Miami Herald - April 27, 2003
Gwen Wurm**

People whose language I did not understand greeted me warmly. And as I walked the road outside of the "guest house" where we stayed, smiling children came up to us to try out English words.

Welcome to a world of contradictions. Welcome to Thomonde, Haiti.

A BARREN WASTELAND

I came to Haiti as a pediatrician with a group of University of Miami medical students delivering care through Project Medishare to patients in the central plateau commune of Thomonde, about 50 miles from Port-au-Prince. Groups of students have been coming to Haiti three times a year over the last decade in conjunction with Project Medishare. The project was started by neurosurgeon Barth Green, the founder of Medishare. He served as a reservist during Gulf War I and, not wanting to waste surplus medical supplies, thought of sending them with a team to Haiti to provide medical care.

Years and many experiences later, the University and Project Medishare have secured a grant from the Green Family Foundation (no relation) to build an infrastructure of health services in Thomonde. To say that central Haiti could be Shangri-La is not an overstatement. But years of cutting down the trees to make charcoal to sell has left the hills a barren wasteland. There are no roots to hold the water. The soil is dust, but patches of greenery burst forth mocking the destruction.

On the first day we pulled into Batarain, a rural collection of homes, it was noon. We had started at 10 a.m. Batarain is 20 miles from Thomonde, but to say you travel there by road does not describe the rock-laden path that blew multiple tires as well as shocks from our four-wheel-drive vehicle. As we entered the small clearing where the church was located, before our eyes literally hundreds of children appeared. Dr. Arturo Brito and I looked at each other and wanted to hide under the seat. The children's eyes looked so hopeful. Yet scanning their dry rough skin and seeing their large distended bellies, we knew there was little we could do. To say we felt like a fraud would be generous.

These people, many whom had walked five hours to see us were looking for a cure, which is not in medication, but in the basics such as access to clean water, sanitation and food. Short of that, nothing in our "black bags" stood a ghost of a chance.

We cared for many children over a few days. Most were so malnourished that they didn't make it onto the growth curves. People are fond of saying that the U.S. growth standards aren't appropriate for other countries. But the Haitian children who have been born and fed in the United States fit just fine. We should expect nothing less of the children "in country." The protruding bellies and orange tinted hair told the story of a diet too low in protein to allow adequate growth.

One bright spot is the breast-fed babies. Chubby, with skin shining of health. Thank goodness for the local public-health campaign to encourage breastfeeding that had been previously discouraged by multinational corporations wanting to sell formula.

There were children who we knew in our hearts might soon die. The one listless child with a large liver, held by a mother who had recently lost many pounds, haunts me. Having seen many HIV families, I was sure this could be one. Arturo's mind constantly returns to the malnourished, rapid-breathing 13-month-old who we treated for pneumonia. Of course we recommended going to the clinic in the village for further testing, but a six-hour walk through rocky hills gives a new meaning to "access to care" issues.

Yet I believe our work will have some beneficial results. One night we met with the two doctors in the area to ask them what were their needs. It is critical when coming from the outside to listen to the locals so that they can be part of the solution. The doctors' request was practical: a vehicle to reach the far-flung settlements and an improved microscope to better diagnose diseases such as malaria.

Project Medishare is building an infrastructure of health workers to work with the local doctors to deliver ongoing care to the people in the rural areas. The project will also help address basic public-health issues like building cisterns for clean water and latrines. Hopefully we will be able to start a program of educating families to boil their water and wash their hands prior to food preparation. These, along with treating the children regularly for parasites, may make a difference.

In the long term, identifying crops that can be grown for protein sources such as beans and peanuts and reforesting the land to allow it to once again become paradise should allow the people of Thomonde to no longer need our help.

SO CLOSE TO HOME

Can this be done? Of course. For just a fraction of the cost of the destruction that is taking place in Iraq, we can recreate Shangri-La. Will there be challenges to face -- including those involving politics and corruption? Yes, but it is worth taking on the challenge to change the lives of thousands of people.

The other night I saw the movie The Pianist. I was troubled by the gratuitous inhumanity. That night I dreamed again of Haiti. No, we are not putting bullets into the backs of people's skulls. But knowing the kind of suffering that exists just a few hours from home, we, too, are guilty of inhumanity if we do not answer the call.

Change can happen. Humanity depends upon it.

**Gwen Wurm, MD, is director of community pediatrics at University of Miami/Jackson Childrens Hospital. gwenwurm@bellsouth.net

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