Saturday in Port au Prince, March 20, 2010

No rain this morning! People out in droves doing Saturday things. One thing was a food distribution wait line that really must have stretched more than one half mile in all. I asked one of the translators how long people would typically wait, and he said "all day". At least more than a few hours, from the look of it. Clinic was good, a steady stream most of the day, it seemed. Lots and lots going on out on the street below. At lunch, dragged Kim out with the guys (Marc and Jean, two locals and translators at the clinic ) who were such exquisite guides at my lunch the other day. I think she liked being in the neighborhood. Marc took us to see his house. I'll put the video on facebook later, but it's pretty sobering.

Marc lived in the US for 10 years, too, before coming back to Haiti not too long ago. His whole family is in fact still in the US in Florida. This is hard on him, as it is for everyone. Marc truly  is a wealth of inside information, and he reminds me that some of the best resources are right under our noses all day long. He was discussing the cultural differences that he has trouble with here vs. the US, and how everything here is kept in the dark--those in the know, or possessing a particluar skill or piece of education--work to keep it secret from people so that they retain their position of relative power. Or preserve a livelihood that might not otherwise be marketable. For a 'medical' example of this shifty kind of entrepreneurism, he said that there are people on the streets of Port au Prince who make their living by walking the around with a blood pressure cuff and simply charging people to have their BP checked. No medicine, no treatment to offer. Hell, they aren't even doctors or health care professionals! There are people who carry scales around in the same fashion, and people actually pay to be weighed. They play on people's perception of the mystery of medicine in general. It's sad, and unfair, and frankly, pointless. It explains a lot though, as far as all the people I've seen this week who tell me they have high blood pressure but who have never been diagnosed or treated by a doctor. Some will go to their local pharmacist and ask for blood pressure medicine and will get something or other...no idea if it is right for them or safe.

Then they take it for a while, until they feel better, and...

Not that I haven't seen this here in the US. But here, I don't think you will catch anyone allowing themselves to be charged a few dollars on the street for some guy with a cuff to check their BP and tell them it's high, low or even perfect. We just don't work like that. We would balk!
So; onward. Said goodbyes after lunch to catch my ride to PAP. I am not good at that part; I prefer to believe I will be back again and that no major goodbye is in order. And so far, I've been right. But just in case,  I had my last beans and rice lunch today. I will miss it! I again gave the second half away as it's waaay to large a plate. But good stuff. And with it my last Fruit pop. And for the line to security in the airport, a farewell present: The long awaited bottle of "Prestige" beer. Blech! But it's the symbolic significance that tasted good.

The airport was full of people like me, more and more blancs in matching Tshirts, more young faces that haven't yet begun to show the little bit of extra aging that this experience adds to one's countenance. Going to Haiti is routine again almost. But it's a new routine, for sure. Or maybe it's leaving Haiti that has become the routine?
Looks easy, feels easy enough too now. But it stays with you under your skin. Not quite so routine as you thought, maybe.

Until next time,

Jen

Friday March 19th, Bel Aire after the rain

"Did you stay dry last night?" was the question of the morning on arriving to clinic.
Thankfully, most of our interpreters said yes. My guy Isaac slept in a 'cracked building', he said. But at least he wasn't stuck out in the rain all night. There are many more and 'nicer' tents out there nowadays, but still. Would you want to be there?
Because of a combination of the wet weather and the fact that there was a large food distribution line going somewhere in the vicinity, there were less than 10 people waiting for us at the clinic this morning!This has been practically unheard of. But they came later. It rained on and off most of the morning, and had rained all night last night--that was the first time in the trip it had lasted so long. But the streets were busy on the drive in at 8 and although it was messy, things were moving along. You pass by many many tent cities on the drive in, but you can only see the perimeter from the street. I noticed one that was substantially lower than the level of the road, and wondered if it had been flooded. It doesn't take many fractions of inches of water on the ground to make living in a tent pretty miserable. In clinic, the overcast and rainy skies blotted out what little light we did have before, and I had to use a flashlight to examine just about every part of each patient because it was just too dim in the building.
Meanwhile, the morning soundtrack was dripping water from the cracks in the roof, the splash of tires in giant potholes full of water on the road below our windows, and crying babies.

