Dispatches From Haiti: Physician Advocacy

Mr. and Mrs. Valcin–July 2020. Photo: John Carroll.

“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.”

– Dr. Martin H. Fischer, German-American Physician

Mr. Valcin is stuck in Port au Prince.

He is the Haitian man who is very sick from valvular cardiomyopathy and needs his heart valves operated by a heart surgeon. Mr. Valcin has been offered pro bono life-saving heart surgery by a heart surgeon and medical center in the United States but the American Embassy in Port au Prince will not issue him a visa for travel.

What is physician advocacy?

According to Dr. Kathyrn Hughes, a surgeon who posts on Kevin MD–

Physicians fundamentally care for patients, their families, and our communities. We advocate on a small, individual scale for each patient, and we advocate on the large scale for the entire population of patients and society.

Patient advocacy seems a noble pursuit and often much needed. Patients and their families are distressed and vulnerable, even in good health; add illness, and the ability to navigate the system and the decision-making can be daunting if not impossible.

Hughes states that the physician is the “ultimate patient advocate.” Patients are more likely to trust their physician and medical care if they realize their doctor is advocating for them.

I have needed to advocate for Mr. Valcin at the patient level for his immediate health care needs in Haiti, and at the administrative level, i.e. helping him apply for his visa for travel to the United States.

Our country is living through a tumultuous time. The White House is not only rocked with Covid-19 but suffers from xenophobia, racism, and animosity to immigration. And these sentiments from the White House are not lost on our State Department.

During the last several months, we have applied twice for the visa for Mr. Valcin. He received an interview in early September with his first application but was immediately refused a visa. So we helped him apply again, and with his second application, he was not even granted an interview.  So I have been forced to advocate for him by sending multiple emails and documents to the American Consulate in Port au Prince trying to convince the Consulate that Mr. Valcin is an excellent candidate for a travel visa. We have employed the use of other officials in the US to advocate for Mr. Valcin, too.

But so far our advocacy for Mr. Valcin has not convinced the American Consulate to issue him a visa. I think that the Consulate fears that Mr. Valcin will remain permanently in the United States even though his submitted documents support him returning to Haiti to his wife, kids, and job as a teacher.  It appears that the American Consulate is ready to let him die in Haiti rather than risk his highly unlikely defection to the United States.

Being an advocate for Mr. Valcin takes a lot of time and energy and takes me away from clinical medicine. But if I don’t advocate for him, who will? He and his wife are too weak, too poor, and too docile to effectively advocate for his life at the American Consulate in Haiti.

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