Monday, October 17, 2011

Day 138: How To Build A Coffin

I've always known the work I do here in Haiti shields me somewhat from the most painful aspects of what this kind of poverty can produce. Yes, it is hard not to be affected when you see a family of five sharing a tiny, dirt-floored shack, or an old woman stooped over knee-high in a filthy canal digging through the waste looking for ... what? I don't even know what you could find in that cesspool that could be of any value. Haiti, now as before, does not attempt to veil her troubles.

But I hadn't seen death, even though I know it is all around me. With the exception of a horrible motorcycle accident I passed by in January that left two young men dead in the highway, I hadn't had any relationship with it. I know it's there, the statistics are well-known and the spectre of cholera looms over this country. Inevitably some of those caught in its shadow won't find their way out again. Still, to know something exists is very different than to witness it.

I've been spending some time with a girl I met a few weeks ago, Sabrina. She's here for three months and is volunteering at a very small NGO that operates out of a house in Chatulet, near the Route National. The NGO, Espwa Berlancia, is run by a young woman, Rhyan, who I met last year when I installed biosand filters in an orphanage she was helping. Since then, she's transitioned into focusing on helping pregnant women and infants who are HIV positive. It's a tiny operation - right now just the two of them - but it's clear they are passionate about it. When I came over to visit them a few nights ago and forgot the money I needed to pay the moto-driver, a young man in his late teens or twenties, the girls offered him the choice: 50 gourdes (just over a dollar), or an HIV test. He chose the test. So, 9PM at night and the four of us are sitting on the porch as he waits to get his results. After a false-positive scare, he could breathe a sigh of relief: negative. He left smiling.

But that isn't always how it ends. A few days ago, Sabrina told me that a baby girl had been dropped off at the orphanage and was to receive no care because they didn't think she'd live. When you don't have a lot to work with, you have to make ugly choices. But Rhyan and Sabrina weren't having that, and brought the little girl back to their home to try and pull her back from the brink. She was somewhere between one and two years old, a skeleton in every sense of the word, and HIV positive. Her mother abandoned her at the orphanage when she thought death was inevitable, maybe to avoid the pain of watching it, and maybe to avoid the cost of burying her. Probably both.

The first day the girls had her, they didn't think she was going to make it. She wasn't eating, wasn't drinking, and was slipping in and out of unconsciousness. Sabrina committed herself to that little girl, and spent the whole day with her, holding her, sleeping next to her, feeding her and changing her. I didn't see her that day, she had her priority.

The following day, Saturday, the little girl began to turn a corner. Her eyes cleared, going from yellow to white, and showed focus where before there was drift. She stopped moaning and began to make noises that babies are supposed to make - gurgles and giggles and squeals. Most importantly, she ate. Mac and cheese and avocado and other assorted delectables. When Sabrina came out that night to go dancing with a bunch of us, she looked happy, and told me the good news.

Yesterday morning I could tell Sabrina's mind was elsewhere. She was thinking about the little girl. We walked back to her house together, and I got to meet the little one for the first time. She didn't look healthy. She'd taken a turn for the worse over night and wasn't eating again. Sabrina began to feed her Pedialyte, which she kept down, but as I held her I could feel it pass right through her and into her diaper. She was tiny, her head rolling weakly into the nook of my shoulder where she settled into a half-sleep, making her little moans again. The smell coming off of her smelled of sickness. After another attempt at feeding, she vomited, and the reality of what it means to try and care for an incredibly sick baby hit me. We had to leave her on the cold tile floor as we put on gloves to protect ourselves from the virus she carried, and was in her diarrhea and vomit. It felt so cold. Clinical. Rhyan, who has been in Haiti for four years and has been exposed to this many times before, was doing what needed to be done - cleaning, organizing, doctoring. Sabrina and I were more focused on trying to show the little girl affection, to push back against the cold tile floors and injections and baby wipes working methodically to "make things better". Things weren't getting better, and I knew it was time for me to leave Sabrina and Rhyan alone with her.

