Thursday, January 27, 2011

Haiti Epilogue: "Malfiní an te Ateri"

Today's view from the ground: Philadelphia, PA


On my way to a meeting at the University of Pennsylvania School of Medicine, I remember the last time I was here. I was walking into the halls of brilliance and drive that cured diseases, replaced faulty organs and improved countless lives. I was barely worthy to sweep the floors of the offices I was meeting in, begging for attention and money to treat the simplest of maladies and prevent it from further eviscerating the poorest country on this side of the globe.

As those who have been reading along thus far may think, I plan to walk in with my head held higher than last time.

Cholera, it appears, is broken. It is under control in the three hardest-hit provinces of Haiti. The death rates slowed to a crawl and I couldn't find a clinic in enough trouble to even take the nurse and EMT we had looking for work. If you don't see me dancing on a table, I have two major concerns that keep me seated. The first is the upcoming rainy season, which will make it even harder to maintain sanitary conditions in the dirtiest place I've ever seen. The second is the complacency already gaining strength in the headlines coming out of Haiti, written by and about people so willing to declare victory and depart the field.

I have been told, however, that one of my biggest problems is that I think my shoulders are broad enough to carry such things and I fail to see those around me also bearing the weight. Personally, I have a lot to be proud of. I co-wrote the first curriculum approved by the Haitian Ministry of Health for Haitian volunteers to prevent and treat cholera. I was one of the teachers of it and I got to sign the certificates for its completion. This was all after I spearheaded an attempt to create a new at-home remedy for cholera that ended up saving lives and speeding up recovery. The University of Pennsylvania School of Medicine, entrenched as many other noble institutions of healing are in modern methods, was impressed with the return to basics that the alternative rice therapy entailed. If cholera returns to our doorstep, we are ready as ever to fight it off.

There is little I could be more proud of than the heroic efforts of volunteers in setting up the school of emergency medical services and disaster response in Delmas 75. We are not the first. We are not the largest. But I would willingly challenge anyone who says we are not the best.

This can be measured in many ways. Did we overcome every obstacle? Yes. The shutdown of MMRC's compound, the lack of political & financial support and the loss of an expected indoor space for teaching did not faze anyone involved in the project. Even the discovery that a trusted member of the team was a thief did not dissuade those who had lost possessions. They did not lose faith. They were in and they were all in.

Did we meet our original objectives? Yes. On 12 January, the anniversary of the earthquake was met with LAHAF volunteers on the ground outside the collapsed Presidential Palace offering medical care and familiarizing the hopeless and homeless with a new brand of civil service. The next day, those volunteers were training GAI to do the same thing full-time, long-term and in their home country. The teaching continues today and will go, we are sure, until the program is completed and GAI has the opportunity to take final exams.

Are we ready for the next step? Yes. LAHAF grew faster than it planned, but a lot of hard work and dedication is making sure that we won't flame out. I just finished a dozen emails and calls to other organizations willing to help us, delineating what we need to keep going. Some have already responded, on the lookout for us.

That is not enough to make us complacent. That is not enough for us to declare victory. Of course, we have a tinge of pride in every smile, every word and every reference since we returned from Haiti or discuss our friends still there. We don't want to keep it to ourselves. On the contrary, we want to share it.

The first rule of fundraising is not to act like it's different than sales. Fundraising is sales - a more difficult brand of it. We have to sell something that the buyer isn't going to use. A lot of people waste time and effort trying to sell an idea. We are trying to sell a product. It exists, it is viable and it works as advertised.

But why would someone want to help pay for a school two thousand miles away teaching something they don't care about? We know that there is good news coming out of Haiti. We have seen it. We want it to shine through the horror that is broadcasted to the rest of the world, and the beginning of true medical independence in Haiti is the perfect star. Who in America does not want Haiti to respond to its own problems, to have it fade from the headlines of bad news and become a neighbor thanking us for its new-found strength - especially when we can help so inexpensively?

Those who help us will share our pride and be joining a distinguished group, including (so it appears) the University of Pennsylvania School of Medicine. And they will be adding to a coffer that began quite humbly three weeks ago, with twenty gourdes (fifty cents) taped to the wall of our compound with "Malfiní an te Ateri" - "The Hawk has landed" in Creole - written on it. You read it here first, folks. We're in it to win it.

Want to help? Visit www.lahaf.org

Thank you all. That's the view from the ground.

Saturday, January 22, 2011

Haiti: The Incident Has Landed

Today's view from the ground: Port-au-Prince, Haiti and New York, NY


In the above photo, a Haitian national police officer stepped on a piece of burning tire in the Martissant section of Port-au-Prince after protesters set fire to barricades on Tuesday afternoon.

I woke up on Tuesday morning to brilliant sunshine on the roof and a clear feeling that it was going to be a good day. I made some eggs on our new stove and sat down to work. By the end of the morning, I had gotten a call from an associate at the UN mission and gotten a job for the afternoon as medical support to a unit in Martissant. It was good news, as our cash on hand was getting dangerously low again. Then I got a call from Clancy. Baby Doc had just been arrested.

