I usually drove slowly on the roads in Haiti’s Artibonite Valley; they were a major thoroughfare for women walking to market, donkeys, and Tap-Taps, resurrected pickup trucks
which weave down the roads, filled to overflowing with passengers, goats, and sacks of grain. My old 2-door Japanese jeep couldn’t get up much groundspeed, anyway, and trips were usually leisurely jaunts. The afternoon was cool on that January day, and the valley floor looked beautiful, with the irrigated fields of green rice and sweet potato mounds. Suddenly, I found my car swerving wildly, and despite my efforts to control it, it pointed into a drainage ditch, and I fell into the passenger seat. Shaken, I quickly assessed my injuries; nothing important, but then questions – had I had a TIA, had my attention wandered, or at age 70, should I be driving at all? Then, as always happens in Haiti, people appeared out of the houses next to the road, and with great hubbub and poorly-coordinated but enthusiastic effort, lifted the small car onto the road. Out of the cacophony, I heard sound bites of fear-laden cries. “The ground shook”, “What happened?”, and “Lwo yo fashey, the gods are angry!” An old woman emerged, hitting people on the back with a small branch. “You are too young” She cried. “That was an earthquake! I remember them!”
Slowly, my clouded thoughts focused; there had been an earthquake, I had not caused the car to go off the road, and I had better get back to the hospital to see if it had been damaged. The 15-minute drive up the rocky corridor lasted forever, as crowds of people rushed onto the roads, shouting and crying. No houses seemed to have been affected, but the fear was contagious. I jumped up the steps to the hospital door into the always-crowded registration hall, and walked into the outpatient corridor, and then through the high-ceilinged wards, looking for cracks or other indications that the tremblors had damaged the facilities. Only slowly did it occur to me that the activities were normal; patients waiting outside consultation rooms, nurses guiding stretchers through the halls, employees greeting “Bon swa, Msie Jean”. A doctor approached me, waving his laptop. “The internet’s down! Can you get it fixed?” This was a common concern in our rural area, so I said that I would check on that, the most common resort of a busy administrator.
There were no cracks or fallen plaster; the hospital was designed in 1956 by an American architect whose previous assignment had been to build hospitals in South Asia, so ours was stressed against hurricanes, earthquakes and fire. It had endured for 50 years, and it appeared to have come through the day unmarked. So I turned to the inevitable concerns of the nurses and staff; a toilet was clogged, a cell phone has no reception, we have an injury from a nearby town – his two-story house had collapsed (not an uncommon occurrence in regulation-free construction), the internet was still down…. Slowly, a pattern emerged; things were not normal, but it wasn’t clear why. Nurses coming onto their shift said that people in their communities were frightened by the moving earth, but that things were returning to normal.
In Haiti, the absence of electronic communications had led to an efficient alternative – the telediol¸ the swift passage of news, often credited to magical powers, but with no scientific explanation. Now, the telediol sprung to life; a mototaxi driver who had brought a passenger from the crossroads with the major road to Port-au-Prince told about rumors of turbulence there; nobody’s cell phones worked, and now a common occurrence became a cause for concern. Radio stations were not on the air, and we were cut off from the outside. The demands of a 130-bed hospital shoved aside these minor irritants, and we prepared for the evening shift.
“There has been a tap-tap accident!” a security guard announced to the observation/emergency unit, and we followed him back to the front door. There, we encountered a familiar site; injured people lying in the beds of pickup trucks, often caused by the crash of an overloaded tap-tap. The injuries were familiar, and the security staff, which had been trained to transfer patients from the trucks to stretchers, carried them in to the triage zone next to the one-room emergency room. As other trucks arrived, it became clear that we were receiving patients from a major accident, and we opened the closet which was prepared for mass casualties. The triage system worked smoothly, and patients were selected to be brought to the observation unit, and security guards were sent to the homes of on-call physician and nurses. More trucks continued to line up in the driveway to the door. Some patients were carried from the back of the line by drivers, shouting for help.
Because we were focused on the needs of each patient, and had experience with accidents with as many as two dozens injured patient at a time, it only slowly dawned on us that there was something different now. The trucks and cars kept coming; as the 11 o’clock shift change approached, nurses arrive early and the ones who were there decided to stay to help. Patients were beginning to line the halls to the observation unit, and some were put on the long benches in the outpatient wing.
The patients were frightened and in pain; most had a companion who was also consumed with fear and now with some relief, described a harrowing 3-hour trip out from Port-au-Prince. We only listened to their stories with half an ear as we focused on the crushed bones and bleeding wounds. Slowly, the pieces fell into place – the quivering road, the loss of communications, and the flow of patients with crushing injuries all were explained. A terrible disaster had struck the capitol, and ours was the closest undamaged hospital.
We worked through the night, as all of the hospital staff came in from their nearby homes, the laboratory, blood bank, radiology, and operating rooms were opened up and staffed. No one gave out directions; the clinicians were experienced, and knew where to be and what to do. As the beds were filled and the corridors lined with benches, staff members went home to bring mattresses from their own beds to put on the floors for the patients. Companions of the patients were accommodated as much as possible, but eventually it was necessary to restrict one to each patient. As the crowd of patients increased inside, another large group assembled quietly outside, waiting on the steps or under the large Mapou tree.
And still they came; in cars and trucks, in pain and terrified. But quiet. Strangely quiet. Comforted by the knowledge that they were now in a safe place, their tensions relieved, they watched and waited until they were approached by hospital personnel. Our mass casualty stocks of patient labels were used up, replaced by the plain backs of sheets of printed papers from a recycling bin, with brief notes written in magic markers.
