A Girl Named Lovely

by Catherine Porter

A previous pregnancy? This was the first time I’d heard of it. I pieced together scraps of information she provided with gentle coaxing. It seemed she’d had a baby ten years earlier, when she was just sixteen. That little girl had also died. I was stunned. Losing one child was an unspeakable tragedy, but two? It was too much to bear.

  I asked Rosita why she hadn’t rushed the baby to the hospital for treatment when he started to wheeze and stopped feeding.

  “We didn’t think of it,” she said simply. “We just thought it was the weather. He had a cold.”

  Elistin offered a different explanation. They still owed money to the nurse. They couldn’t afford to foot the hospital bill.

  “The baby was missing vitamins. We could see his ribs,” he said. “I wanted to take him to the doctor, but the financial pressure . . . I couldn’t deal with it.”

  The mission hospital charged just US$1 a day for a bed, but every laboratory test and prescription was extra, and they quickly added up. In June, the nurses and doctors staying in my guesthouse had pooled US$320 to pay for ten days’ worth of treatment for a premature baby in a Pétionville community hospital.

  I understood the math. Spending US$320 was more than a year’s earnings for Rosemene right now.

  But still, anger bubbled up inside me. I’d been helping this family for months now. How, on my watch, did a baby die without ever seeing a doctor?

  Their resignation infuriated me. In Canada, there would be an inquest over this child’s death. Professionals would be subpoenaed to testify about how our social safety net had failed to catch him, all so that it might be carefully mended and strengthened to support the next child. But here there were no ambulances to dispatch, few doctors to call, little medication to offer, and no social workers to make sure each child was protected—even from his or her parents, if need be.

  No building had collapsed or buried this child. He was smothered by poverty, and no international aid workers had rushed in to help. This was considered normal. It was the human picture of those daunting statistics collected by the World Health Organization that showed, every four years, more babies and the mothers delivering them die in Haiti than just about anywhere else in the world.

  “I told her not to cry. The baby’s dead. There is nothing she can do,” Elistin said.

  Later that evening, we stopped at the cemetery. Most of the tombstones resembled miniature concrete apartments, all rising shoulder to shoulder. Each held a number of caskets; people often rented the space by the year. Large stone crosses loomed high above them. Elistin had brought the baby here and buried him less than an hour after he’d died. He hadn’t paid for a plot. He had just dug a hole, placed the child inside, and prayed.

  “I asked God to receive his soul, because it wasn’t his fault he died,” he said. “It was his mother and father’s fault.”

  I couldn’t help but add a few more names to that list: his grandparents; the Haitian government that looked out only for its own interests and not those of its poorest citizens; and foreign donors, who were still not working together to weave a safety net for Haitian children . . .

  • • •

  The next day, in the city below, I dropped into Port-au-Prince’s general hospital, as I did every trip.

  The security guards waved Dimitri’s SUV in and we parked by the ragged garden that was the central point of the hospital’s dismal complex. About 40 percent of its buildings had been damaged or completely destroyed during the earthquake, including the outpatient clinic and pediatric ward. The ones left standing looked as though they’d been hauled up from the ocean floor, their once white walls mottled with gray and brown spots and cut by long, curving cracks. Metal bars curled up the side of one building like eyelashes. The brown tents that had clogged the garden and surrounding cobblestone roads immediately after the disaster had dwindled to just a few. The pediatrics ward had moved into four low-slung plywood bunkers near the entry gates.

  The smell of urine was overwhelming. A thin river of gray water pulsed down the gutter by the SUV’s wheels. It came from half-naked people who were bathing from buckets out in the open. A man pushed his shriveled father, dressed only in underwear, around parked cars in a wheelchair that could have been fished from the trash, its leather seat and backrest replaced by a white plastic chair. The place reminded me of those Renaissance paintings of hell I’d seen in the galleries of Florence and Paris—all wretched naked people fighting with death.