That may have been good news for Haiti but it wasn’t for me. An afternoon spent hanging out with a bunch of blue-helmets just turned into something more dangerous. Most of the Haitians we had been talking to seemed to think that the country would be righted if Baby Doc was in power again, even the ones who were not alive when he was president. It seemed like a lot of people would get upset, and you don’t want to be around a large group of upset Haitians.

Mobs were already forming around barricades of burning tires, the unfortunately preferred medium of expressing discontent in Port-au-Prince. The acrid smell gets on everything and it makes even the usual hazy smog seem like a trip to the oxygen bar. As Doris was once again missing, I had to catch a moto (motorcycle taxi) downtown, where I was picked up by the UN convoy. Martissant was already acrid with the black smoke of burning rubber. Maybe someday, people will learn to grow flowers or do laundry as a form of protest.

Meanwhile, back at the LAHAF base, the Miami medics were doing a great job. Kate and Kay had written the names of body parts in French on pieces of tape and were putting them on the medics and the students as well as themselves. Nick and Bridget had reinforced two of my sloppily-made benches with some found wood and a few old tiles. The embedded journalists were filming class and visiting a hydroelectric plant, which is working at 10% efficiency. On that subject, the blackout relief time ended quickly after Baby Doc’s arrest and parts of the city were powerless again.

The national police had attacked several of the protestors burning tires in the western edge of the city, and then silently patrolled around protestors doing the same thing. I couldn’t figure out what precipitated the change until a UN truck brought me to Petionville, where Baby Doc had been staying, and I met a journalist who had written for the same agency as I had during the fight against cholera. Baby Doc had been released. The government wanted there to be unrest at that event. The more I know about Haiti, the more I see even the highest levels of authority as a lawless gang. There was little I could do except help a few of the injured, as much as I was allowed to by protocol, and walk off the job as the sun was going down.

The convoy bringing Baby Doc back to Petionville from the police station drove past me as I headed towards Delmas. National riot police filled a truck behind several SUVs. The truck was pursued by nearly a hundred motorcycles, some of which carried three people, all jubilantly honking horns and screaming. We would hear little more about Baby Doc for the rest of the week, although a few manifestations near our base ruffled our feathers – not enough to even force a lockdown. We spent the night, mostly in darkness, laughing on the roof and occasionally spotting fires in the city below.

Wednesday was an adventure in transportation. Lou had brought Doris to get insurance paperwork and was severely delayed. With no vehicle, Emma the epidemiologist was getting dangerously close to missing her flight. I eventually gave one of our neighbors $30 so we could use his truck, into which piled Emma, Bridget, Kay, Alex the photographer, Eric from Miami and Andrew Fishman, who was also catching a flight that afternoon. I drove like a Haitian (you can probably guess what that means) across the crowded, pocked roads of Delmas to the airport with most of the crew hanging on in the back. We made it to the airport just in time and were on the way back when we spotted several of our students walking up Route Delmas to class. We offered Gerard’s sister and were then joined by five more. It was too much for four cylinders on the 30-degree hill and the engine overheated, less than ten minutes’ walk from the base. Alex walked ahead, bringing the truck’s owner, and we abandoned it, stalled out in the middle of the road, after being stared and jeered at for half and hour.

It was this occasion that spawned a new identity for me. My twice-weekly reports, known as "situation briefings," were often the subject of laughter. Bridget was constantly referencing a character on "Jersey Shore" who calls himself "The Situation," because his six-pack abs create a situation with the ladies. Parallel to that, I called myself "The Insight," as Kate's father called my situation briefings "actionable insights" - apparently high praise. Bridget thought I said "The Incident," which is a far better name for me on this mission. I drove the truck through the streets yelling "There's gonna be an incident up in here!" Port-au-Prince brings out my inner inner-city kid.

At the end of the day, Peter, the Miami medics and I went to Hopital Bernard Mevs, the facility run by Project MediShare out of the University of Miami. They agreed to lend us a backboard and a scoop board so we could demonstrate immobilization and transport of trauma victims to the class. I had not been there since two months ago, when Kay got dengue fever in the north and we evacuated back to Port-au-Prince to have her checked out there. The hospital is very well run and organized, and we made the first inroads into having volunteers work there. I was quite relieved at that, since a lot of the excellent medical team we had assembled at LAHAF had little to do for most of the time.

Peter and I went back the next morning, and he spent the day volunteering in the emergency room. I took Doris to the UN logistics bases next to the airport and joined another UN mission to Martissant. It would be my last of the trip and finally paid off the initial loan from the Canadians, putting LAHAF’s Haiti operations in the black for the first time. It was a quieter day than the one in which Baby Doc changed residency twice, and a case of heat exhaustion followed by a handful of normal injuries – machete wounds, blunt trauma, motorcycle crashes and the like – was the most exciting things got. To cap my experience in the troubled neighborhood, a truck hit the side of the UN personnel carrier, throwing the lot of us around a bit, but we all escaped with no serious injuries.

