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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Benediction Spring 2001. DRIVING ON HAITIAN ROADS demands the complete attention of all of one’s senses. On the one hand, the questions of my students were somewhat of a distraction. Potholes, pedestrians, and polis estasyonnen (speed bumps) lurked ahead, while in the opposite direction tap-taps of every color and dimension rushed toward us bumping, jerking, and narrowly missing us at every turn. On the other hand, I’d never felt more alive. Nothing seemed impossible. We were driving to Croix de Bouquets to read tuberculin tests at an orphanage. In seven years, Medishare had grown from a small volunteer organization to a charity sponsoring major programs in community health in Thomonde and in training Haitian doctors to be family physicians in Cap Haitien and Pignon. At the same time, we maintained an ongoing commitment to provide health care services to a cluster of orphanages in the vicinity of Port-au-Prince. Support for our charity had grown steadily. Initially funded predominantly by contributions from Barth and to a lesser extent by me, we were becoming more and more successful with our art auctions and with grants and donations from the community. Furthermore, we impressed on our students the need to raise funds—at least what was required to pay their own way.
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti A cohesive plan was starting to evolve. The first class of Haitian residents was at work at Cap Haitien and Pignon, and over 100 medical students had volunteered for Project Medishare. Between the orphanages, the residency program, and Thomonde, we were poised to make a difference. There was no denying that Haitians were still dying in boats trying to get to Florida, that AIDS was still creating orphans, that the news out of Port-au-Prince was perpetually bad, and that the “powers that be” at our medical school still didn’t get it. We were making a difference. The finally completed guesthouse in Thomonde exceeded everyone’s expectations, not just in terms of comfort but also in expanding our capacity to work in the village of Thomonde and its surrounding communities. Students from other medical schools, coming to Miami for fourth-year experiences called externships from as far away as Saskatchewan, heard about our Haiti experiences and signed on. “What about the elections?” came a voice from the back of the van. “They’re going to happen,” I answered. The Miami press was all wrapped up in the impending legislative and municipal elections. Was Aristide stalling, so that one combined presidential and legislative election would sweep Lavalas into power at all levels? “None of our business,” I told the students. “Too much of Haitian politics starts and ends in Washington. What this election flap is all about is whether there will be a ‘globalization’ of the Haitian economy. Aristide was elected by promising jobs for the poor and taxes for the rich. After the coup and his expulsion, accommodation with globalization was the price he had to promise in exchange for a United Nations intervention to return him to power. The Haitian peasants couldn’t care less about the World Bank or globalization of their economy. Furthermore, the bloom was off the rose of globalization. It was not working the miracles it had promised, and its cost is being carried on the backs of the people.”
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Meanwhile, as Paul had explained, 50 years of American foreign policy toward Haiti had been shaped by the fear that Haiti would go communist. Cuba had gone communist, and according to theory, Haiti, even poorer, was certain to follow. But anyone with a modicum of knowledge of Haitian history knew Haiti would never become a communist country. To Haitian peasants the land was their birthright, the gift of their ancestors’ revolution. They’d never give it up. So for that misreading of history we supported Duvalier and the generals. My advice is, “If you want to help Haiti, ignore the politics and focus one-on-one on our humanitarian mission. Given enough time without outside influence, the Haitians will fix their own politics. It won’t be easy, but it’s the only way.” “I don’t understand this birthright thing, Dr. Fournier,” came a challenging voice from the back of the truck. “And this liberation theology preached by President Aristide. It sure does sound a lot like socialism.” “In 1815, Haiti’s leaders tried to revive the plantation economy. They enacted ‘land reforms’ that would have tied the former slaves back to the sugar fields and a state of serfdom. The peasants voted with their feet. They took off into the mountains, carved up the land among themselves, and passed it on from generation to generation. In effect, they traded a subsistence existence for their freedom. Aristide and his liberation theology have to be seen in the context of 200 years of struggle between the poor and the elite for what they both consider their birthright. But trust me—the Haitian peasants will never give up their land. The problem is, with the average family having five kids, the birthright gets smaller and smaller and subsistence gets harder and harder.” Silence descended on the van as the students pondered my diatribe. It was great to see how much they learned in only a week, not just about medicine but about Haiti, the world, and themselves. Past the wattle and daub huts, the piles of watermelons, the hand woven baskets, and the continuous stream of life on the Route Nationale, we raced from the north toward Croix des Bouquets. As we passed
