IMAGINE ALL OF the Federal buildings in Washington collapsing in less than a minute killing 30-40% of our government workforce, crippling the tax collection system leaving the government no money to pay salaries or overhead. Our government, which seems to barely work at full capacity with gleaming buildings and a gargantuan budget, would come to a halt.
This is the state of Haiti today. Arriving again in Haiti, five weeks after we first landed in the chaos of the first days after the earthquake, the tarmac of the airport was eerily quiet, almost deserted. Some things had changed. There were more tent camps, a few more latrines, less rubble in the roads, more mouths fed, less acute medical injuries and trauma, more tents instead of open air surgical wards at the University Hospital where we were the first surgical team after the quake. But the layers of trauma were more apparent. At the University Hospital, the entire second year nursing class was crushed and died in the nursing school. Teachers and nearly all the schools were destroyed. During the five o’clock hour of the quake all the priests and seminarians met in their churches. Most of the priests, the future priests and their churches are now gone. The Universities with most of their precious intellectual capital of professors and the best and the brightest of Haiti are gone.
With few to govern, few to teach, few to learn, and few to help the people pray and soothe their souls, with the political, cultural, educational, and spiritual amputation of a nation, the world community must recognize the deep, cold, dark and powerful vacuum left by the quake that sucks deep into the heart and soul of every Haitian.
Now imagine New York after a similar disaster, a city of 8 million with a loss of a million citizens, with four million people living in the streets, with winter about to come and a marginally functioning government without resources to help. That is the state of Port au Prince today. With our global attention deficit disorder, we have moved on. The “donate to Haiti” banners at the bottom of our television screens have disappeared. At the Ebolele Hotel in Port au Prince, where many of the major networks stayed, there was one reporter from CBS left on ground, and he too was leaving in a week. Only Al Jeezera, committed to reporting on the poor and Third World countries, is moving in en force build a new Haiti bureau.
We used a hotel room occupied by ABC until a few days prior. Piled nearly to the ceiling in the midst of a city of dehydrated and thirsty Haitians, were cases upon cases of Dharasni filtered pure water. The outpouring of money and aid to Haiti in the immediate aftermath of the quake is still piled half a billion dollars high waiting to be distributed, with only a fraction spent. There are few mechanisms to receive the funding. Absent are the governance, management and accountability necessary for intermediate needs or effective re-building.
In the best of times, their equipment was inadequate for a rural clinic in Alabama…
We went back to the University Hospital, across the sprawling, crumbling compound patients still were crowded in sweltering tents under the hot Haitian sun. Most of the hospital staff still has not returned to work because their homes were destroyed and many fled to distant locations to find shelter with family or in tent camps, and most had not been paid in many months, even before the earthquake. Many of the NGO’s who came with us the first week, were now gone or are soon to leave, fulfilling their mission of immediate disaster relief. With the outpouring of aid, the nation’s largest and public hospital, which trains nearly all the physicians and nurses in the country, still has no sheets for the beds, still has no wash basins and towels to clean the patients, still doesn’t not have a generator capable of stable power to run even the copier and printer in the makeshift administration office.
In the best of times, their equipment was inadequate for a rural clinic in Alabama, and now in the time of greatest need they still have no EKG machines, pulse oximeters (to measure blood oxygen levels) glucometers to measure blood sugar, a view box to examine X-rays. Imagine the most important University Hospital in the United States without a CT scanner. There was not even the most basic and cheapest medication (chloroquine) to treat the cases malaria and cerebral malaria increasing now that the rainy season has started.
When I asked the director of the hospital, Dr. Alix Lassegue what he needed most, he said 1000 tents for his staff, and enough money to pay their salaries to encourage those who survived to return to work. Those who had not lost their homes, or who could stay with friends did come. Dr. Patrick Charles, a pediatrician who worked at the hospital before the quake was taking care of the dozens of children with marasmus and kwashiorkor (severe malnutrition) in the pediatric tent. He had been working 12-hour shifts without pay since the earthquake and no food all day, while he fed starving children therapeutic milk and Plumpynut, a protein and vitamin rich food.
But the problems of the Hospital are a microcosm of what is endemic to Haiti now. A medical school professor makes $500 US dollars a month. Those in private practice can make $5000 making it difficult to rebuild any enduring, effective public hospital.
