LEOGANE, HAITI
Candles and small fires cast the shadows of thousands of homeless people against piles of earthquake debris strewn along the rutted road from Port-au-Prince. Inside a white Toyota SUV, Dr. Brett Hendel-Paterson sped by, absorbing the sight of so much misery and grief. He was 40 sleepless hours out of Mendota Heights, rushing into a catastrophe.
Soon his car pulled into a makeshift medical compound filled with tents and protected by walls topped with razor wire. The hot night air reeked of burning garbage. In an instant, his work as a volunteer on a medical relief team began.
Another Haitian baby was dying.
"You the pediatrician?" asked a doctor in scrubs whom Hendel-Paterson had never met.
"Yes," he replied.
"We've a got a very sick baby ... and we want the Canadians to take it," the doctor said. "Can you come with us and see if you can help convince them?"
"Let me get my stuff."
The 35-year-old physician was suddenly thrust into a life-and-death debate. Canadian medical volunteers didn't want to put the baby, who seemed likely to die anyway, on their advanced equipment. They wanted to conserve resources for others in need. Hendel-Paterson lost the debate. The baby lost its life.
"All we could offer the woman who lost her child was a ride back to her village, which was devastated," he said. "A ride back to the place she slept on the street."
He had learned his first lesson: In Haiti, when the earth moved, the old adage flipped. Hell now lines the road to good intentions.
The morning sun beat down on tattered blue tarps strung over the dusty outdoor clinic. As chickens strutted by, Hendel-Paterson, a solid 6-footer with close-cropped brown hair, examined patients victimized by the massive January earthquake. It has killed more than 200,000 people and sent Haiti, already among the poorest countries in the world, spiraling into unrelenting pain and chaos.
About 150 patients in need of medical attention sat in chairs or lay in stretchers waiting to see the team of doctors Hendel-Patterson had joined. All day long, the injured and desperate kept coming.
At one point, as he poked and prodded a lethargic toddler dehydrated by a lack of clean water and diarrhea, a woman behind him laid a hand on the head of a friend wearing a bloody, leg-long cast and raised her other hand toward the heavens in silent prayer. A girl missing a foot and with a cast on her other leg hobbled by on crutches.
Next, he had to treat a baby with a fever. In the United States, Hendel-Paterson said, he would have hospitalized the baby for two days to rule out a potentially fatal bacterial infection. No such option here. Instead, he began flipping through a copy of the "Harriet Lane Handbook -- A Manual for Pediatric House Officers" that he had brought to Haiti. Finally, he chose an antibiotic, gave it to the newborn and sent him back to the streets with his mother.
Hendel-Paterson washed with hand sanitizer to keep from spreading germs or getting sick himself. He chugged Gatorade to keep from going goofy in the heat.
Then, as he waited for his next patient, he recalled what Joel Leyden, the communications director for Israeli Flying Aid, had said on his way out of Haiti after two weeks of earthquake relief work. Leyden had described the country's dire conditions, its uncertain future, and its ability to grind good-hearted volunteers into emotional dust as thick as the stuff that covers the streets.
Haiti, Leyden said through tears, is "9/11 times 1,000."
To survive during his week in Haiti, Hendel-Paterson tried to focused on a single digit: One.
One patient at a time. One hour at a time. One sleep-deprived night at a time.
There is no big picture in Haiti for Hendel-Paterson and other medical volunteers. At least not one they can afford to look at.
Only: Help the person in front of you. Don't worry about what's stacked up behind or beside.
The victims kept coming.
People gathered all around Hendel-Paterson. Children with the blank stares and fever of malaria, children with anemia and scabies. Plaster of Paris swathed one child from waist to toe, turning her broken lower body into a tragic frieze. Other children, clobbered by falling houses, awaited surgery for head wounds that left large sections of their skulls exposed. Some who were having wounds cleaned screamed in ways that reminded Hendel-Paterson that sometimes the healing hurts as much as the injury.
