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“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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