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Mambo

MEANWHILE, THE UNIVERSITY OF Florida School of Medicine, Miami’s state-supported sister school, was following in Project Medishare’s footsteps. Nestled in the small north Florida college town of Gainesville, UF seemed worlds apart from Miami. Surprisingly, though, it always had a fair number of Haitian-American students from Miami in attendance—students willing to give up the comfort and support of home in exchange for Florida’s much lower tuition. One of them was Serge.

Serge somehow found me at Miriam’s orphanage, where a small Medishare team was performing physical exams on the kids. He had been home for spring break visiting his family in Carrefour, on the other side of Port-au-Prince. He had heard via teledyòl (“word of mouth”) that some dokte blan-yo (“foreign doctors”) were working at an orphanage in Post Cazeau. He and his brother, Rousseau, borrowed the family car, an old red Pinto, drove across town and, in a manner similar to my first failed attempt to find Père Luc, asked and searched, asked and searched, until they found us.

“Hi! My name is Serge. I’m a first-year student at the University of Florida School of Medicine. Are you Dr. Fournier? I heard about what you’re doing from my cousin in Fort Lauderdale. She works as



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Mambo MEANWHILE, THE UNIVERSITY OF Florida School of Medicine, Miami’s state-supported sister school, was following in Project Medishare’s footsteps. Nestled in the small north Florida college town of Gainesville, UF seemed worlds apart from Miami. Surprisingly, though, it always had a fair number of Haitian-American students from Miami in attendance—students willing to give up the comfort and support of home in exchange for Florida’s much lower tuition. One of them was Serge. Serge somehow found me at Miriam’s orphanage, where a small Medishare team was performing physical exams on the kids. He had been home for spring break visiting his family in Carrefour, on the other side of Port-au-Prince. He had heard via teledyòl (“word of mouth”) that some dokte blan-yo (“foreign doctors”) were working at an orphanage in Post Cazeau. He and his brother, Rousseau, borrowed the family car, an old red Pinto, drove across town and, in a manner similar to my first failed attempt to find Père Luc, asked and searched, asked and searched, until they found us. “Hi! My name is Serge. I’m a first-year student at the University of Florida School of Medicine. Are you Dr. Fournier? I heard about what you’re doing from my cousin in Fort Lauderdale. She works as

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti a nurse at Jackson. There’s a group of us at UF trying to organize to work here in Haiti, but we don’t have any faculty. Do you think you can help?” Serge was tall, very dark, and somewhat reminiscent of a young Sidney Poitier, except with a squarer jaw. He had a heavy accent and spoke with a little bit of a lisp. That day he wore a T-shirt and jeans. I acknowledged that I was Dr. Fournier and invited him to join in with our exams. I then peppered him with questions, in part to get him involved and in part to assure myself that he was, in fact, a medical student. He passed the test. As it turned out, the University of Florida’s spring break always occurred the week following Miami’s. It was therefore relatively easy for me to stay on an extra week each spring, supervise my Miami students, and rendezvous with the Florida students at the airport in order to supervise them. Serge had returned to Gainesville after our first encounter and organized his fellow students to work in a similar manner to Medishare. Unlike the University of Miami teams, however, Serge and his team set their own itinerary. The first two trips on which I worked with UF students focused on orphanages in Port-au-Prince. “So, where are we going, this time, Serge?” I asked during a phone call in anticipation of our third trip together. “We’re going to Jacmel. We’ll be doing health fairs in villages right behind the beach at Raymond-le-Bain. But first I’ve found a new orphanage that needs our help. It’s up in the mountains on the way to Jacmel in the village of Decouze. They have about a hundred kids. There’s only one problem, Dr. F.” “What’s that Serge?” “It’s a Voodoo orphanage.” I think Serge expected me to be shocked. “So? We’ve got a Catholic orphanage [Luc’s] and a Protestant orphanage [Miriam’s]. This will make us truly ecumenical!” About 20 miles out of Port-au-Prince, the road to Jacmel branches off the road that snakes down Haiti’s southern peninsula,

