The humidity is intense… the heat intolerable, and the air is so thick you can taste it. The mosquitos are buzzing in your ear driving you crazy, a reminder of how itchy your whole body feels from bites. We spend the day seeing a wide range of patients varying in age and severity of disease. A woman walks into the emergency room with a dirty rag tinged in a yellow fluid covering her right breast. She uncovers it slowly, explaining that she spent the whole morning picking out maggots from her rotting flesh - the remnants of what once was her breast tissue - before coming to see us. I have never seen a cancer progress to such an extreme case of necrosis in the developed world. But in Haiti, it was so commonplace that the Haitian doctor immediately knew the homemade remedy to get the rest of the maggots out: Simply pour sugar water on the breast tissue so that the maggots would come to the surface for easier removal. This is just one example of the plethora of preventable diseases that I encountered. This is Haiti.
Diseases in Haiti are able to progress to such stages because health care in Haiti is far too expensive for a population that averages only $480 a year. 80% of nationals live below the poverty line. Options are limited for care. It is common for many Haitians to have been treated by voodoo doctors prior to seeing us. The nation of Haiti only spends a paltry 5% of their GDP on health, education and social protection. Only 40% of Haitians even have access to healthcare. 10% of children die before the age of 5. Half of its children are unvaccinated.
Haiti, despite its history of entrenched in hardship, is a beautiful country with a strong and resilient people. To understand the current political climate in Haiti, it is important to see how things got to this point: The entire island of Hispaniola was long under Spanish rule until 1697, when the Spanish rulers handed over the western third of the island to France. The area named “Saint-Domingue” became the wealthiest French colony. Hundreds of thousands of African slaves were brought in to help with the production of sugar, coffee, cocoa and cotton. The land and people were both abused, leaving the land deforested, and the soil depleted. A 1791 slave uprising led to a brutal war of liberation. The region finally gained independence in 1804. Saint-Domingue was renamed Haiti, the first nation to abolish slavery, and the first free black republic. This move did not come without its consequences: After fighting their French oppressors for 12 years, an already indebted Haiti had an economic embargo placed on it by nations that feared this movement would spark similar uprisings throughout the world. Furthermore, France refused to declare Haiti an independent nation until Haiti paid an estimated $21 billion for the loss of French lives and land during the revolution, further bankrupting the country.
Coming from the United States and flying over the island, you can see the clear line dividing Haiti and the Dominican Republic. The Dominican Republic has lush greenery as far as the eye can see. The Haitian side, on the other hand, is a barren landscape. Haiti's huge coastline makes it especially vulnerable to hurricanes. This country, already ravaged due to overgrazing by their French captors, now worsens; its poorest peasants are forced to cut down the remaining trees to build huts or make charcoal to sell, as access to electricity is reserved to only those who can afford it. The resultant deforestation has caused extensive erosion, hurting the agriculture, muddying the surrounding waters, and killing the fish. Since all of the country's big cities are located on the coast, floods often have dramatic repercussions. The weak infrastructure impedes quick delivery of aid and emergency help during natural catastrophes. As a result, some 220,000 people were killed during an earthquake in early 2010. Furthermore, the Haitian government is wrought with scandal and corruption. Any relief money sent to Haiti was allegedly stolen by the leaders of the country. Much of this shapes the current political climate of Haiti… a climate of distrust.
Upon landing in the capital Port au Prince, we were hastily rushed in a van to ride to our final destination, Pierre Payen. A group of us had come to volunteer at the hospital there. Riding through the countryside, we saw unfinished homes without roofs, small shack shops that couldn’t fit more than 3 people in it at a time, people selling coal on the street, and dirt roads. The roads in Haiti are all dirt roads, which extended travel time significantly. We saw pickup trucks acting as busses lined with passengers who hop on and indicate wanting to get off the pickup by hitting the side of the truck. This mode of transport was appropriately named a “tap tap”. Despite the hardships, the city was bustling and vibrant. There was beauty as far as the eye could see: There were charming unfinished homes built on the sides of hills with children playing. There were beautiful lakes and mountains with goats and chickens freely roaming. It was truly amazing to experience this first hand.
