Haiti's wounded long to heal

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For Elisa Zlami, the burden of her fractured leg just got heavier, literally. The day before, Marc, an ortho-tech at the General Hospital in Port-au-Prince, came immediately to her tent, "Post Op 3," after I asked him to "do something" about Elisa's old split cast that was causing her pain. Haiti's earthquake snapped her shin bone in two, and left an open wound that has finally healed.

Marc expertly rewrapped her leg in a new plaster cast. Despite a day of drying, the new cast must weigh 20 lbs. Yet her leg still hurts along the fracture point. A summoned orthopedic doctor inspects Elisa, and tells her the pain should go away, and Elisa need not stay in the hospital. But Elisa has lost her home, and her family too.

A few weeks after the earthquake, Rea is desperately trying to get food for her community of children and their families from the school she ran before the earthquake. It now is a community centre and clinic. Baz, an American medic, has told her that there might be food from the U.N., but it is very confusing. The Italian Navy is also promising food in a few days. The prospect of being able to participate in that food distribution system seems daunting for Rea, whose English is not very good and whose Italian is nil.

A new French doctor, Michelle, breezes into Post Op 3 and cuts away the dressings from Mrs. Wintour's heel. Mrs. Wintour's wounds are now green with infection. I changed her dressing two days ago and there was no green then, so daily dressing changes are now mandatory. Better nutrition is essential too, since malnourishment is preventing healing.

At the sprawling, busy United Nations compound, there are no hungry people. Not many are Haitians either. They are being stopped at the gates, while whites like me are waved through. I have no business there really; I am wandering around looking to book a flight to Miami. I see many cheerful foreigners working for NGOs, governments, militaries and businesses. Haiti is now a boomtown. The opportunities for aid and development work are enormous thanks to the disaster and the millions or billions of dollars being pledged. Foreigners, especially Americans, are flocking to Port-au-Prince to pursue this offshore opportunity. Many are earnest, believing sincerely in their humanitarian mission. Of course, the thousands of mostly U.S. soldiers didn't exactly come by choice.

When deposed, popular Haitian President, Aristide told the U.N. in 1991, "Everyone must have a place at the table," he was referring to Haiti's hungry dispossessed. But it is the international community that has invited itself to feast. Little has changed since Columbus first colonized Haiti, including blaming the Haitians for their poverty.

The community of the injured

Post Op 3 tent is a small community where Elisa and Mrs. Wintour live with 18 other patients, their families and friends. The young girl who often tends Elisa is a friend, the healthy sister of another girl living outside the tent, who also has a painful broken leg. Food brought in by the families to supplement the meager daily hospital meal is often shared. Nearby, the Haitian Adventist hospital sponsored by U.S. Adventists and an evangelical food mission provides two large vegan meals a day with food mostly purchased in the neighbouring Dominican Republic.

I asked Mr. Abelard, Elisa's older neighbour in the next bed, to make sure Elisa gets to x-ray. He knows how the informal system works -- you flag down someone walking by in Transport, hand them your paper note saying "Radiograph -- jambe droit", and they put you on a stretcher and carry you to and from x-ray.

Emmanuel has extensive injuries, including an amputated right arm, and is fighting an infection to hip and leg wounds that have been repeatedly surgically cleaned. He also has two sisters jealous of his neighbour, Mrs. Wintour, and her new, experimental mechanical wound suction device that aspirates draining fluid from her foot wound into a corrugated blue squeeze bottle. The sisters want one for Emmanuel. The device is being developed by a Boston medical team who work with Partners In Health based here in Haiti. Kristine, their engineer, thinks when the kinks are worked out, they can provide the molds for the plastic bottles to businesses in third world countries that can stamp out bottles for a few dollars. They hope each system will cost less than $75. In the U.S., a more efficient electrical system called a Wound Vac costs $25,000; its manufacturer made $1.4 billion from it in 2008. The next day, Emmanuel gets the blue bottle wound suction for his hip.

Shekhar, an Red Cross volunteer from Edmonton, called me the other night after assisting with food distribution that day. He can't understand why food distribution is run so badly in Haiti. After all, Shekhar and the international agencies have done this successfully around the world. The Haitians are prepared to do anything they can to help. Those of us who have had the good fortune to hang out with Haitians or wander around Port-au-Prince's poor neighbourhoods remark to each other how kind and gracious these Haitians have been to us. This is in contradiction to their sinister portrayal by our media and governments.

