The Orphanage

Feb 6th, 2008

For several weeks now, Patrick has been volunteering on his days off at an orphanage. He stumbled into the volunteer opportunity through a connection made during a CONASPEH function, and decided it was yet another way he could learn about the culture. He has always been passionate about children and in every job he’s had, he advocates for their health, rights and well-being. Up until today I have been hesitant to go to the orphanage. The situation of the Haitian family here and the harsh realities that exist are hard enough to witness as we face them at work and on the streets. Every day we encounter parents who can’t afford to buy their sick children medicine, school children whose family can’t afford to feed them 3 squares a day, street children hanging on the windows of our car as we drive down the street, begging with hallow eyes and hungry stomachs, and bare-footed, big-bellied children with red hair and the flat affect of malnutrition walking through the poorest of neighborhoods. I wasn’t sure my heart could survive walking into a home with hundreds of hands reaching out, hundreds of eyes looking for attention.

But the heart is stronger than I give it credit for.

Trish and Caro have helped me with two clinic days at CONASPEH administering consultations to the students and professors there, a clinic day at Carrefour practicing true family medicine to patients of all ages with their assortment of wide-ranging complaints, and today Patrick had arranged a time for us to do some medical consultation for the kids at the orphanage. It was a way to show Trish and Caro a very real part of Haiti while allowing some good work to be done in the process.

I was glad to be going to the orphanage with good friends, good FEMALE friends who I could count on to react and feel the same way I would.

So we drove through the orphanage gates. We walked up the orphanage steps and were greeted by children almost immediately. Teenage children ran up to us, surrounded us on all sides, wedging in to be close, to hold our hands, our arms, to touch our skin. The toddlers waddled forward in their school room to see the new visitors, to flash us their smiles, to giggle and reach up to us in hopes of being held. A quick tour of the orphanage showed us rooms divided by age. One for infants, another for 1 year old toddlers, another for 2-4 year olds… school rooms, dorms for older kids. In a seemingly small place, one hundred and thirty children resided, went to school, were fed, got sick, got treatment, were loved by very hard working but over-extended staff. The orphanage manager tells us that they have to turn away 80 children a MONTH because they are just too full.

There is no walking into an orphanage and being introduced slowly to the realities within. Much like stepping off the plane into Haiti, the full force of the realities of the situation of the country hits you in a moment, all the beauty and heartbreak assault you on your very first ride out of the airport gates. The same could be said with walking into the orphanage. The children—like all children—were heartbreakingly beautiful. And like all children, they were hungry for love, for affection, for human touch. The close proximity to each other ensured that every cold and bout of diarrhea were shared, and therefore despite a staff constantly in motion feeding, changing, bathing, and cleaning children, there were always 10 more that needed noses wiped and diapers changed. I watched one staff member sitting on a stool. She had one baby lying in her lap, she was spoon feeding another in a chair next to her, and her foot worked to rock a third baby in a bouncer near by. Each of the staff was required to multitask as such. But they did so without an air of stress, of frustration, of fatigue. The smiled, they sang, they joked. They created an atmosphere of a huge busy family. The love the woman had for their work and for the children was clear, and the children seemed to give them patience in return.

My own reactions went from feeling overwhelmed with the assault on the senses, to feeling like I could dissolve into tears at the witnessed reality of so many children with so much need, to wanting to run away and remove myself from a situation I felt powerless in, to feeling numb. Caro turned to me, her eyes glassy with tears and said, “I have to turn off now, especially if there is any chance I can practice medicine here.” Of course I agreed. As physicians, we’ve had to learn to “turn-off" at times, to put a little emotional distance between ourselves, our brains and the very real human part of medicine. It isn’t an exercise of building walls and distance but rather an exercise in maintaining the ability to think, to work, to function without letting your very human response to life and death, suffering and sickness leave you immobilized. So we relied on that professional ability to focus on the task at hand today. It took a great exercise of will.

After holding babies, changing a few diapers, and holding many tiny hands, we commenced with clinic. The childen were brought in with snotty nose, coarse coughs, pink eyes, round tummies, and fevers. Often they would wrap their arms and legs around one of us, sinking into our arms, heads tucked in. We took the team-care approach; one would hold the child while the other listened to lungs and peeked in ears. The children allowed such invasion as long as they were cradled in our arms. We consulted on kids with a zillion kinds of rashes, questionable congenital abnormalities, sickle cell disease and HIV complications. Of course there was no shortage of common colds, ear infections and diarrhea.

We moved through the children with determination, feeling relieved to be able to do something, to offer advice, to give free care. The action helped numb the emotions that swelled within. After several hours and so many children, we left the feeling numb, shocked, and emotionally spent.

We rode in silence from the orphanage as Patrick steered the Galloper up the mountain. Our mission to show Caro and Trish more of the countryside outside of clinics had a dual function today. The route to Kenskoff through the lush mountainside offered moments of reflection, of quiet to allow the experience we’d just had settle, process, and sink in. And the mountain road wound us past mansions encircled by walls, buildings that seemed a mirage in the setting of the a country with such staggering poverty. Even a relaxing drive through the mountains in Haiti is full of food for thought. All of a sudden we are given more than simple poverty to digest, but were also forced to consider the reality of incredible wealth in the setting of such poverty. And our own relative wealth in such context is inescapable.

Tonight we ended the day with dinner at the Hotel Olofson, dinning on the grand porch of the hotel, eating Creole cuisine in the setting of old French architecture. The stark contrast of the old-but elegant hotel was not lost on us, given the fresh memories of a very different reality we had been immersed in at the orphanage. Such is Haiti.

This is the reality of the world we live in, and Haiti offers a clearly illustrated microcosm of the world's reality. Our world is a complex, interrelated mix of extreme wealth, staggering poverty and a little inbetween. To experience one without the other is to deny a part of the reality that contributes to the complexity of the situation world-wide. At what expense do we live our wealthy lives? Who is to blame for orphanages full of children, children who aren’t orphaned largely by the death of their parents, but orphaned because it is the only alternative to starving in the arms of their penniless mothers, dying of preventable disease while their job-less fathers helplessly watch. There are a lot of fingers to point in blame; Its easy to single out the corrupt Haitian government who is ill equipped to offer infrastructure to a starving country, or to the powerful international governments who continue to cripple efforts at a self-sustaining small-country economy. But let us not forget to look in the mirror and at our own involvment, regardless of intention, in the imbalance of the world. We are consumers, and we encourage a consuming society and the international economic domination that we inadvertently support.

The fact of the matter is that the world has rich and the world has poor. I personally believe we can achieve a middle ground. But it will take a lot of work, take a radical change in mentality, take a world-wide awakening. In the meantime, we continue to discover, to process, to chew on the experiences we have, the realities we face. We start with the courage to look outward, to see and hear the stories of life outside the walls of our comfortable houses and safe communities. We then choose how to process, how to be crippled or empowered, how to perpetrate or to heal, how to ignore or be changed. This is our challenge as humans on this journey of mission. Thanks for coming along with me.