Tuesday, January 25, 2011

Running in Circles

It is that time of night when all that remains of the firey sun is a faint neon orange band on the horizon, above which are deepening shades of azure to navy blue to black. Someone has taken a pin and stabbed holes in the dark canvass of the sky, and small spots of twinking white light shine through. My feet pound rhythmically on the soft grass below me. I am running in circles in the dark. Literally.

I have always loved running in the dark. If you have never done this, I highly recommend you give it a try. Maybe first try shuffling, or perhaps walking, if you are a bit hesitant about your first full-on face plant into the dirt at your feet. You'll get the hang of it eventually. You will be amazed by the light you discover emitted by the moon and the stars and the occasional humanoid light source. Your eyes will soon adapt, and you will be impressed by the hughs of blue and grey and silver and black that define the world around you. You will be enchanted by blackened profiles now illuminated by the lesser grey of sky and field. Like you are wandering in a photo negative. You will realize that the animal in you knows how to do this, and revels in this.


I like to run to loud, rhythmic music in the dark. I find it cathartic. I admit, this is not an intelligent practice in places like rural Alaska, where large carnivores lie in wait for such nocturnal idiots...er...snacks...or urban America, where carnivores are replaced by bipedal predators. But in many non-threatening places in my life -- winter in Alaska, winter in Antarctica, nighttime in island Maine -- I have run for miles by the light of the moon and stars. The music helps to drown out the gasping whining that I imagine accompanies my running. And I am lost inside a dark, glorious introspection.

Tonight as I run, the palm trees sillouetted against the last band of orange in the western Haitian sky gradually fade, and the black sky descends, overtaken by stars. I am guided by the vague outline that is the soccerfield, and the knowledge that there should be nothing to trip me here. I have a sudden memory of running in the dark of night in winter Maine, and coming upon a deer licking salt from the middle of the road. It was surprised when I came upon it in the dark. As was I. I remember the startled jerk of his body (and mine) as my mittened hand glanced off his flank and he skittered away into the brush aside the road. I wonder what sort of creature I might encounter tonight, here in this field, in this dark Haitian night.

A Seminarian, most likely. There are 200 late-teen to young twenty-something Seminarians studying to be Catholic priests living on this compound that houses our clinic. They have come from around Haiti to study, and live in tents on the grounds of our community. I was somewhat discouraged one day to observe them holding mass, so apparently solemn and rigid and formal in their crisp white shirts and crisp black pants and carefully folded hands-- with my memory of the raucous, loud, lively spirituality that I identify with Haiti. I felt suffocated for them, all folded so stoically into their chairs.

But, never fear. They, I have discovered, like I, seem to morph at this time of night. They gather in a tent alongside my soccer field, and just as the sun goes down, their spirits alight. Inside their canvas shelter, one can suddenly hear the deep beat of a base hand-played drum. Then an accompanying sound -- reminiscent of the hollow, resonating clickety drumming one hears on the street corners of Washington, DC or New Orleans -- when inner city kids pound out dueling rhythms on old white plastic buckets. Suddenly, in the dark, alongside this obscure Haitian soccerfield, a deep, almost tribal drum rhythm pounds aggressively from the tent...as if spiralling from the genetically African DNA of these young Haitian men.

It is stunning.

Entrancing, pounding, drum rhythm, then in unison, 200 deep Haitian male voices begin to chant and sing in beautiful harmony, flowing out into my dark night. A hip mix of African-like rhythmic gregorian chant. I stop running and pull the headphones from my ears. I stand in the dark in the middle of the soccer field.

I am enchanted. This is more than beautiful. It is alive. Somehow primitive. Gutterally human. These are the moments I love most about human beings. The unexpected, artistic, spontaneous surprises. Tonight: the creation of a stunning, unexpectedly joyous noise.

I find myself at the chainlink fence which separates the soccer field from their canvas tent. I slide down to sit on the ground, my back to the fence and their tent, which is now a mere 10 feet away. And I listen. The rhythm of their drums resonates through my chest from behind. I stare up at the now pitch black sky, clustered with stars. And absorb these amazing sound waves.

