NORTH MIAMI, Fla. — It may be hard to remember now, but there was a time when a mysterious disease baffled doctors and frightened a world unfamiliar with what is now called AIDS. Arthur Fournier recalls the rise of the epidemic far better than most. In some ways it made him. In others, it nearly broke him. Above all, it helped define the rest of his life.
In 1979, Fournier was a young doctor at Miami’s public hospital when patients exhibiting the symptoms of AIDS began flooding in — only these patients weren’t gay men, who accounted for many early cases of the disease. Rather, they were Haitian.
Confounded, Fournier and some of his colleagues soon published a study about what they were seeing among their Haitian patients, concluding “it is possible that this syndrome … is the same as that found among homosexual men.”
Their work would go a long way toward helping the medical community better understand how AIDS is spread, but it also had unintended consequences: Just being Haitian was initially listed by the federal government as a risk factor for AIDS, along with heroin use, hemophilia and homosexuality — a macabre “4-H club,” as it became known.
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For years, discrimination and recrimination against Haitians ensued. Fournier and the other doctors were accused of committing bad science, asking biased questions, failing to employ Haitian Creole translators when talking with their patients and targeting an immigrant community derided as “boat people.”
Now, some 35 years later, Fournier is one of the Haitian community’s biggest champions: A man whose career is dedicated to improving access to medical care for Haitians in Miami and back home.
“I think I believe in reincarnation, and I’m convinced he was Haitian in a different life, because he has given and done so much for Haiti and the Haitian community,” says Dr. Marie-Denise Gervais, a Haiti native and a professor of medicine at the University of Miami who works with Fournier in a network of school-based health clinics.
Haitians were targeted
From Fournier, now 65, there was never an “I’m sorry” for what happened in the aftermath of those early AIDS studies. Shortly before the research in Miami was published, officials at the Centers for Disease Control began warning doctors who cared for Haitians that their patients might be prone to terrifying infections.
In the panic that followed, Haitians in the U.S. reported losing jobs, and their children were taunted at school. The U.S. government would briefly ban Haitians from donating blood. Anger in the Haitian-American community manifested in massive rallies that blocked the Brooklyn Bridge and Miami streets.
Fournier, who endured pressure to cut back on his AIDS work, says he never felt like he had to apologize for contributing to the stereotype that shadowed Haitians for years. Rather, he says: “I did it with my words and actions.”
Growing up north of Boston, Fournier was the oldest of six children whose assembly-line worker father died at age 40.
He wanted to work with the poor — circumstances he found familiar — and after completing his residency at the University of Miami hospital, he spent two years in rural Virginia. His return to Miami to teach public health in 1978 coincided with the arrival of thousands of Haitians, mostly by boat.
When these Haitians got sick, they lacked the money to go anywhere else but Miami’s public hospital, exposing Fournier for the first time to Haitian culture and AIDS.
“The people in the hospital, they were going nuts,” is how Fournier remembers those early days of the AIDS epidemic. He would step into elevators at Jackson Memorial Hospital to see orderlies dressed head to toe in protective suits just to transport AIDS patients, whom some residents refused to examine. When he got home from work his wife, terrified of infection, ordered him to shower before he did anything else.
Amid the criticism from Haitian community leaders that the doctors had failed in the most basic aspects of medical exams — simply asking their patients about their health — Fournier stood by his work and continued to treat Haitians and other patients with AIDS.
“I feel like they were my brothers and sisters,” says Fournier, who later published research about the socio-economic forces that helped HIV and AIDS spread worldwide. “It’s not really guilt, but I was extremely disappointed when … our identification of HIV amongst the Haitians so led to their stigmatization. That was so wrong.”
Fournier and others in the medical community later would come to understand that poverty played a significant role in AIDS cases among Haitians, the homeless and other impoverished communities.
Prostitution and sexual tourism; drug use; and social and political forces affecting women, families and minorities also facilitated the spread of AIDS. The most effective treatments and education about preventive measures such as condoms required large amounts of money and time from a limited number of doctors — resources often out of reach for the poor.
In the years that followed, Fournier focused on community health and finding new ways to provide health care for the homeless, immigrants and schoolchildren in South Florida, projects funded with more than $71 million in grants he secured. He served for 25 years as associate dean for community health at the University of Miami Miller School of Medicine.
In Miami’s Little Haiti, he participated in health fairs and helped fund a medical clinic at the Center for Haitian Studies. He developed a program to provide comprehensive health care to schoolchildren in Miami-Dade County’s impoverished, largely immigrant neighborhoods. Today, 11,000 students receive care that includes vision, dental and mental-health services at clinics based in 10 area schools.
The doctor worked to become fluent in Haitian culture and Creole, the country’s most widely spoken language, says Marleine Bastien, a longtime Haitian-American advocate who has worked on health-care issues in Little Haiti with Fournier since the 1980s. Soon, the culture Fournier found charming but mystifying when his first Haitian AIDS patient showed up in 1979 became like a second skin.
In 1994, Fournier co-founded Project Medishare, a nonprofit that provides health care in rural Haiti.
In the 20 years since his first visit to Haiti, Fournier has been back more than 150 times, bringing University of Miami medical students to teach them about Haitian culture in hopes of encouraging them to pursue careers in global health and change medicine for the poor, says Dr. Barth Green, who co-founded Medishare with Fournier.
Today, Fournier still travels to Haiti and parts of Miami, continuing his work with the community to which he committed his career. He recently showed off the benefits of a medical clinic embedded in a North Miami high school, and he reflected on his years of work with the Haitian people.
“When you come from impoverished circumstances, I think you realize there are barriers to class and culture that consciously or unconsciously interfere with the people you’re trying to serve,” Fournier says. “I used to think that all you had to know to be a good doctor was to know medicine, but you really have to have a bond with the people you’re trying to serve.”