Issue Seven

Haiti Day One

Haiti International Airport in Port au Prince. Tens of thousands of dollars in gear and drugs donated by a local church, and not one bag was even unzipped. I found out later that this required a bribe. In Haiti any trouble whatsoever can be fixed with an
appropriate bribe.

The ride from Port au Prince to Coq-Shant was the first truly disturbing thing I’d seen. The ghetto near the airport, next to the Cité de Soleil, is an endless maze of corrugated tin and cardboard shanties on a gigantic mountain of raw sewage and refuse. The chaos and the smell made my eyes water and head pound. It is impossible to convey in words the depth of human suffering and poverty that exists here.

 Once we got out of the city of Port au Prince the view was seemingly more pleasant. Flying down curvy treacherous mountain roads seemed rather sanguine after crawling though the chaotic sprawl of destitution in the city. Imagine a city the size of Toronto after some kind of technical holocaust–devoid of infrastructure, without street signs, traffic lights or drivers’ licenses. I was admiring the countryside as we sped along when Dr. Grimm reminded me that the mountains of brown I was admiring used to be dense green rainforests of mahogany that had been stripped by French colonists.

It took three hours to get to Coq-Shant. The rectory we were to stay at is on top of a mountain–beautiful, really, from a distance. Up close the whole place is just a pile of rock and sandy soil that is nearly impossible to farm. The people are beyond destitute. The livestock we passed along the way looked like skeletons standing on piles of bones and jagged rock. Everyone is completely emaciated and empty-looking. Despair. What kind of difference did I possibly think I could make? This place doesn’t need a physician–especially a relatively green one–it needs a wholesale re-genesis.

The rectory is amazing compared to the three walled shacks we passed on the way up to the house. Two stories, running water collected into a cistern from rain, and electricity–albeit limited to a few hours a day–stored in a row of car batteries, generated from a solar panel on the roof. Father Fasame has labored to make this place as comfortable as possible to attract doctors and nurses to come here. He speaks mostly Creole but greets us in English with his warm and relatively toothy smile. From his wild and fiery eyes, it’s clear to me he is a man of great intelligence and motivation. His love for his people is also quite apparent.

Dinner was served at a large rectangular table in a roomy kitchen. To make us feel at home the women of the rectory made us pizza. It was worse than terrible; wafer thin partially cooked dough, ketchup for sauce, and some ham-like substance to pass as pepperoni. We devoured this crap because we were starving. The sentiment was touching however.

I crashed right after dinner, combat boots and all, after drinking two “Prestige” Haitian beers which would prove to be one of the essential elements to my sanity and our mission’s success.

After a restless night of extremely vivid and disturbing nightmares generated as a side effect of chloroquine, an antimalarial drug I was taking, I awoke promptly at 4:30am to the cacophony of roosters–one of which was literally tied up ten feet from my left ear. The other guys: Dr. Tony Bonner, the spunky, older-looking-than-he-is cardiologist; John, our suave dentist and Arnold Palmer look-alike, and Frank, our meticulous organizer and devout pocket protector-sporting engineer/ambassador, were completely unstirred. I decided to prepare myself mentally for the day ahead.

Haiti Day Two

Hope on the island of despair. Sunday mass at 9am. One of the most amazing spectacles I have ever witnessed. The entire ceremony was in Creole and lasted more than three hours. Three hundred-plus people all holding hands, singing in harmony. The choir was absolutely dynamic. If Roman Catholic mass in the states was anything close, I’d bet there would be a lot more people going to church. Hell, I might even go more often.

Building the clinic. We cleared out the church and used the pews to section off a triage area, pharmacy, dental clinic, and three exam rooms–the walls of which were plastic sheets hung on clotheslines. We set up a surgery suite and an area for diagnostics and IV fluid administration. It was amazing to watch this operation materialize.

We returned to the rectory rather late. We missed dinner by a couple of hours. Nevertheless we got down to the serious business of planning for the next day. Our two hours of electricity were long gone so we worked by the soft glow of an old oil lamp. We settled on the most effective and simple regimen for treating malaria, intestinal worms, scabies and skin infections. We discussed prevention and teaching general health maintenance. We discussed ways to enhance our efforts toward better nutrition with a livestock program and agriculture techniques. Dr. John said he was impressed with me tonight–he said I was fairly intelligent for a thug with a beer buzz. From him that’s a hell of a compliment.

