For Elisa Zlami, the burden of her fractured leg just got heavier: literally. The day before, Marc, an ortho-tech at the General Hospital in Port au Prince, came immediately to her tent, post op, after I asked him to ‘do something’ about Elisa’s old split cast that was causing her pain. Haiti’s earthquake snapped her shin bone in two, and left an open wound that has finally healed.

Jeanne is one of thousands who suffered traumatic or surgical amputations from the Haiti earthquake. Her son sits in the background.

Scott Weinstein

Marc expertly rewrapped her leg in a new plaster cast. Despite a day of drying, the new cast must weigh 9 kilos. Her leg still hurts along the fracture point. A summoned orthopedic doctor inspects Elisa and tells her the pain should go away and that she need not stay in the hospital. But Elisa has lost her home, and her family too.

A few weeks after the earthquake, Réa Dol is desperately trying to get food for her community of children and their families from the SOPUDEP school she ran before the earthquake. It now is a community centre and clinic. Baz, a US medic, has told her that there might be food from the UN. But it is very confusing. The Italian navy is also promising food in a few days. The prospect of being able to participate in that food distribution system seems daunting for Rea, whose English is not very good and whose Italian is non-existent.

Boomtown

A new French doctor, Michelle, breezes into Post Op 3 and cuts away the dressings from Mrs Wintour’s heel. Mrs Wintour’s wounds are now green with infection. I changed her dressing two days ago and there was no green then, so daily dressing changes are now mandatory. Better nutrition is essential too, since malnourishment is preventing healing. At the sprawling, busy UN compound, there are no hungry people. Not many are Haitians either, who are being stopped at the gates while whites like me are waved through. I have no business there really; I am wandering around looking to book a flight to Miami. I see many cheerful foreigners working for NGOs, governments, militaries and businesses, because Haiti is now a boomtown.

The opportunities for aid and development work are enormous, thanks to the disaster and the millions or billions of dollars being pledged. Foreigners, especially from the US, are flocking to Port au Prince to pursue this offshore opportunity. Many are earnest, believing sincerely in their humanitarian mission. Of course, the thousands of mostly US soldiers didn’t exactly come by choice.

When deposed popular Haitian President Aristide told the UN in 1991, ‘Everyone must have a place at the table,’ he was referring to Haiti’s hungry dispossessed. But it is the international community that has invited itself to feast. Little has changed since Columbus first colonized Haiti, including blaming the Haitians for their poverty.

Post Op 3 tent is a small community where Elisa and Mrs Wintour live with 18 other patients, their families and friends. The young girl who often tends Elisa is a friend, the healthy sister of another girl living outside the tent, who also has a painful broken leg. Food brought in by the families to supplement the meagre daily hospital meal is often shared.

On a mission

Nearby, the Haitian Adventist hospital sponsored by US Adventists and an evangelical food mission provides two large vegan meals a day with food mostly bought from neighbouring Santo Domingo.

I asked Mr Abelard, Elisa’s older neighbour in the next bed, to make sure Elisa gets to X-ray. He knows how the informal system works – you flag down someone walking by in Transport, hand them your paper note saying ‘Radiograph – jambe droit’, and they put you on a stretcher and carry you to and from X-ray.

Emmanuel has extensive injuries, including an amputated right arm, and is fighting an infection to hip and leg wounds that have been repeatedly surgically cleaned. He also has two sisters who are jealous of Mrs Wintour’s new experimental mechanical wound suction device, which aspirates draining fluid from her foot wound into a corrugated blue squeeze bottle. The sisters want one for Emmanuel. The device is being developed by a Boston medical team working with Partners In Health based here in Haiti. Kristine, their engineer, thinks when the kinks are worked out, they can provide the moulds for the plastic bottles to businesses in Majority World countries that can stamp out bottles for a few dollars. They hope each system will cost less than $75. In the US, a more efficient electrical system called a Wound Vac costs $25,000; its manufacturer made $1.4 billion from it in 2008. The next day, Emmanuel gets the blue bottle wound suction for his hip.

Like a bridal registry

Shekhar, an Edmonton Red Cross volunteer, called me the other night after assisting with food distribution that day. He can’t understand why food distribution is run so badly in Haiti. After all, Shekhar and the international agencies have done this successfully around the world. The Haitians are prepared to do anything they can to help. Those of us who have had the good fortune to hang out with Haitians or wander around Port au Prince’s poor neighbourhoods remark to each other how kind and gracious these Haitians have been to us. This is in contradiction to their sinister portrayal by our media and governments.

