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The Forgotten Victims: Haiti's Elderly

Thousands of Haiti’s elders languish as they wait for help

by Cynthia Ramnarace, AARP Bulletin, June 28, 2010

En español | The heat was oppressive, yet Marie Therese Alaine, 88, lay covered with blankets. Months after the earthquake that devastated Haiti, her body tells the story of all her country has been through. Skin hangs on bone, leaving knees and elbows that look as if they’ve been sharpened to a point. Her eyes, clouded by cataracts, stare at nothing yet plead for something that her demented mind cannot convey.

Alaine is one of dozens of older adults living in a makeshift tent village outside Asile Communal, the government-run nursing home in Port-au-Prince. Except for when she is bathed, Alaine spends her entire day propped up on a stiff cot that is undoubtedly harsh on her bony frame. She is too weak to walk; but even if she weren’t, the burn on her foot would make standing in line for water, for food, for the bathroom, impossible. So she waits for the essentials she needs, relying on little more than her faith and the kindness of others.

Martin Gorbien, a medical doctor, cleans her wounded foot. Gorbien oversees geriatric medicine and palliative care at Rush University Medical Center in Chicago, but here he is a volunteer with HelpAge International, an organization that specializes in the needs of older people. With no medical record system, Gorbien can only assume what kinds of treatments she has received. He tries to ignore the frustration he feels, frustration that has filled him since the first day he arrived in Port-au-Prince. In the United States, or anywhere with a functioning medical system, Alaine’s wound would be healing more quickly. She would not be malnourished and dehydrated. The cataracts that blind her would have been removed long ago. She wouldn’t be sleeping outside in a tent.

Alaine is one of the estimated 200,000 people over age 60 displaced by the Jan. 12 earthquake. Many, like Alaine, suffer dementia. Blindness is rampant, Gorbien says. Lack of food and water has hit all Haitians hard but particularly the elderly, whose bodies are less resilient against dehydration and malnutrition.

Able-bodied older adults in the camps are more often than not battling silent killers such as high blood pressure, says Gorbien. During his 10-day medical mission he doled out 30-day supplies of medications such as anti-hypertensives. He is sure that his effort likely prolonged life, calmed the patients and eased suffering—but didn’t cure anything. “Most all of the older adults that I saw will be dead within a year,” Gorbien says. “And they’ll be dead because of malnutrition and dehydration.”

An insurmountable problem

For many older Haitians, pure luck helped them survive the earthquake that killed an estimated 300,000 people. Every Haitian has tales of miraculous survival and devastating loss, says Margaret Chilcott, emergency coordinator for HelpAge International, one of the many aid groups in Haiti but one of the few focusing on older adults. For one older Haitian woman, a friend’s comment that “it’s too hot inside” made the difference between being alive on the street versus crushed by her collapsed house. Many others tell tales of losing adult children in the quake, a loss that rips not only at the heart but at the pocketbook. For many older Haitians, their children provided their sole source of income.

Being older in Haiti was difficult before the earthquake. So difficult, in fact, that the average Haitian lifespan is only 61 years. Those over age 65 make up only 3.4 percent of the population, compared with 13 percent in the United States.

While aid organizations are trying hard to assess the needs and demographics of the community in need, no reliable large-scale data has yet been collected specifically on older adults. “Without such baseline information, knowing where to begin and how to address older people’s needs remains a challenge,” says Rosaleen Cunningham, HelpAge emergency information coordinator.

Overwhelmed

Before the quake, Asile Communal was already the shelter of last resort for disconnected elders unable to care for themselves. Now it has turned into an orphanage for older adults abandoned by families that lacked the resources or ability to care for them.

“Often family can’t look after them because they’re mentally disabled or old age and dementia has taken over,” says Chilcott. “Or all the family has gone to the States and there’s nowhere else for these old people to be.”

More than five months after the quake, roughly 65 residents from Asile Communal are still living outside. They sleep on cots in tents and spend their days waiting for aides to bring food, water and medical supplies, waiting in nakedness to be bathed as passersby giggle and jeer. In the struggle to survive, privacy has been sacrificed and dignity stolen outright.

But hurricane season is coming, and living outside is a concern, says Cunningham. “Most of the residents would like to move back in, but many people here, as in Port-au-Prince, still prefer to sleep outside.”

For some, conditions have improved. The Asile Communal residents who need more intensive care are now in a nearby hospital where an entire floor has been reserved for them. There, they see a doctor on a regular basis. Before the earthquake, patients only saw the doctor when they were near death.

Still, the doctors must focus on treating physical ailments. And though everyone Gorbien and his colleague Lauren Kessler, a social worker, treated appeared incredibly resilient, never complaining about their situation, their bodies relayed the telltale signs of depression. “There were sleep issues and insomnia,” says Kessler. “People described this all-over pain, which could be a reaction to the trauma of it all. It’ll be really difficult to evaluate and treat the emotional needs of this population.”

But psychological issues fall to the bottom of the long list of immediate needs.

A struggle to help

Helping older Haitian’s satisfy their basic needs is an uphill battle. HelpAge’s role at Asile Communal—and other nursing homes throughout the quake zone—is to manage day-to-day operations. The homes are still government-run, and HelpAge can only suggest improvements to care, a major complication to an already challenging situation. The organization has made numerous recommendations to improve the well-being of elders, but HelpAge CEO Richard Blewitt says it’s a struggle to get them implemented.

Although the local government has turned down HelpAge’s request to move more residents to other nursing homes, it has allowed the organization to begin reconstruction work at the Asile soon. In the meantime, Blewitt’s team continues to focus its efforts on providing medical care, food, water and shelter to displaced older adults at risk of chronic illness, spending more than $40,000 a month in the process.

Safety also remains a daily concern. The spontaneous camps that sprung up around Asile Communal bring with them the constant threat of violence. HelpAge workers carting supplies are potential targets for thieves and gangs; they’ve hired security staff on the premises at all times. Leaving food and medicine with elders makes them equally vulnerable to theft and attacks. A fence to thwart displaced people who don’t belong will soon surround those lucky enough to have a tent in the instant village.

In the meantime, older adults are languishing. Losing the comforts of home, income and family are hard enough when you’re young. But youth breeds energy and faith that tomorrow can be a better day. As elders enter the twilight of their years, being optimistic about the future can be exceedingly difficult.

As he traveled through the quake region and met so many patients with dementia, Gorbien couldn’t help but be reminded of a bit of history he learned in medical school. “Theologians once thought that dementia was a gift from God, so people would not have to see evils of the world,” Gorbien says. “And my God, to see your country destroyed, and to be in a situation where one can argue there is truly no hope—if there’s one situation where we perhaps can turn dementia into something positive this is it.”

Cynthia Ramnarace writes about health and families from Rockaway Beach, N.Y.