It turned out to be a hell of a day to miss back at the LAHAF base. The Miami medics and the rest of the crew and patched more of the benches, put up a second canopy and tied them together so the whole outdoor “classroom” was in the shade. This was after Nick, Bridget and Alex had gone to the house belonging to Billy, the Haitian translator from MMRC who had helped us teach the cholera prevention class, and start fixing his moldy sunken roof. The students had loved the class involving the backboard and scoop board we had gotten from MediShare and had an incredible rapport with the teaching staff. At the end of the day, the crew got charcoal and made kebabs on the back deck after Kate, Bridget and some of the guys had walked to the supermarket and hauled back half the store.

The reason they had to do that was the same one that I missed the whole thing. Doris had died – twice. The battery gave up on the UN base and I finally got her started again with the help of the same UN unit who had left me in Cite Soleil a week earlier. The delay made me late to pick up Nick Gingold, another photographer joining our team. As we drove down Boulevard Toussaint l’Ouverture towards MediShare to pick up Peter, she died yet again. The reason for this breakdown is still being debated, but at the time, we cared about little else except that we were stranded at sundown with $10,000 of electronics on the edge of the most dangerous slum in North America.

So Nick and I got to know each other. We talked about travelling, photography and the problems with non-governmental organizations while we made calls and got calls about getting the hell out of there. Eventually, Lou showed up with the Tracker and drove us to the hospital, where Peter and the MediShare staff were preparing to go to The Deck, the bar restaurant on the UN base I had just left. We had wanted to take the whole base crew there the next day, but Doris was the only way to do it. I had the first meal of the day before I came back to discover that the base had been preparing to receive us after a day of hell and we were late to the party after hours of human and mechanical failures.

Yesterday was my last full day in Haiti. There was a lot to do, as I had lost half of Thursday to logistical difficulties and the other half due to trying to make money for the base. Bridget woke up with an ugly cough and a rattle in one of her lungs. As soon as we could, we drove down to MediShare, stopping to pick up a bunch of paper towels, plastic cups and hand sanitizer for them. They never had enough of such things, as no one was allowed off their compound except in the shuttle to the UN base. Bridget got a shot of steroids, leaving her wired for most of the rest of the day, and we got another thank you for bringing in medical volunteers. I was finally feeling good about our position in Haitian medicine; one of the EMTs working at the hospital said “everyone here thinks you guys are total bad-asses.”

My day was certainly not bad-ass, but it was comfortingly productive. I finished a lot of paperwork on the cholera program and got ready to leave, calling people at other organizations about supplies and personnel. I also gave two interviews to the press guys. After class, we got Doris (somehow recovered from the edge of Cite Soleil) ready to take us to The Deck, finally as a team, and found that the owner, already known for shady dealings, had left with the key. When we got it back, we drove up Delmas 75 until she died yet again. I felt like a complete fool, taken in again by a liar and a cheat with a 30-year-old van that should be a septic tank. Once we walked back to the base, I scared the owner so much that he left the base and I didn’t see him again.

With the help of one of the locals, we got a tap-tap to drive us to The Deck, where the MediShare staff had already settled in. We were certainly the loudest people around, as the rest of the place was full of European NGO workers who looked at us in temperate disdain as we turned the dining room into a dance hall. This was only the beginning, however, as Lou had set up a party with a Haitian hip-hop DJ back at the base. It was the evening before Nick’s birthday and the day many of the first team were scheduled to leave, so we partied as hard as we could until we went to the roof and began to calm down. It didn’t leave much time for sleeping, but we had already been running on three or four hours a night.

Saying goodbye today was very difficult, even more so than I had thought it would be. I remembered this morning what everything looked like two weeks ago, when Kate and I were sitting in the dark, eating pasta I made on my tiny gas burner, living next to a plot of weeds. It's a school now. We built a school, the only one of its kind in Haiti. Now, as I sit at my desk in East Harlem, I am already looking back to it - and forward to it.

That's the view from the ground.

Monday, January 17, 2011

Haiti: Long Live the King

Today's view from the ground: Port-au-Prince, Haiti

In the above photo, Haitians celebrate in a "rahrah" (impromptu parade) after a concert starts in the Saint-Gerard section of Port-au-Prince last night.

This morning, the international news community is abuzz with the news that Jean-Claude Duvalier, the rapacious dictator who was responsible for the deaths of thousands of Haitians and the theft of millions from Haiti's treasury, returned to his home country last night. While we sort through the security consequences and political ramifications of this somewhat cryptic event, I will fill the reading several in on the last two days.

Saturday was a paperwork day, which took all day to finish. After about half an hour of work, I realized that the second week of teachers, three men from the Miami/Dade County Ambulance Service, were flying in. Nick, Jeff and I piled into Doris (I finally got to drive) and drove through Delmas to the airport. Doris has a charming new tendency to stall out when she is pointed uphill, so we learned how to contend with that. My UN ID got me into the airport arrivals hall, so I could guide the new guys through the crowd of hecklers yelling, "Hey, I'm your ride!" While I was waiting, I was approached by a American man holding a suitcase and a briefcase, looking like he was embarking on a journey rather than ending one. He said he flew down from Buffalo for a week to see what he could help with and had made no plans at all. I admired his resolve (and ouevos) so I drove him to Grassroots United where he will at least be safe and possibly busy.

