Delivered at the White Coat Ceremony at Quisqueya University, January 15, 2012
English translation courtesy of Tonya Buckler
French text available here
Dear members of the Rectory of the University of Quisqueya, Deans of the different faculties, Professors, Ladies and Gentlemen,
I would first like to thank Dr. Genevieve Poitevien, the inexhaustible Dean of the Faculty of Sciences and Health (FSSA) of UniQ as well as Dr. Galit Sacajiu of the Haiti Medical Education Project, as well as the Arnold Gold Foundation for having initiated the white coat ceremony in Haiti and for inviting me to deliver the speech for this occasion.
I am very honored. I hope that this event, which symbolically takes place at UniQ, the university with which GHESKIO has worked in close collaboration, will be the beginning of a long tradition that will be adopted by other schools of medicine in our country.
Dear Medical Graduates of 2012,
Congratulations on this new stage of life you have embarked upon, in the beginning of this new century and in such difficult conditions!
You have fulfilled the hopes of all: parents, professors, friends who have supported, encouraged, and supervised you throughout this learning period. This ceremony is the coronation of several years of work and a celebration earned by you and your parents.
It is a time to remember that your generation was singularly marked by two great scourges: the earthquake of 2010, of which we will be commemorating the 3rd anniversary, and the cholera epidemic that followed 9 months later, and that continues to ravage our country.
I take this opportunity to mention the immeasurable efforts of the Rector of UniQ, Mr. Jacky Lumarque and to the whole body of teachers who quickly rendered this university functional in spite of the much loss of human life and complete destruction of their university campus after January 12, 2010. It is thanks to their immense courage and steadfast determination that you were able to finish your university studies and for other advancements to follow. I ask you to applaud very loudly.
Class of 2011 and 2012, welcome into the brotherhood!
Your new role in society is about to begin. I would like to share with you some thoughts that will help you to attain new heights that until now may have seemed inaccessible.
You have worked hard to earn the medical diploma you cherish today. In our profession, there is no question of resting on your laurels. In fact, your work has not yet begun. Medical science advances by leaps and bounds. You must constantly retrain in order to meet the daily challenges that await you. Regular reading of scientific journals and participation in medical conferences to keep you informed of the latest scientific progress.
A doctor is above all a man of science. You must question everything. It is by this questioning that science progresses. The science of medicine discovered the vaccines that eradicated, among others, smallpox and polio, the drugs to treat the scourge of the century, AIDS, and to vanquish several forms of cancer. The implementation of prostheses in almost all the joints has become commonplace, transplanting of nearly every organ a reality. Life expectancy has almost doubled in 50 years particularly in developing countries. The human genome project, a titanic work, permits us to map the human genome. It remains to establish their relationship to the development of most diseases.
Anatole France, who was an atheist, did not believe in the miracles of Lourdes. When he learned that a blind person had suddenly regained sight he replied “I expect one could more easily sprout a cut limb, an arm or a leg”. What would he say today if he knew that the use of stem cells is opening new doors to medicine and permitting the development of interventions that seemed unthinkable, like the regeneration of a limb? The optimism today is such that certain researchers are asking if old age, considered an inevitable process, may simply be a disease.
I would like to share with you a personal experience. I returned to Haiti in 1979. My primary mission was to determine the causes of diarrhea in children. At the time, gastroenteritis was the major cause of death for those under the age of five. Forty out of 100 children admitted to the State University Hospital of Haiti would die. The main causes, rotavirus and e coli toxins, could only be diagnosed in two laboratories in the United States. One had to perform complex laboratory tests over several months to obtain these diagnostics. Actually, these 2 infectious germs and the 22 other agents that cause diarrhea infections and comprise the cholera virus that causes cholera can be detected in one hour by tests that we can perform here, even in Haiti in our laboratories in the GHESKIO center. In a few years these tests will be commercialized and accessible.
It will be the same for tuberculosis. By conventional culture methods it took at least 4 to 6 weeks in order to establish the diagnosis and another 2 weeks to discover antibiotic sensitivity. Today we can diagnose tuberculosis and even multi- resistant forms of tuberculosis in a few hours in our molecular biology laboratory. Even the dehydrated seeds that can’t grow in the culture can be diagnosed in a precise way. These methods will help us to quickly treat characteristically epidemic infections and to bring about a considerable reduction in their propagation. These rapid tests are already available for the diagnosis of AIDS, syphilis and malaria.
This is why you must all ask questions in order to advance science. This is why you must proudly wear the while coat.
What you will not learn in medical school or in the specialized articles, you will learn from your patients. Listen to them!
Medicine is not simply a profession. Medicine is a vocation, if not a priesthood. The doctor is above all a servant. You stay a doctor day and night. With or without the white coat, you stay a doctor. One may call on you at any moment in a catastrophic situation like the ones we have recently known, in a road accident, while traveling by plane or boat, to come help a patient in distress. In our country where a large part of the population does not have access to health care, you must be ready to respond to all calls at all moments and in all circumstances and particularly to the calls of the poor.
Consider each patient a brother to be treated with respect. He trusted you and gave you access to that which is most intimate, his body. Unspoken language is also important. Never be haughty, always be human. Show each patient that you hold his sickness in your heart. Never betray the confidence he has placed in you. Each moment you must treat the patient, not the disease. Above all, never destroy hope. Each patient is a separate being. You must consider their social condition, their financial means and their family support. Nothing can replace the human touch. Neither lab tests, nor medications that very often the sick of Haiti are unable to get.
There is no better school than that of suffering. You will learn a lot from the suffering of others. One day the roles will be reversed: we are all patients in waiting. You or a dear member of your family will have to be cared for.
When you wear this white coat the challenge will be to do everything in your power to be at the patient’s bedside and to heal him. Often a friend will ask you to see a patient thinking it will only take a few minutes of your time, consultation time. The friend cannot know that unless the patient is healed and out of danger the doctor will not be at peace with himself. It is this professional conscience that every doctor worthy of the name must possess.
There is no greater joy than the power to heal. You often hear the thoughts of those you are helping: “After God, comes Doctors”. This must not go to your head. Don’t be arrogant. Arrogance keeps you from learning from your mistakes.
The healing of patients must be your unique compass. You must have humility to recognize your limits and to seek council from your colleagues when a case is beyond you. You must also reserve compassion for those whom you cannot heal. Your presence alone is a comfort during their distress.
A doctor is also a leader. This is hard to miss when one knows Haiti’s rate of maternal mortality, colon cancer, and tuberculosis are among the highest in the world. A leader is a team leader. Whether in a hospital, in a public office, at the clinic or in a research laboratory you will work as a team for the common good. You must respect and encourage all members of the team. They also wear the white coat. The initial purpose of the white coat was to protect the doctor and patient and avoid the spread of disease. This white coat has become a symbol of authority, knowledge, science, the art of caring and of hope.
A doctor is at the same time a man of science, a servant, a humanist and a leader. This is why the task that awaits you is so hard.