Mountains, Still

The heartbreaking, life-changing education of a Haiti medical mission group.

by Beth McNichol ’95

Before his first trip to Haiti, in 2015, Neal Nichols ’96 received advice from his father, who had embarked on volunteer trips to Honduras for many years: Prepare to be shocked by what you see.

“And he was right,” Nichols said.

Dr. Benny Joyner ’93 went to Haiti with a clear perspective on need. He grew up on a strip of land 70 miles long and seven miles wide in the middle of the East China Sea. The Joyners weren’t poor, but their lives tipped toward not having much. Even with so little to give, they were people who served others on Okinawa — a collection of islands that rises between mainland Japan and Taiwan known as “the rope in the open sea.”

Joyner — who also earned his MD and a master’s in public health from Carolina, both in 2002 — never really left that rope of islands behind, nor their metaphoric meaning, a place where he came to believe that throwing a lifeline to those in the depths of need was a moral imperative.

Two years ago, he began to spend his vacation time on a different island, without his family back in Durham, on a rugged strip of land in the Caribbean that Christopher Columbus once mistook for Japan. The literal translation for Haiti is “the land of mountains,” and it’s an apt description for one of the most challenging places on earth to be a human being.

Nichols’ first glimpse of Port-au-Prince, the Haitian capital that is home to 2.6 million, was of waves of people and forgotten rubble crowding the streets. A thick smog and a pungent odor — the potent combination of unregulated vehicle exhaust and open trash — menaced the eyes and throat. Some members of the mission team donned face masks in near-100-degree temperatures to combat the pollution. Debris and garbage rode rainwater from the mountains down into the city, further clogging its streets.

To Nichols, who received his doctorate of pharmacy degree from Carolina in 1997, Port-au-Prince was “controlled pandemonium,” with no traffic lights or signs to guide the vehicles, which seemed to bump along the pocked roads in a language all their own.

And yet. Walking past a renovated building here, a still-pancaked building there — the slow-tour progress after the 2010 earthquake — Nichols saw focused kids in freshly pressed uniforms heading to school.

“You look around, and the street they’re walking on is just completely devastated,” Nichols said. “There are holes, there’s rubble, there’s gravel. It’s not patched. It’s hardly traversable with a car. There are no sidewalks. And the kids are so sure in their stride. They just keep going.”

“Haiti reminds me why I went into medicine in the first place. I get to practice medicine in a way that’s free of arguing with consultants and fighting insurance bureaucracies, and it’s made me a better doctor back home. I don’t necessarily rely on a lot of tests or support. I know I can just rely on my diagnostic skills.” 

— Dr. Benny Joyner ’93

Nichols is a product information specialist at GlaxoSmithKline who serves as the clinical pharmacist for a medical team from Westminster Presbyterian Church in Durham dotted with Carolina graduates from health care fields. Joyner is chief of UNC Hospitals’ division of pediatric critical care, one of several people with a lot of initials after their names who could no longer watch the suffering from afar: the devastation from the earthquake that left tens of thousands of Haitians dead, a health care environment struggling to conquer medical conditions long abated in the States and the shortage of clean water and public works that lead to devastating disease.

Like the estimated 2 million volunteers from North America who travel to developing countries annually — often sponsored by their local churches — they go seeking to spread their good fortune to a land that has seen little such luck. They return home changed down to the marrow of their bones, conflicted about what they leave behind and powerless against the pull to keep going back.

A world apart

Nichols’ father, Larry Nichols ’66, worked in Honduras for many years. But in the relative world of impoverished nations, Haiti is much poorer, the only country outside of Africa to rank in the bottom 20 nations by GDP.

