Nathalie explained to Francky that he had a brain tumor and needed surgery. They told him that I was visiting from Boston and had recently gotten another patient in his situation free surgery in the US, and would try to arrange this for him. I asked Francky if he had a passport. He did. This was great news—the passport had been a rate-limiting step for months in Janel’s case. We prescribed steroids to reduce the swelling around the tumor, hoping to alleviate his headache and give us some time to try to find a solution.
It didn’t seem like the right moment to ask Brigham to provide free care for another patient from Haiti. Janel had just been admitted for a month of chemotherapy and radiation, and the complexity and cost of his care was far exceeding what any of us had anticipated.
I asked a doctor visiting HUM from another US hospital if she would be willing to contact one of her neurosurgery colleagues back in the States. I sent her some cell phone pictures of the CT scan to pass along. Her neurosurgeon colleague replied to us that the young man absolutely needed surgery and asked if it could be done in Haiti. We said it couldn’t and asked if he would consider bringing the patient to his hospital in the US. He didn’t reply.
I would be spending the following week teaching at one of the other PIH/ZL-supported hospitals in a different part of Haiti, but I assured Nathalie I would keep working on trying to get Francky to the US and keep her posted.
While I was at the other site, Nathalie wrote to me that a radiologist from another US hospital was visiting HUM. She asked the radiologist to show the scan to his neurosurgical colleagues back home. The radiologist replied that he couldn’t say whether the tumor was operable without an MRI and so he didn’t think it was worth showing the CT scan to any surgeons. I disagreed. Although an MRI would certainly help us better define the tumor, even without it, it was clear that this patient needed urgent surgery.
I asked Nathalie to tell the radiologist that a visiting neurologist had seen the patient and his CT scan and was sure the patient needed surgery, so we would appreciate if he could show it to neurosurgical colleagues from his institution to see if they might be able to help. Nathalie went back to the radiologist and tried again, but this time he told her that he thought the tumor was inoperable based on the CT scan. She interpreted this as the radiologist simply not wanting to get involved. Frustrated by the interaction, she gave up on trying to convince him to help us.
I called Anne in Boston to see what she thought we should do. She agreed that it probably was not a good time to ask Brigham about another case when things had not gone as planned with Janel—who, by the way, was doing okay with his treatment in the hospital, she said. But she thought that at eighteen years old, Francky was not necessarily too old to ask for help from a children’s hospital she had worked with in the past for surgical cases from Haiti. Anne contacted a neurosurgeon at the hospital, and he agreed that the patient needed urgent surgery. He copied in one of his hospital’s administrators to see if free care could be arranged. The administrator sent us a set of forms, and we filled them out and sent them right back. It looked like we had a promising path for Francky, and I called Nathalie to let her know.
She said she would relay the good news to Francky, who fortunately had remained stable over the week I had been at the other site. He was still blind and still had a headache and a stiff neck, but he was still able to eat, talk, and move normally. I was headed back to Boston but promised her I would keep in touch about the plan.
* * *
As I sat with my backpack and suitcase waiting for my ride to the airport, two conflicting feelings dueled in my mind: I felt bad that I was going home and I was glad to be going home.
My trips to Haiti always felt so short, and I knew I could do more if I lived and worked there full-time. The one neurologist in Haiti had recently fallen ill, meaning that by leaving I was decreasing the number of practicing neurologists there by 100 percent, from one to zero. Back in Boston I was one among hundreds. It didn’t seem right. But I was also eager to return to my Boston life—Nina, my fulfilling new job at Brigham, the basic comforts we take for granted. And this made me feel guilty.
I liked to think that I could adapt well to life in rural Haiti. Although the frequent power outages, blistering heat, oppressive humidity, and lack of air-conditioning and hot water seemed to frustrate some visiting staff, I always enjoyed my time there. But it’s easy to adapt to anything for two or three weeks. I am well aware that my colleagues in Haiti have to live with this reality all the time.
Almost every year, one of our Haitian physician colleagues moves to the US. Since they can’t work as doctors in the US without repeating all of their training, many go back to school and become nurses. I’ve heard my US colleagues criticize them. “I thought they were so committed to Haiti. How can they leave? Haiti needs them! What a waste of all their public education!” Easy for us to say, we who come and go, who can be evacuated if something doesn’t go according to plan, who can rough it for a few weeks at a time, knowing we’re returning to air-conditioning and hot showers, to say nothing of paved roads and continuous electricity. If the opportunity arises for our Haitian colleagues to move to a place with better schools for their children and better healthcare for their families—not to mention safe drinking water from the tap and political stability—how can we fault them?
I heard a car horn beep, and the security guard opened the gate to let the driver in. It was one of HUM’s larger vans with two benches along the windows in the back. I pushed my suitcase between the benches, shut the rear doors, and climbed into the passenger seat. Then we waited.
Ten minutes.
Fifteen minutes.
The driver got a few calls, but his Creole was too fast for me to understand what he was saying.
We continued to wait there, engine idling.
Twenty minutes.
Thirty minutes.
I tried to ask if we were waiting for others—maybe that was why he had come in a van instead of a car?—but again, he spoke too quickly for me to understand.
I started to worry that we could be late for my flight. And then I started to worry that since we could be late, the driver would drive quickly and recklessly to avoid being late. I had been in that uncomfortable situation before.
I heard the rear doors of the van open. I looked over my shoulder to see several of the women who work in the staff house piling into the back seat. They left the doors open. A few minutes later, another car pulled up. They loaded some things into the back of the van, but I couldn’t see exactly what they were. Then, finally, we left.
Running late, we took the winding, perilous mountain roads at dizzying speeds. When we finally descended onto the straight, flat stretch that leads from the base of the mountains into Port-au-Prince, I was relieved that we’d made it in one piece. The driver floored it, weaving erratically past trucks, taptaps, and motorcycles on the crowded street.
A chicken scampered out onto the road ahead. The driver beeped but didn’t slow down. The chicken darted back and forth on the road in panicked confusion. At the last moment, it flapped its wings into clumsy flight, bounced off the grill of a truck coming in the opposite direction with a hard smacking sound, got thrown to the ground, and was run over by our van with a loud thud.
As I winced at the sound of our tire crushing the chicken, the women in the back of the van burst out laughing.