So much has happened this week that I’m having a hard time deciding what to say. For every word written there are 10 more left unsaid – I really feel regret that I won’t be able to capture every instant. Some life, and some death, and a lot of in between.
To begin, I’ll briefly say that there was a lot of walking. I use the word “walking” loosely here, since I really mean a combination of extreme climbing, slipping, maneuvering rocks, and eventually collapsing. We weaved through the mountains, forded rivers, and scaled boulders, with the goal of meeting with refugees who came to Annette after the earthquake in Port-au-Prince over one year ago. It was exhausting and technically difficult, but even when I was puffing and sweating and cringing at the taste of the Clorox I used to purify my water, I can say that I was always happy.
But there was fear. I say that not because I really felt fear, but I knew in my mind that I actually was afraid. The day before we left, it rained all day. I knew that this meant that cholera would spike, especially in remote villages. Last time it rained, the village of Castillon (not far from Annette) lost 7 people in one night – the rain washed infected mud into the drinking water. I’ve written about cholera before, but just to revisit: it’s a pretty terrifying disease that, once contracted, can kill you in 6 hours. It causes your body to flush gallons of water out of your system at a time, first from diarrhea, and later from vomiting. It is especially deadly for people with compromised immune systems – which of course puts most people in rural Haiti at high risk. (The UN is currently being sued for introducing the pandemic into the population). It must be immediately treated with doxycycline and rehydration solution, at which point there is a decent chance of survival. I always carry a bag of rehydration mix and extra doxycycline in my travel bag for any time I travel into the mountains.
I’ll give you a few scenes in flashes, because for some reason I’m having difficulty articulating it all at once:
* * *
We were all sitting on our small wooden chairs, under the yellow glow of the solar-powered lights that had been charging on top of the latrines all day. We’d finished our dinner (they offered me a congealed red substance that turned out to be goat’s blood, which I politely declined, and took rice and beans instead). All of the health agents were telling jokes very fast in Creole, and I was doing my best to keep up. Michel Louis, one of the nurses, had a booming laugh, and everyone leaned in when he spoke. I was sitting in the doorway. I glanced over, and I noticed that one of the health agents, Romulus, was sitting on the outside, leaning against the wall in his chair, looking very distraught. Our eyes met, and he stood up quickly and disappeared off the side of the porch. I returned my attention to the lighted room until I decided that I should get some rest for my hike the next day. I walked into the adjacent room and arranged my blankets on the bed mat on the cement floor (we all slept in a row, we seven, and it was a snug fit). I drifted to sleep.
I was awakened some time later, I’m not sure when, but I thought it was morning. Everyone was shouting, some people were laughing, and I realized that everyone was coming to bed. The last thing I remember before closing my eyes was thinking that they were saying the word “Cholera, cholera” over and over.
The sun rose, and so did I. We ate some bread and sweet coffee for breakfast, and I gathered my things. Romulus was sitting on the front porch, I noticed that sweat was pouring down his face. Michel Louis told me that Romulus thought he has cholera, but he’s not sure. He took some doxycyline already, he said.
We finish breakfast. Romulus got up and staggered over to the latrine. Without opening the door, he got violently sick on the grass. And then again. And again. I heard Michel Louis curse behind me.
We all stared, worried.
“You said he already took doxycyline?” I asked.
“I think so,” Michel Louis said. “Romulus, eske ou te pran doxycycline deja?”
Romulus replied, and Michel Louis translated: “No, he actually didn’t. He couldn’t find any.”
“He couldn’t find any?”
“I have some,” I gasped suddenly. “I have extra.”
I ducked into my room and returned with the small bag of the precious pills. I counted them out – one, two, three. Romulus took them all at once, with water. He collapsed on a chair on the porch and leaned his head back against the wall.
I saw the plastic gallon I had carried up, in case of emergency, filled with some liquid. “Is that rehydration solution?”
He wasn’t drinking.
We remained there on the porch, and the minutes ticked by, him sitting, sweat pouring down his face, leaning against the cement wall. Me, standing, staring out at the road. A five hour walk to the nearest village, plus another 4 hours to the nearest hospital, if a car managed to get there in time, I calculated. Nine hours.
“You should drink more,” I said in Creole, as firmly as I could, although I’m afraid it came out fainter than I intended.
He picked up a Sprite bottle and took an unconvincing swig.
Two gallons right away, I’d heard.
“You need to finish that right now,” I said.
He finished the Sprite bottle, and refilled it with more solution.
I felt infuriatingly calm. I knew that I needed to be pushing him harder to drink more, I should be yelling. But I didn’t know how much water we had. We were an hour’s walk from the nearest water source.
The mule arrived, with a small bustle of people behind it. He would ride the mule to Castillon. They strapped the plastic gallon to the mule. He staggered out onto the grass, and climbed on a rock to mount. When the mule shuffled out of the way, he looked utterly defeated. He took heavy, sliding steps after it until it stopped. He mounted, stooped over its neck, and disappeared around the corner.
