There is a hospital in Haiti, on the edge of the Artibonite valley. If you walk up in the hills behind it, past the painted mud huts roofed with palm fronds, past the goats flapping their ears, and the laughing little boys, up the rocky paths through the sugar cane, and you look back into the valley, you will not see the hospital, only the water tower rising above the trees. Beyond the trees, rice paddies glow brilliant green in the sun, lined with irrigation ditches and coconut palms. Then, bending and twisting through the valley like a series of lakes and flood plains, flows the Artibonite itself. In the distance rises the Massif des Montagnes Noires, and away to the west lies the blue Atlantic. There are no cars, no power lines, no billboards, no smog. No airplanes or traffic break the silence, only the occasional bleating of a goat or crowing of a rooster. From a distance it is paradise. Up close it is not.

My first day working in The Hospital Albert Schweitzer was memorable. I had imagined being another Albert Schweitzer myself, bringing health to the natives, and appearing on the cover of Life magazine in a pith helmet. These illusions faded as I walked in the door of the clinic. I was overwhelmed by the smells, strong and unfamiliar. The room before me was full of babies and mothers. The babies were crawling on the floor, urinating on their mothers’ laps, vomiting on their mothers’ shoulders, breastfeeding, crying, or just staring vacantly at me with sunken eyes. The heat of the day was already rising. Everyone looked sweaty and hungry, yet the parents waited patiently without complaint. Mothers wore brightly colored handkerchiefs on their heads under straw hats. The fathers were generally bareheaded, though one big, macho fellow wore a Girl Scouts of America hat. Most of the older children wore plastic sandals with Mickey Mouse’s image stamped on the top. It was all some of them wore. They were seated shyly, expectantly awaiting their turn.

On ward rounds I saw wasted skeletons of children with orange hair, swollen bellies and legs, peeling skin, and apathetic expressions. Clinic in the afternoon seemed interminable, as the patients filed through with diseases I had only read about: typhoid, malaria, xerophthalmia, rickets, congenital syphilis, scrofula, and malnutrition. That first day, the interpreter probably made more diagnoses than I did.

After work each day, I walked home through a gauntlet of beggars: small children and, I expect, midgets disguised as small children who knew how to say “I am hungry” in eight languages. Their second favorite line was, “My parents are dead.” Everyone, it seemed, was an orphan. One little boy, Genardi, would do dramatic renditions of collapsing from hunger on our porch, a look of long-suffering in his glazed eyes as he staggered back. “M grand goo,” he would say. (“I am very hungry” in Creole. Actually there is no term for just hungry — you have to be very hungry or else you don’t talk about it in Creole.) I finally got out my stethoscope, listened to his chest, checked his pulse, and soberly declared the diagnosis: “Grand goo.” He and his friends howled with laughter and scampered off, shouting “Monsieur Grand Goo!” which became my nickname. They all did look hungry, though. The horses and cows were skinny, too, with bulging ribs and scraggly hair. Even the mosquitoes looked malnourished. They would fly up to you slowly and erratically, making barely a sound, and then bite you: a puny little bite that had a good chance of giving you malaria.

As time passed, work in the hospital became familiar. Patterns emerged. I noticed that all the patients weighed about nine kilograms, which greatly facilitated calculating doses of medicines. The reason for this was that the children grew rapidly after birth, until they were weaned from the breast, and then never grew again. We never saw any cases of diaper rash because nobody could afford diapers. I had never before thought of diaper rash as a disease of affluence.

Mothers were always very agreeable. After almost all of my instructions in Creole, they responded with “Oui.” It took me several weeks to realize they didn’t understand what I was saying. They were just answering yes to keep me happy. In contrast, I found myself expecting everything people said to be a request for money, so I responded to things generally with “Non.” A romantic view of this would be that Haitians, having so little, respond to life with “Yes.” Americans, having so much, respond to life with “No.” After living in Haiti, though, I find it difficult to be romantic about it.

My early days in the hospital were spent staring with frightened eyes at the patients and families who stared back at me with frightened eyes. After a while, I stopped looking frightened and started smiling, talking Creole to the babies and playing with them. People in turn smiled at me, became animated, and jabbered away in Creole. Sometimes an entire roomful of mothers would break into peels of laughter at my accent, or maybe just at me, and I would hear them imitating me as I walked through the halls: “Bonjou Madame, pas pi mal!”

I discovered the Haitians actually laugh a lot, and usually have a good sense of humor. Once, as we made our rounds, Sue, an American doctor, asked a mother if she had plenty of milk in her breasts. In response, the woman removed her breast from the baby’s mouth and squeezed her nipple, spraying with milk Micheline, another doctor, from a distance of three feet. The mother blushed so deeply I could see her face change color in spite of her black skin, while all the other women present roared with laughter.

People had a lot of faith, it seemed, perhaps in our medicine or perhaps just in life. Apparently a common ceremony performed by the bokor (the voodoo witch doctor) was to test parents’ faith by passing their child through fire. If the child was burned, it meant the parents didn’t have enough faith. We didn’t see many burns.