At the moment, however, none of that could be his concern. Now he was trying to figure out why a child he was treating was drifting into semi-consciousness.
"I think it might be pneumonia or malaria," he said.
He moved on quickly to another patient.
"Do you have anything wrong?" Hendel-Paterson asked a young woman, whose child he had just examined.
"My heart races," she said through an interpreter. "I can't sleep. I have no appetite."
Hendel-Paterson examined the woman, then delivered the bad news to her, and himself.
"What you have is caused by stress," he said. "Unfortunately, we don't have anything for that."
Pressure-packed days
No one has an accurate count of how many medical volunteers have come from around the world to help Haiti, but as he passed through an airport in the Dominican Republic on his way here, Hendel-Paterson crossed paths with everyone from a Vietnamese medical team numbering at least 10 to a single physician assistant from Colorado. Thousands more health care providers will arrive in the months ahead, full of energy and resolve to help the millions maimed and displaced by the quake.
But many, like those who have come already, will leave exhausted after performing multiple miracles -- not with whiz-bang technology, but by making do with dirty exam areas, equipment shortages, spartan living conditions and crushing patient loads.
The daily pressure on them all is immense, and the psychic toll can be subtle and lasting.
"The last time I came to Haiti, I didn't cry until I got home," said Nate Harmon, a doctor in residency at the University of Iowa. "The first Sunday at church I broke down and sobbed for 10 minutes."
This time, Harmon said, he arrived to discover that an earthquake that lasted less than 45 seconds had "created a war generation" in a place where prospects for a decent life already were bleak.
Kris McCain, an obstetrician from Nashville volunteering in Leogane, said she decided to set aside her work in the United States "because I felt like I was taking care of economically advantaged people who could get care from anyone."
She planned to stay two weeks, but she lasted only eight days.
It didn't take long for Hendel-Paterson to begin feeling the burden and strain of his mission. One of the first things he heard when he arrived at the compound was that a soldier had sexually assaulted a nurse the night before. Another afternoon, he walked over to an area manned by Japanese Army medical troops to ask for a blood test for a child he suspected had malaria. As he stood talking to a lab technician, a Haitian guard walked by with a stockless shotgun.
For Hendel-Paterson, who works at Regions Hospital in St. Paul and teaches global medicine at the University of Minnesota, seeing a shotgun-toting guard inside a medical clinic was as unusual as the sight of U.N. soldiers clutching automatic weapons at the clinic's entrance.
He tried to ignore the presence of all the guns and returned to get blood drawn and insert an IV, which proved no easy task for the nurses involved because dehydrated children have ropey veins that wobble under the needle.
"Turns 'em into leather," explained Dean Vantiger, a nurse from the University of Iowa Hospitals and Clinics.
As the nurses fought to insert the IV, Hendel-Paterson started seeing more patients -- and ran into another obstacle now evident in post-quake Haiti: a clash of cultures.
Jeff Wasserman, a volunteer anesthesiologist from Rochester, N.Y., explained the problem to Hendel-Paterson when he came seeking guidance on an antibiotic.
"I've got a kid who is toxic and needs to go to the hospital ship Comfort,'' Wasserman said. "But the family won't send him because of voodoo stuff."
The child rested on a low bench inside the clinic's surgery center, his left leg dangerously swollen. Hendel-Paterson looked at him and headed for the pharmacy to see whether he could find something that could keep him alive while the team persuaded his parents to let him go to the hospital ship.
Late in the afternoon, the parents relented, the child was airlifted to the hospital ship, and the clinic closed.
But there was still one more patient for Hendel-Paterson and the medical team: a pregnant woman who needed a Caesarian section.
She had been buried overnight in rubble after the earthquake. Her belly had settled into a void in the debris. She had shouted to rescuers for help and heard one say that they shouldn't bother trying to dig her out.
