, in some senses, to stay there. But, by 2010, Partners In Health/ Zanmi Lasante had become the country’s largest health provider; we worked closely with the Ministry of Health; we had support from the likes of President Clinton; the Obama administration had already declared earthquake relief a priority; and members of our Haitian staff were volunteering in the earthquake zone from rural sites and also from African posts. What did “business as usual” mean after all these changes?

  Louise is as dedicated a physician as I’ve met and never one to shy away from a challenge. Because she’d been working in Haiti for eight years and was a key leader of Partners In Health’s efforts, I knew she’d have clear ideas about the months and years ahead. Would we stay in the camps, and in the General Hospital? How could we train more doctors and nurses, now that the state medical and nursing schools were damaged or down? And what about the new hospital planned for Mirebalais since the storms of 2008—should it be a major teaching hospital or the smaller one we’d planned? (I’d already heard that Ministry officials were planning to ask for a large teaching hospital.) There were so many questions, such need for new ideas, that I didn’t know where to begin. When we finally got on the plane, sitting next to each other en route back to Port-au-Prince, I asked Louise, simply enough, “Now what?”

  “We’ll figure it out,” she replied. “We’ll get our job done.” She paused, and noted, more than once, “But I didn’t sign up for earthquakes.”

  None of us did. None had been trained for such a shock to the body politic; none were prepared to manage, much less salve, such destruction, such a collapse of the systems, however inadequate, that struggled to keep people alive in a city of three million. Louise herself was an infectious disease expert and researcher and an excellent one at that. Now she was charged with leading our disaster relief efforts. None of us were prepared, but we were trying our best. Other self-described disaster experts had already informed us, gravely, that they were prepared. But privately, at least, we remained unconvinced. Now that the experts were there, would relief and recovery proceed rapidly enough for the millions—it was millions, we knew that much—in need of food and water and shelter? We were in uncharted territory and knew that a certain humility about diagnosis, prescription, and prognosis was surely warranted.

  We landed in Port-au-Prince and were greeted by Loune, Claire, and Louise’s driver, Médé; the vehicles were waiting for us right there on the crowded tarmac. We loaded Louise’s kit and some supplies into a white Toyota jeep with a crumpled passenger side and sheets of plastic in place of windows. “It’s kind of like the whole country,”
Médé remarked with good humor. “I’ve bandaged it up.”

  Claire and I headed back to the General Hospital, which still looked like an anthill poked by a stick. New tents had been pitched, and new tarps, too. (Many of the patients and some of the staff were still reluctant to go indoors.) Evan Lyon, Dr. Lassègue, and Miss Thompson (“Miss” is the Haitian word for nurse) were sitting in the same dark office where we’d left them. Casualties were still coming in, most as transfers from other institutions, but a few directly from the wreckage.

  After an earthquake, there’s only a limited amount of time to save those trapped under the rubble. And although the actual number of persons saved by the superhuman efforts of the rescuers tends to be small, some of those lucky, dusty, and dehydrated souls—like the siblings a few days earlier—were brought to the General Hospital (and other facilities), lifting the spirits of those working there. But in week two, we didn’t expect many more of these “saves.” Lassègue and Thompson (with Evan Lyon, Natasha Archer, and others at their side) spent most of their time on triage—a harsh and crucial part of emergency medicine. Most patients still needed surgical care; some were in renal failure; others needed advanced diagnostics unavailable at the General Hospital. Where should they go?

  The arrival of the USNS Comfort a week and a day after the quake afforded one such site. So did certain MASH units (run by the University of Miami, the Israeli Defense Forces, and other groups) and the network of Partners In Health’s affiliate hospitals to the north and west of the epicenter. (Surgical teams from U.S. academic medical centers had beefed up our critical care in Saint-Marc and elsewhere.) Central Haiti was also home to the venerable Schweitzer Hospital, founded seven decades ago by the Mellon family and still run by Mrs. Mellon’s son. Louise, Claire, and I hadn’t yet left the quake zone, but we knew from our friends that heroic efforts were ongoing elsewhere. One Dartmouth nephrologist, Brian Remillard, had already managed to get renal dialysis up and running in the town of Hinche (where it had never before been available), which heartened us and saved several young lives.

  But even with these new assets in place and the floating hospital in the harbor, many patients needed care that was not available in Haiti. We could send some of them to Boston, Philadelphia, and Miami. Many went on their own to the Dominican Republic, but as we’d later learn, the care they received was not always good, nor was the welcome always warm. (Given the troubled history of these neighbors, most agreed that any post-quake assistance from the D.R. was a big step forward.)

  The reason we could get critically injured Haitians to U.S. hospitals was always the same: personal connections with caregivers and hospitals, many of them Harvard affiliates. One new connection arose thanks to the efforts of my former assistant, Naomi Rosenberg, who was in her second year of medical school at Penn at the time of the quake. After hearing of swamped hospitals and clinics in Haiti, she became downright militant about these transnational transfers, spending her days sweet-talking hospital officials and professors (all inclined to help), working with Partners In Health and Homeland Security on paperwork, and coming to Haiti to accompany patients back to the States. On the day that newspapers announced the end of such transfers (because, absurdly, of fears of “saturating” U.S. facilities), she traveled with two more earthquake victims from Port-au-Prince to Philadelphia—an exception noted in several national papers.14 Within a month, Naomi had set up a home for these patients and family members, and she decided to take the rest of the year off from medical school to tend to their needs. (She details this experience in her essay “Those Who Survived” in this book.)

