AMERICAN MEDICAL STUDENT IN HAITI DESCRIBES WORKING WITH HAITIANS - A Thread 🧵
Haitians have been making the news yet again - A Short Thread once more re-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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If you liked this Thread you may also like the Africa Resource Megathread - a compilation of similar stories and anecdotes from Africa web.archive.org/web/2018020111…
Vanilla is not even native to Madagascar yet they have an 80% global market share what is going on. A location from a Final Fantasy game pretending to be a country as a front for a criminal ‘Vanilla Industry’
No strong opinion on tariff policy for you except hopefully Madagascar gets what it fucking deserves sorry
Emerging feature of the Public Space in recent years especially after COVID is its increasing ‘Ninja-fication’ or Balaclavaisation. More and more people covering part or all of their face. You can expect this trend to grow now there is no stigma against it in the post-masking era
Many Roadmen actually use the 🥷 Emoji to mean Roadman
Many of Britain’s increasingly Jawa-fied youth are somewhat autistic - or at least callow and badly socialised - (mumbling, struggling to make eye contact, distrustful etc.) so the face coverings also work as a kind of stimming and self-soothing method for managing social anxiety
ASSIMILATION, DEASSIMILATION AND ROADMEN - WHAT INTEGRATION ACTUALLY LOOKS LIKE
🧵 ‘Integration’ and ‘assimilation’ are often taken as a given as critical for any society seeking to welcome in migrants in order to ensure that the society retains its cohesiveness. But what does integration realistically entail for the historically large numbers of migrants arriving into today’s hyperdiverse Britain AKA ‘The Yookay’? What this looks like (at best) under an ideal theoretical model (aside - nobody can agree on what constitutes ‘ideal’) and what this looks like in real, material world practice are two distinct realities.
We might say we want migrants to integrate into ‘British Culture’. It is a little facile to ask maybe, but what actually is ‘British Culture’? What does it actually mean to identify as British? What is the British Identity? In very broad strokes, there is a historical dimension to that identity, there is an ethnic dimension to that identity and there is a cultural dimension to that identity. There is some overlap between these categories. Historical in the sense of the identity existing in historical continuity with what has historically existed in the country, (Alfred, Shakespeare, Cromwell) ethnic in the sense of a certain version of it being broadly tied to a particular ethnic group (Anglo-Celtic) and cultural insofar as it is constituted by particular behaviours and an assumed shared knowledge base (some of it quite ‘high level’ eg a certain cultural polite indirectness).
Taken together for migrants without this background (ie most of them) integration into these identities is collectively quite a difficult barrier to overcome. Perhaps not for a small number of (motivated) individuals but on the whole for the mostly unmotivated and occasionally antagonistic majority, especially in their being an ever-increasing majority in constant flux, it is probably unrealistic to expect full integration if there is much integration at all.
Is there then actually any kind of shared ‘British’ culture for immigrants to realistically assimilated into? Many will tend to just retain a version of the culture they migrate from, sometimes they affix ‘British-‘ to a new double-barrelled identity. For those who have been in Britain longer, especially those generationally divorced from their home cultures, any emergent ‘on the ground’ culture would have to account for the interactions between many different groups ‘thrown in’ together in urban environments with a retreating historical British culture - Afro-Caribbeans, Nigerians, Somalians, Moroccans, Albanians, Bengalis, Kurds, Congolese, Ecuadoreans etc.
This is why for many migrants integration into a kind of British culture looks something closer to Roadman-ism rather than Richard Curtis, Paddington Bear, Blackadder and Jeeves and Wooster. The assumed knowledge and motivation required to proficiently arrive at ‘Britishness’ - especially when there are hardly any actual British people to be found in your day to day life and most of the social media you consume is preoccupied with your community and culture and separated from (an increasingly fractured and decentralised) mainstream British media - is normally too great to overcome. If you live in an urban environment sometimes mediated by exposure to the gang culture experience this is the culture you will be exposed to. Roadman-ism, MLE, Drill - for disaffected hyperdiverse urban youth this culture is, ironically, more inclusive, malleable and in some senses aspirational.
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What is a ‘Roadman’? The term can refer specifically to a person in a gang (poetically ‘on the road’) but it also has the broader sense of ‘Urban Youth’. ‘Hoodie’ has also sometimes been used interchangeably though the connotations are not quite the same. There is some overlap with ‘Chav’ but that subculture is increasingly anachronistic and is in many places being subsumed into the Roadman culture. Chav is also White British-coded whereas Roadman is multi-ethnic and in that way is more inclusive. It is also similar to the urban culture that exists in other countries, eg in the US Hood culture, in Germany ‘Talahon’, in France ‘Racaille’ and in Australia ‘Eshay’. It is interesting that some version of this kind of culture is close to universal in western countries, in the main probably because of its being non-exclusive and its low barrier to entry. Roadman-ism then is the British manifestation of that (in many respects African American origin) culture with particular ornamentations unique to the interactions between the extant British culture and the particularly British migrant settlement patterns.
