Haiti: Things Shift

The following has been re-posted to HCPLive.com with permission from Dr. Jan Gurley. You can visit her blog, Doc Gurley, at www.docgurley.com.

Even the predawn day began a little differently. The shrill distant stadium cheers of hundreds of Haitian roosters sounded oddly synchronized, as though perhaps they were doing the wave. There were more dogs keeping the beat with incessant, rhythmic barking.

Dogs in Haiti are everywhere underfoot, seemingly ownerless. It is something of a shock, after all the warnings about rabies everywhere, and the need for immediate evacuation if any of your skin is broken, to find one nosing against your leg as you try to walk to the pharmacy area is the day’s tightly-controlled clinic-space. All the dogs — all of them – are the lean, feral-looking, arrow-nosed, mottey-colored variety that are never at rest. They nose through trash and scratch at rubble and weave needle-like through the fabric of masses of people. Dogs of the relatively wealthy are just the same, wandering collarless, ribs almost visible through their short mat of fur. They all have the shrill, piercing yapyap that I remember of feral dogs from when I grew up in rural Georgia. There are no woofs, no baying, nothing that we would, if pressed, truly call a bark, which makes me wonder whether they would find our own pampered, exotic, baroque variety of dogs equally odd and a bit disturbing. And these dogs are loved by their owners, who apologize for them, and shoo them out of the way like chickens.

Chickens, too, wander freely in this dense urban city of over 4 million (keep in mind, San Francisco is less than a million). There are no goats, no livestock of any kind, and, frankly, the chickens are bedraggled and pitiful. Actually looking stunted and anorexic instead of just small. Like the dogs, they nose and scratch through rubble, but theirs is a furtive, always at a near panic type of movement, feathers askew as though they haven’t had a decent night’s sleep in far too long.

We were supposed to be working today in one of the largest constantly collapsing sheet cities (I refused to flatter them with the false-advertising, put-the-best-spin-on-it-possible name of “tent city”). An open area that looks, underneath it all, like it may have originally attempted to be some sort of park — but who knows? It’s like trying to imagine the shape and function of a hand from fortune teller bones tipped out of a rattled cup. There are over 2,000 people there, without one single toilet, not even an end-of-a-free-Lady Gaga concert overflowing Portapotty. Crowds of faces glance through a fences railing bars as a woman casually heats a large sizzling shallow hubcap-like metal disc full of boiling oil, preparing to cook, the whole device precariously perched over a propane cannister on top of a waist-high concrete wall as dogs, chickens and children weave and roam behind her. There was a Lombard-street-esque hill rising straight up into the sheet cities, some rare trees on either side of the road shelter prime spots on either side. 2,000 people in there. Imagine what such a thing would be like in San Franscico – Golden Gate park a sea of blue tarp, women who are being raped screaming in the night, and, after a month, disease, dehydration, and diarrhea spreading almost as fast as despair.

But although we sat and stared at it, people boiling past like ants, we never made it into the sheet city. In what seems typical now to me of this type of ever-shifting (even hour-by—hour) relief work, Our organizers were told by the administrators of the area that a new direction was being taken. Efforts needed to be made for Haiti to normalize, for people to return to their lives, and no one wanted this type of sheet city more enshrined. People needed to start using existing hospitals and clinics.

After looking at a situation like that, and hearing that official response, you cannot help but have an urge to guffaw in disbelief. Go back to what lives? Where? On which pile of still-falling dangerous rubble?

But I have to say, brutal as it sounds, after being here only a few days, it may not be completely right, but there may be some truth to that approach for many people here. If only it could be made to work soon enough. The horrors of The Day were just too inhuman. Our gracious and lovely hostess, a principal of a school, confessed that she had not, until we arrived, returned to her seemingly intact and partially functional large home. Until we arrived, the poor woman had spent over a month in a tent (a real tent) on a patch of grass inside a gate in front of her home. She thanked us for helping her walk back inside. She said she could only have done it with all of us there for her, carrying her in with us. All I could think was, but are any of us safe?

