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Winter 2014
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FIELD NOTES
 
A Year in Haiti
A different kind of medical education.

On the day of my high school graduation, I received six copies of the book Mountains Beyond Mountains as graduation gifts from six different people. I took this strange coincidence as a sign to find out more about its subject, Dr. Paul Farmer, and his work in Haiti. After reading the book, I contacted the author, Tracy Kidder, by email. The same day, Kidder responded to my email with a personal phone call. We talked for hours about Dr. Farmer and what it was like to follow him around on the ground in Haiti. He put me in direct contact with Dr. Farmer’s office and a month later, I met Dr. Farmer for what would be the first of many times. I began researching Haiti and its history. As my passion for the country, human rights, poverty, and infectious disease began to grow, I changed my major from neuroscience to public health and decided then and there that my future was to be a doctor for the poor.

At 4 a.m. on June 26, 2008, I set off on a plane to live in Haiti for a year as the first public health director for the non-governmental organization Pwoje Espwa (Project Hope) in Les Cayes.

I lived off the beaten path in a village known as Castel Perre, where the houses are made of straw, patched with mud, and the roofs covered with palms. While Haiti is known for its political corruption, kidnappings, and rebel uprisings, I never once felt threatened or unsafe. I lived where I worked and my patients were my neighbors. I ate on the streets, ate only when I was hungry, and slept without bed nets, getting malaria, amebas, and shigella. Castel Perre soon became a home. People stopped calling me blan (foreigner) and began calling me by my name, Dok or Ti Dokte (“doc” or “little doctor”).

Basic Needs

I did not go to Haiti to serve as a doctor or work in a clinic. I was brought to create a public health program that would address the most immediate health needs of the residents in the orphanage and nearby villages. I deferred medical school so that I could experience the public health field through an anthropological lens rather than a strictly medical one. Yet, I was the closest thing they had to a medical person and for that reason, I found myself on duty at the clinic 150 hours per week as the on-staff doctor.

The clinic I worked out of was the only local health care facility for the 800 children and adults of Pwoje Espwa orphanage and the thousands of people living in the surrounding villages. Visiting doctors from the States came down every two months to teach me what they know ─ how to suture, perform minor surgeries, treat common illnesses like TB, STDs, parasites, diabetes, hypertension, kwashiorkor, and anemia. The more I saw a sickness, the better I got at treating it. If I encountered a disease that I was unfamiliar with, I looked it up or contacted a doctor in the States who could help me. I referenced absolutely everything. I even referenced the things that I had seen a hundred times. I couldn’t live with the idea that I may have overlooked something or that I may have given the wrong dose or worse yet, the wrong drug. I saw cases that are considered jewels in the states: nephrotic syndrome, schistosomiasis (blood flukes), shigella (bacterial infection), filariasis (elephantitis), cerebral malaria, and advanced TB. I was forced to step up, often before I felt ready, and act on my gut instincts. I learned that not knowing the answer could mean life or death for a patient.
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