GUEST BLOGGER BARBIE: MORE ON WORKING TO SAVE LIVES

Posted: March 22, 2010 in Uncategorized
Let me explain to you the anger surging through me as I sat in the back
of our pickup truck at 2:00 AM with the limp form of a child draped over
my legs.

Travel back with me to 1:15AM.

Whimpering…sobbing….in
the gentle, hesitant high pitch of a child. In the distant corner of
the courtyard of our hospital, under a tarp. She is trying to be quiet.
She knows it is dark in the hospital, and people around her are trying
to sleep. Mewing like a small, injured kitten. Tears run down her
cheeks. Her legs are pulled to her abdomen. Heat rises off her febrile
form, burning. Her lower jaw trembles as a wave of rigors shakes her
small body. Blistering fever.

Father looks on with quiet,
concerned eyes. He stands above her and watches intently as I examine
her in the small circle of light of my headlamp, kneeling beside her cot
in the darkness. Her heart is racing. Heat radiates off of her body. I
gently touch her abdomen. A small whimper escapes her dry lips and her
glassy eyes open to meet mine. Her hand touches mine and attempts to
push it away. "Fe mal…" she whispers weakly. "Fe mal…" It hurts…it
hurts. I hold her small, protesting hand in my left, and push again
gently with my right. Her eyes clench tightly. She sucks in a deep
breath and whimpers again. Her belly is rigid. A frighteningly sick
child.

"This is very bad…" I whisper to our nurse translator as
I administer a dose of morphine. "We need to get her to a
surgeon…now."

She had presented to our hospital earlier in the
afternoon with high fever, headache and abdominal pain. We tested her
for malaria — which will become epidemic as the rainy season encroaches
and the mosquito vectors reproduce in pools of standing water. She was,
unfortunately, negative. "Unfortunately", because in Haiti, malaria is a
very serious, but very drug sensitive illness which is relatively
easily treated when diagnosed. With the easy diagnosis eliminated, the
more concerning reared their ugly heads. Typhoid? A severe intestinal
illness leading to bloody diarrhea, severe abdominal pain and sometimes
intestinal rupture. Early appendicitis? Both requiring a surgeon.

Our
pediatrician, earlier in the day, drove with the girl to Miami Field
Hospital to consult one of the volunteer American pediatric surgeons.
The surgeon evaluated her, and advised that her illness was early, and
nonspecific, and that we should watch her carefully, treating for
possible infection. This is a common medical practice, even in the
United States — watch the patient closely, and await for the illness to
"declare itself" into a specific diagnosis. If it declares, come back
immediately.

So, at 1:15AM, the illness declared. Quite
vigorously. And absolutely. Intestinal perforation. Millions of small
bacteria from the intestines spilling violently into the pristine,
sterile cavity of the small child’s abdomen. An exquisitely painful and
potentially deadly event.

We called our midwife, who lives one
street over, and has a truck, begging a ride back to the Miami Field
Hospital. Father carried his precious child to the back of the pickup
and lay her gently across my lap. And in the darkness of early morning,
we drove through the deserted streets of Port au Prince, to the only
available surgeon in the city. The heat of her body burned across mine,
small moans escaping her lips.

The Miami Field Hospital is
located in a series of large tents inside the walls of the Port au
Prince airport. It was set up within the days after the 12 January
earthquake, and placed to be central and convenient to patients,
international volunteer medical providers, and imported medical
resources/equipment. From outside, it is a series of giant white tents;
inside, a bustling field hospital with a lab, pharmacy, xray, and adult,
pediatric and neonatal ICU. It is our — and much of Haiti’s — only
referral center for patients requiring intensive emergency and surgical
care, as much of the city’s medical infrastructure was destroyed in the
quake, and many medical professionals were killed. At present is the
last hope of many of Haiti’s sickest patients.

At 2am, we arrived
at a new entrance to the hospital — a set of wooden gates recently
placed into the concrete wall surrounding the airport. This new,
unadvertised, unmarked and solitary entrance to the Miami Field Hospital
was luckily discovered by our clinic staff during the visit to the
hospital the previous day.

Our American midwife, 20 year resident
of Haiti, pulled the pickup truck in front of the gates and sounded her
horn repeatedly. The gate was locked tight.

"How can the gates
be locked?" I asked. "This is crazy."

She honked the horn again
and again, echoing in the early morning darkness. Finally, from behind
the gate meandered a man in dark clothing appearing to carry a weapon. A
security guard. She honked her horn again. The man did not move.

Our
midwife turned to our Haitian translator. "Go tell him to open the
gate. Tell him we have a sick child in the truck, and this is a medical
emergency."

Our translator exited the truck, running to speak to
the man behind the gate. Words were exchanged vigorously back and forth.
Finally, he turned and ran back to us.

"He says the hospital has
closed, and the doctors have all gone."

I am stunned.

