What I've Learned

The past decade has been the best learning experience of my life.

It had to happen and I wouldn't trade it for anything.

In the words of the philosopher Edmund Burke, "All that is necessary for the triumph of evil is for good men to do nothing."

Haunted Doctors

While working in Haiti during the last three decades I have been haunted.

With almost every patient that I have examined, I feel like I didn't do enough or that I did too much. But in order to work in Haiti, I think health care professionals need to reconcile that we are limited and weak human beings and the conditions in which we work are inhuman and disorienting.

And most Haitians forgive us when we walk away. Or when we shake our head and give them the the third best treatment because treatments one and two are not options in Haiti.

In Haiti I sometimes stare at the next patient and don't see him because I am thinking of the last patient who is shuffling out of my "office". I am asking myself, "Was that the best you could do?"

All I can say in those circumstances, is "forgive me God".

Everyone working in Haiti needs to be gentle on themselves. But we need to do our best to speak and act for Haitians whom the world will soon begine to ignore again. Most importantly we need to try and help Haitians build a society which will never allow this travesty to happen again.

Below is an article from the New York Times that chronicles some of the "guilt trips" that foreign doctors are on right now after their recent medical experiences in Haiti.



February 13, 2010
Doctors Haunted by Haitians They Couldn’t Help
By DEBORAH SONTAG

PORT-AU-PRINCE, Haiti — The foreign doctors who performed the first amputations after the earthquake used hacksaws. They relied on vodka for sterilization, substituted local numbing for general anesthesia, jury-rigged tourniquets from rubber gloves. Working around the clock in improvised operating rooms, they sacrificed limbs and lost patients to injuries that are no longer supposed to be disabling or deadly.

Now back in their antiseptic, high-tech offices in the United States and elsewhere, the medical professionals who initially flew to Haiti’s rescue are haunted by their experiences, “overwhelmed by conflicting feelings of accomplishment and guilt,” as Dr. Louisdon Pierre described it.

They witnessed what Dr. Laurence J. Ronan of Massachusetts General Hospital described as a “mass casualty horror show.” They practiced what Dr. Dean G. Lorich of the Hospital for Special Surgery in Manhattan called “Civil War medicine.” They saved lives, probably by the thousands. But their accomplishments were limited by the circumstances, and then they left, uneasily, before conditions for doctors and patients alike started improving.

Most of the doctors interviewed said they were committed to returning to Haiti and to marshaling the medical community’s resources to deal with the thousands of Haitians who sustained permanently disabling injuries. The needs are staggering: from basic wound care to skin grafts, revision surgery, physical and occupational rehabilitation, prostheses and trauma therapy.

“Everything that everyone did during those first two heartbreaking weeks will have been for nothing if these patients don’t get continuing care,” said Dr. Elizabeth Bellino, a pediatrician based at Tulane University who worked in Haiti right after the earthquake.

In Uganda now on a project, Dr. Bellino, 34, said she closed her eyes and saw the beaming face of a 12-year-old Haitian boy named Mystil Jean Wesmer who ended up comforting her when she dissolved into tears. As she recounts it, Mystil smiled gently and, sensing that she was overwhelmed by the need around her at a field hospital run by Americans, said: “ ‘Go take care of the sicker kids. I’ll be O.K.’ ”

He himself was waiting to have his leg amputated.

“All he wanted to know was how he was going to walk to school and church,” Dr. Bellino said. “I said, ‘Well, we’ll figure that out.’ But now I’m so worried about him, about all the kids.”

Dr. Pierre, a Haitian-American who is the director of pediatric intensive care at the Brooklyn Hospital Center, said he thought constantly about the patients he left behind, too. Even as he plans his next trip — he and Dr. Stephen Carryl, the chairman of surgery at his hospital, will be returning with a prosthetics maker — a few memories plague him.

Back in Brooklyn, he still hears the loud, shrill cry of a mother at the moment her small son died of a raging infection on the lawn of a hospital in the Carrefour neighborhood. The mother and father, one child already lost to the earthquake, had implored Dr. Pierre to help their 4-year-old, who had been eviscerated by a concrete block and hurriedly stitched back together by a local doctor.

But the boy, lying in a crib under a tree, his heart rate racing, his breathing way too fast, was clearly suffering septic shock, and Dr. Pierre, equipped only with his stethoscope, could do nothing.

“I felt so helpless,” he said, and not long afterward, while he was deeply sedating another patient for surgery, he heard the wail that told of the boy’s death.

