A waiting room in a charity clinic in rural Haiti... It is a humid afternoon, and huge drops of warm rain are starting to fall. A young woman is watching as her ten-year-old son, Dominique clutches miserably at his abdomen; he is staring at the roof, not saying anything. A Haitian colleague says to me, "His temp is 104, it's been up for over a week, his belly pain began three days ago. I'm getting the films and labs now." He pauses, looks darkly at the mother: "It's late." I say nothing, but look at the woman as I reach for the boy's abdomen, praying that it's not yet rigid (it is not). Though she is no doubt younger than I, she appears weathered, for Haiti has been no kinder to her than to her son. She looks at me, sighs, and wordlessly makes a weary gesture. I know it well: What can I do?, she asks with her hands. It's beyond my control.

And so it is. Well beyond her control. Her boy probably has typhoid fever, and the severe abdominal pain is ominous: one of the worst complications of typhoid is intestinal perforation, which usually leads to peritonitis and death in rural Haiti. Typhoid, a classic public-health problem, is caused when drinking water is polluted by human feces. Not her fault. Ours perhaps, I think immediately. We could have worked harder on water-protection efforts, even though another, more conventional voice in my head reminds me that Dominique and his mother live well outside of our "catchment area," the region in which we- Partners In Health, a Harvard-affiliated public charity-work closely with community-health workers.  And only by redefining the whole of public health as a private concern, one to be handled by do-gooder organizations like our own, could this be seen as our responsibility.

Increasingly, such a redefinition- the "privatization" of health- has come to hold sway in the hemisphere. Assessing public health in Latin America is a treacherous exercise. This is not because it is impossible to evaluate the state of the region's health, nor is it because the admittedly enormous variation, both across and within nations, leads to analytic impasse. It is treacherous to comment on public health in Latin America because of the ideological minefields one has to traverse in order to do so.

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