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Close Encounters

1998 MY BEEPER WENT OFF WHILE I was giving expert witness testimony at a malpractice trial in West Palm Beach. Annoyed, I pressed the button to stifle the beep without interrupting my testimony. I rechecked my beeper during recess. The number started with an area code I was not familiar with. “Must be a mistake,” I remember thinking, but if I’m compulsive about one thing, it’s answering my pages. I dialed the number on my cell phone.

“Open Society Institute. Farzi speaking. How may I help you?”

“Hi. This is Dr. Arthur Fournier in Miami, Florida. Did you page me?”

(Farzi chuckled softly) “This is the Open Society Institute, New York City. Just one moment.”

“Hi. My name is Ellen. Congratulations. We’ve decided to fund your project, ‘Family Medicine Training in Rural Haiti.’”

“Wow! Thanks! Um, is this official? Is there anything else I need to know?”

“I’ll be writing you with all the details. It’s a challenge grant. That means we’re only giving you half of what you need. Another foundation will need to match our challenge, but we’ll help you find that partner. The First Lady will be announcing the award in Haiti



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Close Encounters 1998 MY BEEPER WENT OFF WHILE I was giving expert witness testimony at a malpractice trial in West Palm Beach. Annoyed, I pressed the button to stifle the beep without interrupting my testimony. I rechecked my beeper during recess. The number started with an area code I was not familiar with. “Must be a mistake,” I remember thinking, but if I’m compulsive about one thing, it’s answering my pages. I dialed the number on my cell phone. “Open Society Institute. Farzi speaking. How may I help you?” “Hi. This is Dr. Arthur Fournier in Miami, Florida. Did you page me?” (Farzi chuckled softly) “This is the Open Society Institute, New York City. Just one moment.” “Hi. My name is Ellen. Congratulations. We’ve decided to fund your project, ‘Family Medicine Training in Rural Haiti.’” “Wow! Thanks! Um, is this official? Is there anything else I need to know?” “I’ll be writing you with all the details. It’s a challenge grant. That means we’re only giving you half of what you need. Another foundation will need to match our challenge, but we’ll help you find that partner. The First Lady will be announcing the award in Haiti

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti when she visits on November 22. That’s in three weeks. Can you be there?” “Can I bring Michel, my co-conspirator?” “Surely. We’ll work through the details. She’ll announce it at a ceremony at Dr. Guy’s hospital in Pignon.” “I’m giving testimony at trial right now. This is for real, right? Is there a number where I can call you back tomorrow?” “Just use this same number. The First Lady wanted to announce something positive while she was in Haiti, so she called us to see if we had anything in the works. We reviewed all the proposals and yours was the best.” I had just enough time to call Michel before the trial resumed. After our first trip to Haiti, it was clear that what we could do that would help Haiti the most was what we also did in Miami—train family physicians. The Haitian medical education system, modeled after the French, had only one residency position for every two graduates. These residencies in traditional specialties were all based in Port-au-Prince. Thus, the system forced its graduates to either specialize or emigrate. Meanwhile, in rural Haiti, where 85 percent of the people lived, there were hardly any doctors. Those who did practice outside the capital were not trained to meet the health care needs of the people they were supposed to be serving. We put these ideas down on paper, organized into an ambitious program to fund three residency programs throughout the country—one in the north, one in the center, and one in the south. Now, at least one was going to become a reality. Michel and I had to book reservations in first class in order to get to Haiti with only three weeks’ notice. We drank champagne and congratulated each other during the flight. Mostly, we were thrilled that our plans for training Haitian doctors in family medicine were about to become a reality. But this scholarly achievement was about to be infused with star quality. We were going to meet the billionaire philanthropist George Soros and the First Lady, Hilary Rodham Clinton. We rendezvoused with Mr. Soros, the philanthropist who

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti founded the Open Society Institute and Ellen at the Hotel Olaffson, a classic Caribbean gingerbread design hotel in Port-au-Prince. George (he insisted we call him George) had made his fortune in international finance. In financial circles he’s known as the “man who broke the Bank of England,” the ultimate capitalist. But he gives most of his money to his charity, which is dedicated to transforming countries formerly ruled by dictators into democratic, open societies. Casually dressed and unassuming, he bought us drinks at the bar. “Now tell me, what’s family medicine, and why is it so important for Haiti?” Most Americans don’t realize that the discipline of family medicine is a modern American invention. In fact, it was invented in large part in Miami in the mid-1960s, by Lynn, my roommate during our first trip to Haiti. Our medical school created the first department of family medicine and the three-year residency training program in family medicine. Prior to that, doctors going into general practice did only a one-year rotating internship. Best suited for rural communities, family medicine had not taken hold in some U.S. urban enclaves, such as Boston and New York. Michel and I were not surprised, therefore, with the tone of Mr. Soros’s question. Michel reviewed for him the theory behind family medicine—the need for broad-based generalists with special skills in primary care to deal with 90 percent of the health problems that affect poor Haitians, with special skills in primary care. Cleverly, he explained how, in a country like Haiti, the family medicine model complimented his vision of an open society. The profession of medicine in Haiti was, until now, a closed society. Even though medical education was free, only the sons and daughters of the elite could afford the education needed to pass the test for admission to medical school. Most graduates chose an urban specialty private practice after graduation or emigrated to France or the United States. Objectively, a poor country like Haiti simply could not afford the luxury of one doctor for its children, one for its adults, and one for its pregnant women. George listened intently.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti I had been a little left of center since my college days. But after an hour of some of the most stimulating conversation of my life, I found myself thinking, “Gee, maybe capitalism isn’t so bad after all.” I promised George and Ellen that of all their grants they would never get as great a return on their investment as they would from our training program. That evening we attended an informal reception at the U.S. ambassador’s residence. After short speeches by President Preval and Mrs. Clinton, the audience broke into small groups on the lawn for cocktails while the ambassador, the first ladies, the president, and Mr. Soros went inside for a formal dinner. We spent the night at Michel’s mother’s house in Petionville and then headed for the general airport for the charter flight to Pignon. Pignon boasts “the third-best airport in Haiti.” It was built to accommodate doctors visiting Dr. Guy’s Hôpital Bienfaisance. It would be hard to imagine a more difficult hospital to get to if it were not for the airport—six hours from Port-au-Prince and three hours from Cap Haitien, on the world’s worst road (the same one that passes through Thomonde). Not a problem for the First Lady and her entourage; they’d come by helicopter, a half-hour flight. Pignon is a dusty village on the northern edge of Haiti’s Plateau Central. Dr. Guy’s father was Pignon’s pastor, the only formally educated person in the village. Growing up, Guy would visit the sick with his father. From these visits grew his resolve to be a doctor. Somehow, after his medical school in Haiti and residency in surgery in New York, he became a flight surgeon for the U.S. Air Force, and he used his savings to fund his hospital. We had visited it as Project Medishare volunteers and deemed it perfect for family medicine training. When our chartered Cessna circled the field and landed, we were the first dignitaries to arrive. Both Michel and I wore dark suits and ties, as dictated by Haitian protocol. I was envious of the children running around naked, as the temperature was at least 90 degrees. A small crowd gathered at the airport building—equally divided among

