Stephen Holt MD, Distinguished Professor of Medicine (Emerite), Scientific Advisor to Natural Clinician

Note from the Editor:
Our valued contributor to the Townsend Letter submitted his perceptions of the devastation that affected Haiti in the early parts of 2010. His observations were made during May 2010 where he predicted “an ideal breeding ground for communicable disease”. His early observations in Haiti are updated in his recent submissions to the Townsend Letter in early February 2011.

I regret to bring a message of despondency from one of the dark sides of the world. Several weeks after the devastating earthquake in the vicinity of Port Au Prince, Haiti exists a heart-wrenching circumstance that has not been addressed to a significant degree effectively by internationally. Arriving in Port Au Prince, I clamored to view the landscape as the airplane landed, after a short descent over the Port Au Prince Bay. My flight was in the early evening (May 18, 2010) and I experienced a sensation of sinking emotion as I saw the waters of the bay severely contaminated with drifting garbage that was strewn for miles. The pollution of the Port Au Prince bay with non-biodegradable garbage will take a generation to clean up.

The plane landed in front of a fractured airport building which led into an escalator where one had to catch a bus to the point of customs and immigration control. These controls are housed in a makeshift building. My first encounter was with several people who appeared marginally depressed. These individuals were passive to a degree that one may find after a large dose of tranquilizers. The exit from the airport led to uncontrolled rabble of people begging for sustenance. Within a few feet of the airport exit was an encampment with hundreds of canvas shelters that had been erected shoulder to shoulder with rickety poles. The encampment was landscaped by a huge amount of garbage in which rats were playing in broad daylight. Garbage heaps were attended by pigs who were free roaming and feeding on a combination of garbage and human excrement. I was met at the airport by a close friend who works with the management team of the Ministry of Environment of Haiti. I could not resist approaching the tent city outside the airport, but I was repulsed by the stench.

Transported in a modern SUV, I entered the ruins of Port Au Prince. The vehicular motion was like crossing the desert on a camel. While several weeks have passed since the original earthquake, collapsed buildings were present in monotonous rows, as though the quake had struck yesterday. Any piece of a concrete or solid surface in the ruined town was the site of more plastic sheeting strewn over tree branch poles, interspersed with the occasional modern tent that bore the insignia of relief agencies. An unquantifiable number of people have taken refuge under canvas, cardboard or plastic. The encampments are present in front of the Presidential Palace or adjacent to ruined office buildings. Perhaps hundreds of thousands of people are sheltering in locations that would not even qualify as shanty towns.

I was privileged to drive through what was the most affluent community in the Port Au Prince area, Petionville. This town is now the location of much business that has migrated from central Port Au Prince. This business has become located in various places at the base of a mountain that was somewhat spared the devastation of the earthquake. Many of the businesses are operated by street vendors who provide road blocks that are impassible. The obstruction of mounds of garbage in the street made this small area of Haiti unable to be freely navigated.
Petionville, which was once a proud residential district and banking center for the privileged sector of Haitian society, has small public areas occupied by makeshift enclosures for people who evacuated downtown Port Au Prince. There is a strange dichotomy of social and living circumstances in Petionville. On the one had, there are people begging for anything to eat, but on the other hand there are operating restaurants and night clubs that are busy with a clientele that pays food and beverage prices that downstage the cost of the best Manhattan restaurants. This was both a strange and alarming paradox.

The roads are a series of potholes including the single lane highway that ascends from Petionville into several mountain communities. These residential communities had houses of opulence, mixed with occasional tent cities and overt ghetto properties. I had the privilege of staying in a mountainside four story concrete villa with a breathtaking view of the devastated town of Port Au Prince area and the polluted bay.
My first initiative was to present my relief proposals to the Prime Ministers office. I had carefully considered the environmental needs of Haiti and I had looked at the geographic devastation, climatic circumstances and environmental challenges that required urgent intervention. Such challenges include the further creation of sources of potable water, establishment and continuity of medical services, public or professional health education, distribution of adequate nutritionals and pharmaceuticals etc.

My local friends, including several physicians, assisted in directing me to the various government agencies. After visiting facilities controlled by the Ministry of the Environment, I realized that relief donations have been made, but there was lack of an infrastructure to capitalize on the humanitarian gifts, including vehicles and medical treatment supplies. It took a great deal of time to locate the Ministry of Health, but I was welcomed into their offices and had a very cordial meeting with the Minister of Health, a Belgian trained physician, who sat at his desk, with the world on his shoulders. This fine gentleman and his support staff were inundated with personnel of different relief agencies who have not shown a consistent willingness to cooperate with each other. In the waiting area of the Ministry of Health I was approached by an executive of a large non-government organization that was making extraordinary efforts to engage in humanitarian work.