After a morning that saw me back at the base feeling ready to burst into tears at any moment, and an afternoon of meeting with an interesting NGO that wants to potentially partner with our BSF program next summer, I found myself en route back to the house to bring the girls some BBQ chicken platters. My friend Andy, who just moved to Leogane and is getting the lay of the land, was driving. Thinking the little girl would likely be doing better or perhaps be asleep, I'd brought a few beers and a bag of Doritos, simple pleasures really, but they go a long way sometimes.

Knock knock. Rhyan opens the gate. "Do you have a driver? I need a driver, I think she's dying. I need to go to the orphanage." OK, this is happening. "Quinn, stay here with Sabrina, I'll go with your driver." OK, this is happening. I went inside, the house was dark, as the electricity to it hadn't been turned on yet. I found Sabrina in her room, huddled over the crib where the little girl was laid out with a wet cloth on her chest. A tiny clip-lamp was attached to the lip of the crib, casting pale light down on her. She looked much, much worse than when I'd left her that morning. It brought back images of my mother in the final moments before she died, lying in the adjustable bed provided to her by hospice. The little girl's eyes were open, weakly, one more than the other. She didn't seem to see anything. Her ribs expanded and sank gently, pushing against the skin. Her old man legs coming out from her diaper were collapsed outward, her arms at her sides, palms up. There was a tube in her nose. My mom had a tube in her nose when she died.

Sabrina was quiet, her hand on the little girl. I didn't know what to do. I put the chicken platters down on the ground, but had forgotten to close the front gate and soon enough had a rowdy puppy wanting to get into everything. "Sota, out!" I took her out, closed the gate, came back to the crib. "Hey little one. How you doing?" Stupid question to ask her, hand on her swollen belly, both because it was clear how she was doing, and because I said it in English. We just sat there with her for a while in silence. I thought to myself, "This is Haiti. This is the true reality just under the surface." For every smiling kid asking you for a sip of your soda, there are children like this little girl. I thought of my friend Christina, a nurse here last year who worked at a field hospital. She'd sometimes come back from work and cry. "We lost a baby today." I didn't really know what that meant then, but was now in the process of learning.

Andy and Rhyan came back with Madam Claudia, who runs the orphanage. Andy looks down at her in her crib. "Ah, poor baby." It's a little awkward, but genuine - Andy's a bit of a cowboy. He pulled bodies out of buildings in Port-au-Prince. He drives a heavily-armored car. He smokes a lot. "L'ap mouri." "She's dying." Madam Claudia would know, she's seen this before, many times. I ask her questions. She tells me she lost a baby yesterday, and another just before. She tells me about a woman who has given birth to a total of nineteen children, all premature. All of them were brought to Madam Claudia. All died. "This is Haiti." It's stuck in my head.

The little girl is getting worse. She's vomited. They take her out of the crib, she's completely limp, stick-figure arms and legs hanging. They face her forward, one hand under her, her head down, and they slap her back. Vomit comes up - yellow brown and full of feces. There's a lot of it. We put our gloves on. I'm crying quietly. Sabrina is silent. Andy's holding Gup, Rhyan's adopted toddler, in another room so he doesn't have to see it. Rhyan and Madam Claudia sing a song from the Bible. They say a prayer in Kreyol. They pour a little water over her head, and it trickles down her skull into the vomit bucket. They lay a towel down in the crib and put her back in it. Andy says goodbye. "Give my chicken to Madam Claudia. I'm not hungry anymore." I do. Madam Jimmy has joined us now, the young wife of a man named Jimmy who is a neighbor and helps Rhyan and Sabrina with random odds and ends. She and Madam Claudia eat the chicken on Sabrina's bed as Sabrina sits by the crib with me. We talk in Kreyol. Madam Claudia states the sad truth - "It doesn't have to be this way. If she had someone who could afford to care for her, and HIV medicine, she wouldn't die." That's true. "This is Haiti."

