Touch Rounds

(Photo by John Carroll)
Ministry of Touch — Reflections on Disaster Work after the Haitian Earthquake

Annekathryn Goodman, M.D.

After the January 12 earthquake, I traveled with a national disaster team from the Department of Health and Human Services to Haiti, where we set up a mobile tent hospital on the sites of a devastated school and a nearby adolescent clinic. My 2-week deployment was marked by sensory overload. There was the hot sun, the humidity, and the swirling mosquitoes. The air was full of dust and smoke from burning bodies and burning tires. The smell of diesel fuel from our generator was mixed with those of decomposition, garbage, and unwashed bodies. The sound of women and children weeping in sorrow and pain joined the noise of roosters crowing from 4 in the morning until noon, the drone of the generator, and the throb of rescue helicopters. But at dusk, voices of the earthquake survivors rose in gospel song from the tent city next to our camp and seemed to weave a tapestry of solace.

Despite the horror of unburied dead, crushed homes, and twisted streets, Port-au-Prince burst forth with color. Women and children wore beautiful bright pink and purple dresses and ribbons in their hair. In the schoolyard where we worked, a mango tree displayed one stubborn, bright red flower.

Patients soon filled our two tents, dressing station, and surgical unit. They lay on canvas cots, 10 to 14 to a tent, their bodies mapping out the stories of their agonies. I walk among them. Guillame, at age 18, is in early labor. She is living in the tent city out on the soccer field, in a tent with six other people. Stella and her newly delivered baby, Samson, sleep quietly face to face. They will return to the sidewalk where she was living. Christi, age 13, lies with a leg wound. Sévère, age 58, has a right humerus fracture and left leg wound. Stephanie, 28 years old and 25 weeks pregnant, comes in with abdominal pain and an open, draining leg laceration. She is living with her father, mother, sister, and brother out in the open in a park. She ate one bowl of rice 24 hours ago. Next to her lies a nameless woman who has just had her leg amputated. She is in pain, and she starts to sing a song of suffering.

On my first day in Haiti, knowing no Creole, I resort to smiling and waving. Everyone responds. I study people's smiles and read the messages in their eyes — pain, resignation, amusement, irony, grief. On the second day, I begin what I come to call "touch rounds." Even without an interpreter, I can visit each cot and touch a face, an arm, or a hand and receive a touch in return. The patients and I develop our own handshake: a finger catch, thumb grip, fist pound, and finally the hand to the heart. This hand gesture causes general hilarity, and everyone wants to participate.

By the second week, more patients are coming through. I miss some of their names. Rounds with the rest of the team are focused and directed: Patient 350 has a closed right femur fracture and abrasion to the left leg. Patient 304 has a left lower leg fracture, right ankle fracture, L4 fracture, and paraplegia. There is Patient 275, who has an open-wound, left bilateral malleolar ankle fracture. Patient 307 sustained a closed right femur fracture and has a left external fixator. Patient 335, an 84-year-old woman with a macerated body who was found under the rubble after 10 days, is receiving comfort care and morphine. She is dying quietly in a corner. Patient 328 is a 19-year-old man who was under the rubble for 3 days and came in with a partial amputation of his right hand and a clostridial infection. He now has the horrifying and painful contortions of tetanus. Patient 250, who has a gunshot wound that fractured his right tibia, now has a fever of 102°F. We move on, quickly seeing more and more patients with injuries of numbing and nightmarish similarity.

I return when I can to touch patients and learn their names. This is a place of lost treasures: lost lives, families, limbs, homes, work, wishes, hopes, and futures. It is easy to lose one's name here. Out under the rubble, it is easy to lose one's body. I notice that people hold their hands up to the sky, palms up in supplication, as if they are asking God to hold them.

One day, members of the U.S. Army's 82nd Airborne Division, who are quartered with us, go into a field and rescue injured, unattended children. The camp is now filled with the sounds of children weeping. We become a team of huggers and cradlers. We take turns holding the babies. As I wander around in the evening, I pass the pharmacist holding a baby who has had an above-the-knee amputation, rocking him while he dispenses medications. Another baby is being carried around by one of the EMT–firemen while he checks an electrical line. A nurse, Madonna-like despite her work boots and lived-in uniform, is cradling a small boy who appears inconsolable. I sit with three small children in what is now called the children's tent. They all respond to hugs. They all cry when put down, a deep primal wail that speaks of their fear and their psychic wounds. I suspect this pain will linger long after their physical pain is relieved.

Each day, a new woman in active labor arrives. In my last 24 hours in Haiti, four women deliver their babies in our hospital. Each difficult labor reflects the trauma and insecurity of this shifting world. I notice that every woman in labor wants to be held. We develop a system whereby one of us sits behind the woman and holds her, another rubs her back, and I sit or kneel near her, touching her belly and legs, whispering words of encouragement. I pray, and I watch the woman's face for clues as the labor progresses. After the lost children arrive, I notice the similarities in the way we cradle them and the way we hold the laboring women. This ministry of hugs reflects our desperate attempt to stabilize the random, cruel chaos in this world of loss and grief.

The team becomes close, and many of us meet in the evening to hold hands and say a prayer for each other and for our patients. I tell the story of "stone soup," and we each put an ingredient into our metaphoric stone soup; love, hope, security, strength, thankfulness, passion, skill, and luck. Then we reflect on how together we can make something rich and nourishing that binds us together and keeps us whole. Beyond our gathering in the smoky dusk, we hear the voice of survival singing.

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

From the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston.

This article (10.1056/NEJMp1002311) was published on March 3, 2010, at NEJM.org.