Friday, January 29, 2010

Haitian Hearts Summary of the Last Two Weeks

Dear Haitian Hearts Friends,

Haitian Hearts thanks you for the tremendous financial support you have given the Haitian people following the earthquake that destroyed Port-au-Prince two weeks ago.

We have made or received hundreds of phone calls and e mails to and from Haitian Hearts patients, their families, and their friends during the last 14 days.

We have heard from Katia, Caleb, Suze, Henri, Mirterlande, Frandy, Jenny, Katina, Marie, Rodolphe, and Nadia. Most of them lost their homes, relatives, and friends, and almost all of their possessions, including their heart medications. But none of them were physically hurt by the quake.

It is very sad and sobering to listen to their desperate voices from the streets of Port-au-Prince. Most are living on the streets. They describe lack of clean water and food. There is no infrastructure that is working well. There is no sewage system in Port-au-Prince.

Katina's father and family fled to the countryside in southern Haiti to live with relatives who have a garden. Katina's father explained to me that he escaped the earthquake "with only his head".

Mirterland's sister Carminne called today and she is living in Liancourt, a village in Haiti's central plateau.

Jenny, a thirty year old girl who needs repeat heart surgery, is living in a car body parked in her yard near her damaged home.

Suze, Henri, Frandy, Marie, and their families are living on the streets of Port-au-Prince.

Maria has been able to wire money via Western Union from Haitian Hearts to almost all of the people mentioned above. Western Union is not charging any fee for our Haitian friends to obtain their money in Haiti.

Haitian Hearts supporters have allowed us to do this and the people and their families mentioned above who lost almost everything are benefiting right now.

Unfortunately, we have lost some Haitian Hearts patients.

We were working on getting Valerie, a six year old girl, accepted to a medical center in the United States for repair of a hole in her heart (atrial septal defect). Valerie, her twin sister, and her mother were all killed in the earthquake. Her recent video echocardiogram sits on the floor of our living room. It is hard to look at it.

Dieula was an eight year old girl that I examined for the first time in 2006. She had a ventricular septal defect and active tuberculosis. We treated the tuberculosis in Haiti and another group was successful getting her accepted into a large pediatric medical center for heart surgery. Dieula had the surgery in 2007 and returned to Haiti.

When the earthquake struck Port-au-Prince, Dieula was killed. Her seven siblings and mother survived.

Several days ago a six year old Haitian Hearts patient that I first examined five years ago was formally accepted for surgery in California. Her name is Widnerlande. She has a ventricular septal defect also. She and her mother Magalene live about three hours by car north of Port-au-Prince. We have been unable to contact Magalene since the earthquake, but we will continue to look for them until we get an answer.

Medjina is the last Haitian Hearts patient that we brought for heart surgery. Medjina arrived in the States in December and is scheduled for mitral valve replacement this spring. Medjina's mother gave the ok for surgery two days before the earthquake and has not been heard from since. If we do find out Medjina's mother status, we will let you know on this site.

As you are following in the news, the majority of search and rescue teams are done with their work. Now Haiti has entered another stage of disaster medicine in Haiti.

This stage will be just as horrific if not more so than the first stage. Infections due to trauma, surgery, and dirty water will be rampant. Haitian mothers will not be able to get their kids medical help quickly due to the Haiti's deficient infrastructure which even became more impossible two weeks ago. Lack of good shelter and sewage systems will cause more morbidity and mortality.

People suffering diseases of tuberculosis and AIDS will go without treatment which will hurt them and possibly others around them.

Many more orphans in Haiti need help right now. And BEFORE the earthquake there was an estimated 300,000 orphans in Haiti.

And what about the psychological help that hundreds of thousands of Haitians need that have survived this disaster? And there will be significant burn out and severe stress for the relief teams that enter Haiti to help out.

Unfortunately both national and international corruption will slow down the aid to the people that need it most. Fuel prices have already been elevated.

The funds that are donated to Haiti need to filter up and not down. There are hundreds of thousands of young men and women that can and would rebuild their country if they were paid fairly and could provide basics for their families. During the last 29 years I have seen Haitians do unbelievable physical labor, and I have no doubt they could rebuild Haiti with their bare hands. The work force is in Haiti right now. Why not use them?

Poor Haitians have had problems for centuries. True justice for the majority of people in Haiti, to enable a basic standard of living, simply does not exist.

Haiti will not be fixed quickly. It will take decades of intense work at every level. But it can improve significantly if the national and international will is there.

Haitian Hearts will do the same work this year that we have been doing for the last 15 years. We will continue to work in hospitals and clinics with Haitian doctors and nurses seeing whoever comes in.

When a young heart patient comes along, we will do our best to examine, diagnose, treat, and determine if the patient is a surgical candidate. And if the patient is operable, we will attempt to find medical centers in the United States or other countries, to accept the child and perform the surgery.

Jenny, Henri, and Rodolphe all had heart surgery about 10 years ago and all three need heart surgery again. We have their exams and echocardiograms done. They sit on our living room floor too, reminding us to work hard. We will continue to search for medical centers to accept them.

In summary, Haitian Hearts work will be challenging in 2010.

The world has now seen the courage of the Haitian people. And from our personal experience we know our Haitian Hearts patients will not give up. And they won't let us give up either.


John and Maria

Thursday, January 28, 2010

You Have to Read this Article!

January 25, 2010

On Street Tracing Haiti’s Pain, Survival Goes On
New York Times
Photo by John Carroll

PORT-AU-PRINCE, Haiti — Avenue Poupelard in the center of this devastated city pulses with life and reeks of death almost two weeks after the earthquake.

Before what Haitians call “the event,” it was a chaotically bustling street of lottery kiosks and cybercafes, gated homes and shacks, churches and schools.

Now, a coffin maker spends the day hammering wood as fast as he can get it, while the body of a 6-year-old boy decomposes in the ruins of a school. Hundreds of displaced residents squat in the junked cars of a mechanic’s lot as a lawyer, writing briefs, camps under the bougainvillea of her uninhabitable villa. A fiery pastor preaches outside the ruins of his church; street vendors hawk small plastic bags of water; an AIDS clinic reopens briefly each day for patients who survived the earthquake but ran out of essential pills.

And, bound in muslin like a mummy, a cadaver lies beneath a sign that screams “S O S,” deposited there by neighbors as if to underscore their cry for help as they struggle to reconstitute some semblance of community and move forward.

“We are not blood relatives but we are all the dispossessed of Avenue Poupelard,” said Franc Danjou, gesturing at those around him in one encampment. “We must pool our resources — and get help! — or in a year this community will be dead.”

Over a quarter-mile stretch, Avenue Poupelard, a residential and commercial strip in the area called Nazon, offers a panorama of life in the ruins of the Haitian capital where a stricken heart still beats.

A complete damage assessment is impossible without tax and property records, which are not available. But of 53 buildings examined on Avenue Poupelard, only six appeared to be intact. Twenty-three are completely or partially collapsed. And the remaining 24 show damage ranging from cracks to crumbled walls, with daily aftershocks presenting a continuing threat.

Despite such widespread destruction — and an incalculable number of deaths — almost no one on Avenue Poupelard seems to let himself cry, not even the children. Grief is still buried under shock, and there is a stoic determination to face the future because, no matter how tenuous, it is far less frightening than the immediate past. It is daunting to imagine the recovery that lies ahead. But in this one pocket of the city, as elsewhere, life of a survivalist sort goes on.

Some small businesses — a barbershop here, a tiny food stand there — are stirring back to life. Political debate, a sign of normalcy, is resurfacing, with many openly cursing President René Préval for making few forays into hard-hit areas.

Food, water, shelter, sickness and death: these continue to be urgent problems even as some help is finally arriving. For many on Avenue Poupelard, the trauma of loss has created an almost existential vertigo. Nora Jean Phillipe, an office worker who sat beside a tent with a box of Pop Tarts in her lap, was keenly, almost obsessively, focused on one thing: excavating her family’s birth certificates from their destroyed house.

“Please understand,” she said. “I lost my home. I lost my son. Somehow, I have to find a way to salvage our identity.”

Determined to Stay

The Legros family settled into their villa on Avenue Poupelard over a half-century ago when the area was affluent and surrounded by farmland. As he grew up, Michel Legros, 53, owner of a popular radio station, Radio Maximum, watched the neighborhood grow denser and more socioeconomically mixed.

Late last week, Mr. Legros and his sister Gladys Legros, a lawyer, opened their gates, ushering visitors onto the patio in the shadow of their elegant house, which is still standing but badly damaged.

Mr. Legros is a well-known political activist. “Politics sticks to him like a disease,” his sister said. His patio, shaded by palm and banana trees, used to serve as a meeting place for the Democratic Convergence, a largely elite political coalition opposed to former President Jean-Bertrand Aristide, a champion of the poor. Now the Legros family sleeps there alongside the many less privileged, displaced neighbors they have invited in.

Most of his friends, Mr. Legros said, have abandoned the country, but he refuses to go. “If you hear there is one person left standing in Haiti,” he said, “you can be sure it’s me.”

Despite his bravado, Mr. Legros, unlike many of his neighbors who have repressed the horror of the earthquake itself, keeps reliving it.

After the earthquake struck, he said, he rushed downtown, where his cousins owned a small hotel and found it a pile of heavy concrete slabs. After learning that his cousins were buried inside, he saw an employee, whom he knew only as Rudy, lodged in the rubble, crying for help. He ran to search for equipment to help get Rudy out. But with Port-au-Prince wrecked from one end to the other, Mr. Legros found that his political connections did not help — not on the day of the earthquake, or for the two days after that.

