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Revelations

1984 FOR SEVERAL WEEKS MY MOOD was clouded by a story I saw on the evening news. The bodies of 32 Haitians had washed up on a beach just north of Miami. Their homemade sailboat had broken up at night during a storm only 200 yards from shore. The images on the screen were both horrible and fascinating. The sailboat was still recognizable, half-buried in the sand, with waves breaking over it. With honesty rarely shown by television news, the dead Haitian men and women were shown strewn along the beach almost as if enjoying a holiday. Most were nude and in death beautiful. Their bodies were young and muscular, and their skin was textured by sand and beads of water sparkling under a brilliant sun. They must have died shortly before the cameras arrived, for rigor mortis had not yet set in, and they had not yet become bloated. Each wave would wash over them and then ebb, moving them just enough to make them appear to be still alive. Most were face down, looking perfectly at peace. The next day the television station that carried the story apologized for the graphic footage the night before; they claimed it was a late-breaking story.

A few who survived the ordeal had been taken to the Krome Avenue camp. They told how they had signed up with smugglers for



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Revelations 1984 FOR SEVERAL WEEKS MY MOOD was clouded by a story I saw on the evening news. The bodies of 32 Haitians had washed up on a beach just north of Miami. Their homemade sailboat had broken up at night during a storm only 200 yards from shore. The images on the screen were both horrible and fascinating. The sailboat was still recognizable, half-buried in the sand, with waves breaking over it. With honesty rarely shown by television news, the dead Haitian men and women were shown strewn along the beach almost as if enjoying a holiday. Most were nude and in death beautiful. Their bodies were young and muscular, and their skin was textured by sand and beads of water sparkling under a brilliant sun. They must have died shortly before the cameras arrived, for rigor mortis had not yet set in, and they had not yet become bloated. Each wave would wash over them and then ebb, moving them just enough to make them appear to be still alive. Most were face down, looking perfectly at peace. The next day the television station that carried the story apologized for the graphic footage the night before; they claimed it was a late-breaking story. A few who survived the ordeal had been taken to the Krome Avenue camp. They told how they had signed up with smugglers for

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti $200 per person and how 40 people had crowded into the small open boat and set sail up the windward passage. Two hundred yards from shore, just before dawn, a squall capsized the boat. Most were just too weak from the journey to make it the remaining distance. The survivors were not even allowed to attend their shipmates’ funerals. Amal and I discussed the tragedy during our ride home. While our rides to and from work were frequently taken up by theoretical discussions of theology and philosophy, this time I spoke directly to the point. “I’m angry with my government for forcing disasters like this to happen and ashamed to be an American,” I told her. “Everyone gives lip service to love and freedom and uses them to sell everything from hamburgers to insurance. But when you cut away all the crap, nobody really cares about these people. How many others do you suppose have been swallowed up by the ocean without a trace? At least these 32 were lucky enough to make the news for their efforts. Altruism is a luxury you have to be able to afford to dabble in. Look at poor Régis. All he wants to do is complete his education and then go back and fill and pull teeth in his country. Now he is forced to go begging.” My voice was raised, and I was talking to her as if the boat tragedy were her fault. I knew I was being unfair to her: since she was Egyptian, she was not to be blamed for our national hypocrisy. What I was really angry about was her persistent optimism that all things would work out for the good. When we had reviewed our data and reinterviewed our surviving patients in response to our critics, we discovered that indeed a small minority of the Haitian men had had homosexual experiences. This fact was seized on by our detractors, who ignored the fact that in most of our men, and all of our women, there were still no reports of homosexuality. New theories appeared in the newspapers every day: AIDS started in New York, transmitted by gays vacationing in Haiti to destitute Haitian men forced to prostitute themselves; conversely, AIDS started in Haiti as a tropical disease and then was trans-

