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War and Peace

THE FOLLOWING EVENING I WAS sitting on the dock at Habitation Labadie, sipping a rum punch and watching the sun set when one of the hotel employees ran up to tell me I had a phone call. “Who is it?” I asked, surprised that someone had found our little hideaway.

“Your dean, I think.”

“Uh-oh. Um…. Would you mind rounding up the medical students who are with me and ask them to meet me at the phone?”

Actually, it wasn’t the dean, but Mark, the senior associate dean for medical education.

“Hi, Mark! How’d you find us?”

“I got your number from Larry at the Center for Haitian Studies. Where are you?”

“Exactly where I said we’d be if there was trouble. We’re in the walled and guarded resort I told you about in Labadie.”

The simmering issues between Medishare and the medical school were coming to a head. On the one hand, there was Mark, the general counsel, and the provost, terrified by the never-ending series of articles in the Miami Herald focusing on Haiti’s political violence and concerned about liability and their responsibilities in loco parentis. On the other hand, there was Barth, the school’s most effec-



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti War and Peace THE FOLLOWING EVENING I WAS sitting on the dock at Habitation Labadie, sipping a rum punch and watching the sun set when one of the hotel employees ran up to tell me I had a phone call. “Who is it?” I asked, surprised that someone had found our little hideaway. “Your dean, I think.” “Uh-oh. Um…. Would you mind rounding up the medical students who are with me and ask them to meet me at the phone?” Actually, it wasn’t the dean, but Mark, the senior associate dean for medical education. “Hi, Mark! How’d you find us?” “I got your number from Larry at the Center for Haitian Studies. Where are you?” “Exactly where I said we’d be if there was trouble. We’re in the walled and guarded resort I told you about in Labadie.” The simmering issues between Medishare and the medical school were coming to a head. On the one hand, there was Mark, the general counsel, and the provost, terrified by the never-ending series of articles in the Miami Herald focusing on Haiti’s political violence and concerned about liability and their responsibilities in loco parentis. On the other hand, there was Barth, the school’s most effec-

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti tive fundraiser, myself, and a growing number of other faculty members and students who came to Haiti, had life experiences, and, more importantly, transformed those experiences into grants, projects, and peer-reviewed articles that made the project valuable to the university. Our residency training program in Cap Haitien was the first grant the school ever received from the Open Society Institute, the foundation established by George Soros. An article describing the project had been published in Academic Medicine, and our paper on screening for tuberculosis in orphanages won a prize for best student paper from the American Journal of Preventive Medicine. Unfortunately, liability was a huge issue for our school, and the photos published by the Herald just before we left were particularly graphic. One photo of a demonstrator with his hand shot off graced the front page. So that day I got a call from Mark telling me that the provost wanted us to cancel our trip. My protestations that it was too late to cancel, that people were counting on us, and that we weren’t going to be in the capital where the violence was centered but rather in the countryside, at the invitation of the people, fell on deaf ears. His opposition to the trip was no small issue, as Mark could make the students’ lives miserable and the provost has the power to fire even tenured professors. My final parry—we were volunteers, traveling on our vacations with no ties with the school—produced a compromise. Mark would “allow” us to go, but at the first sign of trouble we had to seek safe haven. That is how we got to Labadie, the pristine peninsula owned by Royal Caribbean Cruise Line on the other side of the mountain from Cap Haitien, where we had conducted a health fair a few years before. Royal Caribbean is so protective of it that it is walled off and guarded with private security forces. All the people there, including the guards, knew me. There was no safer place on earth. It was our escape valve. The day started in Leogane at a subsidiary orphanage/farm set

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti up by Père Luc. The students were continuing their physicals on children ranging in ages from 2 to 6. “Hey, Dr. F!” yelled Russ, “Would you check out this kid’s heart? His whole chest wall is buzzing.” I listened for all of five seconds and then called the other students to examine six-year-old Dieudonel. “He’s got a hole in his heart—a ventricular septal defect (VSD). What you’re feeling is called a thrill. Congratulations, Russ. A good pickup. It probably explains why he falls off the growth curve. We may need to bring him back to Miami to get it fixed.” My dissertation on the differential diagnosis of heart murmurs was interrupted by Delva, who had been waiting in our 4 × 4, listening to the radio. He motioned to me to leave the students and come have a seat next to Père Luc. “There’s trouble on the road back to Port-au-Prince in Carrefour,” he whispered in Creole. “A little manifestation, a few burning tires. That’s all.” “What should we do, Delva? I promised our school that if there was trouble we’d hide out in Labadie.” “I don’t think this will escalate to the level that you should change your plans,” said Delva. Père Luc invited us to spend the night at the orphanage. I thanked him but explained that wouldn’t solve my problem with the school. The irony was that the only road to the airport, where we could catch a plane to Cap Haitien, passed right through the neighborhood where the protests were occurring. “Go back to your students and the children,” counseled Delva. “I’ll keep listening to the radio.” “Dr. F.! We’ve found two more children with cataracts!” exclaimed Rob. “Make sure you take pictures,” I suggested. “You’re a lucky group of first-year students. How many medical students in the whole United States have seen, much less diagnosed themselves, a VSD and congenital rubella in the same day? Let’s get ready to go. We may have to fly to Cap Haitien.”