The U.S. Department of State warns visitors to Haiti to avoid travel by tap-tap service — what Joyner described as an old pickup with a bench welded on back and a cab over the top — because the taxis are “often overloaded, mechanically unsound and driven unsafely.” But eight members of the Westminster team, plus several local Creole translators who serve as cultural lifelines for the group, pile into a tap-tap each morning with bags of supplies resting between them, dodging livestock and descending potholes and holding on tight as they journey from their hotel to the Haitian Outreach Ministries clinic in the Port-au-Prince neighborhood of Cite Soleil.

When the mission team arrives at 7:30 a.m., patients already are waiting on both the clinic’s Haitian side, where two local doctors see patients year-round, and the mission side, which hosts a foreign medical team like Westminster’s 25 weeks out of the year. The patients know that American doctors are in town, and they walk for miles each day in the predawn hours to secure a place in line, dressed in their best clothing and hats and hoping to receive one of the 120 to 160 tickets that clinic staff distribute. Every morning, the patients outnumber the tickets available. Every day, they sit outside on the clinic’s concrete benches in a blazing Caribbean sun and wait for their number to be called.

Among adults, hypertension, diabetes and infection are common ailments. “But we know that some of the people come every day that we are there, just seeking some attention,” said Pat Gunter ’71, the Westminster organizer, “and that’s OK, too.”

The patients know that American doctors are in town, and they walk for miles each day in the predawn hours to secure a place in line, dressed in their best clothing and hats and hoping to receive one of the 120 to 160 tickets that clinic staff distributes. 

Joyner and Dr. Andrea Dunk, a Durham pediatrician who completed her residency in 1998 at UNC, mostly see children who need Tylenol and dehydration solution, although more serious cases clustered one morning inside the stifling-hot clinic. Dunk determined that one young girl, screaming with abdominal pain, required surgical help; she sent her to the hospital and gave the mother $20 from her own pocket to pay the hospital’s fee, a widespread practice on mission teams.

Dunk and Joyner collaborated on another baby with a high fever who began to have seizures in the clinic, an orphan who needed care that his aunt would have trouble providing.

“She had her own children at home and no ability to take care of them,” Dunk said. “Just the social difficulties alone that she faced were overwhelming.”

Joyner started an IV on a lethargic, severely malnourished 9-month-old whose mother was having trouble feeding him. (By the end of the week, he’d helped that baby gain three and a half ounces, recover alertness and start crying actual tears again: an accomplishment.)

The physicians looked up from all those acute patients and found that it was only noon on a Wednesday. For Joyner — who must leave the convenience of X-rays and breathing devices and cardiopulmonary bypass machines behind in Chapel Hill and rely only on a stethoscope, an otoscope and an ophthalmoscope in Haiti — the work was invigorating and satisfying.

“We can do so much to cure patients at UNC,” Joyner said. “The technology we have in the ICU is so amazing that I feel like almost anybody can do that back home. But in Haiti, I feel a real sense of purpose, of usefulness. I have a real calling and ability to sort of bond with some of these patients and to be able to make a difference.”

Of course, no place in the world exposes the limitations of poverty on health like Haiti, even for an experienced critical-care physician like Joyner. Every positive deed has a heartbreaking moment waiting just around the corner, like the 4-year-old girl with a bump on her arm that, her mother said, had been growing for a year and a half.

Joyner suspected that it was not a bump but osteosarcoma, a rare bone cancer for her age. In the U.S., osteosarcoma is treatable but not always curable. In Haiti, where Joyner said she would need amputation above her elbow and a chemotherapy regimen to which she had no access, the outlook was extraordinarily grim. He found a Haitian orthopedic group for the child to visit.

“But I just knew,” he said, “that there was no way this was going to have a good outcome.”

Why they went into medicine

Two decades ago, in 1994, Joyner had upended his career path because of the loss of a young life.

He had been an education major at Carolina and eventually landed in Durham public schools, where he hoped to be a role model to students. One dark weekend that fall, one of his students at Riverside High School, a 16-year-old boy, was shot and killed by another teenager. Joyner recalls teaching members of the boys’ basketball team how to tie their neckties and wondering if, with so little life experience himself, that was the most guidance he had to offer students.

