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In the Time of Cholera

Earthquakes, epidemics, appalling poverty—how much more can one country take? St. Louis physician Bill Guyol doesn’t want to find out.

Photographs by Patti Gabriel

(page 1 of 3)

WEB EXCLUSIVE: CLICK HERE FOR A GALLERY OF MORE SHOTS BY PHOTOGRAPHER PATTI GABRIEL, WHO ACCOMPANIED GUYOL'S TEAM TO HAITI.

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.
 

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