p(image-left). !/assets/67403/vdegennaro.jpg(Doctor Vincent DeGennaro)! I’m headed home from Haiti in 24 hours and there’s still a lot to do. I’m applying for my Haitian visa, I have a meeting with the director of the national oncology program, I have to interview candidates for the oncology nurse position and…BANG! I lurch forward in the back of the Land Cruiser. I snap back out of my head and I’m present in the moment. I turn to see a black SUV nearly in the back seat with me after the car slams into us from behind. I make eye contact with the driver and he throws the car in reverse to come out from under our fender, and his bumper falls off completely as he does so. Both drivers descend from their vehicles to inspect the damage. The other driver picks up the fender, gives it a once over, and, as if his fender falls off every day, he opens the back seat of his SUV and simply slides the rusted metal piece along the already-torn fabric. The door slams shut with a clang, the rubber lining of the door frame long since fallen away. Our driver bends to look at the dent on his fender but since the black SUV is lower to the ground most of the damage is on the underside of the aging behemoth. There is some brief discussion and obligatory yelling from our driver, but his heart isn’t in it ¬— the other driver was clearly in the wrong and he knows it. He shrugs his shoulders and shakes his head as he climbs back into the driver’s seat, restarts the engine and drives away without a front fender. That evening, we’re headed out to dinner in Petionville, the nicest part of town, to a chic restaurant with white marble floors, matching gossamer curtains and a menu of French-American fusion. The driver pauses at an intersection to check for oncoming traffic and a motorcycle blows by the left side of the car and into the intersection. CRACK! When approaching an intersection, it is customary in Port-au-Prince to either honk loudly to declare your arrival or to slow down and check the cross traffic before proceeding. With very few traffic lights, common courtesy and self-preservation usually suffices. The motorcycle taxi chooses neither option and drives full speed into the intersection. A truck is proceeding through the intersection as well and collides with the bike directly on the side, T-boning the motorcycle with a sharp metallic crack. The driver and the passenger, neither wearing helmets, are thrown off the bike and somersault repeatedly over the asphalt, finally landing on the opposite curb. Sitting in a car full of doctors and nurses, we hop out to check on the injured men. Within a minute, the driver is back on his feet and comes to check on his passenger, who unfortunately has a broken shin. The break is obvious even through his long pants, but at least the bone has not pierced the skin. I tell him in Creole that his leg is broken and he grimaces while searching for a cell phone in his pants pocket. The ER doctor we’re with whips out a pocket knife and slices the pant leg up to the thigh where the patient, afraid that the tearing might continue into his groin, stops the knife with his hand. We locate two wooden planks lying at a nearby run-down building and pull his leg as straight as possible to set the bone. He pauses in his conversation on the phone long enough to inhale sharply through his teeth, but never utters a sound. With the leg in a splint, the blame game can begin. The driver of the car and motorcycle argue about whose fault the accident was and who should take the man to the hospital, the underlying assumption is that they’ll help with the hospital bill. By now, a few dozen people have gathered on the corner to watch the show and everyone vociferously shares their opinion. The raucous dies down when an ambulance from the nearby clinic approaches and divides the crowd. We load the patient into the ambulance while the driver of the car, clearly from a different socioeconomic class than both the motorcycle taxi driver and the injured passenger, agrees to follow the ambulance to our hospital and likely help with any bill. We saddle up again and drive to dinner where I enjoy asparagus and quail egg pizza for an appetizer followed by roasted lamb with a mint and fig jelly reduction sauce. The next morning, I have my bag packed to head back to Miami and we’re just pulling out of our neighborhood on the way to the hospital when we spot a crowd of people gathered around a person lying face down in the narrow street. Through the car window, my colleague and I ask the crowd if anyone knows him or is helping him, to which we receive blank stares. We climb down and observe that he’s lying face down in a puddle, the crowd afraid to move him for fear that they might exacerbate any underlying injury. I can see from his face that he’s a teenager and the backpack with some papers indicates that he was walking to school. He has urinated on himself and there are small bubbles of foamy saliva frothing out the corners of his mouth. We cannot leave a young man who had a seizure on the street, so we enlist the crowd to slide him into the sideways benches in the back of the Land Cruiser and continue our drive to work at the hospital. I search his pockets and bag for some form of identification or cell phone but find nothing and I suspect that his pockets may have already been pilfered when he was initially lying in the street. Maybe he has a seizure disorder or cerebral malaria or undiagnosed diabetes — we won’t know until he wakes. For the rest of the journey to work, I hold his limp body in place as the car rumbles over the uneven pavement. The EMTs at the hospital unload him onto a stretcher and carry him into the emergency room where he has some purposeful movements and occasionally opens his eyes. I say goodbye to my colleagues in the office and hop back in the car for an uneventful trip to the airport. By the time he comes to, I’ll be airborne above Port-au-Prince, hoping that the events of the last 24 hours are all the excitement for the week. I’m not sure that I can handle much more.
_Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit "Project Medishare":http://projectmedishare.org. See his An American Doctor in Haiti blogs._