Haiti After the Earthquake (15 page)

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
staff 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
Comfort
ʹs 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.

The second image on the screen was my friend's son, in a black body bag. Only his face was visible, but it was him, and I said so. “We are so sorry for your loss,” said the officer. It was formulaic, and I knew he'd been trained to say it, but I was grateful nevertheless for the civility and compassion that I will always associate with the ship. I was also grateful that I could count on Father Fritz to break the news to the young man's parents. Another name had just moved from one grim list to another.

The math was becoming clearer, and the grimmest list of all was growing. Sober estimates a week or two after the quake were that more than two hundred thousand had perished. This figure included at least a quarter of Haiti's civil servants. (Almost all federal buildings had collapsed.) I wasn't sure how such numbers were generated, but I suspected the tally would continue to grow.

So, too, would the tally of the displaced and homeless. Each day more spontaneous settlements appeared in the few remaining open spaces in Port-au-Prince. Some estimates pegged the number of displaced at close to a million; we later learned that these were too low. Without water, sanitation, and food, the camp dwellers would be in
trouble. As President Clinton had predicted, shelter would prove the hardest nut to crack; epidemics of waterborne disease and gender-based violence were growing concerns.

These challenges—housing, water, and sanitation, but also gender-based violence—were questions of recovery and reconstruction, not rescue and relief. I'd made a pledge to focus on building back better, so a few days later, I headed back to the airport, at Clinton's request, to help prepare for a donor conference in support of Haiti's reconstruction. Although the previous ten days had been grueling, working with patients and their caregivers seemed somehow less daunting than an international meeting. But medical care was not going to rebuild Haiti. The meeting was in Canada, so I started looking for a warm coat.

“Donor conference” wasn't, I soon learned, the correct term for the gathering in Montréal on January 25. It was rather a “ministerial conference” to prepare for a donor's conference on Haiti's reconstruction. It was a meeting about a meeting. Recovery would require billions of dollars in capital, and one didn't have to be a trained economist to see that those billions weren't going to come from within Haiti. So I was to join Jean-Max Bellerive, Gabriel Verret (a Haitian economic advisor), Edmond Mulet (Special Representative of the UN Secretary-General), and Gilles Rivard (Canadian Ambassador to Haiti) on a small jet bound for Ottawa. Canada was one of the largest per capita donors to Haiti, and Quebec and Haiti have particularly strong ties. Michäelle Jean, then Canada's Governor-General, is of Haitian descent. I knew her slightly and was hoping to see her and some other Haitian friends when we reached Montréal.

In Port-au-Prince's damaged airport, still redolent of a morgue, I ran into Marie-Laurence Lassègue, the Minister of Culture and Communication and the wife of Dr. Alix Lassègue. Like Leslie Voltaire, she'd held a number of cabinet posts in post-Duvalier Haiti. We'd known each other for years and had, before the quake, discussed making a joint trip to Rwanda. The deafening racket of arriving and departing aircraft made it hard to catch up. I managed to ask her, as I
had asked other surviving civil servants, whether there was anything we could do to help. She said she could use a satellite phone. In disbelief, I handed her one a colleague had given me a few days before. (I hadn't even used it.) That the Minister of Culture and Communication still needed a satellite phone two weeks after the quake spoke to the basic deficits paralyzing Haiti's government. She was probably accustomed to attending meetings about meetings, and wished us well.

As the Canadian jet lifted off the runway, I tried to suppress the sense that I was abandoning quake victims in need of emergency medical care and colleagues trying to provide it. Most of the passengers on the plane hadn't slept much since the quake and were nursing their own private thoughts or soon asleep. Before long, we flew over Haiti's northern coast, and I saw a giant tourist cruise ship resting in the turquoise waters. I'd written disparagingly about the tourist industry twenty years before.
¹⁵
But after the quake, the ship—and the undamaged northern reaches of Haiti—looked serene and somehow hopeful.

The plane made a brief stop in Turks and Caicos to refuel. Several people at the tiny airport there were collating diapers, clothes, and other relief materials for Haiti. Bellerive, especially, was moved by this modest gesture. Across the world, people were thinking about his country. There were other stirring examples: Partners In Health's teams in rural Rwanda sent 10 percent of their salaries to their colleagues in Haiti; they also hosted, along with Didi and our oldest daughter, Catherine, a series of fundraisers in Kigali; colleagues in Lesotho raised $20,000 in two weeks; colleagues in Peru helped out on the difficult border between Haiti and the Dominican Republic; some of my closest friends and many of my former students were camped out in the Boston war room; the New York businessman who'd lent us a warehouse in Miami had continued his support. Spontaneous expressions of solidarity like these might go unnoticed in professional development circles, but they were encouraging to consider en route to a meeting about long-term reconstruction.

We stepped off the plane to some diplomatic rigmarole and a biting cold. A Canadian official handed me a coat and scarf, and the
delegation packed into a series of town cars bound for a meeting in Ottawa. I wasn't needed at that meeting and headed directly to Montréal. Images of the flattened city left behind invaded my mind's eye as I looked out over the frozen landscape.

My colleagues from the UN met me in Montréal with briefing documents, a change of clothes, and yet another coat. The Canadian foreign ministry hosted a dinner at the hotel attended by delegates from perhaps twenty countries—another sign that the eyes of the world were on Haiti.