It Takes a Disaster to Improve Medical Care in Haiti

I'm from New Orleans and have been studying the city in the five years since Hurricane Katrina hit.  One of the ongoing stories has been about how to restore and improve medical care in Post-Katrina New Orleans.  The immediate aftermath of Katrina saw many potential patients receiving care in the cities to which they had evacuated.  Not so in Haiti, where the doctors have come to the patients.

Two days ago, I went to the field hospital set up by Médecins Sans Frontieres (Doctors without Borders) to see my housemate, Joris.  This was a hospital without walls, at least the kind that don't flap in a strong thunderstorm like the one that hit the day after my housemate suffered an injured shoulder in a motorcycle accident.  According to the statistics reported in an article last month in the Los Angeles Times, of 20, 000 surgeries from 2001 to 2008 performed by Doctors Without Borders in remote or impoverished areas such as Haiti, only 0.2 percent resulted in fatalities.  This demonstrates that such procedures can be performed in resource-poor regions with little or no technology.

One technological limitation that affected Joris was the absence of an MRI machine.  The MRI could tell doctors about the extent of damage to the meniscus in his shoulder, something the X-ray device available to them couldn't do.  As a result, Joris left Port-au-Prince to return to his country of origin and citizenship, Belgium, for an MRI.  He hopes to be back before the Haitian presidential election in the second half of November.  It is his opinion that medical care is better after the earthquake than it was before January 12.

What if MSF/DWB came to New Orleans?  They did do an assessment soon after Katrina struck the city.  Customarily, they operate in less developed countries such as Haiti, where they have been since 1991.  While Haiti's health care has improved because of their work, New Orleans needs a Lobbyists Without Borders to advocate in the state capital in Baton Rouge for healthcare for people without many resources.

The Day After

I came to Haiti in part to pursue a longstanding interest in studying disasters.  I came to Haiti to continue a longstanding interest in studying disaster.  That interest intensified when Hurricane Katrina slammed into the Gulf Coast five years ago with the eye of the storm coming ashore just East of New Orleans.  The ensuing flood covered 80 percent of the city, including the home where my father had lived since Betsy, the last killer storm to target the area.

Post-earthquake Haiti, a new disaster area for me, seems like a replay.  Mid-afternoon on Friday, Port-au-Prince time, I was writing e-mails to my colleagues at my home institution, California Lutheran University, when the wind started to swirl.  My first impulse was to shoot photos, since I hadn't seen it get so dark so fast anywhere else but New Orleans.  I managed to squeeze off a photo when I realized the rain was partnering with le vent.

The second-floor apartment that I share with a Belgian, who sublets it to three Americans, has a wonderful terrace with wrought ironwork that permits breezes to make themselves at home.  This afternoon the guest was a lot more than a breeze, blowing over small flowerpots and causing the two of us who were home to run madly around the apartment closing windows and, more importantly, lashing down a large, blue Katrina-style tarp to the grillwork.  Failure to do so would result in certain flooding of the terrace and the adjoining room.

The wind caused the tarp to flap up over the roof.  I soon determined that a large potted plant had fallen over and trapped the tarp.  I wasn't going up on the roof, which though flat, didn't offer me any shelter from the wind-driven torrents.  Frankly, I wasn't sure that a sudden wind gust wouldn't blow me off the building.  So, I decided to go out on the steps and pull hard on the tarp, bringing the large plant and the pot holding it, crashing to the pavement below.  Now, we could tie the wildly flapping tarp to the ironwork and reduce the rainfall accumulating on the white tiles.

After a half hour, the third American, a freelance journalist, came running up the stairs.  He soon joined his partner and me in mopping up the water.  Small irony: the apartment had just been cleaned and mopped.  As we worked together, he shared that he had passed a camp of persons displaced by the earthquake.  The same wind that bedeviled our attempts to secure the tarp to the terrace made their tents flap in the angry wind.

Now for the worst part: The freelancer told me the government has admitted it has no hurricane evacuation plan for the more than one million residents of the camps.  Less than a week remains in September, which means the Haitians have to endure five more weeks of the hurricane season.  Clearly, strong thunderstorms can add immeasurably to their misery.  I now have a working knowledge of a new disaster in the making on the ground in Haiti.  

Trailers to Tents to T-Shelters

Saturday, I went out with a colleague from Sun Mountain and a construction expert from CHF.  The ride out to Corail-Cesselesse was a cross between demolition derby and Formula One race.  Once at the huge displaced persons camp, I was impressed with the enormity of the community, stretching almost from one horizon to another and to the foot of the deforested hills serving as backdrop.

As I got out of the four-wheel drive vehicles, a virtual necessity on the rough roads in and around Port-au-Prince, my Sun Mountain colleague, a Haitian named Sam, greeted me with the words, "Welcome to Hell."

As we observed the five-year anniversary of Katrina three weeks ago and the nine-month anniversary of the earthquake in Haiti just a little more one ago, I sought to connect the housing issues surrounding Katrina (eviction from destruction of public housing, formaldehyde-laced trailers, uneven neighborhood reconstruction, and Brad Pitt-supported building, often with a green slant) with those I was discovering in Haiti (people living in tents in front of red-marked, unsafe housing, people separated from their neighborhoods in camps in public plazas, the most remote of all, residents of places like Corail, sleeping in half-pipe-Quonset-hut tents to transitional or T-shelters, square houses designed to go up quickly without costing an arm and a leg.)

Time did a story on the displaced persons camps for sixth-month Haiti earthquake anniversary and the New York Times did one on the same topic two days ago with a focus on poignant letters from camp residents to the International Organization for Migration, one of whose vehicles I had ridden in for much of my first week in Haiti.  New Orleans, say hello to your sister city, Port-au-Prince.  Welcome to hell, a place where not enough gets done, at a snail's pace.  Here's one of the Corail photos from the Time magazine article.