By the time Mr. Legros secured a bulldozer, Rudy was dead.

“I feel impotent, and that impotence bothers me a lot,” he said. “But what bothers me even more, is that my country is impotent.

“My God,” he added, “what has happened to Haiti?”

Crossroads of Need

Avenue Poupelard crosses a major north-south thoroughfare, Avenue Martin Luther King. At their intersection, a sign in English — “We need help. Food. Water.” — has arrows pointing both east and west.

To the immediate west lies the AIDS clinic opposite the car repair lot; to the immediate east, the coffin maker — who is charging his neighbors $125 per plywood box, about a quarter of the average yearly income — and a cybercafe offering free phone calls to the United States. Among those thronging the PMS Cyber Café late last week, one caller was recounting how a cousin had died at the hospital: “They cut off his leg,” he said into the phone, “so I don’t think he wanted to live after that.”

Across the street from the cafe last Thursday, a community center was converted into a triage unit by American doctors, volunteers with a Catholic missionary group who tended dozens of survivors with crush injuries and fractures. The patients included Linda Saint Alain, 27, who had languished in pain with a broken back on the patio of a family home since being dragged from its wreckage during the quake.

The American doctors quickly determined that Ms. Saint Alain needed to be transferred to a hospital, and helped her brother put her onto a flatbed. Before leaving, the brother jumped down to hug Gaston Jeaneddy, a voodoo priest and community leader who had arranged for the rescue team to visit the neighborhood.

“No one person can fix all of Haiti,” said Mr. Jeaneddy, a short, muscular man with the bark of a drill sergeant. “Each has to fix his own piece.”

Earthquake injuries are not the only urgent medical problems on Avenue Poupelard. The quake has left many thousands of Haitians who have H.I.V./AIDS without the antiretroviral medication that they need to stay healthy. On Thursday, scores of newly homeless Haitians managed to make their way to a dermatology clinic on Avenue Poupelard, where a guard let them wait for assistance on the wooden benches of the open-air waiting room.

The clinic, which used to focus on leprosy and now treats many AIDS patients, is damaged but standing. Its staff members, many of them also homeless, have been showing up for a couple of hours a day to dispense pills.

One patient, Yvose Descosse, 38, wore a turquoise flower in her hair, and twisted her beaded necklace as she spoke in a soft sing-song. She had walked three hours to the clinic from her tent city in the sprawling slum of Cité Soleil. Having missed an appointment the day after the earthquake, she had run out of pills and found herself racked by diarrhea and vomiting — on the streets, no less.

Further, she added, patting her very small belly, she was eight months pregnant and the father of her baby had been killed during the earthquake.

“I needed to come to Poupelard, where they will help me,” she said, covering her face with her hands.

Seated near her, Claude Chevalier, 24, a medical student who has H.I.V., said the earthquake had killed his mother, father and sister and left him completely alone. “Everyone in Haiti is in the same situation,” he said, closing his eyes briefly, then shrugging.

Not everyone can shrug. For some, the dispiriting reality inspires grim thoughts. Florence Mabeau, a former Red Cross janitor, said she almost envies her teenage daughter for lying unconscious at the General Hospital: “I wish I could sleep through this nightmare,” she said.

Ms. Mabeau was squatting in the mechanic’s yard opposite the dermatology clinic, where about 300 people have taken shelter in junked cars. It is one of the largest encampments in the neighborhood, with extended families crowding into broken-down vans and painted jitneys. At night, they reserve the best car seats — where there are seats — for the babies, and sleep in the open air.

Conditions are harsh. The people pool their pennies to buy small packets of water and spaghetti, they have no running water or electrical generator and diarrhea is rampant. And now, most have little patience for questions about where they were when the earthquake struck. What’s gone is gone, some say, slapping their hands. But others cannot help but yearn for what they lost.

Huguette Joseph, 53, who shares a yellow Nissan bus with 10 children and grandchildren, said she did not have much before the earthquake, living in a leaky, one-room house. Still, she said, “I had my own house. I had my own kitchen. I had my own pots for cooking. I had shoes on my feet.”

Sermon Amid the Ruins

Before the earthquake battered the large Evangelie de la Grâce Church, Pastor Enso Sylvert said he routinely drew hundreds of worshipers who spilled out onto the sidewalk for Sunday services. Now he has a gravel lot and a circle of folding chairs, but during a morning service last Thursday, his faith was on fire. He wore a salmon shirt, bounced on the balls of his feet and thrust his Bible in the air, working a crowd of displaced residents into a good-spirited frenzy.

“We call the president ‘Onion,’ ” he said in a chant, using a Creole insult. “We call the ministers ‘Onion.’ We call the government ‘Onion.’ Our only hope lies with God.”

For a couple of hours, the service enlivened the camp beside the church, a ragtag assemblage of working-class and poor neighbors who once coexisted in the various structures — main house, cottage, shacks — on an old villa property with an empty, cracked swimming pool. Jean-Claude Gouboth, 36, a thin, serious man in an Italian soccer shirt whose small store was crushed in the earthquake, lived in the main house, now damaged.

That made him the de facto leader of the impromptu refugee camp, a post that he did not appear to relish. Life was not easy before the earthquake, he said, with three children to put through school and mounting debt to the bank underwriting his business. But now his 3-year-old girl had been killed by the quake, his wife and other children had fled to the countryside, and he was sleeping with the neighbors in his rocky backyard.

“We are trying to stay on friendly terms, but sometimes there are disputes,” he said, citing not a squabble over scant resources, but a theological debate about exactly what God was trying to say when he shook Haiti to its core.

Jesumelle Gustave, 44, who lives in the rubble of the church, does not participate in such esoteric conversation. She thanks God, she said, for leaving $4 in her husband’s pocket when the earthquake killed him, money that she has needed to sustain her family of five, including a son with a broken back and an amputated finger.

“How merciful is God!” she said, as the little boys in the encampment kicked a soccer ball onto Avenue Poupelard and across the street to a schoolyard where some friends are living.

Two slim teenage girls ran past them in flip-flops, mattresses on their heads. The school, its roof knocked off, has one wall chiseled away to reveal a blackboard chalked with the chemistry homework assigned the night the earthquake struck.

“We don’t have school anymore in Haiti,” Sophonie Daniel, 17, said. “Can we come to your country to study?”

Her friend Danuela Bayard, a 21-year-old marketing student, chimed in: “We are young, and we don’t want to waste our time in life. This earthquake just paralyzes our lives.”

Damien Cave contributed reporting.

Wednesday, January 27, 2010


(Photo of Dr. Jennifer Carroll examining baby with congenital heart disease in Port-au-Prince, Haiti.)

Hard lessons, humility for big-city doctors in Haiti

By Elizabeth Cohen, CNN Senior Medical Correspondent

Doctors arriving in Haiti learn there is no technology, no basic equipment
Doctors created operating room with no surgical lights, oxygen, blood or ventilators
After witnessing death of children, surgeons quicker to give permission to amputate

Port-au-Prince, Haiti (CNN) -- Dr. Roberto Feliz and Dr. Hiba Georges were quickly jolted from the most modern of medical care in Boston, Massachusetts, to the most rudimentary of care when they flew to Haiti last week to work at a hospital housed in two tents run by the University of Miami.

The doctors, who worked at the Boston Medical Center, quickly learned that when you have no technology -- not even the simplest blood test -- you have to make medical decisions in an entirely different way.

The first death they witnessed taught them a valuable lesson.

The patient was a boy who needed his leg amputated or else he would die of either an infection or rhabdomyolysis, a kidney disease that follows injuries where muscles are crushed.

Find loved ones in Haiti | Share your story

Feliz, Georges and the other doctors had nowhere to take the boy. Their own hospital had yet to open its operating room, so they spent hours trying to find a hospital that could do surgeries. Their search was in vain.

Finally, the doctors decided to do the surgery themselves that night by the moonlight under a mango tree.

"We just sawed his foot off. We didn't have to use anesthesia because he was already unconscious and wasn't feeling a thing," Feliz says.

But they'd waited too long. The boy took his last breath during the surgery.

"Some of the doctors cried," Feliz says. "I told them, 'There is no crying in medicine.'"

As a direct result of the boy's death, a few hours later, at 3 in the morning, the surgeons at the University of Miami hospital decided to build their own operating room. They had no surgical lights, no oxygen, no blood, no ventilators and no monitors. For a tourniquet they used one of the doctor's belts.

"We'd been waiting to build the operating room until we received better equipment, but after that boy's death we became more aggressive. We said let's do it, because they're going to die anyway," Feliz says.

The doctors continued to learn lessons about what one had called "civil war medicine" after the operating room went up.

At one point, a 16-year-old boy needed an amputation, but the surgeons asked Feliz and Georges to make sure the boy's kidneys were working before they put him through surgery. Without any blood tests to assess kidney function, the only thing they could look for was urine as a sign that his kidneys were working.

"We tried to see if we could get some urine going, but there was not a drop. We filled him with fluids and gave him Lasix, a diuretic, to get him to pee, but nothing," Feliz says.

The boy died as the doctors were treating him.

"I saw a lot of deaths there, but this one hit me the hardest," he says. "I texted my wife back at home, 'I've had a bad day.'"

After that boy's death, surgeons were quicker to give permission to amputate, Feliz says.

Feliz says if there's any silver lining to practicing such rudimentary medicine, it's that it made him a more humble doctor.