Then, after a wrong turn, we bumped back to base, after finding the propane tank we bought for the new stove (a reward of my UN experience) was broken and we had to return it to the higgler who cheated us. It was a fun "welcome back to Haiti" for the Miami guys, who had already been relieved of $15 at the airport for no good reason. Eric, Enrique and Yosuel ("Joe") settled in fast and with good humor. I've already learned a few new paramedic pranks from them. They set up a tent on the roof next to Bridget's, so they're not even taking up space on the third floor. I slowly finished my paperwork (as well as the preceding THHL entry) while some of the local women cooked us a wonderful Haitian meal. Nick finally lived his dream of watching "Zombieland" on Matt's projector and my computer, but I sacked out early - too many nights of three or four hours' sleep.

I apparently woke up briefly in the early morning, but I don't remember. Everyone in the camp heard gunshots and some of them got pretty freaked out. It turns out it was the sheriff of Delmas across the street target-shooting (and missing) a barrel across the street. It's nice to know the local law enforcer is a bad shot.

Yesterday was our day off, and that means only one thing: more work. We got the medical team together and prepared an outing to Martissant, a nasty neighborhood in the western extreme of Port-au-Prince. Doctors Without Borders has a no-go order there, so they rarely see medical support. Peter led Enrique, Joe and Kate into Camp Sainte Bernadette, a tent city guarded by Sri Lankan UN troops (who loved that two of us responded to the tsunami, confirming we are not "disaster tourists") that Gerard and GAI had previously trained at. I took Bridget, Eric and Matt to Marie Madeleine, a school in the slums where Clancy had arranged several women for interviews. We offered to do blood pressure checks and basic diagnosis, which was the limit we could deal with. We had some medications, but not enough for everyone, and almost everyone had some serious medical problems - ringworm, tetanus, herpes and hypertension. I pulled a couple stitches out of a girl's badly-infected hand, as someone had tried patching a blade wound several days earlier with cotton-polyester sewing thread. I wish I could have used Lidocaine to numb the girl's pain as I removed the stitches and added two silk ones, but I couldn't flash drugs around.

Peter and Kate pulled two patients for transport out of the camp: a man with a urostomy bag as well as a variety of other health problems and a woman with a years-old vaginal infection and the commencement of congestive heart failure. We drove them past the Doctors Without Borders hospital, knowing they wouldn't accept patients, and went to HUEH, where the ER was open but the doctors were gone. Megan took a look at our people as a favor and determined that the man was not emergent and got some hypertension medication for the woman. After that, we had no choice but to drive them back. It's time to realize that EMS in Haiti isn't anywhere near the point when we can do transport to a medical facility. We have to go back to school.

After wading neck deep in medical problems we can't fix, we blew off steam at the Oloffson again, hearing frenetic band music outside. We left to find a "rahrah," in which hundreds of Haitians were surrounding a brass septet marching through Rue Cabot Jeremie. The energy was undeniable, and we all got dragged by the music and cheering into the street. I danced on a wrecked car, then Bridget pulled me and the others into the crowd, where she became the hit of the party with her dirty South dancing style (those pictures won't be posted). I dance badly but I loved loosening up - and so did the Haitians. It was the first time in the day I felt like I belonged. Then we went back to the Oloffson, stripped down to our underwear and jumped in the pool.

I found out at the same time that Jean-Claude Duvalier - "Baby Doc" - had just landed at Toussaint l'Ouverture Airport and was on his way to the Karibe Hotel, where a throng of supporters was waiting and no one, including Brenda from HERNow, could get in. He is apparently less than two miles away from us at the moment. No one seems sure why he is here, although he landed on the day that was reserved for a runoff election (that isn't happening) to choose the next president. President Rene Preval ordered an end to electrical blackouts for the rest of the week, at untold expense, to show that things are actually better now than under Baby Doc. Most Haitians don't need much convincing, but no one here is immune to a little political pressure. At least we can stop buying fuel for the generator. Maybe we can watch another movie or two.

Our water is still not working, but we seem to be past the days when there was no water, no power, no gas and no toilet paper (which, of course, didn't matter, because we also didn't have any food). LAHAF may finally be out of the NGO basement.

That's the view from the ground.

Saturday, January 15, 2011

Haiti: Communication and Communicability

Today's view from the ground: Port-au-Prince, Haiti

In the above photo, a woman carries a bucket of water on her head from the local well in the infamous slum of Cite Soleil yesterday morning.

Haiti is a very complex place, yet also a very simple one. The complexity is in the eye of the observer, and observers are often baffled here, especially poor ones.

So it should come as no surprise that Haiti's largest public health crisis at the moment is an incredibly simple disease with incredibly simple prevention techniques, yet everyone is baffled as to how it's so damn tough to beat.

On Thursday, LAHAF embarked on a cholera prevention and treatment class for the GAI students. It's not part of the EMS curriculum, but it's the only thing we can certify in any way. The Haitian Ministry of Health (Ministère de la Santé Publique et de la Population - MSPP) finally got a curriculum for public education about cholera after, well, Kay and I wrote about half of it. Baffling point #1: why did it take this long and why was it a pair of EMTs from the United States who did a lot of it?

