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Photographs by Patti Gabriel
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In the evenings, Tim Traynor, a retired contractor from Wilbraham, Mass., puffs his pipe and holds court on the wide porch of Mission House, in Milot, a town in northern Haiti. Traynor’s taken to Haiti the way Ernest Hemingway took to Paris. He spends half of every year volunteering at Hôpital Sacré Coeur here. The town is 12 miles south of the city of Cap-Haïtien, which is a tangle of trucks, white United Nations tanks, old women leading donkeys, and young men yelling over the guttural rev of beat-up motorbikes. Milot is green and quiet, set in a valley at the foot of Bonnet à l’Evêque mountain.
After the January 12, 2010, earthquake, Sacré Coeur was one of the only hospitals left standing. That’s when Traynor came and stayed for months. He ran lights out to a soccer field so helicopters could land. He got a banana plantation cleared in three days to make space for military-tent operating rooms. When the high-school basketball court became the emergency room, he had a numbered grid painted over the court markings so patients could be identified. When there wasn’t enough oxygen to put two people on a ventilator, and it became “Sophie’s choice which one got to live,” he picked up the phone at midnight, got a U.S. sales manager out of bed, and asked him if he’d like to sell the Haitians an oxygen generator at cost.
Traynor’s learned to ask, but he’s also learned, from the Haitians, to make do. “You start to see stuff,” he tells me. “Like that broken light fixture over there: I see wire that could tie things together, plastic sockets that could isolate a machine from vibration. You could make a metal trowel to smooth concrete, a scraper to pull bark off a tree.” He drags deeply on his pipe. “After the earthquake, a guy would come in with a fracture, and we’d go over to the shop, weld some reinforcing steel into a traction device, sling a rock in a net, and hook it onto the leg.”
A police car pulls up, red and blue lights flashing.
“They just got those,” Traynor says, grinning. “They’re showing off.” The officers come by often, he says, for a Coke or to borrow batteries.
“Relationships matter here. When I started coming, what was discouraging was the ingrained attitude, which is pervasive among NGOs in Haiti, of being a caretaker. That we possess this complicated technology and these people are too innocent to step into that role.”
More than 10,000 nongovernmental organizations are now working in Haiti. Many use donated money—Americans alone gave nearly $2 billion after the earthquake—to tackle specific problems. Yet Haiti remains the poorest country in the Western Hemisphere, still critically lacking roads, plumbing, and clean water. And the country has been overwhelmed by a cholera epidemic.
Traynor stares off the porch, into the darkness. “Haiti is for the most part a failure. Nothing works. Milot is one of the very few places you can point to where it does work. Part of that is that we’re isolated in a valley at the end of a road. Part is the history—the Sacred Heart brothers came here in the ’60s, planted avocado and orange trees, and taught people an agrarian mentality again, after years of cheap American rice handouts. But it’s also, I think, the answer to Haiti, what goes on here in Milot. You have an economic engine—Milot would shrivel up and die without the hospital. You have an NGO with a history in the region, and great trust between the population and the volunteers. There is hope. There is training and education. And the donated money comes directly into Haiti; nothing gets siphoned off.
“I don’t know of another successful Haitian enterprise that is 100 percent run by the Haitians.”
Behind a tall wooden gate, through a gowning-up tent that smells of bleach, Hôpital Sacré Coeur’s quarantine area opens into a courtyard. Laundry is strung everywhere, and bright-blue nylon cots lean against trees, drying. Missionaries of Charity, brothers of the order founded by Mother Teresa, cross back and forth, their white robes cinched with sky blue.
It’s late November, and I’ve come to watch Dr. William Guyol at work. A St. Louis physician, he chairs the medical committee for the board of the CRUDEM Foundation, which supports Hôpital Sacré Coeur.
This is Guyol’s 13th trip to Haiti and his fifth in 2010. The earthquake left an estimated 230,000 Haitians dead, 300,000 injured, and a million homeless. By late summer, most of the patients Guyol helped treat in the quake’s aftermath were well enough to rejoin their families in tents outside Port-au-Prince. “And now,” he says, “they’re dying of cholera.”
Three cholera wards are set up in old schoolrooms that open into the courtyard. Guyol heads for the first ward, which is full of children. Unnaturally quiet, they curl on their sides or sit cross-legged on their cots. A little boy rocks incessantly, fists pressed hard into his eyes. A toddler in a pink dress, probably 3 but as tiny as a doll, sits straight-backed in the middle of a cot, eyes wide. Both of her parents are dead.
Guyol is tall and comfortably chubby, with the demeanor of a kindly Irish priest. He digs out a sheet of tropical-fish stickers and bends low, producing them with a magician’s flourish at a little boy’s cot. “How do I say ‘fish’?” he asks. “Poisson?” He puts a few stickers on the child’s arm. “Oui? Non? Oui?”
The boy stares into the middle distance, showing no reaction.
