Teaching resources

Letters from the FieldThe Letter that Changed Me

Entrance to Choscal Hospital, Haiti ©Julie Remy/MSF

Subjects: KS4 English Language

Teaching resources: Letters from the Field

The Letter That Changed Me

Learning Objectives:

Reading Skills – Identifying Ideas, Use of Language, Comparing Perspectives, Implicit and Explicit Detail. Narrative Skills – Recognition and Use of Descriptive Language, Using Descriptive Detail, Informal Letter Writing.

Task 1: Setting the Scene

Mobile treatment centre, Haiti ©Junior Augustin Jeanty/MSF

Describe the following scene to the class (you can use the picture above to help):

You are in a makeshift hospital Cité-Soleil in Haiti in 2010. It is one of the poorest parts of one of the world’s poorest countries. It was devastated by a huge earthquake earlier that year, which claimed up to 316,000 lives and damaged what little healthcare was available to the population. Hurricane Thomas is due to arrive tomorrow.

The staff here are busy trying to move patients to the higher floor as flooding was expected after the hurricane. A man in a white t-shirt sits on a plastic chair, exhausted. He is handed a letter and begins to weep.

In groups, discuss what you think might be happening – who is the man and why is he crying?

Feed your answers back to the class.

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Teaching resources: Letters from the Field

The man is Dr Javid Abdelmoneim, a doctor from London, who has spent many years of his career working for the international medical charity Medécins Sans Frontièrs/Doctors Without Borders (MSF), including assignments in Iraq, Haiti, Sierra Leone during the first Ebola outbreak and more recently in Syria. Javid has spent his career providing healthcare to the people who need it most around the world - he is now President of the board of MSF UK.

In 2016, when Javid was on assignment in Haiti, this already poor country had been devastated by a number of tropical storms and had not yet recovered from a powerful earthquake in 2010. More than 6 million out of 10 million Haitians live below the poverty line (ECVMAS 2012), and in 2017 around 1.8 million people were in need of healthcare assistance, and 1.4 million people were found lacking access to proper sanitation. (OCHA 07/04/2017). With many people either displaced from their homes or living in terrible and dangerous conditions, the risk of outbreaks of diseases such as cholera is high – in 2017 9,700 cholera deaths had been reported since its original outbreak in late October 2010 and 815,000 cases of infection were registered. (OCHA 25/09/2017).

A makeshift shelter on the site of destroyed homes Haiti. ©Joffrey Monnier/MSF

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Teaching resources: Letters from the Field

An open sewer in an urban slum, Port au Prince. ©Lauranne Gregoire/MSF

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Teaching resources: Letters from the Field

Task 2:

Individually, read the following article by Dr Abdelmoneim. In it he describes why he reacted the way he did to the letter handed to him during assignment in Haiti in 2010, and why he feels it changed him.(Note to teachers – if you would prefer the students to discover the letter for themselves online, the link is provided below)

https://www.msf.org.uk/article/letter-changed-me

The letter that changed me

“Dear Dr Javid, I salute you in the name of He who, through his death, gave us life, Jesus Christ.”

Thus starts one of the most important thank you letters of my life. The setting: Haiti, 2010, post-earthquake, intra-hurricane, pre-cholera. I cried when I read it then. I cry when I read it now. Different tears though.

I went to Haiti with MSF in June 2010 to help reinstate emergency and internal medicine services at our hospital in Cité-Soleil. ‘Sun City’ is the capital’s gang-ridden slum and is anything but filled with rays of hope. I found violence, accidental trauma and infectious diseases; death, death and death.

Dr Abdelmoneim. ©Fathema Murtaza/MSF

In November in Cité-Soleil we were busy. Hurricane Thomas was due the next day. We intended to evacuate the entire ground floor of our 100-bed hospital to the first floor to avoid the expected flooding. The logistics of the move had taken our team one week of planning and preparation.

Persuading the Haitian staff and patients to enter the building’s upper floor, which had no quick escape route in case of emergency, was difficult. People were still scared, despite it being nearly 11 months since the earthquake.

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Teaching resources: Letters from the Field

I’d been there almost five months. It had been very hard, and I still had to persuade myself every day to remain, not to give up and go home prematurely.