"Back in Boston, I'm a hot shot. The nurses have to respect me," Feliz says. "Here, I'm just a worker bee. I cleaned the OR floor after surgery. I carried dead bodies down the street. I was in traffic carrying dead bodies. That makes you human. I came here a very fancy doctor, and I'm leaving here as a humble man."

New Civilization Discovered Close to Florida

(Photo by John Carroll)
The Onion reports new civilization discovered.

After reading their report the people in Haiti DO seem human.

I wonder if OSF-SFMC in Peoria is aware of this breaking news?

Tuesday, January 26, 2010

Madame Mellon of Hopital Albert Schweitzer

The young girl pictured to the right is Mirterlande. I took this picture in 2006.

Haitian Hearts first examined her during the fall of 2006. She clearly had a damaged mitral valve due to rheumatic fever and was in congestive heart failure.

We were able to bring her to the United States at the end of 2008 where she underwent mitral valve replacement by and excellent surgeon at an excellent medical center. Mirterlande is doing very well today.

Mirterlande is from Haiti's central plateau. She told us that she had been hospitalized as a child at Hopital Albert Schweitzer (HAS) for heart problems.

HAS was founded in the mid 1950's by Dr. Larry Mellon and his wife Gwen Mellon. They built the hospital for approximately 1.5 million dollars with their own money.

I had the opportunity to transport a patient to HAS in 1981. My patient was a little 5 year old boy that had fallen off a donkey, struck his head, and was leaking cerebrospinal fluid from his fractured skull.

HAS accepted the little boy and the pediatrician placed him on antibiotics. I begged this physician to send me follow up. Several months later I received a letter from this Haitian pediatrician who told me that the little boy survived, did well, and was discharged.

In 1987 I was able to work at HAS from July until November. It was the best medical experience of my life. Dr. and Mrs. Mellon were elderly at that time but still lived close to the hospital and were very involved in the daily operation of the hospital.

My friend David Volk and his wife Dr. Lauze Volk worked at HAS ten years ago. David sent me the following post written by Ian Rawson. Mr. Rawson is the son of Gwen Mellon. The lady he refers to in the post is his mother.

Please see article below.

Tuesday, January 26, 2010

Each day I try to go through the hospital several times in the early morning, during the day and in the evening. I try to encourage the people who are waiting for surgery and their families, and then to check on the progress of those who are recovering from their procedures. I have become quite close to several of these strong people, and our visits buoy the spirits of both of us.

We have never asked people about their experiences in the earth quake, but some now want to be able to express themselves about the disaster. One of my special friends is an elderly lady who has required two surgical procedures, with her leg in traction between them. She has endured pain and discomfort with strong perseverance (that's the word she used). She has a beautiful smile, which she usually shares with me each time I visit. If not, I know that she is suffering.

Once, when I went to see her, the bed was gone, but her son, who has not left her side, indicated that he wanted to talk, so we went out the ward door to a breezeway, and sat on a concrete bench. His mother comes from a small community on the north side of the Artibonite River. She had come in to Port Au Prince with her family to prepare for the daughter's wedding. When the quake hit his mother was buried in the rubble of a 3-story apartment building.

Miraculously, her sons found her and carried her to a nearby house. One of the sons drove to three hospitals to seek help for her broken leg, but he only found bodies of people which had been carried there by distraught families. The son returned to report to his mother, who was coming out of the initial shock of the quake. She told her children to take her home. Why? They asked, and she told them about the hospital across the river where she had gone when they were young, to have an operation.

The sons drove around buying gasoline, for which the price had doubled, and started on the road to Deschapelles and Hôpital Albert Schweitzer. On the way, she told them about the hospital and the American woman who visited her every day.

I met her the day after she arrived, when she stopped me to ask me when she would have her operation. We talked a while, and she asked if the American lady was still there and I explained that she was not, but as the American lady was my mother, she had taught me how to care for our patients. That earned me the first of her beatific smiles.

She said that she will be my Mami, and I am honored with the relationship.

Later today, she will have her second operation and will be on her way to recuperation, and I am certain to be graced with another of her smiles.

Ian Rawson

Haiti's Shameful Medical State

The young lady pictured to the right is Mona. She lives in southern Haiti and has the most common cyanotic congenital heart disease called Tetralogy de Fallot. Most people with heart defect do not make it out of their teenage years. Mona, being Haitian of course, survived. She needs surgery and I am looking for a medical center in the States to accept her.
Please help if you know of a good medical center that would operate adults with congenital heart disease.

Below is a commentary written from the heart by a team of doctors that found the medical situation in Haiti worse than they could imagine.

Doctors: Haiti Medical Situation Shameful

By Drs. Dean Lorich, Soumitra Eachempati and David L. Helfet, Special to CNN

Doctors gathered sophisticated team and equipment for Haiti on private plane.
They found nobody in charge, chaos, hospitals had nothing, not even elementary equipment. Plane sent with equipment; supplies hijacked; resupply plane not allowed in. They say the "lack of support for our operation by the United States is shocking."

Editor's note: Dr. Dean G. Lorich is the associate director of the Orthopaedic Trauma Service at the Hospital for Special Surgery and New York Presbyterian Hospital and teaches orthopedic surgery at the Weill Medical College of Cornell University. Dr. Soumitra Eachempati is a medical researcher with a clinical surgical practice and teaches at Weill Cornell Medical College. Dr. David L. Helfet is professor of orthopedic surgery at Weill Cornell Medical College and director of the Orthopaedic Trauma Service at the Hospital for Special Surgery and New York-Presbyterian Hospital.

New York City (CNN) -- Four years ago, the devastating Hurricane Katrina affected millions in the United States. The initial medical response was ill-equipped, understaffed, poorly coordinated and delayed. Criticism was fierce.

The response to Haiti has been the same. The point no one seems to remember is this: Medical response to these situations cannot be delayed. Immediate access to emergency equipment is also crucial.

Within 24 hours of the earthquake, Dr. David Helfet put together a 13-member team of surgeons, anesthesiologists and operating room nurses, with a massive amount of orthopedic operating room equipment, ready to be flown directly to Port-au-Prince on a private plane.

We also had a plan to replace physicians and equipment -- within 24 hours, we could bring in whatever was necessary on a private jet. We believe we had a reasonably comprehensive orthopedic trauma service; as trauma surgeons, we planned to provide acute care in the midst of an orthopedic disaster.

We expected many amputations. But we thought we could save limbs that were salvageable, particularly those of children. We recognized that in an underdeveloped country, a limb amputation may be a death sentence. It does not have to be so.

We thought our plan was a good one, but we soon learned we were incredibly naive. Disaster management in Haiti was nonexistent.

The difficulties in getting in -- despite the intelligence we had from people on the ground and Dr. Helfet's connections with Partners in Health and Bill and Hillary Clinton -- only hinted at the difficulties we would have once we arrived.

We started out Friday morning and got a slot to get into Port-au-Prince on Friday. That was canceled when we were on the runway and was rescheduled for the next day. We were diverted to the Dominican Republic and planned on arriving in Port-au-Prince on Saturday.

That Saturday morning slot also was canceled and postponed until the afternoon. The airport had one runway and hundreds of planes trying to land. But nobody was prioritizing the flights.

Once we finally landed, we were taken to the General Hospital in Port-au-Prince with our medical supplies. We had been told that this hospital was up and running with two functioning operating rooms.

Once we arrived, we saw a severely damaged hospital with no running water and only limited electrical power, supplied by a generator. Surgeries were being performed in the equivalent of a large storage closet, where amputations were performed with hacksaws.

This facility could not nearly accommodate our equipment nor our expertise to treat the volume of injuries we saw.

We quickly took our second option: Community Hospital of Haiti, about two miles away. There, we found about 750 patients lying on the floor. But the facility had running water, electricity and two functional operating rooms.

We found scores of patients with pus dripping out of open extremity fractures and crush injuries. Some wounds were already ridden with maggots.

About a third of these victims were children. The entire hospital smelled of infected, rotting limbs and death. Later on, we would judge our surgical progress by the diminishment of the stench.

In our naïveté, we didn't expect that the two anesthesia machines would not work; that there would be only one cautery available in the entire hospital to stop bleeding; that an operating room sterilizer fit only instruments the size of a cigar box; that there would be no sterile saline, no functioning fluoroscopy machine, no blood for transfusions, no ability to do lab work; and the only local staff was a ragtag group of voluntary health providers who, like us, had made it there on their own.

As we got up and running and organized the patients for surgery, we told our contacts in the United States what we needed. More supplies were loaded for a second trip. Those included a battery-operated pulse lavage, a huge supply of sterile saline and the soft goods we needed desperately in the operating room.

The plane landed as planned Sunday night, and the new equipment was loaded onto a truck. Then that truck, loaded with life-saving equipment, was hijacked somewhere between the airport and the hospital.

We had planned to run a marathon round-the-clock operation and leave at 11 p.m. Tuesday. We worked for 60-plus hours without stopping. The plane that would take us home would bring with it not only a new medical staff, but also equipment that was nonexistent in the hospital, or even the country.

These pieces of equipment, two of each, were urgently needed: portable anesthesiology machines; electrocautery machines to stop bleeding after amputations; portable monitors for the recovery room; autoclaves to sterilize equipment; and a lot of orthopedic equipment, which we were quickly using up. The other items were those that were on the previous flight and had been hijacked.

Officials at the Port-au-Prince airport canceled that plane's 6 a.m. Tuesday slot, and the plane never made it to us on time.