This individual had a significant, but puzzling initiative that could not be undertaken. This organization has millions of units of pharmaceutical products and much durable medical equipment that could not be placed into any form of distribution in healthcare centers. It appears that sometimes medical relief agencies are not willing to share resources or cooperate. This agency with the relief medical materials wanted to go direct to hospitals to distribute but many hospitals were destroyed in the quake. The strange nature of medical care at present in Haiti, involves the absence of functioning hospitals and local Haitian physicians are seeing relatively few patients as the population gets free healthcare through relief agencies (International Medical Corps or Doctors without Frontiers etc). It is difficult to understand this startling enigma and the inability to distribute pharmaceuticals was reported to be compounded by an unwillingness “to damage existing pharmaceutical markets”. I made no comment and I walked away with a sense of anger, combined with despondence.

Tears came to my eyes when I visited orphanages where abandoned children where housed in tents on car parks of the hostel premises. These were children with little spark in their eyes and with a range of age from new birth to late teens. While I was unable to communicate in Creole, my high school French permitted some degree of dialogue with these heartbroken kids.
I waited patiently for my meeting with the Prime Minister, but he was busy and I met with the former Prime Minister, a wonderful gentleman who expressed heartbreak at the circumstances present in his nation. It was clear to me that the rainy season had just started. I walked the harbor streets of Port Au Prince and realized that anticipated monsoons could not be handled by the dysfunctional drainage system of the city was not functional. The consequence of this circumstance together with overcrowding and potential flooding of the makeshift camps produces an ideal breeding ground for communicable disease.

I was reassured that relief agencies and the Haitian government were doing the best they could to undertake a vaccination of preventive healthcare, but organization with efficiency in Haiti is a great challenge for anyone who wants to help. I predict outbreaks of typhoid, cholera and malaria. It occurred to me that there is a possibility of returning to medieval times if outbreaks of bubonic plague or other pestilence borne illness. These possibilities scare the “living daylights” out of me.

After 8 days in Haiti, I returned to the United States and I reflected upon my surreal experience. I was left with a sinking feeling, but I have a residual hope that I can contribute in some way to support individuals with the most severe degree of privation and neglect. Haiti is a diabolical experience of humankind that should never have occurred and I worry about the loss of life and misery that may continue in the aftermath of the earthquake. God Bless Haiti and its citizens who should be embraced by the world with our desire to love one another. I do not know if I shall ever be able to overcome the painful memory of my mission to Haiti. Whatever the international community is doing to help Haiti is just not enough!

Note from the Editor:
Dr. Holt provides us with an update from his earlier trip to Haiti and his message remains quite depressing as he perceives continuing delays in the provision of adequate humanitarian support for Haiti. Dr. Holt states on February 7, 2011
I have not been able to revisit Haiti since May of last year, but earlier predictions of the widespread outbreak of communicable disease, most notably cholera, have come to pass. There was nothing in my earlier thought process that was equivalent to the prophecy of Cassandra. International governments and relief agencies cannot claim success in what is now a very slow impact of any substantial intervention.
My early travels to Haiti were for several specific reasons. First, I presented plans for the provision of clean water. Funding had been given from a variety of sources to address the issues of clean drinking water but plans were not undertaken in a manner of expedience. Perhaps, the ravages of the cholera outbreak could have been prevented, to some degree, by earlier action.

A second focus of my mission was to attempt to facilitate the distribution of donated medical equipment, pharmaceuticals and supplies to institutions and locations of need within the country. Several aid agencies had problems in distributing medical supplies to hospital locations in Port Au Prince, but they had overlooked needs that existed beyond city limits. It is with regret to report that some of the necessary medical supplies did not leave warehousing facilities and there was no local organization to transport materials despite the presence of many donated vehicles from multiple sources. The organization of medical services in Haiti was to some degree handicapped by the evolution of independent clinics that were run by various aid agencies without mutual cooperation and government leadership.

Political maneuvering for government control seems to have been the focus of attention at the expense of addressing the urgent needs of a distressed population. Some civic leaders have packed their bags and left in disgust with varying degrees of desperation. The media has gone somewhat silent on this plight of a distressed nation. The infrastructure of Haiti requires rebuilding and attempts have not been timely or focused and financial donations appear to be locked up by bureaucracy. I admit to my own personal perceptions of the circumstances and any criticism of existing operations in Haiti makes the country an unsafe location for some advocates of the health and wellbeing of the nation-vide infra. I hope that some of my statements will prompt some of my colleagues to direct their attention to help Haiti.

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