Horror in Haiti, Then and Now

Jan. 19, 2010— -- I remember walking through the squalid downtown of Port-au-Prince and coming across a woman sitting by the roadside selling carefully washed tin cans. That was how she made her meager living.

There were scenes that were more appalling -- a man on a street corner with his head split open by a machete, a corpse on a pile of burning tires. This was in late 1987, when hopes for freedom and democracy after decades of brutal dictatorship were rudely shattered by election-day violence. In the days before the election, gunfire and explosions echoed in the night but the people I talked to were optimistic about the future.

In fact, on the morning of election day, I spoke to people in long line-ups waiting to vote at polling stations that had been fire-bombed overnight. They were hoping against all evidence that they would still be able to cast a ballot and that their votes might somehow improve life.

That election was canceled after hundreds died in brutal gun and machete attacks on polling places. I spent several hours hiding with colleagues, sheltered by a Haitian family, after gunmen chased us with automatic rifles.

But although the aborted election clearly was not going to improve life, I thought -- with that woman in mind -- that it could at least not get much worse.

Last week it did.

Until Tuesday's earthquake, death in Haiti had been retail. Now it was wholesale. When I started to interview people familiar with the country, the word most used was "horror." It came up again and again.

So far we don't know how many have died. We may never know, although the European Union is now suggesting it could be 200,000. The population of Port-au-Prince is a guess at the best of times, with its bitter slums crowded with people who have little or no business with officialdom. How to count the dead, when many had no official lives in the first place?

The Canadian government says there were about 6,000 of its citizens in Haiti at the time of the tremor, of which about 860 remained unaccounted for Monday. I haven't seen comparable figures for Americans.

But if you assume that missing means dead -- and as time passes the assumption becomes more and more plausible -- then the quake killed about one in seven Canadians in Haiti. Extrapolate that to a low-ball estimate of the population of Port-au-Prince -- say 2.5 million -- and there could be 350,000 dead.

It will probably -- I hope -- be lower.

There will also be deaths outside the capital. Jacmel, for instance, is a lovely seaside town about 25 miles south of Port-au-Prince (although about twice that by road). Jacmel was about 17 miles from the epicenter of the quake, and it, too, was shattered. Although the focus of aid efforts has naturally enough been the capital, we can assume other Haitians need help.

At MedPage Today, of course, we are concerned about the medical aspects of the disaster. Those we interviewed said that by and large the Haitian healthcare system was a mess before the earthquake. That means that immediate care will mostly have to come from outside, with the inevitable delays. And, as television images have shown us, it has been enormously hard to get even first aid -- let alone definitive care -- to the people in need.

But the aid is trickling through, and the trickle will no doubt become a torrent in the next day or so.

After the immediate crisis, though, there is another challenge: rebuilding the country. The key question is: will it be re-built better? Or will it be patched up and set adrift again, prey to the next natural disaster that strikes?

The world can send aid. Will we have the will to build good hospitals, comprehensive healthcare, modern water and sewage systems?

If we do have that will, perhaps life will finally improve in Haiti.

Michael Smith is North American Correspondent for MedPage Today. He has been covering the health and medical impact of last week's earthquake in Haiti.