Absent Care: Remembering Haiti

It all started with a homeless man crouched on a street corner. We were stopped at a light, my two younger daughters and I, on our way to pick up my eldest daughter from ballet. He was across the street, facing away from us, holding out his tattered cardboard sign. I felt immediate relief that he was not on our side of the street. I swallowed. We would see him on our way home.

“Green means go!”

I drove through the intersection. There was no time to feel guilty.

In April 2005, during my fourth year of medical school, I went to Haiti.

In the first month of my first year, one of my professors, Dr. Nguyen, nonchalantly mentioned during one of his lectures on the different types of white blood cells that he went to Haiti every spring for about a week with a group of volunteers. If any of us wanted to do that, we could come find him during the beginning of our fourth year to set up an elective rotation. If that seems vague, I think, on purpose, it was.

His trips were not sponsored by my medical school or by where he worked as a physician. They were not sponsored by any major nonprofit organization. His yearly trips were organized by an energetic woman named Pat whose white hair glowed about her face.

Animated and funny, Pat Labuda had started going to Haiti with support from parishioners of her local Catholic church. (My professor was Buddhist.) Her eyes sparkled every time she mentioned a person we would meet on our journey or whenever she offered a little story about a patient helped on previous trips. She insisted we read Haiti’s long history: that in 1804 it became the second country in the western hemisphere, after the United States, to fight for its independence from colonial power; that the people continue to strive for democracy amid political turmoil, corruption, revolution, and conflict; that the then-current United Nations Stabilization Mission in Haiti—she called it by its French acronym, the MINUSTAH (Mission des Nations Unies pour la stabilisation en Haïti)—was just another human rights–violating occupying force. She was passionate about giving us Haitian Creole language lessons. When she paused between her stories or to listen to others, she would nod and close into herself as if far away from this suburban life, as if she were already there.

“Why doesn’t everyone have a home?” my eldest daughter, Evelyn, asked from the back seat.

We were stopped behind several cars, waiting for the light to change. The man crouched at the corner, his chest on his knees, his sign extended in front of him.

I looked into the rearview mirror. Wispy hairs had come loose from Evelyn’s bun; her cheeks were flushed.

“That man.” She pointed. “Why doesn’t he have a home?”

I was going to say something about economics that I don’t quite understand, about affordable housing and minimum wage, about narcotic overdoses and the oblivion of heroin and fentanyl. About a million things that are not fair. Whatever fair means.

But then I saw that her cheeks were wet, not flushed. Her eyes glistened. As we had been idling at this red light, she had been crying.

I gripped the steering wheel. I wanted to tell her that everything was going to be all right, that this world she was quickly growing into was not cruel. But she would have known I was lying.

The man started walking toward the line of waiting cars. He held the edges of his sign with both hands: ANYTHING HELPS.

“I don’t know why he doesn’t have a home,” I said. “I’m sorry.”

On our plane out of Miami, I’m stuck in the middle seat. My feet tingle from shoes retied too tightly after going through security. I sit hunched between two strangers, going through my lists again—language phrases to memorize, names and addresses if I get separated from the group—and when I come to the list of medications we are bringing, I discover I only have every other page. I sift through my backpack again, but do not find the missing papers. Perhaps I was never meant to have the entire list.

I look out the window and see a black, dark island. Cuba, just northwest of Haiti. I touch the wadded bills in the crease of my right jeans pocket. Have easy access to $50 cash when you go through customs, I was told, just in case.

A white strip appears on the horizon. Then a darker edge. Then a whole mass of plywood, green tarps, pink and purple blankets crowd together, swelling, at the edge of the water. This is Cité Soleil, Port-au-Prince’s largest slum. Over a quarter million people live here and it pulses with the wonderful energy of life.

The plane lands, we taxi, then stop a few yards from the terminal. The door opens and a wall of humid air hits my lungs. I pick up my backpack and join the queue exiting the plane. We walk down a set of stairs directly onto the tarmac, congregate at the baggage claim, grab the med bags as soon as they are unloaded, then rush through the yelling, grabbing, jostling passage through customs, and back out into the sunshine. I blink and touch my right front pocket. I still have my five $10 bills.

