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Where the Poor Must Be Our Preference

A House Call in Haiti

by JOHN CARROLL, MD

Port-au-Prince, Haiti.

Many years ago while working in a free clinic in Peoria, Illinois, I came to realize how a house call could teach much more about a patient than seeing the patient in the office. Office visits are artificial and don’t tell you near as much about the patient.

I remember visiting a 90-year-old patient of mine in Peoria who weighed 350 pounds. During my visit she showed me where a raccoon fell through the ceiling of her closet in her bedroom and then was shot dead by a family member. I also noticed how far away her medication was kept from her and how dificult it was for her to access it. Her handicapped son George, replete with tuxedo, sang beautiful songs, but didn’t help much with his mom’s health care. I couldn’t have learned this information with a simple office visit.

Yesterday in clinic in Soleil a father brought his three year old daughter to clinic. It is not often that fathers bring their children to pediatric clinic in Haiti. He seemed to be a very caring father. The little girl had orange hair, a congested cough, and impetigo on her arms.

They seemed to be quite poor–I would say close to the bottom of Haiti’s poor class.

The father’s name is Jean-Ronel and his daughter is Manaika.

I asked the father where Manaika’s mother was. Frequently when the father brings the child to the doctor the mother is selling goods on the street, has sick kids at home, just had a baby, or is sick herself.  However, Jean-Ronel told me that his wife had died suddenly on December 17, 2010. He told me that she had died due to a spell cast by the houngan.

I treated Manaika yesterday with medication for impetigo and institued empiric treatment for worms and iron deficiency. However, I wanted to see Jean-Ronel’s and Manaika’s living conditions and I wanted to talk to him more about their lives.

I needed to make a Haitian house call.

I got Jean-Ronel’s cell phone number before he left and told him I would call him today to arrange a visit to his house and talk to him about his life. He agreed.

So today I met Jean-Ronel on a street corner here in Sarthe, a huge northern section of Port-au-Prince. It was a typical Saturday morning in Port-au-Prince. Temperature in the sun today had to be about 100 F. We inched slowly in traffic about four miles north along very congested Route National 1 to Jean-Ronel’s neighborhood called Lizon.

Forty-five minutes later we arrived at the place Jean-Ronel calls home. The front door to the very unfinished cinderblock house was a piece of plywood that Jean-Ronel removed to let us enter the house. Looking to the north one can see mountains in the distance.

Jean-Ronel’s brother Nazair, the owner of the house, proudly showed me each room. He named the rooms as the kitchen, the living room, the dining room, the bathroom, etc. This all seemed normal conversation except all the rooms were empty and most had no roof. Nazair told me that he had been building this house for 10 years now assembling it block by block. Cement is not cheap in Haiti. Nazair lives here with his wife Vela, their three children, Jean-Ronel and Manaika.

So after the brief house tour, I sat down in a plastic white chair in a roofless hall and listened while Jean-Ronel spoke.

Jean-Ronel is 31-years-old and very thin. He wears a baseball cap.

He was born and raised in Mirebalais, a village just 30 miles north of Port-au-Prince over the mountains in the distance.  He completed 10 years of education but had no money to finish his secondary school.  And because he had Nazair and his wife Vela here in Lizon he decided to move here a few years before the earthquake. There just were not any opportunites for him in Mirebalais.

Jean-Ronel says that he can read and write some. He said he has been to southern Haiti only once and has never been north. Mirebalais and Port-au-Prince are almost all he knows.

After arriving in Port-au-Prince he and his wife produced Manaika in 2008. His wife was about 15 years older than Jean-Ronel.

The earthquake occured on January 12, 2010 and the three of them were living in a rented house. And it was not damaged in the quake and none of them were hurt. So they stayed there.

I asked Jean-Ronel what happened to his wife.  He told me that she had an argument with a woman in December 2010. Some bad words were exchanged. Jean-Ronel left the house one day shortly after the argument to run some errands on the streets.  When he arrived back at the house later in the day his wife was gone. His wife’s family told them that she laid down during the day and died. Her family insisted that she died because an illness was sent to her by the houngan because of her argument with the lady a few days before. And they had already transported her body to the morgue.

I asked Jean-Ronel if he believed in the houngan and he said no that he did not but his wife’s family did. I asked Jean-Ronel what religion he is and he said Catholic. But when I asked him what church he goes to he said the “The Church of God” locally in Lizon. I told him that was not a Catholic church. He looked surprised and just shrugged. He also volunteered that he has never been baptized.

So after his wife’s death, he and baby Manaika, unable to pay rent any longer, moved to a tent city in Sarthe, and stayed there for four months. But the living conditions in the tent were so bad that Nazair accepted them into his house in Lizon which is where they remain today.

Jean-Ronel and Manaika sleep on a mat on the floor of the bathroom which is just an empty room with a rocky uneven floor and a blue tarp for a roof.

