Haiti After the Earthquake (53 page)

Each of the patients who survived the earthquake and came to Philadelphia for treatment has a harrowing, tragic and important story. It is impossible to tell each of those stories here, but I can share a bit more of Seleine's story. I hope the others' stories will also be told one day.

On Tuesday, January 12th, as the world learned of the hundreds of thousands injured by the earthquake, countless surgical, medical, and supply teams began preparing to deploy to Haiti. Those working in Port-au-Prince, however, quickly realized that it would be days before visiting surgeons could begin operating in makeshift field hospitals set up throughout the city. One walk among the thousands lying injured in General Hospital also made it clear that many would not survive to see the arrival of those teams.

On Friday, January 15, Dr. Joia Mukherjee, Medical Director of Partners In Health, suggested that PIH consider evacuating some of the injured for surgical care. For years, PIH had been operating a
Right to Health Care (RTHC) program, which brings patients to the United States and elsewhere when care is not available in their home countries. Many RTHC patients require cardiac surgery; occasionally we provide chemotherapy or surgical intervention for young cancer patients easily treated with the tools of modern medicine. PIH triages these patients, lines up institutions willing to donate treatment, shepherds families through the arduous passport and visa processes, and then addresses the need for clothes, food, and other supplies upon the patients' arrival. A PIH staff member stays with patients and their families through tests, operations, and appointments, careful to understand the treatment so that he or she can offer comprehensive and meaningful guidance and support during a tremendously difficult time. When patients are ready to leave the hospital, we also place them in a home and assist throughout the outpatient treatment while preparing them to return to their home country with whatever follow-up care is necessary.

Described this way, the process sounds tidy, but it never is. For a young rural Haitian, often ill for years, leaving the countryside for potentially lifesaving treatment can be a harrowing experience. The abrupt transition from illness to health and from rural Haiti to the cutting edge of modern scientific research and medicine can be both lifesaving and brutal. Whenever our staff picks up a patient arriving in Boston, usually in the middle of the night due to flight schedules, and whisks him or her to the hospital emergency room, we find ourselves face-to-face with the gross inequities that cause many to suffer greatly from treatable, preventable illness and injury.

After Dr. Mukherjee's January 15 request that we look into evacuation for the injured, the RTHC team set to work. I immediately contacted my home institution, the Hospital of the University of Pennsylvania (HUP), while others went to our contacts at hospitals in Boston to see what they would be willing to do. Dr. Richard Shannon, Chair of Internal Medicine at HUP, responded within the hour. “I have contacted the CEO of HUP. Let's do it.” Without a doubt, this quick response made possible the days and weeks of work that would follow. With HUP's guarantee of free care for the injured regardless of their ability to pay (often the most difficult piece to put
into place in the pre-earthquake era), we could approach the many United States government institutions responsible for immigration and say confidently that transport and treatment for the dying had already been arranged. We would simply need permission to leave Haiti and enter the United States. However, obtaining these permissions was not a simple matter in a place where the nucleus of government and the majority of government facilities had been destroyed. Our contacts in the embassies, immigration offices, and airport in Haiti were no longer available. The city of Port-au-Prince was in chaos, and the air traffic control tower was out of commission. The United States military was taking over the airport, and getting a landing slot in Haiti became a Herculean task.

Vanessa Kerry, a doctor who has worked with PIH for many years, and her father, Senator John Kerry, stepped in to help immediately. Dr. Kerry made contact with USAID and others to help pave the way for the necessary permissions. Senator Kerry, as head of the Foreign Relations Committee, had taken a leadership role in congressional efforts following the earthquake, and a member of his staff guided us in requesting the appropriate permissions to proceed with evacuations. Tremendous efforts were made by those in the network of government agencies tasked with various Haiti assignments to get us landing slots and alert Homeland Security to our arrival. Given the life-ordeath urgency of getting some patients to the hospital, we were able to get permission for some of them to go through customs without passports and photo identification—patients'copies of which had been destroyed in the earthquake, and the original documents destroyed along with Haiti's National Archives—in time to save their lives.

A medical evacuation company donated its plane and crew for what would become our first post-earthquake evacuation. The pilot and plane nurses were far more than a flight crew. One in-flight nurse had served in the U.S. Army and would later prove a strong advocate and a whatever-it-takes friend as conditions in Port-au-Prince made it difficult to land, load patients, and take off in the time needed to give them the best chance of survival.

