Tuesday, November 30, 2010



Photos by John Carroll
November 30, 2010
Cite Soleil

This young lady got sick today. Nausea, vomiting, and diarrhea.

She lives in the Brooklyn area of Cite Soleil.

A neighbor pushed her for one hour in this wheelbarrow to the hospital.

Cholera is killing people here in less than 24 hours.

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Cite Soleil--November, 2010


Photo by John Carroll
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The Hippocratic Oath

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

OAS: The Vote is Valid

Photo by John Carroll

This man showed me his Haitian identification card. He was on his bicycle and had just been turned away from voting at the sixth voting office he had been to early Sunday morning.

The Organization of American States said that the vote in Haiti on Sunday should be considered valid.

See this report.

The methods that I witnessed on Sunday morning sure wouldn't give robust results choosing new Haitian leaders.

Monday, November 29, 2010

Follow up: Road to Vote in Haiti

Photo by John Carroll

Today is Monday in beautiful Port-au-Prince. The capital was frozen in fear early this morning. Many businesses were closed and public transportation was much more difficult to find than a usual Monday.

I am at a cybercafe because the Internet signal is strong here.

Jean, the young Haitian man who voted yesterday, told me today that he did not take his wife to vote in Tabarre yesterday.

Reports of rock throwing and disorder at the Tabarre voting station scared Jean and his wife. Who would not have been scared?

So his wife did not get to vote. She is just one of many Haitians that did not get to vote for one reason or another.

And where exactly did the 25 million dollars from the US and Canada go to help the Haitian election process yesterday?

I have heard many other problems occurred at other voting stations around the country.

A Haitian policeman told me how Jude Celestin's men (mandate) were occupying voting stations "encouraging" people to vote for Mr. Celestin. The policeman just shook his head as he related the story.

Many Haitians are unhappy today regarding the national election farce yesterday.

Candidates Call for New Election

Haiti's presidential candidates say the election yesterday was no good. Read this from CNN.

Sunday, November 28, 2010

Anger and Confusion in Haiti

See this Reuters article regarding elections in Haiti today.

The Road to Vote in Haiti


The Road to Vote in Haiti
by John A. Carroll, M.D.

I walked to church in LaPlaine this Sunday morning. I usually go to Mass at La Chapelle Marie Auxiliatrice de Sarthre. Salesian priests say Mass and run the parish.

The fifteen minute walk was very easy. There were hardly any moving vehicles in the streets. An occasional motorcycle would go by. The Haitian Government has banned cars and motorcycles from using the streets today for the entire country.

Today is election day in Haiti.

However, hopes are not high that the election results will actually help Haitians who need the most help.

I arrived at church which is a long lean-too. It has a roof made of corrugated metal and a cement wall along its west side. The original church at the same location was destroyed in the earthquake in January.

The church was filled with people sitting on wooden benches. The sun did not feel too hot today. And there was a little breeze.

The man leading the services was the “responsable du chapelle” (director of the chapel.) The priest that should have been there saying Mass was not able to get there because he lives in Croix-du-Bouquet and had no way to come to this area of LaPlaine without a ride. And rides were off limits today...even for priests.

So the director told us there would be no Mass or communinion but he gave a great homily and the choir was fantastic.

The director spoke alot about cholera and how to prevent it and that we must pray for cholera victims. He also told people not to accept money from corrupt people today to vote for a candidate.

The service ended with another long prayer for cholera victims. The prayer was printed nicely and about five people would share each paper with the copied prayer.

After the service was over, a man approached me and said his three year old was sick and would I examine him right there in the neighborhood. After a short walk we arrived at his house. A large gray tent filled his front yard in front of his little house. The tent seemed larger than his house. His house had been “fissure” in the earthquake and is still being patched with cement when he can afford it. He and his family still sleep in the tent.

On the front porch of his house was a young lady holding his three year old son. The little boy had cerebral palsy and developmental delay and was covered with scabies. This little one seemed miserable.

I told his father that I could not help the little boy with his brain problem but could help with the scabies and malnutrition if he would visit the pediatric clinic in the back of Soleil where I work. The father assured me that they would come next week and knew exactly where the clinic is located.

I met another young man named Jean. He is 37 years old and is an advisor for a Catholic Youth Group in the parish. Jean was happy to report his Group is celebrating its 15th anniversary this year.

I asked Jean if he was going to vote today and he said yes. He is in his fourth year of “infomatik’ education and he received an e mail that said he would be voting in Duvivier.

He invited me to come with him to the voting station.

So we set out.

We walked and talked about everything. Many times during our one and one-half hour walk Jean had to stop and ask people directions regarding the location of the voting station on Duvivier.

I asked Jean how most people received information as to where they should vote. He said it was listed in many places, but he thought that many people did NOT know where to vote. He was happy he received an e mail telling him where he should vote.

As we walked down the dirt roads of LaPlaine, it seemed like a normal Sunday except for the paucity of vehicles on the streets. Little kids were carrying water and young adults stood around talking. Men were sawing boards and putting varnish on furniture. Green mucky horrible water filled the ditches along the street just like usual.

We passed a large field on the main road that contains a cholera compound for hundreds of paitients suffering from severe cholera that need intensive rehydration and medical care. It is staffed by Doctors Without Borders.

We kept walking.

Down big dirt roads and little dirt roads until we reached Route 9. It was surreal to see Route 9 deserted of vehicles. This highway runs north and south and leads directly into Cite Soleil. A barefoot little old lady with a long green dress was walking alone on the highway. She did not appear to be searching for a place to vote.

We crossed Route 9 and kept walking down a large path towards Duvivier.

After another half mile we turned left onto another little dirt path. We could see alot of activity several blocks down.

At the end of the street, where it turned to the right, was a small kindergarten with many people milling around it.

This was the voting station.


The crowd was mainly young adults. Mostly men.

Four UN soldiers from Brazil stood together just to the right of the front door. They wore “rapid acting” patches on their left shoulders. The front door was managed by two Haitian National Police.

The environment was busy but calm.

Jean simply stood in line for a few minutes and showed his Haitian identification card. He was ushered in and handed me his knapsack to hold outside.

There were three “voting offices” inside. The tip of his right thumb was impregnated with purple ink.

Jean voted and came out of the kindergarten/voting station smiling.

We immediately left and started retracing our steps towards LaPlaine.

About fifty yards from the voting station were a group of about 8-10 young men standing to our left. I could see some open Prestige bottles.

“Get out of this country” was screamed at me in Creole. I looked straight ahead and said nothing.

We walked a few more yards and I repeated what had been screamed. Jean broke down laughing and said that they were just “making a joke” and were just "vakabon" in the first place. I knew they were not joking.

A quarter mile later we met Jean’s brother-in-law. He was on a bicycle.

He was frustrated and told us that he was not allowed to vote in Duvivier. He showed us his thumb which had no purple ink.

His last name started with “Cou” and the list he checked told him where he should vote.

Duvivier was the 6th voting station that had turned him down this morning. I think Duvivier was going to be his last attempt to vote as he mumbled that “the country would continue its misery under Jude (Celestin)”. Both Jean and his brother in law referred to the presidential candidates by their first names.

So that was it.

Jean walked for three hours to vote and he is a computer student and understands e mails. And it was difficult for him.

And believe it or not, he and his wife are pedalling bikes to Tabarre for HER to vote this afternoon. They couldn’t both vote at the same location. And Tabarre is in the opposite direction from Duvivier. (The good news is they have no kids, so no one needs to watch children for them.)

So the big election day in Haiti happened. However, the whole process seemed horribly dysfunctional to me. How many voters were left out just due to logistics? And what about fraud and intimidation?

The results of the election, whenever they will be determined, will not be the result of robust methods.

And no school for kids tomorrow and Tuesday. Need to protect the children of course.

During our walk today, Jean checked his cell phone often to get text messages from a “correspondent” regarding how voting was going all over the country. Text messages said President Preval was happy with the way the voting process was going, another message said that there was some violence here and there, and yet another message said that a body was lying on the side of the road on Delmas 33, cause of death unknown, and “someone needs to remove it”.

John A. Carroll, M.D.

Brightest Light in Port-au-Prince

Last night, after the sun had set, I was sitting on the guest house roof looking into Port-au-Prince's darkness.

There were a few lights here and there which allowed one to see smoke wafting about. However there was a bright light right in front of me about a half mile away.

This beacon of light seemed brilliant compared to the others.

Where was the light coming from?

It was from a very large field and was illuminating tents filled with hundreds of cholera patients. The tents are staffed by Doctors Without Borders for the sickest cholera patients who need the most intense rehydration and care.

I am glad for these cholera patients that they are being given a chance. But this light shining down on Haiti's dark seems cruel. The brightest light in the sky marks the abysmal failure of Haiti's government and the international community that should have protected tens of thousands of Haitians from acquiring this disease.

Saturday, November 27, 2010

Haitians are Prey to Vultures

Please read this excellent article from the Montreal Gazette.

Since Christopher Columbus stumbled upon it more than 500 years ago, Haiti has existed to feed the needs of an avaricious few, to the detriment of the vast majority of its population. This began in its inception as a slave state and continued even after the slaves overthrew their colonial masters in 1804, as a small elite sprang up to control the reins of power and make sure their wealth and privilege would be protected.

What evolved was a governing system that exists to this day and is at the root of Haiti's perpetual misery -a ruling elite that seeks to control whichever government is in office and extract wealth from the state as quickly as possible before it is overthrown. Actual governance -putting in place institutions like a ministry of education so the children will be literate and employable, for instance, or promoting business or agriculture so the masses will have jobs and food -was never developed, and constant political instability means the government is still incapable of governing today.

