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Conundrum

THE NEXT DAY WE WERE STANDING in the general airport, waiting for the Caribintair clerk to write out a receipt by hand. We had just flown back from Cap Haitien, where the dean and the president had toured the family medicine residency program we had founded with the assistance of the Open Society Institute. I was escorting them back to the international airport so that they could return to Miami for a faculty dinner the president was hosting that evening. It seemed like a good time to share my vision of a Center for Humanitarian Medicine.

The dean had opened the door by mentioning to the president how we had struggled for a while in defining the relationship between Medishare, our charity, and the school. In an era of falling income, rising costs, and high liability concerns, some questioned whether there was any legitimate reason for our school’s faculty to volunteer in Haiti. The sentiment seemed to be, “Let Medishare do it, and keep the school out of it!” That’s where the Center for Humanitarian Medicine came in.

I had come to believe, over several years, that a “perfect storm” had been brewing, threatening to blow away all that was noble in the profession of medicine. The convergence of forces that formed this



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Conundrum THE NEXT DAY WE WERE STANDING in the general airport, waiting for the Caribintair clerk to write out a receipt by hand. We had just flown back from Cap Haitien, where the dean and the president had toured the family medicine residency program we had founded with the assistance of the Open Society Institute. I was escorting them back to the international airport so that they could return to Miami for a faculty dinner the president was hosting that evening. It seemed like a good time to share my vision of a Center for Humanitarian Medicine. The dean had opened the door by mentioning to the president how we had struggled for a while in defining the relationship between Medishare, our charity, and the school. In an era of falling income, rising costs, and high liability concerns, some questioned whether there was any legitimate reason for our school’s faculty to volunteer in Haiti. The sentiment seemed to be, “Let Medishare do it, and keep the school out of it!” That’s where the Center for Humanitarian Medicine came in. I had come to believe, over several years, that a “perfect storm” had been brewing, threatening to blow away all that was noble in the profession of medicine. The convergence of forces that formed this

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti tempest included the corporatization of medicine, the rising debt of medical students, the falling incomes of physicians, the malpractice crisis, and lifestyle choices—choosing careers that don’t involve nightcall, long hours, hard work, and low remuneration. In 2004 only three of our 150 graduates had chosen careers in family medicine. In a world where medicine had become a business and health care a commodity, the committed, compassionate, caring physician who treated everyone regardless of their ability to pay had become an endangered species. Through the Medishare years I’ve loved how our students have embraced the humanitarian cause during their trips to Haiti. Responsibility is an even greater teacher than experience. In Haiti they got a heavy dose of both. Michel and I would marvel at how quickly they ascended the learning curve and laughed secretively among ourselves. “They learn so much, and they don’t even know they’re learning!” We had created, without knowing it, the anticurriculum—no tests, no grades, no rote memorization of obscure minutiae, just the pure joy of learning what you need to know to actually help people. But the sad truth was, once they returned to an educational environment that’s become increasingly dehumanizing, only a few were able to maintain their commitment. A Center for Humanitarian Medicine would bring together faculty from several disciplines to teach and role model professional values. In the process they could provide services to those in need both in Miami and abroad and demonstrate creative ways to alleviate suffering regardless of their patients’ lot in life. It seemed like a good idea to me. “ ‘Humanitarian’ has become a bad word, Art,” responded Ellen. “You definitely don’t want to call it the Center for Humanitarian Medicine.” “Humanitarianism is a bad thing? When did that happen?” I protested, crestfallen. “You need to read David Reiff’s A Bed for the Night. It’s depress-

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti ing but true how humanitarians like yourselves are taken advantage of by the realities of politics.” “But, you see, we’ve got a huge need in medical education these days to shore up professional values.” “I understand the concept and support it. I’d just call it something different. How about something like what Paul has created at Harvard, a Center for Health and Social Justice?” “That would never fly in Miami. It sounds too much like socialized medicine. Besides, I’m coming more from my role as an educator and what we need to be teaching our students. Paul’s coming from his commitment to service.” “Ellen’s right,” chimed in the president. Why not call it the Center for Human Security—a takeoff on the Department of Homeland Security!” This conversation was a mixed blessing—perhaps I was naive in my beatification of the need for humanitarian values in medicine. I could probably use an upgrade in sophistication on humanitarianism, and perhaps Mr. Reiff’s book could serve as a useful primer. On the other hand, Ellen and the president understood the concept of a Center for Humanitarian Medicine and agreed with the need. I took this as a green light to proceed. We continued the discussion during the 15-minute cab ride from the general airport to the international airport. A short while later, I escorted them through customs and waved goodbye as they boarded for Miami. The trip had gone better than I had hoped. Haiti had worked its magic charm. The president and the dean were committed to our cause. But where would it all lead next? I bought A Bed for the Night shortly after I returned home. Ellen’s assessment was accurate. The book was depressing, irrefutable in its logic, and offered no solutions. The author starts with the trap of neutrality that has entangled the International Red Cross, forcing it unintentionally to enable some really bad characters. He then moves on to the abuse of humanitarianism in Bosnia, Kosovo, and Rwanda.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti His point, hammered home over and over again, is that humanitarian aid is a cosmetic Band-Aid on the really horrible things that some human beings do to others. Shortly after we returned, Haiti erupted into chaos. It was no secret that forces inside and outside Haiti wanted to get rid of President Aristide. Rebels in new uniforms, well armed, and rumored to be supported by the Central Intelligence Agency surfaced, first in Gönaives, then in Cap Haitien, and finally in the central plateau. Many were former army veterans hoping to restore the armed forces banished by Aristide. Several of the rebel leaders had a history of human rights violations during the Duvalier era. They had been hanging out on the other side of the Dominican border, making occasional forays into the Central Plateau. They had passed through Thomonde several months before, frightening the Thomondois. Worse yet, they stopped some Zanmi Lasante volunteers traveling from Cange to Las Cahobas, forced them to abandon their supplies and vehicle, and later killed two security guards at the dam at Lac Péligre.