Injustice

Let me explain to you the anger surging through me as I sit in the back of our pickup truck at 2:00 AM with the limp form of a child draped over my legs.

Travel back with me to 1:15AM.

Whimpering...sobbing....in the gentle, hesitant high pitch of a child. In the distant corner of the courtyard of our hospital, under a tarp. She is trying to be quiet. She knows it is dark in the hospital, and people around her are trying to sleep. Mewing like a small, injured kitten. Tears run down her cheeks. Her legs are pulled to her abdomen. Heat rises off her febrile form, burning. Her lower jaw trembles as a wave of rigors shakes her small body. Blistering fever.

Father looks on with quiet, concerned eyes. He stands above her and watches intently as I examine her in the small circle of light of my headlamp, kneeling beside her cot in the darkness. Her heart is racing. Heat radiates off of her body. I gently touch her abdomen. A small whimper escapes her dry lips and her glassy eyes open to meet mine. Her hand touches mine and attempts to push it away. "Fe mal..." she whispers weakly. "Fe mal..." It hurts...it hurts. I hold her small, protesting hand in my left, and push again gently with my right. Her eyes clench tightly. She sucks in a deep breath and whimpers again. Her belly is rigid. A frighteningly sick child.

"This is very bad..." I whisper to our nurse translator as I administer a dose of morphine. "We need to get her to a surgeon...now."

She had presented to our hospital earlier in the afternoon with high fever, headache and abdominal pain. We tested her for malaria -- which will become epidemic as the rainy season encroaches and the mosquito vectors reproduce in pools of standing water. She was, unfortunately, negative. "Unfortunately", because in Haiti, malaria is a very serious, but very drug sensitive illness which is relatively easily treated when diagnosed. With the easy diagnosis eliminated, the more concerning reared their ugly heads. Typhoid? A severe intestinal illness leading to bloody diarrhea, severe abdominal pain and sometimes intestinal rupture. Early appendicitis? Both requiring a surgeon.

Our pediatrician, earlier in the day, drove with the girl to Miami Field Hospital to consult one of the volunteer American pediatric surgeons. The surgeon evaluated her, and advised that her illness was early, and nonspecific, and that we should watch her carefully, treating for possible infection. This is a common medical practice, even in the United States -- watch the patient closely, and await for the illness to "declare itself" into a specific diagnosis. If it declares, come back immediately.

So, at 1:15AM, the illness declared. Quite vigorously. And absolutely. Intestinal perforation. Millions of small bacteria from the intestines spilling violently into the pristine, sterile cavity of the small child's abdomen. An exquisitely painful and potentially deadly event.

We called our midwife, who lives one street over, and has a truck, begging a ride back to the Miami Field Hospital. Father carried his precious child to the back of the pickup and lay her gently across my lap. And in the darkness of early morning, we drove through the deserted streets of Port au Prince, to the only available surgeon in the city. The heat of her body burned across mine, small moans escaping her lips.

The Miami Field Hospital is located in a series of large tents inside the walls of the Port au Prince airport. It was set up within the days after the 12 January earthquake, and placed to be central and convenient to patients, international volunteer medical providers, and imported medical resources/equipment. From outside, it is a series of giant white tents; inside, a bustling field hospital with a lab, pharmacy, xray, and adult, pediatric and neonatal ICU. It is our -- and much of Haiti's -- only referral center for patients requiring intensive emergency and surgical care, as much of the city's medical infrastructure was destroyed in the quake, and many medical professionals were killed. At present is the last hope of many of Haiti's sickest patients.

At 2am, we arrived at a new entrance to the hospital -- a set of wooden gates recently placed into the concrete wall surrounding the airport. This new, unadvertised, unmarked and solitary entrance to the Miami Field Hospital was luckily discovered by our clinic staff during the visit to the hospital the previous day.

Our American midwife, 20 year resident of Haiti, pulled the pickup truck in front of the gates and sounded her horn repeatedly. The gate was locked tight.

"How can the gates be locked?" I asked. "This is crazy."

She honked the horn again and again, echoing in the early morning darkness. Finally, from behind the gate meandered a man in dark clothing appearing to carry a weapon. A security guard. She honked her horn again. The man did not move.

Our midwife turned to our Haitian translator. "Go tell him to open the gate. Tell him we have a sick child in the truck, and this is a medical emergency."

