Saturday, February 27, 2010

The Haitian Chronicle...A Firsthand Account

This is my Uncle Bruce's firsthand account of his trip to Haiti. Be brave and read it through. Don't look away.

The Haitian Chronicles

Haiti, the second country in the New World to gain their freedom from a European colonial power has never had it easy. Thousands were brought to the New World by France as slaves to work the sugar plantations. A revolt lasting over ten years finally gave them their independence and freedom. The French demanded that reparations be paid to the former slave owners amounting to 60 million Francs. Haitian economy has never recovered from this debt which was not satisfied until the 1940’s. Life in Haiti is very difficult even into the 21st century. As the poorest country in the Western Hemisphere they have been neglected for almost two centuries. The land there is more mountainous than most Americans realize with the capital city of Port-au-Prince bordered on three sides by steep hills and on the forth by the ocean. The mountains are almost devoid of trees. The rich tropical forests were cut for fuel and to pay debts to other countries. The soil is rocky and scarred by years of erosion. The average Haitian earns only $500 per year. Their government, by all accounts is one of the most ineffectual and corrupt in the world.

Tuberculosis, Hepatitis, HIV and a host of other illness abound in Haiti along with diabetes, hypertension, anemia, malnutrition and malaria. Only one Haitian in 10,000 has ever seen a doctor. A mostly Christian country, the church is the center of most life there, after just staying alive. Haiti is the dirty little secret of the Western World; tolerated, minimally assisted and ignored for the most part. The people there are almost all descendents of the slaves that made Haiti the richest of the French colonies. Most speak Creole, a language with its roots in the French of more than 200 years ago, and West African languages. After the Haitian slave revolt and the loss of their rich colony, France offered to sell the Louisiana Territory to the U.S. The French packed up and left. Haiti has struggled ever since.
January 12, 2010.

It was life as usual until the earth shook violently for about 40 seconds. The epicenter of this 7.1 seismic event was centered just a few miles southwest of the heart of Port-au-Prince. The buildings in the cities and villages are almost all of concrete and mortar. There is little regard for building codes. Most have concrete slab floors and roofs with block walls. Large areas of the rambling city collapsed. In less than a minute of shaking, thousands were killed. Many more were trapped beneath the rubble to die over time. The streets were blocked by rubble making any transportation impossible. What few hospitals there are in Port-au-Prince were mostly ruined. Life, as bad as it was for most Haitians, suddenly became the ultimate horror. The damage far surpassed any capability of their government to take charge. People tried, mostly in vain, to free their family members and neighbors from huge piles of twisted re-bar and concrete. There was no electricity, no water, and little food. All rescue work was done by hand at first, there was no heavy equipment. Bodies littered the street. Horrendous injuries were common. An estimated 280,000 people died as a result of this 40 second slip of the earth’s crust.

Within hours relief efforts by the rest of the world were started. The scale and logistics of the task were unprecedented. Just getting to Haiti was not easy. Their airport has a single runway, without adjacent taxiways. Any plane landing must taxi to the “terminal” on the only runway. Only a couple of planes could land each hour. The airport tower was destroyed. Water and food were almost impossible to find. There was essentially no medical equipment or supplies for this city of 2.5 million. Chaos reigned.

The first serious relief effort from the outside world arrived to an unbelievable scenario. The call went out to the world for a massive rescue effort. To rescue as many trapped people as possible and to care for the staggering amount of trauma was the immediate goal. Efforts to supply food, water and shelter to the survivors rapidly accelerated. The call for surgeons, physicians and medical personnel went out across the globe. Medical teams streamed into the city from the U.S., Europe, Mexico, even as far as Pakistan, Japan, Korea and Australia. U.N. forces were sent to Port-au-Prince for security.
About a week after the earthquake I received an email from Dr. Susan Caldwell of Lansing, MI. I knew her from her mission work in Honduras. She asked if I would go with her to Haiti, she was putting a medical team together. I had been planning to go to Honduras during that time period on a medical mission team with AHMEN (Alabama Honduras Medical Education Network) based in Jasper, Alabama. Things had not worked out for that trip, and I had already arranged for time off from my work at Urgent Care Northwest is Jasper. It was obvious to me that I was destined to go to Haiti. God has a way of closing one door while opening another if you watch for it. Sometimes, He gets your attention with a bang, not just a whisper.

