A week after the January 12 earthquake, Wesly Pierre momentarily considered leaving Haiti. His wife and daughter would go, no question. He had a travel visa and a degree in computer science, a job he’d held since high school and money for a plane ticket, things most of his countrymen only dream about. “Wesly,” a friend told him, “If I was you, I already left.”
As he tells his story, Pierre jockeys a white Toyota pickup over the ruts and chuckholes in Léogâne, his hometown. Dogs skitter out of his path and lapse into a trot, untroubled by the motorbikes that buzz past with two or three passengers.
The streets are clearing. It is cool this Sunday evening, Day 57 of Haiti’s latest trauma. The temperature, at least, will not trouble the city’s homeless, which is still most of its men, women and children. Passing untold tonnage of concrete ruins even at the city’s necropolis, we see little sturdy shelter for the living or the dead.
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Downtown, an ominous crack runs up the three-story white walls of the abandoned Hôpital Sainte Croix. The hospital, now more concept than functioning healthcare facility, still runs a small outpatient clinic and research lab with Pierre’s employer, the Notre Dame Haiti Program. Slight and wiry, Pierre is one of the few Haitians who will enter buildings like this one. In the hours after the quake, daring the aftershocks, he had dashed inside Notre Dame’s Residence Filariose to retrieve laptops.
Pierre is that guy you want on your side under any circumstances. At the edge of town, he pulls out onto a pocked highway that cuts through open fields of sugarcane and tall grasses dotted by coconut palms and cigar-box cedars. The truck lurches toward the steeply banked stretch of road where, on his recommendation, planes full of food, tents, medical supplies and doctors first reached Léogâne after the disaster.
In the first days with his country in ruins, he had wondered where to go: the United States? Canada? But someday he would need to come home. If people like him left, what would he find when he returned? “That’s why I need to stay,” he says as a goat ambles in front of the truck. “I need to stay to participate in the construction of my country.”
The truck clears the old runway and approaches an encampment of blue vinyl and white sheets. At dusk, purpling mountains frame the horizons. “The big problem now,” Pierre remarks, “is the rainy season. Oh my God.”
Saturday, 1 p.m.
Descending over Port-au-Prince Bay the day before, Bill McEnery’s plane punches through eddies of warming air. The faint smell of sewage fingers its way into the cabin. Islands of blue tarps fill the flats between the city’s moistened hills. We glide over Cite Soleil, among the poorest neighborhoods in Haiti’s dense capital, and touch down at Toussaint L’Ouverture Airport. A few lingering U.S. Marines in fatigues remind us why we can land here at all, rather than shuttling from the Dominican Republic to Léogâne’s erstwhile airstrip.
“Léogâne Team VII” is six doctors, a scrub tech and a lot of other people like McEnery — the father of a ND student — his pilots and me. The medical team includes three anesthesiologists to soothe down the towering misery index at the field hospital outside Residence Filariose’s front gate; an obstetrician to deliver babies and treat women suffering miscarriages; an orthopedic surgeon to handle broken bones; and and a urologist to attack the backlog of hydrocele surgeries needed by hundreds of Léogâne’s men, whose contraction of the mosquito-borne parasitic disease lymphatic filariasis (LF) has bloated their scrotums. The surgeries, set back weeks by the post-quake focus on trauma and wound care, are a service provided under the Haiti Program by Haitian doctors and American volunteers.
Dan Towle ’77, an anesthesiologist and Léogâne veteran from the first week of the response, worked for weeks to muster the group and solicit food and supplies. McEnery’s pilots help us load a creaky baggage train with the 4,600 pounds of new tents, camping tarps, beans, rice, dried carrots and medicines along with a portable anesthesia machine that Towle’s hospital, Children’s Mercy in Kansas City, Missouri, purchased at a cut rate from a sympathetic vendor.
Outside, the curb is wet with rain. Barefoot children wade through gutters ankle deep in brown water and push through the crowd of helpers-for-hire who have gathered around the trucks that will transport us the two hours and 18 miles to Léogâne. An aggressive, well-dressed Haitian scolds them in Creole, somehow managing the tension while we load the flatbed and pickup brought to meet us by the Haiti Program director, Jean Marc Brissau ’08LLM.