At 8:05 P.M., as the plane took off from Fort Lauderdale, three PIH doctors—Evan Lyon, Joia Mukherjee, and Louise Ivers—were in
Port-au-Prince, making their way to the damaged General Hospital, where many patients had gathered. People later asked, “How was that one group chosen?” The patients would likely tell you, “Only God knows. Obviously God has a plan for my life.” But we used the principles of the Right to Health Care program, which prioritizes patients who would die without care, who could not be treated in their own country, and whose lives could be saved with a relatively straightforward intervention readily available in the United States. Hundreds if not thousands of people fit that description that night in Port-au-Prince. Our doctors had to choose five: the plane could carry four patients who could sit and one who could lie flat. In the end, our doctors chose Seleine Gay; a four-year-old boy, Given Dorsinde Denera; Given's father Marcel Denera; a twenty-one-year-old orphan, Rose Sherline Pluviose; and a thirty-three-year-old mother of three, Berlyne Bernard. With little discussion, our patients were brought out of the hospital into an ambulance and jostled through Port-au-Prince to a plane waiting on the runway at the airport.

Upon arrival in Philadelphia, U.S. Customs and Border Protection opened the door to the tiny plane, and the patients were loaded on board an ambulance, smelling of urine and blood and dying flesh. The immigration intake process was mercifully quick. By 5:55 A.M. on Sunday, January 17, the group was traveling to Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia (CHOP), where teams in both hospitals worked tirelessly to save the patients' lives.

The weeks of surgeries, tests, procedures, and appointments that followed are difficult to chronicle. All three adult women required amputations—two upon arrival and one a few days later after a brief attempt to save her foot. The wounds were gangrenous; after each woman's initial operation, doctors would need, again and again, to “revise the stump,” each time taking off a bit more bone to stay ahead of infection. It is difficult to know what each person was feeling during that time. I spent the days racing back and forth among the women, who were dignified and gracious under the most difficult of circumstances. It was a lengthy stay: Seleine and Rose Sherline remained in the hospital until February 23, Berlyne was
discharged on March 4, and Given left the hospital during the last week of March.

By September 2010, nine months after the earthquake, twenty-one people had been evacuated from Haiti to Philadelphia in the care of Partners In Health. Thirteen of them had been hours away from death. Our patients and their guardians ranged in age from two months to fifty years. Their education, socioeconomic status, and life experiences are as varied as those of any twenty-one strangers plucked out of a disaster anywhere in the world. Now, in many ways, this community of circumstance has become a family. Ricot Noel, who arrived in April, now says “We live like brothers and sisters. If one of us is sad, thinking about what happened, we can know. We just know.”

Many times, the Haitians in Philadelphia referenced January 12 as “the day I died.” Sometimes they also referenced January 17 or January 31 as “the day God saved me.” Today they are all recovering. The tools and comforts of modern medicine have been made available with great success. They are healing from injuries and illnesses that threatened to take their lives within twenty-four to forty-eight hours had they not been evacuated from Haiti. And yet the complexity of survival in United States is overwhelming. Among just this one group in Philadelphia, the list of losses is long: five limbs, the ability to walk, a wife, a mother, seven neighbors, nine houses, two businesses, possessions too numerous to count. These patients were uprooted and dislocated from their families, from a language they understand, from their country full of people with a common experience and grief. They are still trying to make sense of what happened to them.

It is the central work of any doctor to help the patient in front of her. The tension between serving those in front of you and seeking to reduce the risk of their ending up in front of you, as Paul Farmer has described, keeps many of us up at night. We try hard to plan our next moves thoughtfully and delineate in our mind's eyes the communities we serve and the institutions we choose to align ourselves with. At times, the possibility of erasing the ever-widening gap between the world's rich and poor becomes reality in the experience of
one small group of individuals. In this case, institutions answered the call and a community came together to heal the sick and comfort the suffering.

How do we care for the sick and injured after they are here? What are the responsibilities of those who bring them? How far should we go to make them healthy? The Partners In Health model emphasizes the concept of accompaniment, be it for patients in Haiti's rural Central Plateau or Boston's chronic disease clinic. A community health worker is hired and trained to deliver medications each day, as needed, and to return to the hospital with a checklist of deliveries and any relevant medical information they've collected while visiting their patients.
Accompagnateurs
, as we call those community health workers, have been the backbone of twenty years of work in rural Haiti, constantly teaching one another and the newer teams in Rwanda, Malawi, and Lesotho the best ways to provide high-level care under difficult physical, economic, cultural, and geographical conditions.

In Philadelphia, our program remains true to form. During the initial weeks, I spent hundreds of hours in the hospital talking to doctors, joining patients for various tests and procedures, helping them make phone calls home, and trying to provide consistency in lives that had been torn apart. A call to all PIH donors and supporters drew enormous response. We needed for these families anything and everything one might need in daily life—the basics of food, shelter, clothes, and transportation. Our patients arrived with literally the clothes on their backs—some without even shoes. A local contractor put together a team of men who spent twenty hours a day rebuilding a house that had been donated for the patients to live in. The contractor remembered the earthquake in Mexico City, near the city of his birth, and quickly learned how to make the house handicap-accessible and otherwise ease group living for the Haitians. Local donors visited the hospital with fresh fruit and supplies from their own homes, and they continued to help with rides, with outings in an effort to make the days more fun, and by paying for any number
of things. We simply could not have cared for these patients as we did without the network of generous and compassionate people that PIH has built throughout the country.