Haiti After the Earthquake

by Paul Farmer

  In all, eight medical groups and twenty-eight aid organizations are in Léogâne. All but the Cubans, who were here when the earthquake struck, have arrived in the past couple days. In a few more days, about the time most of the field hospitals get finished, the flow of gangrenous survivors will abruptly abate. Those that didn’t get help will be dead. Some of those who did will be missing limbs. A lucky minority will have been treated and returned to a relatively normal, if traumatized, life. Then a new avalanche of patients will begin, what the doctors call primary care patients, the many Haitians who were already suffering from chronic diseases, worms, and infections before the earthquake. They will come to take advantage of the opportunity to get high-quality medical care, for Léogâne is turning into a massive hospital.

  But for now, hundreds of wounded are pouring in and Léogâne has all these organizations with different capacities and supplies. The Spanish Red Cross has water makers. The Austrian Red Cross has latrines and pumps. The French at MSF have meds and a laboratory for blood work. The Japanese are the only ones with an X-ray machine, but the Germans are bringing another. The Cubans have four surgery rooms, twenty general practitioners, and five orthopedic surgeons. Heart to Heart at the Nazarene Church has pharmaceuticals, vaccines, and disposable medical supplies; and on and on.

  “Wait! Can you take a baby back to Port-au-Prince with you?” a German paramedic asks. The baby, he explains, has a hematoma on its head and is in critical condition. “If it does not get to the children’s hospital, it will die.”

  I don’t want to take a baby with a busted skullcap twenty miles back to the city, through congested streets, battle my way into a hospital crowded with earthquake survivors, and then try to find a doctor to take the baby from me. I am trying to be a journalist here, and now I have this little volunteer job for DART. I am on a motorcycle, which means I really cannot take the baby. But what do you do?

  “I will find someone to take the baby,” I tell the paramedic and get on my motorcycle.

  It can’t be difficult. All these aid agencies plus the U.S. Marines, the Canadian Navy, the Canadian Army, Chilean, Nepalese, and Brazilian soldiers, and the UN World Food Programme. They are camped all over the place, in closed and guarded compounds, and they all have vehicles. I crank the bike. I try the Marines first.

  “I don’t think it’s going to happen, sir.” I am standing in a field where U.S. marine helicopters have been landing and taking off all day, talking to a marine who’s guarding the launchpad. “You guys can’t airlift the baby out with you? It’s only this big.” I hold my hands out. He looks like the classic bad-ass marine. Blond, tough, cradling a machine gun, mouth full of chewing tobacco. “It seems like it would be the perfect system,” I say, trying not to seem aggressive. “You guys could just take injured people back to Port-au-Prince with you when you go.”

  His eyes light up, “That’s what I’ve been saying: evacuate people in helicopters.”

  “Well, why the hell won’t they do it?”

  “Hey man,” he spits a large black mouth full of tobacco juice into the dirt, “I just work here.”

  I am at the entrance to the Canadian army compound asking another heavily armed soldier if his people can help the baby, when two white American men and a Haitian-American man jog over, dressed in fresh surgery garb. They pass right by me and talk to the Canadian guards, explaining that they are a group of five orthopedic surgeons. Do the guards know of any hospitals where they can do surgery? As the guards tell them about different hospitals, the doctors are shaking their heads and growing more frustrated. They have been to all those hospitals and they won’t do. They lack supplies or already have too many doctors. Defeated, the doctors begin to walk away. I hear one say, “Let’s go back to Port-au-Prince.”

  “Wait!”

  The doctors stop. “Can you take a baby with you?” I ask.

  “Oh, no, no, no.” says the Haitian-American doctor.

  I can’t believe it. “What the hell do you mean, ‘no?’” I want to unload this moral burden. “The baby is dying.”

  “Where’s the baby?” He asks.

  “Follow me.”

