Haiti: the Ugly, the Bad and the Good

Returning to Haiti this past May, 16 months after its devastating earthquake, was a rather emotional experience.

I was privileged to go to Port-au-Prince two weeks after the magnitude-7.0 quake in January 2010. I worked with the International Medical Corps, and we staffed the emergency department tents at the University Hospital. The suffering and devastation were beyond belief. Treating so many patients with textbook diseases and horrific injuries was both humbling and numbing. But on returning home, I felt what so many other responders reported feeling too: Did I really do anything? The lack of closure was intense and left many of us feeling unfulfilled and empty.

This year I was presented the opportunity to return to Haiti. The National Association of Emergency Medical Technicians was asked by the United Nations to teach a Prehospital Trauma Life Support course, and I was offered the chance to participate as medical director. With some trepidation, I accepted.

We brought the outstanding faculty of Mike Hunter, Mark Lueder and Augie Bamonti to Port-au-Prince. There we taught the course to representatives from 13 countries. It was an enjoyable experience, but perhaps as important, the trip provided the opportunity to see the country again and obtain a bit of much-needed closure.

One can now say that Haiti is considerably changed, mostly for the better. Seeing children proudly going to school, dressed in their fine uniforms, brought tears to our eyes. It marked a sharp contrast to the thousands of pediatric patients we'd seen last year with casts, amputations and illness. Roads are mostly passable, allowing for bustling sidewalk and street vendors. That is certainly different from the rubble that made street travel so difficult or impossible before. Some rebuilding has begun, with construction projects in contrast to the omnipresent structural collapses post-earthquake.

However, these improvements do not mask the tons of destruction still visible behind walls, nor do they obscure the hundreds of thousands of tents (or worse) that provide a semblance of shelter to the estimated 700,000 still homeless.

We had the opportunity to visit University Hospital. It is open and functional. Most of the post-earthquake tents (ED, ICU, pre-op, post-op) are gone. The destruction on the hospital campus is still there, but there's now a sense of medical care being provided.

A particularly fascinating experience occurred when I responded in a United Nations ambulance to the mountains outside the city. A tap tap (open bus) had rolled over, ejecting six patients. Providing medical treatment in an area with no real roads, where cholera, malaria, tetanus and rabies are present, was a highlight of my EMS career. Maybe it was the closure I sought.

In the earthquake that struck Haiti in January 2010, there was some good along with so much bad and ugly. The ugly was that this neglected country had become so vulnerable to the consequences of natural disaster, and was now even more devastated. With minimal public infrastructure and virtually no ability to respond to such an event, Haiti was, in itself, a disaster waiting to happen. The mediocre international response seemed politically expedient and self-serving. This ugly should never have been allowed to develop or continue.

The bad was the catastrophic effects of the earthquake. The unimaginable death toll, the number and types of injuries, and the resulting homelessness and suffering are incomprehensible in a civilized world.

The good, though, are the dedicated and sincere individuals who have worked so hard to help the people of this ravaged country. And, as well, the amazing people of Haiti, who have demonstrated a resilience and dignity that the world should hold with utmost admiration. They are the good.

Bernard Heilicser, DO, FACEP, is medical director for the South Cook County EMS system in Illinois, and deputy commander and deputy medical director of the Illinois Medical Emergency Response Team.

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