Moving through the city, the taste of sooty rain on our lips, we cling to handholds as dust layers into our hair. Buses, colorful Haitian tap-taps, belch clouds of black smoke into streetside encampments and joust with motorbikes at intersections. Most streets are clear. Rubble has been jammed back onto lots and forced into sewage runnels already choked with plastic bottles.
Saturday, 5:46 p.m.
Dr. Ralph Pennino ’75 pauses in twilight at the open metal door of the nursing school dormitory next to Residence Filariose. The school exists in suspended animation. Meanwhile, the earthquake spared this plain structure, which for weeks became a shock trauma hospital where foreign doctors and many of the school’s nurses practiced courageous do-it-yourself medicine.
The door is covered with dozens of short strips of duct tape that served as name tags for medical volunteers coordinated by Pennino’s InterVol, World Wide Village and Notre Dame. Pennino’s, plastered to his chest, reads simply “Dr. Ralph/Plastics.” Three tags on the door belonged to Week One veterans Towle, Lars Ellison and Kevin Olehnik ’78, who today listen to Pennino’s breakdown of what’s changed with astonishment.
Earthquake trauma now accounts for 30 percent of cases, he says. The rest is general healthcare. Without the proper hospital infrastructure, demand is crushing. Medical records and triage are becoming issues. Funding is an issue. The place needs more nurses, a maintenance staff, secretaries and ward clerks as much as doctors. Stay fluid, the reconstructive surgeon advises. “If I have to scrub on a C-section, I’ll scrub on a C-section.”
Rarely seen in anything but blue scrubs and a baseball cap, Pennino conducts his tour of the old hospital with a Maglite torch, leading nearly 20 new arrivals through chambers that still function as examination rooms and a “kick-ass” pharmacy during daylight hours. The group enters a large room where boxes of medicine and supplies have been dumped. Later in the week, helpers from Hands On Disaster Response will begin shelving and creating an inventory.
The group follows Pennino through the outdoor triage area where hundreds of Haitians will line up in the morning. They cross a yard and enter the cooler air of the new field hospital, six brightly lit, vinyl-walled bays off a single main corridor, provided by World Wide Village.
Underfoot, the plywood floors are already settling. But the quality of care is high — probably the best these patients have received in years. In the maternity ward, twins delivered at 37 weeks struggle to complete their first 24 hours outside the womb. Down the hall on the left, men snore through recovery after surgery. A stoic 5-year-old boy, scalded over half his body by a pot of boiling water, rests his head on a woman’s lap. On the right through a heavy flap door, a lanky Haitian named Sam sterilizes instruments in the operating room where surgeries — hydroceles on the right, everything else on the left — begin shortly before daybreak.
This is the resurrected Hôpital Sainte Croix, christened yesterday by Episcopal bishops whose church is chartered by the government to administer healthcare in Léogâne. Once a national referral center, the old, cracked hospital downtown was shuttered two years ago after bungling administrators mismanaged it into the ground. All that remained open was the LF research and treatment partnership with Notre Dame — the hydrocele surgery program and the clinic where lymphedema patients receive pills and creams to fight infections in their swollen limbs and manage painful symptoms.
Six weeks of post-earthquake acute care restored the hospital’s referral center status, a process quickening with the departures of significant healthcare partners. The USS Comfort, though visible offshore from the road to Port-au-Prince, is ready to pull anchor. The Canadian military is leaving. A Médecins Sans Frontières hospital remains open downtown, but Sainte Croix patients register from distant villages, some even from Port-au-Prince.
By determination and the grace of God, all partners hope, the American volunteers will gradually hand over a functioning primary care hospital to Haitian doctors and nurses in a rehabilitated downtown campus, leaving at least this segment of the national healthcare landscape in better shape than before.
Sunday, 7 a.m.
Mass at Sainte Rose de Lima is a bring-your-own-chair affair. Those who come without perch on the pulverized remnants of the old church. The steel-framed roof sits atop mounds of shattered concrete and yellow brick. At my feet are large fragments of shell and brain coral, mixed into the brittle blocks that formed the church’s unsupported columns and walls. The reason for the collapse is no mystery.
