Haiti After the Earthquake

by Paul Farmer

  This hope sustained me in the early hours before we had any sense of the body count. Good intel depended on reliable sources, and there were few of those on day two. When Clinton was asked whether estimates of one hundred thousand dead were off the mark, he responded, “They do seem high. If you think about the population of Port-au-Prince and the surrounding area, in excess of two million, one hundred thousand would be about 5 percent. What I am hoping is that, when they clear the rubble away, they will find that more people have survived these collapsing buildings than they think. We just don’t know.”5

  Looking back, it’s apparent that the rubble will take years to clear away and that the toll was far greater than feared. But on January 13, we didn’t grasp the size of the disaster nor did we anticipate the magnitude of the relief efforts that would follow. Still, every report coming out of Haiti suggested that it was worse, far worse, than anything that had happened there before. Few Haitians were present at the UN meeting. Leslie Voltaire (also required to speak) was dazed, as I was. He still didn’t know if his son was alive, and I still had no idea what had become of my in-laws, students, coworkers, and friends. Neither of us was sure that we were in the right place that day.

  Thus began, well before the end of day two, the making of grim lists. In those first hours, Haitian families and their friends and colleagues kept lists, mental or otherwise, of those unaccounted for. The lists grew shorter with the hours, as searches and queries turned up the living and the dead. It was the living I wanted to help directly—that’s why I felt out of place on the UN dais sitting behind President Clinton. At least Voltaire and the others were real diplomats. But what was I doing sitting in a meeting when medical needs were great? (Or was my ardent desire to show up in Haiti merely a symptom of some misguided personal quest for efficacy?)

  Ill at ease listening to declarations in the UN general assembly, I knew I needed to get to Haiti immediately. There had to be a way, even though the airport had been damaged and was closed to all commercial traffic. Claire Pierre caught a train to New York to join me; she too wanted to return to Haiti, which was a great relief to me (and to her mother, who had spent the night after the quake on the lawn of the Prime Minister’s office, along with hundreds of others). Voltaire wanted to go, too, and Clinton was ready to join us, he said, “as soon as I know I won’t be in the way.”

  It took a dozen phone calls and Secretary Clinton’s help, but by the end of the next day we boarded a small private jet headed for Haiti. On the plane was precisely the sort of team Dr. Alix Lassègue had requested: two orthopedic surgeons (a father-daughter team) and others able to take care of the critically injured, including a Haitian-American ICU doctor from New York. Flying to Port-au-Prince from New York takes only three or four hours, but for about an hour, our plane circled the city. Smothered by near-total darkness, the only sources of light were small fires dotting the vast conurbation of Port-au-Prince.

  I’ve lost track of the times I’ve flown into Haiti, sometimes during political violence and sometimes during disasters natural and unnatural. But I’d never arrived with a heavier heart than on that day. As soon as we opened the door, it hit us: a charnel-house stench filled the air of the windswept runway. I knew this smell but never imagined I would encounter it in an open space. Now it hung over the city like a filthy, clinging garment—the stench of a battlefield without the violence or din of war. Except for airplanes and helicopters, there was silence.

  Loune Viaud and Nancy Dorsinville were there, as was the reporter Byron Pitts—he’d done a 60 Minutes piece on our work in central Haiti and had become a friend. Pitts had flown to the Dominican Republic and hired a car to take him to Port-au-Prince. Although I felt entirely unprepared to speak on camera, Pitts was about the only journalist I was glad to see. We’d come with surgeons and medical supplies, and were headed for the General Hospital. Pitts and his team would meet us there, and I promised to sit down with him later that night. (It was already ten o’clock.) But first I went to the nearby UN logistics base, where my colleagues had cobbled together a makeshift field hospital under a tent and were attending to a number of survivors. I saw them—David Walton, Joia Mukherjee, and Louise Ivers—coming from rounds. David and Joia had flown to the Dominican Republic and come into Haiti by road, but Louise had been right in the middle of it all since the earthquake. She hadn’t slept more than a few hours in the previous two days, and was signing out patients and duties to Haitian and American colleagues.

