Ah, The Places You Will Go

Nandana Kansra, MD, MPH, FACP

Oh, this is just feels just like home,” I said to myself, comparing the landscape of Haiti with India as I got into a rickety bus that took my team and me from the airport to our clinic in Port-au-Prince. We were going to be here for a week on a medical service trip and I was full of excitement.

However, as we traveled down the dusty streets, I gazed at first in delight at the vendors selling their wares at the side of the road, then had a growing realization that there was not much to sell. The fruit on the carts was meager and dull, while other carts sold rusted wires and broken automotive parts. The vendors looked listless as they sat by their wares apparently without much hope of making a sale. In a sharp contrast, the children in the streets played happily, splashing in the puddles that collected in the damaged roads.

It was my first time in Haiti, as I led a group of three doctors, three nurses, and three students into a land that had never known peace for very long. Haiti has a complex, rich, fascinating, and tumultuous culture and history filled with stories of resistance, revolt, and instability. But one of the fundamental aspects of Haiti is its resilience. Despite slavery, multiple coups, various foreign occupations, and militarization, Haiti continuously fights to remain strong. Haiti’s very existence is inscribed in its many proverbs, such as “Dèyè mòn, gen mòn,” which translates in English to “Behind the mountains there are mountains.”

Prior to this trip, I spent years volunteering in my community, spending Tuesday evenings at St. Anne’s Free Medical Program clinic in Shrewsbury seeing patients who lacked health insurance. However, the service trip to Haiti was my biggest leap of faith in leading a team to provide medical services and supplies in a country that was challenged by a sparse and rudimentary medical system.

Every physician who sets out on the journey of medicine likely asks themselves: Am I doing enough? Have I given back in a meaningful way to my community outside of my work? Have I made myself worthy of being able to heal and alleviate suffering with the training I have received? My one week in Haiti would be a humbling lesson on how little I knew and how much there was to learn.

After a simple meal on my team’s first night in Haiti, we all gathered around in the kitchen with our local guide, Emily who briefed us on what to expect in the one week we would be there. We had to wake up early, as lines to see the “d octor team from the U.S.” started to form around 4:30 a.m. People often rode two-to-three hours in a tuk tuk, sometimes bringing their entire family to be seen. The doctor- topatient ratio is Haiti is one doctor per 4,000 patients, the local clinics could not keep up with the demand for healthcare.

We slept in bunkbeds with mosquito nets draped over them to protect us from the frequent outbreaks of malaria and dengue. The tap water was not safe for consumption, so we only drank filtered or boiled water. Our showers were mostly cold, depending on the weather. Quietly, we began to understand that the luxuries we took for granted in

the United States were a rarity here, and how the simple act of drinking a glass of life- sustaining water was not something all Haitians could do safely.

The next morning, we were all ready by 7:30 a.m. to see the patients. When the doors opened, we realized that the line extended for about a mile- anda- half into the street, and that people had indeed gathered in the wee hours of the morning to be evaluated. We were equipped with nothing but the simple tools of our trade: A stethoscope, an otoscope, a flashlight, a nebulizer, and the medications and food packs we had secured thanks to the generous donations of our local community in the United States.

As my colleague and I started seeing patients that day, one thing became apparent: Stomach pain would be the most common complaint we would hear about all week. It did not matter if it was a child or an adult. What we didn’t realize that it wasn’t just parasitosis that was causing abdominal pain.

“I wake up at 2:00 every morning,” said one patient. I made a mental checklist of all the questions that usually follow this complaint: How much caffeine do you drink ? How much alcohol do you consume? Do you drink fluids close to bedtime ? Then, I asked: “What wakes you up?”

“I wake up thinking about food,” he said .

On further questioning, the patient had not eaten a proper meal in days. He had five children and an unreliable job in construction. We loaded his bag with protein bars, biscuits, dry cereal, and the donations we had brought from home. As he left the clinic for his long journey back home, he flashed a smile of gratitude, promising to return with his children later in the week. None had received any childhood immunizations.

In the one week we were in Haiti we saw close to 600 patients, each one of them a story of resilience and courage. There was a 60-year-old grandmother raising the eight-month-old twins of her daughter, who died as a result of a post-partum hemorrhage.She carefully balanced one child on each hip, and when we asked her how she was coping, she said, with a smile, “I don’t have a choice. I am now their mama.”

There was a gentleman in his 50s whose face lit up in a smile as for the first time in his life, he wore eyeglasses which corrected his presbyopia. There were children who presented with severe dehydration and smoke inhalation injuries for which we used

basic oral re-hydration solution to hydrate, or we relied on solar electricity and our only nebulizer machine to give them respiratory treatments.

On our last day, we all gathered in the kitchen one final time, some of us breaking down in tears knowing that while we were returning to a life of comfort back in the United States, a lot more work needed to be done. We knew that the one week we spent there was just a minuscule Band-Aid on the colossal problem at hand.

When I look back on that trip and the many others I’ve taken since, I realize that what volunteerism really taught me is that it is easier to give from a state of relative abundance. However, those who give when they themselves are suffering are some of the most generous beings of all. My travels with my team over the next several years took us to different countries and to rural parts of America, each experience searing itself into our minds and hearts and teaching us invaluable lessons in humanity and the resilience of the human spirit. It showed us how easy it is to be trapped by the zip code of one’s existence, and how much work needed to be done to fight for basic equality and universal access to healthcare. Volunteerism is the essence of medicine—it’s when all transactions between a physician and a patient cease and one’s desire to help another human being is at its purest intention. In that healing lies the greatest gift for the healer. +