by Dr. Kerry Forrestal, MD ’01
Late January 2006: A Month Before Departure
Why Haiti? It is a question frequently asked as word gets out that I’ve signed up for a medical mission to Cap Haitian, Haiti. Elections are upcoming and violence is escalating. Many point out that there are kidnappings; I am aware of this fact, and don’t add that there are some 30 a day. I am comforted somewhat by the fact that there is a 5,000-foot mountain range between my group and Port-au-Prince. At 200-plus pounds, I’m a fair amount of person to lug over a 5,000-foot anything, and I’m hopeful that the kidnappers are lazy.
My team will stage in an area called Cap Haitian, in northern Haiti. In addition to “Cap,” as the locals call it, we will be working in the villages of Borde, Juchereau and anywhere else we are needed. I will be accompanying an internal medicine doctor for adults and an obstetrician. My job is pediatrics and adults secondarily. Our group will also have several nurses to help get the job done.
I was advised not to have any expectations entering this trip, and yet those who have been there cannot help but share their experiences. I am told that a banana tree will likely be our office, and that the locals have no idea how to form a line. There is excitement among team members and unspoken trepidation as we pay attention to the upcoming elections.
So the question remains, why Haiti?
The truth is: I don’t know. I’m going because there is a need. I’m going because my parents taught me that you have to give something back in this world. I’m going because I have a remarkable wife, Shannon, who made it possible. I’m going to Haiti so that my daughters know that being a physician is not about privilege, but rather about service.
I’m aware that visiting Haiti for so short a time with 50 pounds of medical supplies on my back isn’t likely to change a whole lot. And yes, I know the story about the man chucking starfish back into the sea. It goes like this: An old man is walking on a beach littered with countless starfish stranded after a high tide. He sees a younger man busily throwing the starfish back into the water. The older, presumably wiser man tells the younger man that he can’t possibly make a difference amidst the unending numbers. The younger man picks up a starfish and heaves it into the water and replies, “It made a difference for that one.”
Emergency doctors have a great ability to figure things out as they go. Perhaps once I get there, I can figure it out.
Day One: February 21
Our flights to reach Haiti are like decompression from civilization as we know it. The first leg of our journey involved interstates, large terminals and jet engines. We fly from Dayton to Atlanta and have to kill some time during a brief layover. I score some coffee and a magazine to pass the time. It seems a small thing to have coffee, flavored if you like, or the ability to select from nine kinds of tea. It’s something that I will later learn to appreciate a whole lot more.
The second leg brought us from Atlanta to Fort Lauderdale where things began to look a little different. No, Florida hasn’t changed, but as we walk toward the flights that service Haiti, we see the airlines are smaller. One of the nurses remarks that she sees “Bob’s Discount Air” and “We-Be Flyin” off in the distance. I’m not entirely sure if she is joking.
The plane that took us to Haiti was tiny. It barely fit our team of 12, one other passenger and another pilot. He sat in the back and I took comfort knowing that our plane has a spare pilot. One other observation about the flight: You never appreciate the safety instructions that they give before you take off until you cannot understand them. The only thing I understood was something about a water landing and that most sharks are not man-eaters. I think.
After two and half hours, we are approaching our destination. As we came in over the mountains I was taken by the beauty of the land from afar: lush, rolling mountains in multiple shades of green surrounded by an inviting blue ocean. As we draw closer to Cap Haitian, we see areas of deforestation. Depending on which way you look, you either see ecological devastation or a Caribbean paradise. It was sobering to see smoke near the runway as we came in for landing.
We are greeted by the Haitian heat. I think of the moment in the Tom Hanks film Volunteers when he walks out of his jungle hut and proclaims that they must be about a mile from the sun. We are a source of some interest to the locals, though I soon gather that we aren’t a novelty. The check-in station-a tall plywood box cobbled together by a distracted carpenter – proclaims “Missionary Flights International.” Really.
Our experience at immigration and customs was the first confirmation that we are in a different world. Fortunately, we have a contact in Cap Haitian, a man named Wilbert (pronounced Will-bear) Merzilius. Wilbert runs the Living Hope Mission, a non-denominational group, that helps the people of Cap Haitian and surrounding areas. Wilbert meets us at customs and thank goodness he does.
