Haiti copes with a nightmare

WHY DID you go to Haiti?

THE SPECIFIC reason I went to Haiti was as a cameraman with this group of filmmakers who had been planning to go to make a documentary about Partners in Health (PIH). It wasn't slated to start filming until June, but for obvious reasons, they quickly got a crew together, and so we went down to film for two weeks. In May, they'll start making the main part of the documentary.

Coincidentally, I had, prior to that, been working with students at Shalhevet High School in Los Angeles, where I work, to collect surgical supplies (gloves, drapes, things like that) to send to St. Damien pediatric hospital in Port-au-Prince, the only functional hospital still standing in the city. I had arranged to get some of the supplies delivered through a guy who had a private plane and was ferrying supplies for some NGOs, but there was more to send.

As I was on the plane with the documentary crew, I happened to mention to the flight attendant that I was trying to get more supplies sent to the hospital. She talked to the captain, who talked to others at the airline--Virgin Airlines--and they ended up arranging for the rest of the supplies to be sent. Employees at the airline used their free miles to fly from Los Angeles to Florida, with the supplies checked as baggage (Virgin waived the baggage fee).

The students, on their own basically, had collected and packed 600 pounds of surgical supplies. It was really cool--an example of how everyone got together to help. Things went from people thinking, "I wish there was something I could do to help," to 12 50-pound boxes of supplies getting to St. Damien.

WHAT DID you see when you arrived in Haiti?

WE GOT to Haiti on January 27, two weeks and a day after the earthquake.

From the air, you can't see much. One thing I did notice is that as you're flying over the Dominican Republic, it's green and beautiful, and then the second you go over the border into Haiti, it becomes brown--because Haiti has been deforested down to 1.5 percent of its original forest.

You get off on the tarmac, and you see that the airport building itself is cracked and can't be used--and there are military planes and military personnel all over the place.

Then we got in a truck and drove out a small gate, with a huge UN tank next to it and lots of guards. Outside the gate was a mass of people. I think some people were waiting for supplies, some people were trying to get out of the country, and some were trying to get work as interpreters or drivers, because this is the place where everyone is coming in.

The first thing I saw were signs that said "We need help, water, medicine," written on scraps of metal or whatever people could find--in Creole, French and sometimes English.

You start seeing the buildings that are down, three-story buildings that are now four feet high. Its amazing how everything just crumbled, and you look at it and realize the people inside probably didn't even know what happened--it looks like they came down so quickly.

This is absolutely everywhere. At the end of two weeks there, you sort of become anesthetized to it, because you can't look anywhere without seeing the same thing.

There are people everywhere, and they're walking. On the main streets, you have to be careful driving around because people are camped out on the street, whether their buildings are standing or not, because it's not safe to go back into the buildings.

One thing that really bothered me was that out at the airfield, there was this huge area cordoned off with pallets and pallets of supplies, water and other things. What seemed to be happening is that pallets of stuff arrived, but there was confusion about how to distribute it or who to give it to.

FROM WHAT you saw while you were in Haiti, filming PIH hospitals and their mobile clinics at the tent cities, what do you think about this quote from the U.S. ambassador to Haiti that "humanitarian aid delivery is working really well...a model for responding to an earthquake?"

IT'S HARD to say. We didn't see food and water being delivered, but on the other hand, we weren't everywhere, so I can't say it wasn't happening. The people in the tent cities we went to did say that every other day, they received some rice and water--I don't know who that was coming from. There's part of me that absolutely thinks there could have been a lot more done, but I can't say for sure if it was feasible or not.

One thing that should be done is the tent cities should be built on elevated platforms. For those 20,000 people, the tent cities have already turned to mud fields, and once the rainy season comes, it will get worse.

SECURITY WAS the big issue on the news here. What was your impression?

YOU CAN say that it's not a secure situation because there isn't a policeman on every corner, but that doesn't mean there needs to be policeman on every corner. During the two weeks we were there, we never saw a food or water riot, we never met anyone who said they saw a food or water riot, and we never met anyone who had heard of one.

Maybe there really was one or two, but frankly, if the same thing had happened here, and a truck comes up with water and food, and I'm at the end of the line and my kids are starving, I might push to the front, too.

We went to film the PIH mobile clinics set up around Port-au-Prince. One of the clinics was at one of the largest tent cities in Port-au-Prince--called Parc Jean Marie Vincent, where they estimate 20,000 people are living and six or seven children are born every day. Really, they should be called sheet cities. There are just row upon row of sheets and tarps, propped up on sticks to make some sort of basic shelter--all crammed in together, with no running water and no sanitation.

We never felt any kind of security issue there. On the contrary, people would welcome us. For most, their only possessions were a pot, and maybe a stove and a basin, and the four sheets around them, blowing in the wind. There was no security, no police and no military. My sound guy and I would walk through there at night and never had a problem.

As far as other kinds of safety issues, when we were flying down, I made the mistake of watching CNN, and they reported that power lines were down everywhere. Walking around downtown, I was tiptoeing around these lines, worried about getting electrocuted, and our interpreter Andre was laughing at me. He said, "Dave, don't worry about those, there was no power in those lines before the earthquake."

WHAT DO you think should have been reported about the earthquake and the aftermath?