This pattern of predatory governance is not exclusive to Haiti -leading economists note the majority of the world's nations work in a similar fashion, with a relatively small elite controlling power and most of the country's wealth. But the wealth is generally distributed back into the nation in some form of investment, and a civil service ensures basic needs like clean drinking water, roads and hospitals are provided and maintained, even as political parties come and go.

In Haiti, however, there is little to invest in, little local production to support, so money siphoned from the system is sent abroad. True governance is ignored or left to a disorganized hodgepodge of nongovernmental organizations, some that are effective, many run by corrupt members of Haiti's elite, none of them capable of forming a cohesive administration that can meet the needs of 9 million people.

What results is chaotic mass of political instability that permeates all aspects of Haitian life: Large corporations feel unfairly taxed or too frightened to invest; legitimate small and medium-sized businesses face competition from an informal sector that pays no taxes at all; the poorest citizens have lost faith in the government, or their own power to create change.

On the eve of tomorrow's national elections, considered by many to be the most important in a quarter-century, there is a deep fear the simmering rage and despair of the impoverished majority, long used to watching the venal nature of their elite and ineffectiveness of their government manifest itself in the slow starvation of their children, will erupt. A population now living amid a growing cholera epidemic and in the aftermath of the Jan. 12 earthquake that killed 230,000 and has forced 1.3 million to live in tents.

"If you know Haitian politics, protests are often groups of people paid to go out and make trouble," said Haitian-born Robert Fatton, a political-science professor at the University of Virginia and author of Haiti's Predatory Republic. "But there is a real popular frustration with the Haitian government and the international community for their inability to change current conditions that are really absolutely miserable for the vast majority of Haitians.

"The state is extremely fragile right now. There is resentment that could explode at any time ... and I don't know who will be able to control that."

Alongside the fear is resignation among many that regardless of the results, tomorrow's vote will do little to change the endless misery of Haitian life.

There is a popular depiction of Haiti as

a land of perpetual sorrow, fated to be the victim of tragedy after tragedy sent by bad luck, cruel Mother Nature or wrathful God. Not so, says author Mark Danner, who has written extensively on Haiti since 1986.

"There is nothing mystical in Haiti's pain, no inescapable curse that haunts the land," Danner wrote in The New York Times. "From independence and before, Haiti's harms have been caused by men, not demons. ... The earthquake was able to kill so many because of the corruption and weakness of the Haitian state, a state built for predation and plunder."

The predation began under European colonialists, with hundreds of thousands Africans imported to work themselves to death harvesting coffee and sugar from its rich soil. Perhaps even more cruelly, the exploitation continued once those slaves rose up and won independence from France in 1804 after a bloody 10-year rebellion. Independence for most of the population of half a million former slaves would not mean true freedom, as a small class of roughly 30,000 to 40,000 of the elite of society would take control. Most were mulattoes, the mixed-race progeny of colonialists and slaves who were given greater privileges, such as education, wealth and social status. Many were officers in the military. Originally rebellion leader Toussaint Louverture and other members of the elite would suggest maintaining the slave plantation system, an idea that did not sit well with the slaves who had battled for independence. Instead, over a period of decades, large landholdings were broken up into small farms for them to own.

"Unable to replace the whites in their plantation manors, Haiti's new elite moved from controlling the land to fighting to control the one institution that could tax its products: the government," Danner wrote.

"While the freed slaves worked their small fields, the powerful drew off the fruits of their labour through taxes. In this disfigured form the colonial philosophy endured: ruling had to do not with building or developing the country but with extracting its wealth. 'Pluck the chicken,' proclaimed revolutionary leader Jean-Jacques Dessalines, now Emperor Jacques I, 'but don't make it scream.' "

Raised in a culture of violence and predation, the elites would maintain tradition, fighting one another for control, establishing power and taking as much as possible before the inevitable coup. As Terry Buss notes in his book Haiti in the Balance, the nation has had 55 "presidents" since 1804: Thirtyone held office for two years or less, 23 were overthrown in military or paramilitary coups, only nine completed full presidential terms.

Haiti's deprivation was increased by economic blockades by countries like the United States and Germany, and crippling debts imposed by France to cover for the revenue the country lost because their slaves were no longer working for them. More recently, foreign interference and misguided trade policies also played a part.

In addition to profiting from taxes on goods exported from the country, and, to a lesser extent, taxes on imports, a new form of revenue started arriving in the 1940s -international aid. By the '90s, foreign governments and aid groups that wanted to avoid the corruption of the Haitian government started donating directly to non-governmental organizations, notes professor Fatton. In Haiti, where residents are renowned for their entrepreneurial spirit, members of the elite who once used government to line their pockets quickly learned to adapt to a

new model: They created their own NGOs and took the wages, vehicles, housing and money that flowed in.

What resulted was a chaotic system of aid organizations, some corrupt, some not, competing for their part of the international aid pie, and robbing legitimate government initiatives of funding. It also allowed relieved government of its obligation to provide services.

"What has changed in Haiti, and this is a big change, is the state is becoming increasingly fragile. ... as the resources are not going to the state," Fatton said. The political system, he said, is poisoned by candidates who run to use the resources of the state to enrich themselves and switch political alliances repeatedly for opportunistic purposes, with the result there is little sustainable government policy.

"There is no co-ordination, the government can't govern, and the international community sits above it all with no clear capacity to deliver what it must deliver," Fatton said.

The results of the predatory state are felt at all levels. At the bottom are the poor for whom there is no welfare system other than family, living hungry in dirt-floored shacks, unable to send their children to school. Functionaries on low salaries raised in a culture of corruption resort to corruption, so in Haiti it is normal to have your electricity or phone line cut on a regular basis, followed by a visit from a functionary charging you to fix it; or to pay extra to pick items up from customs rather than risk a lengthy wait.

For Canadian entrepreneur Tom

Anderson, who has lived 32 years in Haiti, the last 20 as part of a Port-au-Prince firm that employs 130 workers making mattresses and bailing twine, his response to the predatory state is like that of many medium-sized companies in Haiti -try to fly under the radar to avoid the vultures. But he still feels its effects.

A study conducted by an association of local industries determined that most formal sector businesses imported their supplies through the main port in Port-au-Prince and paid the accepted fees of about 24 per cent in duties, taxes and customs. But businesses in the so-called informal sector, which accounts for roughly 80 per cent of employment in Haiti and pays no taxes, were found to be using the provincial ports and paying only 4-per-cent fees. This includes entrepreneurs importing discarded mattresses from the United States to sell directly to Haitians. The government says it lacks the infrastructure to help, but Anderson sees it as more of a political decision by a government afraid to tackle the informal sector, and another example of inertia in an underfinanced civil service.

"At the time we did the study, we estimated the government was leaving $150 million annually on the table, which was one-third of the total of all local receipts. ... If they just invested the money in enforcement, they would have it back in three months. ... We're not asking for special status, but as taxpayers, we are asking for a level playing ground."

The largest private sector players in Haiti these days are the cellphone companies, with successful industry leaders like Digicel and Voila paying more taxes than any other corporation in the country. Yet sources within the industry accuse the Haitian government of "opportunistic public policy making" akin to African governments who impose surprise taxes on successful resort hotels in their country. In the case of telephony in Haiti, private sector players note the Haitian government, which lacks an independent regulator to oversee the telecommunications industry, appears to give preferential treatment to Teleco, in which the state has a 40-per-cent stake. Preferential treatment could mean offering more lucrative duty-free terms -telecommunications companies import tens of millions of dollars worth of equipment. Players in the industry accuse the government of plucking the feathers of a rare golden goose in the country, a shortsighted money-grab that could hamper further investment of hundreds of millions of dollars, and deter other companies from coming. Digicel has invested $320 million since it entered Haiti in 2005, and plans to invest another $150 million.

Organizers fear voter turnout could be as low as 40 per cent tomorrow, which would taint its legitimacy and increase political instability. Why vote? is a typical statement from the man on the street in Haiti -the same powers that have always ruled will continue to do so.

Haitians' lack of trust and cooperation with government initiatives dooms many well-intentioned national development projects. Avoiding payment of taxes is a point of pride for Haitians, one reportedly common among the elite. And entering into the civil service with

the hope of making a difference is considered the move of a crazy person, because nothing will change, and the pay is low.

"You have that erosion of civic aspirations," said Fatton. "People look at every job as a business, and a business is essentially 'How can I make money for myself ?' "

How then, does one change a system so deeply flawed? International bodies, Canadian aid organizations chief among them, have long emphasized improving governance among their aid goals, only to be met with disappointment. Despite roughly $10 billion in aid money to Haiti over the last 30 years, the standard of living for the average Haitian has dropped.

In a talk given to the University of California, Berkeley, author Danner suggested putting control for rebuilding into the hands of Haitian builders, masons, and electricians -"not just the elite who send the money abroad." Focus on agriculture so the masses can feed themselves. Get Haitians involved at the government level in planning and rebuilding, and ensure that the raw materials needed come from Haiti - build a cement factory there.

"The only way to achieve some kind of non-violent progress is to achieve some kind of alliance with the rising middle class ... some kind of entente with at least some of the powers that be." That should include allowing the followers of former president Jean-Bertrand Aristide, a galvanizing force for Haiti's poor whose Lavalas party is currently excluded from the elections, to be included in the political process, he added.