Four of us – Wilbert, our lead doctor, myself and a dour-looking Haitian who I assume was in charge of customs, all file into an office. As we did, the customs officials outside tear into our six carefully packed boxes of medications. These boxes are tightly packed, and I cannot help but wonder how we are going to repackage our supplies.
Back inside the office, the customs agent offers a rapid-fire speech in Creole and starts punching numbers into an old adding machine. After arriving at the right number, guided by “strict” tariff fees, he shares the figure with our host and guide. Wilbert then leans over the man’s desk, clears the machine and starts inputting his own numbers. This goes on for some time until a deal is made. All told, it cost us two hundred American dollars and a bottle of our hand sanitizer, with moisturizer, to clear customs.
I will not be able to forget the first time I left the terminal. Americans have a much different definition of poverty. A homeless person living in the United States has access to more resources than most of the people we will encounter. In America, you can visit a mission for food and clothing, or an emergency shelter when it gets too cold for a steam grate. What Haitians define as “normal,” I would soon learn, is far below the concept of poverty in America.
No one, for example, has access to our version of a bathroom in the areas we visited because there is no sewer system. There are two kinds of outdoor bathrooms – a hole in the ground without walls or a pile of garbage. Public electricity, when it works, is available a few times a week. The roads resemble a motocross track designed by a sadist. The list goes on.
I also find myself bewildered by the Haitians themselves. Haiti is a land of desperate poverty and absolute want, but it is populated by people filled with an illogical and beautiful sort of grace. I do not claim to understand Haiti completely, partially, or even at all, but I believe there is something to be gained by sharing this experience.
We spend the night getting to know our new hosts, Wilbert and his wife, Meg, a native of Ohio who has lived in Haiti for 14 years. We begin preparing our pharmacy. We spend a long time placing de-worming medicines and Flintstones chewable vitamins in plastic baggies. I wonder if we are making too many bags. By the end of the week, I would have increased the number tenfold.
We are acquainted with the voodoo drums and, soon thereafter, the “rooster brigade,” the latter of which does not understand that 3 a.m. is not the optimal time to start crowing. We soon get acquainted with the Haitian uber-mosquitoes for which DEET is not so much of a repellent as it is an appetizer before their meal of American red blood cells.
Day Two: “My Love” of Juchereau
I suppose if this were a novel, I could tell you that I couldn’t sleep all night from the excitement of helping the poor of Haiti. I would also be lying. I fell asleep almost immediately as we started our trip the day before at 2 a.m. in Lima, Ohio, and did not arrive in Cap Haitian until 6 p.m.
I slept through the drums, roosters, mosquitoes and pretty much everything else. I didn’t feel rested, but I felt functional. Fortunately, our hosts understand the American need for caffeine as we had access to coffee. After a light meal, we load a pickup recently donated by a group in Texas and a van. Room was tight so I volunteer to sit in the back of the pickup.
My lungs and I are still not on speaking terms.
The roads are mostly washed out and when I use the term moguls, trust me that I am not kidding. First gear is the best friend of the drivers here.
We travel some two and a half hours and arrive at a small church in a place called Juchereau. The church is of stone construction with a metal roof, but it in no way seemed meager as we settle in. The first step leading to the church was quite high as the rainy season had washed away much of the soil from the area.
Our “waiting room” is a shady area on the side of the church and several pews that needed to be moved to make way for our clinic were carried outside to allow people to sit down as the temperature rose to well above 90 degrees. We set about seeing patients and it wasn’t long before “it” happened.
You can always identify a sick child, a dying child. They are unnaturally quiet; they lay in their mothers’ arms without interest in the world. Anyone in health care who has ever seen a child die will tell you that a screaming child doesn’t worry them. A quiet one scares them the most.
The young woman with a deathly quiet child sits down in the chair with an infant we judge to be a few weeks old, a month at most. The young woman is not her mother, but her aunt. The child’s mother had died three or four months before of an unknown wasting disease after long bouts of terrible diarrhea. It didn’t take much more of a description to know that she had died of AIDS. Before she did, she named her child “My Love.” The aunt had tried everything to nurse the child, but the child was failing.
