Newsletter # 361
- Dr. Maxime J. Coles
- Sep 29, 2025
- 63 min read
Updated: Oct 6, 2025
Table of Content October 2025 AMHE Newsletter
1- Words of the Editor-in-Chief: Basic Sciences Up-to-date on Prg4
2- Maxime Coles MD: Autism
3- Rony Jean Mary MD: Fils de la Broussaille
4- Reynald Altema MD: The vagaries of patient care (Medical Ethics)
5- Requiem AMHE: Destin Cadet, Jean-Robert Fanfan, Addie Cornet, Jacques Guiteau MD
6- Maxime Coles MD: A mes amis disparus
7- Rony Jean Mary MD: 11 September 2001
8- Reynald Altema MD: Famille Taurier "LaVie en Louisiane"
9- AMHE Activities: Membership, Activities, Residency Program, Gala
10- Bertrand Laurent: Anthropology of the Blame
11- Jean Serge Dorismond MD: Alexandrins de de la Vérité de Demain
12- Maxime Coles MD: Mon Papa
13- Rony Jean Mary MD: La Mort de Charlie Kirk
Words of the Editor-in-Chief
Maxime Coles MD
The discovery of a stem cell capable of healing bone may be the key for better treating tough to fix fractures following motor vehicle accidents as well as military traumatism. It is understood that a newly stem cell originating from skeletal muscle may turn into bone and could hold the key to fracture healing. Orthopedists have shown a sustained interest in this new discovery.
We have all seen open fractures with loss of bony substance or large soft tissue deficit and if current treatments allow often the healing process, it is not always that the results are satisfactory. Many remain with some disabilities especially following any delay in healing or other complications like infections, mal-unions and non-unions as well as leg length discrepancy.
Newly discovered stem cells from skeletal muscles may improve recovery by producing a different type of cells able to enhance bone healing. This new study was performed at the Perelman School of Medicine by the scientists of the University of Pennsylvania and published in the “Proceedings of the National Academy of Sciences”. This may allow the body to heal such fractures with more efficiency as reported by a professor of Orthopedic Surgery Ling Qin, PhD.
In the lab, and on the mouse models, a “Prg4” type of stem cell originated from muscles was found to be crucial in bone repairs, transforming muscle cells to bone cells. They were able to activate such cells in the body via growth factors or introduce an activated form of these cells to directly introduce them into a fracture site in the hope of accelerating the healing process.
We know well that this process is constantly repeated when any closed fracture is under repair through the presence of stem cell under or into the periosteum covering the bone but, unfortunately, becoming defective once an open fracture with an important loss of soft tissues, is trying to heal. The challenge to heal such fractures is well known to the orthopedists.
Some of the co-authors like Jaimo Ahn, PhD, a professor of Orthopedics at Emory University and other colleagues consider the Prg4+, as a type of fibro-adipogenic progenitor (FAP), originated as well in the skeletal muscles.
It seems that Prg4+ has the tendency in responding quickly once any skeletal injury is present, rushing to the damaged areas to initiate the repair needed. They migrate to the fracture site from the skeletal muscles producing all type of cells necessary to repair bone like chondrocytes, osteocytes and osteoblasts.
These researchers have also discovered mature cells in the healed bone, originating from the Prg4+, also capable of repeating the healing process and transform muscles into bone.
It is certain that this new researchers like Qin Ahn and his colleagues have tried to convince us on the importance of the muscle next to bones in initiating the desired healing. We will have to wait for convincing evidences on the role of PRG4+ in the process of bone healing, especially in catastrophic injuries… So we may be able to add this new technique in our armamentarium, especially when more routine injuries are performed on older adults or in any patient with chronic injuries and experiencing a reduction in their muscle mass.
Maxime Coles MD
Boca Raton FL (Sept 2025)
Références:
Autism
I remember being in my late teens, almost ready to finish my humanities (baccalaureate) when my adopted sister Eliane, living in Puerto Rico decided to send her second son, her third kid, to us for the length of a summer vacation at Montagne Noire, Haiti. She wanted to expose him to another audience because he was already three years old and has never started to engage in any conversation. We all had our suspiscion that something was wrong with our little nephew.
He was alert and extremely intelligent, able to accomplish all tasks but was short in words while engaging in a conversation or taking contacts. He was not proficient in words and appears to be able to understand discussions but not pronouncing words. To the one close to him with whom he will share the table to eat, he enjoyed repeating the word “salute” to express his joy. I would play with him regularly and discuss everything possible in the goal of understand the reasons why he was unable to engage into a conversation. He would enjoy playing and going to the beach while being an excellent observer. It was a joy to have him around and like a little brother, he will follow me everywhere.
Mom was just returning back from a long stay in Montreal where she worked profisciently with so many children acting in this way on the pediatric floor at the Marie Enfant Hospital and she insisted for my sister to have the child come over for a while in order to change his “entourage”. He grew up in Puerto Rico and was accustomed to hear family and friends engaging in Creole, English and Spanish. We thought that it was perhaps the reason for his confusion and the delay in conversation and interactions he was demonstrating.
I remember hearing how he was participating to the plays with his elders, rarely but my remembrance of him was certainly the way he was bringing joy to interact with me while I just finished passing the entrance exam to the medical school at Port-au-Prince. He was pleasant but did not act like any other baby in the family, or any other friends’ children.
He often was moving around and willing to perform his own tasks. He had good appetite and appeared to be conscious of the world around him. It was fun having him and he was following me often around. He did not give me the impression that he was not enjoying playing with others. In the contrary, he would look at you and wait for an invite prior to perform a task. He may have given the suspicion in having difficulties with the changes of activities but I do not remember any temper tantrum unless it was for his inability to pronounce words.
He would follow your moves whenever he become familiar with your routine and keep eye contact while performing even if he showed sometimes repetive motions. I had the impression that he was trying to perform in the best of his ability. I never observed any “stimming”, rubbing his shoulders or the top of his head. It was my pleasure to teach him how to recognize things, perhaps allow him to understand the way of observing or discerning objects. I remained convinced in optimism that while becoming my friend, he would one day start a fluent conversation with me.
I was eager to explore a way to render him open to me enough and see him start talking. I understood that a mixture of different languages French and Creole, English and Spanish, may have played a role as well in the delay of development of his speech.
At this time, I was not sure of what I was dealing with while entering the Medical school. The term “Autism”, if it were his possible diagnosis, finally reached my ears but I was not too familiar with this vocabulary. I started reading about it and become “afraid” of considering such pathology for my little nephew.
I started instructing myself and reading through the medical literature and found out that Autism was dealing with developmental and neurological conditions of the brain and that such conditions were possibly lifelong conditions. I wanted to shear some tears because I was so close to him and did not understand why he was chosen to suffer from such condition. I started reading on the subject and discovered the way such children would experience challenges with their social communications and interactions, engaging in repetitive behaviors or presenting with overwhelming emotions while learning or playing with others. They may lose attention.
My nephew did not show any sign of violence and appeared to me very pleasant with a delay in expression and no temper tantrum. I started de-differentiate such diagnosis from his gentle nature and felt a personal satisfaction because he did not have any problem in learning or paying attention.
I learned also that such symptoms were frequent and persistent, becoming worse with time when one suffers from Autism, in milder or more severe forms. Unfortunately, there were no known causes for Autism. We will try to go over such pathology in views of novel researches and data, especially after Autism was recently re-classified in the Medical textbooks.
Althrough there are no medical or laboratory tests able to diagnose such disease, it is considered through a child‘s developmental history or behavior or through their social interactions.
Autism has no known etiology but it is a developmental disability that results in impaired social skills, communication and reasoning. It can cause profound changes in a way that one seems to view the world around, differently than others. Many other conditions could explain such. A mild form, “Asperger’s syndrome”, is seen in patients who seem to be able to integrate the society and live a normal life.
Autism is encountered in every country among all demographic groups. It is not affected by race, or socioeconomical conditions. Many researches have show the incidence to be significantly more frequent in the LGBTQ population of lesbians, gays, transgenders, intersexual etc than the general population. Religion seems to play little role in this population.
We owed the name “Autism” to a Swiss psychiatrist Eugen Bleuler who chose “Autismus”, german name and “autos” = same, greek word for ” (Autism), describing symptoms of schizophrenia he observed in 1912. Later, an other German psychiatrist Fritz Kunkel described the symptoms encountered in Schizophrenic patients and labeled the name “autistic” because of the disturbances in their emotional life.This is on 1926, that the team, with Grunya Suhareva published their study after discovering that 6 children (boys) were musically gifted in the group but were exhibiting “abstract thinking”. This attitude was called “autistic attitude” and was able through the years differentiate Autism and Scizophrenia, thirty years ago.
We will try to discover different signs suggesting autism in infants althrough there are no known causes, but it is surely not due to any bad parenting nor there are any racial or religious, ethnic or cultural, economical barriers or social binders related to income status or gender in a disparate society.
It is estimated that the prevalence for the disease has increased from 1:150 in 2000 to a 1:68 ratio in 2010 but now, since 2022, a prevalence of 1:31, is seen according to an April 2025 survey. We believe that it is surely due to better testing techniques for the condition as well as the way more people become aware of the disease. Identical twins share 100% of their genes and if one has autism, the other one carry a more than 80% of being also autistic while fraternal twins carry less than 30%.
Signs and symptoms are not always apparent but it seems that girls have the ability to mask the disease at an early age better than the boys until they showed developmental differences as they grow. Several studies have shown a higher incidence among males than females. Signs of Autism often appear early between 8 and 28 months of age but if every child develops differently, a parent can certainly become resistant to such diagnosis. It is believed that timing may affect also the outcome.
A study published in 2013; supported the fact that children, once diagnosed, and have received support at 18 months, have shown better improvement on social-skills tests than children who started nine months later. They benefited from major gains in language and social skills as well as in cognitive development. Hafeez believed that early intervention leads to most positive outcome in all areas of “functioning”.
A child with Autism who does not answer to his/her name by age 9 (nine) or does not engage with their parents or care givers, or simpy does not respond to smiles or facial expressions or does not maintain eye contact, responds often to the diagnosis.
Often, a toddler would not even demonstrate any interest or show any reaction when others are hurt or angry. They do not sing, dance or engage in plays. They do experience delays in speech or language development or simply remain non-verbal. They demonstrate difficulties in sleeping and eating and flap their hands and arms or spin around while rocking back and forth. Often, they may experience a meltdown in relation to the emotional overload. The sensory stimuli like by example when one is being touched may encourage a child to react negatively or the same when exposed to loud noises, bright lights, strong smells and even bad taste.
The young student has a tendency of placing things in order especially when he believed that their orders were disturbed. They have difficulties in transitioning between activities or may repeat words or sentences over and over. It was well exposed in the movie the “Rain Man” played by Tom Cruise (Charlie Babbitt), a car dealer who came back home when his father passed to find out that a 3 billion dollars in fortune was left to the foundation taking care of his Autistic older brother (Dustin Hoffman). The movie was a masterpiece and received the Academy Award for the best picture in 1989. Hoffman display well his impulsivity and hyperactivity with his fixated interests like watching a TV show at time, but it did have skills also in reading and counting the cards at a casino, allowing his brother to win money. He would develop metdowns from emotional overload and become anxious.The autistic patients generally stick to their routine.
Parenting such child is challenging and often overwhelming. They may find their way with determination and optimism. Often, they may manage to train for a full-time position and work with tremendous charm and with a pleasant personality. I notice the same determination with many other kids with disabilities like Down syndrome as well. Once they are taught to perform a job, they will do it with seriousness in the line of their duty. So many parents have written their memoir in books. An example is: “A Parent’s journey raising children with mental illness”, worth to be read. I would encourage one to live such experience, in sharing the emotional life of parenting in order to better educate other family members, friend’s and even heathcare providers in the care of an autistic child.