Later, amid the patients strewn across the hospital’s grounds, Dr. Pierre spotted a wrapped bundle in what appeared to be an abandoned incubator. The bundle, mewling, was a premature infant whose mother had died in childbirth. Dr. Pierre and a pediatric nurse from Brooklyn, Sharon Pickering, frantically tried to find a way to hydrate the baby.

“This is something we know how to do,” he said they told each other. Finally, they managed to insert a needle in a bone cavity and get the baby some fluids. But the next morning, Dr. Pierre found the incubator empty.

Such losses were shattering but it was hard to react at the time, the doctors said. There was too much to do, and the circumstances were disorienting. Dr. Lorich, an orthopedic trauma surgeon at the Hospital for Special Surgery, said it was hard to adjust to the grim reality of mass amputations. “I am in the habit of saving legs,” he said.

When his 13-member team from New York arrived at the Haitian Community Hospital, thousands of terribly injured Haitians lay on stretchers, boards, mattresses and the floor, among them tiny children with crushed legs, all by themselves.

The hospital had two functioning operating rooms, Dr. Lorich said, but the anesthesia machine did not work, the oxygen tanks were empty, there was no blood supply and the labs were not functioning. Still, the New York team plunged in, performing 40 amputations, 60 limb-saving operations and, to conclude three sleepless days, one Caesarean section — “a nice pink baby,” Dr. Lorich said.

The departure, however, was unsettling. Dr. Lorich’s team was exhausted, as were their supplies, but a flight that was supposed to be arriving with a fresh team of surgeons and nurses to replace them had been canceled. Outside the hospital, crowds seeking help pushed against barricaded doors, and they did not want the foreign doctors to abandon them. The doctors needed a military escort to leave.

In Uganda, three weeks away from her return to Haiti, Dr. Bellino said she could not stop wondering how the 12-year-old Mystil had fared after his amputation.

Through an uncle, the boy was found at the World Harvest Missions/New Life orphanage, where American volunteers are looking after wounded children who have been discharged from field hospitals.

Mystil was lying on a mattress on the concrete floor of a church with a roof damaged in the quake. On his plaid shirt he wore a SpongeBob sticker, which a volunteer said he had earned by doing several laps around a mango tree on his new crutches. Sarah Wimmer, a paramedic from Arizona, said that Mystil’s wound was healing well, and that he was receiving some physical and emotional therapy. When his stitches are removed, he will be sent home to his parents, who are living outside their cracked house, but he will be considered an outpatient, Ms. Wimmer said.

Reached in Africa, Dr. Bellino sighed. “I can breathe now,” she said after learning that Mystil was all right.

Lying on the mattress, with tired, sad eyes, Mystil had said he missed “Dr. Elizabeth.” Asked if he wanted the doctor to bring him anything when she returned to Haiti, Mystil said: “Toys, I guess. I know — a bicycle!”

Then, looking down at his bandaged stump, the boy slapped his forehead and buried his face in a pillow. “I forgot,” he said.

Haiti's Common Good

National Catholic Reporter Editorial
Febrary 4, 2010

It is a bitter and awful irony that it took an earthquake of horrifying dimension to bring a stop to it all and to rivet the globe’s attention and compassion. A redemptive quality mixes even now with the stench of death that hangs over Port-au-Prince. The questions arising from the rubble are enormous. Reconstruction will occur, but it must be done in a way that does no further damage to the integrity of Haiti and that advances the broadest benefit for the greatest number of people.

The common good is not a well-established concept in Haiti, and Port-au-Prince before the earthquake provided the best evidence of the degradation that occurs when the perks of commerce and political power accrue to only a few while the rest remain in poverty.

Post-earthquake possibilities include the opportunity to manage the enormous outpouring of the world’s compassion and resources to develop Haiti beyond the borders of Port-au-Prince, to establish the infrastructure and services so desperately needed to revive agriculture and other industries in Haiti’s rural provinces.

Haiti has paid a historic price to the slave trade and to those in the hemisphere with the power to manipulate. It now deserves a fighting chance to reestablish itself as a player on equal footing with the rest of the world.

The Rest of the Story is Ours

Haiti: The rest of the story is ours

By Joan Chittister

Created Jan 25, 2010

I went to Haiti years ago. There was an earthquake going on then, too, but that earthquake was of another making. That earthquake rumbled up from the underground of a people who had been exploited, abandoned, abused and forgotten by their own government and brought to the point of total resistance.

