Inside the Box | Ten days after the Haitian earthquake on January 12th, my wife and I received a call that there was space available for us to join relief efforts in Haiti. We traveled with Family Health Ministries (FHM), a group that has been in Haiti for the past 15 years, building clinics, schools, an orphanage, and a women and children’s clinic. The group serves several communities in Haiti, from the worst slums of Port Au Prince, to Leogane (the epicenter of the quake), to a tiny mountain village called Fondwa.
We have been to Haiti with FHM several times since 2006. Most of the buildings where we previously had worked were leveled. One surviving building was the FHM clinic in the “Terre Noir” neighborhood of Port Au Prince, close to the airport and perhaps a mile from the slums of Cite Soleil. This clinic, sharing a walled compound with a church and a school, was where we lived and worked for six days.
On the day we arrived, we set up a triage area, a system for taking vital signs, physician rooms, and a pharmacy/waiting room. We were not planning to see the seriously injured—our clinic was intended as an ambulatory care center for the “walking wounded.” Each day by sunrise, there was a line of at least 100 patients waiting on rows of benches outside the gate. We worked through the day with a break for lunch, generally closing up around sunset. With 6 health care providers and 9 other supporters, we saw more than 1,500 patients over six days.
During our time there, we treated broken bones, wounds, infections, and severe dehydration in perhaps 10% of the patients we saw. Each day, we could think of 5 or 10 people who would likely have died except for our help. For the remaining 90% of the patients who came to see us, we took time to listen to each person’s story and to provide basic medications. We treated what we dubbed “Earthquake Survivor Syndrome”: inability to sleep, night terrors, acid stomach, and generalized body pain. Every person who set foot in our clinic was able to tell their story at least three times (in triage, to the providers, and again in the pharmacy). Nobody left empty handed, although we felt incredibly helpless handing out ibuprofen, TUMS, and Tylenol to people in such straits.
Each person on the team had multiple roles; I worked in our makeshift pharmacy, counting pills and mixing suspensions. I also organized the meager laboratory, running blood sugar and hemoglobin tests and the occasional pregnancy test. In the evenings I worked on the satellite uplink and sorted out software issues with the clinic computer. Our resident architect had the much more daunting task of examining standing and fallen buildings through several of the poorest communities in Port-au-Prince. The loss of so many lives in Haiti was directly related to poor quality concrete, insufficient structural support, and non-existent building codes. Whereas steel can flex and retain most of its strength, concrete shatters under duress. Because of this, many surviving buildings are essentially death traps, made up of materials (in his words) not suitable for a dog house.
There are many positive things that came out of our trip to Haiti. In the week that we had to prepare, people showed astonishing generosity. My Bioteam colleagues provided a mobile satellite Internet uplink that we used while bringing the building’s link back online. This allowed the medical team to post blog updates (read mine at http://blog.bioteam.net/tag/haiti/). Friends, coworkers, and local institutions came together providing materials until my living room looked like a medical supply depot.
Some images stay with me: The little girl with severe dehydration who sat next to me for hours, taking tiny sips of rehydrating solution every couple of minutes until she was able to eat a little and walk home with her mother. The man who began demolishing the building next door to the clinic, using a 5-pound sledgehammer and the strength of his arm. “If he hasn’t given up hope, how could we?” became a touch phrase on the team. The people who came to see our unshaven and motley crew of providers were dressed in their Sunday best—they somehow found a way to shine their shoes and press their shirts even though they were sleeping under tarps near their ruined houses.
“How is the country doing?” people ask since my return from Haiti. “Badly,” I reply. I’ve seen stories in the media that things are “returning to normal,” but as someone who has visited Haiti on a few occasions, this is simply not true. What is true is that the people who were going to succumb to trauma have died. The United Nations (UN) estimates that between 100,000 and 200,000 people were killed in or immediately after the quake. Perhaps those who claim ‘normalcy’ refer to the fact that most of the visible bodies have been cleared from the streets, and the backlog of funerals is beginning to clear.
Life has resumed in Haiti to some extent because it must, but in a constellation of refugee camps rather than in an impoverished but functional city. The UN uses the acronym “Spontaneous Temporary Settlements” rather than the colloquial “tent cities.” They estimate nearly 600 STS city-wide with an estimated 1 million people living in temporary shelters in and around Port Au Prince. (Perhaps another half million people have abandoned the city for a countryside already wracked by poverty and deforestation, and inhabited by subsistence farmers.) These tents, tarps, and pieces of scrap will have to last through the next hurricane season, until major portions of the city are razed, the rubble is carted off, and the buildings rebuilt. Even three weeks after the earthquake, we saw the first signs of tuberculosis, malaria, cholera and other communicable diseases. Without aggressive preventive measures, these deadly and preventable diseases will characterize life for many in the STS for years to come.
Despite all of this, the Haitian people are bearing up remarkably well. We saw the same amazing resilience, ingenuity, and deep faith that we have come to know and love. We saw those with little giving of what they had to help others with nothing. There is a Haitian saying that held true: “If there’s enough for two, there is enough for three.” Certainly there were occasional scuffles and confusion over food or clean water, but these were the exception rather than the rule.
Technology in Haiti is highly decentralized. Wherever possible, systems are configured to function without a central power or communications grid. Because Haiti leapfrogged copper connections in favor of a loose network of wireless and satellite networks, the cellular networks stayed online through the aftermath of the quake. That being said, electric power is intermittent—every household and business that can afford it has multiple methods of generating and storing electricity. Most Haitian facilities know how to route power to various subsystems, conserve limited electricity and make do without when resources are scarce. Decentralization meant that even without city power, we had a solar panel generating electricity and (eventually) a reliable Internet connection through the satellite dish installed on a neighboring church. Unfortunately, one cannot ship antibiotics over TCP/IP. Even the best telemedicine requires real medicine on the ground.
By contrast, Haiti’s governmental and social organizations were highly concentrated in Port Au Prince and were decapitated by the earthquake. Death was remarkably egalitarian. Because of the timing of the quake, some groups escaped largely unscathed, while others were decimated. In many cases technical schools, businesses, and some entire government ministries were depopulated—the national nursing school lost every member of the second year class.
Where do we go from here?
First and foremost, we must continue to pay attention to Haiti and to aid the Haitian people in rebuilding their country. The initial outpouring of generosity needs to convert into a steady commitment over the next decade. The crisis has already faded from our 24-hour news cycle, and it would compound the tragedy if our massive initial effort merely stabilized the wounded, allowing them to die in a raging epidemic of preventable disease.
As much as possible, Haiti needs support to do its own rebuilding. Haitians are looking to earn their livelihood—but many of the institutions that used to educate and employ them have disintegrated. Medical, construction, communications, and government teams need to partner with Haitian-run organizations and provide investment, work-exchange, training, and long term partnership to help the country get back to a position of stability.