I guess the thing is, it's been one of those desperate days, when you wonder if there is anything positive in this place called Haiti. The 33 pound 9 year old, malnourished and neglected. The cholera babies. The malaria. The hemorrhaging 22 year old, who was miscarrying, and then suddenly, in front of our eyes, went from 60 breaths a minute (far too fast) to zero breaths a minute (far too slow), instantaneously horrifyingly lifeless.

On some days it just feels like we're bailing a sinking ship with a tea cup. Or just running in circles, with no direction, in the darkness.

Where is the public health system? Where is the 911 system? Why is there no ambulance to call in an emergency? Why are children still starving to death in front of me? Why are young women bleeding to death in front of me? Why are children not getting immunized? Why can I not find a surgeon for my patients in need? Why am I still finding untreated fractures more than a year post earthquake, which have now healed (or failed to heal) into dysfunctional and sometimes dangerous deformity? I know...these "whys" go on ad nauseum, and I can't even stand hearing myself ask the questions any more.

Isn't there anything positive about this place?

Of course there are. Many many many things. I know there is much more to Haiti than the daily medical glimpse that sometimes makes me a cynic, and drives me with my headphones into the night to run in circles. There are many wonderful things about this place.

A figure suddenly looms over me, from above, from the other side of the fence. My encounter. A tall, slender Seminarian.

"Who are you?" he asks me curiously, staring down at my form seated with my legs crossed in front of me in the darkness. I'm not sure how he spotted me here.

"I'm 'Dokta' Barbie from the clinic," I say, pointing across the field.

He smiles, then pointedly, "What are you doing down there?"

I smile back.

"Oh, I'm just listening to you guys. Thanks for the music. It's nice. A beautiful thing."

"You can come in, you know," he gestures to the tent. "You are welcome."

"Thanks," I say. "I think I'll just sit out here and listen for a while."

"Okay, but we are here every night. You are welcome to come in any time."

"Okay," I say. "Thanks a lot. But I'll just sit here for tonight."

"Okay," he shrugs at the wierdness of my presence in the grass in the dark. He smiles again, then waves slightly as he walks away. He lifts up a corner of the tent, revealing a triangle of light. Then disappears behind the dark flap. Back into the sea of deep voices and rhythm.


Amazing what one can discover, when one thinks one is just running alone, in circles, in the dark.

Good night.

Saturday, January 15, 2011


I remember my first days at Heartline Field Hospital, reading through charts, trying to familiarize myself with our earthquake patients -- trying to grasp the essence of the patients lying side by side in our courtyard-turned-hospital ward. Chart after chart...."buried under a house for 3 days...family killed...a wall fell on him...a block crushed her....parents killed....wandered without care for four weeks...innocent bystander shot by police..." Blankly, I continued to open charts, digesting the undigestable.

People ask how Haitians survived this time. I remember faces staring blankly sometimes, with great depths of emptiness. Homeless. Parentless. Familyless. Jobless. Futureless. Minds turned inward, reviewing hideous memories. Impossible memories. With only occasional moments of overt grief. A mother with PTSD, herself with a healing femur fracture, who would suddenly start screaming when the memory of her dead two year old flashed into her mind. She would grip her chest, and scream and scream, crying that her heart was going to stop. And indeed, in those moments, if sadness could stop a heart, I truly believe hers would have. Hers, and so many around her.

And so, at times, even my own.

But, I learned in those early days.. sadness doesn't stop a heart.

Thank God.

Joy, in contrast, is an amazing thing when it acts on a heart. And love.

How is it, that the father of one of our young patients turned out to be a Haitian minister? And that he would make it his business to preach to our patients? And return, day after day to them, even in the weeks after his daughter was discharged. And that every night, he would spontaneously stand up in our courtyard and lead our patients in prayer -- in a way that only Haitian ministers can do? (That is -- pacing almost wildly around the center of our hospital, screaming out to God until his voice went hoarse, and pulling our patients almost physically from the depths of their emotional darkness...Reconnecting them with their lives, their souls, their spirituality.)

