Communichi

Haiti Journal – February 18 to Feb. 28, 2010

On Tuesday, January 12, 2010, a magnitude 7.0 earthquake struck at 4:53 local time near Port au Prince, the capital city of Haiti. According to the Haitian government, approximately 230,000 people died in the quake, 300,000 were injured, and 1,000,000 people became homeless.
Soon after the quake, I made a decision to join the Tzu Chi International Medical Association (TIMA) on a relief effort to help survivors. I offer the following reflections from my journey in the hopes that other medical professionals will be inspired to take advantage of this opportunity to experience profound professional, as well as spiritual growth.  It is also my hope that everyone reading this – medical professional or not – gains a deeper appreciation of the simple requisites of a healthy existence: clean water, nutritious food, access to medical care, safe housing, intact infrastructure, and most of all – a sense of inner peace, and hope for the future, and does what they can to ensure that everyone in the world has these needs met.

Friday, Feb. 19. I arrived at the Tzu Chi camp in Port au Prince after a grueling 8 hour bus ride over bumpy roads and heavy traffic with many trucks moving relief goods in from the Dominican Republic. There is a distinct difference between the affluence of the D.R. and Haiti. As one gets closer to the disaster zone, one sees many camps of people living in shelters constructed of sticks, plastic sheeting, blankets, whatever can be found to protect one from the heat of the day, and the cold of night. With the rainy season approaching, and the hurricane season soon after that, it’s quite clear that with the millions of people living in these makeshift shelters, the public health situation will likely worsen, with an increase in respiratory illness, TB, gastrointestinal illness due to poor quality water and food, and consequent mental despair. One of the members of my team subsequently visited one of the few functioning hospitals in Port au Prince and was told that on average, five babies die every night in that one hospital.

It is hot and humid here with day time highs in the low 90s. I am drinking lots of water to stay hydrated. It feels like a perpetual sauna. So far, my body is adjusting though. We are quite fortunate to have 3 healthy vegetarian meals a day, air conditioned sleeping quarters, and access to cold showers. With fresh water trucked in every day at a cost of $600/day, I do my best to minimize water consumption. It would be easy to feel guilty – seeing so many people every day who lack these basics. But I quickly reason that a more productive thought is to accept that having a few comforts enables me to stay healthy and thereby have the energy every day to serve others. The work itself isn’t tiring, just the long hours in the heat. Each person who sits down in front of me represents an opportunity to connect with love and respect, to offer hope, and to help alleviate suffering. When the situation seems hopeless, I focus on the person in front of me and it isn’t so difficult to revive my hope, holding a long term goal of recovery for Haiti, realizing this will demand patience and persistence from me, and everyone involved.

In the month between deciding to volunteer, and actually arriving, many times I experienced doubt about the importance of my participation in the relief effort. Three times, my flight to Haiti was canceled adding to my doubts about whether the universe was signaling me that I was not needed. I often asked myself, “What can I, as an acupuncturist do, with a few boxes of needles, to improve the lives of Haitian people  in a lasting way?” Certainly, I can alleviate their pain and stress for a day, or even a week, but what then? What happens after the relief organizations inevitably close their free medical clinics due to the reality of resource limitations? The Haiti disaster is fading from the awareness of the general public. There are so many problems on the planet, and already, the earthquake in Chile is the hottest news story. This kind of thinking easily lends itself to despair.
Yes, it is sad to acknowledge these realities, but nonetheless, essential not to underestimate the value of a small act of kindness performed with love and intention. As the Buddha said, the barrel of goodness is filled one drop at a time.

Saturday, February 20. Today we visit a garment factory where about 200 workers have volunteered their time to help sew tarps for free distribution. The factory is still standing, though some of the roof framing is twisted from the earthquake. It is about 86 degrees inside according to the thermometer on wall – literally a sweatshop. But these are the lucky ones, the ones who still have employment and an income, however meager, to take home to their families. We offer the workers a simple meal of rice and dine together.

The Tzu Chi spirit is to respect and love every sentient being and that guides the manner in which relief operations are carried out. Video footage of some of the initial disaster response in Haiti showed food tossed out of helicopters, as if to wild dogs. This is very sad. The Tzu Chi way is to make eye contact, smile, bow and offer goods with outstretched arms and an understanding that the person we offer to is not to be pitied. We owe them a debt of gratitude because they give us the opportunity to open our hearts in love and this is what leads to internal peace as well as healing in the world. By serving others, we gain insight into deep truths. All of the happiness we enjoy is dependent upon the kindness of other beings. Contemplating this deeply dissolves the limited notions of self that we habitually cling to and enables us to merge with a spacious heart that has no limits. Meditation on Emptiness or selflessness, conjoined with dependent arising, is the gateway to realization of ultimate truth according to the ancient masters.

