Pharmacology is over. I sit in my house with the post-test buzz still ringing in my ear amid a rhythmic background of raindrops striking windowsills and cars sliding past outside. I doze, and the rain conjures afternoons in Borgne when the clinic visitors had slowed to a drip after the morning hubbub.
The end of summer happened fast. At times I have to catch myself to remember that I am back in Rochester since the green and damp could fool tired eyes. When I first started doing these trips I had a much harder time coming back, but now I have become more used to it. Strangely enough, a world where cyclones, tropical hamlets and cane fields can be connected to one with cranes and helicopter ambulances by a short flight doesn’t seem so weird after all. Or maybe I have just learned to accept the dramatic inequalities that lie across a puddle of water.
My time in Borgne was wonderful. I observed an incredible amount of medicine from a highly capable team of very dedicated individuals. My already solid respect for the capacity of Haitians was again superseded. Not only was I impressed by the ability for these professionals to provide a basic service in the face of incredible obstacles; I was impressed by their ability to provide a stellar one. Being a bystander observing this health care team makes one wonder about the physician’s role within this team. The more I visit Haiti and see the slow progress of rebuilding, dogged perseverance and incredible capacity—especially among the ashes of an international ‘humanitarian response’ generally accepted to have failed miserably—the more I question why, how and if I can be a companion to this country. When you look at it objectively, most of what’s wrong with Haiti has come at the hands of those outside it.
Just look at the past few disasters. In the 1990s, free trade policies brokered by the U.S. government ruined Haitian farmers, resulting in the displacement of millions of impoverished Haitians. Many were in Port-au-Prince when the earthquake hit in 2010, increasing the destruction of the disaster. Additionally, an incredibly resilient form of Vibrio cholerae brought to Haiti in October 2010 is surmised to have been introduced by United Nations peacekeepers. To this day, they refuse to admit to this fact and share potentially valuable epidemiological data, and they also shrug off any possible compensation to families or the Haitian government for an epidemic that has killed thousands.
From my limited perspective, Haitians, whether they are farmers, teachers, physicians or even government representatives know best when it comes to their own country. We, on the other hand, do not. Physicians can play a role in Haiti, but it must be done with Haitians in the driver’s seat. What we can offer is pretty clear.
Training is a huge need for physicians in Haiti, especially postgraduate training, and this is something that academic health centers can contribute towards directly. Advocacy is another powerful tool. Modern Haiti’s ‘republic of NGOs’ has taught us is that a patchwork of well-meaning but ultimately unaccountable foreign organizations cannot replace strong, national health care institutions. This means that more funding and technical support should be provided by our government directly to Haitian institutions in place of donating to American nonprofits or doing Rambo-esque surgery missions that do little to provide prenatal care, public health infrastructure and infectious disease management.
This whole reality has been a tough pill to swallow, yet has been made more apparent the more I visit Haiti. I love that country. I love being there, I love the people, I love the rich history and culture and art and music and pride and raw perseverance. However, I may have to accept that my role in Haiti may be different than the one I used to dream of. The beautiful thing about medicine is that if you truly believe it to be a force for good, it should lead you in the right direction. As I start year two in the long trek towards my MD, Haiti has forced me to accept my failings and take stock of my strengths as I consider what type of physician I want to become. It has forced me to ask myself where and how I can best use medicine to improve the lives of others and challenge a system with entrenched inequality.
On my last day at the hospital I was with the attending physician trying to resuscitate a man in his sixties as his pulses slipped away by the minute. It wasn’t dramatic or unique in the sense that it was just another person to die from a disease that held a few article headlines in 2010 and then was forgotten. Faintly, you could hear a whimper from a six-year-old boy as he hid underneath his bed sheet in the bed next to the old man’s. The boy was the last patient left in the cholera treatment center. You could feel the fear in the room.
Why do we make mistakes that cost people their lives, feel sorry about them, and then keep doing the same thing? This is how we have been dealing with Haiti since it became the second independent nation in the Americas. This is how we deal with health care in our own country. Nobody should have to die from a disease that is as easily treatable as cholera. Nobody should be denied access to life-saving health care based on their social class.
As physicians we will have more riding on the decisions we make because we will see the consequences of our action and inaction at an acute level. We will know what poverty and gun violence and sexual violence do to individuals and communities. I am proud to join a cadre whose our work is that critical. I just hope we can get it right.
Haiti Teaches is a column that explores the opportunities, nuances and conflicts associated with time spent as a medical student in a foreign country. It follows a second-year medical student before, during and after his two months with a community development organization in Borgne, Haiti.