I am not an overtly spiritual person. But I recall the warm nights of post earthquake Haiti, when my feet, almost against my will, would drag me to the doorway to our courtyard. I would lean unobtrusively against the hospital's stone wall, slightly hidden behind a flowering tree. And watch the electricity of these people and these moments. The exquisite, palpable spirituality of these patients. Despite pain, exhaustion, physical and emotional fatigue. Their hands would slowly, hesitantly, lift in prayer. Then, more forcefully sway. Reaching up. Then clap. Then voices, singing in unison. United with a palpable energy. Singing songs of faith. And thanks... In the absolute darkness of their lives.

No matter the pain of the day. No matter the trauma. The torment. The angst. The visions. The memories. No matter the hours in the sun, spent riding past crumpled buildings and crumpled lives. Community and spirit and love and joy... nightly brought our people back to life.

I recorded some of these songs on my phone on those dark, tropical nights. And in the year since then, have occasionally listened to my ten minutes of riotous Haitian mass.... at the end of a crazy day in my clinic in America, or driving across the vast empty expanses of Alaska, or sitting on a bus in New Orleans. A reconnection to the souls and the love that was Heartline Field Hospital in 2010 -- a hospital that rose from nothing, in the courtyard of an orphanage in Port au Prince, upon the wills of individuals...who knew, together, they could contribute, and make a difference, in the darkest time in people's lives.

On this anniversary of the Haiti earthquake, here's a thank you. To the nurses. The doctors. The translators. The Big White Truck driver. The guy in the white socks getting smacked in the face with palm trees. The physical therapists. The intimidating body guards in lavendar Crocks. The cooks. The nannies. The girls with the jump ropes. The sleepless midwives. The ministers. The giggling children. The new mamas, loving their babies. The new papas, loving their wives. The spiders, rats, insomniac chickens and lizards that roll their Rs in the darkness. The surgeon in the floppy safari hat. The anesthesiologist, who cared for Amanda...and revealed he had survived her exact same injury. The heroes, learning to walk again. Learning to live again. The survivors. And those who were lost. Too violently. Too exquisitely soon.

Thank you for filling my heart this past year.

I lay in bed as the clock struck midnight on January 12, 2011. One year to the day of the disaster. Back in Haiti. Beneath my mosquito net. High pitched buzzing of an insect swirling about my ear. Suddenly, in the dark, in the street, over the wall, rolled the sound of a spontaneous Haitian mass. An almost screaming, hoarse minister. Clapping hands, stomping feet. A massive crowd. Calling out in joyous song. On and on and on they sang and clapped, for hours, before I dropped back off to sleep.

Singing Alleluhia.

Alleluhia? For what? For a horrifying anniversary? For ongoing poverty? Infinite struggle? Hunger? Homelessness? Sprawling tent cities? The stench of smoky air? Malaria and cholera? Lack of access to health care? Undervalued people? Political corruption and strife?

I closed my eyes in the darknesss. A smile slowly met my lips. My heart swelled.


Alleluhia. For community. And love. For family. And faith. And friends. For healing. And growing. For those who reach out, to hold up each other, in the darkest of their darkness. For living on.

Sunday, January 9, 2011

The Day of Rest

It is Sunday and our clinic is closed for the day. We don't see patients on Sundays in this new clinic, unless there is a walk-in emergency. This is a giant shift for me, from our Heartline Hospital model, which was open 7 days a week, tending to inpatients around the clock, as well as an outpatient clinic and a mobile clinic. One could always count on a banging on the metal gate and a mystery patient standing behind it. A laboring mother about to squat and push out a baby on the street? A seizing child? The guy who drove his motorcycle full speed head-on into the cow in the middle of the road? (One of them resembled hamburger after that...and it wasn't the cow, on that day.) It was always something. But here, it seems, today, we have a day of rest.

(Not that it isn't earned. Our clinic sees a staggering 250 walk in patients each day when it is open. At some time, I guess, you just need to close the gate and allow the staff to recover.)