The group of volunteers I came to Haiti with uses the Victor Brinkley hospital twice a year for two weeks at a time to offer care to the community. We stayed in a house across the street. Our home had two levels and housed the entire team. I shared my room with 6 other women. In our room we had a shower in the corner with a standing wooden divider acting as the shower curtain. The shower had hard water that was also very cold. This water prevented shampoo from lathering in your hair, ultimately leaving your hair feeling dirtier after you showered than before. There were a lot of mosquitos flying around, even in the shower. No matter how much you tried to clean yourself off, you always felt sticky. As soon as you stepped out of the shower you had to smother yourself with mosquito repellant so that you did not lay awake in bed scratching all night. But in truth, the heat outside made you ok with the ice cold showers, even though it was a big shock to the system.
Working in the hospital was a challenge in itself: All the instruments were donated and many did not work. There were sutures and medicines expired by over 20 years. It was impossible to keep operating rooms completely sterile, because there were flies and mosquitos landing on the surgical fields, and spider webs covering the corners. We worked hard to prepare for the hoards of people who were coming from all over the country to see us. These people who spent every last cent they had just to be seen at a hospital for treatment. But nothing could prepare us for the more than three hundred sick people waiting at the gate as we entered. Some had traveled for days to get to us without sustenance or rest. For many of them, we were their last hope.
While rotating through the different areas in the clinic, I found my time most heavily invested in the operating room. In my everyday life, I work as Physician’s Assistant in cardiac and thoracic surgery in the state of Washington, and so my main job was to first assist in the operating rooms. We had three very talented surgeons: An OBGYN who did anything from birthings, C-sections, hysterectomies, to removal of uterine cysts from bellies big enough to look like that of a pregnant mother of twins at her final term. We had an orthopedic surgeon who fixed shattered bones, separated the congenitally fused fingers of a 3 year old child, performed amputations of limbs too far gone to repair, and relocated extremities into joints that had been dislocated. We had a trauma surgeon who removed tumors and masses, treated burn injuries, fixed hernias and essentially put people back together. Most patients would come into the operating room with their regular clothes, and would leave with those clothes stained with the blood and fluids accumulated from surgery. We simply did not have gowns for them, or even clean linens for them to lie on.
This experience allowed me to be a part of many interesting stories. A few of these stories really stuck out, and the resiliency of the Haitian people left me awestruck. They sat patiently waiting while experiencing horrible pain, or limbs hanging off their bodies. They had spent so much time traveling to see us, many had not eaten or drank anything and were stuck with the hot sun beating on them. One woman was rushed into the hospital after being in a car accident that broke her foot completely off the leg. Her foot was literally hanging on by the skin. But when relaying her story, she stoically told us what happened without pain or fear in her eyes. In case you were wondering, we were able to salvage her foot and fix the bone. With physical therapy, she will regain functionality.
The story that stood out the most to me was one regarding a woman who had fallen into a fire. Haitians cannot rely on electricity so they dangerously cook over fires. This emaciated woman had burned the whole left side of her body the year prior. This caused her arm to contract up from the elbow making it unable to straighten and rendering her arm useless. What made this situation worse is that a large cancer resembling an open bag of worms had grown from right above the elbow. The people in her village were convinced that she was cursed with dark voodoo magic and for this reason would not even associate with her. She had traveled far and sold her last possession - her horse - in order to be seen by us and gain her status as “human being” back in her village. She had not been touched by another person in over a year. She was sent for some imaging across the street after being seen by our primary care physicians. On her way there, she fell and had a seizure on the side of the road. She had not eaten anything in days and her low blood sugar had finally caught up to her. She was carried back to the hospital, fed and hydrated. We set her surgery for the next day.
