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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.



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