Haiti: The Rubble Remains, The Wounds Still Fester

WE ARE HERE for the sake of each other–above all for those upon whose smile and well-being our own happiness depends, and also for the countless unknown souls with whose fate we are connected by a bond of sympathy. Many times a day I realize how much my own outer and inner life is built upon the labors of my fellow men, both living and dead, and how earnestly I must exert myself in order to give in return as much as I have received.

–Albert Einstein

I want to invite you all to imagine what we saw the dark humid night we arrived in Haiti, one year ago, less than 3 days after the earthquake which lasted only 40 seconds but killed 200,000, injured and maimed 300,000 more, and left 2 million homeless.  The aftershocks of that quake will ripple through the lives of the Haitian people for decades to come.

Imagine you arrive to a place where everyone you meet has just lost someone–a mother, father, brother, sister, cousin, or friend.  Imagine everyone looking but finding nothing, waiting patiently, calmly in the streets under the hot, humid Haitian sun for water, food, medical care, shelter, or comfort that didn’t come for days and days and still one year later only trickles in.  Now imagine that all this happened in New York City. And that it was the poorest country in the Western hemisphere on a good day.  That is what we walked into that night one year ago.

Imagine what our surgical SWAT team of seven saw the night we arrived at the University Hospital in Port au Prince–1500 hundred wounded, suffering, dehydrated, hungry, patients laying about the courtyard of the hospital afraid to enter the buildings. Patients who needed urgent surgery four days after the quake with the sweetish fetid smell of infected open wounds everywhere in the air.

There was only a few local staff left for thousands of patients.  They too were dead. They too had lost their homes. Slowly after a week, those who survived began to return to work, their families gone or injured, their homes in piles of rock and debris, nowhere for them to go home to, but still they came to help.

At the hospital we exited our air-conditioned land cruiser into the thick, rancid stench of decaying flesh. The morgue was around the corner –a vast open parking lot of putrefying bodies, bloated and swollen and rotting, hundreds upon hundreds were piled and strewn across the concrete–thrown into piles and hoisted up by their limbs into pick up trucks or by bulldozers into large dump trucks to be buried in mass graves. Those images, smells, and the sounds of the bulldozer scrapping up bodies off the pavement still haunt me in the darkest hours of the night.

And yet that first night we arrived, in the park at the center of Port au Prince in front of the collapsed Palace thousands of people slept outside–sitting, talking, laughing, praying, living while death was all around them. There was peace and calm and cooperation and acceptance among the people, even laughter and smiles in the face of no homes, no water, no food, nothing at all to soothe them except their common humanity.

Haitians danced and sang in the streets that day celebrating life and the human spirit’s extraordinary capacity to survive.

And throughout the hospital I heard people saying –“Bondye kite nou kanmpe.  God left us standing.”  God left all of you standing. And for a moment, the world stood up with Haiti.  But now a year later, most have turned away again, have sat down drawn into the next drama on television, and Haiti has faded into a memory, a place we imagine has been healed and saved and repaired.  But it has not.  There are still 1 million homeless, only a fraction of the aid pledged has been received by Haiti, the volunteers and aid organizations have mostly left, the government, disenfranchised by decades of aid given to NGO’s has still not built the structures and capacity to govern and guide their small nation.  The help that comes is in small acts of great love, as Mother Theresa said, by a few individuals who know still that Haiti’s healing is a journey of a hundred years.

How can we measure the resiliency of the Haitian people who are the poorest in the western hemisphere with 55 percent living below the extreme poverty line of $1 a day, where on a good day nearly half the population doesn’t know when or where the next meal will come from, where on good day 47 percent don’t have any access to the most basic health care, 90 percent of children have intestinal infections, 45 percent of the population doesn’t have clean water, and 80 percent are without basic sanitation?

And today is not a good day in Haiti.