A large truck with a brightly covered bed rumbles by, a Haitian tap-tap. Flinging dust in its wake, riders cram into the back, overflow out the doors, hang off bumpers. Another has its sideboards painted red, gold, and green. First Love, it says. In English. A third has rainbow tasseled windows. God Is Love.

“Krista.”

I blink.

“Over here,” Pat beckons. Our group boards two white midsize vans. I climb into the bench seat and Dr. Nguyen climbs in after me. The driver confers outside with Pat, then with the driver of the second van, then gets into his seat. He performs a silent headcount in his rearview and we are off.

We bump along the rutted and gutted streets, Dr. Nguyen making small talk with the driver. We pass magnificent stone and pillared buildings alongside crumbled wooden and cement houses. “From the last earthquake,” the driver says as we continue down the middle of the street.

We drive on winding roads, some topped with a sort of haphazard cobblestone, some composed of only mud and dirt. Hundreds of cramped plywood buildings are just arms-length from the van. We make a sharp turn, narrowly avoiding a lady with a large bundle perched on her head, and proceed up a steep road.

Cement walls line both sides of the road. The van engine whines. The driver hunches over the steering wheel, and I reflexively follow his lead, enticing the van to continue up the hill. As we near the top, the cement walls on either side disappear, and I relax back against my seat. The city is behind us with its houses and shacks and winding roads, every possible space occupied with something to assist the living, spilling all the way out to the edge of the sea. The brakes screech; a wrought-iron gate opens. We have arrived at our destination for the night.

I rummaged through my bag on the passenger’s seat. I had no cash. My usual stash of snacks—peanut butter crackers, goldfish in a reusable bag, grilled-cheese crackers, chocolate-yogurt covered raisins—had been depleted by Waverly and Lynden, my seven- and three-year-old daughters, as they’d waited for their big sister at ballet.

I stole a glance through the windshield: the light was still red; the man continued down the line of idling cars. My hand searched between the Family Issue of Zyzzyva, grocery receipts, Band-Aids, a pocket-size journal, outside edges worn to a smooth, black, smudge (I paused; this journal’s beginning pages were filled with scrawled notes about my trip to Haiti so long ago), and the dented bottom edge of my reusable water bottle. In the far corner, my fingers grasped the smooth, crinkly package.

“Green means go!”

The car in front of me released its brake. I pulled the package out of my bag. It was supposed to be in the shape of a log or rod, but it was broken in half, one end squished flat from my water bottle. But it was still sealed.

A car honked behind me.

I rolled down the passenger-side window and took my foot off the brake. We inched forward and I pushed my foot down. Leaning over, I stuck the chocolate-dipped, chocolate-chunk granola bar out the window.

His eyebrows raised; his lips parted.

Again, the car honked behind me.

He grabbed the granola bar.

“Thank you,” I heard him say as I drove through the intersection.

Hospice St. Joseph is a compact cement building located on top of a hill overlooking Port-au-Prince Bay. There is an open-air lanai on the second floor that has black metal lawn furniture, pink linoleum flooring, and two wooden desks. One desk has an extensive paperback collection that includes a well-thumbed copy of Patricia Henley’s Hummingbird House. The other has stacks of VHS videocassettes, including Somewhere in Time and Top Gun.

After eating a modest dinner, we walk up the narrow stairs to the lanai and sit together, looking out across the bay, breathing in the smells (smoke, wood, charcoal, spice) and listening to the evening sounds of the city (women yelling, dogs barking, wind chimes, generator hums). I write in my journal until I can no longer see and the mosquitoes become too persistent. I say goodnight to our hosts, the sisters who run the hospice, then walk down a dark hallway to my room. I barely sleep. I lie on my back in the dark listening to the clack of dominoes, filled with anticipation of things to come.

We eat a light breakfast, then drive back to the airport, buy tickets at the domestic terminal, and walk out onto the tarmac. The plane has one engine. Our group, plus two other passengers, fill every seat. The door closes and we drive down the bumpy runway. I reach underneath my seat but only feel empty space, then bare metal bars, then the underside of my cushion. I wonder if I should pray.

