Trip Report Dr Arthur E. Palamara • Jan 22, 2010

God Doesn’t Wear Ray-Bans

By Arthur E. Palamara, MD

January 22, 2010

In the grand scheme of things, I recognize that what I did was negligible.  People who said “God bless you” were not aware of the paucity of my contribution, nor the immense contribution of others who gave so much more.  Still, this experience paints a portrait of our frail humanity and our incomplete ability to deal with it.

On Thursday, January 21, 2010, I had the privilege of traveling to Haiti on a Med Evac mission, to reunite a family, transport their two injured children and two others to Jackson Memorial Hospital.  Fortuitously, whatever injuries they suffered had already healed by the time of our arrival.  Authorities insisted that their travel be accompanied by a physician.  By shear chance, I became the anointed physician, accompanying another individual whose compassion for human suffering far exceeds mine.  As a doctor for almost 40 years, I admit to having become desensitized to pathology, condescendingly able to distinguish between genuine deprivation and its pretention.  Nevertheless, this experience left in me a void that may never be filled.  Perhaps that is the conflict between our divinity and our humanity.

Our mission was to return 5 Haitians to the United State to reunite a divided family and allow their injured members to receive needed medical care.  A simple mission, yet potentially complex, since it occurred 9 days after a major earthquake; one that jarred the soul of an already impoverished nation.  We stowed aboard a plane chartered by ( Miami ’s) Jackson Memorial Hospital and Children’s Hospital.  These fine physicians and nurses would remain for an extended period and sacrifice infinity more that we, who were on a two hour turn-around.  Airplanes are allowed to land in Port-au-Prince for only two hours since there simply is insufficient room at the crippled airport.  Flights have one hour to deplane and one hour to re-load.  After that, they are “wheels up”.  If you are not on board, good luck.  It will be difficult finding a hotel that accepts credit cards.

We left the Opa locka Airport (Miami) on a chartered 737 filled with doctors and nurses who were none too pleased since we delayed their departure, laden with the same uncertainty that gripped us.  None of us knew what to expect.  On board was the famous Paul Farmer, MD, the genius infectious disease specialist, who had started a hospital in Haiti against amazing odds and now battles drug-resistant tuberculosis world-wide.  I had read his book.  He has accomplished great things.  He smiled when I pointed out that he must be on Harvard’s faculty since he was the only person on the airplane wearing a white shirt and a blue blazer.  At least it wasn’t tweed.  Probably not the best attire when traveling into Dante’s 7th circle of hell.  But his experience with Haiti far exceeded mine.

The airplane made a soft landing and pulled up at dusk, next to a Galaxy Star Lifter.  We were warned to prepare for the acrid odor of putrefaction when the cabin door opened.  Teams were organized to help unload the airplane since no other help was available and Miami ’s supplies would be transported to their encampment. My companion and I were told to find our charges and return to the airplane as quickly as possible.  If we did not return within two hours, we would be left behind.

The cabin door opened offering only the feint hint of smoke, neither oppressive nor fetid.  The 100,000 dead bodies having already been stacked, buried in mass graves, or burned; their aroma did not provoke recollection, so fast does nature purify itself.  My friend and I were at last allowed to leave the plane to seek our evacuees and return as quickly as possible, not knowing what obstacles bureaucracy would place in our way.  Thrusting through several cordons of uniformed Haitian border policemen, we asked guards to remember our faces to facilitate re-entry.  Since their patois contained little English, our entreaties only partially cushioned our reentry.

The airport itself, destitute by third world standards prior to the earthquake now resembled a shattered cavern with cracks in the wall, and piles of rubble and water puddles littering the floor.  Provocative advertisements of tourist attractions featuring oiled, sun-tanned, partially clad female bodies were not present.  The dimly lighted terminal challenged us to find a functioning exit.  After twisting and turning, we exited the sanctity of the terminal only through breaks in a security fence.  The inner perimeter was protected by assault rifle bearing American GIs who prevented the milling mass of underfed Haitians from storming the terminal to seek escape on chimerical airplanes.

Some have criticized the American government for taking-over of the country.  Without order, little could be accomplished and aid not dispensed.  Providing generators to light the airfield, and providing organization to the multitude of well-meaning countries offering aid would have resulted in a cacophony of effort.  Dropping supplies from helicopters would result in starving people killing each other for food.  Organizing food distribution lines and relief efforts appears entirely necessary to avoid wanton killings by those destitute enough to disregard their fellow man.

After leaving the safety of the terminal, we rapidly walked through a pitch-black, broken parking lot, a facility lighted only by a automobile headlights.  Columns of dust billowed up each time an army HumVee darted past.  Using a satellite cellular phone, we connected with local ground forces to locate our evacuees. We found them in a darkened corner of the parking lot between two cars, two adults and three children waiting, uncomplaining, with the patience of Job for their two saviors.

Transfer of medical information was minimalistic at best.  Wounds were haphazardly redressed and IVs restarted on the one child.  Contrary to our expectations, the children uttered not a peep and silently accepted every pain and indignity without protest.  Obviously, their life-experience could not have prepared them for this calamity, nor its aftermath.  My partner relates a story that the week before he had transported a 5 year old from this same family to Miami. The child suffered a gaping, infected head injury and crushed right arm (since amputated.)  When talking to physicians at Jackson Memorial Hospital upon arrival, the Jackson resident surgeon (appropriately) asked what the CT scan revealed.  The young doctor obviously was uncomprehending of the depravity of conditions in Haiti.