I called Dr. Caldwell and said I would be proud to go and do what I could in Haiti. I had made several trips to Honduras, but I knew this would be much rougher duty. Dr. Caldwell was pulling all the strings she could to gather donations to buy medications and supplies through her foundation at We had to buy commercial airline tickets to PAP. The airlines were not cutting their fares at all for relief workers. We even had to pay full baggage rate for all of our medical supplies we carried. Before departure, we had accumulated over $250,000 worth of medicine and supplies, thirty eight large plastic containers similar to foot lockers. The team paid an additional $1700 in extra baggage charges.

We were first booked into Port-au-Prince airport. All commercial flights into PAP were cancelled a few days prior to our departure. We quickly changed our destination to Santo Domingo is the Dominican Republic. This involved an extra day of travel as night arrival precluded travel across the mountains into Haiti. We arrived in Santo Domingo on February 11th expecting our previously arranged transportation to take us to Port-au-Prince that day. Alas, the vehicles they provided would not carry the large amount of supplies we had brought with us. We had to spend an extra night in the D.R. while suitable transport was found. Early on the morning on the 22nd we were all packed like sardines with thirty eight large containers, into a small bus for the six hour trip to Port-au-Prince.. The closer we got to Haiti, the more inhospitable the terrain became. When we finally crossed into Haiti we were told to close the curtains on the bus. Bandits might want what we were carrying. After another hour or so, we began to see a few collapsed buildings as we traveled up and down the steep hill surrounding PAP. We were all awed at the mountains, poverty and the traffic on the roads. Haitian drivers can turn a two lane road into four lanes and do it at 60 mph. Damaged buildings lined the roads in places. Our road was on the very edge of steep drop-offs into the deep valleys below. The views were impressive, but a little disconcerting.
The last portion of our journey was to the GCOM orphanage about 15 miles southeast of PAP in an area called Calabasse. We traveled up a winding dirt road for several miles. I was amazed that our bus was able to negotiate the sharp turns and deep holes. We ascended to almost 5000 feet above sea level and there were taller mountains around us. The weather was very cool and the air was clean instead of the smog in PAP. There were several destroyed buildings nearby, but the large orphanage had withstood the quake. We felt safe there and spent our first night sleeping wherever we found space.

We were unsure where we would go to work the following days. The next morning, we traveled down to PAP across the roughest dirt road I have ever been on. Sixteen of us in a small “Tap-Tap” truck with what we hoped would be a day’s needed medication. We ended up at a hospital in the Pernier section, the Centre de Sante de Pernier in P├ętion-Ville, a suburb in PAP. The hospital serves 100,000 people with hardly any supplies or medications. Despite all the foreign doctors now in Haiti, none had been to Pernier. We were greeted with open arms and given the entire second floor to set up our clinics. Our group of three physicians, one PA, one CRNA, several nurses, pharmacy techs, volunteers and translators evaluated and treated well over 200 people the first day.

We treated patients with diabetes, hypertension, diarrhea, infections, stomach ailments, worms, malaria, and much more. Because the hospital had no surgical facilities, our surgeon and anesthetist did general medicine this day. We saw a small number of patients with injuries directly related to the earthquake. Most of the severe injuries had been treated over the past weeks and were now recovering in the tent cities. At the end of the day, we piled back in the truck for the long uncomfortable drive back up the mountain to Calabasse.
On the drive through downtown, we passed countless destroyed buildings. On a few occasions we could smell the unmistakable stench of rotting corpses, but only rarely. People were working on the piles of rubble, looking for possessions or for loved ones. Who knows? We passed many smaller tent cities. Any place that was open and flat seemed to have sprouted closely packed shelters. Some were real tents, some just blue tarps or sheets of tin roofing or bed sheets. Anything that would give some shelter was put into use. The street were lined with people selling whatever they could; vegetables, water, shoe-shines, phone cards, even DVDs. The traffic was as bad as anywhere you’ve seen. Exhaust fumes, crazy drivers, honking horns, weaving motorcycles and brave pedestrians. People seemed not to notice the surrounding devastation. I guess it was now commonplace. We were all too tired when we arrived back at our base. We ate a light supper, took uncomfortably cold showers and crashed for the short night’s sleep.

The next morning we split into several groups and left the orphanage at dawn. One group set up a clinic near the orphanage and saw over 200 patients. I spent another day at the Pernier hospital, and the surgical team was sent to a functioning surgical hospital to work. In all we saw in excess of 400 patients. On the third day, we again split up our forces to care for as many persons as possible. We had decided to form a relationship with the Pernier hospital and their staff, to continue to provide supplies after we returned home. We planned to leave them all unused medications remaining when we left Haiti. We probably had 50 times as much medicine with us as they had in their whole pharmacy. We worked closely with their staff of Haitian and Cuban trained doctors who enjoyed having sufficient medications at their disposal and a chance to practice real medicine. Word had spread in the neighborhood that there were American doctors at Pernier. Hundreds of people were waiting for us. We treated several very sick patients. One had typhoid fever, several with severe dehydration from diarrhea, even one with chicken pox. Visions of epidemics of any of these diseases were frightening to us all.

