Haiti After the Earthquake (51 page)

On the night of January 12, the HUEH campus was rent by the cries of the hurt and dying—and filling rapidly with more casualties from the disaster. A courageous few staff tended to the injured with flashlights and the few materials they could salvage.

As the sun rose on the morning of the 13th, the extent of the devastation to the campus became clearer. The structural damage, itself immense, paled in light of the human suffering that flooded the hospital as patients—first tens and then hundreds—arrived, searching, too often in vain, for care.

Although many of the hospital staff were now homeless, a brave number of them, as well as Haitian friends and volunteers, came immediately to the hospital to offer their assistance, displaying the same bravery it takes to run toward a burning building. The first foreign assistance workers from the International Medical Corps (IMC), a United States-based nonprofit humanitarian organization, arrived within twenty-four hours to find a devastated campus and very few staff members able to work. By the second and third days, more outside assistance arrived to support the Haitian staff and the IMC in
triaging patients, prioritizing the hundreds in need of urgent surgery, and providing first aid and medical treatment as materials allowed. Teams from NGOs around the world, including the International Red Cross, Medécins du Monde, Swiss Humanitarian Aid, Medécins Sans Frontières, and a number of smaller organizations such as Partners In Health/Zanmi Lasante (PIH/ZL), quickly followed. In those first few days, much of the effort was simply stopping the bleeding and attending to the dying.

At the moment the earthquake struck, I was in a clinic caring for people living with HIV in Montgomery, Alabama—applying skills I had learned in Haiti to aid another poor community. During that first night, like everyone connected to Haiti, I did not sleep. It was nearly impossible to gather news from loved ones in Haiti, or much information at all.

A year-long volunteer posting, a few blocks from HUEH, had introduced me to Haiti in 1996. Until I moved to Alabama in 2009, my work centered on Haiti—as a teacher, as a community health volunteer and human rights advocate, and as a physician. When the earthquake struck, I felt, like so many others, that I had no choice but to return there. At Partners In Health's direction, I went to HUEH to volunteer as a doctor—and more important, as part of a team working as a bridge between the Haitian public health system, HUEH leadership, and the many international volunteer relief workers.

When I arrived at HUEH with colleagues from PIH, on the fourth day after the catastrophe, approximately fifteen hundred sick and injured people were spread around the grounds of the hospital, seeking shade or creating shelter from salvaged materials. Many had nothing more than a cloth sheet for cover. A small, newer building at the top of the sprawling campus that had not been seriously damaged by the earthquake was quickly converted into basic operating rooms. Narcotic pain medicines were in very short supply and available only during surgery, with perhaps one dose following. There was no oxygen, making inhaled gas general anesthesia impossible. Operating time was limited by daylight, though teams pushed into
the night wearing headlamps. Conditions were clean but far from sterile. Basic surgical supplies were limited, to say nothing of the simple but specialized hardware needed to mend a broken bone. Our surgical teams were forced to resort to a hardware store hacksaw for amputation: a tragic and lasting image of what patients faced in Port-au-Prince's largest hospital.

By the fourth day, more than one thousand patients had been identified as needing major surgery, including amputation, bone repair, and cleaning of dead and infected tissue. That day, we performed between thirty and forty procedures. It took eight days to obtain the antitetanus vaccine we needed. The clinical teams watched helplessly as deadly cases of tetanus and gangrene accumulated day upon day, affecting tens of victims at a time. Unknown numbers of patients who died from infection, blood loss, and simpler medical illnesses might have survived if the hospital had withstood the earthquake.

Even if the hospital campus had been built to withstand an earthquake of this magnitude—as it would have been in a nation not beset by centuries of underdevelopment—and even if the necessary supplies had been available, HUEH would not have been able to function in those first weeks without its staff. As the largest public hospital in Haiti, HUEH employs more than two thousand people. Every single employee was affected by the disaster. Many died. Many more were rendered instantly homeless, tending to basic needs and to injured family and friends with whatever materials they could find. Nearly everyone suffered severe psychological trauma. As is the case throughout Haiti, and especially in the public sector, General Hospital had too few medical professionals even before the earthquake. Senior faculty at HUEH are paid about one-tenth of what they could earn in a private clinic. The situation is even worse for clinical nurses and nurse educators, the vast majority of whom are required to work more than one job to make ends meet. The hospital's cardiology department was relatively strong before the earthquake, with six practicing and teaching faculty. One cardiologist died in the disaster; two others will not return. The entire internal medicine faculty was reduced to fifteen individuals.

