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Dèyè Mòn Gen Mòn

1996 PROJECT MEDISHARE HAD BEEN in operation for two years. Junia stuck her head through the doorway of my office.

“Were you expecting a delegation from Haiti?”

“No. How big a delegation?”

“Just three people. They’re from a place called Thomonde. They want to get one of the generators.”

Barth had arranged for Jackson Memorial Hospital to donate four huge generators it was recycling to Project Medishare. They were originally intended for the university hospital in Port-au-Prince, but eventually that hospital’s administration turned them down—too many issues involving operational costs and maintenance. We decided to offer them to any Haitian entity that could demonstrate need and promised to maintain them.

“They’ve caught me at a good time. I’m just doing paperwork. Show them in.”

Junia left and returned a minute later with the Komite Zamni Thomonde (Friends of Thomonde Committee). Of the three, Bob, Mathieu, and Delva, only Delva had actually come directly from Thomonde. The others were Haitian-Americans living in Miami, although originally from the same area. Bob had heard about the



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Dèyè Mòn Gen Mòn 1996 PROJECT MEDISHARE HAD BEEN in operation for two years. Junia stuck her head through the doorway of my office. “Were you expecting a delegation from Haiti?” “No. How big a delegation?” “Just three people. They’re from a place called Thomonde. They want to get one of the generators.” Barth had arranged for Jackson Memorial Hospital to donate four huge generators it was recycling to Project Medishare. They were originally intended for the university hospital in Port-au-Prince, but eventually that hospital’s administration turned them down—too many issues involving operational costs and maintenance. We decided to offer them to any Haitian entity that could demonstrate need and promised to maintain them. “They’ve caught me at a good time. I’m just doing paperwork. Show them in.” Junia left and returned a minute later with the Komite Zamni Thomonde (Friends of Thomonde Committee). Of the three, Bob, Mathieu, and Delva, only Delva had actually come directly from Thomonde. The others were Haitian-Americans living in Miami, although originally from the same area. Bob had heard about the

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti generators via teledyòl (“word of mouth”) and invited Delva to come up and make his pitch. Delva was the magistrate of Thomonde and—as I would come to find out, a visionary—totally dedicated to the well-being of his citizenry. All three wore long-sleeve white shirts, red and black ties, and black trousers. Their demeanor expressed their seriousness of purpose: They were on a mission to earn one of those generators for Thomonde. Even though Bob and Mathieu spoke better English, after the introductions, Delva did all the talking. He was a short, stocky man who spoke with that perpetual Haitian smile, a smile that reminded me of Régis. Thomonde is more than just a village in the central plateau. It is actually a whole section or “commune,” roughly equivalent to a county, which included four other villages and the surrounding countryside, with approximately 50,000 people. Historically, in the eyes of the government in Port-au-Prince, Thomonde did not exist. There had been no electricity in Thomonde for more than 20 years, which adversely affected health and community development. Delva then rattled off a string of statistics documenting just how bad things were in Thomonde and how much good could be accomplished—refrigeration, a hospital, improved education, jobs—if only they had power. There is an expression in Creole: Lespwa fè viv, “Hope makes us live.” Delva was clearly pinning a lot of his hopes for Thomonde on one of our generators. “That’s very impressive,” I told the committee, after Delva finished his presentation, “but it doesn’t work like that. It’s not within my power to just give you one of these generators. Everyone wants one and everyone claims they need one. You have to write a proposal. It’s competitive. The generators will be awarded according to merit.” The committee members conferred among themselves for a minute. “No problem. We will have it to you by tomorrow morning.” Sure enough, Delva returned at 8:30 the following morning with a 20-page plan to bring electricity to Thomonde. He asked if I would review it to be sure it was what I wanted. Remarkably, it was