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti ascending and then descending over the peninsula’s mountainous spine. In contrast to most of the roads in Haiti, the road to Jacmel was newly paved—Jacmel had an influential legislator who hoped a paved road would increase tourism. So even though the road twisted and turned as it climbed the mountainous ridges, it was a relief from the dust and ruts of Route Nationale 2. The view as we ascended was spectacular—first the plain of Leogane, then off in the distance Isle de la Gonave and the mountains of the southern peninsula, tumbling into the sea. These mountains were greener than those to the north of Port-au-Prince. Nestled between the Caribbean and the Golfe de la Gonave, they get more rain. As a result, the terraces carved out of the side of the mountains seemed more productive. The peasants farming there seemed relatively prosperous, with larger plots of land, more distance between their neighbors, slightly larger homes, and much more impressive tombs. By this time I’d been to Haiti often enough to know that everything there has meaning. I tried to explain this to the Florida students as they took in the homes, markets, farms, and cemeteries we passed along the road. “Let’s start with the tombs,” I began. “In New Orleans, they tell the tourists the tombs are built above ground because the city is below sea level. Really, the above-ground tomb is a Creole tradition, seen all around the Caribbean. It’s part of Voodoo. An elaborate tomb shows respect for deceased ancestors. Look there! You can see an offering left of grain and rum.” “That tomb is more elaborate than the house next to it!” exclaimed a student, pointing through the window of the van to a three-tiered crypt with a gothic facade. “That’s because for a Haitian your tomb is your home for eternity. You’ll be spending more time there than in your earthly home,” explained Serge. “And notice the colors and the crosses. Blue and white are Christian colors, black and red are Voodoo. Then there’s a cross for the

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Catholics and a different-shaped cross for each Protestant denomination.” “Is that why all the houses are painted blue and white?” exclaimed another student. “I just thought they must have had a paint sale for those colors.” “No, it’s the same symbolism,” I continued. “If you see a red and black house, it’s probably a ounmfò, a Voodoo temple. And notice the carvings on the wooden eaves. They’re all symbols of either saints or voodoo spirits.” The road dipped and weaved through Tombe Gateau (“Fallen Cake,” the mountain on the other side of the ravine looked exactly like that!) and then ascended to Decouze, the highest point on the mountain ridge. The students’ emotions alternated between awe at the spectacle of Haitian life unfolding before us, the beauty of the terrain, and the terror of oncoming trucks whipping around hairpin turns. As we approached Decouze, a mist (or was it clouds?) intermittently surrounded us and the temperature cooled noticeably. When the mist cleared, we could see both the Caribbean and the Golfe de la Gonave at the same time. Up ahead the road was clogged with burros and women selling wares, a traditional Haitian market. Fortunately, we had reached our destination—Orphelinat Bon Secours. The name was painted stylishly in large black script on a rose-colored wall that surrounded the whole compound. “How did you find out about this place, Serge?” I asked. “Do they know we’re coming?” Serge explained that the orphanage (actually it was both an orphanage and a school, and some children from Decouze with parents were allowed in for classes during the day) was founded and financed by a bookstore owner Serge had met in Port-au-Prince. His wife, Madame Felice, not only ran the school and orphanage but also served as Decouze’s mambo, a Voodoo priestess. She was assisted by her two daughters and a nurse. The founder told Serge he would