Clinic Day One

6:30am: It was already a complete mob scene outside the place. Domo (our head guide) put a couple of the village elders on crowd control and we were all a little worried we’d be setting fresh fractures and sewing lacerations all day from injuries sustained in the line to get into the place. The Haitian method of waiting in line makes New Yorkers actually seem civil. Thankfully nobody actually did get hurt, although there was a lot of shouting back and forth in Creole.

The whole day was a whirlwind and torrent of distended bellies full of intestinal worms, massive lymphadenopathy, and raging skin infections of every flavor. Dr. John was yanking rotten teeth left and right. I wondered how many more cases of tuberculosis and HIV I would see.

By the end of the day I had seen seventy-plus patients. One case of note was a fairly good looking boy of about nine years, with a ferocious skin infection on his lower lip and chin. He had apparently been suffering from this infection for nearly a year. The infection was so painful that he had difficulty eating. I cleaned it up as best as possible with what we had, and crossed my fingers. I saw the boy at the end of the week and he was grinning ear to ear, his infection significantly improved. It felt great to help–even a little. It might be a drop in the bucket but it’s my drop.

 I couldn’t believe how much hypertension I treated. I really thought the high salt, high fat diet (i.e. McDonalds) of our society was the main culprit for the refractory hypertension seen in African Americans. I guess not. Can’t be lack of exercise either. Haitian people are the hardest working humans I’ll ever know. I’m confidant of that. All of the women complained of sore necks. Not surprising considering they all lug the pound for pound equivalent of a Hyundai on top of their heads up and down mountainsides all day long.

The group was noticeably punchy that evening. We all felt pretty satisfied with our initial accomplishments. We hung out on the roof, checked out stars, and rehashed the pathology of the day.

Clinic Day Two

I got my requisite thirty seconds of nightmare-filled sleep and had to go down and kick the rooster to wake him up–just kidding. I had a piece of bread for breakfast and a lot of coffee. I started to feel the itch of someone who needs a good shower. A sensation that would only intensify as the week progressed.

It was another mob scene outside the clinic. I amused myself with the analogous situation that occurs in our church parking lots, only we kill each other to get the heck out of there, not to get in.

My first surgical procedure was a nasty perirectal abscess on a one year old boy. The whole procedure, including packing the wound, took over an hour and I was completely drenched in sweat and other unsavory substances by the time I was finished. We were very backed up. There were literally hundreds of people out there waiting to be seen and I spent an hour on one kid. I’m worried about him too. If he should develop a perirectal fistula he’d be in big trouble.

Malnutrition and the signs of protein starvation were common–the chubby cheeks and puffy hands and feet that to a lay person might be confused with baby fat were in fact edematous. The hair on the children was grey, fine, and falling out in patches. Their eyes were dull and fatigued. It broke my heart over and over again. All we could do was take down the names of the families that seemed the worst off and hope to arrange some help through our livestock or food relief programs.

 One of the problems of our mission was its limitation of scope. What was going to happen to these people after we left? Who was going to follow up? Our answer was Dr. M. Doctor M. was straight out of Compton or, at least, the Haitian equivalent. Actually, he grew up around this area but trained and was currently practicing in Cité de Soliel in Port au Prince. It’s probably one of the nastiest, most hopeless ghettos on the face of this planet. I can’t even imagine what he’s seen. The HIV rate rivals sub-Saharan Africa. The poverty and lack of infrastructure are as bad as anywhere in the world. He busts his ass for around 10,000 Haitian dollars a year (about 1,000 U.S.)

I only saw 57 patients on the second day. These are the facts:

Nearly one in ten infants will die before reaching their first birthdays.

Average life expectancy will soon decline to an average of 49 years.

The population’s overall HIV/AIDS rate will soon be at 5.17%, rivaling Sub-Saharan Africa. Thousands of infants yearly are orphaned as their parents succumb to this plague. Thousands more needlessly perish as essential medications that could prevent the spread of this disease from mother to child at birth are unavailable.

Epidemics and outbreaks of other vaccine-preventable diseases such as Measles and Poliomyelitis occur as a result of fuel shortages that break the “cold chain” of refrigeration necessary for their distribution.

Kwashiorkor, or protein malnutrition, is pervasive among the population. Most people live on the edge of complete starvation, eating barely once a day if they are lucky.

Young girls are sold into slavery and prostitution at an alarming rate.

If you are interested in learning more about the plight of the Haitian people and what may be done to help, please go to www.trafficeast.com and Haiti and click contact on the contents page. Your e-mail will be directed to the attention of Dr. Donald Pickhardt.

Donald Pickhardt is a third year pediatric resident at Women’s and Children’s Hospital of Buffalo, New York.