It was mid-morning and a long way from quiet. One child was screaming out his frustration while another loudly insisted on her mother’s immediate attention. Cleaners were swapping jokes in Creole, mopping floors, and moving furniture in their never-ending effort to wipe out those nasty bacteria bugs that lurk about in nooks and crannies. Nurses were pushing clanking carts loaded with equipment, taking temperatures, changing bandages and coaxing liquid medicine down unwilling throats. Doctors were consulting, instructions were clarified, and questions were being answered.
There were phones ringing and pinging. Simba was roaring as a Disney favorite played on the TV in the far corner. And there were smiles. Always room for smiles. Even in the pediatric ward of the MSF burn unit in Cité Soleil, a commune of Port-au-Prince, Haiti.
And there in the midst of the noise and chaos that mid-morning, a mother and her son found the environment a perfect place to give way to their exhaustion. Sleeping soundly, both of them recovering from their visible and invisible wounds.
Each patient in the unit has many stories to tell. Their recent burn injuries are only the most visible of the stories. 50% of our patients are children under the age of 15. Over 70% of those are under the age of 5. “But why are so many people burned in Haiti?” friends ask. “Because of poverty,” I answer.
I know that at first this answer might not make sense. We all have our own understanding of what poverty looks like and for most of us, burns usually don’t factor into what we see. But poverty has many faces. And in those worlds where there is a lack of basic infrastructure, safety standards, and availability of cooking appliances, burns are a common part of poverty.
In a country of nearly 11 million people, approximately 60% of Haiti’s population live below the poverty line of $2.41 per day. 24% live below the extreme poverty line of $1.23 per day1. As if making your way on $2.41 per day isn’t extreme enough. These numbers translate to people living in less than desirable conditions, often with many people living together in the small quarters. With no money to buy cooking appliances or fuel to run them, families cook over open flames. Add to this an average birth rate of 3 children per mama and the median birth age of mamas at the young age of 22, it doesn’t take much to imagine the infinite number of ways domestic accidents can happen in a Haitian home. Nor does it take much of a leap to imagine the many other stories our patients might have to tell.
Before making my non-medical rounds, I steel myself for the visit to the wards. There is nothing pretty about burn injuries. And it is not easy to watch, even from a distance, the painful and slow recovery process the patient and their family have to go through. The fear for the future is evident in the eyes of the patients and their caregivers.
While carefully washing my hands before entering the wards, I emotionally prepare myself. I don’t want my eyes to be a reflection of the reality I will see. My eyes need to reflect only joy for the many small improvements the patients make day by day. My eyes must show encouragement and hope for the future.
It feels silly to walk along and ask, “Koman ou ye?” (which is about the only Creole I know) when I visit. They’re in a hospital. They’re not ok. But what else is there to say? Without a medical background, the only advice I can give is to “avoir beaucoup de patience, manger beaucoup, et dormir beaucoup,” because in the end, this is all a burn patient can do: have a lot of patience, eat a lot, and sleep a lot. The medical team will take care of the rest.
The doctors have their way of knowing when a patient is getting better. They have charts, medical case reviews, and test results. The only way I know a patient is improving is by the size of their smiles.
For this baby and mama, if they fall in the range of our hospital statistics, they will stay with us for about 16 days. The baby’s bandages will be changed every other day and there will be multiple visits to the operating room. A psychologist from our staff will spend time with the baby and mama to help with wounds we cannot see. Physiotherapists will exercise the baby’s limbs to prevent long-term damage and show the mama how she can continue the therapy. Throughout the day, she will feed, clean, and comfort the baby. She will also learn how to prevent future accidents and learn the importance of hygiene in the house. And during the night, mama will sleep on a plastic mattress on the floor next to her baby, ready to respond at the slightest call of her son for comfort.
Recovering from a burn injury is a full-time job for all involved. It’s no wonder I found these two sleeping so soundly in the midst of chaos that one mid-morning.