"Haiti's catastrophe will forever divide its history"

PIH Executive Director Ophelia Dahl has been visiting PIH’s sister organization in Haiti, Zanmi Lasante (“Partners In Health” in Haitian Creole). She recently sent the following note reflecting on her first 48 hours in Haiti, where she visited the University Hospital in Port-au-Prince and the Zanmi Lasante (ZL) hospital in Cange:

PIH Executive Director Ophelia Dahl with a patient in Haiti.

Haiti’s catastrophe will forever divide its history into before earthquake and after.

Dust has not settled. Flying towards Port-au-Prince, you can see a thick layer of smog lingering above the city. The air is acrid, stings the eyes, and makes you cough.  The airport is its own world:  a spread of tents large and small, containers, supplies, boxes, vehicles, bicycles, and people wandering about—both  in and out of uniform.

We bumped into Jens, the UN engineer who had worked with us on the bridge we helped build in Boucan Carré last year.  He was the last person to be pulled out alive from the UN meeting building. He had been under rubble for 6-8 days. Needless to say, he looked like a walking skeleton and sounded very jittery. “I had a lot of luck,” he put it simply

We drove to the University Hospital (HUEH).  The scene there is truly impressive in so many ways. Much progress has been made.  Medical tents are lined up in a row. Inside, beds and stretchers lie close together. Most patients are post surgery, bandaged, or in casts. They are now receiving narcotics. Operating rooms are up and running—now 24 hours a day. Patients are lying down, most with haunted eyes, but always responding to a greeting, often waving a slow hand. I had to stop myself from greeting them so they wouldn’t have to wave back in pain.

Last night, I sat outside the main tent at HUEH on a bench talking to Dr. Evan Lyon and Dr. David Walton, both have worked with PIH in Haiti for many years. With the lights on inside the tent, I could see the silhouettes of relatives tending to the patients, washing them with a rag, feeding or massaging them. The sadness everywhere is so palpable. Haitians are usually very expressive in their mourning. Before the quake occurred, wakes would typically last all night, with women wailing and shouting in agony outside on the ground. People often fainted during funerals. I can’t imagine that happening here now. The wailing would never stop.  There is no energy for weeping. Everything is marked by the quiet. Nearly everyone—adults and children—wear the same flat, sad expression on their faces.

Volunteers run about. Some nurses, both Haitian and American are around, but there is a lack of nursing care everywhere.  The nursing school collapsed in the quake, flattened between two buildings that still stand.  Its rubble holds the remains of the entire second-year nursing class. You can smell the bodies when you walk past.  It seems so arbitrary which buildings crumbled; maybe that’s why no one feels safe in any concrete structure.

Outside in the courtyards at HUEH, the patients who were evacuated from the ward after the second wave of aftershocks have constructed makeshift tents over their beds. It is starting to look like people are staying – where else can they go? The main buildings are mostly still standing on the HUEH campus, but several have major cracks. Patients are afraid to be inside. Evan told me that when people felt aftershock tremors last week, they pulled out their IVs and just scrambled out as fast they could.

Polo [PIH co-founder Dr. Paul Farmer] described a 35-year-old woman who had come to the hospital from the south. She was also attached to oxygen and afraid. He asked her whether anyone was with her. She said no one. She lost all her family and was brought to the hospital by a neighbor.

We also saw a woman who had been brought back to the hospital with tetanus. She was fine and had been discharged after the initial surgery on her foot. But now her neck was stiff, her head tilted back. She looked rigid and very sick. There will be medical challenges for many months and years to come. Other challenges remain too, including sanitation (there are no real toilets). You can imagine.

So many people are doing such a stellar job. Obviously, I know it is the effort of many, many folks, but Evan and David are shining stars. Old news, I know, but Evan reinforced how life-saving it has been to have Jim Ansara [founder of Shawmut Design and Construction Company] help get the electricity going. A lack of power was responsible for a lot of deaths in the first few days.

My first night, after touring parts of the city, Evan, David, Jim Ansara, Chris Strock [an engineer from Virginia Tech], and I stayed with a family in Port-au-Prince. We slept on the floor inside their house. The family slept on the ground outside—still too unsure to go in.

Yesterday, we had a leadership meeting with Zanmi Lasante (ZL) Director of Operations Loune Viaud, ZL Director of HIV/TB Dr. Fernet Leandre, PIH Clinical Director Dr. Louise Ivers, ZL Director of Monitoring and Evaluation Dr. Wesler Lambert and PIH Medical Director Dr. Joia Mukherjee and Polo to talk about the mid- and long-term response, particularly a community-based outreach movement. We spoke of ten specific communities, with a massive training of Community Health Workers for follow-up wound care and chronic care. We discussed key partnerships with food and water organizations. Joia also returned yesterday and has a plethora of details to be shared and refined.

Polo and I headed to Cange following our meeting. Silence was everywhere, as was a sort of stoicism I had not seen here before. It is impossible to greet colleagues and friends and not see that their hearts are broken. 

We went first to visit the church, which has probably 70 patients lying on mattresses in rows on the ground. All of them have casts on their limbs or white bandages over their stumps. Haitian staff and volunteers change dressings every day, and this need will endure for weeks to come. In the corner of the church is an overflow pharmacy, where the piano has become a workbench and meds cover the altar. Docs round on the patients. Lovely Dr. Jon Crocker [formerly the clinical director of PIH’s project in Malawi] was seeing patients with a team of volunteers. And, as always, relatives help their loved ones with simple tasks.  There is mostly quiet, no one is talking much, but there is a sense of community. Apparently, some patients moved to other wards have asked to come back to the church. We will have mass today in the Clinic Externe. 

In the hospital, all wards are taken up with amputees, patients with fractures, and some in need of spinal care. Probably 200 patients altogether. The team reported having done 1,150 x-rays. The x-ray room is a miserable place to be for those who have made the long trek, because their limbs must be repositioned to get a good film, and it is painful. But the films help ensure that their surgeries go smoothly.

There is a long road ahead for plastics, including skin grafts and wound care. We are planning for all that. We’ll need a big infusion of prosthetics in a few months. There will be perhaps tens of thousands of amputees, but it’s hard to count. Dr. Koji Nakashima, who has been working with Zanmi Lasante in Cange, says there are some NGOs with good experience helping landmine victims that we should reach out to because it is clear that expertise is required, as is steady, dedicated funding. Also, there loads of physical therapists will be needed. It is so hilly in Haiti that it’s hard to imagine life here without both legs.

I’m deeply moved by our staff. Many are suffering huge losses, but are still here. One of our lab technicians lost her husband, and her son suffered head trauma and kidney failure, yet she keeps coming to work. Having volunteer teams working with our staff is going well . The lovely team  from California here right now. The operating rooms are working hard; we’re able to do roughly 16 surgeries per day. There are three rooms available, but one is kept for emergencies and C-sections.

I am struck by many things, but the silence is deafening. The road from Cange to Hinche used to be a busy thoroughfare with trucks hurtling back and forth all day and blasting their horns. Yesterday, I counted only a handful of trucks. The trucks used to be loaded with food and things for market. Now there is just quiet—a sign that we are far from any sort of economic normalcy.

I’m heading to Hinche and, hopefully, to St Marc tomorrow.

-Ophelia Dahl