From Dawn To Dusk

At St. Damien's, there is a mass every day at 7 a.m. It almost always also serves as the funeral service for those patients who have passed away at either St. Damien's or St. Luc's (the affiliated adult hospital across the street) and who do not have family to take care of their remains.

"The Destitute" are wrapped in cloth and lain in the center of the small chapel just next to the hospital. Father Rick, the Passionist priest/physician who founded and oversees St. Damien's (as well as numerous other projects throughout Haiti) presides. He does so with quite a flourish in a mixture of Creole and English, as the early-morning sun rises above the compound walls and light streams through the windows on the right side of the chapel.

View toward the inside of the chapel at morning mass

When mass ends, the bodies are carried out of the chapel on battle-field stretchers amidst the sounds of joyful Creole hymns and lain next to each other in the back of a flatbed pickup waiting outside. Father Rick and the Haitian men and women who helped carry the bodies climb into the back of the truck, still singing. The sounds of voices finally give way to the sputtering of the diesel engine as the truck disappears around the corner of the hospital and the morning sun fully emerges above the compound walls.

"Our every sunrise is someone else's sunset."

These masses have served as a stunning example of the contrast between life back home and life in this country. Death is much closer here.

The sky above St. Damien's compound at sunrise

This afternoon, a young mother showed up to Urgence with her baby wrapped in a thin blue blanket. She didn't have to unwrap him for us to realize that he was not doing well. He was very small and was grunting with every breath. When she did unwrap him, it was obvious that he was burning up with fever. Also obvious were his bulging anterior fontanelle and jaundice.

He had been born at home 4 days earlier. The mother had had no prenatal care, and the baby had not seen a doctor since he'd been born. He was so small that he'd not been able to figure out breastfeeding, so he'd not had any nutrition since the mother had tied off the umbilical cord with a string after cutting it with a box cutter. She finally brought him in today because he had stopped waking up and was having trouble breathing.

There were no beds available for him in the main area of Urgence, so we laid him on his blanket on the mint green countertop between the sink and the infant scale. We corrected his hypoglycemia with IV fluids and got antibiotics into him relatively quickly. When I was finally able to get someone to help hold him for a lumbar puncture, pus poured out of the needle. The nurse drew his labs, and I left him in the care of his mother while I went to work admitting another child just a few feet away.

About an hour later, he stopped breathing--the infection finally overwhelming the breathing center of his brain. We used a bag-mask to breathe for him for over an hour, stopping periodically to see if he would take a breath on his own. Back home we would have put a breathing tube in and put him on a ventilator until the infection was well enough under control to give him a chance to breathe again on his own. That wouldn't be an option here, since the only ventilator in Urgence is made for adults and cannot be set low enough for any baby, much less one his size.

Without us giving him breaths, his heart finally slowed and then stopped. He lay there on the green countertop, tiny and cyanotic, while his mother sat stoically at his side in a metal folding chair and the Haitian doctor filled out the death certificate.

It was only then that I noticed the 5-year-old boy who I had been seeing for pneumonia when this baby stopped breathing. He was sitting in his mother's lap a few feet behind us, staring at the tiny body on the counter. He and his mother were both looking on, not with faces of horror or curiosity, but with what appeared to be grim acceptance. I'm sure that the boy didn't really understand what had just happened, or the permanence that this tiny body represented, but his mother made no effort to turn him away. It was as if she were saying to him, "This, too, is part of life."

Death is much closer here.