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti the best proposal I had received. “If I give you one of these generators, Delva, how will I know it is actually being used as you have written here?” “Dr. Fournier, you have my word and an invitation to be my guest in Thomonde whenever you wish. You will stay in my home.” Six months later I received a letter stating that the Thomonde generator had, indeed, arrived, been set up, and was functioning. Delva ended by repeating his invitation to visit Thomonde. I decided to take him up on his offer. The health statistics Delva provided in his application were appalling: 200 cases of active tuberculosis. Eighty-five percent of the children malnourished. No health care providers or facilities for 50,000 people. Perhaps this was the “place of our own” Medishare was looking for. In any event, the place, Thomonde, so isolated and remote, and the person, Delva, so sincere and determined, intrigued me. How improbable that from the middle of nowhere with no modern means of communication with the outside world, he discovered we had generators to give, found his way to Miami, successfully competed for one, and not only got it back to Haiti but got it back up to the town, which I was told was six hours from Port-au-Prince on one of the world’s worst roads. And then he was polite enough to write me, when he could have just taken the generator, sold it on the black market, and put the cash in his pocket. Delva met me at the airport as he had promised. We rented a 4 × 4; stopped at a gas station for ice, water, and supplies; and headed out for Thomonde. Shortly after leaving Port-au-Prince, a large green sign marks the point where Route Nationale 3 branches off, threading through the interior of Haiti to Thomonde, Hinche, and points beyond. That sign is a perpetual source of humor for me now, as its large size and block letters complete with a diagonal exit arrow create the impression that Route Nationale 3 is a real road, perhaps even a highway. In actuality, shortly after the sign the pavement ends and the road becomes a dust/dirt/rock/hole/puddle obstacle course that crosses a desert, three mountain ranges, several rivers (some with

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Two visionaries—Dr. Paul Farmer and Delva, Magistrate of Thomonde. bridges, some without), and a savannah, finally ending in Cap Haitien. Haiti is a small country about the size of New Jersey. But it deserves to be a country nonetheless, not only for the uniqueness of its language, history, and culture but also for the fact that it physically takes so long to traverse, making it seem larger than it really is. Delva warned me that his six-hour time estimate from Port-au-Prince to Thomonde was just that. The trip, if complicated by breakdowns, mud holes, tap-tap turnovers, or washouts, could take twice as long. Recent improvements have cut the time to three and a half hours, but for the last hour and a half it is still, arguably, the worst road in the world. Shortly after Croix des Bouquets the road crosses an arid plain carpeted with cacti and thorn acacia trees. The road then ascends rapidly up the face of Mòrn Kabri. This is one of the most desolate regions of Haiti, totally treeless and infamous in Haiti’s history as a dumping ground for the victims of the Ton Ton Macoutes. Yet even

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti in its desolation, there was still a steady stream of people—some on foot, some on horse or mule, and a seemingly endless stream of trucks so top heavy with people and produce that each one seemed destined to topple over at every twist and turn of the road. White limestone dust raised by these trucks coated everything—rocks, vegetation, people—along the way and obscured the view of the road as it hugged the side of the mountain. When we reached the summit, we were greeted with a spectacular view of Lac Cayman, La Plaine, Port-au-Prince, and the mountains of the south beyond. The far side of the mountain turned greener as we descended toward the Val Artibonite, and the way of life, as seen from the road, was correspondingly less harsh: men working rice paddies with sticks to plant and hoes to plow, women with straw hats and hand-made livery riding burros to market. Wide deserted stretches of the road inexplicably transformed into impromptu markets, with thousands of vendors and buyers and piles of rich Haitian produce—eggplant, carrots, onions, and mangoes—freshly butchered goats, and still-living-but-doomed chickens and guinea hens. The road followed the river and the continuing flow of Haitian life in the countryside—women washing clothes and people of all ages, but particularly children, swimming and bathing. Around noon the schools let out and suddenly the road was flooded with children, clustered in color-coded uniforms (each school with its own color) walking hand in hand. Later, we passed through Mirebalais, a fair-sized town for the area, and stopped for a Haitian cola at a roadside restaurant near the cathedral. Above Mirebalais the river valley steepened into a canyon, and the once-tranquil river boiled with cascades and rapids. The road also seemed to boil with ruts that resembled solidified cascades and rapids. After we passed the abandoned cement mixers and the dam that created Lac Péligre (Danger Lake), the road once again climbed the side of one of the mountains that surround the lake. Since the road here was only rocks, there was no dust, and the view was breathtaking—a huge mountain lake surrounded by peaks on three sides, with the Dominican Republic off in the distance. The

