Global Health, Public Health

Insights from a surgical prowess

Founded in 1703, Mirebalais is a small commune situated in the Plateau Central, approximately 60 km Northeast of Port-au-Prince, the capital of Haiti. Birth place of the Haitian combatant Benoit Batraville, it is a 88.899 inhabitants, vivid locality where agriculture and livestock are predominant despite the many difficulties of commerce and daily life. Fortunately, the Peligre’s hydroelectric dam, opened 59 years ago in the Centre department, provides energy to the whole city. I first visited the town five years ago, immediately after the 2010 earthquake, with a team of medical students who volunteered at the hospital Bon Sauveur of Cange (village located near Mirebalais) run by the international NGO Partners in Health and local sister organization Zanmi Lasante.

In this 330 square kilometers town, five years later, a surgical team led by Dr Henri Ford, Haiti-born renowned surgeon, successfully separated six-month-old abdominal conjoined twin sisters. Being the first of its kind in the country, the successful operation marked a turning point in the history of Haitian medicine. This prowess, which took place at the recently erected University Hospital of Mirebalais, has drawn many insights on Haiti and the future of medical cooperation among which: the benefits of global health and surgery for the resource-limited country, the need for a paradigm shift in international medical cooperation and the opportunity to share an accurate image of Haiti.

Marian's surgical team wore red bandanas, while Michelle's wore yellow ones as they worked in an HUM operating room on Friday, May 22. Source: Partners in Health

Marian’s surgical team wore red bandanas, while Michelle’s wore yellow ones as they worked in an HUM operating room on Friday, May 22.
Source: Partners in Health

Let’s consider first, the benefits of global heath and surgery for Haiti. Defined as the area of study that places a priority on improving health and achieving equity in health for all people worldwide, global health stands as a common ground, where international and local health professionals perform together in order to overcome enormous challenges usually unconquerable by a sole performer. As noted, surgery can help reduce the burden of disease by 11-15% globally, but unfortunately, the poorest people have little access to surgical care for malformations and pregnancy-related conditions like it was the case for Ketan, mother of the conjoined twins Marian and Michelle Bernard.  In a context of economic insecurity and shortage of medical professionals, global health and global surgery, in Haiti, can be considered as one of the most accurate vehicule to strengthen the health care system by providing affordable access to care and sharing of knowledge and experience in the respective fields. The separation of the conjoined twins at the University Hospital of Mirebalais is a typical experience of the opportunities provided by surgery used in a context of global health.

These open doors consequently foster the need to look at the future through different lenses. They emphasize the vision that the new way of considering international medical cooperation should privilege sustainable partnership over mere assistance. This paradigm shift, in the case of Haiti, may come very gradually. Hence, the need of courageous visionary people here and abroad to challenge the status quo and be the change they want to see. The surgical prowess of Mirebalais is undoubtedly a milestone in the future of medicine in Haiti. It offers a fresh look on what is possible here where weaknesses are overly pictured. In the path of Dr Anténor Miot who introduced orthopedic surgery in Haiti, the vision and work of pioneers will definitely have an astonishing impact in the future. Not only will it lead to better care for the Haitian people but it will also propel a more accurate image of the country which is striving to build a resilient health care system.

In fact, as of the early years following the earthquake, Haitians recognized the need to share a new and appealing image of Haiti in the global scene. It comes in reaction to negative news, often spread by international medias through shocking headlines and repulsive photographs, emphasizing the state of poverty of the western part of the Hispaniola island. In the context of the separation of the siamese sisters, Haiti has retained a new kind of attention. There was extensive media coverage both prior and after the surgery by the Haitian newspaper Le Nouvelliste and international medias. The Huffington Post and CBS News among others have instantly released the positive news of the successful seven-hour surgery. As Dr Jon Lapook, CBS News chief medical correspondent, present at the event, stated “This is a country that’s trying to rebuild the health care system”. In fact, since positive changes are happening home, positive feedback will surely counteract destructive attempt.

Ultimately, leadership can be defined as the ability to inspire people to dream more, to accomplish more and to be more. It is a matter of influence through innovative ways to look at the world. No matter the field of action, no initiative will be sustainable without the necesssary amount of cooperation and knowledge sharing between people of different academic and cultural background. Therefore, the majestic surgery of Marian and Michelle Bernard at the University Hospital of Mirebalais has cast a bright light on Haiti’s future particularely in medicine despite the remaining challenges. It also outlined the power of taking impactful initiatives inside to bring a positive image outside of Haiti. In 2010, as I assisted my first surgery at Cange, I couldn’t imagine that such an astonishing event would take place at Mirebalais, little town where we used to stay not more than a few hours, the time to jump in a bus to Port-au-Prince. Next time you come across the astounding country of Haiti, make sure you pay a visit to the Hospital of Mirebalais which stands today as a cornerstone where history was written.