“OK, he’s not buying it.” Guyol pats his hand and moves away. The minute he’s gone, the boy reaches for the sheet of stickers Guyol left on his mattress.
“Komen ou ye?” Guyol asks a skinny, tired-looking woman in the next room, using the Kreyòl phrase for “How are you?” (“Kreyòl” has become the preferred spelling for what was formerly known as “Creole,” the French-based language Haitians speak.)
She insists she is “fini.” Le cholera is over.
“How long ago did the diarrhea end?” he asks.
Ten minutes ago, it turns out.
She’s from Cap-Haïtien; she got here on the back of a motorcycle. She says she didn’t even try to go to the hospital in Cap.
Guyol nods. “They’re overwhelmed,” he says quietly.
He approaches a pregnant woman, her skin a dark caramel color, her eyes set wide above high cheekbones. When she arrived, she asked for a private room. Now, tethered to an IV in the middle of the crowded ward, she has withdrawn inside herself, her only expression a slight, sad smile. She asks a single question: “How soon?”
Guyol palpates gently. “I think you are seven months,” he says.
He turns to an old man shuddering under a blanket, despite the heat. He’s been sick for eight days. He just came to the hospital today.
Guyol frowns; eight days is unusually long. He rests a steadying hand on the man’s arm. “It’s not just feeling chilly,” Guyol says, explaining as he goes. “It is bone-shaking. You can get it with any infection.” He presses a finger against the man’s chest, where every rib is visible, and taps on it with the other finger. “He’s got no muscle mass. The malnutrition is not new.”
A rooster struts through the open door and down the aisle, looking around with casual interest. “That rooster may be on a cot tomorrow,” Guyol says dryly.
He bends toward a man in his sixties, skin burned off his ankles because he had to ride on the back of a motorcycle to get to the hospital. “It shredded his feet,” Guyol says, wincing. “He probably burned them on the tailpipe. I’m going to change this dressing.” The burn is bloody, oozing pus. “I need gauze pads—4-by-4s, the bigger ones—and something to clean the wound.” He finds only 2-by-2-inch gauze pads. Next he rummages through a cabinet and lifts a stack of charts, sure that he spotted a tube of antibiotic ointment on a nurse’s desk just a minute ago. It’s vanished. “You spend 80 percent of your time looking for stuff,” he says, his voice calm. “This isn’t for everyone. Some doctors just want to walk into the OR”—he holds his hands up as though gloved—“and do their mastery.” The old man moans and begins gesturing: The diarrhea is back. Guyol moves away tactfully.
A few minutes later, he returns and kneels by the man’s leg, sliding a borrowed pillow under the ankle. “This will hurt,” he warns. As he pours antiseptic over the wound, the man rolls over, clutching the side of the cot, and exhales in a fast “whoosh, whoosh, whoosh.” The
little girl in the pink dress sits at the end of her cot, head tilted, watching.
In St. Louis, Guyol has a private practice in internal medicine, giving general medical care to adults. From his Clayton Road office, he can walk across the street to SSM St. Mary’s Health Center, where he is on staff. He lives with his wife and kids in nearby Brentwood, not far from the house where he grew up. He went to De Smet Jesuit High School, then the Irish-Catholic favorite, the University of Notre Dame.
On the French side, Guyol’s ancestors were colonial administrators in Haiti. “All but one were killed in the revolution,” he says. Long and bloody, it was the world’s first and only successful nationwide slave revolt, ending in 1804 with Haiti’s independence from France.
Guyol’s family never talked much about Haiti. But he grew up hearing about Dr. Tom Dooley, whose service in Southeast Asia helped inspire the Peace Corps. Dooley was a year ahead of Guyol’s uncle at Saint Louis University School of Medicine, and he became a family friend.
After college, Guyol, too, went to SLU’s medical school. By the time he joined St. Mary’s, another SLU grad, Dr. Theodore Dubuque Jr., was chief of surgery there. In 1986, Guyol heard that Dubuque was going to volunteer for a week or so in a place called Milot in Haiti.
Milot had a small health clinic, started by the Brothers of the Sacred Heart as part of their Center for Rural Development of Milot
(CRUDEM). Dubuque came home and convinced one of his best friends, St. Louis investment executive Carlos Reese, that they should set up a foundation to support the clinic.
The CRUDEM Foundation turned the clinic into Sacré Coeur, now the largest private hospital in northern Haiti. CRUDEM promised it would send money, expertise, and a steady stream of volunteers—and Haitians would run the hospital.
When another of Guyol’s uncles, a businessman, joined the CRUDEM board, Guyol was tempted to volunteer. But for years, he held back. “It’s a surgical hospital,” he thought. “I’m in internal medicine. What can I really add?”