Late in the night, a patient was brought in with an IV line in his arm; we absorbed this anomaly, and then another and another followed, bandaged and splinted. I went outside to see where they were coming from; a large school bus, which is the long-range travel conveyance on Haiti’s roads, was pulling away. I asked the driver where he came from. He described an apocolyptical trip from one of the city’s hospitals, loading patients whom the few doctors had determined had a chance of survival and told to come to “Hopital Schweitzer”, passing through rubble-filled streets, hailed by desperate victims, and finally onto the major road north. I asked him where he was going; he answered with Haitian understatement, “M’ap touney”. “I’ll be back”.
Dawn arrived, the grey sky bleeding into red and yellow over the Artibonite Valley. Light flooded through glass louvres and screens of the hospital’s open walls. Patients stirred as the morning shift came on, and the evening shift remained. Housekeepers, not normally noted for their energy, continued to sweep away the bandages and plastic bags, keeping a narrow path in each hallway, offering encouragement to patients and their families. From the observation unit, we lifted stretchers over our heads to carry them down the halls to the corridors leading to the operating suite, laboratory and X-ray. Medical assistants marked each patient’s sheet of paper with a priority code, to be routed into the lab or operating rooms.
The line of tap-taps at the door was shorter, but never-ending. The crowd outside continued to grow, and the grounds staff attached a spigot to a 55-gallon drum filled with drinking water for them. Inside, several patterns emerged; Patients moved through the triage process, at the diagnostics and operating suite, and passed to newly-unoccupied beds as less acute patients were discharged. A semblance of order had been established by the nurses and doctors, with no supervisory direction. The acting Medical Director, Dr. Toussaint, a calm and self-confident neonatologist, served as a problem-solver, encouraging and commending each hospital worker. The companions of patients cared for their wounded relatives, and offered support to those in the next bed or bench. All of the hospital’s clinical staff had arrived, and stayed. There were no shift schedules any more, and there were no clear demarcation of roles. People did what was required, despite the limits of their professional competencies.
I saw a nurse from one of the hospital’s remote clinics, stepping smoothly at a bedside into an inpatient care role. I went over to thank her for coming to help, and she said “Of course, these are my brothers and sisters.” There is a considerable cultural space between the cities and the villages in Haiti, and she took a gracious interpretation of this assumed familial link to overcome the gap in education and wealth which these urban dwellers brought to our country hospital. This was not the time to observe differences, but to recognize the universality of pain and suffering.
The next weeks were a blur of sorts, filtered through sleep deprivation and the adrenaline surges of constant demands. With thanks to Allegheny Community College’s training as an EMT, my role shifted more to my administrative duties. Dr. Toussaint and I shared a small office off the main corridor, and we took turns napping in our beat-up but now luxurious office chairs. Here was no use going down to the Mellon House to rest; there were no beds there, and the staff had come up to help in the hospital.
Slowly, the blur of many images passed into focus; many patients had been carried out of their ruined houses on doors, and placed on them into the trucks to come out to Deschapelles. As the patients were transferred to stretchers, the doors were leaned against the large tree which shelters the front courtyard. The stacks continued to grow for more than a week, a visible but not statistically valid measure of the flow of patients. One morning, a pack of young boys and girls arrived at the door, dressed in pressed scouting uniforms with colored scarfs, and carting cartons of Styrofoam food boxes, which they distributed to each patient. When they ran out, they apologized, and returned within the hour with enough for all of the other patients. The adult leader stood back, proud of their calm work, and their tolerance for the distressing wounds of the patients, as they greeted each with a smile and words of encouragement. Beds were lined up on the corridor to the operating suite, and periodically a nurse would emerge, going up the line to select the next patient to be prepared for surgery. The eyes of the patients followed the nurse, somewhat hopefully, until she took a bed out of the line and wheeled it into the operating suite. No one complained, no one begged for priority.
One older woman, who had an NPO tape on her forehead which indicated she could not eat or drink before surgery, watched patients pass her bed to the surgery. I comforted her, and asked about her pain. She said simply, as she pointed to her leg, “It hurts”, and tapped the manila folder which contained her X-rays. I took one out, lifting it to the light from the screened half-wall, and swiftly shifted it so it she could not see my reaction as I looked at her shattered leg, which was mass of cracked and disconnected bones. I put the xray back in the folder, and gave it back to her. I said that I was sorry, that I hoped she could be brought into surgery soon. “Se bon”, she said, with a weak smile, “Persevérence”.No translation necessary for this typical Haitian reflection; “It’s OK; perseverance”. Life is hard for people in Haiti, but they have faith that it will get better, and that they will endure.
Now, five years after these painful days, it is clear that the perseverance which brought the Haitian people out of slavery to an uncertain freedom and autonomy, and allows them to proceed even in the face of grinding poverty, and which has brought them through the unimaginable terror and pain of the earthquake, is the residue of strength which carries them forward. For, despite the well-advertised flood of support and aid which has poured into Haiti, and sometimes disappeared without a trace, it is the strength, the dignity, and the perseverance of these proud people which provides the energy with which they have slowly rebuilt their capital and their nation, and which offers the ray of hope for a better future.
Ian Rawson served as the administrator of Hopital Albert Schweitzer from 2009 through 2012. He is retired and lives in Squirrel Hill.