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I went to Haiti in late January as a member of an Operation Rainbow (www.operationrainbow.org) surgical team which comprised both Kaiser Permanente (KP) and non-KP team members. As background, my own medical charity, Medical Exchange International (www.medicalexchangeintl.org), had partnered with Operation Rainbow in the past to provide anesthesia equipment for several surgical missions in the developing world. In Haiti, we had an opportunity not only to provide pulse oximeters and anesthesia supplies, but also to help out on the clinical front line. As an anesthesiologist with a background in medicine and critical care, I split my time about half and half between the operating rooms and the intensive care unit (ICU), both of which were intense and busy. Whereas I could write at length about what we did and how we coped with severely constrained resources, I want to focus this article on an important “epiphenomenon”: the catalytic action of the earthquake tragedy to create a new inflection point in the long history of Haiti-Dominican Republic relations.
Although we experienced the startling devastation in Port-au-Prince when we went into the city to deliver a pulse oximeter, our clinical work took place entirely at the Buen Samaritano (or Bon Samaritain in French) makeshift hospital in the town of Jimani, one mile east of the Haitian-Dominican border in the Dominican Republic. Before the earthquake, the facility was a yet-to-open complex comprising a chapel, an orphanage, and a dental clinic. After the earthquake, the chapel and the orphanage were rapidly converted to hospital wards, and the dental clinic became our acute care venue including a 4-room operating suite. We estimated we had about 250 patients on site, almost all of whom were injured Haitian refugees. We did between 20 and 50 surgical cases a day in 4 converted dental consultation rooms. The vast majority of our surgical cases were orthopedic and plastics procedures, as expected. In our makeshift ICU, I cared for 5 to 10 patients on any given day, and we also opened up a perinatal ward when we suddenly found ourselves doing C-sections (if you build it, they will come …).
The facility was staffed by volunteers from all over the world. We worked closely with our own superb Operation Rainbow orthopedic surgeons, including our mission lead Dave Atkin, MD, from San Francisco and pediatric specialist Chris Comstock, MD, from Corpus Christi, Texas, and with surgeons from around the US and around the globe. In the ICU, I worked closely with an excellent emergency/critical care team from Barcelona (and by closely I mean cross-covering to maintain 24/7 on-site care—the real thing). Nurses and pharmacists from all over the world worked together, and I remember being particularly touched when I saw a group of Israelis help an Arab team unload several tons of food that was brought in by the United Arab Emirates. All this is to say that there was a tremendous and truly inspiring internationalism—a deep humanism was in full bloom here.
This leads me to my main point: I witnessed first-hand an extraordinary stepping-up-to-the-plate by the Dominican government and the Dominican people. From the moment we arrived, we saw that the Dominicans had dedicated their major international airport in Santo Domingo to international relief efforts. Because Haiti's airports were marginally functional at best, this was crucial to the immediate relief efforts. The short aid corridor between the Dominican Republic border and Port-au-Prince was active 24/7 with an endless stream of trucks laden with food, water, tents, coal, firewood, blankets, medical supplies, and more from dozens of countries and with a very notable contribution from the Dominican Republic itself. For example, the Dominican Republic sent 15 mobile cafeterias serving 100,000 meals a day into Haiti. Santo Domingo Water Corporation sent dozens of tank trucks, each containing 2000 gallons of water. Estimates of total Dominican Republic aid for Haiti to date have exceeded $17 million, no small sum for a small island republic that is itself a developing nation. We witnessed the Dominican army conspicuously keeping the Dominican side of the relief corridor safe and functional until the United Nations (UN) Peacekeeping Force (which fortuitously had been in Haiti prior to the earthquake) took over on the Haitian side to assure the relief lifeline kept flowing. Thankfully, the Dominican authorities allowed thousands of Haitian refugees to cross the border eastward into the Dominican Republic to seek care in our emergency relief hospital and in other Dominican hospitals.
