Picking Up The Pieces In Haiti

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Read the Refugees International field report, "Haiti: From The Ground Up."

It's been seven weeks since a massive earthquake flattened much of Port Au Prince, and many areas in Haiti.

Relief groups are helping to reconnect families, make sure aid is distributed evenly, and get Haitians accustomed to life after the quake.


Debbie Elliott, national desk correspondent, NPR

James Gordon, psychiatrist

Emilie Parry, field researcher for Refugees International


This is TALK OF THE NATION. Im Neal Conan in Washington.

Seven weeks ago today, the lives of the people of Port-au-Prince and other areas of Haiti changed forever when a massive earthquake flattened much of the city. The estimated death toll hovers around 200,000 with over a million people displaced.

As time passes, the sense of crisis ebbs. Donations are down. Attention inevitably turns to the emergency in Chile. But it will be a long time before anything close to normal returns to Port-au-Prince, and there are still enormous problems that need to be dealt with right now: food and water and medical care.

The rainy season comes in another few weeks, and many people are living in makeshift tents. There are still intermittent power outages, and efforts are underway to get schools up and running.

Later in the program, whatever happened to the flu pandemic. But first, picking up the pieces in Haiti. If you have family there, how are they doing? If you've been to Haiti since the earthquake, what did you see? 800-989-8255. Tell us your story, or send us an email, talk@npr.org. You can also join the conversation on our Web site. Go to npr.org. Click on TALK OF THE NATION.

NPR's Debbie Elliott now joins us on the line from Haiti. Debbie, appreciate your time.

DEBBIE ELLIOTT: Thanks for having me, Neal.

CONAN: And you've been there just over a week now. What's your impression, after that time, of where Haiti is today in terms of recovery?

ELLIOTT: Well, it's still in the very, very early stages. I mean, I think it's fair to say they're still figuring out how to get aid to all the people who need it. Thoughts of rebuilding are we're not even there yet. At this point, I think the government and the humanitarian groups that are working here are just trying to get a handle on the scope of the problem and how to go about clearing the rubble.

You know, you go up and down the streets of Port-au-Prince, and everywhere you look, there are just piles and piles of rubble. Occasionally, you will see a bulldozer trying to clear something away, but it's clear that it's a long way off before the thought of even starting to build something back will begin.

CONAN: Get people inevitably, if they're living in tents, they're going to try to build something better.

ELLIOTT: They are, but right now, it's not clear what that is. You know, people are either they're living in these makeshift camps that have popped up everywhere, absolutely every community has them, where just thousands of people are living in either tents that they've gotten from a humanitarian group, or they've fashioned a shelter much like I heard in the promotion for the show, where people have just put linens and plastic bags on tree limbs, trying to fashion some sort of a shelter.

But as the rains come, and we've had rain already, heavy rains a couple of nights ago, they've got to figure out where to put people, but there aren't any buildings. You know, there aren't large apartment buildings or somewhere where you could house a lot of people. So that's something that I think the government is struggling with.

And the government, of course, is hobbled. Fourteen of the 16 ministries here collapsed. So they're trying to dig out their rubble. They're trying to find their employees. They're trying to find important documents. So still very much in the early stages of recovery here.

CONAN: What about medical care? Obviously, the situation of a lot of people traumatized in the quake itself, but we talk with doctors who came back from Haiti and said, well, not just those people, a lot of people were turning up with chronic malnutrition and other problems.

ELLIOTT: Right. I think this is a country where people already had health issues, and now this just makes it worse. You know, an example of what's happening, you know, people are just now starting to come out of hospitals, for example. We ran into a woman yesterday who was struggling to walk with crutches in the mud. And our driver pulled over and offered her a ride.

She had just been released from the hospital for the first time since the earthquake. She had been buried in rubble for three hours where she worked, had been rescued. Her ankle was injured. She had some internal injuries and had been in the hospital this whole time.