We fly over the bay, along the Canal de La Gonâve, and land in the small town of Jérémie. If you look up Jérémie on a map and draw a straight line north, you will hit New York City.

We stay in a Catholic boarding school on a hill overlooking the water. The next day we rise early, pack our things, and get into two old Toyota Land Cruisers. It had rained overnight. We drive into the mountains. All the roads are dirt and mud, a path gouged into the jungle comprising more holes than even ground. Ten hours later, we arrive at the rectory of the Catholic church in Léon, a remote village on the east bank of La Rivière Voldrogue, just as the sun is setting. This will be our home for the next week.

We eat dinner: fried plantains and goat. I feel bad for the goat, not because it is dead but because of what it cost to kill it. Goats represent much more than meat to be eaten. Alive, they give milk and more goats. Dead, they serve one last fleeting purpose, a meal to fill our American bellies with something close to what our hosts think would be our American diet: steak, the goat, and potatoes, fried plantains.

I look over at Dr. Nguyen’s plate. He picks up his knife and fork, cuts a piece of goat, and brings it to his mouth. He nods to the hostess at the far end of the table, then eats his piece of goat. Buddhists are not supposed to eat meat, but Dr. Nguyen understands this gesture of hospitality, the futility and finality of it. I pick up my own piece of goat, place it into my mouth, and am grateful for this offering, this gamy, stringy flavor. I resist the urge to ask for a second helping of plantains.

There are not enough beds for all of us. “Don’t worry,” Dr. Nguyen says to me quietly. “You are going to want to sleep out on the porch anyway. Less humid.” He asks the lady of the house if three of us can sleep out on the porch. She is very concerned about this arrangement. I am the only woman of the group and will be on the porch with two men, neither of whom are a husband or family member. I immediately say, “It’s OK, I can sleep anywhere,” knowing this statement does not assuage her Catholic faith–based concerns but hoping that it could appeal to the practical dilemma at hand. I look over at the EMT, who shrugs. The lady opens her mouth, but Dr. Nguyen interrupts: “We will just need three sets of mosquito netting.” He picks up his bag and we follow him out to the porch.

I sleep on my back in the far corner. Roosters crow, dogs bark, ladies walk by–they haggle and confide, cars drone and idle. Diesel fuel wafts in and out of the mosquito netting. The generator power is turned off at 9 p.m. and then comes back on at 2 and 7 in the morning. I can tell by when the overhead fan starts then stops again.

When the sun filters in through the trees that surround the porch, I get up and take a shower, but as instructed from our pre-trip medical recommendations, I do not get my face or eyes wet. Toweled dry, I am immediately damp with sweat again. The next time I come here, I tell myself as I dress, I must remember to bring an extra shirt: one to sleep in and one to wear during the day.

The humid air is an organism all around me.

We arrived home. Waverly jumped out, and ran down the driveway. “I’m going to be first!” Evelyn clambered out and slammed the door. She was a bundle of ballet bag and water bottle and arms and legs and hair, yelling, “No you aren’t!”

I got out of the car and looked up at our porch. They jostled for space next to the front door, trying to be the first to touch the doorknob, the windows, the lock. Evelyn seemed to have completely recovered from her moment of moral questioning in the car.

I unbuckled Lynden from her car seat and reached for her tiny body.

“I can do it myself!”

We walk to the clinic early. It is a single-floor cement building built above the road on its foundation, a series of seven or eight steps up to the front door. A crowd of people line the road.

I see patients right away. At first, like any good medical student, I find Dr. Nguyen or the family practice doctor to present my patient and discuss my plan for their care. After the second time Dr. Nguyen gently holds up his hand, stops my presentation, and gestures to the groups of people waiting in the halls. “I trust your judgement, Krista. You will be fine on your own.” Then he turns away from me and calls his next patient.

I swallow. Ten patients are lined up in my corner, waiting to see the “blonde one.” I smile, push my doubts away, and offer a seat to my next patient.

We saw 169 people in clinic that day.

Que problem? What is the problem?

Bonswa Good evening

Mwen rele Krista I’m called Krista

Doule La? Pain here?

Fè mal Hurts

Doule tèt, Tèt fè mal Headache

Acide Acid Reflux/Stomachache

Ou habite la? You live here?

