Why Haiti (still) Matters

January 18, 2013 Featured, From the Medical Director

The three year anniversary of the Haitian earthquake is upon us, and Haiti still matters.

The following “letter to the editor” is a response to an article which appeared in the New York Times on January 24th. The NYT article was critical about the impact of recent international aid to Haiti.

[The photo, by the way, shows the just- completed PIH teaching hospital in Mirebalais, 40 km north of Port-au-Prince.]

I have been asked several times in the past month the same question. “What happened to all the billions of dollars sent to Haiti?”

I don’t pretend to be able to answer that question on a broad scale, but I have personally witnessed exactly the types of good results that the American people would hope that their donations had gone to – providing direct lifesaving assistance to the poorest of the poor, in their hour of need. To be sure housing must be addressed more completely and expediently. Recovery is far from finished, or even in full swing, but there is cause for more than naïve optimism. Let’s start with the literally thousands of lives saved by rescuers and disaster personnel who sprang into action following the earthquake in 2010. While less dramatic, important and effective strides are being made today by Haitians and Americans and other nationals. For example, as bad as life was in the tent encampments, and still is, that there were not rampant typhoid epidemics or huge spikes in drug resistant TB is a public health accomplishment that ought to be touted as an example of a successful collaboration of the Haitian Ministry of Health and the international community. The Ministry of Health in Haiti today is a much stronger institution than it was in 2009.

Drs. Paul Farmer and Jim Yong Kim, (Dr Kim is now head of the World Bank) have successfully implemented a model of healthcare in the developing world that has become prototype. The organization they helped to found, Partners in Health, has demonstrated decisively, on multiple continents, that by working with the local government in helping to develop the public health sector, using local talent and paying fair wages, quality lifesaving healthcare with sustainability can be delivered. A new teaching hospital that will train tomorrow’s doctors and nurses in Haiti is one byproduct of such collaboration.

Our organization, Lamp for Haiti, works in a dangerous and very poor slum called Cite Soleil. Taking a page from the PIH book we utilize local talent, including Haitian doctors and nurses, and work in collaboration with Ministry of Health. We see about 200-300 patients each week, providing them with quality free primary and urgent care. Many of our patients thank us each week for our presence and lifesaving work, made possible because of outside donors’ support in conjunction with skilled and intrepid Haitian staff.

A recent piece by Deborah Sontag in the New York Times sheds critical and much needed light on how recovery funds have been spent – or not spent – in Haiti following the January 2010 earthquake. While the article is important as a means of public oversight of a vast project, I fear it misses contextual points. First, recovery is expensive and often slow but it can yield results with flexibility, patience and persistence. Consider that CNN’s Adam Lashinsky reported a full two years after Katrina that the Lower Ninth Ward “…still looks as if a powerful bomb had struck.” But America continued to believe in the Gulf, and it continues to recover today.

Katrina recovery in government funding cost over 140 billion dollars. Recovery from the tsunami in Japan has been estimated to cost 300 billion dollars. Governor Cuomo has asked the federal government for almost 42 billion dollars for New York State alone following Hurricane Sandy.

Haiti has about $7.5 billion to work with to recuperate from one of the worst natural disasters in recorded history. Haiti is among the poorest countries on the earth. On that day in 2010, Haiti was devastated by a magnitude 7.0 earthquake at a relatively shallow depth of 8 miles. (A shallower earthquake sends more force to the surface, inflicting greater damage. Compare Haiti to Chile’s most recent earthquake with a magnitude 8.8 but occurring at a depth of 22 miles. This greater depth contributed a substantial degree of protection from surface damage.) The Haitian disaster left over two hundred thousand dead and perhaps 1.5 million more people “displaced”, a euphemism for newly homeless.

The entire earthquake event was and is tragic. I still experience unwanted, intrusive memories of a particular young man, about 22 years old who was lying on a gurney in a preoperative ward at St Damien Hospital. The air was dense with death, a result of gangrenous limbs and slowly fading persons awaiting amputations , those limbs which only hours before had carried them to their children’s’ schools or had waved good-bye to husbands and wives, or had flagged down a Tap-Tap to bring them to work. Now the young man with a mangled right arm and severely crushed left leg – the crushed bones in the calf felt like sand and small stones in a leather sack – was lying on his back pleading with me through a steady stream of tears… “Please Doctor James. Don’t let me die. I can’t die. You understand? I just graduated from university and I have a job and I am to be married. You are married, right Doctor James? You understand me? Please don’t let me die.”

