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@kunley_drukpa

Sep 11, 2023 • 13 tweets • 7 min read • Read on X

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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.

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@kunley_drukpa

Aug 23

“MY APARTMENT IN NIGERIA IS CONSTANTLY ROBBED” - what it is like to live in a poor part of a Nigerian city 🧵

In Ryszard Kapuściński’s Book ‘The Shadow of the Sun’ the author spends time in Nigeria and decides to try living in an African neighbourhood instead of an expat one. He describes how he is constantly robbed until a witch doctor helps him protect his apartment with enchanted totems

“The apartment that I rent in Lagos is constantly broken into. It happens not only when I am away for a longer stretch of time- even if I am going on a short trip to a nearby town, to Abeokuta or to Oshogbo, I know that upon my return I will find the window popped out of its frame, the furniture turned upside down, the cupboards emptied.

The apartment is located in the center of town, on the island of Lagos. The island was once a staging area for slave traders, and these shameful, dark origins of the city have left traces of something restless and violent in its atmosphere. You are made constantly aware of it. For instance, I may be riding in a taxi and talking with the driver, when suddenly he falls silent and nervously surveys the street. "What's wrong?" I ask, curious. "Very bad place!" he answers, lowering his voice. We drive on, he relaxes and once again converses calmly. Some time later, we pass a group of men walking along the edge of the road (there are no sidewalks in the city), and at the sight of them the driver once again falls silent, looks about, accelerates. "What's going on?" I ask. "Very bad people!" he responds. It's another kilometer before he is calm enough to resume our conversation.

Imprinted in such a driver's head must be a map of the city resembling those that hang on the walls of police stations. Little multicolored warning lights are constantly lighting up on it, flashing, pulsating, signaling places of danger, sites of attacks and other crimes. These warning lights are especially numerous on the map of the downtown, where I live. I could have chosen to live in Ikoyi, a safe and luxurious neighborhood of rich Nigerians, Europeans, diplomats, but it is too artificial a place, exclusive, closed, and vigilantly guarded. I want to live in an African street, in an African building. How else can I get to know this city? This continent?

But it is far from simple for a white man to move into an African neighborhood. To start with, the Europeans are outraged. Someone with my intentions must be deranged, not in complete possession of his mental faculties. So they try to dissuade me, warn me: It is certain that you will perish, and the only thing still in doubt is the precise way this will happen--either you will be killed, or you will simply die of your own accord, because living conditions are so dreadful there.

But the African side also regards my plan with scant enthusiasm. First of all, there are the technical difficulties--live where, exactly? This kind of neighborhood is all poverty and overcrowding, wretched little houses, clay huts, slums; there is no fresh air, and often no electricity; it is dust, stench, and insects. Where can you go? Where can you find a separate corner? How do you get around? What do you do? Take, for instance, something as basic as water. Water must be brought from the other end of the street, because that's where the pump is. Children do this. Sometimes--women. Men? Never. And here's a white gentleman standing with the children in the line for the pump. Ha! Ha! Ha! This is impossible! Or let's say that you have found a small room somewhere, and you want to shut the door to work. Shut the door? This is unthinkable. We all live together in a family, in a group--children, adults, old people; we are never apart, and even after death our spirits remain among the living, with those who are still in this world. Shut yourself alone in a room, in such a way that no one can enter? Ha! This is impossible! "And besides," the natives explain gently to me, "it is dangerous in our neighborhood.”

[1/5]

There are many bad people around here. The worst are the boma boys--gangs of debauched hoodlums, who attack, mug, and rob--a dreadful swarm of locusts that ravages everything. They will quickly sniff out that a lone European has come to live here. And to them, a European is a rich man. Who will protect you then?

But I held firm. I didn't listen to the warnings. My mind was made up--perhaps in part because so often I had felt irritated with people who arrived here, lived in "little Europe" or "little America" (i.e., in luxury hotels), and departed, bragging later that they had been to Africa, a place that in reality they had never seen.

