Saturday, February 20, 2010


I have finally settled in for the evening.  It is impossible to walk anywhere now without people stopping me and wishing me safe travels and showing me more love than an empty ocean could hold.

There have been only a few tears because Edry, one of the organizers of the transporteurs and a dear friend, made everyone promise that they would not cry at me today because I was still working.  Edry told everyone they could sing, cry, pray, or anything else tomorrow.  Edry even went to the airport supervisor to make sure the guards didn't flip out when they saw a bunch of my friends coming to the airport to see me off.

I am eager to see my loved ones at home, but I know I will quickly be counting the days until I return.

Some People Who Have Become Dear To Me

  Christine came by to let me see David again before I left, and to tell me she worried that I would not return to see her and David.  He's doing fine, as you can see.

It's pretty amazing.  She has to travel four hours to get here, and she brought me some  tangerines for the trip.  Who is taking care of who??

And here is Mouvaux, the son Tamara is in the process of adopting. 
             Tamara has done amazing work in orphanages in Haiti and other 
             nations,  for years, but has never, ever adopted a child before.
             Mouvaux has become her sidekick (and mine) and it is changing her life.

And last, but not least, Nixon, on the left, who has become a great friend (and is an endlessly patient translator)

 and Adrian, our master electrician and power scrounger, without whom NONE of this would work.

American Airline's Departure Lunge

OK.  People have asked why I write that I am "trying" to leave on Sunday.

American Airlines began commercial flights Friday.  Kleiman has bought me one for Sunday.  But yesterday I learned that it might not mean shit.

About ten days ago American announced that it was resuming commercial operations and began selling tickets for Feb. 19.  Some of our docs seats on yesterday morning's AA flight out.  Dufflebags packed, good-byes said.  Families and "day jobs" looked forward to, they walked to the airport.

That's as far as they got.

Seems the geniuses at American, after selling tickets and letting these folks make plans to get home, decided that before any new passengers could fly, priority would be given to those who had flights booked which had been cancelled after the earthquake.

Those people should sure fly first.  But why the fuck sell new tickets to new people and not let them know they were really "stand-by" -- at $700/per ticket for a 90-minute flight, I might add.

Two docs, husband and wife, are beside themselves.  They had come for a week, leaving their young children with visiting grandparents.  This is not good.

- - - - - - - - - - - - - - -

There used to be the alternative of hitching a ride home on a military flight.  Chancy, but it worked.  The lucky ones would get a lift to Homestead AFB, a thirty-minute cab ride from Miami's commercial airport.  But for security reasons, the military, which just does this as a tremendous favor to the relief workers, doesn't tell you where the flight is going until you're airborne.  If you get to Homestead, great.  Or they could be going to a remote base that is hours from even the nearest car rental agency, much less a commercial airport.  Some of our volunteers have taken 2-3 days to get home after leaving PAP.

Now traditionally, the military stops airlifting NGO volunteers once commercial flights resume, so we have no idea if the risk of getting dropped somewhere obscure is even a possibility any more since we can theoretically get a ticket on an actual flight that might, one day, lead to a theoretical seat.

We'll see.


The staff was just devastated.    A wonderful, bright two-year old had come through surgery safely and was recovering well.  She spoke English as well as Kreyol and because of that was getting a lot of attention.

Mom was nowhere in sight and the little girl announced that her mother had abandoned her. Nurses, doctors, and aid workers were stunned and tearful. 

Then her mother returned.   She had left only to wash clothes, and was gone barely two hours.
Kleiman was in terror that I would try to bring this abandoned girl back with me and waxed cynical about  about childish manipulation. 

But this is a little girl who lost her father and older brother in the quake, an I am certain that every departure seems permanent to her.

I just went down to the OR to check on the neuro case still in progress.   Another pediatric disaster.  It won’t be okay.   It’s oddly calm because everyone accepts that we do our best.  We give our best.  We are the best that Haiti gets right now.