Formerly called the “Kanner’s syndrome” or Autism spectrum disorder or Aperger syndrome, we observe Autistic child with different capabilities, capable of functioning with difficulties in social interactions, during verbal or non verbal communications while he/she demonstrates repetitive body motions. A family history of genetic conditions in older parents may explain the arrival of an autistic child likewise any prenatal or neonatal conditions are encountered or even following certain drugs ingestion, conditions which may play a role in the life of an autistic child.
Clinical observations in the behavior and comprehensive testing and even written tests have also helped in diagnosing or differentiating an autistic child from other hyperactivity disorder or anxiety disorders or other personality disorders like schizophrenia.
It remains that Autism is better known as “Autism Spectrum Disorder” with its difficulties in social communication and interaction including repetitive behaviors present in early childhood and persisting throughout life. The early 1990’s has placed greater awareness on the disease to a point that many activists have considered vaccination to be a cause of the disease based on a fraudulent 1998 research-paper, which has since been retracted from the litterature.
Autism is also heritable and was found to involve many genes. Boys are more often disgnosed than girls and other conditions as depression, anxiety, attention deficit, hyperactivitiy disorder (ADHD in 30%), Intellectual Disabilities (40%) Epilepsy (10%), Genetic disorders (10%), Obcessive Compulssive Disorder (7%), Depression ( 13%) etc are commonly encountered or associated.
Unfortunately, there is no cure for Autism. Therapies aim at self-care, social and language skills for autistic children to encourage education and their search for an employment. There are no medications able to change the course of the disease althrough other conditions like anxiety, depression, epilepsy, ADHD can also surface. In such situations, the autistic person may have already a productive life, althrough intellectual disability or language impairement may affect their levels, according to biological researches. Scientists question more the full phenomenon and insist on the biological markers or the rare genetic or environmental factors like any genetic mutation influencing the psychological and neurodevelopmental conditions.
The autism spectrum disorder demonstrates more the persistence of the deficits able to impose a certain social interaction or communication with atypical and inflexible patterns of behavior especially in the early childhood.
Indeed, Autism is primarily charcterised by differences and difficulties in social interactions and communications with repetitive patterns of interests and activities or behaviors (Stimming) especially sensory. We have already stated that ADHD or other mental conditions may also be present, rendering social relations and eagerness to learning difficult. Unfortunately, some may become significantly disabled.
It is believed that children with presumed Autism showed “babbling” during infancy when such babies are unable to make vowels or consonnants sounds like “ba-ba”or “ma-ma” while trying to form words. Often, they may express a social naivety this has forced experts to consider what they called a “double empathy theory” (2012), arguing that there maybe a lack of mutual understanding between autistic and non–autistic individuals. Others believe that autistic children may repond differently with a display of atypical and non verbal behaviors, leading to infrequent eye contact upon calling their name, because they may find the moment distracting or arranging their toys in line. Occasionally, they may respond with facial expressions while changing the tone of their voice. It appears that autistic children show better social relationships, dealing with other autistic children, especially when the autistic person influences their life.
They may often be involved in bullying situations with their peers or become a victim. One thing is sure, they have challenges in developing romantic relationships. Children may focus on things that spin like lights and ignore everything else or they may be interested in learning on one topic, such as the weather or the sports or the music.
Similarly, many autistic children develop language skills at an uneven pace while verbal communications may develop later or never with unusual gestures.
30% of autistic school-age children are non speaking or minimally speaking.
Self-injury is three times more common in autistic people due to head-banging, hand-bitting, leading to more serious injuries. They may become suicidal because of their social problems in relation to an unemployment or their isolation. They remain at risk for bullying and sexual assault. Autistic persons were found to have four times more depression:10% of autistic children and 25% of autistic adults have attempted suicide or experience suicidal ideation.
70% fo Autistic people develop poor muscle tone and can be toe walker with difficulties in motor coordination while 70% will develop atypical eating disorders. They may exhibit “splinter skills” like for memorization which I have mentioned earlier with the movie “Rain Man” played by Dustin Hoffman, memorizing the cards in the casino. They may express the same with mathematics or music (Savant syndrome). They may even have superior skills in perception and attention than others in the general population.
By and large, Autism is a genetic condition and researchers have identified more than 100 genes which play a role in the disease. These genes are present at birth and work even before during fetal brain development. Autism start in the pre-natal period and not later in life. One can be diagnosed before the age of 2 because of regression skills. Vaccination has nothing to do with autism. These genes have been associated with Epilepsy, Schizophrenia, Dystonia or other genetic conditions.
Environmental factors are difficult to isolate but parents older than 40, prematurity between 22 and 27 weeks of gestation as well as complications at childbirth (injury to the umbilical cord or defect in the immune system of the pregnant mother, perhaps added to a nutritional status lacking folic acid especially… etc.). A pregnant mother with a previous autistic child in the family carry also a higher risk in having an other autistic child. “Air pollution” have been named as environmental indicators. Further researches at Yale, Duke, Los Angeles centers may hopefuly enlight us on the topic. I would urge you to extend your curiosity in this field of genetics.
There is no cure for Autism but it is aggreed that an earlier diagnosis before the age of 3 would allow the family to start a behavior analysis (ABA) in order to help the kids learn social, academic, motor, dexterity and hygiene skills. It is considered to be effective in language skills, adaptive functioning and intellectual performance in pre-school children.This technique focus on parent and child social interaction and communications. Others mentioned the lack of adverse event monitoring.
An other treatment is the equine therapy (AAI) showing the autistic kid how to groom, feed, saddling and ridding horses or donkeys. It is believed also that the rhythmic motion of horse riding can improve the coordination of eyes movements, posture and equilibrium. I read also about summer camps for autistic kids in Galveston TX, where the sound of the rhythmic wave movements caused by the tides, appeared to help such kids to enjoy a calm atmosphere for their learning skills.
I would state that there are still much to add to the subject especially when pharmaceutical drugs may be as well prescribed because of the association of Autism and other diseases or syndromes. I will choose to stay away from the pharmacology and urge one interested to discus with the pediatric neurologist different drugs affered. More, many have also used “Pet therapy” with dogs or ducks to ease the tempers of these children and help the learning process.
There may be also a role for Alternative Medicine with “chelation therapy”, hyperbaric Oxygen, dietary supplements and Casein-free diets with low Calcium or Vit D, or with “CEASE therapy” in the refusal of taking any vaccination etc. I will invite the public to consider reading on these variants of palliative treatments and discuss options with the specialists.
In conclusion, the exact cause of Autism remains unknown while the disease persists through the adulthood inspite of many giving the perception that it has improved or is being masked in order to avoid stigma. In general, 85% of autistic persons will need support althrough they have enjoyed independent living and self-determination through their adulthood. They may face discrimination in education or in professional setting, leading often to violence, assault or social exclusion.
“An Autism epidemic is rampant” as mentioned by the actual Robert F Kennedy Jr, present secretary of Health and Human Services (HHS). He was given the task to find out the cause for such disease. May God guide his search because following studies initiated at the Yale School of Medicine for Perinatal, Pediatric and Environmental Epidemyology which have raised concern since May 2025, on the use of Acetaminophen in pregnancy and the possible relation with the incidence of Autism, ADHD, althrough not proven yet ( Professor Zeyan Liew PhD, MPH).
Autism may have been traced in a single-gene as a Mendeliam mutation or as an abnormal chromosome but there are no associated genetic disorders causing a syndromic Autism, in the fragile X chromosome. Around 25% of autistic people develop intellectual disability and more may present with a rarer and more impactfull genetic mutations like demonstrated in Prader-Willi, Down or Angelman syndromes…etc. Often, it is when the child reaches the age for starting vaccination, like “mmr”, that the parents may detect some characteristics of Autism. (Fraudulent Brittish study in 1998). The study tried to blame the “mmr” vaccine for its contain in mercury or for the vaccine itself. These claims were not supported while vaccines were not responsible for Autism. Cognitive theories have also been developed to explain patterns of information, common to autistic people with theories suggesting a tendency to focus on details (coherence theory) etc or trying to explain the behavioral and the cognitive aspect (systemizing theory) assuring the neurobiological development.
Finally, researches exploring the evolutionary psychology in the relation between Autism and Schizophrenia has also been studied and published in Evolutionary Psychology journal, proposing that autistic traits may be naturally selected (Solitary Torager Hypothesis) to explain the prosocial adaptive strategy seen with the Asperger syndrome (2016).
Maxime Coles MD
Boca Raton FL (10-2025)
References:
1- Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, Yusuf A, Shih A, Elsabbagh M (15 May 2022): “Gloal Prevalence of Autism: Systematic Review Update”. Autism Research: 15 (5) pp 778-190.
2- “Autism”: World Health Organization (March 2022).
3- DSM-5-TR
4- Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatic Association. 2013. Pp 31-
5- Whitely P (October 2019). “Is Autism Inborn and Lifelong for Everyone?”. Healthcare (Basel).7 (4):132.
6- Wikipedia: Autism.
7- Hirota T, King BH (10 January 2023). Autism Spectrum Disorder A Review”. JAMA. 329 (2): 157-168.
8- Zeyan Liew PhD, MPH: Potential link between Acetamonophen and Autism ; May 2025 Study at Yale School of Medicine.
9- Viktor H, PhD, Hugo Sjoqvist MSc; Chrisitna Dalman, MD, PhD: "Acetaminophen Use During Pregnancyand Children Risk of Autism, ADHD and Intellectual Disability"; JAMA. 2024;331;(14):1205-1214.
JE SUIS UN FILS DE LA BROUSSAILLE
Je suis né là-bas, sans rien, absolument rien.
J’ai grandi simple, sans confort ni apparat.
Je m’éloigne des tentations, louanges et adulations
qui me font croire que je suis un être exceptionnel.
Je n’ai eu qu’une chance que j’ai su exploiter à temps,
car j’ai compris que je devais faire mieux
chaque jour, à chaque heure.
J’ai admiré le beau, j’ai embrassé la lumière
sans oublier la caverne d’où j’ai échappé un matin,
un matin d’automne quand papa me prit la main
et m’emmena pour la première fois à l’école du village.
Je retourne à mes sources, à mes amours passées
pour me rappeler d’où un jour, je suis parti…
Je n’ai aucune haine contre ceux qui en ont trop
des choses de la vie; ceux qui n’en ont jamais
assez et cherchent à combler leur vide.
Ils ne sont point heureux.
J’aime partager mon pain avec les moins fortunés.
Je m’assieds volontiers auprès du clochard
pour apprendre de son passé.
J’ai le goût simple de la vie.
Dans mon sens inné de la caverne, moins le projecteur
est sur moi, plus confortable je me sens.
Je n’ai pas peur de tout perdre.
Visa, carte de séjour, que m’importe !
L’argent, la fortune et la richesse idem.
Gardez-moi ma dignité et mon âme sereine.
Car elles seules me rendent heureux.
Elles seules me rappellent au soir de ma journée
que je peux dormir en paix,
sans peur d’affronter le jour d’après.
Car j’ai toujours été, je suis, et resterai
un enfant sauvage,
un être indomptable, un fils de la broussaille.
RONY JEANMARY, M.D.