The Aid Community

Yesterday I got out of the work area Sun Mountain has carved out of the poolside lounge at the Hotel Villa Creole.  Workers from a gamut of organization from the Red Cross on meet, Skype, and make mobile calls around the city and the hemisphere.

The hotel itself, known as HVC by those staying there, carries wounds from the January 12 earthquake and some of the employees live in tents on the grounds.

I went out with Scott, the Sun Mountain director and Hans, one of the team members, to visit a number of organizations, starting with Worldvision, in the process meeting Haitians, Asian Americans, South Asians and Middle Easterners serving as staff.  In some cases, we had appointments and in others we stopped by hoping to catch folks.  Driving around in a vehicle marked IOM, for International Organization for Migration, we saw small SUVs (everyone seemed to be in one) with letters indicating UN (DP or OP),  USAID (US Agency for International Development), CRS (Catholic Relief Services),  CHF (Cooperative Housing Foundation) or the aforementioned Worldvision.

Part of the reason for the trips was for Scott to confirm partnerships for documents being finalized or already completed and also for me to meet some people that I may need to contact for later assignments.

Dinner was structured around discussion of a displaced persons settlement that would incorporate best practices.  The consultation took place mainly between Scott and a representative from the UN supervising the camp development.

Bookended by the Media

I started the day by descending the hill to the market from the "compound" (my term for the dwellings behind a very large gate that shelter four households).  My companion was a freelance journalist who was on a mission to find breakfast (le petit dejeuner in French, kolasyon or dejne in Creole)  for his significant other and himself.  He's done work for Free Speech Radio.  On the way Ansel asked me if I had been to Haiti before.  I told him how I had almost bracketed Haiti in travels to Santiago and Guantanamo in Eastern Cuba and to Puerto Rico.

Here's the view from the roof of my apartment building:

  In contrast to the idyllic scene with the sea in the distance, tableaux of dezas, or disaster, begin practically right outside the gate of the compound:

I took my leave of Ansel to start my first run in Haiti.  It's impossible to avoid hills in my neighborhood and it was also impossible to think of the myth of Sisyphus and the Haitian people and the Creole saying I recently read that goes, “Deye mon, gen mon,” "after the mountains, more mountains."  Do I need to stress the point that pushing boulders uphill can get tiring?  My run chock full of hills was nothing.

Tonight,  I've been listening to snippets fo conversations between an NPR reporter and a guest at his table.  On a day of running in the ruins, the media representatives are almost as prevalent in Port-au-Prince as the aid organizations.  More in the next blog.

Working at the Hotel Villa Creole

Riding shotgun with Lemoune, I saw the first displaced persons camp right outside the airport.  Later I would be informed that it was a fairly small one as the camps go.  The heat was blistering, the traffic snarled, and the people were moving with purpose and determination.  No one I could see seemed to be in a state of mourning for the dead or for the death of a way of ife.

I saw political grafitti foretelling the November presidential elections.  I remember seeing Justin Celestin's name.  Cell phone and other billboards proliferated along the road.  PAP is fairly hilly, and when we combined congested traffic, bad roads, and eight month-old rubble, our progress slowed to a crawl.

I recognized that the neighborhood might be where I would stay that night, Christ Roi.  I confirmed that with Lemoune, my driver.  The Hotel Villa Creole is situated in Pétionville, in the verdant hills above PAP.  It turned out to be an oasis that had largely survived the earthquake (more on that in a later post).  I met my new co-workers, co-volunteers (I'm not the only one donating time, but I'm the only professor.).

After reading environmental reports to get up to speed, I rested in the Sun Mountain hotel room (definitely not a suite).  Later, I would spy an article by Amy Wilentz in the Sept. 6 New Yorker about the upcoming elections ("Running in the Ruins")  The piece conveys the color and corruption of Haitian politics and deserves a read, especially for the contrastng portraits of René Préval, the outgoing president who is fond of siestas and rap artist Sweet Micky Martelly, the real Wyclef Jean, an eligible candidate who can reach the people in their favorite language, Haitian Creole.

In PAP, Attention to Detail is De Rigeur

Yesterday I arrived at Toussaint L'Ouverture International Airport.  I was arriving at a Caribbean country not to vacation, not to present and listen to papers at a conference, but to do work as a volunteer for an international NGO, Sun Mountain International.

Despite my noble intentions, the immigration officials were not impressed.  They didn't want to know who Sun Mountain International (SMtn) was, that it was started by an alumnus of California Lutheran University, the university where I teach.  They didn't want to know that SMtn was working with the International Organization for Migration and US Agency for International Development.  They didn't even want to know that I had received a commendation for patience from una abuelita on the overnight flight from LAX to Miami for sitting among her three generation deep family - I got something out of being able to practice my Spanish.

What the immigration officials in Port-au-Prince (PAP) wanted to know was the exact street address in the Christ Roi district where I was going to stay.  My passport confiscated and protests ignored, I was sent packing until I could produce a more detailed address.  After a few seconds, I returned to the immigration supervisor.  Eventually, I wheeled around and suggested that the Hotel Villa Creole was my destination.  Rejected again, I was told to get my taxi driver.  Rolling two duffel bags across a dusty pavement, separated by a chain link fence from a horde of desperate and no doubt hungry kids yelling "Boss" at me, I found Lemoune, who was holding a sign with my first name and the words, "Hotel Villa Creole."  Salvation.  We deposited the bags in his SUV and marched back to the immigration office to secure my passport.  Sweaty and a bit angry, I returned to my appointed task.  Onward, Lemoune.  The devil's in the details.