After he met CRUDEM board members at a cocktail party in 2005, he agreed to go to Milot and gave several lectures on hypertension and diabetes. Only 10 doctors showed up for his first talk in Milot. He pushed ahead, giving a new talk every day. He kept his mouth shut when he went on hospital rounds, waiting until people started to ask questions. He pointed out, as tactfully as he could, that many ulcers in Haiti were bacterial, and if antibiotics were prescribed, people would see some real relief. He brainstormed diabetes treatment for patients who had to walk miles to buy a block of ice every day in order to keep their
By the end of the week, his lecture room was crowded with physicians. Staff members were bringing their family members to him for consultations.
Milot smells of marijuana, raw sewage, spicy food, wood smoke, and burning plastic. Scrawny cows meander its back streets, their undone tethers dragging in the dust. Vendors cluster outside Sacré Coeur, selling chicken, fish, fried and boiled plantains, rice and beans, yams, grits, coffee, oranges, and sugar cane. A small tan goat hangs upside down from a parked motorcycle’s handlebars, bleating.
Guyol walks a quarter mile from the hospital, nods to a guard, and turns between two white pillars marked with the red Maltese cross. This compound includes two houses for volunteers: Mission House, where Traynor, the retired contractor, holds court, and the Doctors’ House. A tan dog named Bebop and a dark one called Rocksteady curl up in the doorways at night, guarding the residents from tarantulas that creep up the outer walls. Behind Mission House there’s a third house where the Sacré Coeur’s medical director, Dr. Harold Previl, lives with his wife and two daughters.
After dinner, Previl drops by the Doctors’ House and sinks into the lumpy sofa, elbows on his bony knees. His dark eyes are grave and thoughtful. Nothing about him seems impulsive until he smiles a greeting, and the dimples cut deep into his lean face. “Since January 12, things are going pretty fast in Haiti and in our hospital,” he says. “We’ve gone from 70 beds to more than 200. Last week, we had a lot of trouble, because people think the outbreak started because of the U.N. soldiers.”
“Probably true,” Guyol says quietly.
Cholera broke out in Saint-Marc, in central Haiti, in late October.
“It took three weeks to reach the north,” Previl continues. He pulls out a sheet of statistics: As of November 24, this region had 5,191 cholera cases, 228 deaths. “I think we can double that. Since cholera can kill fast, a lot of people will not have time to come to the hospital. And people now have some fear to say they have cholera, because it has some stigmata.” He means stigma. “This afternoon I saw a lady who was obviously dehydrated—her eyes were sunken into her head—but she denied vomiting and diarrhea, because she did not want to be classified as ‘cholera.’”
Previl sets the statistics aside and leans forward. “We were expecting to receive many more patients, but Doctors Without Borders is in charge of the cholera management.”
I ask how that’s working. He laughs.
“May we talk politics?” he asks. “Sometimes when you have disasters in low-resource countries, some people are happy with this, because they are in business. Doctors Without Borders are very, very useful, because they are taking care of the patients, but nobody has any control over the way they are behaving. They are recruiting doctors and nurses from everywhere and paying them four to five times the usual fee. So the people we used to have to work with us, we cannot have access to them anymore. We are asking the staff to work twice the time they have been working, because when you are short of providers, some patients will die.” His voice stays low and even, but his jaw’s tight. “In an organized country, the government would be regulating Doctors Without Borders, and CRUDEM, and all the people providing care. Governance in Haiti is, if not zero, near.”
National elections will be held tomorrow, Sunday, November 28. Earlier, three of the Haitian hospital interpreters told me the election had already been fixed in favor of President René Préval’s handpicked successor, Jude Celestin—and politicians had tried to pay people in Milot for their vote. Previl’s asked some of his staff to spend the night at the hospital, in case riots block the roads from Cap-Haïtien tomorrow.
Last week’s riots shut down even the Cap-Haïtien airport. “Nou bouke,” the signs read. “We are tired.” The earthquake, the cholera, Hurricane Tomas, the election… Even in peaceful Milot, Haitians burned tires and smashed bottles outside the hospital compound. Every so often they came up to the gate and told hospital staff, “This has nothing to do with you. We love you guys, OK? You know that?” And then the yelling would start again. The hospital ran low on medical supplies, and when the roads opened, cholera patients arrived near death because of the delay.
Now Previl is trying to find volunteers to teach local families to boil water and give them chlorine tablets, soap, and oral rehydrating solution. He had a source willing to donate more rehydrating solution—“but that was before Cap kind of blew up,” he says.
Previl’s father, Ovide, was a driver for the government. His mother, Manotte Seide, once turned down a chance to go to the U.S. “She said she might make money there, but she would lose us,” he explains. “We wouldn’t study hard enough without her. She said the only thing she was going to leave us after she died was what she put into our brains.”
They lived in a poor neighborhood in the heart of Port-au-Prince, but all six children went to good Catholic schools—Previl to the Jesuits’ venerable Petit Séminaire Collège Saint-Martial. He wanted to be an army officer. His mother demurred, he says: “When you are in the army in Haiti, sometimes you will get involved in politics, and it is a very dangerous path.”
