AMERICAN MEDICAL STUDENT IN HAITI DESCRIBES WORKING WITH HAITIANS - A Thread 🧵
A Short Thread sharing the Infamous Blog Post of a Medical Student’s Experience in Haiti about ‘How Haitians Think’ 🇭🇹
It has proven hard for me to appreciate exactly how confused the Haitians are about some things. Gail, our program director, explained that she has a lot of trouble with her Haitian office staff because they don't understand the concept of sorting numerically. Not just "they don't want to do it" or "it never occurred to them", but after months and months of attempted explanation they don't understand that sorting alphabetically or numerically is even a thing. Not only has this messed up her office work, but it makes dealing with the Haitian bureaucracy - harrowing at the best of times - positively unbearable.
Gail told the story of the time she asked a city office for some paperwork regarding Doctors Without Borders. The local official took out a drawer full of paperwork and looked through every single paper individually to see if it was the one she wanted. Then he started looking for the next drawer. After five hours, the official finally said that the paper wasn't in his office.
Part of it is Haitian education. Even if you're one of the lucky ones who can afford to go to school, your first problem is that the schools can't afford paper: one of our hosts told stories of Haitian high schoolers who were at the level of Western 5th graders because they kept forgetting everything: they couldn't afford the paper to take notes on!
The other problem is more systemic: schools teach everything by uninspired lecture even when it's completely inappropriate: a worker at our camp took a "computer skills" course where no one ever touched a computer: it was just a teacher standing in front of the class saying "And then you would click the word FILE on top of the screen, and then you'd scroll down to where it said SAVE, and then you'd type in a name for the file..." and so obviously people come out of the class with no clue how to use an actual computer. There's the money issue - they couldn't afford a computer for every student - and a cultural issue where actually going to school is considered nothing more than an annoying and ritualistic intermediate step between having enough money to go to school and getting a cushy job that requires education.
There are some doctors and nurses, who are just as bad - though none at our compound, which is run by this great charity that seems to be really on top of things. We heard horror stories of people graduating from nursing school without even knowing how to take a blood pressure - a nurse who used to work at the clinic would just make her blood pressure readings up, and give completely nonsensical numbers like "2/19". That's another thing. Haitians have a culture of tending not to admit they're wrong, so when cornered this nurse absolutely insisted that the blood pressure had been 2/19 and made a big fuss out of it. There are supposed to be doctors who are not much better, although as I mentioned our doctors are great.
But I was going to talk about the patients. I don't really blame the patients. I think they're reacting as best they can to the perceived inadequacies around nurses and doctors. But they seem to have this insane mindset, exactly the opposite of that prevailing in parts of the States, where medicine is good. In particular, getting more medicine of any type is always a good thing and will make them healthier, and doctors are these strange heartless people who will prevent them from taking a stomach medication just because maybe they don't have a stomach problem at this exact moment. As a result, they lie like heck. I didn't realize exactly how much they were lying until I heard the story, now a legend at our clinic, of the man who came in complaining of vaginal discharge. He had heard some woman come in complaining of vaginal discharge and get lots of medication for it, so he figured he should try his luck with the same. And this wasn't an isolated incident, either. Complaints will go in "fads", so that if a guy comes in complaining of ear pain and gets lots of medicine, on his way out he'll mention it to the other patients in line and they'll all mention ear pain too - or so the translators and veteran staff have told me.
I haven't gotten any men with vaginal discharges yet, but many (most) of the patients I've seen have just complained of pains in every part of their body and seen if any of them stick. A typical consultation will be a guy who comes in complaining of fever, coughing, sneezing, belly pain, body pain, stomach pain, and headache. The temperature comes back normal (not that our thermometers are any good), abdominal, ear, and throat exams reveal nothing, and we send them away with vitamins and tylenol or maybe ibuprofen.
My cousin Samantha and my friend Charlotte, both of whom have come with us, have studied medical anthropology and think this is fascinating. I am maybe a little fascinated by it, but after the intellectual clarity of medical school, where every case has textbook symptoms that lead inevitably towards some clever but retrospectively obvious diagnosis, I'm mostly just annoyed.
Also, if I ask a question of the form "do you have X", people almost always answer yes. "Are you coughing?" "Yes." "Are you coughing up sputum?" "Yes." "Is the sputum green?" Yes." "Is the sputum coalescing into little sputum people who dance the polka on your handkerchief?" "Yes".