The UN in Haiti did not do a very good job switching from an armed security force that was often accused of human rights abuses of the poor, to becoming a humanitarian aid distribution organization after the earthquake. They often abandoned attempts to distribute food and water on the pretext that crowds were 'out of control'. Here, they have organized food lines for women only.

Scott Weinstein

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I happened to have been in Washington when the quake struck down Haiti. I’m not a bad schmoozer, so with a little luck and effort, I found myself connecting with people and agencies that were to be some of the players in the emergency medical response.

Last week, Christine, a trauma surgeon in Washington, told me that I should tell the director of the General Hospital that if he wants medical materials, he should go to the US AID web site. ‘Like a bridal registry,’ Christine texted. I presented the message to Director Dr Lassegue, who responded sceptically, ‘Oui, perhaps something will come of it.’

Many experienced in disaster response label the initial organization ‘a cluster fuck’. I bumped into David, a young tattooed American, at the UN campground walking to a health-cluster meeting. David griped that the scheduled meeting times were often changed, and tended to be useless because the decisions had already been made overseas.

Rebuilding

Like so many of the people sharing the Post Op tents, Elisa’s losses are more profound than her wounds. It’s not their crooked or missing limbs that will be their biggest impediment. It is the prospect of trying to make a home and a life out of their shattered country that again is being occupied – and is now run by a coalition of a post-coup regime, foreign governments, militaries, religious charities, NGOs and aid agencies – all under the umbrella of humanitarian relief.

Three weeks after the quake, the French-run Handicap International organization set up shop at the hospital with a plain green military tent and a team of about a dozen French physical therapists and Haitian trainees. The French will leave eventually, but they understand that the Haitian staff will need to continue their work. This model has yet to be adopted by most aid agencies, which have no plan to sustain their programmes without their presence.

Most charitable aid to ‘take care of Haiti’s poor’ spends little actual money inside Haiti. We long to hear announcements that there will be substantial aid for Haiti’s peasant farmers to provide credit and resources to plant sustainable crops for local consumption, and to help Haitian businesses produce essential local goods.

Back at the trauma ward, we have to figure out who will be operating on the patients now that the Red Cross Norwegian orthopedic surgeons have left for another health facility, and the Médecins du Monde surgeons are leaving this weekend. The rapid turnover of many volunteers is maddening. In the operating room, I ask the Haitian surgeon in charge, who says, ‘When you need a surgeon, just come in and grab one of us.’

Sounds like a plan.

Fixing it

The staffing at the hospital, at least during the dayshift, is much better now than when I first arrived. Many more Haitians are able to work. Even the Israelis just sent in a half dozen Mogen David staff, while they are still busy blocking medical aid to Gaza after destroying hospitals and ambulances there last year.

Diana is a US nurse running a clinic inside a tent community of 2,500 homeless and hungry people. Talking with a worker at the airport where supplies are being delivered, she found out that his friend has a quadriplegic child who needs a wheelchair with a head support. With the help of a Mr Fix-It friend, Diana presents the worker a retrofitted wheelchair with a headrest, and drives back to the tent community with four pallets of food. But two weeks later, Rea still has not been able to tap into a food pipeline for her community.

National Nurses School: Five storeys, up to 150 lives. At Hôpital Université d'Etat d'Haiti.

Scott Weinstein

The informal networking ways of getting things done described above can only work on an international scale if the Haitian people are included and are allowed to be masters of their destiny.

International businessmen are urged to take advantage of the new manufacturing climate in Haiti. Foreign aid earmarked for security will also revitalize Haitian security forces which historically have been the island’s death squads, attacking labour and community organizers who might reduce profits from the sweatshops.

The aid response is not so confusing after all. The Montreal Meeting of international donors, the Davos Forum, the Clinton-Bush Haiti Fund, US AID, the UN and the various security forces in Haiti all seem to be navigating the humanitarian response ship to further their interests in Haiti. Most NGOs and religious missions have found a niche to plug into.

Humanitarian aid is perceived as just and moral. But until Haitians like Elisa, Mr Abelard, Mrs Wintour and Rea are permitted at their own table and given the chance to build a sustainable infrastructure, so-called aid becomes another weapon to exploit these good people who liberated themselves from slavery, and are still paying the price.

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