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|Dream of a Better Day: The Crisis of Health and Education in Haiti |
|Article # : ||23669 |
|Category : ||CULTURE > PEOPLES |
|Issue Date : ||2 / 2004 || Print Close |
|File Size : ||3,340 Words ||Page : ||158 |
|Author : ||Barbara McClatchie Andrews |
Barbara McClatchie Andrews is a freelance writer based in Canada. This essay is a companion piece to "Life Is Tough: Children in Domestic Labor in Haiti," published in the January 2004 issue of The World & I .
Marnie, a physician's assistant, chuckles and shrugs. She is relating a conversation she had with a man during triage one morning at the clinic where she works. "Qui problem ou geyen?" (what's the matter?) she had asked in Creole. The weary-looking man replied that his roof leaked. When it rained, his family got wet. Marnie swears that she got the same response from another patient earlier that week.
It would be funny were it not so sad. The anecdote illustrates what is most on the minds of 80 percent of Haiti's population: the struggle to find and maintain a home that might keep them dry, food to nourish their growing children, and the dignity of clean clothes on their backs. These are preoccupations that won't go away, because most Haitians can't meet those needs.
This means that Haitians can't meet other needs either. What is a given in most of the modern world--the development of a sound body and educated mind--is an unattainable dream for the majority of Haitians. Statistics suggest how bad things are when it comes to health, for example. There are fewer than a thousand doctors in this country of eight million inhabitants. And while the attention of a doctor is free in government hospitals, nothing else is. A social worker told me about a Haitian woman friend whose daughter died while she was running about looking for the drugs and equipment needed to save the child's life.
With care and medication largely unavailable, Haiti's poor ultimately turn to the dozens of clinics funded and staffed by generous Europeans and North Americans. Marnie's clinic is run by a Catholic order. It eschews publicity, preferring to depend on "divine providence," as Marnie puts it, to satisfy its needs. Nonetheless the order gave me free access, provided that I name no one and take no pictures. For this article I have therefore changed names of volunteers, and some minor details, in order to protect their identities.
'Places of last resort'
I was permitted to follow Marnie on her rounds to get a sense of the patients' conditions. I also began to understand the challenges, both material and cultural, that medical teams must overcome to treat the afflicted. One volunteer simply called such clinics "places of last resort."
Early every morning, looking down from the clinic's balcony, a sea of faces greets you. These are the hopeful, most of whom have been waiting since dawn. After triage, around four hundred of them will receive tickets promising medical attention that day. The rest will go unattended. Inside the clinic, narrow corridors are choked with patients. Some stand, those too exhausted to stand, sit or even slump on the floor. In the wards, beds are tightly packed and it is hot. Sometimes patients lie on the floor, where it is cool.
Death is a nightly visitor here. Days usually begin with a brief memorial service in the clinic's chapel: a sprig of bougainvillea is placed on a chest, the last rites are pronounced, a wish for Godspeed is whispered to a departed sister or brother. Then the staff goes about its work, which isn't over until the last patient is seen. Days are long.
As we enter the small examination room, an assistant is spraying the air with a generous dose of a floral scent. It seems to contradict the philosophy of economy that prevails here, but I soon learn this isn't the case. The medical assistant turns his attention to a weather-beaten man who is waiting on the table. His left calf is swathed in rags. As they are taken off, a gag-inducing stench fills the room. It has been weeks since this luckless laborer cut himself with a machete; gangrene has now consumed half his calf muscle. He will be lucky to survive, never mind not lose the leg.
In the clinic's HIV/TB ward, the stillness is palpable. The quiet is broken only by the occasional crowing of a rooster or the creak of bedsprings. Ninety women lie on metal cots separated by narrow passageways. No one talks except for Marnie, who works her way through the ward taking pulses and blood pressures. Strips of white cloth--looking incongruously festive--hang from the ceiling. The strips support intravenous bags whose plastic tubing snakes into arms so thin you can circle a biceps with your thumb and index finger. From the corner, a cry erupts. "God have mercy on me," implores a woman, her teeth chattering as her head twists from side to side, in a futile effort to escape the pain.