"What?
No it’s not…" I declare with frustration and disbelief. "No, they
haven’t left. That’s not true. That’s crazy!"

Our midwife shares
my incredulity. This is obviously a mistake. Just 5 hours ago, the child
on my lap was in this very tent hospital, consulting with a pediatric
surgeon from USC Los Angeles. A hospital overflowing with patients,
volunteer medical staff, and technical medical resources. There is
absolutely no way this hospital has closed its doors and evacuated it’s
staff in the 5 hours since our previous visit.

Our translator
turns to our midwife. "You’re going to have to show your face," he
declares with a mixture of frustration and acceptance.

Translation:
You need to show your Caucasian, non-Haitian face. You need to play the
White Card.

Our midwife– fabulous, strong, intelligent,
compassionate, wielding a beautiful Boston accent (the other Boston) —
gets forcefully out of the car. She strides powerfully and
authoritatively to the gate, and in fluent Creole, confronts the guard.

She
advocates. This is a medical emergency. There is a dying child in the
car. She was at the hospital earlier in the day. The head surgeon saw
her. He asked that she return. We are an ambulance from a Field
Hospital. LET US THROUGH THAT GATE.

"No," says the guard. "The
hospital is closed."

I can see the top of the hospital tent over
the wall surrounding the airport. It is illuminated white against the
2am night sky. It is obviously inhabited and operational.

I am
growing furious. I am growing desperate. This is obviously a political
power play. And we are the pawns.

I call out the truck window in
English to our translator. "What’s going on? Does he want a bribe? Tell
them I am a doctor and the child in the car is going to die and he MUST
let us in."

More negotiation. The whimpering form in my lap is
breathing rapidly and shallowly. My hand on her chest feels the fever
burning through her thin cotton top, and the wild racing of her heart.
She moans.

This is impossible. Yet, it is not. It is, perhaps,
exquisitely predictable.

Less than a football field away from our
truck sits a hospital full of medical specialists. Volunteers from all
over the United States, giving of their time to provide free medical
care to this city in its darkest hour. On my lap is a dying child. And
between us is a wooden gate, and a man with a gun and a political
agenda.

The airport authorities have apparently decided that the
Miami Field Hospital, which sits on an unused grassy lot on the
periphery of the airport, is an inconvenience. And this week, after the US
military handed back control of the airport to the Haitian government,
public access to the only emergency hospital in Haiti has apparently
been extremely and underhandedly curtailed. Hospital personnel report
repeated efforts to obstruct patients’ access to the hospital and
emergency care – as we experienced on this night. A new unmarked
entrance to the hospital, for example. A locked gate, with a belligerent
guard. This political stand off — so detrimental — drew the attention
of Haiti’s President, who commanded the Airport Authority to allow
patients through the gates and access to the capitol city’s only
emergency hospital. This was met, apparently, with political belligerence and opposition. And, at 2 in the morning, the power play is
acted out. And the order of the country’s Commander in Chief is
disobeyed. And we — the patient and her advocates — become the
powerless victims.

As I sit seething in the back of the truck, I evaluate the integrity of the flimsy wooden gate which separates us from
the lifesaving hospital visible beyond the trees. It is an absurd
barrier of chicken wire and two by fours. I am certain we can crash
through it with the truck if need be. My outrage is spurred on by the
limp child in my arms. As I plot, I observe that the guard has a gun,
and I fear he would be willing to use it. The images of several patients
in our care flash through my mind — innocent bystanders shot when the
police fired recklessness into the ground around crowds in gestures of
authority and intimidation — striking bystanders with ricocheting
bullets.

At this moment, I am impotent in my ability to help this
child. We are at the mercy of this political agenda. An argument over a
strip of land superseding the value of a child’s life. A metaphor for
the consequence of political ineptness and corruption.

I imagine
this is how it felt on the night of 12 January, in the hours after the
earthquake, when the sun left the sky and darkness fell. When the
screams of the injured rang out, and access to medical care was, in a
moment, non-existent. Hopelessness. Dying patients, in desperate need of
surgeons. And no surgeons to be had.

I recall news reports of
patients having amputations in city parks by the light of hand held
flashlights…without anesthesia. I recall patients telling grim stories
of being taken to the remaining local and overwhelmed medical
facilities, lying without medical care, in rooms filled with dead
bodies, themselves fearing that they would soon become just that —
another body, to be disposed of en mass in the back of dump trucks
visible outside their windows. Desperate acts to save lives. Desperate
patients. Desperate providers. Reflecting complete lack of access to
care.
In Haiti’s time of crisis, hope came in the form of volunteer
field hospitals — such as ours and Miami’s. At the beginning, lack of
medical access reflected the utter chaos of an unprecedented natural
disaster. Now, lack of access is caused, in part, by political
corruption.

