Reflecting on Haiti

By Dennis Rosen, MD

Photo: Dennis Rosen

This month marks the second anniversary of the January 2010 earthquake that devastated Port au Prince, killing more than a quarter million, injuring over 350,000, and leaving an estimated one million without shelter. Having gone there three times since then with groups from Children’s Hospital Boston to participate in the relief efforts, hardly a day goes by that I am not reminded of what I saw and lived during those weeks. Ranging from the truly horrible to inspiring and uplifting, many of the experiences were unlike any others I had had prior to setting foot in Haiti.

The first time I went was in May 2010 with a group that worked at the General Hospital along with Partners in Health. Conditions on the ground were utterly chaotic, and the disorganization made it difficult for foreign volunteers to work as we were accustomed to doing back home. This only added to our frustration at the discrepancy between the enormity of the challenges we faced and what we could (or could not do) to help. Many of those we cared for were suffering from the after-effects of injuries sustained in the earthquake, including chronic bone infections following amputations. A significant number of the children we saw were malnourished, their golden, frizzy hair and big bellies (often full of worms) helping us to make the diagnosis as soon as we saw them.

Others presented with routine medical and surgical problems which would have been straightforward in Boston but which were, in fact, very difficult to treat in Haiti because of the limited resources available and the lack of continuity of medical care. Perhaps the hardest of all was to repeatedly see children die from conditions and diseases which could have been prevented or treated back home, at little cost, and to be powerless to stop that from happening. On both the first and the second trips our teams cared for children who died from diphtheria. Previously widespread in the United States, it has not been reported here since 2003 thanks to widespread vaccination. However, diphtheria remains endemic in Haiti, and because most children do not have access to vaccinations, hundreds die from it there each year.

Photo: Dennis Rosen

Returning in November 2010 with another group from Children’s to work at Bernard Mevs hospital with Project Medishare, not much seemed to have changed, at least superficially. The tents, which were everywhere (and continued to house more than one million people), seemed shabbier and more tattered than they had six months earlier. Raw sewage still ran through streets choked by enormous mounds of broken concrete and twisted metal that didn’t look as if they had been touched since the earthquake. Goats, dogs and hogs rooted through the garbage that was strewn everywhere. There were, however, two major differences. Cholera, which had surfaced in Haiti three weeks earlier for the first time in at least half a century, had just arrived in the capital, sickening thousands and killing hundreds. Its appearance had added new layers of misery, fear and despondency to the lives of the more than two and a half million inhabitants of Port au Prince. The other difference was a positive one: driving through the city it was striking to see throngs of uniformed children in their white shirts walking to and from newly rebuilt schools. While some things were better—the pediatric units at the General Hospital were now housed in wooden barracks rather than in tents—it was puzzling and frustrating that they weren’t a LOT better.

The most recent trip in November 2011 was the most sobering of the three. Things seem to have reached equilibrium, though not one any of us would wish upon ourselves or our families. There were still an estimated 600,000 people living in the tent encampments. The city seemed just as filthy as it had been a year before, and although people did not appear to be as thin as I had remembered them, malnutrition, especially in children, remained widespread. While the schools are open, the grim reality of poverty prevents many from attending: our group cared for an 8 year old who was struck down by a car while washing the windshield of another for money, sustaining multiple skull fractures. And despite the pressing need everywhere, the Haitian president had just announced plans to re-establish the army, something sure to divert resources away from other essential projects.

Photo: Dennis Rosen

This last visit made me much more appreciative of my own good fortune, and also made me confront some underlying and assumptions and expectations I was not aware of previously. We are all extremely lucky—though most of us rarely think about it much—to live in a functional society that cares about the common good of its members. Where trash gets picked up, and rivers of waste and disease don’t flow freely through the streets. Where 8 year olds like my daughter can go to school in the mornings and to dance or music lessons in the afternoons and on weekends; eat three nutritious meals plus snacks every day and feel entitled to make a face if dinner isn’t their favorite. (Don’t you know that I don’t LIKE fish?) They sleep in a warm bed at night. They live safe, healthy, and happy lives in a society in which medical services are available to those who fall ill, and disease easily prevented or treated does not abruptly snuff out young lives with chilling regularity.

Few in this country can imagine the daily existence of people such as those we cared for in Haiti, or in hundreds of other places around the world where poverty and need are so great. To have been born into this particular time and place, I realize, is nothing short of miraculous or accidental, depending on your perspective. And by extension, one sees how illusory it is to assume that conditions in places like Haiti reflect the natural order of how things were meant to and will always be. No, Port au Prince isn’t transforming into Boston, nor is it likely to anytime soon. But just as other nations throughout history have pulled themselves out of poverty through hard work, education, and common goals, there is no reason to believe that Haiti will not be able to do so too, some day.

A pediatric tent in Port au Prince

Until that time, however, reaching out and helping those who are so less fortunate than us in order to speed up this process is something we should all consider taking part in, however we are able to. Almost two years ago I met a pediatric pulmonologist from Miami who told me about some of her volunteer work in Central America. “It keeps me grounded,” she said. “Doing this work reminds me why I wanted to be a doctor in the first place.”

Her words are what spurred me to travel to Haiti in the first place, and reflecting back on my experiences there, I couldn’t agree with her more.