I told him I wouldn’t let him die, but he did, sometime during that night from overwhelming infection.

As an internist and palliative care physician, I have seen scores of families through the process of dying. As an Emergency Physician in lower Manhattan on September 11, 2001, and again in Port- Au- Prince after the 2010 earth quake, and again when cholera swept Haitian tent cities in 2011, bearing witness to death has sadly become a part of my professional experience. Yet while this death was as tragic to me as any I have experienced, it has also inspired me; it has given me focus. We cannot allow ourselves to become numb to such stories. They are real, and when we allow them to move us, they lift us up as individuals and as a nation, spurring us to act.

The second bit of context relates to geography. It takes just under 4 hours to travel from JFK to Port-au-Prince. The proximity of Haiti to the US means that the problems, particularly infectious diseases, on that island will not stay isolated there, and they are far more likely to find their way to America than diseases from more remote parts of the world. Bacteria cannot read, and they don’t respect international rules or territorial lines. We would be wise to robustly bolster our efforts at supporting public health in places like Haiti, where such measures can have a significant impact on lowering the risk of the spread of disease in this country.

Finally, the concept of fairness is perhaps the greatest reason we ought to continue to be actively interested in Haiti. Americans inherently seem to understand fairness. Imperfect in our attempts to do so, we continually strive to level the playing field, as evidenced by UN data on recovery and reconstruction following the 2010 earthquake, showing that fully one-third of funding came from the US. Fairness as it pertains to Haiti demands that we continue to care. As for me, I don’t give in to the naysayers who tell me that things will never improve, or that whatever resources sent there are squandered. I suggest instead that they look into some of the positive work that is being done there, and I encourage them to stay involved.

Haiti still matters. Reconstruction in Haiti must continue, and surely housing needs to be addresses at a substantially more robust pace. But we can’t give up. We can’t give in to frustration. We must stay involved as individuals and as a nation. It’s good for Haiti, and it’s good for us.

The State of the Lamp 2012

November 20, 2012 Featured, From the Medical Director

By James Morgan MD (from the Fall newsletter)

For most of my adult life, a common refrain that I have heard is “we are living in difficult times”. I suspect that throughout the ages, there has been a tendency to say that the current epoch is more difficult than the ones preceding it. And yet what often shapes our common knowledge of those eras is not so much the difficulties faced but the responses, the human responses, sometimes right on the mark but just as often a little off-center. Mother Teresa comes to mind as one who faced certainly overwhelming odds in addressing poverty. But rather than feel hopelessly paralyzed she put one foot in front of the other, and tirelessly cared for those that even the inanimate gutters of the dirt and cobblestone streets seemed to have rejected. She would go on to start an order of nuns providing care to the most marginalized persons of the globe. (She started two homes in Port-au-Prince which operate there fully today!)

The earthquake in Haiti, that furious and terrible 40 seconds, seconds of horror that would for some bring years of misery, was in January 2010, almost three years ago. The country in the immediate aftermath was a cracked shell of the shell it had been just before the tranbleman tè. It was, in a word, teetering. People living there and people all over the globe, people just like you who care about souls they have never met and never will meet, people who have families and jobs and debt, and parents who are aging and grandchildren who are sick, who themselves have health problems, these people – you are among them – reached out a hand and said “grab hold. I can help. I can’t do it all, but I can help.” And it is because of your solidarity, real and pragmatic and soulful, I am convinced, the country did not teeter over the edge into absolute despair. There is progress. I bet Mother Teresa would be proud of your path.

Lamp’s Health Center is now staffed with full time professionals and support personnel. Our primary and urgent care setting allows people to see one of our two physicians, Dr Jude Dorsainvil and Dr Barrère Hyppolite who provide respectful and quality healthcare. Our laboratory allows for testing for common diseases of poverty and the tropics, like malaria and typhoid, as well as basic serologies that serve to screen for illnesses such as diabetes and kidney disease. Our pharmacy has benefitted from donations from individuals and larger organizations, for example AmeriCares and Catholic Medical Mission Board, and allows our doctors to appropriately treat those conditions, and then to see the patient back in follow-up weeks or months later.

We are especially proud of our own Ms Moza Flaure Alcius, RN, who next month will complete a one year training program to become a nurse midwife. Lamp sponsored her enrollment in this excellent schooling, run by Midwives for Haiti, located in the country’s Central Plateau. Ms Flaure will be the driving force behind our women’s center, slated to launch January 2013. She is guided by Anjali Gupta, MD, a physician in New Jersey, as well as Board member Dr Dulaurier Jacques, a Haitian OB-Gyn physician.