Dr. Emma Sacks, an epidemiologist who Walter recruited in New York, was supposed to arrive on Monday, was delayed to Wednesday because of bad weather and then again to Thursday. She arrived 30 minutes before we began teaching, but dropped her stuff, got briefed and then hurried to our outdoor classroom (where Nick and I had just finished four benches and a table made out of a shipping pallet from HUEH) and began talking about prevention. I took over on treatment, talking about IV lactated Ringer's solution, oral rehydration salts and, my pride and joy, the alternate rice therapy. I put on a chef's kerchief and made it in front of the giggling students. Then it was time for questions.

Emma and I kept looking at each other and trying not to laugh. The first question, which we knew would come, was 'Where did the cholera come from?' It came from south Asia, certainly; it was the last place I saw it (kind of like finding my house keys) and geneticists from Harvard showed up to make super safety sure. The politics of the situation, including the UN troops from Nepal who probably brought it in by accident, are complex to any observer, but that's not the province of medicine so we're not supposed to care. I told them it came from south Asia and left it at that. Baffling point #2: Can I actually say what I just said when medicine is one of the most political things in Haiti?

The other questions verged on hilarious for us. We made it quite clear how you get cholera: you drink water with bacteria in it. But can you get it by sitting on a toilet after someone with cholera sat there? Well, not unless you lick the toilet. Can you get it by kissing someone with cholera? We suppose so, if that person vomits in your mouth. The possibilities of the scenarios they envisioned were so remote that we were losing the larger point about prevention: boil water, treat water, don't crap in the water. A man expressed a diatribe to Billy, our translator who I met in St. Louis du Nord and selected due to his fluency in English and experience with cholera, that only IV medicine would be effective and food would not be enough. I tried to make the point that all medicine is just another way of getting something from nature into you. Baffling point #3: would you rather eat food or take medicine?

I then spent most of the night writing the exam for what GAI students learned about cholera, translating it into French and then translating it into Haitian French, as there are some differences between it and the French I learned. Gerard had the patience to sit with me and fix it up a little. By 8 AM yesterday, we had the first test of a government-approved cholera curriculum for the Haitian people. Baffling point #4: WHY DID IT TAKE THIS LONG?!

Most people could probably guess that we've been having a true Haitian experience: we either don't have what we need or we're rapidly running out of it. Nick, Clancy and I have pretty much run out of money for day-to-day operations, as food and fuel alone end up taking more than half our budget. The broken-down grey Dodge van, which Nick named 'Doris' after the struggling bus in 'Almost Famous,' has been filled with $200 worth of fuel and the driver continues to claim it's always empty. The lumber was expensive and the building process was time-consuming. We ran out of water in the tanks and then finally got it, only to find the pipes were broken. I paid the plumber for parts and then learned that I was the third person to do so. Electricity is only on for a few hours every evening and a generator is running if we need it during the day, guzzling more fuel. The Hanukah Stove, the tiny gas burner designed for tea and such which lasted much longer than expected, expired on (amusingly) Day 8 and the electric hot plate burned out soon after. We are putting far too much effort into financing or otherwise ensuring our upkeep here than into our actual mission: training GAI in emergency medical services. And, to be sure, we lost about half of our money and effort to miscommunication.

As such, most of yesterday was spent preparing for a shift with a unit of UN troops in Cite Soleil, which the UN once named "the most dangerous place in North America." One of their medics was sick (food poisoning, apparently) and the other never showed up, so I offered to join them for a decent contractor's fee, to be donated to LAHAF. The night was not kind to the residents of Cite Soleil, where gangs rule the streets and battle for supremacy beyond the political motives that first established them. I treated three knife wounds, one of which rendered the recipient near death, after treating a minor contusion on a soldier's hand. We then ran across a man who had taken a shotgun blast to his arm and lower abdomen. He was obviously near death and I hot-footed it to where he lay, assuming the soldiers would form a perimeter. Instead, they drove the opposite direction, leaving me alone on the streets of Cite Soleil with a critically injured man. Baffling point #5: Does the UN still wonder why they are so despised in most parts of Haiti?

After carrying the man to the nearest hospital four blocks away (and holding out little hope for his survival), his friend and I walked to Boulevard Jean-Jacques Dessalines and I continued on to HUEH, where Jeannie got me a ride back to Delmas 75. I made it in time to sort out some camp business and help administer the cholera exam. Many of the students seemed confused and several were looking at each other's exams. On top of that, 22 more students came to take the exam than showed up for the class the previous day. Kate had to give the remainder of the class an oral exam while they wrote answers on any paper they could find. Emma, Kate and even Victor were obviously getting frustrated with students that are, for the most part, older than they are.