Make sure the money gets to the middle class so they can start businesses, in the hope that "to spread money around is to spread power around," Danner said.

Professor Fatton emphasized agriculture and food production as a means toward self-sustainment. He was critical of plans for the country's rebirth proposed by the government that focus on the export of textiles, garments, coffee and mangoes, and sound much like the old plan that has failed for decades, he said. Fatton espouses a national debate on the future of its economy.

A clever president might be able to form coalitions with other parties to create a stronger government, Fatton said. But he didn't sound hopeful.

"Every time there was a major crisis in Haiti I used to assume, 'This is it, something is going to change,' and every time I'm disappointed. ... You hope there will be a shock to the system and people will finally realize they really have to change their ways."

When asked for signs of hope, respondents inevitably refer to the resilience of the Haitian people, and of people like Canadian entrepreneur Anderson, a self-professed optimist who married a Haitian, raised children and wants to stay to help make it better. ( "I think the pessimists left a long time ago," he said. "The only ones left are the optimists. Whether they're realists or not, I'm not sure.")

But how far can a nation of 9 million go, no matter how resilient or entrepreneurial its people, if the vultures won't let them govern themselves?


© Copyright (c) The Montreal Gazette

CNN Reports Violence in Haiti

This article by CNN reports on pre election violence in Haiti.

How pathetically sad is it when the Senegalese Force Police Unit are dispatched to take care of election problems in Southern Haiti?

And Haiti's leading voodoo priest is begging for calm amidst a population of people who are living in tents, sick, weak, and afraid.

This article could almost have come straight from The Onion. Sadly, it did not.

What Happens to Haiti's Orphans When they are "All Grown Up"?

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Yet Another View of Haiti

Who Cares About Haiti?

The Wall Street Journal
November 21, 2010

Ten months after a magnitude 8.0 earthquake killed more than 200,000
Haitians and destroyed an already decrepit infrastructure, some 1.3 million
impoverished souls are still barely surviving in tent cities around the
country. Living conditions are deplorable and after nearly a year, optimism
about a way out of what were once dubbed "temporary" camps has dimmed.

Now more than 1,100 people have died in a cholera epidemic, and riots that
began in the northern city of Cap-Haitien spread to the capital of Port au
Prince last week. Protestors allege that the United Nations peace-keeping
mission brought the disease to Haiti. The jury is still out on the source of
the cholera, but the unrest has taken a further toll.

And so it goes. Just when you think things can't get any worse, more
poverty, violence and sorrow conspire to increase the sense of helplessness
in what is the ultimate economic basket case in the Western Hemisphere.
Millions of people the world over watch from afar and wonder why something
can't be done.

Here's the $64 million question: Is Haiti's seemingly intractable misery the
result of a society and culture that is incapable of organizing itself to
create civil order and a viable economy? Or is it the consequence of ruling
kleptocrats—abetted or at least tolerated by influential foreigners—treating
every economic transaction in the country as an opportunity for personal

Evidence abounds that it is the latter. So why have the U.S. and the U.N.
refused to take even small steps toward shutting down an official corruption
racket that pushes millions of helpless people into lives of desperation?
Instead they've put Bill Clinton—whose political family famously went into
business with the notoriously corrupt former President Jean Bertrand
Aristide—in charge of rebuilding the country with billions in foreign aid.

Development takes generations, and nation building by outsiders is a fool's
game. But often there is a simple change that can yield fast returns. One
no-brainer target in Haiti is the port at Port-au-Prince, where the bulk of
imports must enter the country, but where Haiti's legendary mafia will only
release containers after sizable bribes are collected.

A report this year by the Rand Corporation describes the port's importance
this way: "The costs of shipping through Haiti's ports have imposed a major
burden on Haitian consumers and businesses. Because imports play such an
important role in consumption, investment, and business operations, the cost
of imports is a key determinant of living standards and economic growth."
And yet, Rand says, "importing a container of goods is 35 percent more
expensive in Haiti than the average for developed OECD countries."

Haitian officials like to blame inefficiency at the capital's port on a lack
of modern infrastructure. But Haitians know that's only part of the story.
Writing for the online magazine The Root in October, Haitian-born business
consultant Yves Savain explained that pulling a container out of the port in
the capital "takes walking the documents from office to office to secure an
unspecified number of signatures." The full cost, which he said includes
"legitimate and illicit duties," constitutes "a substantial and arbitrary
financial drain on all sectors of the national economy."

Mr. Savain was being diplomatic. On a visit to the Journal offices last
week, former Haitian ambassador to the U.S., Raymond Joseph—who resigned in
August—was more direct. "The corruption situation in the ports was one of
the major reasons I decided I could no longer defend this government," he

In the aftermath of the earthquake, Mr. Joseph says, "I had so many
[nongovernmental organizations] calling me and saying 'ambassador, could you
help me get our things out of the port?' They kept telling me [port
officials] want so many thousands of dollars to get the things out." Mr.
Joseph says that by calling the minister of finance he could sometimes get
the goods out but that he wasn't always successful.

Another example: A Nov. 14 CBS "60 Minutes" report featured the case of six
containers destined for an NGO housing project that had been "stuck" in the
port for months. No one could figure out why the goods couldn't be released,
but the NGO was still forced to pay $6,000 to the Haitian government for an
"imposed storage fee."

Haiti holds elections on Nov. 28 for parliament and president, and enemies
of representative government want to disrupt that process. This partly
explains the recent violence. Yet it would be foolish to write it off as
solely the work of the nefarious underworld.

Haitians are fed up with the squalor that seems to promise an end only in
death. They are angry not only with their own crooked politicians but with
the way in which outsiders turn a blind eye to their tormentors. The fact
that Washington and the U.N. have refused to rein in the extortionists
running the port demonstrates the lack of international political will to
alter the status quo.

Haitian "Selections" Tomorrow

This is Saturday and things are quiet in Port-au-Prince.

Almost too quiet.

A Haitian Hearts patient braved her way across the capital this morning to pick up her heart medications. She said there is little traffic, no road blocks, and not near as many people in the streets as a usual Saturday. She was clearly nervous and wanted to get back on the streets to get home.

I am at a guest house several miles from Cite Soleil.

When I asked our cook today if she was going to vote tomorrow, she smiled and shook her head no. She said there would be "trop dezod", which means she thinks there will be too much violence in the streets tomorrow.

A 31 year old chauffer from the Fontamara zone of Port-au-Prince told me today that he would not vote either because it is dangerous to vote and he is simply not interested.

Please see Wadner Pierre's article here.

Neonatal Tetanus


(Photo by John Carroll)

This worried lady is holding her 10 day old son who is wrapped in this white towel.

She reported that the baby started having funny spells last night and she brought him to the hospital today.

The baby is clearly having signs of tetanus. He startles easily, clenches his fists, and flexes his arms at the elbows. His grimace during these spells shows the pain in his beautiful face.

And in the meantime, election pamphlets scandalizing presidential candidates circulated in the hospital distracting employees from more important issues...like this newborn boy.

The UN soldiers stood in front of the hospital as this insanity continued inside the hospital.

The baby's chance at survival are pretty bad on a good day in Soleil. His chances this weekend with the skeleton medical staff and fear in the city are even less.
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(Photo by John Carroll)

This is Isaack. He is nine years old and was carried to the hospital yesterday by his mother.

They live in Soleil.

He cannot stand any longer because he is too weak.

Isaack has been sick with cholera like symptoms for a few days.

Mother proudly reported that Isaack plays drums and the tamborine in his church choir.

As Isaack slowly sipped oral rehydration solution from the cap of the bottle, mother reported that the "solution" for her son rests in the hands of God. (Not surprisingly she did NOT mention Isaack's fate in the hands of the politicians to be elected tomorrow.)
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Cholera's Knockout Punch

Read this article by Catherine Porter.

Dancing and Dying in the Streets

The situation IS tense here in Port-au-Prince.

Politics and corruption do not mix well with the many sick people coming from the slums to St. Catherine's Hospital in Cite Soleil.

Yes, there is alot of cholera here in the slum, but there are the usual illnesses too.

There was a 10 day old with neonatal tetanus yesterday. And this was totally preventable if his mother had been vaccinated and had not delivered him at home.

But when a population has been ignored and worse for a couple of hundred years, we should not be surprised of these atrocities that occur every day here.

(The internet signal is to weak right now to post pictures or video from yesterday.)

Please see article below which explains perfectly the tenseness in the city and slums as the election approaches.

My guess, for what it is worth, is that there will NOT be near as much violence tomorrow as people expect. But the poor will continue to be poor and ignored after the new leaders are elected.

November 26, 2010
Death and Dancing Coexist on Haiti’s Tense Streets
PORT-AU-PRINCE, Haiti — One body gets a light kick and tumbles into the pit.

Another — this one the body of a 7-year-old boy — sails briefly in the air before dropping with a sickening thud. He was named Stanley Faustin and fought cholera in the hospital for 11 hours, a government paper shows.

Nachena Bien Ame, 18, landed here, too. And so did Roberto Dupitan, 49; Jean Mary Mirat, 30; Pierre Gasnes, 40; heavy sacks colliding with rock over and over.

This city’s body collectors work quickly and unceremoniously, dragging the bodies of people who died of cholera from trucks and converted pickups known as tap-taps and sending them into pits freshly dug at the edge of town.

Cholera overtook them in hospitals, on the streets, at home — more than 1,500 Haitians dead in the past month and 28,000 more made sick.

