In Creole, it means “don’t make noise.”
It was posted outside of our sleeping quarters in an attempt to facilitate better sleep hygiene. Personally, I took it as a joke: roosters, random farm animals, Haitian holiday partyers, gunshot firers – I don’t think they were made aware of this policy.
Everytime I saw it, the phrase also made me think about how much cultural “noise” we were making as foreigners. What I’m getting at is medical tourism. I feel guilty of it.
Don’t get me wrong: working in Haiti over the holidays, during the cholera epidemic, rioting, extremely short-staffed, hospital compound on lock-down – it wasn’t a vacation. In a state of post-nights delirium, myself and another staff calculated we were 5k from the beach. You would never know it. Our lives consisted of patients, sleep, eat: repeat. There wasn’t one among us who wasn’t completely exhausted by the end. Emotionally affected, altered.
But there is a certain element where you gain more than you give. Expand your scope of practice. Sharpen alternative methods of diagnosis and treatment. Challenge your capacity to provide care in the setting of resource shortages. Be humbled by the constraints of the context. Forget about the superficial things in your life that occupy a disproportionate amount your mental energy.
For those patients whose lives were saved from dehydration, hemorrhagic shock – I have no doubt that they could care less about medical tourism and long-term sustainability. The point was: we were there. Someone cared. They lived.
But there is something that doesn’t sit quite right at the bottom of your soul when you think about yourself dropping in — stitching, bandaging, amputating, pill-pushing, line-inserting — resuscitating a few back to life, and peacing out.
What I am getting at is capacity-building: local ownership and direction of a project. Amongst those of us with a longstanding interest in resource-poor settings, these terms are old hat. But I worry that in the popular media, this message has been lost. Long-term investment in Haitian-driven solutions does not often make headlines amidst CNN appeals for immediate volunteer aid.
The long-term vision of Bernard Mevs in Port-Au-Prince is for it to be 100% Haitian run and staffed. In the interim, the only critical care hospital in PAP straddles the awkward position of relying on foreign volunteers in order to remain open.
Amidst medical surge capacity being reached over the holidays, a proposed solution was to just “shut the hospital down.” No more patients allowed in. No ability to be accountable to the population being served. Nowhere else for them to go.
While, to a certain extent, this increases your feeling of importance as a volunteer; paradoxically, it also begs the question as to the humanitarian ethics of perpetuating such a system.
The more I perseverate on the topic, the more I generate questions with no immediate answers for Haitians or for humanitarian aid workers. But I still like to ask them. And, in lieu of working longterm on the ground, making a little noise on the topic seems like the next best thing.
New Years resolution: fe bruit …. louder… longer.
Happy Haitian 2011
Anne
http://insidedisaster.com/haiti/
http://www.nytimes.com/2010/03/31/arts/design/31planning.html