"Haiti Chéri, Haiti Fâché" - Saint-Marc after the violence

© Linda Van Weyenberg/MSF In mid February, MSF staff took over emergency treatment and surgery in the hospital during the absence of the permanent medical staff who had fled the violence.
The coastal town of Saint-Marc is a two-hour-drive from the Haitian capital Port-au-Prince - along a breathtaking coastline with turquoise water and richly-coloured flowers - and home to some 50,000 inhabitants. In the past weeks the city has suffered badly from insecurity and political instability. In early February, it was taken by rebels and then retaken by the police. Since the departure of President Aristide, the political situation has now changed again. All these power shifts have caused a series of violent acts of vengeance in which every party has been hunting down and killing suspected opponents. "Haiti Chéri, Haiti Fâché," Congolese emergency doctor Albert Tshiula summarized the current situation, meaning that Haiti has everything to be a Caribbean fairytale but has turned into a nightmare because of the endless political turmoil. In its 200 years of independence, Haiti has had no less than 35 coups d'état. The original proverb 'Haiti Chéri, Haiti Joyeux' - Lovely Haiti, Happy Haiti - has turned into 'Haiti Fâché' - Angry Haiti. As the MSF car drives past some rubble in the street, Dr. Tshiula points out that this is the place where only a few days ago seven sympathizers of Aristide were burnt after being slaughtered by machetes. Dr. Tshiula and the Chilean logistical coordinator, Juan José 'Paco' Arevalo, are the first MSF team to arrive in Saint-Marc since Aristide left the country. Everyday life seems to be restored again. The population has returned to normal life. There is a lot of traffic, the colourful market is full of energy and commercial institutions such as banks are open again. But both Dr. Albert and Paco realise that there is still much anger beneath the surface of society and that violence can flare up any moment. There are no police or other force in the city - the town is running itself. But for the moment, MSF does not fear this power vacuum because it trusts the local population. "We have much to thank our local staff and the local population for," explained Paco. "Last Sunday, the day that Aristide stepped down, a group of armed men came to our office here in Saint-Marc. They threatened Bruno, the guard, by gunpoint and Godson, our local logistician. They wanted to take our cars. Our staff began to negotiate with them and explain that MSF was not working for the government but for the Haitian population and that it was wrong to take our cars. "The negotiations lasted for more than an hour and after a while the local population came to the rescue, to persuade the armed men not to take the cars but to respect the work that MSF is doing. In the end the men left without taking anything." The sympathy that local inhabitants have for the work of MSF is demonstrated by the sparkling enthusiasm with which they welcome the MSF team's arrival in the city. The destination of the team is Saint Nicolas Hospital, a 110-bed public health structure and reference hospital for the whole region, which has a total population of some 250,000 people. In mid February, MSF staff took over emergency treatment and surgery in the hospital during the absence of the permanent medical staff who had fled the violence. Dr. Tshiula organized a rotation duty with the remaining staff to ensure 24-hour access to emergency care, and gave training to health staff. But after the MSF team went to Port-au-Prince some two weeks ago, they were unable to return to the Saint Nicholas hospital until now because of insecurity. The hospital seems almost empty. There are only a few people in the emergency unit - no war-wounded - and inside the hospital there are less than ten patients in total and only one war-wounded to be found. The low number of patients in general is mainly because most of the medical staff have not yet returned to the hospital, forcing patients to seek treatment elsewhere. The patients who could afford it sought help from private clinics or doctors. The patients who could not afford private care, either simply stayed home and hoped for the best, or received very limited basic care at the hospital. When asked where all the war-wounded went to, nurse Fanfan - responsible for the emergency room - says "There are no wounded, only dead." Dr. Albert explains further, "The insecurity and absence of medical staff have halved the number of people attending the emergency unit in the hospital. In January, we had 296 patients, but in February we counted only 141 patients, of whom 27 were wounded by bullets. A total of 21 patients were operated on in the operation theatre that MSF constructed only recently to ensure proper emergency treatment." The prediction that patients will start coming back to the hospital now the local population has seen MSF is back to run the emergency unit is confirmed the next day: early in the morning there are already eight patients. MSF staff pull up their sleeves and go back to work.