He went to medical school instead, and specialized in obstetrics and gynecology because he liked feeling useful under stressful conditions. “When everything went fine, and I saw the joy of the entire family, the smiles on their faces—” He shrugs. “You feel a little bit proud, because you at some point contributed to that event.”
Previl moved to Milot right after he finished his residency, liking the quiet of the rural area. At Sacré Coeur, he fell so obviously in love with Sandra Saintilme, a nurse anesthetist, that staffers started predicting their marriage. They now have two daughters, Sarha-Benedicte and Jade-Orelie.
Previl talks easily about medicine, how it “gives you every day an opportunity to be human.” He talks with a clear, hardened anger about Haitian politics, its corruption and blindness: “Sometimes I give up. Sometimes I say to myself, ‘Why did I not leave the country? What is the future of my children?’
“If it were up to my wife, we would not be here. But I see a lot of wealthy people—Marilyn Monroe, a lot of stars—killing themselves. They have millions of dollars, but they are not happy. It is not a matter of living in a wealthy country. It is a matter of living in a place where you feel you are OK.”
Sunday afternoon, a storm erases the hot yellow sun; by dusk, the air is a pearly pale gray. The loud election-day arguments inside the walled high-school courtyard have subsided.
Ryan Smith, a college student who’s been volunteering since summer, wants to show Guyol the cholera pits. After much negotiating with the mayor, Smith dug them himself, behind Milot’s cemetery.
The air is still wet, and in the half-light, the monuments glow, the concrete painted in Easter-egg shades of yellow, pink, blue, and aqua.
Families that cannot afford to buy a burial plot outright can rent one by the month. If they fall behind in the payments, the body is dug up.
A small goat rummages in garbage strewn amid the graves, ignoring the pelvic bones and skulls tangled in the vines. Near one banged-up coffin lies a leg bone still clothed, the faded denim slumped toward the ankle in folds, bits of red plastic bag clinging to the fabric.
Guyol makes it only a few steps into the cemetery when a Haitian man approaches. His penis hurts, the man explains with gestures, bits of Kreyòl, and grimaces. Before Guyol can answer, the man has taken his penis out for the doctor to examine. Even in the dim light, Guyol can see the accumulation of fluid. “It’s a hydrocele,” he says. “A huge one. Hernias can be huge here, too. Things go untreated for so long.”
The man leaves relieved, with instructions to go to the urology clinic. Smith leads on to the cholera pits, which are behind a locked gate in the back of the cemetery. Lined in lime and soaked in bleach, they can contain burned waste and, should the deaths increase, mass graves.
“We did start burying some people back here, in individual graves,” Smith says, pointing. “That’s a kid. That’s a kid.” He marked the first grave himself, but no one’s marked the others. The urgent need was to isolate and line the graves, because the dead bodies continue to release contaminated waste that can travel through soil to groundwater.
Smith’s a little disappointed that the staff of Sacré Coeur is not even using the pit he dug for waste. They tried, but the sight of blue-gowned, gloved hospital staff carrying bags across the street unnerved the townspeople. The mayor quickly rescinded permission. Now the hospital is using a small incinerator in the back of its own complex, and these empty pits sit like hungry mouths opened in the earth.
At dawn on Monday, a sleepy-eyed Previl straps luggage to a white Toyota Land Cruiser. He is taking 10 young people from Milot—six women, four men—to the nursing school in Port-au-Prince. CRUDEM will pay full tuition, and the students must commit to work at Sacré Coeur for at least five years after graduation. “We will have a nurse as training coordinator who will work closely with them, and each will be assigned a mentor from the hospital,” Previl says. “It is something that is not usually done in Haiti. And at their free time, they will be exposed here to everything that we are doing.”
“Will the hospital need all 25 nurses?” I ask.
“We can use every one,” he says.
Parents stand in awkward clumps around the van, exchanging nervous smiles as they observe each detail of the journey’s start. Previl frowns: A young woman is missing. A few minutes later, a motorcycle roars up and she hops off the back, breathless.
After the Land Cruiser drives off, Guyol goes to the cholera wards. He stands for a minute, watching. The Haitian nurses follow the protocol with crisp efficiency, not stopping once to ask for a physician’s input.
Guyol has looked for diplomatic ways to give the nurses more independence and confidence, so they’re not just waiting for doctors’ orders. “The nurses in America save our bacon constantly,” he says. “There’s a disincentive for the nurses here to suggest something.” Now, cholera, with its strict treatment protocols, is helping change that dynamic.
After lunch, Guyol stops by the neonatal intensive care unit. Two nurses from St. Louis, Mary Thompson and Susan Vasel, are watching a 3-pound newborn, the Samson baby, wear himself out trying to get enough air into his lungs. His tiny chest goes concave with each breath, and when Thompson feels him, his skin is cool. The head nurse, Elba Hodelin Zayas, says he is fine, because he’s under a heat lamp.