  When the quake hit, Louise had been in a meeting about, of all things, food security and disaster preparedness. Ounsel Médé—pronounced “Mayday”—had driven her there, and a wall had fallen on the jeep, crushing the passenger side and taking out the windshield. Médé was uninjured but shaken. Louise found herself the only doctor amidst a sea of pain and suffering. But even the best doctors are impotent without the tools of our trade. Her description of the immediate aftermath says a lot about trying to provide care without proper equipment:The majority of injuries that I cared for in the first few hours and days of the tragedy were open fractures and crush injuries that require antibiotics that we did not have and surgery that we could not perform. With the help of surgeons who had just arrived, forty-eight hours after I found him on the street where we had both escaped with our lives from cracking buildings, we amputated the arm of a young man on a table in the open air with no available anesthesia. Not to do so would have left him to die of gangrene.6

  I didn’t know these details when I landed but had a good sense by then of what my colleagues had gone through. It was a relief to see them—my protégés in the deepest sense of the word—and I embraced them all, especially Louise. Few words were spoken, but I was flooded with gratitude for her presence. I could tell that she was tired. But after eight years in Haiti, she was as committed to its people as a doctor could be.

  I wanted to share the burden of caring for the patients streaming into Haiti’s crippled hospitals. Late that night, in two waves, we made our way to Port-au-Prince’s largest health care facility, where Dr. Lassègue (and Bryon Pitts and God knows what else) awaited us. I still had little idea of what to expect, and wanted most of all to confer privately with two of my closest friends, Loune and Nancy. Now we were together at last, alone in a jeep with Samuel, a driver we knew well, and en route to the General Hospital.

  We had been through rough times before: political strife, coups, the loss of many friends and coworkers. (Loune and I had worked together for more than twenty years; she is one of the toughest people I know.) Loune and Nancy tried talking, though not much came out. They had both been in the Global Fund meeting along with Prime Minister Bellerive and many of our colleagues. They didn’t say much about their experience because the building had not collapsed immediately upon them, and they knew how many others had not been so lucky. But the ceiling had started to crack, and they heard another part of the building come tumbling down. Several voices cried out, and one of our friends fainted dead away, they said. But most in the crowded room did not panic; they gathered their affairs, helped their colleague to her feet, and filed into an open courtyard. Outside, a strange cloud of white dust picked up the late-afternoon light as Loune and Nancy moved to safer ground.

  The street around them slowly filled with dazed people, many of them reaching for cell phones. As hundreds of thousands of people all tried at once to call friends and loved ones, overtaxed and damaged switching stations gave way. The city’s residents were cut off from the world. The Prime Minister and other officials got a sense of what had happened—it took some minutes to understand it had been a quake, not a bomb—and sped off towards the city center. I’d gathered that much of the story from Bellerive shortly after the quake.

  As we headed towards the General Hospital Loune and Nancy filled in some of the blanks about the first hours after the quake. In the busy neighborhood of Delmas, where the AIDS meeting had taken place, they could only guess the scope of the destruction. Power poles were skewed at strange angle
s or fallen, and a number of houses and commercial buildings, including some of the country’s larger banks, had collapsed; other structures right next to them had not. It was rush hour, and confusion was welling, but many of Haiti’s famously colorful tap-taps—the local equivalent of public transport—had pulled over as if their drivers awaited some harsher blow. Some cars and vehicles were crushed or damaged (like Médé’s) by collapsed buildings and walls, but most stalled on Delmas’s broad boulevard, as drivers tried to figure out what had happened.

  Soon, confusion reigned. Something bad had happened; that was given and even expected in Haiti. But no one in Delmas or even in more heavily damaged parts of town knew how bad. As the news spread and as dusk fell, the city, then the nation, began keeping personal tallies. Loune and Nancy reassured me that my own relatives were alive and accounted for. But throughout the country, and then the diaspora, it was the week of grim lists.

  Although I’d forgotten to ask, I later learned that at the top of Loune and Nancy’s list were the almost fifty unaccompanied minors in the General Hospital: children with disabilities who had been born or treated in the hospital and whose parents had, before the quake, died or been unable to care for them. For more than two months, we’d been scouting neighborhoods north of the city for a safe haven where we could move them. But such matters take time, ample resources, and the blessing of the child-welfare system. We didn’t want to bring the children to one of the many mediocre orphanages dotting the Haitian landscape; we wanted to find the right setting and the medical expertise these children needed. By January, Loune had found a few properties she thought might work as a home for special-needs kids of all ages, and she and Nancy and others had promised to take all the children into our care.