As head of the medical department, I was to supervise our part of the evacuation. I made the rounds of the 22-bed tent, which served as an inpatient ward, with the aim of discharging as many patients as possible. The wind had really picked up and gusted ominously through the tent. I wasn’t even sure how many spaces I had been allocated upstairs, tucked away at the back of the neonatal ward. It was going to be a tight squeeze. I remember thinking, “Is there room for this one? Evacuate upstairs or discharge?” Then I was handed a letter by a patient.

Oddly, I couldn’t recall him at all. The resident doctor told me the patient had been admitted a week previously with acute asthma and cardiac arrest. She confirmed that I had seen him when I was called into the emergency room. He had not responded well to nebulisers (a device that enables you to breathe), then had had a seizure followed by cardiac arrest. Still I had no memory of him. Then suddenly it came flooding back and I couldn’t believe I had forgotten him.

I remembered: he was young. I watched his eyes cloud over as he stopped breathing. He continued to struggle and looked straight into my eyes. We didn’t stop. We tried every treatment available: adrenaline, aminophylline, magnesium and salbutamol. We carried out CPR for what seemed an age, through three arrests and three returns. I reflected afterwards that I’d forgotten ketamine, but we would never have intubated him anyway, since there were no ventilators and no blood gas measurements.

He had survived and written me a letter. In it he said:

“‘He who despises his neighbour, sins. Blessed is he

who pities the poor.’ Proverbs 14:21.

God is the source of life but it is for man to try to conserve it. God raised your spirit and

you did not abandon me. Therefore, you are blessed.

You are blessed by God in your hard work in saving life.

I tell you ‘thank you’ – the biggest words in the human dictionary.” Cholera Treatment Centre, Haiti, 2014. ©Thomas Freteur/MSF

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Teaching resources: Letters from the Field

I was reading this eloquent letter in the busy tent in front of him as he prepared himself for discharge. The beds were being lifted up around us by the orderlies. The nurses were dismantling their desk. The medication was being packed away by the nursing assistants. The logisticians were taking down the electrics and securing the tent. It looked like it would start to rain at any moment and he was watching me as I cried.

Why was I crying? Because he was my exception to the rule of death in Haiti. Because I was ashamed that I had forgotten him. Because I was tired. Because I had had enough. Because he’d touched a raw spot.

Hurricane Thomas did not strike us with full force that night. It swerved north at the last minute. The cholera epidemic arrived in the capital with the overflow of rainwater the next day. My last few weeks in Cité-Soleil swept me up in a whirlwind of vomit, diarrhoea and much more death.

I’d never before seen so much unchecked misery. It took me a while to recover. I took away many memories, both fond and foul. I took away one particular memory of one particular patient. I took away a letter.

Mr Letter-writer, I salute you. I’m sorry it’s taken me so long to write back, but I was hurt by Haiti. You’ve helped me a lot and I haven’t forgotten you. I can honestly say that I have struggled every day with what I do and why. My need to find fulfilment in what I do overtakes me frequently.

Sadly, I am often left despondent after my day’s work. I don’t know when I became this full of angst. Did I make the right choice in becoming a doctor? It’s been 13 years since I graduated. Should I still be asking that question? Your letter helps me answer it.

Your letter addresses my needs, allays my fears and gives me emotional support. Your letter shows me that the doctor-patient relationship runs two ways. I am not sure that this is revolutionary, but it has been to me.

Your letter reminds me to be kind, gentle, patient and humble, even if I don’t feel

those things some days. I feel as indebted to you as you felt to me. Do you think

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Teaching resources: Letters from the Field

of me as often as I think of you? Mobile clinic Haiti. ©Laura Bianchi/MSF

“May the All-Powerful grant you a lengthy and successful career, which you accomplish so well. Be blessed by God for ever, Dr Javid.” Thus ends your letter.

The biggest words in the human dictionary end mine. Thank you.

Task 3:

Tick four statements from the list below which are TRUE

The Cité-Soleil in Haiti is a nice place to live.

Haiti is one of the world’s poorest countries.

At the time of this article, there had just been a hurricane in Haiti.

Dr Abdelmoneim had recently saved the life of a young patient who had had a seizure and a cardiac arrest.

Dr Abdelmoneim had been a doctor for 13 years when he wrote this article.

Dr Abdelmoneim has enjoyed the past five months working in Haiti.

Dr Abdelmoneim was not sure why he cried when he received the letter from his patient.

Hurricane Thomas struck with full force that evening.