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti send a message to the orphanage that we were coming via the nurse, who traveled back and forth between Port-au-Prince every weekend. We took the presence of a nurse as a good omen—a willingness of the mambo to “work with both hands,” as the Creole expression goes—to accept Western medicine as well as herbal and faith healing. The large red iron gate rolled back in response to our honk and then closed behind us, pushed by two older children. The compound, which filled a bowl-shaped natural amphitheater at the crest of a ridge, was composed of a two-story concrete house painted white, two red barracks-like buildings (obviously the girls’ and boys’ dorms), a building that served as the school, and another—painted red and black, with a huge iconlike mural facing the courtyard—that was clearly a ounmfò, a Voodoo temple. The ancient Romans put realistic faces on their idealized statues. Similarly, the mural was simultaneously an icon of the Virgin Mary/Erzilie Freda and a realistic likeness of what I assumed to be Madame Felice—a pudgy, smiling face, with gray hair covered with a red and purple veil and a gold or jeweled ring on each finger. Before we got out of the van, I explained to the students the significance of Erzilie, a voodoo goddess available for intercession in matters of love and family. Our hostess was there on the wall for all in the village to behold, the embodiment of the Virgin Mary, Aphrodite, and Athena, all rolled into one. “She must be some mambo!” one of the students whispered. The courtyard was filled with naked children, washing themselves with water drawn from several large barrels. There was also one nearly naked adult—Jeanne, the nurse—wrapped only in a towel. “Ou te rive bonè” (“You arrived early”), she stated matter of factly and then excused herself to get dressed. “I’ll be back in five minutes. Your students can set up in the school. But don’t let them get started until you’ve met Madame Felice.”

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti A few words are in order here about Haitian dress (and undress). Clothes in Haiti are not for modesty. It’s a hot country and most people grow up sharing a common room with their parents and siblings. Everyone knows what everyone else looks like. Children, especially boys, run around naked until puberty, and public bathing both at communal wells and in rivers and streams is common for both adults and children. At the time of the Haitian revolution (1792–1804), the fashion statement from Paris was dezabiye—partial undress—a custom that continues in Haiti to this day, with dresses open in the back and breasts frequently exposed. Today clothing in Haiti is about status and artistry. The same child running naked an hour before will don a three-piece suit or ruffled dress to go to church or to visit the doctor. While peasants work the fields in hand-me-downs and rags, every family has at least one set of dress-up clothes, cleaned and neatly pressed, for each member of the family, set aside for special occasions. It came as no surprise, therefore, when Jeanne emerged from her room five minutes later in a tailored skirt, jacket, and medium high-heeled shoes. “Follow me,” she said, in Creole, as she escorted us into what I assumed was Madame Felice’s living room. The room was dominated by a large painting of a white stallion galloping into the foreground. Several other smaller pictures represented saints and voodoo spirits. A sofa and recliner had probably seen their best days in Miami. There weren’t enough seats for all of us, so most of the students sat on the floor. A few wandered down the corridor down to the classroom. Jeanne announced she would return with Madame Felice in a few minutes. Twenty minutes passed. Hezi, a third-year student from Miami assigned to me for his family medicine clerkship (and the only Miami student with me on this trip) came down the corridor and sat down beside me. “Dr. F., I think there’s a kid with appendicitis in the classroom. He’s got fever and a really tender abdomen. Did we bring a surgical tray?”

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti “In the U.S. it would be appendicitis,” I responded. “Here it’s probably typhoid. We seem to find at least one case every trip. I’ll see him as soon as we meet Madame Felice.” Just then Jeanne returned. “Madame Felice extends her apologies. She’s not feeling well today. But she will entertain a small entourage in her boudoir.” I suggested that Serge and Evelyn, the one faculty member from the University of Florida that Serge had been able to recruit, should join me. I then instructed the rest of the students to set up for physicals in the classrooms. Serge, Evelyn, and I ascended the stairway to Madame Felicè’s bedroom. She was a large woman, dressed in a red togalike robe, being groomed by her daughters, radiating her Erzelie personna. I knelt and kissed the largest ring on her right hand and then introduced the others and explained what we hoped to accomplish—a physical for each child, a test for tuberculosis, and a medical record. “Do you have any medicines for sugar?” asked Madame Felice. “I have sugar in my blood, and it’s impossible to get medicine for it.” I sent Serge back to the van in search of medicine for diabetes. He returned with several boxes, which we gave as a donation to the mambo. Pleased, she released us to return to the students and our work. “Jeanne will give you a little tour, but tell your students not to enter the ounmfò. It’s sacred and off-limits to all except the congregation.” I skipped the tour and returned to see the child Hezi thought had appendicitis. Gaby was 12. He was not an orphan, but rather a student—one of the best in the school. His mother, a market woman, paid a small amount each month to Madame Felicè for his studies. His jet black skin and angular features suggested to me what Régis must have looked like when he was a child. I wondered if there was anything like reincarnation in Voodoo. Gaby was stoic, refusing to show pain. Two touches to his abdomen—boardlike rigid and tender to the slightest touch—confirmed not only typhoid, but typhoid complicated by spread of infection to the lining of the abdominal cavity. “Give him some ampicillin [the only antibiotic we had] and stay