One day a mother came in with premature twins, each weighing less than three pounds. In the U.S. they would have been in special-care nurseries drinking formula, and they might even have been put on a respirator. In Haiti such things were unavailable. The twins had been born at home. One had a terrible abscess over her back, buttocks, and abdomen, and looked cold and purple. We opened the abscess and started antibiotics, but by the next day she was breathing in gasps and looked blacker than normal, with hard, swollen skin. When I told the mother there was nothing we could do, she started crying. I left, feeling terrible. An hour later I was walking by and the mother had a big grin on her face.

“Li bwe! (She eats!)” she said, looking positively ecstatic.

I felt like saying, “Lady, you’re out of your mind,” but since I didn’t know enough Creole, I just said “Oui.” By the next day, the baby really was better. Three weeks and numerous abscesses later, the mother and her tiny twins went home.

Another mother, who thought her child was going to die, sang “Amazing Grace” in Creole, right in the middle of the crowded outpatient clinic. She had a magnificent voice, and her words, “Amazing Grace, how sweet the sound . . .” rose high up over the dusty walls, filtering out through the courtyards.

Haiti is rich in insect life, and our house had a complex, carefully balanced insect and spider ecosystem. I first noted the presence of some very large, flat spiders that scuttled across the dining room floor at night. I killed several of them, whereupon the number of flies in the house started rising. After I left the big, flat spiders alone, the fly population decreased. Next I discovered in the bathroom a tarantula, which looks like a cross between a spider and an Irish Wolfhound. This, I felt, was beyond the realm of American expertise. I called the cook, who bopped it on the head with a mop and swept it outdoors. This was followed by an increase in the number of large flying cockroaches in the bathroom. I wondered if the laws of ecology would require boa constrictors to eat the tarantulas, but none showed up.

The temperature was often more than one hundred degrees in the afternoons, and in the first few weeks I thought I would faint amid the waiting crowds. This never happened, though, and relief usually came around 6 p.m., when work was finishing, and a downpour of warm rain began falling on the tin roofs of the compound. Scantily-clad little boys would take advantage of this, running about in the warmth of the rain as if they were taking a shower. They would converge on the employees’ swimming pool, which was off-limits to them, and leap in with great whoops of glee. The rain would stop as the long night settled. I often awoke at three or four in the morning to the sound of far-off drums and chanting from voodoo ceremonies.

We never saw any cases of diaper rash because nobody could afford diapers. I had never before thought of diaper rash as a disease of affluence.

The role of the white man in Haiti was hard to decipher. One day on ward rounds I was seeing a child gravely ill from meningitis when I looked up to find a white man with a beard, wearing a pith helmet.

“Hello,” I said, thinking about the fifty patients I had yet to see.

“It’s so nice to hear a voice speak English!” the man replied. His smile changed to a look of deep concern. “How is the child?” he asked.

Here I was way behind in my work, with barely a minute to see each patient, and the man wanted to have a conversation.

“The child is doing very badly and I expect will die soon,” I replied without emotion.

“Oh dear! You see, I’ve been working with the family. I live near St. Marc.”

“Are you a missionary?”

He smiled. “Well, I suppose you could say that.” A white woman appeared beside him. She looked fatigued beyond fatigue, and he put his arm around her, again adopting a look of concern.

“What do you think the problem is?” and he indicated the child with his eyes.

The problem is that you’re bugging me, I thought, but managed to say something more tactful. As I left, he was seated on the bed reading passages out of a Creole Bible to the mother, who looked as if she couldn’t understand him.

The missionary with his pith helmet seemed incongruous, yet I felt just as out of place. I wondered if anyone really wanted us there, and often felt my efforts were of little value.

Sometimes my efforts were veritable failures. One evening I did a spinal tap on a baby to diagnose meningitis, and the baby died while I was doing it. The parents were watching, along with forty others who were packed into the clinic for lack of bed space. Everyone saw the whole thing. I frantically tried to revive the baby, having to push and shove through the people to get an oxygen mask and other resuscitation equipment. By the time I gave up, the mother was already out in the courtyard, lying on the ground, wailing. (They always wailed. None of the holding-it-in New England style I was accustomed to.) Forty pairs of eyes seemed focused on me as I stood by the dead baby in disbelief. The babies in the room added their screams to the ruckus until an almost deafening roar seemed to be saying, “The blanc did this. The white man did this.” I went and told the mother I was sorry. She stared up at me from the ground with a distorted, wet face, not comprehending my words. My eyes drifted up above her head to a woman standing holding one breast, her thumb shoved into the middle of it. I stared at the thumb, finally realizing this was not some obscene gesture, but that she had been nursing and was holding back the milk. The dead baby was taken away and the family left.

I was working on my charts a few minutes later when a mother called out to me across the room, “Ou ap tounney.”

She smiled as she said it and pointed toward the spot of death. Everyone turned to look at me. She’s saying I killed the baby, I thought.

Ou ap tounney,” the others pitched in, and a great babbling arose of many words, many phrases. “Blanc” was all I understood — that meant me, the white man. I envisioned the lynching scene. They would tar and feather me. No, they couldn’t afford tar and feathers in Haiti, only stones. They would throw stones. Or they might throw a goat at me — they had a lot of those.

“What were they talking about?” I asked the interpreter when I found him.

“They said you were upset. You were moved.”

I went back to the clinic again. People were smiling at me. Those smiles, in that dim room with the warm night breeze blowing, I will always remember.