Claudine Souffrante, a pretty 17-year-old, has her right arm pinned to her abdomen. Her wrist has been grafted onto her stomach where a flap of skin has been peeled back and sewn on close to the joint with the hand. The graft will solve one of Claudine's problems; sealing the gaping hole torn in her arm. Still there are four inches of bone missing where she raised her arm above her head to protect herself as she tried to escape from the College Classique Antoine Dupré when the roof caved in during the earthquake.
The block that hit her arm atomised a section of her radius, scouring out muscle and nerve endings. Now a British surgeon has his face to the wound, sniffing terrier-like for the odour of infection: "That smells ter-ri-fic!" exclaims James Simpson breezily, breaking up the word into its constituent syllables. "Gauze, please. No, I don't want that pre-bandaging," he tells the nurse. "Something cooler."
It is February and we are on the Lope De Vega tennis courts in the badly damaged Delmas district of Port-au-Prince in a field operating theatre belonging to the aid agency Merlin. It is an air-conditioned tent, surprisingly well equipped. In spite of the local anaesthetic Claudine is moaning in pain. Before the surgical procedure, I had found her quietly reading the Book of Psalms on her bed in one of the ward tents. Then she had told me, in a barely audible voice, that since her first night of agony spent out in the open, her memory is damaged. It's left to her mother Marie-Michelle, who is sitting outside, to tell their story.
Marie-Michelle has come to the field hospital in her Sunday best, a smart blouse and skirt and a straw boater tipped back on her head. She visits Claudine every day from the small country town of Pernier, taking four rides by tap-tap, Haiti's brightly painted taxi-vans. Because her house was destroyed, Marie-Michelle and her two other children sleep on the street.
In the first weeks after the earthquake street sleepers were a familiar sight, hundreds of thousands of them across the city and the countryside, lying shoulder to shoulder in the roads, junctions blocked with debris to keep out cars. Theirs were sleepless, fearful nights punctuated by aftershocks that rocked the buildings and quivered through the ground, followed by dazed dawns when damp bedding was hung out in the ruins, ablutions performed in the gutter and food cooked communally on fires of scavenged wood.
Despite the way she is living, Marie-Michelle Souffrante is fastidiously clean, sitting now on a terrace in the shade above the tented clinic. "I was at home in Pernier when the earthquake happened," she recalls. "I had gone out into the street to see a friend when the shaking started. When I got back to my house, it was flattened. Totally flattened. The neighbours were saying they couldn't see my children. I was screaming. They told me that Claudine was dead. They couldn't find her. I was screaming that my life was over, if my children died."
Then, remembering her daughter said that she might stay late at school, Marie-Michelle hurried there. "I ran. When I got there, I found her. Her arm was broken. She had been upstairs. When she saw other pupils running she ran too. The stairs broke while she was going down them. That's when a block fell on her arm. She looked up and saw the school falling on her. With her other hand, the one that wasn't broken, she held the broken one. But the school gate was closed. She hauled it open and got out to the street." Claudine was lucky. Two other pupils died.
I ask Marie-Michelle what she does for a living. She explains that she was a street trader – a "Madame Sarah" as Haitians call them, the lowest form of trader – selling hand cream, sandals and jeans on a pavement not far from Port-au-Prince's port. But one day when she was at the hospital watching over Claudine, she says, looters stole her stock from a collapsed lock-up where she stored it.
Marie-Michelle takes me to where she used to sell in Le Marché de la Croix-des-Bossales. It is a busy, filthy and chaotic place, a jumble of stalls, frenzied with activity. Lengths of chain, the innards of TVs and other broken electrical items are laid out in the street for purchase. As we get out of the car Marie-Michelle is suddenly frightened and asks to leave.
"This place is dangerous. It was dangerous before the earthquake. People used to rob and kill. Now there is more robbery and violence because people are so desperate." She says government officials appointed to oversee the market would steal from the traders or insist on bribes to allow people like Marie-Michelle to operate.
"The money that paid for my stock in the first place wasn't even mine, I borrowed it from a loan company," says Marie-Michelle. "I needed to make enough to pay off the instalments. Because if you miss a month," she explains gravely, "you have to pay them more."
When Marie-Michelle talks about Claudine, I realise it is not just love that she has invested in her clever daughter. She hoped, too, that the girl, who has told me she wants to be a nurse, might lift the family out of poverty. It is a dream that has been shattered by her injury. "Claudine liked school and she was smart," says Marie-Michelle. "I hoped that when she'd finished her studies, she'd get work. You know, I'm in difficulty. I thought she'd help me get out of it one day."
A consequence of poverty is debt, a cruel cycle that insists that the poorest states and the poorest individuals must, in the end, pay more – through interest payments – than the wealthier for basic needs. Since the earthquake, the most impoverished country in the Americas has been the subject of an intense campaign calling for the forgiveness of its loans. But the huge personal indebtedness of Haitians is a largely hidden problem, on which no one is campaigning.