Coral Springs, Florida , le 23 Septembre 2025
MEDICAL ETHICS
The vagaries of patient care
Part of our Hippocratic oath states, “I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.” Obviously, “dietary” in our modern world implies therapeutic intervention of all kinds, including but not limited to advice on proper dieting. Nonetheless, this establishes a covenant between patient and provider based on the principle of mutual trust. Trust can’t be overemphasized, for its absence derails the relationship. Lest we be mistaken, we ought to remember that in the best of circumstances, that special relationship doesn’t always run on a smooth course; bumps come on and off, especially when a precise diagnosis is hard to come by and or the patient’s condition is deteriorating. A fatal breach has taken residence if and when a patient doubts our words, even baking that precision in. The breach inexorably leads to a severance in the relationship because, in matters of life and death, one must have full confidence in the healer. The mirror image is that the patient will be compliant and truthful.
Unfortunately, compliance and truthfulness intermittently come under assault, testing the resolve to maintain the relationship. How we handle this conundrum depends on our sleuthing ability, willingness to think outside the box, understanding the social barriers that stand in the way, and so on. Compliance, like beauty, is in the eye of the beholder. This is a slippery slope when one quickly labels a patient “noncompliant” without inquiring carefully about the patient’s financial situation. Compliance and affordability go hand in hand. This truism becomes necessary for any fair assessment. A patient fending for the self and facing a stark choice of food versus medication warrants a different classification than another one willfully forgoing treatment when affordability is not an issue. This distinction is a sine qua non. How does a clinician interact with a noncompliant patient, especially in a litigious society?
Certainly, the easy answer is a cessation of the relationship. However, the issue is rather multilayered and comes with gradations. Cultural norms, a lack of fluency in basic medical care, and a patient’s suspicion of medical recommendations can all play a role. Several examples will be used to walk through this minefield.
Case 1. A 45-year-old African American engineer whose family history includes several people afflicted with prostate cancer categorically refuses to be screened for it despite having LUTS (Lower Urinary Tract Symptoms). In such a situation, a well-educated man with symptoms suggestive of prostatism who refuses to be investigated for a potentially life-threatening condition is a difficult case to handle. If persuasive arguments, such as a review of the scientific data pointing to a high likelihood of cancer in such ethnic groups, and the tendency of the condition to be passed on from generation to generation, can’t sway the patient, a termination of the relationship is a reasonable choice.
Case 2. A 70-year-old male, deeply religious male refuses to undergo cardiac cath for chest pain because he feels that God wouldn’t want him to have any of his organs tinkered with. According to his religious beliefs, one must go to the tomb as one came out from the womb, an intact body. The patient respectfully requests other alternative methods of treatment besides an invasive procedure. Is there any difference between the two patients? A subtle one, yes. In the first instance, one was dealing with someone who was not going to follow the standard of care or any care while being at high risk. The second patient is exercising the right that all patients have to accept or reject a treatment offered and expressing a preference for another approach. In other words, informed consent cuts two ways; on one hand, one gladly accepts, while on the other hand, one says no thank you respectfully and wants another mode. In both instances, proper documentation adds the official seal.
Case 3. The 2 previous cases are not so egregious. Let’s delve into the following situation. A fifty-four-year-old patient with end-stage renal disease, hemodialysis dependent, gets frequent admissions because she misses dialysis sessions and or eats as she pleases. Her serum potassium at times skirts dangerously high levels, like 7. One can’t be blamed for offering separation to such a patient, but at the end of the day, someone has to take care of the reckless. This illustrates our true calling to serve the needy, come rain or shine. From time to time, we make exceptions because some of them can be the nicest people. Some of them behave in an erratic manner, like Jekyll and Hyde, due to underlying mental illness. Of course, the clinician manages these difficult patients on a case-by-case basis. We are humans with feelings and become attached to patients the same way they can consider us as a relative, and we carry on and continue to care for folks who need our help and depend on us, warts and all. Far too often, we attract a stir for the blaming game and barely receive any accolades for putting up with hardship patients. This reality is par for the course, as the saying goes. Carrying such a burden becomes part of our professional life, sooner or later.
Caveat. The doctor-patient relationship can suffer an awkward twist when personal gain gets in the way. Every now and then, otherwise honest and law-abiding citizens tend to exaggerate their symptoms when filing for workers’ comp or after MVA injuries. That can also test a clinician’s reputation when caving in and straining credulity. Prickly situation, as folks can turn around and be offended when being called out on their exaggeration. This is where ethical standards meet a patient’s personal gain. Not uncommonly, a clinician is best advised to refer these cases to an expert, whose expertise carries more heft. On the other hand, from a patient’s perspective, the perception of collusion between the provider and the powers-that-be (insurance company, big pharma) to deny care can be a chilly zone, casting a shadow over integrity. That type of conflation reeks of the pitting of patients versus the medical-industrial complex. Such misgiving may occur when an imaging, i.e., MRI, is denied, the copay for a desired drug is sky-high, and so on. The messenger seems to be the villain in the play. The outcome leaves no winner. From cordial, the atmosphere can spin into a frosty one. Naturally, it behooves the provider to soothe bruised feelings by explaining the source of the denial, unrelated to the provider’s original recommendation. Whether we like it or not, insurance companies’ second-guessing of a medical recommendation has become part of the landscape. Patients face that burden all the time. We ought to make sure we don’t get the blame unfairly.
The continuum of caring for difficult patients includes downright troublesome elements: malingerers, or persnickety types like hypochondriacs and those suffering from Munchausen syndrome.
Malingerers. Typical among them include drug addicts who will fake pain to obtain opiates. They tend to go doctor shopping to obtain controlled substances prescriptions. A cottage industry had developed to cater to such clientele, making a mockery of good medical practice. This had helped to create the opiate abuse epidemic and deaths by drug overdoses that attracted the attention of authorities once it infiltrated suburbia. The decades-old heroin epidemic that had invaded inner cities had received short shrift and had not elicited the same reaction. These so-called “pain-clinic mills” were money-making ventures, with robust cash registers and anemic ethical standards.
Hypochondriacs are some of the nicest patients, but they always think of the worst. Whenever they hear of an illness, they think they have it. Many of us in medical school went through a period when studying pathology, and we self-diagnosed and ascribed to ourselves illness after illness. Strangely, later on, we clinicians become terrible patients, thinking that we are immune to the illnesses that we see around us. Handling hypochondriacs demands the most tactful flair and literal laying of the hands. A cardinal sin would be to confuse a malingerer with a hypochondriac. An analogous faux pas would be the deceptive residue left by a slathering of hectoring rather than the feel-good mousse generated by a persuasive argument.
Munchausen syndrome. This is the ultimate crucible that tests one’s mettle as a clinician. A patient who suffers from this condition is the extreme malingerer, exposing his body to all sorts of torture to convince others of the existence of an imaginary illness. A perfect example is a pseudo seizure. A patient will fake a seizure and sometimes will fake other illnesses, going so far as being intubated, undergoing surgery, or even causing an infection. The person wants to have the illness and will go to any length to prove it. The exact etiology of this malady is not known, but it’s considered some form of psychiatric disturbance. The afflicted is not out to gain anything other than the claim of having a particular condition at whatever cost. Lifting the gavel to make this diagnosis demands quite a bit of boldness. More often than not, a clinician is leery of missing a real illness by downplaying a patient’s complaint and risking litigation. It requires careful investigation. Not uncommonly, such patients travel from hospital to hospital and move on to the next institution once unmasked. It goes counter to the premise of medical practice because instead of finding an illness, the goal is to prove the absence of one. This can result in the patient’s wrath. Nonetheless, the true calling of “doing no harm” mandates no unnecessary exposure of a patient to a procedure without any good indication for doing so, even though this may upset the patient.
Taking care of a patient is a noble but fraught calling. Many times, one also needs to say no to a patient when the risk of intervention outweighs the benefit. A couple of decades ago, there was a craze for a combination of meds for weight loss called fen-phen (fenfluramine and phentermine). Despite its allure, it had the peculiar potential of causing pulmonary hypertension, especially in young women. It just so happens that it’s a horrible and irreversible condition. At the time, there was no available treatment. To this day, meds now available for this condition have a suboptimal track record. Not writing a fen-phen script for a young female under social pressure to lose weight was the appropriate and ethical decision, albeit not a popular one. Convincing another young female not to proceed with a lap-band surgery (at best with modest results) when her weight is not that far off the ideal one is another fraught maneuver. At the same time, saying no to a young male lifting weights requesting anabolic steroids will not earn one some granny points on the spot, far from that, but is the appropriate and ethical approach because misuse of anabolic steroids is associated with a long list of complications. Ethics still play an essential role in medical decisions, and that’s good news.
Reynald Altéma, MD
Requiem AMHE
Dear Dr. Francoeur Cadet,
On behalf of the leadership and the entire membership of the Haitian Medical Association Abroad (AMHE), please accept our deepest condolences on the passing of your beloved brother.
During this time of profound loss, we extend our thoughts and prayers to you and your family. We hope you find solace in the cherished memories you shared with your dear brother and in knowing how deeply he touched your life.
As a valued member of the AMHE family, please know that we stand with you in your grief. We are here to support you in any way we can during this difficult time.
May you find comfort in the love of those around you and in the strength of your faith.
Sincerely,
AMHE Central Executive Committee
Eulogy for Destin Cadet
We gather here today to honor and celebrate the life of a remarkable man, Destin Cadet, our beloved brother.It is hard to find the right words to capture the essence of someone who meant so much to us all, But, I will do my best to express the deep love and respect I have for him.Destin was more than just my younger brother; but, he was also my friend and my role model in the world of Entrepreneurship.From our childhood adventures (like fighting over girls as teenagers), to our shared dreams and aspirations (like being entrepreneurs), he was always by my side.His jokes like using the word “chake” for everything including food, would light up even my darkest days. As children, we used to compete as to who would get more girls based on our looks and who “got game”,And of course, he would always win even today since I only have oneHe had a unique ability to bring joy to those around him, and his positive energy was infectious. One thing that defined my brother Destin was his unwavering kindness and generosity. He had a gentle heart and a compassionate spirit, often ready to lend a hand to those in need. For instance, during his yearly trip to Haiti, he would feed the less fortunate families and address their personal needs.He taught me the importance of giving back and showed me that even small acts of kindness and compassion can make a significant difference. Destin was passionate about life and work, pursuing his interests with enthusiasm.
Jean-Robert Fanfan
Dear Jocky
My heart breaks for you on this grieving journey, following the passing of your older brother Jean Robert. No matter, the distance who separated you in this adopted country, I know well the way you were close to him. This relation was pure and magic but certainly will live on your beautiful memories. I know that there are no words that can adequately express how sorry we can be, and nothing more can be added, to ease your sorrow, but I want you to know that in the name of the AMHE as well as my own, we would like to support your efforts during these difficult journeys.
To you, Kettely and the children, to all the members of the Fanfan family, your brother Lesly, your sisters Monique, Paule-Marie, Elsie and Michele, to your nephews and nieces Randolph, Gregory, Jennifer and Tania, to other nephews and nieces, to the friends of the family, we would like to present our sincere sympathies. The family will not be the same without him but we hope that you will find comfort in each other and will get through these moments together. One says that: “Grief is Love with nowhere to go”. Jean Robert's mission on earth is over and he was called by his creator.
May his light continue to shine on through you and may he be well received in his eternal residence.
Que la terre te soit légère mon cher Jean Robert.