If our medical school professors made $20,000 a year, while their colleagues in private practice made $200,000 a year our medical schools would collapse. These problems are endemic and will not be overcome easily. The Haitian heart and spirit, their uninvited suffering for centuries call us out of our small worlds to join with them in their struggle to rebuild their country. Mrs. Marlene Thompson, the administrator of the University Hospital lost her home during the quake and has not left the hospital campus in six weeks. She sleeps on a cot in a back room and holds the hospital together through the fierce love for her people and the patients. We cannot leave her alone on a cot in the back of an abandoned hospital ward.
But the question of how to join, how to partner, how to help without dominating and imposing our concepts of development remains as open and rough as the denuded, deforested country. The nation of the first (and only) slave revolt in 1804 was embargoed and isolated in its earliest days by America and the world and then forced to pay reparations of over 400 million francs over many decades for “taking” the French land. Americans occupied and controlled Haitian government directly or indirectly for most of the 20th century and built into the society what Paul Farmer refers to as “structural violence”. It is no accident that there are no trees on the Haitian side of the island of Hispaniola while the Costa Rican side is lush and tropical. It is no accident that there are no industries, no natural resources left, no substantial ways for Haitians to support themselves. This is not just the result of coups and corruption but of centuries of policies that have made the problems structural and embedded.
It is six weeks after the quake and there is no one fully in charge. The UN is observant but not acting, the international aid organizations are mostly disorganized, isolated in silos and uncoordinated, and the government infrastructure had its staff and sources of revenue amputated. The World Bank, International Monetary Fund, various governments are all are scrambling for control of the spoils of the quake. The reparations the world can pay back to Haitians is to accompany them in the process of creating institutions that can sustain civilizations with respect and guidance and co-creation – health care, industry, agriculture, governance, and justice. The collective intelligence and skills of the international community can solve this problem in solidarity with the Haitian people while preserving their sovereignty.
The Haitian people accommodate. Perhaps that is why we ignore them. The dancer who lost both her feet danced for us in her bed, swaying her body and waving her hands entertaining us, imploring us to tell her story. On Sunday morning in Cange, in the central plateau of Haiti where so many escaped Port au Prince to receive care and shelter, the Church was turned into a hospital ward, and Sunday services were held in an old auditorium a thousand people huddled into the building and spilled into the courtyard to celebrate life, to help each other. This was Zanmi Lasante, Partners in Health, the place where Paul Farmer created a vibrant health center and community out of the most desolate place in Haiti 25 years ago. That morning Paul translated the stories of those who survived the quake, who came to Cange to get help and shared their gratitude, their hope, and their love with all of us. There is only gratitude and patience and fortitude in the face of so little.
And soon there will be even less despite the aid. The weather report in Haiti is not good. Storms are coming, rain will wash over the “tent” camps which are often just bed sheets thrown over some sticks housing thousands without sanitation. At the Prime Minister’s house in Port au Prince 3500 people are camped on the ground with four port-a-potties that haven’t been serviced and are piled high with human feces. Children wade through feces in these camps. Some vaccinations against typhoid, measles and yellow fever had been given, but there is no way to vaccinate again cholera, tuberculosis or malaria. The earthquake set the stage for disasters of overcrowding, poor sanitation, and infection. The weather is not good in Haiti.
But the opportunity exists for a partnership model of support for governance aided by the international community so the aid can be effectively deployed, the people house, fed, given clean water, sanitation and soon, jobs to pay them to rebuild their own homes, economy and society. Our army should stay for humanitarian aid. They came when we called them to the hospital and help keep the aid workers and the patients alive. We can bring sunnier days to Haiti. But we have to keep our attention, money, support and participation focused and constant.
The University Hospital needs help now and is caught in the vacuum where aid cannot get through. It is close to our hearts because it is where we spent the first week after the disaster helping bring it back from a standstill and shock. In order to help the hospital, Partners in Health has helped create a small foundation to support the hospital directly, which serves the poor. It is called, at least for now, “Friends of HUEH” or French for University Hospital. Please donate to Partners in Health at http://www.pih.org/and request the funds be for “Friends of HUEH”. A small amount can be the difference between good care and no care.
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To your good health,
Mark Hyman, MD