Emergency Impressions from the Disaster Country
After nearly two weeks in Haiti, I find myself in an uncomfortable – that of being in a country that historically, academically, and culturally, I know very little about. Since my arrival, it has been a whirlwind of emergency logistics and healthcare politics – trying to establish a cholera camps, a base and a team in an area where there is little experience or existing local networks – a rapid immersion into Haitian disaster mitigation that has left little time for background research or touristic observation. I am forced to learn on the job – listening to my drivers, chatting with sub-contractors, scrabbling for information about the inner workings of the health authorities.
I am not sure I had expectations of Haiti, but either way, it has not met them. The most stark contradiction came today – on election day, when the people are out on the streets in numbers, and 11 of the main candidates have opted to bypass the elections and incite the people to riot, we are in a security lockdown, in a hotel in Fort Liberté, and I passed perhaps the first calm 20 on a small Caribbean beach, the wind blowing and the sun shining, a few precious moments of solitude in an intensely social job. There is much to be understood – Wyclef Jean, for example, the famous presidential candidate, born in Haiti but raised as a non-Créole speaker in America like many of Haiti’s rich elite, is immensely popular, and inciting the people to riot. Like his opponents, Wyclef’s supporters spend a lot of money on the elections – in Fort Liberté they hire cars, hand out t-shirts in enormous quantities, and pay for weeks of street parties. Aeroplanes fly over with electoral banners, above a bizarre 6 foot high electoral bicycle on a remote road across the Northern delta. The young men of Haiti, often unemployed, hire themselves out to the political parties – for good money, they will drive round town shouting slogans and inciting people to vote, often covering their faces to shout for a different party the following day. I saw these events being organised in our hotel, by the largest man I have ever seen, twice my width and weight, with his gold chains a stern look, and a pair of dainty cycling gloves. Carrying a large hamburger, and in deep conversation with him, was an immaculately dressed nun with the most reverent of smiles.
And what of the cholera, and the earthquake, Haiti’s unfortunate claims to international fame? Cholera is nasty – people are dying faster than we can set up the camps, rapidly escalating from the early figures of 200 deaths in a population of 300,000 for the North-East. But that which is never seen on television is that life continues as normal – the markets run, half the population continues to runs across the border to the Dominican Republic as usual every day, and my driver will still have several near crashes each day craning his neck at the young belles on the pavement. Cholera is all over the radio, schools, communities – and there is a real fear, and a lack of knowledge – Haiti has not had cholera for 60 years – but, in situations that the West is wont to describe as desperate and unthinkable – Haitians seem to share with many in Africa a far greater capacity for accepting that they will die of whatever they die of whenever they die.
And why have the world’s eyes turned to Haitian cholera, as they did in Zimbabwe last year? Because cholera is a magical disease – incredibly easy to cure, and not too hard to prevent – the results can be impressive and instant. Without treatment, mortality rates are high, but with simple rehydration salts (orally for most, IV in the most severe cases), survival moves above to 90%. T transmission is oral-faecal, so prevention is simple, through clean water supply, hand washing, heating food, and good latrine systems. Setting up a cholera camp is similarly straightforward in principle, albeit logistically heave – basically fences, tents, beds, latrines, showers and lots of handwashing stations, and human resources (nurses, cleaners, hygienists, guards), all washed down with plenty of chlorine. However, the 100/200 bed camps are a last resort – the heart of cholera prevention, and reaction, is a wider question of community sensitization, education and development – clean water supplies, hygienic systems of defecation, clean feeding practices. In the absence of such resources, some aid agencies have been returning to the same places in Congo and setting up cholera camps every year for 20 years.
And where cholera is unknown, you can set up a perfect cholera camp, and patients (and even staff) will not come because they don’t know what happens inside – they see the body bags coming out and they are scared. Even the local authorities are scared – our cholera camps are both in existing hospitals, with directors who are worried about future development on the land, and water sources nearby that could be contaminated by cholera latrines. They are also worried about the balance of resources devoted to cholera, when the health system has insufficient resources to cope with existing demand.
And the earthquake, which shot Haiti to top spot on the global pity rankings only one year ago? In the north, it had little immediate impact. But in the south, it was a humanitarian disaster that did truly merit any coverage it received – the stories from the few days following the 12th January are quite astounding – huge proportions of fatalities – even at the other side of Port-au-Prince from the epicentre, many of our staff had lost sons, daughters, wives husbands. From UN officials to slum dwellers, the earthquake struck the rich just as much as the poor – and more devastating, it hit many of Haiti’s already weak institutions of government – in the health sector, for example, the principle nurse training college was destroyed, taking with it most of the graduating class of nurses.
And we are blessed with the presence of two incredible drivers. Davide has been astutely described by our experienced French doctor, as ‘primitive’ – not in intelligence, but most certainly in humour. He always has a conspiratorial smile, and will spend the whole journey talking at you, either about the cow’s milk his father used to make, but usually a running commentary of the beautiful ‘Chantales’ on the roadside. He enjoys playing boyish tricks – grabbing your feet as you run up the stairs above him, driving away when you try to open the car door – quite refreshing to see in someone who is highly regarded in his profession. His double act, Pascale, an equally brilliant team member was summed up with the observation that ‘if he was American, he would be gay’. His French is almost incomprehensible, even to national staff, which I think could only be put down to its camp lilt, and he will spend long journeys pouring out his heart on his emotions, on how much he misses his wife, which I suspect may be an overegging of the pudding.
A WHO doctor I met, an emergency junkie who spent her life running round the world dealing with crises, regarded the world as a disaster and everyone in it incompetent, and tending to cause more damage than good in her fleeting visits, considered Haiti worse than Congo. There is clearly an immense social divide here, malfunctioning institutions of government, and severe poverty, but it is hard to compare to Congo – even in remote North-Eastern Haiti, there are a couple tarmac roads, banks and people with bank accounts, markets, hotels, internet, and a semblance of local authority systems and health centres. And across the border in the Dominican Republic – a logistics holy grail, albeit inaccessible to most Haitians: PC world, supermarkets, ATMs, hardware stores, motorways – two worlds on the same island.