  On the twelfth, as the sun set over the crippled city, the dimensions of the tragedy had not begun to sink in. But Loune and Nancy felt their first priority was checking on these children. As they made their way to the General Hospital, they saw, as everyone did, the wounded and the dead and the simply dazed. The way into the city center was obstructed by downed buildings and flattened vehicles and utility poles, but my friends pressed on. When they reached the hospital, they found chaos. Many employees not injured or killed had left their posts to search for family members; more and more casualties were arriving at the gates.

  The dead were everywhere, but they discovered that not one of the handicapped children had been injured. (They were shifted to the “safe and accounted-for” list.) Staff moved the children into the open courtyard, where for two days they shared a crowded and foul space with the dead and wounded. The day before my arrival, Loune found safer lodging for them at an undamaged hospital run by a friend, a physician-priest. (Loune would later find a proper home for all of these children, whose number would grow to fifty-three.)

  If Loune and Nancy recounted this part of the story as we headed to the hospital, it didn’t register. What I do recall was that their accounts were interrupted by long silences. I didn’t press them for details. Both were in anguish as we traveled through the ruined city they called home. It was my first look at it, and there was little to say. The headlights from our vehicle penetrated the darkness, which was complete save some scattered fires, thousands of candles, and the alien glow of helicopters of unknown provenance. Everywhere buildings spilled into the streets. Most commonly, concrete slabs—the buildings’ floors—were pancaked down upon themselves, and it was from these buildings that the smell of death emanated. Some structures leaned over the streets, held in place at menacing angles by twisted steel.

  We surveyed the wreckage while moving slowly through narrow openings. It was a transformed landscape, strewn with the ruins of some recognizable landmarks. We reached the densely populated area known as Bourdon. As a student in the eighties, I had spent many weekends with the Lafontants in a house on Martin Luther King Avenue, the main street from the airport to the center of town. To my left and right were scores of similar houses and also small businesses—many now stacks of floors with little more than a foot or two between them. At 5:00 P.M., businesses and homes and schools would have been full. Although we still had no idea of the death toll, it seemed unlikely that many would be pulled from this rubble alive.

  Haiti is probably the only country in the world where a Martin Luther King Avenue runs into a John Brown Avenue, and we soon turned right on John Brown, down the hill towards the federal buildings. For twenty years, we’d traced this route to attend meetings at the Ministry of Health; now it led through empty streets lined by a new nightmare landscape. Could that really be the National Palace? The Ministry of Finance? The Cathedral? Even in the dark, it looked as if the heart of Port-au-Prince had been carpet bombed. People were already camped out in the broad open space in front of the palace, surrounding the famous statue of a marooned slave, broken fetters at his feet. Now his descendants were marooned under sheets pitched close by the symbol of Haiti’s resistance to slavery.

  The Ministry of Health was one of the first federal buildings on the street leading from the palace to the hospital. The heart of the nation’s health system lay in a compact but messy pile of plaster, office furniture, and papers. Although I couldn’t see much in the dark, I soon learned that not even a corner of the venerable building was standing.

  We pulled up at last to the General Hospital. It looked the same as it had before the quake, and the gate was open. The rest of the neighborhood was clearly a mess. Echoing Dr. Lassègue, Loune and Nancy told me that the nursing school had been flattened, its students and faculty crushed. And once through the gates, we saw that like the neighborhoods and public spaces we’d just traversed, the once-familiar hospital campus was transformed. It was mostly dark: a few small generators were sputtering power into a couple of the main wards. Every open space on the campus was occupied by people who should’ve been inside the buildings, not outside. Even in the dark, we could make out people huddled around beds and cots and makeshift tents. Everywhere hung the same overwhelming stench that pervaded the entire city. I felt disoriented, and counted on Loune and Nancy to lead me to Lassègue, to the team I’d traveled with (none of them Haiti veterans except for the Haitian-American doctor who had trained there years ago), and to Byron Pitts, with whom I’d promised to sit and speak somewhere in this wreck and ruin.