Maxime Coles MD:
Eulogy:Jean Robert Fanfan:
In loving memory of Jean Robert Fanfan Sunrise:4/12/1948 Sunset:8/29/2025. Jean Robert Fanfan 77, departed this life in Auburn Georgia on 8/29/2025 Affectionately known as Bob he was the second child in our eight-member family. Bob received his primary and secondary schooling respectively at Notre Dame de l’Assumption and at Lycee Alexandre Petion in Port-au-Prince Haiti. In 1968 he arrived in the US where he attended RCA Electronics Engineering School and obtained a technical degree in Electronics and a love for technology. He then served in the US Armed Forces during the Vietnam War from July 1970 to July 1971 and discharged honorably. Subsequently he had a career as a Data Collection Technician at the US Postal Brooklyn District Center where he worked for 30 years. Bob was a very committed family man and also a man of great conviviality. He is survived by his dear children: Randolph, Gregory, Jennifer and Tania; his brothers Joseph Jr and Lesly; his sisters: Monique, Paule-Marie, Elsie and Michèle. May God receive our beloved Bob in His Kingdom.
Addy left us to join her Creator, yesterday. It is deeply painful and difficult experience for us, because a friendship of more than 50 years can't be replaced. Your short stay in the hospital for medical care has also given us intense grief, sadness and anger. Your mission on earth is over and we hope that your passage to a better world, will be more pleasant.
Parnel and I will remember the bouillon with crabs, we tasted so often while visiting you. I want share with him my condolences as well as the entire family and especially your son family, in the name of the AMHE as well as my own.
Bon voyage Addy et que la terre te soit legere. Ce n'est qu un aurevoir.
Maxime Coles MD
La vie dit-on est un éternel recommencement mais il devient de plus en plus difficile de voir ses amis proches nous quitter un après l'autre. Jacques s'est endormi tout doucement hier, comme il avait vécu... mais il est encore plus penible pour ceux qui le survivent sur cette terre, de continuer le train-train de la vie sans ceux qui nous ont côtoyés depuis plus d'un demi-siècle. Apres une longue maladie qui l'a force vers une retraite méritée, Jacques a su mener une vie de famille.
Nous nous sommes connus sur les bancs de la Faculté de Medecine et certes, j'étais son aine et de plus, nous nous avons pioche pour étudier ensemble afin de réussir aux examens du FLEX. Nous avons aussi milité pendant de longues annees a Howard Universite Hospital dans nos différentes spécialités. Nos familles et nos enfants, aussi, se sont côtoyés pendant de nombreuses annees. J'ai tant exprimé mon chagrin a voir partir ces amis qui nous délaissent un par un, pour un meilleur monde.
Il est dit qu"un ami ne laisse jamais notre coeur". Cependant, je sens bien que notre cercle social s'amincie de jours en jours. Les mots ne suffisent pas pour exprimer un état d'âme et en apprenant le départ de Jacques, Il me revenait de prendre mon courage a deux mains pour essayer de réconforter Frantz, sa femme de longue date. Les enfants étaient aussi près d'elle. J'ai profité de l'occasion pour lui présenter des condoléances émues a elle, aux enfants Johannie, Jacques Frantz Jacques et Frantz Anny et a toute la famille tant en mon nom personnel qu'au nom de la AMHE.
Comme un vétéran Orthopédiste et Traumatologiste, je peux confirmer que la perte d'un ami est l'équivalent de la perte d'une extrémité. Si le temps arrive parfois à pallier, cette perte de i'ami ne peut jamais être compensee. Bon voyage mon ami Jacques et sois heureux dans ta demeure éternelle. Puisses-tu nous préparer le chemin.
Que la terre te soit légère.
Maxime Coles MD
A Mes Amis Disparus
Maxime Coles
Errer durant toute une vie
A la recherche du Bonheur,
Vous donne cette envie
De fuir tout en pleurs.
Comme l’eau d’une rivière qui s’écoule
Sans jamais se laisser saisir,
Emportant vers la foule
Le message d’un désir,
La vie est éphémère et le temps s’enfuit
Oubliant les amis qui nous laissent
L’un après l’autre, dans la nuit
Souvent sans un Au revoir qui blesse..
Sur un chemin parsemé et court
Nous amasserons des fleurs
Pour embellir leur parcourt
En formant un bouquet en pleurs.
Efforçons-nous de sourire
Pour leur préparer une liqueur
Du nectar d’un profond soupir,
Qui s’apprécie de tout chœur.
Amis d’enfance et amis de toute une existence
Soyez heureux dans votre nouvelle demeure
Et préparez-nous le terrain, dans l’essence
De nous revoir, sans peur.
Maxime Coles
3-28-19
11 SEPTEMBRE 2001
Je m’en souviens.
Je ne m’en souviens plus.
Cela faisait à peine une semaine que je travaillais comme médecin de service à Woodhull Hospital.
Woodhull est situé au cœur de Brooklyn dans la zone de Bedford Stuyvesant dont une partie longe la rive Est de l’Hudson River. De l’autre côté du pont, c’est déjà Manhattan, le plus grand borough de New-York City.
Sur la route qui menait de Long Island à Manhattan, le soleil commençait à poindre à l’horizon. Rien d’inhabituel sur ce parcours toujours embouteillé, une fois que sept heures du matin vous attrape. La fraîcheur de septembre imprégnait déjà l’atmosphère après les jours chauds de l’été finissant.
Quelque chose d’inédit allait pourtant se passer à New-York. Quelque chose qui allait changer à tout jamais le cours de l’histoire des États-Unis et du monde : des avions bondés de passagers, décollant des aéroports avoisinants, allaient percuter le World Trade Center (WTC), frappant l’Amérique au cœur de son symbole économique le plus puissant.
11 septembre de l’année 2001.
Le monde semblait encore endormi lorsque je suis arrivé à l’hôpital, ignorant l’ampleur de la catastrophe qui venait de s’abattre sur New-York, « la ville qui ne dort jamais ».
De l’heure exacte, aucun souvenir. Mais on commençait déjà à chuchoter qu’un accident d’avion avait eu lieu à Manhattan, voilà à peine une heure. Les gens ne m’avaient jamais vu à l’hôpital ou, pire, ne savaient pas qui j’étais et s’adressaient peu à moi.
La première réunion débutait généralement entre 8h30 et 9h00 dans la salle de conférence attenante au bureau du chairman du service psychiatrique. On établissait le planning de la journée, qui se résumait parfois au rapport des dernières vingt-quatre heures. Ce matin-là, la nouvelle de l’accident qui se répandait un peu partout abrégea la séance. Il y eut peu de commentaires, et chacun retourna à son poste de travail.
À peine étions-nous de retour dans nos services respectifs, - l’unité #4 du département de psychiatrie pour moi -, qu’un deuxième avion, encore bondé de passagers, avait atteint le second édifice du WORLD TRADE CENTER. À cet instant, nous avons réalisé que le pays était en proie à une attaque terroriste.
On nous rappela en salle de conférence pour des consignes supplémentaires, et sur l’attitude à adopter : recevoir exclusivement les urgences et réserver les lits disponibles pour les blessés graves.
Un premier briefing eut lieu vers onze heures, et on intima l’ordre aux médecins de rester sur les lieux. L’attente était interminable. Nous nous étions préparés pour soigner des blessés, et recevoir des cadavres. Et toujours rien, vers cinq heures de l’après-midi, après le second briefing. Nous apprendrons plus tard que les corps étaient enfouis sous les décombres.
Des mesures de sécurité avaient été prises un peu partout à NY. Les routes étaient bloquées et l’accès interdit au public ; les aéroports étaient fermés à travers tout le pays.
J’ai quitté l’hôpital à deux heures du matin cette nuit-là, pour m’accorder un peu de repos. Grâce à ma plaque d’immatriculation gravée des lettres M.D, j'avais pu traverser les check-points sans encombre. Après un bref répit de 3-4 heures, je suis retourné à l’hôpital. J’avais roulé à toute allure pour assister au briefing du matin suivant.Toujours pas de nouvelles. À midi, c’était toujours pareil.
Ce n’est que le lendemain, dans l’après-midi, que nous avons saisi qu’il n’y aurait ni cadavres ni blessés, et que toutes les personnes coincées dans les deux édifices écroulés étaient à tout jamais calcinées.
Le spectacle était horrible. Les cendres grises en provenance des buildings effondrés et des corps calcinés se répandaient dans l’air à des hauteurs effroyables, polluant l’atmosphère sur des kilomètres. Une véritable désolation s’était répandue en un jour sur toute la ville. Inconcevable. Inimaginable.
Pour échapper à cet inferno, certains s’étaient jetés dans le vide, depuis des hauteurs abyssales, où un sort pire que la calcination les attendait. D’autres avaient envoyé un dernier message SMS à leur famille, pour leur dire que c’était la fin. Certaines victimes s’apprêtaient à reprendre le boulot ce mardi matin, après un long congé, sans pressentir qu’ils quittaient leur foyer pour la dernière fois. Mais ce triste sort fut épargné à des chanceux, grâce à une panne de pneus, ou le retard imprévisible d’un train. Toute la zone du WTC s’était transformée en un champ de ruines. C’était une véritable hécatombe. Les gens marchaient sur les ponts de Brooklyn, de Manhattan, pour rentrer chez eux, car l’accès aux voitures avait été coupé. Ces ponts dansaient follement et vacillaient sous le poids des piétons qui les empruntaient, tant la charge humaine était lourde.
Vous vous souvenez de ce centre commercial qui gérait des millions jour après jour et qui hier encore faisait la fierté du monde des affaires ? Il s’apprêtait à connaître la plus longue pause de son existence. Pouvait-on s’imaginer, une telle catastrophe, même dans nos cauchemars les plus terrifiants ?
Nous sommes souvent si sûrs de nous-mêmes, que nous ignorons nos limitations en tant qu’humains, conçus dans l’imperfection, et faits de chair et de sang. Nous négligeons nos faiblesses et nos imperfections pour abuser démesurément des possibilités dont nous sommes dotés.
Et c’est cette arrogance-là, qui souvent, a causé notre perte.
Pour moi, le 11 septembre représente un jour effroyable qui oblige à un moment de réflexion, de compassion, de questionnement de soi et de solidarité universelle.
On se demande pourquoi des vies sont épargnées et d’autres détruites ? Pourquoi celui-ci a eu la vie sauve et non l’autre ? La conclusion à en tirer est la suivante : on ne meurt qu’à son heure, au jour marqué. Là précisément où il faut quitter cette terre.
Le monde a connu des journées bien plus funestes que le 11 Septembre 2001, et en proportion, bien plus catastrophiques en termes de pertes de vies humaines.
C’est le cas du séisme de Shananxi en Chine, en 1556, où 100.000 morts furent enregistrés en une journée ; du Tsunami du 26 décembre 2004 dans l’Océan Indien où périrent 220.000 personnes en quelques heures; l’éruption volcanique du Tambora en 1815 en Indonésie qui coûta la vie à des dizaines de milliers de personnes, sans omettre Haïti et ces 250.000 vies effacées en un seul après-midi, le 12 janvier 2010.
Mais la différence entre le 11 septembre 2001 d’avec les autres tragédies, est qu’il n’y avait ni tsunami, ni séisme, ni guerre en prévision ou d’éruption volcanique. Un matin, sans avertissement préalable, et sans coup férir, toutes ces âmes qui se rendaient à leur travail, ont marché vers une mort certaine.
L’expérience du 11 septembre marquera à tout jamais les annales de ce pays. Elle a changé pour de bon notre style de vie. Des familles furent détruites, laissant derrière elles, qui des enfants orphelins, qui un époux ou une conjointe, ou des rêves inachevés.