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti the remains of Ibo Beach, I pointed out where tourists had most likely introduced HIV to Haiti, then the salt flats where the bodies of Duvalier’s victims were left for the crabs to scavenge, and the trash dumps where children still forage for scraps to this day. “We can make a difference,” I reminded myself. “Dr. Fournier,” called another unseen voice. “What brought you to Haiti?” “That’s a long story and it’s only 15 minutes to Croix des Bouquets. Let’s save that one for dinner tonight. Have I told you the secret of the zombie curse?” Fifteen minutes was not long enough to capture their imagination with tales of death and resurrection, freedom and slavery. Thank you, Haiti, I thought to myself. I had the zombie curse of a comfortable life in the United States. For all my good intentions, I was in a coma. Previlus, Belony, Theophile, Marie—I’m trying. Régis—I’ve not forgotten. Hopefully, we will make a difference. I proved to be naive in my attitude toward Haitian politics. The elections were contested, and that led in certain legislative districts to a political impasse that paralyzed the government and froze international aid to Haiti. Conditions around the country deteriorated, and people once again started heading out in boats, except this time few made it to Miami. Most were either intercepted by the Coast Guard and returned to Haiti or were lost at sea. Haiti became a political football again, and the people, not the government, felt the pain. To my shock, Delva lost his bid for reelection as magistrate of Thomonde. Delva’s losing that election was about as improbable as the Red Sox losing an election to choose Boston’s favorite baseball team. To make matters worse, the winner, a Lavalas insider, lived in Port-au-Prince. He didn’t even live in Thomonde! “It’s all right, Dr. Fournier,” Delva said, after I expressed my condolences. “He’s my cousin! Besides, now I can devote all my effort to the health of Thomonde.” Delva wasn’t trying to create a consolation prize for himself. The Green Family Foundation, a Miami benefactor, had funded
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Medishare’s proposal for a community health project in Thomonde. In partnership with Paul, we planned to renovate the dispensary and hire Haitian doctors and nurses to bring full-time health care to Thomonde. We also planned to hire a small army of community health workers. Paul would train them in outreach and direct observed therapy, a simple but effective way to make sure sick patients get their medicines. It turned out that in his youth Delva had studied public health and had trained as a tuberculosis control worker. So he would lead our team. It was just like Delva—take lemons and turn them into lemonade. For several months a line had been drawn in the sand at the medical school over Project Medishare. The provost, the general counsel, and the senior associate dean for medical education were on our case over the possible liability accrued by students volunteering in Haiti and their perception of the danger our students might face while working in Haiti. These concerns were fueled by a continuing string of sensationalist articles about the political instability in Haiti in the Miami Herald. It seemed that negative articles always appeared in our local newspaper one or two weeks before each trip’s departure. On the other hand, we had Barth’s clout behind us. He was probably the most successful fundraiser the University of Miami had ever seen. In addition, we had the example set by Paul and his relationship to Harvard and our students, who were doing important work on tuberculosis among orphans, sickle-cell anemia, and women’s health. The dean was noncommittal for several months. Who could blame him, with the challenges facing the medical center? The grant from the Green Family Foundation tipped the balance in our favor—$250,000 per year for three years to improve the health of Thomonde and a parallel grant to the department of pediatrics to start an international pediatric infectious diseases program. A condition of the award was that the issues between Medishare and the school had to be resolved. The grant did more than give Medishare leverage at the school. It gave Medishare a permanent health presence in Thomonde, al-
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti lowing us to break through the limits of what we could accomplish with only episodic visits. The key was not so much the renovated clinic or the Haitian doctors or nurses who would be there full time (although these were all critical advances) but the 36 community health workers, handpicked by Delva. He chose them from every corner of the commune—men, women, young and old, former farmers, market women, teachers, and students. The grant provided them with mules and motorcycles that enabled them to visit every household of every district—Thomonde, Boucan Carrè, Savanette, Tierre Muscadet, and Baille Touribe. Trained to a remarkable degree of medical sophistication by Paul, they could identify the ill, bring them to the dispensary for diagnosis and treatment, educate them as peers, and ensure that they would take their medicines. It was health care by the people, of the people, for the people. We paid each worker about $100 per month, about five times the amount they could earn by farming. With Delva leading them and Paul inspiring them, they took their work with utmost seriousness. Delva arranged for the Catholic bishop to come down from Hinche to bless our guest house and clinic. Actually, the guest house today is no longer just our guest house; it serves as the health care headquarters for our community health workers. It’s now the most substantial home in Thomonde, surpassing that of the funeral director. Everything in Haiti has meaning, and the symbolism of this proprietal comeuppance was not lost on the Thomondois or, for that matter, on me. Death is a growth industry in rural Haiti, and in practically every town the largest and most prosperous-looking home always belongs to the funeral director. This is no longer the case in Thomonde. Health now has the upper hand. The house blessing ceremony included a visit by Paul and his staff from Cange. The ceremony was scheduled for 4:00 in the afternoon, and we spent the day prior to the inauguration giving health care to the citizens of Thomonde. Barth came—his third trip to Haiti with Medishare—and differentiated from neurosurgeon to pri-