  My mental tape loop was dotted with disturbing scenes I’d glimpsed here over the months of visits. On my first trip, I’d stopped at one of the brown tents and looked inside its plastic window to see a skeletal woman completely naked except for bangles on her wrists and rings on each finger, which rested by her groin. Someone had set a green plastic bin on her chest—the kind doctors throw dirty scissors into after cutting a person open. I could barely make out her face behind it, but what I could see was a hole where her eye should have been. Foreign doctors in scrubs raced behind me, but no one stopped. She was discarded, like the mound of garbage in the tent’s corner.

  On another trip, I’d walked into the very last tent on one of the paths and discovered it was the ward for abandoned children, where Gilberte’s second son had come from. There, a newborn baby lay alone in his mottled crib. His head was giant, his legs and arms curled like baby palm fronds. He was so skinny, each of his ribs protruded like the black keys of a piano. The infant diaper covered his entire belly. A nurse brooding in the corner of the tent about not being paid in months told me he had spina bifida.

  The worst part about it all was that this was the best care the hospital had offered Haitians in decades. The aid groups that choked its grounds had brought medical supplies that, traditionally, patients had had to buy themselves from pharmacies across the street—if they could afford them. With the aid groups’ help, the hospital had opened its first intensive care unit, fully staffed around the clock—a service that was unheard-of before the earthquake.

  By now the hospital had received its first three ambulances, so, on paper at least, it could go collect critically ill patients rather than have them arrange their own transportation there on the back of a motorcycle or tap-tap. Even if Lina had made it all the way down the mountain to this hospital with her baby, though, there would have been no assurances he would have received the lifesaving treatment he’d clearly needed.

  Over the past few months I’d been trying to understand the health care system in Haiti—or the lack of it. The picture that formed closely resembled the country’s education system. The constitution committed the state to run hospitals across the country for their citizens’ health, but in practice they were so poorly resourced that patients were forced to pay, which meant many didn’t step through the doors in the first place. Just like teachers, there were few trained doctors, as they typically went into private practice or left the country for jobs in Canada, the United States, or France, where they could earn at least thirty times as much as they did in Haiti. And, just like in education, the rich paid for good treatment, while the poor were left to beg for terrible care.

  The problem wasn’t lack of resources. The government had a meager budget to put toward health care itself, but international donors had funneled hundreds of millions of dollars into health care projects in the country long before the earthquake. The issue was the coordination of those resources.

  The hope was that the earthquake would change all that. The Haitian government had drafted a plan to piece the tattered system into a whole, providing free coverage first to the country’s most vulnerable, and eventually expanding to everyone.

  It had been done before—not just in other countries, like Bolivia, but right here in Haiti. A nonprofit called Zanmi Lasante, or Partners in Health (PIH), had built eleven hospitals, each smaller than the general hospital, of course. But they offered free care, and the quality was reportedly quite good.

  Dimitri and I set out to visit one in Lascahobas, a small town near the Dominican bord
er that seemed like a dusty frontier town from a Western movie: saloon-like stores lined the main street. At the end of the road was the hospital, which seemed like a mirage. Its buildings were white seashells set in a pond of green—manicured lawns and green trees. We got out of the car and walked under a trellis heavy with white flowers. There were ponds filled with goldfish, surrounded by banana trees and glorious orange birds of paradise in full bloom.

  Inside, the wards were simple but clean, with beds in rows filled with patients suffering from heart disease and malaria. There was a large functioning laboratory, solar panels to provide some of the hospital’s electricity, an ambulance to take emergency patients to a larger PIH hospital an hour away, and a large, stocked pharmacy.

  The care wasn’t just basic, either. On my tour, doctors introduced me to a ten-year-old girl who was sliding her injured left foot up and down the hall, practicing the walk her physiotherapist had taught her. She had arrived from Port-au-Prince six months before with what doctors thought was typhoid fever. Five days later she slipped into a coma and stayed there for two whole months. It turned out she had tuberculous meningitis, a disease that requires four courses of drugs over months.