“He’s hot where the heat is,” Thompson agrees, “but he’s cold.”
Vasel joins Thompson at the infant’s bed. “He’s in a thermoregulating bed, but it’s not turned on,” she whispers to Guyol.
“They’re thinking they’re keeping the baby warm, but they’re not?”
“Right,” Vasel says. “If we can get the bed to work properly, it will do all the work for them. They won’t even have to use blankets.”
A flurry of questions and answers follows. It turns out that they can’t use the bed because they don’t have the tiny, disposable temperature probes that go on the end of a wire.
“We could have brought thousands of them!” Vasel says.
Zayas says she’d also like to have a special bed and ventilator over by the delivery room, which is on the second floor of the main hospital.
“Do they have staff for that?” Thompson asks.
“No,” Guyol replies.
“How long till a baby gets over here?” Vasel asks.
Zayas says if a baby is having trouble, the staff rush the baby down from the second floor of the main hospital, across the courtyard, and into this building.
Thompson nods toward a baby girl who lies without moving, her body a comma’s curve. She does not respond to cuddling or movement; does not withdraw from pain. “I’m wondering if that’s what happened over here,” Thompson says. “Not enough oxygen soon enough.”
Tuesday morning, satisfied that the cholera care is running smoothly, Guyol agrees to see a patient with a puzzling stomach complaint. He walks through the dim, musty military tent that’s serving as an urgent-care center, past a row of people waiting on a narrow bench, into a tiny, makeshift examining room. Simone is shown in. She’s wearing an ivory blouse and brown print skirt, and has her hair pulled back.
She says she wants to vomit all the time, and sometimes when she does, there is blood in it.
“How long has she been sick?” Guyol asks the translator.
One year. She vomits everything. Sometimes the color is blue.
“Is it ever black like coffee grounds?”
Yellow. Sometimes white. The day before yesterday, she felt like her head would explode.
“When she moves her bowels…is it ever black?”
Sometimes, if she eats flour.
“That actually doesn’t mean anything,” Guyol tells me quietly. “You have to filter a lot. She has upper-GI symptoms, probably an ulcer. The most common cause is an infection, and the bug is rampant in Haiti.”
He gestures toward the examining table and Simone climbs up a set of wooden steps and lies down, tugging her skirt into place and setting her purse next to her. After the exam, she pulls the back of her skirt up between her legs so she can wriggle off the table modestly. “I could do blood tests, but her color is good, and her symptoms are so classic, I’m going to save that money,” Guyol says.
The nurse comes in, removes that first chart, and hands Guyol 12 more. A man carries in a 78-year-old woman, Malirose. He says she was sitting, and her chair fell over, and now she has a pain and cannot walk well.
“Is there anyplace else she hurts? Did she hit her head?”
Her son gathers her into his arms and lifts her to the examining table, then turns away. She is wearing a red satin bra and white cotton slip.
“The only question,” Guyol says, “is whether it’s the pelvis or the hip.” He rotates her right foot, keeping his hand on her hip and asking when it hurts. “Probably she broke the neck of the femur.”
Her son carries her over to the radiology lab for an X-ray.
“She’s tolerating this really well,” Guyol says when they’ve gone. “The good thing is, there’s an orthopedic surgeon coming Saturday.”
Eleven patients later, he breaks for lunch. “This was a delightful morning,” he says. “In the States, what you go through—the insurance, the obstructions to care… This is simple, real medicine.”
He bolts down spicy red beans and rice and returns to the tents. Charles Jean Claude, a young man with a thin, finely shaped face, is shown in. Guyol holds his X-ray up to the fluorescent light dangling from the tent’s ceiling. “Infiltrates in the upper lobes.” He consults the chart, squinting at the French. “Every time he tries to cough, he gets a headache. When he tries to breathe, he can’t breathe.” Guyol looks at the next sheet: a TB test. Positive. He asks a series of questions: How long has he been sick? Has he had sweats? Does he have shaking chills? Has he lost weight? Does he have an appetite?
“No, he’s not hungry,” the interpreter says. “He already ate.”
“My concern, because of the headache, is that he could have TB and tuberculous meningitis,” Guyol says. “It gets into the brain and spinal cord.” He tests the patient’s reflexes, then straightens. He assures Jean Claude that TB is very treatable, he will go to the TB clinic and get medicine, and he will get better.
“OK, let’s see this next gentleman,” Guyol says after Jean Claude leaves, “and then I’d just as soon evacuate to get away from the TB in the air. I didn’t know we’d be seeing that; we would have worn masks.”
The next patient is the one he’s been dreading, the one he cannot help. Guyol saw Teleus Thelusman, 64, briefly in the morning. Now his X-rays are back.
