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.