Iso There

Antre Enter

Shita Sit down

On the morning of the second day, with my stethoscope around my neck and list of Haitian Creole phrases next to my prescription pad, my first patient sits before me, a young girl with a small child in her lap.

Eighteen or nineteen, she looks more like twelve, with large brown eyes and a Catholic Softball League T-shirt. The child is one of her younger sisters. She asks, simply, for my help. I ask her if she has a headache or if her sister has a stomachache or if anything is bothering them, and she shakes her head, no.

She asks, haltingly, broken English to my question in broken Creole, if we have a few extra vitamins we could spare for her youngest sister and a brother waiting outside. She did not have enough money to get all her siblings seen in the clinic. She had to borrow the five gourde (five cents American) to get this sister, the child she holds in her lap, to be seen. Ever since her mother and father died in a car accident, she has had to take care of her seven younger brothers and sisters. All she wants to know is if we have any extra medication to spare to keep all of them strong.

I hunch my shoulders and look away.

She touches my hand and asks, “Ou byen?” Are you OK?

I nod and stand up. “Yon moman.” One moment.

I walk to the other end of the room and find Dr. Nguyen. Surely, he will assuage my guilt. But there is no time to ask: Are we really doing any good here? Instead, I explain my patient’s story. I ask if I could give her more than the allowed ration of medications. I do not believe she will sell them for money.

We tell her to bring her brothers and sisters inside. We give her eight sets of vitamins and worm medications. We also give her a consult note and bus fare to the local orphanage in Jérémie run by the Missionaries of Charity, a community of sisters originally established by Saint Teresa of Calcutta (Mother Teresa). She takes the consult note and bus fare, smiles up at me gratefully and says mèsi, mèsi, over and over again, small tears making the bottom lashes of her eyes glisten.

We saw 216 people in clinic on the second day. I saw sixty.

Alone under the covers, I wiped away tears. My husband was deployed. He had been gone four months and would be gone at least another three. Thoughts and questions swirled in my head, but I had no one to share them with. I had given the man a squished granola bar that none of my daughters wanted.

The next day is Market Day. We hold a half-day clinic, then join the crowds heading down the main road into the center of Léon. Goats are slaughtered on a sloped cement slab. Red and orange bundles display figures made of tightly wrapped yarn. Morsels of yams sit in steaming pots, flies flicker past.

We head down the main dirt road. Houses no more than six feet tall crowd together on either side. We have started to gather quite a following of children. The road ends at the bank of a river. The children gather around Dr. Nguyen and me, looking up with unblinking eyes. Dr. Nguyen points to the camera around his neck and asks if they would like their picture taken.

They clap and jump. “To see! To see!”

I start to say we probably shouldn’t, but Dr. Nguyen shakes he head, then kneels.

He takes a photo of five smiling children hugging each other at the river’s edge. He turns his camera around so they can see themselves in the screen. The children rush up to him, carefully hang onto his outstretched arm, and point to their smiling faces on the screen. Then they point to themselves and look at Dr. Nguyen. He smiles.

He has shown them, some for the very first time, what they look like to the world.

Five years ago, I stopped practicing medicine. I was an active duty Navy general surgeon, treating patients who did not have to pay me for their medical care, who had the same medical insurance as me. I took out appendixes, fixed hernias, taught residents and medical students and corpsmen. I was good at what I did, not the best, far from the worst, and my patients seemed to like me. I was selected to promote to the next senior officer rank. But I did not know my children: our nanny, a great, sweet lady, was raising them. My ambition to always do better, to always put my patients first because that was what I thought a good surgeon did, because that is what I would want my own surgeon to do, made me a stranger to my family and crippled my marriage. And it was killing me.

At the end of my last tour, a Middle East deployment on a U.S. aircraft carrier, I stepped off the ship one last time and never looked back.

Until now.

As a surgeon I met strangers during their direst times, bellies on fire, anxious, not understanding what was wrong, and I comforted them. I explained the problem, often knowing more intimate things about their own bodies than they knew themselves, and I knew how to fix it. I had a role in society, I was valuable.