The General Hospital also houses the central morgue for the city of Port-au-Prince. Despite the lack of electricity on the campus and the resulting lack of refrigeration, the morgue was the natural place to gather the majority of the casualties that occurred on January 12, 2010, at 4:53 P.M. and in the hours, days, and weeks that followed. No one who worked there will ever forget the image of the dead, stacked and overflowing around the morgue. Nor can we forget the sight of loaders working around the clock to move those who had died to mass graves in dump trunks, their headlights illuminating a scene of unspeakable horror and sadness. The pavement around the morgue remained slick with bodily fluids for several weeks. The smell of dying was everywhere and unrelenting.

In the first days after the earthquake, many remarked how peaceful the streets of Port-au-Prince seemed, even as open spaces were being claimed as camps for the displaced. The darkness and silence of the capital was broken only by the candles or cooking fires of the homeless and the hushed sounds of crying, conversations, and prayer. Dozens of Zanmi Lasante (Partners In Health) doctors and nurses, as well as a few foreign volunteers, circulated throughout Port-au-Prince until 2 and 3 each morning, moving supplies, transporting the wounded, and organizing to provide assistance wherever a foothold could be found. We never worried about our safety on or off the HUEH campus in the two weeks after the disaster.

In stark contrast to the reality in the capital, media outlets around the world began reporting on increasing insecurity and the threat to foreign aid workers in Port-au-Prince. We witnessed hundreds of calm and organized aid shipments and read in the press about unruly crowds and near riots. One breathless article reported that the doors of the national penitentiary had been thrown open, allowing four thousand dangerous prisoners to run amok in the streets. In reality, prisoners had escaped, but with pretrial detention rates of 80 percent, four out of five prisoners in Haiti have merely been accused of a crime. This majority had not yet come before a judge for trial, acquittal, or conviction. Legal scholars in Haiti and the United States
estimate that there were no more than three hundred to four hundred dangerous criminals among the escapees. Nonetheless, a compelling and alarming narrative was set in motion.

Superficial intelligence gathering and reporting had tragic consequences for the disaster response efforts at General Hospital and many facilities throughout Port-au-Prince. An already weak supply chain—including a partially destroyed, single-runway airport and devastated machinery at Port-au-Prince's only deepwater port—was further throttled by rumors of danger in the streets. Supplies stopped arriving inside the disaster zone due to these false rumors. Lifesaving medicines, surgical supplies, food, and water collected on the tarmac and in warehouses as patients died in unsupplied hospitals.

Within two weeks of the disaster, a number of volunteer aid workers arrived in the town of Milot, more than 150 miles and six hours from Port-au-Prince. The undamaged
Hôpital Sacré Coeur
addressed all the surgical patients near Milot within forty-eight hours, and relief workers were left idle for days. Everyone was safe, but there were no patients. Without false concerns about security in Port-au-Prince, perhaps these volunteers could have been where they were most needed. With a narrow window in which to address life-threatening injuries immediately after the disaster, lives were lost because of this kind of missed chance.

By the time eight weeks had passed since the disaster, the majority of foreign aid organizations had left the HUEH campus. Two organizations—the International Medical Corps and ZL/PIH—continued to provide volunteer clinicians to attempt to meet the hospital's needs. More than a dozen other voluntary organizations assisted with safe water, sanitation, logistics, and supplies. For four months, the emergency department was housed in a series of tents near the entrance of the hospital, an extremely challenging setting for intensive care.

Even as a majority of the wards were housed in crowded and impossibly hot tents, clinical rounds by Haitian and visiting physicians resumed. Along with the routine staff, medical and surgical residents returned to work. By May 2010, a new class of Haitian interns
had begun their training and nursing students were back to their studies under tents pitched in a gravel field where their school once stood.

In the months after the earthquake, substantial promises were made about rebuilding the physical infrastructure of General Hospital but progress has been very slow. On February 17, 2010, Nicolas Sarkozy became the first French president to visit its long-independent former slave colony. President Sarkozy toured Port-au-Prince with President René Preval and promised 207 million euros in aid, including the cancellation of 56 million euros in Haitian debt held by France. France and the United States have promised to provide equal co-funding totalling $50 million to go to rebuilding efforts at HUEH. As of this writing, no reconstruction of HUEH has begun under this support, although a feasibility study has been launched.

Unfortunately, this deferred promise to Haiti is but the latest in a centuries-old series. Haiti's history of poverty, environmental destruction, and political chaos, often sown outside its borders, has been discussed elsewhere in this book. Recently, increasing international debt and the austerity of “structural adjustment” has further diminished an impoverished public sector. Basic political, civil, social, and economic rights, including the right to health, cannot be assured by the weakened state. The public sector lacks both the physical and social environment required to create good health for its citizens and adequate health care resources for illness prevention and treatment.