This time, just after I passed through an opening in the chain-link fence of the parking lot, a PIH driver emerged from the crowd and waved me over. As we squeezed between bumpers of tightly packed rows of cars, he asked me how I was and how my family was, and I did the same. We got into the white PIH van, and he cranked up the air-conditioning and the kompa, a Haitian musical genre aptly described by one journalist as the “thumping love child of merengue, funk, and R&B.” As we maneuvered out of the parking lot, I noticed I was nodding my head in time with the groovy beat and funky synthesizer riffs. I smiled. It was good to be back in Haiti. I counted that it was my fourth trip, and I felt like I was starting to get the hang of things.
The driver weaved jerkily through narrow city streets pockmarked with potholes. He shifted gears frequently, honking at every near miss with a person, car, motorcycle, stray dog, goat, or one of the ubiquitous taptaps. Brightly painted in a combination of red, yellow, blue, and orange, these pickup-truck taxis ply the roads all over Haiti, picking up and dropping off passengers who squeeze into the back by the dozens. Taptaps have names painted across the tops of their windshields, some in French, some in Creole, some in English. Most names are religious. There are those that address God (L’homme propose, Dieu dispose [Man proposes, God provides]; Dye seul protej [Only God protects]; Dieu sait tout [God knows all]; Dye w fidel [God you are faithful]; Bondye beni w [God bless you]; Je crois en Dieu [I believe in God]; Grace de Dieu [Grace of God]; God is good; In God we trust) and those that address Jesus (Merci, Jesus [Thank you, Jesus]; Gloire à Jesus [Glory to Jesus]; Jezi prezan [Jesus is present]; Christ revient [Christ returns]; Christ capable [Christ is capable]) and those that make biblical references (Sélon Jean [According to John]; Mt. Carmel; Ebenezer; Grace divine [Divine Grace]) and those that simply cite a biblical chapter and verse, the most popular being Psalm 23:1 (The Lord is my shepherd, I lack nothing), Psalm 34:8 (Taste and see that the Lord is good; blessed is the one who takes refuge in him), and Exodus 14:14 (The Lord will fight for you; you need only to be still). Some express a state of mind (Nostalgie, La perseverance, Patience, La Deliverance), while others state a credo (Never die, One love, First class). Taptaps are painted with everything from religious images to the Batman symbol to the New York Yankees logo to the faces of basketball players from the NBA to suggestively dressed women with exaggerated proportions.
After bumpy stop-and-go maneuvering through the crowded streets of Port-au-Prince, the driver floored it on a brief straight stretch of highway that led toward the mountains. But once we reached the mountains, he slowed to navigate the steep and winding ascent, passing frighteningly close to perilous drop-offs while dump trucks overloaded with huge rocks traveled down in the opposite direction looking like they were about to topple over, and motorcycles carrying whole families of unhelmeted passengers coasted down past them with their engines off to save gas.
After forty-five vertiginous minutes on the mountain roads, we crossed a small bridge over a muddy river where women were washing clothes, kids were splashing around, and trash of all kinds lined the banks. The car bumped along on a chalky white dirt road past tin-roofed shacks and small wooden market stalls, the streets bustling with people and motorcycles. Suddenly a gleaming, single-story white building adorned with shield-size medallions of intricate local iron-worker art came into view: Hôpital Universitaire de Mirebalais—HUM—the largest solar-powered hospital in a low-income country anywhere in the world.
HUM looks like it fell out of the sky. The sharp angles of the hospital’s white walls topped with rows of glistening solar panels contrast with the gently sloping green hills behind it. Stray dogs and chickens graze out front on the tree-lined cobblestone path to the entrance. Just across the street from the hospital, pigs rummage through a trash-filled gutter that lines a dirt road leading into a village of one-room shacks, some wooden, some concrete, most with no electricity or running water. The village is roamed by cows, donkeys, mules, and roosters outdoors, and by rats, geckos, mosquitos, and tarantulas indoors.
The longer I face the complexities and challenges of working in Haiti, the more of a marvel HUM seems. The earthquake that devastated Haiti occurred in 2010, and HUM, part of the reconstruction effort, opened in 2013. A hospital requires not only the structure itself but also, as Paul Farmer likes to say, “space, staff, stuff, and systems.” PIH and its Haitian sister organization, Zanmi Lasante—which means Partners In Health in Haitian Creole and goes by ZL for short—somehow managed to conceive of, plan, build, and staff a hospital of this magnitude in this place in less than three years. And they didn’t just open a fully staffed hospital; they launched postgraduate medical training programs in internal medicine, surgery, pediatrics, and obstetrics-gynecology—the first such programs outside a major city in Haiti.
How did PIH and ZL take this project from idea to realization so fast?
It seemed impossible: from buying the plot of land through a complex and often dysfunctional governmental bureaucracy to commissioning architectural plans to hiring staff, from security guards to surgeons, secretaries to seasoned hospital administrators. Paul Farmer often says that the only failures are failures of imagination. I have an image in my mind of PIH’s strategy as throwing a ball from one end of a football field and then running as quickly as possible to catch it at the other end. Somehow the strategy worked. HUM is a testament to the depth and breadth of PIH/ZL’s thirty-year commitment to and collaboration with the communities they serve, their experience building health systems in some of the world’s poorest communities, and the visionary imagination of their leadership.
We turned onto a smaller dirt road and then a smaller one. We stopped abruptly in front of a red metal gate with barbed wire along the top. The driver beeped twice. He beeped twice again. Slowly, the red gate started moving, pulled open by a security guard. The driver shifted into gear, and the van lurched through the gate. We had arrived at the HUM staff house, a two-floor concrete building with eight bedrooms, two bathrooms, a kitchen, and a dining room.
Opening the car door and stepping out from the comfortable air-conditioning, I was assaulted by the sweltering temperature and heavy humidity. One of the local women who works in the house came out to greet me, kissing me on each sweaty cheek. She asked how my wife was and whether we had children yet. I told her we didn’t. “Not yet!” she said and laughed. She led me upstairs to the room I would be staying in for two weeks. My back soaked with sweat under my backpack as we climbed the stairs to the second floor, where it felt 10 degrees warmer than the first floor. She opened the wooden door to a small room, and dense heat seemed to explode out of it. She flicked on the ceiling light, a plain fixture filled with dead bugs that had flown into the heat of its bulb and died. The room was just barely able to fit a wooden twin bed with a faded peach-colored sheet on it, a wooden desk with a metal folding chair, a small wooden armoire, and a white circulating fan, which she plugged in and turned on. I dropped off my backpack and headed back downstairs.
I ate some rice and beans left over from lunch and then took a refreshing cold shower under a trickling rusted showerhead. But as soon as I dried off, I could already feel droplets of sweat beginning to emerge from every pore. After returning to my room, I set up my mosquito net over the bed, crawled under it with a neurology journal, and pulled the small fan next to my flushed, overheated face. The circulating hot air felt more like a blow-dryer than a fan but provided some small relief. I tried to read but fell asleep with the lights on, exhausted from the day of travel and my abrupt transition from Boston’s winter to Haiti’s oppressive tropical heat.