Haiti After the Earthquake (4 page)

In one tent, two dozen cots were packed into a space the size of a suburban kitchen. The patients on these beds were mostly quiet, with x-ray printouts clipped to the end of their beds; a few were groaning in pain and, post-op, needed nothing more than pain meds, which were in short supply. Most still wore clothes they'd been wearing when the quake hit, though pieces had been sheared away to expose their injuries: a broken leg here, a crushed arm there. Many had multiple fractures, and some had already undergone amputations. Family members often hung close to patients, doubling the number inside the small tent.

A group of nurses from Boston, sweating in the close heat, managed to keep things together—even though they didn't speak a word of Creole. These nurses were among the unsung heroes of the first weeks after the quake. Occasionally a surgeon—in this tent almost always an American—would come to check on a patient with whom he or she could not converse but whose life could be, and often was, saved by surgery. A few Haitian nurses' aides were working in the tent, but they spoke no more English than the patients did. We were lucky enough to have a few young but experienced Harvard doctors—one, in addition to Claire Pierre, was an American internist, Evan Lyon—who spoke fluent Creole and performed superhuman feats of translating inside and outside the tents, while also providing medical care.

I watched my former trainees (and there were many others, Haitian and American) with pride and gratitude. Claire could not be dissuaded from working twenty hours a day, taking no time to mourn the loss of many lifelong friends or the fact that her mother's home had been flattened, taking with it nearly every memento of her childhood. Evan stuck close to Lassègue, trying to help manage the influx of volunteers, some of them prickly, while nursing his own grief. (After a dozen years with Partners In Health, he'd lost friends, too.)

Claire and Evan were soon joined by a handful of medical residents from Boston, one of them Haitian-American and all of them willing to work on the logistics of connecting the disparate worlds of the patients, Haitian providers (from homeless, hungry medical students to returning nurses), volunteers, and even the military. The U.S. Air Force 1st Special Operations Wing took over coordination of the airport within days of the quake; working with them afforded the only means by which we could airlift patients to the ship or other remote sites.
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It was, for all of us, an entirely unprecedented circumstance. We were never sure what to do and were left with doubts about “disaster-relief expertise,” even when those we encountered proclaimed surety. We wanted to be rescued by expertise, but we never were—this was the long, hard lesson of the quake.

To give readers a sense of what it was like in those first few days after the quake, at least for some of the doctors and nurses and patients, let me describe the events of a single afternoon and evening at the General Hospital. At least I believe it was a single night, a very long one, although none of us were taking notes. My guess is that it was day eight after the quake, because the
Comfort
was steaming into port and tents dotted the hospital grounds. These tents—a Red Cross tent, a Dartmouth tent, a Médecins Sans Frontières tent, and on and on—were at times like fractious federations. (There were even Scientologists in bright yellow t-shirts, though I didn't know how to explain to my Haitian colleagues what they were doing because I hadn't a clue what it was.)

In one tent, I spied a Haitian doctor standing anxiously over a thirty-four-year-old man who thought he'd escaped serious injury when his parents' house collapsed around him but now presented in respiratory distress. He looked whole but was gasping for breath. I was surprised when he addressed me by name and in English: “Dr. Paul, I know you from Cange. Help me, please. I can't breathe!”
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This was the first and only time a patient there addressed me in English, and I immediately recognized him as the son of an acquaintance from Port-au-Prince. I had stayed many times with my closest Haitian friends, Father Fritz and Yolande “Mamito” Lafontant, in a house across the street from the one the patient's father was building in a neighborhood called Christ-Roi. (Mamito and Father Fritz had taken me in as a volunteer in 1983 and would later help found Zanmi Lasante and Partners In Health.) Much of the area, including the young man's large stone-and-cement house, had been leveled by the quake, while the Lafontants's house, though damaged, was still standing.

“How are you? What happened?” (I responded in Creole, not wishing to burden the man with a language that his wife, standing by his side, did not understand and which he spoke imperfectly even when not short of breath.)

His story came tumbling out in shreds: part of a wall had fallen on his legs; it took him an hour to free himself, but he was soon up and
helping others in the neighborhood. “I felt okay,” he said, “but my right leg hurt.” He touched his right thigh. “It was only three days later that I suddenly couldn't breathe.” The gasping itself was unnerving; his oxygen-saturation level suggested he should not be able to speak at all. I asked one of the Boston nurses, from Children's Hospital, to give him morphine, which pretty reliably eases such respiratory distress. What we really needed was to get him transferred to the
Comfort
and hooked up to mechanical ventilation—a “breathing machine,” a procedure that would have been step one in a properly equipped hospital—while we tried to figure out what was wrong with him. But it was almost dark when he arrived, and the choppers needed to get him there were grounded for the night.

A physical exam revealed a high fever and minor abrasions on his legs. (Even these can be portals of entry for infection.) He'd been treated with antibiotics in another facility—the General Hospital was the third one in which he'd sought care—but an x-ray suggested severe pneumonia. We gave him a broad-spectrum antibiotic, and tried to treat him for blood clots that might have traveled from the large veins in his legs to his lungs. But we didn't have the right formulation of blood thinner on hand.

In minutes, the morphine kicked in and he was feeling well enough to ask, in one of his first complete sentences, for something to eat. His oxygen-saturation reading had improved some, but we still wanted him out of the tent and onto the
Comfort
as soon as possible. Although the morphine was responsible for his improvement, it wouldn't last long, nor would it treat his problems at their root. Fearing he wouldn't survive the night without mechanical ventilation, Evan and others tried to line him up for transfer.