In the midst of the fissure stood a young Salesian priest, Jean-Bertrand Aristide, shouting like John the Baptist in the desert, for peace and justice for the poor in the face of Haiti's sinful impoverishment by the Western world. From 1845 to 1947, Haiti had been forced to pay France reparations in gold for its 1803 war of independence. This required the country to borrow huge sums of money at egregious rates of interest from American, French and German banks. Furthermore, Western corporations, our own among them, were using Haitians at slave-labor wages and paying not a cent in taxes for the privilege of doing so.

Aristide was being hunted by day and by night by minions of a corrupt regime intent on quieting the fearsome voice. Aristide's great earth-shaking crime lay in running a home for street children and speaking a lonely truth in the face of the national family secret that the country was being prostituted by its own government for its own indecent desires. The dictators François Duvalier, or "Papa Doc," and his son Jean-Claude, "Baby Doc," were draining millions out of the country's coffers for personal use.

During that trip to Haiti, in 1989, I made a 20 minute film about the situation called "Voices of Promise; Voices of Hope," which I smuggled out of the country right through the hands of the government security team. The film was to help to raise consciousness in the United States about the deplorable conditions of the place, but nothing much happened to change things there. The infrastructure remained decrepit, the people remained underpaid, the country remained destitute.

The film, nevertheless, talked about more than corruption. It talked just as much about beauty. The country was desperately deprived but ruggedly beautiful at the same time. The people were pathetically poor but fiercely beautiful in their calm and kindness at the same time. The private civilian and religious aid agencies that sustained the poorest of the poor in the country were pathetically undeveloped and totally beautiful in their commitment to this hopeless place. The future was frighteningly dangerous but spiritually beautiful. Haitians were full of faith in God and full of faith in their own unprepared selves.

I had never seen such suffering, such beauty in my life. But now, since the worst earthquake the Western Hemisphere has ever experienced struck Haiti, I am seeing it again. The only question now is how much beauty will it bring and for how long?

For the first time in years, the lead news story in the United States isn't about war. The banner headlines aren't about suicide bombings. The pictures aren't of maimed soldiers. The sidebar articles aren't about suspicion and body scans. They aren't about the oppression of one person by another. But that doesn't mean that the news isn't about pain and suffering, about frustration and powerlessness, about God-awful deprivation and aching hearts.

Instead, Haiti is a story of 111,000 corpses being tilted from dump trucks into open graves in a public trash heap. It is the story of a small country that had 380,000 orphans before the earthquake and is now calculating that there may well be a million more children, homeless, alone, wandering through life in a place where life does not exist. It is the story of a country of at least 200,000 dead and two million homeless that is totally destroyed and totally demoralized at the same time.

But that is not the end of the story. The rest of the story is ours.

You see, Haiti is also a story of millions of dollars being poured into relief programs for Haiti by simple people everywhere. It is the story of the mobilization of planes, ships, troops, rescue crews and relief agencies from around the entire world. It is the story of reporters gone to record the event having put down their microphones to become part of the rescue scene themselves. It is about celebrities, politicians, presidents and U.N. officials everywhere stopping their own lives and agendas to take up the cause of a people whose cause has almost never been recognized before. It is the story of a world in tears for a people who are surviving their desolation by singing on hillsides together, singing about death as they are pulled from the rubble alive, singing alleluias in their ruined churches as they pray to be delivered from fates worse than death.

This scene, too, has a stunning kind of beauty and deep commitment. This time it is the beauty of the human community dedicated to shining a light through the blackest parts of the human situation rather than aiming predator drones or suicide bombs at other innocents around the world.

For the first time in history, financial aid is pouring into Haiti from every part of the globe. For the first time in history, the ugly face of human abandonment is being exposed to the caring face of human bondedness. For the first time, the human race, ironically, looks totally human everywhere.

There is another test of humanity, however, that Haiti will surely essay and which is a clear and measurable one: How long will the human community stay in Haiti, not just to rescue the few survivors or hand out emergency rations or bury the nameless, unwashed, unblessed dead but how long will we stay there to rebuild it?

After all, U.S. gratitude to Haiti is long overdue. Haiti, the first and only nation to arise out of a slave revolt not only defeated Napoleon in his attempt to retake that island nation but, in the process, foiled Napoleon's plan to then use that country as a launching pad for the invasion and conquest of the land known now as The Louisiana Territory. In other words, Haiti saved the Western United States from French rule. Saved the United States.

