March 22, 2014
Morne l’Hopital (a confusing name for a rural mountain community with no hospital) is home to nine thousand mamas and babies and families and friends. Bumpy dirt roads connect Haiti’s sea level capitol to this community with more goats than cars, more children than schools, and more bellies than food.
A nurse runs a small clinic in Morne l’Hopital, the only healthcare available in the area. Her small facility includes a small pharmacy with nearly empty shelves. Her heart breaks when she cannot provide vaccinations for new babies, antibiotics for sick children, or prenatal vitamins for expectant mothers.
Several medical students from Wayne State University decided to spend their Spring Break in Morne l’Hospital, not Cancun, not the Bahamas, not Daytona Beach, but Morne l’Hospital, Haiti. So did a pharmacy student, two pharmacists, and five doctors. I got to go with them. So did my dear friend Shirley.
Outside the concrete block walls housing a church, school, and the clinic, we were greeted each morning by a sea of desperation longing for medical care. Each afternoon we had to tell a portion of that sea to “come back tomorrow.” On the last day we had to tell the sea “we are going home.” I am not sure who cried harder, them or us.
Among the 600 or so that did make it inside the wall was Elianna, a widow who has lived to see three of her five children die before her. Dr. Diane delivered the exam findings, advanced stages of uterine cancer. Her daughter, Marisse, stood by her side as Dr. Diane helped prepare her for what was to come, telling her to “never give up hope.” John, one of the med students, stayed with them for a long time that afternoon, comforting, supportive, kind, and broken hearted.
A momma carried her 12 year old son, Gregory, on the one hour walk to see us. Gregory has had seizures since he was three years old. The seizures have stopped enough oxygen going to his brain that he can no longer walk, talk, play soccer, climb trees, or any of the other things that a 12 year old boy should be able to do. With three younger siblings, Gregory’s mom is exhausted. She wants someone to help. She wants Gregory to get better. She wants to take care of all of her children. But Haiti is winning right now.
Seven year old Joseph also walked an hour to see us. Not able to eat for the previous three days, a fever of 102 and achy bones, he had no choice but to walk since his mom had to carry his breast feeding baby brother. Blood test evidence was needed to pinpoint the culprit; malaria and typhoid were the top two suspects. “Let’s try General Hospital,” we agreed. General Hospital is the largest public hospital in Port au Prince, Haiti’s capital city with a population estimated at well over two million people. After a long drive followed by a long wait in the emergency room, Patrick and Michael (a team leader), and Joseph’s mom were given written orders for lab work. The lab was closed for the day. The lab is likely owned by the highly underpaid, sometimes not paid doctor. The income from the lab is likely how the doctor is able to feed his family. The next day Joseph was just as sick, or sicker. Not all of the blood work necessary for diagnosis was available. The day after that we took Joseph to Peace Hospital where he was further examined. Still not enough testing, still no containment, still no conclusion. I pray he gets better.
The same night that Joseph went to General Hospital so Latina. Doubled over in pain, the forty year old mother of four found no answers. A chest x-ray was done but a cat scan was needed. The next day we took her to a different facility that had the right equipment. Unfortunately, the machine was not functioning. Nor was the one at the second place we tried. Driving a third day to a third place only to find that the cat scan equipment there was only capable of scanning heads and babies, Patrick called our friend Dr. Gardy who took Latina into his hospital, 2 hours north of Port au Prince. Dr. Gardy will not let her go until he knows she is well as he tries his best, using the resources that he has, to find the cause of her pain and make her better.
Other ‘insiders’ included mother of five with a heart condition that may require life-saving surgery not available in Haiti, a hurting man with probable cancerous lesions on his rib cage, a woman who has had blood in her sputum for the last three years, a father of toddlers with all of the symptoms of stomach cancer, an 11 month old girl who due to yellow fever will never develop mentally, a man with HIV and very painful lasting skin sores, a boy who eats dirt to fill his empty belly and an eye infection that could cause him to lose his sight, a brick layer whose unset broken hand has left him crippled on that side, a young teenager with a severely ruptured eardrum, a man with a grapefruit sized hernia in his scrotum, and a baby who will go blind without the right medicine. Hypertension, malaria, malnourishment, diarrhea, cancer, infections, scabies, ring worm, broken bones, vitamin deficiencies, waterborne illnesses, open wounds, cataracts, stomach aches, headaches, earaches, aching joints, aching muscles, aching hearts. All treatable in our world of modern medicine. Unfortunately, modern medicine has not been introduced to Haiti.
