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Marasa

OF ALL THE VILLAGES IN RURAL HAITI, Labadie would seem the most improbable for Project Medishare to visit. The tiny village is nestled between Morne Cap and Labadie Bay, prosperous by Haitian standards. Most of the adults are employed by Royal Caribbean Cruise Line, a Miami company that owned all the property surrounding the village. Labadie’s pristine beaches were among the cruise line’s most popular destinations. The villagers maintained the property, manned the concession stands, ferried passengers between the cruise ships and the beach, and cleaned up after they left. The cruise line referred to Labadie as its “private island,” never mentioning that it was in Haiti.

We were there for the most pragmatic of reasons. Royal Caribbean Cruise Line had offered to make a substantial donation to Medishare if we’d do a health fair in Labadie. For all its prosperity, there was no real health care in Labadie, and health issues were taking a toll on the productivity of Labadie’s workers.

To celebrate our coming, the villagers decided to spruce up the abandoned government dispensary, located on the edge of Labadie Bay with a view of the tourist beaches and plantation ruins beyond. They had stocked the pharmacy and hired a handyman to plaster the



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Marasa OF ALL THE VILLAGES IN RURAL HAITI, Labadie would seem the most improbable for Project Medishare to visit. The tiny village is nestled between Morne Cap and Labadie Bay, prosperous by Haitian standards. Most of the adults are employed by Royal Caribbean Cruise Line, a Miami company that owned all the property surrounding the village. Labadie’s pristine beaches were among the cruise line’s most popular destinations. The villagers maintained the property, manned the concession stands, ferried passengers between the cruise ships and the beach, and cleaned up after they left. The cruise line referred to Labadie as its “private island,” never mentioning that it was in Haiti. We were there for the most pragmatic of reasons. Royal Caribbean Cruise Line had offered to make a substantial donation to Medishare if we’d do a health fair in Labadie. For all its prosperity, there was no real health care in Labadie, and health issues were taking a toll on the productivity of Labadie’s workers. To celebrate our coming, the villagers decided to spruce up the abandoned government dispensary, located on the edge of Labadie Bay with a view of the tourist beaches and plantation ruins beyond. They had stocked the pharmacy and hired a handyman to plaster the

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti most obvious cracks and apply a fresh coat of paint. About half an hour before the health fair was scheduled to start, Joseph, my lead student, called me over to see the handyman. “I think he’s got typhoid,” Joseph said. One glance confirmed Joseph’s diagnosis. The handyman was lying on the dispensary floor, sweating profusely and clutching his stomach in pain. Next to him was a foul-smelling pot of fish stew. “Gather up the rest of the students, Joseph. We’ve got our first patient.” I asked the students to find some Cipro, mix up some oral rehydration therapy, and start giving the antibiotic and the fluid to the patient. After they started treatment, I explained: “One picture is worth a thousand words. See that fish pot? We don’t see typhoid in the states anymore because of things we all take for granted—clean water, sanitation, and refrigeration. Here in Haiti, even in prosperous Labadie, there is no refrigeration. So our poor patient brought a pot of fish stew with him and tried to nurse it through his two days of work here. It’s a good thing we came when we did. He could have died. Joseph, check his vital signs every half hour and make sure he keeps up on his fluids. Everyone, let’s pick him up gently—his abdomen’s exquisitely tender—and move him to the back room, out of the way. We’ve got to get started. The line of patients already extends to the center of town.” Joseph and I were the only bilingual members of the team. Joseph, being a Haitian-American second-year student was an invaluable resource. I had enormous confidence in him, as I knew him well. As a first-year student, he had been assigned to me in the clinical skills course. So he was my protégé. I actually didn’t have to teach him that much. He had intuitive people skills. He spoke French, Creole, and Spanish, fluently. He had only started learning English when he emigrated to the United States at the age of 14, so his English was marred by a heavy accent. When stressed, he stammered to find the right words, but it took a lot to stress him. During Joseph’s first year, I had him work with Phil, whose

