As Flagstaff orthopedic surgeon John "Bull" Durham walked into an operating room in Port au Prince Haiti last Friday to operate on a Haitian woman with a huge tumor on her wrist, the Haitian government announced that it had raised the cost of fuel.
Gasoline prices increased by 38 percent, diesel went up by 47 percent and kerosine increased by 51 percent, according to a joint statement released by the Haitian Commerce and Economic Ministries.
While Durham and a team of surgeons were getting started on what would be a complex 11-hour surgery, trouble was brewing on the streets of the city. Protestors started to block roads with burning tires and looters took to the streets, smashing storefronts and emptying the contents as vehicles burned.
A black cloud of anarchy and smoke was spreading over the city.
The trip was the 30th Durham has made to the impoverished Caribbean nation, which has been beset by natural disasters, political strife and the lowest standard of living in the Western Hemisphere.
Durham usually leads two medical mission trips to Haiti, one in June and a second in December, with the Northern Arizona Volunteer Medical Corps based out of Flagstaff. Durham is the president of the NAVMC board and the driving force behind organizing teams of surgeons, anesthetists and nurses to travel to Haiti to operate on those who have no other access to medical care.
He had traveled to Haiti on July 4 to operate on a 23-year-old woman named Rose who had a tumor on her forearm the size of a cantaloupe. Durham had met Rose during his June trip to Haiti and realized that he needed help working out how to treat her condition.
For Durham, Rose's case was a very special one.
"This was almost like a symphony. An amazing collaboration of different people around this one woman's arm and finding a way to heal her," Durham said.
It started with Dr. Jean Wildric Hippolyte, a Haitian orthopedic surgeon whom Durham had sponsored to do a residency in Flagstaff. He saw Rose and "immediately realized that her condition was beyond the scope of what he could do for her. He got on the phone to reach out to two orthopedic surgeons in the States. When he contacted me I realized that I needed help too and I contacted 20 different people to consult on the case,” Durham said.
"In Haiti the different medical communities are often each focused on doing their own things and this case was an example of everyone working together. I believe that Rose's case has sown seeds that will lead to future growth and collaboration among the teams working to provide medical care in Haiti,” he said.
Rose is a student who is in the 11th grade and has dreams of becoming a nurse.
"It's not unusual for a 23-year-old woman to be in the 11th grade because education is a challenge in Haiti," Durham said. "Schools will often close for weeks and months at a time, making academic progress difficult. We fixed the femur of a 15-year-old girl while we were in Haiti and she was in third grade.”
After removing the tumor that encased Rose's forearm and rebuilding the tendons connected to her fingers, the surgical team came out of the operating room to discover that the situation out on the streets of the city had become so chaotic and dangerous that everyone was effectively stranded inside the hospital compound.
The streets of Port au Prince, which were normally jam packed with cars and trucks jockeying for position in a never ending traffic jam, were empty of vehicles and instead filled with make-shift road blocks of concrete pipes, burning tires and felled palm trees.
Sporadic gunfire rang out over the city as men wielding machetes roamed the streets looting businesses and hotels.
The sudden fuel hikes were the result of an agreement between the Haitian government and the International Monetary Fund. The IMF organization has called on Haiti to make reforms in its public administration and increase gas prices, which have been kept artificially low through government subsidies. Failing to make economic reforms and raise more revenue could lead to the loss of $96 million in support from international donors, according to the IMF.
As the Haitian doctors and medical staff who had assisted in the surgery looked for places to bed down for the night, in the hospital Durham was thinking about the chances of making his flight home.
"I was scheduled to fly out Saturday night and it was clear things were getting worse, not better," he said. "All flights on Saturday from both of the airports that serve the Haitian capital were canceled."
"The hospital that we were staying in was on the edge of the city at the base of a range of mountains. You could walk away from the city and be relatively safe, so on Saturday we all went for a hike up onto the mountain. You could see the black smoke from the fires just spread out over the city and hear gunshots coming from the neighborhoods," Durham said.
By Sunday morning, July 9, the U.S. State Department was updating its travel advisory for Haiti, raising it to "Level 4: Do Not Travel."
"We had internet on Sunday morning and we were checking every flight that was scheduled to leave the States heading towards Haiti. We would see a flight and its status was canceled, another was delayed, then boarding, then delayed on the tarmac. At 10 a.m. an American Airlines flight from JFK in New York took off heading for Haiti," Durham said.
"Once we saw that the plane was in the air heading for Haiti, we grabbed our stuff and bundled into the back of a Toyota Landcruiser ambulance to try and get to the airport," he said.
"There were no cars on the streets and we had to weave around road blocks and burning tires using side streets and alleys. At one point we came to a road block closing off the street. Seeing that we were an ambulance, a couple of protestors moved a section of the road block and waved us through," he said.
Durham arrived at the airport to find it filled with passengers waiting for flights out of the country who had been camping in the terminal during the unrest. He was able to get a standby seat on a flight out to Miami and arrived back in Flagstaff on Monday.
Durham is already planning the December trip that he will lead to the Bernard Mevs hospital in Port au Prince.
"There is important work to be done and we have an amazing team of volunteers ready to help the people of Haiti," Durham said.