Monday, May 15, 2006


Fastina is with us. When we went to the orphanage on Saturday, she tap tapped and walked down the mountain with her mother. Very slowly, as she was in atrial fib and needed to lean on her mother for support. Her heart rate was 150 and her right lung sounded socked in with fluid. So we decided the best course of action was to have her come with us and stay until our flight on Thursday. John can monitor, give her meds, and she will get good food to eat.

“Fastina is like a female Willy,” said John. This is big praise as Willy another Haitian Hearts patient, is one of the most gentle, likeable souls around. There is something angelic about him. I am convinced that he’s been to heaven. Several years ago he was so sick and in intensive care for five months. Who knows? Like Willy, Fastina has a shy, beautiful smile. She is quiet and low maintenance, content to watch television in the cool, dark cocoon that is our room. Today her mom dropped off more clothes for her, and she washed the outfit she had been wearing in the sink.

We fed Fastina watermelon, pineapple, banana, and papaya—John wanted her to have the last two potassium-rich fruits to replace all that she is losing with the diuretics—pizza and French fries. While we were eating, I conducted a little social history interview with Fastina. She is 13 and has two brothers, 18 and 11. When I asked her if she had any sisters, she said her sister was dead. We didn’t know about this. Seven years ago, Fastina’s 9-year-old sister, Melissa, became ill in the stomach—John’s guessing typhoid fever or appendicitis—and after three days of sickness, she died. Scratch the surface of almost any Haitian family and you find a dead child.

When Fastina’s mother came this morning, she brought three relatives with her. When they left, Fastina cried. She doesn’t know how long it will be before she sees them again. In some ways Fastina is lucky. Most kids in the developing world who have hearts damaged by rheumatic fever die. But she is facing a big trip to live among strangers in a different culture, where she will have her chest split open in a dangerous operation. Sound like fun, doesn’t it?

The end result will be worth it, though. Fastina is worth it.
The Beginning of Hope:

Today Rene Preval is being inaugurated as prezidan of Haiti and, oh, the pomp and circumstance. Our little inn is overrun with South American journalists, girlfriends of Venezuelan dignitaries, and French-Canadian police officers. Outside the entrance, three National Haitian police officers dressed in their crisp blue and ocher uniforms sit slumped in chairs under the shade of a few trees. A huge UN vehicle somewhere between the size of a tank and jeep is parked to the side. U.N soldiers from Nepal sit inside the gate, armed for action, but with expressions that say they know this assignment will be about as dangerous as guarding a Sunday morning parade.

This week the parking lot has been jammed with all kinds of vehicles, including a bus from the government of South Korea. All the money that is being spent on people attending and covering this inauguration—any excuse to go to a party in another country. President Bush is sending his brother Jeb, the governor of Florida, to lead the U.S. delegation. On television, we catch a glimpse of him seated next to a woman in a broad brimmed hat—probably the new U.S. Ambassador to Haiti.

Cripes. I mean I know we need our rituals, but the more elaborate they are, the more obscene they seem in a country as poor as Haiti. I suppose in some ways it’s good that the inauguration of the Haitian president is receiving this kind of attention. After Aristide’s ouster and two years of an incompetent, corrupt government, the international community is tired of babysitting Haiti. This inauguration is evidence of a democratic success, so let’s celebrate! And even though Haiti is the lowliest of nations, it too deserves to have ceremonies like the rich countries. Riding back from the orphanage yesterday, we couldn’t believe how clean the streets were. The garbage that normally overflows from the gutters: gone. Even a lot of the rocks and rubble had been swept away, making the ride as smooth as I’ve ever experienced. So PAP can be cleaned up with the right motivation.

The ceremony is being televised and the wait staff and a few guests gather around the bar watching the ponderous events. The Haitians break out in smiles when Preval appears, presidential and dignified in his neat dark suit. Jeers greet the picture of outgoing interim president Alexandre Boniface, who looks clownish wearing a wide red and blue sash across his chest that will be transfered to Preval. As the camera scans the well-dressed crowd attending the swearing in, I can’t help but think that this is Haiti’s parasitic class. They live off the flesh and bones and lives of the poor masses, who become suddenly human when viewed one at a time. Like the dehydrated baby at the clinic on Friday. I’m sure his family is all caught up in the festivities. As these fine people wind their way into the Palace and then the Cathedral, I think, “Today you are at the head of the line, but in the line that really matters, you will be behind your brothers and sisters from Cité Soleil.” I’ll be back there with you.

I guess I shouldn’t make little of these moments of optimism and success, however temporary or even illusionary. How else can change begin? It’s just that Haiti has had so many new beginnings that actually threw the country in reverse.

Maybe this time will be different. This morning at breakfast, John said to one of the hotel owners, a man who we would guess isn’t a fan of Preval, “Today’s a big day.”

“Yes,” he replied. “It’s the beginning of hope.”

Saturday, May 13, 2006

How Many Dying Babies in the World Are There?

John plunged back into his work the day after we arrived in Port-au-Prince at the Grace Children’s Hospital clinic. It’s the Friday before the Sunday inauguration of president-elect Rene Preval, and we weren’t even sure if the clinic would be open. But it was. John was kept busy for four hours with patients, fortunately none of them too sick today.

After we finished our Cokes and had given the nurses an English book they had asked for, we were getting ready to leave, when we noticed a patient who hadn’t yet left. An older woman, her head wrapped in a scarf, sat on one of the wooden benches, holding a listless, pale brown baby. This baby had been a patient of one of the other doctors. His foot was wrapped in tape where an IV had been inserted. John could tell by looking at the baby that he was dehydrated.

