Gerome

I wanted to begin by posting something that I wrote exactly a year ago. It gets at the profound difficulty and adjustment of providing really high quality healthcare in resource poor environments. It's something we all experience at different times and in different ways. To some degree, we begin by becoming aware of our own preconceived beliefs and expectations.

The photos are of Father Rick, a doctor as well, and the director of the hospital where we are working. He is an amazing individual. The story below describes  a patient who passed away. I've included some photos of Father Rick, one where he's saying prayers at a mass grave just after the earthquake. It's a harsh photo, so I cropped out the majority of it, but it demonstrates the deep respect for the dead and grieving that I've seen in him time and time again and it is no less for his living patients. Even on a weekly basis, on Thursday morning, he goes to the mass burial by the government of all those who remained unclaimed because no one had the money to pay for their proper burial. 

This organization is more than just a hospital. There are orphanages, employment development projects, job training, and much more. One of the most famous chef's in Italy recently helped them set up a pasta factory, an addition to the existing bakery. They're building a fish farm that will feed the orphanage, provide fertilizer for the garden, and employment for others. The hospital which he helped build provides long-term care to critically ill children and outpatient services to more than 40,000 children and adults each year. Amazing!

Gerome – December 2010

I had been working as a translator (Haitian Creole to English) for the past week at a cholera treatment center in Port-au-Prince, yet this morning started like no other. The night before Gerome, a patient, had a common cholera complication of an intestinal obstruction. We lacked the facilities to treat him and had just gotten word that the government run General Hospital would admit him. Even within the medical community, a cholera contamination stigma persisted and we had spent the night hearing rejection after rejection from other hospitals. It is difficult to imagine a more calamitous year for any people than 2010 in Haiti. The earthquake in January killed a conservative 200,000 people, which was followed by a cholera epidemic that began in October. It was now the end of December and only 5% of the earthquakes rubble had been cleared.  Gerome was as familiar to tragedy as most of the Haitian people. He had lost his two children in the earthquake and his wife had passed a few years prior.

Daniel, an Italian nurse, and I road with Gerome in the back of the ambulance. The experience of driving in Haiti is akin to riding a roller coaster without a safety harness. With one hand firmly grasping a rail, I steadied Gerome's head with the other. Occasionally he would vomit intestinal fluid and in an effort to preserve his dignity more than any good it did, I'd braise my legs beneath the stretcher and gently lift his head to clean what I could. As we weaved through the cacophony of street vendors, the onslaught, the dense sensorial experience of Haiti's poverty pored through the windows in a chaotic blur. The streets were lined by refuse filled canals, black with industrial soot and mounds plastic bottles floating in stagnant piles. The smells, thick and heavy in the tropical sun, of coal-fired ash, diesel smog, composting waste, and roaming livestock filtered in.

I had been to General Hospital many times before with bad memories. In fact, in the late 90's when I worked with Mother Theresa's organization, we would pick up the poorest and severest of patients literally discarded on the street by the hospital. When you'd enter, patients would be lying on the floor with filthy bandages, partly unraveled and a smell that I'll refrain from describing. The feeling of the place is captured by the iconic photo by the British photojournalist W. Eugene Smith called "Madness, 1959" taken in Haiti. It had been ten years since I had been there and I hoped that the presence of the UN and recent events had transformed it into an institution that truly served its people.

The most immediate, but temporary, intervention for Gerome would be to give him a nasogastrial tube to suction the intestinal fluid from his lungs and stomach. His stomach was swollen and it was possible the intestine had hemorrhaged. I held his head steady as we barreled down the road. We arrived at the hospital, a gated compound near the now collapse palace. Six, white, concrete buildings that had almost a communistic homogeneity were organized in three rows. We pulled up to the door where a small crowd huddled beneath an awning. With due prudence we brought our patient on a stretcher to the entrance. Gerome was unresponsive, but continued to breath in slow, effortful gasps as air percolated through the fluid. Conan went to the window and told them our situation. I could hear him relaying that Gerome could die at any minute if action wasn't taken immediately; and this is the incredible part – they told us to take a number and they would get to us when it was our turn.

