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Discovery

Spring 2002. MY TEAM AND I WERE Debriefing after a busy day of health fairs at orphanages. Since our first visit, the orphan problem had captured my heart. Most orphanages were started by people of good will, but their medical sophistication varied, as did their resources. Some had Haitian doctors on call for acute illnesses; some had a nurse on duty. In general, however, health was prioritized well below food, shelter, and education. Particularly poignant were those orphanages that took in handicapped and abandoned children.

Haitian family structure is quite strong. It takes a lot to drive a Haitian family to abandon a child, usually a combination of desperate poverty, severe disability on the part of the child, and impending family collapse. Not all orphanages accepted abandoned or handicapped children. That morning we happened to visit two that did.

Debriefings were an integral part of Medishare’s method. Every evening we reviewed the events of the day, presented the unusual problems we’d seen, identified what we did right and what we could do better, and addressed any social or cultural issues that might have surfaced.

It takes dedication to examine a handicapped orphan in Haiti. They seemed so hopeless; it was hard not to get depressed. The or-



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OCR for page 239
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Discovery Spring 2002. MY TEAM AND I WERE Debriefing after a busy day of health fairs at orphanages. Since our first visit, the orphan problem had captured my heart. Most orphanages were started by people of good will, but their medical sophistication varied, as did their resources. Some had Haitian doctors on call for acute illnesses; some had a nurse on duty. In general, however, health was prioritized well below food, shelter, and education. Particularly poignant were those orphanages that took in handicapped and abandoned children. Haitian family structure is quite strong. It takes a lot to drive a Haitian family to abandon a child, usually a combination of desperate poverty, severe disability on the part of the child, and impending family collapse. Not all orphanages accepted abandoned or handicapped children. That morning we happened to visit two that did. Debriefings were an integral part of Medishare’s method. Every evening we reviewed the events of the day, presented the unusual problems we’d seen, identified what we did right and what we could do better, and addressed any social or cultural issues that might have surfaced. It takes dedication to examine a handicapped orphan in Haiti. They seemed so hopeless; it was hard not to get depressed. The or-

OCR for page 239
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti phanages had sequestered these children in separate rooms away from the healthy children. Most were wasted, as they could not feed themselves and required forced feedings, which were difficult for their matant (literally “my aunt”), the Haitian women providing care, to perform. Their limbs were spastic, their comprehension was minimal and, regardless of their physical age, their functional level was a year or less. I attributed their condition to birth complications–lack of oxygen, maternal hemorrhage, or prolonged labor. I had a small but enthusiastic team—Russ, Parul, and Rob, all first-year students, plus my sister-in-law, Nancy, a pediatrician from Cape Cod. The discussion focused on the visual problems of four of the children. “Dr. F., four of these children have cataracts. Why is that?” “Great question, Rob. Usually, we see cataracts only in old folks.” Actually, I was dumbfounded by this finding. “Perhaps it’s a tropical medicine thing. We’ll need to research it when we get back.” “Did they [the children with cataracts] have any other findings?” asked Nancy. “Yeah,” volunteered Russ. “There was not one of them that was normal. Kind of funny-looking.” A long pause ensued. “Congenital rubella. Perhaps they have congenital rubella,” Nancy speculated. My sister-in-law had provided us with a brilliant insight. Rubella (German measles) is a benign viral infection that causes a few days of mild fever and rash, unless one happens to be infected early in pregnancy. In that case the virus can cause cataracts, deafness, retardation, abnormally small heads, and heart defects in the fetus. Nancy’s insight awoke me from the fatigue of a day in which we saw 300 children. This was really important. We’d missed it on the first pass because no one in the United States ever sees congenital rubella any more. It’s easily preventable with immunization. Haiti, however, was the only country in the hemisphere that did not immunize against rubella.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti It was a moment of awakening similar to my first visit to Cité Soleil. Far beyond the four children with cataracts, rubella explained probably a hundred or more handicapped children I had seen in Haiti. Even that young woman in Zetoit probably was a rubella victim. And it all could be prevented by a simple, cheap vaccine. All of this misery and suffering didn’t have to be. These children could have lived normal lives. Instead, they’d been sentenced to a life worse than that of a zombie, simply by the accident of their birth. “I think Dr. Nancy is right,” I chimed in. “You all have made an important discovery. When you get back, you should write it up. I’m impressed. There aren’t that many first-year medical students in the entire United States who can use an ophthalmoscope well enough to see cataracts in adults, let alone kids. Let’s pass by tomorrow and see if these kids meet the other criteria for congenital rubella. It’s a clinical diagnosis; there are no lab tests. We’ll need to measure their head circumference and test their hearing.” The discussion then turned to tuberculosis, malnutrition, and worms. Before breaking up, I asked the students if they had any questions about Haitian history or culture. “Tell us about Voodoo, Dr. Fournier,” whispered Parul, looking furtively from side to side to see if the waitresses were listening. “I noticed some children today with amulets around their necks.” I paused and contemplated how heavily I wanted to delve into this question. “Think of Voodoo and Christianity as the yin and yang of Haitian spirituality. If the Christian God created heaven and earth and keeps the stars twinkling in the sky, the Voodoo spirits, the African gods, are there for your personal intervention in matters of love, health, and family. If Christianity is Apollonian, Voodoo is Dionysian. The church has its liturgy and its ritual, Voodoo its ecstasy and possession.” “Possession?” asked Rob through a blank stare. “Sure. It’s almost sexual. The spirit of the Lwa actually ‘mounts’ the supplicant, leaving him or her in a state of exhaustion.”

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti “Wow, that’s pretty powerful stuff. Much more exciting than my Sunday mornings at church,” replied Russ. “And then there are the saints,” I continued. “A perfect blend of Rome and Africa. Saint Patrick is an incredibly popular Voodoo saint. Any ideas why?” The group looked at me and each other. Silence. “You look at a picture of Saint Patrick driving the snakes out of Ireland and see the saint. The Haitian looks at the same picture and sees the snakes—Damballah, the spirit of fertility and health and magic, the same symbol we in medicine conceptualize in our caduceus. Then there’s the Virgin Mary as Erzelie, the goddess of love, and Baron Samedi, the god of the underworld and so on.” “So what percentage of Haitians are Catholic, what percent Protestant, and what percent practice Voodoo?” inquired Rob. “It doesn’t have to be exclusive. A Haitian sees no conflict between being a practicing Catholic and a practitioner of Voodoo. The Protestants are a little different. They tend to lump Voodoo in with devil worship and black magic. In reality, Voodoo and black magic are separate but related things. Most of my Haitian colleagues say Haiti is 85 percent Catholic, 15 percent Protestant, and 100 percent Voodoo.” The candles were burning down, and the students’ heads were starting to nod. They’d been up for 14 hours and we needed to get started at 6:00. “Okay. Enough for tonight. Let’s turn in.”