Haiti After the Earthquake (13 page)

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Authors: Paul Farmer

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The first week at the General Hospital was surreal and unsettling and sometimes inspiring. The campus was bursting with health professionals, many of them new to Haiti. All sought to provide care to the maimed and sick. Clashes occurred over matters grave and trivial—from arguments over control of space, personnel, and supplies to discord over where to park vehicles.
One nontrivial matter was providing salaries for the hospital staff. Many of those working were homeless and most had lost family; they were now surrounded by volunteers with skills much needed in Haiti, before and after the quake. The hospital needed not only these skills but also a living wage for those who could not afford to be volunteers. A few of the staff, bereaved and beleaguered, simply gave up. But most stuck with it, and more Haitian staff came back every day. If most had already returned, why was there still such demand for doctors and nurses? The answer, in large part, was that the hospital had never been properly staffed in the first place.
As the adrenaline wore off and the enormity of the catastrophe came into view, these structural problems of health care delivery also became apparent to the newly arrived volunteers. Despite the terrible suffering in this hospital and in others, there was something noble and inspiring in the spectacle of caregiving. Academic medical centers made a good showing: in the middle of the hubbub were surgeons and nurses and anesthesiologists from the University of Miami, Harvard, Dartmouth, Mt. Sinai, Duke, Montréal—to name just a few.
12
I saw scores of my former students and trainees, and countless colleagues. Many NGO and government-affiliated volunteers arrived soon after the earthquake. Chinese, Brazilian, and Israeli teams were there in as many hours as it takes to fly from Beijing, Rio, or Tel Aviv, respectively. There were rescue teams from fire departments and ambulance squads. And the Cubans, as ever, sent hundreds of specialists to join the hundreds already working in Haiti.
We saw more helpers from more countries during the week after January 12 than in the two decades previously. Most had never been to Haiti before, but even groups with deep roots, such as Partners In Health, focused initially on bringing in surgical and rescue teams. There were so many relief workers that it became difficult to obtain a landing time at the Toussaint Louverture Airport. Although commercial air traffic to Haiti had ceased, humanitarian traffic was all you could hear within miles of the airport; enormous military transports jammed with supplies made a noise commensurate with their size. Where once thirty flights would constitute a busy day, there were now sometimes a hundred flights in the space of a few hours.
Opening up the logjam required more than largesse. It required logistic capacity and patience. In Port-au-Prince and elsewhere in Haiti, we saw the messy side of this tidal wave of goodwill efforts. Countless stories were told of pallets of medicine and other supplies stuck on the tarmac or in customs. But many supplies did get through. In the Partners In Health Boston office, staff and volunteers—including board members and founders and students—learned new skills almost overnight, coalescing into extraordinarily effective teams of logisticians, visa expediters, and flight coordinators. The providers on the ground were grateful, even though few of us saw with our own eyes the energy and time required to respond to requests from the quake zone. Several of my former students rarely left the Boston “war room.” One, a Haitian-American named Luke Messac, described it in the following terms:
A motley crew quickly took up residence in a large, mostly barren room adjacent to Partners In Health's offices on Commonwealth Avenue in Boston. The space came to be known as the “war room,” in part, perhaps, because it recalled the spartan, kinetic office of a nascent political campaign. Our group included veteran logisticians, computer programmers, and program coordinators, former staff on leave from grad school and medical residencies, stalwart volunteers, and Haitian-American members of the Partners In Health family. A whiteboard at the front of the room tracked flights of cargo, medical volunteers, and emergency evacuees going into and out of Haiti. Fueled by
the demands of the moment and generous offerings of pizza and coffee from local eateries, our teams matched equipment orders and donations with precise lists of urgent needs prepared by Zanmi Lasante. Because cargo planes and donated private jets departed and landed at every time of day and night, the room was hardly ever empty during the weeks following the earthquake. The scale of the devastation weighed on us, but frequent reports from Haiti and the preternatural constancy of the leaders of our stateside response—especially Partners In Health cofounders Ophelia Dahl and Todd McCormack—helped keep us calm and focused.
Similar transformations occurred at the Clinton Foundation, where Laura Graham and others pulled staff from regular activities to buy generators, hunt for medicines and tents, and research everything from prosthetic limbs to rubble crushers. In nearby Miami, Medishare and local universities made earthquake relief a top priority, as did institutions in New York, Montréal, and many other cities.
The Office of the Special Envoy was also working in overdrive. (We'd just moved three of our unaccounted-for staff to the accounted-for column of our own grim list.) The dozen or so staffers and volunteers camped out in our office—one that neither Clinton nor I had visited since the day after the quake. They joined forces with Partners In Health, the Clinton Foundation, the Haitian government, and other new partners to move supplies and personnel to Haiti.
Even with supplies and personnel, the mortal dramas inside Haiti's medical institutions—including those damaged and those hastily confected—continued. People were still being brought in from around and south of the city. A few survivors were still being pulled from the rubble. A day after we'd been told to expect no more survivors, a brother and sister were found under a collapsed building and brought to the General Hospital; people working there cheered as they were carried in. Both survived after minor surgical procedures.
The shortage of surgical capacity would be eased, we knew, by the arrival of the USNS
Comfort
, a floating hospital with twelve operating rooms. As the first week of the aftermath drew to a close, planeloads
of teams and supplies kept coming. It wasn't always clear where to send them. Not all the supplies and personnel were those needed, and the public health and disaster response authorities had been run ragged just trying to respond to offers of help. Efforts to coordinate all this goodwill emerged among UN-affiliates, big NGOs, and the beleaguered authorities. The first week was messy but not a total mess.