Yet we all know that it isn’ the best at all.  It is only the best we can do with what little we have.  It’s not the best because another child is going to die tonight.  In spite of our best.  Some of us will cry and some will try to apply some philosophical or religious spin to make it easier to sleep.  But it is just a delay tactic that we all silently deploy until we deal with the next cup of pain from this bottomless well of suffering.

Christine comes back every day with her baby, looking steadily into my eyes and quietly insisting "I want you to know this baby."

I saw Pierre and Kensey, the two night shift transporteurs / translators and amazing young men who bring their beautiful  spirits every night without fail to what must be a place of horror for them.  They have become my friends and family over the past month and tonight I had to tell them I am going to try to leave on Sunday.

I promised them I would be back and they trusted my word – but with great hesitation and sadness.  They will come with me to the airport on Sunday along with others who have become my family away from family to me.

I told them the truth about being exhausted and frustrated, and why I have to  leave for a while.  They already knew and were not upset or angry that I need a break from this overwhelmingly painful experience.  There are a lot of lessons about life and humanity to learn here but the most important lessons are about ourselves. 

I can’t wait to see Mark and Brett and David.  Sam, Big Mac  and George.  I will also be as sad to leave Haiti as I am glad to be home with you.  

Night Thoughts

Not my words, but they may as well have been.
The Haitian earthquake poses the big questions of the human condition. Life and death. Hope and despair. The good of doctors and rescue workers, versus the evil of thugs who raid orphanages in Port-au-Prince. Why? is the most obvious question; neither God’s will nor science seem adequate responses. Albert Camus’s belief in the absurd comes closest to it, but also fails to satisfy our need for answers.
My flight from Santo Domingo the other morning was filled with volunteer relief workers and journalists, heading back to the land of hot showers and cooked meals. The stewardess called a round of applause for the aid workers. Problem solved. We can go home now. Our short attention span is the biggest threat to Haiti’s recovery.
I’ll bet my bottom dollar that the poorest country in the Western hemisphere will remain so, that in a year or two or three, most of the two million Haitians whose lives have been shattered by the quake will still be poor, jobless and homeless. Urgent appeals have gone out for proper tents. But the rainy season will start in March. Even if tents arrive in the meantime, they’ll be washed down the hillside or mired in mud. We should have the foresight to start building houses on a massive scale, now.
A year after Israel killed 1,300 Palestinians in Gaza, the enclave is still under siege and little of the $4.5 billion (€3.2 billion) pledged to rebuild has materialised. A year and a half after the August 2008 war, Russia still occupies part of Georgia, and refugees cannot go home. I could give many more examples, but you get the idea. The lack of messy political issues comparable to the Arab-Israeli conflict or Russian irredentism made it easy for the world to agree on Haiti. Let’s hope that consensus continues.
The needs of our own countries militate against a sustained effort for Haiti. A young woman with the face of a black madonna, Francina Renard, followed me to the rope that separates US soldiers from Haitians at a camp for the displaced. “Can you give me a job?” she pleaded shyly. During the 10 days I spent in Port-au-Prince, I lost track of the number of Haitians who asked me for employment – not money, employment.
But how will the US government create jobs in Haiti, with 17 million jobless at home? Is America going to build shelter for one million Haitians, when 600,000 Americans are homeless?
Fortunately, Concern, Goal, Trócaire, MSF and the Red Cross will be there to nag our conscience. Their heroism in Haiti has been impressive. I distinguish between those with a commando attitude – who don’t let security worries prevent them rushing to help those in need – and the bureaucrats who waited in compounds for assessments, instructions and escorts. One often finds both attitudes within the same agency. It’s a question of character, and leadership.
Reconstruction will be complicated by the fabled corruption of the Haitian government, and the need to respect Haitian sovereignty, but neither must be allowed to prevent help reaching people.
John O’Shea, the head of Goal, tells how his agency redirected its post-tsunami efforts from Indonesia to Sri Lanka because of the unhelpful attitude of the Indonesian military. Aid agencies owe it to donors to impose conditionality and accountability, says O’Shea.
We should beware of the colour-blindness that affects our scorn for corruption. The biggest thieves in Baghdad after the 2003 US invasion were US contractors, who made off with hundreds of millions of dollars. Dealing with “our sons of bitches” (as Teddy Roosevelt called US-backed despots) does not preclude corruption either. Remember the Shah of Iran, Ferdinand Marcos, Saddam Hussein (before we turned against him), Hamid Karzai’s administration in Afghanistan . . .
Endowing Haiti with effective, democratic government may be the greatest challenge. On the night of the earthquake, what was left of President René Préval’s government got on motorcycles and rode up the hill to the US ambassador’s residence. But the Obama administration and international donors would rather deal with a strong government than a helpless client state.
“The only institutions that function throughout the Caribbean and Latin America are the Catholic Church and the gangs,” notes Patrick Moynihan, an Irish-American who runs a school in Port-au-Prince.
I rode around Port-au-Prince in a “tap-tap”, a Toyota pick-up with benches in the back for passengers. As we headed down the hill one morning, coasting without power to save petrol, a middle-aged man dressed like a clerk or office worker jumped in. Jean-Claude, the tap-tap driver, explained that we weren’t taking passengers, and asked him to leave. The man clutched his document file to his chest and refused to budge.
There was no public transport, he said, and he had somewhere to be going. The determination of the man in the tap-tap gave me hope for Haiti. So did the calm, dignity and resilience of the earthquake survivors.
Haiti is a state founded on two genocides – the native indigenous Indians, exterminated by the Spanish, followed by the slow deaths of up to one million African slaves at the hands of the French. In the 19th century, France demanded reparations from the world’s first black republic. Fearful that the example of rebellion would spread to slaves on its own territory, the US imposed a crippling trade embargo on the former “pearl of the Antilles”.
In Haiti, the evil done by men – including the island’s home-grown tyrants – has lived on. It will take tremendous determination, commensurate with the effort of the past two weeks, to prove that the chains of history can be broken.