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti View of Lac Péligre from Cange. lake was dotted with fishermen in dugout canoes. Tiny unpainted wattle and daub houses clung to the hillside between the road and a cliff that tumbled into the lake. Each home had a family outside carrying on their affairs in full view of their neighbors. At the crest of the peak the road left the lakeside and we found ourselves at the small town of Cange, home of Klinik Bon Sauveur. Delva stopped the truck. As we entered the clinic, looking for Dr. Paul, Delva whispered as if we were in church: “Dr. Paul. He’s a very good doctor.” When Project Medishare was first organized, I had contacted several other medical schools to find out who had been working in Haiti. Dr. Paul Farmer clearly stood out. He had a combined degree in anthropology and medicine from Harvard and had been working in Haiti for 12 years. He spent six months each year at Klinik Bon Saveur. He had written books about his work in Haiti and used the proceeds to support his clinic. His dean (whom I happened to know through a mutual friend) had told me that Dr. Paul was the only

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti living saint he had ever known. His professional life—indeed, even his personal life—reflected total commitment to what he called “a preferential option for the poor,” a belief that poor people had the same right to health as the rich and shouldn’t get second-class care. Klinik Bon Saveur sat on a promontory overlooking Lac Péligre. Its architecture was half functioning hospital and half gothic monastery. “Leave it to Harvard to nail down the prime real estate,” I joked, to break the ice. Paul launched into an apology (in the philosophic sense) about the clinic and the people it served. The people in the village we saw as we drove up were all squatters. They had been flooded out of their ancestral homes when the Duvalier government built the dam that created Lac Péligre. Built with USAID dollars, the dam was intended to generate hydroelectric power for Port-au-Prince. Of course, that never happened: No one ever figured out how to keep the intake valves clear. “So that’s progress in Haiti,” deadpanned Paul. “The power never worked and the people lost their land. There is a lot of poverty here in Haiti, but that’s the difference between decent poverty and indecent poverty. Land is the Haitian peasant’s birthright. For years, the United States was afraid Haiti would go communist, so the government poured millions into Haiti to prop up the Duvalier regime. In the process, thousands of Haitians were displaced from their land. No longer able to subsist and support their families, they slipped into the squatter state you saw as you approached.” I made a mental note not to joke with Paul ever again. I asked Paul how we might work together. Paul is all about service and commitment to the poor. He wasn’t interested in volunteers who showed up occasionally with no thought about follow-up or continuity of care. He was intrigued, however, about a long-term partnership for Thomonde between Medishare and his charity, Zanmi Lasante. Thomonde was his biggest problem. Without access to health care, the people in Thomonde were close enough to Cange to come when desperately ill, but not close enough to come for routine care. Thomonde’s population dwarfed that of Cange. Paul’s sta-

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti A traditional home in Thomonde. tistics amply documented the problem—those estimated 200 cases of active tuberculosis in Thomonde were only one example. So it would please Paul greatly if some group like Medishare would “adopt” Thomonde and work with Delva and the people there to develop a permanent health system. As he walked us back to our truck after the meeting ended he gave me a gentle admonition. “Just don’t be like so many others Art, who’ve come, made promises, and never come back. If you do that, you’ll break the people’s hearts.” Thomonde was 15 kilometers or an hour’s ride after the crest of Cange. As we rounded a ridge, I could see that Thomonde lay at the bottom of a huge volcanic caldera: a green oasis amid the grasslands and deforestation of the central plateau. The main village of Thomonde was a pick-up-stix scattering of streets and cross streets, each lined with traditional Haitian two-room homes—a living room and a communal bedroom. Most were painted bright turquoise blue with white trim. A large mapou tree, decorated with Voodoo symbols, marked the first fork in the road. Delva’s house was of similar

