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?”

1 comment:

Jackie said...

I was brought to tears as I read your post. I am jealous that it is not my time to be there working beside you and your team. We had a team there for a short time in October, right before the cholera outbreak and had a clinic set up in PAP. We treated 876 patients in 4 1/2 days. Such great needs. We are coming back there next October. I may be able to take off in March for a week. I am a physician assistant. Do you think you could use me possibly some other nurses or nonmedicals that assisted our team?