The government, fighting to control the epidemic, has decreed that their bodies are contaminated, and so Haiti, again, is busy with mass graves, this one a little more than a half-mile from the mounds where tens of thousands of victims of the January earthquake are buried.

Back in the city, the bustle of life presses on. The place is pregnant with anxiety and sporadic political violence just a few days from the selection of a new president.

But here the men focus on nothing but avoiding getting sick themselves as they spray a bleach solution on the bodies, on the plastic in which the bodies are wrapped, on their boots, on the trucks, inside the cabs, on their hands, legs, backs — even a splash on their faces.

One of the workers, Andral Jasmin, 33, gingerly holds a small plastic bag by his fingertips and walks to the pit. The bag contains a newborn, but, he said later, he preferred not to think about that. The information was scrawled on a piece of cardboard that he did not read as it dangled from the bag, noting simply that she was a girl, that she was born and died Nov. 24 and that she came from a region called Lily.

No name.

“I don’t feel anything, because it is not the first baby we have had,” Mr. Jasmin said. “We have had many.”

The afternoon sun dropped lower. The shift, 6 in the morning until 6 at night, drew to a close. Soon a bulldozer would come to push the earth over Stanley Faustin and the others, now sinking under the weight of those they never knew.

Campaign’s Last Rallies

As in the United States, negative campaigning is scorned here.

But unlike in the United States, here going negative often means deploying provocateurs who disrupt rallies with rocks, bottles and sometimes gunfire.

Most campaign stops are lively affairs, taking on a free-wheeling, dance party feel.

Candidates typically appear on moving floats similar to those used for carnival celebrations, and no contender can be taken seriously without his own pounding jingle.

So it was in the suburb of Carrefour for the last rally on Friday night — all campaigning was to end at midnight before the voting on Sunday — for Mirlande Manigat, a former first lady seeking to become the country’s first elected female president. Just a few days earlier, one of her campaign rallies in Cap Haitien ended when gunfire erupted.

One of her chief rivals, Jude Célestin, whom President René Préval supports to succeed him, planned a rally a few miles away around the same time on Friday, setting off jitters.

As hundreds of Ms. Manigat’s supporters waited and waited — the city’s epic traffic jams make starting times for anything a mere guess — Mr. Célestin’s motorcade suddenly emerged, bobbing and weaving through the masses on its way to his rally.

Catcalls competed with the blaring sirens.

Then, a large group of his supporters, blowing horns and chanting his jingle, danced and marched through Ms. Manigat’s throng, which responded with jeers and some shoving.

But this time the interruption was taken in stride, as somebody cued up her jingle, “Vote, vote, vote for Mirlande!”

Charm Offensive

In at least one neighborhood, for a short while, it was all smiles and charm as United Nations peacekeepers mounted a patrol. A patrol, that is, modified to show the news media the peacekeepers’ workaday tasks and to counteract reports of poor relations with Haitians.

Many Haitians have blamed the United Nations troops for the outbreak of cholera here. A strain of the disease that is common to Nepal originated near a camp used by Nepalese soldiers where reporters observed what appeared to be sewage flowing into a river.

Even before then, some Haitians viewed the peacekeepers as heavy-handed outsiders.

But now the troops, part of a 12,000-member force that since 2004 has maintained order here, form the backbone of a security force seeking to maintain order for the presidential election on Sunday.

Nine thousand troops will be deployed that day, delivering ballots and other voting materials and patrolling some polling sites.

A contingent of peacekeepers from Brazil says that reports of friction with Haitians are overblown.

Sure, said patrol Capt. Sergio Demique, “the mood of the population is volatile,” and the troops must help control or even end demonstrations and potential riots. But he insisted that, by and large, the public appreciated their presence.

As the troops roamed in their trucks, young men fixed hard stares. One called out, “This is Haiti, we can do what we want!” Other people jeered.

But while the peacekeepers walked in the Fort National neighborhood, women greeted them amiably with “bonjour.”

Several children gave them thumbs-up signs or called out “Hey, you!” in English, the universal greeting here for anybody thought to be an American.

But one little girl was apprehensive.

“Give me a high five!” a soldier called to her in English, holding up his hand in anticipation of a friendly slap.

“Give me a high five!” he repeated twice more.

“I said,” now a little more sternly, “give me a high five.”

Sheepishly, she complied.

Friday, November 26, 2010

More Grim Days Ahead for Haiti

Read this from Scoop. This is a really good article.

Haiti: Waiting for a Leader, by Amy Wilentz

November 25, 2010
In Haiti, Waiting for the Grand Bayakou
Los Angeles

In Haiti, there’s a worker called a bayakou. The bayakou comes in the middle of the night to clean latrines, which generally get shoveled out only once every year or so.

Few people ever see a bayakou. In fact, he has a status somewhere between a magical, fairy-tale figure and an untouchable. To get a bayakou to come and do his work, a homeowner must negotiate with a middleman who arranges the assignment, but won’t let you know exactly when the cleaner is coming. You tell the middleman where you want the sewage from the latrine buried; he tells you that during the next three nights, you shouldn’t worry if you hear a noise in your garden. And then one night, the bayakou comes and the following morning, there’s a heap of freshly turned earth in a corner out back, and a clean latrine. You pay the middleman.

With presidential elections scheduled for Sunday, it’s fair to ask who will be the grand bayakou for Haiti now. The place surely needs a figure of mythic status who’s willing to come in and get real work done. Yet as the country tumbles into the electoral morass, it’s hard to imagine that someone will arrive in the dark to engineer a cleanup.

It’s not only the aftermath of last January’s earthquake that is troubling the still-embryonic democratic process in Haiti — although it’s not easy to promote elections amid mass displacement and homelessness, to say nothing of all the electoral identification cards lost in goudou-goudou, the quake’s onomatopoeic Creole nickname.

What has Haitian political heads spinning right now are the billions in international aid that have been promised in the disaster’s wake. Misery is Haiti’s stock in trade, more so now than ever. With every announcement of a further katastwof, or catastrophe — an aftershock, the rainy season, a cholera epidemic, a potential hurricane — the chink chink chink can be heard from across the sea.

In a way, misery is a natural resource as corrupting as any diamond or gold mine, or the discovery of a lake of oil beneath a desert. This realization may in fact explain the inaction of Haitian leaders so far, including the bizarrely silent and invisible Haitian president, René Préval. As long as the people are homeless and hungry and sick, money will keep on flowing from the outside.

Haitian politicians are traditionally talented at only one aspect of the exercise of power: enriching themselves. This is not surprising. For most elected Haitian officials, their job in the legislature is their first ever regular job, and the salary they receive is often their first ever regular paycheck. A foreign diplomat with long experience in Haiti told me that the average number of hours per day that a Haitian legislator spends on the job is two.

For such novices, and for old hands, the aid money coming in is an irresistible prize. The next leader of Haiti will preside over coffers the likes of which his predecessors have only dreamed. The temptations for this leader and his cohort will be great. One example: for months already, customs has been holding back supplies that were to go to various nongovernmental groups, arguing that papers have not been properly filed. (It is not a stretch to see this as a tacit call for under-the-table payments.)

In other countries, such attempts at malfeasance can be offset and even overcome by government or independent institutions that help distribute foreign largess and monitor the overseers’ management. In Haiti, however, the few weak institutions that existed were ravaged by the earthquake.

Government reform is not high on the list of priorities for many Haitians, at least not compared with daily survival. A cholera epidemic has killed more than 1,400 people so far. A traumatized people at the very edge of survival — ever since goudou-goudou, food, water, cooking oil, charcoal, shelter and health care are expensive or hard to get or to maintain — now feels pushed over the brink by the spreading illness.

To complicate matters, Haitians are starting to look toward the outside world with increasing suspicion. In a trick of almost literary irony, the cholera bacterium itself has been linked to the controversial United Nations stabilization troops who have been the sole force of order in Haiti since 2004, and who are providing security and logistics for the elections. Demonstrations calling for the ouster of United Nations troops now take place alongside political rallies.

Onto this sulfurous stage, no surprising players have emerged to act out the drama. Mr. Préval, who has managed to do next to nothing with considerable means at his disposal, is pushing the candidacy of one of the front-runners, Jude Célestin, a virtual nonentity who, it is assumed, would simply continue the non-policies of the Préval regime. Another front-runner is Mirlande Manigat, a former first lady of Haiti (for five months in 1988, until her husband was deposed) who is associated with the small Haitian middle class. There’s also Michel Martelly, a popular local musician with an eccentric performing style (he has been known to wear diapers on stage), and Charles Baker, a candidate with support from among the business elite.

And there are 15 other candidates, each commanding his or her small coterie. None is truly beloved, none generates much excitement. Indeed, there hasn’t been an important Haitian election in decades greeted with as little enthusiasm as this one, in part because the party of former President Jean-Bertrand Aristide, who is still revered, was not permitted to participate.

People like to say that Mr. Aristide, who has been living in exile in South Africa since he was ousted in 2004, is the most popular politician in Haiti, even though he’s not in Haiti. His hand hovers over these elections, even though his party cannot put forward a candidate and he has not endorsed anyone. (Haiti’s active rumor mill says he supports Jean-Henry Céant, a former close associate.)

With Haitians focused on basic survival, the candidates have spent a significant amount of time courting the Haitian diaspora, which has its own agenda — most notably the desire to be able to vote in future Haitian elections. Thanks to technology, the more than two million Haitians who live outside the country and send money back to family and friends are within reach of text messages and robo-calls. Mr. Martelly in particular, with his distinctive voice, has been urging diaspora Haitians to get their people inside Haiti to vote for him, with an implicit promise that he will work to give them the vote.

