It is very expensive to give bad medical care to poor people in a rich country.
For me, an area of moral clarity is: you're in front of someone who's suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.
If you look at people who seek a lot of care in American cities for multiple illnesses, it's usually people with a number of overwhelming illnesses and a lot of social problems, like housing instability, unemployment, lack of insurance, lack of housing, or just bad housing.
What the American public thinks is very important to the future of global health. Many people are moved by the idea that there is unnecessary suffering in the world, and we could do a lot to stop it. We have the technologies necessary to stop most of the suffering.
I'm not an austere person.
The biggest public health challenge is rebuilding health systems. In other words, if you look at cholera or maternal mortality or tuberculosis in Haiti, they're major problems in Haiti, but the biggest problem is rebuilding systems.
One of the things we have to acknowledge is that if you look at Haiti, many billions of dollars have gone into development aid there that have not been effective.
The human rights community has focused very narrowly on political and civil rights for many decades, and with reason, but now we have to ask how can we broaden the view.
If any country was a mine-shaft canary for the reintroduction of cholera, it was Haiti - and we knew it. And in retrospect, more should have been done to prepare for cholera... which can spread like wildfire in Haiti... This was a big rebuke to all of us working in public health and health care in Haiti.
Again, conventional Catholicism does not much appeal to me.
I would say that, intellectually, Catholicism had no more impact on me than did social theory.
Haiti is always talking about decentralization and nothing has been so obvious, perhaps a weakness, as the centralized nature of Haitian society as being revealed by the earthquake. I mean, they lost all these medical training programs because they didn't have them anywhere else.
Civil and political rights are critical, but not often the real problem for the destitute sick. My patients in Haiti can now vote but they can't get medical care or clean water.
At the same time, it is obvious that clinicians in Haiti are faced with different, and, in fact, greater, challenges when attempting to treat complications of HIV disease.
But as for activism, my parents did what they could, given the constraints, but were never involved in the causes I think of when I think of activists.
I've been working in Haiti 28 years - I thought I'd sort of seen it... I've gone through a number of coups, the storms of 2008, I thought, you know, that I'd seen things as bad as they were going to get, and I was wrong.
The poorest parts of the world are by and large the places in which one can best view the worst of medicine and not because doctors in these countries have different ideas about what constitutes modern medicine. It's the system and its limitations that are to blame.
If you look just at the decades after 1934, you know it's hard to point to really inspired and positive support from outside of Haiti, to Haiti, and much easier to point to either small-minded or downright mean-spirited policies.
Anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care.
We have to design a health delivery system by actually talking to people and asking, 'What would make this service better for you?' As soon as you start asking, you get a flood of answers.