We are late. Dawn was an hour old by the time Wesly Pierre briskly led us to the parish on foot. Along the way we saw the backhoe that has begun clearing the church site. Because of the Mass, the operator has moved a block away to work on the police station and jail. Desertion was a problem for the force, Pierre explains, but the police have regrouped at another site. He doesn’t know what became of the prisoners.
Father Marat Guirand celebrates Mass from a stage set up behind the church and next to the crumpled rectory, where a black rooster has set up a competitive pulpit on the roofline. The setting is almost perfect for an outdoor urban Mass. The congregation listens rapt to the priest’s soft voice, his homily elongated by spontaneous hymns and consoled laughter. Pierre distills the message as a call for the faithful to “become another Christ. And then for the future, if we have another disaster, even if you are dead, you go to Jesus, to God, with the problem, because you know you are okay.”
After 40 minutes, Père Marat rests and his cheered congregation applauds.
Sunday, 6:26 p.m.
Pierre steers the pickup back into town and we pass a clutch of bright lights powered by a loud generator. Vendors sell hot dogs, bread, mayonnaise, ketchup and fruit juice, an evening meal that costs about a quarter. Few can afford it, though the vendors will share what they earn.
Pierre dreams of working with other professionals to open a technical school in Léogâne with Haitian faculty. Even before the quake Haiti hosted one of the highest per capita populations of foreign aid workers in the world. Pierre is grateful for the life support, but he says Haitians must lead themselves into the future. He knows it will take years to cultivate a work force to cover the basics: plumbers, electricians and mechanics. Doctors and agronomists. “If we have good technicians in Haiti, Haiti will build fast,” he says, snapping his fingers.
We arrive at Residence Filariose’s metal front gate, and Pierre taps the horn. Children approach the truck, and a boy places his hand on my forearm. “Hey you,” he says in cautious English. “I am hungry.”
Monday, 10:37 a.m.
“We’ve done our best,” says Jean Marc Brissau, concluding the tale of how he walked home from Port-au-Prince the night of the earthquake, transformed the next morning from program director into a relief worker. He made the spot decision to open the Haiti Program’s medical stores to disaster victims and is working to restock it for the LF patients who are his first responsibility.
Bright morning sun streams into Brissau’s simple second-floor office at Residence Filariose, where the loud, multilingual transactions of doctors, drivers and volunteers patter off the building’s white walls and tile floors. Brissau talks about the Haiti Program’s determination to find new funding — the Gates Foundation has exceeded its typical commitment to projects like this one — and resume distribution of the anti-parasitic drugs that prevent transmission of the worm larvae which cause LF.
The communes that the program and its partners, the Haitian Ministry of Health and the nongovernmental IMA World Health, had identified as ND territory for mass drug administration comprise the earthquake zone, complicating a massive public health project with high stakes for Haiti’s future. Notre Dame has invested 13 years of research, manpower and expertise in it, training Haitians to lead and do the work. “And now that the real emergency is done . . . we have to go on, not with our normal life, but at least with what we were doing before,” says Brissau.
Monday, 12:45 p.m.
Brissau watches as local architect Jackson Maddy draws a chalk diagram on the wall of Brissau’s home. Maddy is explaining to ND civil engineering professors Alexandros Taflanidis and Tracy Kijewski-Correa how the columns were constructed and what decisions he’d made balancing budget and risk. Maddy knows what he’s talking about. If the quality of his work hadn’t been good, a house this heavy wouldn’t be standing.
Nine years ago, Brissau began building this house. He chose a lot near the center of Léogâne and worked on it as time and money allowed. He spent a fortune to finish it and was prepared in January to move in with his wife and sons. For now, Brissau sleeps in a tent, separated from his family, one of Haiti’s estimated 1.2 million homeless. He wants advice on what, if anything, he can do to save his house.
The professors have fewer than 48 hours to survey structures, size up local construction materials and practices, and compare their observations with reports circulated by international engineering teams. Their immediate goal is to find funding for research they hope will answer Haiti’s urgent housing question: How do you build homes that can withstand hurricanes and earthquakes, make use of local resources, respect Haitian customs and remain affordable to an impoverished people?