And suddenly, an opportunity arose. I met an Italian who in a back alley not far from Massey Street owned a little warehouse of farm implements. Like many whites who were gradually liquidating their enterprises here, he had closed his business. The two-room service apartment above it was now vacant, and he was all too happy to rent it to me. He drove me there one evening in his car and helped me carry up my things (the metal stairs were attached to the building's exterior walls). It was pleasantly cool inside, he had turned on the air conditioner that morning. There was also a working refrigerator. He wished me a good night and quickly departed. He was flying to Rome early the next morning--after the latest military coup, he was afraid of further unrest and wanted to take some of his money out of the country.

I began to unpack. An hour later the lights went out.

I didn't have a flashlight. Worse still, the air conditioner had stopped, and in addition to it being completely dark, it now quickly became hot and stuffy. I opened the window. In swept the stench of rotten fruit, burnt oil, soap, and urine. Although the sea was somewhere nearby, you could detect no breeze in this enclosed and congested alley. It was March, a month of crushing heat, when the nights often seemed hotter and more stifling than the days. I looked out the window. Up and down the street below me, on woven mats or directly on the ground, lay half-naked people. The women and children were asleep; several men, their backs leaning against the walls of the clay houses, stared at me. I didn't know what their gazes meant. Did they want to meet me? Help me? Kill me?

I decided that I could not endure until dawn in these sweltering rooms, and went down. Two men rose; the others watched, motionless. We were all sweaty, deadly tired; merely existing in this climate is an extraordinary effort. I asked them if this kind of electrical outage happened often. They didn't know. I asked if something could be done about it. They conversed among themselves in a language I did not understand. One of them disappeared. Minutes passed--fifteen, thirty, forty-five. Finally he returned, bringing two young men with him. They said that they could fix the problem for ten pounds. I agreed. Soon, the lights were back on inside the apartment, and the air conditioner was working. Several days later--another outage, another ten pounds. Then fifteen, twenty.

And the thefts? In the beginning, I was filled with rage each time I returned to my ransacked apartment. To be robbed is, first and foremost, to be humiliated, to be made a fool of. But with time I came to understand that seeing a robbery as a humiliation and an affront is an emotional luxury. Living amid the poverty of my neighborhood, I realized that theft, even a petty theft, can be a death sentence. To steal is to commit manslaughter, murder. A solitary woman had her little corner in my street, and her sole possession was a pot. She made a living buying beans for credit from the vegetable vendors, cooking them, seasoning them with a sauce, and selling them to passersby. For many, this bowl of beans was the only daily meal.

[2/5]

One night, a piercing cry awoke us. The entire alleyway stirred. The woman was running around in a circle, despairing, frenzied: thieves had snatched her pot, and she had lost the one thing she depended on for her livelihood.

Many of my neighbors here have just the one thing. Someone has a shirt, someone a panga, someone a pickax. The one with a shirt can find a job as a night watchman (no one wants a half-naked guard); the one with a panga can be hired to cut down weeds; the one with the pickax can dig a ditch. Others have only their muscles to sell. They count on someone needing them as porters or messengers. In all these instances, the chances of employment are slim, because competition is enormous. And further, these are frequently only odd jobs--for one day, for several hours.

Thus my alley, the adjacent streets, and the entire neighborhood are full of idle people. They wake in the morning and search for some water with which to wash their faces. Then, those with a bit of money buy themselves breakfast: a glass of tea and stale roll. But many people don't eat anything. Before noon still, the heat is difficult to bear--one must look for a shady spot. The shade moves hourly with the sun, and man moves with the shade--following the shade, crawling after it to hide in its dark, cool interior, is each day his only real occupation. Hunger. One badly wants to eat, but there is nothing to be had. Making matters worse, the smell of roasting meal wafts from a nearby bar. Why don't these people storm the bar? After all, they are young and strong.

One of them, apparently, was unable to control himself, for suddenly, a cry resounds: it's one of the street vendors shouting--a boy snatched a bunch of bananas from her stand. The victim and her neighbors set off in pursuit and eventually catch him. The police appear out of nowhere. Policemen here carry large wooden clubs, with which they brutally beat offenders, striking them with all their might. The boy is lying in the street now, cringing, curled up, trying to shield himself from the blows. A crowd has gathered, which occurs here in the blink of an eye, since these legions of the unemployed have little to do besides waiting for some event, some commotion, some excitement--anything to distract them, to help pass the time. They press closer and closer, as if the dull thud of the clubs and the moans of the victim afforded them genuine pleasure. With shouts and screams they encourage and incite the policemen. Here, if a thief is caught, people immediately want to tear him apart, lynch him, chop him into pieces. The boy is groaning, already he has let go of the bananas. Those standing closest throw themselves on the fruit, tear the bunch apart.

