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Shoulders of Giants

I had the delightful experience during my present trip to Haiti of meeting the Haitian dermatologist who noticed an uptick in Kaposi’s sarcoma cases within his clinic in 1981, and thus located the first cluster of AIDS patients within Haiti. The story he told me was a testament to the luck that plays such a big role within global health; he had worked for several years in Algeria, and as such had seen Kaposi’s sarcoma in that context and was familiar with the (still rare) disease. Upon seeing cases in Haiti, he reached out to the limited number of pathologists and dermatologists within the country in 1981, only months after the initial MMWR reports from New York and San Francisco came out. As he prepared a report based upon the 11 patients he and his colleagues found, a friend of his working with the CDC came for a visit to seek out precisely Kaposi’s sarcoma and PJP patients, based on CDC data showing non-gay patients of Haitian origin in the US also suffering from the recently discovered immunodeficiency disorder.
Several other Haitian physicians and public health practitioners contributed to these discussions, first leading to publication of their case series in 1982, and shortly thereafter culminating in the foundation of GHESKIO, one of the premier HIV research institutes and the first, to my knowledge, within a LMIC. More than 30 years later, after period of government intimidation, their group published impressive results of their initial cohort to start ART back in the 90s.
In addition to giving me an appealing model of what my semi-retired life might look like (this gentleman continues to teaching residents at two teaching hospitals and is employed to help with employee education at GHESKIO), he stands as a great example of how we move forward medical science, with a combination of preparation, curiosity, felicity, and perseverance.  As well as a great reminder that our colleagues in LMIC are equally talented (just limited too often by the resources at hand and the demands that they face).
(I didn’t ask for his permission to write about him, ergo I’m not using his name)
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