Chanje

“Is it still bad there?”  If you’ve ever traveled to a similar situation as Haiti then you’ve probably heard this question.  It’s full of sincerity, but complete cluelessness.  Of course it’s bad there.  It wouldn’t be carrying a CDC travel advisory warning if it weren’t bad.  Haiti had years of corrupt leadership followed by multiple military coups that effectively robbed the country of its natural resources and money.  It has a self-centered big brother in the United States that will only offer help if it offers a greater amount of benefit to himself.  And in the last five years it has been hit with half a dozen natural disasters that destroyed what meager gains in infrastructure the country had made in spite of the aforementioned hurdles.  Drop that info and ask the person if they suspect that any country wouldn’t be bad by their standards.  But for people who have visited, and especially those that have had the fortune to visit more than once, they can speak positive about the situation.  They can speak about change.

Change is quite possibly the most important characteristic of disease that physicians use for diagnoses and managements.  The natural progression can help differentiate a virus and bacterial respiratory infection.  It’s been a week and suddenly it’s getting worse?  Then maybe we should start an antibiotic.  You’ve had intermittent back pain for 4 months that hasn’t gotten better, but hasn’t gotten worse?  Sounds musculoskeletal and I don’t want to rock the boat with a bunch of costly tests right now.  Even with patients that are extremely sick, in critical care units, many times doctors treat just to prevent a change for the worse.  Vitals are the same from one day to the next?  Good, let’s keep everything the same.  The patient may not be closer to getting better, but step one is to prevent a chanje mal.

Change impacts so many decisions in our lives.  Don’t like the status of the country?  Vote for a “Change You Can Believe In.”  That’s a change that the U.S. and Haiti share.  Haiti actually had to prepare for their election cycle in the aftermath of the earthquake.  Due to the types of delays one can expect when a natural disaster kills over a quarter of the public servants in a country, the election ended up being delayed until approximately the one year anniversary of the earthquake.  By this time the Haitian people had felt that there wasn’t enough change in their country, so they decided to change the head of state.  In walked Michele Martelly - former musician whose music is more Eminem than Bono.

Now whether the change in President truly had an impact or not is a matter of debate, but I believe that Haiti has been able to avoid a chanje mal, and in many instances experienced chanje bien.  And I do not think that I am alone.  People who are more Haiti-experienced than I can attest: It looks cleaner.  People appear happier.  More services are available.  Driving through Port-au-Prince you can see parks.  Like recreation parks.  With landscaping, slides, basketball courts, etc.  I saw more construction equipment in action than ever before.  More housing projects to help people move out of the tent cities.  Don’t get me wrong.  There are a ton of the shanty communities where I am sure that disease still rages, but I’m talking about change.  Improvement.  It’s there.

Change doesn't end there.  This most recent trip to Haiti featured 5 newbies.  Everyone reacts differently to their first time working a CHI clinic in Haiti.  Some have a deeply spiritual reaction and find themselves pursuing God more upon their return.  Some respond with visceral anger to the inequities they witness firsthand.  Trivial tasks such as opening a refrigerator can evoke tears.  And there are some who don’t really know how to respond.  Maybe the trip wasn’t quite what they were expecting.  They were disappointed in the food and accommodations.  Perhaps they see so many problems in Haiti that they aren’t able to see the changes that are happening.  But it’s to these people that I say, come back.  Wait about 6 months and come back.  You will see changes.  You will notice the spirit of the people more.  You will feel connected.  Come back and realize that you too have been changed.