I take a deep breath as I begin my examination of My Love. Part of me thinks, “I’m trapped in a poorly written Hallmark special. The name just put it over the top.” The infant was impeccably dressed, as are all the Haitians who would visit our clinics. After our interpreter, Julio, translates a few more of our questions it becomes evident that the child is suffering from the virus, too.
How do you tell someone what you know to be true? My Love will die soon. One morning she will wake up, perhaps with a cough and fever or that diarrhea that runs epidemic in the children of Haiti from the parasites in the water, and her condition will worsen throughout the day. My Love will not cry, nor will she struggle for she is already too weak. With perhaps no more than a whimper, the infection will overwhelm the remnants of her immune system and My Love will become one more of the faceless masses to die in the AIDS epidemic. (As you read this, that day may have already passed. I do not know her condition as information reaches us very slowly.)
Every person on our team has the same thought: “Take her home to the United States, bring her to the experts, and let our medical system have a shot at saving this child.” Some will say that for the hundreds of thousands of dollars one could invest in a fight that will likely be lost, you could start an immunization program through USAID and save hundreds of children. While I know in the logical side of my brain that it is true and good math, it held no sway as I cradled this child. It was her eyes that I will remember the most. Her eyes were not dim or dull but rather drank in everything around her. They were curious eyes, those that belonged to any four-month-old. Those eyes will stay with me.
We were quiet at lunch as the weight of the encounter stayed with us. We talk of it throughout the remainder of our trip, and as our experience in Haiti grew, so did our understanding of how common such things are. I don’t know how many patients we saw that day. We did our best. Our interpreter, Pastor Julio, was amazing. He never fatigued. I’m pretty sure he could run the Boston and New York marathons back-to-back and still have energy to spare. I would learn later, while I lay in my bed exhausted, that Pastor Julio went back to his church and preached for three hours.
We drove back home and, after another two and a half hours on the road, I’m certain that there were more potholes than there were heading out. We sit down for a meal and I find more coffee. I retire to my bed to write down some thoughts and think about the day. We are returning to Juchereau in the morning, and after the first day there, I could not help but wonder why I had ever left the states. Though no one is looking forward to the ride out there again, it is far too dangerous to sleep there.
My thoughts return to My Love and I cannot help but think of my youngest daughter, who is near the same age. In another life they could have been playmates. Sleep comes and I miss my second night of voodoo drums.
Day Three: The Return
The next morning I find my way downstairs and drink more than my fair share of coffee. Pastor Julio looks as if he had a refreshing jog around the island of Hispanola and stands ready to climb Mount Everest with the lot of us on his back. We drive back to Juchereau and observe something that we have not seen since arriving in Haiti: a police officer! He is using the United Nation checkpoint to do a little checking of his own.
Unlike at customs, we do not have our guardian angel, Wilbert, with us and the police officer politely informs us that our van is missing some obscure piece of paperwork. Our guides discuss the matter with him for a long time. There are guns everywhere. The UN soldiers have them, the police officer has them, and a lot of other people around them without guns are carrying machetes as long as your arm. The only people without weapons are us, so we stay put.
We end up loading all the equipment and people into the truck and leave our guide to work on freeing our van. We don’t have to wait too long before the guide shows up at the church. The policeman grew tired of the situation and said, “Give me forty U.S. dollars and we’ll consider it taken care of.” It seemed a fair toll.
We set up inside the church and by now, word has spread. People are coming from long distances and there is some desperation among those who want to see the doctors. After our visit, no one could say when another doctor would come back again.
One of the other doctors assists a patient who, at first, looks like a one-week-old girl in a dress. When he conducts the exam he learns that it is a boy in a pretty dress. Perplexed, the doctors learns that this child’s mother lost two other babies, both males. The local Voodoo Shaman had suggested that the mother fool the evil spirits by dressing her baby as a girl. The approach seems to be working.
The onslaught of ill children continues, a few are suffering from protein malnutrition while others have severe heart murmurs. The list goes on. I still find it a bit surreal to be in the stifling heat surrounded by all this while distributing Flintstone’s chewable vitamins as fast as I can.
