Monday, November 07, 2011 -- Ghosts of Port au Prince

Doug
Today we travel to a church in Port au Prince for a mobile clinic. Guesly and I accompany a medical team from Bethel Church, in Washington. This is the first time I’ve actually worked in Port au Prince since the January 2010 trip, when we set up clinic at a school where the main building had collapsed, entombing close to 30 students. We worked there in the eerie wake of those lost but not quite gone children. Now we arrive at a resurrection of sorts. This church building was destroyed in the quake. It is, as are so many buildings in Port au Prince, in the process of being rebuilt. In this shell, I wonder, how many were lost? What ghosts still linger? I’m not talking about the fantastic, tortured shades of cinema. It’s the everyday ghosts. The memories that intrude. The old places, down in rubble. The rubble now cleared. The faces still fresh in the mind that will never be seen again. Every one a husband, a grandmother, a sister, a child. So many lost, so much loss. The scars that are everywhere--on the land, on the buildings, on the bodies. I still can see the haunted look on the faces of everyone we passed in the days after the quake. When I talk to survivors, “Where were you when it happened?” the look returns. The ghosts still just beneath the surface. Guesly and I will see that today.

Guesly
“Doc mwen gen dolor nan pe’m.” The old lady sits across from me in a makeshift church made of cinder block. Steel rebar sprouts from the ceiling and walls. This is our mobile clinic, this church where privacy is gives way to the children peeking through the many cracks in the walls. Again the patient says in “Doc mwen gen dolor nan pe’m.” Creole. Her statement brings me back to reality, the reality of being in Haiti again for another mission trip. This is the first time I am back in Port au Prince, working in a clinic since we were here after the earthquake. The images from the earthquake remain vividly in my mind, through the images from the TV screen and in images from my own memory after leading a medical team to help with relief efforts. I remember all the rubble from the crumbled buildings. I remember the sheer number of buildings destroyed, and I remember the sense of hopelessness in the Haitian people’s faces. Today, I see little remaining of the rubble. I see more normal activity, the hustle and bustle of life in Haiti, which would be considered completely chaotic for anybody living in the States or elsewhere but is welcome and comfortable here. After a few seconds that felt like several hours lost in my thoughts, I ask “Ki kote ou gen dolor, madam?” “Where do you hurt?” She explains in Creole that every day she has pain, tingling, and numbness down her left leg. She describes pain that has stolen her sleep and that grows worse below her knee. She says her pain started over a year and a half ago. As she speaks I begin to think of a laundry list of questions I need to ask to find exactly the source of her pain. When she is done talking, she patiently answers my questions as she sits, well dressed in her Sunday best, a white handkerchief wrapped over her head. Her facial expression appears fatigued like a person who has lived several hundred Sundays and has yielded to the hardship, poverty, gifts, and hopelessness that comes with being born in Haiti. .
After I have asked my questions to satisfy my need for information and develop my differential, I begin to examine her and the suspect area. Finally, I kindly ask her to lift her dress enough so I can see her leg and knee. What I see catches me completely by surprise. I should have thought of this in my differential, but my observation of her started with seeing her walk through the court yard with a considerable amount of large rocks strewn about like a river bed. Even I had difficulty maneuvering without spraining an ankle, but from what I saw she had no trouble walking. She was slow, but that is not uncommon for her age. I recall this as I am staring at what has appeared from under her dress. It is not her own leg. It looks completely different than her other one, and I realize it is artificial, prosthetic.
Her voce soft and gentle, she begins to talk about what people call in Haiti “the event.” ”When the event occurred on January 12, 2010, I was in my house when suddenly it shook and I fell, and the house fell, and I was trapped underneath the rubble…” She smiles to reassure me, but I see through it that she has lost more then her leg Her eyes glaze, and I sense that I have brought back a flood of painful memories that she would rather keep hidden deep in her subconscious as her left leg was hidden underneath her dress. As we talk, she explains that her lower leg was crushed, it was removed, gone, but some days she feels tingling and pain all the way down her leg to the ankle as if it was still there and had not been “cut off.” I place my head down for a second, again reliving the memories of my time spent after the earthquake.
I remember a little girl I saw, just 11 years old, whose father had argued that he did not want “ them” to cut his daughter's legs off so that she would never be whole. “Them” referred to the various foreign doctors that came to help with earthquake relief efforts whose efforts to saves lives meant amputating limbs from crush victims. The Haitian people equated seeing the foreign doctors to losing arms and legs. They had real fears in that time that seeing “them” would destroy their wholeness. The 11 year old’s leg was leg became infected after being crushed, and there were concerns that the infection could be make it way into her blood stream, which meant she lost her leg or lost her life. Either decision came with a terrible price. In the end the earthquake cost the daughter her leg, but not the family their daughter. I know this woman now sitting in front of me must have faced the same awful choice.
I explain to the patient she is experiencing what is called phantom pain. This could be a syndrome in itself as many people who had limbs amputated suffer from these symptoms. Patients often feel as though their leg is still present, causing them pain to the point of being debilitating. Phantom pain can be helped if the patient is placed on medication that decreases the pain signals generated from damaged nerves. She appears to be satisfied with my explanation and wonder about the medication. I explained to her that unfortunately I did not carry that medication with me and she would need to travel to Fond Parisen where the mission hospital and clinic has a limited amount. After some further discussion, I give her prescription for Tylenol as I did not have any narcotic with me and it is hard to find in Haiti. She says a polite thank you “doc” , and promises to try to go to the hospital in Fond. Fond Parisen is the home of the mission hospital I travel to while in Haiti. It is about an hour from the church in Port au Prince but could be 4 to 5 hours with traffic.
After my encounter I begin to think how far in time it seems since I was in Haiti to help treat earthquake victims, yet how is seems like yesterday to the Haitian people who were afflicted and who continue to seek treatment for their injures. I wonder if that little girl is suffering from similar symptoms and if she will seek treatment as my patient today. Already the world has forgotten or is forgetting about Haiti. The news is always looking for the next sensational story. But the people in Haiti cannot forget. They continue to suffer. Their lives are forever changed. The need for healing will surpass my time and my generation. Do not forget about Haiti as the need for help is just beginning.

Doug:
So much is better. So much has healed, but the scars, the ghosts persist. Phantom limb may be a good way to think of it. It’s as if the whole body of the people of Port au Prince has lost a limb. The body moves, the people move about and get along the best they can, but they still feel it, every day. They feel them, the ones they lost, the ones we lost, every day. It’s been a good, tiring clinic. We head back to Fond Parisien to regroup and restock, and leave the city to its ghosts.

Port au Prince, November 7, 2011