Our translator exited the truck, running to speak to the man behind the gate. Words were exchanged vigorously back and forth. Finally, he turned and ran back to us.

"He says the hospital has closed, and the doctors have all gone."

I am stunned.

"What? No it's not..." I declare with frustration and disbelief. "No, they haven't left. That's not true. That's crazy!"

Our midwife shares my incredulity. This is obviously a mistake. Just 5 hours ago, the child on my lap was in this very tent hospital, consulting with a pediatric surgeon from USC Los Angeles. A hospital overflowing with patients, volunteer medical staff, and technical medical resources. There is absolutely no way this hospital has closed its doors and evacuated it's staff in the 5 hours since our previous visit.

Our translator turns to our midwife. "You're going to have to show your face," he declares with a mixture of frustration and acceptance.

Translation: You need to show your caucasian, non-Haitian face. You need to play the White Card.

Our midwife-- fabulous, strong, intelligent, compassionate, wielding a beautiful Boston accent (the other Boston) -- gets forcefully out of the car. She strides powerfully and authoritatively to the gate, and in fluent Creole, confronts the guard.

She advocates. This is a medical emergency. There is a dying child in the car. She was at the hospital earlier in the day. The head surgeon saw her. He asked that she return. We are an ambulance from a Field Hospital. LET US THROUGH THAT GATE.

"No," says the guard. "The hospital is closed."

I can see the top of the hospital tent over the wall surrounding the airport. It is illuminated white against the 2am night sky. It is obviously inhabited and operational.

I am growing furious. I am growing desperate. This is obviously a political power play. And we are the pawns.

I call out the truck window in English to our translator. "What's going on? Does he want a bribe? Tell them I am a doctor and the child in the car is going to die and he MUST let us in."

More negotiation. The whimpering form in my lap is breathing rapidly and shallowly. My hand on her chest feels the fever burning through her thin cotton top, and the wild racing of her heart. She moans.

This is impossible. Yet, it is not. It is, perhaps, exquisitely predictable.

Less than a football field away from our truck sits a hospital full of medical specialists. Volunteers from all over the United States, giving of their time to provide free medical care to this city in its darkest hour. On my lap is a dying child. And between us is a wooden gate, and a man with a gun and a political agenda.

The airport authorities have apparently decided that the Miami Field Hospital, which sits on an unused grassy lot on the periphery of the airport, is an inconvience. And this week, after the US military handed back control of the airport to the Haitian government, public access to the only emergency hospital in Haiti has apparently been extremely and underhandedly curtailed. Hospital personnel report repeated efforts to obstruct patients' access to the hospital and emergency care - as we experienced on this night. A new unmarked entrance to the hospital, for example. A locked gate, with a belligerent guard. This political stand off -- so detrimental -- drew the attention of Haiti's President, who commanded the Airport Authority to allow patients through the gates and access to the capitol city's only emergency hospital. This was met, apparently, with political belligerance and opposition. And, at 2 in the morning, the power play is acted out. And the order of the country's Commander in Chief is disobeyed. And we -- the patient and her advocates -- become the powerless victims.

As I sit seething in the back of the truck, I evalute the integrity of the flimsy wooden gate which separates us from the lifesaving hospital visible beyond the trees. It is an absurd barrier of chicken wire and two by fours. I am certain we can crash through it with the truck if need be. My outrage is spurred on by the limp child in my arms. As I plot, I observe that the guard has a gun, and I fear he would be willing to use it. The images of several patients in our care flash through my mind -- innocent bystanders shot when the police fired wrecklessly into the ground around crowds in gestures of authority and intimidation -- striking bystanders with ricocheting bullets.

At this moment, I am impotent in my ability to help this child. We are at the mercy of this political agenda. An argument over a strip of land superceding the value of a child's life. A metaphor for the consequence of political ineptness and corruption.

I imagine this is how it felt on the night of 12 January, in the hours after the earthquake, when the sun left the sky and darkness fell. When the screams of the injured rang out, and access to medical care was, in a moment, non-existent. Hopelessness. Dying patients, in desperate need of surgeons. And no surgeons to be had.

