Heartbreak is personal for Long Island doctors, nurses in Haiti

At 9:40 a.m., a group of young men carried in a woman who looked to be in her 50s and set her down on a canvas cot. She had only one lung and was having trouble breathing.

She clutched at her throat and chest and pulled at her beige top. Marie Boyer, a New York State Health Department nurse, leaned over, touched her on the shoulder and spoke quietly in Creole. They were inside a makeshift emergency room tent at the city's General Hospital. It was a Friday, 17 days after the Jan. 12 earthquake that rocked the city.

Gerald Augustin, a physician assistant at Nassau University Medical Center, wanted to intubate the woman - insert a tube attached to a respirator down her throat to help her breathe.

"We're not going to intubate anybody, so forget it," yelled a doctor. Augustin looked startled. He knew this was the kind of patient who would be in an intensive care unit back home. It didn't matter anyway: They could not intubate her because they had no respirator - standard equipment for them back home. They couldn't practice basic modern medicine.

Now the woman was trying to lie down on the cot. But Dr. Anthony Boutin, head of the emergency department at NUMC, told her in Creole to sit up. It would help her breathe.

They grabbed the only oxygen tank in the tent, but it was empty, and they didn't know where to find another. Boutin decided to go look, and he sprinted out of the tent. He reappeared minutes later cradling a new tank, and as he and another doctor struggled to connect it, the woman fell back, limp.

A nurse began slapping the woman's face and shouted at her. Boyer pumped on her chest. With no oxygen flow available, Boutin inserted a respiration bag and squeezed air into her lung. There was nothing else he could do. But at 10:01 a.m., he announced: "She's clinically dead." He said it was probably a heart attack, but no one would ever know for sure.

Her son, who appeared to be in his 20s, then entered. He fell on his mother's body. "Maman, maman, maman," he wailed. He pulled at her as though he was trying to physically wrench her back to life. "Oh, finis, finis, finis."

A crowd gathered at the door and windows. Someone yanked down the tent flaps.

They covered her with a blue paper sheet. One arm and leg dangling, she was carried by stretcher at 10:36 a.m. to the hospital's morgue.

There, men were smoking, perhaps to cut the stench of corpses. The tile floor was sticky. A manager opened a dark green canvas ledger. He said the woman's name was Cetalize Dorce. No, he said, he did not know her age. Nor her address.

Living in two worlds
Boutin, Augustin and Boyer were among 13 medical workers, most of them Haitian-American and living on Long Island, who began planning a mission to Haiti within hours of the earthquake that shattered Port-au-Prince, the teeming, troubled Haitian capital where some had grown up, or were trained, and which now had been devastated almost beyond imagination.

Many of them had left Haiti decades ago to make their way as American professionals. They were worn down by the sheer dysfunction of Haiti, the poorest nation in the Western Hemisphere. On Long Island, they had become surgeons, specialized nurses, department heads. They retained strong family ties and deep affection for their homeland. Their voices accented by the melodies of their native Creole, they lived in two worlds.

FLASH: Click here for our multimedia project, Loss and Hope amid the chaos in Haiti

PHOTOS: Hope and heartache for LI doctors and patients in Haiti

VIDEOS: LI doctors work to save lives and limbs in Haiti (some material is graphic)

For many, it would not be their last trip to Haiti. They felt an obligation, somehow, to help rebuild a medical system from the ground up. Was that even possible?

The group, most of them members of the New York chapter of the Association of Haitian Physicians Abroad, arrived as the first phase of the emergency wound down. They would see people who had what were called "crush injuries" from the quake, but also those with untreated chronic diseases and those left with life-changing disabilities - the amputees, the paralyzed and the traumatized. Five tents were needed to treat scores of children, many of whom had lost a mother or father.

Over one exhausting week, nurses would wash festering wounds that had not been cleaned since the injured had emerged from the wreckage. With no power, surgeons donned campers' headlamps to clean up amputations performed by the thousands in the first days after the quake. A doctor spent hours asking various aid agencies if they had any spare lightbulbs for the General Hospital.

The group had landed at 2 a.m. that Monday, Jan. 25, in Santo Domingo, capital of the Dominican Republic. Mounting a chartered bus for Port-au-Prince, they began a 156-mile passage to chaos. It would take 12 hours.

Through the Dominican Republic, the paved highway was two lanes, twisting and full of potholes. But when the bus crossed into Haiti near the town of Malpasse around 8:30 a.m., the road devolved into rock and dirt.

So much was familiar to them: Clogging the way were tap taps, the colorfully decorated Haitian taxis fashioned from pickups or minibuses. Many bore their own words of wisdom painted on the side - "Trust in God" was a favorite - and each seemed to go its own direction.

Soon the bus pulled to a halt and sat for an hour and a half in a traffic snarl next to a gas station. Roadside salesmen filtered through the knotted traffic, hawking everything from sugar cane to aluminum pots. Dr. Lambros George Angus, chief of trauma surgery at NUMC, turned to his good friend Dr. Jean-Bernard Poulard, a surgeon at Queens Hospital who lives in Dix Hills.