But by mid-afternoon the sun was peeking out, and things were livening up into something resembling a Friday in any town. The lighting and the mood improved! At lunch, I was able to get up on the roof of the building and take a short video. Everyone has to go on the roof at least once at the clinic--you can see so much from there. Two of our translators, Marc and Jean Louis, saw me from where they were sitting at the movie house they'd shown me yesterday at lunch down below on the street, and they waved to my video camera from there.  Of course I couldn't tell who they were from that far; they told me later that it was them.

In clinic I had a patient that was probably schizophrenic or suffering from psychosis of some sort. Symptoms had preceded earthquake. Voices in her head, headaches, with "bad intentions". How on earth to get a girl mental health support when there is hardly enough basic medical care..? Luckily, my translator Isaac knew of a Psychiatric Center in town and we referred her there, having not the expertise nor the medication to treat her ourselves anyway. I hope she goes. And I hope the Center is still functioning. And that they will see her.
So many uncertainties every day here.
And more patients with scabies. Horribly itchy, unpleasant little bugs that burrow under your skin. Scabies everywhere, but no medicine here (Permethrin) with which to effectively treat it. Besides that, once treatment is started it is also imperative that all linens, clothing be washed regularly to prevent continued infestation and relapse. But most people don't have ready access to even laundry detergent or hot water. Hard to expect them to be able to meet this treatment program. That, and if the neighbors in the tent sharing your back wall aren't doing the same (and their neighbors, and their neighbors, and so on) and when your back wall may be a bed sheet, the odds that this will return pretty quick are high. We see lots of young kids with terrible infestations that seem to have a predilection for their ears. It's rotten.

We've seen several cases of probable to certain Tuberculosis. Also hard to treat because of there being only one facility that we are aware of being open to handle this at present. And it is in P au P, whereas some of the patients are in outlying areas. It's not as easy as just hopping in the car to go to town to see the doctor. They've no money for a ride! And gas is very, very expensive right now. Of course some people have to work-the lucky ones- and others have obligations to take care of others, which makes it hard for them to feel they can get away for a trip to the hospital that they likely aren't looking forward to anyway.

Now it's going on 11pm here at our house in Petionville, and I am in my bunk getting ready for bed. There is music (loud!) playing somewhere nearby. It is not raining, thankfully. Don't know if I'll be able to sleep through the music, but it's ok. It's an optimistic nuisance.

Tomorrow will be my last day/half-day in Haiti for this, trip #2. Goes by so fast each time. And whether I'm ready to go home or not, I realize how fortunate I am that I have an escape. For me, it's an 'adventure' in a way, really.
 For them, it's all they have. I get to go home, take a hot bath, sleep in my warm, dry clean bed, and wash the grime and filth out of my clothes, and go on with my life as it was before. They have no home, no retreat, no recharge zone.  Things are looking up, though. You just have to tilt your head waaay back and squint, but Haiti is trying. I hope they succeed. I look forward to seeing more changes my next trip.

-Jen

Port au Prince Bel Aire Clinic

Life in Haiti is awful. And yet, not so very bad. It's hard to explain. I oscillate from finding it delightful, to then remembering my surroundings, seeing the waist-high piles of trash lining the streets with pigs, dogs, goats rooting through them-right nextdoor to where someone is selling food or sitting in a doorway.

 Or smell the sewage as the more frequent showers loosen things up. Or hear the rain outside and know that thousands of people I see each day are steeping in polluted mud puddles in crowded tent cities.

                              the lunch ladies

You can actually easily forget these things as you walk through the streets. Really. The visuals fade away into the background as you become desensitized after so much shocking sensory overload, and then, another thing happens: You get pulled into the life that is going on, the hustle and bustle, the women doing laundry, carrying baskets of goods on their heads, the men yelling and joking backand forth across the street, carrying long metal pipes and pieces of lumber to and fro. The kids playing, the food cooking, the guy getting his haircut on the side of the road under a gas station awning. The endless stands of electronics and household equipment for sale under brightly colored umbrellas.

Today at lunch break, I walked with Marc, a translator from clinic, down the street into the neighborhood. He pointed out buildings and told me what they used to be, who worked in them, and what was going on now. We bought lunch from giant boiling silver pots run by hard working ladies. We got cokes at what's left of a local pharmacy, where he sold them from a small BBQ cooler, and where on the shelves inside were scattered boxes of Pepcid, a few pain killers, and some prescription bottles with random people's names on them, all in various stages of disintegration.
the pharmacist

Then across the street to what was another pharmacy, now converted into a movie house. We went inside, and there were about 15 people in little straw and wood chairs all turned to the front of the room where a pirated DVD copy of the US movie 'Legion' was playing on a regular TV set on rollers, like the kind they'd put on in front of an elementary school classroom to watch documentaries or shows about hygiene.

