Wednesday, March 14, 2007

Less than Nothing

Less than Nothing
January 5th, 2007
by Dr. John A. Carroll
Two days ago our “mobile medical team” went into an infamous slum in Port-au-Prince called Jeremy’s Wharf. The team travels there each Wednesday. It is located at the back end of a bigger slum called La Saline.

The driver of our truck let us out about four blocks away from the clinic because the road becomes impassable with people, vendors, debris, and holes. We carry in our own medications and supplies in coolers and walk single file on the narrow paths leading between the corrugated metal shacks and cinderblock homes. Hundreds of people smile and say hello as we pass by.

On the team yesterday was a Haitian doctor who serves as one of President Preval’s private physicians and has traveled to Cuba with him multiple times to assist the Cuban doctors with the president’s prostate cancer treatment. Also on the team are two Haitian health care agents who function as physician’s assistants, three people trained as pharmacists, and two crowd control people.

The clinic has thin metal walls and a dirt floor and the patients that have been chosen are seated on wooden benches around the periphery of the main room. In the middle of this room was a moaning, gaunt lady spitting into a tin can on the floor. An American priest who is a physician and leader of our team led us in a prayer as we gathered around the lady. We then divided up and positioned ourselves in various corners of the second room and began seeing patients.

There is something terribly isolated about Jeremy’s Wharf and it is the most desperate slum I have been in Haiti. If you live here, and are sick, you are really out of luck. It seems worse than Cite Soleil, another slum, which seems to have a worse reputation with the little war occurring there now.

Hundreds of thousands of people are crammed into these tiny slums. They have no running water, electricity, or sewage system. There are no trees and the wind whips up off the bay which makes the dust cover everything.

I had four really sick kids yesterday that I held in clinic until our driver came back for us. The driver would take them to a new pediatric hospital built on the outskirts of Port-au-Prince where they would “get a chance”. Two brothers, aged 12 and 13 years old had the same complaints: diarrhea, fever and shortness of breath. They had to be pulled and carried because they were so weak and confused appearing. My diagnosis, shooting from the hip, was typhoid fever and pneumonia. The third was a marasmic appearing two and one half month old baby that weighed about 6 lbs, wasn’t breast feeding and had a fever. She had a tiny face tucked under a bonnet, her arms and legs were pencil thin with skin that was light in color and all shriveled up.

The fourth child was a 13 year old boy who is pictured at the top of the picture. His name is Jean-Donel. He had two weeks of fever and the whites of his eyes were lemon yellow in color. He couldn’t walk either. The possibilities were viral hepatitis versus leptospirosis or dengue fever. Leptospirosis is caused by a bacteria that one can get from rat urine which Jeremy’s Wharf has no shortage. His skin was very hot and he lay on a wooden bench on his stomach as he patiently waited for our driver to return. He was too sick to stay in the slum.

When we were about one half way done with clinic, three thin young men with stocking caps on in the hot sun, showed up shouting and demanding that their children be checked. The leader of the three took out a silver 45 automatic pistol that he had tucked into his jeans and pointed it at the ground and shouted his demands. He seemed agitated and high on something as well. Two of his colleagues’ guns could be seen in their pants.

The leader demanded that we examine a couple of more kids. We saw the kids that he wanted seen as I said a few Acts of Contrition. I got a little feeling of what poor Haitians must feel trapped in the back of a slum with gun wielding pathetic young men that have no respect for life and hate their own lives. We were really at their mercy when they were shouting and waving their weapons.

Our Haitian health agents reminded the gang members that we are the only source of medical care for the Wharf, that a foreigner was present, and this was no way for them to conduct themselves. The patients in the clinic watched the gang members but no one ran or really reacted much. Gang activity in the slum is accepted and doesn’t surprise anyone.

When we had seen our last patient and the gang had gone, I asked Jean-Donel’s mother about her life in Jeremy’s Wharf. Her name is Ludie. She did not know her age but appeared to be about 30. She said she has lived in the slum for the past 20 years and that she has five children. Jean-Donel is her oldest.

I asked Ludie if there is a father around and she dispassionately told me that the children’s father, Sampson, was shot twice in the head last year in the Wharf. He was 25 years old. He was selling his sugar cane one day on the street and a gang, similar, to what appeared today, asked him for some free sugar cane. He refused, so they shot him. No Haitian police will come into the slum, so no one was brought to justice. Everyone knows who did it in Wharf Jeremy, but no one can do anything. Guns and fear are too powerful when you have nothing to fight with and no system to support you.

So Ludie put Sampson’s body in the general hospital morgue for two weeks. She could not afford a funeral or proper burial so she had his body transported about five miles north of the capital to a place in the country side called Ti Tanyen. This is the Creole version of three French words which literally translate to “Less Than Nothing”. Ti Tanyen has a very large ditch where they bury people like Sampson. They toss the bodies in and push dirt over it. That is it for the Sampsons of Haiti.

Ludie has two years of formal education but she can write her name and proved it to me. She sells charcoal in the slum now and she and her five kids sleep on the floor of a shack owned by a lady who allows them to stay there. Ludie is able to buy a small container (mamit) of white rice every four days and she gives the kids small portions of it once a day until it is gone. They don’t have milk, eggs, chicken, or other types of meat. She has little money. She obtains her water from a community pump. When I asked her what she thought of Haiti’s present condition she shrugged and said, “Mwen domi grangou. Mwen leve grangou.” (I go to bed hungry. I get up hungry.)

When our vehicle came back for us, we walked the four blocks carrying the coolers out and took the four sickest kids we “triaged” with their mothers. The three sick boys were helped up into the back of the truck and the mother with her two and one half month old were lifted up and in. The mothers were very happy they were on the way to the hospital and out of Jeremy’s Wharf.

As we slowly coursed out of the ugly slum in our very ugly truck, I thought of Sampson who was killed on one of these streets and his wife and very ill son in the back of this truck. He and the rest of these people in the slum are treated like they are nothing, and poor Sampson is now resting in a ditch in a place that is “Less Than Nothing”.

John A. Carroll, M.D.

No comments: