So when are you going to Haiti?” No “Hi, Dad” or other words of greeting, identification or salutation. My children had embraced with a vengeance their father’s penchant for bluntness: Occam’s Razor newly honed and freshly applied.

The semi-joking tone in my oldest daughter’s initial words to me on the telephone the day after the Haiti earthquake seemed a tad presumptuous, and yet…confident.

The 7.0 magnitude earthquake had struck 10 miles west of the capital city of Port-au-Prince (PAP) at 4:53 p.m. on Jan. 12. Many schools, businesses, government and non-government organization (NGO) buildings were destroyed along with the teachers, students, administrators, judges, doctors, nurses, etc., still in them. Other buildings were rendered unsafe for occupancy. Seven of eight hospitals in PAP were destroyed. The president of Haiti became one of millions who were homeless. The parliament building, palace of justice (Supreme Court), and City Hall collapsed, as did the National Cathedral, the headquarters of the UN mission to Haiti and the World Bank. Telephone and electrical power systems and most commercial radio broadcasters were knocked out. Four thousand inmates of the main prison escaped. Ninety-seven percent of the schools in PAP (and 50 percent in the entire country) were leveled. The largest school of nursing collapsed during final exams, slaying the entire first-year class. Most colleges and universities were down or deemed unsafe to enter. Water pipes ruptured, the port was devastated, the airport terminal fractured and the control tower severely damaged. Current estimates of the number dead range from 230,000 to 300,000.

I’d always had an interest in doing disaster medicine, perhaps originating back as far as embracing the Boy Scout motto “Be prepared” as a youngster. Growing up on a farm with parents who had lived through the poverty of the Great Depression taught “thinking outside the box” both in terms of what might happen and how to creatively address the unexpected. The old joke that most things could be fixed with either chewing gum, baling twine, or duct tape had a grain of truth behind it. “Waste not, want not”; “A penny saved is a penny earned”; “Use it up, make do, or do without” were maxims branded into the brain by everyday necessity.

On-the-spot problem solving is a daily issue in family medicine, obstetrics, and emergency medicine, the areas of medical practice with which I have the greatest affinity. Formal coursework in neonatal resuscitation, pediatric advanced life support, basic life support, advanced cardiac life support, advanced trauma life support, basic disaster life support, advanced disaster life support, advanced life support in obstetrics, and incident command system 100, 200, 700, and 800 courses followed after my residency in family and community medicine. My two oldest daughters accompanied me on a 10-day trip in 2000 to Belize to work in the PCA’s Presbyterian Mission Clinic, so I had some experience with Third World conditions and medicine. My son and I worked in the D’Iberville Free Medical Clinic near Biloxi, Miss., after Hurricane Katrina devastated the area with a 26-foot storm surge in 2005. With my good wife’s blessing, I responded to the appeal on several web sites for healthcare workers to go to Haiti: Operation Smile, the American Medical Association, and the Presbyterian Church in America’s Disaster Response Ministry, a branch of their Mission To the World (MTW). Four-page applications were completed, my passport renewed, immunizations updated, coverage for my call schedule and patients arranged, a teacher for my high school Sabbath school class scheduled, food/ survival/camping supplies purchased and packed, and prophylactic malaria medicine and antibiotics obtained. MTW was the first organization to respond with a request for me to be a part of a team to go to Haiti in early March, which happened to coincide with time I had already requested off during Penn State’s spring break week.

Dozens of emails with MTW and members of the team followed. MTW asked me to coordinate among the team members who would bring what medicines and supplies. Our team leaders would be a husband and wife duo: He is an architect and she a nurse practitioner. Other team members included a dentist, a pediatrician, a nurse practitioner, and two pre-med students from Wheaton College. Only four on the team were members of the PCA. As some of the connecting flights to Miami were late, most of us met in person for the first time after our arrival in PAP.

Upon my request to our congregation’s deacons, they agreed to provide $1500 from the mercy ministry fund to underwrite the trip. My local hospital donated hundreds of dollars’ worth of medicine. A nurse coworker gave me a $100 check towards whatever was needed; and, since she was the recent Exalted Ruler of the local Elks club, volunteered to get the same amount from them. I didn’t refuse it.

Back in the 1970s a team from Geneva College had been one of many groups that helped build a Christian elementary and high school for local and missionary kids in Haiti. Called the Quisqueya Christian School (www.quisqueya.org), it was built with earthquake resistance in mind. All of those buildings withstood the quake. A former student of the school provided contact information for MTW staff who decided to make the school a base for disaster relief operations.

Other disaster medical teams found space there as well: a German-based group called Humedica; the Vermont Disaster Relief Team, and several other denominationally based groups. Similar installations of many more teams from the U.S., China, Russia, Israel, Italy, France, Canada, Brazil and other countries dotted the city and countryside. Almost all of the various teams’ members came and worked for 1-2 weeks on their vacation time, as I was doing. The Quisqueya school’s walled compound was also picked by the U.S. Army’s civil affairs liaison team as their place to stay. Therefore, in God’s good providence, Navy Seals and Army Special Forces provided overnight security for our camp. We felt secure.

