One Life At A Time: A Haiti Reflection, by Krista Margolis

I have been back from Haiti for almost exactly one week. I have dreamed about this beautiful country and its beautiful people every night since I got back. I find this interesting as I’ve never been one to have recurring dreams about anything; yet for the past seven consecutive nights, Haiti has lulled me through restorative, uninterrupted sleep. While I find it interesting and a little unusual for me, I am not surprised.

Since choosing my path in health care as a women’s health nurse practitioner, I’ve had visions of caring for people from a different part of the world, with different health issues, different world views, different cultures and different opportunities. I got the chance to do just that last week in Haiti. I traveled with a group of seriously gifted nurses, physician assistants, physicians, and non-medical geniuses to Arcahaie, a city located about an hour from the capital city Port au Prince. These 23 people were perfect strangers to me upon arrival; little did I know that upon departure one week later, they would be friends for life. We took tap-taps (awesome little trucks that we all piled into the back of where getting close and personal wasn’t a choice) every morning to a village called Do Digue. We saw 1,559 people in clinic over the course of five days and gave out over 10,000 prescriptions. We traveled with the group Community Health Initiative (CHI), an organization founded in 2012 by two emergency medical physicians, Dr. Chris Buresh and Dr. Joshua White. While I could list about 500 attributes of CHI that I admire, one of the simplest ones is their mission: “Working in solidarity to create healthy, empowered, and self-directed communities in Haiti, until the work is done!” One of my other favorite things about CHI is the idea that we are there to give a hand-up, not a hand-out (thank you, John Osako for those words). While hard at times to not share all my food (those of you who know me know how much food I had packed for this trip) with the kids in the village, the idea of working in solidarity to help the people of this village identify their own needs as a community and work with them in meeting those needs made a lot of sense. After all, it is their country, where they speak their language and have their own cultural values, not ours.

I learned quickly how those cultural values place an enormous burden on the women of Haiti. I also learned quickly how hard it is to be a woman in Haiti. I thought sex education was bad in the U.S. Haiti is a thousand times worse in this department. While Catholicism is the official religion of Haiti, voodoo may be considered the country’s national religion. It seems that many Haitians believe that their voodoo can coexist with being Catholic, which made for some interesting birth control conversations. While there were several women who did want birth control, or planning as they call it, there were just as many who shook their heads no when asked if they were interested. During my first day in clinic, I desperately tried to understand it; I would drill my interpreter (who is my new BFF by the way-she’s nothing short of magnificent) in attempt to figure out their reasoning. I learned that there is a strong belief (still not sure if it’s of voodoo origin or not) that if you take any form of birth control, especially when you are younger, you will never be able to have children. And the inability to have children is found unfavorable in general in Haiti. Yet most of these women did not want to get pregnant; they shook their heads no even harder when asked that question. Luckily, we could get most of them to take condoms; the idea of using condoms as STD prevention vs. birth control was acceptable.

Cultural values and beliefs are not the only challenging aspect of health care for women in Haiti. Preventative medicine just isn’t readily available. I sit with women in the practice I am thankful to be a part of here in MN and discuss their pap smear/cervical cancer screening options all the time. We discuss how current guidelines state that, depending on your age and a few other factors, you can choose to have a pap either every three years or every five years. We get to CHOOSE and make informed decisions on our cervical cancer screening. These women of Haiti do not. They don’t have well-woman exams or preventative screening for anything. CHI comes into their village four times a year and, if they are able to be seen, they get vitamins, anti-worm medication, meds for hypertension and various other chronic issues. This is great, and I’m so glad they get that. But it’s still not what they deserve. I took care of a 40-year old woman on the second to last day of clinic. She came in with some of the same complaints that many of the women came in with; irregular bleeding, belly pain, headaches, vaginal infection symptoms. She was so kind. Her eyes were beautiful and although we needed our wise interpreter to understand the words being exchanged, I only needed to look at her eyes and watch her body language to really hear her. Without going into the details of her exam, I knew she had cervical cancer. And I knew it was advanced. And I knew she was scared. And I knew that she had two kids, ages 10 and 12 and that her husband had died. What I didn’t know but would find out in a quick hurry was how few options she has for treatment. For cervical cancer, a highly preventable cancer with proper screening, treatment and the HPV vaccine. I know that not all American women get the proper screening and treatment either, but at least most of us have the option.

My friend and colleague, and the woman who introduced me to CHI, Judy Stark, a physician at Southdale Ob/Gyn where I practice, said it best. She came up to me after hearing about the tough day we had at the clinic on this day (there were a few other hard patient stories this same day) and said, “You won’t forget her. This is what will bring you back to Haiti.” I knew in that moment that she was right. I definitely won’t forget her. And I won’t forget about the woman who came in very sick after obtaining some meds from the local market to induce her own abortion. Because the eight kids she already had were hungry and she couldn’t imagine one more. But I also won’t forget the lighter stories of women’s faces beaming when they heard their baby’s heartbeat for the first time with the Doppler or seeing their baby move and wiggle on ultrasound.

On the last day of clinic I wore one of my favorite t-shirts. It says EVERY MOTHER COUNTS. I’ve never felt that more profoundly than that day I wore it. Every mother, father, child, life counts. No matter where you are born, no matter where you live. Every night after clinic and dinner we would debrief as a group. I loved this and I’m so grateful it’s part of the itinerary on CHI trips. At our last debriefing, one of our fearless leaders shared the story of the starfish. You’ve probably heard it but the just of it is that maybe as individuals we can’t save every single starfish by throwing them back in the ocean when washed up on shore; but we can make a difference to one. Hearing this story at that moment was powerful and has helped me as I process my entire Haiti experience. I can’t solve the health problems in Haiti. I can’t make sure every woman there has the same opportunities that we have here. But I can go back on another trip with CHI, work hard and hope to make a difference in at least one woman’s life.

“Do not be daunted by the enormity of the world’s grief.

Do justly, now.

Love mercy, now.

Walk humbly, now.

You are not obligated to complete the work,

But neither are you free to abandon it.”

-The Talmud