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti First Lady Hilary Rodham Clinton and Mr. George Soros announcing the grant for Family Medicine training. village dignitaries anxiously awaiting the First Lady and the curious, sure something important was happening but not sure exactly what it was. Protocol officers from the First Lady’s office, Secret Service agents, and officials from the U.S. Agency for International Development scurried about trying to organize the unorganizable. They wanted a rope strung on poles to separate the people from the First Lady. Unfortunately, none of them spoke Creole and not a single Pignonois spoke English. So I translated and soon a 30-foot cordon extended from both sides of the airport building. To the people, this rope was meaningless. They wandered around both sides or out onto the runway, following their cattle or goats. Michel found a tarantula on the grass runway and dutifully notified the Secret Service. They called in a government 4 × 4 vehicle which, in the interest of security, ran over the poor spider six times.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti With the field somewhat secured, we waited in anticipation of the First Lady. Like the climax of the movie Close Encounters, two small helicopters and one large one appeared first on the horizon and then hovered slowly toward the runway. The crowd cheered, and the local high school band played enthusiastically. Aliens arriving, I thought, but friendly aliens. Once on the ground the First Lady and her guests, including George, the world’s second-richest man, and Bill Sr., father of the world’s richest man, disembarked. George was the guy actually giving us the money. Bill Sr. was literally along for the ride, learning the philanthropy ropes. The group was greeted by Dr. Guy and the mayor of Pignon, both with red sashes, and two charming little girls in yellow and pink dresses carrying flowers. The entourage piled into their SUVs and we headed for the hospital. Family medicine training was about to arrive in Haiti. The First Lady wore a pink pantsuit. After we returned to Miami and developed our pictures, this was the number one topic for discussion, with the world divided into two camps—those that loved it and those that hated it. She toured the hospital with Dr. Guy, while Michel, myself, George, Bill Sr., Dr. Guy’s parents, the Open Society Institute entourage, the protocol officers, the Secret Service agents, the hospital workers, and a sizable portion of the population of Pignon waited in the courtyard. To her credit, Mrs. Clinton spent extra time talking to the cadre of fanm saj, the midwives trained by Dr. Guy, who was the principal reason why the hospital had reduced its maternal mortality by two-thirds. Each proudly carried her metal box containing sterile scalpels, ligatures, and gauze pads. Guy, George, and Mrs. Clinton all spoke eloquently, and George introduced Michel and me. We stood and bowed to the cheers of the hospital employees and villagers. Bill Sr. was fidgeting, concerned that he hadn’t gotten to ride in the First Lady’s helicopter. Between speeches Ellen darted between his seat and hers. After she promised him he could ride with the First Lady on the return trip, his mood lightened considerably.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti A young woman strode to the podium, also dressed in pink. She spoke passionately about the difference a micro-loan had made in her life. She had bought a sewing machine and now was supporting her family. Confident, assured, the Haitian peasant eclipsed the billionaire and the First Lady. I glanced at Michel. How strange life is—what accidents create the rich and the poor, and is it justice or injustice that united the seamstress and the president’s wife? More importantly, the young woman’s impassioned speech convinced me that we had to think beyond health and start thinking about ways, such as micro-loans, that would address the underlying cause of most of the country’s problems—Haiti’s grinding poverty. Afterward, I asked Ellen if it might be possible to meet the First Lady. “Sure, no problem! Just wait by the hospital entryway. We’ll have to pass through to get back to our cars.” It turned out that Ellen and Mrs. Clinton had been friends since college. “You know,” I said to Michel as we waited for our big moment, “it was really nice for Mrs. Clinton to come here and do this. I mean, how many votes is she going to pick up by coming to Pignon?” Just then, Ellen, Mrs. Clinton, her photographer, and the Secret Service entourage turned the corner. As promised, Ellen stopped and graciously introduced us. “Thanks so much for caring about Haiti, Mrs. Clinton,” I gushed, starstruck as I shook her hand. “Call me Hillary, please. And don’t thank me. It’s you two who are doing the work!”