Haiti’s 7.0 January quake was as strong as the 1989 Loma Prieta quake that severed the San Francisco-Oakland Bay Bridge and killed 63 people. Seismologists consider these major earthquakes, but in social terms only Haiti’s was catastrophic. As Kijewski-Correa puts it, a well-constructed building that follows baseline U.S. codes — like Maddy’s Residence Filariose — “can handle a seven.”
Haitians build stocky and heavy on weak columns, a wind-resistant approach that is sensible in a hurricane alley. During the 2008 season, a destructive tropical storm and three hurricanes — Gustav, Hanna and Ike — blew through, causing an estimated $1 billion in damage, nearly 10 percent of the national economy. That was bad, but loss of life was a sliver of the near quarter of a million people Haitian officials say died in the 2010 earthquake.
Timber structures, old and rotting on their posts, fared better than concrete because they are lighter, but deforestation has made lumber scarce. Steel is expensive. Most of the gnarled metal we see sprouting from the former homes of Brissau’s neighbors matches the thinnest diameters of rebar listed on Kijewski-Correa’s laminated chart. And the concrete block is fashioned locally, using whatever sand or rock is available for the mixture. One sample crumbles in Taflanidis’ hands like a rice cake.
Down the street, a corner hawker paces behind stacks of concrete blocks for sale and a motorbike drags a load of salvaged rebar, tied at one end like a kitchen broom, to be pounded out for reuse. “They shouldn’t be using it,” Taflanidis says of the blocks. “At least not with interior partitions. But in that case what can they use? That’s one of the answers we need to provide. We cannot simply tell them, ‘Hey don’t do this’ or ‘You’re going to use drywall pieces,’ because they don’t have drywall pieces.”
The pair will look, for instance, at Brazilian studies of such natural fibers as coconut and sugarcane that can strengthen concrete, and bamboo, which has tensile properties similar to steel. Their work could take from two to five years. Since hurricanes threaten every year and another major earthquake is expected within the next generation, the time to influence practices is now.
Tuesday, 12:29 p.m.
Lymphedema is the clinical name for what the Haitians call maladie gwopye. Big foot disease. Once the larvae of the threadlike parasites enter a human body and mature, they compromise the lymphatic system. Minor skin irritations can lead to fungal infections and attacks: burning pain in swollen limbs, headaches, fever, vomiting and diarrhea. At its worst, you cannot eat. You can hardly move. You need help even to sit down.
It took Father Thomas Streit, CSC, ’80, ’85M.Div., ’94Ph.D., several years to expel local myths about gwopye and maklouklou, or hydrocele, the dominant male manifestation of LF, in which golden serous fluid builds up around testicles and causes grotesque swelling of the scrotum. Streit first arrived in 1993 as an epidemiologist working for the U.S. Centers for Disease Control and Prevention and found that one of his first priorities was public health education. The deformations were neither expressions of divine judgment nor vodou curses, as commonly believed. Rather, they were a harsh consequence of life with Culex quinquefasciatus, most illuminatively known as the shitty brown mosquito owing to the deplorable sanitation in areas where infection rates — and poverty in direct proportion — run highest. Half of Léogâne’s population is thought to be infected, far exceeding the national rate of 30 percent.
Today is a good day for Ajax Bethnade, Simon Mirna, Denise Faustin, Charlestin Ersulia and Elisabet Ajax, five members of the Hope Club who sit with Wesly Pierre and me under the shade of an almond tree. The women are eager to tell me about the club, which used to meet at Sainte Rose de Lima school and has about 400 members.
Bethnade describes meetings as a retreat from the rejection members face. They pray and sing together, share struggles and tips on hygiene and managing pain. Someone always offers a message of hope.
Ersulia, a tall woman in her late 30s who was infected when she was 26, says before Hope Club she was afraid to go out. The women all talk at once about cruelties they’ve suffered. Pierre translates: People seem to want to humiliate them. Merchants charge them higher prices. They’re not sure why. The women, exhibiting mild external symptoms, tease each other and dream aloud of comfortable new sandals despite frequent admonitions to wear close-toed, protective shoes.