As expected, we slept in tents for the week; but a predecessor had left an inflatable twin-sized mattress behind for me to use. Unexpectedly, 3 hot meals a day were provided. The jokes eventually came all too readily as to whether the menu for the evening was rice, beans, and chicken; or chicken, beans, and rice; or beans, rice, and chicken. Salad and fruit were also provided; however, we were advised to avoid anything uncooked or that we didn’t peel ourselves to reduce the risk of acquiring a gastroenteritis infection.

Our team was transported by bus or truck each day to the Diquini refugee camp located an hour away on property owned by the Seventh Day Adventist Church. This campus had various schools from kindergarten through university and seminary level, a 30-bed hospital, bakery, cafeteria and an auditorium. Most of these buildings had survived intact. An estimated 20,000 Haitians had fled their destroyed or damaged homes in the surrounding slums and put up tarps and tents on their grounds. A Canadian disaster relief agency called GlobalMed had donated an inflatable 30-by-60-foot tent to serve as a clinic.

After the hour-long drive each morning through the devastated downtown (down had a whole new meaning) of PAP, we would unpack our supplies and start to see patients. Our clinic did primary care for a population that had seen very little of it. We saw diabetes, asthma, hypertension, lacerations, boils, many women afflicted with urinary tract and genital infections, and many people with post-traumatic stress disorder. Since losing homes and loved ones in the earthquake, these people were hyper-vigilant, fearful and depressed, or complained of poor sleep, racing heartbeats, anxiety, shortness of breath, nightmares, loss of interest, irritability, and even guilt over why they were still alive and others were not. Despite a national appeal prior to our departure, our team had no pastors or counselors joining us to provide counseling for those in need of it; so a local pastor did what he could, providing a listening ear and prayer. Almost every patient that our team saw (120 per day, divided among 2 doctors and 2 nurse practitioners) was offered prayer by their clinician. Only one of the patients I saw refused the offer.

Essentially everyone in Haiti has intestinal parasites, including two-to-three-foot-long roundworms. All patients were treated with a single dose of mebendazole, a highly effective treatment. One such patient was a three-year-old girl who was in great pain due to the complications of a severe roundworm infection.

Perhaps the patient with the bleakest outlook was a five-year-old girl whose skull was 50 percent larger than it should have been. She was listless and poorly responsive. Her hydrocephaly (“water on the brain”) had needed neurosurgery months ago. Her overwhelmed mother, with two other young children in tow, had gotten her to see a neurosurgeon a week before the earthquake, but the hospital where she had seen the neurosurgeon had been destroyed in the earthquake, perhaps with the neurosurgeon inside. The University of Miami Medical School in Florida has long had a presence in Haiti in various forms and had set up a several-hundred-bed tent hospital near the PAP airport with neurosurgery capabilities. We referred the mother and her girl to go there, knowing that, if they could get there, she would be able to get care.

The hour-long trip back and forth each day provided new vistas with each turn of the preexisting poverty and post-quake devastation. For security reasons, we took slightly different routes most days to avoid becoming predictable in our travels. While we were there, two female physicians from Doctors Without Borders were kidnapped off the street in PAP. They were eventually released, probably after large sums of money changed hands. Haiti is a failed state for a host of reasons; many not the fault of the people who are born, live, and die there. It was populated largely by kidnapped African slaves who were mostly kept uneducated by their French overseers. When they won their independence from Napoleon’s empire, recognition as a nation was granted only upon condition of reimbursing the French 90 million francs for the loss of their “property.” Subsequent leaders of the newly independent slaves reenslaved and murdered their own people, as did the U.S. during its occupation of Haiti by Marines between WWI and WWII.

Bright points in Haiti are generally centered on the work of the many different Christian churches there. Eighty percent of the 9 million people of Haiti are Roman Catholic. The Catholic church is recognized in the national constitution as the official state religion. Baptists have the largest Protestant presence, with Pentecostal churches next largest. Half of the population also practices Voodoo; it is my impression that this syncretism is most common among those who are Roman Catholic. Many of the Christian groups operate schools, orphanages, or clinics, as do a number of nonreligious NGOs. The PCA and OPC are two sister denominations with a small presence there: 1 or 2 missionary families apiece. Reports indicate a general receptivity to the gospel.

A painful institutional memory of the RPCNA is that the first missionaries we sent overseas were sent to Haiti in the 1800s. Sadly, they converted to Jehovah’s Witnesses. Our denomination has never returned to Haiti in a sustained capacity. Perhaps some reading this will feel called to improve on that. There is no end to the work needing to be done; it is geographically quite close by, living expenses are very low, and, as our Lord proclaimed, the fields are white for harvest—especially for a very hurting people.

—Jonathan Adams is a physician and an elder in the Grace (State College, Pa.) RPC.