We hiked all day, me and Ricardo and our guide, the village’s health agent (a man with a bright smile and carved features that softened when he observed children). So absorbed was I in the technical difficulty of descending the muddy mountainside sprinkled with jagged rocks that I couldn’t think of anything but the present. We descended to a small river, and forded it, and visited several houses. Of them all, one sticks out powerfully in my mind. A girl, twenty-three (my age), with her small child of 3 years old. They came from Port-au-Prince after the earthquake and stayed with the old woman there. Our job is to document who stayed and who went, whether they know how to recognize and respond to cholera, and the quality of their living conditions. They invited us into their home – cement walls, tin roof. There was a single mattress in one corner, it took up about a quarter of the house. Myself and the girl were sitting on the mattress. The child was staring at me – I was the first white person she’d ever seen. Ricardo was speaking rapidly. I watched the girl. Her eyes were half-lidded, not particularly focused on anything, although I saw the spark of intelligence there. Occasionally they would settle on her child, and focus, and she would smile.
“Are you going back to Port-au-Prince?” Ricardo asked.
“No.” The girl muttered.
“Because it is not good there.”
“Why is it not good?”
She inhaled quickly. “It’s no good! It’s no good!” She was getting upset.
The older woman murmured something to Ricardo, and he repeated it to me: “She’s not right in the head. Since the earthquake, she hasn’t been right in the head.”
I looked at her, and I had a feeling that she understood this exchange. I wished I could be a counselor, and live here, and get to know her, and draw her out. I felt she wasn’t all gone, just hidden. Perhaps I am wrong. But I would have liked to find out. But I have no counseling degree, or arrangements to stay, and I can’t do everything. I wondered how many refugees were in need of counseling that was not available.
Her eyes were fixed on the same spot, just above the floor, half lidded. A breeze caught the bright cloth draped over the doorway and blew it inward, and the girl sat there, hands folded palm-up in her lap, head tilted downward, and I felt that I wanted to take a picture to capture the inscrutable expression there, but that a camera would somehow offend her. But the image inscribed itself upon my memory, and I resolved to write it here.
We continued this work for several hours, before returning to the post in the afternoon. I was feeling invigorated from the hard walk and the fresh air, and was all in all in generally good spirits to be returning to our friends back at post.
We were greeted with a somber face that came out to meet us in the yard.
“Romulus fell off his mule. He was too weak to ride. Someone found a stretcher. They’ll carry him to Castillon.”
And again, inside: “Jackson is driving from Jeremie to meet him in Castillon.” This was good news. Jackson is a nurse, and was valedictorian of his class. He had stayed behind. If anyone was capable of dealing with this, it would be him.
I had the strangest sensation that, perhaps a moment or two away, a fear was lurking. The image of Romulus tumbling off of his mule on that steep mountainside, into the mud, wondering if he was going to die – I deflected it. The briefest thought, the what-if – I deflected that, too. I walked into the house, sat down on my mat, and stared straight ahead. Ricardo joined me soon.
“I should’ve been meaner,” I said. “Angrier.” I had a growing awareness that my desire to be nice, to be polite, to be quiet, could have serious consequences here. “I knew he had to drink more rehydration solution. I should have made him.”
That night, we hear: Jackson met him in Castillon and gave him three bags of IV fluid right away before driving him to the hospital. They tested him: it was cholera. He had gotten doxycycline just in time. He would be okay.
* * *
The next day was the hardest yet. No one had slept the night before. Every time someone relieved themselves in the bucket on the floor, someone would wake up and joke loudly that the person had cholera, which I found to be more disconcerting than funny at 2 in the morning after a long hike. Around 3am they all just gave in and sat up, shouting jokes at each other until the sun came up and at 5am I staggered, pale-faced, to leave them behind (they would be sitting all day, I thought crossly) for another day of hiking. It was the hardest day yet, so difficult that it was recommended that I not go – they were afraid that I would, literally fall off the mountain. But I insisted, and off we went. Descend, descend, descend, and try not to slip. Ford a river. Visit a house. Ford back across. Then we ascended a monstrous peak, two hours of straight climbing, a route that literally cut straight up the mountain at nearly 70 degrees. More houses, more interviews. Some people had gone to market for the day – they weren’t there. I knew I should’ve felt frustrated, but I was just tired. The mountains were beautiful, and the air was fresh. My water had been boiled to be sanitized and I could tell – it tasted like old smoke. In that heat, I hardly noticed.
I returned, and collapsed on my mat. I thought that that spot on the floor was literally the most comfortable bed I’d ever been on. I didn’t move for at least 15 minutes, until I finally reminded myself that I did know how to move my legs, and I even wiggled my toes to prove it. The Haitian women gathered at the door and tsk’ed, saying that I should not have walked so far. I stayed, unmoving.
The health agents were walking to another village. Ricardo and I were staying one more night, and meeting them the next afternoon.
After dinner I walked out onto the front porch. The health agent gestured over to the latrine.
“Moun kolera” – that man has cholera.
