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.
This area of Manchester is demographically like a mini Israel-Palestine - a large neighbourhood of Jews rubbing right up next to a large neighbourhood of Muslims
I am mentioned in a new Guardian article which speculates on the origin of the term ‘Boriswave’ and attempts to explain the ‘destabilising’ influence of the ‘extremely online right’ so-called in British politics
Have had the opportunity to visit a fair few so-called shithole countries now that are different degrees of both shithole and captured by some ideology or the other. Common feature of many of these places is that their obviously ‘downtrodden conditions’ have thus far not seemed to have prompted any significant attempts to ‘properly fix things’.
Take the example of Cuba, which this account has talked a lot about. Visit a country like Cuba and its systemic issues fairly quickly become obvious - people are poor and apathetic, there is little to no economic or infrastructure development, what reserves the government does have are used frivolously or lost to corruption, politicians have demonstrably stupid priorities. Etc. A mostly competent (and pragmatic) hypothetical leader who wasn’t wedded to the existing communist ideological structures could go quite far in fixing many of these issues. Easy. But that doesn’t happen - that leader never emerges. Decade on decade conditions deteriorate slightly. There is more trash on the street than there used to be, there are more frequent power outages, the size of the communist monthly rations decreases slightly. Conditions aren’t unbearable but they are worse than they used to be. Surely things can’t continue like this any longer?
Was walking around that country thinking ‘this is a failed state, what is going on?’ Asked some Cubans, “do you think there is going to be a revolution or coup of some kind to overturn this soon?” “What? No.” This will be the reaction more often than you would hope… So where is the bottom? You can have entire cities with continual blackouts, people living on $40 a month and even then the revolutionary talk is still ‘capeshit’ so-called. People just ‘get by’. Which is not to say that revolutions never happen but that often the kinds of conditions that do produce these movements are not in every instance inevitably predicated on these conditions alone.
It seems like prima facie sound theory that if conditions deteriorate sufficiently under a given ideology that that ideology is therefore disproven, disbunked. Quot Erat Demostarum… it’s over... But then define ‘disproven’, theory isn’t ’real life’. Economic growth is down, censorship is up, crime is up, polarisation is up, people may even be being assassinated - so what? Reductively, if the chance of being mugged in a city increases from 1 in 1000 to 1 in 100 over three decades there are still 99 in 100 people ‘un-mugged’. Maybe a decade later the rate increases further to 1 in 50. In response people begin installing electric fences and hiring private security - and this collectively is enough of a deterrent that robbery rates decrease back to 1 in 100. Quality of life has degraded but conditions are still ‘liveable’. These are exaggerated very simple numbers but you take the point that the new standards become normalised. Things are not yet urgent enough to motivate ‘the revolution’ even if it seems like they ‘ought to’ on paper, however you define ‘ought to’.
The still-extant communist countries are good examples in a way. North Korea as a country is ‘a bit of a meme’ but you can make the same point with it. How has a country with such obvious systemic issues as North Korea survived? It just has. Okay it is a little more complex than that but it still turns out you can fairly indefinite sustain juche hermit kingdoms. Doesn’t matter that it wouldn’t be particularly great to be North Korean - there is no coming correction to these conditions, ‘nothing happens’, life continues in North Korea regardless. In North Korea (and incidentally in Cuba too) in the 1990’s there was widespread famine. Did this result in the collapse of the state? No. You might say that many of the old communist countries did fall in the end - most recently in September of 2025 Nepal’s socialist government was even ‘couped’. Not to say such things can’t happen, just that often they don’t.
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The above are examples of extreme declines in quality of life. In a wealthier more established country like Yookay née Britain, Canada or France etc. by comparison what ‘enshittification’ means in practice is slow decline in quality of life across various metrics but where that decline is not so precipitous that people’s lives become unbearable. For most people life will be some degree of Basically Fine even with this gradual decline over time. It is nowhere near as bad as Cuba or North Korea or any other failed or failing state you can think of and it may even be the case that the decline is nonlinear - there may be periods of recovery or technological advancements that improve life in many respects.
Enshittification is the gradual lowering of standards and in this way it can often be melodramatic to paint any individual instance of lowering standards as a catalyst or flashpoint for ‘something needing to be done urgently’ - including even acts of political violence and especially where conditions are otherwise relatively Basically Fine. “Something is definitely going to happen now.” Maybe but also maybe not. Maybe even probably not. Maybe even definitely not. Many people in the west live Basically Fine lives and this kind of often exaggerated rhetoric, especially when it is at odds with their personal experiences, is not always convincing.
One unique feature of ‘the situation’ in western countries vs elsewhere is the world historical large scale ethnic change. This kind of inevitable ‘felt dispossession’ can motivate political change but ‘felt dispossession’ does not always mean commensurate significantly degraded material conditions, conditions that have been unbearably de-Basically Fine’d - at least directly even when the ‘ethnic conflict’ is low-level however defined or when it results in certain kinds of ‘third worldification’. You can still visit a bubble tea shop, a new Ethiopian restaurant with the best injera bread you ever had, go to a park and throw a frizbee with your cockapoo dog in London, Toronto and Paris. Broader purchase is that it helps to be realistic about the actual conditions of a place if this is where you seek change from, how desperate things actually are with respect to how Basically Fine most people’s lives are.
There are many arguments against mass immigration but for me the most impactful one has been on moral and aesthetic grounds. The rightwards shift in western politics is in this way often more than anything else about identity. This is a kind of enshittification to be sure but it is much more abstract and less perceptible, less immediately concrete to detractors than say bin strikes. It is true that standards of living fall because of mass immigration but it is not necessarily true that they will always fall precipitously because of it to the degree it will always motivate unanimous and conclusive pushback. If there is righteous anger over immigration the kernel of that anger will tend to be over the cultural and population change (even if it is not consciously understood as such) - as it often is in different forms in other civil conflicts in developing countries worldwide. Though, while you are waiting for that anger to somehow manifest in the form of competent motivated actors there is still a lot more ruin in your country left than you might think… Efforts towards change may be more productive where they help people conceptualise the degree of transformation - though even here this is often something a person will just instinctively either care about or not.
Not that nothing happens in the sense of it emphatically changing to a far worse, unbearable new norm - but that when it does happen it often happens imperceptibly over a long enough time span such that at the end of that glacial-paced happening only comparatively can something have properly been said to have happened. That may now be more likely to motivate change but actual change still requires galvanising initiative.
DE-CODING THE FAR RIGHT LANGUAGE OF THE CHARLIE KIRK SUSPECT
With the Charlie Kirk suspect now in custody seized communications have revealed a troubled, fanatical man deeply steeped in the worldview of the fringe extreme right. Here is what the memes he often referenced mean 🧵
The suspect once wore a tracksuit and took a picture of himself squatting in it - a reference to ‘Slav Squat Pepe’, a popular meme Neo-Nazis often share to suggest that they ‘Feels Bad Man’ about the lack of Russian intervention in their own country’s domestic populist politics
The suspect had hundreds of images of naked men saved on his phone, a reference to ‘Khalimov-posting’ - a type of Far Right in-group signalling where users would share pictures of ‘CHADS’ to indicate to other users that they were interested in meeting up for casual homosexual sex