Aftershock

PORT-AU-PRINCE-Myerline Guillaume was preparing to walk to an evening worship service when she felt the earth move in her two-story home in Port-au-Prince. When she looked up, the sight was horrifying: "The ceiling was coming down on me."

Three hours later, neighbors plucked Guillaume from the rubble in the dark. Her leg was crushed, and so was her spirit: Of 29 family members living in the house, 16 were at home when the 7.0 magnitude earthquake struck on Jan. 12. Nine were dead, including three sisters.

Twelve days later, in Job-like fashion, Guillaume was preparing to worship again. On a thin mattress over concrete in the makeshift clinic of a small church in the nearby town of Cabaret, Guillaume tended to what was left of her amputated leg and her family. Surrounded by her three young children-all suffering from severe leg breaks or open wounds-she clutched a tattered New Testament in her thin hand. Waiting for a morning worship service to begin just outside, she explained: "It's the only thing that brings me comfort."

Alongside shelter, food, water, and medical care, comfort also is in short supply in the shattered streets of the poorest country in the Western Hemisphere, despite valiant efforts of hard-working groups to provide aid rapidly under chaotic conditions.

The estimated numbers alone are ghastly:

The dead: 200,000 people (est.).The injured: 194,000.The homeless: 1 million.People living in makeshift camps: 800,000.People needing food aid: 2 million.Structures destroyed: 70 percent in the capital; 90 percent in towns close to the epicenter.

The numbers may be hard to grasp, but the sights, sounds, and especially smells of Port-au-Prince give them a stomach-churning reality: Death's odor clings to piles of rubble on roadsides as Haitians pick through the ruins for supplies they could use, discovering also body parts of victims left in the debris. On a busy street near downtown, people crammed along the length of the broken median, setting up camp for the night. Nearby, a stack of partially covered bodies lay waiting for pickup by UN workers.

In the city's once-prized central plaza, the Champs de Mars just across the street from the collapsed Presidential Palace, thousands of Haitians mesh into a squalid tent city, subsisting on food rations from the UN and other aid groups. Not every family makes it to the front of the food lines before the supplies run out or the crowds grow restless and the truck pulls away. Similar scenes unfold in tent cities around the capital and in the countryside, with the overpowering stench of human waste deepening worries that a new health crisis looms if sanitation woes and a lack of latrines persist.

A health crisis also looms for the thousands of Haitians suffering from amputated limbs, serious bone breaks, and severe flesh wounds. Doctors worry that without the proper care, infection and blood clots could usher in a massive second wave of death. Though volunteer doctors have flooded the area, in many places medical supplies run short and hospitals remain overcrowded, forced to turn away patients in need of critical care.

All the while, aid groups clamor to assess the best way to help, as the UN tries to organize a massive but piecemeal relief effort alongside a paralyzed government infamous for its pre-earthquake corruption and ineffectiveness. Haitians remain remarkably calm for the moment, but leaders know that the historically volatile country could quickly turn violent if conditions don't improve.

For now, some of the best immediate help may come from groups working closely with church leaders attuned to their communities' woes and committed to providing both material and spiritual care that Haitians desperately need.

For some large relief groups like Samaritan's Purse, connecting with local churches is central to their strategy for delivering aid. South of the capital in the mountain town of Fermathe, the Boone, N.C.-based group has helped supply relief and doctors to Baptist Haiti Mission, a 60-year-old Christian ministry with a functioning hospital that is providing critical care for hundreds of patients since the quake.

Workers from Samaritan's Purse arrived in Port-au-Prince the day after the quake and began working with a network of church contacts to help with distribution of aid to particularly vulnerable populations.

Few populations are more vulnerable than the thousands of Haitians living in Cité Soleil, one of the largest slums in the capital. The sprawling shantytown has long been notorious for its filthy conditions and dangerous gang wars. The earthquake only deepened the misery, sending thousands into packed tent cities in the baking heat with few resources. Pigs wallow in a nearby riverbed overflowing with rotting trash, and children splash through open sewage.

On a hot afternoon, Jean Claude, an elder at Eglise Chretienne Des Cities, a local church of 1,600, says people are coming to the church's collapsed gate daily, begging for help. The church has little to give and tells people to wait. He says aid groups come only sporadically.

