Earthquakes, pandemics and lessons of the human spirit

Hearing stories about loved ones literally swept away in natural disaster or knowing those killed by coronavirus after serving patients clarifies our priorities

Written March 26, 2020

By Dr. Eric Cadesky

Dr. Eric Cadesky

Dr. Eric Cadesky

As I glanced up at the stars shimmering in the darkness, my tentmate turned to me and said, “What the hell did these people do to deserve this?”

It was early January 2010, our first night in Milot, a small town in northeastern Haiti. It had taken us hours to drive the 12 mile road from the airport in Cap-Haitien and we balanced the excitement of do-gooding with our nascent medical skills against the apprehension of what we had heard about the earthquake’s devastation on what was already the poorest country in the Western Hemisphere.

Restless on the unforgiving cots that served as beds, our bodies ached from the work of that first day: triage, surgery, recovery, clinic, repeat. Teaching the local staff in an effort to leave behind something more than expired samples of next-generation angiotensin receptor blockers sent by well-meaning companies. Trying to make sense of the tragedy before us. Consoling men and women who had lost spouses, limbs, and homes. Sadly yet playfully assessing children who would never again know the loving touch of their parents’ embrace. Physical trauma manifested as limps and scars and bends. Psychological scars presented as pain that could be palpated, an unfulfilled wish that that one day, somehow, one of these foreign doctors could just cut it out and remove the malignant memories inside. 

It’s okay to rage inside. It’s okay to not comprehend that magnitude of what is happening. And it’s okay to cry…

Now as I glance out the window of my home a decade later, I think about Haiti. It is not survivors in a mosquito-netted pavilion next to me, but rather my family. Instead of sharing a tent with a trauma surgeon, I sleep alone for fear of passing on a mostly unknown virus to my pregnant wife and young daughter. Should I even be in the house? Are hugs and kisses okay? The stars are slightly obscured by the city lights, but the lessons from Milot are clear.

First, tragedy refocuses us on what is important. Hearing stories about loved ones literally swept away in natural disaster or knowing those killed by a virus after serving patients in close contact clarifies our priorities. Family. Friends. Meaning. Purpose. And that is why our calling is so difficult: helping others at these times puts us and our families at risk. We don’t know how and when it does, but we do what we can to balance these two competing drives, frequently unsuccessfully, and almost always drawing on the support of those whom we often neglect. 

Second, great challenges can create great teams. The tribalism in our profession and society at large has held us back from reaching our potential, but a common cause reminds us that we are more alike than not. In Haiti there were always things to be done. The pharmacy—a makeshift shed full or morphine, penicillin and mostly useless donations—needed reorganizing. Patients lying on stretchers needed to be moved from triage to the operating room. Orphaned babies needed feeding. The washroom needed cleaning. No one was too important for any job and we moved from task to task knowing that everyone else was doing the same thing. We often worked alongside patients who helped as much as they could, and I learned later that these efforts resulted in an expansion of the hospital and the construction of a modest house for Milot’s permanent local physician. Closer to home the last two weeks has seen medical students volunteering to work information hotlines, get groceries, and child mine. There are countless social media groups trying to solve the issues of COVID-19 diagnosis and treatment. What else can we build together? A global system of information- and supply-sharing? A freely-accessible vaccine? I anticipate that amazing innovations will grow out of this renewed spirit of teamwork. 

Third, good intentions are not enough, but they can be a good start. For example, American naval ships quickly arrived in Haiti to provide care, an admirable intention. But there were negative outcomes. Some local Haitian doctors who could still work were unable to compete with the free and novel care offered by the Americans and had to close their clinics. And although the care provided by the volunteers was high quality, when the ships left they took their knowledge with them, leaving local staff to deal with complications of procedures and medications that they had rarely if ever seen. Similarly now, we all want to help. But we need to be measured in our response, especially with the frightening statistics on physician mortality coming from countries in later stages of the pandemic. We need to first do no harm. How do we protect ourselves, our patients, and our communities? Perhaps one place to start is traditional and social media, amplifying our voice to encourage people to socially distance themselves and follow the advice of public health experts rather than bloviating presidents and self-proclaimed pundits whose advice is confusing at best and deadly at worst

After I came back from Milot I did not cope well. Interest rates, flat bike tires, and choosing the wrong line in the grocery store did not matter anymore and I felt guilty that they ever did. Everywhere I looked it seemed that the more I had, the more I had complained. It took time and many conversations to realize that we are all doing the best we can with what we have experienced and what we know. Now I see that as the world changes around us because of what we do or what is done to us, it’s okay to feel guilty about not being able to do more. It’s okay to rage inside. It’s okay to not comprehend that magnitude of what is happening. And it’s okay to cry: we are all grieving the loss of our remaining innocence, the lives we had, and the relative certainty we once had.

Lastly, even frontline soldiers need to be pulled back. As part of our work in Haiti we were mandated to take a morning to hike up to La Citadelle, a colossal, centuries-old fortress. We were not asked if we wanted to go. We were told. The physical activity allowed our overactive brains to rest. The time in nature restored us. And walking around the UNESCO heritage site brought out the wonder and history of the place we were humbled to visit. I have no doubt that once back in camp, we finished our daily duties with a renewed communal spirit and drive to carry on the work. Similarly now, we will need to remind, perhaps even push, each other to get rest, eat well, spend time with friends and family (in-person at home and virtually for distant or vulnerable loved ones), and get into nature (while keeping appropriate social distance.) We will tell our children that there was a time when planes flew and played announcements that in case of emergency we should put on our own masks before helping others. This is excellent allegorical advice for life. 

Times are difficult and everything is changing. But the lessons taught to me in Haiti give me hope that we will continue to support and encourage each other now, with acts of kindness and shared knowledge shining like stars in this dark sky.

Dr. Eric Cadesky is a family physician in Vancouver.

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