“You can see his airway, how the trachea is blocked,” Guyol says. “He’s breathing through a couple millimeters—an opening no bigger than a cocktail straw. He’s had the cancer for a year; if we’d seen him earlier, we could have operated.”
Thelusman comes in with his son. He’s about 5-foot-4 and skinny, but from his ears, his throat slopes out until it merges into his shoulders.
“This tumor—is there a word for tumor?” Guyol asks the translator. “This tumor is pinching his trachea, his windpipe. The only way to help is surgery. I think now, even with surgery, it would not help.” He stands beside the man, rubbing his shoulder softly, as he relays the information a phrase at a time. “I’m going to make a referral to the surgeon, but I think he will say that this is too big. The tumor is in his windpipe, and we can’t remove it without removing his windpipe.”
The son begins speaking, saying his father’s problem is the big lump on one side, not the throat itself.
“It is inside, also,” Guyol says quietly.
At that, the younger man sits down quickly on the footrest of the exam table. Thelusman says nothing, just nods rapidly. “I think they will deliver bad news,” Guyol continues, his hand still on Thelusman’s shoulder, “but we will ask them.” He walks to the desk and begins writing a prescription. “Now, what will happen is that he will get more short of breath. The one thing I can do is give him a medicine that can help him relax when that happens.” Wordlessly, they leave.
“He is going to slowly drown,” Guyol says, rubbing his forehead. “I can’t imagine a worse death.”
Wednesday, Previl returns from what was supposed to be a six-hours-each-way trip to Port-au-Prince.
“When we got to Saint-Marc, the town where the cholera outbreak started, we faced riots and barricades,” he explains. “People were angry and belligerent because of the election results.” He told the nursing students they could go back to Milot, he says, but they wanted to continue. “We headed back toward Gonaives and slept overnight at the Catholic school there. It is run by my stepbrother, who is a priest. The next morning, we made it to Port-au-Prince and presented the students to the dean of the school.”
Previl and Guyol take me on a tour of Sacré Coeur. Guyol talks first about the new ventilators, rare equipment in Haiti. They have already saved dozens of lives, he says. At the door of what used to be the chapel, he hesitates. “Now that we are so crowded, it is for outpatients.” When Guyol says he can’t imagine a better use, Previl relaxes. “It shows that we have two doctors for each patient,” he says with a grin. “The doctor and God!”
In the hospital’s main corridor, Previl stands in one spot and pivots, pointing to OB/GYN, general surgery, and internal medicine. Beds line the hallway. “Almost any time, the corridors are filled,” he says. “This is the part of the hospital I am the less proud of.” Before the earthquake hit, they’d begun to plan an expansion: more beds, a radiology lab with digital technology, special labs for TB and HIV. Both are rampant here. “We are going to have to live with cholera for the next six months,” he points out. “So we have to get the hospital back
Guyol has spent the morning in the cholera wards, and he gives Previl a quick report. One child has died; most of the others are noticeably better, bright-eyed and playful. The number of patients, which had dropped to 38, is up again. Nearly all of the new patients are from Milot.
That means the treatment centers around Milot are working, Previl says. “Now it will be easier for us”—easier to educate and treat, easier to calm the hysteria. Milot’s leaders have been panicking all fall about germs being brought in, contaminating their peaceful village. At one point, they even demanded that patients from other regions be turned away. “We are a hospital,” Previl told them firmly. “Whoever comes, we cannot turn our back on them.”
Previl says he’s just gotten an email from a group that donated water filters after the earthquake. They want to know if the hospital could use more now, for cholera prevention. “If we can give out those and bleach, we may be able to control the outbreak in Milot,” he says.
Later, he and Guyol meet to discuss whether to resume open-heart surgeries at Sacré Coeur. Previl was on staff as an obstetrician five years ago, when the surgeries were discontinued; he remembers them as consuming all the hospital’s resources. Now they have more resources in place—a ready supply of blood and oxygen, for example. Resuming these sophisticated surgeries, which haven’t been done in Haiti since, would help them get grants, donations, and credibility.
“I am a manager now; my job is to be in the middle of heart surgery and primary care,” he tells Guyol. “The hospital will mostly do primary care, but I will not reject surgery, because I want the hospital to be known.”
Guyol stays quiet. Later, he stops by the community outreach office, with its big, graphic poster showing droplets of diarrhea coming from between a man’s legs as someone helps him toward a clinic. “Drop the diarrhea and the vomit exactly into the toilet,” it says in Kreyòl. The next image shows how to dig a latrine. Most people here don’t have toilets.
Sacré Coeur still needs volunteers to go out and teach these lessons. Its malnutrition clinic has been closed since the earthquake, and there aren’t enough nurses to do mobile clinics. “A heart surgery costs $2,000,” Guyol says. “How many lives can you save by hiring a public-health nurse instead?”
