Self Determinism

We thought we were doing the right thing.

With the continued medical progress of our earthquake victims, the census has decreased to where we could close a tent and consolidate patients in other tents, as well as the sales, an old schoolhouse. We thought the patients would be thrilled, since it meant that many of them could leave the tents to a more solid structure that had better ventilation. Yesterday, we got all the volunteers, and began to move patients out of tent 1. We shifted the other tents and the sales to balance men and woman as well as ambulatory status, and within 6 hours, had reorganized the care structure.

The problem was we didn’t tell the patients until we started moving them.

Within hours there was an uprising. Young men were yelling at our nurses, getting close to our faces. We had a heavy rain and darkness, and the noise on the tin roof was deafening, I expect it was similar to what they heard and felt as they were trapped inside a concrete building in Port au Prince. Cliques and informal support groups that we didn’t recognize were broken up. One patient begged us to keep him next to his friend, a paraplegic, for whom he was providing superb care.
We met with them and an interpreter, and listened. Clearly there was some anxiety, but what I really pick up on was helplessness. They have been displaced from their homes, they have lost what little autonomy they had, and now we came in and told them what was good for them. It wasn’t intentional on our part, but we fallen back into paternalistic habits.

That night, the staff meeting was open and emotional. There was fear expressed by some of the women volunteers; there was open discussion of the little things we could have done to prepare the patients; there was clear recognition that the anger we witnessed was in response to a reminder of how little autonomy they had.
We all want to determine our own destiny.

In America, perhaps we take this to an extreme, as we seek to fulfill unlimited individual needs, manipulate others, and don’t want our government involved in our lives. That is, until we falter and want to be rescued. The Haitian people have no support system. The government throughout their history has been marked by inefficiency and corruption. They have learned to expect little, but they still want some say in their lives. The New York Times editorial this Sunday discussed the billions of dollars heir marked for Haiti, with the concern that it would not rebuild the country, until the Haitians took charge of their own destiny. And what we did with our actions yesterday reinforced a dependency and colonialism that will inhibit that goal. Even with our Haitian medical colleagues, we will give the meds at night if the local nurses decide not to, or we intervene and show them “how we do it”, without giving them the chance to struggle and perhaps learn by making a mistake.

I will be returning to the States soon. I believe that I have made a small difference in the lives of the patients and those that care for them. All of us that volunteer our time and skills here hope that our efforts will lift the Haitians up to lead themselves, not encourage continued dependency.

Only time will tell.