Her home also collapsed. So she was trying to find a friend somewhere in Port-au-Prince where she could stay, and she had no idea of how she was going to continue to get follow-up care for her injuries.

So those are some of the issues here. People who have had to have limbs amputated because of their injuries in the earthquake, now need rehabilitation. Where is that going to happen? How is that going to happen? There are just many, many questions here, and the answers are not clear yet.

CONAN: And let me ask one of them, and again, they are many questions, as you say. Are schools up and running?

ELLIOTT: Well, we did a story earlier this week on MORNING EDITION, and you can go online and listen, if you'd like. There were hopes that schools would open March 1st, and that did not happen. The government had said they would like to see schools in session the end of March, but it's just not clear how that's possible.

Eighty percent of the schools the U.N. estimates that about 80 percent of the schools here were either severely damaged or are just completely gone.

Now, that said, in some of these tent encampments, humanitarian groups have put tents and are trying to have something like school. They're trying to get kids together in some form of organized activity to give them some semblance of routine for their day.

I know that UNICEF is passing out what they call school in a box, and it's a box that opens, and it has a blackboard, and it has some basic tools for adults in the community or a teacher who has lost their school to start to try to do something.

We've met some private educators here who are still trying to get their students together and do what they can. But again, it's not in any organized effort.

The situation we found in the town of Delman, which is just outside of the capital, the government there wanted to reopen schools and was starting to take inventory of where teachers were, if schools were damaged, what they had, and they were thinking they were going to consolidate classes on campuses that are available to take them.

Well, one campus is a large, private school that was not that severely damaged, and they've got a lot of space, but right now, tens of thousands of people are camped there, and they've been told to move, but they don't know where to move.

So there are all kinds of problems as they think about trying to do something as basic as providing classes for kids.

CONAN: And Debbie, I just wanted to give our listeners an opportunity to get some idea of the scale of this, and ways to compare it, you listeners will remember, you've covered a lot of natural disasters, including hurricanes, which hit your home state, Alabama. Is there any way to compare what's happened with that and what's happened in Haiti?

ELLIOTT: It's so hard to get a handle on the scope here. I think that was what struck me the first couple of days here. It's just so huge, the number of people, the number of buildings, and it's hard to imagine.

You know, some similarities. You know, the poorest and the most vulnerable, of course, the young children who are separated from families, those are the big issues, and those are some of the same issues that we saw after Hurricane Katrina. But of course not on this scale.

And you know, New Orleans is not back to, quote-unquote, normal yet. My little hometown, a very small community hit by a hurricane six years ago, and there are still some buildings, maybe, that need to be torn down that shouldn't be there or some parts of the economy that have not even recovered yet.

And to think about how long that takes for a country that has the kind of resources that the United States does and then to look at what you see here and the scope of the damage here and try to figure out, you know, it's going to be decades.

I mean, they have it's going to take I mean, I don't know how long it'll take just to clear the rubble here to start to begin to start to put pieces back together.

You know, engineers were just being trained this week to go in and look at the damaged structures, to decide whether or not they can be livable. Well, after Hurricane Katrina, that process took a long time for the governments to go in and look at cities and see where you can what can stay, what has to do and how do you rebuild.

And some of the you know, we've seen the Lower Ninth Ward in New Orleans. It's not rebuilt. It's mostly empty. You know, it's starting to rebuild, yes; houses back, yes; but that's five years down. Now put, you know, take those eyes and put them here, and it's really hard to imagine how that process, how long that process is going to take.

CONAN: Debbie Elliott, thanks very much for your time. We know you're busy. We'll let you get back to work.

ELLIOTT: Thanks, Neal.

CONAN: NPR's Debbie Elliott, with us on the line from Port-au-Prince in Haiti. We'd like to hear from you. If you've been to Haiti and returned, what did you see? If you've got family there, how are they doing? 800-989-8255. Email us, talk@npr.org.

Let's turn now to Dr. James Gordon, who's with us here in Studio 3A, founder and director of the Center for Mind, Body, Medicine; author of "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression." And it's good to have you here.