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti mary care physician. After conceptualizing Project Medishare and financing and participating in the first trip, he had pretty much turned the project over to me. This was certainly understandable. In addition to running the neurosurgery department, he had launched a campaign to find a cure for paralysis. Now, however, seven years into the project, perhaps because his kids were now volunteering in Medishare, he was once again engaged. We had 30 medical students with us. They had worked hard all day, but filled in the back rows of the tournelle during the benediction, surreptitiously sipping beer and marveling at the event. Paul arrived early and really hit it off with Barth and the students. He and Barth talked about building a day hospital on the property next to the guest house. The bishop said a high mass in French. Afterwards, Barth, Paul, and I were asked to speak. Paul worked the crowd with a rousing speech in Creole, celebrating with the Thomondois their participation in living a healthy life. After mass the bishop passed through the house and blessed it with holy water. The Thomonde brass band, usually relegated only to funerals, played several celebratory songs, including the Haitian and American national anthems. Medical students and the citizens of Thomonde intermingled, drinking beer and home-brewed clairin. The generator hummed, providing light and music well into the evening. Even Paul let his guard down, socializing with the students and sipping enough beer to start telling jokes and pose for pictures. The Peace Corps volunteers fueled the celebration with a homemade rum punch. I slipped away to a quiet corner of our property to play the “rock game” with some of Thomonde’s children. I always play the rock game with the children. They count on this and sit patiently, 20 to 30 at a time, every evening I spend in Thomonde. The game is simple. First, I search the ground for a small, shiny rock. Then I line up the children in a row, sitting on their haunches. I place the rock in a hand behind my back and then offer them my two closed fists to choose which one contains the hidden rock. If
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti they choose the hand with the rock, they win. If they choose the empty hand, they lose. I go down the line, and each child gets to choose. Each child gets lots of advice from the others when it is their turn, and each choice, right or wrong, is greeted with peals of laughter. “Ou genyen” (“You win”), “Ou genyen…. Ou pèdi….” (“You lose”), down the line I go. I pass through the line several times, so that each child wins at least once, and then turn the game over to them. That night the rock game went for hours. Haiti, land of contrasts. For all the misery that surrounds them, these children found joy in guessing which hand holds a small rock. Not just a little joy, mind you, but unabashed, unrestrained joy—more joy than could possibly be produced by a million video games. As much as I keep trying to give to Haiti, Haiti—particularly its children—keeps giving even more to me. When I awoke the next morning the children were there again, ready to begin at first light. I passed the rock to a young girl who seemed precocious, and I took her place in line, pretending to be a kid again, but this time a Haitian kid. I won each time. Later that morning I was standing under the tournelle, sipping a cup of coffee. It seemed strange that I was the only one up at 8:00. Granted, I had turned in early while the celebrations were still going on, but everyone knew we had to be on the road by 8:30, as patients would be waiting for us at Savanette and Tierre Muscadet. The students were huddled in their sleeping bags under the tournelle and Barth was locked inside his guest room. Finally, Gina, one of the student leaders, roused herself and came over to me, following the scent of freshly brewed coffee. “What happened to everyone?” I asked, innocently. “Um, Barth thought it would be a good idea to take us to a Voodoo ceremony. He asked Delva to arrange it.” I cringed. Barth, what were you thinking? I thought to myself. “It didn’t go well,” Gina continued. “It was pretty staged, very touristy, mostly dancing, singing, and drum beating. A lot of candles. And then the Voodoo priest wanted to be paid, and when Barth didn’t pay him right away, it got a little ugly for a while.”
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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti “I’m almost afraid to ask what happened next.” “Oh, Delva smoothed things over. He probably paid the priest a small amount of cash. In any event, Delva gathered up some musicians from the brass band and we danced until 2:00 a.m.” Gina left me to rouse the other students. About half an hour later, Barth emerged from his room. “You missed a good time last night, Art,” he said sheepishly. “Barth, I heard what you did. That was awful. Cultural voyeurism. What made you think you could buy a Voodoo ceremony?” “Well, I paid for my kids’ bar mitzvahs, didn’t I?” “That was different. You were lucky you had Delva to bail you out. It could have given Medishare a black eye with the people!” “Boy, you’re getting as bad as Paul.”
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