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti mitted to vacationing gays by the same mechanism; AIDS started in Africa, brought to the Caribbean by Cuban troops returning from Angola and then was transmitted to the gay community. Again, there were no hard facts to support any of these theories. There were five patients with AIDS on my ward team at that time (early 1984), including Herminio, the first gay man admitted to my service who survived long enough to be followed by me in my office. Herminio probably lived his entire life without anyone, other than his lovers, knowing that he was gay. He was 42 when he was admitted with pneumocystis pneumonia. His hair was gray and conservatively cut. He had worked as a doorman at a hotel on the beach, but he could have easily passed for a teacher or bank teller. He was extremely frightened by his illness. Even when he was clearly getting better he would ask us if it was time to call the florist—a Cuban cultural expression meaning, “Am I going to die soon?” He lived alone with his mother, and he asked us not to tell her what the matter with him was. After his discharge he did well for a while, a fact he attributed to my personal attention to his case. Fanese was perhaps the most pathetic patient of the first wave. She had a viral infection, for which we had no treatment, that slowly took over her entire body. While in the final stages of deterioration she gave birth to a baby girl, who was also discovered to have the syndrome. The father was unknown. No agency would accept the baby for care, knowing its diagnosis. By the time I took over the inpatient service that particular month, the decision had been made that we had done everything we could for Fanese and that she was failing despite our best efforts. We would try to make her comfortable, but there would be no more “heroics.” She was alert but profoundly depressed and too weak to get out of bed. She remained in this condition for two weeks before she became stuporous and then unconscious. She died a week later. In an act of remarkable compassion, one of the nurses working in the hospital who was aware of Fanese’s plight adopted her child. For one reason or another, most of the original study group had

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti stopped seeing patients with AIDS. Only Margaret, Gordon, and I continued. Because of my other responsibilities and commitments, I followed the fewest. Many of the gay men Margaret followed had been coming to the office long enough now that their deterioration was painfully apparent. Men who originally appeared healthy were now coming in wheelchairs or with pillows because they were so wasted that sitting on a plastic seat too long without a cushion of flesh was unbearable. Many now looked like old men, with sparse white hair, wrinkled skin, and masklike faces. The secretaries in my office were genuinely moved by their suffering. They knew them all by their first names. Frequently they would be admitted to the hospital and then be absent from the office for several weeks. When they returned, they invariably showed signs of deterioration. When the secretaries saw them in this worsened condition, they were shocked and frequently hid in one of our offices and cried. When one of them would pass away, no one would commiserate with Margaret more than they would. Margaret took each death personally and after each would mourn for several days. During these times it was difficult for anyone to reason with her. Meanwhile, Alina was talking to Régis almost every day. She had managed to get some support for his rent from Catholic Charities, but his situation was rapidly becoming desperate. He admitted that he had not been entirely honest with us about his immigration status. Apparently he had come to this country three years before on a student visa, which had expired. We sent two letters signed by Margaret, Alina, and me to the INS explaining Régis’s situation and asking that he be allowed to stay in this country for humanitarian reasons. Neither letter was ever formally answered, and daily phone calls to the responsible bureaucrats were not returned. Amal prayed with Régis while he waited to see me. In the privacy of the examining room, Régis told me that he appreciated all that we had done for him, but that he felt the situation was becoming hopeless. He wondered why God had forsaken him. I reminded him that I had promised him during his first ad-