Now I drive from one place to the next, kiss skinned knees, make really great pizza, and am home every night. I offer oats and sugar and chocolate wrapped in plastic.

The next day, we visit St. Antoine Hospital in Jérémie. Our shoes crunch on gravel, we walk past a rusted white Jeep with a single red light on top, HOPITAL DE JEREMIE on its side. Dr. Nguyen is ahead, walking with Pat and the pharmacist. The family practitioner and EMT are next, then me. Two children run out from under some trees. Both of their faces are smeared with mud, both wear T-shirts that look more grey than white. The larger one is carrying an empty Coke bottle.

“Frank! Frank!” the smaller child says.

The pharmacist, whose name is Frank, pauses, shakes his head, then continues his conversation.

The larger child smiles, runs alongside the group yelling, “Frank! Frank! Give me one dollar.”

We continue across the dirt and stone parking lot, up and over a hill, and onto a cement walkway. A building up ahead has red, curved lettering painted on its wall: BIENVENUE A LA PEDIATRIE.

The children stop at the top of the hill.

“Give me my dollar,” the larger child says as I step onto the path.

“Gourde. Gourde,” the smaller child says, his hand out.

The smaller child’s voice is lower than I would have thought, given his size.

Everyone has gone into the ward; I am the last one outside. I unzip my satchel and remove a crumpled dollar bill. I smooth it out on my thigh; the ink is faded. As I hand it to the smaller child, the larger one snatches it and runs off, the empty Coke bottle swinging with every loping stride. The smaller one turns and howls, chases after his associate.

I sigh, zip up my satchel, and jog the last steps to the pediatric ward. I snap a photo—the wall with its painted red words, the turquoise doors, our group just visible in the dark hallway—then join the others inside.

We congregate at the nurses station. In Haiti, nurses sit at the station, record notes, and give medications. Families attend to the patient’s daily needs. Families bring food from home. Families bathe their sick loved ones.

The blue-suited nurse sits behind a barricade of plastic bottles, books, and papers. She is charting in a notebook. We ask if this is a part of her daily routine, and she looks up and nods. She shows us the notebook. It is a regular wide-ruled, spiral-bound notebook. She has drawn a line down the middle of the page separating it into two columns. Patient names are on the left side, long paragraphs in French on the right. Pens and pencils are crammed into repurposed tin cans. There is a stack of aluminum patient charts—just like the ER charts at my hospital–on the desk corner.

Against the far wall is a metal tray filled with bottles. One is an old champagne bottle, a bit of gold foil still wrapped around the neck, labeled “Dakin.” Dakin’s solution is a cheap, effective antiseptic. I had only seen it used once before because it also impedes the body’s own attempts in healing.

We leave Pediatrics and walk past Orthopédie (no patients), Maternité (not able to visit), and Chirurgie (no patients). Our last stop is the adult medicine ward, housed in the old hospital, built in 1923. The building is painted white with dark green trim. There are pillars outside the main entrance and grand, swooping steps that lead up into a small veranda.

Gourde, Gourde.

The two children from before sit in the shadows at the top of the stairs, the larger one swigging from a Coke bottle, the smaller one holding out his hand. I shake my head like Frank did earlier; I should have known he would use my dollar to buy a second Coke.

The interior of the old hospital building is dark, even at two in the afternoon. We walk down the front hallway. We pass a couch occupied by a man and a woman sprawled sideways, flies jumping from toe to nose. The ceiling is high, perhaps twenty feet.

We walk up to the nurses station. Two nurses stop talking, a third sits behind a desk thumbing a glossy picture magazine. The station is in the middle of the building, women’s ward down one wing and men’s down the other. Each ward is one long room with beds along the walls. Large windows provide the main source of light.

The beds have a single mattress, iron frames, barely clean linens. IV fluids hang from poles next to patients who can afford the bottle, fluid, needle, and tubing. Patient families go into town to buy the supplies, then carry them back up the hill for the nurses to administer. If the fluid is expired, the nurses cannot give it and the money will have been wasted.