Herein lies a ray of hope. A diaspora vote could change the political scene in Haiti — ushering in a new generation of leadership and blowing some fresh air and fresh ideas into a fetid situation. The diaspora is educated, and has seen what it means to live inside economies that function. Although diaspora Haitians can sometimes be unrealistic about what’s possible in the country, their standards and hopes are high. For this reason, Haitian politicians are uneasy about encouraging the diaspora to take part in Haitian politics, even as some enlist its help.

So what will happen on Sunday? In all likelihood, the outcome of the election will be ... no outcome. There will be low turnout and probably a runoff between two candidates in a month or so, prolonging Haiti’s political purgatory and postponing the already late arrival of needed assistance. (Foreign organizations want to wait to see who will be in charge; meanwhile, children will die of cholera, a treatable disease.)

It’s easy to see what Haiti needs now, of course. What the situation requires is a responsible manager, someone capable of executive decision-making, and at the same time incorruptible. Someone from the diaspora, perhaps, who wants to give up his day job; who cares about Haiti; who’s not a dictator. Let’s continue to fantasize: someone who’s strong enough to push through to the heart of hundreds of problems and address them on behalf of the Haitian people, but who can also work with the international community.

Many of the candidates would claim that this description fits them, but we have already seen more remarkable men fail when faced with the resistant web of Haiti’s many problems. It will take a person of extraordinary character, subtlety and honesty to rise above the muck. After this election, Haitians will probably still be waiting for the bayakou.

Amy Wilentz is the author of “The Rainy Season: Haiti, Then and Now.”

It Never Seems Like it is....

This is by Roger Annis of
Haiti Solidarity BC

Canada's national broadcaster, the CBC, is airing television and radio
reports daily this week from Haiti.

The cholera epidemic

In the last two days, the reports have focused on the catastrophic
consequences of the cholera epidemic. Television news reports on Tuesday and
Wednesday evenings by Paul Hunter showed graphic images of the epidemic and
its spread. Radio news reports by Connie Watson were similar.

On Tuesday evening, Hunter briefly interviewed the UN's chief humanitarian
representative, Nigel Fisher. He said there is not enough medical supplies
and personnel to deal with the crisis. Hunter reported, "Cholera is
exploding. All the conditions for a massive cholera epidemic are present in
Haiti. People are going to die here in the week and months ahead in the

The late evening radio news on CBC last night carried a report from BBC's
Mark Doyle. He, too, reported on the shortage of supplies and medical
personnel. He quoted a spokesperson for MSF (Doctors Without Borders), "It
is spreading everywhere, and the truth is that we do not know where it will

It must be said, none of the CBC reports have probed WHY the cholera
outbreak is proving as deadly as it is. There is an air of fatalism to their
reports. But of course, fate has nothing to do with it. The conditions for
the wildfire spread of cholera have been laid by years and decades of policy
by the wealthy countries of the world. The policies of neglect and
interference that preceded the earthquake, enforced by a foreign military
and police occupation force, have been extended and deepened since. They
have made Haiti what it is today.

The flawed election

Last night, Connie Watson delivered CBC's radio news' first substantive
report on the November 28 election. The report touched on two of the reasons
that make the election so flawed--the presence on the voter roll of the
names of those who perished in the earthquake, and the difficulty of voter
registration. She gave the example of one woman who was unable to register,
despite several visits to a registration office. Ms. Watson did not report
how typical is the example of this one woman. But most notably, she
continued the de facto embargo by CBC news against reporting the exclusion
of political parties from the election, notably the Fanmi Lavalas. CBC is
aware of the exclusion; it has chosen, so far, to not report it.

The Globe and Mail national daily is also silent on the exclusion.
Yesterday, it penned an important editorial calling for an investigation
into the source of the cholera outbreak. But it also argued in support of
the election, saying that Haiti needs a "strong leader" and the election
will, hopefully, provide this.

Today, the experienced and influential CBC journalist and news program host
Brian Stewart publishes a commentary on the CBC news website on the
situation in Haiti. His views are permeated with prejudice as well
as fatalism for the future of the country. He bemoans the state of
earthquake relief and recovery and concludes that the only answer is an
outright takeover of the country by the same foreign powers that have run
Haiti into the ground. He writes, "Experts I respect have urged the need for
some form of international mandate to protect Haiti, basically from its own
corrupt leadership and lack of governance, until some workable security and
legal system can be established."

But Canada and the other world powers have been funding and training Haiti's
"security and legal system" ever since they overthrew elected government
there in 2004. The "coup" (to use the term in the aforementioned Globe and
Mail editorial) of that year was preceded by a murderous, four-year aid
embargo against the government elected in 2000. No doubt, Mr. Stewart's
"experts" overlooked this small detail when offering to him their
prescriptions for Haiti's future. But how to explain that an experienced
journalist could be either blissfully unaware or uncaring of such facts?

Read his full commentary here,
http://www.cbc.ca/world/story/2010/11/24/f-vp-stewart.html .

Wednesday, November 24, 2010

Cholera Could Affect 400,000 Haitians

Photo by John Carroll
Saint Catherine's Hospital
Cite Soleil
November, 2010

See this article from Voice of America.

Monday, November 22, 2010

Haiti Mired in Crises as the Presidential Election Looms

Photo by John Carroll

Haiti's presidential elections are happening in a few days.

During the last 15 years when I have asked Haitians if they were going to vote in an upcoming election, most have rolled their eyes, smiled, and said no. They have no trust that their government will help them. And most Haitians are not asking for a HD television and a Wii for their kids. They want basics like food, potable water, affordable schools, and a "little job".

See the New York Times article below.

November 21, 2010

Mired in Crises, Haiti Struggles to Focus on Election

PORT-AU-PRINCE, Haiti — Crushed buildings from the January earthquake still spill out onto sidewalks here, people are collapsing from cholera at hospital doors and a wave of rioting last week reminded Haitians of political turmoil of the past.

It may not be the best time to choose a president.

“The nation is not in the mood for the election,” said one candidate, Leslie Voltaire, a former government minister, who, along with other candidates, has suggested that the vote be delayed.

But the election on Sunday may be Haiti’s most important in decades. Not only are competing crises demanding attention, but with the country poised to receive billions of dollars in international reconstruction money, the new president will have a historic ability to reshape the country, from its economy to its justice system to deciding where and how to house more than a million earthquake refugees.

A colorful field of 19 candidates is seeking the highest office in the hemisphere’s poorest country, including a professorial former first lady who would be the first woman elected president, a popular entertainer best known for dropping his pants on stage and a taciturn government minister handpicked by the current, increasingly unpopular president.

All but the last have offered forceful criticism of President René Préval’s response to the earthquake, promising careful, fraud-free management of the aid windfall, although providing few specifics.

For the most part the campaigns have focused on ginning up excitement, plastering brightly colored posters across the devastated capital, blasting catchy Caribbean-beat jingles from trucks and staging large rallies with T-shirt — and sometimes, money — giveaways. It was unclear whether the crowds had as much enthusiasm for the candidates as the freebies.

Emicile Bonhomme, 44, has a view from her refugee tent of the crumpled national palace, where hanging on a fence are black and white photos of the 19 contenders vying to occupy it.

She will have none of them, choosing God instead.

“Only God in the sky can do something for us,” she said. “Since Jan. 12 we have hoped, but nobody has come for us. Look at this home where we sleep on the ground.”

Distracted and distraught, citizens like Ms. Bonhomme are a large part of why José Miguel Insulza, the secretary general of the Organization of American States, says, “The big problem is to get out the vote.”

“There are a lot of people who left town because of the earthquake,” he said in an interview. “There are people afraid of the cholera. There are people angry at the government. There are so many obstacles to getting people to vote.”

A low turnout — below 40 percent, according to some analysts — could raise claims that the election was illegitimate. Many people lost their national identification cards, which are required to vote, in the quake, while others fled Port-au-Prince and have not changed their registration.

The government authority that issues the ID cards said it had registered 30,000 more than the 400,000 it anticipated in the last quarter, the cutoff for the election. While some of that surge may be related to tighter banking rules, which also require the card for certain transactions, it may also reflect some electoral excitement.

Widner Saint-Jean, 24, beamed — “My heart is pounding,” he said — as he was handed a replacement identification card for one he lost in 2005.

“I hope my vote will help reconstruct the country, to change the lives of poor people,” he said. That would include himself. Like most young people here, Mr. Saint-Jean is unemployed.

To combat the fraud that has marked past elections, several dozen international observers will monitor the balloting. The United States is providing $14 million in election-related aid to help pay for voting supplies, international observers and other needs.

Most candidates and political analysts doubt a clear winner will emerge on Sunday, setting up a runoff for the two leading candidates on Jan. 16 and extending what has been a campaign of careful steps, as candidates have tried to balance a show of concern for the nation’s calamities while trying not to appear to be exploiting them.

Charles Henri Baker, an unabashed member of the country’s business elite who is running again after losing in 2006, said he had visited cholera wards to deliver supplies and empathize with the sick, not for the cameras.

Another candidate, Marlinde Manigat, the former first lady, recently insisted to an interviewer that a stop at a tent encampment for earthquake refugees was “just a visit,” not a campaign event. A campaign commercial for Mr. Voltaire shows long shots of the tent camps, unavoidable, he said, to make the point he would better manage relief.

