After I returned to Boston, I received an email from Ricardo that included a long list of the items he recommended purchasing and their prices. I thanked him and forwarded the list to Père Eddy and his team. Père Eddy replied moments later:
Pay close attention! In the needs assessment for Janel, we should be very professional. I looked at this list of things we need, and I’m not certain some of these are priorities! Between being able to not go hungry in the long term and having satellite TV, which is more important? If we fulfilled all of the demands on this list, what money would we have left for Janel and his family’s true needs?
I was shocked. I looked over the list more carefully. Nestled among items such as curtains, chairs, a refrigerator, and a fan were two separate line items for televisions: one satellite, one regular.
I apologized to Père Eddy that I hadn’t looked at the list in detail before forwarding it. We received increasingly frustrated and angry emails from Ricardo about not getting the necessary funds to buy the items he had asked for in Janel’s needs assessment.
I was perplexed and asked Martineau about the situation the next time I was back in Haiti. “Why did Ricardo think Janel needed a satellite TV?”
“Of course he doesn’t need a satellite TV,” Martineau said and laughed. “Ricardo was planning to steal the extra money.” He looked at me incredulously as if this should have been obvious and I was naïve for not having figured it out.
“Wow . . .” I replied, shocked.
“He’s not all bad,” Martineau said. “He did a good job finding the house for Janel and his mother, and he worked hard to negotiate a good price in the community since he is from the region. But then he was stealing a little bit of their stipend each month. Janel’s mother told me, so we did not allow him to deliver it anymore. Then he tried to steal from us again by sending this list with the two TVs.”
“If everyone knows he’s trying to steal, why do you still work with him?” I asked.
Martineau smiled. “You see, a long time ago, he was very sick. A very severe case. He was Dr. Paul Farmer’s patient. Dr. Paul saved him and wanted to give him some work, so we cannot fire him. You know Dr. Paul. If we say, ‘But he is stealing from us,’ he will reply, ‘It’s not his fault, it is poverty that makes him do that, so you have to fix the poverty.’” He laughed. “You can’t win the debate with him!”
“I can imagine.” I laughed too. I had found myself in a debate with Paul Farmer just a few days before. “Paul Farmer is here!
* * *
Paul Farmer is here!”
I looked up from my laptop to see a young American woman standing in the doorway, a medical student who was living in Haiti for the year, working for PIH. It was a Saturday morning, and I was catching up on email with my feet up in the only air-conditioned conference room at HUM. The room is occupied all day each weekday for important administrative meetings, but during the weekend it’s an ideal place to work—quiet, empty, cool, good Wi-Fi signal.
“He’s here right now?” I asked, looking down at my Haiti weekend clothes: a ratty white undershirt, faded blue cargo pants, and a beat-up old pair of mud-crusted tennis shoes. “I’m, um, a bit underdressed for the occasion,” I said and chuckled.
“Whatever,” she replied and laughed. “He’s visiting with some donors. You gotta come! He wants everyone working here to be there!” She ran off.
I had met Paul Farmer a few times after lectures he had given, but we’d never had a conversation. I was just one of the many groupies who would line up to shake his hand. In the field of global health, it was like meeting a rock star. He always looked each person in the eye when he shook hands with them and repeated the person’s name after they introduced themselves (“Nice to meet you, Aaron”). It must have been his way of registering the name and face in photographic memory, because the second time I shook hands with him in his receiving line of admiring fans after a lecture, he said, “Thank you for the work you do, Aaron.” I wondered if he really knew what I was doing or if it was just a stock phrase he had for the many young members of his fan club. Either way, I had been impressed that he remembered my name, since the first post-lecture handshake had been over a year earlier.
I walked out of the conference room into the stuffy late-morning heat of the administrative area at HUM. Sure enough, there he was. In his late fifties, Paul has closely cropped graying hair that forms a receding widow’s peak. Seeing him up close, I was struck by the sharp angle of his nose, on which small rimless glasses were perched. His face looked slightly red, as if he had just shaved or was slightly sunburned, or both. He was dressed casually in a tan safari shirt buttoned to the top. My pulse quickened as I approached this living legend.
Paul was sitting across from two American doctors who were visiting to facilitate a training program in the HUM emergency room. I quietly pulled up a chair to the side of the three of them. The doctors Paul was speaking with were raising concerns about the lack of access to certain lab tests they felt were needed for patient care at HUM. Paul responded by explaining how a new lab they were building at HUM was going to address those concerns and beyond.
“The new lab is going to revolutionize diagnostic capacity in Haiti,” Paul said. “Just like having the first publicly available CT scanner in Haiti here at HUM has done.” Then he turned quickly toward where I was sitting and pointed his index finger at me. “Especially true for a neurologist. Am I right, Aaron?”
I blushed, startled to hear my name, surprised and flattered that he knew it, let alone that he knew I was a neurologist. I wondered if he really remembered or whether he had been briefed on who was at HUM at the time and what they were doing. However he knew me, I suddenly realized that if there was ever a moment to bring up our challenges trying to get neurosurgical patients to Boston, this was it. I had started advocating for the three brain tumor patients I’d met on a prior trip, but the process was slow going, and I thought help from Paul’s position of influence could make a huge difference.
“The CT has definitely been a game changer for neurology here,” I began, “but it has also raised some ethical dilemmas.”
“Which ethics—whose ethics—are you referring to?” Paul quipped with a half smile, cocking his head slightly to one side with jerky, birdlike rapidity.
I kicked myself for using the word “ethical,” remembering that an entire section of a 680-page anthology of Paul Farmer’s essays has the phrase “A Critique of Medical Ethics” in its title. I certainly wasn’t looking for a philosophical debate with one of the world’s leading medical anthropologists. The reference list alone to the collection of his essays is 60 pages, longer than any essay I’d ever written. And it was Paul Farmer’s work that had inspired me to be where I was at that very moment: working for PIH in Haiti. I didn’t want to look stupid or offend him. I sidestepped his question and tried again.
“Well, in neurology, the CT . . .” I began haltingly. “I mean it’s been amazing to have that resource, but . . . well . . . it’s allowing us to diagnose things that we can’t treat here, like—”
“Don’t let anyone say you can’t do something here,” he interrupted with a slightly scolding tone. He seemed to be having fun sparring with me, but I was feeling flustered.