"Bernie, tell me, how do you get gas at this station?" he asked. He shook his head. "When you don't have order and discipline, everyone gets hurt."

It was the way of things in Haiti, they all said. But as the bus inched its way into Port-au-Prince, frustration turned to anguish.

Dr. Micheline Dole, a pediatrician at NUMC, pointed to what had been a modern white building in the formerly upscale neighborhood of Turgeau. It was now a heap of concrete and snarled wires, indistinguishable from the rows of rubble across the city. "This is where I used to live," she said.

Her voice cracked and for a moment she was unable to go on.

As the bus continued to crawl along, she took a microphone. Here was the school she attended. Here was the church where she was married. Here was the business school her father had owned. All in ruins.

It was the same for others.

"Oh my my," said Poulard as the bus passed the church he once attended.

"Oh my my," he said. This time, his old school.

Three weeks before the earthquake, he had been in Haiti for a wedding. At one point, he said to no one in particular: "Do I know where I am?"

Confronting the chaos
At 8:45 a.m. on Tuesday, Angus was pacing outside the department of surgery building, chomping on a piece of gum. Looming behind him was the green-and-white painted hospital that had been built during the American occupation of Haiti from 1915 to 1934. Dozens of medical tents crowded the grounds.

Boutin had already diagnosed a man with acute appendicitis who needed an operation soon and had passed him on to Angus, who would do the surgery. They worked together much the same way at NUMC.

But it wasn't clear when such an operation would take place: The generator was not working, there was no electricity in the OR, and 15 cases were ahead of his. "It's chaos," Angus said. "This is a secondary disaster," he railed. He threw his arms up. "This is what happens when there's no infrastructure. They don't even have a backup generator. There's no plan. The disaster occurred before the natural disaster."

The day before, they had pushed their way through the ever-present crowd outside the hospital gate. Armed American soldiers from the 82nd Airborne stood guard.

For some, this was a place they knew well. Poulard's father had once been the hospital's administrator. He pointed to the second-floor office where his father used to work, its damaged roof now slumped in the center. Dole had been a medical student there and Angus had come as a guest lecturer. Dr. Gerard Guy Prosper, a pediatrician at Lincoln Medical and Mental Health Center in the Bronx, had been the chief of pediatrics at the hospital in the 1990s.

General Hospital had once been considered the pride of Haitian medicine, but it faded well before the earthquake. The doctors said the institution had been battered by paltry government support and a system that promoted people based on connections, not qualifications. Haitian doctors were paid little and thus had little incentive to improve their standards of care, they said.

Entering the grounds, Angus, Dole and the others were immediately confronted by the towering pile of concrete where the nursing school had once stood. Underneath were the bodies of more than 200 nurses.

All around, the grounds had the atmosphere of a bustling village. Young men approached visitors to offer translation services. Workers used wheelbarrows to transport people and wheelchairs to deliver supplies. One medical team or another - among the dozens that helped at the hospital - always seemed to be arriving or going home. Spanish volunteers handled clean water. The Canadians looked after "the forest," a shaded area where patients lay in the open surrounded by their families.

A Haitian administrator said there were 300 patients. But a glance around the grounds showed many more. One doctor said the ER alone had seen 250 people in one day. At any one time, Boutin estimated, about 1,000 patients were being treated in the tents.

The group went to the central administrative office but found no one in charge.

"You don't meet with anybody," a nurse from Florida told them. "You just come and start working."

They looked at each other.

"This is what I'm telling you," Angus said. "This is not the way it should be done."

But it was the way it was done.

Long days, and making do
Each morning, the group fanned out across the hospital grounds.

Dr. Lionel LeFevre, an internist in Huntington, worked out of the internal medicine department housed in a decrepit white stucco building. Paint peeled everywhere, and no room seemed to have more than one or two dim fluorescent lights. As if he were back home on Long Island, LeFevre set off on rounds each day. One morning, deep in the shadows, he attended a hepatitis patient who had fallen into a coma. There was a man with kidney problems caused by toxins released when he had a crush injury to his left leg.

Poulard, a surgeon by training, appointed himself de facto hospital administrator. He sought out Haitian doctors, who appeared to be staying away at the time when Poulard and others felt they were most needed. He wanted to find another generator for the OR. And fluorescent lightbulbs. It wasn't what he expected. "I thought I'd be doing mostly surgery," he said with a shrug.

Nick Cavallo, a physical therapist from Cedarhurst and one of two non-Haitians on the trip, scoured the compound for crutches and wheelchairs for amputees. So far, the quake had produced more than 2,000 amputees, according to Handicap International, a relief agency. For days, he believed he was the only physical therapist at the hospital. But his last day he learned there were three Haitian PTs. He was told that their supervisor had been killed and that they had been waiting for someone to tell them what to do.

Dr. Guy Beauzile, who works at Sagamore Children's Psychiatric Center in Dix Hills, was the only psychiatrist on the grounds. Moving from tent to tent, he counseled trauma victims and acted as a sort of social worker. One time, he secured passage for a woman to the USS Comfort, the Navy hospital ship, to see her only surviving child.

