By Peter Slevin
Washington Post Staff Writer
Tuesday, February 9, 2010; A08
PORT-AU-PRINCE, HAITI -- Nearly one month after a powerful earthquake brought this country to a halt, Haiti is tumbling headlong through a crisis that has not begun to abate, with evidence everywhere that current relief efforts are falling short.
Despite the good intentions of the United States and the world community, weary relief workers say the coming weeks will severely test the resolve of those foreign contributors and the resourcefulness of a Haitian government that remains all but invisible.
Pressure will grow on a fledgling food distribution network backed by U.S. soldiers that so far has largely managed to deliver only rice. From surgery to shelter to sanitation to schooling, the needs are vast and the international commitment unproven.
"The need is so overwhelming. You can't have an initial push, and then it stops. That just won't be enough," Lane Hartill, an Africa-based Catholic Relief Services staff member, said as he walked toward a sweltering encampment of 30,000 people who have spent every hour outdoors since the Jan. 12 earthquake. In the distance, the dun-colored shapes of the makeshift shelters might have been an impressionist painter's rendering of despair.
The sadness is sometimes suffocating, yet the agony of last month's earthquake is being overtaken by the urgency of now. Every day, tens of thousands of Haitians face a grueling quest to find food, any food. A nutritious diet is out of the question.No shelter, no jobs
Shelter is a slender part of the equation because, for those who lost their homes, there is so little shelter to seek. Hundreds of people join lines before the early dawn in hopes of scoring a sack of white rice, but there is nowhere to line up for a tent, a shelter kit or a home any sturdier than a blanket hanging from a clothesline.
Hardly anyone is being paid. For the vast majority, a daily job is out of the question. Every school in the capital is closed, an estimated 75 percent of them destroyed. Many businesses and government offices simply no longer exist. There is no postal service -- and if there were, much of the Port-au-Prince population would not be found at home.
The medical calamity has moved beyond the horrific early days of assembly line amputations. Overwhelmed doctors and nurses are now facing converging streams of need, from untended wounds and the illnesses born of poor sanitation to the ailments of a population that had inferior health care long before Jan. 12.
There are not enough crutches for amputees or people to teach them how to adjust to the physics of their new bodily dimensions. The demands for treatment of all kinds, including postoperative care and rehabilitation, are "massive," said Thomas Kirsch, a Johns Hopkins University physician and disaster expert working here with the International Medical Corps.
"We're seeing as many as 500 people a day in our dinky little health-care center," Kirsch said, after spending a 10-hour shift doing triage in the courtyard of the state university hospital. "We send paralyzed patients out with their families and say, 'Good luck.' "
The psychological pressure is also building. On the morning of the 24th day after the quake, Claude Douge's family felt it was losing its collective mind. The power was out, food was scarce, a mother was crying and two children were sick. Douge, a journalist with money to spend, had been searching fruitlessly for antibiotics for two days.
"I got everybody together and said, 'Look, life's not going to be like it was before. That's over. You have to learn to fight,' " explained Douge, whose own effort to face Haiti's new reality included deleting the names of 15 people from his mobile phone. They're all dead, killed in the earthquake.
At the same time, Port-au-Prince is far from the city of cadavers that it was in the first week after the 7.0-magnitude earthquake struck about 5 o'clock on an ordinary Tuesday afternoon. Every day sees more sidewalk commerce and open shops. Limited amounts of food are arriving from the countryside, and the United Nations has found a way to deliver rice after nearly three weeks of false starts.
The U.N. World Food Program expects shipping arrivals in Port-au-Prince to provide 16,500 metric tons of rice and 6,100 metric tons of cooking oil and enriched corn-soya flour by early next week. U.S. government staff have given 6,000 Haitians two-week contracts clearing streets in neighborhoods chosen by Haitian officials, and the U.N. Development Program has employed about 35,000 more.
"Sector by sector, we're trying to make sure we just continue to solve problems and do better every day," Rajiv Shah, the administrator of the U.S. Agency for International Development, told reporters last week. Shah said Haiti will be facing a medical emergency for "many weeks to come."
At times, U.S. officials have offered sunnier assessments considerably at odds with reality. A State Department spokesman, Gordon Duguid, said in Port-au-Prince on Day 14, "It's a week now that there's no problem for bread." The top USAID official in Haiti told reporters on Day 19 that "the Haitians are leading the process in all the areas that are necessary."'Surreal decisions'
Lorraine Mangones has a less charitable view from her vantage point as executive director of FOKAL, a cultural foundation sponsored by the Open Society Institute. The business community was "already on its knees" before the earthquake, she said, while the state was "already weak and kept getting weaker and weaker." The future, she said, will be "hell."
"It's not making big decisions," Mangones said of the government run by President René Préval and Prime Minister Jean-Max Bellerive. "It's not making small decisions. It's making occasional surreal decisions, like, 'Let's open the schools in Port-au-Prince right away.' "
She added, "Nobody's listening, of course."
Street-level governance has a randomness all its own. In the past two weeks, crews in yellow public works department T-shirts have begun to appear in the capital, pawing through rubble with large digging machines. One crew spent two days removing debris from Caelle Jean-Baptiste's collapsed pharmacy as she watched from across the street.
Asked why the government crew was tackling this particular mess, Jean-Baptiste explained that her brother knows someone at the public works department who dispatched the team and the equipment. She paid the crew for its time.
U.S. Army Col. Rick Kaiser, who oversees the military's infrastructure strategy, said the earthquake created enough rubble to fill New Orleans's Superdome five times. It will be years before the rubble is gone and sufficient housing is built. In the meantime, beyond food, temporary shelter is looming as the next large-scale relief issue.
"That is the issue we are focusing on right now and will need to focus on for the next three to five months," said Tim Callaghan, leader of the USAID Disaster Assistance Response Team. "This is critical, and we're working as hard as we can on it."
Over at the university hospital, where foreign doctors are living their own daily MASH experience, emergency room physician Gene Gincherman from Potomac has been coping with what he describes as "Civil War-era diagnostics." The electrical generator is not strong enough to power the X-ray machine consistently. There are not enough blood-pressure sleeves. There is no oxygen and often not enough medicine.
Gincherman fears that Haiti's national emergency could get worse as the crisis endures and the world's attention span ebbs. He said, "We're so afraid that once it gets unsexy, it will be forgotten."