We continue to provide our services, including medications and supplies and labs testing, at no cost to the patient. This is an issue that has been visited and revisited, and we always come to the same conclusion that people will not choose health care when they cannot buy food. Until the economic climate improves in Cite Soleil – the typical resident there gets by on about 50cents per day, in a country where one gallon of gas is about eight US dollars –we believe that we have no other option.

In what is certainly a good sign, we are growing out of our current space. The coming year will see us either expand locally or move to a nearby spot where we can build. When we do , of course we will maximize our use of local labor and skills as we are able.

These are difficult times, especially if one lives in a slum in Haiti, under a leaky tin roof. And yet this project, the work of the community and staff of Lamp, and of our supporters should give one pause for hope. Most of you reading this have heard at one time or another that Haiti has made no progress in these past three years. I disagree with that, at least in some arenas. (With regards to the public sector it is true that thousands of people are still living in ragtag tents today. However the Ministry of Health is a much stronger bureaucracy than it was before 2010, and has played a key role in helping to address major public health issues like cholera. There are certainly many other like examples. ) Many nongovernmental organizations like Lamp for Haiti, Partners in Health and St Damien’s hospital have made tremendous inroads.

At Lamp , as in each of our lives, we effect change where we stand. This model of quality care in one of the poorest slums on the planet, of showing compassion and solidarity by providing not just throwaways but quality, solid meaningful care, by and for Haitians, this is something of which we ought to be proud. Let’s celebrate that and keep up the effort. Thanks for your continued support and confidence in this important work.

July 15, 2012 – An Interview with Benoit Florestal

July 16, 2012 From the Medical Director

July 15, 2012 – An Interview With Dr. Barrere Hyppolite

July 16, 2012 From the Medical Director

Thank you for your confidence and kindness!

July 2, 2012 Featured, From the Medical Director

On behalf of those whom we work with and for, a resounding Thank you! for your generosity in material, finances and spirit. We are making a difference.

Since the earthquake of January 2010, we have refocused our mission to prioritize that which provides direct patient care, and related services. In short we want to keep our strengths strong and we are doing just that.

Some accomplishments to highlight…

Nurse training

Ms Flaure, one of our top nurses, is presently receiving advanced training in Hinche about 37 miles north of Port-au-Prince in the country’s central plateau region. The program is run by an organization called Midwives for Haiti (http://www.midwivesforhaiti.org/). She will return to work for us in December and will manage the women’s program.

Expanded hours

While previously we were able to see patients three days per week, we now are open five. Under the direction of Dr Barrere Hyppolite and Mr. Benoit Florestal, the facility is operating in a manner consistent with our goal of being about Haiti, run by Haitians.

Laboratory

Our laboratory has been inspected by the Ministry of Health, and we passed with flying colors. We perform basic serologies, blood counts, blood and sputum smears (for malaria, TB and other tropical illnesses). Miss Aline, our certified lab techinician, keeps the lab in top shape.

Pharmacy Expansion

Our pharmacy provides medications to patients at no charge. Periodically we revisit the notion of patients paying a small stipend for the meds. The reality is that when patients need to pay, they forgo treatment. Most people get by on about 50 cents daily in the area where we work.

Leadership

Perhaps more than anything, the leadership now in Lamp for Haiti has taken a huge step forward. Dr Barrere Hyppolite and Mr Benoit Florestal together set the tone for professionalism as they work each day, often under extreme circumstances, to ensure that patients are receiving quality health care.

Partnerships

We have partnered with several organizations providing health care and related services in Haiti. Among them are Americares and Pure Water for the World. We provide logistics support at Cardinal Stepinac orphanage in Bon Repos, located about 30minutes outside of Port-au-Prince.

February 28, 2012 – A Place of Respect in the Community

February 28, 2012 From the Medical Director

If you have ever known someone with true bipolar disease, formerly known as manic depressive disorder, you know that it can be painful.

When I was in medical school I lived downstairs from Don. He had a severe case of the disorder. Don was usually in pretty good shape, but occasionally when he felt himself with the twinges suggesting mania, he would deliberately stop his meds and go manic. He would feel great, until he didn’t . Usually he would wind up in a hospital several states away, feeling “…rather strange.” He had trouble expounding, but he knew it was not normal.