So how long will we ourselves, the United States, a country that occupied Haiti for our own interests from 1915 to 1934 and then put half a century into wars around the world and billions of dollars and millions of weapons into death -- stay in Haiti to save it, to repay the debts that the abandonment of an entire people incurs. How much time, how much money, will we and the rest of the global community put into becoming as much a part of Haiti's resurrection as we have been part of its burial?

From where I stand the situation is a clear one: Haiti in its devastation stands not only for the rebuilding of its own country but for the possible rebuilding of the soul and humanity of the entire human community itself.

If we see this one through, Haiti may well save us again, this time not from the loss of our land but from the loss of our humanity.

From Where I Stand
Copyright © The National Catholic Reporter Publishing Company

Addicted to Haiti

(Photo by John Carroll, pre-earthquake Port-au-Prince)

February 7, 2010
Op-Ed Contributor/New York Times
Addicted to Haiti
By BEN FOUNTAIN
Dallas

IN 1999 I made a day trip from the Haitian capital, Port-au-Prince, up to the wanly charming town of Kenscoff, a couple of hours drive into the mountains. I’d done this journey before, but not in several years, and as the road wound upward I couldn’t help being astonished by the sprawling mansions that had taken over the hillsides.

Where this road had once offered peaceful views of terraced fields, patches of forest, clusters of modest farmhouses, there now hulked villa after mind-boggling villa, as if the McMansions from Dallas’s flat-as-a-pancake suburbs had been transplanted to the mountains overlooking Port-au-Prince. Had oil been discovered in Haiti? As every turn revealed new vistas of architectural bombast, my Haitian friend in the passenger seat was shaking his head, muttering the same word over and over:

Drogue. Drugs.

Since Haiti’s devastating earthquake, much attention has been focused, rightly so, on the convergence of economic, political and cultural forces that rendered the country so vulnerable to this catastrophe. Many have looked to the past for guidance, and recent weeks have given us earnest and often perceptive analyses of Haitian history, reaching back to its brutal colonial origins, its proud, improbable and staggeringly violent war of independence, and continuing on through the next 200 years of mostly miserable governance, that depressing catalog of revolts, coups, betrayals and interventions — usually aided, if not procured outright, by foreign powers — that drained Haiti of so much of its wealth and promise.

But if Haiti is to be rebuilt, or not merely rebuilt but transformed, then drug trafficking needs to be recognized for what it is, a primary force — arguably, the dominant force — in Haitian political life for the past 25 years.

A 1993 memo, written by John Kerry as the chairman of the Senate Subcommittee on Terrorism, Narcotics and International Operations, asserted that “there is a partnership made in hell, in cocaine, and in dollars between the Colombian cartels and the Haitian military.” At the time, Haiti was well on its way to becoming the Caribbean’s leading transshipment point for cocaine entering the United States from South America, and while the individual actors may have changed in the years since then, the partnership has continued to thrive. Today, drug trafficking is a billion-dollar-a-year enterprise in Haiti, generating tremendous profits in a country where most people survive on a few dollars a day.

In any country, this kind of wealth would provide ample incentive and means for acquiring power, but in Haiti the drug trade exerts an influence out of all proportion to other sectors of society. The narrative of Haitian politics since the fall of the Duvalier regime in 1986 closely tracks the rise of drug trafficking. As Haiti struggled to hold elections in the years immediately after President Jean-Claude Duvalier’s ouster, compelling evidence pointed to the involvement in cocaine trafficking of Col. Jean-Claude Paul and other high-ranking officers, a faction of the Haitian military that was, perhaps not coincidentally, especially pitiless in its suppression of the democratic movement.

The military continued to be closely linked to the drug trade during Jean-Bertrand Aristide’s brief first turn as president, cut short by the coup of Sept. 30, 1991, and little changed after his ouster. Indeed, Port-au-Prince’s chief of police, Lt. Col. Joseph Michel François, emerged as the next key man in Haitian drug trafficking, presiding over a notorious network of soldiers and paramilitary attachés that, in addition to expanding the country’s drug trade, carried out a ruthless program of political terrorism in which thousands of Haitians were murdered.