  All of the hospital services were provided to some 250 patients a day for free. Officially, the hospital charged a nominal 25 gourdes (62 cents US) admission fee, but the fee was waived for pregnant women, children, HIV and tuberculosis patients, and anyone who couldn’t afford it, which essentially meant everyone.

  I decided that if I were ever to fall sick in Haiti, I’d beg Dimitri to bring me here. It was the only place I’d seen in Haiti that projected kindness, inspired hope, and offered first-rate service. It felt like a beacon of possibility.

  The hospital had been built on donated land, which was PIH’s model. The government paid the staff’s base salary, which the NGO topped up. It seemed to be the template for the government plan: NGOs stepping in where the government could not, but following the government’s direction and not the other way around.

  “If I wasn’t hopeful, I wouldn’t still be here,” PIH’s country director said. “There is a Haitian proverb: ‘Depi tet pa koupe, w toujou genyen espwa mete chapo.’ As long as your head is not cut off, you have the hope of putting on a hat.”

  Instead of focusing on all that was wrong here, the director pointed to what was not wrong. It was refreshing to hear such optimism for once.

  “We haven’t seen any major outbreaks of anything, which is good. It’s at least something,” she continued. And then, as if to convince herself, she repeated it: “There hasn’t been a major disease outbreak.”

  Six days later, on October 12, 2010, a twenty-eight-year-old man developed acute watery diarrhea after drinking from a tributary to the Artibonite River. He died less than twenty-four hours later. Two people who had prepared his body for the funeral developed the same severe watery diarrhea. On October 17, more sick people arrived at the small Hôpital de Mirebalais, not far from where backhoes were clearing the corn and rice fields to make way for Partners in Health’s new flagship hospital.

  They were the first cases of cholera seen by doctors in Haiti in almost a century.

  • • •

  When I next traveled to Port-au-Prince in November 2010, the cholera outbreak was in full bloom. In just a month it had already killed more than 1,100 people and sent almost 20,000 to the hospital—mostly people from the central plateau near Mirebalais, but the outbreak had already spread as far south as Jérémie and north to Cap-Haïtien.

  My second night back in Haiti, I reconnected with Nigel Fisher, the UN deputy special representative, for dinner. He was crisp and charming as ever. But he was less optimistic. An edge of irritation had crept into his voice. The week before, he’d launched the United Nations strategy to combat cholera in Haiti, which called for more of everything, from water purification tablets and rehydration salts to doctors and nurses trained in cholera treatment stationed across the country. It came with a US$164 million budget. So far, only 10 percent of that had arrived from donors.

  Accusations—which proved to be true—were swirling that the UN peacekeepers from Nepal had inadvertently infected the country with the disease that was endemic in their country through a leaky septic system at their base near Mirebalais. In Nigel’s view, however, an emergency was not the time to cast blame. He feared this would mean hundreds of thousands of people would be infected over the next few months, and that the death toll could reach 10,000.

  Nigel had been meeting with the heads of large aid organizations to ask them to commit some resources to combating cholera, so far without success.

  “I don’t know where the money has gone. I’ve been singularly unsuccessful at ascertaining how much they have left, what they are planning to do with it,” he said. “I know many have got a wad of cash, but I don’t know what they are spending it on.”

  Of all countries to get a waterborne disease, Haiti was the perfect host—and, again, its vulnerability had nothing to do with the earthquake. Most people in the country did not have access to clean water. In the countryside, many drank directly from streams and rivers, and if the waterways became contaminated—as the Artibonite had become—then those people would inevitably become sick. Most city dwellers bought their water, either by the tanker (the rich) or the bucket (the poor). But there was also an ancient underground clay pipe system in downtown Port-au-Prince dating from Napoleon’s era, which the government’s water authority purified with chlorine. If it got infected, many in the city would fall ill.