We had started to see daylight Monday night, having performed about 100 surgeries, which were mainly amputations, fixing broken limbs and soft tissue debridements. Many of the patients were children and babies.

But on Tuesday morning, a huge number of new patients arrived. The Haitians had heard we were trying to save limbs, and families were bringing their injured loved ones to us.

The hospital was forced to lock down, closing its gates to the angry and frustrated crowd outside. On Tuesday morning, we saw that many of the patients we had operated on were becoming septic and would require additional surgeries.

We finished operating at noon Tuesday, our last surgery assisting an obstetrician on a Caesarean section and helping to resuscitate a newborn who was not breathing.

We decided the situation was untenable. Our supplies were running out, our team was past exhaustion, safety was rapidly becoming a concern, and we had no firm plan to leave or resupply.

A hospital benefactor helped us get to the airport. First, Jamaican soldiers with M-16s escorted us out of the building as the crowd outside saw us abandoning the hospital. We made it to the airport on the back of a pickup, got onto the tarmac, hailed a commercial plane that had carried cargo to Haiti and was returning to Montreal, Canada, and had a private jet pick us up from there.

We were unprepared for what we saw in Haiti -- the vast amount of human devastation, the complete lack of medical infrastructure, the lack of support from the Haitian medical community, the lack of organization on the ground.

No one was in charge. We had the first hospital in the Port-au-Prince area with functioning operating rooms, yet no one came to the hospital to assess how we did it or offer help.

The fact that the military could not or would not protect the critical resupply medical equipment on Sunday, or allow the Tuesday flight to come in, is devastating and merits intense investigation.

There was no security at the hospital. We needed a much higher level of security with strong and clear support of the military from the very beginning.

The lack of support for our operation by the United States is shocking and embarrassing and shows how woefully unprepared we are for the realities of disasters. We came to understand that our isolated operation may work in a mission, but not in a disaster.

We first thought we would support those at the helm but soon realized we were almost the only early responders with the critical expertise and equipment to treat an orthopedic disaster such as this.

Still, nobody with a clear plan is in charge, and care is chaotic at best. Doctors are coming into the country with no plan of what they are going to do, and nobody directing them how to do it.

Surgeons who expect to show up and operate will be mistaken. Without a complement of support staff and supplies, they are of limited to no value.

We left feeling as if we abandoned these patients, the country and its people, and we feel terrible.

Our role back in New York is to expose the inadequacies of the system in the hopes of effecting change immediately. Patients who are alive and still have their arms and legs remain in jeopardy unless an urgent response is implemented.

The quickest and most efficient way to really help now and support the medical staff on the ground is to assess needs, provide equipment and personnel in necessary quantities, and bring them safely and expeditiously into the country and to the hospital units caring for patients.

Upon our departure, we witnessed pallets of Cheerios and dry goods sitting on the tarmac helping nobody. Yet our flight of critical medical equipment and personnel had been canceled, and the equipment that did get through was hijacked.

We implore an official organization to step up and take charge of the massive ongoing medical effort that will be necessary to care for the people of Haiti and their children. And to do it now.

The opinions expressed in this commentary are solely those of Drs. Dean Lorich, Soumitra Eachempati and David L. Helfet.

Sunday, January 24, 2010

Piling Insult on Seismic Injury

(Photo by John Carroll)
January 24, 2010
Indianapolis Star

Dan Carpenter

Piling Insult on Seismic Injury

It took no time at all for the politically conservative and the just plain complacent to extend the blame for Haiti's trauma to Haitians.

Not just poor folks, but a "culture of poverty," one pundit intoned. A beggar nation in need of some "tough love."

Cursed for presuming to liberate themselves from French slavers two centuries ago, a noted televangelist assured us.

A corrupt government, whose subjects the Rev. Martin Luther King Jr. would warn us not to "throw money at" if he were here for the earthquake that greeted his birthday, a blogger for The Star surmised.

On and on. And there's worse. Some of the invective long-suffering Haitians have elicited from readers of my columns would make these armchair patronizers seem like advocates for them.

And Haiti has advocates, among them some of the best minds and hearts in America. If the mainstream media and the average Joe would listen to them and read some history, the Haiti we know would cease to exist -- because the Haiti we think we know would precede it into oblivion.

Martin Luther King? Here's how the distinguished author and Boston Globe columnist James Carroll summed that matter up in his holiday piece:

"The catastrophe of Haiti would be no mere symbol of global inequity to King. He was attuned to the real suffering of individual human beings, and would be part of the effort to alleviate it there. But would he be satisfied with the compassion of the moment? Moral sentiment unattached to structural analysis, and to changes in systemic causes of poverty, is worse than useless. The Haiti earthquake might be deemed an act of God, but King would rage at any characterization of the foundational Haitian plight that left out historical factors like slavery and colonialism, or the defining contemporary influence of the United States, which, across the years since King's death, has, in relation to Haiti, defiled the meaning of neighbor."

Want specifics? Margaret Trost, author of "On That Day Everybody Ate," a chronicle of her volunteer work in Haiti, notes that Haiti was self-sufficient in rice, its staple, until the 1980s, when a loan from the International Monetary Fund required reduction in tariff protections for agricultural products. Subsidized rice from the United States poured in, most Haitian farmers went out of business, U.S. rice leaped in price, and millions of Haitians fell into starvation (hence, needing Margaret Trost) and fled to the coastal cities, sitting ducks for hurricanes and earthquakes.

This is called context. It takes more work and more imagination to appreciate the history of foreign influence in Haiti than it does to write its people off as heathens who cannot govern themselves. The white largesse upon which these proud, struggling people are said to depend has been lavished mostly on their oppressors -- dictatorships, military juntas, corporations paying slave wages and no taxes, election opponents of the country's true populists.

One prominent Haitian who suffered personally from American foreign policy, the late Rev. Gerard Jean-Juste, delighted in telling me his country vastly enlarged this one by forcing the French, hurting for cash because of the Haitian rebellion, to offer the Louisiana Purchase.

France, of course, billed the breakaway nation at gunpoint for the loss of its property, creating a debtor status that has never changed.

Is it unfair to suggest that the debt goes both ways?


Saturday, January 23, 2010

Blind Student from Haiti Organizes Drive

See this unbelieveable story.

Haitians never quit surpising the world with their tenacity and will to live.

More on Haiti's Elite

(Photo by John Carroll)

In the highest hills of Pétionville, above the ruined Haitian capital, there
are no dead on the streets. There is no rubble.

The earthquake that killed tens of thousands in the city below hardly
touched the people of this wealthy neighborhood.

``Most of them chose to leave Haiti until the situation improves,'' said
Jean Robert, 55, a worker who has been reinforcing walls in the posh
neighborhood. ``There are homes that have had damage. But they're few, and I
don't think it's a problem. They'll build other ones.''

On the lower sides of the same hill, the change of scene is dramatic: The
straight, spacious, tree-lined streets give way to a tangle of tiny homes.
Bodies still lie amid the rubble, and the victims await help from
international relief agencies.

But at the top, business goes on as usual. The hotel Ibo Lele remains open ,
and there are hardly any cracks in the walls of apartment buildings such as
La Clos. Even the church, Divine Mercy Parish, is lucky. There will likely
be a Mass on Sunday, and a crack on one of the altar walls will be repaired

``The situation here is different,'' said Father Calixto Hilaire, the parish
priest, acknowledging that the impact of the quake was hardly felt among the
wealthier families in the district.

Hilaire, who has been in charge of Divine Mercy Parish since 2001, says he
feels pain at the uncertainty and chaos that surrounds Port-au-Prince. He
says he has been waiting for the wealthier parishioners to offer help, but
until now, only one family of the hundred or so that attended services two
weeks ago has contributed canned goods, water or medicines.

Janel Lettes, a private security guard who keeps watch and handles the
maintenance on a Pétionville mansion, is not surprised that the wealthy have
not helped more. He says many residents left the neighborhood for the time
being, fearing the aftershocks that have shaken the capital since the
earthquake last week.

Lettes carries a shotgun and wears a T-shirt identifying him as a guard. His
employer's five-bedroom home, which features a pool and satellite-TV dish,
was damaged by the quake and will have to be demolished.

But Lettes said that won't be much of a headache for the owner, a
businessman who left the country shortly after the quake and who plans to
rebuild as soon as materials are available.

``Aside from that, as you can see, all is tranquil,'' he said. ``It sounds
like a bad joke, because those below are living through hell, and the people
are hungry and desperate.''

The problems of Pétionville are small in comparison to the devastation in
Port-au-Prince. Gas for the popular four-wheel-drive SUVs is scarce, and the
ballet school has closed for the time being. The nearby golf course has been
taken over by the U.S. military, which coordinates some relief efforts from
there, including moving quake victims to safer areas of the country.

``It's hard to understand. I think things are worse now than at the
beginning,'' said Cabrini Demesmin, 30, an artistwho creates paintings and
drawings for Pétionville's residents.

Demesmin inherited a Pétionville home from his father, a well-known lawyer
who died several years ago. Demesmin shares the home with a dozen family
members who fear that the worst is yet to come.

``They have told us to beware of the aftershocks, at least for another
month,'' he said.

Meanwhile, Lettes, the security guard, spends his time listening to the news
on the radio and asking himself where the half a million people who have
been left homeless will end up.

He mused: ``There's a lot of space on the hills of Pétionville.''

© 2010 Miami Herald Media Company. All Rights Reserved.