Our day comes to an end and we prepare for our journey back to the compound before the sun sets. Leaving Juchereau for the last time is a hard thing to do, as the people we treated were so grateful for the few things we could do for them.
As an emergency medicine doctor, I am often confronted by patients who are angry over a several hour wait to have a CAT scan, labs and a host of other sophisticated tests that are completed on demand, at any hour of the day. In Haiti, we distributed some vitamins, de-worming medicines and some antibiotics to people who had walked three hours only to wait three more before receiving attention. And they were grateful. (A smile still comes to my face as I recall the patients of Juchereau.)
We load our supplies into our two vehicles and it takes us two and a hours to reach the compound. Pastor Julio is at it again, and I find some coffee before collapsing. Our next destination is a village called Borde.
Day Four: Borde
Day four breaks and our team is ready. If nothing else, Borde is closer which means less time on the spleen-rupturing roads. We ready ourselves to run a clinic at another church. This one is run by another of Haiti’s amazing Pastors, Pastor Marius.
Pastor Marius has an incredible story. This young man works with two churches, the one in Borde and another in Cap Haitian. He travels via motorcycle, the best mode of transportation over these roads. He is by any Haitian measure a successful man and someone genuine in his faith. However, not everyone celebrates the success of their neighbor, even if he is a pastor.
On Carnivale Night in 2005, Pastor Marius’ car broke down. He sent his wife and five children home and began working on his car. As he did, he was shot in the back at close range by a man he knew, a neighbor. The reasons are unclear. The bullet sliced through Pastor Marius’ back, destroying his spleen and puncturing a lung. The damage was immense. It should have been a fatal shot.
Pastor Marius lay there on the ground, presumed dead for some hours before anyone missed him. On finding him, deep in shock and laying in a pond of his own blood, his family contacted Wilbert who quickly found a surgeon who came back to Haiti for Carnivale. They operated and though he had a small chance at survival, this man of faith pulled through. He still requires additional surgery for which they have spent a year trying to arrange his passage to the United States.
Pastor Marius still lives in the same neighborhood with his family, as does the gunman. The police were not interested in pursuing the matter.
It was a particularly humbling to be visiting this man’s church to conduct a clinic. We set up quickly after seeing the number of patients. The sickest is a patient seen by our obstetrician. The patient was in the middle of a “septic miscarriage,” in which the uterus is severely infected. It can easily be fatal for the mother. We arrange for her to be brought to a rudimentary hospital in Milot, a nearby city. Though minimally equipped, the hospital offers more than we have at Borde. The patients at Borde are very sick, though we did not understand why. On a brighter note, the school associated with the church asks us to give checkups to the students, so we are able to see some healthy children.
On the ride home we stop in Milot to visit an historic site. We are not welcomed by the people in the street, and I cannot help but think twice about our decision to come here.
A frustrating thing happens as we head back through the town. We see the young woman from the clinic suffering from the septic miscarriage walking home. They refused to do the necessary procedure and, instead, had given her some antibiotics and sent her on her way. At home, as doctors, we would have lit up the staff of our hospital for such a thing, but here we held no authority. I do not know if she survived.
We make it back to the compound and settle in for the night. It is around 8 p.m. when we hear an enormous popping sound, almost an explosion and the lights dim for a moment. Things remain a little tense until we discover what happened. It turns out that a man was trying to throw a metal pole with a hook over the power lines and steal electricity. While he was unsuccessful, he did manage to destroy the transformer outside the compound, so that was the end of our government-supplied power. While electricity was only available every other night, it was still nice to have the ceiling fan going to move some air around. Once the mission generator went off at 9:30 each night, there would be no more power.
Lacking remorse, the man waves at us, smiles and walks away, leaving his pole behind.
Days Five & Six: The Weekend
The weekend is a bit of a loss from a medical standpoint. Sunday is church day in the highly Christian society, and Saturday is a day to get ready for Sunday. Wilbert had arranged for us to go to one of the resort beaches in Haiti. While that must sound like an extreme oxymoron, the island offers some gorgeous beaches and the one we are to visit is called The Cormier.