We had many other patients to see that night. A slight elderly woman at the other end of the tent was wracked by the spasms of tetanus—the first of many cases we would see that week and the next. White-haired and weighing about ninety pounds, she had tears rolling down her cheeks. Every few minutes she would go rigid with potentially bone-breaking and suffocating spasms. The slightest stimulus triggered them; she needed to be in a dark, quiet room. But that would move her far away from medical care because, with frequent
aftershocks shaking the foundations of the hospital, no one wanted to work inside.

At one point, I ducked outside for a breath of fresh air, and saw a young woman, perhaps twenty-five, lying on a stretcher outside, all alone in the pitch dark. Had she died? No, she was breathing and warm to the touch. I said hello and asked how she was feeling; she raised her hand and said, simply, “I think my legs are broken.” I looked at an x-ray that had been tucked under her feet: both of her femurs were fractured high up, near the pelvis. I asked if she'd received anything for her pain; she had not. She had no family presen—that was clear. She feared that her parents and infant daughter had perished. “The roof fell on us,” she said and began to weep quietly. The best feeling I had during that wretched evening was bringing her pain medications, which soon led to what might have been her first sleep in days.
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Her orthopedic injuries could be repaired, but as far as the emotional ones, who knew?

On one of those first days, Ophelia Dahl, the director of Partners In Health, had come down in a plane full of supplies and surgeons. She had also been working in Haiti since 1983, and it had changed her life as it changed mine. She was at the General Hospital that night, if memory serves. “Why aren't there more pain meds?” was one of her first questions. She was headed up to central Haiti to check on our teams there but was spending that night in the city. Ophelia and I were surveying the spectacle in the hospital—the misery and the pain, but also the mercy and compassion—and thinking the same thing: why Haiti?
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As would be the case on many evenings, we had no shortage of work and no reason to leave, except if we didn't we would be exhausted and useless the next day. I tried to corral my coworkers into rest. It was almost midnight, and we'd made some progress: we'd secured for the young man in respiratory distress the promise of a transfer to the
Comfort
by helicopter at daybreak; the old woman with tetanus had received antibiotics and heavy doses of diazepam (she would make it, I thought, if she didn't require mechanical ventilation); a number of patients with major trauma were now, like the young woman alone in the dark, resting thanks to pain meds.

As we prepared to leave, I heard an argument breaking out in English. A couple of Haitian-American doctors were yelling at some incredulous American surgeons. They were clashing over control of the operating rooms, which had never attracted much interest during all the years that poor Haitians in need of surgical interventions died unattended, even in this hospital of last resort.
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One of the surgeons seemed to want me to referee the argument, but although there was much to say, it seemed the very worst place and time to say it. No one had energy to mediate disputes. So I hid in Claire's mother's car, waiting for Ophelia, Evan, and the others, until we finally left the hospital for houses further up the hill, away from the worst damage. We were spent. As our car climbed through a wrecked and darkened neighborhood, a dog darted in front of us and we heard a thud. No one said a word.

Most of my colleagues were staying with Claire's extended family. (Her godmother had taken in scores of volunteers and newly homeless family members, including Claire's mother.) But I headed back to the wooden (and thus safer) house of close friends in Pétionville, arriving shortly after midnight. They lived far above the heat and odor of the vast, blacked-out city below. My host Maryse had even put flowers in my room, as she always did. There was a bottle of water by my bed and, aside from the white noise of a whirring fan, blessed silence.

But I couldn't sleep. In the dim reaches of misery, insomnia is a constant companion, especially when twenty-first-century people die of nineteenth-century afflictions—minor injuries and simple fractures as well as pneumonia, tuberculosis, and other infections, such as tetanus, preventable with a vaccine available for pennies. I was pursued by the sights and smells and sounds of the day: the unrelieved pain; patients and doctors sprinting outside during an aftershock; the young man in respiratory distress (Had we given him everything that might tide him over until he reached the ship? If only we had more blood thinners and the right lab equipment!); the arguments and competition between different dispensers of “disaster relief” over the privilege of looking after people who had long been neglected; the grief of my former students (among the most competent
of the lot, but they too were spent); the solidity of the hospital's Haitian leadership; the unrelieved pain (Why didn't we have, at the very least, more analgesia for those with awful trauma?); and pervading all, the charnel-house odor from the morgue and under the rubble. I tried especially to forget the morgue. But counting sheep kept turning into the grim process of counting the dead. I even thought of the hapless dog. The image of the man who couldn't breathe was still with me as dawn approached. (Had he survived the night? Surely the floating hospital could save him?)

Hanging on to this hope, I fell into a deep sleep. But after just an hour or so, I was shaken alert by a large aftershock. The wood of the house strained and creaked; the paintings in the room tilted; the water bottle at my bedside started to tremble. My host yelled for us to “get out of the house right now!” The sun was coming up, and I watched impassively as the water bottle fell to the floor. I heard those in the house scrambling to get out, and saw, in my mind's eye, the crushed limbs of people trapped in countless other houses during the quake. I knew I should move and thought of my children, who had spent the recent holidays in Haiti but, by the grace of God, had been spared the fate of so many a few days after they left. It would have been prudent to bolt down the stairs and into the street.