Resilience

Woch nan dlo pa konnen doule woch nan soley.”
“The stone in the water does not know the pain of the stone in the sun.” -Haitian ProverbApproximately 1300 days have passed since an earthquake leveled Port-au-Prince on January 12th 2010. Many of us are aware of the horrifying statistics in the wake of the disaster; an estimated 100 000 – 300 000 dead, 200 000 injured, and a million people left homeless due to the collapse of shoddy infrastructure around the Haitian capital. Perhaps some less familiar, but equally shocking statistics include the colossal “lost income” payment to France for the former slave colony winning freedom during the revolution (equivalent to $20 billion in today’s date). The earthquake was of course not the first disaster precipitated by a natural occurrence in Haiti – as tropical storms and hurricanes have inflicted great misery in the past.

I first worked in Haiti six months after the 2010 earthquake and what I observed seemed like widespread hopelessness. Patients sat in long queues in medical clinics waiting to be seen. They did not converse, they started blankly ahead, and then they flatly reported non-specific complaints that could not be cured by pharmacology. My patients almost certainly were suffering from a combination of depression and PTSD resulting from many of their loved ones being killed or maimed. It became evident quickly that they also struggled with homelessness, food and water insecurity and staggering unemployment amidst few social protections. On closer examination, I realized that initially what seemed like hopelessness in the face of remarkable terrors inflicted on the population both by other human beings and by Mother Nature- was actually a spirit of resilience second to none.

Labeling Haitian people as depressed, hopeless, beaten down victims of circumstance is inaccurate as it ignores the tremendous ability of the people to overcome adversity that is evident throughout history. Haitians are today – as they have been in over two hundred years – the agents of change and the life force in the transformation of their homeland. For every one “heroic” foreigner who is recognized for their tremendous commitment and sacrifice in working in a strange land –there are dozens of Haitians who go unrecognized for their undying commitment to bettering the lives of their fellow countrymen.

Every visit to Haiti teaches me of the daily struggle that Haitians face for survival. On a recent mobile health clinic with UCSF Fellows, Partners in Health, and Harvard Global Health Equity Residents – I had been mentally prepared for a challenging walk up a steep hill in order to reach our patients. What greeted our group was in fact a trek up treacherous rugged terrain in blistering heat, an endless climb amidst mountains, only to arrive at a place without running water, latrines, and certainly no infrastructure or amenities. The population – our patients – had to make this arduous climb and dangerous decent on a daily basis in order to get food, water, supplies (and heaven-forbid access to healthcare if they could ever find it).  All the while I realized that as we, drenched in sweat, struggled to negotiate the terrain, shoeless Haitians passed us carrying weights on their backs and heads, conquering the landscape because they had no other option but to persevere.

During a two-week training in the Central Plateau of Haiti as part of my UCSF Global Health Hospital Medicine Fellowship I can’t help but be impressed by the local Haitian healthcare providers we have worked along side of. They seem unconcerned with getting their names on research publications, tenure, careers and job security. Contrary to Western views; in fact they have options too – and do this work because their spirit compels them. Some of their predecessors took off to Canada and the United States to earn a fair wage as professionals and security for their families, and to this day some of their peers work in the private sector in Haiti earning 5X their income. These brave souls choose to stay and stand beside their brothers and sisters. They choose to work within an under-resourced healthcare system, in partnerships with a new government struggling to raise funds for its treasury, and above and beyond, they chose to allow us – foreigners – the privilege of working with them (even though we have repeatedly and magnificently failed them in many of our interactions previously).

While I leave Haiti temporarily to return to UCSF, I hope to remind others not to mistake incredible resilience for pervasive hopelessness. The Haitian people exemplify what it means to stand up after being knocked out – from the inception of their nation and brutalization by a colonial power, to the repeated insults they have endured by natural and unnatural forces throughout the last two hundred years. They have undoubtedly survived, and I look forward to witnessing further progress in their homeland as a result of their dedication