I graded the exams to find that 60 passed out of 70 (only 48 took the class). We had a success rate of 120% (or 90%, more realistically, as 43 of the people who showed up both days passed). The standards were low, as 70% is a passing score for most EMS exams, but sufficient. It was a very good start to the cholera testing, and we hope to offer the course to many more Haitian students, as well as foreign health volunteers. I rode to the UN logistics bases near the airport to collect my money for the botched medical mission in Cite Soleil, as I did not want to wait the usual four to six months before getting paid for such things by NGOs. Bridget, the MMRC nurse who I met on the way to St. Louis in November, was a welcome arrival yesterday evening, as she helped me put things into perspective. When I told her about everything LAHAF has been going through, she said "Why are you being so complainy?"

She has a very good point, as all of our tribulations resulted in one undeniable fact: it's working. We grew too fast, we worked too hard and we spent too much, but an amazing project is being done. Most of the staff went to the Olaffson Hotel to relax for a few hours last night, staying out until after midnight. I spent most of the time talking to the resident journalists about the manifold problems of Haiti and they seemed to be getting their heads around the complexity. Baffling point #6: They're actually quite simple, if you work hard and spend a lot of money.

That's the view from the ground.

Wednesday, January 12, 2011

Haiti: Wood, Wear and Weeping

Today's view from the ground: Port-au-Prince, Haiti


In the above photo, the sun sets over the collapsed Presidential Palace in central Port-au-Prince at 4:53 pm this afternoon.

No one involved in the effort to train GAI in emergency medical services thought that they would have to build the school first. After the valiant effort to clear the back garden of Lou's house, we were still left with a piece of uneven ground full of rocks and shattered concrete with no seating. The next step was what men like Nick gear up for.

Nick and I met at a build, by which I mean the preparation for a warehouse party that takes ten times as long as the duration of the party. My friend Audrey introduced me to such things, as she often meets people at the builds and gets to talk to them more than when the music is pounding and people are in advanced states of mental disability. Nick and I put a bunch of teepees together with knots more advanced than anyone who thought up the project knew.

As soon as we cleared some base business, I went out with Jeff and Samuel, two of the local hires, in our rented clunky grey Dodge van and went comparison shopping for wood. After three stops, I finally got six 16' one-by-fours for the equivalent of $18 each. Lumber in Haiti is substandard and very expensive, as there are no trees of lumber value here and we end up with the world's reject products. With no power saw and two plastic-handled saws that cost $5 each, Nick and I shredded into it, building two benches to hold five people each. We finished one during the first class and put it on the side of the tarp where most people were sitting on the ground. Victor, our lead instructor, jumped on it to show it was sturdy structure. I held my breath until it proved we did a good job.

The first class went well. We had 51 students out of the original 62 who registered, which is a good number. Everyone was laughing and having fun with Victor, Kate and Matt Malin, the CPR instructor who all the students think is Brazilian. I was hoping to sit in but Nick and I were still running what is known in Figment and other such events as "public works." Kay arrived, much to our relief and joy, but was out during class, tending to remaining MMRC business with Junior, Ralph, Billy and the other Haitian guys who had our back during its operations.

We put together a few more benches by the time the sun went down, but it was clear they were too wobbly, especially holding five people on uneven ground. I went to Route Delmas and bought a few 12-foot irregular boards for $12 each, then got a power drop saw from Lou's neighbor. It is at least 50 years old and so dull that the motor began spewing smoke after the third cut. It was taking as much time as hand sawing. Clancy saved the day by handling dinner, going up to the local supermarket, where enough food for twelve people and a case of beer ran nearly $100. It's amazing how expensive the hemisphere's poorest country is.

Another surprise was Sarah, the D.C. ER nurse from St. Louis du Nord. Her flight back to the States was canceled and she needed a place to stay. It was surprisingly good to see her again and swap some stories about rice and such. She and I shared a lot of war stories with Peter Taft, the wilderness paramedic who brought his rescue dog, Cassius, to Haiti. We're the oldest Americans here and probably the most experienced in mass casualty incidents. Sometimes it's nice to bullsh*t with some old hands who know the same feelings - or lack of them - you get while in the field.

Gerard was in and out. He has a mountain of responsibility on his shoulders, being in charge of getting GAI students to our compound and being the main contact point for them and us. He has been working on this for a year and is facing the realities that things aren't working out exactly as he hoped. We are getting juiced up by the challenges and our ability to face them, while he seems sad. I wish he could tell what a great job he's doing and how many people have his back.

Sarah left in the morning, after talking to Clancy about a place in Cite Soleil. Clancy is writing a story on gender-based violence and it was a relief to her, as well as to me, that she was going out there because she has had quite a few early setbacks in her attempt to interview people on such a sensitive subject. We were going to go join her, despite the danger in the area, but it took Kate, Matt, Nick, Lou and I until noon to finish five more benches and build cross-braces for the original ones to correct the wobbliness. I got the medical team together and suggested we go to HUEH (Hopital de l'Universite d'Etat d'Haiti - the general hospital) and see what medical support we could offer. We had today off, since it is the first anniversary of the earthquake that shattered the city. Matt wanted to honor the day with some type of service, and that was the best I could come up with. As it turns out, we should worked faster, because we missed a visit to HUEH by President Clinton by half an hour. Kay doesn't want to talk about it.