Manoucheca Ketan holds her conjoined twin daughters before their separation at University Hospital in Mirebalais, Haiti, on Friday, May 22. Source: Partners in health

Manoucheca Ketan holds her conjoined twin daughters before their separation at University Hospital in Mirebalais, Haiti, on Friday, May 22.
Source: Partners in Health


Resilience is resistance

Being the first black republic in history on 1804, it goes without a doubt that Haiti was born in unbearable suffering. More than two centuries later, the country’s history still holds an uncountable number of tragedies and struggles, begun with the assassination of Jean Jacques Dessalines, the founder father of the nation. To make a long story short, political instability and corruption coupled with several natural disasters have plunged the western part of the Hispaniola island in deeply rooted poverty. But contrary to popular beliefs, such conditions of existence are far from abating the people. As an example, on his visit in 2010, former France president, Nicolas Sarkozy was right to affirm that though it was bruised on a never-ending night (January 12), Haiti has remained standing. A lesson of courage to the world.

Resilience, which has nothing to do with invulnerability and social success, is the key to unveil this mystery. The french psychiatrist Boris Cyrulnik defines it as the ability to stand against all odds and pursue one’s development despite the many adverse circumstances. Resilience relies on multiple factors to grow, among which four can easily be identified in Haiti: the creole language, religion, community life and music.

A language is a powerful tool that allows you to communicate your whole person besides expressing a practical idea. In the case of creole, it is strongly tied to the Haitian’s creative mind. Through its flexibility, It offers a wide opportunity to appropriate oneself of a situation and consequently hold power over it. The Haitian humor has been well expressed in the word “goudougoudou”, based on the sound of concrete-made houses shaking during the earthquake. The word aimed to name the event but also gave the people a certain level of familiarity with the disaster and the ability to raise themselves over it. Other creole words or proverbs are as powerful such as “wozo” (reed in english) meaning that Haitians may bend over but never will they break down. However, creole is not the only factor boosting the Haitian resilience.

From the beginning, religion has played an astonishing role in the slaves’ ability to cope with their situation and to overcome it with courage and pride. The story of Bois-Caïman ceremony which led to a catastrophic revolt, testifies the importance of religious gathering through Haitian history. It was such a known fact that the French have forbidden all kind of vodoo practices in Saint-Domingue colony. But as the iconic group Boukman Eksperyans asked in “Kouman sa ta ye” song: “what would it be like, if it wasn’t for vodoo?” Until today, the majority of Haitians practice vodoo (though secretly because of cultural discrimination) along with Catholicism and Protestantism which are highly spread and constitute deep sources of hope and force for the people. No matter the confession, religion remains an unquestionable pillar for resilience building in Haiti.

Cayman wood ceremony by Ulrick Jean-Pierre

Cayman wood ceremony by Ulrick Jean-Pierre

In line with religion, community life is another big rock in the process. It is common in Haiti to assimilate neighbors to family. Activities like agriculture, religious practices, commerce and entertainment evolve around various size of more or less constant communities. Even impermanent ones play a major role, like a cheerful tap-tap or a marketplace where strangers share a portion of their life with anyone like old acquaintances . In Haiti, the communities constitute an appropriate frame necessary to nurture one’s character and contribute to his continuing development no matter life’s circumstances. In hard times, when a hurricane hits or during the post-earthquake period, when a mother, a father or a child dies, when losses are unexpected and hard to accept, having a community to rely on is already a step towards a new beginning. In brighter moments like a child-birth, a kid’s first communion or a large harvest, the community’s presence remains highly reliable.

The last growth factor for resilience we’d like to describe here is not however, the least prevalent nor important. Every second of an Haitian’s life is punctuated by music. It lives in his soul no matter the type, the more popular being konpa, rasin and creole rap. The current president himself, is a former popular singer and musician of the konpa group Sweet Micky. Music is the perfect vehicle for expressing the dreams, fear, sorrow, beauty, sarcasm, accomplishment, spirituality, political position or any common life experience. It is where Haitians look at life, grasp it, question it and make it their own. Every moment of life- carnival, protests or elections- carries a variety of rythm or definite songs. With the power of music, the most unbearable situations become poetry, a comfortable place to grow better and be more resilient. As an example, Zenglen reminds people to keep fighting despite the daily struggles in its song “Rezilta” (Results). More others can be found to illustrate the importance of music in growing resilience. This is absolutely why carnival and rara can be counted as the most popular seasons in Haiti.

This analysis of the four different elements cited above, under the light of Haitian history and daily life events, has let us trace down their impact on character building, on the way they help people turn tragic events into relatively harmless memories and definitely how they contribute to development of constant resilience in Haiti since centuries. This core attitude is critical to the existence of Haitians as a people. Resilience is their resistance. Resistance against inertia, defeat, resignation and mind slavery. As the Haitian proverb goes: “Toutan tèt pa koupe, li espere mete chapo” (As long as the head is not cut off, there’s hope to wear hats). Day by day and one stone at a time, Haiti will strive to keep building its resilience castle.