But within 24 hours, Samaritan's Purse was formulating a plan to care for the residents in a tent city a few hundred yards from the church. The team will organize sanitation, clean water, food, and hygiene kits, and point residents to the nearby church for spiritual care, while also providing clean water and other relief in more remote areas outside the capital. For Jean Claude, it's an answer to prayer. He says he's been telling community members: "We will knock, and we know the Lord will open the door."

While international attention remains transfixed on Port-au-Prince, rural towns closer to the epicenter are even harder hit, but see far less aid. In Leogane, a town southwest of Port-au-Prince, some 90 percent of structures are destroyed. While the destruction in Port-au-Prince seems dramatic but random-with intact buildings standing next to collapsed structures-the devastation in Leogane appears complete.

On the side of a rutted road in Leogane, a man holds a sign asking for help. When relief workers ask him what he needs, he appears dazed and disoriented. "I'm dislocated," he mutters. "I need everything."

Villagers at a nearby orphanage need everything as well. The Haitian-run orphanage housed 30 children before the earthquake. A 10-year-old handicapped girl died when the structure collapsed. Franklin Marceus, who lives in the village, leads the way down a rubble-strewn road to show where the children live now: a series of tattered tents on a small patch of treeless land in the searing sun. Nearby, a woman cooks rice for the two dozen children in a small pot over an open fire. With nearly every home in the village destroyed or severely damaged, families can barely care for themselves. What will happen to the orphans? "We really don't know," says Marceus.

Further west in the town of Petit Goave, at least 500 people are dead and hundreds homeless. Under the shade of a few trees, a group of local pastors meet to discuss the need for clean water. As they meet, mangos plunk to the ground, shaken off a tree by a mild aftershock. These frequent aftershocks mean most people in this area-and all over Port-au-Prince-sleep outside, unsure if intact houses are safe to inhabit, compounding the problem of widespread homelessness.

After the meeting, I talk with Gedeon Sanon about what his community needs, but the pastor of a local Apostolic church is already thinking long-term: "The best way for people to help us is to help us do things for ourselves."

Sanon is director of a local group called Haitian Foundation for Assistance and Safe Development of People, a Haitian-run organization aiming to establish educational and agricultural projects for nationals. Before the quake, the group had a 20-year plan. Now they're starting from scratch. But Sanon says the organization's principles of a biblically based work ethic and just government remain the same. And he worries that poorly planned international aid could lead Haitians to rebuild the same problems that have kept them poverty-stricken for 200 years. "We've been receiving outside help for a long time, and things are only worse," he says. "If we can do it, we should do it ourselves."

Sanon, who fled a volatile Haiti with his family in 1990, says his mother calls him "a son of promise." "She promised God if He would spare our lives, she would dedicate me to His service," he says. That's why the pastor returned to Haiti eight years later. "If I am a son of promise, I have to go back," he told his mother. "I have to help the people, and I know the Lord will help me."

Charles Amicy is a son of promise too. The Haitian pastor and founder of Presbyterian Mission in Haiti (PMH), just north of Port-au-Prince in Cabaret, attended Greenville Presbyterian Theological Seminary in South Carolina but returned to Haiti to serve his country with the gospel. His small compound includes a church, a school for 500 children, and an orphanage for 12.

These days the focal point of the compound is the makeshift clinic where Guillaume, the injured and bereaved mother of three, is seeking treatment. When I visited 11 days after the quake, three volunteer doctors and two nurses from Flying Doctors of America-a group that sends medical personnel into remote areas-were treating nearly 20 patients sprawled on twin mattresses on the cement floor of the church.

The injuries were grim: amputated legs, amputated arms, broken femur bones, severe flesh wounds. Though the doctors could manage the patient load, they were running low on critical supplies, partly because donated items from different countries didn't fit together. In one case, doctors rigged a catheter for an 11-year-old girl by duct taping together a Belgian tube and a German tube, and draining it into an open vegetable oil jug.

In another case, the doctors performed a painful procedure without anesthesia on a malnourished and dehydrated 6-year-old boy who was near death when he arrived at the clinic. Desperate to find an elusive vein for an I.V., they drove a needle through the bone in his tiny leg, cut an incision near the back of his bony foot, and finally went through a major vein in his neck as the lethargic child whimpered in pain. Nothing worked.

After two agonizing hours, a fresh group of doctors arrived at the compound with a simple remedy the clinic lacked: Pedialyte. With a tube running through his nose and down his throat, the small boy appeared to process the fluid, but his long-term prognosis remained tenuous.