At Buen Samaritano, I noted that many of the drugs we used, and a hefty component of the supplies we used such as oxygen masks, epidural kits, and IV catheters, came from the Dominican Republic. The Dominican personnel presence was huge, literally hundreds of Dominicans representing the Dominican Public Health Department (known by its Spanish acronym of SESPAS), the Dominican Food Aid Program, the Dominican Republic's major emergency relief organization (known as URN for Unidad de Rescate Nacional), as well as Dominican representatives from countless humanitarian programs such as the Pan-American Health Organization (PAHO), US Agency for International Development, the UN World Food Program, and Ninos de las Naciones. The Dominican-based ARS Humano provided the trailers we used for our tuberculosis isolation ward and our spinal cord injury care unit. Dominican interpreters navigated the tricky Creole-French-Spanish language challenges for us. The Dominican government allowed US military transport choppers as well as those of several private US entities into their airspace to help us evacuate some of our most critically ill patients to the USNS Comfort hospital ship. The Dominican army was on-site day and night in Jimani, keeping us safe and keeping the peace amidst the influx of refugees. The Dominican charity Esperanza provided transportation and meals for our team. Last but certainly not least (from an anesthesiologist's standpoint), the Dominican Red Cross filled our rapidly depleting oxygen tanks every few days—life-giving assistance, literally and figuratively.
This Dominican largesse would be worthy of praise and worth relating in and of itself. But what makes it all the more heartening and extraordinary, in fact truly “game-changing” if one can apply that adjective to international relations, is that it opens a new era in the long history of tense and violent relations between these two neighboring nations. Columbus landed on the island of Hispaniola on his first voyage to the New World in 1492 and promptly claimed it for Spain. But it did not take long for the French to wrest half of the island from the Spanish, thus establishing two separate but equal colonies with political, cultural, and economic disparities that persist to this day. The Dominicans still resent a period of Haitian occupation from 1822 through 1844, though some Haitian scholars insist that the Haitians were “invited” in to ensure abolition of slavery in post-Spanish Dominica. Little known to most outsiders, the Dominicans ultimately had to win their independence not from Spain but from their Haitian overseers. The Dominicans repaid the favor in kind with a brutal retaliatory massacre of over 20,000 Haitians by the despotic Trujillo regime in 1937. To make matters worse, the persistent sharp contrast in prosperity, and some say an inherent racism in the Dominican Republic—have continued to fuel the fires of hatred, fear, and mistrust. The Dominican Republic ranks a respectable 90 out of 182 countries on the UN's Human Development Index, a composite measure of wealth, health, and educational indices. Haiti comes in at a miserable 149, just a hair above Sudan. The Dominican economy has long profited from cheap Haitian labor: more than 90% of the country's sugar workers are of Haitian origin. The average Dominican can expect to live into his or her 70s, whereas 61 is the average life expectancy for Haitians and this is now surely reduced as a result of the earthquake. All of this makes it understandable that Haiti rejected an offer of over 3000 Dominican troops which was tendered the week after the quake with the intent of assisting the UN battalion in securing the aid corridor in eastern Haiti. To many Haitians that offer was similar to the idea of having Russian “peacekeepers” come into the Ukraine.
But that long and mostly ugly relationship which has prevailed for centuries may now be coming to an end. The opening was there after January 12, 2010, and the Dominicans took it. Some say it is in their interest to prevent a “failed Haiti” (if that is not already the case) and that the Dominicans are just pragmatists working to stem the tide of refugees. No doubt there is, as always, an element of public relations at work here and in fact the Dominicans have received some good press for their efforts. But having seen it in action, on the front lines, the Dominican effort by my observation is more than pragmatic and more than PR. It is huge and robust, carefully thought out, and thoroughly genuine.
Time will tell if this represents a true turning point and ushers in a new era for these two countries that uneasily share an island in our own backyard. Haiti's tragedy is the costliest natural disaster in recorded history according to the Inter-American Development Bank. But as with any great tragedy, there is great opportunity inherent in the rebuilding phase, and the Dominicans seem to have grasped that. The Dominican effort and the healing of Haiti-Dominican Republic relations may turn out to be a very major ingredient in the formula for Haiti's long-term (and I use the word advisedly) reconstruction.
How wonderful it is that nobody need wait a single moment before starting to improve the world.
—Diary of a Young Girl, Anne Frank, 1929–1945, Jewish-German diarist and holocaust victim