August 2018: Reality

August 2018.

Being over 3,000 miles away from home has proved itself more challenging than I imagined. I mentioned this back in July- coming here was covered with these overly optimistic ideas about social justice, being down with the cause, being a change agent and in the 'trenches'. It didn't sound glamorous and that's why I loved the idea of being in a place like Haiti even more. Part of my mission in life has been fueled by a crafted dream to serve and work alongside those most in need. However, this month some realizations set in about my previously held ideologies pertaining to global health/aid/relief shifted. Perhaps how I get there, what I do, and how I go about fulfilling my calling will manifest in a different way. As I look at my future in efforts to become a medical provider, Im left with questioning what my role will be on the ground locally and abroad. Health Policy? Maybe.

Before I get into all of that, let me backtrack to the events that led me there. The central plateau (which includes cities/villages such as Thomassique, Hinche, Mirebalais, Cange, Cerca la source, etc) is the poorest region of the poorest country in the western hemisphere. Klinik Saint Josef (KSJ) serves as a medical hub for the Thomassique region, and provides wide range but limited health care. All of this is orchestrated by medical and non-medical staff 24 hrs/day, 7 days/week. Care is free for those that are unable to afford the small cost of 50 gourde (less than 1 USD), and no-one is ever turned away. Part of our efforts to maintain a sustainable future for KSJ is built on encouraging and inspiring the community here to invest in their clinic.

This enthusiasm does not only exist at KSJ, but echoes across the voices of community healthcare workers throughout Barank, Boloume, Darlegrand, Savane Platte, Nan Kwa, and Bok Banik. This month we celebrated Barank at their annual anniversary party (Fèt Anivèsè). Between us...Barank is easily one of my favorite communities, partly because of their tenacious and proactive community health worker, Robenson. Of the 6 communities, we work with, Barank has the highest rate of Cholera due to, among other things, water contamination/lack of access to cleaning drinking water. As a guest in this place, it's easily to ‘leave’ feeling drowned with helplessness but, you are also equally awakened by the continued efforts of those living in Haiti to mitigate their situation. I am constantly learning alongside my co-fellows, Jason and Ruth as we work in tandem with the staff at KSJ to relieve suffering through various program/projects/initiatives. In the past two months we have seen the incredible ways the KSJ is providing for the community at large.

There are moments however, when the reality of health inequity in the developing and its impact on health outcomes makes me wish I could snap my fingers, rub one of those magic genie bottles, or wave a magic wand and whisper abracadabra into the universe to "cure" these disparities. However, those are empty thoughts and unrealistic hopes. Coming face to face with the realities that exist in Thomassique and recognizing how both the historical and existing structures have contributed to health inequity is essential to creating interventions. Having this knowledge is critical, and the hope is, of course, to improve health outcomes. The disappointing part, is that sometimes, even with our best efforts, these hopes do not always materialize in the way we imagined or even within the timeline we anticipated.

This story is one of those moments.

At the end of July 2018, during our monthly meeting with Barank, we were approached by one of Baranks Komite Ajan Sante (committee members) who was with his 3 year old daughter (shown above) and was holding his 3 month old son (shown below). The Child’s abdomen was grotesquely swollen, while his arms and legs showed wasting suggestive of severe malnutrition. Though unable to provide medical advice, we did what we could and asked him to come to the clinic to meet with the attending physician. We reminded the father that we would cover the cost of transportation and took down his contact information. Our attempts to contact that family were unsuccessful. Two weeks later we returned Barank for our monthly mobile clinic. By that point, the infant's condition had significantly worsened. Dr. Lawrence, our attending physician, immediately suggested that he be sent for advanced treatment/imaging to the premier hospital in Mirebalais, approximately 4 hours from Thomassique, through rough and mangled dirt roads. We quickly convened, and gathered all of our resources and were able to provide funds for the transportation of mom and baby, along with covering all medical expenses. The sense of urgency among all of us was palpable, and the family departed to Mirebalais that day. Unfortunately, the hospital was unable admit the baby and they sent back, with an appointment scheduled for the following week. When we learned of this, we spoke with that the family and informed them that we would assume all financial costs upon their return to Mirebalais the following week should they decide to proceed. They agreed to return.

A week later, we were taken back, when learning from the community health worker in Barank that the child had not been taken to his appointment, and subsequently, his illness had worsened. Desperate to ensure the safety of the child but also represent the interests of the family, we offered to accompany them to the hospital, we invited them to stay in town/at the clinic, we offered everything that would encourage them to seek care. The family was overcome by fear of traveling with the baby again, and decided not to go to the hospital. Six days later, we received news that the family had taken the baby into further into the region to see a Boko (voodoo priest). They believed the illness was being caused by a “lwa”, a spirit. The following day our phone rang and we learned that the baby died.

Thoughts flooded in- What happened? Where did we go wrong? What could we have done better? Why didn't we do more? Placing blame is one of the most ferocious and vicious forces that can enter one's mind at a time like this. I hate that I let myself get there. But for transparency, these were legitimate questions I was grappling with. I was angry with myself and the system that I believed had failed this child. But, most of all, I was devastated for the family. There was no way to absolve ourselves of moral implications. This tragedy was a reflection of the painful reality that exists for the mouns (people) of Thomassique. Their struggle with severe lack of access to quality care is compounded by widespread poverty and lack of resources.

Though this experience did not give me a visceral understanding of suffering as it pertains to the developing world, what I have gained is a shift in perspective about my role as an advocate and ally for the community in Haiti. Perhaps the best way or the most meaningful impact I can have across borders is not necessarily here on the ground but rather in fostering agency and building capacity.

Haiti is filled with the strength and vibrancy of people ready to step in and be part of the progress. If systems interventions and sustainable environments are the needs of the community, then my intention is to be fully engaged in combating the structural hurdles and working to ensure that our initiatives are driven by the stories of the most vulnerable.