Tuesday, February 16, 2016

Will You Fix the Hole in My Roof?

I hope to find time and clarity to offer several updates about things in Haiti and the trip the Midwives just took to work in Tanzania. For now I am still deciding what I think and feel about some of it. 
In the meantime I wanted to share this excellent post. Please read it. -Tara 

~   ~   ~
Twenty years ago I was referred a seven-year old little Haitian boy from Ti Riviere de Nippes, a little village in southern Haiti. His name was Abdon and he was a blue baby who was born with four things wrong with his heart (Tetralogy of Fallot). He was not able to play normally with other kids in his village and spent much of his day squatted down watching other kids play. We were able to get Abdon accepted by a children’s medical center in the US for heart surgery.  Without surgery Abdon’s chances of surviving past his teen age years were small.

One afternoon shortly before Abdon and I were to get on the plane for the States,  I was sitting in a chair next to Abdon’s father in Port-au-Prince. He listened to me explain the risks and benefits of cardiac catheterization and heart surgery for Abdon.  I needed him to understand everything and to put his signature on the line if he agreed to let us operate his son. The father had no questions at all and scratched his harsh “X” on the medical center form.
After Abdon’s father “signed” I asked him again if he had ANY questions. He looked at me and asked, “Will you fix the hole in my roof?”
I was taken aback and a little frustrated with him. But he was obviously a practical man and figured if we could fix his son’s leaky heart, we surely should be able to fix his leaky roof. (We were able to help Abdon, but his roof never got fixed by me.)
There are only three types of people in the world: downstreamers, upstreamers, and people who really don’t care.
Downstreamers are a grungy sort of people and we don’t always smell fresh because we sweat a lot. And we kind of resent academic upstreamers who accuse us of putting band aids on problems rather than asking key questions regarding causation.
Upstreamers are not grungy and as a rule don’t sweat. They ask big questions and rely on data.
And people who really don’t care are people who are indifferent.  And this is by far the biggest group of the three.
In Haiti downstream workers like myself see problems in front of them, are appalled,  and try to fix them.  Upstream workers see problems, are appalled, and ask why the problems exist in the first place.
And sometimes there is friction between these two groups. But there doesn’t need to be. (The third group of people who really don’t care are not involved in this friction because they really don’t care.)
The above story about Abdon and his father is a vignette which is defined as a “small literary sketch.”  My blog posts (as well as other downsteamer’s posts) are frequently based on vignettes. I also rely on anecdotes.  My posts are anything but academic but I do want to get people’s attention by the narrative of a person, or his family, and his thousand neighbors in Cite Soleil or Park Cadot or wherever.
However, vignettes and anecdotes don’t have the power the upstreamers want and need.
With Abdon’s father’s question about the hole in his roof, an upstreamer would have asked, “Gee whiz, I wonder why he has a hole in his roof? Rats, bad construction, heavy rains, no job for money to repair it,  or a dysfunctional government?”
In my defense, I was more concerned with Abdon’s dysfunctional physiology than with his leaky roof.  I was nervous. Would Abdon be ok on the plane ride back to the States? Flying at almost 40,000 feet altitude is not always a good thing for blue kids who barely have enough oxygen in their blood stream at sea level. Would Abdon die in flight? I was worried about Abdon’s immediate disposition and his surgery, not about his father’s leaky roof or what CAUSED the leaky roof. My hands were full.
Another example is a cholera patient who presents in shock and needs IV rehydration quickly. I can’t give the family a lecture on how cholera is caused by a bacteria, how it was introduced to Haiti, or get all upset with MINUSTAH right then. But someone needs to and I depend on them and am thankful for the upstreamers to do this.
During my recent stays in Park Cadot on the Haitian/Dominican border, using vignettes I describe the people and their deplorable conditions.  Occasionally I offer my common sense and simple solutions for their problems. But my analysis of the legalities behind the Dominican deportation of people and the legalities behind the non-response of Haitian authorities is lacking. I am not a Haitian Constitution expert and don’t want to be. But I do want upstreamers to do the research regarding the politics and the legalities behind this horrible massive deportation of innocent human beings from the Dominican to Haiti.  And I want them to suggest solutions to help these displaced people.
When the earthquake stuck Haiti in 2010, hundreds of thousands of people were killed and 1.5 million people were made homeless. The downstream people raced around Port-au-Prince in all sorts of fashion and many others flew in from all ends of the earth. And they did what they could to help injured people strewn all over Port.  And the upstreamers sat at home or in their university offices and determined that the earthquake DIDN’T really kill people and make them homeless. They determined that bad construction, faulty zoning, widespread corruption, and a feudal land owning system were the culprits.
And both groups were right. (The people who really don’t care didn’t know about the earthquake…)
The bottom line is that the upstreamers and downstreamers need to get along and respect each other. Sincere people from both groups are trying to better the lot of Haitians. Both groups are fallible. But we are not enemies. The real enemy is indifference.
John A. Carroll, MD