Social Issue

A tale of two Haiti(s)

My brother Keddy and I grew up in Karenaj, a then hassle-free neighborhood in the world-renowned city of Cap-Haitien. Although our family had relatives in Saint-Michel de l’Attalaye, an Artibonite county south of Cap-Haitien, we lived far removed from rural Haiti, except for a few sporadic trips to “andeyò” which is the term Haitians use to refer to rural areas. It’s a Kreyòl word derived from the french “en dehors” translated as outside. So my twin and I, we were raised unfamiliar with most traditional food and to a greater extent, the language and culture of Haiti’s rural regions with their complexity and richness.

When our grand-mother passed away, I could feel that the few stories of Saint-Michel along with anecdotes of our elderly’s rural trips had also vanished. But now, as adults and doctors, we’ve managed to visit the entire country apart from Grand-Anse, either during professional endeavors or on personal adventures. As far as we could tell, decades later, differences still persist between how us, city-raised gentlemen, perceive and express reality and how rural populations do. Not only the rhetoric differs but the very elements of culture struggle to collide. During our trips, those gaps even impaired our ability to communicate with the locals. In terms of local tourism, this situation wouldn’t be much of an issue. But consider the heavy toll of such discrepancy when it comes to patients explaining their symptoms or when it comes to us doctors communicating health risks and treatment options.

In the 1970s, as Haiti’s agriculture sector plummeted, people massively moved from rural regions to adjacent towns in search of a better life. Throughout the decades, the dynamics of rural exodus have only made this transit skyrocket. More than half of Haiti’s population now live in cities. Needless to say that the emigrants carry what they have accumulated as a cultural background with them. The vacuum left by such demographic movement and social context leaves the rural areas very vulnerable. Which in turn often leads to city dwellers, with their own culture, to commute to rural areas for work-related projects, many of them provided by NGOs. This is how we found ourselves on a day-to-day journey trying to comprehend each other.

In rural populations, overcoming issues such as academic illiteracy or comprehending the beliefs in magico-spiritual forces is often a pre requisite for creating rapport and therefore to have impact on a patient’s health outcome. But some other concerns are subtler. I recall having examined an old woman named Annia in Saint-Antoine, a neighborhood next to Poupelard avenue, in Lalue, Port-au-prince. The old woman was from the South and had settled in Saint-Antoine less than 2 years prior to her consultation. Visibly uncomfortable, she described her pain to me in those words: as if a stack of millet was being pounded upon with a big pestle. She made it clear: – “The big ones Doc, not the small ones”. Coffee is very much engrained in every Haitian’s life and I’m very familiar with scenes of people pounding coffee roasts in big pestles, it happens in rural zones as in certain towns, but I sure had no idea as to what it feels like. And can’t obviously make the difference between the big and smaller ones, except for their size. While I was expecting her to describe her symptoms using my words, she relied on images of her daily life. As she spoke, even though we speak the same language, I could feel the gap between us widen and as if we were losing each other.

Keddy has also experienced such “language barrier” when he asked a patient from a locality near Montrouis, when she’d last had her period and she casually replied: – “On the last moon”. While he was anticipating an exact date, ignoring when the last moon was or even what that actually means.

It’s not a mere matter of language (French versus Kreyòl) as the concern is raised ad nauseum but instead a collusion between two different cultures, impairing understanding and proper health communication between two people speaking the same language.

These cultural barriers to communication stress the difficulties to assess and address health risks in patients and communities alike. I remember visiting Maniche with a team of Port-au-prince-based health agents. Most of them were hailed from this very Southern locality, and although our job was to raise concern about the safety of a water source, because they used to drink it and were actually baptized in these waters in their youth, it became harder for them to question its quality. The same goes for patients suffering from high blood pressure who dismiss any change in the way they prepare food because they’ve been taught a particular way by a parent since they were kids. Habit is more powerful than science and without the psychological tools of social and behavioral change communication the work of healthcare providers might as well be for naught.

I went back to Karenaj recently. As I sat in furniture that feel older than the city itself, I was thinking that until we reduce the gap between urban and rural realities we will not be able to understand each other, recognize what puts us at risk and heal our common evils. As I thought of my conversation with Annia and the way many pride themselves as educated, I asked myself if we were hardly doing any good. What good is a doctor’s vast knowledge if he can’t even understand his patient, let alone help her improve her behavior? There is not a single way to resolve these differences. But if we at least stop considering distance as difference, maybe we can start learning and improving together.