Late one afternoon, outside the wall, my dear friend Shirley met Vesta.
“Please, just one more! This poor woman needs a doctor!”
Vesta’s face does not show her forty four years. Sparkling chestnut eyes and glowing skin the most marvelous shade of sweet tea, her visible signs of a life full of love. A few months into her ninth pregnancy, a lump was discovered in her right breast. A doctor told her that treatment would hurt her unborn child so she waited until after the baby was born to seek help. Leaving four month old David at home, Vesta walked in alone. At first discovery, the lump was a couple of centimeters wide. Now it has grown into a nine centimeter mass. Swollen lymph nodes suggest the disease has traveled. With the aid of a portable ultrasound, a biopsy was not needed.
Doctor Diane delivered the news. Priyanka, a medical student team leader, stood by her side. Knowing my history, I was invited in to the conversation.
Vesta expected the diagnosis but prayed for a different answer. Diane and I talked to her about how much support she had in her husband, how much she had to fight for, how miracles can happen, and we will help her and there is hope and all the while my gut was aching and my eyes were dripping and my heart was busting.
“It will be alright. I lived through it,” Then I showed her my scars as the voice in my head screamed, “David needs his momma. God, please help this woman. Modern Medicine please come meet Haiti!”
“I will die. I am going to die.”
“No, no Vesta. No, you will not die. You will be alright. Have hope. We need to run tests. We don’t know the whole story yet.”
“But I am going to die. What will happen to my children? What about my baby? What about my husband?”
“Vesta, you will live. We will find the right doctor, the right hospital, the right treatment.”
“I should have come sooner. David is four months old. There was no doctor. Now it is too late. I am going to die.”
“No Vesta, this is not your fault. You took care of your baby. You made sure that he was healthy. You had no opportunity. It is not too late. My diagnosis was five years ago. Look at me! I am just fine. You will be too.”
Woven together convincingly, even the tiniest threads of hope can blanket a soul.
The next day Vesta walked inside the wall with her husband. Obviously very happily married, the two told us how they met when they were just ten years old and have been together ever since. Marco works hard to provide for his family, not easy in a country where unemployment significantly outweighs opportunity. For Vesta and Marco, some days lack work but no days lack love.
We talked and we hugged, then we hugged some more. Excitedly, we talked about the arrangements made with the help from my friend John Carroll to take them to the new Partners in Health facility where a full time surgeon holds clinic once a week, hopeful that the three hour drive would be fruitful. With the promise to dance together at David’s wedding, I said good bye to Vesta and Marco.
We have all read about and sometimes repeated ways to avoid cancer. We blame cleaning products, preservatives, antiperspirants, and red dye number five. We say don’t eat meat, don’t eat grain, don’t eat preservatives. Don’t breath in fumes, smog, or polluted air. We must garden, juice, sleep, and do forty five minutes of cardio vascular exercise three times a week followed by one to two glasses of red wine. We blame the water, blame the mother, blame the victim.
Vesta’s diet is all organically, locally grown. Meat is a luxury that is rarely consumed. There are no fumes from cars or smoke from factories in her air. She does not have time for exercise because her time is spent walking far for water balancing a full bucket on her head for the return trip, hand washing her family’s clothes, cooking rice and beans over a charcoal fire, bathing the younger of her children and herself daily to remove the dirt from the roads, getting school uniforms ready for the next day’s wear, hand washing all dishes and glasses and pots and silverware, grinding grain into powder to make bread, buying food at the market because she has no refrigerator to stop spoilage, starting her day with the sun and ending the same because at the setting, in an area with no electricity, all things go black.
Then come the judgments. If she hadn’t been pregnant with her ninth child she could have gotten help sooner. She should not have waited four months after the baby was born to find a doctor. She should had been doing regular self-examinations. In her forties, she should have been receiving annual mammograms.
Modern Medicine lives in the palace of plenty, inside the lines on the map. Outside resides the sea of desperation, a great abyss with occasional small islands of hardworking compassion. Last week our group of twenty cracked open the portcullis.
Fortunately, love has no periphery. Unfortunately, cancer swims.
I will be keeping in touch with Vesta as together we work to further pry open the door.