Now that we are barred from the sheet mega-city, we need another plan in only a very short time. Our organizers demonstrate yet again how gifted they are at this kind of impossibility. The problem is that we told people we would be there, including a local doctor. People will drag their sick selves, leaving precious bundles of belongings behind, to come to where they think we will be. Word here spreads faster than a tweet.

But there’s another gaping need. The amazing duo of Enoch and Jesse have identified a clinic that is losing all its 12 French doctors today, leaving behind 5 Haitian helpers who functioned as nurses, only 1 of whom was an LVN — it’s a local clinic that has seen, with the 12 docs and 5 Haitian helpers, at least 200-300 people a day since The Day. The Haitians have been hoping and praying that somehow, some help would appear once the French doctors leave. They are committed to keeping the doors open and seeing the same already-overwhelming numbers, without docs, with only 5 people. Their plan is that they will meet as group each morning and decide how best to treat what may come in, given what they have and know.

So which to choose — the clinic, or the people who we already promised we would be there? It is an agonizing kind of Sophie’s choice – all of them needing all of us. We had promised before the trip, for security reasons, before we had to face this kind of need, that we would never split the team up. But we did it. Part of our group went to work with the nurses, and the rest, a larger share because the nurses already had supplies and rooms, went to throw together a site near where we’d originally planned to be.

Who goes where? Because of a touching and gracious modesty among the Haitian women, I have become the sole Pelvic Queen for the vast unfulfillable reproductive needs of the women we see. Since there are female providers among the 5 left at the clinic, I did not go to the clinic. I instead went with the rest of our group to our Plan B site which Enoch and Jesse have found.

Early in the morning, we rumble past yesterday’s road and (in only a few hours, since after sunset last night) it’s already blocked by 2 women who have erected a mini-supermarket: 2 semi-circles that extend into the road, made of meticulously arranged, tiny piles of damaged fruit that they carefully guard and hover over, adjusting a piece here or there to display it to advantage.

Our freshly indentified SWAT insta-clinic is wonderfully situated — it’s a pool hall, next to large, open concrete space packed full of humans and blue tarp. The incongruous pool table sits under rusted, chain-hung pool-hall lights, in a long, narrow, roofed and back-walled corridor with a waist-high front wall, perfect for crowd control.

The problem is that there’s at least 100 feet of concrete between us (where we sit idling with our piles of supplies on the bus) and the Pool Hall Corridor clinic. Every single inch of space from here to there is packed with tarp, sheets, children, men, women, pathetically small bundles of belongings — a dented pan, an irreplaceable tiny camp stove, a folded square of tee shirt all visible just at the edge of the first dwelling alone.

The next few minutes are like some bizzare reality show and, even in retrospect, it’s hard to decide whether it was cruel or inspiring. Our bus driver plows ahead, a martial arts smoothness to the extreme slo-mo action. Women, men, kids scramble and grab, churning and rolling wave-like away from the massive prow of the bus, leaving behind them a 3-foot swath of naked concrete always between themselves and the oncoming never-slowing bus. There is an odd ballet grace to it, and there are a few stragglers as we finish snow-ploughing our way to the corridor. That’s when I see that the stragglers have hastily grabbed twig-tied brooms and are frantically sweeping, trying to make the space look nice for us.

We don’t want to waste a minute of daylight, so as they shyly sweep and nod their way ahead of us, we paratrooper in, brawny, well-fed arms toting box after box of supplies.

Intake/triage is at one end. Exit and pharmacy at the other. If you have any claustrophobia, wait until things improve before going to Haiti to do relief work. Even with the wall, a mass of people push forward, beginning to push even against our gun-strapped police security guards.

We are learning and we move fast. Camp beds are simultaneously clanking open, one of our Haitian translators and a Stanford cardiologist moving as seamlessly together as though this were a cath lab. In the rush to make room for us, there is one sad black flipflop and a precisely-draped pair of pale pink panties left behind. Probably irreplaceable. We carefully work around them.

Set-up is hampered only by the pool table owner, who is more jealousy protective of it than the mini-market women were of their fruits. He is very upset when he discovers that someone thoughtlessly left a few ziplock baggies on its massive, tarp-draped, earthquake-damaged edge.