Now, deep in labor, she lay on the operating table about to give birth.
She did, without a hitch. After the mother had spent some time with the baby, Hendel-Paterson, the father of two young boys, took the newborn and cradled her. He checked the baby's vital signs and carefully wiped her clean. Then he showed her to her father.
There was life here after all.
Scrambling to volunteer
As soon as the earthquake struck Haiti, Hendel-Paterson, a doctor's son from Fergus Falls, who has wanted to be a physician since he was a kid, longed to go and help.
"I didn't think I could go because of my family," he said. "But my wife told me, 'You may go.'"
Her blessing unleashed a frenzy of activity. First, he found doctors to cover his shifts at Regions and his other responsibilities. Then he consulted with a friend and fellow physician, Christina Ward, a hand surgeon at the University of Minnesota. She told him about medical missions sponsored by World Wide Village, a Christian nonprofit group in St. Paul. It focuses its ministry and relief efforts on children and families in Haiti.
The group worked out of a clinic established in Leogane in partnership with a medical compound owned by the University of Notre Dame. World Wide Village agreed to help pay Hendel-Paterson's way and find him a safe place to pitch his tent. Most of all, the group would give him a chance to practice real medicine, not just organize and cheerlead.
Once he reached Leogane, Hendel-Paterson bonded instantly with medical team members who had come from Iowa, Massachusetts and New York.
"I was surprised to see him," said Amy Walsh, who went to medical school at the University of Minnesota and is now in residency at the University of Iowa. "But I was happy because I knew he knew a lot about kids and adults when he was supervising me at the U."
Trust between doctors and nurses doesn't always develop quickly. In Haiti, it has to. "In this situation, you figure out what someone's strengths are, where they can help you, where you can help them," said Emilie Hitron, a Needham, Mass. internist who has been coming to Haiti for a decade.
Most members of Hendel-Paterson's medical team chose not to measure the earthquake relief effort in terms of lives saved. In Haiti, they quickly learned, there was too much they could not control -- from the dogs who interrupted their sleep by barking all night to the roosters who sometimes began crowing at three in the morning. Sleeping in a tent and eating power bars got old quickly. Fatigue came on fast. And the disappointments and dilemmas piled up.
Hendel-Paterson tried to redefine what had not gone well. The baby who died on his first night, he reasoned, "probably would have died in the U.S.''
Still, the days were tough. "Discharging someone from the clinic to the sidewalk they're sleeping on is hard," he admitted. But it was all that the circumstances allowed.
The doctors and nurses working alongside him understood what Hendel-Paterson meant. Surgeons fitted one child with a metal brace that holds in place rods passed through skin into shattered bones. Then they had to take an unsettling step. "They sent her home on a motorcycle," marveled Vantiger, the nurse.
Motorcycles, the most affordable motorized transport among Haiti's poor, were parked outside the clinic for rent by people delivered from treatment on stretchers. Inside the clinic, Hendel-Paterson and his colleagues tried not worry about how medically inappropriate these rides might be, or where those being transported might end up.
Meanwhile, with no general anesthesia available, patients where Hendel-Paterson worked underwent surgery under local anesthesia.
"We were operating on someone and the guy in the corner cleaning the surgical equipment started humming Motown tunes," a surgeon from New York said one night at dinner. "Then the nurses started humming. Suddenly, the patient started humming, too."
Helping administer an IV to a patient lying on a dirty outdoor bench surrounded by sick, injured and infected people, Marta Eichhorn, a nurse from Dubuque, Iowa, described the challenge in stark words:
"This is Civil War medicine at its finest," she said. "But you do what you can."
'This is Haiti'
Across Haiti, tens of thousands of shanties now compete for space with thousands of pancaked buildings, roofless homes, fallen walls and huge chunks of concrete studded with steel reinforcing rods like a modern sculptor's nightmare. Outside the shanties, people bathe themselves and their children out of buckets.