The Haiti I Michael Diebert

(Photo by John Carroll)

The Haiti I love is Still There

Returning to my sometimes-home, I discovered devastation and friends who died, but the country's heart is beating
By Michael Deibert

Jan. 23, 2010

One night, only days after an earthquake had leveled huge swaths of Haiti's capital, Port-au-Prince, and killed an estimated 200,000 people there and in its environs, I found myself cruising thorough the city on the back of a moto-taxi.

A crowded, dirty but also irrepressibly vibrant city during normal times, Port-au-Prince that night presented a landscape that could fairly be described as nightmarish.

Visible through the darkness, the ruined shells of buildings destroyed in the 7.0 quake looked over the fragile forms of hundreds of thousands of people reduced to sleeping in the streets, while in the air mingled the corrosive smell of burning garbage and the vomitous, cloyingly sweet stench of human decay.

A city I have sporadically called home since I first visited Haiti in 1997, and whose personality had become deeply ingrained in my soul, Port-au-Prince had never seemed more desperate or defeated.

Then something happened. Despite the terrible suffering that had been visited on this poor nation of 9 million people, it began to dawn on me that, along the streets that I knew so well, life was going on after this terrible trauma.

Next to the shell of Haiti's Palais National, the hypnotizingly white grand dame of the city's architectural jewels that successive Haitian politicians have fought to control even as their country grew ever-more impoverished and ruined, market women were still frying up marinade and fritay in old steel pots. In the Petionville market, despite the late hour and lack of electricity, goods and fried chicken were still being sold by the orange glow of kerosene lamps. By the following day, dozens of young Haitians had begun sweeping with brooms in front of the ruined Cathédrale Nationale, in preparation for the Saturday funeral on its grounds of Archbishop Serge Miot, who perished within its walls.

"I've worked with this moto for my entire youth," the driver, a young man named Emmanuel, told me that night as we headed up Avenue Pan American, passed the ruins of the United Nations compound where scores of United Nations workers, including mission chief Hédi Annabi, and his deputy, Luiz Carlos da Costa, lost their lives.
"Tout moun jwenn," Emmanuel told me as we conversed in Haiti's native Kreyol language. "Kounye-a, y'ap domi ak Jesu." Everyone was hit. Now they sleep with Jesus.

Far from being the looting mobs that some media have portrayed them as, hardly anyone who has witnessed the response of the Haitians to this great catastrophe has not been moved by their incredible resilience and solidarity and their intact sense of humor in the face of an unimaginable tragedy.

As all the pillars of the Haitian state -- a state that has often seemed only able to rouse itself to parasitically victimize its own people when it did make its presence felt -- collapsed around them, the Haitians helped one another, dug through rubble, prayed, sang and showed everyone who has watched them what the meaning of true perseverance in the face of adversity looks like, even though the losses have been tremendous and irreplaceable.

Micha Gaillard, a university professor and son of one of Haiti's eminent historians, was one of the first political leaders I met while traveling to Haiti, and I recall him greeting me in his modest home in the Turgeau neighborhood as his charming wife, Katy, prepared us coffee. Katy passed away far too early a few years ago, and Micha died after the Palais de Justice collapsed on him, dying in what must have been agony after having been trapped for many hours. Three of the country's foremost feminist thinks -- Myriam Merlet, Magalie Marcelin and Anne Marie Coriolan -- also died that day. The damage to the country's artistic heritage, from the almost-total collapse of the Episcopal Cathédrale Sainte Trinité, which boasted stunning indigenous murals by such eminent Haitian painters as Wilson Bigaud and Philome Obin, to the loss of much of the Nader art collection, probably the best private collection of Haitian art in the world, is incalculable.

Sometimes since I have returned to Haiti in the immediate aftermath of the earthquake, I have felt as if I would be overcome by despair. Looking at block after block of ruins throughout the capital's downtown, or seeing the terrible death and destruction caused by the collapse of the Université de Port-au-Prince, ringed by weeping, desperate relatives of those lost, one almost wants to turn away.

But the Haitians, always the Haitians, keep one going, and seeing their dignity in this moment has made me love them and their battered country as never before.
"Life goes on," a friend of mine who lost his wife in the earthquake told me yesterday, bringing to mind the famous Haitian proverb, deye mon gen mon. Beyond the mountains there are more mountains.

There is time to mourn a loss, and to bury the dead. More aid is needed, and more transparency and coordination to get it out to people, not just now but over the long term.

But step by step, I believe that Haiti, a country of personal goodwill and stunning artistic accomplishment as much as it is a place of dysfunctional politics and venal politicians, will indeed rebuild. Perhaps differently than before, but a people who have suffered and endured so much seem, in my conversations with them on street corners under the blazing sun, in tent cities that have sprung up along the roadside, and in grievously affected provincial villages, to be able to withstand even this latest grievous shock and come back swinging.

I hope that we foreigners, who have been so moved by the place, treated so kindly and educated so patiently by its people, will be there to help. Haiti needs its friends now more than ever.

Michael Deibert is the author of "Notes From the Last Testament: The Struggle for Haiti." He writes at

Haiti's Elite

(Photo by John Carroll)
Haiti's Elite Hold Nation's Future in their Hands

A few businessmen like Gregory Mevs will decide how -- or whether -- Haiti recovers from one of the worst natural catastrophes in modern times.

By Tracy Wilkinson

January 21, 2010

Reporting from Port-Au-Prince, Haiti

Gregory Mevs leaped from his armored silver Toyota SUV and marched past the guards and mango trees into what serves these days as the center of the Haitian government.

He was ready to dispense a million gallons of fuel to the earthquake-ravaged capital. But the paperwork was not in order. He needed the Haitian prime minister's signature.

Ten minutes later, he had it.

Mevs can do that. He has the prime minister's ear. He hobnobs with people like Bill Clinton, George Soros and the chief executives of the world's largest corporations. He is one of Haiti's storied elite, a member of one of the six families that control the Haitian economy and have essentially called the shots here for generations.

They are mostly light-skinned, multilingual entrepreneurs with a dismal reputation for profiting handsomely on the backs of the poorest people in the hemisphere. The actions they take now will prove decisive in how -- or whether -- Haiti recovers from one of the deadliest natural catastrophes in modern times.

"A lot of friends say, 'Get out, it's only going to get worse before it gets better.' But all of us have to be here," said Mevs, a solidly built, slightly balding man of 50. "We have to rebuild. There is no choice."

The rich do have a choice. They could easily pull up stakes and go somewhere else. The question is whether they will go, or whether they will decide to throw themselves into the (potentially money-making) business of reconstruction.

As of Wednesday, the majority seemed bent on the latter, pledging to do what it takes to get Haiti back on its feet.

Some have described Haiti's earthquake as "democratic" because it afflicted poor and rich alike. That would be an oversimplification.

The rich are never hurt the same way the poor are. Their capacity for revival, thanks to resources, private planes and visas, vastly outdistances that of the poor and middle class.

Certainly, however, they are suffering too. Their houses and offices also collapsed. Few, if any, of their number died, but there were injuries and the loss of friends and employees.

It takes people with Mevs' skills and wherewithal to get much of anything done in Haiti these days. What's left of the government -- every major institution was pulverized -- has essentially ceded important sections of the recovery operations to the businessmen.

In theory, these businessmen report to a committee that includes members of President Rene Preval's administration, but most are acting independently. It has to be that way, they'd argue.

"We have, more than ever, a tremendous responsibility to help this country rebuild. We are needed," Mevs said. "I know people, I have access, I can get financing, I know how to negotiate."

Mevs' days are filled with all that and more. His BlackBerry buzzing incessantly, he rushes to hospitals to see how much gasoline they need, then gets it for them. He oversees the off-loading of tons of Dutch aid. He sets up computers for the provisional government, which is working out of a police station flying the Haitian flag at half-staff.

In Armani eyeglasses and Hugo Boss jeans, with a Mont Blanc pen in his shirt pocket, Mevs climbed into the armored SUV one day this week and escorted two reporters through some of the damaged parts of his empire.

The Mevs family owns all the petroleum storage facilities in the country, 30% of the Internet business, a 2.4-million-square-foot industrial park and a network of 50 warehouses for food and other material, among many other properties.

Mevs figures he lost as much as $40 million at the wharf his family owns, where most oil shipments are received. That's only a fraction of his financial losses, however. And when half the wharf fell into the sea, it took 54 workers with it.

Most of the elite are descendants of Europeans who in the mid- to late 1800s came to Haiti, a nation that had been founded largely as a slave plantation. (Mevs' grandfather came from Hamburg, Germany, in search of a rare breed of parrot.) They were -- and are, for the most part -- merchants. Their money is from commerce.

They control all the major sectors of the economy, from banking and telecommunications to apparel factories and food. They go to the French schools here, and they attend university in Miami. They vacation in Europe. They live farther up the hills that rise above the squalor of Port-au-Prince.

Haitians sometimes refer to them as the Bambam, each letter the initial of one of the six families. During tense times under populist President Jean-Bertrand Aristide, when politicians stoked class warfare and pointed to the nation's egregious income gap, they were called MREs. Not after the packaged military "meals ready to eat"; rather, the initials stood for "morally repugnant elites."

Patrick Elie, a leftist sociologist who has been extremely critical of Haiti's elite, said the magnitude of the disaster may shake the wealthy out of their complacency. Several have spoken of feeling "humbled" by the ordeal.

"This crisis will separate those who can pick up and go from those with real roots, who are heavily invested in Haiti and whose survival depends on the survival of the country," Elie said.