I happened to have been in Washington when the quake struck. I'm not a bad schmoozer, so with a little luck and effort, I found myself connecting with people and agencies that were to be some of the players in the emergency medical response.

Last week, Christine, a trauma surgeon in Washington, told me that I should tell the director of the general hospital that if he wants medical materials, he should go to the US A.I.D. website. "Like a bridal registry," Christine texted. I presented the message to the director, Dr. Lassegue, who responded skeptically, "Yes, perhaps something will come of it."

Many experienced in disaster response, label the beginning organization "a clusterfuck." I bumped into David, a young tattooed American at the U.N. campground walking to a health-cluster meeting. David griped that the scheduled meeting times were often changed, and tended to be useless because the decisions had already been made overseas.

Losses deeper than the wounds

Like so many of the people sharing the post-op tents, Elisa's losses are more profound than her wounds. It's not their crooked or missing limbs that will be their biggest impediment. It is the prospect of trying to make a home and a life out of their shattered country that again is being occupied -- and is now run by a coalition of a post-coup regime, foreign governments, militaries, religious charities, NGOs and aid agencies -- all under the umbrella of humanitarian relief.

Three weeks after the quake, the French-run Handicap International organization set up shop at the hospital with a plain green military tent and a team of about a dozen French physical therapists and Haitian trainees. The French will leave eventually, but they understand that the work must continue with the Haitian staff. This model has yet to be adopted by most aid agencies that have no plan to sustain their programs without their presence.

Most charitable aid to "take care of Haiti's poor" spends little actual money inside Haiti. We long to hear announcements that there will be substantial aid for Haiti's peasant farmers to provide credit and resources to plant sustainable crops for local consumption, and to help Haitian businesses produce essential local goods.

Back at the trauma ward, we have to figure out who will be operating on the patients now that after a month, the Red Cross Norwegian orthopedic surgeons have left to another health facility, and the Medecins du Monde surgeons are leaving this weekend. The rapid turnover of many volunteers is maddening. In the operating room, I ask the Haitian surgeon in charge, who says, "When you need a surgeon, just come in and grab one of us." Sounds like a plan.

The staffing at least during the dayshift at the hospital is much better now than three weeks ago when I first arrived. Many more Haitians are able to work. The Israelis just sent in a half dozen Mogen David staff (while they are still busy blocking medical aid to Gaza after destroying hospitals and ambulances there last year).

Diana is an American nurse running a clinic inside a tent community of 2,500 homeless and hungry people. Talking with a worker at the airport where supplies are being delivered, she found out that his friend has a quadriplegic child who needs a wheelchair with a head support. With the help of a Mr. Fix-It friend, Diana presents the worker a retrofitted wheelchair with a headrest, and drives back to the tent community with four pallets of food. But two weeks later, Rea still has not been able to tap into a food pipeline for her community.

Haitians must run their own recovery

The informal networking ways of getting things done described above can only work on an international scale if the Haitian people are included and are allowed to be masters of their destiny.

International businessmen are urged to take advantage of the new manufacturing climate in Haiti. Foreign aid earmarked for security will also revitalize Haitian security forces who historically have been its death squads, attacking labour and community organizers who might reduce profits from such sweatshops.

The Toussaint Louverture International Airport was being run by the U.S. military when I arrived for my departure, notwithstanding the handful of Haitians who stamp our passports before we walk out onto the tarmac. Homeland Security's immigration police and border agents then check our passports as we board. Three weeks previously when I arrived, no one asked for my passport -- in fact, no one asked me for any identification or professional license during my entire stay. On the tarmac are Canadian soldiers, RCMP officers, CIDA aid employees and diplomatic personnel waiting to board their military transport plane to Ottawa. There is also a tent for the U.S. soldiers, and the U.S. State Department processing civilians for their humanitarian transport to the U.S. in military C-130s.

The aid response is not so confusing after all. The Montreal meeting of international donors, the Davos Forum, the Clinton-Bush Haiti Fund, U.S. A.I.D., the U.N., and the various security forces in Haiti all seem to be navigating the humanitarian response ship to further their interests in Haiti. Most NGOs and religious missions have found a niche to plug into.

Humanitarian aid is perceived as just and moral. But until Haitians like Elisa, Mr. Abelard, Mrs. Wintour and Rea are permitted at their own table and given the chance to build a sustainable infrastructure, so-called aid becomes another weapon to exploit these good people who liberated themselves from slavery, and are still paying the price.

Scott Weinstein is a nurse from Montreal, Canada.

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