Getting the electorate to focus on the election and not the country’s troubles remains a challenge. The cholera outbreak in particular is reshaping the race. It led to rioting last week, with crowds directing their anger at foreign troops blamed for bringing the disease, and several candidates are struggling to adapt.

Jacques-Édouard Alexis, a former prime minister from Gonaïves, one of the areas hardest hit by the epidemic, said he had curtailed campaigning there on the advice of medical professionals (although generally, cholera is not transmitted by casual contact). “We have to be careful with big rallies,” he said.

Ms. Manigat described a recent stop at a hospital with her entourage in which she decided not to enter the main treatment room for cholera patients. “I would not mind, but it is not appropriate to get 20 people in the room — for what?” she said. “I waved at the door. They were happy to see me.”

Polling here is considered sketchy, but the local news media have focused their attention on a handful of candidates.

They include Ms. Manigat; Jude Celestin, Mr. Préval’s preferred successor; and Michel Martelly, a kompa singer formerly known as Sweet Micky who draws large crowds and is banking on votes that might have gone to Wyclef Jean, the Haitian-American pop star who was barred from running by the country’s electoral commission.

Mr. Martelly, though, has struggled to explain away his penchant for dropping his pants on stage and why he should be taken seriously.

“I agree I am a novice in politics, not a politician,” he said in a late-night interview during an impromptu tour through a notorious slum, hoping to prove he was welcome there. “But I am proud I am not one.”

Even the establishment candidates promote themselves as outsiders.

Mr. Baker, the businessman, said he would bring order and discipline, even the return of the disbanded, once-feared army, to a country lacking one. “I am part of the elite but I am also someone who creates jobs,” he said.

Several candidates said privately that they believed the international community was awaiting the outcome of the election before committing to more aid.

American aid to the reconstruction effort was hung up in Congress for months until the delivery of $120 million this month, about a tenth of what was pledged to the Haiti Reconstruction Fund, and several other countries were also slow in delivering aid.

The candidates have not criticized those countries, focusing instead on Mr. Préval, who is completing a second term and barred from running for another.

They also promise to wean the country off the influence of the myriad nongovernmental organizations that function here as almost a shadow government.

“Relative to presidents of the past, this president is going to have an enormous opportunity with significant resources,” said Mark L. Schneider, a Haiti expert at the International Crisis Group. “The challenges are mind boggling; you have to reconstruct the government. This isn’t just rebuilding infrastructure, it’s rebuilding whole institutions.”

It remains to be seen how much the voters are buying. Haitians, analysts said, tend to make their choices at the last minute.

Randal C. Archibold reported from Port-au-Prince, and Damien Cave from Miami.

Saturday, November 20, 2010

If You Don't Read Anything Else About Cholera, Politics, the UN, and Haiti, You Need to Read This

Photo by John Carroll
Outside of St. Catherine's Hospital
Cite Soleil
November, 2010

This article written by Jonathan Katz appeared in the Washington Post.

The second article (below) is from Senator Bill Frist, M.D.

As the cholera outbreak continues to ravage through Haiti, killing hundreds and inciting terror and riots throughout the country, I'm afraid I may have more bad news. It has come to my attention today that the cholera outbreak is being vastly underreported and underestimated. My sources on the ground in Haiti have estimated that the current epidemic is up to 400% worse than the official numbers reflect. Considering that the official numbers already state a toll of 1,110 dead and another 18,000 sick, the scope of this savage outbreak is shocking.

Furthermore, it seems that nearly all the organizations on the ground were caught by surprise by this sudden outbreak and are grossly undersupplied. Simply put, eradicating the cholera outbreak requires resources beyond Haiti's capacity. Ringers Lactate fluid (required for intravenous rehydration) remains incredibly scarce within the country. The UN also refuses to provide any cholera treatment supplies to any NGO, instead dedicating all its supplies to the Haitian government. Medications from the Haitian Ministry of Health are also currently not forthcoming. Certain organizations are simply waiting for the disease to strike the capital, Port-au-Prince, before acting. A group I frequently work with, Samaritan's Purse, is receiving reports of high mortality in remote areas with no assistance reaching them. The U.S. government claims that materials are in place to respond to this developing disaster, but this does not seem to be the case and I worry that false confidence may cost lives.

The spread of cholera now seems past controlling, and using Pan American Health Organization calculations (in the MOST optimistic, with an attack rate of 2% scenario) around 200,000 people will require IV fluid. As around 75% of all cases require hospitalization, each patient uses 8 liters per day for three days, the conservative estimate for IV fluid needed stands at 3.6 million units. Unfortunately, some experts believe that the attack rate will rise above 2% due to lingering sanitation and hygiene conditions caused by the devastating earthquake combined with a Haitian population with no exposure to cholera and immature resistance.

With much of the country living in squalid post-earthquake conditions, we should expect an attack rate of up to 5-8%, according to the Refugee Health Manual. At this rate, we can expect as many as 500,000 to 800,000 cases of cholera. Due to the intense overcrowding, these cases might not be spread out over six months, but rip through the population in six weeks. Roads in Haiti, already devastated by the earthquake and again recently by Hurricane Tomas, continue to keep sick people from seeking and receiving proper aid, meaning that more advanced treatments are needed to halt the disease.

Save the Children, which has been in Haiti for over 30 years and currently operates in 17 large urban camps, is desperately struggling to fight back the disease. They are scrambling to set up new treatment centers around the country as current ones, such as their facility in Port-au-Prince now operates 24 hours a day and still cannot do enough. On the preventive side, Save the Children has distributed 10,000 hygiene kits, 19,000 bars of soap, and chlorinated water to schools and camps. These actions are important and have saved thousands of lives, but in a country of 10 million people, they are simply not enough to hold back the tide.

Similarly my friends at Samaritan's Purse, who remain a major national player in Haiti, report that even with their huge public awareness WASH program, 400 treatment beds, and over 300 staff dedicated solely to cholera, they were completely unprepared for this outbreak. I find it hard to believe that many organizations were prepared for this and I simply cannot imagine that any hidden capacity exists.

This issue needs immediate global attention. Many organizations on the ground do not have the resources to quickly buy, deliver, and administer necessary cholera medications, like Ringers Lactate. Even if they can afford these costs, it is only the beginning of the current logistical nightmare. The airport in Cap-Haitien has been shut down and there are roadblocks between Cap-Haitien and Port-au-Prince, effectively isolating the entire North of the country. If supplies do make it to Haiti, customs holds these shipments 3 to 10 days and the backlog of supplies, not just at Port-au-Prince but around the country is staggering and costing lives every day. NGO's are unable to receive and distribute supplies and are resorting to covert and illegal means in some cases to secure these life-saving medicines. Civil unrest around the country, caused by the belief that the UN Peacekeepers are connected to the outbreak, are further hampering the delivery of supplies that eventually do get through the ports.

These hindrances to saving lives must be eliminated. Haiti needs IV fluids sent in massive quantities. Life-saving supplies must be allowed to enter immediately into the country, not sit on pallets for 3 to 10 days out of bureaucratic formality. Organizations on the ground have sophisticated software that allows all the various partners to work together to comprehensively treat the population; we simply do not have enough supplies. The immense backlog of supplies at the ports has strained the entire response grid to the point of collapse and the internal rioting makes it difficult and dangerous to move supplies inside Haiti. The world must help, and must help now.

In addition, the United States needs to seriously and objectively consider a military airlift of supplies into Haiti. While this may appear a drastic measure to some, we cannot sit idle while our neighbor to the south suffers through this nightmare. Our military provided crucial support to those suffering after the Indian Ocean tsunami, Hurricane Katrina, and the earthquake that ravaged Haiti in January, and can do so again in this dire time of need.

Cholera is a disease we can defeat if we work together. Up to 80% of cases can be successfully treated with relatively simple medicines, such as rehydration salts. So join me in telling your friends, writing your congressman, volunteering, or writing a check to one of the many worthy organizations on the ground. We need to spread the alarm, and quickly. This epidemic is larger than previously thought or reported, we are drastically underequipped to deal with it, and it's moving fast.

Very best,
Senator Bill Frist, M.D.

- - - - - - -

Why Aristide's Party Won't Vote

Read this Counterpunch article.

This is Not Looking Good....

Read this.

If You Think You Are Having A Bad Day...

See this New York Times article.

Twelve Hundred and Counting....

See this article.

Friday, November 19, 2010

Cholera Response "Inadequate"

Read this Reuters' article.

Under Haiti

Photo by John Carroll
Laplaine, Haiti
November, 2010

Friday, Nov. 19, 2010

Underneath Haiti, Another Big Quake Waiting to Occur
By Tim Padgett / Port-au-Prince

Last week, on the morning of Nov. 11, a tremor shook the Port-au-Prince suburb of Carrefour. It was a minor geological event, but given the still fresh and haunting memories of the 7.0-magnitude earthquake that hammered Haiti on Jan. 12 and killed some 230,000 people — many of them in Carrefour — even that mild shudder caused public panic. The only reported injuries, in fact, were due to people scrambling to take cover.

To geologists, it's good to see Haitians on such heightened alert. Most scientists believe the western hemisphere's poorest country is hardly out of the seismic woods — and after studying the Haiti quake data for the past 10 months, they're more convinced than ever that Haitians can expect another major quake sooner rather than later. That's largely because they've found, according to a new study by 10 prominent geologists, that the lion's share of the January temblor occurred not along the fault line they originally suspected, known as the Enriquillo–Plantain Garden fault zone, but on a previously unknown fault. (Faults separate plates in the earth's crust, which cause quakes when stress makes them collide.) As a result, says Falk Amelung, a University of Miami geologist and one of the report's authors, "the prospects of another serious event may be rather worse than we first thought."