The sadness has abated a bit, the shock with it. Sabrina and I go out to the kitchen and try and eat our chicken with the aid of a flashlight. We manage to laugh a little bit - "I don't really know what I'm eating right now. I can't see anything." Me neither. I'm drinking one of the beers. Sabrina's happy about the Doritos. There's a baby girl dying in the room next to us. Should we be doing this? I don't know what the rules are.

The electricity comes on. "Yes! Mesi Jezi!" Rhyan says it, but I'm the one who confuses it. Jezi? Is that the name of the electrical company here in Haiti? No, it's Jesus in Kreyol. Sabrina laughs hard. That makes me happy.

The little girl and her crib are moved from Sabrina's room to the living room. Madam Claudia is talking to Rhyan, Sabrina avoids the living room, Gup has been put to bed. I'm by the crib, talking to her. "You're a little fighter you know that?" She is. Her breathing is weak, but her heartbeat is strong. It's the first time I've used a stethoscope. "What were we saving her for?" Rhyan asks the question. "She's an HIV-positive orphan in Haiti. What kind of life will she have even if we could save her?" It's a question I imagine all of us have been thinking, and is clearly one that has tortured Rhyan before. Sabrina's still quiet. "I'm OK, " she tells me, "I just don't want to look at her like this anymore." I get that. I think about the day my mom died.

"Her heartbeat is a lot weaker now." A few minutes have passed. The little girl is still alive, eyes open but unseeing. "She doesn't see us anymore, she sees Jesus." Rhyan says it, Madam Claudia and Madam Jimmy nod. I have my hand on her belly. "Be careful, when she dies she might vomit on you." She doesn't. Her passing is peaceful. The breaths come short and drawn out, her eyes still open. Her little jaw works in a three-part jerk as she sucks for the final bit of air, then she's gone. Rhyan begins to close her eyes, which are still open. I try and help her but do it wrong. "You have to hold the eyelids down for a while."

I go out to the porch where Sabrina is smoking one of her menthols. "She's gone." She nods. Gets up and goes inside. The waiting is over. We start doing things again. The girls bring some clothes up from the basement to dress her in. As they lift her out of her crib to put her on the ground to clean her, the image burns into me - a dead skeleton infant, surrounded by nobody she knew when she was alive, lifted and set down like some morbid ragdoll. No amount of tenderness, of which there was plenty, could have changed it. "This is Haiti." Rhyan is careful with her as she removes her diaper and cleans her wrinkled legs and butt. They dress her in a white fluffy gown. Her hands are bound together in a prayer shape, as is Haitian custom. They've forgotten the bonnet, so I go down to the basement and bring up the suitcase with the death stuff in it. It's full. Two others are down there, empty. I don't know what that means.

We need to get the body back to the orphanage. How? Jimmy doesn't want to take a dead baby on his motorcycle. It's too far to walk. It's too late to find another moto. Rhyan approaches me, "Quinn, do you know where we can get a coffin, or build one?" We could build one on base, but it's late on Sunday and none of the people who know how to do that are around. Lots of people have gone to the beach to camp for the night. I try to call Elivert, but he doesn't answer. I try my other local friends. They don't answer. I don't know where we can buy one. Jimmy says he can go get wood, and Rhyan has a circular saw and some nails. We'll build one.

Jimmy and I do our best cutting the wood but it's cheap plywood and damp and the electricity running to the house isn't enough to fully power the circular saw. It jams a few seconds into every cut. The lines are all wrong. Jimmy does his best to fix them. Once we've cut the pieces we realize the nails are too small. They don't have any others. "I'll go get them." "OK, while you do that, can you call Andy and ask if he'd be willing to drive us to the orphanage with her?" I do. He is.