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Achilles’ heel as our best doctor and teacher was that he could not speak Spanish or Creole. At the time, we had a patient from Honduras with a wasting syndrome strongly suggestive of AIDS. The patient was in denial, however, and refused to be tested. It was Joseph who not only convinced him that he should be tested but also explained the results in Spanish to the patient and his wife. The couple had been separated for several years, he having been forced to return to Honduras by the Immigration and Naturalization Service, but now that he had returned and was ill, she was his only source of support. At first she was so upset to discover her husband had AIDS that she threatened divorce. Joseph’s people skills won the day, though. He not only convinced the wife to be tested (she also tested positive) but counseled them to both start therapy and stay together. They are alive and well to this day. Joseph was a proverbial gentle giant. He towered over me and showed his affection for me by rubbing my head, as if it were a bottle with a genie in it. I’d become something of a father figure to him, in part because of my devotion to Haiti and in part because his own father had died when he was younger. He grew up in St. Marc, a dusty ramshackle colonial town on the coast an hour north of Port-au-Prince. He worked three jobs while in his preclinical years to pay his tuition, but still found time to volunteer for Medishare. This was our third trip together. Joseph took each patient’s history as he registered them, told it to a student who took the patient into an exam room, and reported the results to me. From there the patient went to the pharmacy for medicines and then out the door. Soon the health fair was humming. As we got busier and busier, the improbably beautiful setting of the clinic by the sea faded from my consciousness. This could be a health fair in Thomonde or anywhere else in rural Haiti—lots of children with malnutrition, worms, and scabies. By noon the handyman felt well enough to return to his painting. “Make sure he’s got a week’s worth of Cipro and knows how to take it,” I told the student manning the pharmacy.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti “Hey, Dr. Fournier. Help me with this exam!” called Ana from the prenatal station. “I can’t be sure of this baby’s position.” Part of good prenatal care is to determine the baby’s position in the womb. Normally the head should be down. A breech-first baby almost always requires a Caesarian delivery. Not knowing in advance that you need a Caesarian is pretty much a death sentence in rural Haiti. I examined the eight-month pregnant woman carefully. “Feel here Ana,” I said as I placed her hands on the patient’s abdomen. “What do you feel?” “Oh, so that’s where the head is!” “Now feel here.” “But that feels like the head also!” “Now listen here with your stethoscope.” “Oh, the baby’s heartbeat!” “Now listen here.” “Another heartbeat? Dr. Fournier, I’m so confused!” “What’s your diagnosis, Ana?” Ana looked at me dumbfounded. “Marasa!” I told the patient with a smile. “Twins!” “Omigod, Dr. Fournier! You can do that? Diagnose twins without an ultrasound?” Maybe I was better prepared to practice medicine in Haiti than I realized. One of my pet peeves about how medicine was changing in the United States was its increasing dependence on technology. In fact, I was firmly convinced we were being enslaved by it, unable to practice without it. So diagnosing twins the old-fashioned way gave me particular pleasure. Twins are special in Haitian culture, and this particular mother-to-be left very happy. Joseph, however, had found another set of twins, and they weren’t so fortunate. “Look at this, Dr. Fournier. The twins were identical, as evidenced by a photo the healthy one carried with him that had been taken a few years before. In the interim, one had developed extreme weight loss, chronic cough, and

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Identical twin brothers, one with AIDS, one without. diarrhea. His physical exam showed the telltale yeast infection of AIDS. The healthy brother looked about 30. The sick brother looked three times older. His healthy twin implored us to help. “He’s probably got SIDA [the initials that stand for AIDS in French] and tuberculosis,” I explained in Creole. “The best we can do is send him to Hôpital Justinien au Cap. I know the doctors there. They’ll take good care of him.” Joseph picked up the patient from the examining table and, with the patient’s arms around his neck, carried him out of the clinic. He waded into the bay, hoisted him over the gunwales of an anchored water taxi, and hailed the captain. “You’d better go with him,” I suggested. “We’re almost done here. Look for one of the family medicine residents and make sure he gets admitted.” I gave him $20 for the water taxi and helped the

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti brother climb in. “Bon dye beni nou!” (“God bless you both!”), I called as the boat turned and headed into the setting sun. The next morning I had a meeting with a village elder, Franco. I expressed my concern over the quantity and severity of health problems I had seen the day before. “There’s not much we can do,” said Franco. “Our only source of water is the stream that flows through the village. We have no electricity and no doctor.” “I’ll talk with the people at Royal Caribbean when I return, and we’ll see if they’ll help. You seem to have an AIDS problem here. Where did that come from?” “It came from the path.” “The path?” “Yes, the path. I’ll show you on your way out.” Off the trail that connects two beaches in the tourist part of Labadie is a small but well-worn footpath marked by some painted rocks. The path leads up to a small clearing in the woods that cover the mountainside behind the beach. According to Franco, it’s there that the village girls and boys wait for the tourists on Mondays and Wednesdays and sell themselves for $10 or 10 euros. Tourists interested in casual anonymous sex know about the path or find out about it shortly after their arrival. Somehow, they slip away from their spouses or partners or group; trudge up the path with their snorkel masks, sunscreen, and flippers; and enjoy the pleasures of the harbor. The stream is pretty constant, from the first disembarkation until the last whistle call. The exchange rate doesn’t seem to matter. Smart virus. Smarter than we are.