Yesterday I had the feeling that mine was a reportable case of bipolar disorder, but rather than a week or a month of sadness followed by an equal time of mania, I had these feelings at the same time. It really should be in a medical journal somewhere.

As we were driving into Cite Soleil, the huge, dirty urban slum was coming physically into view, and into smell. Strangely absent were the people, its streets typically teeming with their activity. Our manager Benoit was driving, and he slowed the vehicle to maintain a safe distance behind the truck ahead. He was not following the “one car length for every 10mph” as I like to remind the new drivers in my own home. Rather he was lagging behind to scope the road ahead and to ensure that should bandits suddenly appear with guns ready to pull a carjacking, we have a chance to turn around quick. The collegial chatter that normally reminds me of traveling home from high school with friends, suddenly ended. The nurses donned their Lamp for Haiti scrubs. The doctors put their stethoscopes around their necks. ( I gave mine to Toma, our registration clerk, thinking he would look silly in his sunglasses and trying to explain that he was with a medical team. ) We made it through, and the friendly banter rose up again to its normal volume.

The Lamp medical team has earned a place of respect in the community. Even the robbers will show some mercy, as they did two weeks ago and only stole about half of what they might have taken. Our staff’s courage in the face of such daily challenges is impressive, and they routine talk of the need to provide the care that they were trained to do.

Minutes later a young woman came in to be seen with pelvic pain. After examining her , and dong some simple tests in our lab, we were able to treat her with appropriate medications, professionally administered, in a way that made me beam with pride. The staff’s professionalism was standout. The young woman’s modesty and privacy was maintained, and she was treated with respect and kindness. Again, I think of college… I knew a gal who used to say “anyone can be nice”. And while not all follow even this minimum, what we are trying to provide is quality, not just nice care. We are doing that at Lamp.

Jim

April 27, 2011 – “Can you work tonight?” (Jim’s blog)

April 27, 2011 From the Medical Director

The day started like a typical Haitian Sunday… relaxed. I had made plans the day before with Junior to catch a ride to St Damien’s hospital in Tabarre. Fr Rick lives there and I wanted to meet up with him and to go to Mass. He’s been a great mentor and friend for me in my Haitian journey. When I spoke with Fr Rick by phone the night before, he told me that Mass would be in the evening. Unusual for him to have a Sunday evening Mass St Damien’s . I knew things must have been busy.

“Can I give you a hand tomorrow?”

“Sure, we could use the help. Come on by and speak to Conan.”

I awoke early, as is my norm there, sleeping and arising in sync with the sun, particularly when there is no electricity. I have often been struck by how quickly I do so when there is no power. It makes perfect sense of course, and yet in 2011 the injustice of that scenario is not lost on me. The news reports about how electricity shortages in Baghdad make life tough. In Haiti that’s the norm. How can people study when there is no light, ne expect advancement when hours are spent on daily travel, on water and food procurement? As a kid I remember hearing once that Abraham Lincoln knew the importance of studying, and so he would do so by candlelight. Over a century later we still accept such an approach.

As we were getting ready to go, Junior went out to the truck and found the front passenger side tire flat. The day before, I had paid to have that same tire repaired. It was impressive to watch the guy jack up the truck, remove the tire, then using what looked like a wheel jack from my parents’ old Country Squire station wagon, and manually remove the tire from the wheel. Except he didn’t use the jack part. Rather he swung the 3’ long steel upright pole, lodging the base of it between the rubber tire and the rim. It can’t be too good for either part, but such is the common way it’s done. Next the inner tube is removed and the hole located by squeezing, listening for the hissing leak. The hole is patched using rubber, heated over a wood fire and allowed to cool. The process is vintage Haitian—simple, logical, exactly how I fixed flats on my old Schwinn. The result is too, unfortunately. Cheap materials, cheaply repaired on the street just don’t have a great track record, and so our predicament was not unexpected.

Junior told me that we would not be able to repair the tire until the next day. I was not happy, and the familiar frustration of Haiti washed over me like an unwelcomed kiss planted by an ancient aunt on an eight year old boy. The trick in navigating Haiti without having a stroke is to stay cool when the inevitable happens – like getting a flat on the worst roads you’ve ever seen – and to know to get pissed off when you need to, not settling for the status quo when better results are within reach. It’s a delicate balance that I struggle with on a regular basis.