The nurse who was looking at the magazine follows us into the men’s ward and points to a patient: “Peritonitis.” Then in Creole she says that his belly is swollen, that he cannot have a bowel movement. He is in extreme pain. Do we have any medication for him? The Cuban doctors who contract to work at the hospital, filling the void after all the Haitian doctors left for better paying jobs elsewhere, have written a prescription for him, but he cannot afford the medications. The medicines sit in a locked wooden closet behind the nurses station.

The skin on the patient’s face stretches tight over his bones, then disappears into the hollows of his cheeks. The nurse pulls down his blanket—he does not resist—and reveals a bloated, taut belly, almost as if it is fat, a gut, a grotesque contrast between his thin limbs and protruding bones.

He speaks.

He says he has pains in his abdomen, doulè vant, and touches his swollen belly. He flinches once, then his face returns to an unreadable mask.

He has ascites, an abnormal fluid built up around his intestines, most likely from an enlarged liver and spleen caused by malaria. We ask the nurse to see his prescription list: IV Aldactone (a diuretic) and a second injection, some sort of pain medication. His side table is empty except for a few used tissues, a drained glass. No one sits at his bedside.

We give the nurse $20 U.S. and say, “Dollar pu medikamen.” Hopefully, he will have a couple of pain-free hours. Hopefully, after administering the medication, the nurse will have time to sit with him awhile.

I look from the nurses station to the medicine cabinet, then back to the patient lying on his bed. I don’t know his life; I can only compare it against mine. I was born an ocean away and he was born here. In a few days I will go back to my own life, and he will remain here.

Evelyn says she remembers when I was on call at the hospital and would not come home until the next day. She says she remembers when, on weekend mornings, I would take her with me on my patient rounds, the first to knock on the door, the first to say, “Good morning,” leading my team into a patient’s room.

I don’t think she remembers. Evelyn was three, maybe four years old. She has seen pictures of us standing together in the surgery ward’s carpeted hallway, grinning. Perhaps it is those pictures she is remembering. Perhaps, like me, she is reaching for the story she used to know, reaching for the meaning behind it.

When asked what her parents do, Waverly says, “My dad is an orthopedic surgeon, and my mom is my mom.” She does not remember that I left her one month before her second birthday for a seven-month deployment. She does not remember the look of defeated realization she made when she could not get out of the car and go with me. I do not want her to think that I changed my life just for her, or because of her, because that revelation is too much to give any child.

When someone falls on the neighborhood playground, Lynden runs up to them and says, “Don’t worry, my mom’s a doctor, you know.” Because even at three years old, she knows you never stop being a doctor.

It is the morning of the last day, Friday, probably ten o’clock. I have already seen ten or fifteen cases of tèt fè mal, acide, and vant fè mal (probably from worms). One of the paramedics comes over to my corner of the clinic and says there is a stretcher patient for me.

Stretcher patients are brought to the clinic on the back of a donkey. They are carried up the cement steps then placed on the floor in the front hallway until a room is free and a provider is available.

This patient is a child, lying on his stomach. His mother is shouting in Creole, waving her arms wildly. She yells that her beloved son is having the worst belly pain of his life. He might have appendicitis!

The child lays perfectly still, trying hard not to move. But he can’t stop looking at me. He attempts to move his head without appearing to move it. His mother must have told him to act as if he were dead.

I ask him to sit up so I can examine him. He immediately, unencumbered by any sort of pain or deficiency, gets up and sits on the exam table. He must have also been told to follow the doctor’s instructions.

I listen to his heart, lungs, belly. This kid is not sick. He did not need all the fuss of a stretcher. I feel a crushing sensation, the withering misery of all the sicker patients this mother has passed over, of all the other patients who perhaps need this stolen minute, this stretcher, this moment of examination, taken from them forever.

Dr. Nguyen walks into the room. He tells me to write a prescription for vitamins and worm medication, then go see my next patient. We have more serious patients to see. Or at least we have patients to see who are willing to wait their turn in line.

I sign the script, give the paper to the boy. The mother runs past me, takes the paper, and presses it to her chest. She leaves the room backwards, bowing to me all the way to the pharmacy line. Her son remains on top of the exam table. I help him down, walk out of the room, call for my next patient.

In our short time in Haiti, we cared for 1,101 patients.