  Those of us in Haiti felt pretty sure that anyone who ended up in a U.S. hospital would be okay. We were less sure about people who remained in Haiti, except the ones who received care in the giant hospital ship a half mile offshore in the Bay of Port-au-Prince.

  Even transfers to the Comfort required close follow-up. In Chapter 1, I wrote of a young man in respiratory distress whom I’d come across in the General Hospital, and of our efforts to stabilize him through the night until a helicopter could airlift him to the Comfort. When I reached the General Hospital the following morning, I asked our “resident physicians” (Drs. Natasha Archer and Phuoc Van Le, who were, with formidable composure, juggling tasks ranging from providing direct care to coordinating volunteers to transferring patients) about the fate of the gasping young man. (I had scant hope.) They were sure he’d been intubated and transferred to the Comfort but had heard nothing after that. This was unusual because the ship’s staff was meticulous about follow-up. He was alive, barely, when we left the hospital that night. Some of our coworkers had heard that he had died, but three residents weren’t sure.

  The young man therefore remained on my grim list as unaccounted for. His parents began sending out bulletins on the radio, asking if anyone had seen their son. This was unnecessary (he hadn’t gone missing somewhere radio listeners would visit) but to be expected. They wanted to know he was alive or to have, at least, proof of death. Through a mutual friend, Father Fritz, I promised the young man’s parents that I would look for him on the Comfort while checking on some other patients we’d transferred there. Phuoc had been on board several times, and told me that the commanding officers would be glad to receive us. The medical staff on board had some infectious disease patients they wanted me to evaluate and perhaps help move to one of our facilities. The ship also had patients who’d received surgical care, but needed to be transferred where they could receive longer-term postoperative care and rehabilitation. Might they go to Cange?

  The coordination of such services was slowly improving, but such questions remained unanswered for most of the gravely injured. Many would require prostheses and rehabilitation; some were paralyzed and unlikely to walk again. Many of the younger victims would require long-term nursing care, but adequate facilities simply didn’t exist in Haiti. Families struggled alone with such burdens. Haiti’s handicapped citizens had never had the kind of disability rights nor resources they deserved.

  The Comfort is a converted oil tanker, huge and ungainly. But it lived up to its name. The only ways to get there were by boat or helicopter, and we were due to meet a regular transport boat down at the docks. Before the quake, I’d given a talk at the U.S. Naval Academy about the potential significance of a mission like the Comfort. Now that the ship was in the Port-au-Prince harbor, I wanted to see it but feared wasting staff time. Rescue-and-relief teams were still focusing all energies on saving lives.

  Phuoc was waiting for Claire and me at the rundown docks just south of the city center. (The city’s largest docks had been heavily damaged.) This deserted spot was the loading site for Comfort personnel—a mix of civilians (some colleagues from Harvard hospitals), merchant marines, and members of the Navy. Most had volunteered for the assignment.

  As we headed across choppy waters towards the giant ship, Claire and I started reviewing what we hoped to accomplish: we would thank the people taking our referrals, as is customary in medicine; we would check on a few patients, as we’d promised colleagues and patients’ family members in central Haiti; we would see if we could help the on-board staff transfer patients needing skilled nursing care or rehab services on land (so the overbooked ship could take on new surgical patients); we would review some of their infectious disease cases, as requested; and we would look for the thirty-four-year-old question mark looming large in my mind. This would require, we feared, a trip to the on-board morgue.

  We reached the ship in about twenty minutes and walked up a gangplank to a large hole in the hull—the front door for those coming by sea. (It was clear from the noise overhead that the front door via chopper was on a top deck many levels above us.) By this time, the on-board staff was familiar with Partners In Health because we’d been coordinating patient transport from the General Hospital and elsewhere. As we signed in, a senior Navy medical specialist from Jacksonville, Florida, greeted us. (We later became friends and eventually lured him and other Comfort s
taff to visit our facilities in central Haiti to see some of the people they’d saved.) Soon, we were getting the grand tour.

  The ship was vast. We hiked up a few levels to our first stop, the emergency room. It wasn’t crowded, although we’d heard that the ship was as full as it had ever been since being recommissioned as the Comfort almost twenty-five years previously. On a loudspeaker overhead we heard a page for Dr. Mill Etienne, a young Haitian-American Navy physician who had gone to college with Natasha. As a Creole-speaking neurologist, he was no doubt being pulled in many directions during his stay in Haitian waters.

  We didn’t have time, on this first trip, to meet all the goals we’d discussed on the transport boat. But we did see a number of patients—all in good hands—and conferred with those seeking to transfer stable patients back to facilities on land. We also got a good sense of the Comfortʹs quality: it was, truly, an American hospital—not as fancy as Harvard hospitals, perhaps, but clean and efficient and spacious.

  I was wondering how to suggest visiting the morgue when one of the commanding officers pulled us aside and offered to take us there. Everything on board ran by protocol, even the morgue. The attendants were expecting us. They’d been told about the patient we were looking for and had already run through a list of potentials—people in our patient’s age range who had arrived early in the transfer mêlée. An officer advised me that there might be no need to go into the morgue. First he would show me images on a computer, and then, if still necessary, I could examine the unidentified bodies.