I asked the driver how we could fix the problem and he looked behind me. As luck would have it, his own vehicle , a Montero SUV, is the same make that our organization, Lamp for Haiti, uses. His truck has four flat tires not because he keeps going back to the same tire repair guy, but because he hasn’t driven the vehicle in months. He simply swapped out the wheels, pumped it up and we were in business. We arrived in Tabarre a little later than I had planned, but not too far off the mark.

When I walked onto the grounds of the hospital, I was told by the guard that Fr Rick was in church. I walked the 100 yards toward the chapel, but did an about face after seeing a coffin in the center aisle, and hearing sobs exude outside. I walked to the side of the chapel and ran into my friend Conan.

Conan, an American, should be in a movie. He is a nurse by training, and he used to help run an Emergency Department in the States. He works like a dog seven days a week. His pay is food and a room. His red hair and fair eyes belie a propensity for skin cancer that makes my dermatologist wife cringe even talking about him. On this day he is wearing mirrored wrap-around shades, and a blue bandana as a head cover.

“Hi Jim, can you work tonight?” is his greeting. He disposed of the formalities like “Hi how have you been?” and “Good to see you” long ago. I am happy to be on that level of comradeship with him. Conan is about the work. His work ethic is impressive. It’s an elite group that is so dedicated to a cause. In that group is also Fr Rick, a physician and Catholic priest, who works even more nonstop on behalf of the poor.

Among other hats he wears at the hospital, Conan is responsible for staffing the cholera tents with doctors, nurses, and ancillary workers. We share stories about the cholera patients we have seen over the last few days, and he is exhausted in his rendition.

“Sure I can work tonght.”

“How long? When can you start?”

“I have to be at our clinic tomorrow at 7am. I’ll work all day and night if you want. You tell me where.”

“Ok good.” That’s all you get. Nothing more. No, these guys work like that all the time. I neither expect nor want any other response.

The funeral has ended in the chapel, and the mother of the boy who died is running around, sobbing uncontrollably. Fr Rick is headed towards us, but is stopped by the mother, who literally throws herself into his arms. She asks him where her son will be buried, since he died from cholera and the general hospital morgue won’t accept the body. He speaks softly to her in Creole. I can’t hear what he tells her.

Speaking in his Canadian-Connecticut-Haitian accent, Pere Rick says to me “Oh jim. Nice to see you. Are you seeing a lot of cholera at your clinic? We have to bring this body over to be cremated. Can you give us a hand?” He too does not waste his words. The three of us load the cheap plywood casket onto a truck and drive to the crematorium. We unload the cargo, and I hold open the iron gates as they deliver the coffin. The all too familiar smell of death is present. The oven is working on one body already, but other lifeless ones wait on tables nearby. The smell, I know it as that of anaerobes, bacteria that grow well in nonliving or poorly oxygenated tissue. It is akin to the smell of dirty socks from a bunch of teenage boys, left in a pile for a week. I am instantly transported back to a side street I walked down after the earthquake ten months ago. Then, as now, bodies were decomposing, and the exuded odor was harsh. I recall reading somewhere that scent memories are imprinted deeply in the brain and some of the most difficult to forget. Unfortunately I am finding this all too accurate.

After dropping off the body, we go over to a storage area to collect some wooden pallets. We have to build a tower to put a water tank on. The plastic container, about 1000 gallons in capacity, is being used to supply water for cleaning in the cholera treatment area. Gravity will allow the water to be distributed to several different places. Water is key on a normal day in Haiti. During a cholera epidemic, it becomes the Rosetta Stone.

We load the pallets onto the truck. I try not to let on that the giant bugs jumping out from the crevices of the pallets really do gross me out. We drove over to the cholera treatment area about four football fields away.

Conan tells me that I will be working triage, and also the treatment tents. Currently there are three large tents, like the kind my parents rented for my sister’s wedding reception in our backyard. The only dancing though, is by the nurses who are working their butts off, trying to keep up with the volume of patients and their needs. “Ok, no problem” I tell him, even though I have never taken care of a cholera patient in my life before this week. I read a lot about the disease in the past two weeks, and attended a meeting with the Lamp medical team the day before, sponsored by the Haitian Ministry of Health, for NGO’s working with cholera patients. I guess I’m as good as they’re going to get today.

Conan tells me that I’ll work until about 11pm. That will give the American guy, Jeff, an ER physician from Ohio, a few extra hours of rest. No problem. It’s just past noon.