by Lara Marlow, Washington Correspondent for The Irish Times

Thursday, February 18, 2010

Other Highest Acute Care Priorities

We are still doing surgeries without real anesthesia.  We use very heavy conscious sedation which sorta kinda works but is really inferior.

We do not have decent lighting in the O.R. areas.

Our beloved scrub techs are great, but systematic sterilization will be a lot better, especially with the coming infections.

We need:

·         Tuttnauer 5075 Hsg Class B Autoclave – Stand alone – on wheels

·         OR lights – either DRE Medical free-standings or DRE Vision Excels

·         Anesthesia Machine --  Narkomed with ventilator and with servo forane vaporizers   


Gentleness That Rips Open Your Heart

The Haitian people do not celebrate Valentine's Day but they know it is a big thing in the U.S.  My sweet patient, Puerre, who at 16 lost his entire right arm in the earthquake, gave me his bear to sleep with so I would not be alone.

Who is caring for who?

Tents Won't Last. Plywood Yurts Will

From Kleiman:

For perhaps 2-3 times the cost of a tent which will not last the rainy season  (and is barely helpful now) Hatian families can be sheltered in durable yurts that will last 2-3 years.
Units take a team of three people around an hour to assemble. They are assembled using a 6" wide, 600+lb bidirectional filament tape, and anchored to the ground like tents. No heavy lifting, ladders or scaffolding are required.

Any wood shop or packaging factory can be taught to manufacture units in an afternoon. In emergencies, basic units can be manufactured on site with hand tools in half an hour each (only six cuts are required for each unit.)

Keep the Haitian People Close to Your Heart. There Problems Have Just Begun.

Haiti’s rain falls in diagonal sheets.  The raindrops here are the biggest I have ever seen. 

It is.  3:30 in the morning.  I’ve spent the better part of two hours trying to duct tape plastic garbage bags over the “windows” of the shelter box tent, which leaks from every zipper.   The shelter boxes are fine ideas, but not for Haiti.   There are leaks throughout my tent, after two hours of efforts to secure it.  And I have tape.