A depressing number of our patients have split into two categories: patients with such minor self-limiting illnesses that there's not much we can do for them, and patients with such massive inevitably fatal illnesses that there's not much we can do with them. There are a few who slip in between: some asthma patients, hypertensives, diabetics, people with UTIs and other bacterial infections, a man with serous fluid in his knee that my father drained for him - but they're depressingly few. And even when we can help them by, say, giving an asthmatic a month's worth of asthma medication, it's worrying to think about what happens when the month is up. Coming back to our clinic requires traveling on awful Haitian roads and waiting in line in the awful Haitian weather with two hundred other people and then hoping there's even a doctor who will see you, so I don't know how many people return for refills or what the effect of having to do so on quality of life must be.
To be honest I think a lot of what we're giving are placebos. And placebos have their uses, but here I think we have lost the comparative advantage to our competitors, the witch doctors, who can placebo the heck out of us. One of our translators' grandfathers is a voodoo priest, and he was describing some of the stuff he did. It sounded pretty impressive, although at least no chickens get harmed during any of our treatments.
But we have certainly helped a few diabetics, people with bacterial infections, and the like; and we're connecting a lot of kids with vitamins (not to mention stickers), so I do think we're doing a bit of good. My father loves working in Haiti and has made best friends with all the translators and is always going out into Port-au-Prince to see the sights and taste the social life. I think it's great for my education, great for my resume, and great to be helping people, but I will breath such a sigh of relief when I get back on that plane to the States.
The year is 2050. Changing demographics have Latinamerica-fied your politics - like in Latin America western countries are now condemned to neverending lurching between two ideological extremes that then only further radicalise in reaction to each other. Which side do you choose?
America will fulfil its destiny and become the penultimate Latin American country in the Americas, before Canada which will first become a Subcontinental country and then a Latin American country after the Latinos move up into it from America. Trump is the first American Caudillo
This is the politics you get if you de-Basically Fine-ify your society with decades upon decades of Ideology-maxxing
HOW NATIVES THINK - WHY MANY PEOPLE SEEM TO THINK SO IRRATIONALLY 🧵
Lucien Lévy-Bruhl was an early 20th century French anthropologist writing before many of the taboos academic anthropology has accumulated today. In his book ‘How Natives Think’ he explores why so many people - and for him especially so many ‘non-civilised’ peoples - seem to be so superstitious. He tries to explain what it is that is happening inside the minds of (he calls them) ‘natives’ when, for example, they appear to have difficulty understanding causality in anything other than in terms of spirits or djinns. Though the work is not without its critics (eg it has been called reductive, eurocentric and generalising) it is an interesting example of taboo-free study on the ubiquity of a kind of magical thinking or djinnbrain
Lévy-Bruhl’s core claim is that so-called “primitive” peoples do not think illogically as such, but instead according to different rules. Reasoning is primarily shaped by emotion, symbolism and collective belief, not contradiction or empirical causation
That is, their thinking is guided by collective representations - shared mental images (like totems, taboos, spirits) that have a deep emotional force. See: the power of djinn in some societies (ie Djinnbrain). These guide thought and action without needing justification
New Article in the Telegraph on ‘The Yookay’ and my @MythoYookay page. “The "Yookay" now has a wider implication too: to suggest … we are now a new country, an actual successor state to the old Great Britain”
Impressions from recent visit to Zagreb and the ways in which the city is and is not changing in the 2020’s 🧵
This is not a complaining thread, more just to describe Zagreb as it is today and the extent to which Zagreb is or is not changing. ‘TLDR’ - Zagreb is not as interesting VS Croatia’s coastal areas but it less touristy, a good ‘local’ city. Guest workers recently started to arrive
Don’t think visitors will ever really be blown away by Zagreb but it’s not a bad city. Very similar in layout and look to smaller capitals of other smaller Eastern European cities, eg Bratislava, Ljubljana, Sofia, Belgrade, Vilnius and so on. Wealthier than some of those at least
BBC Journalist asks Danish Politician how Denmark is able to maintain trust in its Democracy - “Give voters what they want. If they want lower immigration lower it”
Advanced Techniques for Expert Democracy-Heads (Experts Only) to maintain trust in your Democratic System
• Release all data for transparency, even if the findings are uncomfortable
• If voters want lower immigration, lower immigration
• Don’t allow foreign ghettos to form
In the C19th and 20th large numbers of Nepali workers were settled in the Himalayan Kingdom of Sikkim, over time becoming a majority - this demographic change providing the impetus for the eventual dissolution of the historic Sikkim state 🧵
Sikkim, once a sovereign Himalayan kingdom, saw its tenability as a state dramatically contested by waves of Nepali migration - initially as labourers, but then as dominant political actors who transformed the state’s demographic and political character, eventually dissolving it
Old Sikkim was a Buddhist kingdom ruled by the Namgyal dynasty (1642–1975). The political system was feudal - led and upheld by the royal and spiritual authority of the Chogyal (king), with power shared among Bhutia aristocrats and local Lepcha chiefs under a theocratic-monarchy