Our head doctor declared today that we should take advantage of the small window of time -- between medical business and anticipated political unrest -- to take a drive north of the city into the hills. With the upcoming anniversary of the earthquake in 3 days -- which some feel might result in political protests due to slow recovery efforts -- it is possible that future jaunts beyond the block walls of our compound will not be sanctioned.

I have flashes back to last spring. Can we really leave the clinic? What if something happens while we're away? Can we really afford to waste the fuel to take a ride into the countryside? (I sharply recall hunts for a single gallon of gasoline sold in glass bottles by vendors on the side of the road last spring, and calculations to determine if one gallon would be enough to get us across the city and back again with four surgical patients in the sweltering truck...Yes, we'd decided, we could make it if we didn't run the air conditioning and didn't get caught idling in traffic.) Things, it seems, have improved. Things are now a bit more stable.

We drove north, armed with a wand of fresh Haitian bread, a slab of cheese, crispy salted fried plantains in search of the perfect picnic spot. Our translator/driver spent much of his childhood in the north, and spoke of a secret waterfall known only to the locals. A perfect, magical destination.

We passed a massive tent city sprawling across the countryside. I have never been this far north. I am told this is the biggest of the tent cities. One in ten Haitians now live in these displaced person camps. I observed the tents; they seem more substantial than those I recall from last spring, now with more solid stick construction, better tarp coverage, even corrugated metal walls and roofs becoming incorporated into the design. It appears they are morphing into permanent fixtures; they have the look of sturdiness, of permanence. The evolution of a shantytown. I feel for the Haitian government -- how will they ever effectively move these hundreds of thousands of people away? It seems like an impossibility now. I am struck by the fact that each tent stands a bit away from its neighbor in this camp. It is not quite the tarp-on-tarp labyrinth that was so familiar in Port au Prince last spring. Absurdly, I think -- for what it is -- it looks a little bit better than what I remember. As "better" as thousands upon thousands of tarp shelters can look, sprawling into the distance.

To my right, the Australian medical student who is working with us for a month whispers, "Oh my God. It's unbelievable." He is taking photos of the shelters, extending to the horizon. And of the caved in buildings, still half standing from the earthquake, visible from the road. I didn't notice the buildings. I have to look again to have them register in my mind. Oh, yes. Crumbling buildings from the earthquake. Still marked with a series of spraypainted red letters and numbers. Red meaning "uninhabitable/condemned". Oh, yes. Of course. There they are. The crumbled buildings. Right in front of my eyes. The still-standing, half-teetering cement structures. He is right. It indeed should be unbelievable. I am bemused -- because I have become numb to this...that my first thought was..."Gee, things are looking a bit better 'round here."

We continue on our journey north. We pass a compound on a river with a big blue U and N painted on the gate. "This is where the Nepali UN Peace Keepers live," advised our translator.

Cholera ground zero. It is here that many speculate a leaking latrine spilled sewage into the river, and introduced the deadly organism cholera to the communities downriver. The tracking of the origins of the epidemic remain controversial. Prior to this fall, cholera had never been seen in Haiti. And the serotype is consistent with a strain normally found in Southeast Asia. Just prior to the outbreak of cholera in Haiti, there was apparently a similar outbreak in Nepal. Many observers have put two and two together, and believe they've arrived at "four". "Four" being the supposition that the epidemic's origins lay with these Asian peacekeepers. Yet, officially fingering them as the source, some fear, puts the UN soldiers at risk from a possible hostile backlash of frustrated, overwhelmed, end-of-their-rope people for whom a deadly cholera epidemic is a last straw lain onto an already buckling back.

We drove farther north.

"Here is where sewage trucks that pump local latrines dump their waste directly into the river," noted our driver. I recall seeing just this place in a news photograph, with a sewage truck offloading its foul contents into the water. Another possible source of cholera contamination. I look down river. Children are playing along the edges of the riverbanks, some up to their waists; adults are bathing; women are washing clothes -- all wading downstream in the current of the sewage trucks' foul discharge.

I close my eyes and sigh. Unbelievable.

We drive farther north.