Inside the compound where Hendel-Paterson worked and elsewhere, one expression kept getting invoked: "This is Haiti." It was a benchmark against which to set expectations. In the country's tortured history, no amount of donated time, money or material, or the volunteers who come and go, have been enough to save it from suffering and squalor. But Hendel-Paterson and his colleagues refused to use the mantra to excuse poor medical care. Rather, it allowed them to define what was possible.
After Hendel-Paterson finally got a chance to walk around Leogane, the enormity of what Haiti now faces settled in.
"I can't fathom how they're going to rebuild," he said. "Everywhere where there is not rubble and streets, there are people. Some of the aid they need is there. How it can be coordinated is another question."
In Leogone during the doctor's stay, parishioners from the collapsed Catholic church tried to clear a 100-by-50 foot mound of rubble with shovels and 5-gallon buckets. Hendel-Paterson saw few aid distribution points.
At one point, the American volunteers bartered crutches with the Canadians in hopes they might allow the transfer of a patient in need of advanced medical tests.
As they donated their skill time, the doctors and nurses also were unexpectedly solicited for cash -- to pay Haitians who had done site work for a new mobile hospital near the medical compound. The cost of the hospital was exceeding what a philanthropist had donated. Hendel-Paterson chipped in $100 to help cover the shortfall.
Still, there were a few signs of hope. The medical team left supplies better organized for the next group of volunteers, and the mobile hospital promised more sanitary conditions. Besides, as Hendel-Paterson realized, complaining about conditions was as counterproductive as obsessing on the fallen buildings, or the dead, or the roadside shanties, or the flickering ghost people in the dark. Being distracted by any of it threatened to overwhelm, then paralyze.
All that ever mattered was the next patient in front of him.
A baby's life in the balance
Another day, another earthquake victim on the verge of giving birth.
Hendel-Paterson helped deliver the baby. The doctors decided to take it prematurely because the mother was running a fever that threatened both her and the child.
When the child struggled to breathe, an anesthesiologist from New York inserted a tube into the newborn's throat. Hendel-Paterson used a bag attached to the other end to squeeze oxygen into his lungs. The medical team decided to try to transfer the child to St. Damien pediatric hospital in Port-au-Prince. Getting permission took two hours.
Hendel-Paterson borrowed an SUV and a portable oxygen tank from Japanese volunteers. He happened upon a neonatologist volunteering with another medical team in Leogane who was headed to Port-au-Prince. He recruited her to come along. They took off on what became a slow-motion thrill ride.
Leogane is only 19 miles from Port-au-Prince. It took three hours to get there.
"Traffic," said Hendel-Paterson, "was at a dead stop."
He used the ventilation bag to help the baby breathe. But then Hendel-Paterson started feeling sick; he was getting hit by a flu that eventually had him strapped to his own IV. He had to hand the baby over to the neonatologist.
As traffic crawled, the oxygen tank ran out.
Hendel-Paterson and the other doctor pulled the tube from the newborn's throat. He was breathing on his own now, but struggling. He still needed to get to the hospital.
Hendel-Paterson saw a U.S. Army personnel carrier from the 82nd Airborne Division pulling out from a side street. He jumped from his vehicle and ran up to a soldier directing traffic.
"I'm a doctor," he said. "And we have a critically ill baby who needs to get to St. Damien."
"Follow us," the soldier said.
"They brought us through an area they had secured, where there was no traffic," Hendel-Paterson said. "We came out 100 yards from the hospital."
The baby lived.
Hendel-Paterson will never know how the child fares in the long run. He won't know whether the boy will live on the streets impoverished and malnourished, or whether he will succumb to the epidemic of disease predicted for the rainy season.
He couldn't think about any of that.
Maybe no one can save Haiti, he said, but this work felt worthwhile.
"Operating on the principle that you do what you can for the patient in front of you, it seemed like the right thing to do," he said.
"Really, that's all we can do here."
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