There were four of us, Conan, a young Haitian man who assisted at our hospital, Daniel one of the Italian nurses who I had been translating for, and myself. We stood, surrounding Gerome's stretcher who lied at our feet, and waited in the heat of the late morning sun. Our frustration and impatience was apparent in our lack of conversation. The emotion was most palpable in Conan who seemed restless and on the verge of an expletive but at a loss of where to aim it. Then suddenly he seemed to calm down some and said, "This is poverty. This situation is poverty."

Over time, this struck me as so perceptive. Haiti's poverty was not just a lack of resources. The poverty of Haiti was infinitely more complex and it would be a gross simplification to place blame solely on the hospital, the greed of the administrators who had received lots of money from the UN and Red Cross, or the ambivalent staff. I don't mean to discount their responsibility, but the destitution within Haiti has been so chronic, so pervasive, that it has become inextricably woven into Haiti's social, psychological, educational paradigm. What we saw as repulsive apathy toward Gerome's suffering was for them normal and how things had always been done. On a daily basis they had to decide who would live and died because there was nowhere near the resources for everyone. The staff went months without getting paid, and most of the staff had never been properly trained. The complexity of the situation reminded me of the most recent educational reform 'No Child Left Behind', where schools were financially punished for when their students under-performed on a standardized test. The argument was that this held the teachers accountable. Yet the true cause of under-performance was so radically more complex. Students do poorly because they live in violent neighborhoods and deal with detrimental levels of fear, because both of their parents work 60 hours a week and aren't there to support them through homework, because 20% of the children in our country go to bed hungry and this nutritional deficit impacts cognitive functioning. It was like doing surgery with an eight-inch chef knife.

Haiti's own histories that lead to our circumstance at General Hospital was the culmination of hundreds of years of individual desperation and self-focused survival. Without the model of another way, there was no way the current system could change. And change if it could, would have to happen individually, collectively, and with an equal intensity and persistence as the suffering that preceded it.

Eventually, they lead us into a small room where because of a lack of an examining bed, we pushed a tall bench against the counter and laid Gerome there. The hospital itself was cleaner than I had seen it before and more organized. With trepidation we left. Later that day Conan, and Father Rick (the director of the hospital) went back to check on Gerome; and there he was propped up on the counter and the bench, untouched.  Conan and Father Rick brought him back and later that night we were able to insert the nasogastrial tube.

The next day we found a surgeon who would admit Gerome. Here he stayed under observation. The following morning, Conan came around asking for volunteers to give blood.  I agreed with two others (two women, Swiss and German) and we were off to General Hospital again. There's a funny way that patients receive blood from the blood bank in Haiti. Because blood drives aren't really a social responsibility, the blood bank requires that you give blood in order to receive it and it's kind of a three pints to two ratio. Our blood donation was fairly routine, and immediately we went with our cooler carrying two pints of blood to the surgeon's office. We arrived and were told that Gerome had died one hour ago.  

We brought Gerome back to our small chapel where our patients who had passed away awaited cremation. That night Conan told me that he was going to spend sometime in the chapel with Gerome and another young woman that had also passed earlier. I mentioned this to others who had worked with Gerome and the word spread. Conan had found a surprisingly elaborate coffin for Gerome that had been left by another family who decided on cremation. As I approached the small chapel, more than just those who had worked with Gerome were there. Incense had been lit and the chapel had been swept. The melancholic, nasal drawl of Bob Dylan played in the background. Father Rick sat with us and I wondered what he thought of this less than ceremonial wake, but he sat humbly, with a gentle grin, possibly even enjoying the irreverence of our gathering. I think that Gerome's story, for those who had known him through the death of his children in the earthquake, and his own in the cholera epidemic represented the grief we all experienced through our work in Haiti. As I sat on a pew against one wall, I could see the others who quietly, vulnerably sat with these emotions which had not had the time to be addressed and for this tender moment we opened ourselves to the sadness the Haitians experienced everyday.

Father Rick and Conan