"Certainly, patients may be noncompliant, but how relevant is the notion of compliance in rural Haiti? Doctors may instruct their patients to eat well. But the patients will "refuse" if they have no food. They may be told to sleep in an open room and away from others, and here again they will be "noncompliant" if they do not expand and remodel their miserable huts. They may be instructed to go to a hospital. But if hospital care must be paid for in cash, as is the case throughout Haiti, and the patients have no cash, they will be deemed "grossly negligent.""
I often hear people blaming poor health outcomes in Pine Ridge on the "agency of the patient." It is interesting and important, I believe, to take into account this alternate perspective.