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti mission that I would tell him when I thought the situation was hopeless and that I didn’t think we had reached that point yet. Although his financial and social problems seemed insurmountable, his T cells were still holding their own. I agreed with him that returning to Haiti would be disastrous, for I was sure there were no resources there to treat his illness. I told him that he had to trust what Alina had said. If there was to be any hope of him remaining in this country he had to go to the INS office and straighten out his immigration status. Then Margaret and I could continue to treat him and Alina could arrange for some financial assistance. Régis complained of losing vision in his left eye. I tested his vision with our eye chart and found that his vision was still 20/20 in both eyes. His eye examination was normal. He was almost as frightened of blindness as he was of losing his mental powers. I tried to reassure him that his vision tested normally, but he was adamant that his eyesight was failing. I came to my office one morning and found Alina fighting back tears. My first thought was that she was going to tell me that Régis had died. Instead, she told me the following: “I’m so angry at myself, Art, for not listening to him,” she said, composing herself. “It was exactly what Régis said would happen. For months I have been telling him that he had to go to the INS office and straighten out his immigration status. He told me that if he went there they would arrest him. I assured him that it wouldn’t happen, and when he finally took my advice, that’s exactly what happened. They called me this morning from the emergency room. There are two versions of what happened. Régis claims that he went to the INS office, and after waiting for a long time in line he started not to feel well and asked if he might be moved ahead in line. When the others in line found out he was a Haitian and didn’t feel well, someone yelled, ‘Hey, you’ve got AIDS!’ Suddenly they were beating him and kicking him until he fell to the ground. Guards came and arrested him and took him to Ward D [our prison medical ward inside

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti the emergency room]. The charges against him were dropped when they found out he had AIDS. Evidently, they didn’t want to have to touch him after that. The story that the police told the doctors in Ward D was that Régis had tried to cut in line and then began fighting with the others in line and spat at them and told them he had AIDS. He was arrested for disturbing the peace. By the time I got to the emergency room he had disappeared. I tried to convince Alina that she could not blame herself for the suffering Régis had gone through. We had all heard stories about what it was like at the INS, I told her, but given his situation we had no other choice than to recommend what we recommended. She wondered out loud why there were two versions of the story. Was there any truth to the police’s version of what happened? I told her about the pictures in Régis’s album, the ones where he was photographed with the missionaries and the children. Was the person we knew capable of initiating that sort of violence? I had no difficulty deciding which version of the story I would believe. Régis showed up unexpectedly at our office three days later. Since fleeing the emergency room, he had been living on the streets. He still had bruises on his face and arms from the beating he had received. His clothes were wrinkled and dirty. I told him how sorry I was for all he had gone through. He was very concerned that his vision was now deteriorating rapidly. When I examined him I found spots on the retina of his left eye, which indicated a viral infection. He had been right about his vision all along. It had just been too early for me to pick up on examination. I spoke with Margaret. There was a possibility that a new antiviral agent might slow or reverse the progression of his blindness. I admitted him to my ward team. Riding home that evening, Amal and I were somber. I asked her if she believed in the second coming. “As sure as my next breath.” she responded. “And what is prophesied about the Second Coming?” I asked.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti “The Book of Revelations says that He will come in a time and in a manner that is least expected.” She lowered her eyes in reverence as she always did when she quoted or paraphrased the Bible. “And what if I told you that Jesus Christ came for his Second Coming as a young Haitian man with AIDS? And what if the entire world missed it? Régis, art thou a king?” “Don’t speak such blasphemy!” she gasped. “What blasphemy? He may not be crucified but he has certainly been beaten and spat on. Actually, he is being crucified. It’s just that it’s playing out over three years rather than three hours. If he is not dying for his own sins, he must be dying for ours. Another innocent on the altar. Another virgin in the volcano. You want blasphemy? Not only did you miss the Second Coming, but probably a third, fourth, over a million comings. He comes every time an innocent suffers unto death.” She was silent for a long time. I’m sure she thought that if she provoked me further I would lose my soul forever. Just before I let her off at her home she asked if there were anything she could do. I surprised her by saying, “When he is ready to go home from the hospital, take him home with you.” “Take him home with me?” “Well, isn’t it written, ‘and I was naked and you clothed me, and I was starving and you gave me food, and I was homeless and you sheltered me?’ You’re missing your big chance!” “I would take him home with me if I had a place of my own.” “You have your own room.” The thought of this Egyptian woman taking a Haitian man home to our neighborhood and nursing him back to health was beautiful enough to intrigue me. But I knew that I was kidding myself. And she knew I had won our philosophical war. Such things were just not done. She said nothing further as she got out of the car and entered her house.