How can we measure the resiliency of these people who have endured natural after political after natural disaster for 200 years?  Perhaps it is in the strength of the 85-year-old woman found in the rubble 10 days after the quake still breathing, with a pulse and blood pressure and who with a little intravenous fluids started producing urine again.

Or the little boy pulled from the rubble after a week, who was up the next day running around our medical camp hugging the nurses and doctors who brought him back from near death?

There was barely a whimper from the hospital campus where we reduced fractures with barely any pain medication and where gaping, infected, and necrotic wounds were re-bandaged daily without sedation, where my wife and father in law performed amputations lit by camping headlamps without water, electricity, or disinfectant with a rusty hacksaw that we washed with vodka.

There was only the occasional wailing from a broken heart.

After the second quake on the third morning we were there, all the patients ran, hopped on one foot or were dragged from the hospital wards screaming. I wonder, how can they live with only one arm or leg, when it was hard enough with two?
Yet a year later the catastrophe continues, not the acute, horrific, world stopping horror, but the slow, embedded and smoldering chronic illness of a nation made dysfunctional by the worlds mistakes and crimes, by the inciting of corruption through the side-stepping of government as the world of do-gooders innocently do ill.  Rather than build the capacity of the government to govern and lead, donors and NGO’s often provide chaotic, uncoordinated support for the things a government is meant to do, leaving the government without support, money or capacity to govern and lead.  Haiti has become a welfare state.  We don’t need more NGO’s handouts, we need the world’s nations to support Haiti’s government to reinvent itself from the rubble and build the structures, institutions, and the capacity to lead.  This will not be easy or quick, but it is necessary, and essential.

We need to find a way to rehabilitate a broken nation.  Just as we had to find a way to care for the patients discharged from the hospitals who needed care for months, and those who needed rehabilitation after losing their limbs.

My cousin, David Meltzer, in charge of International Affairs for the American Red Cross shared with me that 2 years after the earthquake in Chengdu, China nearly all of the 20 plus million homeless were housed in new homes in new communities and were thriving.  Totalitarian focus has its benefits.  But today, sickened by cholera, drenched by the rains, tents ripped apart by tropical winds, there is little change and most of the estimated million homeless remain in tents and shacks or live on the median of highways in Carrefour.

Every other building has collapsed in the city.  There is a saying that the Haitians are not afraid of war or earthquakes or hunger, but they are terrified of rain.  And the rains have come.

They bathe, eat, drink and defecate all in the same few square feet, and are at risk of tetanus, or diseases of overcrowding such as meningitis, diarrhea, cholera, typhoid, hepatitis, or tuberculosis.  A 5 year-old boy at the hospital had tetanus.  That should not happen in the 21^st century.

Now that the immediate life-threatening needs are met, the psychological trauma and support and re-building of communities will need to happen.  As we drove through the rubble of the city to the hospital one morning, a woman was screaming and writhing on the cement in an alley, grieving and expressing the anguish felt by millions in Haiti and around the world.
My heart is still broken, the tears still flow, the nightmares come and Haiti lives in my heart.  I have been back three times, and continue to work in small ways to do what I can.  My friend, Auguste Joseph, the medical student that helped us remove the severed limbs from the operating table and cleaned the operating rooms 12 hours a day, in those first days after the quake, still struggles to feed his family, to find shelter, to dodge bullets and violence.  I send him a little something every month to feed his family.  But that is not really what he needs.  He needs a functioning medical school, a way to earn a living, an infrastructure that provides electricity, food, housing and transportation, all of which we take for granted, but none of which he enjoys, struggling a year later to forage a life in the rubble.  There is a way to rebuild Haiti in partnership with the Haitians and the government to support the sustainable emergence of Haiti’s enduring, resilient and open-hearted people from two centuries of darkness.

Buddha said, “When your heart breaks, it can either break open or it can break closed.”

Let your heart break open for Haiti!

Mark Hyman, MD

To see more photos from my trips to Haiti, please see my Haiti photo journal.