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House Calls

1995 “AS BAD AS IT IS IN Port-au-Prince, it’s worse in the countryside,” Miriam had told us on our first visit. “The people there have nothing—no water, no sanitation, no medicine, no electricity, and no roads.” After seeing Cité Soleil, I was skeptical that anything could be worse. But Miriam encouraged me to come out to Pestel and see for myself.

The trip from Port-au-Prince to Les Cayes, approximately 110 miles on a poorly paved road, took four hours. After spending the night in Les Cayes, we embarked in our four-wheel-drive vehicles, equipped with altimeters, inclinometers, and internal/external thermometers, on the 50-mile, five-hour journey across the mountains that form the spine of Haiti’s southern peninsula to the coastal village of Pestel. The following morning, Aussibien, a Haitian boat captain, took us in his sailboat to Cayémites, Au Basse, and Zetoit.

Each mile sharpened the contrast between the natural beauty of Haiti and the poverty its people must contend with. The southern peninsula is lush compared to the rest of the country. We saw mountains tumbling into the sea, beaches whose only signs of human presence were abandoned dugout canoes; and forests of palms, vanilla, orchids, and poincairnas. Not far from Port-au-Prince we noticed



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti House Calls 1995 “AS BAD AS IT IS IN Port-au-Prince, it’s worse in the countryside,” Miriam had told us on our first visit. “The people there have nothing—no water, no sanitation, no medicine, no electricity, and no roads.” After seeing Cité Soleil, I was skeptical that anything could be worse. But Miriam encouraged me to come out to Pestel and see for myself. The trip from Port-au-Prince to Les Cayes, approximately 110 miles on a poorly paved road, took four hours. After spending the night in Les Cayes, we embarked in our four-wheel-drive vehicles, equipped with altimeters, inclinometers, and internal/external thermometers, on the 50-mile, five-hour journey across the mountains that form the spine of Haiti’s southern peninsula to the coastal village of Pestel. The following morning, Aussibien, a Haitian boat captain, took us in his sailboat to Cayémites, Au Basse, and Zetoit. Each mile sharpened the contrast between the natural beauty of Haiti and the poverty its people must contend with. The southern peninsula is lush compared to the rest of the country. We saw mountains tumbling into the sea, beaches whose only signs of human presence were abandoned dugout canoes; and forests of palms, vanilla, orchids, and poincairnas. Not far from Port-au-Prince we noticed

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti small houses scattered through the countryside, with families cooking over open charcoal fires. Women washed their clothes while their children bathed in a low-lying aqueduct built by the side of the road. People traveled on foot, on donkeys, or in impossibly crammed multicolored buses. A child walking toward us, carrying a small tin bowl on her head, held out one hand and rubbed her stomach with the other. She was pencil-thin, about eight years old, and dressed in an old tattered party dress. Lynn, who accompanied Miriam and John (Barth’s missionary college friend) and me on this trip, was particularly moved by the girl’s gesture, so he asked our driver to stop and gave her some of our food. Children in nearby homes who witnessed this act of charity were soon scurrying toward our car, forcing us to hastily speed away. There was a perfumed scent in the air that mingled with the scent of charcoal, diesel, and cooking oil. “What’s that?” I asked our driver. “Vétivert,” he responded, “a perfumed grass that grows in abundance on the southern peninsula. The peasants ship it to France, and it’s distilled into perfume.” I could make out the large trucks hauling this in front of us, heading for Les Cayes. As we traveled into the interior, the road became rockier and steeper, the houses smaller and more fragile. We passed through Camp Perrin, a small town that looked like it belonged in a western movie, complete with wooden sidewalks and hitching posts in front of its main buildings. We bought some supplies at the general store and then ascended up the mountains. The altimeters registered 3,000 feet. We pulled off by the side of the road halfway between Les Cayes and Pestel for a “deworming clinic.” High in the mountains, people live in huts constructed of thatched and woven palm fronds, connected to each other by footpaths. Miriam was right: There was no water, electricity, or sanitation. Yet the people had their families, their traditions, and their little plots of land—their birthright. The government back in Port-au-Prince could do little to help them, but neither did it oppress

