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One by One by One

When we count objects in our everyday lives, our minds can generally get by with simply distinguishing between one, two, three, and “many.” So what happens when we’re confronted with thousands, millions, and billions? These numbers are hard to conceptualize and difficult to visualize. They overwhelm us. And yet they’re often used to convey some of the most pressing issues of our time: over one thousand people die from police brutality each year in the United States; several million people worldwide have died from COVID-19 over the past months; nearly one billion people live on less than two dollars per day; over four billion lack access to basic health care.

Statistics shock us. But that shock can be paralyzing—when problems seem mind-bogglingly large, it’s hard not to simply give up. How could we possibly solve a problem that measures in the billions?

There’s a Haitian Creole proverb, “Tout moun se moun,” that means “Every person is a person.” It reminds us that every statistic presented to us to convey the magnitude of a societal problem—every thousand, million, and billion—is composed of individuals. Then, rather than think about large numbers characterizing conceptual issues, we feel compassion for fellow human beings facing suffering. Every billion is made of a billion ones—people with hopes and dreams, family and friends, and the desire to live a healthy life.

When I first began working in Haiti with the organization Partners In Health, I was overwhelmed by the extreme poverty, the lack of medical resources, and the destitute conditions in which people lived. I was one of just two neurologists working in a country of over ten million people. I felt powerless to make any meaningful difference. Working with doctors in Haiti, I met Janel, a young man rendered mute and bedbound by the largest brain tumor I had ever seen. He needed a complex brain surgery that couldn’t be performed in Haiti. I asked my colleagues in the United States how we could help him but was told that his care would be too expensive to be cost-effective, too complex to be sustainable. I was advised to focus instead on easier, higher-impact fixes, on lower-hanging—and lower-cost—fruit.

In other words, experts were suggesting that I throw up my hands at the inequity that’s a much larger problem than Janel alone, turn a blind eye to his bad luck, and concentrate on helping patients in simpler situations with more straightforward solutions. Yet while concepts like sustainability and cost-effectiveness may be well-intentioned on a policy level, they break down when you are faced with a patient. Of course, I can’t come up with a sustainable, cost-effective solution that would fix enormous problems like global poverty and inequitable access to modern health care. But as a doctor, couldn’t I try to help this one patient?

Partners In Health’s mission statement describes their work as based on “solidarity rather than charity alone.” Charity is necessary, of course: those who have more should help those who have less. But charity means us giving to them, to some abstract all. Solidarity redefines this relationship. It invites all of us to share with one another, because we are each part of the same all. I realized that the possibility of trying to provide care to Janel opened the door for me to try to help in some small way in the pursuit of the larger goal of equity. And so I chose solidarity over sustainability, compassion over cost-effectiveness.

Did I make the right decision? One by One by One explores that question, telling the story of what happened when I stepped from the realm of inspiring principles into the reality of taking action. It’s a story of triumphs, tragedies, and the confusing spaces in between as I attempted to bridge the gap between the rich-world medical metropolis of Boston and one of the world’s poorest regions in rural Haiti. It’s about what I learned and grappled with as I strove to do what I thought was the right thing and struggled to figure out the right way to do it. It’s a portrait of the inspiring hope, courage, and faith of the often voiceless ones amid the faceless billions—and how a few individuals working together might just be able to make a small difference in those big billions, one by one by one.

– Aaron Berkowitz, author of One by One by One

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