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.