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Category: Health, International

Haiti: The Land of the Unknowns

| February 16, 2010

An ER doc from Atlanta describes her mind-numbing experience in Haiti and explains what the island nation needs from us now.

It has been several weeks since my return from participating in the Haitian relief effort. As I attempt to regain a life of normalcy, I am bombarded by questions from well-meaning individuals. "Did you enjoy your trip?" "Did you have a good time?"

My face usually remains placid as I try to process these questions: If "good time" means bearing witness to complete devastation, then I guess it was a cabaret. But before I give an instinctively snarky response, my frontal lobe kicks in. How would anyone be able to ask the right question about something as unimaginable as this calamity?

The time I spent in the disaster zone haunts me. I joined 10 other medical professionals with the Lutheran Christian Missouri-Synod, which traveled to the Haitian-Dominican border to work at the Good Samaritan Hospital. We were a part of an intensive, international relief effort already in progress. It was as if I had walked into a movie set of a 19th century battlefield, except this was real and the patients were not extras.

When we arrived on a Tuesday night, every square inch of ground held a thin, blood-stained mattress with a Haitian suffering from a physical ailment and almost definitely a psychological one as well. As I organized in my mind what actions to undertake that night, I tried to keep count of the number of people without an arm, a leg, or completely disfigured. I couldn’t. There were just too many.

At this point, supplies were beginning to get in, but the stronger pain medicine would not arrive until the next day. So my team walked around the ward carrying bandages, tape, intravenous material, plastic baggies with Tylenol, ibuprofen, oral antibiotics, and bottled water.

As an emergency room physician, once I meet a patient, I take a history in order to arrive at a quick diagnosis. On this mission, I quickly abandoned the practice and stopped asking what particular circumstance had led to a patient’s disability.

I heard enough the first night to know the basic narrative, each with unique and horrible twists. It went something like this: person engaging in their daily life, part of edifice falls on top of his or her extremity, crushed for hours or days without proper medical attention, now overwhelming infection in one or more body part—amputation prior to arrival or here in surgery.

In the process of my rounds, I learned that many were their household’s sole survivor, and that many of the children were now orphans. I can picture one particular child, not much older than six, who just wandered around the ward looking for his parents.

With each patient, I heard an experience that I found hard to reconcile with my basic sense of fairness. The three-week-old who had her right hand amputated so shortly after birth. Or the woman without family rendered quadriplegic because of a spinal cord injury, who was being kept clean and sanitary by a family member of another victim.

Or the numerous people who had been bleeding from their wounds for so long that I was urged by my nurses to move along to the next patient who could still be saved. How does one make such choices when it comes to life and death? You would think that as a practicing physician, I would be comfortable with this question. I’m not.

There was one young woman I just couldn’t turn away from. Her right leg was amputated above the knee, and she was, as we say in medical jargon, "circling the drain." Her body was shutting down with high fever, fast heart rate, and hallucinations. I attempted in vain to give her intravenous antibiotics and fluids, but what she needed was blood. We had none. It was a futile effort.

I learned from the woman next to her—who lost her own right leg the next day—that she was the only person to survive in her family. An American chaplain who happened to speak Creole asked me if there was anything I wanted to say to her. "Just tell her that it will be okay, and that her family will be waiting for her," I barely whispered.

She died minutes later but remained in the room with the other patients. We had no place to put her. My stomach flipped when it dawned on me that no one ever got her name. And such is the nature of an international response to an insensible human tragedy. Teams of medical personnel descend upon a country with only one singular goal: to save human life. Personal details, for lack of a better term, become irrelevant.

In the chaos of the hours after the quake, she was probably going in and out of consciousness, and since no one in her family was alive, she sat in the hospital, pre- and post-surgery, identified only as a "young Creole woman." Through no malice on anyone’s part, nobody ever got her name, including myself.

Her initial surgery had been performed by a Japanese team that probably didn’t have a Creole translator. Her care after that was handled by a group of physicians from Puerto Rico that was focused on keeping her alive. The paper on her body bag read: "Mourir, femme Creole, 1/20/10, 0320, inconnue." Inconnue means "unknown" in French.

Haiti should haunt all of us for a long time. This disaster should serve as a cautionary tale for what havoc occurs when purposeful neglect and natural disaster meet. We should wonder how such a catastrophe occurs at all, but certainly how it happens a mere 700 miles from Miami.

We are collectively responsible for allowing an island-nation to be indebted and dangerously weak in infrastructure. It would be folly to pretend that the destruction that followed this earthquake occurred on an economic tabula rasa.

The developed nations—particularly France, Britain and the United States—bear much of the economic responsibility for conditions that molded Haiti’s development. (To get a better understanding of the complex and painful history between Haiti, the Dominican Republic, and the West, read Why the Cocks Fight: Dominicans, Haitians, and the Struggle for Hispaniola by Michele Wucker). And numerous hurricanes and tropical storms have leveled this country in the past without any change in our basic interaction with its citizens.

As has happened to many countries in Africa, Haiti too has been victimized by draconian loan rules from the IMF and World Bank. The country was forced to privatize its health and education system and open itself up to imports, leaving Haitians to drown in debt repayment of loans distributed in the most undemocratic way.

After all of the well-meaning celebrity telethons, public service announcements and hand-wringing have waned, let us stop being an accessory to such a crime against humanity. The Haitians who have survived are exhausted, hungry, terrified, and vigilant, but they are not ‘inconnue.’

Let’s continue to treat Haitians like they matter.

The views expressed in this commentary are those of the author alone and do not represent WMC. WMC is a 501(c)(3) organization and does not endorse candidates.

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