As caregivers tend patients, cultures clash

Luc Bouquet treats patient Marie Flor Sylveain, 28, at Hopital Saint Francois de Sales. She has an infected back.
Luc Bouquet treats patient Marie Flor Sylveain, 28, at Hopital Saint Francois de Sales. She has an infected back.
Posted: January 23, 2010

PORT-AU-PRINCE, Haiti - The spotlight landed on Hopital Saint Francois de Sales yesterday, on a day when it was at both its best and worst.

What a parade of prominent Haitians, foreign correspondents, and visiting medical experts saw at this small and badly damaged Catholic hospital was impressive - dedicated workers tending to more than 100 severely wounded victims who lie on hospital beds, cots, and mattresses in the open courtyard under the shade of plastic tarps.

What they missed was the subtle tension that exists between the Haitian staff and the foreign volunteers.

"There is no organization here," said Luc Beaucourt, a disaster-relief doctor who leads a team of 12 Belgian health-care workers, speaking in French. "I'm trying to have a system to make sure each patient is seen and has a follow-up."

Unlike his team, which follows a strict schedule, arriving on time and following his leadership, the Haitians come to work at different times.

"Sometimes," he said, "we have just put on a bandage and they don't know when it was put on, so they take it off and replace it."

Beaucourt called it a problem of "mentalité."

For 15 years, Beaucourt has been treating patients in places where chaos reigns. Victims of hurricanes, tidal waves, war zones, and earthquakes in Iran, Pakistan, Myanmar, and Indonesia.

But nothing, he said, has come close to his experience in Haiti over the last eight days, and that's not because the earthquake was the worst natural disaster he has seen.

"This country is en faillite," he said. The phrase, roughly translated, means "on the brink of collapse."

Within the first week in Myanmar, the army had set up refugee camps. "Here," he said, "there is nothing."

Few Haitians would argue that their country was an unmitigated disaster long before the earthquake hit.

But not everyone has an equal right to state the obvious.

As in any dysfunctional family, it is fine, even healthy, to acknowledge when their own relatives are lazy or deluded. Outsiders who make the same observations, no matter how accurate they seem, are liable to be seen as insulting and arrogant.

With the flood of foreign volunteers in Haiti, different cultures have been thrown in, working together, without the luxury of time to learn each other's social cues and manners.

Earlier this week, Luc Bouquet, a Haitian American nurse practitioner who volunteers from time to time at the hospital, snapped at a Belgian nurse who seemed to be second-guessing a Haitian surgeon.

Bouquet's behavior, in turn, seemed arrogant to Beaucourt.

Yesterday, when Bouquet returned to the hospital to offer whatever help was needed, he and Beaucourt avoided each other.

Until a young man went into respiratory distress.

While reporters aimed their cameras and took notes - the hospital was visited by a television crew from Baltimore and a correspondent from the Washington Post - one cluster of doctors and nurses rushed to the man's bedside to prepare him to be transferred to the USS Comfort hospital ship.

Another group, including Beaucourt and Bouquet, emptied out a rusty white van to make room for the patient.

"One, two, three!" Beaucourt commanded, and Bouquet and several other helpers lifted the man on his mattress and scuttered over to the open back doors of the van. They eased him in.

Bouquet, speaking in French, asked a Belgian worker where the heliport was located to get the patient to the ship. Then he ran around to the driver and in Creole told him where to go and which streets were clear.

"We're wasting time," one foreign volunteer said.

"Does he know the route?" Beaucourt asked.

"He does," Bouquet said.

Then Beaucourt hustled over to the driver as it backed out toward the gate. "Are you sure you know the route?"

But Bouquet's day went beyond the mistrust and disrespect he felt at times. Here, in the hospital, was a woman he had sent from the nonprofit Haiti Clinic where he volunteers, smiling and on the mend.

In another bed, he found a boy whose foot looked like scrapple when he examined it in Cite Soleil, the ghetto where Haiti Clinic is located. He was grinning, too, his foot on the mend without apparent complications.

Haitian-born Yveline Auguste, a nurse practitioner from Baltimore who is volunteering at the hospital, said she understood both sides of the culture divide.

"I don't think there's disrespect toward the local staff," said Auguste, who has been working in Haiti for two years with the Institute of Human Virology and the University of Maryland. "But there's a lack of coordination. A lack of management.

"When the volunteers come in with equipment and supplies, they have the power. It makes the staff feel they have a lack of control. But we are in an emergency situation," she said, and hurt feelings are less important than getting the job done.

"I am trying to be the bridge," said Jean Marie Caidor, medical director of the hospital. "We need their help."

His greatest concern about the cultural differences is that foreign medical teams are more willing to amputate legs and arms that Haitian doctors would rather treat more conservatively.

They know there are no prosthetic or rehabilitative services available to amputees. Basic medical and social services are also extremely limited, which may be one reason nobody wants to leave the hospitals in Port-au-Prince - at a time when the city's populace is being encouraged to get on buses bound for the provinces. So hospital officials are having a hard time freeing up beds for others in desperate need.

"We're trying to save Haitians' feet," Caidor said. "It's not cut, cut, cut. Luc [Bouquet] and I have the same vision. We're going to work to stop cutting limbs."

Their shared vision also applies to the changes needed in Haitian culture, which Bouquet views through a highly refined prism, having grown up in Haiti but lived and worked for years in the United States.

Accustomed to cultural mores foreign to his homeland, Bouquet scolded his nephew yesterday for indulging in a second breakfast.

With the arrival of food supplies from Bouquet's father-in-law's farm, the house's stores were plentiful.

"As long as I'm here. This is the way it's going to be. We will have one breakfast and everyone will share."

As a child, Bouquet said, he was often hungry. "I would put salt under my tongue to make myself thirsty and drink water. I believe in tough love. I will do anything to make your life easier than it was. But at the same time, I will teach you hard lessons because I had it the hard way."

He has no patience for shortsighted indulgence.

"It's not just my nephew. It's the whole country," he said. "We look at today and forget about tomorrow. We don't have a sense of savings. This is a big, big, big problem in our country. We don't go beyond what our eyes can see."

Contact staff writer Melissa Dribben at 215-854-2590 or

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