One of my team mates observes that many of the Haitians only take a few bites of rice and then stash the remainder in their shoulder bags. It is clear that food is still scarce here. Most people are visibly thin, and for every worker in the factory, there are probably many more mouths to feed elsewhere.

Whenever we drive anywhere outside our camp compound, the masses of people living on the streets is staggering. If their house wasn’t completely destroyed, the people are afraid to sleep inside due to the persistent aftershocks, so they use their homes to wash, and store their belongings, but do not linger inside. Throughout my day, I am constantly feeling tears well up inside.

Wed, Feb. 24. Aside from the professional and spiritual growth opportunities already mentioned, what I most appreciate about volunteering with the Tzu Chi organization is the focus on team work – appreciating and taking care of one another. Disaster work isn’t easy. In Haiti, the environment is very harsh. The heat and humidity, the dust and air pollution from trucks and generators, the noise – are seemingly ever present, assaulting the body’s physical senses. Mental stress is also a factor. The needs of the population are so great. So many people are suffering. There are only so many of us, and so few hours in each day.

It’s a fine line between helping effectively, and burning out due to secondary trauma exposure. I feel like crying about 50 times a day, but usually there is no time to allow those feelings visible expression. There are patients waiting to be served, and so one must carry on, understanding that one will need to make space for these feelings later, possibly after the team splits up and goes home. One therefore needs to be very mindful of one’s balance of mental and physical capacities as they fluctuate throughout the day.

The days are long and the inner and outer challenges are many. Every situation becomes a learning opportunity to think creatively – how to serve more people, more effectively, in less time, using less resources. And these challenges are shared by everyone on the team. Being human, sometimes these stresses lead to interpersonal conflicts – though fortunately, the spirit of teamwork at Tzu Chi usually prevents such problems from arising.  We constantly have the opportunity to go the edge of our personal limitations and then take one step back, giving us greater capacity and flexibility to negotiate future challenges.

Trauma Stewardship. During my time in Haiti, I read an excellent book, Trauma Stewardship, An Everyday Guide to Caring for Self while Caring for Others, by Seattle author and educator, Laura van Dernoot Lipsky. This should be required reading for everyone who works in the disaster response field, and beneficial for anyone in a service profession.

Friday, February 26. The first patients are hobbling into the clinic on crutches and sticks. About 30% of my patients complain of suffering from concrete debris falling on them during tay tremble (the earthquake, in Haitian Creole). I am without an assigned translator this morning, so I will have to rely upon instincts and patience this morning in order to give acupuncture treatments. I asked one of the company workers how to say “Where is your pain?” in Creole. “Keebow, oo gan doo ler”.

A Compassionate response to the Psychology of Human Need. An 18 year old woman has been triaged to receive acupuncture for a headache. Upon interviewing her through my translator, it turns out she also complains of stomach and back pain, and vaginal infection. It seems many of the women are complaining of vaginal infection and there is speculation that many of our patients say whatever they can in order to receive medicine – pills especially. This complicates the task of our doctors and nurses to responsibly dispense the appropriate medication.  Haitian people seem to have an almost religious faith in pills. A Haitian dentist who lost his office commented as such to me while receiving acupuncture. The acupuncture treatment seems to bring little positive effect to my patient and so I send her to another doctor for further examination. She does not have the usual signs of vaginal infection, only a mild temperature. So the doctor gives her some tylenol and tells her to come back the following day to see how she is feeling.

I am surprised to see her the following day, seeking another acupuncture treatment. Again, my treatment seems not to help, and she grimaces when I palpate her low back. So again, I refer her to the doctors for further examination. We don’t have an x-ray machine. Referral options are limited. Many of the other hospitals are so stretched to capacity that they turn away anything that doesn’t appear life threatening. It’s all educated guesswork, and one variable that needs to be factored in is the psychology of need.