Dr. JAMES GORDON (Founder, Director, Center for Mind, Body, Medicine; Author of "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression"): Good to be here, Neal.

CONAN: And one of the questions I did not ask Debbie, but we're asking you, because you were there just back a week ago from Haiti, the enormous volume of mental difficulties that are going to be presented there.

Dr. GORDON: The first thing that I felt, aside from the scope that Debbie described of the destruction - of the physical destruction, is the weight of sadness in Haiti, and I could feel that coming across the border from the Dominican Republic. And that's with everyone in Haiti all the time, and it's almost as if you can feel it from their bodies and hear it in their words and see it in their eyes.

So this is the overwhelming feeling that the population has, and I think Debbie said it quite well. I've seen been in wars and post-war situations with our work for the Center for Mind, Body, Medicine and post-Katrina, some terrible situations, but there is something about this one, about both the scope of the destruction, the physical destruction but also about the weight of sadness and the loss.

If you figure that at least 200,000 people have died, and there are probably around nine million people in Haiti, and you understand what that means in terms of how many people are affected directly and through their extended family...

CONAN: Everybody has to know somebody.

Dr. GORDON: Everybody. Everybody is affected. Everybody's affected.

CONAN: And how does that at some point, obviously, the immediate situation has it's seven weeks. You have to pick up. You have to move on. Yet it's incredibly difficult to do that.

Dr. GORDON: Well, what you see is, along with the weight of sadness and the confusion and the chaos and the huge challenge of putting society back together and perhaps putting it back together in an even better way, along with that, people are very resilient. People are very sweet and remarkably open in spite of this. And yet underneath, as they're trying to move forward, as they're connecting with the people they need to connect with now, there's also this sadness which often goes unspoken. So...

CONAN: The elephant not just in the room but the elephant in the country. Dr. Gordon, stay with us, and we'd like to hear from you. If you've come back from Haiti, what did you see? Also, if you've got family there, how are they doing? Give us a call, 800-989-8255. Email us, talk@npr.org. We're also going to be looking at the next steps for the relief effort there. Refugees International released a new report on that today. Stay with us. This is TALK OF THE NATION, NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. We focused yesterday on the massive earthquake that shook Chile over the weekend. Rescue operations continue there. Secretary of State Hillary Clinton visited today to offer U.S. assistance. Nearly 4,000 miles away, residents in Port-au-Prince and other areas of Haiti are focused on rebuilding their lives and their country seven weeks after the earthquake there.

If you have family in Haiti, how are they doing? If you've been there since the earthquake, what did you see? 800-989-8255. Email talk@npr.org. You can also join the conversation on our Web site. Thats at npr.org. Click on TALK OF THE NATION.

Our guest is Dr. James Gordon, a psychiatrist and founder and director of the Center for Mind, Body, Medicine, just back from Haiti a week ago, and let's see if we can get a caller on the line. This is Iman(ph), Iman with us from Toledo.

IMAN (Caller): Yes, hi. Thanks for taking my call. I've been twice to Haiti, and I just came back Sunday afternoon, my second trip. And I cannot agree any more with your guests. Things are still the same, Rubble's, you know, still all over. Cleaning or rebuilding, nothing happening. You barely see anybody building anything. Lots of camps, and what's really bothered me is the new law that the Haitian government put on the 25th of February, that you cannot bring any aid to the country unless if you have a type of formal letter from the government both in French and English to explain exactly what you have and where you're going to do the distribution.

Now, the problem is there's no government to and you don't know where to get this type of documentation, and it...

CONAN: Oh, I can understand. Another bureaucratic hurdle at this moment, you can understand their effort to see if they're making sure that they're coordinating things. You can see both sides of that. Iman, what were you doing there?

IMAN: I work with Life USA. It's a relief agency based in Southfield, Michigan, and we do provide temporary shelters like tents and tarps to build something that they could live in and food, besides the water. Last trip we took, with the help of Cleveland Clinic in Ohio, we got some wheelchairs and some cushions and some medicine through the Dominican Republic.

