Miami Herald; Friday, December 24, 1993
John Donnelly, Herald Staff Writer

Bibiana Pinto, a missionary doctor from Argentina, examined a parade of patients, women with cancer and TB, a man with a worm in his belly, children without any food in theirs.

She arrived after begging an army commander for gas. After changing her third flat tire in a week. After passing by a 2-year-old child severely malnourished, the same child she had miraculously saved the year before.

"There are days when I don't always love it," Pinto said, running her fingers through her graying hair that was covered by a film of dust from the ride to Bayeux. "It's a challenge just to keep the clinic going."

Because she does -- the clinic sees 1,200 people a month on an astonishing $75 budget -- she is one of the final pillars in the crumbling Haitian society.

"The health care workers are the last ones to hang in there," said Larry Koch of Medical Ambassadors in Modesto, Calif., which assists Pinto's clinic. "For people there, this is their last ray of hope."

"Just keeping open a clinic that serves the poor is a victory of sorts," said Jim Kim, executive director of Partners of Health in Cambridge, Mass., whose clinic in the central plateau sees 40,000 patients a year.

All over Haiti, clinics are reporting a rise in cases of malnutrition and dehydration, symptoms of a society choked by the military's repression and an international embargo. In pockets of the country where doctors don't reach, villagers report deadly outbreaks of almost anything you can imagine -- even anthrax, so lethal that it's used in stockpiles of biological weaponry.

So it is that doctors scramble from one crisis to the next. There's little time for day-to-day preventive care. It's all triage, all extremes.

What makes doctors stay?

Just look at Pinto's life.

She is 34, the daughter of a truck driver and a mother who died when she was 9. She dreamed of a career in tropical medicine; her evangelical church in Buenos Aires nurtured that dream, paying her a small salary the past three years. She can now see living here a lifetime.

That belief has something to do with 11-year-old Niquette, whom she adopted after the girl was abandoned. It has something to do with running the clinic, which she took over from Lois Herron, a registered nurse who now works in Jacksonville.

And it has something to do with her patients. All along the road to Bayeux, hundreds waved to her, and she gave a running commentary on how she made them well, if only for a spell.

The international oil embargo, restarted two months ago, gets in the way of all this.

Pinto lives in Cap-Haitien, about 90 minutes, or 2 1/2 gallons of gas, from Bayeux.

To get here recently, she spent two days in gas lines. She camped out at the local army headquarters. The commander wouldn't give her a permit for a 55-gallon drum of gas. He dismissed her. And she began to cry.

"I told him, 'I'm a doctor, I'm a doctor,' " Pinto said. "He said no. I couldn't take it anymore."

Hours later, her luck changed. She found someone who could get black market gas and arranged to buy eight gallons.

At 6:30 the next morning, wearing a blue doctor's smock, she was on the road to Bayeux, an astonishingly beautiful road that dips under the cover of a canopy of trees and re-emerges to sunshine high above a river.

Deep in a valley, only a few hundred yards from the ocean, the town of Bayeux is laid out on a grid of roads rutted from rain. Every square inch of property is accounted for, usually lined by trimmed cactus hedges.

Pinto pulled into the mustard-colored clinic and sighed. Her left rear tire was flat.

With patients looking on, she pulled out her jack and lug wrench. Minutes later, she had mounted the spare. She washed her hands and led the morning prayer -- a tradition that began nine years ago with Herron, the registered nurse.

Minutes later, Pinto saw patients in a tiny waiting room. The scene was similar to any American doctor's office -- except for the old dentist chair that serves as her examination table. Herron had pulled 5,500 teeth in seven years; Pinto discontinued the practice, opting to spend more time on other maladies.

Her first patient had severe stomach pains.

"This is a sad case," Pinto said in English as she felt the woman's midsection. "She had a baby in June. Several months later, a nurse discovered a mass in the abdomen. She has a fever, losing weight. It could be TB or cancer in the liver. I think it's cancer."

Pinto wrote a prescription to treat tuberculosis. "If it is cancer, she will die no matter if she were in Argentina, the U.S., or Haiti."

She sighed. Often, she said, she has to guess at the illness without any advanced diagnostic tools. "You lower your professional standards. That took me a long time to accept."

This morning, the patients kept coming.

She saw malnourished children, and she saw a 60-ish man with stomach worms who had walked 15 miles on the broken backs of his black shoes. Why did he travel so far? "Where the old dog has the idea," he said, "that's where he goes."

She saw a 71-year-old man who closed his eyes, tilted his face toward the ceiling and whispered of his nighttime horror.

"What is it?" she asked.

"I can't sleep," he said.

Pinto rolled her eyes and prescribed a mystery pill. It came in an unmarked large container with an assurance from a physician that it didn't do much except make people drowsy.

She saw a young mother with HIV, or TB, or possibly both, and she saw a 70-year-old woman who couldn't follow the doctor's questions about her bad cough.

Pinto: "Do you cough often?"

Woman: "Yes, my ear is draining pus."

Pinto: "But do you cough often?"

Woman: "Yes, but my ear is draining pus."

Pinto examined her. The woman had a high fever and had difficulty breathing. She prescribed medicine to treat all the possibilities: malaria, typhoid or pneumonia.

The patients paid no more than $2 each for the visit and drugs, which barely covered any of the medicine.

Of the $75 in monthly donations, $50 comes from the founding nurse's old church, the Victory Christian Center of Orange Park, Fla. The church also gives about $300 every three or four months; Pinto uses those infrequent donations for larger projects, such as digging a new well, because she doesn't want to become dependent on the funds for daily operations.

But Pinto may get more help soon from Medical Ambassadors, which already provides medicine and money for the salaries of the nine workers.

She also hopes to receive shipments of food from a European development organization. But her dreams of training villagers to treat people in the countryside will have to wait. For now, there's no gas to go anywhere.

As she got ready to leave -- after checking the generator's battery water with the lighted instrument she uses to examine ears, dropping in on a class of midwives and looking at the clinic's books -- the workers told her there was one other matter.

A birthday party.

Pinto had just turned 34; one of her aides, Margaret Rock, was turning 25.

The doctor, usually somewhat stern with her workers, excitedly confided to a visitor: "I think they bought something. They never have done that."

Rock appeared with a present: a roll of crackers.

It was arranged neatly on a white plate, a small plate of thanks.

Pinto almost cried with joy. "Oh," she said quietly, "this is so nice to celebrate something."

CUTLINES

CHUCK FADELY/Miami Herald Staff

ONE CRISIS AFTER ANOTHER: At left, Dr. Bibiana Pinto examines a patient at her rural clinic on Haiti's north coast. Above, a woman climbs over a wall built around the facility to keep out floods. The clinic serves 1,200 people a month.

CHUCK FADELY/Miami Herald Staff

AT MERCY OF ELEMENTS: On the road to Bayeux, Haitians do their laundry in the river. If it floods, patients and staff can't get to the medical clinic.

CHUCK FADELY/Miami Herald Staff

MISSIONARY DOCTOR: Bibiana Pinto, who works on Haiti's north coast, says, 'It's a challenge just to keep the clinic going.'

CHUCK FADELY/Miami Herald Staff

EMBRACE: Bibiana Pinto, a doctor from Argentina, gets a hug from a staff member at a birthday celebration for Pinto.

CAPTION: PHOTO Bibiana Pinto is embraced by staff member (a); photo: Bibliana PINTO* (2), clinic, Haitians wash clothes in river (HAITI*)

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