As he heads back to the compound, the strains of “Auld Lang Syne” emerge from a distance. Slowly they grow louder. Horns wail; drums beat slowly. A bronze casket becomes visible in the open back of a battered taxi. Mourners walk behind, some sobbing, others singing. A woman sets out in the other direction, toward Cap-Haïtien. On her head, a wooden carton of empty Coke bottles sparkles in the setting sun.
Thursday, Guyol heads for a remote clinic in Tibo, up in the hills. He introduces himself to the nurse in charge, Dadeline Jean, an elegant woman dressed in a starched, white, high-collared blouse and skirt. She has only one question: “Are you here to help?” Ten minutes later, a crowd has formed.
A slender, weary woman in a flowered dress walks in, clutching a towel. Davilma Amenia, age 38, leans back in her chair, limp. Then she picks up the towel and bends forward, wracked with dry heaves. One year, she’s felt this bad, she says. She has been agitated since the earthquake. She hasn’t had a period since.
Guyol asks gently, “Does she know people who died?”
Non. She’s worried that there will be an earthquake here. That’s why she’s never sleeping.
Guyol does a brief exam and looks up, relieved. “Her real problem is an overactive thyroid. That would stop the period, keep her from sleeping. She probably has Graves’ disease. So now the question is, can they test for it here?” He looks down at a sheet of codes. “Yeah, they can’t. She needs to go to the clinic at Sacré Coeur.” He scans the clinic’s list of meds, hoping they’ll have a beta blocker so he can begin treatment. Beta blockers are inexpensive, commonly used; surely there will be one…
“Nothing,” he sighs. “She can get that at the hospital, too.” He looks up, smiles at Amenia, and recites a list of symptoms: “Weight loss. Anxiety. Insomnia. Muscle weakness.” She nods vigorously at each one—her first sign of energy.
“At first, I thought it was all psychosomatic,” Guyol says when she leaves, “because she doesn’t look sick. ‘I can’t sleep since the earthquake’ is a very common complaint. So is ‘I don’t want to be inside; I don’t want to be in a concrete building.’ But it was the disease that made her anxious in the first place; the earthquake just gave her something real to worry about for a year. And Graves’ is easily treated; the medicine’s cheap.”
The next patient, Jean Pierre Malherbe, covers his head with his hands. He says he has a headache, and his head is hot, sometimes every day. “For how long?” Guyol asks.
“Forty years?” Guyol repeats, keeping his tone even.
Yes, 40 years.
Back in the neonatal intensive care unit, the fly strip hanging from the ceiling is black. Mary Thompson, one of the nurses from St. Louis, is washing her hands constantly, trying to set an example, but there are no towels. She tugs gloves onto her dripping-wet hands and glances over at the Samson baby they were trying to keep warm. He has stopped breathing.
The nurses and Dr. Nelcie Voltaire, the hospital’s pediatrician, fly into action, doing chest compressions, then reaching for an oxygen bag. The oxygen concentrator’s working, but it rasps loudly—it’s due for maintenance from TriMedx, a firm that flies in every three months, pro bono. Voltaire startles her nurses by agreeing to get the ventilator.
“A year ago, this would never have happened,” Guyol whispers, watching from the doorway. “They wouldn’t have even tried to resuscitate.”
Minutes later, a big oxygen tank is rolled in, then a ventilator. Vasel’s still squeezing the oxygen bag, her rhythm steady as a clock.
“Is the vent going?” Guyol asks.
“No, it’s not! It’s set up for an adult!” calls a volunteer pediatrician from California. She scans the controls and curses; there’s no easy way to change the setting. Another doctor’s gone to get smaller tubing, but it’s too late.
In Sacré Coeur’s pediatrics ward, 6-year-old Guitho Evariste sleeps under a Pokémon blanket, oblivious to the chaos, his feverish head turned toward the wall. He didn’t realize his parents were trying to make charcoal, and he ran straight into the fire. That was two months and one day ago, says his mother. He didn’t talk for 15 days after. The family cried; they thought he was dead. They tried to make a coffin for him.
Duchenne Voltaire, the mother of the boy in the next bed, presses her hand to her back; she’s been sleeping in the narrow aisle beside her son Nicolas’ cot. He nearly died, too: Typhoid caused a perforation in his abdomen.
“He had three liters of stool in his gut,” Guyol says. “Luckily, the head of colorectal surgery at the University of Vermont was here that week.” Nicolas was on a ventilator for four days afterward; the infection caused respiratory failure. Now he is fine, Duchenne says; they’re just waiting for the final closure to his incision so he can go home. Provided they can pay his bill. It has already reached 32,000 gourdes (about $795). They’ve paid 19,000 gourdes for medicine, but there’s the cost of the ventilator, and the surgery—and Nicolas’ father isn’t working.
Jacques Raymond Delnatus, the hospital’s chief financial officer, comes every morning to talk to the family about how they will pay.
