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tables to register patients in advance. I estimated 300 patients were waiting to see us. It was going to be a long day.

My team included several returning Medishare veterans, most notably Joseph, about to finish his second year in our family medicine residency program; Rachel, a graduating senior who had come on three prior trips; and Rick, who had come four times before and was now an emergency medicine resident. Nine enthusiastic medical students, a volunteer nurse, and four Haitian health workers rounded out the group. The health fair the day before at Boucantis, an even more desolate and remote part of the commune, had gone very well. Construction of the new hospital/clinic complex in Thomonde was proceeding more quickly than anticipated, and we had just received some good news about funding for our nutrition program. Considering all this, I should have been in better spirits. But our trip to Thomonde had been delayed a day by violence. On the day we arrived, the United Nations forces had engaged in skirmishes with former rebels in Petit Goave, with casualities on both sides, and demonstrations had erupted in Terrier Rouge. Terrier Rouge straddled our usual route up Morne Kabrit on Route Nationale 3. So after a night in Petionville, we were forced to take an alternate route to Thomonde—an exhausting eight-hour journey through St. Marc and the Artibonite Valley. Plus, I had a mild knee injury from a previous trip, which was aggravated by long car trips or standing for long periods of time. Between the ride up, the ride out to Boucantis the day before, five hours on my feet there, and a one-hour ride to Croix Rondo that morning, my knee was already throbbing like a toothache. The pain, fatigue, dust, and noise combined to create an unusual sense of foreboding.

The boundaries of the commune of Thomonde were defined politically, not geographically. To get to Croix Rondo, our convoy had to first ascend and then descend the Thomonde caldera’s volcanic lip, cross a river, climb back up onto the central plateau, turn off a bad road onto a glorified footpath, and bounce and pitch for another half hour to the ridge where we would hold our fair. I esti-

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