Dr. Rosalyn Chan, an AP MPH student in the class of '13, traveled to Haiti to work on a course project sponsored jointly by the Yale Law School Transnational Development Clinic (TDC) and the Yale Global Health and Justice Practicum (GHJP). The purpose of the trip was to understand the context of the country’s recent cholera epidemic and the United Nations’ role in it.
The epidemiology of the outbreak — its origination, spread and genetic characteristics — link it to South Asian strains brought to Haiti by Nepalese troops stationed at a U.N. camp as part of the UN peacekeeping forces. To date, over 600,000 have been ill and at least 8000 have died in this epidemic, the country’s first in over 100 years. In November 2011, a claim on behalf of 5,000 victims was filed against the U.N. because of its role in introducing the cholera bacteria through untreated sewage that spread virulently, in part because of the already weakened infrastructure of post-earthquake Haiti. In February of 2013 the claim was denied.
The spring break trip allowed students and faculty from the schools of public health and law to study institutional accountability, better understand the range of best practices as they relate to water, sanitation, humanitarian interventions, and potential remedies to help the Haitian people. Their work will culminate with publication of a human rights report that will be made widely available to advocacy groups and litigators.
This project originated in the Law School in the Transnational Development Clinic under the supervision of Muneer Ahmad, Clinical Professor of Law. Since finishing the course Rosalyn and many of her fellow students are continuing to work on the issue to support the Haitian project partners’ plans for the use of the report.
The GHJP, co-directed by Ali Miller (YSPH/YLS/Jackson Institute), Gregg Gonsalves (YLS/YSPH) and Amy Kapczynski (YLS), plans to offer continuing opportunities for its student and post-graduate fellows to network on global health justice issues, projects and careers.
Reflections on Haiti
by Rosalyn Chan
If I were to choose three words to describe my recent experience in Haiti, they would be: frustration, awe and awakening.
I say frustration because I found that the time was too short, the health problems too overwhelming and I felt helpless much of the time. I had ventured so far out of my comfort zone that I did not have the training or expertise to judge my impact. It felt almost as if I was running a marathon, pushing myself to the physical limit, only to look down and realize that I was running in place. There is so much that I wanted to do, so much help I wanted to provide, and so much I wished I could change that my mind felt pulled in a hundred different directions and my heart struggled to reconcile with the very difficult reality of the situation. Frustration is generally not a good emotion, but in light of the desire to do more than most deem humanly possible, frustration is not only a good emotion, but an inspiring one.
Awe because Haiti is a beautiful country with music blaring everywhere and vivid colors adorning the sidewalks and streets. The disconnect between what is and what could be, what was and what might have been tempts the imagination. Rubble is piled beside brightly colored flowers and ripe foliage that shade the skeletons of gingerbread houses from a different era.
Awakening because so many years spent studying one subject has forced me to prioritize my interests, forgetting many of the things that inspired me to choose this path to begin with. Medicine is not a career for the faint of heart. Personally, sacrifices are made and some choices never do settle well, even with the passage of time. There is daily exposure to injustice, death, pain, suffering and heartache. Allowing one’s self to feel all this on a daily basis is a recipe for insanity. During my four years of medical school, I was filled with intense anger at the injustices I witnessed. It was a simmering rage that never quite dissipated, regardless of my efforts, and the efforts of my teachers and mentors, to quench it. But somehow, in the time since graduation and the start of graduate school, that rage has become a sort of dead weight in my chest, not quite gone but not quite there either. I felt lost. This project in Haiti, however, reawakened a sense of indignation that had lain dormant for nearly two years.
Haiti is a stunning country with a culture and a vibrancy that echo its voodoo and Caribbean roots. It is not, however, the poor, helpless child that is often portrayed in the media – a victim of circumstance, subject to the powers that be. It is a country of individuals more capable of adapting to life’s circumstances and unpredictability than most inhabitants of richer nations. Haiti is also a country that has been historically wronged and mistreated and much of its population today suffers as a result.
The issue of cholera in Haiti is not so much an issue of blame but of respect. Lives have been altered, and not for the better, and human beings are now dead – these dead deserve the respect of being acknowledged and those they left behind, as well as the generations that will follow them, deserve the right to avoid suffering the same fate.
My greatest moments in Haiti were fleeting moments when patients and their families first indicated that they trusted me, and were comfortable placing their lives and the lives of their loved ones in my hands. The look of trust that comes with that exchange still moves me to tears. It is, and always will, be the greatest privilege of my chosen profession and the greatest honor I will ever receive. When in Mirebalais, speaking with the cholera victims, I saw that same look in the eyes of those we spoke to. They trusted us, complete strangers, to carry their stories forward and somehow transform their words into changes that would remedy the harm inflicted. Doing so is a huge responsibility, but it is definitely one worth having.