Megan and Jeanne, two former MMRC nurses who now work at HUEH, said the only thing they really needed was a set of shelves for the mini Quanset hut they were using as a supply shed. Enter Public Works. Nick and I, joined this time by Victor, starting pulling apart a shipping pallet and the remainder of our tangled boards (and dumpster-dove for lumber from a collapsed fridge room), recycling concrete nails and using new ones to bash together a set of shelves. It was the worst wood I'd ever worked with, they were the worst nails for the job and we had no power tools of any kind. The end result was something that looks a bit too postmodern to be a functioning shelf, but it stood strong and true. It should; it weighs fifty pounds. We come. We saw. We conquer.

At the same time, Peter led the rest of the medics, as well as Cassius, around the slums near the presidential palace. It was the first EMS squad, irregular as they were, that the camps had seen. The place used to be lovely; I remembered seeing it two years ago when it was a bit worn but still showing the splendor of Haiti. Now they are packed so tight with tents and shelters that not a single blade of grass still grows in what were the national parks and precincts. Our small tribute to the anniversary of the quake yielded a few bandage jobs and a return to HUEH with a boy with a chest cold and a woman with conjunctivitis, an ailment running rampant through the camps. The Haitian nurses seemed annoyed we were there. Victor thought it was because we were giving them more work; I thought it was because they don't know what EMS is. They'd better get used to it, because it's coming to their town.

We all took a break to walk to the Pyramid, a structure intended to house an eternal flame under Aristide's rule. It is now dilapidated and surrounded by homeless people living in its shadow. Clancy and I climbed it in November, but it is now sealed with bricks and barbed wire. Thwarted, our party then moved to the gates of the presidential palace (seen above) where a quartet of honor guards marched out to the flagpole as the seconds ticked down to 4:53 PM, the moment when the quake hit. They raised the Haitian flag up from half mast, then down as one played a bugle and a somber folding ceremony went through its steps. Then it was over and they were gone. It wasn't until then I noticed Peter, Kate, Victor, Kay, Nick, Matt, Jon Denby (one of our resident journalists), Cassius and I had been surrounded by a semi-circle of dozens of Haitians, trying to sell us things or ask about Cassius. I had blocked it all out.

I don't know where my mind was. I had my cap at my chest the entire time, frozen against the gate. Kay was leaning comfortingly on my shoulder. Maybe I was trying to count down to 4:53 and imagine being the one man standing there, knowing what was about to happen. I imagined watching the palace be flung into the air and then land in a stack of ruins. I imagined the screams that must have been heard through the city by multiplying the ones I heard 363 days ago by who-knows-how-many. As I put my cap back on and wiped some of the dirt off my face, I noticed that I had shed at least one tear.

Peter and I were talking about how this is one of the only places either of us have ever come to after disaster relief. We are hit-and-run specialists, treating one disaster much like the last or next. But we are in this now; I am wearing the Haitian flag on my shoulder, and so is Kate. We do not call this home, like Gerard does, but we are invested in Haiti's future, not just its present. Starting at 4:53 PM, we walked off our first shift. Maybe at 4:53 on January 12, 2012, a group of Haitians will do the same thing.

That's the view from the ground.

Sunday, January 9, 2011

Haiti: Revenge of the Janitors

Today's view from the ground - Port-au-Prince, Haiti

The reading several know that I have referred to myself as a humanitarian janitor, cleaning up messes with no particular endgame other than, if we're lucky, the status quo. This is one of the first times I've bothered to help build something, a real mission. Of course, something like that requires a strong foundation. And that often requires destruction.

We have the right crew for that job. For the last 36 hours, it's felt like we are leading the lives of early railroad workers - waking up early to labor in the sun all day and then laughing over drinks and cards at night.

After Kate and I finally met GAI, we tried to figure out the best way of making an outdoor space to put up a tent and hold classes in. My mind was racing, trying to make up for the fact that I thought we would have another building to use. We could pour cement. We could level out the ground behind LAHAF. We could use rubble from the earthquake to fill in the space. We could, we could, we could. We can't.

So Kate and I got to work when we returned to LAHAF. The backyard was overgrown so much that we never noticed that it had once been laid over with concrete. It looked like this:


Obviously, that would be unsuitable for 64 students. It would be akin to leading people into a jungle and learning sophisticated medical procedures there. The only nice thing about it was that Kate and I got to act like Safari Jack and attack the various plant life with every instrument we could find. Tifre, one of Lou's FilmAid guys, got us a machete and a pair of rusty shears. I sharpened the machete the old-fashioned way - with spit and a rock - while the local kids looked on like one of their toys had come to life. There were a couple times that I had to stay my hand against some weeds because one of the kids had gotten so close to me, trying to help carrying dead foliage away, that it wasn't wise to be swinging a blade like I was fending off Vikings. By the time Clancy and Nick arrived, the place looked like this:


Nick told me that the tent being brought from New York to shelter our outdoor classroom is 30 feet by ten feet, which turned out to fit perfectly, with less than a foot to spare in either dimension, into the space we had hacked out of the backyard. This morning, Tifre, Peter (another FilmAid guy), Gerard, Nick and I started digging the perfunctory drainage ditch for the uphill sides of the tent. Every temporary structure in Haiti, or at least any one without a floor, needs one. It ended up being 45 feet long with a distant right angle that was a little wrong, but it was done by noon. The longest part was the hardest, as we discovered the house's long lost patio. Since it was neither level nor complete, it was no use to us. Nick, Peter and I took turns hacking away at with a pickax missing one tine and having two feet of a tree trunk for a handle. Peter (who I renamed Iron Man) struck at it like a machine gun, while any union demolition guy would have waited for a jackhammer - and waited a long time, with coffee and doughnuts to boot. The tent will now fit perfectly in a yard that looks like this:

We spent the rest of the day cleaning our new offices on the third floor of the building, with a lovely view of Port-au-Prince and a slightly more distant sound of children playing football in the alley or playing tricks on each other that make us glad to be hosting a medical school next door. Clinical work, anyone?

And now, as a reward for the reading several, the words to today's LAHAF anthem, to be sung to the tune of "Sixteen Tons" -

I was born one morning when the sun didn't shine
I drove to the gas station and waited in line
Then dug fifteen feet of a water canal
And the engineer said, "How 'bout thirty more, pal?"

You dig fifteen feet, and what do you get?
A few pulled muscles and a mal-a-la-tete
Saying "Guys, don't you text me, 'cause I can't go -
I owe my soul to the NGO.'"

That's the view from the ground.

Saturday, January 8, 2011

The Hawk flies again: Port-au-Prince

Today’s view from the ground: Port-au-Prince, Haiti

In the above photo, Ronald, one of the FilmAid workers, waits for Gwoup Ayisyen pou Ijans (Haitian Emergency Group) to break up near the Stade Nationale in Port-au-Prince this morning.

Haiti. You’ll laugh. You’ll cry. It’ll change your life – or end it.

I bring some bad news to fellow Friends of Cloud Forest. Upon my arrival in Port-au-Prince, I waited for 90 minutes for Clayton’s partner Kyle to meet me on a flight from Miami. After Kate Hanselman, my trusted lieutenant on this project, arrived, we waited for another 90 minutes. When the sun began to get low, I called one of MMRC’s remaining Haitian members so we could be picked up from the airport and delivered to the only place I could think of: General Hospital. It was there that I used one of the nurses’ phone to find out from Clayton that Kyle missed his flight and it was then too late to get to Cloud Forest. Kate and I retreated to Lou’s building in Delmas, got some food and beer and commiserated over the loss of our beloved mission.

For those who donated supplies to that project, have no fear. Clayton will be coming to Port-au-Prince at some point before I leave Haiti and will bring the supplies back to Cloud Forest with him. I must apologize, however, because I have no photos or video of the clinic. Hopefully, in the future, Clayton will share some with me and I will do the same with you.

Lou was not back from the States yet and was not going to be for another two days. The house had its Haitians residents and managers, the men who work for Lou’s FilmAid project, and they let us in and gave me the key. We officially took control of the place, dumping our 120 pounds of supplies on the floor and setting up my tiny gas burner to make dinner. Kate and I stood on the balcony of the third floor, from which we can see the following view during the day, and spoke about many things, most of which had nothing to do with Haiti.

The next day, we did the exact same thing. I had hoped to hear from some colleagues and other organizations about getting some help preparing our building to teach 64 EMS students in, as well as house a dozen instructors and other volunteers. No one called back. No one came by. Most people didn't answer their phones. On top of that, the air in Port-au-Prince was thicker and smokier than I remember, and my throat began to close up. As Hour 48 ticked by and little had been done except the thorough cleaning of the entire bottom floor, we were pretty antsy for something to do.

As there were periodic blackouts (which were fine, since we didn't have any electronics), we passed the time the old fashioned way. We drank beer. We read. We taught each other card games. I got Kate hooked on Texas Hold 'Em, and we played it for more than a day, breaking only briefly for sleep. Then Gerard, the head of the group of Haitian students, came in to talk and we got him hooked as well. We were playing it, in fact, when Lou came in with his luggage. He then joined in and almost cleaned out the lot of us. I managed to win the day.

Today, Kate and I went with Gerard to meet the rest of the students. They are mostly young, educated people, inquisitive and hopeful of a better future. I felt a little uneasy, as some people were asking what they could do after we finish training them as EMTs. I had no answer, as Haiti has no jobs for EMTs at the moment, since there is no such thing as an EMT in Haiti. We just want them to learn since that's what they said they wanted.

On top of the Cloud Forest setback, we don't have the support we hoped for, and costs are growing. We remain hopeful, as we got some good news: with the arrival of Clancy, the photojournalist who came here in November, and Nick, the supply master of the group of instructors, I found out that Kay, late of MMRC, should be here tomorrow. I breathed a deep sigh of relief as I read that. There is quite a load of things on too few shoulders.

And so, I end the evening (after another three-hour round of poker) with this photo of a random kitten that wandered into the building. Tomorrow, there will be progress made, since the next day, the calm before the storm will finally be over.

That's the view from the ground.