None of these women were expected to leave the ward alive. Like the laborer in the examining room, they came for treatment too late to be helped. Some put off seeking aid because they are single parents and the sole support of their children. Others may have arrived on time but--in their anxiety to return home--left early, thus sealing their fate. Women who make such a decision usually return here to die.
Many women die for reasons that are unthinkable in the developed world. Their killer is not simply tuberculosis, the opportunistic disease that is consuming their lungs, but also their poverty and ignorance. One of the clinic's doctors tells me that superstition is another factor in delaying treatment. The symptoms of advancing HIV, for example, correspond to those associated with a voodoo curse. Haitians will thus ignore the advance of AIDS, which then permits tuberculosis to take fatal hold. Machismo is also a factor. The doctor tells me that cultural taboos and superstition cause men diagnosed as HIV positive to withhold the information from their partners, who may be numerous. In fact, 12 percent of Haiti's population now suffers from AIDS.
Understanding is key to this clinic's success. Volunteers must grasp the prevailing social and economic circumstances and the deep-rooted cultural differences between Haitians and the well-meaning caregivers. The patients' lack of education is a significant problem. One day I encounter Marnie in the oversized closet that serves as a storage room. She is sorting pills into plastic bags. She shows me, with obvious satisfaction, the system she has devised to solve problems caused by illiteracy. Using a felt marker, she draws a line to indicate the separation of night from day. Then she draws a sun before the line to indicate the morning, and one after it to indicate the evening. This is how patients know when to take their pills.
Self-medication is another problem of concern. Many Haitians rely on ambulatory drug salesmen whose wares cook in the midday sun. Some of these drug purveyors cannot distinguish a decongestant from an antibiotic. It is not just a question of lack of education but also economic duress: I was told that only the day before, one of the doctors had discovered his Haitian assistant signing up his friends for X rays.
Lives of shared compassion
Part of understanding patients comes from greater intimacy with them. This is one of the reasons that Marnie--who works six months of each year in Haiti--walks the two and a half miles to work each day. Although her pace is brisk, she stops often. A woman, in tears, begs for help. Her story is hard to follow, in part because she is excited and also because Marnie's Creole is limited. It seems the woman's husband has beaten her and thrown her out of the house. She is nursing and wants to rescue her baby. Marnie apologizes, sadness clouding her pretty face and green eyes. There is nothing she can do.
On a dusty road, edged with characterless concrete-block dwellings, a woman asks Marnie to examine her husband's eyes. Marnie expertly thumbs down his lower lid. Conjunctivitis runs rampant in Haiti, overcrowding and a lack of hygiene being the main underlying causes. But in this case, what the man has is not pinkeye, but a scheme. Drugs are worth money and he can sell the ointment she would give him. Sometimes, I learn, a desperate mother will even sell her child's medication so she can feed the family. For the poor, the only treatment is often compassion, prayer, and faith.
The story of the Catholic clinic repeats itself throughout Haiti in the dozens of clinics that rely on First World funds. They are Catholic, Protestant, and Jewish. While all offer the same high level of expertise, what differs might best be described as their style. The clinic where Marnie works is staffed by volunteers from around the world. Though they perform miracles on a daily basis, there are times when, in spite of all their training, understanding, and goodwill, they come to an end of their resources. One example is cancer. There is only one cancer clinic in the country. Its clientele consists of patients from among the 4 percent of Haitians who are considered wealthy.
I had intended to observe a clinic run by a Protestant mission. Ultimately, I was unable to visit it. The group's liaison in Port-au-Prince, a Haitian pastor, decided--for reasons he chose not to explain--to rescind the invitation the medical team had extended to me. Although this behavior was somewhat high-handed, it was hardly surprising given Haiti's political history. The team's members were clearly chagrined by the decision. Some undoubtedly found it ironic that their politically correct behavior--handing over the controls to a Haitian pastor--should thus undermine them.
Since the team and I share the same guesthouse, I am able to turn the setback to my advantage. Casual proximity affords me a unique perspective on the way its members function. To avoid compromising future missions, which will be in the hands of the same pastor, I have again changed names and minor details in this account.
