Haiti After the Earthquake (49 page)

Central to the
Itorero
is the message that Rwandans of all ages, sexes, and social classes—from community health workers to teachers, university professors, students, and ordinary citizens—contribute to the development of their country. A lesson that we as Haitians can draw from this approach is that we must not wait passively for governments or NGOs to provide solutions to our problems, but must actively partake in the reconstruction process.

The great strides that Rwanda has made over the past seventeen years offer not only hope but also a way forward for countries struggling to rebuild in a post-disaster context. For our friends in Rwanda in the mid-1990s, this progress was perhaps unimaginable, following unprecedented destruction and terror. For Haitians, it offers one blueprint for the type of transformation we seek in the wake of our own tragedy.

With the support of President Kagame, and the remarkable teams in the Ministries of Health, Education, Foreign Affairs, and Local Government, the Haitian community in Rwanda established a Haiti-Rwanda Commission to disseminate lessons from Rwanda's experience in Haiti's rebuilding process and foster cooperation around challenges common to both countries. In my role as its Chairwoman,
I am charged with facilitating exchanges between my colleagues in Rwanda who have been at the forefront of the country's renaissance and my fellow Haitians who seek to draw both hope and pragmatic policy approaches from their progress. In the last several months, we have initiated a series of projects to bring together both the leadership and people of both countries.

A focus of my efforts as chair of this Commission has been on the youth, which represent Haiti's best hope for a brighter future. At the Commission's request, the Government of Rwanda offered fulltuition scholarships at the National University of Rwanda for five Haitian students whose studies were disrupted by the earthquake. These students, who we hope will be the first of many to study in Rwanda, not only will have access to an undergraduate education but will return with the skills and commitment to rebuilding our country. Rwanda's was not merely a gesture of solidarity but also a measure of the progress that was possible.

This nascent cooperation has given birth to a much more ambitious initiative to bring students to institutions of higher education across the African continent for undergraduate studies. Building on the South-South Cooperation, we have been working to secure opportunities for Haitian students in other countries in the region. Lesotho, for example, has already made a similar pledge following my visit to Maseru. Other nations will surely follow.Our mission is twofold: contributing to the development of a new generation of leaders in the country while addressing the educational crisis created by the earthquake. The Commission has set the goal of bringing two hundred students to study at institutions of higher education in Africa in 2012. It's an ambitious goal, but my work in Rwanda, and my visits to other countries in the region, have convinced me that such exchanges will help young Haitians learn about alternative models of recovery and also allow them to serve as living links between our wounded country and the continent that also calls us home.

 

 

 

O
n Saturday, January 16, 2010,
I stood battle-weary on the tarmac at Port-au-Prince airport. A huge Canadian Airlines aircraft had just landed, bringing tons of supplies and a medical team. Scores of small private aircraft also dotted the tarmac. Military airplanes roared into position, and men and women in combat fatigues walked with a mission across the runway. Behind us, hundreds of Haitians and foreign nationals were lined up in the shadow of the fractured airport terminal building, waiting for a flight out.

The previous four days had been some of the hardest of my life. I had seen the city that I called home flattened. I had witnessed unimaginable pain and loss. Working in a makeshift clinic at the United Nations logistics base, I had seen some of the best and worst of humanity. Now, waiting for a ride home, I felt that the airport, my airport, was being invaded. Newcomers descended the steps of highclass private jets sporting “Earthquake 2010” t-shirts hot off the presses. Stethoscopes at the ready, boxes of granola bars in the backpacks, they posed for team pictures. It was a civilian and a military invasion, a “save Haiti” invasion.

I am a doctor—an internist, an infectious disease and tropical medicine specialist, and a public health practitioner. I have spent the last seven years working in Haiti with Partners In Health, caring for patients and trying, with the support of a large Haitian team, to address some of the underlying causes of disease amongst the poverty-stricken. When the earthquake struck on January 12, 2010, I was in a meeting with my colleague Kim Cullen and members of the World Food Program in Port-au-Prince. We had been planning a research project to document the effects of food assistance on the rural poor living with HIV. The area where we met, in the foothills of Petionville, was later documented to have experienced some of the most severe shaking during the earthquake. Kim and I spent the night on the driveway of the WFP building, setting up a makeshift first aid hospital.

That night was hellish. As scenes of devastation unfolded in the streets around us, a small group of us worked as a team—going outside the gates to help where possible, lifting rubble, carrying the injured inside the gates, comforting children who had been separated from their families. Some sat glued to the spot, paralyzed by fear as hundreds of aftershocks threatened to topple the already damaged buildings beside us. Others leapt to help in any way they could. An administrator became comforter of the dying; a researcher held the hand of a small child separated from his family; my driver, Médé, used his car jack to free trapped limbs; Kim became a first-class nursing assistant. We witnessed injuries that no one should have to suffer, deaths that were senseless, pain that must have been unbearable but was borne. As helicopters flew overhead, the driveway became a temporary refuge—survivors huddled together, seeking solace from one another. A couple sat cradling their adult son, rocking him back and forth, even though he had already bled to death from a leg injury.

During the night, a certain kind of order was established in the driveway. A few individuals in particular were calm and decisive in the face of the chaos; I later learned that they were ex-servicemen in the British Armed Forces. Kim and I triaged patients with red stickers from research supplies salvaged from our car, which was buried beneath the wall of a nearby house.