We leave Léon the following day. We clamber back into the battered old Land Cruisers, drive the many hours over rutted and gutted dirt roads, and that evening, return to the Catholic school in Jérémie.

The next morning, I wake to singing voices. A children’s choir is practicing in one of the classrooms. There is no piano, no tape player. There is just a drum to keep the time. The young lady before the group directs the song with her arms outstretched, first in front of her face, then swooping down to her hips, then raises them back up again to her face. Everyone is marching in place. They harmonize perfectly.

That evening, we return to Port-au-Prince and stay one last night at St. Joseph’s. We enjoy another cozy evening on the lanai. One of the hospice ladies—she calls herself Buddhist Dawn—sits in deep discussion with the family practitioner, nodding solemnly at everything he says. When the doctor finally concludes the conversation in Creole, she replies: “Well, you can’t find a comfortable chair in Haiti.”

The next day, we drive back to the Port-au-Prince airport. There is none of the jostling, shoving, and grabbing like on our arrival. We board our plane, fly back across the waters.

I return to my apartment. A futon is rolled up in the corner of the front room, duffle bags of clothing and books sit next to it—I had let friends crash here while I was away. I wander into the bedroom, put my bag on the floor, and lie down. I listen to the rush of cars outside my window. I try to remember what the ladies’ voices outside my mosquito netting sounded like. I try to remember the exact cadence of the dominoes clacking together. I sit up and look at the closet full of clothes, all those clothes that were not needed for my trip. I look at the nightstand piled with books and wonder where my copy of Hummingbird House went.

I strip naked, walk to the bathroom, and run the shower. I step over the white linoleum edge, careful not to get my face wet. Then I laugh. Once. I shake my head and dunk it all the way under the water, careful to keep my face there, my tears disguised as just the water running down my face.

For the last several weeks he hasn’t been on the corner. As I drive across the intersection, I look for the crinkly red and silver granola bar wrapper. Absurd, I know. If he had dropped it, the plastic would be washed down a storm drain or stuck beneath an azalea bush. Or perhaps he carried it away with him, like the Haitian boys with their empty Coke bottle, a reminder of possible generosity.

If those boys from outside the St. Antoine Hospital building are still alive, they would be about his age by now.

In the mornings, before I unload the dishwasher, before I pack lunches and cajole my daughters to get ready for school, I frantically search on my computer for anything about Léon, Jérémie, and Hospice St. Joseph, all the places and names I have remembered because I had written them down in my notebook.

One early morning, I found a website about a doctor from Milwaukee who went to Haiti two years after my trip. Dr. Catherine Wolf started a clinic in the town of Gatineau, one and a half hours inland from Jérémie, two mountain ranges west of Léon. The permanent clinic building was completed in 2014. Since 2007 they have taken care of more than 20,000 patients.

Another morning, I found that in 2016, Dr. Daniel Scoppetta, a surgeon from Bristol, CT, started the Grand Anse Surgery Project at St. Antoine. They are “passionate … about society’s obligation to provide quality surgical care for all,” and believe that ultimately to remain successful the project will need to be self-sustaining, a goal they work on with every Haitian surgeon they mentor. Haitian surgeon.

Dr. Nguyen went back to Haiti several times, continuing to help at the clinic in Léon, until he retired from his teaching job and moved out of state. Pat became the executive director of a nonprofit organization, Health and Education for Haiti, continuing to take medical volunteers down several times a year, until recently, when civil unrest has made it unsafe to travel.

The roof of the old St. Antoine Hospital building was damaged in the 2010 earthquake. Hospice St. Joseph was also destroyed. Despite horrendous odds, continued natural disasters, and a global pandemic, the newly rebuilt building was completed in December 2021.

Were my group and the groups before mine, like Paul Farmer’s Partners in Health, the nidus for these autonomous programs? Perhaps, as Dr. Nguyen says, “We were one of the early bricks that paved the way.” With the current turmoil, are they still able to continue?

Though I vowed I would, I never went back to Haiti.

The unfairness in this world is the early morning mist, returning daily, that obscures a lush, green canyon. Doing one small thing, offering a granola bar, jogged by an old memory, is how I show my daughters that you only need to have the courage to take the first step through it.