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti design but totally white, with a large tournelle—a large round open space covered by a roof—that served as a village gathering place. Thomonde, like Mirebalais and its neighbor, Hinche, appeared on colonial maps of Haiti. The town was originally settled by the Spanish in 1630. They were probably pushed out by “maroons” (runaway slaves) in the 1700s. The name Thomonde was derived from the Spanish todo el mundo. (all the world). The reason to give this name to a town so isolated escaped me. Somehow, Todo El Mundo changed into Thomonde, roughly translated as “Tom’s world.” It was built on the French village model, with a town square in front of a church at the center of town. Delva took pride in the town square, a small park and a gazebo that he built with money from the European Union. He introduced me to the village notables and then asked me to address the village via megaphone from the gazebo. I met the vice-mayors, the schoolteachers, and Bernardeau, a local success story who had emigrated to Boston years earlier and sold used cars. Now he was wealthy by Thomonde’s standards and returned to Thomonde every winter to avoid Boston’s chill. A party erupted with dancing and rum and clapping. Project Medishare, in the person of Dr. Fournier, had come to Thomonde. Delva gave up his bed and home and moved in with a neighbor for the night. I marveled at the workmanship of the shutters and the doors of Delva’s house. When the kerosene in the lamp burned out, I was left in the darkness with my thoughts. Voodoo drums pounded in the distance. Their rhythm and intensity helped me focus. Here was a place no one else wanted but a place that wanted us, a place where Project Medishare could make a difference. The roosters started crowing at 2:30, coupled with the yelping of dogs and the braying of mules. At 5:00, the church bell started chiming and shortly thereafter the farmers started out for their fields. At 7:30, as the schoolchildren marched to their schools, I took a walk around the town. The children whispered and giggled as I passed. Some of them silently followed me. One, a natural leader

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti even at six years old, took my hand and smiled with silent pride, the envy of all her peers. Delva came by with breakfast around 8:00—wonderful Haitian coffee, fried plantains, and a Haitian style of spaghetti. It was the beginning of a beautiful friendship. How could he know that my mom is Italian-American and that pasta for breakfast is my ultimate fantasy? We sat under his tournelle in the coolness of the morning and he told me of his dreams for Thomonde. Health care was at the top of his wish list, even higher than electricity. “If you don’t have health, you don’t have anything. Here, if you don’t have your health you can’t work. If you can’t work, not only do you die, but your children die also.” I thought about how many people I know who take their health for granted or, worse, abuse themselves. “You’re very wise, Delva,” I responded, “for a politician.” Later, we took a walk to the old dispensary, which had been closed for three years and was in a sad state of disrepair. “This is the only health care facility in the entire commune,” Delva confided. We then took our 4 × 4 to a field outside town. There, in a little shed, stood the generator. “The town of Thomonde owns this land,” Delva whispered conspiratorially. “Wouldn’t it be a great location for a hospital?” “Someday, Delva, perhaps, but we have a saying in English, ‘You’ve got to crawl before you can walk.’ I can come back in two months and bring a team of medical students with me. We can only stay for a week. It’s not much, but it’s a start.” Before we left Thomonde to return to Port-au-Prince, Delva took me to make a house call on his parents. They lived in a small house on the edge of town, with a surprisingly large plot of land, neatly demarcated by cactus hedge rows. His father had suffered a stroke in the recent past, and his mother had some pain in her left shoulder that caused Delva some concern. Before I examined them, Delva introduced me and pulled over a handmade ladderback chair for me to sit on. His mother had been

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti cooking soup for her husband over a charcoal fire outside. She was short and, like Delva, always smiling. Instead of the usual head wrap, she wore a cheery blue broad-rimmed bonnet. She beamed with pride as I told them the story of the generator and Delva’s first trip to Miami. There wasn’t much I could do for his father. The stroke had crippled his right side and made it extremely difficult for him to speak. The smell of urine permeated his bedclothes. I suggested he take an aspirin a day and that the family try to get him out of bed as much as possible. His mother had a simple case of tendonitis. I gave her an anti-inflammatory medicine that I had in my suitcase. In half an hour her pain was gone—Medishare’s first miracle in Thomonde.