Few things are more desperate for a physician than the knowledge that a medical problem is curable, treatable, or manageable with the right assortment of basic medical supplies only to have none of them: a tighter tourniquet, a pain medication, sterile water. A driveway and a first aid kit are not meant to treat mass casualties. When a handful of Argentine soldiers from MINUSTAH arrived to take some of the injured to medical care, we felt as though our work had not been totally in vain. The soldiers appeared to me to be almost heaven-sent. Where the injured would be moved, I did not know. But moving patients seemed to offer the only possibility of surgery or proper wound care. Given what I later discovered about the state of the city's hospitals post-earthquake, however, moving these five or six injured was unlikely to have made much difference to their lives. Most hospitals lacked even the basics.

The driveway where we worked was part of the UN headquarters collection of buildings, and many of us worried that when vehicles came to move UN staff, Haitian nationals might be left behind. We were promised by those in authority that everyone on the driveway would be brought to the same place. So, when trucks arrived the next morning and UN peacekeeping (MINUSTAH) soldiers entered the building compound to escort us out, we packed up our medical kits. The injured, all but one of them Haitian, filled every empty spot on the benches of the trucks. Sitting side by side with them were disheveled international UN staff, many of whose colleagues and friends were missing and suspected dead. Having carefully watched out for us during the evening, our colleagues from the UN ensured us that Kim, Mede, and I were included in the group of evacuees.

I waited to be sure that none of the patients on stretchers were forgotten. A man with crushed feet, who had pulled on my shirt, begging for help every time I passed by the previous night, looked me in the eye as I climbed up to the last seat in one of the trucks. A MINUSTAH soldier, weary-eyed, clearly pained by what I knew to be the loss of his colleagues just 100 meters away at the UN headquarters office, took time to reassure me that he would take responsibility for this man being moved. He urged me to take my seat. I sat
beside a short, dark-skinned soldier who closed up the truck and tapped his long gun on the back to signal that we could move off.

The white canvas truck made its way through the battered streets of Port-au-Prince while pedestrians handed us their injured. “He's a police officer” (a young man with a serious head injury). “She was at the General Hospital” (a small child with burns to her face). Somehow, we became a lifeline for Haitians. Getting in the truck meant getting care—or at least the hope of getting care. We moved at a snail's pace down the rubble-filled streets. Block after block revealed familiar landscapes gone. Streams of people walked with determination—to find their families, to check on their homes, to search for the missing. Cries of pain and wails of despair filled the air.

Our convoy of trucks loaded up more and more of the injured. The Haitian sun gave no reprieve. A mother sat facing the street on one of the army cots that we had placed in the space between the benches of the truckbed. As she held her child, she also tried to comfort the stranger on the cot. The man had a head injury and struggled to move around, confused and bewildered. I believed that his injury was life-threatening. The UN soldier took his plastic water bottle and cut it to make a drinking cup for the infant. Later he gave up his seat as another injured person was handed in to us. Then he found a position that would block the sun from the child's face, relieving the mother of at least that job. Together we found some cloth, and seeing me struggle to tear it, he put away his gun and cut the cloth into sections that we handed around to protect against the heavy dust that burnt our eyes and our lungs.

At that time, as a survivor of the earthquake and as a doctor with a nongovernmental organization, I was glad that MINUSTAH was there. If it weren't for the soldiers, how would I have left the grounds of the building, unfamiliar as I was with all but the main roads of Port-au-Prince? How would these patients have received care? I felt a sense of safety somehow and comfort in the fact that we were en route to what I believed would be medical refuge for these patients.

Moments later, reality struck. My truck, having somehow become separated from the others during the drive through the city, came to a stop in front of the Argentine military hospital facing the UN
logistics base. A female soldier at the gate was denying us entry. Knowing that I was the only doctor, the blue-helmeted soldiers in the front of the truck gestured for me to get out, and so I did, accompanied by my new shade-providing comrade. The soldier at the gate spoke neither French nor Haitian Kreyol, the two national languages of Haiti. My Spanish being limited, I spoke in English. She gesticulated wildly that we could not enter. I stood just inside the gates, outraged that a UN truck could not enter a UN hospital. I tried to explain that the acting head of the UN in Haiti had guaranteed that we could be brought to a hospital.

“No Haitian nationals can be taken care of here; we are full,” a male in uniform lied. Behind him, scores of mattresses were piled one on top of the other, and a medical team stood anxiously by, waiting for patients, their mandate to care for UN staff members, not Haitian civilians. When my Sri Lankan escort interrupted and said “Sir, she was told that she could bring patients here,” he was given a fierce look. When he continued. “Excuse me sir, permission to speak,” he was again reprimanded. After four or five more minutes of pleading, then pointing out angrily that they didn't have any patients in their wards, and then asking him to call his boss, all to no avail, we turned around and boarded the truck.

I cursed the hospital as we backed up noisily and headed toward the UN logistics base across the street, where the other trucks must have gone. We were easily granted access but were told that there was no hospital—just a makeshift clinic under semipermanent tents. Here I spent the next three days working almost nonstop with other volunteers, trying, again with almost no supplies, to provide some kind of semblance of medical care to the seriously injured. Many volunteers worked around the clock; some were UN staff assigned to other things but helping here anyway. A British ex–Royal Air Force engineer kept up my spirits. We lifted and moved patients, found them food and water, set up our open air operating room, and transferred hundreds of the most seriously injured to vehicles for the airport and evacuation to Martinique, Dominican Republic, Miami, Canada—anywhere with a functional operating room was a better option.