“I had no context with which to even advise these kids about how to cope with this loss,” he said. “I was 23 years old, and I felt like the world was going to hell in a handbasket.”

Joyner left teaching two months later and regrouped. He worked a desk job and volunteered with the South Orange Rescue Squad while taking EMT classes at Durham Tech. He fell in love with medicine — a field in which he could hold himself accountable, a field in which he would have the tools to help others — and headed back to school.

Now 46, Joyner is a rising star at UNC Hospitals, where he also is an associate professor of medicine and directs the Clinical Skills and Patient Simulation Center. But a large piece of his heart remains tethered to that rope in the open sea, and for all the lives he saves in Chapel Hill, his “vacations” in Haiti bring him closest to that idealistic kid from Okinawa.

“Haiti reminds me why I went into medicine in the first place,” said Joyner, who also has volunteered in El Salvador and Uganda. He relishes the way global health providers challenge his Western training and knowledge base. “I get to practice medicine in a way that’s free of arguing with consultants and fighting insurance bureaucracies, and it’s made me a better doctor back home. I don’t necessarily rely on a lot of tests or support. I know I can just rely on my diagnostic skills.”

In Haiti, Joyner encouraged Jami Howell ’87, an outpatient nurse educator at UNC Health Care, to interrupt him in the exam room when troubling cases emerged in triage.

“All U.S. protocol, and the do’s and don’ts, are kind of thrown out,” said Howell, a veteran trauma nurse.

Howell, too, switched careers 20 years ago in search of service to others, leaving advertising behind. She’s sprained an ankle and broken a wrist in separate falls on Haiti’s rough terrain, but she kept quiet about her injuries during those weeks and kept going. The echoes of her Haiti experiences have trailed her long after her return, including her favorite: the young boy who once handed her a gourde — Haitian currency worth about 16 cents.

“He wants to give this to you because he loves you and thanks you for helping his people,” the translator had explained as Howell handed the child a quarter from her pocket. She keeps a picture of herself and the boy on her refrigerator in Durham.

Dunk learned from Anderson, her translator, that he had lost two sisters in the 2010 earthquake; both were training in medicine themselves. Anderson hoped to resume college studies one day, but, for now, he was working to support elderly parents.

And Nichols was standing outside the clinic one afternoon when a young schoolgirl playing nearby came over to him, took his hand and drew a heart on his palm in ink pen. (The Westminster group also sponsors Cite Soleil children financially, which enables them to attend school.)

The impact of harsh words

Members of the mission team thought of those moments last January, when, on the eighth anniversary of the earthquake, President Donald Trump spoke in derogatory and reportedly vulgar terms about several countries, singling out Haiti, while discussing immigration policy.

Howell can’t talk about the comments without becoming emotional. Before Trump’s remarks, she had decided to skip this year’s trip due to the expense — about $1,500 per person for travel and fees.

“The visceral reaction that I had was that I cried,” Howell said. “And my next reaction was: I know Haiti is where I need to be. That’s where I need to be.” She’ll return for a fourth time in September.

“I don’t want you to feel sorry for us. We don’t like being in this situation any more than you like to see us in it. We want to work our way out of it.”

–Paulinx Gedeus, Haitian translator

The comments, lacking compassion, wounded many members of the mission team. But the team members also noted a lack of historical awareness of the United States’ and its allies’ complicated relationship with Haiti, which was once a French slave colony and became the world’s first independent black republic in 1804.

The clinic the team services sits in a municipality that was once a residential area for garment workers. But a perfect storm of policies and actions from both within and outside Haiti in the 1980s and ’90s — including a U.S.-led economic boycott following the overthrow of democratically elected President Jean-Bertrand Aristide in 1991 — helped transform it into a shantytown of 500,000 instead. It never recovered, and Cite Soleil now is the poorest community in the Western Hemisphere. Its images are unimaginable: Near a dump, children sleep atop mountains of plastic bottles.

