Facing instability like the recent upheaval in Haiti may be the norm rather than the exception for people working in international health, says Frank J. Bia, M.D., M.P.H., FW ’79, co-director of the Yale/Johnson & Johnson Physician Scholars in International Health program, which sends residents to more than 14 countries. “The inherent nature of international health is working in an unstable world,” says Bia, professor of medicine (infectious disease) and laboratory medicine. “It’s unstable because it’s unfair, and I think it’s getting worse.” Increasingly, he said, the world’s poor are becoming aware of “how bad off things really are in terms of the increasingly skewed distribution of both wealth and technological resources.”

Since the international program began in 1981, more than 100 Yale residents have volunteered for a month or two at Haiti’s Hôpital Albert Schweitzer. The program has rarely suspended activities due to turmoil abroad, but temporarily stopped sending physician volunteers to Haiti this year, said program co-director and professor of medicine and public health Michele Barry, M.D., HS ’77. She expected that rotations in Haiti would resume later this year. (Four years ago Yale suspended its program in Zimbabwe in the wake of widespread violence there.)

Second-year resident Emmanuelle Clérismé-Beaty, M.D. ’02, found herself in a strange situation while volunteering in Haiti last January in the weeks preceding the ouster of President Jean-Bertrand Aristide. Although most foreigners felt safe at the hospital, she was harassed by hospital workers who wanted her to join protests against the hospital administration. Clérismé-Beaty, who grew up in Haiti and speaks Creole, was taken for a “local.”

“It got pretty scary,” she recalls. She chose to leave a few days early, catching a ride to the airport before dawn to reduce the danger of being robbed on the road. Clérismé-Beaty feels ambivalent about the experience. “Being there, you knew you were needed, and you were appreciated,” she says, adding, “I didn’t really feel safe.”

For those in charge of sending students and residents abroad, security is always a concern. Summers are nerve-wracking for Curtis L. Patton, Ph.D., head of the Division of Global Health at the School of Public Health. Patton directs the Downs International Health Student Travel Fellowship program, which funds research for about 16 students of public health, nursing and medicine who spend a summer abroad.

He relies on four sources to judge the safety of research sites: advisories from the State Department and the Centers for Disease Control and Prevention, Yale College’s list of countries declared off-limits to undergraduates and information gleaned directly from people at the sites. This spring he advised one student to avoid Haiti. She went anyway, and “she seems to be fine,” Patton reported in mid-summer. He barred another student from studying diarrheal diseases in Iraq; she went to Tanzania instead.

“I have my heart in my throat all summer until they return,” says Patton.