As if to suggest the beginnings of a new Haitian world order, Elie was sitting outside the government's refuge next to Mevs' brother, Fritz -- an ardent Aristide ally wearing a Che Guevara cap next to one of Haiti's wealthiest men. They embraced.

Gregory Mevs bristled when a visitor referred to him as part of the cabal of families running the place. It's an unfair and outdated image, he argued. Years of dictatorship stifled any sense of civic duty, he said, but today's globalized economy means that entrepreneurs can no longer cling to colonial ways.

"My generation is between two worlds," he said. "We had to learn how to reach out, we had to learn to work with social responsibility."

Mevs' house, next door to the prime minister's, was damaged, and he and his family have been camping at a friend's house, sleeping on their lawn. His children, who were at home when the quake hit, watched in horror as an exterior wall collapsed and crushed the family gardener to death. Mevs' niece was among the people trapped at the Hotel Montana, a legendary salon for the Haitian elite and visiting intelligentsia that pancaked into a concrete mountain. Rescuers pulled her from the rubble.

As Mevs traveled about Port-au-Prince, he bounced between eagerness to rebuild and despair over the devastation. His chauffeur has been so traumatized, he said, that he has been in two wrecks in the last few days.

Mevs noted that Haitian construction uses a lot of pillars and concrete slabs to withstand hurricanes. No one was thinking much about earthquakes, he said. The gorgeously quaint slat-wood house built in 1911 that serves as Mevs' main office endured the quake undisturbed.

He acquired the armored vehicle with darkened windows and diplomatic license plates four years ago at his wife's request, he said. He was working a lot in Cite Soleil, the enormous slum that abuts some of his commercial properties.

The license plates speak to another quirk of Haiti's elite: Most have finagled posts as honorary consuls of any number of countries. It's sort of a status symbol, like owning the latest iPod.

Mevs is the official consul of Finland.

Copyright © 2010, The Los Angeles Times

Friday, January 22, 2010

Healing Haiti

January 22, 2010

Op-Ed Contributor
To Heal Haiti, Look to History, Not Nature

HAITI is everybody’s cherished tragedy. Long before the great earthquake struck the country like a vengeful god, the outside world, and Americans especially, described, defined, marked Haiti most of all by its suffering. Epithets of misery clatter after its name like a ball and chain: Poorest country in the Western Hemisphere. One of the poorest on earth. For decades Haiti’s formidable immiseration has made it among outsiders an object of fascination, wonder and awe. Sometimes the pity that is attached to the land — and we see this increasingly in the news coverage this past week — attains a tone almost sacred, as if Haiti has taken its place as a kind of sacrificial victim among nations, nailed in its bloody suffering to the cross of unending destitution.

And yet there is nothing mystical in Haiti’s pain, no inescapable curse that haunts the land. From independence and before, Haiti’s harms have been caused by men, not demons. Act of nature that it was, the earthquake last week was able to kill so many because of the corruption and weakness of the Haitian state, a state built for predation and plunder. Recovery can come only with vital, even heroic, outside help; but such help, no matter how inspiring the generosity it embodies, will do little to restore Haiti unless it addresses, as countless prior interventions built on transports of sympathy have not, the man-made causes that lie beneath the Haitian malady.

In 1804 the free Republic of Haiti was declared in almost unimaginable triumph: hard to exaggerate the glory of that birth. Hundreds of thousands of enslaved Africans had labored to make Saint-Domingue, as Haiti was then known, the richest colony on earth, a vastly productive slave-powered factory producing tons upon tons of sugar cane, the 18th-century’s great cash crop. For pre-Revolutionary France, Haiti was an inexhaustible cash cow, floating much of its economy. Generation after generation, the second sons of the great French families took ship for Saint-Domingue to preside over the sugar plantations, enjoy the favors of enslaved African women and make their fortunes.

Even by the standards of the day, conditions in Saint-Domingue’s cane fields were grisly and brutal; slaves died young, and in droves; they had few children. As exports of sugar and coffee boomed, imports of fresh Africans boomed with them. So by the time the slaves launched their great revolt in 1791, most of those half-million blacks had been born in Africa, spoke African languages, worshipped African gods.

In an immensely complex decade-long conflict, these African slave-soldiers, commanded by legendary leaders like Toussaint Louverture and Jean-Jacques Dessalines, defeated three Western armies, including the unstoppable superpower of the day, Napoleonic France. In an increasingly savage war — “Burn houses! Cut off heads!” was the slogan of Dessalines — the slaves murdered their white masters, or drove them from the land.

On Jan. 1, 1804, when Dessalines created the Haitian flag by tearing the white middle from the French tricolor, he achieved what even Spartacus could not: he had led to triumph the only successful slave revolt in history. Haiti became the world’s first independent black republic and the second independent nation in the Western Hemisphere.

Alas, the first such republic, the United States, despite its revolutionary creed that “all men are created equal,” looked upon these self-freed men with shock, contempt and fear. Indeed, to all the great Western trading powers of the day — much of whose wealth was built on the labor of enslaved Africans — Haiti stood as a frightful example of freedom carried too far. American slaveholders desperately feared that Haiti’s fires of revolt would overleap those few hundred miles of sea and inflame their own human chattel.

For this reason, the United States refused for nearly six decades even to recognize Haiti. (Abraham Lincoln finally did so in 1862.) Along with the great colonial powers, America instead rewarded Haiti’s triumphant slaves with a suffocating trade embargo — and a demand that in exchange for peace the fledgling country pay enormous reparations to its former colonial overseer. Having won their freedom by force of arms, Haiti’s former slaves would be made to purchase it with treasure.

The new nation, its fields burned, its plantation manors pillaged, its towns devastated by apocalyptic war, was crushed by the burden of these astronomical reparations, payments that, in one form or another, strangled its economy for more than a century. It was in this dark aftermath of war, in the shadow of isolation and contempt, that Haiti’s peculiar political system took shape, mirroring in distorted form, like a wax model placed too close to the fire, the slave society of colonial times.

At its apex, the white colonists were supplanted by a new ruling class, made up largely of black and mulatto officers. Though these groups soon became bitter political rivals, they were as one in their determination to maintain in independent Haiti the cardinal principle of governance inherited from Saint-Domingue: the brutal predatory extraction of the country’s wealth by a chosen powerful few.

The whites on their plantations had done this directly, exploiting the land they owned with the forced labor of their slaves. But the slaves had become soldiers in a victorious revolution, and those who survived demanded as their reward a part of the rich land on which they had labored and suffered. Soon after independence most of the great plantations were broken up, given over to the former slaves, establishing Haiti as a nation of small landowners, one whose isolated countryside remained, in language, religion and culture, largely African.

Unable to replace the whites in their plantation manors, Haiti’s new elite moved from owning the land to fighting to control the one institution that could tax its products: the government. While the freed slaves worked their small fields, the powerful drew off the fruits of their labor 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 Dessalines — now Emperor Jacques I — “but don’t make it scream.”

In 1806, two years after independence, the emperor was bayoneted by a mostly mulatto cabal of officers. Haitian history became the immensely complex tale of factional struggles to control the state, with factions often defined by an intricate politics of skin color. There was no method of succession ultimately recognized as legitimate, no tradition of loyal opposition. Politics was murderous, operatic, improvisational. Instability alternated with autocracy. The state was battled over and won; Haiti’s wealth, once seized, purchased allegiance — but only for a time. Fragility of rule and uncertainty of tenure multiplied the imperative to plunder. Unseated rulers were sometimes killed, more often exiled, but always their wealth — that part of it not sent out of the country — was pillaged in its turn.

In 1915 the whites returned: the United States Marines disembarked to enforce continued repayment of the original debt and to put an end to an especially violent struggle for power that, in the shadow of World War I and German machinations in the Caribbean, suddenly seemed to threaten American interests. During their nearly two decades of rule, the Americans built roads and bridges, centralized the Haitian state — setting the stage for the vast conurbation of greater Port-au-Prince that we see today in all its devastation — and sent Haitians abroad to be educated as agronomists and doctors in the hope of building a more stable middle class.

Still, by the time they finally left, little in the original system had fundamentally changed. Haitian nationalism, piqued by the reappearance of white masters who had forced Haitians to work in road gangs, produced the noiriste movement that finally brought to power in 1957 François Duvalier, the most brilliant and bloody of Haiti’s dictators, who murdered tens of thousands while playing adroitly on cold-war America’s fear of communism to win American acceptance.

Duvalier’s epoch, which ended with the overthrow of his son Jean-Claude in 1986, ushered in Haiti’s latest era of instability, which has seen, in barely a quarter-century, several coups and revolutions, a handful of elections (aborted, rigged and, occasionally, fair), a second American occupation (whose accomplishments were even more ephemeral than the first) and, all told, a dozen Haitian rulers. Less and less money now comes from the land, for Haiti’s topsoil has grown enfeebled from overproduction and lack of investment. Aid from foreigners, nations or private organizations, has largely supplanted it: under the Duvaliers Haiti became the great petri dish of foreign aid. A handful of projects have done lasting good; many have been self-serving and even counterproductive. All have helped make it possible, by lifting basic burdens of governance from Haiti’s powerful, for the predatory state to endure.

The struggle for power has not ended. Nor has Haiti’s historic proclivity for drama and disaster. Undertaken in their wake, the world’s interventions — military and civilian, and accompanied as often as not by a grand missionary determination to “rebuild Haiti” — have had as their single unitary principle their failure to alter what is most basic in the country, the reality of a corrupt state and the role, inadvertent or not, of outsiders in collaborating with it.