  As for the sewage system, there was none. The country did not have a single sewage treatment plant. Half of the population practiced what UNICEF called “open defecation.” The rest either owned septic tanks if they were rich or dug holes that they paid men called bayakous to empty at night. The bayakous typically dumped the sewage into the ravines, so during the rainy season the huge slums along the city’s waterfront—like Cité Soleil—were flooded, spreading the waste from latrines everywhere.

  It was easy to see why government and health workers feared the arrival of cholera to the city. The camps were protected, since they were still equipped with Porta-Potties and water stations. It was the slums that presented the nightmare scenario and, sure enough, when cholera surfaced first in Port-au-Prince, it was in a part of Cité Soleil called Wharf Jérémie.

  The disease spread quickly. In one day 85 deaths were recorded in Port-au-Prince. The next: 146.

  I saw my first cases at a treatment center in Cité Soleil. I will never forget it: patients lay on wooden cots with their pants pulled down. Their bums had been placed over holes in the beds and liquid poured from them into buckets below.

  Experts said cholera could kill someone within four hours, and I could see why: the dehydration was so rapid that it could cause a heart attack or renal failure. But as quickly as cholera could kill someone, it was also mercifully easy to treat. No chemotherapy or blood transfusions were required. All that a patient needed was rehydration with clean water, salt, and a little sugar; even severe cases only needed a simple rehydration IV and some antibiotics. The fact that something so treatable had killed so many people so quickly underscored the feebleness of the country’s health care system.

  Fear was palpable in the city. Walls that once were plastered with political graffiti had turned their sights to the disease. Aba UN Kolera Kaka—Down with the UN That Brought Cholera—was a popular tag. Locals attacked the new treatment centers opening in their neighborhoods for fear they would bring the disease to them. Mobs stoned bodies left in the streets and blocked city workers who tried to bring them to cemeteries. The government had recently hired a couple of crews in the city to collect bodies from the streets and swiftly remove them before they contaminated others, and those workers were set upon, too.

  Early one morning I met with one of the collection teams, made up of a dozen young men, and trailed them for the day. When a call came in about a body, they climbed into a van, a couple of trucks, and a t
ap-tap and raced off. Dimitri and I followed them in his SUV, charging up a road into the poor district of Carrefour-Feuilles. The convoy came to a sudden stop, and we watched the men get dressed into poor men’s hazmat suits: yellow rain jackets, large black rubber boots, dishwashing gloves, surgical masks, and chemistry lab goggles. Then they donned the hard plastic backpacks that gardeners use, usually brimming with insecticide, that came with long tubes and nozzles. Theirs sprayed just chlorinated water.

  Laid out on the street beside a small lottery stand was a fifty-seven-year-old man dressed in a fresh brown shirt and dress pants. His feet were bare and his eyes were open and glassy. His daughter appeared from a crowd in the distance and pleaded with the crew, telling them her father had died that morning of a heart attack on a tap-tap en route to the hospital. They told her to back away and began to spray the ground around his body. Then they showered her father’s corpse. Clearly no one believed her: If he had died of a heart attack, why had she left him on the road? Why was he not laid out at home?

  I watched as the workers performed their dehumanizing ritual. One worker rolled the man’s head to one side and then the other, stuffing his ears with chlorine-soaked cotton balls. Then he did the same to his eyes and nose and finally the dead man’s open mouth.

  The workers brought out blue flagging tape and bound his legs. They crossed his arms and lifted him awkwardly into one white body bag, and then another, for safe measure. That night they threw his body into a mass pit in the same area where earthquake victims had been dumped just ten months before.

  It all was so gruesome and grim. Thank goodness the disease had not made its way up the mountain to Fermathe, where Lovely lived. How could this little country bear so much suffering?

  • • •

  On this trip, for the first time, I packed an extra bag full of rad kenedi, one of the names locals used for the secondhand clothes hung up for sale on walls around the city, because the first such shipments had arrived during US president John F. Kennedy’s administration.