I relieve a young and very pleasant Haitian doctor, a woman, who gives me a detailed sign out. “This man has diarrhea and vomiting. We are hydrating him with IV fluids, and we will give him antibiotics – just one dose. This woman has diarrhea and vomiting. We are giving her IV hydration and antibiotics- just one dose of antibiotics, you understand? This baby is vomiting and has diarrhea. Baby needs hydration and antibiotics, just one dose, you understand ?” And so on went the sign out. After about the tenth patient I asked her to point out the ones who were not vomiting with diarrhea. Of the 40 or so patients, none fit that description. “Tout moun genye diarya ak vomis.” We cut to the chase, and she bade me bon chance.

After a few hours, I had my mojo on. Having worked as a doctor in a level I trauma center in New York City for six years has some advantages to it, and one is confidence. A PhD student in public health was there, whose area of interest is cholera. “Perfect,” I tell her. “You can do discharge training of patients. We need to educate them on eating and cleaning and toileting.”

I schmoozed a couple of nurses early on. My ER experience had taught me that if you don’t do that first, you’re dead. The nurses are the hub of the wheel in the ER. Doctors maybe driving the car, but the vehicle won’t move an inch without them. A nursing friend once told me that I could charm the skin off a snake when it came to those situations, a talent I am happy to have, because the team has to get along to have a chance at being effective, especially in the face of catastrophe.

The cholera epidemic in Haiti is a catastrophe.

Patients coming in were being triaged and treated appropriately. I even was able to discharge a few patients, and they received discharge instructions, in Creole.

About 4pm, Fr Rick asked if I could head out to Warf Jeremie. I had been there a few times before. It is a place in Cite Soleil, not far from Bwa Nef where our Lamp clinic is located. Warf Jeremia too is poor, and densely packed with people. There is a clinic there, run by an Italian nun, he told me. “The clinic needs to send some patients to St Damien’s , and they need a doctor to tell which ones are the worst. Bring the generator and some gas, since they don’t have electricity and it’ll be dark soon. Win can drive, and he’ll bring Allain with him too.” And off we went. There were five of us, all blan, the Creole expression for white people.

We drove along Route Nationale, on the outskirts of Cite Soleil. Win was kind enough to bring along a plate of food for me, and I ate in the back seat. The food tasted delicious, and after the first bite I remembered I had not eaten all day. I was hungry, and practically ate the plate on which it was served.

After about 20 minutes in the truck we turned right onto the road leading to Warf Jeremie. It was dark now, and the way was lit up by headlights from the occasional vehicle, and by the small cooking fires on the side of the road. Tin shacks, held together by rust, dogs barking, smoke spewing from in front of homes, children sitting naked on the ground. Horns honking. I was looking for Mel Gibson in Road Warrior garb to come racing by on his motorcycle, but this scene was even more distressing than anything Hollywood had yet offered. I asked myself “what could be worse than to live like this?” I was about to find out.

We arrived at the front of the clinic in silence.

On entering the dark building, we were greeted by Sr Michaella, an Italian nun, maybe 50 years old. She was happy to see us for sure. The clinic was officially to open in about 2 weeks. She had arranged for medical staff to start at that time, but then came the epidemic of cholera. Like most disasters, this one didn’t read the schedule and came inconveniently early. People in the neighborhood began coming to the clinic looking for help. “I could not turn them away” she told me, and soon the beds were full. There was a team from another medical NGO who were awaiting clearance from the Ministry of Health to work at a state hospital, and fortunately they would be able to assist. “But they told me yesterday they would not come today since it is Sunday and they needed a day off. So it is just me and my boys. We have been working nonstop since very early this morning. I have no energy left. What do you think I should do?”

Win and I looked at each other. We came to take the worst of the patients and so we started to go around triaging patients. Very quickly, I had to assess each one, and decide who would be transferred back to the hospital in Tabarre. Sister Michaella had a tap-tap available and so we figured we could transport five patients. Someone started the generator, and there was a dim light throughout the building. It was worse than I could have imagined. People were crowded into that place. Vomiting and diarrhea was rampant. It was a horrible sight to see such suffering. It was worse to smell. An old woman was sitting on a red bucket, her flowered dress pulled up around her waist, with diarrhea. She hadn’t the strength to sit up, and she rested her head on an adjacent cot. Babies not crying, dry mouthed. Young men , obviously from the community, moved about with purpose, looking for IV’s not functioning, assisting new patients to cots or open floor space. I asked Sister Michaella if she needed me to stay. “If you would, yes. Otherwise we will have to send people home. For the last two days we arrived in the morning and found four dead bodies on the steps, waiting for us. ”

Win heard my conversation, and said “Jim, if we take the worst cases back then you wouldn’t have to stay. “ He sensed my nervousness in making the offer. Cite Soleil is a notoriously tough place under the best of circumstances. With the upcoming elections, it had become a lot more risky, as local gangs backed by different candidates, tussled. The wrong comment could be big trouble. He went on… “We don’t know how long the gas will last in the generator. You won’t have any nurses. I don’t know how long the IV fluids will last.”