What are those unique features? The substrate of this new urban culture and its distinct Multicultural London English sociolect is of Jamaican / West Indies origin - since Afro-Caribbean migrants (‘Yardies’) were the first group to settle in these environments, (often replacing cockneys,) the so-called ‘Windrush Generation’. ‘Mandem’, ‘Innit’, ‘Wagwan’, ‘Ting’, ‘Blud’, ‘Batty’. Etc. Thereafter, when subsequent incoming groups moved into those urban environments the Yardies were the established, ‘on the ground’ culture they would encounter. For new arrivals the ‘Yardie’ culture would be ‘the culture’ of your immediate lived experience and the environs that you integrate into. This is why MLE etymologically as a sociolect has so many patois origin terms vs eg African Language terms from the now much more numerous Africa African origin migrants. (Some of whom acquired English as a second language and acquire it from contact with MLE, which further reinforces it.) Afro-Caribbeans are themselves being increasingly displaced by new groups and are in many ways now almost a legacy group but in this way their contribution to the ‘New Culture’ is as a kind of Proto-MLE.
South Asians are also a major formative group - particularly Pakistanis and Bengalis because of the cultural assertiveness of the brand of Islam they bring with them - and many Arabic terms have entered into some versions of MLE. Because South Asian communities tend to be more self-segregating and self-contained where Yardie culture intermixed more it wasn’t until somewhat recently that their brand of Islam in its capacity as an actual religion filtered into Roadman environments - even though there were other kinds of cultural and aesthetic overlap before. That is, the influence of the particular British subcontinental ‘Rubber Dinghy Rapids’ Islam they established is growing within Roadman culture because the two communities now interact more both because of their growing numbers and because of the increasing prominence of new ‘crossover’ Muslim migrants from new, different migrant groups.
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There are regional versions of these cultures and sociolects too. Cities with large numbers of eg Turkish, Albanian, Kurdish etc settlers see new slang terms with origins in their native language introduced. In Yorkshire towns like Bradford, the emerging culture represents a fusion between British Yorkshire regionalisms and the Punjabi / Urdu migrants that settled there, of different patterns of settlement, as distinct from the Yardies who settled more in and around London. (Though some of influence has still spread to the urban culture there.) See unique terms like eg ‘Yara’, a Punjabi origin word meaning roughly ‘Bro. ‘Chow’ from the Choudary Caste in Pakistan, again roughly ‘Bro’. ‘Rami’ meaning bastard from ‘Harami’, someone who commits Haram - though can also have a friendly connotation like ‘Bro you bloody bastard haha’. ‘Ghaint’ as in super, amazing. ‘Kusmeh’ as in ‘I swear’, similar to ‘Wallahi’ as in ‘I swear (to Allah)’ but of Urdu origin not Arabic. ‘Acha’ meaning ‘okay’ etc. Urban Youth are also sometimes described as ‘Charva’ instead of Roadman or Hoodie, Charva being a gypsy origin word.
Roadman culture and MLE is not static, it is very much in flux - much more so than other extant established British cultures. Because of the high migrant turnover and churn in the shared urban environments it is susceptible to incoming influences and can very rapidly introduce new language and customs. For instance, if Yookay social media is a reliable indicator, one new emerging feature of MLE’s continued development is the Somali language slang terms being introduced into the sociolect. ‘Jareer’ meaning Black African, used like ‘Nigga’, ‘Bisad’ meaning drug addict, ‘Askar’ meaning police, ‘Miskeens’ meaning innocents, ‘Habad’ meaning gun, ‘Abtii’ meaning (with some deference) uncle etc. That it is particularly Somalian terms being introduced is in the main a feature of Somalian migrants’ ‘fitness’ for the particular hyperdiverse ‘ecological niches’ they migrate into. How? Somalians, maybe more so than almost any other group (excepting perhaps eg. Roma) ‘have a tendency towards’ exaggeratedly clannish behaviour. “You criticise me, me and my cousins are going to come swarm you.” What this means in practice is that as a group they ‘tend to be’ much more culturally and politically assertive. An incredibly high in-group preference and reputation for bellicosity has very quickly led to for example their being overrepresented in gangs, like the infamous gangland Malistrip. This is not something particularly likely to be represented in the mainstream British culture yet on account of its relative ‘alien-ness’ but ‘on the ground’, in urban environments, the lived reality is aggressively assertive Somalian gangs thus Somalian culture becomes a major contributor to its continued development.
Modern Britain AKA ‘The Yookay’ is home to many colourful characters. Social Media has allowed lots of these figures to bypass traditional media channels and rise to fame off the back of online followings. Here are ten of the most interesting 🧵
AKHMED YAKOOB
Lawyer famous for his popular social media reels and attempts to enter British Politics in aid of Gaza. As a lawyer, he is known for dubious defences of questionable clients including terrorists. His motto is “There is a defence for every offence - remember that!”
SLIIME
A Bengali rapper repping Bengalis in the British rap scene - who were previously underrepresented and criticised for having ‘gay and lame’ lyrics. Sliime’s raps include lyrics about how his high BMI body type is a result of generational trauma caused by the Bengal Famine
Pictures from my visit to Aleppo. Aleppo is a city of major historical consequence but it was badly hit during the war and large parts are bombed out. In one sentence I would describe the city as ‘still standing but clearly exhausted’ 🧵
A street-level view of the rubble in a heavily bombed out part of the city. Some buildings still partly retain their structure but others have collapsed in on themselves. The debris not yet cleared because there is just too much of it - stretching on for miles, a sea of rubble
A view of part of the sea of rubble from above. Otherworldly to walk through. Aleppo was besieged by the opposition from ‘12-16 and people in the city often told you how harrowing they found the experience. One person did tell me though he found the experience “thrilling and fun”