Dans tous ces cas où survient une tragédie à grande échelle, l’impact psychologique sur les familles des victimes et sur la population des environs est toujours profond, dévastateur. Le post traumatic stress disorder ou « traumatisme d’après «est toujours poignant et récurrent. Les séquelles de cette journée noire, où tant de gens périrent l’espace d’un matin sont innombrables. L’impact sur les voyages est incommensurable. La prudence reste de mise. On monte toujours dans un avion avec le drame en tête.
Vingt-quatre ans plus tard, la plaie est à peine cicatrisée et la fin du cauchemar ne semble pas être proche.
11 septembre 2001. Je m’en souviens. Je ne m’en souviens plus. Et vous ?
Rony Jean-Mary, M.D.
Coral Springs, Florida.
Le 11 Septembre 2025
LA FAMILLE TAURIER
LA VIE EN LOUISIANE
La fratrie Taurier qui quitta le pays, était composée de l’aîné Pierre-Marie François Benjamin Sylvestre Roger, du second Joseph Charles-Marie Arnold Timothée Bernard, et de la fille Marie-Geneviève Sylvie Françoise Anne Justine. Marcel n’y faisait point partie. Le premier-né, un mâle, par tradition, jouissait du droit d’aînesse et pouvait prendre des décisions importantes de façon unilatérale. Jusqu’à présent, cela fut la plus importante, car irrévocable et surprenante, et elle a divisé la famille pour toujours. Roger ne souffla mot à leur mère, car elle aurait été un colis encombrant dans leur quête d’une nouvelle vie comme des blancs. La morsure de cette décision coupa la chair pire que celle qui est impitoyable d’un piranha. Lorsque leur mère apprit la nouvelle, elle eut une crise d’apoplexie et sa chute libre devint irréversible. Son cerveau perdit toute habileté à l’association de la faim avec l’appétit, de la soif avec la boisson, ou de la signification de la joie de vivre. Dans cette nouvelle perspective, la mort n’était plus considérée comme la faucheuse qui gâchait la fête de l’existence, mais plutôt comme la main généreuse qui offrait à l’être humain une courte échelle pour le bond vers l’au-delà, la fin des souffrances sur terre. Depuis ce jour, un compte à rebours de son décès dérapa dans une course à sens unique.
Malgré leur décision de trahir leur mère, son héritage génétique perdurait dans sa progéniture. Justine charriait les taches de rousseur et le séant identiques à sa génitrice. Bernard portait le même nez camus tandis que Roger partageait le visage joufflu. En dépit de ces empreintes indélébiles acquises dans la matrice maternelle, cette fratrie, en délaissant Saint-Domingue en 1801, avait commis l’ultime acte cruel. La genèse de ce revers remonte à des années plus tôt.
Choyée par leurs parents, la fratrie s’aimait bien et s’entendait à merveille. Envoyés en France pour leur éducation, les garçons sont revenus changés. On n’encourageait point les filles à développer leur cerveau. Justine était restée à Saint-Domingue. Roger et son frère benjamin, Marcel, tous deux brillants, jugèrent les faits à partir de portées opposées. Leur passage en France a laissé des empreintes différentes. Une différence d’âge de quatre ans les séparait, mais leur mentalité s’écartait comme l’étendue d’un océan. Roger s’arrangeait fièrement avec la Royauté et sa hiérarchie distincte séparant les classes ; cette analyse, de son point de vue, s’étendait aux groupes ethniques et aux genres. La culture française fascinait Roger. Il disait : « Ce milieu m’a comblé d’une épiphanie existentielle et salvatrice. Il m’a transformé à jamais. » En riposte, Marcel expliquait, « J’ai fréquenté ce milieu, je le connais et j’apprécie son jus qu’elle détient, mais je rejette sa lie qu’elle partage et qui nous étouffe. » Roger le curieux, durant son séjour en France, toujours friand d’événements contemporains, était un témoin oculaire de la Révolution française de 1789. Il lisait les journaux si avidement pour progresser en un véritable mordu de la politique. Il se rendit compte immédiatement de l’emprise de la puissance économique dans les décisions géopolitiques. Il conclut que le don de la Société des Citoyens de Couleur libres de 6 millions de livres à l’Assemblée Nationale via la Société des Amis des Noirs, présidée par Condorcet, permit à ces acteurs d’entrer en lice pour leurs droits. Il devina que les adeptes du Club Massiac se comportaient de même pour défendre leurs intérêts opposés. Donc, il prit la décision de n’être jamais pris au dépourvu du point de vue matériel et stratégique. À titre personnel, il ne voyait qu’une montée vers le haut dans la société et il ne voulait pas perdre cette gageure.
Marcel pendant son passage en France, vit un paysage différent. L’hypocrisie de la Déclaration des droits de l’homme par des intellectuels qui bénéficiaient financièrement de l’exploitation des autres humains à travers l’esclavage le déroutait. L’idée d’une race inférieure à une autre le consternait. Sa performance académique, comme un sang-mêlé, égalait celle des autres qui n’avaient pas de métissage. Il passait un bon bout de son temps dans les bibliothèques et il pouvait lire sur la sensation de l’époque, Benjamin Banneker, un Américain, métis comme lui, fils d’esclave, mathématicien et astronome autodidacte capable de prédire les éclipses solaires. En guise de préjugé a priori, l’investigation scientifique le captivait. Les deux frères entretenaient des discussions passionnées pour défendre leurs différents points de vue. Bernard s’alignait avec son frère aîné Roger qu’il adorait et imitait, dans la meilleure illustration d’harmonie fraternelle. Roger dominait sa sœur et l’avait prise sous sa protection. Elle le suivait depuis la nuit des temps, la modèle de Semper fi. Le séjour en France pour les frères qui s’aimaient tous, malheureusement, avait mal fini. Adieu au ciment de l’union, bienvenue au glaive clivant. À sa façon, la France dessilla leurs yeux, mais dans des directions divergentes. Aucun sujet n’a suscité autant de disputes que l’esclavage. Roger le vit comme un outil nécessaire qui créait la richesse pour les planteurs. Marcel aperçut une organisation ignominieuse qui utilisait des méthodes brutales pour dominer certains individus tout en avantageant d’autres. Ainsi, une guerre froide entre les deux camps mijotait. Comme conséquence, deux camps séparés par une paroi étanche siégeaient dans la famille.
****
Lorsque les réfugiés de Saint-Domingue vinrent en Louisiane, ils découvrirent un environnement à la fois similaire et différent de leur propre. Ce que nous connaissons de nos jours, comme l’État de la Louisiane constituait un vaste territoire allant du sud au nord du golfe du Mexique à la frontière canadienne et de l’est à l’ouest du fleuve Mississippi aux Montagnes Rocheuses sous le nom de « Territoire de la Louisiane ». Les événements qui se passaient à Saint-Domingue produisaient des retombées par-delà ses limites géographiques. En effet, Napoléon, grand tacticien militaire, mais piètre homme d’État, aveuglé par sa négrophobie, rata une occasion de continuer son emprise sur Saint-Domingue à travers Toussaint Louverture. De surcroît, il avait besoin de beaucoup d’argent pour soutenir son armée et les multiples guerres entreprises. Son échec cuisant face à une armée d’esclaves créa une pénurie monétaire urgente. L’embarras de cette débâcle de proportion historique se fait sentir encore de nos jours, car les élèves français ne l’apprennent pas en classe d’histoire. Thomas Jefferson profita de cette conjoncture précaire de Napoléon pour la transformer en une opportunité pour son pays. Le malheur de Napoléon fit le bonheur de Jefferson : l’aubaine de doubler la superficie de son pays. Ainsi, en fin de 1803, il acheta cette étendue pour une valeur de quinze millions de dollars, soit sept centimes par hectare. Naturellement, les livres d’histoire se gardent bien d’établir la connexion entre les deux paradigmes, mais cela ne peut pas duper ceux qui suivent la ligne woke de l’analyse en dépit de l’assaut lancé contre elle. Au début du dix-neuvième siècle, l’actuelle Louisiane n’était ni peuplée ni très développée.
Au fait, la traversée de Saint-Domingue à La Nouvelle-Orléans pour ces réfugiés fut un calvaire. Au premier lieu, le navire arriva au port de Biloxi qui fait partie de l’actuel État du Mississippi. Le reste du trajet emprunta « la route des caravanes » de l’époque, fameuse comme terrain difficile et marécageux. Dans un territoire tropical, l’humidité s’associe à l’abondance des moustiques avares du sang humain. Dans le jargon de l’époque, ces zones marécageuses se nommaient « lagunes ». On devait se frayer un passage à travers des forêts vierges, et quasiment impénétrables. La faune incluait des serpents venimeux. Le trafic fluvial de grande envergure menant à la Nouvelle-Orléans devrait attendre quelques années plus tard. Entre-temps, le transport se faisait en carrosse, en dos d’âne ou de cheval et même à pied.
Après un voyage éreintant, les deux frères et la sœur arrivèrent à La Nouvelle-Orléans dans la première vague de réfugiés de leur terre natale. L’histoire retient qu’entre 1809 et 1811, le nombre augmenta considérablement. La Nouvelle-Orléans, alors, comme maintenant, comprit une majorité de basanés, mais n’avait pas encore acquis sa réputation de centre principal de commerce d’esclaves. Sa position stratégique sur la rive du fameux fleuve le Mississippi incita un explorateur, de Bienville, à y fonder ce port en 1718. Les habitants hésitaient à choisir entre l’Espagne et la France. De fait, la France avait cédé la zone à l’Espagne en 1762 comme butin pour son soutien durant sa guerre avec l’Angleterre. Les réfugiés trouvèrent une ville récemment rénovée par les Espagnols après le fameux incendie de 1788 qui l’avait rasée à 80%. La France réclama ses droits en 1800. Sous l’égide de la France et de l’Espagne, deux pays en grande majorité catholiques, les divisions géographiques en Louisiane se faisaient à partir de la paroisse d’une église et non d’un comté. Ainsi, la Nouvelle-Orléans est dans la paroisse d'Orléans ; au nord de cette agglomération, une autre paroisse, Saint-Charles, à l’époque, retenait une population de descendants allemands aussi bien que de Français expulsés de la Nouvelle-Écosse du Canada. Ces Français étaient connus sous le sobriquet « Acadiens ». De nos jours, ce mot a évolué en « Cajun ». La paroisse de Saint-Charles contenait des espaces immenses prêts pour de grandes plantations. La population parlait français et créole.
Les débouchés à La Nouvelle-Orléans dépendaient du statut social de l’individu. On pouvait se lancer dans le commerce ou l’on pouvait gagner sa vie comme ouvrier. À cette époque, les plantations étaient modestes et la population d’esclaves assez restreinte. Pour les femmes, à moins d’être mariées, les débouchés s’avéraient assez limités. Pour les réfugiés, ceux qui venaient chargés d’argent trouvèrent les portes ouvertes. Pour les autres, c’était une autre affaire. La société obéissait à des règles parfois rigides ou fluides. La hiérarchie sociale dépendait de la classification de groupe ethnique. Le tout se centrait simplement sur la carnation. Donc, la fratrie Taurier, issue d’un Caucasien et d’une mulâtresse, appartenait au groupe quarteron. L’ascendance demandait le croisement avec un Caucasien pour devenir un octavon et ainsi de suite pour éliminer toute trace africaine. On devait renoncer à toute source autre qu’européenne et cette démarche méticuleuse acquit les éléments d’une hantise. Pour ainsi dire, devenir plus royaliste que le roi. « Passer pour blanc », loin d’une injure, retenait le cachet d’un achèvement social tacitement consenti en obéissant et exécutant les règles et la fierté de se bomber la poitrine pour se dévêtir de la tare d’association avec une classe traitée comme sous-humaine. Personne ne peut pénétrer l’esprit de l’individu qui se sent confortable à renier ses parents pour se rehausser socialement. Personne ne saura le conflit interne tel un dédale émotionnel de rejeter ses racines, la psychose de peur d’être démasqué et l’opprobre subséquent. On ne peut que s’imaginer le doute possible que la raison ou la conscience infiltre sur cette décision infâme, irréversible, égoïste et, en tel cas, le pincement au cœur ressenti. Ce qui est certain, pour être pur jus, c’est qu’on ne doit jamais donner l’impression de sympathiser avec les dossiers épineux, chers aux membres du groupe abandonné, l’esclavage en tête de liste.