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti At 2:00 p.m. Delva reported that the radio claimed all was quiet in Carrefour and Port-au-Prince. In Creole, r’s are very soft. So the French carrefour (“dock” or “quayside”) becomes kafou—literally, “crazy car,” which is exactly what it is on most days. The most densely populated section of the most densely populated country in the hemisphere flushes its traffic into the one functioning west-east road, creating traffic jams, pedestrian jams, and creative route seekers hoping to beat the traffic into and out of Port-au-Prince. There have been times when traversing this stretch of road from Leogane to Port-au-Prince would take four hours. Today, miraculously, we passed through in less than one hour. “The demonstrations worked in our favor” was Delva’s opinion. Had we come by two hours earlier we would have lost our tires, if not more. We arrived at the general airport and were soon whisked away for the short plane ride to Cap Haitien. Then, after a 45-minute bone-jarring ride around the Cap Haitien mountain and some sweet talking of the guard to let us in, we arrived at the beach at Labadie and awaited the water taxi that would take us to our hotel. After only four days in Haiti, the students were not prepared for the culture shock of the manicured, tourist-ready Labadie. “Did you see the Caribbean Market building with the sign in English? said Rob, sarcastically. “They should take the tourists over the hill to see the iron market in Cap Haitien. Now that’s a market!” “It certainly is beautiful here,” offered Parul. “Who knew?” “Columbus described this whole coast in the log of his first voyage. The wreck of the Santa Maria is five miles due east of that rocky point over there.” I gestured toward Point Honoré. No one believed Columbus’s descriptions—they thought he was selling real estate. Actually, his description was quite accurate and—except for the tourist stuff—what you are seeing now is pretty much what he saw over 500 years ago.” “Wow, Dr. Fournier. This morning Father Luc’s orphanage. This afternoon Carrefour. This evening Labadie. Haiti, land of contrasts.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti They’re not going to believe us when we get home,” exclaimed Russ. “Thank you.” Russ’s words proved to be ironic, although disbelief does not do justice to the hardened opinions back home. The early evening’s news had broadcast the morning protest back in Miami, hence Mark’s phone call. “We want you to come back home, Art. We’re concerned about your safety.” “Mark, we’re up here in this resort. We’ve got the whole hotel to ourselves, and there isn’t another person around for miles. The students are sipping rum punches after a hard day’s work. We’re due home in two days anyway. If we come home early, we’ll have to return to Port-au-Prince. That’s where the trouble is! Plus we’ll have the added expense of changing our tickets, on top of what I’m already paying extra to stay in this nice hotel. Here—talk to the students.” The students, summoned up from the beach, interrupted, shouting into the receiver. “You don’t understand! It’s paradise here!” “You wouldn’t believe the stuff we learned today.” “We feel safer here than in Miami!” “Here. He wants to talk to you again.” “Art. The provost wants you home. The dean wants you home. I want you home. Come home now or we’ll never allow another student to go to Haiti ever again.” “Well, I think you are all overreacting, but if you insist, we can fly directly back from Cap Haitien. Is the school willing to help us with the added expense?” A long pause and then, “Yes. Come home tomorrow.” The students were frustrated and despondent for the rest of the evening. “Just when we were getting good!” one exclaimed. “What about the other orphanages we were supposed to visit? I don’t understand the attitude of our school,” another added.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti “Things will work out,” I counseled. “We’re in a war for the health of the people in Haiti. This is just a small tactical retreat. Live to fight another day. Have another rum punch. We’ll be back with another team in three months.” Medishare did, indeed, return to Haiti three months later, despite continuing political turmoil and perpetual bad press. That trip and the next several trips happened over the objections of the dean and the provost. It threatened to get ugly.