Most of the friction did not stem from cultural barriers. Some of the complaints came from Haitian-American professionals who spoke Creole and French just fine. (Many were happy to question, in those languages, the competence of their fellow Haitian professionals. It was a combustible mix, and a conversation to which non-Haitians contributed at their own peril.) These were, rather, structural problems. The urban public health delivery system, long weakened, was now all but destroyed. Beyond saving lives, the medical practitioners faced a choice between giving up on the public system and seeking to rebuild it. It was for this reason we sought to direct expertise, skills, and goodwill towards the public-sector institutions still standing.
These frustrations were not new. In previous decades, we had encountered the same deficits and dysfunction while trying to provide health care to Haiti's poor. We learned early on about the friction between the diaspora and the Haitians we worked with-those who had never left. But such friction was not a given, nor did it prevent young Haitian-Americans from providing some of the best, most patient care in the days after the earthquake. Natasha Archer, a young Haitian-American resident physician from Harvard, was one of the many volunteers based at the General Hospital. One night, after a long day of service, she wrote about lifesaving work of a makeshift surgical team from Haiti, Boston, New York and New Jersey. When a young girl presented with a rigid abdomen late one evening, and an x-ray suggested a perforated small intestine, she was immediately taken to the OR. The cause was likely typhoid. Natasha warned, correctly, that a lack of proper sanitation would lead to more such cases- and other waterborne illness.
I had reviewed the scant literature on typhoid in Haiti a decade before (it revealed the same high prevalence) and came to the same conclusion. I'd issued the same warnings. A few years before the earthquake, Haiti was declared the most water-insecure country in the hemisphere. After the temblor, sanitary conditions only magnified the threat of waterborne pathogens, including cholera- the most dreaded consequence of disaster and displacement. This was, again, what doctors termed an acute-on-chronic problem: one that should have been dealt with long ago, and one crying out for attention in the weeks after the quake. The good news was that, with proper surgical care, this girl's life could be saved, and it was. Young doctors like Natasha were often the glue that held together people from what seemed like different worlds, people with the best of intentions."
Haiti: After the Earthquake, pp. 70-72