Now work in pairs to discuss the following questions about the article:

Dr Abdelmoneim uses the metaphor ‘rays of hope’ to describe what is lacking in the ‘Cité-Soleil’ or ‘Sun City’ slum. How does the use of this term make the description more vivid?

The wind had really picked up and gusted ominously through the tent. Dr Abdelmoneim uses an example of personification to describe the situation – how does this help to reflect the situation he is describing? What kind of atmosphere does this use of language create?

How did Dr Abdelmoneim feel about his work before being given the letter? How did the letter change this?

Does Dr Abdelmoneim’s opinion about his work at the start of the article differ from that of his patient who wrote the letter?

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Teaching resources: Letters from the Field

“‘He who despises his neighbour, sins. Blessed is he who pities the poor.’ Proverbs 14:21. God is the source of life but it is for man to try to conserve it. God raised your spirit and you did not abandon me. Therefore, you are blessed. You are blessed by God in your hard work in saving life. I tell you ‘thank you’ – the biggest words in the human dictionary.”

“Your letter reminds me to be kind, gentle, patient and humble, even if I don’t feel those things some days. I feel as indebted to you as you felt to me. Do you think of me as often as I think of you?”

The paragraphs above show the different feelings of these two men towards the work Dr Abdelmoneim is doing in Haiti. Can you work in pairs do describe how these perspectives differ? You may refer to other parts of the letter if you wish.

Task 4:As a group, discuss: Why do you think Dr Abdelmoneim wrote an open letter to his patient rather than just writing an article about his experience in Haiti?

- Do you think an open letter might be a good way to directly address more than one person about your thoughts or experiences?

Individually, take a few moments to think about someone who has inspired you to either make a positive change, to try something new, or to do something to help others. They might be:

a famous figure such as a politician, a lawyer, a businessperson, a charity worker you have seen on the news or a political prisoner or campaigner.

someone who has made a difference in your school, your local community or even your family.

a fictional character from a book, movie or TV show.

Write an open letter to that person, using the structure of an informal letter. You may wish to describe the things they have done to inspire you, or to thank them for the work they do on behalf of those they have helped, or simply outline why you think they are an inspiration to you. Use examples from your own lifestyle and activities if possible.

If you were writing to Dr Abdelmoneim, for example, you may wish to mention the things he sees and deals with that we do not have to face at home in the UK

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Teaching resources: Letters from the Field

and remind him of the difference that his work makes to the thousands of people depending on him and his team to keep them alive.

Try to use descriptive language to make your writing more interesting and to make your points more effectively. See below the table below for a reminder of how to use some of these techniques.

Make sure you consider that person’s own perspectives and opinions on the situation you are writing about and whether they would differ from your own.

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Teaching resources: Letters from the Field

Table 1. Reminders of Descriptive Language Techniques

Narrative technique Example

Simile – describing something by comparing it, often using ‘as’ or ‘like’

As fast as lightning

Metaphor – describing by naming something such as a person or action as something else entirely

My sister is a night owl

Hyperbole – exaggerating or effect I’m so hungry I could eat a horse

Personification – a metaphor that attaches human feelings or actions to an object

The trees danced in the breeze

Pathetic Fallacy – personification that provides emotions to a setting or an object

The wind howled angrily around them

Onomatopoeia – words that sound like their meaning

The snow crunched underfoot

Oxymoron – a phrase combining two contradictory terms

A deafening silence

Emotive language – language intended to create an emotional response

The scene around them was heart breaking

Source: (MSF-Table-Source)

Note to teachers: The letters could be pooled and entered into a writing competition e.g. a theme provided such as local heroes / charity workers, and the winning entry could then be sent off to either the local newspaper (local heroes) or to the charity concerned.

MSF can provide case studies of field workers for students to read about and write to. A winning letter could be selected by MSF to appear on our website or in our quarterly publication, Dispatches, via prior arrangement and subject to availability of editorial space.

Further informationIf you like our resources, help us spread the word among your peers by sharing the link on Twitter, Facebook or Instagram. For further information on MSF resources for schools please visit www.msf.org.uk/schools-resources.

If you are interested in finding out more about how MSF can work with schools, including additional resources, providing speakers, the Missing Maps project, please contact schools@london.msf.org.

If you are interested in fundraising, please visit https://www.msf.org.uk/fundraise.

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Teaching resources: Letters from the Field

MSF UK was set-up as a registered charity (Charity Number 1026588) and a company limited by guarantee (Company Number 2853011) in September 1993.

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