“You’re right.” It was a bad idea. After all, we’ll be taking the five worst cases, right? Then with a little luck people can go home and come back tomorrow morning for more treatment. Also, God knows I didn’t want to spend the night in Cite Soleil alone. Though I’d worked regularly in Bwa Nef for years, it had always been during the daylight hours, and always with close confidants. I told Sister my reasoning. She understood and assured me it was okay. She squeezed my hand and thanked me for coming to help those people we would be taking back to St Damien’s. She turned to continue her work, and I went about helping to load up the patients.

As we were getting the last patient ready, I turned to Win. “I’m staying. I can’t leave these people. Look at them. There’s no one else to do it.” He called on his cellphone back to Fr Rick, and we got the OK. I spoke to Sr Michaella again, and I thought she would kiss me. I didn’t know how I would make it through the night. In a weird way, I was reminded of when I used to be an ER doctor in the West Village of Manhattan, starting a shift on the night of the Halloween parade. You knew it would be crazy and exhausting, but you would get through it. I didn’t linger on the obvious — in the ER we had lights, running water, security, professional nurses and doctors, and every modern medical test at our fingertips.

As Win and the others were readying to leave, Sr Michaella told me that I would have some help. There was a group of five nuns and priests from Brazil who happened to be living in some tents nearby. They had come recently to minister to the poor. She introduced me to Sister Cacilda.

Sister Cacilda smiled so radiantly and gently, it was a gift from above. She told me in broken English that she and the others would help me, and that together with the help of the young men from the community, and “most importantah” – she pointed up – “with His help. We will do this.” She beamed with faith. I felt lifted up by her courage. Here I was, a relative veteran of the streets of Cite Soleil, a seasoned doctor who worked through 9/11 in NYC. I thought I’d seen it all. And yet it was a nun who had just recently arrived in Haiti, and was living in a tent in one of the worst places one could imagine who became a conduit of holiness and strength. Amazing.

As the night wore on, the vomiting and diarrhea continued, and more patients came. I had no idea how long the fuel would keep the generator going. Most patients needed intravenous hydration, and lots of it. Finding a vein in a dehydrated body can be really tough. I was particularly happy when I finally was able to get a line in the old woman with the flower dress. She was close to death, but the hydration worked.

Sister Cacilda never stopped smiling. She asked me if I would like something to eat, and though I hadn’t thought of it, I realized that I felt ravenous. I answered yes. She spoke in Portugese to one of the young priests, and he brought me a mango and a chunk of peanut butter. I think it’s one of the best things I have ever tasted.

At about four in the morning, I was completely exhausted. I told Sr Cacilda that I had to lie down for one hour. I crawled into a cot in the back, and lay down. The room started spinning, and I thought I would puke. “Oh my God. I can’t get sick.” I said aloud to the empty room. I got up and used the bathroom, and didn’t vomit. I crawled back into the cot and somehow woke up exactly one hour later.

At six o’clock I was had just finished putting in a line into a child who was severely dehydrated. As I looked up, the sun was just coming up above the horizon. On cue, the generator started to sputter, the familiar sound it makes when running out of gas. It had lasted all night as we needed it to do.

The daytime medical team began arriving, doctors, and nurses and the others. Sister Michaella introduced to me some of her “boys”, whom I assumed would be young men, maybe in their late teens or twenties. But they were boys, literally about twelve years old, assisting the sick, working tirelessly. Once again the Haitians impress me.

Sister Cacilda and I exchanged numbers and email. I am sure we will work together again, and again it will be my privilege. We proudly noted pa mori – all our patients survived the night.

A driver came to pick me and the generator up, to go back to St Damien’s . I needed a shower, and some sleep. Getting out of the truck the first person I saw was Conan. “Oh good. Jim. Can you work tonight?”