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti them. Mostly, the government seemed invisible way up there. Alongside the crushing poverty, there was pride and hope. Tité called out in Creole to the nearest hut. The mother there sent her four children scurrying toward us and called out to the next hut. Within 10 minutes, teledyòl (“word of mouth”) had produced 50 children. All the children had the red hair and swollen bellies of malnutrition. According to the routine, they each got a dose of piperazine syrup (we brought gallons), followed by a chunk of bread and then a piece of candy. I was entrusted with this last task. If the candy were unwrapped, there was no problem. If, however, I gave a child candy in a wrapper, he or she stared at me with a look that asked, “What do I do with this?” I had to teach them how to take the wrapper off before they would eat the candy. We stopped for lunch in the village of Joli Gilbert. Miriam had set up a small malnutrition station there and owned a piece of land on which she hoped to build a clinic one day. From there we could look all the way down the northern slope of the mountain to the village of Pestel below. We unloaded our supplies at the malnutrition center while the woman who worked there prepared a meal for us in her home on the other side of the road. It was the first home in rural Haiti I had been invited into. The walls were made of wattle and daub, whitewashed inside and out, with blue trim. The roof was thatched palm and the floor hard-packed dirt. The furnishings in the front room (we did not enter the back room, which served as a communal bedroom) were sparse—a homemade table, some homemade ladderback chairs with rush-matted seats, and a charcoal pot over which she was cooking us a lunch of rice, beans, and chicken. Lunch was interrupted by the sound of singing from the road outside. “Oh, it’s a wedding!” exclaimed Miriam, evidently recognizing something about the hymns being chanted by the procession. We left our lunch to wish the bride and groom well—she in her formal bridal dress, he in a tuxedo, both riding mules behind a double line of singing, palm-carrying guests. After lunch we rapidly descended a rocky road that traversed the

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti slope down to Pestel. We wanted to be settled in by nightfall. Arriving just as market day was winding down in the village square, we inched past throngs of people on foot and on mules heading in the opposite direction. Pestel had a beautiful natural harbor surrounded by a riot of colorful, ramshackle buildings. The town cistern was broken, so even in this large town there was no water. Electricity came on only sporadically, Miriam explained. The streets in the main square were still clogged with people, engaged in end-of-the-day buying and selling. The harbor was full of dugout canoes. A small island on the other side of the harbor was rimmed with minuscule houses. Six wooden sailboats, in various stages of construction, lined the waterfront. Four recently completed boats lay at anchor. We rented a canoe to paddle over to the island and inspect the sailboats. They were totally made by hand—their thick planks ripped from logs with handsaws, the ribs carved with axes, the seams of the sails stitched by hand. The spaces between the planks were caulked with rags; then the boats were filled with saltwater, making the wood swell and the boat watertight. The colors—vivid blues, yellows, and greens—were the same as I had seen on the sailboats used by the boat people seeking refuge in Miami 15 years earlier. Over dinner that night I asked Miriam and the others if this was a place where many Haitians departed for the United States prior to the interdiction policy. “Here and every harbor along the coast,” was their reply. “It costs 1,500 U.S. dollars to make one of these boats. That’s just about what they sell them for when they’re done. The captains are unbelievable. They navigate by the stars and the shape of the mountains on the horizon at night.” As we were speaking, I looked over the balcony to the harbor below. Aussibien was finishing his preparations for our journey the next day. “What time do you want to leave in the morning?” he called in Creole as he cast off. “Seven,” we responded in unison. He disappeared into the dark-