Upon (gently) questioning one patient “why did you come here today?” She replied matter-of-factly to the Haitian translator in Creole – “it’s a free hospital, why wouldn’t I come here?” Tzu Chi not only provides medical care, but also distributes blankets, food, tents. The patients see the water truck rolling each day, see the well-fed healthy volunteers from first world countries. Even a small supply of pills can become a street commodity in a post-disaster economy. If you were in dire need, wouldn’t you seek every means you could to survive? Waiting for a Haitian government response when your family is starving and sleeping in the open is a potential (slow) death sentence.  There is no government here in a conventional sense. The international community is providing security, that’s about it, at least from a street vantage point.

So it seems completely understandable that people show up with vague medical complaints, difficult to confirm. It can be frustrating if we think we are there to only serve people with diagnosable conditions. Or, if we do not include dire poverty and hopelessness within the scope of illness that we are trying to treat.

Of course, you cannot cure poverty and hopelessness with a pill. One needs to begin by restoring hope, by smiling and respecting the individual, not faulting them for following their biological instinct to survive. At times, I tried to tell my patients that the acupuncture would help their headache, would lessen their depression. That natural healing would have fewer unpleasant side effects for their body. Even so, again and again, I would get the same request at the end of the treatments: “Please give me medicine”.

I confess that I practiced a little deception and often gave them a small package of 7 red pills – vitamin supplements. Through the translator, I said “this will help your condition.” I smiled and placed it in their hands and bowed, silently praying that it would indeed bring them all that they needed. They would usually smile in appreciation and say “merci”…thank you. I prayed that the placebo effect would work in their favor and that they would feel better. Lacking the knowledge or the staffing resources to accurately diagnose their condition, it seemed a more compassionate response than lecturing them and sending them away empty handed.

Most of the Haitians have lost family members, or is close to someone who has. PTSD-like shock exacts a silent, but deadly toll on the mental psyche of the culture. In such an environment, a sincere smile conveying love can be like sunshine in the eye of a hurricane.

Sunday, March 28. At the Immigration counter inside Miami Airport. “What were you doing in the Dominican Republic and Haiti”, the agent asks me?” “Medical relief”, I stammer sleepily. “What is your profession?” “Acupuncture”. He pauses, seemingly satisfied that I’m not a terrorist, and then asks me an unexpected question. “How is the situation down there?” My mind shifts into some sort of timeless realm beyond words. I search for the words to respond and then look him in the eye and speak from my heart: “It’s going to take a long time to heal.” He thanks me and indicates that I can go. As I walk down the corridor, the tears well up like a sudden earthquake splitting open the ground of my heart. But I cannot linger, time to find my luggage and pass the immigration counter and then find the transfer area. I will make time for these feelings I keep telling myself.

And I shouldn’t have any expectations as to how the feelings will arise. Maybe they will manifest as a flood of tears, or maybe just as a deep reflectiveness, like swimming beneath the surface of a warm tropical ocean. It doesn’t matter what the experience is. What matters is how I interpret it, the lessons I learn, and the vision I continually recreate in each moment of however much time remains in my life.

I do know this; ten days in Haiti has taught me to appreciate the simple things in life, like good health and the privilege of having access to health care when I need it. A happy intact family living in a society with a relatively intact infrastructure.  Clean air. An opportunity to gain a livelihood through meaningful work. Access to education should I wish to go back to school. Of course, I could complain about a thousand and one things – national and professional politics, the economy, the stranger who cuts me off on the freeway. But these sorts of petty concerns are trivial in contrast to life in a disaster zone.

My translator friends were enrolled in a University in Haiti that collapsed. Out of three hundred something students, only twenty made it out alive. One of the young men heard his friends, trapped in the rubble, calling his name. There is no talk of rebuilding the school, and seemingly no government to even do the talking. Haiti is the world’s injured child for now, this much seems clear. Let us all do what we can to tend the suffering.
This is our life, our planet, our world. What are we going to do with intention? How are we going to get there? Do we wait for the government to solve the problems? There is a saying; the people lead and the government follows. The people are, more often than not, the true leaders, the unheralded saints who never lose hope, who strive in their personal lives to uphold righteousness and goodness in their communities.

Gratitude: With gratitude to all those who contributed directly, and indirectly to supporting my journey. Gan En (Mandarin for “gratitude”.)

Note: I will be showing pictures and telling stories from my Haiti trip on Saturday evening, March 13 at 7:00 p.m. Location: Dharma Friendship Foundation,  2420 East Union St. in the Central district.  (I gave out the wrong address in my newsletter….look for the colorful prayer flags flying above the bus stop. ) There will be fresh baked treats and a short meditation on compassion after the presentation.