The Ethics of Business

[I thought that it might be nice to follow up my previous blog with a run down of the business aspect of things down here in Haiti . . . specifically, where I am working.  However, after an incident last night, I feel it necessary to update you on the bat status.  It turns out, I’m not as over my bat phobia as I had hoped. 

The ceilings here, in the main room are quite high, and open to the outside.  I was sitting down, minding my own business, eating my dinner, and all the sudden, a bat swoops in, flies in a circle, and goes right back out.  I may have gone into Vtach just for a moment, but then it went back to a normal rhythm.  I thought to myself, that’s fine . . . if this is what everyone is talking about, I can handle it.  It was not invading my personal space.  I was fine. 

Later in the evening, I was sitting in my room (which has a ceiling that is a lot lower), reading, when all the sudden a bat flew it.  My heart stopped as I prayed that it would exit just as quickly as it had entered, but it didn’t.  It just started flying around in circles.  I nearly jumped off my bed to the floor and got the hell out of there.  I stood in the kitchen, now with heart palpitations, hoping that it would just leave and never come back (with my history, fat chance, I know).   I finally made one of the doctors come check my room to make sure it was gone.  As we exited, the damn thing flew right past my face.  Once I was assured that it was gone, I attempted to sleep with a sheet over my head.  I began having flashbacks of the night of my bat attack in Columbia . . . the palpitations, the sweating, the fear . . . not good memories.  Every time I started to uncover my head, it would fly into my room again.  At this point, I’m fairly certain it was taunting me.  I fell asleep eventually, with a towel covering the back of my head.  I hope to God that it rains tonight, with the goal of creating a bat free bedroom!]

For my entire life, my dad has been the ‘beer man.’  He worked for Anheuser Busch since before I was born up to my intern year.  This was shortly after the big Inbev takeover, an event that was very difficult for him (and many people, especially those loyal customers of St. Louis).  I wont go into too much detail here . . . but I’ve always thought of my father as an ethical man . . . in every aspect of life (one of the many reasons why the end of the Busch regime and the takeover was somewhat of a difficult point in his career). 

I always joked around with him, saying that I became a doctor in order to avoid the corruptness that he dealt with.  His response . . . ‘medicine is very much a business.’  It took me a while, but with age, I have come to realize he was correct.  Whether a large beer company monopoly, a hospital, university, NGO, or little clinic in Haiti . . . good business skills are an essential for success. 

Within any organization, there are many actions whose ethical standards can be called into question.  The problem is, there isn’t always just one right answer.  Is it appropriate for the head of an NGO to make a six figure salary?; Is it just as bad to have a similar organization run inefficiently, refusing to hire someone with business expertise?; Should all people be held accountable for their actions? [And, if so, at what point to you cross the line . . . do people who smoke not deserve treatment for their lung cancer? . . . Do the morbidly obese not deserve care for their DM II, or sleep apnea?].  You start asking yourself these questions, and it gives you a moral headache.  There isn’t one right answer.

I have always liked the concept of OSAPO . . . kind of a ‘help others, but keep them honest.’  The organization gives something to ‘the people,’ whether it’s clean water, latrines, health care . . . but the people have to give something back . . . whether it is paying a small fee to see a doctor, or building the latrines after the supplies are provided.  The first time I went to OSAPO, Dr. Gardy said that if you just gave the people everything for free, they will just take advantage of you (he went further on to explain how people do not appreciate things that are just given to them). 

In the grand scheme of things, accountability is a very good concept.  Now . . . here I am, just trying to give a little something back (to a community very far away from home).  Everything I am using here has been donated . . . the LEEP machine, the bovie pads, the LEEP loops, monsels . . . (and everything that is on it’s way here  . . . any day now, Sandra . . . was bought with the donations that many of you have kindly gifted after I graduated residency).  All donations, all equipment free, my services are free . . . I felt that the LEEPs should be free as well. 

In my first week working with Carine, she said that I really should not be performing the procedure for free, as it would cost a lot anywhere else in Haiti.  A discussion had already occurred with her and the medical director . . . patients were to be charged for a LEEP.  I don’t fully agree with charging for the procedure, but I’m just here as a volunteer, and I understand that in order to ensure that things will keep going when I’m gone, we need to meet somewhere in the middle.  When the first patient who was notified of the fee said she could not come back as she needed to pay for her kids to go to school, I asked what amount was being charged . . . the equal to fifty us dollars (which is more than what some people make in a month here).  At this point, I said that was not acceptable . . . it had to be less.  I requested it be no more than the equivalent of ten US dollars (whether or not that is the price, I’m not sure, but we have not had anyone say they can’t afford it thus far). 

In my short period of time here, I’ve been attempting to take care of the full spectrum of patient needs . . . diabetes counseling, dating ultrasounds, ward catheter placements, GYN ultrasounds, discussing the complexity of the GI system in relation to ‘pelvic pain,’ I even performed a few endometrial biopsies yesterday.  I have avoided telling people that many of these things are considered procedures, which could warrant some type of fee.  Although, as a physician, I want to take care of the patient, [and not let ‘business’ get in the way], without a good business model, the infrastructure necessary for me to practice would not exist.