Gathering up the three children and two adults, we made our way back through the smoky, dusty potholed parking lot to gaps in the perimeter fence.  Haitians without food, water, jobs, homes, beds, or hope clutched at us asking to take them with us.  When the need is so great and the resources so little, one’s mind focuses only on a singular image: a starfish on the beach.  For those of you who haven’t heard the metaphor, a boy walked along a beach where thousands of starfish had been left on the shore by a receding tide.  He picked one up and tossed it back into the ocean.  Then another. Then another.  A man walked up to the boy and said: “surely you don’t expect to save them all?”  The boy said: “No, but I sure can make a difference in the lives of a few.”

At the first gap in the fence, our party was greeted by a representative of the State Department and several assault rifle bearing Federal Agents.  We explained our mission.  The mother and her two injured children were being allowed to return to reunite with her injured son in Miami and her husband.  The other man and his son had Green Cards and seats on the airplane.  One Federal Agent had lived in Miami and understood its complex cultural composition.  They let us pass, wishing us a “God Bless you for what your doing.”  I heard this repeated many more times during the remainder of the evening and still only partially comprehend the profundity of their blessing.  We passed through two cordons of Haitian border guards who could do little but permit the egress of humanity and wish us God Speed.

We arrived back at the tarmac, standing at the nose of our chartered 737, joined by 150 other émigrés desperately trying to exit the ravaged country.  Although we were on the passenger manifest, we were told to wait at the back of the line until they could accommodate us.  The three children although scared and tired, uttered not a word.

My partner, who organized this mini-evacuation, and who possesses leadership capabilities of unimagined proportions, helped to load the sparse baggage carried by the departing Haitians.  Although there was NO security, one bag was unaccounted for and was finally identified by an elderly Creole speaking woman who would have abandoned her few meager possessions in this earthquake ravaged country.  Opening the bag revealed a family photograph that securely identified her and her family, an heirloom that would otherwise have been irretrievably lost.

A few minutes past the two hour deadline, our Sky King 737 was “wheels-up”.  Kathy and Seth, the two airline employees who made this evacuation possible, were overjoyed by the success of “our” mission.  And they should be.  Without them it would not have been possible.

Approaching 11 PM, we made our landing at Miami International, a straggly a group of passengers that has ever deplaned.  We woke-up the children and face our last series of hurdles, American immigration.  While two of our evacuees had valid American visas, the mother and her two children, traveling with us did not.  The mother was returning to see her severely injured son and husband who had been taken to Jackson a week earlier.  The 5 year old had undergone a craniotomy for a depressed, infected skull fracture and amputation of his arm.  The mother was not aware of the loss of her son’s arm and we worried about her reaction.

Deplaning, we presented ourselves in front of the first of three series of immigration officers. Mark, the organizer of the rescue mission pleaded our case.  The mother and her children had no identifying documents.  The immigration officer, a Haitian-American woman asked: “Do they have passports?”  The answer, “probably, inside of the pile of rubble that was once their home.”  These people came with only the clothes on their backs and the family’s expectation of seeing their father and brother.  Two TSA supervisors were called over.  Our only documentation was an email from United States Senator George Lemieux authorizing their admittance.  I was holding the young girl and her IV bag and I showed the ravages of our trip.  Wearing scrubs, with my white hair and with all the surgical officialdom I could muster, I spoke up: “We have two injured children, one with an epidural hematoma or concussion and dehydration, the other with a fractured radius and dehydration.  We sure wish you could help us.  We are taking them to Jackson Memorial Hospital .”  After a moment’s pause, the senior officer offered: “Do you need a wheel chair?”  I should have said yes, not knowing the distance between immigration and the exit.  I was proud that I, a 66 year old, could carry a 40 lb. child a quarter mile without stopping.

We declined an ambulance. Mark’s wife Astrid, picked us up in their family SUV, they have 5 children.  If they have any more, they will need a school bus. Astrid brought us to Jackson Memorial Hospital .  At 11:30 at night, we marched onto the pediatric floor and with the benign indulgence of the head nurse, quietly knocked on the door of the 5 year old who had undergone the craniotomy and arm amputation.  His father was staying with him.  Joy slowly spread over his features as he became aware of the presence of his family.  The three year old girl, who had snuggled into my arms for warmth yelled “Pappi!” and jumped from my arms to his.  The face of the boy with the amputated arm lighted up like the Christmas tree at the White House.

We had done our job.  I’m sure that their medical injuries will be well treated and their wounds will heal.  I’m not so certain about their country.

I arrived home, exhausted, at 1 AM.  A half hour later, famished, I sat down to a tepid bowl of fettuccine and a glass of wine but could not help thinking that I had a home to go to and a meal to eat.  Those people who clutched my sleeve earlier in the evening had no such reprieve.  Stiff and tired, I arose at 7 AM to do an operation on an 89 year old.  Kind of puts things in perspective.

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I am sending this out unedited, on less than 5 hours sleep, to catch the rawness of my emotions and the freshness of my recollections.  In 1992, I worked in Homestead after Hurricane Andrew and saw similar devastation.  The difference was that the people of Homestead knew that their city would be rebuilt.  It was.  The people of Haiti have no similar expectation.

In all humility, I understand that my contribution pales to insignificance.  Others have given so much more that I am a mere pretender.  They, and the people of Haiti , who are overcoming this tragedy with super-human acceptance, are the true heroes.