I recall news reports of patients having amputations in city parks by the light of handheld flashlights...without anesthesia. I recall patients telling grim stories of being taken to the remaining local and overwhelmed medical facilities, lying without medical care, in rooms filled with dead bodies, themselves fearing that they would soon become just that -- another body, to be disposed of en mass in the back of dump trucks visible outside their windows. Desperate acts to save lives. Desperate patients. Desperate providers. Reflecting complete lack of access to care.
In Haiti's time of crisis, hope came in the form of volunteer field hospitals -- such as ours and Miami's. At the beginning, lack of medical access reflected the utter chaos of an unprecedented natural disaster. Now, lack of access is caused, in part, by political corruption.

Hints of such corruption were evident in my first week at our field hospital. Still on the forefront of the medical crisis, relief organizations were stunned to discover their medical and relief supplies being suddenly unexpectly being held ransom at the airport...many for tens of thousands American dollars. Donated medical supplies and shelters. For the country's injured and homeless. Provided free of charge from the generosity of the world community. To be utilized by volunteers, many of whom had paid their own way to Haiti to provide relief. Flown in by privately donated charter flights and international military flights. At the request of the Haitian government. Held at the airport and not released without the organizations first paying exorbitant and newly invented importation fees. While Haitians slept homeless in the streets of Port au Prince, enduring early spring rain without shelter; while the President of Haiti visted the White House in Washington, DC, asking for relief assistance for his struggling country... lifesaving relief supplies -- tarps and tents and medications -- sat undistributed in boxes at the airport. Our own hospital had its supplies held hostage for weeks -- including medications requiring refrigeration which sat sweltering in the Haitian heat.

And now, once again, the Airport Authority, blocks access to medical relief. In the form of this flimsy gate, and a man with a gun, who tells a blatant lie: "The hospital is closed. The doctors have left."

What will we do without a surgeon, I ask myself as I watch the negotitations. Turn around with this child? Bring her back to our hospital to die of sepsis?

Our midwife and translator continue to negotiate with the man behind the fence. Finally, they return to the truck. The guard, miraculously, manipulates the lock and slowly swings open the gate.

"Okay, he's letting us in," our midwife says, as she quickly puts the truck in gear, taking advantage of the sudden opportunity.

"Wait a minute," I say. "I thought the hospital is closed and everyone has gone home. Isn't that what he's been saying for the past five minutes. What did you do? Did you have to bribe him?"

Our Haitian translator turns to me. "He's letting us in because she's white," he says matter of factly, gesturing to our midwife. "You have to know how to work the system. It's just how things are here."

I am relieved for the girl in my arms, but absolutely infuriated for the people of this city.

"Wait," I say, as we start down the dirt road to the hospital. "Are you telling me that if I were a Haitian pulling up with a dying person in this car, that I would be turned away from the hospital?"

"Yes," he replied, absolutely.

"And we're getting in because we're white people?"

"Yes," he replied.

I am horrified and infurated by the injustice. But, for the moment, I am grateful for the incidental lack of melanin in my skin which, tonight (and, unjustly, through modern human history), has provided me with this seemingly random political advantage. I am perceived, by the color of my skin, to be someone who has possible political connections to a higher authority, a political democracy, which I can call upon to advocate on my behalf.

And for the local Haitian, who pulls up the the gate tonight with a dying child, without a political advocate? They will likely be turned away.

If you are reading this tonight from the comfort of your home, which fortunately is located in a representative democracy -- perhaps one of the wealthy first world nations which, through your tax dollars, has provided disaster relief to the nation of Haiti -- I ask you to advocate for those who are less powerful than yourself. Use the representative government that you are so fortunate to have peacefully elected, and which politically advocates on your behalf. Contact your congressperson or political representative, and ask that the government of Haiti be held politically accountable for properly managing their international relief; ask that further relief be contingent upon allowing that relief resources be accessible to its people. Ask that relief supplies be released to organizations on the ground helping their injured and homeless. Ask how your tax dollars are being spent, and how they are being managed, in this crisis.

And of course, because you care...you perhaps would like to know the rest of the story.

So, we drove the remaining distance down the dirt path beyond the gate and pulled up to the front of the great white hospital tent. Father took his whimpering child gently from me and cradled her in his arms as we walked together from the truck, exiting the tropical Haitian night, and entering the front door of the still-bustling field hospital. Immediately, we were greeted by a doctor -- in fact, a board certified pediatric surgeon from Children's Hospital in Los Angeles. He gladly took her back into his care.

I guess the hospital wasn't closed after all. And, apparently, all the doctors had not flown home in the five hours since our last visit. I guess it was all just a simple misunderstanding.