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Social Issue

Beneath the Beautiful Bright Paint Covering Jalouzi

This story first appeared on WoyMagazine – Design by EBMD 

I still remember that November morning, Moise Street in Petion-ville was under reconstruction. Dust filled the air and provoked my nose to sneeze multiple times. It was my first day of work as a doctor in Jalouzi. I decided to walk to get there; that was my way of getting to know this colorful neighborhood I knew very little about. All I had in mind were my brother’s quips likening Jalouzi to Kabul by day and New York City by night.

Jalouzi is an impoverished, overpopulated neighborhood, or what the international media would call a slum, in Port-au-Prince with countless houses stacked on top of each other. It is not unlike many other neighborhoods in places like Carrefour feuilles, Carrefour, la plaine etc. The only thing special about Jalouzi is its proximity to Petion-Ville. The view from Petion-Ville’s hotels and bustling restaurants occupied by tourists, expats and the wealthy is none other than the stacked houses of Jalouzi. Ever since the beginning of Jalouzi en couleurs, a government project to paint the houses of Jalouzi in bright colors, a couple of years prior, the slum had caught the world’s attention. So my heart was filled with excitement to experience this side of Haitian life. Almost a year after my experience there, the memories are still vivid in my mind. Yet Jalouzi remains the media’s cherished story, to the extent that RYOT has recently shot a 5-minute documentary short called “The Painter of Jalouzi” for the release of the iPhone 6S Plus of the mega brand Apple. Much to my disappointment, the movie conveys a good bit of misinformation and heavily clashes with the daily reality of Jalouzi.

It took a visit to the archives of Petion-ville’s Town Hall and to the bureau of the civil protection while researching for a book I am writing about Jalouzi to learn that nobody knows the exact number of people actually living there. I realized then that while the bright colors provided the slums with more visibility, the people remained invisible to the State. The people of Jalouzi welcomed the Jalouzi en couleurs government project simply because these people have nothing; they have no choice but to welcome whatever is offered to them. It is no surprise then, that for many of the patients I discussed the project with, healthcare and running water would have been their top priorities if they were given a choice.

Along the Stenio Vincent street in Jalouzi, three health care centers could be counted as of December 2014. But since my first visit, the one that belongs to the Ministry of Health has been closed. Today, its driveway is occupied by vendors, making it difficult to even be noticed. One of the private centers has packed up and the building has been rented to other businesses. Yet the need for healthcare itself has not diminished one bit. On the contrary, in the midst of this situation, various illnesses have arised. Why? Because poverty leaves people extremely vulnerable.

There is no reliable running water in Jalouzi. On the days I reached Jalouzi by foot, I climbed along the slippery steep stairs where women and children carry buckets of water on their heads. Unfortunately, they can only get this water from trucks with water tanks that come once or twice a week, depending on how business is. In the rainy season, there is no clear distinction between the trash and the walkways. Therefore, the soles of people’s feet become public transport for germs which end up straight inside their homes, the stacks of chaotic construction. In the marketplace, food is sold on the floor, meat is covered with flies, the sanitation conditions are dire and precarious.

A mother confessed one day, in the examination room: “All the problems I have go beyond the bright color of my house.” As her issues accumulated, she ran out of money to pay the rent, solely relying on family based in the United States. Her problems, which are closer to the rule rather than the exception, could not be alleviated nor transformed by a paint job. Just as her constant headache did not go away with the makeup she wore that day. Throughout its narration, RYOT’s documentary depicts a delusional image of what life is in Petion-ville’s Jalouzi, which is far from being Haiti’s largest slum, contrary to what they report. Its transformation is only superficial, and the ultimate beneficiaries remain the spectators, foreigners or locals, enjoying the view of Jalouzi’s brightly painted houses from a distance.

In spite of its worldwide reach, “The Painter of Jalouzi” has failed to call for real transformation in people’s lives. To be more accurate, the short film might as well had depicted the real painter of Jalouzi as an outsider. Someone far from the reality of the neighborhood, working in the slums during the day, and returning to relax in his suite at the Royal Oasis Hotel in Petion-Ville at night. This is a missed opportunity to raise awareness on the very real issues of healthcare, education, clean water, energy and human dignity. The government’s Jalouzi en Couleurs project has failed the people of Jalouzi. Why don’t we build schools in the name and memory of Préfète Duffault? Why don’t we push the Ministry of Health reopen its health center? Does it help to apply lipstick to a pig, or to disguise the misery and hunger of the most vulnerable? By blinding ourselves from the suffering of others, one day we might end up being the victims of our own farce.

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