We apologize and roll large blue barrels over, set them upright and put on top a ragged wide sheet of plywood (undoubtedly someone’s roof only moments before) to make a pharmacy table.

My Pelvic Palace is in the farthest corner, shaded but airless. We duct-tape every possible loose edge of concealing plastic draped walls.

My fabulous translator and I have, for the first time, a chance and the space to organize our goodies. This woman, MBA candidate, is oddly touched I have put her in charge of all these products. She won’t meet my eyes and looks like she might cry when I tell her that she needs, if she doesn’t mind doing it, to give it all out — condoms, pads, tampons, birth control pills, that I know when things got crazy busy, or someone was crazy sick, I forgot. She glances at me and I realize that she did indeed notice each and every time I forgot yesterday and I suddenly see myself through her eyes, a careless visitor so rich, so well-off that I could just “forget” something that has such value for a woman who is struggling. I say I don’t want to every forget, so could she help me?

We have a smoother, steady day — women with miscarriages from The Day (called, in French, Le Tremblement Du Terre – literally, the name for when the world trembled). I see women who are still bleeding, who still have products of conception inside, a uterus swollen and tender with weeks of hurt. I see a woman who wants to know why her pee is almost green, it’s so dark. I ask how much she drinks and am shocked to discover less than a glass a day – that she only pees once a day. But she has access to water, plenty of it, situated as this location is next to a broken water pipe that drips constants. The most alarming thing is that when I begin to earnestly explain (again) that this situation is very “grave,” that she could, in fact, die if she doesn’t drink, she just looks at me, her expression, dull and flat. Nothing seems to sink in, and she leaves with her bag of goodies and nothing else.

Around eleven in the morning, we discover to our horror the huge problem with our site — there’s no toilet. Nothing. People squat in front of the entire crowd of people in one corner of the vast concrete yard. Boys pee in the general direction, kids tumble and play all around. There’s no other option – once you step outside the enclosure, there’s a steep and sidewalks in all directions. None of which have toilets of any kind. We are getting uncomfortably full, and some of us [read: women] just cannot squat and do it, not even with another woman on the team holding a thin sheet of plastic up. I suddenly have more insight for the plight of the woman who would not drink anything.

We’re getting seriously uncomfortable when my translator comes up with the brilliant idea that we pee in the Pelvic Palace, into one of those dark-beige rectangular medical buckets. We each take a turn and I am somewhat shocked when a woman who is a patient, after her evaluation, when she is full of gratitude, insists on carrying it out and emptying it for us. She could not be dissuaded, and thought the whole concept of gloves laughable.

I saw two more women in the afternoon who would not drink — one a young, thin girl with small breast buds. Both of them, also, looked at me with the same flat, expressionless gaze when I explained that in this heat, if you do not drink, you die. I could not begin to imagine what it must take to decide that you can’t go on. Dying of thirst, with water all around, is an unimaginable act of despair.

And what do you offer? There is no promise that things will improve. Not anytime soon.

We hurried and hurried and hurried, seeing more people than we expected, all of it going more smoothly than it had before. I was handed a phone in between patients and our organizer, Jesse, was awkwardly calling from a pharmacy where he was trying to buy more menstrual pads. You could hear the embarrassment baking off his voice like heat. “So, I don’t know about these kinds — it’s not really something I…” “Buy Super,” I said, “Or even Super Plus. But not the expensive extra thin ones – we want to get all we can for our money.” “So how many should I get?”

I thought for a moment. “All of them.”

His voice rose to soprano heights, “All of them?”

So, at the end of our session, my translator decided to give away all the Kotex (clearly the product of choice in Haiti — tampons are more than a little suspect – downright scary to most of the women). A mass of women began to literally run to our half wall. It was the closest we came to a riot. We had to shout for them to line up, to go slowly, that everyone had to take a turn (one of our nurses said, “this is breaking my heart”).

Leaving our clinic space we were, for the first time, surrounding by waving, jumping kids who smiled and shouted the American “HI!” at us.

Each day we have driven past a house that is, foot by foot, falling into our road.

Today it gave way.