The long-term prognosis remains tenuous for other patients as well. Most have come here from hospitals in Port-au-Prince on pastor Amicy's white school bus. The pastor drives doctors to hospitals in the city to pick up patients who need urgent care for serious wounds. In many cases, overloaded hospitals discharge such patients with nowhere to go. But many of the patients arrive at the PMH clinic still needing skin grafts or surgery for broken femurs and other wounds. Though a U.S. Navy helicopter evacuated six critical children, more remain with serious needs. When the doctors take patients to other hospitals in the capital to seek surgery, they say they are usually turned away.

One of the volunteer doctors, Jim Tierney, a pulmonologist from Boston, worries that more patients here and in similar clinics all over the city will die from complications like blood clots that are normally preventable: "It's a simple injection, twice a day, that takes three minutes," he says. "But we don't have it." Within 12 hours of my arrival at the clinic, two patients had died, possibly from blood clots.

On a bright Sunday morning, the doctors wrapped one of those patients in a white sheet and carried her to the back of the compound until a local morgue could retrieve her body. A woman next to her with a similar injury wailed, fearing a similar fate. More wailing would come with the difficult task that each morning at the clinic brings: dressing changes.

As doctors peeled away layers of gauze, some patients shouted and cried in pain. A boy with an open foot wound grimaced as doctors cleaned an area with two bones sticking out. Another woman's open wound at the bottom of an amputated leg revealed a protruding bone. A 13-year-old girl suffered a face laceration that had ripped off her ear and damaged a major nerve.

As the painful work went on, members of the local congregation lined up benches next to the church so patients could hear the worship service through the open doors and windows. As the church service began, a new sound swallowed the cries and wails in the clinic: the patients singing hymns with the outdoor congregation.

Some lifted amputated limbs in the air, and the Creole singing reverberated off the concrete walls: "The only friend I have is God/This friend always knows my trouble/His love always comforts me/His hand always dries my tears/Sweet Jesus/Sweet Jesus."

Though the clinic will eventually close, Amicy says he is preparing for construction projects and a new wave of orphans. The UN estimates thousands of children have lost one or more parents, or are separated from their families. "The people of Haiti know suffering. They grew up in it. They are going to die in it with no hope at all because nobody seems to care for them," he says. "We will care for them."

After the church service, members of the congregation visited patients, and doctors cared for Guillaume, helping her move outside. As she leaned on crutches with her amputated leg, a small group outside sang a different song: "Every step I take, Jesus will help me."

Though the work is indescribably hard, Amicy describes the scene in the hospital as a picture of how Christ cares for broken souls. He is glad his church can provide such a ministry. "We wanted to preach the gospel to Port-au-Prince," he says. "But we never expected this."

Traumatic history

1957: Voodoo physician Francois "Papa Doc" Duvalier seizes power in military coup. After his death in 1971, his son Jean-Claude "Baby Doc" takes over.1986: Mounting protests force Baby Doc to seek exile in France.1988: Leslie Manigat wins presidential election, but is soon ousted by military coup.1990: Former Roman Catholic priest Jean-Bertrand Aristide becomes Haiti's first freely elected president.1991: Aristide is ousted in a military coup that triggers a mass exodus of Haitians.1993: UN Security Council approves and deploys peacekeeping mission to Haiti.1994: U.S. intervention spurs the military regime to relinquish power and Aristide returns.1996: René Préval becomes president.1998: Hurricane Georges claims the lives of more than 400 people and wipes out 80 percent of Haiti's crops.2000: Aristide wins a second presidential term.2003: Voodoo becomes an official religion in Haiti.2004: Violent uprisings in February sparked by allegations of election fraud force Aristide into exile; an interim rebel government takes control. In May, flooding in the south leaves more than 2,000 dead or missing.2006: Préval returns as president.2008: Soaring food prices incite riots in April, spurring the government to cut rice prices in an emergency move to halt unrest. Hurricanes Fay, Gustav, Hanna, and Ike strike Haiti in August-September, killing nearly 800 people and wiping out 70 percent of the country's crops. In November, faulty construction causes a Petionville school to collapse, killing nearly 100 children and adults.2010: A 7.0 magnitude earthquake rocks Haiti on Jan. 12, toppling buildings and burying thousands of people in the rubble. Estimates are that more than 200,000 people may have perished.

Related coverage:

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