I walk out the gate and head left up to the Route National. It feels like a long time since I brought over the chicken and beer and Doritos. It's only been a few hours. I walk to Ocean Grill, a restaurant nearby run by my friend Jacques, a Haitian guy who lived in Boston for many years and makes some mean seafood. He recognizes me as I come in and jokes, "Hey Quinn! You look hungry." "Nope, sorry Jacques, not tonight, I'm just hear to ask a favor." I tell him what happened. He nods quietly, finds some nails but they are used to nail tin, and too big for the little coffin. They'd split the plywood. "Ah man, I'm sorry to hear the news." "It's OK, life right?" "Right." Right. Right? I'm not sure if that's true, or if it is, if it should be. I buy a beer. He lets me take the bottle with me. I grab a moto and stop by Klinik Kominote, which is run by my friend Jason, to see if they have nails. Nobody is there. I get back on the moto and head back to base. Joe's, the bar next door, is blaring music, as usual. Black Eyed Peas. "Tonight's gonna be a good night, tonight's gonna be a good, good night!" People are laughing. I hate the Black Eyed Peas. I grab a can of nails, a bucket of paint and some brushes. Paddy and Dylan know, offer to help if we need it. I'm OK. I'm back on the moto, and then back at the house.

We finish the coffin. It's decided there isn't enough time to paint it, so we opt to line it with some white cloth. The little girl is bound up in a shroud now, a rigid something on the floor next to the crib. There is a note taped to her releasing Rhyan of any responsibility for her death, signed and stamped by the orphanage. She has to take photos. Sabrina is still quiet. Andy is there. "That's a good coffin. Quinn the carpenter eh?" Anything but, really, but it'll have to do. It's better than a suitcase, which is what they had to use last time. The orphanage can't afford wood or coffins. Sabrina lifts her. "She's stiff." She sets her in it. The lid is too small, it doesn't fit right. There are gaps. Duct tape? No, they'll just have to open it up again anyway to check her.

I carry her in her coffin to Andy's SUV. I'm afraid the nails will slip. I have a vision of the bottom falling out or the walls giving way and her falling and hitting the street. The coffin holds and I put her in the back. Madam Jimmy and Jimmy leave, Madam Claudia is gone. We drive to the orphanage. I recognize it. We installed filters in it last year. It's late, people are asleep. "You need to let me carry her in." Rhyan does. She talks to the orphanage staff for a bit. She unwraps the baby girl and shows them her face. They nod. It's decided that she'll be left in her coffin on the porch. That's it then. There's nothing else to do. We leave. Andy drives us back to the house and says goodbye, offers to help dig a grave the next day with one of his excavators if need be.

The house is quiet. Sabrina and Rhyan are talking. I'm exhausted. Sabrina makes me a bed on the couch. I grab a book about village medicine when no doctors are present. I read about malaria and dengue and typhoid fever. Sabrina comes and sits at the end of the couch. She tells me stories about her scars. I want to listen but I'm so tired I can't stay awake. My eyes are closing. She laughs. "Fine, well if you don't want to listen..." She's kidding, and we both know it. "Goodnight." "Night."

It's 8:30AM. I need to get back to base. Paddy and Jenni, my two BSF coworkers, are both leaving for a vacation tomorrow. I have a lot of things to do. I say goodbye to Rhyan. Sabrina is still asleep in her room. I leave her be.

I'm on the motoride back and I'm thinking about something I saw on TV the day before. An Indy car driver named Dan Wheldon died in a car crash. The sports world is in mourning. It's all over the news. I can't help but feel a bit jaded. He drove race cars. He knew the risks. He made the millions. He died doing what he loved. I think about the little girl, maybe still in her hacked-together plywood coffin on the porch. I don't even remember her name. I doubt many people will. It seems wrong.

I take a deep breath and refocus. The motorcycle engine whines and the kompa music blares and the people are everywhere and I'm still alive and moving, on and away, and this too is Haiti.

- - - - -

R.I.P Little Girl

- - - - -

Edit: To be clear about something I unintentionally omitted in writing this -  yes, Rhyan and Sabrina attempted to take the little girl to get medical treatment at numerous hospitals and clinics. None would accept her given her HIV positive status, and the belief that she would die regardless of any care received. 

Edit: Rhyan updated her blog to write about her experience with the little girl, who's name was Miguerlene. Read it here.

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