  We arrive in the compound, me on my motorcycle, the doctors following in a battered sedan. When they get out of the car and realize that the surrounding tents are field hospitals, the doctors brighten. “Are they doing surgery in there?” a young American doctor asks me, ducking into the nearest tent to check it out.

  Meanwhile, the other four doctors cluster around the baby, which is nestled in its mother’s arms, mouth in a kind of scowl close to her breast. The baby’s eyes are closed, the sockets sunken and dark. The hematoma, a squishy baseball-sized glob, is off one side of its head. When one doctor pokes at it, the baby’s scowl tightens into a grimace. The mother appears about to cry.

  The doctor goes into diagnostic mode, “There is nerve reaction.”

  “Yes.” The other doctors nod their heads.

  Then the four doctors, standing around the seated mother and baby, launch into a brisk discussion. They use medical jargon, nod a lot, and in less than sixty seconds reach a conclusion. They break. Two of the doctors duck into the surgery tent where their colleague had gone earlier, another heads for the car, and the last one, the Haitian-American, remains. “The baby,” he addresses me directly, “is not dying,” and he then drives his point home, “as you said.”

  He is off the hook.

  “The baby should have an X-ray,” he continues, aiming the directive right at me. “When you are finished with that, get the number of the X-ray. Tomorrow, when I come back through here, I will take a look at it.”

  Even if I could take the baby for an X-ray and keep track of the mother, I know that I will never see this doctor again. Indeed, Léogâne will probably never see this doctor again.

  The other doctors come out of the surgery tent shaking their heads and talking about the lack of equipment. They cannot work here. Defeated, they head for the car, all five of them.

  “Wait!”

  They stop.

  “Can’t you take the baby?” I ask.

  “No, no, no.” They all get into the car.

  I am pushing it, I know. Five doctors, surgeons no less, in the wake of the most destructive earthquake in the history of the Western hemisphere. But then, the X-ray machine is on the other side of town, miles away at the Japanese field hospital. I can’t carry the baby on my motorcycle.

  “Not even to the X-ray machine?” I ask, but none of the doctors are even looking at me now. They are climbing into the car, closing the doors.

  When the earthquake struck, I was in the Dominican Republic. I drove to Haiti with Ben, a retired special forces army major. We drove through the night, down dark and deserted Dominican roads, and arrived in Port-au-Prince with the rising sun. We had come to help.

  I’ve spent a large chunk of the past twenty years living and working in Haiti as part of the aid industry. Like so many people who’ve worked here, a sense of frustration and failure haunts me. I’ve watched the country sink ever deeper into a quagmire of misery and despair while I’ve accomplished nothing tangible to stop the process; indeed, occasionally I have earned a respectable salary or, by Haitian standards, a fortune. Now with the earthquake, the tasks at hand are obvious. Thousands of injured and homeless people need immediate help, no question about it. No need to sit down and write a proposal or a plan; no time for meetings or evaluations. It’s just a matter of doing something, fast. So we came to help, to pull people from the rubble, to carry people to hospitals.

  That first day we helped the Embassy and USAID officials evacuate. We carried their luggage. Then we stood there in the Embassy parking lot, watching as the American officials pulled out, a long line of black SUVs, headed to the airport. “As an American,” Ben said to me as we stood there, “I find this a little embarrassing.”

  The second day, desperate to participate, Ben and I hauled around a team of rescuers in my truck. But we didn’t feel like we helped
. Their supervisors, who were orchestrating our movements over a radio, kept directing us to the same four high-profile sites, sealed off compounds where we would join dozens of other rescue teams, and where we did nothing, absolutely nothing. We sat there. It was wrecking our nerves.

