They said she was a “one-eyed baby” and I immediately knew what they meant. I asked to see her, and they said yes, for a student it was okay. I walked over to the maternity ward at the rural Hopital de Fort Liberté in Haiti. It was a room with three beds separated by two curtains. The middle bed was propped up at a 45-degree angle and had a pool of blood soaking into its cracked green leather. On the floor beneath it, a large basin overflowed with pinked water.
The mother was gone, but the baby was wrapped in a white towel on a counter. She wasn’t swaddled, instead the nurses had wrapped her the way you might wrap a gift, with each corner of the towel tucked over her. I pulled the towel back starting at the feet, and worked my way up. The toes were tiny, and on each hand was an extra digit, sticking out 90 degrees from each pinky. Her lips were puckered in a small kiss, as they are in all babies. There was no nose and she had one wide, flat eye in the middle of her brow. I remembered the pictures of holoprosencephaly from class well, and I struggled with the correct balance of curiosity and respect as I looked at her small body, embarrassed that someone might catch the look of awe on my face.
I had to check my curiosity many times during my first medical mission trip to Haiti in efforts to expand my foreign perspective and show a genuine desire to help. The goal of our trip, led by an organization called Hernia Repair for the Underserved (HRFU), was to treat hernias and train local surgeons in Lichtenstein hernioplasty—a procedure where mesh is used to cover the opening of the hernia rather than sewing the edges of tissue together—so they could continue the work after our departure. In our makeshift pre-operative area at Fort Liberté, I worked with a team of nurses and doctors to diagnose hernias. We asked dozens of men to disrobe, to trust us strangers as we picked up our markers, needles, or razors. Many hernias had gone untreated for years; in some, complicating cases of filariasis created enormous testicular bulges. Although we had a translator, I found myself wary of my demeanor. At my medical school’s teaching hospital, I could temper a look of surprise with kind words, or explain away a frown by discussing my concerns. Abroad, without the help of language, every nod, smile, or pat on the back became an important tool for conveying professionalism and care.
Many patients had multiple problems. One girl approached us with an infected ingrown toenail that had swollen to the size of a clementine. We struggled to relieve the pressure, and instead prescribed antibiotics and daily soaks in warm water. But even as she thanked us and walked home, we knew it would be challenging for her to get to a pharmacy, to buy drugs, and to find clean water. Still, we let her leave. Cases of hypertension walked away. Cases of diabetes left for home, no good next steps in place. At home in Los Angeles, I could tell myself that a social worker or a specialist would follow up to close the wide circle of care that surrounds a patient. In Haiti, I found it troubling to leave problems unaddressed.
The desire to fix was overwhelming at times, but I realized that our short-term solutions were a way to satisfy ourselves more than anyone else. They placed us back in our comfort zones, helping us avoid the strange and bizarre. After working in Fort Liberté, we spent the last half of our trip at Universitaire Hopital de Mirebalais. The two-year-old hospital is an architectural triumph, with elegant open-air hallways and a roof of solar panels that takes advantage of the sunny tropical weather. A staff member at the hospital told us that Mirebalais’s beauty can fool visitors like us who expect the same processes one might find at an American hospital. These visitors will often try to fix what they deem wrong, but these fixes can be disastrous because they confuse staff members, who are inundated with new ideas and new rules every time a service organization comes to visit. Even if something seems wrong, she told us, “Sometimes you need to let us improve it ourselves.”
This approach of empowerment mirrors the mission of many global health organizations today as we learn to listen to each community’s needs. HRFU has a multi-year mission to build surgical capacity for hernia repair in Haiti. We emphasize sustainability and education rather than solely addressing base desires to fix. The hope is that we will ultimately train enough surgeons so that our group is obsolete. What I found most effective in building empowerment however, were the friendships formed between our team members and the Haitian patients, nurses, residents, and surgeons. If we could get these individuals to trust our medical care, we counted ourselves lucky. But if they viewed us as friends and colleagues, we could make a true difference. They are the ones who will stay in touch throughout the year, update us on their successes as well as challenges, and seek our help as advice, not lecture. Their friendship will provide an opportunity for us to learn from them, to share ideas and work together to improve each other’s lives. This, I felt, was the unstated yet most profound impact of our service trip.
When we were at Hopital de Fort Liberté, our translator Frisel helped me learn a few words in Haitian Creole. We sat outside with the surgery patients’ family members, who listened as I tried to recreate sounds I had never heard before. When I motioned to ask if I could practice with them, they nodded. “Comment ou rele?” I asked.
“Bien,” they would reply. Over time, they began to correct me. “Com-moh,” they said. “Reh-lay. Reh. LAY.” Though our relationship was rudimentary, it created an atmosphere of ease. They tried to learn my name, and I tried to learn theirs. They were clear when I was doing a poor job, and with their help I began to find the rhythm of a basic conversation in Creole.
Treating interactions as potential friendships rather than charity can help foster the long-term dialogue and education we need to help each other. The experiences I had in Haiti were not all unique to Haiti, and I found that my trip had taught me what kind of doctor I’ll strive to be, both at home and abroad. It will always be difficult to balance curiosity and respect, to understand why a quick fix may not be the right way to help—but a friend may be able to show me why.
Featured image courtesy: Jon Shoer, Hernia Repair for the Underserved