As Guyol leaves the pediatric building, a woman runs across the courtyard, screaming. She begins a slow, wild dance, clapping and moaning. There’s a choreography to her grief; she’s not falling apart. “It’s controlled emotion,” Guyol remarks quietly. “A demonstration, as opposed to a collapse. It’s almost expected.”
Security guards put their arms around the woman and lead her away. Word filters back slowly: Her 4-year-old grandson is dead.
When Delnatus comes by later to review charts and bills, he explains that the family gave the child some traditional medicine, probably herbs used in vodou. (“Vodou” has become the preferred term for the Haitian religion that is sometimes called “voodoo.”) By the time they brought him to the hospital, he was dead.
Delnatus, Guyol says, has the hardest job at the hospital: figuring out who can afford to pay, and how much. Family members bring a patient’s food and pay whatever they can for the care and supplies. They go back and forth every day from the wards to the cashier, carrying invoices for 50 gourdes (about $1.25) for a syringe, or 660 gourdes (about $16) for IV fluids and medications, and returning with fresh supplies. The hospital stay itself costs 62 cents per day—half of some families’ daily income. And many families are not earning a wage at all; by Previl’s estimate, unemployment has risen to 94 percent since the earthquake. “Delnatus Eating Shit” is spray-painted on more than one wall in Milot.
“People who are really very poor, we give them all things for free,” Delnatus insists. “About 25 to 30 percent of the people are not really poor. But since they know the hospital is for the poor, they become poor.” He shrugs. “Most of the time they leave without payment anyway. ‘Please,’ I tell them, ‘give the hospital what you can.’ I have to force them. ‘How much do you have in your bank? Tell me. I am your friend. We want the hospital to keep running. I will let you go home easily.’”
He has no income-tax records to check, no salaries to verify. “When people get to the hospital, I follow them all day and see what kind of dress they have on, what kind of shoes, what kind of food they eat,” he explains. “This is information I collect. By example, someone who eats every day chicken, rice, beans, and drinks coca, this is someone who can pay the fees. But someone who is wearing the same dress for four days and eating some little piece of bread with some bananas and drinking sweet water, I call the religious center and get them a meal right away.”
“How often do people try to fake penury?” I ask.
“Every day,” he says, sighing. “Every day of my life at the hospital. They take [the itemized bill] and give it to someone without shoes to come to me and ask a favor. I take the paper—” he mimes tucking it under his arm, out of sight—“and say, ‘What is the patient’s name?’ And they say, ‘I do not remember.’”
Friday afternoon, the hospital pharmacist has sent word that in a town just 20 minutes away, people are not getting treatment for cholera. They have decided it is a vodou curse.
Werly Valcin, one of the hospital translators, nods rapidly. He says his brother died in 2008, leaving three small children, because “someone don’t like him, kill him by a mystic thing.” At the mention of vodou, Dieula “Fifi” Gilles, the cook, hisses, “Go!” and stalks out of the kitchen.
“Fifi is Adventist,” Delnatus explains. He, on the other hand, is Catholique. He says he does not take part in the ceremonies, but “most of the Haitian people trust in vodou. They think they came from the vodou, and most of them think the vodou helped them to become independent.
“Vodou is our culture,” he continues. “We cannot leave the vodou. People come to the hospital very sick, fever, headache, stomach pain, and think this is a kind of vodou disease. If they take their pills for one day and they are not working yet, they want to get a traditional doctor. They cut trees and mix some medication that I cannot explain to you.”
“Does it work?” I ask.
“It works for people that trust in it.”
Guyol knows sorcery consultations are common: “People hedge their bets. They will not volunteer the information, but sometimes it’s obvious: Somebody comes in looking like they’ve been poisoned.”
It’s often been said that 70 percent of Haitians are Catholic, and 100 percent practice vodou. Guyol, a devout Catholic, can’t quite fathom this. To him, the two cannot coexist.
Previl disagrees. He’s studying by distance for a master’s degree in hospital management at the Université de Montréal. For his thesis, he wants to research ways a hospital in Haiti can collaborate with the houngan (male) and mambo (female) priests of vodou.
“I want to try to understand why, when someone is sick, they prefer to see those traditional practitioners,” he says. “How can we work jointly with them? I want to go deeply into that. Most of them are well-intentioned, but because this is their way of making a living, they see us as competitors. They are not giving the herbs to harm people, but they are harming people without knowing it. This is where I think there’s a big window to train them.”
In Haiti, he says, half of illness is thought to be supernatural, half natural: “I have a headache: It may be malaria, or it may be somebody who doesn’t like me.” Vodou uses rituals and ceremonies to invoke spirits, loa, that can affect the universe.
“This is something that is highly cultural, because it goes back to when the French were in power in Haiti,” he continues, “When we were slaves, we were supposed to be Catholic, but we’d come from Africa with vodou. So it means, in front of the masters, we will be Catholic.
“But behind each Catholic saint there is a loa.”