A unique position to help

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Author: John Nagy ’00M.A.

haitidocs

Sister Esta Joseph, C.J., baked a cake and a pizza whenever she knew Emil Hofman was coming.

Over the past six years, Sister turned out a lot of cakes and pizzas. Hofman made a point of visiting her at Saint Rose of Lima parish school every time he visited Léogâne, Haiti.

The legendary Notre Dame chemistry professor guesses he’s traveled to Haiti a dozen times during that span, leading his “Hofman Reconnaissance Trips,” mostly for groups of experienced doctors who share one thing in common. They are Hofman’s former students. Many are men and women he taught 20, 30, 40 years ago. Today they are medical school professors, surgeons, ER physicians, anesthesiologists, pediatricians, urologists, research biologists. To Hofman, they’re all “my freshmen.”

“I never stay more than a week,” Hofman recently said. Saint Rose of Lima is one of several priorities on his itinerary. The idea, he explained, is to give the doctors an overview, “so they can see whether they want to come back at some other time to practice their specialty. And most of them do.”

So a few times a year Hofman and these Notre Dame docs stepped out on the verandah above the schoolyard at Saint Rose of Lima, where the girls, smiling and beautiful in their sky-blue gingham uniforms, typically began the rites of hospitality with school songs and an a cappella rendition of the Haitian national anthem. Their guests responded with the Notre Dame alma mater and the fight song.

Hofman began 2010 with one such trip. Though the group was smaller and included Hofman’s grandson, Colin, a Notre Dame senior, the routine was no different — except that Hofman, 88, took ill. An infection was attacking his kidneys, and with great difficulty the professor boarded a plane on January 8 and returned to the United States.

Before her guest left, Sister Esta Joseph pressed a note into Hofman’s hand, thanking him for the gift he’d left in her care as principal the last time he’d visited. It was his custom. This time the money had financed sanitation and hygiene improvements at the school, and Sister, who had dictated the note to a translator, blessed him. “All the school say thank you and wish you 12 months of blessings, 52 weeks of happiness, 365 days of health and 8,760 hours of love,” it read.

One month later, over lunch in the Corby Hall dining room, Hofman shared the note with Father Thomas Streit, CSC, and a guest. His hand trembled as he held a photograph taken of the schoolgirls, bunched together and laughing as a nun tried to restore order.

Hofman’s voice broke as he remembered saying goodbye to the holy woman who had become his friend. “She was killed in the damn earthquake,” he sobbed.

“She was a saint,” Streit affirmed, placing his hand on his old professor’s shoulder.

A biology professor and director of the Notre Dame Haiti Program, “Pere Tom” has called Saint Rose of Lima home for much of the last 17 years while conducting tropical disease research in Haiti, where healthcare has long lagged badly even behind other poor nations.

“The sister in the picture was killed, too,” Streit said. So were two others. “Hopefully the students were not, because that was the morning group. The afternoon group, about 150 kids were killed.”

Hope crumbles

According to government estimates, the “damn earthquake” of January 12 claimed the lives of some 230,000 Haitians. While frequent tremors terrified survivors in the month after the disaster, an estimated 300,000 received treatment for injuries. Tens of thousands more face a perilous future that promises battles with infected injuries and disease aggravated by dehydration, malnutrition, heavy spring rains and the merciless sun.

The devastation also directly hit the Notre Dame family. Emmanuel Guillaume, a Haitian seminarian of the Congregation of Holy Cross — which has served Haiti since 1944 — died instantly. John Kloos ’74 lost his son, Ryan, 24, and rushed to the hospital in Miami where his daughter, Emily, 26, was admitted with life-threatening injuries. The siblings were serving in Haiti with Friends of the Orphans, an international children’s aid organization.

The disaster destroyed nearly everything in a relatively small area of the country that happens to be its most populous. Look at a map of Haiti and imagine it as an outstretched hand, thumb in the north and palm in the south. Léogâne, the small, coastal city closest to the epicenter of the 7.0 quake, rests in the palm’s inner curve, about 18 miles west of the capital, Port-au-Prince.

Two of the very few buildings left standing in Léogâne house the Haiti Program, where Father Streit ’80, ’85M.Div., ’94Ph.D. and his staff of 35 labor with realistic hope of ridding the country of lymphatic filariasis (LF), a mosquito-borne, parasitic disease that can cause the grotesque swelling of the legs, female breasts and male genitals known as elephantiasis. Though rarely fatal, the deformation often leaves victims debilitated and ostracized.

The evening the earthquake struck, Streit and several members of his staff were in Port-au-Prince attending a conference of Notre Dame’s partners in the fight against LF at the Hotel Montana. The tone was upbeat. Participants outlined plans to treat preventatively half of Haiti’s nine million people by the end of the year and eradicate the disease later in the decade. Relaxing after an early adjournment, Streit, Sarah Craig ’98MSA, Logan Anderson and Marie-Denise Milord, a Haitian doctor and public health official studying at Notre Dame on a Fulbright scholarship, survived the hotel’s instant collapse. Streit made phone contact with Notre Dame and then lost touch for several days.