I don’t mean to complain, because our situation is by far better than most in PAP.  The majority of Haitians do not even have leaky tents.  They have plastic sheeting and tarps to cover their families and belongings.

Sean Penn left yesterday and is telling the world about the impending health crisis that will be caused by the rains if housing issues are ignored.    I hope someone at home listens to him because every good thing that has been done here (medical and otherwise) will be destroyed if we fail to address and solve some basic infrastructure problems.

Our transporteurs sat in the rain last night and begged me for plastic sheeting.  I tried to get them some but the project insisted (not unreasonably) that we need it for the hospital to patch up our own holes so the patients can be moderately dry. 

Mud is being tracked into and through the hospital tents.  More flies and mosquitoes will follow.

I feel so helpless.  None of what we have done will make a difference in a month or two.  All the people in casts will lose their limbs because the casts will get infected.  Once the water starts moving through the streets all of the human waste and human remains will move with it.  

We already saw our first case of salmonella poisoning -- from fresh lettuce at the U.N. restaurant!    

This will only get worse.  Fast.

Here is what my "shelter" looks like from the inside in the rain.  Apologies for the in-the-dark in-a-downpour quality of the images

Monday, February 15, 2010

Last night we were going to close the O.R. and reorganize it, to get better control of who walks through our sterile areas in the middle of abdominal surgery, which is what happened two nights ago.  Instead we operated through much of the evening, a steady diet of traffic accidents and a smattering of gunshot wounds and stabbings.

Now that the worst of the crisis has subsided, Haiti's Knife and Gun Club seems to have been reactivated.  Although it is no worse than I've seen in many U.S. cities, it is hard to see here, and hard to see now.

Last night's rain weakened some structures and a school wall collapsed this afternoon.  We received the news and readied the O.R. and cleared the Emergency Area.  And waited.  Four children died at the scene.  There was nothing for us to do but shudder.

We still don't have enough ICU nurses, so I am again getting up at 2 a.m. to relieve another R.N.  I tried to go to bed early enough to do this, but some of the new nurses think they're at camp, and are pretty fucking loud for 11:30 at night.  I can still hear them over my noise-cancelling headset.

But I am happier to whine about this than about no O2, no water to cleanse wounds, and no anesthesia.  I guess this will have to pass for normal tonight.

An Amazing Post From Another Aid Workerèn-days-remembrance-letters-port-au-prince

Jounen jèn -- Days of remembrance: Letters from Port au Prince

Friday February 12, one month after the earthquake, the first day of Jounen jèn, the days of mourning and remembrance, and we walked through the twisted iron and dusty shards of glass of the shattered National Cathedral. As we crossed through the open door and stared down the length of the cathedral it was as though the world had ended and even the wind had disappeared into the silence of the rubble. Just blocks away, in front of the crumbling palace, thousands of people dressed in white were singing songs of grief and praise, but inside the National Cathedral, on this national day of remembrance there was only the sky and the crumpled flowers from the alter scattered across the floor where so many feet once tread. 

As we stepped gingerly through the cement dust, climbing towards where the alter once stood, I remembered the last time that I walked down this aisle, through the sunbeams and the wailing, walking to pay my last respects to Father Gerard Jean Juste in June 2009. This place has always broken my heart. So many voices that once sang in this church have been swallowed by the earthquake and I longed to hear Father Gerry’s voice, but I knew what he would have told me. He would tell me that those of us who survived have to sing louder, to work harder and to love each other more.  As we left the cathedral and passed the crowd on Champ de Mars I could hear the crowd of thousands singing their sadness into salvation.  I knew that Father Gerry was with them, under the tarp churches, marching through the streets, watering the parks of the city with their tears. 

When we got home in the evening on Friday everyone at Matthew 25, where we are staying, gathered to read aloud a prayer for Haiti.  Three quarters of the way through the prayer the tears began rolling down my cheeks, I could see the cathedral as they carried Father Gerry’s body down the aisle and the flowers buried in dust that we had walked through earlier.  I cried for hours that night for the first time since coming to Port au Prince.  Mine were only drops in the lake of tears that flowed through Haiti this weekend as people said goodbye to their loved ones and their lost city.
I end with an excerpt from the prayer that we read on the 12th.