Tel fut le fardeau volontaire au dos de chaque membre de cette fratrie. L’aîné, Roger, méticuleux, astucieux, avait préparé le départ en prenant soin de ne laisser aucun détail au hasard. Il avait accumulé de l’or d’une valeur considérable pour la traversée. Arrivé à la Nouvelle-Orléans, il n’avait aucun désir d’aider les autres réfugiés qui n’avaient que leurs habits sur le dos. « Je n’ai de responsabilité que ma petite sœur et mon frère ». Roger avait suivi les transactions de son père dans la gestion de sa plantation ; ainsi, il se sentit bien imbu pour établir une entreprise commerciale. Il avait l’expérience, les ressources. La question demeurait : quelle entreprise créer ? Il observa la position stratégique du port et, d’après les cartes, l’importance potentielle du transport fluvial pour le commerce. Les denrées récoltées devraient être expédiées dans les autres territoires. Il arpenta la région et visita la paroisse au nord de La Nouvelle-Orléans. Les vastes étendues de terre l’impressionnèrent. Il observa la carence d’esclaves, une entorse à la formule de la croissance en utilisant une main-d’œuvre gratuite. Cependant, à cause du prix bas des lopins, il acheta une centaine d’hectares. Il établit un entrepôt et se lança dans le commerce des denrées en gros. Il instaura une maison du nom de « Taurier et Frères, S.A. », un mélange de quincaillerie, provisions alimentaires, où la vente en gros et en détail allait bon train.
Il ne tarda pas à suivre les mœurs locales. Les hommes d’affaires à succès se procuraient une épouse de la campagne, mais prenaient leurs ébats en ville avec une femme dans le quartier chaud de la rue Bourbon. Deux ans plus tard, pour clore son ascension sociale, Roger épousa une descendante allemande de la paroisse Saint-Charles, du nom de jeune fille Frederika Glaubt. Bernard, qui vivait à l’envi de son grand frère, quelques mois plus tard, jeta son dévolu sur une Arcadienne, Catherine Nevers. Chaque épouse calquait l’idéal aryen : une blonde avec des cheveux soyeux rappelant la barbe d’un épi de maïs. Dans le cas de leur sœur, Justine, la situation suivit un parcours imprévisible. En effet, durant la traversée du pays natal à la nouvelle destination, un jeune officier de l’armée de Rigaud, Frédérique, lui envoya une œillade et furtivement engagea une cour. Sans crier gare et à l’insu de tous, il saccada son être avec des mots adoucissants qu’elle ne put oublier. Ce genre de réaction, qui entre deux personnes d’habitude, entraîne une liaison amoureuse, menaçait de naufrager dès le début. Beau comme Adonis, un mulâtre, mais pas « passable », sans un sou, les frères ne l’acceptaient pas. « Tu n’as d’autre choix que d’accepter un blanc, même s’il est pauvre. De cette façon tu pourras compléter l’ascendance hiérarchique sociale». Elle croyait dans ce principe et, simultanément ne pouvait oublier le sourire engageant et la voix balsamique de ce chic compatriote avec un physique qui représentait l’éphèbe de ses rêves. Ils se rencontrèrent de temps en temps malgré l’interdiction, car son cœur était accroché.
Ils étaient tous en terre étrangère pour la simple raison qu’ils ne pouvaient pas tolérer le concept d’égalité avec ceux choisis comme esclaves. Justine savait bien que sa persistance avec ce prétendant l’emmènerait dans un sillon similaire au sort de sa mère. Les frères étaient déterminés à faire table rase avec leur passé. Leur décision cynique avait coûté la vie à leur mère après leur départ. Leur comportement clairement indiquait que la possibilité du décès ne les aurait point ébranlés. Justine pourrait obtempérer à la règle de ses frères et épouser un blanc et risquer une vie gâchée au cas d’incompatibilité. Elle pourrait tout aussi agréger sa vie à celle de son intendant et risquer un pire sort de séparation de ses frères en pays étranger. Une troisième option demeurait de rester vieille fille pour la vie et de haïr le choix fait de laisser la terre natale et de ne pas suivre son cœur et ce faisant, de tenir une dent contre ses frères. Ce bras de fer potentiel ne pouvait ignorer une autre réalité : si on était démasqué, on pourrait toujours plaider et espérer être accepté comme une personne de couleur libre pour éviter l’esclavage. Cependant, ce statut de personne libre charriait des restrictions de droits civiques, tout comme dans la colonie. Au lieu de prendre une décision définitive, Justine tergiversait. Elle ne coupa pas sa liaison avec son intendant ni ne désobéit pas ouvertement aux dictats de ses frères.
Peu de temps après son mariage, Roger eut l’occasion de prouver sa trempe. La famille de son épouse subit des pertes aux mains de ses deux esclaves, car ceux-ci voulurent commencer une insurrection. Roger joignit un groupe de miliciens blancs qui poursuivirent ces marrons, les capturèrent et les exécutèrent. Pour intimider les autres esclaves, la tête de chaque rebelle fut empalée sur une pique et exposée publiquement. Il établit ses lettres de créance de négrophobe et s’est fait aimer par la communauté blanche. La petite communauté des réfugiés prit ombrage de sa fortune. Son succès dans les affaires causa un peu de jalousie, surtout qu’il agissait comme un égoïste qui n’aidait pas les autres réfugiés moins chanceux. Son opposition à la liaison de Frédérique avec sa sœur laissa un goût amer dans leur bouche puisqu’on le connaissait comme un mulâtre, et non un blanc. Dans cette communauté, on ne s’opposait pas à « passer pour blanc », mais on s’attendait à un traitement généreux, à l’entraide, entre ses membres.
Roger, comme homme d’affaires, eut un succès phénoménal. Il s’aventura dans le transport fluvial, améliorant le passage de Biloxi à La Nouvelle-Orléans et de l’embouchure du Mississippi au port. Comme hommes mariés, son frère et lui restèrent bredouilles dans leur quête d’une progéniture. Justine, qui vivait dans sa maison parce qu’il voulait la protéger, ne s’entendait guère avec sa belle-sœur Frederika, qu’elle croyait rapace et pas si éprise de son frère. Pour maintenir l’harmonie conjugale, Justine dut déménager et emménager chez Bernard. La même scène se reproduisit, car les deux femmes ne se toléraient pas et se considéraient comme rivales. Frustrée, Justine accepta l’offre de Frédérique et ils vécurent en concubinage. Elle avait soutiré de l’argent de ses frères pour établir une taverne dans le quartier français, « Le Palais fin".
La loi ne permettait pas le mariage entre blancs et non-blancs. Justine officiellement vivait comme une blanche. Ses deux belles-sœurs lui interdirent l’accès à leur maison. Dans leurs yeux, elle avait choisi la race noire sur la race blanche et devrait être considérée et traitée comme telle. La règle cynique à laquelle toute la clique participait, avait engendré une victime. Justine accoucha d’un bébé garçon en bonne santé, six mois plus tard, à la consternation des deux couples jaloux. Roger voulait continuer la lignée et ne pas pouvoir enfanter un garçon représentait la pire malédiction possible. Il ne pouvait pas concevoir avec sa femme, mais il n’était pas stérile non plus. Les hommes aisés à La Nouvelle-Orléans à cette époque d’habitude supportaient une maîtresse, de n’importe quelle race. Dans ce cas, il s’agissait d’une jeune femme foncée, une « griffe », une métisse de Noir et d’Amérindienne, selon la classification d’alors. Une femme aguicheuse à première vue, bien en chair, experte en plaisir lascif. Roger la décrit ainsi à son frère : « Elle m’a initié à la volupté, un sirop qui t’ensorcelle et dont on devient accro instantanément. Elle m’induit à commettre le péché auquel je ne peux pas résister. » Bernard n’avait pas besoin de meilleure incitation pour trouver sa propre maîtresse, la petite sœur de celle de Roger, aussi orageuse au lit, provocatrice dans sa démarche ou sa parure et ravissante à la vue.
Pour la grande surprise de Roger, sa maîtresse devint enceinte et lui donna une fille qui ressembla beaucoup à sa mère. Bernard n’était pas si chanceux. Stérile, il ne pouvait pas enfanter. La fratrie Taurier pour laquelle l’ascendance comptait tant, ne pourrait pas avoir une progéniture octavonne. Le seul garçon de la lignée appartenait à leur sœur, maintenant bannie parmi la race de métis, interdite de jouir du statut d’Aryenne. La fratrie avait réussi financièrement. La taverne de Justine regroupait les réfugiés qui y venaient pour savourer la cuisine d’antan, le grog local qui rappelait le clairin du pays natal. (à suivre).
Reynald Altéma, MD
An Inquiry into Social Resilience in Five Steps
Sep 11 |
I'm an anthropologist who works on governance and development problems around the world. Using my personal experiences and observations I write about how economic processes and human relationships build (or destroy) social systems and the institutions of governance.
Which communities will succeed, and which are failing? Many lines of inquiry claim to come to their own conclusions. Do they differ from each other? My own line of inquiry concluded that in order for a community to succeed (i.e. be “resilient”), nature must be understood as an integral part of its governance. My line of inquiry as an anthropologist concludes that nature cannot coexist in a resilient governance model alongside social exclusion and corruption.
First step: My introduction to the anthropology of agriculture.
I was transfixed as I left Professor Boyd’s class. In that very first lecture he combined everything that fascinated me—anthropology, geography, ethics, law, political science, agriculture, economics, humor, mythology, philosophy. He even passed around a small paper bag of what I assumed were salted nuts; someone later told me they were salted insects, but I didn’t believe him. He had just returned to the United States from fieldwork in Papua New Guinea (“God’s country,” he called it) and he was bursting with stories about the isolated Stone Age communities he had left behind. People there had been living, fighting, loving, dying, and creating for thousands of years in majestic thatch-roofed villages in the clouds, without formal currency, legal systems, or institutions—relying instead on the honor and trust each person built. Every aspect of their lives wove myths, fear, bravery, fellowship, gardening, camaraderie, debt, wealth, birth, and death into interlaced concepts, spoken and sung in a thousand languages and scattered over nine hundred and eighty mountaintops.
In subsequent classes he revealed the magic, horror, and elation of a faraway world where people were constrained less by institutions than by fear, hunger, and one another. Though everything in their lives seemed tethered to the forces of nature and the spirit world, his course focused on how people produced food, and on the social economy that grew around that labor. I was especially drawn to pigs, because beyond providing the family’s largest source of protein, pigs were prolific breeders and a preferred medium of exchange in a world where currency did not exist. What little written work I could find about the economics of animal production in Papua New Guinea (PNG) appeared in short, obscure references that were often buried in accounts of intertribal conflict. Much of it framed livestock as social capital in moneyless communities. Some compared the birth of piglets to yields in what economists in my western world would call interest-bearing accounts.