The sound of Haiti’s suffering is deafening now but behind it one can hear already a familiar music begin to play. Haiti must be made new. This kind of suffering so close to American shores cannot be countenanced. The other evening I watched a television correspondent shake his head over what he movingly described as a “stupid death” — a death that, but for the right medical care, could have been prevented. “It doesn’t have to happen,” he told viewers. “People died today who did not need to die.” He did not say what any Haitian could have told him: that the day before, and the day before that, Haiti had seen hundreds of such “stupid deaths,” and, over the centuries, thousands more. What has changed, once again, and only for a time, is the light shone on them, and the volume of the voices demanding that a “new Haiti” must now be built so they never happen again.

Whether they can read or not, Haiti’s people walk in history, and live in politics. They are independent, proud, fiercely aware of their own singularity. What distinguishes them is a tradition of heroism and a conviction that they are and will remain something distinct, apart — something you can hear in the Creole spoken in the countryside, or the voodoo practiced there, traces of the Africa that the first generation of revolutionaries brought with them on the middle passage.

Haitians have grown up in a certain kind of struggle for individuality and for power, and the country has proved itself able to absorb the ardent attentions of outsiders who, as often as not, remain blissfully unaware of their own contributions to what Haiti is. Like the ruined bridges strewn across the countryside — one of the few traces of the Marines and their occupation nearly a century ago — these attentions tend to begin in evangelical zeal and to leave little lasting behind.

What might, then? America could start by throwing open its markets to Haitian agricultural produce and manufactured goods, broadening and making permanent the provisions of a promising trade bill negotiated in 2008. Such a step would not be glamorous; it would not “remake Haiti.” But it would require a lasting commitment by American farmers and manufacturers and, as the country heals, it would actually bring permanent jobs, investment and income to Haiti.

Second, the United States and other donors could make a formal undertaking to ensure that the vast amounts that will soon pour into the country for reconstruction go not to foreigners but to Haitians — and not only to Haitian contractors and builders but to Haitian workers, at reasonable wages. This would put real money in the hands of many Haitians, not just a few, and begin to shift power away from both the rapacious government and the well-meaning and too often ineffectual charities that seek to circumvent it. The world’s greatest gift would be to make it possible, and necessary, for Haitians — all Haitians — to rebuild Haiti.

Putting money in people’s hands will not make Haiti’s predatory state disappear. But in time, with rising incomes and a concomitant decentralization of power, it might evolve. In coming days much grander ambitions are sure to be declared, just as more scenes of disaster and disorder will transfix us, more stunning and colorful images of irresistible calamity. We will see if the present catastrophe, on a scale that dwarfs all that have come before, can do anything truly to alter the reality of Haiti.

Mark Danner is the author, most recently, of “Stripping Bare the Body: Politics, Violence, War,” which chronicles political conflict in Haiti, the Balkans, Iraq and the United States.

Thursday, January 21, 2010

Better to Light one Candle...

See Elaine Hopkins post regarding local support of Haiti.

Pictured to the right is a small Haitian Hearts patient with her mom.

January 21, 2010

Peoria connections with Haiti: inside stories

PEORIA -- Many people from central Illinois are involved in charities that attempt to help Haiti. Below are some accounts of what's really going on there. The first is from Dr. John Carroll, a founder of Haitian Hearts, which arranges for heart surgery for Haitians.

He writes:

1. None of what happened or is happening in Haiti is surprising to me. The courage of the Haitian people during adverse circumstances is what I am used to seeing.

2. The international community is a day late and a dollar short as usual. Haiti's government is mainly absent right now. Haiti's government has actually been absent for many years. The Haitian people have no trust in their government whatsoever. Haitian police are executing looters right now. Haitian police have told the people of Cite Soleil to kill gang members that have escaped from the prison when it fell.

Building codes, infrastructure, clean water, basic things needed to be in place like humans deserve, decades before the quake. The quake would still have happened, but recovery would have been much quicker and less lives lost.

3. And why is PAP so densely populated? Because people can't survive in the countryside because the trees have been cut down, deforested, because they use the trees to make charcoal to cook. But with deforestation, the erosion is terrible during the rainy season and the Haitian farmers can't plant and grow crops. So they can't live and wonder in from the country side and live in massive shanty towns in the capital. The shanty towns, frequently named for the area in the countryside (province) where they come from, may have hundreds of thousands of people.

Haitian farmers have been hurt by food that comes in from overseas and sold on the market for much less than the Haitian farmer can sell his grain. Haitian farmers work by hand and hoe, not big tractors. They have no good fertilizer.

So if PAP, which may be able to accommodate 400,000 people, did not have 3 million people living on top of each other, there would be less chaos and less death now because the epicenter was just a few miles west of PAP. Now, people are fleeing the capital to head out to the pathetic and poor countryside. The roads are damaged even more, the villages are flattened south and west of the capital, and people are even leaving on overcrowded ferries. And we know that overcrowded Haitian ferries don't historically do well. One trip in the early 90's, I saw hundreds of bodies at the General Hospital of people that drowned on a ferry called the Neptune...several thousand people lost their lives on the Neptune, and it barely made international news.

4. The Haitian elite of course has not been interviewed by the media. They really control Haiti and are hunkered down in their big homes, surrounded by security, or have already left Haiti for New York, Montreal, Miami, etc. It used to be said that 40 influential Haitian families controlled 40% of the wealth in Haiti. What plans do Haitians elite have to rebuild Haiti? They have no plan of course. They have their textile factories, etc, which with globalization enslave the Haitian people all the more.

5. The stages of Disaster Medicine are playing out in Haiti. First there is the acute injuries and confusion. Extrication of victims is on everyone's mind. Now we are entering Stage II of infection, lack of water, new water borne diseases, lack of security, lack of housing, new orphans, and what we all forget is the psychological trauma of surviving an earthquake while your family doesn't.

6. Maria and I have probably received or sent 400-500 emails or phone calls in the last 8 days. My patients call from Haiti or send an indirect message through a friend or send a message via internet. Many Haitian Hearts patients are homeless and living on the street. You can listen to a voice mail I received last night from a Haitian friend living on the sidewalks begging for help. They have lost all of their medicine and all of their material goods. Of all the patients we have played a roll in bringing to the US for surgery, we have lost one 7 year old girl who was killed instantly in her house as the quake hit. She had been operated in Saint Louis a couple of years ago.

7. Haiti's future is uncertain to say the least. It will take decades to "recover".At least one silver lining is that the world for the first time has seen the courage of the Haitian people and their suffering. Most of Haiti's days have been bad during the last 29 years that I have been working there. This will be the worst natural disaster ever recorded in the Americas in my opinion.

These are a few of my thoughts about the disaster....

Again, an ounce of prevention would have been worth a pound of cure...the camera crews will leave shortly, and Haitians will have some help, but not enough.
-- Dr. John Carroll

This commentary is from Pat Sloan of Hands Helping Haiti. The website gives some information, and here's more:

Our group is a 501(c)(3). We have people involved primarily between Peoria and Rockford, Illinois. We sponsor a clinic in Hinche and just built a school last year near Jacmel. We sponsor a number of children and the school as well. We have 4 Haitian staff.

Thank goodness our school and staff are OK. All the children we've found have been OK, although most of their houses have been damaged or destroyed. We stay somewhat in contact, but it is very difficult, because the cell phone system is not working well and they are not getting new fuel for their generators yet.

We do at least one medical clinic per year which involves 12 - 20 from the states and about the same number from Haiti. We will be rescheduling our trip for as soon as we can. We've been preparing for months to go down Feb. 1, but that won't happen now.

I help with the clinic and the school construction, but mostly now about our water filter project which we were on the verge of starting production. It will be somewhat delayed, but this earthquake just points out even more that safe drinking water is of utmost importance.

-- Pat Sloan

Also, see Pam Adams article below.

Let's not fail poor Haiti again

Pam Adams

Journal Star
Posted Jan 20, 2010 @ 10:30 PM
Haiti is never far from central Illinois.

No further than right around the corner or just down the block, there's a neighbor who cared for, maybe adopted, a Haitian child brought here for heart surgery through the Haitian Hearts program.

Or a cousin who travels there often on medical mission trips with Friends of the Children of Haiti.

Or a co-worker who's involved with Haiti Mission Connection, another Peoria-based group that organizes medical mission trips to Haiti.

There's a friend who was a foster mom to teenage refugees fleeing Haiti in the 1980s, or a member of one of many area churches that do the trips, raise the money to help feed, house and school Haiti's poorest.

Even before the earthquake, Haiti and its problems had been growing closer to central Illinois. One friend, one church, one co-worker, one cousin, one neighbor is connected to 10, and 10 are connected to hundreds who give time, money or compassion to the island nation best known as one of the poorest countries in the world, the absolute poorest in the western hemisphere.

Poor Haiti. Already doomed to dependence on the kindness of strangers, and now a major earthquake has crushed the country to the bone, leaving much of the capital, Port-au-Prince, in ruin, displacing some 3 million people and who-knows-how-many tens of thousands dead.

To go to Haiti 30 years ago was to return to central Illinois with a sublime appreciation for the marvel of running water and traffic stoplights. To go to Haiti today is to confront wreckage that leads a coordinator of Doctors Without Borders to tell the Associated Press, "We were forced to buy a saw in the market to continue the amputations."

Poor Haiti. With each passing day, the death toll climbs as deaths due to natural disaster give way to deaths due to the man-made disasters that hinder aid to the injured, avoidable deaths brought on by the economic and political poverty that leaves Haiti's social infrastructure virtually paralyzed in the aftermath of a massive earthquake.

