Global Doc: Gates of Oz

Author: Dr. Vincent DeGennaro Jr. ’02

Vincent DeGennaro

Most of the people at the Dominican embassy started lining up at 4 a.m., but some of them had even been there since the day before. We rolled up at 8 a.m., expecting the staff to open the doors half an hour later. Daniel, a 15-year-old boy with a massive throat tumor, and his mother, dismounted from the truck and followed my lead. I feigned that we had no desire to cut the line by milling about on the sidewalk adjacent to the line, but in reality I was looking for an in as I handed Daniel and his mother their passports. I fumbled in my backpack for my stethoscope, draping it around my neck even though I had no intention of examining a patient while waiting in line — the stethoscope commands access to all sorts of places that I wouldn’t normally be welcomed in. I approached the only other two white people in line and asked in Spanish how we might get a medical visa, but they informed that they hadn’t had any luck getting a visa the day before and now had returned to attempt again.

Our social worker had gone to the embassy the day prior to purchase the visas, but she had gone by herself, without the pity that Daniel might inspire, and had failed. I pinned our hopes on my American passport, Spanish language skills, my medical school diploma and the pathetic sight of Daniel.

Daniel weighed about 85 pounds, his body slowing disintegrating as the tumor sucked up his nutrition. He covered the bulbous tumor bulging out the sides of his neck by sporting a Green Bay Packers cap on top of a towel that hung down like a desert sunhat. His stomach ached, likely related to something that he had eaten, so he elected to perch himself on top of a large rock, away from the entrance to the embassy.

A man, like the Gatekeeper of Oz, cracked open the iron door within the gate, and I asked him in Spanish what I should do with a sick child who needed a medical visa. He answered in Spanish with a thick Haitian accent so I switched to Creole, but never made any progress. Then a man with tight, dark jeans and a haircut perfectly lined by a razor blade appeared on the top of the wall, surveying the crowd. From atop the parapet, he barked instructions in Spanish and the security guard next to him translated into Creole for the people below. They reformed an orderly, single-file line.

“I have a sick child and need a medical visa. I’m an American doctor and we’ll pay for all his medical care. He has an appointment with the doctor in Santiago on Monday. How do I get a medical visa?” I shouted up to the gentleman in Spanish, attempting my best Dominican accent, honed from three years in the Manhattan neighborhood of Washington Heights.

“No. I’m American,” I answered in Dominican Spanish.
“The child. Is he Haitian?”
“Yes.” With that and a scowl on his perfectly-shaved face, the conversation ended. “But we’ll pay for all his medical care,” I yelled as he walked back inside.

They finally opened the gate and unleashed the pent up fury of those who had waited in line for hours or days. People filed in through the crack in the door, slowly at first, and then gaining speed as the numbers that the Gatekeeper of Oz mumbled grew closer to 60, the magic number of visas to be granted on that day. At 58, the shoving began when a man who had slept on the sidewalk the night before was denied entrance and then tried to pry his way in. The police shoved him forcefully away from the entrance and into me and Daniel’s mother — fortunately, Daniel was still perched on his rock, fatigued and clutching his stomach. The tenor of the crowd bubbled from pleasantly expectant to irate.

“Que hacemos con el niño?” I shouted to the embassy employees while holding aloft the stethoscope and American passport for extra emphasis. “I have a sick boy here…” I spoke forcefully, telling the entire story to any citizen of Oz that made the mistake of making eye contact with the crazy gringo shaking a stethoscope.

“Sixty.” With that, the gate slid shut, leaving a roiling mass of humanity outside, clanging on the steel barrier.

The week before, I had been through something similar at the US embassy. Two girls from the Renmen Orphanage had been denied student visas once already, and another denial would mean that they would have to forgo the full scholarship they’d been offered at a US university. We woke up early and waited in an orderly line outside the US embassy, pressed into place by a dozen private security contractors. At the gate, the man informed me that the US embassy considered the 22-year-old girls adults, and as such did not permit them to have a chaperone in the visa process.

Denied entry into the embassy of my own country, I waited outside while the girls proceeded through the lines and paperwork themselves. Since four out of five Haitian college graduates live outside of Haiti, most of those waiting for a student visa will stay in the US or Canada. The US diplomats understand and throw up bureaucratic barriers to their entry. This time, the girls answered all the questions that we had rehearsed perfectly, and both were granted five-year student visas. Classes in Arizona start on Monday.

No such luck at the Dominican embassy. After a few minutes of relative quiet, waiting outside the gate of the Dominican embassy, still hoping that fate would intervene, I asked Daniel to come stand near me in case the gate opened again. He wobbled over and the crowd parted to let him pass, arriving just as the gate slid open, the man with the well-manicured hair motioning to me to come in. At first, they only permitted me to pass with the documents of Daniel and his mother, but as the crowd separated to let me through, the Dominicans saw Daniel and allowed them both to pass as well. They showed us to an unused office and turned on the air conditioning for our comfort while the fortunate 60 continued to stand in line on the floor below.

A light-skinned woman with flowing dark hair and deep curves opened the door. She said that she would be assisting us, and handed me forms to fill out. Her brow furrowed with sympathy when she saw Daniel, all angles and bones, lying on the two chairs in the corner. When handed the papers to sign for her and her son, Daniel’s mother said that she did not know how to read or write, making random marks on the paper in lieu of a proper signature. Two hours later, the process ended and, with visas in hand, we headed back to the hospital to call the team in the Dominican Republic to coordinate the travel plans.

“You’re coming with us, right?” she asked me several times, and each time I gently reassured her that she could manage with her teenage son to board the direct bus to Santiago. I instructed her to call a Creole-speaking contact in Santiago, tapping on the paper where the number was, but she stared back at me blankly. Remembering that she was unable to read, I turned to Daniel and instructed him on which numbers to call when they arrived at the bus station in Santiago.

Two days later, Daniel and his mother arrived safely in Santiago. Daniel’s journey was just beginning, but he was one step closer to a cure.

Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.