As one of the first students in agricultural anthropology at Columbia University back in the seventies, I was excited by a torrent of follow up questions, with which I engaged professors in other courses. The economists I consulted struggled with my insistence on trying to define value without the concept of price. And the sociologists I consulted struggled with my preoccupation with the economics of social standing. I talked with psychologists about individualism and group cohesiveness. I read and interviewed as much as I could on the economics of barter and social capital, but my questions were pushing beyond labor and agricultural economics into models where the acquisition and consumption of protein were central to rural labor, exchange, and political relationships. In PNG responsibilities for pig production were shared in mutual or reciprocal interdependence, in which every task was strictly assigned, so that each person’s work was necessary for the other’s to matter. As in many other agricultural societies, farm responsibilities were divided either into mutually interdependent roles where farming families relied on each other to achieve their outcomes, or into reciprocally interdependent roles where their work flowed back and forth. Most of the tasks in family farm food production are reciprocally interdependent, so that each family member’s output becomes the others’ input in iterative cycles, with each one’s role being complementary to those of the others. In PNG as in other societies the roles were more than simply raising a pig and producing meat.
Second step: Differences over resource management pressures creates political conflicts between entire communities.
After graduate school and a few years in an international education job I joined the Peace Corps to manage a rural development program in Mali. Though the main sources of animal protein in Mali are sheep, cattle and goats, all livestock are windows into family status and relationships. Age old politics and social issues, which have contributed to today’s full-fledged war, were important even back then. Nomadic herders in northern Mali clashed with settled farmers in ways that echoed the cattle-and-fence wars of the nineteenth-century American West. In each place, - whether PNG with pigs, Mali with sheep and cattle, or the American West with cattle, - people’s social conflicts were expressed through economic assets on four legs. Favors and grudges were enflamed or placated over access to water and grazing rights; livestock was traded, pledged, or withheld to establish or change political and security relationships. Mali is a living laboratory where one can see how livestock-related resource management pressures can affect political and social conflicts between people as well as between entire communities.
Third step: Being one of man’s earliest domesticated food animals, the pig became a social symbol and economic asset ever since the dawn of society. So the pig has been a natural candidate to be society’s first and most enduring scapegoat. An excellent proxy for the evils in society, the pig has been blamed for social and governance shortcomings.
A few years later, I was transferred to Haiti as the Peace Corps’ first Country Director. Soon after I settled in and began traveling, one fact stood out: Haiti’s food self-sufficiency was under siege. African Swine Fever (ASF) had appeared next door in the Dominican Republic in 1978. With a strong ministry and trained animal-health services, the DR announced eradication within two years, sadly at the price of slaughtering nearly half a million pigs. The ASF virus crossed into Haiti, where the government aimed for a similarly swift victory despite having twice the population, half the agricultural infrastructure, and a fraction of the budget. But in 1982, just a year before I arrived, Haiti’s then “President-for-life” smugly declared the virus vanquished.
For such a triumph, achieved with so few resources, one might expect a national celebration of sorts. Instead, there was a quiet uneasiness. Agronomists I met avoided discussing their roles in the eradication of the virus. It had involved culling of tens of thousands of pigs killed in gruesome pits beside rural markets. Farmers were angry: pigs had been their savings accounts, the mainstay of household investment; often their route to school fees or emergency cash. Besides the different levels of efficiency of the two countries’ institutional responses to the ASF problem, the social impact of their eradication experiences differed like night and day. In the Dominican Republic not all the pigs were owned by small peasant farmers. Many were owned by agricultural businesses, and so the culling program had an effect in rising prices rather than a social disaster in the peasant economy. To make things worse, in Haiti when success was declared, the agency created to cull infected pigs was quietly and quickly shut down. In many communities its staff simply disappeared overnight. There was no budget for monitoring or social-impact measurement, or after-action review and, as far as I could tell, hardly any baseline data had been collected at the start. Donor agencies that had funded the slaughter retreated behind opaque statistics. Discussions were rife that a modern swine industry could soon be built, but planning was not being publicly discussed. The Agriculture Ministry created a “sentinel” herd to watch for reappearance of the virus. The problem had entered the realm of politics and social trust.
The economic consequences unfolded quickly. The rural economy slid into depression. Young, broke farmers migrated to cities not prepared to receive them. Labor and capital fled the countryside. The sentinel program eventually declared the country virus-free, and a small, U.S.-funded, stopgap repopulation project began, distributing virus-free piglets to cooperatives under strict conditions. The team was capable; targets were met. But the design had blind spots. Beneficiaries needed bank accounts to prove they could buy commercial feed before they could receive piglets. Banks, however, opened accounts only for men, excluding women from legal ownership of the new pigs, even though women had long been central to pig production. Imported feed was expensive; local mills were unreliable in times of unrest. The repopulation program’s reports ticked off kilograms of feed and workshop counts, but rarely addressed governance and inclusion. Volunteers and extension agents saw the truth on the ground: pigs had never been just meat; they were family economies, gendered labor, and community trust made visible.
In the absence of data and fueled by a growing sense of schadenfreude directed against the aid sector, conspiracy theories flourished. It was quickly amplified by chatter on the internet, a nascent medium, and the small swine repopulation project became a lightning rod online. By the time I completed my post in Haiti, the President-for-life had fallen to a movement fueled in large part by rural anger carried into the cities by displaced youth. It was clear that modernizing the swine sector would take more than technical fixes. It would require confronting governance, equity, and an understanding of the social meaning of livestock.
The pig, as an animal, was not complex; the economic role and social meanings layered upon it, though, were. Years later, Dudley Alexis, the renowned Haitian documentary film maker, would stitch together much of the story for a highly acclaimed PBS documentary and I was honored to share my observations as one of the film’s key interviewees. The film can be viewed online at “YouTube: The Creole Pig”.
Fourth step: Increasingly, human society is incorporating nature into governance to the point where nature is no longer blamed for society’s shortcomings.
My next assignment took me to Senegal to manage a rural credit project and bring it to scale. My colleagues and I eventually privatized it into a highly successful cooperative institution that now operates across multiple countries. Back in a Sahelian sheep-and-cattle country, livestock were everywhere in my work and my thoughts. I paid attention not just to how people related to their animals, but to how they related to each other through those animals. Religious calendars, marriages, circumcisions, these events set the rhythm of buying and selling as surely as rainfall and pasture. In Haiti, as in Senegal, Mali, and PNG, livestock was mapped onto social time and political life.
I developed a way to assess the economic and social realities of communities when making village visits. This enabled my project to determine not only the real economic health of the community but also its resilience. This was eventually the basis of the credit program’s success and enabled it to eventually scale up from a donor-funded project into a borrower-owned firm. The method was straightforward: besides the health of the livestock and the way families shared in production, the number and ages of the animals would signal whether the family was preparing for trade, for celebrations, for lean seasons and Harmattan winds, for displacement, or for civil strife. Everywhere, livestock were proxies for wealth, identity, and order. It didn’t have to be pigs. Whether sheep, goats, or cattle, they played the same role in managing risks and constraints.
A fortunate assignment then followed to manage a grant-making program in Madagascar to build local private sector support for environmental conservation. Stunning cases of destruction of fragile natural resources due to poor governance and corruption made it impossible for conservation initiatives to gain popular support. Every review of past efforts at creating sustainable and resilient systems consistently showed in order for a community to be resilient, nature had to be inclusively managed. And in order for nature to be inclusively managed, governance and corruption had to be addressed. Our success in laying the groundwork for establishment of the Masoala National Park, Madagascar’s largest protected area, was only possible because where Malagasy traditions and ethics prevailed, conservation simply became part of good governance. It was clear that in many societies, the relationship with nature and poor environmental management are issues of governance and power.
Eventually I returned to Haiti, this time to direct another grant management project that had a strong civic development component. It was the perfect suite to the Madagascar program. As I reconnected to old colleagues I learned that though the economy had not recovered and consumer purchasing power had not increased a great deal since the eradication program, pigs had once again become available in village markets. Local feed producers, who had been competing against imported feed to set their prices, found that they could not compete against farm scraps. Farmers resumed feeding pigs as before: field scraps in the countryside, garbage heaps in towns. Litter sizes fell; free-ranging pigs returned. The crisis and its “solution” had come full circle, and the lessons were not agricultural so much as institutional.
Fifth Step: I had gone beyond the anthropology of agriculture into the anthropology of governance.
Our relationships with nature are changing, and our need for scapegoats from nature are diminishing. We no longer need to explain our differences or justify our conflicts or social ills by placing blame on animals or the natural world. The complexities of pig production that I first studied in Professor Boyd’s classroom were the first step in a series of explorations into how nature is being incorporated into governance.
Looking back over my notes, I realized that the pig, being one of humanity’s earliest domesticated food animals, has long served as a ready scapegoat for social blame. Before governance systems were robust enough to confront wrongdoing and social conflict, we assigned to nature the blame we were unwilling to assign to ourselves. At the national level, relationships with nature are now encoded in park systems, animal cruelty laws, rules for lab use, fair use laws, even in the constitutional legal personhood for natural features in some countries.
I curated my notes into a book, “Who Put the Devil in the Pig?” (published on both Barnes & Noble and on Amazon). The title is a play of words and images. The “devil” stands for the many collective failures of human society through time. And the “pig”, being our oldest domesticated food animal, stands for society’s relationship with nature. To “put the devil in the pig” is to export our guilt onto the natural world, thereby absolving ourselves.
The answer to the question in the title, of course, is: We all did.
Bertrand Laurent
The Governance and Ethics Committee is pleased to announce to the membership of the Association that at the completion of the electoral process held at the 52nd Annual Convention of the Association in Gosier, Guadeloupe July 20-25, 2025 a new Central Executive Committee (CEC) has been formed. It is composed of: AMHE Inc. - Central Executive Committee 2025-2027 President: Schiller Castor, MD President-Elect: Dr. Karl Latortue Vice-President: Yasmine Titus-Pompei, MD General Secretary: Francelot Moise, MD Assistant-Secretary: Fahimi Saoud, MD Treasurer: Harold Laroche, MD Assistant Treasurer: Nancy Calixte, DPM Immediate Past-President: Jean Rony Jean-Mary, MD Congratulations to the new executive members of the Haitian Medical Association Abroad.
Ducarmel Augustin, MD Rapporteur |
A Call to Action
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For more than five decades, the Haitian Medical Association, better known as the Association of Haitian Physicians Abroad (AMHE), has been a lifeline for our community. We have bridged borders, shared expertise, and delivered hope when and where it was needed most. AMHE, through the generosity of its members, has championed access to health care, contributed to educating the next generation of Haitian medical professionals, and stood as a beacon for our people both in the U.S. and in Haiti and elsewhere.
But our ability to continue this vital work depends on you. It relies on your generosity and the membership dues you pay.
Why Your Membership Dues Matter
Your annual membership dues are more than just a contribution—they are an investment in the health, education, and resilience of our people. Here’s how your personal and financial support make an impact:
Medical Missions & Training – We provide critical training for healthcare providers in underserved communities in Haiti and Haitian diaspora neighborhoods in the U.S.
Student & Resident Mentorship – We offer scholarships, mentorship, and professional opportunities to Haitian medical students and young physicians, ensuring the next generation receives the support it needs. Such support is needed more than ever before.
Disaster Response – In times of crisis—whether earthquakes, hurricanes, or public health emergencies—AMHE mobilizes resources, expertise, and supplies quickly and effectively, delivering relief where it is most needed.
Raise Community awareness: Through its chapters, AMHE delivers education radio programs; virtual meetings to reach those unable to connect in person.
We accomplish these through your contribution. As a united force—we are stronger together!
Renew your membership today: https://aohpa.wildapricot.org/https/aohpa.wildapricot.org/Membership and keep hope alive!