But the Hope Club isn’t so helpful for Yves Bon Garçon, who visits later in the evening. Few men with LF develop lymphedema. Bon Garçon knows only six, leaving him a lonely exception to most of the disease’s rules. Bon Garçon’s gentle manner thinly masks his desperation. The clean lines of his beard, his dark-framed glasses, the gray dress shirt all evoke conference rooms in glass-walled office buildings. But his black pants conceal the hardened tissues that have swollen his skin pink in places.
In clear evening light, Bon Garçon removes a shoe and sock and cuffs his pants. He stands and struggles for balance on his cane. The leg cannot support him.
He needs no translator to tell his story, a narrative of emergence from self-destructive myth to disappointing scientific truth to anguished faith. As a boy, he says, he fell from a bridge and injured his leg. His mother turned to folk medicine and thought he was cured. When the swelling began years later, Bon Garçon hid the leg from her until a bout with typhoid fever left him unable to care for himself.
When his mother heard of the Haiti Program, she encouraged him to seek treatment and support. He spent years asking doctors about research and surgeries to fix his leg. His spirits rose and fell. At present there is no hope of a cure. Meanwhile a friend had taught him cabinetry. He showed promise as an apprentice but the work required him to stand and he had to give it up.
“But now let me tell you my hope is in God only,” he says. Bon Garçon believes his leg will be cured before he dies because God promised him. His faith frees him to make a new wish: a scholarship to study architecture or computer science in America. There, he says, his “unuseful” leg will not matter. One day, Haiti will be like that, too. He simply needs to be prepared.
Wednesday, 7:56 a.m.
Medicines are disappearing from the field hospital, and fistfights have erupted outside the front door. Dan Towle and Jean Marc Brissau confer about locks and policies, and Towle says Abbey Merryman and Brennan Bollman ’09, the two medical students serving as liaisons among the medical staff, new Haitian doctors and community partners, are aware of the problem.
After breakfast, carpenters from Hands On Disaster Response resume their work on construction projects, one of which is still just a concept drawn on plywood in thick pencil: a series of three lumber-framed structures with pitched roofs and drainage systems that will house the pharmacy and clinic. Hilda Alcindor, dean of the nursing school, wants her building back.
Thursday, 9:30 a.m.
When disaster and the devil have taken damn near everything, you do what you can. Thursday morning in Port-au-Prince, an old woman tenderly sweeps the walk in the plaza, 30 yards outside the front doors of the ruined Cathédrale Notre-Dame de L’Assomption. Nearby a choir rehearses hymns where street vendors peddle fruit, tools and used electronics from filthy blankets.
Father Streit worries the earthquake may diminish the institutional church in Haiti as a respected authority and mediator of material help for the poor. Wesly Pierre believes it will have the opposite effect, reinforcing clerical messages of the faith and hope that people need to transcend their circumstances.
The Congregation of Holy Cross, through the missionary efforts of its Canadian wing, created a province in Haiti in 2003. When the quake hit, Father Michel Eugene, CSC, its third superior, was working to reform provincial finances and secure funds for a technical school like the one Pierre envisions.
Now Father Eugene must rebuild. The provincial house was destroyed, and several schools and churches were badly damaged. The ND engineers visited several facilities, and Father Eugene has met with priests at Notre Dame, who immediately reached out to commit their support.
True to his vocation, when Eugene talks about rebuilding he has souls in mind, too. A psychologist, he counsels those priests still in shock and has sent all of them out to listen and to inspire the faithful. He wants Haitians to stand up once again, to tell their stories, grieve their losses, resume their activities. “The Haitian people have a tremendous capacity of resilience,” he says. “We knew that, but we’ve realized it these days, seeing that our people, who lost everything, can stand up and see life with some hope.”
One of the priests, Father Michelet Dorescar, CSC, manages the factory near the Port-au-Prince waterfront where Haiti Program employees wash sea salt, fortify it with iodine and DEC, an anti-LF drug, and bag it by the pound for distribution.
As an educator, Eugene is especially interested in iodine’s salutary effects on childhood brain development, but fighting LF is Father Streit’s highest priority. He views salt as essential to the eradication strategy as the Haiti Program and its partners nationalize mass drug administration. He’s seen it work on a small scale and knows salt helped China conquer LF four years ago.
