In terms of failing to provide poor citizens affordable health care, Florida is similar to Haiti, and probably worse than Rwanda.
How much could possibly go wrong in the 24 hours before leaving Haiti?
We saw nine patients with breast tumors on the first day and performed biopsies on two of them, all with a staff that had no prior oncology experience. In the first week of operations, we infused chemotherapy in eight patients and started another three on outpatient hormone treatments.
Over the last year and a half, I’ve been to 10 foreign countries — Rwanda, Democratic Republic of the Congo, Kenya, Ethiopia, Belgium, France, Ireland, Turkey, Haiti, Dominican Republic. I lived in Rwanda for a while and now spend most of my time in Haiti, and the rest I visited for work and play and travel. Recently, though, I’ve rediscovered the joy and beautiful diversity of the greatest country in the world — the good ole’ USA
Each pain or medical problem ends and begins with the excess weight. We can ease the pain with pills and control the infections with antibiotics, but the obesity complicates any treatment and prolongs every illness.
The deluxe supermarket represents the new Haiti, perhaps even the coming Haiti, but not the economy of the real Port-au-Prince, which is found on the streets, alleys, tap taps and sidewalk markets. Economists might label it the black market or underground economy, but in a country with seventy percent official unemployment, the underground drives the commerce engine that keeps the city alive.
“How long have you had the mass in your breast?” I ask Natalie, a 43-year-old woman, in Creole. “Some time,” she replies, an indicator of the Haitian measurement of time. I prod and she eventually reveals that she has had the tumor for about a year. The first question to come to mind is simple and inevitable, but is so often tinged with judgment: Why did she wait so long?
Port-au-Prince is by far the dirtiest place that I have ever been to. Plastic shopping bags cling to hillsides and ledges, randomly distributed by the drainage of repetitive torrential rains. Pieces of old clothing, shredded and discolored, protrude from layers of dirt like the strata of an archeological dig, marking the time in history when they were deposited there.
At first, my guard is up, casting glances around every corner, suspicious of every man I pass on street. As he recounts the histories of the buildings we pass, many of them destroyed by the earthquake in 2010, he senses my taut body language. “Don’t worry. This is Jacmel, not Port-au-Prince. You are safe here.”
Rivette led me by the hand, pointing out the aspects that she felt are the most important to know. We’d only just met, but she had a sense of the importance of visitors to her home, and there was a formality to the proceedings I hadn’t expected. She tugged at my hand, pulling with the entirety of her body weight, urging the tour on by force of will. I was obliged by good manners and the laws of physics to comply.
Cheap, plastic sandals hang underneath the little feet that dangle off of the wooden bench he is sitting on next to his mother. They’re covered in mud, as are his feet, and are not offering much protection from the elements of rural Haiti, but they are shoes nonetheless.
There are only two numbers that I’m concerned with for Antoinette. One is her age: 22. The other is her oxygen saturation: 85 percent and dropping.
Gladimir is only 28 years old, and he’d be dead in any other hospital in Haiti. Of course, he doesn’t know that because he’s been unconscious since he fell off of a motorcycle three days ago.
Driving through downtown Port-au-Prince yesterday, the signs of progress are palpable but serve as a reminder of what was lost.
John Doe’s hair looks like it is usually blond, but now it is covered in dried blood and caked to his scalp. Unfortunately, there is often a John Doe in the trauma hospital I work at in Port-au-Prince. People are victims of motor vehicle accidents, falling off of motorcycles or out of tap taps, the brightly colored pickup trucks that function as public transportation. Gun shots tear through their abdomen or bounce off of their skull.
In May 2010, life in Haiti was chaotic at baseline, and in a massive tent hospital with over two hundred employees and a hundred American volunteers, it was difficult to maintain any semblance of order. I haven’t been to Haiti since then.
I feel guilty for every extravagance, no matter how small. I reused the same paper napkin for lunch and dinner, not wanting to throw it out after being soiled with only a daub of mustard.
I don’t want to leave Rwanda, but the time has come for a change. Haiti has been calling me since I last left two years ago and the longer I stay in Rwanda, the less likely it seems that I’d get back to Haiti. So I’m leaving, and going home.
“He’s in the office there. Go listen to his lungs and tell me if you have any idea what he has,” one of my American colleagues said to me.
“Did you kill anyone during the genocide? Did you spend days hiding in a ditch to avoid the death squads? Or did you watch as your family was hacked to death? Did you profit financially from the war?”
I stepped off the plane into the daylight, bleary-eyed from lack of sleep and an ineffective sleeping pill. The line at immigration stretched down the airport, overflowing with people and excitement.
“Her name is Billie, named after Billie Holiday,” my friend John said to me over the phone, the day after his first daughter was born last month. I was happy for him, but felt a profound sadness for myself at the same time.
In American medicine, every symptom is seen as something that needs to be acknowledged, addressed and solved. Drug company commercials have created an entire society of hypochondriacs, myself included. Patients in Rwanda walk around with pain or a massive tumor on their face, and even then they hesitate to complain.
“You are going to die today,” I kept thinking. But I couldn’t get the words out. I’ve never had to say those exact words to a patient before. I’ve told dozens of patients they have an incurable disease that will ultimately claim their life. It’s an abstract concept at that point.