The Power of Unity
When we each do our part, we make an extraordinary impact. This can only be accomplished through the support of everyone. Paying your dues on time ensures that AMHE can plan initiatives, expand programs, and respond swiftly to urgent needs.
Your membership is more than a line in a database—it is a statement of commitment to your peers, your profession, and your people.
A Legacy Worth Sustaining
Most of us agree that AMHE is a legacy worth preserving. We are part of a proud tradition. Since its founding, AMHE has shown the world what Haitian medical professionals can achieve when united. Our past accomplishments, whether in the operating room, the classroom, or the disaster zone, are proof of our collective power. But history will judge us not only by what we have done, but by what we choose to do next.
Let us not allow this moment to pass without action. Let us recommit ourselves to the vision of a healthier Haiti, a stronger diaspora, and a united AMHE that continues to inspire as it has throughout history. There are numerous reasons why we band together to carry the AMHE legacy into the future. Here are a few reasons why we must carry this legacy forward:
Top 5 Reasons to Renew Your AMHE Membership Today
Save Lives in Haiti and the Diaspora
Your dues fund medical missions, emergency relief, and critical health programs for those who need it most.
Support the Next Generation of Haitian Physicians
Scholarships, mentorships, and residency support help young doctors thrive and carry our legacy forward.
Strengthen Our Collective Voice
A united membership gives AMHE the influence to advocate for health equity and fair policies affecting our communities.
Stay Connected and Informed
Gain access to professional development, continuing medical education, and a network of Haitian physicians worldwide.
Be Part of Our 52-Year Legacy
Every member is a link in a proud chain of service, leadership, and impact that spans decades.
Renew Today. Let’s continue building a healthier future—together.It takes just a few minutes to renew. Visit us at: https://aohpa.wildapricot.org/https/aohpa.wildapricot.org/Membership
Marie Michaël Débrosse-Bruno, DMgt
Executive Director, AMHE
South Florida AMHE Chapter
Alexandrins de la Vérité de Demain
Une fois marié(e), tu fais tout un autre choix
Tu t'engages à fond dans une nouvelle voie
Oublies tes regrets et ton passé quel qu'il soit,
Simple ou composé et retrouves ton vrai moi
Dans le présent créateur où par mille choix,
Forgées dans l'action, la volonté et la foi,
Fusionnant leur faisceau d'énergie et leur poids,
Changeront l'imparfait en parfait mille fois ,
Par le Pouvoir réel de la confiance en toi
Grâce au miracle de l'amour, le seul vrai Roi .
Jean Serge Dorismond MD
PAPA
Tu m’as guide dès mon premier voyage
Et j’ai suivi inconsciemment, ce soir-la.
Les instructions qui m’ont permis, avec patience
De délaisser les entrailles de Maman,
Tu nous as offert un premier amour, sans âge,
Qui a su nous protéger dans le noir,
Alors que je suis reste impatient, avant de voir le jour,
Dans une atmosphère d’allégresse.
Papa, tu es cette muraille qui nous a protégés
De tes bras musculaires autour de l’abdomen.
Tu m’as guide dans mes premiers pas
Pour m’apaiser à chaque fois.
Tu es ce guerrier qui a veillé sur moi
Sans même m’avoir rencontre.
Tu es cette barrière qui nous a clôturés
Dans une vie de combat.
Tu nous a rassure tout bas
Pour nous venger si malheur nous frappait.
Tu as agi comme le gardien de notre destinée
En nous ramenant sur le bon chemin.
Nous avons craint ton courroux
Pour avoir dévie de notre mission.
Et ta colère nous a rendus conscient
De l’erreur du parcours.
Tu nous as assuré un bien-être
Comme pour te lier à nos cœurs.
Tu nous a consoles dans nos pleurs
Pour mieux étancher nos larmes.
Tu es notre premier bonheur
Pour n’avoir jamais douté de notre fidélité.
Et tu m’as donné l’espoir de croire
Que le monde entier était à notre portée.
Maxime Coles MD
(September 2025)
LA MORT DE CHARLIE KIRK :
L’IMPLOSION D’UNE SOCIÉTÉ AUX ABOIS.
Je n’avais jamais entendu parler de Charlie Kirk jusqu’au jour de sa mort.
Charlie Kirk, jeune influenceur américain, activiste conservateur, a été froidement assassiné en plein débat sur le campus de l’Université d’Utah Valley, dans le nord-ouest des États-Unis. De voir tomber si brutalement un jeune homme à la fleur de l’âge, provoque un choc. Il exprimait avec clarté ses idées, à travers des déclarations-chocs, et avait sa propre vision sur la façon dont son pays devrait être dirigé.
On peut dire sans sourciller qu’il est mort pour des idées auxquelles il croyait et qu’il a défendues jusqu’à son dernier souffle.
Force est de reconnaître que la violence ne date pas d’hier dans ce pays. On se rappellera les supplices infligés aux esclaves noirs de l’Amérique. On attachait leurs corps à des animaux pour les démembrer en les écartelant ; on les brûlait vifs pour étouffer tout sentiment ou velléité de révolte de leur part. On se rappellera aussi l’assassinat des Kennedy et de Martin Luther King et plus récemment, ces tueries dans des églises, ces fusillades en masse. Il n’y a aucun doute, la violence est imprimée à l’encre rouge dans le génome de la société américaine.
Je n’avais jamais entendu parler de Charlie Kirk jusqu’à ce 10 septembre 2025 où il fut assassiné. Mais à voir la manière dont il a su se construire une vaste communauté de followers et d’adeptes, il faut admettre qu’il était doté d’une forme de génie et d’un esprit hors du commun, même si certaines de ses thèses, étayées par des versets de la Bible tirés ça et là, s’apparentaient à des propos incohérents.
Pour un homme qui n’a pas fait de grandes études, il a véhiculé ses idées avec force et conviction et a révélé un talent oratoire hors pair. On a dit de lui qu’il était un nationaliste chrétien, un ardent défenseur des « valeurs américaines », un opposant farouche de l’avortement qu’il affirmait être une forme de contraceptif dans ce pays. Il soutenait que tous les immigrants étaient des criminels qui avaient un impact néfaste sur le mode de vie habituel du pays, et que les enfants d’immigrés qui naissaient sur le sol américain n’étaient pas des citoyens au même titre que les autres.
Charlie Kirk avait fait l’objet de plusieurs menaces dans le passé et aurait même changé ses lieux de débat ou annulé plusieurs de ses apparitions en public, pour éviter d’être la cible de ceux qui n’aimaient pas les idées qu’il représentait.
Le douloureux constat en cette tragique circonstance est que nous ne sommes plus cette terre de tolérance et de « respect de l’autre ». Notre société est en carence morale et en déficience intellectuelle. Trop longtemps, on a voulu ignorer les signaux de détresse qu’elle émettait. Elle ressemble à un corps physique en pleine décrépitude dont le maître refuse de se faire soigner, préférant se déresponsabiliser en culpabilisant les autres. C’est toujours l’Autre qui est la source de nos problèmes.
Le gouverneur de l’Utah, Spencer Cox, aurait préféré que ce crime fût l’œuvre d’un étranger, d’un immigrant en filigrane, plutôt que d’un américain dit « natif ». Ce faisant, il embrasse le crime tout en voulant le rejeter sur quelqu’un d’autre. Voilà le genre de pensée qui émaille le cerveau de nos dirigeants actuels. De ce moule sont issus ceux qui prêchent l’exceptionnalisme américain. Charlie Kirk y avait puisé sa théorie de « l’objectivité morale » des actes et des propos dont il se voulait l’avant-garde.
Nous avons une conception manichéenne de la vérité, comme si tout se concevait en bien et en mal, sans aucune zone grise où les deux puissent s’interpénétrer ou interagir. Il va en résulter un nivellement par le milieu aux conséquences imprévisibles pour le pays.
On dirait que cette Nation qui a bâti l’un des plus puissants empires de tous les temps est aujourd’hui à bout de souffle, incapable de se réinventer et de s’imprimer de nouvelles directives.
Les deux grandes tendances qui prédominent dans la vie politico- sociale de ce pays, la droite et la gauche, sont enlisées dans des travers de radicalisme, sans pour autant être capables de retrouver le sens du juste milieu.
Quand un groupe vous condamne à donner naissance à un enfant issu d’un viol ou d’un inceste d’un côté, et qu’un autre groupe revendique la possibilité pour un homme de donner naissance à un enfant en se faisant implanter un utérus, ne s’agit-il pas là de deux formes de radicalité qu’il faut réfuter à tout prix ? Et pour l’influenceur Charlie Kirk, une fillette de dix ans n’aurait pas droit à un avortement, lors même qu’elle serait violée par un criminel.
Notre collectivité, jouant les idiots utiles, prête trop souvent une oreille complaisante à tout ce qu’elle entend, sans aucune capacité de jugement ou de discernement. Deux grands maux la rongent : l’hypocrisie et la quête de sensationnalisme. C’est toujours à qui fait le plus de bruit que revient la dernière manche. On dit une chose et on en pratique une autre; et tout le monde veut jouer à la superstar.
On ne comprend pas trop bien ce qui a poussé le jeune Tyler Robinson à perpétrer un tel acte. Au tout début du drame, on accusait la gauche radicale d’être responsable de l’état d’esprit surchauffé et de l’ébullition politique constante que connaît le pays actuellement. Mais est-ce possible qu’un homme, prônant l’extrémisme tout comme la victime, ait pu être radicalisé en un laps de temps aussi court ?
L’autre hypothèse se base sur l’orientation sexuelle du meurtrier. Il habitait depuis un certain temps avec son partenaire, un homosexuel, avec qui il entretenait une relation sentimentale.
En raison de l’homophobie de Charlie Kirk, la grande question sera de déterminer si Tyler Robinson a agi pour des motifs émotionnels, avant d’explorer l’aspect politique du crime.
En résumé, Charlie Kirk n’était pas un homme de paix. C’était un homme très controversé qui n’avait aucune compassion pour les plus faibles. Il avait l’art de débattre sur plusieurs sujets à la fois, et si beaucoup de gens l’admiraient, il avait aussi beaucoup de détracteurs. Il a semé la haine et a pratiqué la rancune jusqu’au dernier jour de sa vie.
Toutefois, Charlie Kirk demeure une perte colossale, pour sa famille d’abord, pour le parti dont il était un adhérent et pour la communauté qui partageait ses valeurs.
Fallait-il pour autant mettre en berne le drapeau de la Nation suite à son assassinat ? Cela en dit long sur le degré de perversion, d’irrationalité et de déraison auquel on nous habitue. Son immaturité a conduit à sa ruine. C’était un gros bébé, un colosse aux pieds d’argile. Comme tant d’autres adultes enfantins de ce pays, parvenus trop tôt d’ailleurs au pinacle, il n’aura vu, ni vécu, que le quart ou le tiers de ce qu’il pouvait ou avait encore à apprendre. Il est mort comme il a vécu, en brave et intrépide mais aussi en imprudent cavalier.
Charlie Kirk a été déchiré par ces graines viciées qui germaient en lui, et qui l’empêchaient de grandir, de prendre de la hauteur.
Avait-il néanmoins mérité de mourir de sitôt ? Et de la sorte ?
Rony Jean-Mary,M.D
Coral Springs, Florida.
Le 15 Septembre 2025.
Dear Maxime
the fruit on the cover is NOT passion fruit!
I believe it is a variety of carambola or star fruit in english.
Passion fruit is what we call "grenadia" en Haiti.
It is one of my favorite flavor.
Congrats on your poetry.
Lucien Armand MD FACS MPH