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I’m a neurosurgeon, and I had the opportunity to spend a couple weeks in Port Au Prince, Haiti last year, arriving just two weeks after the earthquake in February. This was a great opportunity to serve people in need, but I also benefited from seeing WTSHTF firsthand. I brought in a team of three doctors and two nurses , along with one former Marine turned pastor (for security).

When a missionary flight company said: “We can get you in if you can be here day after tomorrow, but we can’t guarantee you a flight out,” a wiser person might have said “no, thanks.”  But I said “We’ll be there.”  The flight in was on a private jet, donated for use by a NASCAR driver. On board, we had pizza and propped our feet up in the leather recliners. We knew the party was over as we approached Port Au Prince. Not only could we see the smoke from the burning bodies piled up in one location, and the harbor full of warships and one massive hospital ship, but we could also see the planes landing before and behind us. As we taxied off the runway there was already another plane touched down at the far end of the strip, and two others behind him making an approach. The US Air Force was controlling traffic and they didn’t have one accident despite the incredibly high traffic volume. The airport was absolutely packed with containers, cartons and bags of supplies.  Most of them were unsorted and useless. The pilot handed us a case of water bottles as we got off the plane.

I’m sure most soldiers have seen as many guns, tanks and helicopters as I did in Port Au Prince, but I had never seen so many people openly armed before. U.N. and U.S. forces predominated, but there were also Haitian police and other forces I couldn’t identify. Nobody carried just a handgun. Traffic was snarled, and there were wrecked cars and debris in most streets. In some areas of town there were still unburied bodies. The last few survivors were dug out while I was there. There was no power but there was pretty good cell phone service, which was great as I was able to use the internet to look up some of the odd diseases I was treating.  AT&T provided free Internet/text service to subscribers, which was most helpful.

We had coordinated with a large local church, and were able to set up camp in the walled yard behind the church itself. The area was guarded 24/7 by the church youth group (older teens) who were not armed but wore military type uniforms. US troops made regular patrols, and one patrol gave us some water bottles and additional MREs. I have a great photo of me and my girlfriends: a couple of female lieutenants armed with M4 Carbines. All I had was a scalpel and a multi tool. I recommend stocking up on weaponry now in case we find ourselves in a similar situation in America. That multi tool looked pretty small compared to the carbines everybody else had.

The biggest issue in coordinating response to this disaster was a total lack of leadership and organization. Sadly, we had the same problem in the U.S. after Hurricane Katrina (I live and work about 350 miles from New Orleans, so was involved in the refugee management also).  We spent our first afternoon in a Haitian hospital. Conditions were miserable. No power, no clean sheets, very limited medical supplies. No one was in charge. The French were snapping orders to everyone, but getting little done. A team of EMTs from Utah was trying to help, but didn’t know what to do. There were some US surgeons doing amputations and abdominal explorations but they were so overworked they couldn’t leave the operating room to see what was going on in the wards. There were supplies, but no one knew what was available or where it was. People were dying there from lack of care. I decided we would be better off setting up a community clinic as I didn’t think conditions were conducive to neurosurgery, and the massive crowd of people outside the hospital compound suggested that there were lots of others needing attention.

A team of Brazilian disaster response specialists were also staying in the church yard with us. Brazil has a network of primary responders, including doctors, nurses, EMTs and even an architect to inspect the buildings for safety. They rotate the teams every two weeks, overlapping the departure of the members so that the new team can be adequately briefed. They have standard supplies (pre-packed bug out bags) and equipment. Some of the individuals staying with us had also been to Indonesia after the tsunami. They made us look bad!

We flew in with our “bug out bags” and as many medical supplies as we could carry. I brought a backpack with two scrub sets, 5 changes of underwear and socks, 3 t shirts to wear underneath the scrubs, a hat, a silk mummy bag (very light), tent, 10 complete MREs, a bag of mixed granola and dried fruit, instant coffee sticks, propal sticks, several 16 oz water bottles, water bottle with filter,  flashlight, matches, multitool, bug spray, and basic toiletries (soap, toothpaste, toothbrush, small towel, nail cutter, saline for contacts).  I also carried a compact video camera. Please note I didn’t have any of the fancy equipment recommended in some survival literature, though we did have a couple hours access to a generator at the church each night, which I used to charge my phone. I didn’t miss much, but if I was packing again now, I would add an inflatable pad (I did inherit one when one of the Brazilians left, but that ground was pretty hard before that), an extra set of scrubs, a couple more t shirts and some laundry soap! We had a group set of walkie-talkies, but they were useless out in the city and failed us on several occasions. The rest of my backpack and a bag were filled with pre-sterilized surgical kits, dressing supplies and medications, mostly antibiotics and pain medications.

Between the Brazilians and the very organized church we were staying at, we managed to set up some good quality clinics with one running daily in the church yard and another in different refugee camps. We did some wound management, but most of the problems we were seeing were related to poor sanitation and lack of clean water on the streets.

Just our group of six saw more than 1,200 patients. We had translators and nurses from the community. The translator I worked with the most was an attorney, volunteering his time. He and his wife and their two small children were living in the backyard of their house because it had not been checked for structural safety. Despite that disruption, he cheerfully sat next to me for hours each day, translating patient complaints and my responses.  Order was key to our success, as we had hundreds of patients responding at each site daily. People were easily angered, and we had near riots at one camp over the medical line, and several times over water distribution as the church was also running an industrial sized water filter and distributing water. One of these was stopped only by the pastor, who went chest to chest with the loudest of the agitators and backed him down. Survivalist books that tell you that attitude is everything are correct, as that pastor had no weapons, just his authority (though I’m sure God’s protection was helping as well).