The members of the Greenwood Protestant Medical Mission arrive at their guesthouse wearing matching T-shirts and bearing canvas bags stamped with their logo. Their luggage is packed solid with drugs, equipment, and gifts--things such as Trojan condoms, Crest toothpaste, and Pert shampoo--for their Haitian translators. Most of these missionaries are highly skilled professionals: nurses, doctors, even an ophthalmologist. They are here to give their all to a clinic in one of Port-au-Prince's worst slums. It is a whirlwind tour. Their presence imparts to the guesthouse dormitories an air of summer camp, and they seem to do everything together. Tap taps (trucks that serve as public transport) take them to and from the clinic, to church on Sunday, to a nearby sister mission, and even on a weekend tourist junket. At night they gather about a table to pray, sing hymns, and share their triumphs, failures, and fears. They discuss a life saved by expert teamwork, another lost in a gang war that raged outside their clinic while they watched helplessly inside. Finally, having accomplished all they could in a matter of weeks, they leave.
Their modus operandi raises questions. All travelers know that a group is a two-edged sword. While engendering a sense of security, group experiences often preclude intimate contact with the people who live within the host country. But the mission's leaders know that volunteers who feel uncomfortable won't come back. What the missions need are willing participants. That is why--unlike the Catholic venture--they make sure that there is air-conditioning in their clinics. They also don't discourage such familiar American comfort foods as Coca-Cola and peanut butter and jelly sandwiches. As for the volunteers' clothes and gifts, apart from indicating a frank desire to share things American, these things perhaps reflect a belief in the power of advertising to raise both funds and awareness. Many of the group exude a sort of "God helps those who help themselves" attitude.
Perhaps the most critical concern is the issue of time spent in the country. These volunteers spent a markedly shorter period in Haiti than do most of their Catholic counterparts. But these are professional people who have likely sacrificed all the time they can afford away from their families and work. They must trust in the efficacy of maximum "production" through the effective use of what time they have to give.
Clearly, differences in style, which are discernible in different clinics, affect the way volunteers work and relate to Haitians. Stylistic differences aside, what unites the hundreds of volunteers who come to this poverty-stricken country seems more important than any matters that separate them. They share an abiding compassion for those who are poor and sick and a determination to improve their patients' lives. And they do.
'I extend my hands'
Their satisfaction or joy in their success is not unqualified. After they have mended broken bones, repelled disease, and palliated pain, there remains the hard realization that their task is Sisyphean. Patients continue to turn up suffering from diseases such as tuberculosis, polio, hepatitis, and even leprosy, or conditions that could have been prevented or cured if detected earlier. Patients whom they cannot help but haven't the heart to abandon keep turning up when there is nowhere else to go: psychiatric patients, for example, are often abandoned at the clinic's door by families at their wits' end. Some of the patients who keep lining up are not even sick but just believe they are. Detecting a "welfare mentality," some doctors have suggested instituting a fee system as a potential cure. But Don de Hart, founder of From Haiti with Love, a burn clinic in Cap Haitien, calls that "unusual punishment of the poorest of the poor."
What de Hart perceives as the root of the problem--the reason for the procrastination, superstition, and ignorance--is the education system or lack thereof. As with health, the statistics on education are depressing. Eighty percent of the population is illiterate. There are too few schools to accommodate the school-age population and all but 10 percent are privately run, the majority by Catholic or Protestant organizations. Only 10 percent of the population completes primary school. Haitian teachers--some of whom cannot even put a list of words in alphabetical order--lack fundamental preparation.
As if that were not bad enough, the vast majority of Haitians speak only Creole. They must struggle with a language problem in education because instruction is in French. Finally, among the handful of Haitians with a university education, brain drain is common. Those with education who can leave the country all too often do so.
Some valiant souls are trying to bring an education to their fellows. At the periphery of Cit‚ Soleil sits a concrete-block building measuring no more than twenty by thirty feet. Freshly painted in primary colors, it presents a welcome sight in this slum settlement. The interior, however, belies the school's appearance. Crumbling plasterboard panels divide the space into four diminutive classrooms. Seating is provided by six-inch benches, and writing tables are not much wider. Sixty-five uniformed students sit in each classroom, so tightly packed they can barely flex an elbow. The low roof is made of tin. By noon the classrooms are stifling.