UN personnel relax here along with people on religious and medical missions. We are told that the beach was 15 to 20 minutes away. I am sure that’s accurate in “Haiti Time,” though in “New York Time” that means more like an hour and a half.
What has impaled this trip in my memory banks – not embedded, not anchored, not etched, but impaled – is the fact that we had to travel over a mountain, while standing in the back of a dump truck with no sides, to get to the beach. I found myself looking from the side of the truck as we inched closer and closer to the edge of the road and the several hundred foot drop. I begin planning how I would get out of the truck in case of a rollover.
Our hosts want us to have a relaxing time and for us to recharge our batteries for the next set of clinics. The beach, I must admit, is stunning, and that’s coming from a Hamptonite. The fact that we had to cross that same mountain again to return home somewhat diluted the restorative powers of the Haitian waters.
Having survived Saturday, we attended church in Borde with Pastor Marius. Aware of the wounds he received, I stood amazed as he preached with unbridled passion to his flock. He is wearing a suit in 100-degree weather and giving a sermon that must have been as much of a workout as one leg of a ironman triathlon. I half expected him to collapse at the rate he was going, but he did not.
On Monday we visited the Cap Haitian Clinic. Pastor Julio, who had volunteered for the first two days of our trip, is now in his fifth day of translating. Lindsey, our pediatric team nurse, Pastor Julio and I experience one of those rare times when you meet someone you bond with from the first encounter. I was thrilled to have him translating again.
The clinic is swamped. As with all our visits, we did our best to see and treat everyone. Once again, the sick children piled in. Perhaps the sickest child is a young girl named Marlie, who has a severe heart murmur. She complained of symptoms whenever she played with other children. Her health remains uncertain.
The day ends and we hand over our remaining medical supplies to the nurse at the clinic, Madam Kesnel, and return to the compound. Tomorrow will be our last day in Haiti and the thought of seeing my wife and daughters again has me wishing the clock hands around the face at light speed.
The Wait & Reflection
As we settle in for the night, we experience our first rain on the trip. The storm is a violent affair with lightening and driving rain. During one of the lulls, we hear a shotgun blast right outside the compound walls. At first we think it’s the transformer again, though the man with the pole had taken care of that possibility a few days ago.
I sit and listen. There is always an energy during emergencies: shouting or movement. There are two dogs in the compound and I wait to hear their barking. I strain my ears but I cannot hear anything. No one is seeking help for a gunshot wound, and no one is trying to enter the compound. I continue to sit in the darkness of that hour, with the storm around me, and use a mini-flashlight so as not to attract any attention as I flip through a small picture album of my family.
Our lead physician had joked earlier in the trip that should kidnappers show up, he had brought his checkbook. I start to think I should have brought a few blank checks of my own.
Morning arrives without incident or explanation of the events of the night before. The storm has knocked the dust down quite a bit for which we are thankful. We leave Living Hope Mission and Haiti around midday.
So my trip has ended and the question remains: Why Haiti?
It comes as no surprise that the question no longer matters. The real question is: Will I return?
There is a terrible truth that must be faced. It’s the part of the story of the young man and the many starfish that they don’t tell you: Sooner or later you are going to have to leave the beach. Whether it is because of hunger or exposure or fatigue, you will have to lay down the burden and leave. The thousands left will look at you, and you will think: Why not one more? In that moment you must decide if you are a one-time visitor or an active participant. Will you return or not?
I believe that I will return to Haiti because it is no longer a place on a map to me, but a place where remarkable people I have come to value live. Wilbert and Meg Merzilius can leave anytime they wish, both are U.S. citizens. They could get on a plane today, but they stay as they have for the past 14 years working to better the lives of those around them.
I will return because Pastor Marius won’t leave. He will awake today, just as he has for every day this past year, knowing that the man who shot him lives only a few doors away. He knows this, but he continues to preach and build his ministry and riding his motorcycle on the dusty and sometimes muddy roads that span the many miles between his churches.
I will return to see my friend Pastor Julio and share in his laugh and smile.
I will return because being a physician is about service and not about privilege.
I will return because of Marlie and My Love.
I will return because I can. I will return because I should.