The Other Caribbean

How should we best live in a world with inequality?

I just went on a cruise in the Caribbean with my in-laws: a celebration of my wife's parents' birthdays. We celebrated on a large beautiful ship that carried us through the warm waters of the Caribbean. The ship was a floating pleasure palace taking us to private beaches with perfect turquoise water.

Perhaps I am already too disillusioned to enjoy this Caribbean, because I have seen the other side of these islands—the side hidden from vacationers. I lived a summer in Haiti eight years ago, so the warm blast of tropics brings to my mind suffering, disease, and death. Unlike our own sterilized tropics of Florida, the paradise of the Caribbean seems to me a bandage hiding a gaping wound of human suffering.

This place has become the perfect escape because here among the impoverished the American can live like a king. We are taught to imagine the poor people as living charmed idyllic lives. Their suffering and squalor is carefully hidden from tourists.

On this cruise another island people, Indonesians, did all the manual labor on the ship. They were hard working and kind to all of us over-eating vacationers. I asked one Indonesian man what he does on his days off, but he has no days off—not a single one in his 11 month work contract. I asked what he does when he goes ashore, but he isn't allowed off the ship. All this labor for what I'm sure I would find a shockingly small salary. This is certainly a job he chose of his own volition, but not in some fair system in which transactions are beneficial to all parties, rather out of desperation because his world contained no opportunities at all. It is his cheap labor that makes this pleasure cruise affordable to Americans.

I don't think all inequality is necessarily wrong, but it is not a thing to desired. It also seems obvious that inequalities easily become opportunity for exploitation of those less advantaged. Our use of the people of these islands for our enjoyment demonstrate a pattern of exploitation, both intentional and unconscious. These island are populated by the decedents of sugar plantation slaves—the sweet, fattening substance was produced by the most brutal form of slavery this continent ever saw. Are we so sure that now our behavior towards them in the tourism industry is not also exploitation? Do we not purchase the destitute of the world cheaply with our dollars?

When I was a boy I first saw third world poverty in Mexico on a vacation. We were American tourists on buses, being taken from a beautiful hotel to a scenic destination. Out the windows I couldn't help but see them, people dressed in rags living in tin shacks. My father saw me staring. He said, “A lot of people here have it very hard, but I am glad we came here. Being here on vacation means the money we spend goes to improve their economy here.” My father is a good man, who worked hard and saved to give his family a nice vacation. He was genuine in his belief that he was being socially responsible with his tourism, and I believed him then.

But I have since lost my confidence that trickle-down economics will save the destitute in a world that is stacked against them. I have also come to believe that coming here to celebrate our good fortune in front of those who have nothing is an unintended insult to them. Treating our fellow man with dignity requires we don't use him wrongly.

I'm not always sure how to live in a world with inequality, but I am certain this will be my last pleasure cruise in the Caribbean.

Death & Christmas

This is a poem I wrote in Haiti after watching a newborn baby (the one in the picture) die. I hope it doesn't lessen your joy of Christmas, but perhaps deepen joy with a perspective we all need: the understanding that our hope was bought with a price.

The Incarnation

Why did I ever come forth from the womb to look on trouble and sorrow, so that my days have been spent in shame? -Jeremiah 20:18

Unto us a child is born
Unto us a son is given.
Born of blood,
Born to bleed.
Born into the cold
Born into squalor
Among the filth of animal feces
On the coldest night of the year
Night air carries distant moaning,
The bitter moaning of death vigils.
Many die on such a night.

...and the bloody infant
Miserable yellow jaundice.
Wrap the infant tight,
Lay him shivering in the hay
To be bitten by lice and fleas
And bored through by parasites.
He whines and writhes,
Vomits, then shakes in quiet agony
But the child will not die tonight...

He will live to know more agony
The suffering life of a dirty peasant,
Building with broken hands.
Born of suffering,
Born to suffer.
And pitiful, muffled cries draw
Men of the fields,
ugly and reeking,
Bringing infection to the infant.
Unto us a sickly child is born,
Unto him the plague is given
And the infection of us all
Will be upon his shoulders.
But the wretched one will not die tonight...

He will live to know more agony
To die tormented and alone,
Rather than here in his mother’s arms.
Brought to life this night
Brought to life to die.
In the wretchedness
Of this yellow, shivering body:
Here is the only hope
Of peace and salvation.