I asked Jean-Ronel if he had ever heard of cholera. He said yes he had heard of it on the radio but did not know what it was. Incredibly, after almost two years of cholera ravaging Haiti, Jean-Ronel didn’t know what cholera was.

I explained to him that cholera is an illness that causes vomiting and diarrhea.  I asked Jean-Ronel where he would take his daughter if she got ill from cholera and he shook his head and said he did not know where to take her. However, Vela, his sister in law who was listening to our conversation, commented that cholera causes diarrhea, vomiting and death and she would take any ill family member to Foyer St. Camille if they became ill. (This is a hospital set up by an Italian order of Catholic priests and nuns several miles from their house in Lizon. It no longer has an active Cholera Treatment Unit, but Vela does not know that.)

When I asked Jean-Ronel where they get their drinking water, he replied that they buy it from a truck which has treated water inside it. But I saw no cistern to store the water.  I saw no Culligan water bottles. And so I asked them again where they get their drinking water and Vela pointed down the road. She said they get it from a hand pump which pumps up water from the water table (anba woch).  Vela said that they purify that water only when they have AquaTabs which she buys at the boutique. And this depends on whether she has a few extra cents for the AquaTabs.

I asked Jean-Ronel how often the family eats and he said twice each day. But Vela overruled him again and said that they only eat once a day. And that is rice covered with red bean sauce. No eggs, meat, milk for anyone.

I asked Jean-Ronel if he was happy with his life. He said yes right away because he still has “souf”. ..which means he is still breathing.

I asked him what he wishes for. He said he wishes for a job and that his Manaika is cleared of her illness.

I asked him if he knows the population size of Haiti. He said he had no idea. I asked him to try and guess and he said that he couldn’t.

I asked Jean-Ronel what he thought of President Martelly. He answered that he is a good president. I asked him why and he said that President Martelly is putting kids in school around Haiti.

Many Haitians have strong ideas regarding US politics and our president. Over the years President Clinton was well liked and President George W. Bush was not so well liked by Haitians in my very informal surveys.

When I asked Jean-Ronel what he thought of President Obama he said that he does not know because he (Jean-Ronel) “does not live in Miami”. (Poor Haitians refer to the entire United States as “Miami”.)

I asked Jean-Ronel what he thought of me. He said that I was “not a bad person”.

I asked Jean-Ronel what he thought of MINUSTAH. He said they were good because they enforced security in Haiti. (I don’t think he knows that MINUSTAH costs 2 million dollars each day to have them here occupying Haiti. But I doubt that fact would change his mind at all. Big sums of money mean absolutely nothing to dirt poor Haitians who have only a couple of cents in their pocket.)

When I asked Jean-Ronel if he had any questions for me, he asked me what would my questions and photos do to solve his own problems. I told him “probably nothing” but this information could make people aware of Haitian problems like his and maybe it could help Haitians “collectively” in the future.

Lets face it, Haiti is a broken place. The situation here is inhumane, terrible, outrageous, unthinkable, and embarrassing. ( I worked last week with an American dentist who described her experience here as embarrassing….she meant that her Haitian patients’ teeth were so bad, she was having a very difficult time extracting them. And it was embarrasing for her to exctact teeth rather than restore them.)

In my opinion Jean-Ronel has no good chance at having a better life at least by our Western definition. He lacks the basics to survive with any dignity.

His daughter Manaika has a chance if the system could be fashioned to work for her over the next twenty years. She doesn’t need an i-Phone, an i-Pad, or an i-Pod. She needs i-Basics. She needs security, clean water, nutritious food, a good education, and a chance at a good job when she is 23 years old. Manaika does not need to be in an orphanage. She needs to be with her father and her cousins in Lizon. And she needs to be hugged.

Would Jean-Ronel and Manaika survive a bad case of cholera today if left to their own devices? Probably not unless his sister-in-law Vela intevened quickly. And right now she made it clear that she would take them to the wrong place for hydration. Thus, education has to occur from the ground up if we really want to help Jean-Ronel, Manaika, and their extended family.

So can Haiti change?

I don’t understand words and phrases like “neoliberal economic policies” or “globalization” very well.  But I do understand what Jesus said. He said to take care of the poor. And if all the emphasis in Haiti with the billions of dollars that was pledged to Haiti since the earthquake was focused on the poor, everyone’s life in Haiti would improve…even the 1% of the people who own 50% of Haiti’s wealth. Jesus would have been a good economist.

The poor Haitian community, about 10 million of them, need to be put first. And alleviating Haiti’s misery could begin. The poor should be our preference.

House calls can be sobering events. One may hear stories of fallen raccoons or even worse.  But house calls can teach a lot about people we care for and want to help.

John A. Carroll, M.D. is a physician working in Port-au-Prince.

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