Pat Gunter has been volunteering in Haiti longer than any of the other members of the Westminster crew; she left for her first trip in 2013, the day after she retired from her job as a data-and process analyst.

It’s a place her conscience can’t shake.

“Haiti’s history is filled with European domination, slavery and cruelty, natural disasters and despair,” Gunter said. “In spite of this, the Haitian people are resilient and proud of their country. There is no doubt that they want to do better, be self-sufficient, provide for their families and have hope for a better future.”

The team’s dentist, Dr. Joe Bell ’79 (DDS), and his assistant in Haiti wondered how Haitians wished to be viewed by the rest of the world. “What is it,” they asked Paulinx Gedeus, their translator, “that you’d like Americans to think about Haiti?”

Gedeus worked long days and traveled far distances to put himself through school, with aspirations to become a politician, to “try to change things.”

“I don’t want you to feel sorry for us,” Gedeus replied. “We don’t like being in this situation any more than you like to see us in it. We want to work our way out of it.”

Poverty and privilege

If Haiti is a place of conflicting forces, of strength and gratitude in desperate conditions, then so are the emotions of the Westminster team. A low hum of guilt is omnipresent, undergirded by a recognition of Haiti’s vast challenges.

“The first year, it bothered me going from the clinic to the hotel,” Nichols said. “The big door to the wall of that compound shuts behind you, and the rest of Haiti is gone. Our hotel is not luxurious, but it’s comfortable and it’s safe. When I go back out and I see everybody else in Haiti, see my translators, and I know I’m never going back to a challenging home and life, it is hard to reconcile that.”

Global health experts often criticize short volunteer trips as a flawed aid model and question whether they help enough. All of Westminster’s group members understand that criticism; the question gnaws at them, too.

“You think about all the time and finances that went into all of us going down there and providing care,” Dunk said, “and you think, is that the best use of our resources, or would a clean water system, or starting a nutrition clinic, be the best use? I don’t know the answer to that. I do feel that we are able to provide some care to some individuals who need it.”

Joyner said the knowledge that the Cite Soleil clinic has continuity of care, with Haitian doctors present year-round and foreign medical teams visiting half of the year, helps allay his concerns about the effectiveness of a short mission trip. Patients receive their medical records on pieces of paper stored in Ziploc bags, which they can bring back to the clinic at any time for follow-ups and care for chronic conditions.

Cultural exchange also aids long-term progress: The Haitian clinic director is considering attending UNC’s School of Public Health, so he can return home with skills and knowledge to improve care for Cite Soleil residents.

“The hardest thing for global health is that you’re never going to solve all the problems,” Joyner said. “You just try. For me, these trips don’t get to the root of global health, but for those 625 patients that we see in one week, it does provide a little bit of relief. I’m on a team that’s part of a larger group, that’s part of an even larger group, that’s in Haiti trying to help.”

Gunter used to come home from Haiti uncertain that she would ever want to return, spending an entire day crying “at the unfairness of it all.”

“But each year,” she said, “there was an almost physical pull to go back. Now I can go and be happy that we have changed a few lives for the better and have been changed for the better ourselves.”

At the end of a long week of intense service at the Cite Soleil clinic last fall, Joyner visited the Haitian History Museum, where he saw an artist’s depiction of the brutality the first Haitians experienced at the hands of European settlers. It unbottled his emotions.

In a matter of hours, Joyner would be back with his family in the U.S., land of miraculous machines that save children’s lives, home of faucets that flow with safe, clean water. He’d go back to teaching Sunday school, back to leading his son’s Boy Scout troop.

Back to fighting bureaucracies, back to his Nissan Pathfinder with the tire pressure that always seems low. Back to privilege and good fortune.

But in this moment, 9,000 miles from the island he grew up on, he stood before all of Haiti’s history and dared his tears not to fall.