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Exposition Santé

THAT WAS OUR FIRST HEALTH FAIR in Thomonde. We’ve subsequently returned, about three times per year, with an ever-growing cadre of committed students. The early health fairs were pretty chaotic. Michel and I were the most consistent trip leaders. In a community that had received health care only episodically from missionaries, we had to break through an unspoken communal mind-set in which every patient pushed to be seen, shared a litany of complaints, and hoped to walk away with some magic pill, any pill. It didn’t matter whether it would really help them or not.

In the beginning, malnutrition was rampant in Thomonde. It was easy to screen for: Simply line up all the children with red hair. Hair is, in essence, pure protein. The first signs of protein deficiency show in hair. The hair of malnourished children in Haiti changes from curly, thick, and black to thin, sparse, and red. Human beings are 95 percent water. One of the many miraculous things that protein does is to keep water in our cells and circulatory system, rather than us dissolving into an amorphous puddle. As protein deficiency progresses, therefore, a child’s belly and feet swell with fluid. Malnutrition is further complicated by worms. When we first went to Thomonde, we just assumed each child had worms. Therefore, each



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Exposition Santé THAT WAS OUR FIRST HEALTH FAIR in Thomonde. We’ve subsequently returned, about three times per year, with an ever-growing cadre of committed students. The early health fairs were pretty chaotic. Michel and I were the most consistent trip leaders. In a community that had received health care only episodically from missionaries, we had to break through an unspoken communal mind-set in which every patient pushed to be seen, shared a litany of complaints, and hoped to walk away with some magic pill, any pill. It didn’t matter whether it would really help them or not. In the beginning, malnutrition was rampant in Thomonde. It was easy to screen for: Simply line up all the children with red hair. Hair is, in essence, pure protein. The first signs of protein deficiency show in hair. The hair of malnourished children in Haiti changes from curly, thick, and black to thin, sparse, and red. Human beings are 95 percent water. One of the many miraculous things that protein does is to keep water in our cells and circulatory system, rather than us dissolving into an amorphous puddle. As protein deficiency progresses, therefore, a child’s belly and feet swell with fluid. Malnutrition is further complicated by worms. When we first went to Thomonde, we just assumed each child had worms. Therefore, each

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti health fair in the early days always had a “deworming line.” The red hair and swollen bellies of malnutrition were not just clinical signs of the disease; they were signs for all to see that these children were somehow marked for misfortune and probably premature death. While in Ireland red hair might be considered beautiful, in Haiti it’s a symbol of shame. One family was particularly poignant—two devoted parents and five daughters, all under the age of 5, all slowly starving to death. I explained to my students how the mother had breast-fed each child but had to stop prematurely to return to her work selling produce in the market. With this many children, none could be adequately nourished. As I was telling the mother what kinds of foods she should be giving her children, she burst into tears. Her children were marked by a particularly unusual sign of malnutrition: Their hair turned not red but blonde, and she blamed herself. Worse, there was nothing she could do about it, as the family was too poor even to raise chickens, let alone goats or a pig. I was ashamed of my insensitivity. Before I left them, I touched her hand and whispered “kenbe-la” (“hang in there”). Riding back to Port-au-Prince, one of the students, Stephanie, volunteered that her husband worked for a company, Rexall-Sundown, that made vitamins and protein supplements. She would write a letter to the president of the company, requesting a donation. Stephanie’s letter resulted in a donation of 14 palettes (approximately two tons) of multivitamins and protein supplements. With the help of a Peace Corps volunteer, we started feeding and prenatal care programs. Shortly thereafter, the kids in Thomonde started having black hair again. Over time our health fairs became more organized. The focus shifted from acute care to screening and prevention. I think of Tim at the start of every health fair. He’d be surprised and delighted to see the unexpected way I fulfilled his dying wish. If he could have held on until HAART (Highly Active Anti-Retroviral Therapy) arrived, he’d probably be in Haiti with us.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti We started going out to the remote corners of the commune—Baille Touribe, Tierre Muscadet, and Savannette. It takes as long to get to Baille Touribe from Thomonde as it takes to get from Thomonde to Port-au-Prince, and the road—built by hand by the Thomondois and Baille Touribois—is even worse than Route Nationale 3. It’s hard to imagine a more isolated corner of the planet than Baille Touribe. Totally cut off from everything but Thomonde and Cange, not even within range of the nearest radio station, it’s surprising the Baille Touribois have not evolved their own language. With no electricity, cars, anything remotely modern, the people live in a timeless, traditional way. Most Baille Touribois rarely travel more A family of four, Baille Touribe.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti than 10 kilometers from the place of their birth during their entire lifetime. We began doing our health fairs in the church in Bas Touribe, a cool shady place, with a good breeze when its doors are open. The priest let us use his vestibule—a small room off the altar—for Pap smear screening. Pap smears had never been done in this part of Haiti—a Project Medishare first. We found a lot of positives, but imagine the difficulty of explaining the need for and the process of such a procedure to people living in such a timeless, isolated place. So we started with a class in Creole outside the vestibule door that began with the basics: What is a cell? What is cancer? Does anyone know someone who died of cancer? Hundreds of women lined up and patiently waited all day for their turn to climb up on the makeshift examining table and submit to the examination. Pap smears continue there today. While the students set up for the screening, I usually circulate among the crowd, explaining that we’re not there to treat every ache and pain but to screen for problems that might kill them. I also scan the throngs for the obviously ill who need to receive individual attention. They’re easy to identify with their wasted frames and gaunt, frightened stares. The patients I can visually identify as having AIDS or tuberculosis invariably are standing off by themselves, shunned by the crowds. Failing health can only be explained by a curse, you see. Both the victims and their neighbors understand that. The health fairs proved to be invaluable for screening and prevention. They were also a clever way to engage and organize our enthusiastic but inexperienced medical students. Since Medishare had first come to Thomonde, we had brought the commune from no health care to episodic care, with screening and patient education. Episodic care was certainly better than no care at all, but the visiting American doctors and students were never going to break through the stigma and shame of AIDS, tuberculosis, and malnutrition. We’d need a permanent presence. And it would have to be Haitian.