In Léogâne , program acting director Jean-Marc Brissau’s sense of isolation deepened. Initially forgotten as international relief organizations rushed to the broken capital, Léogâne had no airport to receive supply planes. With no cell phone service or Internet connection at Residence Filariose, the two-story house where community leaders had gathered for LF information meetings and Hofman and other guests had stayed during visits, Brissau ’08LLM watched as thousands of homeless neighbors gathered in tents and makeshift shelters outside the compound in search of food, water and medical assistance.

Brissau mobilized the staff, offered what he could to the refugees and worked to re-establish communication. When by the weekend it came time to find a place for relief planes to land, he identified a stretch of road he remembered drug runners using as a runway for cocaine drops. He contacted U.N. officials, who dispatched troops to provide security escorts and crowd control.

That is how, when help finally arrived in Léogâne six days after the quake, Notre Dame found itself in a unique position to support the relief effort. To the doctors who flew in with food and medicine on single-engine planes, the ND haven seemed nothing short of providential.

The summons

Ralph Pennino ’75 had been there before. So had Kevin Olehnik ’78, Marty Dineen ’74 and several other doctors who responded to Pennino’s summons in the weeks after the earthquake.

Pennino, a plastic and reconstructive surgeon, is founder and president of InterVol, a Rochester, New York-based network of healthcare providers and volunteers that coordinates and delivers medical care, supplies and professional support to places around the globe in need of it. He led three missions to Haiti in the 1990s and returned again in 2008 with Emil Hofman.

After his 2007 Hofman trip, Olehnik had stepped out of his orthopedic specialty to draft teams of urologists who, like Dineen, perform hydrocele surgeries on male victims of elephantiasis. He was among the first to respond to Pennino’s call for a team of surgeons and anesthesiologists, including Daniel Towle ’77, who could relieve the agony building up outside the Notre Dame compound.

While InterVol volunteers packed supplies and medicines donated by Rochester General Hospital and contacts around the country, the doctors petitioned their own networks for medicine and equipment. The response was overwhelming. A Rochester wine distributor, Constellation Brands, offered its corporate jets to shuttle the volunteers and their supplies to the staging airport in Haiti’s neighbor, the Dominican Republic.

Pennino arranged for another donation of air transport from the DR with Tradewind Aviation, a charter flight company, enabling doctors on Léogâne Team I to arrive in Haiti nine days after the earthquake. Landing on the highway outside town, the plane was rushed by locals desperate for food and water. Surrounded by armed U.N. soldiers, the doctors and flight crew hastily loaded 3,000 pounds of supplies and food onto trucks for the 15-minute trip into town.

“We traveled in silence, basically because the moment we hit the city I think everybody was just absolutely horrified and in awe of what they were seeing,” said anesthesiologist Towle, a 25-year veteran of international medical work. “Nothing prepared you for this.”

People were still trapped inside the pancaked buildings. Signs lined the road: “Please America, help us.” “Welcome America.” “Welcome Marines.” Inside the compound, Pennino’s group found that other teams of physicians had set up operations in the nursing school adjacent to Residence Filariose. They could hear the screams of patients enduring amputations performed without anesthesia.

Pennino and Olehnik scrubbed up to help with a complicated hand crush surgery, and Towle’s medical partner Catherine Powers provided the anesthetic. Towle claimed some “reserved” vacant rooms and began tearing open boxes and throwing supplies around to establish turf. The team pulled tables together and set up operating rooms for its first full day of surgery.

The first InterVol team performed 120 surgeries over the next 10 days. Until Towle found a local supplier, he and Powers anesthetized patients without benefit of oxygen. Electricity was limited to a few hours a day. Temperatures soared to the high 100s. The rudimentary sterilization procedures available to the Haitian nurses who stayed to help rather than leaving to find their families were undone by sweat and dust and the fans that drew air in through vents 15 feet away from the tent city growing outside the OR walls.

When the tremors shook — three or four times each day — dogs began to howl. Mothers cried for their children. Those who had roofs were afraid to sleep under them. But at 4 o’clock every morning, the doctors heard hymns of praise rise up outside the gate. “It’s a Catholic country,” Towle said. “Some sort of leader would show up, and people would gather. We laughed about it the day it didn’t start until 4:30, wondering, was he late?”

Between the dogs and the roosters, sleep was hard to find. The doctors rose by 6 in air that hung like wet wool. At daylight, patients arrived. Families carried their wounded on blankets and tree limbs. Some made their own way on homemade crutches. Others came in the arms or Humvees of U.S. Marines, or the trucks that circulated through nearby villages to pick up the sick and wounded. In the field hospital that a medical team from Iowa set up in the ND yard, doctors treated a steady flow of 300 outpatients per day.

The surgeons, through translators, had to console their patients several times before they could operate. “We had patients who said, ‘No. You’re going to cut off my foot. I’d rather go home and die,’” Towle recalled. The team kept them around until they relaxed and learned to trust. Towle took a picture of one fearful woman’s repaired feet to show her when she awoke after surgery. “We both burst into tears,” he said.