Unto us a sickly infant is born.
Through suffering hope is born.
And the weight of the world
Will be upon his shoulders.
And Death will be upon his shoulders
Tremble before your newborn Savior.

…and the Word became flesh, and dwelt among us.


*

A Sense of Home

Having returned from seeing Europe, my wife and I have settled into life in our native state of Georgia. I have been surprised how strongly affected I am to be living here again. I am so proud of my new driver's license and tags that say I belong to Georgia.

Not long ago I wouldn't have cared in which state (or even which country) I resided. As any good liberal arts student, I believed it best to be a cosmopolitan world citizen. Even if I acted locally it should be due to thinking globally. Any real dedication to a particular place was embarrassing and likely evidence of closed-mindedness.

When I went to live for a summer in Haiti as a 21 year-old, I thought of myself going there not as an American, but just a man (as if there is such a thing as a pure person, without the complications and limitations of cultural grounding). Of course, Haitians being grounded people immediately recognized me as what I was. In fact, the more places I go and people of other cultures I meet the more I know myself as a product of my own place.

Now moving back to Georgia after living only a few years in Tennessee only a few hundred miles away, I find I have missed this place so deeply! I find comfort in the sound of the accents, the red clay and loblolly pines, even the sweltering humid days. It is not that this place is somehow better than others—it is that this place is mine. It is the place that produced me.

The transition to a globally interconnected world comes with many advantages, but human nature has it's limitations. We are designed to have some connection to our place. If we are not careful we could all end up “world citizens” who are lost and without a home.

"Died of Renal Failure"

I worked in a hospital in rural Haiti during the summer of 1999 as a college student. I recently found some old folders from back then, and saw faces of patients long dead. Since in Haiti there are not the same privacy laws we have here, I can share the faces of the people I saw there. I still wish to portray people with the utmost respect. (Often patients asked me to take their pictures or draw them.) There are some things you can see in the face of dying patients that it is impossible to describe. This is a woman who came to our hospital from a tiny village. She was found to be in renal failure. There was no dialysis for poor Hatians, so there was nothing that could be done for her. She went home to die with her family. Before putting her in the truck to carry her home, I made this picture. She asked me not to forget her. I haven't.

I first experienced medicine in Haiti. I still think of the people I cared for there, as I now study medicine here in Tennessee. I have another woman (whose name or story I would not be permitted to tell) who will die very soon, perhaps even tonight. I sometimes wonder if I get “too involved” with my patients. In specialties other than Family Medicine loving your patients is often looked down upon. I think, however, that for those who are suffering, kindness is often much better than medicines.

The Allure of Wealth in Medicine

I wrote this when I was in Medical School. It is amazing how easily idealism can become greed in the world of medicine. I need to think on it more often as I approach the point when I will finish residency and apply for jobs:

In medical school you work for free. In fact, you pay to work 16 hours a day and go into debt doing so. It conditions us for greed. When I arrived in medical school I thought it a bit vulgar that doctors are so highly paid for the work in human suffering. Now I am ready for the big paychecks. I am tired and the dream of wealthy leisure appeals to me. During the late nights on call I find myself dreaming of a large house deep in the woods far from the rest of the world. I long for the room full of books with the seat by the great fireplace where I can read my books and drink my coffee, safe and secure in the comforts of riches. It is comfortable, safe, unconcerned, and it is a far cry from the ideal I learned in Haiti from the Brothers and Sisters of Charity. Greed creeps in under cover of comfort that I begin to feel that I deserve. Medicine makes one tired. It teaches you that no matter how hard you work suffering always continues.

Temptation whispers in your ear, "Why not look out for your own comfort? You have done enough for your poor suffering brothers and sisters. You have done more than your share. You deserve this. How can you be what they need without taking care of yourself? You are called to share the sufferings of Christ and consider yourself the least among our brethren, but your responsibility of suffering has been paid of in these years of grueling training and long hours. When off-duty you must be pampered, safe, and free from concern for your fellow men. You need to be rich."

And so the physician who should be servant of all suddenly becomes a person of wealth and privilege. I should fear this temptation much more than I do. This new and wealthy "Dr Whittemore" is here to rob you of who you were meant to be. Do not trust his kind and happy face. He means to suck you dry and leave you greedy yet unsatisfied.

-10/29/03