Sabrina Jasmin, an intensive-care nurse at NUMC, found herself alongside Dr. Emmanuel Hostin, an orthopedic surgeon at Lenox Hill Hospital in Manhattan who is half Haitian and half Spanish. She had little experience in the operating room. "I don't know the tools," she said. "I'll just do my best. We have no choice."

Dr. Julius Garvey, affiliated with Long Island Jewish Medical Center, worked nonstop alongside Boutin. Poulard and Angus had once been his residents, but there was no rank pulled in the tents. A thoracic and vascular surgeon, Garvey helped to diagnose the trickier cases, but he also waded into the most basic ER chores, including dressing minor wounds.

Dole and Prosper, meanwhile, made their way to the pediatric tents, where children lay in rusty metal cribs - painted white - or on mattresses on the ground. Dole cast a worried glance at the scene. A little girl was curled up on a pallet, her abdomen swollen from sickle-cell disease. A little boy with two broken arms and shoulders lay in a cast smeared with feces. Relatives washed underwear in small bowls beside the children. A pile of rubbish stood next to the drinking water tank. Flies buzzed everywhere.

The Haiti they remember
At the end of every day, the group took an hourlong bus ride on a narrow road lined with thousands of homeless people, bleached mounds of rubble and endless ranks of makeshift shelters.

The trip ended at a place called Cazeau - at the home of Lyssa and Lionel Beauduy, relatives of Poulard's who once lived on Long Island. The group slept in tents on the grounds.

Lyssa Beauduy served Haitian dishes that touched familiar chords for the doctors and nurses from Long Island. Fried plantains. Delicate meat-filled pastries. Cornmeal with black mushrooms. Each night, they dined al fresco under a mango tree.

The hosts were mirror images of many in the group.

Lionel received his master's degree in civil engineering from MIT, and Lyssa had worked as a registered nurse at Jamaica Hospital Medical Center in Queens. They knew all about the two worlds: They were in Commack before moving to Miami, where he ran a construction business. Their three children went to American universities.

But the lure of family and friends left behind was strong, and Lionel moved back to Haiti in 1996. Lyssa followed a few years later.

They were determined to stay, even if Lionel wasn't sure about Haiti's future: "I tell you I don't know, but I'm going to be part of it."

'It's a cultural issue.'

Angus was getting worked up. He, Boutin and Augustin were taking a break around 3:15 on Wednesday in the shade of a building outside the ER tent. The sun was still intense. They all had been working since the early morning.

"Where is the health minister? The government is absent in this partly because others are doing it," he said. "It's a cultural issue. There's a great deal of incompetence."

"The sad part is," he went on, "I don't see any hope."

Augustin agreed. "Reconstruction may never be done," he said. "Who's going to invest in this city?"

Port-au-Prince would remain a tent city for 10 to 15 years, he and Angus predicted.

As for health care, the surgeon said he believed any U.S. aid should be tied to concrete goals. And to make certain that the money isn't squandered, American hospital administrators should work side by side with the Haitians.

"There's nothing good here. There's absolutely nothing good here," Angus ranted. "If it does get built up, are you going to give it to the Haitians?"

"Nobody pays taxes," Augustin said. "It's a problem."

Boutin spoke up. "Think about this," he said. "Everyone can have jobs if you rebuild."

Poulard joined the group. He was more optimistic, if only marginally so. "It's going to take years and years," he said, sighing. "In my view, taking a vacation is not an option. When you have a week off, you come here."

Boyer emerged from the emergency room tent and approached the men. "I am beyond exhausted," she told them.

The men then returned to their jobs: Boutin and Augustin to the ER; Angus to the OR; and Poulard on his usual quest for lightbulbs.

He would never find them.

The lost girls
At 1:07 on Thursday afternoon, Prosper had come upon a group of about 30 women and children sitting patiently outside a pediatric outpatient tent where there was no doctor. He stepped inside and began calling them in.

An emaciated infant girl lay on a cot hooked up to an IV, her large brown eyes darting around the tent. Two women sat by her. One fanned her with a piece of cardboard. The women said they were relatives. Asked the girl's name, they wrote Kwashiorkov, all one word. The girl was a year old, they said, and her mother had died in the earthquake. She made no sound.

Next to her on a second cot sat another little girl, perhaps 3. She was alone and sitting perfectly still. She too was silent. Neither Prosper nor the other girl's relatives knew her name or whether she had any family.

Three and half hours later, the tent was empty except for the two girls. A new cardboard sign had been placed outside of the tent: "Pediatrique Malnutrition Hospitalisation."

Another relative - a man - had replaced the two women. Now he was fanning the infant.

The nameless toddler sat in the same spot, motionless and silent.

The next morning, the tent was empty. One doctor heard the emaciated infant had died during the night. Another said the baby was still alive.

No one remembered anything about the other girl.

FLASH: Click here for our multimedia project, Loss and Hope amid the chaos in Haiti

PHOTOS: Hope and heartache for LI doctors and patients in Haiti

VIDEOS: LI doctors work to save lives and limbs in Haiti (some material is graphic)

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