But we had to stop on the border, and again, when they ask for the government documentation, and I was not aware of such thing, and they said this is a new thing they started. I mean, the thing is, I understand they have they're trying to put stuff together, but if you go and find the demand for the help, it's huge, I mean humongous.

CONAN: It seems bottomless, yes.

IMAN: People still and we experienced an aftershock on Monday and Wednesday, and then we're back, which makes our job worse because of people panicking again. The first one struck about 1:30 a.m., and you could see the people I used to live next to a camp, and it had, like, a couple thousand people in that camp, and all of them screaming at the same time, and there are little kids.

You know, the second one struck on Wednesday about 4:30 also a.m., and that makes, again the job is harder. But what's nice about the people, as your guest mentioned, very humble people, very down to earth, and what's amazing, the prayers that they do together.

You know, it's nice, but again, they need a lot of help and a lot of help.

CONAN: All right. Iman, thanks very much for the phone call. We appreciate it. Dr. Gordon, he was talking about the you were talking about the resilience of the people, as was Iman, and nevertheless, the level of grief there, their concern for those they've lost must be enormous.

Dr. GORDON: Well, both of them are in a kind of delicate balance between resiliency and the commitment to moving forward and the love of life and, on the other hand, the sense of profound grief.

So often, when I would talk to people, whether in a hospital or workers in an orphanage or in an education center or in the little tent cities that have grown up, people would be focusing on what's happening now and telling me about problems they have and hopes they have and difficulties they have. And only 20 minutes or a half hour into a conversation, when I would say something like and how is the rest of your family might I hear something like, well, my husband and my son died, and my aunts and my uncles died.

So there's this incredible sort of tension between the sadness that's always there and the need to move ahead, to survive, to live in the present.

CONAN: Joining us now from member station WGVU in Grand Rapids, Michigan, is Emilie Parry, a field researcher for Refugees International. They released a report today that outlined the next steps for the Haitian relief effort, and very nice of you to be with us today.

Ms. EMILIE PARRY (Field Researcher, Refugees International): Thank you very much. Good afternoon.

CONAN: And as you I know you were down there to evaluate what's necessary. Are we out of the emergency phase?

Ms. PARRY: Unfortunately, we're not, and frankly, there were a lot of things that one would have hoped to have happened in the first few weeks following the earthquake, in terms of getting out immediate non-food items: tents, food, water, basic relief supplies. And what we're looking at is at least 70 percent of the people have been displaced, and we're looking at 1.2 million people have been displaced have not received any aid, have not received any support or assistance. And as has been mentioned, you have hundreds of thousands of people who are out in open spaces with their entire families without anything to cover their heads.

Some of them scraped together sheets and fabric and hang them on sticks, but they're out in the rain, and the rainy season is beginning. So we are looking two months down the road, and some of the immediate humanitarian response elements have not been completely engaged, and we're not able to go into the next steps that really need to be happening in terms of transitioning.

CONAN: And part of the I just had a glance at your report - but part of your analysis is essentially and it's not just Haiti every international crisis like this, it seems like we have to reinvent the entire wheel.

Ms. PARRY: Well, I wouldn't say that we have to completely reinvent the entire wheel. We do have great mechanisms within the United Nations and the international non-governmental community that has learned a lot from humanitarian response and recovery, and I do believe a lot was learned with the tsunamis of 20034, 2005.

But what I'm saying is, and what our report is saying is, that in every emergency, it is absolutely essential that the international agents from the United Nations, the military and the nongovernmental organizations, that they have a link in to the local community mechanisms.

They need to link in to the networks and leadership and knowledge within a country, and within Haiti, there is an extremely civil society and strong Haitian leadership that has developed over years and years of extreme poverty, instability and natural disasters such as hurricanes and floods.

