I was diagnosed with asthma in 1984. It was easy for me, then a student at Harvard Medical School, to get the medication I needed, even as I shuttled between Haiti and Harvard.
My Haitian colleagues, who had built a clinic in rural Haiti, and I attended to the sick and injured as best we could. We could see that much more preventive care was needed, and to this end we trained and salaried community health workers in dozens of villages. Part of my job was to visit them and their neighbors. One day I walked eight miles to attend a town meeting in a thatch-roofed, dirt-floored church. Afterward, anxious to get back, I looked up at the gathering storm clouds. It was afternoon already, and getting back across the reservoir meant a lot more walking, even if we took a dug-out canoe halfway.
“Dr. Paul, he can’t breathe!”
A community health worker wanted me to see a patient. I had an image, in my mind, of an older person, short of breath. I responded firmly, “The patient’s home is not even in the right direction and it will soon be dark. He should get to the hospital for a chest X-ray and lab tests.” I added, perhaps guiltily, “I didn’t even bring my stethoscope.”
The sick man’s young wife came to my side. “Please come see him. He’s been sick since yesterday.” Frustrated, I acceded, complaining en route that whatever he had would be better treated in the hospital.
It took 45 minutes to reach the house. There, leaning against a dirty pillow on a mat on the floor, was Jean. His muscles looked corded and tensed; his lips were the color of bruises; and he couldn’t speak. Even without a stethoscope, I could see that he was dying of nothing other than an asthma attack.

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