“Raise up your people from the ash heap of destruction and give them strong hearts and hands, shore up their minds and spirits.  Help them to bear this new burden”

This week with your donations we were able to provide a week’s worth of food to over 350 families, deliver 24,000 gallons of water to 5 communities, provide medicines to several mobile clinics, give over 4000 water sachets in churches during Jounen jèn and purchase 140 tarps, reaching over 5,000 people in Port au Prince.  In Cap Haitien the SOL team provided food and medicines to victims of the earthquake that have been relocated out of the capital. SOIL is still small and though we cannot rebuild the National Cathedral, with your support we can help thousands of families in Port au Prince to bear this new burden.

It is the strength of the Haitian people that has helped me to rise from the ashes of my own fear and sadness, today on this final day of mourning I pray that I can treat the victims of this tragedy as they have treated me, with compassion, respect and dignity.  I am so grateful to all of you who have helped to lighten Haiti’s load, this experience has helped us all to remember our humanity. 

With love from Port au Prince,

Sunday, February 14, 2010

Valentine's Day Steam Bath

Our Haitian patients and their families were amused by our observance of Valentine's Day. but were quite happy with the candies and M&Ms I passed out to them in pill cups.  Just as well that I was able to do it.  "Lunch" came at 4 o'clock, with the news that there would (again) be no dinner.  We passed it out, telling all of the patients that this was dinner, and supplementing it with the staff's rations, which we donated to keep the patients nourished.

The staff, tired and mostly beaten down by the heat trudged the long way around to the U.N. restaurant.  Most of us were lucky enough to get back before the deluge.  I had used the term 'torrential downpour' many times.  Now I have been in one.  It rained more in seven minutes than I could ever have dreamt.  Even with the tent zipped, a bunch of my stuff was soaked.  I can only imagine what it is like for the hundreds of thousands living under tarps.

And don't think for a minute that it cooled things down. It didn't.  Just turned it into a sauna.

Days in the Life

A V-Day Note to my friends and loved ones who have asked about some of the living conditions for us:

A major score this week -- someone sent some cotton sheets, and I now have sheets for my foam pad mattress, which is very cool, especially as I'm getting some kind of a rash, probably just due to the heat, which is still well over 90 every day.

We handwash our scrubs daily and have shower stalls enclosed by plywood.  The cold water showers are actually a great relief here, given the heat.

One of the docs who rotated in on Friday brought a cooler full of Subway sandwiches.   Must confess that I relished it.  Subway has never tasted so good.

One final, utterly surreal note:  Every traffic signal in Port-Au-Prince works perfectly.  They are all solar powered.  Completely dark streets.  No lights visible for miles except candles and occasional handhelds...but perfectly times, perfectly bright traffic lights.


Last night without warning, the U.N. ordered all Haitian hospital workers who have slept on base with us to leave.  This is not just rude – it is dangerous.  We run surgeries 24/7, all without a Central Supply operation that stockpiles surgical instruments.  Our scrub techs are here without letup to make sure we have sterile instruments on hand when they are needed.  It’s specialized work and I don’t know how to do it.  I’d be surprised if any of the nurses here did.

So now the scrub techs are being ordered out.  Insane.    Not a chance.

For now I have moved a bunch of supplies around and our three scrub techs are somehow fitting themselves into a two-person tent.  Tomorrow, one of the logistics guys is going to set up a  Shelter Box  for them as part of the hospital encampment.

The predominant UN force here is from the Brazilian army.  They seem to hate the Haitians.  They have been known to provoke riots to justify their presence.  Many Haitians believe that last year U.N. troops fired at people attending the funeral of a pro-Aristide priest who Had been assassinated. 

You’d think in the face of all this carnage and misery there would be some let-up, wouldn’t you? 

You’d think.