We did not see that those linkages had appropriately been made, or effectively been made, with the community-based organizations that are networked under umbrella agencies, and the nongovernmental organizations that have been working throughout the country are very established and know the dynamics within Haiti, within the populations. So what we're...

CONAN: Does that suggest that without contacting these local networks you're talking about, a lot of this effort is either duplicated in some places or wasted and not going to other places?

Ms. PARRY: Absolutely. We are seeing gaps, huge gaps, some overlap in the attempt to coordinate, and let's also look honestly that there was a massive upsurge of nongovernmental organizations, nonprofit agencies, other groups that came into Haiti, and they need to be organized, and they need to be coordinated in order to avoid gaps and overlaps and make sure that the aid is getting where it needs, that there is no unnecessary violence of power dynamics that are created by the way the aid is distributed and that everybody gets what they need.

Just one example, I was speaking with Mario Serrano(ph) of the Jesuit Refugee Services, and he was talking about a day after the quake, they had organized food, water, basic hygiene supplies, tents, that sort of thing, and had a plan of where they were going to go, but their neighbors came and knocked on the door and said: We need this. We need this right now.

And the neighbors had their own community-based organizations because everywhere you go, you will run into a community-based organization, and what they did was they actually the trucks were provided by Jesuit Refugee Services, but they coordinated the entire distribution, including registration, tracking of recipients. They themselves paid for the gasoline. They came and got the trucks, picked up the supplies and distributed in a very quick, effective, peaceful manner.

If international agencies had been able to link in more quickly to these broad networks of community-based organization and nongovernmental agencies, that kind of thing could have taken place across Port-au-Prince and the provinces where we see displaced people and to the West in Leogane and Jacmel and other places that were impacted by the quake. That didn't happen, and there is different reasons that it didn't happen.

CONAN: Emilie Parry of Refugees International. Quickly, I wanted to turn back to Dr. Gordon. You're a psychiatrist. Are there networks, the local people you work with and contacts that your work can be ongoing a week after you've returned?

Dr. GORDON: Our work is really to establish a basic system of mental health for all of Haiti, to develop a concord with the Haitian medical association, with the ministry of health, with the local hospitals. And we've had meetings with them while we were down there because we're going to be developing a program to train up to 1,500 health and mental health professionals, educators and other community leaders and clergy in the techniques and the methods of self-awareness, self-care and how to set up groups from mutual support. It's got to be - everybody's got - focus from now on has to be on developing programs that are sustainable, and that's our focus.

CONAN: Well, let's get our caller in. Brian(ph) is calling from San Mateo, California.

BRIAN (Caller): Hi. I just got back from a week in Haiti in (unintelligible). There was a fair amount of musculoskeltal injuries I attended to, as you might imagine, although a great majority of them were chronic conditions. There was longstanding (unintelligible) pre-existed the event.

And I think what the folks need is some reassurance that they haven't been forgotten. I think it's evidenced from most everybody that the government isn't there for them, that whatever aid they felt there is maybe getting to them but very slowly. There are ways of reaching out to the population, simply by touching them, by looking them in the eye, by giving them some sense of - that you're connecting with their suffering, and by giving them some reassurance that, yeah, it's difficult right now but they're going to make it. You know, they maybe have some sort of hope that there's something on the other side.

CONAN: Dr. Gordon?

Dr. GORDON: I think that's absolutely true. There's tremendous uncertainty about the future. The past is characterized by loss, the present by disorientation, and the future by uncertainty. And people need to know - and as you said, there needs to be evidence that people can feel that their concerns are going to be the concerns of others, not just now, not just for the next few weeks, but over the years ahead. And that's why it's crucial to create systems that are sustainable and to be there for people on an ongoing basis and to give them the skills that they need to do this work of rebuilding personally and nationwide.

CONAN: Emilie Parry, are there systems being created that will sustain these operations through the months and years ahead?

Ms. PARRY: Well, I really believe that a lot of the systems already exist. For many Haitians the greatest strength that they have, the greatest asset they have is their community and their community network's relationships and the history of what people have gone through together. So I believe what it really is, is about linking into those systems and while they have been shaken, absolutely they have been shaken.