I looked closer – on a stretcher on the ground, a gaunt man lay unmoving. A single wrist, no wider than a pencil, hung at an odd angle over the side. I wondered if I should discreetly take a picture, to show it to the world. I decided that would be a pretty callous thing to do. His eyes were sunken in. I could see it from across the yard. He was severely dehydrated.
“Did he get doxycycline?” I asked the health agent.
“I gave him some already,” he replied.
It was more important for him to drink, I knew. If he didn’t drink now, he was going to die. But for some reason I couldn’t move – it felt like one of those dreams where you’re running in slow motion – so I stared. Time stretched out. I became aware that everyone present was staring, as though watching a car wreck in slow motion. I found myself staring at his chest, as though afraid that soon it would stop rising and falling.
He sat up suddenly, and I started. He opened his mouth and let out a small moan: “Diarrhea.”
His caretaker helped him stand, and he staggered into the latrine. I heard Ricardo let out a defeated breath.
“He should be drinking more,” I said to Ricardo.
“Yes,” he said.
Do something. Do something. Do something.
You’re not a nurse. You’re not in charge. You can’t disempower the people who will be here all the time.
If you don’t do something, you are going to regret it.
The man left the latrine, stumbled, and collapsed face-first on the stretcher. I walked over the the man’s caretaker. He was violently washing his hands.
“He needs to drink more,” I said in Creole. “If he doesn’t, he’s going to die.”
“Yes,” the man agreed. He continued to wash his hands.
“He needs to drink that whole gallon.”
“Yes,” the caretaker agreed again. Scrub, scrub, scrub.
Why am I so calm? Why is everyone so calm?! Get angry! Be rude! Why can’t you be rude?! It was like a slow-motion nightmare.
The man in the stretcher fixed his hollow eyes on me. His wrist flopped out, his palm turned skyward, and then – he was gesturing for me to come closer.
I brushed past the caretaker and approached with trepidation, feeling as though I was approaching someone’s deathbed. What could he want? What would he ask? For water? Food? I bent down. I was terrifyingly undisturbed, perfectly composed.
“Photo.” He rasped. A request just like one of a child I would pass on the road.
I had the strangest sensation in that moment. It was as though somewhere, on the exact opposite side of the world, there was a girl with my name, and face, and memories, who suddenly broke down sobbing and laughing at the same time.
But not me, and not here. Although I am vaguely aware of having cried out that single word back to him, as though struck: “Photo?!” But a moment later I was recomposed.
“First you need to finish this.” I gestured at the gallon of water by his side, nearly empty. They only had one more.
He blinked slowly, and then weakly lifted it to his lips. He gulped once, and then set it back down.
“No. You need to finish it,” I said.
He fixed his eyes on mine. “I am finished.” His voice was firm. His eyes rolled back in his head and he sunk back down. “Now take my picture.”
If it had been possible for me to remain there all night, coaxing him to take sip after sip, I would have done so. But never, for the life of me, could I have shouted at that man, could I have done anything other than what he asked me in that moment. It seemed that to do otherwise would be to deny the last simple request of a dying man. I lifted the camera. Click. I showed it to him. And I’ve attached it here.
The health agent called to me. We had to leave to go to his house before sundown, we had to leave now. I straightened and turned to see everyone in the yard staring at me. I walked quickly to the house and gathered my things, and we left.
* * *
That’s all I can share tonight, I think.
But I will leave you with this: the next morning, I awoke in total darkness in the health agent’s house, to the quiet murmur of voices next door. I listened more closely and realized that the whole family was gathered around an oil lamp in the living room, praying before sunrise. The voices were quiet, but somehow filled me with a deep and quiet peace.
“Others have cars, or airplanes, or money, but we subsist by the grace of God, and on His grace alone we live,” they murmured.
As I write it now, I feel the indignance that some of you may feel to hear such a prayer after witnessing such suffering. But who are we to deride their faith, they, who live here, who see death every day? There was something so simple, and so beautiful, about the way the light glowed between the cracks of the door, listening to that small family sitting on their floor and praying together. There is something ineffable and unspeakable about the mysteries here, that I cannot capture, and I am sorry that I cannot do so. But I hope that you will take my word for it – it was good and simple and beautiful in the way that all things strive to be good and simple and beautiful, and that is the most I can say.
And I can leave you with this, too: when we returned to Jeremie at the end of the week, we stopped by Romulus’ house and waited anxiously to see him. And then – he burst out of his front door, grinning widely, hands out to either side. He ducked in the window and gave everyone fist pumps, and everyone in the car couldn’t stop smiling. His mother came out, practically in tears, and just kept saying “Thank you, thank you so much,” over and over. She met my eyes a couple of times and gave me such a look that I wondered if Romulus had told her that the American had given him the medicine. I felt a lump in my throat. Cholera used to be a death sentence, but her son was alive. We knew what to do, and all of us, from calling the mule, to the ones who carried the stretcher, to Jackson driving four hours to give him IVs, to the cholera treatment centers that HHF had established – we had saved her son. I couldn’t stop smiling all the way back to my house, and it was the closest I’d come to tears all week.
I’ll leave you there. Thanks for reading.