We are passed by two large white dumptrucks. I know these trucks. They were donated by USAID to Haiti in the aftermath of the earthquake last year. Initially, they were used to carry corpses to large mass graves when the the capitol city was overwhelmed by the sudden challenge of dealing with the remains of 250,000 dead citizens. I see they are now hauling limestone sand, apparently to a foundry where new blocks are being formed, to aid in the country's rebuilding process.

I pray the new blocks meet better building standards. Apparently previous Haitian cement blocks had a 1500 pound per square inch strength -- evidently one fourth of the strength which is traditionally required by building codes of more developed nations like the United States. Images of toppled and pancaked cement block buildings flash suddenly in my mind.

"Please," I plead silently, as if the Minister of Reconstruction exists and, in his clairvoyance, cares to read my mind. "Please build back stronger. Please change your building codes. Please don't repeat the errors of the past."

The trucks pull away.

We drive farther north. And swing up a long dirt road, past sprawling, luscious, green fields of beans. Children spy our pale faces through the truck windows.

"Blanc!!" they call out, chasing the truck. "Blanc!" (White person.) I smile. More memories of previous excitedly pointed fingers, assigning me a color. (Or shall I say, an absence of color. Actually, I consider myself a paler peachy color...but, whatever. "White" works for the moment.)

"Hey, you!" others call. I smile again in memory. "Hey, you," I think back to them, silently.

We arrive at the top of a hill and our driver declares, "We're here!" The secret waterfall. A crowd of local children and adolescent boys follow us down the trail, curious of our presence, welcoming and helpful. Some offer me a hand over slippery muddy sections of trail.

"Merci," I say to one.

He smiles, and says, "Give me one dollar." Ha.

"No," I say with pseudo-annoyance. "You give ME one dollar!" I poke a finger in his chest in emphasis. He laughs. I laugh. He tried. No dollar. We walk on.

We arrive, after a time, at the base of the waterfall. There is a large Haitian man sitting there in his swimming trunks. The water cascades in glorious, beautiful, muddy, dramatic slipperiness. I turn to glance at the man on the water's edge. I start suddenly. I know him.

"I know you," he mirrors with surprise, in English, his brows knitting together in a frown of puzzlement.

"Yes!" I responded. "You were my patient at Heartline Hospital last spring!"

Weird. Weird weird weird.

He laughs. I do, too. "You injured your back in the earthquake," I said, remembering him. I extend my hand in warm greeting. His large one engulfs mine, pumping it heartily.

"How are you feeling?" I ask earnestly.

What a place for a follow-up visit. Eight months later, down a winding muddy trail, at the base of a secret waterfall, several miles north of Whoknowswhere, Haiti. I smile. If he could wind his way down here, I muse, I guess he's doing pretty well.

"I'm better," he said with a smile. "I'm doing a whole lot better."

He nodded and wandered off, wading into the pools at the base of the crashing waterfall, throwing me a small wave as he went. He walked tall and strong, no evidence of injury.

I turned back to the waterfall. Amazing thing, water. No matter how fast and far and violently it crashes over the most hair-raising precipice, it ultimately remains unscathed. Still, fundamentally, water. So adaptable, molding itself without complaint to the complicated features of the surrounding terrain. I followed it with my eyes as it regrouped, and serpiginously began to flow with a sweet, trickling calm towards the vivid emerald fields below. If you follow it out far enough, I realized, you might never suspect the shocking drama of its recent journey.

Saturday, January 8, 2011

One Year Later

Photo: Haiti Ministry of Health, January 2010
It's dark. And pleasantly, tropically warm. The bugs are slowly rubbing their hairy legs together, squeaking in violin-esque symphonies. The dog network has been activated, barking a message from here towards Port au Prince. The occasional embittered insomniac rooster calls out from the shadows, determined that if he can't sleep, no one else should either. Familiar sharp pinches of possibly rabid mosquitoes nibble not-so-subtly on my ankles. In the corner of my room is a small Cirque du Soleil of multiple-sized daddy-long-leg spiders on strings; big ones, mediums, smalls...and, lucky me...apparently a new hatching, adding a small mobile blur of pin-head sized fellows to the mix. It is possible they are small enough to crawl through my bed's mosquito net and join me in my slumber. Thankfully, though, the barrier will prevent the nocturnal visit of larger things...like the tarantula I met this morning.