When Amelung and other geologists started poring over information from the earthquake's satellite-radar images last January, they were flummoxed by a variety of features. One was the vertical motion the quake exhibited — unusual because the Enriquillo, which runs across Haiti's southern peninsula just below Port-au-Prince, is a strike-slip fault, the kind that almost exclusively displays horizontal motion when it ruptures. At the same time, the quake's horizontal movement was partly north-south, another anomaly for a strike-slip fault. "Those were the two important smoking guns" that made scientists question their early assumptions about the quake, says Eric Calais, a Purdue University geologist who is in Haiti as a science adviser to the U.N. Development Program and is a lead author of the study, which was published last month in Nature Geoscience.(See more about the January earthquake that devastated Haiti.)

There were others. Why, for example, did the earthquake's rupture not reach the surface, despite its strength? And, perhaps most important, why did so little of the Enriquillo fault itself seem to rupture? The answer, say the geologists, is that another, unmapped fault line parallel to the Enriquillo was also involved, one they've now identified and named the Léogâne, for the city west of Port-au-Prince where the quake had its epicenter. The Léogâne fault, they add, seems to be a combination of a strike-slip and a thrust fault (which helps explain the vertical motion and other unexpected behavior) and was responsible for about 85% or more of the quake's energy.

But even with the important discovery of the Léogâne fault, geologists say Haiti is still left with an ominous reality: the larger Enriquillo has yet to fire much if not most of its volatile seismic ammunition. Before January, the fault hadn't had a major rupture since 1751. Scientists have observed that only the western half of the segment that broke in 1751 came apart this time, meaning the eastern portion — closest to Port-au-Prince — is now likely a geological hair trigger. In fact, the discovery of the Léogâne fault, as geologists like Amelung suggest, may mean things are more dangerous than previously imagined, since it indicates the Enriquillo spent even less of its own energy in the January earthquake than they had assumed.(Comment on this story.)

Calais, however, thinks the Léogâne's appearance "is no reason to be alarmist." In the study, Calais agrees that on Hispaniola, the Caribbean island Haiti shares with the Dominican Republic, "vulnerability to earthquake shaking will probably remain high in the near future." But finding the new fault, he tells TIME, "doesn't mean Port-au-Prince is more or less exposed than it was before. It's still sitting on a [seismic] time bomb that Haiti had unfortunately ignored before Jan. 12, and which we and the Haitians now have to focus on more closely." Geologists like Amelung's Miami colleague, Tim Dixon, began to identify the Enriquillo fault as a major Caribbean quake hazard in the 1980s.

New leaps in satellite imagery and GPS technology, spearheaded by organizations like the Japanese space agency JAXA and the international Group on Earth Observations, helped make the new fault discovery possible. It's sure to renew discussion about whether Haiti should rebuild away from its overpopulated southern capital, although scientists now fear there may be hidden faults to the north as well. More important, it's another reminder that Haiti has to rebuild smarter — the quake's death toll could have been slashed if the country hadn't allowed so much shoddy concrete construction and poor urban planning — so that when the next big quake does hit places like Carrefour, Haitians can escape horrors like those of January 2010.

Thursday, November 18, 2010

A Doctors's Life in a Haitian Slum

Photo by John Carroll

Dr. Jim Morgan wrote this and it was posted on the Corbett list.

Dr. Morgan hits it all on the head.

This is exactly how it is right now as Haiti's crises continue.


By Jim Morgan, M.D.

The day started like a typical Haitian Sunday… relaxed. I had made plans the
day before with Junior to catch a ride to St Damien’s hospital in Tabarre. Fr
Rick lives there and I wanted to meet up with him and to go to mass. He’s been
a great mentor and friend for me in my Haitian journey.

Whne I spoke with Fr Rick by phone the night before, he told me that Mass would be in the evening,unusual for him to have a Sunday evening Mass St Damien’s to have it at night.

I knew things must have been busy. “Can I give you a hand tomorrow?” “Sure, we
could use the help. Come on by and speak to Conan.”

I awoke early, as is my norm there, sleeping and arising in sync with the sun, particularly when there is no electricity. I have often been struck by how quickly I do so wene there
is no power.