  Like the doctors who couldn’t be bothered with the baby, we wanted to do the things we felt we could do best. We imagined ourselves translating for doctors, carrying the wounded, fetching supplies. So we abandoned the rescue crews and spent the morning of the third day trying to attach ourselves to a medical team. The only medical team we found was an air force team in the U.S. Embassy, but they were not authorized to leave the compound. They had been there for almost two days but had not performed any surgery because they had no medical supplies. Not medics ourselves, we went to the airport to try to fetch their medical supplies. But we had to have security clearance. So we attached ourselves to an 82nd airborne unit. We were supposed to act as translators, fly in on the helicopters with the troops, talk to the crowds through bullhorns, coax them back as the soldiers delivered food and water. But instead, we wound up sitting around for six hours with fifty soldiers and a crew from 60 Minutes, doing nothing.

  Frustrated, Ben got on a boat and sailed for the Bahamas. I went home, back to the Dominican Republic for a few days. I thought that when I came back there would be some organization; that someone would have taken control of the logistics. Then I could find a place where people could make the most use the skills I have to offer.

  When I got back, a new trend had taken hold. Armed security guards and soldiers barred access to most compounds: the Embassy, the airport. Offers to help aid agencies came back null. I settled into being a journalist. And that’s what I was doing when I volunteered for DART and the problem with the baby came up.

  The baby was only a single incident. While I was going around to the different hospitals gathering information for DART, other doctors and paramedics had stopped me. First someone wanted hypertension medicine for a woman with preeclampsia. Then a person wanted me to lead a team of surgeons to another hospital where they had facilities to work on a patient suffering a particularly complex wound. Finally I realize that this is an opportunity.

  Haiti has all this equipment and capacity but it’s scattered all over and no one knows what is where. Perhaps more important than anything else, the Japanese have the only X-ray machine in Léogâne, but it is on the far side of town. But where I am, the doctors are amputating limbs because of infection and are trying to evaluate the degree of damage before they do so. If only they could get to that X-ray machine. The solution is easy: They need a vehicle to ferry people back and forth.

  I realize that at this point we don’t need more doctors, and we may not even need more equipment or medicines. What we need is communication and transportation between the organizations that are here. I go around with the bright new idea: “We can pay a taxi to haul patients to the X-ray machine.”

  Everyone, Germans, Cubans, Dominicans, even the Canadian director of the field hospital thinks it’s a great idea. But no one has funds on hand to pay for it. So I go out and with my last $20, a lot of promises, and arguing, and putting the moral burden on someone else—in this case Haitians—I hire a taxi. As we are pulling into the compound, I see a helicopter lifting off. “Okay,” I ask one of the German paramedics, “where’s the baby?”

  “In that helicopter,” he says pointing to the sky. “We are sending it to Port-au-Prince to be flown to Miami.”

  “What?”

  “Yah,” he says, in a heavy German accent, “it will die soon if we don’t.”

  I am at a compound called New Missions talking to Boga, a Haitian man who says that he is in charge of regional NGO coordination. I think Boga might have something wrong with him. Who stands around in the middle of an earthquake saying they are coordinating, though it is clearly evident that in the ten days since the earthquake he has not coordinated a damn thing?

  I introduce Boga to ten motorcycle taxi drivers—all of whom he already knows by name—and explain that they are here to run errands and transport medicines, messages, and people between the different hospitals. “If the doctors need anything, you send these guys.” Then, getting a little ahead of myself, I tell him that DART will help us coordinate. Boga is delighted. I introduce him to the driver of the van I hired the day before, put him in charge, and then head back to Port-au-Prince where I can report to DART and start working on pulling together the coordination effort.

  On my way home, riding my 400 Suzuki, I calculate the tasks that have to be accomplished. I will begin by circulating a text message explaining that this is a coordination of aid efforts to best manage the resources and not duplicate efforts. I will explain that everyone should direct requests for airlifts to DART. DART will surely set up a switchboard where doctors, paramedics, and other aid workers can direct requests so that we don’t inundate one another with e-mails. It’s a no-brainer.