Ah, Haiti. Thanks for dispatching the welcoming committee. Its nice to be back.

In 4 days it will be a year from the earthquake. I have returned to volunteer at a different clinic, located in the city of Croix des Bouquets. Things are similar here...and yet different from a year ago. There are still more than a million people living in tent cities in and around Port au Prince. So much for the word "temporary" that, as of last year, used to preceed the word "shelter". And the health challenges have morphed into the diseases of poverty, neglect, homelessness and overcrowding: violence, rape, unwanted pregnancy, STDs, HIV, tuberculosis, malnutrition and cholera. Some are familiar to these people. Others are new.

Now, instead of the desperate urgency of patients with massive trauma, we see the tragic urgency of cholera -- a diarrheal illness that can kill a patient within hours. This illness looms to threaten any large population of displaced persons -- especially those without access to clean water and sanitation. An illness that can be stopped with one dose of a 10 cent antibiotic and simple rehydration -- if the patient can find access to a clinic.

If you got cholera in your developed-nation neighborhood, you would do just fine with your fortunate access to medical care and your 10 cent antibiotic. In a refugee camp setting, in contrast, past experience shows that up to one in three symptomatic patients can die without care -- a number which drops to 5% or less with a basic, cheap and effective cholera management protocol. Without care, you could die within hours from the absolute dessication of your body.

Our doctor described our clinic's first cholera patient, who was carried in in October by his grandmother: a four year old floppy grandchild.

"He started having diarrhea at 4am," she said. It was 7am. The child, unbeknownst to grandmother, was already dead in her arms.

His body was gently taken from her, cleaned with alcohol, mouth and rectum stuffed with bleach-soaked cotton to prevent the spread of the bacteria -- which continues to live on in a corpse, even after a patient's death, and threatens to spread to the living. A coffin was somehow located on the grounds of the clinic. It was too large for his tiny body -- built for an adult -- but it served its purpose. After a small memorial service on clinic grounds, his corpse was transported to the local children's hospital for cremation. His family expressed gratitude for the coffin -- for they had observed the bodies of three other children, dead of cholera, laying alongside his at the entrance to the crematorium, wrapped only in black plastic garbage bags.

Look over at your four-year-old child, grandchild, neighbor, nephew... Note the magic of his or her spirit. Her high pitched giggle. His suffocating, uninhibited hug. The speed of little running feet pattering about your house. Childish shrieks of happiness from outside in the yard. The massive potential of his beautiful life. The joy of her birth. His first steps. Their impish, beautiful spirits. Imagine putting him to bed tonight. And by morning, as you walk desperately with him in your arms...miles over a dirt road to a clinic... you fear what you deny. You hand over his body when you arrive. Hopeless. Hopeful. But, that thing you knew, deep inside, they confirm for you. He is dead. Already dead.

From a germ that could be prevented with a bar of soap and running water. Or, if acquired, halted with a 10 cent antibiotic and a mixture of water, sugar and salt. Literally could have been saved for less than a dollar. Your child: dead from lack of clean water, sanitation, and simple access to health care.

On January 12, 2010, 27 of Haiti's 28 governmental ministries were destroyed by the earthquake -- including the Ministry of Health. A complicated and devastating blow to a country already struggling with effective governance. Will the fate of the poor and homeless improve here in Haiti? It is unlikely, in the short term. People look towards the government for solutions. But, the integrity of the political system is in question. There have been protests -- many violent -- over recent presidential elections and questionable outcomes. Outside observers have documented massive voting fraud. There is fear that the results of the recount will cause more violence and chaos in this country. On February 7th, per the Haitian constitution, the current president must step down from power, whether or not the new president's identity has been determined. What a tangled, tangled mess.

I look back to the nest of spiders in my corner. A couple of big ones. An overwhelming multitude of little ones. Where will they be come morning? I am curious to see.