February 2010 – Thank you for Generosity and Kindness

February 24, 2010 From the Medical Director

Dear family and friends of the The LAMP for Haiti-

Thank you, thank you, thank you! I have heard this so many times from people whom we have helped this week and you need to hear it, because it is through your generosity and kindness that we have all become a part of Haiti in such a positive way. I am certain that many of you share in having been moved by the outpouring of humanity towards this country. In a way that sentiment sums up what Haiti is right now — disaster and hope. People suffering and people pitching in to relieve that suffering. Today a patient said to me “Dr James, thank you and God bless you and the people that sent you.” This is the real thing, and we are making a difference in our response — yours and mine.

Jim

I know that I am overdue to let you know what is going on in Haiti, and what we are doing to assist. Forgive me as this is the very 1st time I have had access to email. I am currently staying at our project manager’s home. She has no electricity. Our clinic’s electricity is out as well. We have a generator but it was being repaired prior to the quake. The owner of the repair closed his shop this week as his wife and daughter died in the last week. The hospital where I have been working after we finish in Cite Soleil does have its own power, but I have been too busy there to send email! (Today someone suggested I charge our laptop at the hospital and then write tonite — brilliant.)

I flew To Santo Domingo last Saturday, and was able to make contact with USAID at the airport. It was packed with people trying to get back to the US. USAID was organizing flights via helicopter for medical personnel and I was happy to be among those flown in the early the next day to Port au Prince.

All telephone service was essentially down and so I took a taxi straight to our clinic site since I could not contact our staff immediately. The driver quickly informed me that gas prices had shot up and so the ride was going to be expensive. He was right, as gas is now about 12USD/ gallon and there are long lines . Last night our driver, Junior, slept in our car overnight at the gas station to get an early spot in the line so that we could get to work on time.

Once at our clinic I was warmly welcomed by Jesula, our “keeper of the keys” and she showed me the damages to our neighborhood, including the entire back wall of her house which no longer exists. Adjacent to our center is a small church where 11 people died when it collapsed on them. A major water cistern in our neighborhood was destroyed. Many small homes are destroyed, having fallen into rubble. Our clinic security wall collapsed. Our water system is out. Many people have come into see us asking for food and water.
Mending a Broken Leg

We have been treating both acute wounds as well as wounds that have been as yet untended to. We have managed lacerations and bone fractures. We have seen many infected wounds. And we have seen lots of infectious problems (yesterday, a volunteer and our driver brought a 7-day-old child to a pediatric hospital in Tabarre — about 15 min away — and he was immediately begun on appropriate treatment for fear and respiratory distress in a newborn. I saw the child today and he is doing well. I strongly suspect he would have died had we not intervened when we did.

Because of the disruption of services to people living such fragile existence, this vulnerable population will feel the effect of the earthquake for along time to come. Housing, water, and food are generally a daily concern, now even more so. (Two of our staff members’ homes have collapsed).

To that end, on this initial trip following the recent earthquake, we knew that several goals needed to be met and I think that we have strongly engaged them:

1) Re-establish our clinic presence in Cite Soleil. The recent quake effected the prison, and many escaped. Security was initially an issue and staff were accosted twice last week. Security in Cite Soleil is much improved with military presence for the time being. Additionally, our residents like us, and they watch out for us. One patient told me the other day, “Someone told me, Dr James, that LAMP abandoned the clinic after the earthquake, but I did not believe you would.” He was quite correct.

2) Show solidarity with our staff by being present with them in body and spirit. They are happy for the efforts we all have made in getting me here. It speaks to our dedication to them as staff and members of this project, and to them as persons.

3) To provide immediate and ongoing assistance. We are providing medical care in their neighborhood, as well as in other areas of great need. After our clinic ends, our staff doctor, Joey Prosper, has been working in a clinic/hospital in the center of P-a-P , while I have been working at Our Little Brothers and Sisters Hospital, started by a Passionist priest and physician, Rick Frescette. It has been a major receiving center for traumatic injuries of adults and children alike, and it has been a privilege to work alongside some terrific doctors, nurses, and volunteers from Italy, the DR, Poland, Germany, and the US.

Today we purchased badly needed tires for a water truck and arranged for two deliveries of potable water. Both were delivered already, and were a welcome sight. We picked up food for a mother/child feeding center in Cite Soleil and delivered it along with toys for children (there were even women’s hairpins!) We began our rebuilding plans to secure our site. Cement should be soon coming.

And so, again thanks to all, for your kinship, and your friendship. In particular thanks on behalf of those whose lives you are truly helping to make better.

Jim