Then everything returns to normal. The vendor still complains and curses, the policemen leave, the battered, tortured boy drags himself to some hiding place--sore and hungry. The onlookers disperse, returning to their places under walls, under roofs--to the shade. They will stay there until evening. After a day of heat and hunger, one is weak and listless. But a certain stupor, an internal numbness, has its benefits: man could not survive here without it, for otherwise the biological, animal part of his nature would bite to death everything that is still human in him.

In the evening, the alleyway comes ever so slightly to life. Its residents gather. Some of them have spent the whole day here, tormented by attacks of malaria. Others are just returning from the city. Some have had a good day: they found work somewhere, or else they met one of their kinsmen, who shared his pennies with them. They will be eating supper tonight, a bowl of cassava with a hot paprika sauce, perhaps even accompanied by a boiled egg or a piece of lamb. Some of this will go to the children, who watch the men greedily as they swallow each bite. Every bit of food disappears immediately and without a trace. Everything is eaten, down to the last crumb.

[3/5]

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@kunley_drukpa

Aug 21

https://twitter.com/samuli_salminen/status/1958462257051980284

🇫🇮 New Finnish Study on the Net Financial Costs of different immigrant groups. It replicates the findings of the famous Danish and Dutch studies - almost all immigrant groups are net costs to Finland. Migrants from the Middle East and North Africa are the biggest financial drains

https://twitter.com/samuli_salminen/status/1958462257051980284

In Finland even western migrants are rarely net fiscal contributors

Finland’s data almost perfectly replicates Denmark’s

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@kunley_drukpa

Aug 15

Are Somalis the world’s number one rattlers?

They are such talented wind-up merchants it almost loops back round to being a soft power

https://twitter.com/kunley_drukpa/status/1845424771208470891

Apart from the many content ‘collabs’ my accounts have with them for which I am grateful I have come to in a certain kind of way respect their temerity. Did you know there are only 35 mil ethnic Somalis worldwide? Even vs eg South Asians they massively over-index as provocateurs

https://twitter.com/kunley_drukpa/status/1845424771208470891

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@kunley_drukpa

Jul 29

REVIEWING EUROPEAN CITIES - PARIS 🇫🇷

Impressions from recent visit to Paris 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 Paris as it is today and the extent to which Paris is or is not changing. ‘TLDR’ - A lot of what is said about the scale of change in France is true but Paris is such a great city it can still fairly easily accommodate it

Paris really is ball-achingly beautiful. Hurts to say it if you are British but you sometimes get a sort of seething Antonio Salieri jealousy when you walk around it because it is so often such an effortlessly attractive city. Severe Paris syndrome is invariably a bit contrived

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@kunley_drukpa

Jul 27

REVIEWING EUROPEAN CITIES - BUCHAREST 🇷🇴

Impressions from recent visit to Bucharest 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 Bucharest as it is today and the extent to which Bucharest is or is not changing. ‘TLDR’ - Bucharest feels comparatively poorer vs other EU capitals but seems to be improving. Relatedly, recently migrants started arriving

In contrast to some other Eastern Europe cities like Warsaw or even Belgrade Bucharest still ‘feels’ a little developing. It is much richer than it used to be but there is maybe a little further to go on that front yet. That said it is not a bad city, it is often quite lively

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@kunley_drukpa

Jul 26

REVIEWING EUROPEAN CITIES - BRUSSELS 🇧🇪

Impressions from recent visit to Brussels 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 Brussels as it is today and the extent to which Brussels is or is not changing. ‘TLDR’ - Brussels is possibly the worst capital in Europe in terms of demographic change, migration has run wild and the city has transformed

Had not been to Brussels for maybe a decade and had fuzzy memories of it being… ‘bougie’ if dull, visiting recently - rare I am genuinely shocked by the pace of change nowadays but I was pretty shocked. It’s more Yookay than the Yookay if that is even possible. Has changed a lot

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