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti with him, Hezi. You’re his nurse! Get some fluids in him. Evelyn, can you help Hezi?” Evelyn was a pediatric intensive care specialist in Gainesville. If Gaby had presented there rather than in Decouze, he certainly would have had the full-court press-monitors, IVs, etc. Here, it was basically a pill and a prayer. Evelyn looked bit like a fish out of water. The children, freshly scrubbed and dressed now in their finest, waited patiently in line. The Florida students worked efficiently. Before I knew it, it was 2:00 in the afternoon. Evelyn came over as I was checking a young boy for a hernia. “I’m worried about this boy with typhoid. He’s not getting better.” “We’ll have to take him with us to the hospital in Jacmel,” I told her and then asked Jeanne to send a child to the market to find Gaby’s mother. It took about half an hour to retrieve Gaby’s mother from the market. She was short but quite muscular, dressed in a white peasant dress, a white head scarf, and sandals. I explained the situation in Creole as simply as I could: Her son had a life-threatening infection and needed medicines we did not have with us. We’d have to take him to Jacmel to save his life. Gaby’s mother resisted. She was sure Madame Felice could cure him. She had done so with every other illness he’d ever had. She knew of other children who went to Jacmel and never came back. And then there was the issue of cost. I told her that some illnesses were so bad that we needed to work with both hands to beat them. This was one of those illnesses. If Madame Felice and she prayed and we got Gaby the medicines he needed, we could probably pull him through. Either approach by itself might fail, but together we should be able to save him. I also promised that we’d pay his bills. She looked at her son and his obvious anguish and agreed on two conditions: She and Jeanne had to accompany us to Jacmel, and we’d need to give her a small donation she could pass on to Madame Felice for her prayers. “Dakò!” I exclaimed as I pressed her hands. We finished up the health fair and gently loaded Gaby into the

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti back of the open cab truck we had used to haul our medicines and bags. He was cushioned from the metal base of the nine-inch cab by a series of student volunteers’ laps acting as cushions, with Jeanne cradling his head. It was getting close to 5:00 and Gaby’s mom had disappeared. “Where’s Gaby’s mom?” I asked Serge. “She had to go home. She said he needed a clean shirt and a new pair of shoes!” No matter that he was too weak to stand. Haitian custom dictated that he couldn’t go to the hospital without a clean shirt and decent shoes! The students took advantage of the down time to wander off and peek inside the ounmfò. Gaby was kept in Hôpital St. Michel for three days. The Haitian doctors there pumped him full of three antibiotics at once. He made a dramatic recovery. I visited him every morning, got a hug from his mom, and gestured to her with my hands together, signaling that our Voodoo/Western medicine approach was working. On the day of his discharge, she pulled me aside and showed me his bills for the hospital, the doctor, and the pharmacy. Paying the bills worried me. Three days in the hospital in Miami would cost tens of thousands of dollars. But paying Gaby’s bill was literally the price we had to pay to save his life, so I figured, if worse comes to worse, Evelyn and I would phone home and wire transfer the money. I added up the three bills and divided by 17, the conversion rate from Haitian currency, gourdes, to dollars. “That can’t be right,” I thought, as I checked my math again and again. One hundred gourdes each for the doctor and the hospital and 225 gourdes for the pharmacy—that’s 425 gourdes—25 bucks! I laughed out loud, which surprised and puzzled Gaby’s mom. I reached for my wallet, took out the correct amount of gourdes, and asked her to check to see if I’d given her the right amount. She kissed me on the cheek and ran to the cashier’s window. So life is cheap in Haiti, but saving lives is even cheaper. Gabuy’s life cost $30 total, if you include the $5 we gave to Madame Felice for her prayers.