It makes perfect sense of course, and yet in 2010 the injustice of
that scenario is not lost on me. The news reports about how electricity
shortages in Baghdad make life tough. In Haiti that’s the norm. How
can people study when there is no light? As a kid I remember hearing
once that Abe Lincoln knew the importance of studying, and so he would
do so by candlelight, but how many Honest Abe’s ought we expect? As we were
getting ready to go, Junior went out to the truck and found the front passenger
side tire flat. The day before I had paid to have the same tire repaired. It
was impressive to watch the guy jack up the truck, remove the tire, then using
what looked like a tire jack from my parents old Country Squire station wagon,
ala 1969, manually remove the tire from the wheel. Except he didn’t use the
jack part.
He would swing the pole, and lodge the base of it between the rubber
tire and the rim. It can’t be too good for either part, but such is the
common way it’s done. Next the tube is removed and the the hole located
by squeezing the inner tube and listening for the hissing leak. The
hole is patched using rubber, heated over a wood fire and allowed to
cool. The process is vintage Haitian—simple, logical, right out of my first
year physics textbook. The result is too, unfortunately. Cheap materials,
cheaply repaired on the street just don’t have a great track record. Junior
told me that we would not be able to repair the tire until the next day. I was
not happy, and the familiar frustration of Haiti washed over me like an
unwelcomed kiss planted by an ancient aunt on an eight year old boy.
The trick in navigating Haiti without having a stroke is to stay cool
when the inevitable happens – like getting a flat on the worst roads
you’ve ever seen – and to know to get pissed off when you need to, not
settling for the status quo when better results are within reach. It’s a
delicate balance that I struggle with on a regular basis. I asked Junior how
we could fix the problem and he looked behind me. As luck would have it, his
own vehicle , a Montero SUV, is the same make that Lamp uses. Junior’s truck
has four flat tires not because he keeps going back to the same tire repair
guy, but because he hasn’t driven the vehicle in months. He simply swapped out
the wheels, pumped it up and we were in business. We arrived in Tabarre a
little later than I had planned, but not too far off the mark. When I walked
onto the grounds of hospital,
I was told by the guard that Fr Rick was in church. I walked the 100
yards toward the chapel, but did an about face after seeing a coffin in
the center aisle, and hearing sobs exude outside. I walked to the side of the
chapel and ran into my friend Conan. Conan
should be in a movie. He is an American, with eight kids, and divorced.
(Many of my American friends who work a lot in Haiti seem to be
divorced. It’s something a stay very aware of, as I don’t want to be
among their numbers).
He works like a dog seven days a week. His red hair and fair eyes belie
a propensity for skin cancer that makes my dermatologist wife cringeven
talking about him. On this day he is wearing mirrored wrap-around shades, and a
blue bandana as a head cover. “Hi Jim, can you work tonight?” Is his greeting.
He disposed of the formalities like “Hi how have you been?” and “Good to see
you” long ago. I am happy to be on that level of comradeship with him. Conan is
about the work. His work ethic is impressive. It’s an elite group that is co
dedicated to a cause. In that group is also Fr Rick, a physician and Catholic
priest, who works even more nonstop on behalf of the poor. Among
other hats he wears at the hospital, Conan is responsible for staffing
the cholera tents with doctors, nurses, and ancillary workers. We share
stories about the cholera patients we have seen over the last few days, and he
is exhausted in his rendition. “Sure I can work tonite.” “How long? When can
you start?” “I have to be at our clinic tomorrow at 7am. I’ll work all day and
night if you want. You tell me where.” “Ok
good.” That’s all you get. No “wow, you are so kind, thanks.” No these
guys work like that all the time. I neither expect nor want the kudos. The
funeral has ended in the chapel, and the mother of the boy who died is running
around , sobbing uncontrollably. Fr Rick is headed towards us, but is stopped
by the mother, who literally throws herself into his arms.
She asks him where her son will be buried, since he died from cholera
and the general hospital morgue won’t accept the body. He speaks softly to her
in Creole, but I can’t hear what he tells her. Speaking in his
Canadian-Connecticut-Haitian accent, Pere Rick says to me “Oh Jim. Nice to see
you. Are you seeing a lot of cholera at your clinic? We have to bring this body
over to be cremated. Can you give us a hand?” He too does not waste his words.
The three of us load the cheap plywood casket onto a truck and drive to the
crematorium. We unload the cargo, and I hold open the iron gates as they
deliver the coffin. The all too familiar smell of death is present. The oven
is working on one body already, but other lifeless ones await on tables nearby.
The smell, I know it as that of anaerobes, bacteria that grow well in nonliving
or poorly oxygenated tissue. It is akin to the smell of dirty socks from a
bunch of teenage boys, left in a pile for a week. I am instantly transported
back to a side street i walked down after the earthquake ten months ago. Then,
as now bodies we decomposing, and the odor was harsh. I recall reading
somewhere that scent memories are some of the most difficult to forget.
Unfortunately I am finding this all too accurate. After
dropping off the body, we go over to a storage area to collect some
wooden pallets. We have to build a tower to put a water tank on. The
plastic container, about 1000 gallons in capacity, is being used to supply
water for cleaning in the cholera treatment area. Gravity will allow the water
to be distributed to several different places. Water is key on a normal day in
Haiti. During a cholera epidemic, it becomes the Rosetta stone. We load the
pallets onto the truck. I try not to let on that the giant bugs really do gross
me out, and we drove to the cholera treatment area about four football fields
away. Conan tells me that I will be working triage, and also the treatment
tents. Currently
there are three large tents, like the kind my parents rented for my
sister’s wedding reception in our backyard. The only dancing though, is
by the nurses who are working their butts off, trying to keep up with
the volume of patients and their needs. “Ok, no problem” I tell him, even
though I have never taken care of a cholera patient in my life before this
week. I
read a lot about the disease in the past two weeks, and attended a
meeting with my Lamp team the day before, sponsored by the Ministry of
Health, for NGO’s working , so I guess I’m as good as they’re going to get,
today at least. Conan tells me that I’ll work until about 11pm. That will give
the American guy, Jeff, an ER physician from Ohio, a few extra hours of rest.
No problem. It’s just past noon. I relieve a young and very pleasant Haitian
doctor, a woman, who gives me a detailed sign out. “this
man has diarrhea and vomiting. We are hydrating him with IV fluids,
and we will give him antibiotics – just one dose. This woman has
diarrhea and vomiting. We are giving her IV hydration and antibiotics-
just one dose of antibiotics, you understand? This baby is vomiting and has
diarrhea. Baby needs hydration and antibiotics, just one dose, you understand
And so on went the sign out. After about the tenth patient I asked her
to point out the ones who were not vomiting with diarrhea. Of the 40 or so
patients, none fit that description. Tout moun genye diarya ak vomis. We cut to
the chase, and she bade me bon chance. After a few hours, I had my mojo on.
Working as a doctor in a level I trauma center in New York City for six years
has some advantages to it, and one is confidence.
A PhD student in public health was there, whose area of interest is
cholera. Perfect. You can do discharge training of patients. We need to
educate them on eating and cleaning and toileting. I schmoozed a couple of
nurses early on. My ER experience had taught me that if you don’t do that early
on, you’re dead. The nurses are the hub of the wheel in the ER. Doctors maybe
driving the car, but the want to go. A nursing friend once told me that I
could charm the skin off a snake when it came to those situations,
a talent I am happy to have, because the team has to get along to have a
chance at being effective, especially in the face of catastrophe. The
cholera epidemic in Haiti is a catastrophe. Patients coming in were being
triaged and treated appropriately. I even was able to discharge a few
patients, and they received discharge instructions, in Creole. About 4pm, Fr
Rick asked if I could head out to Warf Jeremie. I have been there a few times
before. It a place in Cite Soleil, not far from where our Lamp clinic is
located. It is poor, densely packed with people. There is a clinic there, run
by an Italian nun, he told me. “The clinic needs to send some patients to St
Damien’s , and they need a doctor to tell which ones are the worst. Bring the
generator and some gas, since they don’t have electricity and it’ll be dark
soon. Win can drive, and he’ll bring Allain with him too.” And off we went.
There were five of us, all blan, the Creole expression for white people. We
drove along Route Nationale,
on the outskirts of Cite Soleil. Win was kind enough to bring along a
plate of food for me, and I ate in the back seat. The food tasted
delicious, and after the first bite I remembered I had not eaten all
day. I was hungry, and practically ate the plate on which it was served. After
about 20 minutes in the truck we turned right onto the road leading to Warf
It was dark now, and the way was lit up by headlights from the
occasional vehicle, and by the small cooking fires on the side of the
road. Tin shacks, held together by rust, dogs barking, smoke spewing from in
front of homes, children sitting naked on the ground. Horns honking. I was
looking for Mel Gibson in Road Warrior garb to come racing by on his
motorcycle, but this scene was even more distressing than anything Hollywood
had yet offered. I asked myself “what could be worse than to live like this?”
We arrived at the front of the clinic in silence. On entering the dark
building, we were greeted by Sr Michaella, an Italian nun, maybe 50 years old.
She was happy to see us for sure. The clinic was officially to open in about 2
weeks. She had arranged for medical staff to start at that time, but then came
the epidemic of cholera. Like most disasters, this one didn’t read the schedule
and came inconveniently early. People in the neighborhood began coming to the
looking for help. “I could not turn them away” she told me, and soon
the beds were full. There was a team from Doctors without Borders who
were awaiting clearance from the Haitian Ministry of Health, and
fortunately they would be able to assist. “But they told me yesterday
they would not come today since it is Sunday and they needed a day off.
So it is just me and my boys. We have been working nonstop since very early
this morning. I have no energy left. What do you think I should do?” Win
and I looked at each other. We came to take the worst of the patients
and so we started to go around triaging patients. Very quickly, I had to
assess each one, and decide who would be transferred back to the
hospital in Tabarre. Sister Michaella had a tap-tap available ,and so we
figured we could transport five patients. Someone started the generator, and
there was a dim light throughout the building. It was worse than I could have
imagined. People were crowded into that place. Vomiting and diarrhea was
rampant. It
was a horrible sight to see such suffering. An old woman was sitting on
a red bucket, her dress pulled up around her waist, with diarrhea. She hadn’t
the strength to sit up, and she rested her head on an adjacent cot. Babies not
crying, dry mouthed. Young men ,
obviously from the community, moved about with purpose, looking for
IV’s not functioning, assisting new patients to cots or open floor
space. I asked Sister Michaella if she needed me to stay. “If you would, yes.
Otherwise we will have to send people home. For the last two days we arrived in
the morning and found four dead bodies on the steps, waiting for us. ” Win
heard my conversation, and said “Jim, if we take the worst cases back
then you wouldn’t have to stay. “ He sensed my nervousness in making the
offer. Cite Soleil is a notoriously tough place under the best of
circumstances. With the upcoming elections, it had become a
lot more risky, as local gangs backed by different candidates, tussled.
The wrong comment could be big trouble. He went on… “We don’t know how
long the gas will last in the generator. You won’t have any nurses. I
don’t know how long the IV fluids will last.” “You’re right.” It was a bad
idea. After all, we’ll be taking
the five worst cases, right? Then with a little luck people can go home
and come back tomorrow morning for more treatment. Also, God knows I
didn’t want to spend the night in Cite Soleil alone. Though I’d worked
regularly in Bwa Nef, another neighborhood in the slum, for years, it was
always during the daylight hours, and always with close confidants. I
told Sister my reasoning. She understood my reasoning, and said Okay.
She squeezed my hand and thanked me for coming to help those people we would be
taking back to St Damien’s. She turned to continue her work, and I went about
helping to load up the patients. As we were getting the last patient ready, I
turned to Win. “I’m staying. I can’t leave these people. Look at them. There’s
no one else to do it.” He called on his cellphone back to Fr Rick, and we got
the OK. I spoke to Sr Micahella
again, and I thought she would kiss me. I knew all along it was the
right decision. I didn’t know how I would make it through the night. In a
weird way, I was reminded of when
I used to be an ER doctor in the West Village of Manhattan, starting a
shift on the night of the Halloween parade. You knew it would be crazy and
exhausting, but
you would get through it. I didn’t linger on the obvious --- in the ER
we had lights, professional nurses and doctors, and practically every
modern medical test at our fingertips. As Win and the others were readying to
leave, Sr Michaella
told me that I would have some help. There was a group of five nuns and
priests who happened to be living in some tents nearby. They had come
recently to minister to the poor. She introduced me to Sister Cacilda. Sister
Cacilda smiled so radiantly and gently, it was a gift from above. She
told me in broken English that she and the others would help me, and
that together with the help from the young men from the community, and most
important – she pointed up – with His help. We will do this. I felt lifted up
by her courage. Here I was,
a relative veteran of the streets of Cite Soleil and no stranger to
working in disasters and a nun who was living in a tent in one of the
worst places one could imagine became a conduit of holiness and
strength. As the night wore on, the vomiting and diarrhea continued, and more
patients came. I had no idea how long the gas would keep the generator
going. Most patients needed intravenous hydration, and lots of it.
Finding a vein in a dehydrated body can be really tough. I was
particularly happy when I finally was able to get a line in the old
woman with the flower dress. She was close to death. Sister Cacilda
never stopped smiling. She asked me if I would like something to eat,
and though I hadn’t thought of it, I answered yes. She spoke in Portugese
to one of the young priests, and he brought me a mango and a chunk of
peanut butter. I think it’s one of the best things I have ever tasted. At
about four in the morning, I was completely exhausted. I told Sr Cacilda
that I had to lie down for one hour. I crawled into a cot in the back,
and lay down. The room started spinning, and I thought I would puke. “Oh
shit. I can’t get sick.” I said aloud. I got up and used the bathroom,
and didn’t vomit. I crawled back into the cot and somehow woke up
exactly one hour later. At six o'clock I was had just finished putting in a
line into a child who was severely dehydrated. As
I looked up, the sun was just coming up above the horizon. On cue, the
generator started to sputter, the familiar sound it makes when running
out of gas. It had lasted all night as we needed it to do. The daytime medical
team began arriving, doctors, and nurses and the others. Sister Cacilda and I
exchanged numbers and email. I am sure we will work together again, and again
it will be my privilege. We proudly noted, zero dead that night. A driver
came to pick me and the generator up, to go back to St Damien’s . I needed a
shower, and some sleep. Getting out of the truck the first person I saw was
Conan. “Oh good. Jim. Can you work tonight?”