DESDUNES, Haiti - As the morning sun stretches into the sky promising with it another afternoon of scorching heat, the locals here busy themselves with their daily routines.
Some are already knee-deep in the wet rice fields that surround the city, getting a head start on the day's work. Others are bathing in the canal that runs alongside the bumpy dirt road.
Motorcycles and small trucks packed with passengers buzz past, beeping their horns and dodging puddles. The occasional donkey nibbles on the grassy sides of the road and pigs wallow wherever they can to keep cool.
As a bus full of foreigners makes its way to the city, a crowd of a few thousand already has gathered outside the high cement walls of a local medical clinic.
Many cling to the top of the wall in order to hold their place in line. Most have been there since the early hours of the morning – waiting. Some have walked for miles to be there when the clinic opens.
As the bus pulls into the city and through the gates, the crowd comes alive, shouting for favor and hoping for early entry. Some try to cut to the front of the line and are met with angry cries and shoving.
Army Capt. David Bourgeois of the Louisiana Army National Guard is hoping for a good day.
"I always like it when we can get there and start letting patients in right away. Sometimes there will be something that happens in the night – the wind will blow and knock one of the nets down, or we'll have to adjust something," Bourgeois said. "If I can come in the morning and within a few minutes have my doctors set up in their room and have the patients coming in … that makes it the best day."
Bourgeois is the coordinator for the medical exercises for Task Force Bon Voizen, a Louisiana National Guard-led humanitarian exercise sponsored by U.S. Southern Command.
He brings with him a team of military doctors, dentists, nurses, veterinarians and other medical staff from the Unites States, Colombia and Canada. He is on his fourth and final medical exercise rotation for the task force that began in late April.
All of the exercises have been in small communities within the Artibonite department, or province, about 70 miles northwest of Port-au-Prince. The turnout for free medical care is heavy. Health care in this impoverished rural region is scarce for those here who live primarily on what they can grow or fish from the streams.
The Haitian government chose this region for the task force’s efforts, chiefly because of the influx of residents after last year's earthquake. Thousands left the devastated Port-au-Prince area, seeking food and shelter and jobs in the surrounding rural areas. Haitian officials would rather improve the infrastructure here than have the displaced return to the already overcrowded inner city that is still struggling to recover.
Since the task force began, its medical crews have treated more than 800 dental patients and nearly 23,000 medical patients. By June 22, when the final medical exercise is finished, they will likely treat nearly 30,000.
Setting up the medical sites and dealing with the heavy demand is not easy, Bourgeois said. He was recruited for the job by the task force commander and has served a tour in Iraq.
"It sounded simple, me not knowing what I was getting into," he said. "I didn't think it would be as complicated as it has been."
Bourgeois has been on the ground here since early April, setting up each site long before the medical staffs show up. He meets with the local clinics to find out their capacity. He talks to community leaders, mayors and pastors. Both the ministers of health and agriculture need to be kept in the loop on the task force's efforts.
Bourgeois has to know all of the local hospital's phone numbers, and which has ambulance service, in the event someone shows up in the line needing critical care. It's happened 10 times already. But each time he called for an ambulance, it was either broken down or unavailable. So, it is up to him to have a backup plan because the patients cannot be transported in task force vehicles.
Bourgeois deals in worst-case scenarios.
Today, he is danger of having to shut the site down only two hours into providing care.
Heavy rains have left huge puddles of mud lining the walls and most of the locals are ankle deep in the mixture of dirt, feces, water and urine.
Inside the complex, pools of standing water are breeding mosquitoes. And the locals are cleaning their muddy feet in them. All of this is dangerously close to the dental tent and other medical services.
An inspector deems the site OK for the day, but the standing water has to go.
Bourgeois contacts the company that drains the sewage from the portable toilets to see if they can also suck out all of the standing water. Sand will serve as a backup to fill in if needed.
A potential crisis is averted, and the staff ends up treating 1,700 patients by the close of the day, a record for the exercise.
It's all in a day's work for the cavalry officer, who said his operational experience works to his advantage.
"I think all of the years of being in the military, being an officer specifically, and all of the operations I’ve been involved in have helped me really prepare for this mission," Bourgeois said.
During the day, he walks the line outside ensuring everything is under control and searching for anyone who needs to be moved to the front. He looks for the elderly or anyone seriously injured or ill.
