60 Minutes

This is a really good story that aired Sunday on 60 Minutes. It touches on many of the issues that people are really frustrated with. Government says its a lack of money. NGOs say its the government interference or worse. And the international community is too nervous to make good on their commitments.

I've driven past those tents on the road to Carrefour many times and have distributed medicines in that tent city. We've also donated to that Partners in Health Hospital.

It's a bad sign that it takes seeing it on film to make me remember how bad it is down there. It has all started to become the new reality for people in Haiti and it's not hard to imagine a future where those tents and those camps just become the norm.

Dr. Charles

An hour and a half after leaving the crowded streets of Port au Prince, we arrived at the gates of the new Camejo Hospital in Leogane, a town only 20 miles outside the capital city where the January 12^th earthquake was centered. After honking our car horn at the gate, an older man dressed in nurse scrubs and holding a machete opens the gate and waves us in. Like every time I pass through one of the large metal gates in Haiti, I have no idea what I’m going to find on the other side. In this case, what we see is a lush piece of land, two football fields in length, with a wooden building standing in front of a larger, mostly collapsed, concrete building. This is the site of the new Camejo Hospital that is being run by Doctor Joseph Charles and the Camejo Group, a group of Haitian doctors of various specialties.

Working in Haiti over the past ten months, I’ve constantly found myself wondering what the country looked like before the earthquake. Like so many other aid workers I’ve meet here, I had never been to Haiti prior to January of this year so I have no personal reference for the state of the country before “the twelfth,” as they say here. However, what I can do is compare what it looks like now to what I witnessed when I first arrived at the end of January. Unfortunately not much has changed. Although the rubble is finally beginning to be cleared from the streets, very few homes or businesses have been rebuilt and all of the tent camps that sprung up in the immediate aftermath remain. The cramped conditions of the tent cities are unsanitary, unsafe, and provide no real shelter from the brutal sun and constant rain. And as we all are well aware of now, these are the conditions where cholera thrives.

Depending on who you talk to, you’ll get a different answer for the reason behind the slow recovery effort. Some say the government is underequipped and unprepared to deal with a recovery effort of this size. Some say that the non-governmental organizations (NGOs), which have received most of the aid money that’s been given for Haiti thus far, are short-sighted and unable to work within the government’s reconstruction plan. And some say that the Haitian people have become so dependent on foreign aid (it’s said that Haiti has more aid groups per capita than any other nation) that they often rely on outsiders to help solve their problems for them instead of taking the initiative. Clearly, there are aspects of all three at play. But Dr. Joseph isn’t using any of these excuses – and he is going to prove that Haiti can be rebuilt better than it was before the earthquake.

Dr. Joseph is a Haitian surgeon and his wife Dr. Marie is a pediatrician, however between them they have about a dozen different medical degrees and certificates. Although he couldn’t tell me for sure, Dr. Joseph thinks there are probably only one or two other Haitian surgeons working in Leogane, a town of over 250,000 people. I first went to see their clinic back in February to see if Direct Relief could help supply them with medicines and supplies because there were almost no other medical facilities that survived the earthquake--although by that time numerous NGOs and foreign armies (including the US, Canadian, and Japanese) had come into town and set up field hospitals and clinics. When I arrived at the clinic, there were roughly 20 mothers with their babies waiting to see Dr. Marie and another handful of patients waiting to see Dr. Joseph. I remember feeling badly that I was taking their time away from their patients just to show me around their clinic.

Joseph and Marie were extremely grateful for the medical support that foreign groups were providing but they knew that in time, the foreigners would leave and it would be up to the Haitian people to figure out how to care for their own people. So shortly after the earthquake hit, Joseph and Marie’s son and daughter in law, Jodel and Sulfrance Charles, started an NGO called Renewal 4 Haiti in their hometown of Aurora, Colorado. They planned to raise funds to build a new surgical, referral hospital in Leogane. They already had the land, a parcel that was acquired from a patient who Dr. Joseph treated for free in 1988, but now there was a small wooden hospital on the site that the Canadian Army had built and operated out of when they were working in Leogane. Dr. Joseph let the Canadian Army use his land for free because they were helping the people in his town. In return, they left behind the brand new wooden building that was perfect for a temporary hospital because it is not made of concrete. People are wary of concrete in Haiti.

While there are plans in the works to build a permanent hospital on the site, for now there is no rush. Dr. Joseph has capacity for 20 beds, and while we were there about half of them were filled. Two people had typhoid. One patient had malaria. But thankfully there were no cholera patients yet. Recently they built another room which will serve as the operating theater, and Direct Relief has provided them with the funds to outfit it. Because the site is on a major highway that connects Port au Prince to the Western departments, Dr. Joseph expects to see many patients who have been injured in traffic accidents.