Her surgery was one I had never seen before. We removed all the dead tissue and cut out the mass. We were able to free up the tendons and the skin enough to straighten her arm. With extensive physical therapy, she would gain back the use of her arm again. The skin removed needed grafts to cover them. We basically shaved a thin layer of skin from her thigh and put it through a device that turned the thin layer of skin into a larger net like mesh. We sewed it to cover the skin removed to promote healing and wrapped her arm to protect it from infection. I remember walking into her room the next day to do a dressing change and seeing her sitting up smiling. This is especially impressive considering that just the area of thigh that was used for the skin graft would hurt like a third degree burn. But in her face, all you could see was gratitude. There was no pain.
We saw numerous patients every day and worked at least twelve-hour days. But we were rewarded with home cooked meals three times a day. We had Haitian ladies come in before sunrise humming or singing hymns as they cooked signaling that it was time for us to start the day. They would spend the whole day in those kitchens making fresh food for every meal. We also got the opportunity to hike the countryside every morning so that we could see some of the beauty this country still held. Here is this beautiful place in turmoil surrounded by all these forces that historically have conspired to bring it down.
On our way back from our last hike of the trip, we noticed many young men carrying machetes walking angrily in the street. These men moved purposefully past us and paid us little mind. I thought nothing of it at the time and headed into the operating room ready to start another busy day. Halfway through that day’s caseload, the whole hospital staff was pulled together. The corruption in the government had incited people to voice their anger, and we were told that the already prevalent rioting had gotten worse. We were forced to evacuate.
A few of us were scheduled to fly out on a red eye flight the next day. But because there was no guarantee for safe passage to the airport without extensive delay, we were forced to abscond to an Air BNB close to the airport. We packed up quickly and said our goodbyes. We were told to keep our scrubs on so that people would know we were medical volunteers and hopefully let us pass. The owner of the home we stayed in along with a Haitian local escorted us, in hopes that they could get us past any roadblock we may pass. The main streets were empty, and that, according to the man driving, indicated we should stay off the roads because people were hiding in their homes.
We didn’t encounter any of the riots and reached our Air BNB safely. I still had the whole day weighing heavy on my body. I went to take a shower. The water was unbelievably cold but there was actual shower pressure. It felt like a piece of heaven. The joy I felt from this small luxury is something I can’t express in words. But it made me reflect on the man I saw during our evacuation who was bathing in the gutter adjacent to his home. I felt a twinge of guilt that that man may never feel the comfort I so quickly take for granted when I’m in my home. We were not the only ones at the Air BNB. Every group was getting evacuated and many had the same idea. We met another group of travelers. Their experience had not gone as smoothly as ours. They did not know to stay off the main roads and had some rioters throw rocks at their van, or try to shake it as they passed. The Haitian people are angry, and rightly so. The people demand better from their government. A feeling of rebellion is palpable.
Our early departure had consequences: This meant people coming for follow ups, needing tubes removed, needing antibiotics, physical therapy, or all those who had spent their life savings seeking help… they were all out of luck. It also affected the people who rely on the hospital for the majority of the money they make that year. We had many young interpreters, nurses, transporters, cooks and vendors that come into the compound that depend on the money they earn and American tips. It was hard to leave all that behind.
My experience in Haiti was incredibly transformative mentally, physically and emotionally. Haiti forced me to slow down, and reconnect the frayed parts of myself to humanity. Working in the healthcare industry, we are initially guided by the simple idea of helping the sick. Somewhere along the line, we lose sight of this mission. We become more myopic in our approach towards helping the individual, and we find that the skills and knowledge that we have attained become diminished. Haiti gave me the opportunity to refocus that initial spark of helping the sick and allowed me to utilize the skills that I had attained to the fullest. It gave me the opportunity to find like-minded people committed to a single cause. Most importantly, it allowed me to believe in the bravery and kindness of people, in the vibrancy of a culture in danger of being lost, and in the spirit of a nation that refuses to be overcome by overwhelming adversity. I rediscovered the fundamental truth and beauty of humanity in a world that seems lacking. Haiti represents the height of potential and growth as a human being. I do not know how to solve the situation in Haiti. But I am glad my presence helped some of the people, even if it is minuscule compared to their daily plights. And despite the cold water, mosquitoes, rodents, and daily horrors I witnessed… I can’t wait to go back.