In concentrated pill form, DEC has a reputation for sickening people for a few days. It also requires five consecutive annual doses to quash worm reproduction in humans. Lapses can set the effort back years, another reason the quake and mass exposure to looming rains are so devastating.
So salt, laced with DEC, provides a gentle insurance policy against dosage gaps, says Streit. But making fortified salt costs about six times more than the going price — about 13 cents a pound — of unfortified salt, making subsidies essential to keeping prices competitive. The government, readily cooperative with plans for mass drug administration, is cool toward the salt scheme as a market-driven solution. Notre Dame’s is the only fortification facility in the country, and plans to build a seawater processing plant large enough to produce fortified salt on a national scale have met resistance.
Concluding the factory tour in a storage room where sunlight peeks through a door over a giant mound of 25-lb. salt sacks, the buoyant Dorescar shrugs off the setbacks. When the earthquake scrapped planned school visits in the nearby suburb of Carrefour to educate families and sell the salt, he turned to the church. Now his fellow priests preach fortified salt and sell it to parishioners.
Friday, 9:30 a.m.
Dry winds gust through the open windows of Residence Filariose, slamming metal doors open and shut. In his upstairs room, Dr. David Lesser tries to rest after attending a mother ready to deliver the eighth baby of the week. Next door, Father Streit multitasks, sending one last email before setting out with Wesly Pierre to the Sainte Rose de Lima schoolyard, where hundreds are gathering to memorialize and mourn the nuns who ran the school. This is Streit’s first real visit since the earthquake. He can hardly take 10 steps without pausing to shake a hand and talk. His staff tease him about his Creole, but people on the street don’t care. They hope he can help them.
Mass is barely audible over street traffic and the hum of a generator. During the presentation of the gifts, a woman drops to her knees and releases a long scream, as if purging eight weeks of grief and rage.
In Hôpital Sainte Croix’s OR, Lars Ellison sutures up a hydrocele surgery while his Haitian colleague begins another on the opposite table. Ellison and his old friend, scrub tech T Davis, have become increasingly efficient. He torques a hook-shaped needle and surgical thread through an incision. The mood is light. “Pants, Lars!” Kevin Olehnik chides when a photographer calls attention to the shorts Ellison is wearing under his scrubs.
When new patients enter, translator Nelson Hilaire closely watches anesthesiologists Jennifer Weiford and Randy Lowe. Hilaire talks like an American teenager and dreams about medical school. Though his father, who lives in the United States, can’t help him financially, the two often speak on the phone so he can practice his English.
Olehnik, an orthopedic surgeon, made his first trip to Haiti years ago and recruits volunteers to help with the hydrocele program. After the quake, he did not hesitate to return. “I find it’s cleansing to come down here,” he says. “We’re practicing medicine the way we all want to practice it. The layers of bureaucracy are gone, all the garbage, and you’re just taking care of patients. And they’re so grateful.”
They look tired, especially the nurses. In the maternity ward, Dan Towle, Brennan Bollman and pediatric nurse Susan Forsyth hover above a newborn, 42 minutes old. The baby is pale and her patient eyes wide as Towle suctions her mouth and Bollman, fingers gloved, tickles her cheeks. Bollman, whose valedictory inspired Notre Dame’s 2009 commencement, has taken a leave of absence from her first year at Harvard Medical School to help coordinate the relief effort. She is doing a little direct patient care before the next round of volunteers arrives.
Moments later, World Wide Village president Randy Mortensen enters the tent with his family, checking in on the hospital during a tour of the country. He chats with nurses and says he expects Americans to comprise only 20 percent of its staff by summer’s end.
Over in recovery, the scalded boy munches Pringles while his aunt shows him pictures in an English-language board book. Towle crouches next to a patient and motions to Bollman, who speaks Creole. “Can we ask if her pain is indeed gone?” he wonders.
Outside warm winds tug at the hospital’s flaps and seams. At the triage shelters, heavy white sheets snap free of their moorings like so many flags of truce.
The sky is hot and cloudless. The rains will soon come.
John Nagy is an associate editor of Notre Dame Magazine.
Photos by Matt Cashore.