  In a disaster, shortages of personnel and supplies were to be expected. One didn’t have to be an expert in disaster relief to know that. But the director of the hospital was there, as was the chief of nursing—even though it was after ten at night before we arrived. We found Dr. Lassègue and Marlaine Thompson tucked into a small office in the middle of the darkened complex, pouring over their own grim lists in the dim light—lists of what was needed but also lists of personnel unaccounted for. Outside the office, a handful of people were moving stacks of boxes and doing inventory; some of the tools of the trade, surgical and first-aid supplies, were coming in.

  It was in this room, filled with stacked boxes of supplies, in the heart of a hospital that could not possibly provide the kind of care needed most—trauma care, much of it surgical—even if it had not been crippled by the quake, that I sat down with Pitts to discuss what was unfolding around us. I have little memory of our conversation, although one of Pitts’s questions stayed with me: “Haiti was already in dire straits prior to the quake. Do you believe it’s possible for it to recover?” I am paraphrasing here, because I’ve never had the courage to watch the piece through in one sitting, nor the reserve it would take to read the transcript of the interview and report.7

  Although weary, Lassègue and Thompson were clearly happy to see us. We’d been last together a month previously to cut the ribbon on a kitchen we’d helped build for the hospital. It was something we should have done years ago because our avowed philosophy—to make a preferential option for the poor—always led us back to dilapidated public institutions, whether in Haiti or elsewhere in Latin America or in Africa. After all, what institutions confer the right to health care? Not
NGOs, universities, or patients and their families; not aid agencies or the UN. The government confers rights, and this was supposed to be the premier public hospital in the country. Our tardy and overmodest contribution to build a proper kitchen in the General Hospital was intended to help the hospital live up to its obligations. Feeding the patients was one such obligation, but as elsewhere in Haiti, patients’ family members were expected to bring their meals to them. This practice had been extolled by some as community participation but had never been lauded by the poor, the sick, and the injured who found themselves in these institutions. (It reminded me of nothing so much as the fiction of community health “volunteers.”)

  If there had not been enough food for inpatients in Haiti’s referral hospital a month before the earthquake, it wasn’t hard to imagine what it would be like in its aftermath (in spite of the growing piles of medicines and supplies that served as the backdrop for my interview with Pitts). The hospital would also need food, fuel, and cash; it would need salary support. But very few of the Good Samaritans now pouring into Haiti were seeking to provide these basics. We wouldn’t have been able to help much in those first days if family and friends, including a well-respected nun from Miami, hadn’t given us thousands of dollars in cash to meet those needs.

  Miami seemed like one obvious place to store other supplies we would need in the weeks ahead: medications, generators, anesthesia machines, water, tarps, portable ultrasound machines. (The lists went on and on.) Jennie Block’s sister Laurie Nuell, a close friend of mine who lived there, helped organize such efforts. Before long, our teams in Miami and Boston had amassed hundreds of truckloads of supplies. The next issue was where to put them, and how to get them to Haiti. A New York–based supporter helped overcome this hurdle by donating a plane and a private airport hangar. (A number of our supporters in the business community, including Denis O’Brien and Rolando Gonzales-Bunster, also lent us planes.) Thanks to the logistical wizardry of the Partners In Health procurement team, which coordinated the entire process, private jets were soon flying in around the clock, picking up supplies and bringing them to Haiti. Laurie described it well:We quickly had to learn the language of shipping—skids, pallets, tail numbers, flight trackers, slots, manifests, knowing which jets could hold which cargo. Calls to and from Boston occurred every couple of hours, from 7:00 A.M. to 2:00 A.M., detailing what supplies were needed, what plane was going to be in to pick them up. Calls went out all over Florida to procure the necessary items. My house became a makeshift depot with people delivering all kinds of supplies throughout the day. It quickly became apparent that Partners In Health was going to need more warehouse space, with a forklift and palletizing capability, and staff to run the operation. Within days, space was donated, and a staff person was on board. Phone calls began arriving from Haiti for personal requests too—staff needing clothes because they hadn’t changed their clothes in weeks. Cots were needed so they didn’t have to sleep on the rubble; tents were needed for shelter. Housing was being set up for staff, so everything was needed for that: blankets, towels, plates, cups, silverware, even a coffee maker. Every request, no matter how big or small, was fulfilled.