"The evidence is anecdotal," says Julie Schindall of Oxfam one evening. "But the people we had on a cash-for-work programme after the earthquake were paying as much in debt repayments as they were for their rent."
On top of this there have been harsh increases in the cost of living. Food prices have risen steadily over the past six months and with so many homes destroyed, rents go up continually.
The difficulties facing Marie-Michelle and her family become more obvious when I see them a second time. The drive up to Pernier takes us out of the city and on to a high plateau. There are trees and fields, children splashing at a village pump. The town, built around a single main road, seems at first to be less badly damaged than other places lower down. But when I turn into the alley where Marie-Michelle and Claudine's two-room house once stood I am shocked by the totality of its destruction. All that remains is a concrete floor, cleared of rubble, which is piled round the edges. On the apron of concrete, polished to a shine by brushing brooms and feet, is pitched a white family dome tent bought for the family by Merlin.
It is April now and the skin graft has taken. Claudine's arm is encased in a white bandage. She smiles but still appears withdrawn. Marie-Michelle seems exhausted and despondent. We sit down under a tarpaulin that has been erected over the tent's entrance to shield them from the sun and to provide a place, when the storms come, where they can cook. They have saved some white painted, high-backed metal chairs from the rubble, on one of which Marie-Michelle is sitting. "The last two months have been so hard," she says after a while. "After the earthquake I had a little bit of money, but I spent it on Claudine. When that was gone Merlin gave me some food and some soap to wash my clothes with."
Claudine appears and tells me that the family is eating only once a day. Hunger was an acute problem before 12 January in a country where almost 2.4 million were food-insecure and over half the country lived on less than $1 a day – and three-quarters on $2 daily. Things are worse now. Despite emergency food aid most Haitians I speak to complain that it is patchy and irregular.
But food is not the most urgent problem for the family. The company from whom Marie-Michelle borrowed $300 to pay for her stock is pursuing her aggressively over months of missed repayments. She explains that she arranged the loan via an agent of the company, a DJ she knows. "When I was at the hospital someone kept calling me. They called me last Monday. I said I will give it back but I can't at the moment. I can't sleep when I think about it. I can't eat either because I'm scared that if I don't pay they will have me arrested. If they send me to prison, I am dead. I won't survive." Claudine interrupts: "If they arrest my mum we won't be able to manage either. She pays for the school. She cooks for us."
"If I can find a job, I'll go to work," insists Marie-Michelle, "but there isn't any work." I don't doubt it. When she was working as a "Madame Sarah" Marie-Michelle would get up at 4am to cook breakfast for her children before heading out to work. These days she seems crushed by her enforced inactivity.
There is then, however, what sounds like good news. I hear from Merlin that Claudine's absentee father, who lives in France, has arranged for his daughter to fly to Paris for a bone graft. But when her father arrives the plan quickly unravels. At the French embassy Claudine is told that documents required for her emergency visa are missing. Her father needs to sign a paper but, for reasons that are difficult to establish, does not. The prospect of her travelling to France evaporates.
It is June and the family's life has descended into a perpetual cycle of hunger and waiting. They are not starving but are condemned to an enervating whittling away of their physical resources. The sun hits the tent at 7am, making it unbearable to stay inside. Claudine at least is back at school, when her mother can scrape together the fees. But her injury means she has missed exams.
Marie-Michelle appears to be suffering most. She complains of headaches and feeling dizzy and listless. Claudine too says she feels ill and is unable to leave the tent one day I go to visit. When Marie-Michelle gets out of the tent, it is only to lay out a blanket on the concrete beneath the tarpaulin to lie where it is marginally cooler, where there might be a breeze. Her world has contracted to the few metres of her tiny compound. I realise, on one of these stultifying days, that it is the experience of the Souffrantes that most perfectly defines Haiti six months on. An exhausting waiting without end.
"When I get up in the morning I brush my teeth. I prepare some food – if I have any – then I lie down," says Marie-Michelle. "Before the earthquake I used to always have food to give the children every morning. I would cook them spaghetti or eggs, then at 12 some rice. But since the earthquake food has become more expensive. It gets worse and worse each day."
A bag of rice has gone up from $3 to $4. Oil has risen by the same percentage. A food assessment by Oxfam confirms that even as Haitians have tried to cut back on food, the proportion of their available income being spent on food has increased by between 60% and 400%.
On my final visit to Pernier, I look into the tent where Claudine is sitting. In the shelter's second "room", which she has transformed into a teenage girls' bedroom with her older sister Rose-Laure, she is sitting on the bed writing carefully with her left undamaged hand. But then she shows me something extraordinary, how she can – ever so slightly for now – pinch her index finger and thumb together. It is the smallest of movements, encouraged by the exercises she has been given by the hospital. It is an improvement so small as to be almost invisible at first. That is how Haiti is recovering as well, after six months; painfully slowly where it is recovering at all.
