It’s Thursday, February 9. 9:54 pm. Today is Day 28 of my journey. I am safely tucked into Room 209 at the hotel Auberge Picolet, overlooking the bay at Cap Haitian, the second largest city in Haiti, after Port-au-Prince. Tomorrow was to be my last scheduled day at the hospital in Milot, with my flight out scheduled for Saturday, but as of yesterday, all of the visiting American doctors have been evacuated from the town as a result of civil unrest. I have written so many essays in my head over the past two weeks, but between patient care and mounting political unrest it has been impossible to devote time to writing.
As to the political unrest, we experienced 4 incidents called “manifestations” (what in the US we would call protests or riots) over the past 2 weeks, each escalating in intensity, until the final one drew a crowd of about 1,000 Haitians. Tires were burning in the street and employees were blocked from entering and leaving the main road by tree limbs drawn across the main street as roadblocks by the local mob. Nurses remained for 36-hour shifts on some services because their replacements couldn’t get in and they couldn’t leave. Other services, for example, the OB service, had no local doctors and only one nurse, in addition to my presence and the American doctor there with me.
UN troops were called in and Cap Haitian armed police were gathered in force. There was an invasion of the hospital grounds and rooftops of surrounding buildings, rocks were pelted at the hospital, and a brick was thrown through one of the operating room windows, which nearly hit an American surgeon during a cleft palate repair on a child, and weapons drawn on some of the more aggressive members of the crowd. There were tires burning in the streets, chanting and drumming, and an overall feeling of volatility and unpredictability. People here are hungry – actually, starving – and tired, and frustrated, and as Bob Marley says “A hungry mob is an angry mob.” People were describing the environment as a war zone, though I do think that was a bit extreme.
All of the doctors, me included, continued to work throughout each of the days. I assisted 3 babies into the world on the morning of the last manifestation. Rocks pelting the tin roof sounded enough like gunshots to keep us on edge. At one point a young nurse named Lisa, and I, along with a 14-month old baby in her care, were barricaded in the neonatal resuscitation room, discussing what provisions we had with us should we be stuck in there for awhile, and whether a mob would actually storm the hospital.
While I am confident that we would not have been injured intentionally – we were told by members of the local community that we were respected and this was not about us – there was enough volatility and uncertainty in the air that by about 2 PM we were escorted as a group out of the hospital to the main compound and after a very compelling presentation on Haitian history and politics, we reached agreement that for our safety and for the liability of the hospital and the longevity of the volunteer options at the hospital, it would be best for the Americans to evacuate. We remained in the compound for the remainder of the day and evening. By the next morning, things were quiet again, and in fact, I went to the hospital to say my good-byes and bring some gifts to the nurses with whom I’d worked all month. I inadvertently got called into 2 births – in my skirt and flip-flops – immediately before returning to the compound where I packed the remainder of my belongings into a backpack and left Milot. The evacuation insurance provided by the relief organization I travelled under covered the change in my ticket for an earlier departure and a stay overnight in Cap Haitian.
The reason for the violence seems to be multifaceted. On the surface, there were complaints leveled at the hospital administration, some of which are founded in reality, that employees had gone unpaid for several months. While finances had reportedly been squared up, mistrust in authority is a common theme in Haitian culture, and once this seed of mistrust has been planted, it is hard to weed out. The locals wanted the chief financial officer ousted – and because of the risk for his personal safety in this setting, he did ultimately resign on the final day of the manifestation and was escorted out of the town by police for his safety. On top of this, there are numerous complexities in obtaining medications when one is in the hospital, forcing many patients to go without needed inpatient meds. You see, when you are in the hospital, you have to purchase your medications from the pharmacy – a family member must physically go to the pharmacy to obtain the meds. This is not uncommon in Haitian hospitals. In fact, in the government hospital in Cap Haitian, one also has to purchase gloves, gauze, syringes, IV needles, etc., before they can be used on a patient in need. But not all families can pay for the meds, and their family members go untreated. Or they are provided with treatments and the sick family member cannot leave the hospital until the bill is paid. It is incredibly complex and a rich environment for fomenting anger. On top of all of this, there seems to be a greater evolving political instability in the country related to locals instigating issues about the national government. So all things together, tensions erupted.
At the completion of this writing, I am now safely home in Boston. I have slept in my comfortable bed, had my choice of abundant foods at the local Whole Foods, have had a “real” shower, and am surrounded by my 4 healthy children. Any one of those things seems like a miracle of abundance compared to what my new friends and patients in Haiti experience. Just a few days ago I delivered babies to women who’d had several full-term pregnancies and had no living children. I treated people who ate less than a meal a day. I took care of a baby whose malnutrition was so bad that I was relieved when his family took him home to die because it was so painful to see him day after day. I have had a journey in which I had a lifetime of experience each day.
While I was in Haiti I often had the recognition that I was one of the wealthiest people in that town. It was an amazing feeling to be somewhere and know I had everything I needed and even living very simply, I had more than most of the people surrounding me. There was nothing to need, want, buy, vie for. Coming into the airport in Miami I was struck by the onslaught of incentives to purchase, to have… My son told me that when he returned from Haiti just after the earthquake, he was stuck in the customs line behind an American couple arguing about whether they were going to eat at McDonalds or Burger King. Literally arguing, he said. I get the irony and the decadence. It bothers me. Selfishly, it felt good to be away from the material trappings of my life, and day-to-day have nothing to think about or feel or focus on but service and compassion and gratitude. I hope these qualities stay at the forefront of my consciousness for the rest of my life. I hope that going forward I can find deeper, larger, lasting ways to change the face of maternity for women who are the mountains of Haiti, and for their next generations. I will be forever grateful for the kindness, generosity, and warmth of my new friends and I look forward to returning to Haiti someday, hopefully not too far away.