At night, the doctors gathered around a fire of burning trash with their colleagues from World Wide Villages, Save the Children and the Children’s Nutrition Program. They drank hot Haitian beer and traded stories and ideas.

The first surgical team at “Léogâne Shock Trauma Hospital,” as its staff came to call it, performed only two limb amputations. They pronounced three deaths; one was a 100-year-old woman whose body couldn’t handle the antibiotic fighting her infection. They delivered babies, many premature, the mothers’ bodies unable to withstand the fatigue, stress and hunger. Most made it. Some didn’t. The ones who did were balm. “I loved it,” Towle said. “Amidst all the death and tragedy, a baby was being born. Hopefully into a decent world. Who knows?”

When Team II flew into “Léogâne International Airport” — the name another instance of field humor — Towle and Olehnik stayed behind a day to orient the new team. The weather cooled. As the disaster neared one month, demand for trauma care began to subside at the ND compound and the other field hospitals operating in town. “Our biggest concern is post-op healing,” Pennino wrote in one of his regular email dispatches. “We have no inpatient capability and patients are sent back home — aka refugee camp — to return for post-op wound checks.”

Ricocheting between Rochester and Léogâne, Pennino continued to recruit doctors and donors via InterVol. At Notre Dame, valedictorian Brennan Bollman ’09 had taken leave from her first year at Harvard Medical School to coordinate offers of medical help through the Haiti Program office. Word of the response effort — and of Notre Dame’s role in it — was spreading through informal networks as well as such established channels as the Tom Dooley Society.

Five weeks after the earthquake, Léogâne Shock Trauma Hospital shifted operations to an improved field hospital provided by a World Wide Village donor. Pennino reported 7,000 patients treated and 250 operations performed. “Incredible,” he wrote,” is an understatement!”

Hope endures

The ND campus responded to the crisis with creativity and determination, beginning with a well-attended Mass for Haiti on January 18. The University raised nearly a quarter of a million dollars in donations, gate receipts and concessions revenue at the men’s and women’s basketball games the following weekend.

Students took up a collection at a faculty panel on Haiti. Others put together a benefit concert, a tent-and-tarp collection in conjunction with South Bend-area Boy Scouts, and a “Polar Bear Plunge” in which 100 undergrads dipped into the 40-degree waters of Saint Joseph Lake. Senior Jeffrey Lakusta secured commitments from wineries to donate a cut of their sales to relief agencies.

Much of this money supported immediate relief efforts. But the University had already begun to think about its long-term role in Haiti, where the disaster crumpled hospitals, schools and churches as indiscriminately as people’s homes.

No longer a missionary effort, Holy Cross’ presence in Haiti is native-born and growing fast. The pain of seminarian Guillaume’s death was compounded for his religious brothers and sisters by the destruction of the provincial house. Many of the eight parishes and 10 schools the order serves were badly damaged.

Hope and vision at Residence Filariose are as strong and tall as walls that withstood the January 12 quake, thanks to Father Streit’s consultations with ND civil engineering Professor Yahya Kurama earlier in the decade. For now, Haiti Program staff have become relief workers. Like their partners in the Haitian government and a cluster of cooperating organizations, they recognize that fractures and flesh wounds come before LF treatments, deworming and iodine deficiency in the triage line.

Still, Streit believes the program can press its effort outside the West Department, the district that encompasses the nation’s worst structural damage. Even the Port-au-Prince warehouse where the program subsidizes the production and sale of salt fortified with iodine and the antiparasitic drug that fights LF is structurally sound and operable. With support, Streit thinks Haiti Program clinicians could add critical services like bednets, malaria drugs, Vitamin A and iron.

He is sensitive to the impact relief efforts can have on Haitian institutions. Hôpital Sainte Croix, his lead research partner in Léogâne, was already struggling before the disaster. Once it rebuilds, it may have to compete with sturdier relief organizations just to stay open for that day when the last foreign medical teams depart. The competition extends to personnel. Streit himself lost two recent hires to Doctors Without Borders, “but I’m happy that they’re working to help get us out of this situation,” he said.

He trusts that experienced agencies share the ethic of “building local capacity” — training and employing Haitians to do most of the work, a key component of the Haiti Program’s success to date. It’s important, he says, to make sure Haitians are prepared to build a future in which healthcare, education, business and government function radically better than they did in the pre-January 12 past.

Once Haiti’s emergency needs lessen, capable volunteers are welcome. Notre Dame Professor Karen Richman has posted Creole language course materials at the University’s open courseware site, ocw.nd.edu, for cooperative self-starters ready to do anything from dropping a well to building homes and churches to comforting orphaned children. Streit likes the idea of something like a Hofman trip for non-medical personnel so people can think about how to plug in.

Hofman himself yearns to return. “I’m 88 years old, and I want to do with the rest of my life what is worthwhile,” he said in February, sitting in his blue ND parka and sipping soup in Corby Hall. “I found what is worthwhile, and it’s what we were doing there. Very, very much so.”


John Nagy is an associate editor of this magazine.


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