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Haiti’s coastline. ness for the hour-long trip down the coast to the village of Zetoit where he lived. We were awakened by the roosters at 4:00 a.m. Aussibien appeared on the horizon at 6:30 and was at our dock at exactly 7:00. His boat had the look of a Chesapeake Bay skipjack, with a gaff-rigged sail and a small outboard motor bolted to the back. We spent the day making “house calls” on remote islands—Cayémites, Au Basse, and Zetoit, where most people had never seen a doctor in their entire lives. Everywhere, families kept inviting us into their homes to see their loved ones—people with malaria, tuberculosis, and worms diagnosed without x-rays or laboratory tests. AIDS seemed invisible, very far away, something to worry about on a future trip. How providential it seemed that, for no logical reason, we appeared at that time to help so many people we met. But how diabolical that so much time had passed before we arrived and how much more time might pass before our return. And Haiti, although

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti poor, was not the poorest spot in the world or the most isolated. There were other places where conditions were probably worse, where there is nothing and no one to alleviate the suffering. At least this place had Miriam and her organization. Cayémites was little more than an inhabited dead coral reef and Au Basse an inhabited sandbar. The only vegetation was a fringe of mangroves at the water’s edge. Cayémites had 700 families that subsisted by building boats and fishing. The village had one well, actually a cave that dripped water out of its porous sides. An old woman stood at the bottom of the well collecting these drippings into a bucket. Since the bottom of the well was clearly below sea level and the sea was less than 100 yards away, the water she was collecting had to be brackish. There was another small basinlike pit carved out of the coral closer to the sea. This makeshift cistern collected rainwater for the dogs, chickens, and goats of the island to drink. Wiggling mosquito larvae created a geometric design of intersecting waves on the otherwise stagnant water. The husband of the house immediately downwind from the cistern anxiously invited us in to see his wife. She was sweating so profusely that a puddle of sweat formed on the dirt floor between her feet. A few sentences in Creole confirmed the diagnosis of malaria. In addition to giving her chloroquine, we suggested to her husband that he pour some oil onto the cistern for mosquito control. Au Basse was closer to the mainland and therefore more populous and noticeably more affluent. The homes were larger, and some even had paint. Au Basse had a dispensary, which was the home base of Aldrich, a nurse who served the three communities. Aldrich spent two days a week on each island and then had one day off. He immunized the children, tested for tuberculosis, and arranged consultation with the government-sponsored doctor in Pestel for his most difficult cases. Aldrich’s office consisted of an examining table, a chair, and a charcoal pot, over which he cooked us lunch—fish freshly harvested from the sea. The last patient I saw that day was in the most peripheral home

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti in Zetoit, the furthermost village we visited. The family insisted I see her, claiming she was gravely ill. I entered a small, two-room house with a dirt floor, one door, and no windows. My patient was sitting on the floor in a brown dress, the color of the floor. The dim light made it difficult to see her, except for her eyes and her smile. Although her family referred to her as a child, she was obviously a mature woman. She was retarded, with a small head, and both legs paralyzed. Her family obviously took good care of her. She was clean and well nourished. Why have they asked me to see her? I thought to myself. She’s had this problem from birth. They must think I have magical powers, that I can just lay my hands on her head and restore her to health, that I might be more powerful than a bokar. “Nou pa kapab fè plis. Bon kouraj” (“We can’t do any better than you. Take heart”), I told her family members, who were surrounding me and expecting a miracle I’m sure. As is their custom, everyone thanked us, whether we helped or not. They fed us and sheltered us in their homes. They gathered at the dock to wave goodbye and sang to us as we departed. And I thanked them in return, though I’m not sure they understood why, as we began our long journey back to Miami. As gratifying as the trip was, it was also troubling. On the one hand, it was a return to the pure joy of being a doctor, unburdened by the bureaucracy and liability and insurance issues that were stultifying my practice in Miami. But I was frustrated by my limited fluency in Creole and by my inability to practice without the bare essentials of medical technology taken for granted at home. And Medishare needed a home of its own, serving a place that no one else was serving, that no one else wanted.