Hints of such corruption were evident in my first
week at our field hospital. Still on the forefront of the medical
crisis, relief organizations were stunned to discover their medical and
relief supplies being suddenly unexpectedly being held ransom at the
airport…many for tens of thousands American dollars. Donated medical
supplies and shelters. For the country’s injured and homeless. Provided
free of charge from the generosity of the world community. To be
utilized by volunteers, many of whom had paid their own way to Haiti to
provide relief. Flown in by privately donated charter flights and
international military flights. At the request of the Haitian
government. Held at the airport and not released without the
organizations first paying exorbitant and newly invented importation
fees. While Haitians slept homeless in the streets of Port au Prince,
enduring early spring rain without shelter; while the President of Haiti visited the White House in Washington, DC, asking for relief assistance
for his struggling country… lifesaving relief supplies — tarps and
tents and medications — sat undistributed in boxes at the airport. Our
own hospital had its supplies held hostage for weeks — including
medications requiring refrigeration which sat sweltering in the Haitian
heat.

And now, once again, the Airport Authority, blocks access
to medical relief. In the form of this flimsy gate, and a man with a
gun, who tells a blatant lie: "The hospital is closed. The doctors have
left."

What will we do without a surgeon, I ask myself as I watch
the negotiations. Turn around with this child? Bring her back to our
hospital to die of sepsis?

Our midwife and translator continue to
negotiate with the man behind the fence. Finally, they return to the
truck. The guard, miraculously, manipulates the lock and slowly swings
open the gate.

"Okay, he’s letting us in," our midwife says, as
she quickly puts the truck in gear, taking advantage of the sudden
opportunity.

"Wait a minute," I say. "I thought the hospital is
closed and everyone has gone home. Isn’t that what he’s been saying for
the past five minutes. What did you do? Did you have to bribe him?"

Our
Haitian translator turns to me. "He’s letting us in because she’s
white," he says matter of factly, gesturing to our midwife. "You have to
know how to work the system. It’s just how things are here."

I
am relieved for the girl in my arms, but absolutely infuriated for the
people of this city.

"Wait," I say, as we start down the dirt
road to the hospital. "Are you telling me that if I were a Haitian
pulling up with a dying person in this car, that I would be turned away
from the hospital?"

"Yes," he replied, absolutely.

"And
we’re getting in because we’re white people?"

"Yes," he replied.

I
am horrified and infuriated by the injustice. But, for the moment, I am
grateful for the incidental lack of melanin in my skin which, tonight
(and, unjustly, through modern human history), has provided me with this
seemingly random political advantage. I am perceived, by the color of
my skin, to be someone who has possible political connections to a
higher authority, a political democracy, which I can call upon to
advocate on my behalf.

And for the local Haitian, who pulls up
the the gate tonight with a dying child, without a political advocate?
They will likely be turned away.

If you are reading this tonight
from the comfort of your home, which fortunately is located in a
representative democracy — perhaps one of the wealthy first world
nations which, through your tax dollars, has provided disaster relief to
the nation of Haiti — I ask you to advocate for those who are less
powerful than yourself. Use the representative government that you are
so fortunate to have peacefully elected, and which politically advocates
on your behalf. Contact your congressperson or political
representative, and ask that the government of Haiti be held politically
accountable for properly managing their international relief; ask that
further relief be contingent upon allowing that relief resources be
accessible to its people. Ask that relief supplies be released to
organizations on the ground helping their injured and homeless. Ask how
your tax dollars are being spent, and how they are being managed, in
this crisis.

And of course, because you care…you perhaps would
like to know the rest of the story.

So, we drove the remaining
distance down the dirt path beyond the gate and pulled up to the front
of the great white hospital tent. Father took his whimpering child
gently from me and cradled her in his arms as we walked together from
the truck, exiting the tropical Haitian night, and entering the front
door of the still-bustling field hospital. Immediately, we were greeted
by a doctor — in fact, a board certified pediatric surgeon from
Children’s Hospital in Los Angeles. He gladly took her back into his
care.

I guess the hospital wasn’t closed after all. And,
apparently, all the doctors had not flown home in the five hours since
our last visit. I guess it was all just a simple misunderstanding.

Barbie

The health care professionals with Heartline are not just treating patients, they as well are fighting to save their lives.  Often it is a fight not just against injuries and sickness but also against a government that lacks social consciousness or a tunnel vision politition, or a mindless gate guard or someone looking for a bit of money to allow you to pass through a gate or open a door to get to those that can offer life saving medical treatment.

Help Heartline help others.  Click here to donate.

John

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Comments
  1. James says:

    Barbie, great job!!!! I was on the first team there and it fills my heart with joy to see all the great work that has continued and progressed from that first week. You are an inspiration. I am returning to Haiti with another group and am trying to contact John, I know he is always busy but when you see him, let him know I have emailed and would love ot connect with him when i return and see all of my friends at Heartline. james.spdx@hotmail.com

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