  On the median that divides the road are makeshift tents of sticks and deteriorated plywood boards with bedsheets hung over them for cover. My phone starts buzzing. It’s the director of MSF hospital in Léogâne, and he needs to evacuate someone. I call Joseph, who is with the DART guys. They make some calls and then Joseph tells me everything is taken care of. I feel good because things are happening. Taxis, evacuations. I’m helping.

  When I get back to Port-au-Prince I text DART but get no response. In the morning, still no response. I head back to Léogâne.

  The first thing I see when I get to the mission compound is our taxi van pulling out of the compound, headed for the X-ray machine. It is full of wounded and bandaged people. A leg wrapped in fresh white plaster sticks out a back window. The side door is open and I can see people sitting on one another’s laps. Despite all the inertia and my ineffectiveness that first week, I now have something to contribute.

  But who is going to pay for this? There’s plenty of money. Wyclef Jean and Hollywood just collected sixty million dollars. The UN released some thirty-six million. The European Union gave an enormous sum. Obama released one hundred million. My friends and family have been calling, asking which organizations to send money to. All I need is $300 per day.

  I go back on the road, back to the city, to find money. I pass an aid vehicle. No one but the driver is inside. A line of colorful buses and trucks comes down the highway, their roofs piled high with furniture. People are fleeing the city, leaving crumbled homes and dead family and friends behind. As I travel down the asphalt edge of an earthquake-cracked stretch of road, I see a piece of plywood propped in the middle of the road, scrawled with the words, “Help us. We are people too.” It occurs to me that the sixteen-mile stretch between Léogâne and Port-au-Prince, an area punctuated with collapsed buildings, has not a single field hospital. They’re all in Léogâne.

  All I need is $300 per day. That’s less than the per diem for UN employees. Any one of the rescue workers is making twice that. It’s just a matter of explaining the situation to the right person.

  “No problem.” The guy is telling me on the phone.

  Bingo!

  “I am the country director,” he explains, “I will authorize three weeks’ pay for the taxis.”

  I was speaking to Randy Wortenson, the U.S. director of World Wide Village, an organization that is in the process of erecting one of the largest medical facilities in Léogâne. He’s glad to help. “That’s what we’re here for.”

  I explain to a group of the paramedics and doctors that I have talked to their head guy, Randy Wortensen, and that we have an okay for them to pay. “You don’t have to take my word for it,” I tell them, “he’ll be calling you.”

  “Man, that’s great,” A big muscular American guy named Shane shakes my hand. “This is exactly what we need,” Shane is saying, “We got guys coming out of here with busted femurs and they lay out there by the gate for days. No way home.”

  Now aid workers and surgeons are asking if we can get other stuff,
such as supplies and transport to the airport. Boga and Shane are already coordinating the taxis. A surgeon explains that he has a woman who he needs to evacuate because he doesn’t have the equipment to operate. “She is going to lose her leg,” he tells me. Then he tells me about the supplies he needs and asks if I could talk to the DART guys about having the surgeon come down to look through what they have. Of course I can! The DART guys sent me over here. And this is important.

  Shane and the surgeon walk us partway to the gate. One of them introduces me to the guards there: “He’s going to be coming in and out.” The guards smile and nod. The three Haitian motorcycle taxi drivers who have been following us around stand at the gate beaming. The sense of mission is thick, and everyone knows their part.

  Just then, one of the American aid workers runs up behind me. “Chris needs to talk to you.” I return to where I was not two minutes before, but something is different. The surgeons and Shane have scattered. A handsome thirtysomething doctor named Chris is telling me, “I misunderstood what you were saying. We don’t need anything.”

  “What?”

  “Yeah, we have everything we need.”

  “What about the taxis?”

  “We have five vehicles.” He is taking the blood pressure of a Haitian man. “They are all out in the rural areas right now, scouring for patients.”

  I don’t have time to figure this out, not at the moment. “What about the surgeon and the surgical equipment he asked for?”

  “I am in charge here,” Chris snaps, “not him.”