AN UNEXPLAINED DEATH IN HAITI

By Rob Chamberlin

My best friend in Haiti, Bòs, died two weeks ago. He was the one that I ate meals with for two years while I served in Haiti as a Peace Corps volunteer. He was the one who welcomed me into his house as a family member. He was the one who showed me around the village and who sat underneath the big neem tree with me as the sun set over the fields of millet on the other side of the 10-foot wide Route Nationale # 2. And two weeks ago, he died at the age of 47.

His son told me that he died of something 'unexplainable', something caused by a 'voodoo curse'. Yet, I believe that he died because of something that is indeed very explainable and much more scary than a voodoo curse- I believe he died because of poverty and the lack of access to adequate healthcare.

Haiti is the 'poorest country in the Western Hemisphere'. This is a tagline that accompanies almost all news of Haiti. And the healthcare indices support this association. According to the World Health Organization (WHO), Haiti has an infant mortality rate of 120 per 1,000 live births and a life expectancy of 53 years. The per capita healthcare expenditures stand at a paltry US $22 per year. Of the adult population, the estimated HIV prevalence rate ranges from 2.5 - 11.9 percent.

The list of such poverty-related health statistics goes on and on. Yet, nowhere was I able to find a single statistic that indicated the number of Haitians who died from a cause that was left 'unexplained'. For so many Haitians, the struggle is not only with a lack of treatment options, but also with a lack of diagnostic capabilities. Many, like my best friend Bòs, die without ever knowing what kills them. They do not even have the opportunity to know that there may be a drug that, although too expensive for them to buy, could save their life.

Of course, although left 'unexplained', there is always a reason given for the death - 'the wind was changing', 'God decided it was time for them to die', or 'someone had laid a voodoo curse upon the victim'. This last explanation, a voodoo curse, is often the hardest one for the family to deal with. For, in the case of Bòs, his son now has to deal with trying to understand who cursed his father and why. As he explained to me on the phone last week, his aunt may have arranged the curse because she has had such an inimical relationship with Bòs's wife. Or, he said, it could have been one of Bos's coworkers who was jealous for some reason. And now the son must also wonder if he too is in danger.

When I visited Bòs in February, he was already suffering from some unknown illness. He had visited a number of doctors, and at that point he was taking Penicillin, vitamin B12 syrup, Phenylephrine, and Loracarbef. However, he told me, none of them were helping very much. He also had pierced his earlobe with a string, a 'mystic thing' he told me. A few days after I left Haiti, he had gone up into the mountains to have a voodoo healing ceremony performed for him.

Assigning the cause of death to supernatural phenomena or fate is not at all unique to Haiti. Today, even people in the United States often attribute the underlying cause of death to something beyond the illness. People will say that it was 'just his time to go', or that 'God has a reason for everything that happens'. My stepmother recently told me of how her Yankee puritan upbringing had made her believe that her actual steps were limited in number. So as a young girl she made her strides as long as possible when crossing a field in order to delay her time of death.

What distinguishes the US from Haiti, however, is that medical technology exists here to uncover the pathophysiology of illness, enabling us do all that is possible to extend someone's length of life. In Haiti, however, people usually are not able to delay someone's 'time to go'. They do not have that opportunity to deny the supernatural for another day. For instance, a child in Haiti who gets diarrhea will be 775 times more likely to die from that sickness than one in the US ¹. Furthermore, while the majority of people who need antiretroviral therapy (ART) in the US are able to receive it, only 1,400 of 40,000 Haitians who need ART have access ².

People in the US and Haiti assign responsibility to the supernatural. And in both places people often believe in a predestined fate. Yet the effects of these perceived supernatural interactions with humans, in the form of disease, are drastically different in Haiti compared with the United States. The difference, of course, is that such 'fate' can much more easily bring one to death in a country stricken with poverty such as Haiti.

Until we choose to create a world in which resources are distributed equally, people in Haiti will continue to die of treatable diseases. They will continue to depend on strings in their ears and a random assortment of medications they get from doctors with limited diagnostic equipment. And many will continue to die of unexplained causes, and their relatives will continue to struggle to understand who placed a voodoo curse on their loved one, and why. I doubt that the relatives will look to the current state of inequalities and structural violence and point the finger of blame for the voodoo curse there. However, that is where the blame needs to be placed, and until we, as a world community realize this, I can see no other way to change this unequal distribution of wealth, and ultimately, fate.

ROB CHAMBERLIN is a first-year medical student at Boston University. His current plan is to pursue a career in infectious diseases, eventually working part-time in both Boston and Haiti. He can be reached for comment or questions at robch@bu.edu.

Footnotes:

1. Parashar, Umesh, et al., "Global Illness and Deaths Caused by Rotavirus Disease in Children", Emerging Infectious Diseases, 9 (5): 2003. Retrieved on September 17, 2005 from http://www.cdc.gov/ncidod/EID/vol9no5/02-0562_appB.htm..

2. World Health Organization, (n.d.), 9/15/ 2005. http://www.who.int/ countries/hti/en/.

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