Central Illinois and Haiti are close. Haiti and the United States are linked.

The barren land known as Haiti was once a fertile colony of France. It was France's richest colony, producing at various times in its very early history three-fourths of the world's sugar, coffee, rum and cotton.

If the United States was the first independent nation in the Americas, Haiti was the second. Both countries share a history of revolution to overthrow colonial masters. After that, the histories diverge. An independent U.S. feared an independent neighbor where slaves had overthrown slave masters. The U.S. went on to become the richest country in the hemisphere, Haiti the poorest.

As one partial explanation of Haiti's persistent poverty goes, in Haiti, slaves overthrew their masters and Haitians have been paying for it ever since - beginning with billions paid, essentially in reparations to the French, to gain diplomatic recognition from the rest of the world.

Haiti's own legacy of corrupt regimes combined with our own often disastrous political, economic and immigration policies toward Haiti have continued almost to this day.

"For some of us Haiti is a neighbor and, for others of us, it is a place of historic and cultural ties," former President Bill Clinton told the Washington Post. "But for all of us it is now a test of resolve and commitment."

Current President Barack Obama has promised the U.S. will not fail the test.

U.S. policies toward Haiti have not always been as benevolent as the efforts of the friend, the church, the co-worker, the cousin, the neighbor in central Illinois. But if there was ever opportunity in disaster, it's time for this nation's long-term policies toward Haiti to get closer to what Haiti needs rather than what the U.S. wants.

Pam Adams is a columnist with the Journal Star. Her e-mail address is

Copyright 2010 Some rights reserved

Tuesday, January 19, 2010

The Sound of a Wooden Bell....Can you Hear us Now?

A Haitian proverb says:

"No one hears the cry of the poor or the sound of a wooden bell."

Haitian Hearts protested when OSF-SFMC was slow to do the heart surgery on a sick Haitian baby boy. After he arrested at home, we asked OSF, why? And when we went to the Catholic Diocese of Peoria to report this incident, we were told by the Vicar General to "let me know if this ever happens again."

Can you hear us now?

Haitian Hearts protested and notified the OSF Pediatric Resource Center when a young Haitian Heart's patient's pre operative work up was cancelled. She was put on the schedule immediately after we notified them of medical abandonment by Children's Hospital of Illinois.

Can you hear us now?

OSF-SFMC told the Journal Star that Haitian Hearts would not change at the end of 2001. We knew better. OSF cut all funding of Haitian Hearts six months later.

Can you hear us now?

Haitian Hearts picketed OSF when the Executive Director of Children's Hospital of Illinois called the American Consulate in PAP and asked the Consulate to deny any visas for children coming to OSF for heart surgery. The Consulate official in Haiti became tearful as she told me this story in Haiti. She knew that this would cost Haitian kids their lives. And it has.

Can you hear us now?

Haitian Hearts picketed OSF when Willie Fortune was denied any care at OSF when full charges were offered to OSF to pay for a new pacemaker after his old pacemaker failed. OSF's CEO Keith Steffen stood behind 88 year old Sr. Canisia while both looked out her administration office window at us. Mr. Steffen smiled as Willie and I stood on the sidewalk. Sister Canisia did not see Mr. Steffen's antics behind her, but Willie did.

Can you hear us now?

Keith Steffen told me that fear amongst empoloyees at OSF is a good thing.

Can you hear us now?

Jackson Jean-Baptiste and Maxime Petion both became ill in Haiti. Both were OSF patients and Haitian Hearts patients. Both needed repeat heart surgery to stay alive. OSF refused to care for either of them and they both died extremely painful deaths. Both are buried outside of Peoria.

Can you hear us now?

Heurese was denied repeat surgery at OSF too. She had heart surgery elsewhere and was denied a post operative outpatient echocardiogram at OSF. And last year OSF's attorney contacted the non immigrant visa section of American Consulate in Port-au-Prince requesting private information on Heurese. For what reason?

Can you hear us now?

And Jenny e mailed me from Haiti last night. She had heart surgery at OSF in 1999. She was on the fourth floor of a building in Port-au-Prince during the earthquake. She escaped with no physical injury. However, she states that she is not good and has lost all of her medication that Haitian Hearts provides her. She needs repeat heart surgery but OSF is denying her any care. Is this not insane?

Can you hear us now?

And Bishop Jenky assumed control of the Haitian Hearts program to cover for OSF's public relations nightmare. However, Bishop Jenky's fear of OSF's money was obvious when he told me that OSF was a "1.6 billion dollar industry" and refused a Catholic Tribunal Court against OSF stating, "I won't rule against OSF."

OSF and The Catholic Diocese of Peoria, can you hear the Haitian people now?

(Maxime Petion photo above, one month before his death.)

Haitian Hearts Patients Still Hungry and Thirsty

We have had contact with many Haitian Hearts patients in the last week who are victims of the Haitian earthquake.

Pictured above is Katia and below is Suze. Both had valve replacements several years ago at Provena St. Joseph's Medical Center in Joliet, Illinois. Both are homeless in Port-au-Prince and without any medication to prevent them from clotting off their artificial valves.

Our patients are contacting us via cell phones, cybercafes, and through friends and relatives in the United States.

Most have lost everything and are living on the streets with their families and neighbors. Our patients are pleading with us for water and food. They repeatedly tell us that international aid has not reached them.

Haitian Hearts has received significant donations from many generous people. These funds will go to our Haitian Hearts patients and families who are homeless and also to the Daughters of Charity Pediatric Clinic in Cite Soleil.

When one leaves Port-au-Prince and travels south and west, there is a huge amount of destruction. Roads and bridges are bad and villages have been leveled.

See Michael Diebert's article below.

One Week in, Haitians Are Still Hungry

By Michael Deibert

Posted Tuesday, Jan. 19, 2010, at 11:34 AM ET

LEOGANE, Haiti—When Elvis Cineus rushed to his home in the town of Leogane, 18 miles west of Port-au-Prince, in the aftermath of Haiti's devastating earthquake, he was not prepared for what awaited him.

Under the remains of his home, smashed flat as if pummeled by a giant fist, lay the bodies of his wife, his nephew, his cousin, and a friend, all dead. His 1-year-old son was dangling from the building's jagged facade, injured but alive.

"It was a miracle," he says of the infant's survival. "But I think there are still survivors in the fallen schools, because we still hear them screaming."
This coastal town, once one of the most pleasant in Haiti, was largely decimated by the quake. The International Federation of Red Cross estimates that as much as 90 percent of the town has been destroyed.

Along Leogane's Grand Rue, once-stately concrete buildings lie in rubble, with only a few structures built in Haiti's distinctive wooden gingerbread style remaining. The putrid smell of death wafts through the lanes, helped along by an ocean breeze.
At a ruined dental clinic, a woman cries when she tells how a neighbor died after her leg was severed by falling debris and how the neighbor's child, a little girl, took off screaming down the street.

"It's beyond chaos, beyond catastrophe," says Michael Moscoso, a local businessman. "The losses cannot be numbered."

One week after the earthquake flattened large swaths of central Port-au-Prince, people beyond the capital and closer to the epicenter have grown ever more desperate as much-promised aid has been slow to trickle in or has failed to materialize altogether.

In the Médecins Sans Frontières hospital in the capital's southern Carrefour neighborhood, several hundred people lay on makeshift surgical tables, on benches, or sprawled on the floor. Half a dozen people groaned with severe suppurating burn wounds caused when a gas cylinder exploded during the great tremor. Nine-year-old Michel St. Franc lay with blood caking his face, his leg in a primitive cast and tears in his eyes.

"This is the worst situation I've ever seen," says Julien Mattar, project coordinator for the hospital. "We have huge needs in terms of human resources, medical supplies, and materials."

Mattar tells me that a supply plane that was unable to land in Port-au-Prince was instead rerouted to the Dominican Republic. From there, the supplies made the seven-hour overland journey to Haiti.

The injured who were able to reach the hospital were the lucky ones. Farther down the road, both the living and the dead waited for respite in the form of assistance from the international community or from the government of Haitian President René Préval, who has faced withering criticism at home for his perceived lax and disorganized response to the disaster.

Along the Route des Rails, almost every home seemed to have been destroyed, and, again, the intense smell of decay intensified under a glaring Caribbean sun. Residents say they feel abandoned.

"No one has ever been here," Vilaire Elise, a 38-year-old Protestant minister, said as he led a visitor and fellow residents to survey homes where his neighbors had died. "We have no water to drink, nor food to eat. We are suffering here."

Though nearly 105,000 food rations and 20,000 tents had been distributed by humanitarian groups on Monday, the effort seemed unable to come to grips with the scale of the disaster. The U.N. World Food Program has said it will need 100 million prepared meals over the next 30 days.

The growing foreign military presence in Haiti, which has played host to a U.N. peacekeeping mission since 2004 and will now house at least 2,000 U.S. troops, also seemed overwhelmed.

Late on Monday, with the sun setting outside Leogane, in a scene reminiscent of others played out in severely war-torn countries such as the Democratic Republic of Congo, at least 1,500 townsfolk rendered homeless by the quake took over a flat patch of grassy land and constructed fragile shelters from logs, twigs, bed sheets, and leaves.

"Since the disaster, everyone here has had nothing," said Innocent Wilson, a 31-year-old who acts as one of the impromptu camp's spokesmen. "No one is here to help us, so we are organizing ourselves."

Michael Deibert is the author of Notes From the Last Testament: The Struggle for Haiti.