President Clinton made his first post-quake visit on day six and was anxious not to interrupt rescue and relief efforts with the protocol that attended visits from a former U.S. president. The UN Secretary-General had been in Haiti the day before, but I pushed President Clinton to make the trip to the General Hospital. We needed him to show up in part because we'd given him quite the shopping list: medicines we couldn't find at the General Hospital, dozens of generators, and a host of other supplies. We gave him all of forty-eight hours to complete the shopping, and Laura Graham and the staff at the Clinton Foundation had been asking for regular updates on what was needed.
Clinton was scheduled to arrive on the morning of January 18. I went to the airport with Prime Minister Bellerive rather than the UN team, but we were in the wrong place and missed the motorcade. (This was the sort of protocol error that would've driven Mr. Annabi mad. Clinton visited Haiti as a UN envoy, and it was our responsibility to welcome him and see him off.) I was pretty worked up over this error, having begged Clinton to come with supplies and to give moral support. His staff—a small and close-knit team—were expecting me to be on the tarmac to welcome them. In the chaos of the airport, even the country's prime minister couldn't get a straight answer about when the plane landed or where it was on the tarmac. Although the stench had lifted, the noise of the military cargo plane was still deafening, and Bellerive and I had to shout to hear each other. “You missed them,” someone finally explained. “They're on their way to the General Hospital.” We piled into Bellerive's jeep and headed through what Bellerive had aptly termed the “ruined city”
towards the hospital. The traffic, humanitarian and otherwise, was already infernal.
Wearing a lime-green t-shirt, Bellerive looked tired—he had been logging twenty-hour days—but in good cheer. He was unfazed by our welcoming mishap. “Don't worry about it,” he said. “We'll see Clinton at the hospital. He's not the sort of person to be irritated by us being at the wrong part of the airport when the control tower isn't functioning and phones aren't working well.” Exactly right. Clinton wasn't at all that sort of person; he would be focused on rescue and relief. He was also likely to be thinking, already, about reconstruction. That would be the herculean task entrusted to Bellerive's government (or what was left of it) after the acute relief phase had passed. I didn't envy him a bit.
We tried to make small talk as the driver fought to catch up with the UN motorcade. But small talk was hard in the midst of such devastation. There was a certain fecklessness of collapse: you would see one intact building surrounded by crushed homes, huge piles of debris, and cracked walls at alarming angles. This unruly pattern of devastation would make both clearing and reconstruction difficult. As we drove by the fallen palace and then Bellerive's former office, laid low and with papers and filing cabinets cascading into the streets, I saw tears running down his face. We didn't speak again until we reached the hospital.
When we arrived, President Clinton was visiting patients and staff. (He was being led around by Mark Hyman, a doctor friend of his and the husband of the orthopedic surgeon with whom I'd flown to Haiti.) Dr. Lassègue was there, of course, but was doing more listening than talking. Bellerive waded through a crowd towards one of the makeshift postoperative “wards,” where some children were recovering from surgery. Clinton had brought the surgical supplies and generators and anesthesia, as we'd asked. By then a dozen operating rooms were running, although the conditions were poor in the eyes of the visiting teams and the Haitians.
With President Clinton there, it was a double mob scene: there were scores of patients and families and relief workers but also a small horde of journalists and camera crews. This marked their first
chance to ask Clinton questions directly. Still embarrassed about being late, I hung back, listening to his conversations with Haitian staff, American volunteers, and the press. One reporter asked what seemed the most pertinent question: “Have you, in your experience, ever seen anything as bad as this?” This was precisely the question I'd meant to ask him. He paused and then said, “I have seen many large natural disasters, in my country and in others. But never has there been one so concentrated in such a heavily populated part of a densely populated country, one that has devastated a capital city and with this much loss of life and infrastructure.” Without pause, he added, “This is worse than what has happened before, but I'm confident that Haiti will recover and will build back better.”
I never found out if this was reported exactly as he said it, but those three sentences finally put into context what I'd been struggling with, personally and professionally, since January 12. Was an inability to come to terms with the disaster's dimensions a reflection of a lack of imagination? For that matter, what
were
the dimensions of the disaster? Who was tallying the grim lists, and how accurate could they be? Did our powerlessness to save more lives—we all felt it—stem from incompetence or sluggishness in accepting offers of aid? (None had been spurned, as far as I knew, but deploying aid effectively was another story altogether.) Was there really hope of building back a destroyed city while survivors pitched “tents” made out of sheets and sometimes pieces of plastic or tin (donated tarpaulins had not yet arrived, nor had tents) between piles of rubble and in every other city space? We knew that hundreds of thousands had fled the city, but it seemed as crowded as ever, even in the worstaffected areas.
Clinton and Bellerive moved slowly through the hospital in a thicket of people. I was trailing them, trying to digest what Clinton had said.
Never in his experience had such a catastrophe struck the heart of such a densely populated capital city
. When a journalist asked me to comment, I couldn't get a word out in response. He was kindhearted enough to withdraw his microphone.
Clinton's words haunted me. I considered myself experienced in tough situations, but here was someone who had, for decades, dealt
with flood and fire and quakes and every sort of misfortune, as public officials must. For eight years, he had done so as leader of a nation with a long history of responding to disasters beyond its borders. If Clinton hadn't seen anything like this, why was he confident that Haiti would claw its way back? I resolved to ask him when we were next alone.

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