We asked him how he expects to fund and sustain a hospital in Haiti. The majority of Haitian people cannot pay for medical services, even at a place like Camejo Hospital where the supplies and medications are often given away for free. “There are ways to do it,” he said with a smile. “If someone comes in for a surgery and he cannot pay, we ask the family what they can do to help. Maybe they can work around the hospital for a week.” “Another way,” he says, “is if we have ten patients and only two can pay, they help pay for the others.” We found out later that the man with the machete who opened the gate for us will be the first one to have surgery when the new surgical suite opens. He has a hydrocele (an accumulation of fluid in a body cavity) that needs to be removed and is working there now to pay for it.

If only donors and NGOs can do more to encourage and support these kinds of activities instead of thinking about how to spend their money in the short term, Haiti can harness the talents of people like Drs Joseph and Marie Charles and indeed rebuild better.

End of Another Trip

Once again I find myself sitting in a Florida airport contemplating the trip I've just returned from. This one-week trip absolutely flew by as compared to the past few where I've spent three weeks down there and usually had at least a bit of down time to process some the things that I'd been through and experienced.

First off, and on a totally different note, I should say that it's extremely unfortunate that Brazil just lost to the Netherlands 2-1 in the World Cup. Haitian people are completely obsessed with Brazilian football and the country has been in a fervor as they've been winning over their past games. It really seemed like it was one of the few things keeping many of those people upbeat. The first night we got there, we almost couldn't get to our house because of the parades and parties in the streets that thronged late into the evening. The past wins and future predictions were on everyone's lips and I'm sure the country feels like they've just suffered another huge letdown. It sounds strange to say but anyone who has experienced the World Cup outside of the Unites States will know what I mean.

Ok, back to my contemplation in the airport...

The big question on all of our minds during this trip now that we are nearing the 6 month anniversary of the earthquake was, "are things any better now than they were 5 months ago when we first got down there?" On the surface, it appears that they really are not. The tent cities seem to have grown even bigger since the last time I was there. Actually, a 'tent city' doesn't really describe it very well but I'm not sure what else to call it. Basically any open space the city has to offer, from the park in front of the collapsed presidential palace, to the median in the center of the highway, to ravines where the rain water flushes thru after any heavy rain, has turned into a place where people have either put up a tent or a tarp so they can have a place to sleep. For the first few months, there often weren't toilets or running water for these people to use so the hygiene was appalling. Typhoid has now broken out in many camps, as has outbreaks of scabies and TB. Violence and rapes are on the rise and families have taken to sleeping in shifts so they can keep watch for each other.

Six months on, the larger of these camps are much more organized and sanitary now because most of the larger tent camps have been taken over my at least one NGO that usually provides water, toilets, and possibly a health clinic. However, the fact remains that it has been 6 months and people are still living in appalling conditions.

Food provisions have been cut off so as to limit dependency yet there are almost no options for employment (aside from the "cash for work" programs for which the lucky few Haitians can earn $5 a day cleaning the streets, piling rubble, or cleaning the latrines in the camps). Schools are back in session but they are asking parents to pay for the 5 months that they weren't operating. And hospitals are functioning again yet many facilities are so poor that patients are required to not only buy their medicines and pay the doctor visit, but also buy the latex gloves the doctor uses to examine you with or the needle and syringe he uses to treat you with.

Rubble removal throughout the city is almost non existent, and since the government has been so slow to provide any help or guidance on rebuilding people's homes, people have begun to do it on their own using whatever wood, concrete, and bent rebar they can find.

So yes, things are still quite bad and it's both appalling and tragic that the government remains basically silent in the aftermath of this tragedy when they possibly could have galvanized the support of the entire world to rebuild Port au Prince and encourage decentralization by upgrading the infrastructure of the outlying cities. As it is, the opposite is occurring. People who initially left the city to live with family or friends around the country are now moving back into this city that was built for 500,000 that now hosts over 2 million people and counting. It seems that no matter how bad the outlook is in Port au Prince, prospects for jobs outside the city are worse.

However, despite all of this, I truly don't leave Haiti discouraged. To be quite honest, I don't think you can expect that after the largest natural disaster in the Western Hemisphere in the poorest country in the same region that things will be better, or even back to normal, within 6 months. I'm fairly certain that some people in New Orleans were still living in asbestos filled FEMA trailers years after Katrina hit and it took almost four years to start clearing out and rebuilding the Lower 9th Ward. It might be overly optimistic to think that Haiti, with the host of problems the country was already facing, should be able to move people back into their homes in that amount of time.

And at the risk of sounding like a broken record, I've gotten to meet and spend time with some incredible and dedicated Haitian people who are absolutely committed to lifting their country up from it's current state. These doctors, politicians, philanthropists, and activists have not given up on their people or their hopes for a better Haiti. They are frustrated by the Haitian leadership and by the soaring budgets of many of the large international NGOs in Haiti who are not focused on sustainability or empowering the Haitian people. But they are encouraged by the sad fact that as a result of this event, many of their hospitals are now better equipped, their schools are being rebuilt better, and the world may actually remain focused on Haiti for years to come.