by Stephen Joyce, MD, MPH
Member, Christ Community Church
Board Member, United Way of Elgin
Port-Au-Prince, Haiti is an absolutely lovely spot–for a giant slum. Haiti literally means “High Hills”, and the once lush tropical island’s Western nation capital sits along a lovely bay with still beautiful mountains to the south and east. And that’s where the fantasy ends.
The poorest nation in our half of the world (the Western hemisphere), most of Haiti’s millions have suffered untold misery for years. Once a slave colony ruled by the French, native islanders (the Taino Indians) were nearly wiped out long ago and replaced by captives from Africa. Like our “Tomb of the Unknown Soldier”, once having achieved their freedom and independence after a 13 year struggle that began late in the 19th century, there is a commemorating and achingly yearning “Statue of the Unknown Slave” near the center of the capital.
Modern Haiti is the result of many decades of foreign occupation (including the U.S., from 1915-1934), corrupt governments, and exploitation of its resources, including a French demand for “reparations” (backed by the U.S. and others) for having freed themselves from the French, which took this small nation 122 years to pay off. So impoverished, Haiti is now 90 percent deforested, due to Haitians not only cutting trees down for wood, but burning them down to make coal to sell. The city streets in some areas of Port-Au-Prince (“Port of the Prince”) are lined with people selling everything from cell phones to kitchenware to furniture to live chickens. Infrastructure is sorely lacking, including things like intermittent electricity in the capital and hit-or-miss running water. Men push or pull huge loaded wooden carts for lack of trucks, dripping sweat in the hot sun, in scenes that look like something from the dark ages.
Having twice been to this beaten-down nation as a short-term medical missionary, I have been struck and deeply touched by the kind and gentle nature of many Haitians. Bad enough that their countryside and treasury have been ravaged repeatedly, that coups and gang violence lead to the need for a U.N. peacekeeping force since 2004–but on top of that it’s been one disaster after another in recent years.
Near the end of my first trip there, with no building codes, very limited heavy equipment, and lacking in modern construction techniques, a school collapsed, trapping and ultimately killing hundreds of children. Over 24 hours after the collapse there were still some desperate parents on the collapsed upper story roof, futilely attempting to gain access to their children with one crow bar and a hammer. The street below was packed full with more anxious and wailing parents.
The next year four named tropical storms in a row (Fay, Gustav, Hanna, and Ike) hit, with vast flooding, wide-spread disease, destruction of shops, churches, and over 20,000 homes, with tens of thousands more damaged, nearly 1,000 dead and 70 percent of the nation’s crops destroyed. Add in the downturn of the global economy and rising food prices, and in 2009 large numbers of Haitians were reduced to eating dirt cakes—literally fried dirt—just to have something in their stomachs. Other severe storms in 1994, 1998, and 2004 (Hurricanes Gordon, Georges, and Jeanne) killed nearly 5,000 more people and devastated more crops and homes.
This all comes on top of a baseline of severe widespread poverty and suffering to begin with, which touches nearly everyone. Two Haitian physicians, with funding help from Lumiere Medical Ministries in Gastonia, North Carolina, and groups from Christ Community Church in Saint Charles, have built a new charity “Hospital” called King’s Charity Hospital (a largish clinic by U.S. standards); they run an orphanage as well. One of these men is a surgeon, the other an obstetrician and gynecologist, and while they live in a lovely home, they have no hot water and have to rinse all of their dishes in bleach solutions using collected rainwater from their cistern. They also have intermittent electricity, and often go without any power at all. Despite being surrounded by a six-foot high concrete wall topped with barbed wire and imbedded glass shards (as are many buildings in Haiti, including kindergartens and the supermarket they use, which also has two armed guards with pistol-grip shotguns patrolling the parking lot), they have been robbed more than once.
Staying with these two dedicated and caring physicians (who could have prospered elsewhere in the world with their educations), our small group took cold “showers” from pipes without shower heads and gravity fed water pressure, when not having to bathe from a bucket when the roof water tank was empty because there was no power to pump the cistern water to it. They have a generator (guarded by a really, really unfriendly beast) but can afford to run it only a limited basis, and often may have no fuel anyway.
At night the city becomes not only more dangerous in terms of assault, but also much more toxic as locals burn kerosene and make fires for light and cooking, even setting tires alight. Add to that the crawling rush hour traffic of aged vehicles with limited pollution control—just walking around outside can make the unaccustomed sick. And then there’s the endless dust from the dry heat of the hot sunny days. Conjunctivitis, chronic cough, sore throats, and “dry eyes” are rampant, taking on new depths.
Working in their original King’s Charity Hospital, which was basically the second floor of a somewhat unfinished small warehouse-like building with bare concrete and rebar exposed in the ceiling and some walls, we had no air conditioning or running water, very few supplies (mostly brought with us), and even more limited basic laboratory testing. Still, we were fortunate to have what we did. Across the street was “City of the Sun”, one of the largest homeless camps in Port-Au-Prince, literally standing on top of the city garbage dump. The “parking lot” for the hospital was rutted dirt and became a mud pit when it rained. Having been told of American doctors coming to help, Haitians arrived daily from hours away by “Tap Tap”, which is a nickname for the many small pick-up trucks with benches in the back and a cap top as the most common form of public transport. They came to see us—some ill, some with ill children, or both—all day without food or water. The nurses counted thirty women and children exiting from the back of just one “Tap Tap” (tap tap — on the roof, for the way to signal the driver to stop). We were treating people with malaria, TB, ulcers, pneumonia, old injuries, rashes, malnutrition, and various intestinal infections. These infections are the most common cause of infant death–Haiti’s infant and child mortality rate is roughly 10 times that of the U.S.
On the next trip we worked out of the unfinished concrete shell of the new hospital, with concrete dust everywhere, no power or water, and no windows when we arrived (a few were put in while we were there, but it still rained on all of our supplies one night and flooded our “pharmacy”). A young girl passed out while waiting in the heat to see us one day and went into continuous seizures. Our medical leader had to flag down a passerby in a car just to get her to a fully functioning hospital elsewhere. The driver did not hesitate to help, abandoning whatever plans he had.
We saw the same travesties of health as before. Unlike in the U.S. where people usually seek help within days (if not hours) of the onset of a health problem, the Haitian patients I saw often had suffered symptoms for anywhere from months to several years. Can you imagine having a common ailment, such as a stomach ache, for 6 months or even years? Or that in addition to starving much of the time or at least being hungry most of it, and living in a make-do shack down by the riverbed where you bathe and wash what few clothes you have in the same place where all the sewage goes?
I always bring extra snacks like granola bars and nuts with me to work because of patients like Phillipe, the young, hollow-looking child who had diarrhea and a rash. According to the pastor who brought him, he was living on water and the few cookies a day the pastor could give him. These stories go on and on, none of them good, most very sad, and many heartbreaking. I always gave away all of the food and water I had when there was someone there at the time who needed it.
What would New York, Los Angeles, London, Paris, or even Chicago be like if all of these conditions hit one city? Each of those cities has populations roughly similar to that of Haiti’s–nearly 10 million. Now add the earthquakes–it’s hard to imagine, but I do know one thing. There but for the Grace of God go I, and you.
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