Haiti Reflections: Epilogue

“Is this worth it?”

I can’t tell you the number of times I heard this question.  THE question.  I heard it in the Barracks and over meals, and an awful lot on the porch during our moonlit debriefing sessions over our Prestige beer.  My answer was always yes, but I rarely said it out loud.  This was because, at the time, I couldn’t clearly articulate why I felt it was, but also because most of the time it was asked by somebody who was clearly leaning towards an answer of no, and I wanted to hear why.  Overall, these negative perceptions were born from a sense of frustration and futility.

Not too long after coming back, Shelagh and I were in Tampa.  We got together with Rich and Ginny Salkowe for dinner one night.  We got along pretty well and I wanted Shelagh to meet them, and them to meet Shelagh (“See? I told you I married Mary Poppins!”).  One new thing about Chantal came up while we ate.  We were talking about the hypertension we encountered.  Why would so many people who are malnourished or starving have such spectacularly high blood pressures?  Rich, who has an interest in geology, has a friend who is a geologist at the University of South Florida, and he asked him if there were any geologic clues.  In looking at the hydrogeology of the region, it was clear that the source of the problem was probably the drinking water.  The aquifer around Chantal has extremely high levels of sodium that will leech into the water.  The aquifer around Canon also has high levels but somewhat less than Chantal.  This would explain a lot of the B/Ps we saw and the differences between the two areas.  It also follows Haitian luck: their sources of “safe” drinking water are poisoning them.  Slowly, but surely.

The Question came up here, too, over dinner.  Was it worth it?  The Salkowes didn’t feel that it was, at least, not for them.  But from my perspective, if they hadn’t gone, the aquifer might not have been identified as the problem.  Will it get fixed any time soon?  No.  But a problem can never be fixed until its cause is found.  Rich, with his geological affinity, likely completed Step 1.  The chances that anyone else with his combination of interests will happen by Chantal are so slim as to be unimaginable.  So if his discovery of the correlation between rocks and blood pressure is remembered, then in my estimation their trip was worth it.  At the very least, his was.

Many times during our stay, Father Yves told us, “We are not here to save Haiti.  We are here to do what we can to help.”  Clearly, he was trying to temper some expectations.  And I think expectations are the source of the sense of frustration, and the sense of futility.  These expectations have both individual and cultural origins.

In listening to all those who said no in answer to The Question, I found that some of the individuals clearly went to Haiti with an idea that they were going to effect some great change.  Some clearly had the idea that, even though it was 15 months later, we were going to be providing more earthquake-related relief.  But while there was a population surge because of the quake, it was made clear to us from the outset that we were there to provide primary care.  These individuals with great change or possibly even heroics on their minds were going to be disappointed from the get go, and as a result, got frustrated.

But the origin of the sense of futility comes, I believe, from our culture.  We are Americans, and when we get sick we have a reasonable expectation that when we go to our primary care physician, we will be cured.  In the subculture of American clinicians, we are used to being part of the team that provides cures for everyone we see, or at least a fighting chance at being cured.  And therein lies the source of the overwhelming sense of futility: the lack of a cure.

The vast majority of people we saw had maladies that we weren’t going to be able to cure.  There were profound numbers of people who had chronic musculoskeletal pain, mainly because they are subsistence farmers and for them “backbreaking work” is not a cliché, it is literal.  There were people with heart failure, cancer and a host of disorders caused by malnourishment.  We weren’t going to cure any of them.  This reality was emotionally insurmountable for a few of the team because the inability to cure is considered a failure here at home.  Those who had this mindset were of the opinion that if we don’t have even a remote chance of curing, what we were doing is futile.

Most people could see past this inability to cure, knowing it wasn’t going to happen.  But the culture of American clinicians tripped some of them up with the sense of futility when they realized what help we were providing was so very limited.  They had expectations of being able to provide care based on American standards, not the harsh reality of the third world.

For those who may go to Haiti or another third world country to provide help, but haven’t been to the third world before, I would like to engage you in an empathetic exercise.  It may help you understand.

You are a Haitian, living in a remote area outside Chantal.  You are a subsistence farmer, growing the only thing that is marginally viable: rice.  To produce enough rice for you and your family to live on through the year, you must plant several acres.  It requires you to work all day, every day, bent at the waist, whether you are planting or harvesting.  The very nature of rice farming means that you will, with 100% certainty, develop chronic lower back and hip pain, probably at a very early age.  As you get older, the pain will get worse.  There is no relief and you will live with this pain.  You will also work with this pain, which will make it worse still.  There are no drug stores and you can’t afford any medicine anyway.  And there is no welfare, so if you stop working, you will starve. 

I am willing to come to you and help you as best I can, even if it’s just to provide you with a few weeks of reduced pain.  If I cannot cure you, or treat you to normal American standards of care, I will still provide you with some relief, some respite.  It is the kind thing to do.  It is the compassionate thing to do.  It is merciful.

So my answer to The Question remains yes. 

Mercy is always worth it.