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over the gunwales, I stared at the inside of the hull stained with the grim but unmistakable colors of diarrhea, blood, and vomit. What must drive these people to risk such an ordeal? I wondered. And how many people have died completely unknown in the passage?

By early 1980 I sensed that something strange, different, and desperate was happening to some of our Haitian patients. Before 1980, spectacular illnesses caught our attention for teaching purposes like an exploding firework and faded just as quickly. Gradually, however, several faculty members simultaneously realized that what was happening to some Haitians was different from the rare, sporadic illnesses that not infrequently presented themselves to our training program. The patients with these diseases were “classics,” behaving in accordance with the classic laws of medicine. But there was nothing classic about what was happening to the Haitians. Some of their illnesses defied all the rules, both in their severity and in the manner of presentation. At first we ascribed the severity of their illnesses to familiar problems in developing countries—poverty, malnutrition, and tuberculosis. By early 1980, however, there were just too many facts emerging to let us continue in our complacency. The illnesses were so bizarre that Lynn, the chair of family medicine, invited a Voodoo priest to consult with him. “It can’t hurt,” he explained, “and some Haitians truly believe they have a spell cast on them.” Word of this consultation spread rapidly through the medical center. While Lynn already had a reputation as being something of an eccentric, the Voodoo priest episode only cemented that impression among most of his peers. To me the patients with these strange illnesses seemed terribly frightened, and medical science had little to offer them to assuage their fears. Lynn may have been onto something after all.

The first person I met who, in retrospect, had acquired immunodeficiency syndrome came into the general medical clinic on a Wednesday afternoon sometime in the fall of 1979. One of the residents who was scheduled to see patients that afternoon fell ill unexpectedly, and I was helping out by seeing some of his patients.

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