In Haiti, there's a saying, (speaks foreign language), which means after the mountains more mountains. People are prepared to get up and keep going. And what we, as an international community, need to do is to support those systems, to plug in to the civil society and support and help them build back their capacity and build their capacity back stronger. And this does not just count for Port-au-Prince and Leogane and Jacmel, it's the entire country, the entire provinces, the infrastructure, the resources. If we invest in that now, it allows Haiti a fighting chance to build itself back. They have the capacity within communities.

But we're not - right now we're operating almost as two parallel systems of the international agencies and the local civil society. We need to make that connection.

CONAN: Emilie Parry of Refugees International. Also with us, Dr. James Gordon.

You're listening to TALK OF THE NATION from NPR News.

Let's go next to Brooke(ph). Brooke's with us from Traverse City in Michigan.

BROOKE (Caller): Yes, I'm here.

CONAN: Go ahead, please.

BROOKE: Yes. I was in Haiti for the third or fourth week after the earthquake. I'm a nurse and I went in with a medical team with a small mission group, Missions of Love. They have a clinic about 140 miles north of Port-au-Prince, but we took our team right into Port-au-Prince.

And I have to say that I agree with your last speaker about the refugees. We were fortunate enough to be in a neighborhood - excuse me - that has - two doors down from where we stayed was the wife of the former prime minister. And she was a community organizer and they had a committee of people that we were able to work with. And they had not received any of the aid that had come in. There were a lot of hungry people living in tents, and we were able to set up some street clinics for them. We were able to arrange to get food, rice and beans coming in. And they were distributed in a very orderly fashion through the community committee. And it was a wonderful experience to see them working together. But I have to agree that, you know, we have to make that connection with the communities.

CONAN: All right. Brooke, thanks very much.

Let's see if we can get one more caller in, and this is Tim(ph). Tim with us from Albany, Georgia. Excuse me, Albany, California.

(Soundbite of laughter)

CONAN: There's lots of Albanys. Go ahead.

TIM (Caller): It's Albany, New York.

CONAN: Yeah.

TIM: Thanks, Neal. I'm an ER nurse. My wife and I went to Haiti about two weeks after the earthquake, stayed for two weeks with a small NGO out of New York City called NYC Medics, worked in a university hospital, also did mobile outreach clinics. We did work with local Haitian providers. I think it's really easy to miss that link and try to work with them. And they're going to need us to help train them. The nursing school collapsed and those nursing students died. I also was really impressed with the Haitian people. They're working hard. They're taking advantage of any opportunity they have to improve themselves.

CONAN: So you - it sounds like you saw a positive change. Tim?

TIM: Yes.

CONAN: It sounds like you saw a positive change.

TIM: I did. You know, two weeks is a very short period of time. But I was so impressed with the people, the teams coming in from around the world and with the Haitian people, and theyre the toughest people I have ever had the privilege to take care of.

CONAN: All right. Tim, thanks very much for the phone call. Appreciate it. We're going to continue to follow the issues in Haiti. Sadly, we have to follow these issues in Chile as well.

But we'd like to thank our guests for their time today. Emilie Parry, a field researcher for Refugees International. And she joined us from WGBU, our member station in Grand Rapids, Michigan. Nice to have you with us today.

Ms. PARRY: Thank you so much.

CONAN: And Dr. James Gordon was here with us in Studio 3A in Washington. He's a psychiatrist, founder and director of the Center for Mind-Body Medicine and author of "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression." Dr. Gordon, nice to see you again.

Dr. GORDON: Thank you. Good to be here.

CONAN: And when we come back, we're going to be talking about the flu season. We're right in the middle of flu season, right at the peak of flu season, but, well, far fewer are sick than usual. What happened to the pandemic? Nurses, doctors, teacher, what kind of flu season have you experienced?

800-989-8255. Email: talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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