Q&A: Dropped at ground zero, Big picture, Barriers, and How to help

More questions, from my cousin Karen. She astutely noted that although my organization has been in Haiti for many years, it seems as though I have been “dropped at ground zero” without a very coherent plan. The brief answer to that is that although the organization has been in Haiti a long time, they have only been working at my particular site in Saint Marc for the past few years. My co-fellow and I are the first pediatricians to be doing what we are doing in Saint Marc. There have been other pediatricians before us, but none staying at this particular site long-term. So in a way, yes, we are at ground zero.

Another factor which contributes to the chaos is that although my organization and my fellowship both have people coordinating from Boston, they depend heavily on Haitians locally for support and follow-through. One of the guiding ideas of the group is one of “accompaniment” – not just stepping in, taking over, and putting a band-aid on things, but partnering with local providers to strengthen the system and create sustainable change. Haitians love proverbs, so here’s one that fits this situation: “Give a man a fish, and you feed him for a day; teach a man to fish and you feed him for a lifetime.” While this is a beautiful idea, it often translates into a less orderly, less “American” system that we might like.

Karen also asked if I could talk about the “big picture” in terms of what my organization does to support me and what the barriers are that keep them from doing so. We have frequent phone calls and emails to try to discuss what the challenges are, what can be done to address those challenges, etc. but again, it’s all happening in the context of trying to strengthen the local system. This means that progress is often slower than we’d like, but as long as we keep moving forward I think we’re doing okay. The barriers, as described above, seem to stem largely from logistics and limited funding, but also come from a system which is just so broken on so many different levels that even the so-called experts don’t always have a good fix.

Right now we have run out of tuberculosis drugs at several sites. I’m told the reason for this has to do with everything from the US FDA to the way that we stock medication, to the budget for getting medication, to the system that we use for distributing those medications. I’m sure I am leaving out many parts of that particular equation, but you get the idea – even a simple problem is never as clear-cut as it seems. To quote another proverb, this one Haitian: “Beyond mountains there are mountains.”

Final question from Karen: is there anything we can do to help? Hmm. For me personally I would say everyone’s comments and emails really go a long way to lift my spirits when I am having a hard day here. For Haiti I would say supporting an organization* like mine is probably the best way to help. This country needs long-term thoughtful solutions, and supporting the groups trying to provide them allows their work to continue.

*Email or comment if you want the name and I’ll send it to you privately. I prefer not to mention it in order to keep this a neutral place for me to express my thoughts, and not a reflection on the group I’m working with. I try to keep the personal and professional separate, as much as that is possible.

Leave a comment


  1. Hello Sara,
    I just read your last Blog re responding to Karen’s questons. Very interesting to learn more about your mission etc. Send me an email re the address and/or person I can contact re offering some assistance with all this terrific work, your involved with. Love you, Sara.
    Uncle Dick

  2. Karen

     /  April 21, 2012

    Thanks, Sara. I appreciate your answering my questions. Please let us know the contact info for gifting as well. Love you! Karen

  3. Barbara

     /  May 6, 2012

    Hi Sara,
    Could you tell us something about the place (structure) where you live? e.g. Is it a house? Do you grocery shop and cook? Are there restaurants in St Marc’s? How/where do you wash your clothes. What about transportation? Are you able to walk to the hospital? Do you work in 12 hour shifts?

    Love, Aunt Barbara


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