As this was not Haiti’s first disruption, most people were used to living without power and had generators or candles. All the houses in town had high walls, topped with broken glass or barbed wire. Windows were covered with iron bars or heavy shutters. Houses had heavy iron gates (usually solid), and the vehicles pulled up inside the gates before the occupants would get out.  We were cautioned to remain very alert when traveling in town and never to leave the vehicles. The vehicles did not stop in the back streets to avoid traps. The back streets were dirt, and homeowners often added cement bumps in front of their houses to slow traffic. We mostly traveled in the back of two pickups. One of them always had to be parked on a hill and rolled to start. The other had no headlights, but someone in the front seat would carry a flashlight and shine it out in front as we approached intersections at night. We did travel at night several times to the pastor’s house to shower (generator and cistern), and he would call ahead so someone would be ready to open the gate and we would not stop in the street. He said a car had been attacked nearby when stopping to open a house gate, and the occupants killed.

We had not brought all the medications we needed, as we didn’t expect to see so many kids with parasites and fevers, and ladies with vaginal diseases. Most of this was from poor living conditions and bathing in unfiltered water. There isn’t much worse than giving calcium tablets to sick kids because that is all you have. I took the former Marine, and went to the University of Miami hospital which was set up at the airport to see if we could get some supplies. Disorder reigned there also, though it was certainly better than the Haitian hospital. Despite the stacks of supplies, we couldn’t get anyone to agree to let us have some. After talking to several people, we got permission to get “a couple” bottles of children’s Tylenol, which was better than nothing. Visiting the supply tent, we talked the teenage volunteer out of a case of Tylenol which was put to good use. We then tried the US Army without success, but we were referred to a warehouse run by the World Health Organization. After we made it past the armed guards, the first clerk told us we needed an account there, and even if we had one the supply delivery would take a week. Happily we found a sympathetic supply officer, who listened to our story and asked how many patients we were seeing, and then twisted our story slightly and wrote that we were from Miami Hospital on the form. After all, we had just come from there. He told us to come back that afternoon. I was crushed that we couldn’t find a ride that afternoon, but the next morning he loaded us up with antifungals, parasite treatments, and even medications for high blood pressure and diabetes.  It was like striking gold! God bless that guy that bent the rules to get the supplies out to the people.

Psychological preparedness in the responders was very important. One of the doctors with us was convinced she would get sick if she drank anything but bottled water. When the bottles ran out, we all began drinking the filtered water from the church. Sure enough, she got sick (and even fainted). The rest of us did not. On the other hand, the former Marine and I were able to liberate supplies, because we went in unwilling to take no for an answer (when Miami wouldn’t give me what I needed, I said sweetly “How about a couple bottles of children’s Tylenol, at least?” and got a yes).  I found it was very difficult to manage even the small group I brought with me once they were all under stress. If you plan to face TEOTWAWKI with a group, make sure you get to know each other well before the event, and establish a clear chain of authority.

Water containers were at a premium, both large to get water from filtration sites and small bottles for drinking and refilling. Tarps were also like gold. People were building shelters from rags and sticks. Thanks to the international response, there was plenty of food, but distribution sites were crazy and there was rioting, so going to get it was pretty risky. It would have been better to have stocks at home. Homes in Haiti were already fortified before the quake, so for those that didn’t lose their houses security was already set up. Because the power wasn’t reliable before the quake, most middle class people had generators at home, as well as rainwater collection systems and cisterns. If you live in a city and plan to stay in case of an American economic collapse, I would strongly consider you figure out how you are going to collect and store water. Even if some public services remain, water delivery may not be reliable.

There were two principles that I observed in this disaster. First, people in this situation behaved in one of two ways. Some rose to the occasion, volunteered to help others, shared what they had and remained calm. Others sunk to crime, anger and violence. I was amazed by the church members who remained faithful and were praising God right through this disaster. Many of them spend hundreds of hours helping us in clinics, passing out food and water and risking their own lives. Second, organizational and leadership skills are absolutely critical in disaster response. The U.S. Air Force took charge of traffic control at the airport, and as a result it was flawless. In the hospitals and streets, however, no one was in charge. Many people with wounds went without antibiotics, while crates of them sat unopened at the airport.  Though there were plenty of doctors around, it was very hard for individuals with wounds to reach them. I saw a completely unset leg fracture three weeks after the earthquake in the clinic behind the church. She couldn’t get through the crowd outside the hospitals! People couldn’t get medications for their chronic diseases, like high blood pressure and diabetes, and there was little available at the hospitals (but the WHO warehouse had a stock). 

Tarps were selling like gold. Food was available, but it was dangerous to go get it. People were washing in contaminated water and spreading disease. Having someone in charge would have made a huge difference, but the Haitian government was not prepared and with the large international response everyone was doing their own thing.

As we face “rolling power outages” here in Texas this week, due to freezing weather and snow storms, I am amazed more people don’t realize how close we are to the edge. Preparedness, both practical and psychological, should be a priority for all Americans at this point. I was able to fly out of Haiti, thanks to the U.S. Air Force, but if it happens here, there won’t be a midnight flight out.