PERSONAL STORIES of how people are coping. Our interpreter, Andre, is 45 and has three children. Their schools are gone, and he doesn't know what their future will be. He had a few small businesses running, but they're gone, so he's now trying to earn money working as an interpreter for folks like us.

Their apartment is still standing, but they're sleeping outside because it's safer. He has 11 other people that he invited to stay with him because they lost everything. When I asked what I could do, he asked for a tent--not for himself, but one he could give to the people who lost everything.

Or there's the story of a nurse we met, who lost her arm in the earthquake and was back at the hospital three weeks later, working. And the doctors at the hospital who had been working since the earthquake, and literally didn't know what had happened to their own families--they just continued to work.

One nurse we met, who is 24 years old--her sister and niece were killed in a church. She's now entrusted with the care of her sister's nine surviving children. She was discussing with her family whether they should give up some of the kids for adoption since she can't afford to take care of them all.

You realize in Haiti how badly people had been suffering even before the earthquake. We'd see these kids in the tent cities, kicking around a ball or flying kites they made, and you'd see sometimes that they had these swollen bellies. But then you'd realize that that's not from the earthquake.

To me, another story of the earthquake is how so many different people from all over the world came together to help. I met two American surgeons, Bob and Samir, who'd done 72 surgeries in nine days, and they said it was the best thing they'd ever done as doctors. People just came down and started working, without necessarily knowing where they were going to sleep or how they were going to eat.

It was interesting--we were meeting people who had come into Haiti to help, and we asked what they were doing about food. (I had packed my bag full of powerbars.). And they said, "We just sort of find it, but if you can stumble into an army tent, you can definitely get something there."

WHAT DO you think about the delay in the response of the U.S. government?

I THINK it's wrong. I've been told the reason they didn't go in immediately was because of security. I personally think that it's pretty ridiculous for the U.S. army to say that they couldn't come down there because it's not secure. It's like a doctor saying, "I don't want to see you because you're sick."

I do personally believe that if, for example, all our oil came from there, we'd be there in two seconds. I don't think it's a nefarious plan, but the reasoning is like: Let's help them, but let's not put our guys at risk.

For what it's worth, the army guys I met down there were unbelievable, although they were kind of pissed--they were saying this isn't what they signed up for. They're upset because they'd be getting paid more if they were in Afghanistan. I have a tremendous amount of respect for the job they are doing, though.

It was so strange to see a 19-year-old kid from Iowa, sitting on the side of the road with this big gun, and guarding people who don't need to be guarded.

I asked him, "What kind of gun is that?" And he said, "It's a grenade launcher." And I asked, "Do you really think you're going to need a grenade launcher?" And it was so classic, because he said, "I don't make the decisions. If they tell me to carry a grenade launcher, I carry a grenade launcher." I said, "But can you see a situation where you're going to need to use that here?" And he says, "Probably not, but they tell me to carry it, so I carry it."

CAN YOU talk more about Partners in Health?

PIH WAS founded 25 years ago in Haiti by Paul Farmer. It works hand-in-hand with a group in Haiti called Zanmi Lasante. The main goal was originally to wipe out tuberculosis. Dr. Farmer's point is that TB and AIDS are preventable, and in the case of TB, completely treatable diseases. The only reason not to eradicate these diseases is money, and it shouldn't come down to that.

So they started this hospital in Cange, on the central plateau, in the poorest area. Essentially, you get free health care there, no matter what you need. Nobody is denied.

PIH realized it was ridiculous to get people healthy and then send them back to where there's no nutrition, so they started a nutrition program where they have local farmers planting peanuts, which is turned into a super-enriched peanut butter to give back to people. Then they started a housing program and an AIDS prevention education program for women.

Their philosophy is that they can't save everybody, but they can do everything in their power to try to save everybody, and they do it equally, because everybody deserves the same amount of dignity as far as their health care is concerned.

We went to where they set up mobile clinics in the tent cities, and PIH would see 1,200 people in a single day. They don't stop until everyone has been seen, given medication, and given a booklet to track their progress, which they bring back when the mobile clinic returns the next week. It's unbelievable what they do.

Dr. Farmer told us the hospital at Cange has a budget of $5 million and Mass General in Boston has a $2 billion operating budget, and they see the same number of people. Cange is the only PIH hospital. The others are hospitals that PIH has helped to restructure or re-organize, but they don't want to run the hospital--they're there to train Haitians to run their own hospitals. In every area, they train local people as paid community health workers, whose job is to check on patients who've returned home.

We followed several PIH doctors and coordinators as they were doing their work. In one case, a young woman whose leg had been crushed was ready to be released from the hospital.

First, they send a health care worker to her family home--we go on this road, really more like a riverbed, up the side of a huge hill, through the little shantytown to the family's shack. There, they discuss with the family where her bed will be, what food and where her water will be from, etc. Then back to the hospital, put the patient in an ambulance, and drive as far down the road that they can go. Then four guys carry her in a stretcher up the hill to her house, get her settled, explain to the family how to care for her injury and stay for over a hour.

I asked what happens next. They said the community health worker will be here in a couple hours to see if they have any questions. Then they'll be back in the morning and tomorrow night and the next day, until the person is healthy.

All the American doctors who we saw down there were amazed at the level of care. When is the last time a doctor came to your house in the U.S.?