Many call his name, the French heritage easily recognizable to them. But few gain early entry.
"If they're walking up to me and I don't see blood coming off of them I just have to tell them no," Bourgeois said. "I know if I give special treatment to some in the lines, it would cause the rest of the line to get rowdy. And I don't want to do that."
Today the first in line is a lady who walked for three miles to get here, leaving her home just after midnight. She wants to see an eye doctor.
Another lady waiting in line said she been here since 1 a.m. She walked here from a nearby town with her baby. She wants to see the doctor for eye and teeth problems. She can't remember the last time she saw a regular doctor, and can only be treated locally if she gets a referral from one of the task force medical staff.
Common medical problems are the norm with most of the people seeking care. Routine medical care is in high demand, and the patients complain mostly of high blood pressure, skin infections, chronic pain, bad teeth and poor eyesight.
Army 1st. Lt. James Wong, a nurse practitioner and Army Reservist from Fresno, Calif., has seen a lot of such cases.
In many cases, only 99 cents worth of medication can save their lives, or at least can make their life better, he said.
But the issue, Wong said, is convincing them to continue taking the medicine after the staff leaves and the locals return to their normal routines.
"The hardest part is helping them understand why this is good for them. It's not an easy task, but I think it's worth doing," he said. "There's always a trust issue. I'm here and gone. There's no continuity."
To establish trust with his patients, Wong always introduces himself and shakes their hands.
Even though he is speaking through an interpreter, Wong said his mannerisms communicate more than his words. How he acts, he said, will make or break their experience with the task force.
"If they have a good experience or interaction here, they go back and talk about it. If they have a bad interaction, they go back and talk about it," Wong said. "So, I don't want to miss a chance to say 'We're your friends.'
"Part of our mission here is not to just give them [better] health, but to win their hearts and minds. One patient at a time," he added.
Born in Burma, Wong has a passion for rural health care. He served in the Peace Corps in Papua New Guinea 20 years ago, and has volunteered his services in Sri Lanka following the tsunami there in 2004, and in New Orleans after the devastation of Hurricane Katrina.
Wong said he likes to work with the poor.
"They're the underserved. Somebody has got to stick up for them," he said. "In every country, we're judged by how advanced we are in terms of civilization by how we treat the poor."
Still, Wong was not prepared for the poverty he saw here and the feeling of helplessness when a patient sat down in the chair before him that he could not help.
It was a 14-year-old girl with what Wong believes is a genetic enzyme deficiency. She was wasting away, no fat or muscle on her bones. Her mother didn't really understand as Wong tried to explain that the illness would likely claim the girl's younger sister as well.
That night he returned to his tent and cried, Wong said.
"Every once in a while you will see something you can do nothing about," he said. "I have never cried about a patient in the states. Ever. It's just the helplessness. I was stuck. [There was] nothing I can do for her."
Despite the few cases that are beyond his care, there were hundreds more Wong could help. And one after one they sat in his chair – boys and girls, small and big, young and elderly.
"Hi, my name is James," he would say. "I'm sorry for your wait."
He patted the kids on the head and asked them how they were doing in school. He reminded them to study hard, brush their teeth and listen to their parents.
Wong would then proceed with a thorough exam, poking and prodding as gently as possible, all the while asking questions about their health, their job, their family.
And his thoroughness often paid off.
One lady came in with only the same general complaints as most of the patients, Wong said. But after removing her hat, he saw that her head was bleeding. She hadn't even mentioned that.
He asked her how long it had been bleeding. Since the day before, she responded.
Wong cleaned and stitched the wound and asked her to return in a few days. The lady did, indeed, return a few days later and the wound and stitches were healing nicely.
"She was so happy and smiling. It was just amazing. To me that's objective evidence that she trusts us now," he said. "That's one heart I can say we've won."
By the end of the day, only a handful of locals were left outside the gates. A final 30 were let in because the staff was ahead of schedule. They are restricted to the hours they can keep the site open, and they have to return to their forward operating base in order to prepare for the next day's operations.
Bourgeois said most locals know when the site is ready to shut down and will leave to return another day. They have yet to leave with many, if any, still waiting.
Still, like today, if Bourgeois can squeeze a few more through the line before quitting time, he will.
"That's what we're here for, to give to the people," he said. "And if we're still capable of giving, I like to keep doing as much as I can."