On the third day we went again to the hospital. I had been lax in drinking enough water in the heat and became ill requiring IV fluids. We continued to see as many people as we could. The line to see us seemed to never shorten. Everyone wanted to see the American doctors. After another long, long day we returned to the orphanage where our anesthetist fell and dislocated his shoulder. We were able to reduce his shoulder and realized that he may have to return home in the morning. One of us would have to go with him back to Santo Domingo. We made plans to catch a bus in the AM. The next morning Randy was more comfortable so the team stayed together in Haiti.

Several members of the team went into the center of Port-au-Prince to one of the larger tent cities; concentrated poverty with only minimal health care, sanitation and food. All these tent cities are ripe for the violence seeded by the condition there. We held several clinics in tent cities. We saw many patients that had been cared for right after the earthquake and had been returned to their tents to recuperate. We supplied medications and supplies to the local camp leaders and nurses.

We had a chance to see the heavily damaged area in PAP. The beautiful Presidential Palace in ruins. The Palace of Justice totally collapsed while in full session. These are the seats of government in Haiti. All the records for the nation were destroyed. The Haitians, despite their distrust of their government and its lack of effectiveness are very patriotic. Seeing the destruction of their government seat affected them deeply. The tent cities in the heart of Port-au-Prince were shocking. Against the background of the collapsed Palace, to see acres of tents and masses of displaced people was a sight I will never forget. We saw many Haitians just standing, staring at the ruins of what were once the showplaces of their country. There were many America Soldiers and Marines in the city. We always felt better when we saw them, knowing there had a special eye on us as Americans. We always took time to greet them and thank them for their service to the people of Haiti, and to us.

By Thursday, we were reasonably certain that the Port-au-Prince airport would be open. This meant we would not have to return home via Santo Domingo. This was great news. We spent that day in more tent cities. The hospital in Pernier apparently had been shipped a load of supplies and equipment from a relief organization in the States. It was being held until “taxes” were paid to customs. Donated equipment is supposed to be tax free. These demanded taxes were most likely bribes. When money was found to pay customs, the amount required suddenly was increased! Dr. Caldwell; no meek individual, made a couple of phone calls to a local major relief group and the full shipment was delivered to Pernier in two days…. with no taxes due. Rumor has it that the President of Haiti was called and he had a word with the Customs officials. On Friday, we made brief visits to one more tent city and saw another 200 or so patients. We then returned the Pernier Hospital to deliver all our leftover medications. The truck from Customs was there. It was a great last day for us and for the Hospital. There was now the real possibility that this small hospital will have the materials, equipment and supplies to make a real difference in the lives of the people they serve. Plans were made to form an ongoing relationship between an American hospital and the CENSHOP hospital in Pernier. Because of the efforts of our team, Pernier Hospital will now be a site for foreign healthcare providers to work as long as the relief effort continues in Haiti.

Saturday morning we made our final trip down the mountain into Port-au-Prince. This time to board our planes back to the United States. There were sad goodbyes and promises to return as we walked the long road to the terminal. In total, our teams treated well over 2000 patients while in Haiti. We were all emotionally moved by what we had seen there.

What will become of Haiti? Where will all the displaced people end up? How long will the tent cities be required there? Where will the money to rebuild Haiti come from? News today tells that people are being told to leave the tent cities and return to their homes. The rains are coming and the authorities are likely afraid of the epidemics that will certainly accompany the floods, landslides and seas of polluted mud. Where do you go when your home is now no more than a pile of broken concrete?

This country is poor beyond belief. There is no money from within this nation to rebuild Port-au-Prince. Is there money enough in the world to rebuild? I would like to return to Haiti in a few months to see what changes have been made. This catastrophe has been quickly moved off the front pages of the world’s news papers. There were already more relief organizations and NGOs in Haiti than anywhere else in the world, and that was before the earthquake. Will Haiti slide back into the shadows of the world?

Can and will the world do what will be required to repair 200 years of poverty and neglect compounded by this natural disaster? Only time will tell. No one can answer this question with any certainty..

Bruce McFadden, PA-C
Birmingham, AL
February 25, 2010