Palo Alto Weekly

Spectrum - June 18, 2010

Guest Opinion: Haunting images linger from a 'medical-service' trip to Haiti

by Joseph Schwartz, M.D.

My eyes stared transfixed at the mosquito net above my bed, and questions started to pour through my mind. If a mosquito net has more than 100 pieces of tape on it is it still considered a mosquito net? Or is it now tape woven together with netting?

If both the temperature and the percentage humidity exceed 95, is it possible for a person to actually boil? It was now 3 a.m. and my daughter and I had just arrived at a small orphanage on the border of Dominican Republic and Haiti — a very long way from our home in Palo Alto.

In the comfort of my own home, a medical service trip with my 16-year-old daughter (a Gunn High School junior) seemed like a brilliant idea. Now, before seeing a single patient, I had doubts.

Upon arriving at the orphanage I quickly scurried into a cabin filled with more than 40 boys and men. In oppressive heat and darkness I groped for the one open bunk and when I climbed up through the mosquito net onto the large piece of foam and Mickey Mouse sheets I actually felt a sense of accomplishment.

That was until I realized that this bed was only millimeters wider than my body. I was faced with a quandary: If I moved at all, there was a very good chance that I would fall out. So, I stayed completely still as I felt mosquitoes land on my body and abuse me. And these were not ordinary mosquitoes; back in the states a flying object this large would require a license. So, I just laid in bed and listened to the music of the night — roosters crowing in the darkness (which still baffles me), loud reggae music, distant gunshots, the sounds of teenage hormones flowing around me.

And the questions started to flow again. Is it possible to stick to foam? How many sleepless nights could I tolerate before starting to hallucinate? Actually hallucinating was starting to sound like a pretty nice alternative at this point.

The next day was spent getting to know the 70 premed students who were helping deliver the medical services and packing up medications. Then we were off into the fields of the Dominican Republic to set up our makeshift medical clinics. The bus trips were memorable due to the picturesque views of banana fields and the inspiring stories of many of the college students and how they had decided to come on this trip as opposed to the usual college spring-break rituals.

One of the young women gave me a lengthy lecture on how the financing of higher education was in crisis and we were in danger of creating an entire generation of students who would be in massive debt the day they graduated. We talked about how the education system in the United States was deeply flawed.

But as I gazed into the eyes of the Dominican youths later that day I realized how lucky we are. These children had a less than 40 percent chance of getting an elementary education, around a 10 percent chance of a high school diploma and virtually no chance of getting a college degree.

They were trapped in their lives.

On the following nights, I spent my sleepless nights tossing and turning in appreciation, despair and even guilt.

I deliberately gave myself a month or two to write about this trip, as I needed to process the events and experiences. The lives of the Dominicans and the Haitians passed by like the tiny pieces in a kaleidoscope, where I could fleetingly see into their lives but never gather the depth of their daily existence.

There were images of countryside roads lined by huts with no electricity or plumbing but myriads of cell phone towers throughout the banana fields. I saw hoards of people waiting patiently in the sweltering heat, uncomplaining. There was the nun who gave one of the medical students her phone number and begged him to call. There was the teenage mother with four children, one so dehydrated that he had only hours to live. But she could not afford to get him to a hospital — her look of acceptance will haunt me forever.

The man with an abdomen needing surgery who could not even bear that I touch him. Yet he rode his dirt bike more than 50 miles to get to a hospital. I still get abdominal pain myself when I think of him on that bumpy road, but his courage always makes me smile.

The 70-year-old man draped with his machete and cell phone who just came from a full day of work in the banana fields and his blood pressure was a high 230/150. When I asked him to take a few days off work to let his blood pressure settle down he just laughed, choked down the blood-pressure medication and headed back out to the fields.

I think of the look of joy on the face of one of the premedical students as she walked around the clinic with an 8-day-old newborn and decided that her future would have to be in pediatrics or family medicine.

And then there are the memories of coming back from long days and feeling ecstatic about taking a cool shower to douse the myriads of mosquito bites; of course this enthusiasm rapidly faded when I realized that I was not alone in the shower — I lived in Florida for several years and am fluent in roach, but these creatures were like something out of a science fiction movie. It was bad enough when I would see my foot start to move involuntarily, but when the creatures started to fly I knew it was time to come home.

The images of these Dominicans pervade my consciousness.

As I poured teaspoons of rehydration fluid down the throat of a 4-month-old I wondered what prospects this child had of leading a happy, long life. That's when it fully hit me that what separated me from this child was a mere roll of fate's dice.

Then the harder questions started to flow. How is it that these people endure such hardship yet seem fairly content and well-adjusted? What is the source of their contentment — faith, acceptance, lack of expectations?

It was then that I realized that, on my medical-service trip, I had actually received much more than I had given.

Joseph Schwartz, M.D., is a family practice physician at the Fremont Center of the Palo Alto Medical Foundation. He is a 16-year resident of Palo Alto, and is married with three children. He can be e-mailed at njga12@yahoo.com.

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