Beside the school stands a cinderblock building that resembles an upturned cargo container. It is the office of Fran?ois Onel, the school's founder and director. He props the door open with a crowbar because otherwise the wind would blow it shut, leaving us quite literally in the dark. On the wall, painted by hand, is inscribed the mission statement of this intense, idealistic man: "I extend my hands to all those who live in the slums, to all those who struggle for liberty, to all those who dream of a better day for Haiti."
Inspiring words, but Onel is practical too. He knows that a positive attitude won't guarantee the education he believes to be the salvation of his people. For that to happen, he must solve a number of problems. Although it is sadly easy to anticipate most of his answers, I ask him to talk about the challenges he faces at L'‚cole mixte petit coeur de J‚sus. The problems he discusses are common to virtually all of Haiti's schools.
The first, of course, is a lack of funds. His teachers, who earn $200 Haitian a month (roughly U.S. $5), come and go. They can't begin to live on this salary. There are no substitute teachers, and today, for instance, two have not turned up for work. In Cit‚ Soleil, which Onel euphemistically characterizes as "d‚faveuris‚" (disadvantaged), money is always short. Although Onel makes regular rounds of the neighborhood to encourage attendance, the children are usually too busy combing the slum's garbage dumps for food. Hunger, he remarks, makes it hard for many of his students to focus. Malnutrition eats away at concentration too.
Then there is the lack of equipment. Blackboards, canted at strange angles because they are mounted on uneven two-by-fours, appear to have been salvaged from a dump. There are no textbooks. Many students lack notebooks or pencils. When there is a demonstration in Cit‚ Soleil, or news of an outburst of gang warfare, Onel tells me, they must close the doors to minimize the odds of a bullet killing a student. Then, because they have no electricity, they must carry on in the dark.
The elusive goal
Things are better at a privately funded Catholic secondary school for girls. The room, while crowded, is well lit, and the children have texts, pens, and notebooks. The teacher's method is reminiscent of that of an early-twentieth-century French lyc‚e. For a good half hour he holds forth at the blackboard, which he fills with copious notes. Then he departs, leaving the girls to copy and memorize the material. A talk with the school's affable headmaster is also thought-provoking. The problem in education, he declares, is to decide "what kind of citizen they were preparing for what kind of country." This seems a classical ideal not necessarily borne out by practice in this country.
In Haiti's Protestant schools, the goals are distinct. Spreading the Gospel is foremost, while mastering the basics--mathematics, language--is secondary. Here the emphasis seems to be on product, on examination, rather than education's necessary underlying skills. As with health care, but with a more significant impact, the imposition of foreign cultural norms is implicit in the conduct of these foreign-run missions.
I also have the chance to talk at length with a group of teachers who had recently graduated from university. What emerges is disappointing. Their French is deeply flawed, underlining a serious problem: learning in a foreign language hampers progress for all but the most linguistically gifted. More troubling is the realization that the concept of "critical thinking skills," no matter how expressed, is alien to them, as is the idea of abstract thought. When asked to select the most effective speaker at a conference, they are unable to separate style from content. Finally, while my goal in meeting with them is to find out how well they are prepared to teach, their only common goal is to find a way out of Haiti. Last year over 3,500 well-heeled Haitian families immigrated to Canada.
Finally, I have the chance to talk with Michele Karshan, President Aristide's foreign press liaison, about issues in education that need resolving. She suggests that big changes are in the air and mentions a high-profile literacy campaign designed to reach Haitians of all ages. Banners around Port-au-Prince bear out her claims. She also mentions thousands of government schools that have opened since Aristide came to power, promising to send me a list of these schools. It never arrives.
Most of us understand the concept of "a sound mind in a sound body." We know that these qualities are the basis of a healthy state. Educated Haitians know it as well. Sadly, they have not managed to act on that understanding. Haiti must confront enormous challenges in the fields of education and health care. It needs affordable schools and medical facilities with adequate equipment, teachers, doctors and nurses with appropriate training, and administrators with the vision to lead the Haitian people into the twenty-first century. Failure to meet this challenge will continue to condemn Haitians to the all-too-familiar cycle of poverty, ill-health, and despair. Failure will ensure that Haiti will be unable to cast off its distinction as the most depressed nation in the Western Hemisphere.