Four months after Haiti quake, wounded Carroll County aid workers return to devastated country

Trapped in the darkness of a wrecked Haitian hotel, choking on the dust of crushed concrete, Richard L. Santos wondered whether anyone would ever find him and his five colleagues, two of them badly hurt. At one point, the thump of a helicopter's swirling blades gave them hope, only to fade into silence.

As he awaited rescue from the Jan. 12 earthquake that shook Port-au-Prince to its core, Santos made a vow. "We knew the whole city must be devastated, and I realized that the rebuilding of Haiti would take decades," he recalled. "I told myself that if I got out of this alive, I would come back and be involved for as long as it would take."

Now, four months after his rescue, Santos is keeping his word. The 46-year-old chief executive of the Carroll County-based aid organization IMA World, and a colleague, Ann S. Varghese, 31, are returning to Haiti. Both plan to fly out on Sunday, determined to help restore the country to health even as the American public's attention turns to fresh disasters such as the huge oil spill in the Gulf of Mexico.

"The quake created a bond with me and the people of Haiti," Santos, who had never been to the Caribbean nation before his fateful visit in January, said a few days ago at IMA's headquarters in New Windsor.

Within days of the disaster, IMA's staff in Maryland arranged for a shipment of $250,000 worth of medicine and supplies to help Haiti's injured. A few weeks later, IMA -- the acronym stands for Interchurch Medical Association -- sent two assessment teams to Haiti, one to determine how to get its tropical-diseases program back on track, the other to look at the broader needs of Haiti's badly compromised health system.

What became clear was that for aid workers from overseas, the earthquake and its aftermath compounded enormously the obstacles and difficulties already prevalent in day-to-day life in Haiti, one of the world's poorest and most dysfunctional nations. By any measure, a sense of chaos continues to envelop Port-au-Prince and its environs, with thousands living in makeshift camps, snail's-pace efforts at reconstruction and bottlenecks in foreign aid.

"There were definitely things thrown our way that would not have been there without the quake," said Varghese, who runs one of IMA's tropical-disease programs and was with Santos in the destroyed Hotel Montana.

Of immediate concern was that IMA's offices, housed next to a Port-au-Prince hospital that was demolished by the quake, were quickly taken over by medical workers in need of usable space. So IMA decided to move its base of operations to the port city of Saint-Marc, 60 miles north of the capital, along with the organization's five Haitian staff members, all of whom lost their homes. The move to Saint-Marc made sense, Santos said, because the town suffered much less damage than Port-au-Prince and is in a more central location, making access easier to communities far from the capital, which is in the south.

The 7.0-magnitude quake also forced the postponement of a distribution of tropical-disease medications to some 230,000 people in Cap Haitien, on the northern coast. Initially set for the last week of January, it took place in April and ended up helping 15 percent more patients than planned "because of all the people who had moved out of Port-au-Prince after the earthquake," Varghese said.

Several other so-called mass drug administrations, scheduled for May, will now be undertaken this month, some during the visit by Varghese and Santos. By the end of June, more than 4 million Haitians will have received medications since last fall under the IMA program, known as Neglected Tropical Diseases, which seeks to eliminate elephantiasis, a mosquito-borne disease that causes abnormal enlargement of parts of the body, and soil-transmitted helminthes, intestinal worms that mostly afflict children.

IMA's Haitian volunteers, about 17,000 of them, also distribute Healthy Kids Kits -- soap, toothpaste, toothbrushes, combs, skin lotion, washcloths -- and Safe Motherhood Kits, which provide sterile items such as gloves, umbilical ties, gauze pads and plastic sheeting for women about to give birth, as well as blankets, tunics and hats for their newborn babies.

But the devastation wrought by the earthquake prompted Santos and his associates to study the needs of Haiti's health system as a whole. "We looked at it from a longer-term perspective," he said, concluding that the best way to approach the country's health-delivery shortfalls is to begin by decentralizing the system, moving its directorate out of the capital and splitting it into smaller regional hubs, each served by a major hospital and concentric rings of smaller hospitals and clinics.

"Everything can't run out of Port-au-Prince," said Santos, who suggested establishing a pilot program in a regional health district over a period of some three years, during which the infrastructure for a local health hub would be set up. "It would coordinate hospitals and clinics in a way they haven't been previously."

If the model works, he said, it could eventually be established throughout Haiti, but it would cost "hundreds of millions" and would need the support of organizations such as USAID and the World Bank.

Santos, Varghese and Sarla E. Chand, IMA's 65-year-old vice president for international programs, had gone to Haiti in January for a meeting of the partners behind the tropical-diseases project, which include U.S. Agency for International Development, the University of Notre Dame's Haiti Program, the U.S. Centers for Disease Control and Hatian officials. They were standing in the hotel's sumptuous lobby when the five-story building began to shake violently. At the time, some 300 people were thought to have been registered at the Montana, built in 1947 on a mountaintop with a panoramic view of the city below and the sea beyond.

When the quake hit, the IMA team and their colleagues were knocked to the floor by the collapse of the lobby and would have been crushed were it not for the sturdy reception desk, which propped up a piece of the ceiling inches above their heads. Two ministers with the United Methodist Committee on Relief, Samuel W. Dixon Jr. and Clinton Raab, were pinned by debris and could not move. A third, James Gulley, appeared to be uninjured, while the three IMA officials were cut and bruised.

Despite the tiny space into which they were crammed -- a cavity of rubble about 8 feet by 5 feet, and 3 feet in height -- and the fear that they would die before being rescued, "no one lost their stuff," Santos said. "Everyone stayed calm."

He conducted an inventory of their electronic equipment -- a half-dozen cell phones, a couple of laptops -- and although none could send or receive transmissions through the piles of debris, all were successively pressed into service to illuminate the space while their batteries lasted.

After about 36 hours, Santos, who was keeping track of time, shared with the others a Tootsie Pop he had. He also produced a bottle of Aleve -- which he uses for his arthritis -- and gave the pills to Dixon and Raab, who were both in severe pain.

Sometime after that came the rumbling of the helicopter. "That was initially reassuring," Santos said, but nothing came of it. "It was probably a politician surveying the damage."

At the 50-hour mark, members of a search-and-rescue team from France made contact, although it would take another three hours for them to dig through and provide water to the group and another two hours for those with minor injuries to be pulled out, one by one.

A French doctor made his way inside the cavity and tried to stabilize Raab and Dixon, but the latter had a fatal heart attack before he could be moved. Raab's feet were amputated and he was flown to a hospital in Florida, where he too died.

For Santos, the father of two boys ages 5 and 3 at home in Silver Spring, the first task was to borrow a satellite phone and call his wife, Silvana, who had already heard from an ABC News reporter that her husband had been found alive. Varghese called her sister in Kansas City.

Haitian government officials estimated that 230,000 people died in the quake, with 300,000 injured and 1 million left homeless, although other assessments put the casualties in smaller numbers. As many as 200 people were reported to have been killed in the Hotel Montana alone.

"It's a complete miracle that we survived," Santos said last week. "My wife doesn't want me to go back. And a couple of friends said they don't want to travel with me anymore," he added, laughing.

Turning serious, Santos said that he plans during his visit this week to return to the ruins of the Hotel Montana as a way of coming to terms with what happened and to honor the two men who died after he had been rescued. "It's going to be very emotional for me," he said. "When I was pulled out, they were still alive. Now, I want to close this chapter. I want to go back and pay my respects and put some closure to the experience."