“Combyen mwa?” I asked the lady holding him. She held up 10 fingers—10 months old. The baby has no neck strength and his head lags back; he can’t lift it at all, though his brown eyes are surprisingly bright. I don’t think she’s the mom I say to John, and he confirms that she wasn’t. Where is the mother? Mama mouri about eight months ago.

John talked with the lady about how important getting fluid into the baby is. She took a cup and a glass jar with a lid out of her bag. She unscrewed the top of the jar and poured some water into the cup. She gave the baby the water as he lay in her arms, but she gave it faster then the baby could swallow and some of the water ran down the sides of his face. John took the cup to demonstrate how to give the baby water. He poured a swallow into the baby’s mouth, removed the cup and let him swallow. After the baby swallowed, John repeated the process several times. “Jesus,” whispers the woman, under her breath. She doesn’t have time for this. She probably has more children at home and this clinic visit is taking the greater portion of a day, all for a baby who isn’t hers. It would make her life simpler if this motherless baby would die.

John stares down at the tableau. “The baby wants to drink,” he says, though the caretaker has put the water away again. One of the nurses walks by and hands the woman two packs of U.N. oral rehydration mix. This baby’s most serious problem, the cause of his dehydration, is diarrhea, the leading killer of children in poor countries. The rehydration mix contains sugar and salt, which the baby needs.

But really the baby should be in the hospital, receiving an IV and being monitored by a nurse says John. None of the clinic staff knows if a bed is open in the hospital. “There are babies like this all over Port-au-Prince,” says John, which partially accounts for the lack of urgency among the staff. John gives the old lady 500 gourdes about $12 U.S. “For the baby,” he tells her, and she nods.

John tortures himself over these cases. “If that baby came into an American hospital, I know the 15 things I would do for him. It would be so easy to save this baby’s life,” he says. Even in Haiti in a well-organized clinic stocked with some basic medicines and staff who have the training and time, this baby could be easily cured. Most times, though, in Haiti, the system doesn’t work and the doctors and nurses are overwhelmed and many of them calloused.

“I have to ask myself is this really a human baby?” John continues. Why are babies in Haiti who are totally curable just allowed to die?”

Transitioning from One World to Another:

For me, the worst part of our trips to Haiti is that at some point in traveling we have to get up in what seems to be the middle of the night and with bleary eyes rush off to some airport. It feels so horribly wrong, like being plunked down in frozen tundra wearing only our undies: something is missing, in our case sleep and the sun. On the morning of this trip, I woke up two minutes before our alarm was set to go off, mysteriously jerked awake from a vivid dream. I had been batting a beach ball to small groups of people, single-handedly keeping the ball in the air, while trying to engage the other people in playing. When I relayed the dream to John, he told me Marie was the beach ball.

Marie is the 4-year-old we are escorting back to Haiti. She had successful heart surgery at St. Louis Children’s Hospital and, after a three month stay in the States, is going home. We left from St. Louis for Haiti via Miami. Marie could not have made the trip easier, though the same can not be said of the airlines.

At first Marie didn’t want to leave her host parents to come with us, but as we were walking to the gate, I said, “Marie, ou ap veni avek Dr. John e mwen.”—Marie, you are coming with Dr. John and me—and she nodded. “This is good,” I thought. But Marie didn’t realize that Jim and Jane, her host parents, wouldn’t be coming along, too. So when Jane handed her to me, Marie started to cry. But it only lasted about 10 seconds as we wound our way through the security line. We had beaucoup carry-ons: a large backpack, a suitcase on wheels, two computer bags with laptops, and Marie’s little backpack. The security agents helped us put our stuff on the conveyer belt, and we got to our gate, C10, with 20 minutes to spare.

Marie sat in our laps, played, ate her snacks and asked, “What?” a lot. It’s amazing how much English she has learned, calling to John, “Wait a minute!” if he got ahead of us walking through the terminal. Our two and a half hour flight to Miami was fine, but once in Miami, we faced a two hour delay and a gate change. As we waited, we ate delicious Cuban sandwiches stuffed with ham, pork, and Swiss cheese.

A sign at the Miami airport reads: “Behind this wall, we are building the future Miami International Airport.” I certainly hope so. Besides its frivolous deficiencies, like not enough restaurants, the Miami airport forces travelers to walk cross country distances to get through customs and to the various gates. Our flight was switched from Concourse A to Concourse C. We walked for 20 minutes to get to our new gate. After we had been walking for 10 minutes, we saw signs that said Concourse E is 16 minutes away. You can walk a mile in 16 minutes!

The flight to Port-au-Prince was fine. Marie fell asleep, leaning against the side of a fellow passenger, who didn’t seem to mind. We were the only plane being unloaded on the windy tarmac of the Touissaint L’Overture International Airport, so we got through customs and claimed our luggage quickly.

Marie is returning to an orphanage where she has lived for the past year and a half. Prior to this, she lived with her grandmother. When her heart problem—Tetralogy of Fallot—was diagnosed, the grandmother placed her in the orphanage so that she could get better nutrition as she waited to be accepted by a U.S. hospital for surgery. My mind is a little eased that we are returning Marie to this place, with its three meals a day, clean water, and schooling, rather than a poor Haitian home. A worker from the orphanage and a teenaged Haitian Hearts patient who also lives at the orphanage are waiting for us. We get into the battered, blue SUV and drive off. They drop us off first. Little Marie climbs in the front seat—no car seats or often seatbelts in Haiti—for the last leg of her journey.