Those years of intense repression coincided with Haiti’s rise as the region’s major transshipment point for cocaine, a distinction it maintained even after civilian rule was restored in 1994. By 2000, an estimated 75 tons, or 15 percent of the cocaine consumed annually in the United States, was being channeled through Haiti. Drug-related corruption and violence became endemic during Mr. Aristide’s second term as president, with many in his inner circle — including the National Palace security chief, the director of the Haitian National Police, the head of an investigations unit of the National Police, and the president of the Haitian Senate — eventually serving time in American prisons for violations of American narcotics and money-laundering laws.

At virtually every turn over the past two and a half decades, Haiti’s attempts to establish the institutions and standards of civil society have been subverted or crushed, often with the hand of the drug trade clearly evident. President René Préval’s administration made greater strides than any previous government toward true reform, yet progress even before Jan. 12 was tenuous. The National Police remained a weak and uncertain force; the judiciary was dysfunctional; government ministries were highly politicized and rife with corruption; concepts of transparency, human rights and the rule of law were fragile at best.

At present, there is no lack of debate on how best to go about remaking Haiti. Plan better. Build better. Push for institutional reform. Pour in many billions of dollars in international aid, with stronger oversight, firmer resolve, greater involvement of the Haitian public and private sectors. An opposing school of thought says that aid should be cut off completely, forcing Haitians to take ownership of their country’s fate; only shock therapy can break the enduring cycle of dependence, dysfunction and self-inflicted poverty.

Whichever way you lean, chances are that the power and profits of drug trafficking will doom your prescription to irrelevance. Yes, Americans have shown tremendous generosity toward Haiti since Jan. 12 — more than $20 million in text donations to the Red Cross, $57 million and counting raised by the Hope for Haiti Now telethon, the private planes stacked up at airports in southern Florida, waiting for a landing slot in Port-au-Prince. That’s the part of the story that makes us feel good.

Then there’s the other part. The United States leads the world in cocaine consumption, which means there is a line that goes straight from our stupendous drug habit back to the conditions in Haiti, all those years of toxic governance that set the stage for so much destruction, so much death and injury.

So it’s come to this: the richest country in the hemisphere and the poorest, the first republic and the second, trapped together in the New World’s most glaring modern failure, the war on drugs. It would be naïve to hope that Americans will quit their cocaine any time soon for Haiti’s sake. But it would be equally naïve not to recognize this huge obstacle standing in Haiti’s way, and the role we’ve played in creating it. Our aspirations for Haiti lead straight through our addictions.

Ben Fountain is the author of the short-story collection “Brief Encounters with Che Guevara.”

Bishop Jenky, Haitian Children, and the Earthquake

Dear Bishop Jenky,

The Catholic laity in the Catholic Diocese of Peoria recently raised tens of thousands of dollars for Catholic Relief Services (CRS) for the Haitian earthquake victims.

Several days ago a letter was written by Catholic Relief Services, Catholic Charities, and the United States Catholic Conference of Bishops.

I am sure you would have seen this letter that attempted to ensure that vulnerable Haitian children and orphans are protected and taken care of in an expeditious and ethical fashion.

A significant bullet point in the letter states:

"Ensure that children in need of urgent medical care are able to access life saving
services as soon as possible, whether in Haiti or in another country. Whenever
possible, these children should be accompanied by a parent or guardian if one is
available."

Bishop Jenky, as you know, Haitian Hearts in Peoria has been doing this for over 15 years.

In fact right now we have children in Haiti that have survived the earthquake and need heart surgery that they cannot obtain in Haiti.

Will you help us find a medical center(s) in the United States to accept these children?

Also, Haitian Hearts has two young adult patients, Jenny and Henri, that were operated at OSF-SFMC in Peoria ten years ago. Both are homeless in the streets of Port-au-Prince now and both need repeat heart surgery. Unfortunately, both have been rejected by OSF-SFMC and Jenny and Henri have not been allowed to return to OSF-SFMC.

Will you intercede at OSF-SFMC on their behalf? Other medical centers do not want to accept them for a variety of reasons. And OSF-SFMC really needs your guidance now so they can follow their mission philosophy and never turn any one away. (Haitian Hearts will obtain their passports, visas, and pay for their travel to and from the United States. We will bring them to the United States and they will stay with the same host families in Peoria that they lived with ten years ago. We will also provide their medication post operatively in Haiti for the rest of their lives.)

Bishop Jenky, please do what is right for the Haitian children and for Jenny and Henri. I am sure that Catholic Relief Services would support you in this humanitarian effort.

Thank you.

John Carroll, M.D.

(Jenny is pictured above.)