                                the movie house

It's weird, and difficult to reconcile the pleasures of the goings on around with the utter wreckage of the environment in which it is taking place.

In clinic, we saw some interesting things. People with masses on their faces and necks that had been there for years, people with contractures after not having their broken joints properly managed over the last 2 months, people with all manner of rashes and itchy parts. Similar to what we saw in Leogane, people are all still having trouble sleeping, anxiety, palpitations, nightmares, cough, watery eyes, stomach aches and bladder infections. And lots of STDs. By comparison to where I'd been working in Leogane, it was a slick and well-staffed location. For one thing, it was in a building, period. We even have little dividers creating semi-private spaces in which each provider saw their own patients, and about 7 guys manning crowd control/patient flow, with a translator for every provider there. Wow! But no sunshine, little light at all actually, and incredible noise from the street below. Difficult in its own way.

We got out a little early and rode back to the compound as it began to rain. We sitting in the back of the truck got wet, but it felt nice in this heat. At the house, we met a slew of new docs and nurses who arrived today, one of whom-Jeff Alpert, MD- I knew from my last trip here. It was great to see him and know that he will be leading the next team to Leogane tomorrow. He will get a lot done there as he knows it and loves it already. The other doctors and nurses are lovely and I think they will be great additions to the teams.


Got wrapped up in lots of admin/business tonight, but in the end I think it was useful. What a job it must be to organize a entire operation like this. Our man here now, Steve Hower, is working his butt off constantly. It's kind of a thankless job, but I hope he knows how much he is appreciated.

Well, bed sounds good right about now.
Tomorrow we will see what the rain has washed up around town...

-J

St. Patrick's Day in Haiti

By this morning, with or for lack of the luck of the Irish, the rest of the team from Leogane came down with the gastroenteritis that Matt had yesterday. So, no report on Port au Prince clinic from me except that the local team reported a steady day without as many terribly sick babies as the day before.
Trish and I tried to speed our recoveries by sleep, immodium, oral rehydration, phenergan and a little Cipro.
We felt a lot better by evening when the team came home.
Evening meeting, lots pre packaging for tomorrow's clinic, and then a knock at the front door:  the pastor from the seminary next door where we stayed previously came by the house with his daughter, who Doc Bruce ended up seeing in the living room. Luckily, she was not seriously ill, so no major meds required (all our meds are stored off the living compound).

Trish, Cyndy and Viv head home early in the morning. I will miss them! At least I get to see them again when I return home. The rest of the people I've met here, not so simple. But I think we will likely all see each other again somewhere.

Since I was home sick today, I got to know our cooks a little bit when I would go down for water.
Anne Marie, Edele, and Kresna.One middle aged and two twenty something Haitian women, who are so cute. When I introduced myself as 'Jennifer', one asked jokingly 'Jennifer Lopez?'. They thought it was so funny, so I wagged my rear at them. Even funnier. They are trying to converse with me in Creole, and I am not too good today, but it is fun anyway. They were astounded that I am not married, have never been married, and do not have any kids. "Pour quoi? Pour quoi? Pour quoi? I don't know! ;)
Different culture, but not so different.

I am a little envious of the guys (Docs Fred Fox and Robert Ullom) that took our place in Leogane, as they are headed up to Fondwa in the mountains tomorrow for a clinic. This is the place I described in another note, that I went on a more social mission to see Saturday, but haven't actually worked at yet. Should be a very rewarding and fun --and less hot--day for them. I think they will like it a lot.

On an evening scouting trip Monday, we found more orphanges and communities out Darbonne road that were asking for medical attention to come to them. I made some connections thanks to our translator George, and hopefully in the next week the incoming team will be able to set up a mobile clinic day in these spots. I imagine they will have very busy days when they do so.

So, sort of a slow day as things go here for me, but it beat being sick in a 100 degree clinic with no way home. I'll try to use my remaining awake time to add pictures to some of the older notes. More tomorrow!

Jen

Tuesday, Coming in from the Heat, a day of beach medicine

We held clinic at Gressier/Valou Beach today, and it was a nice change to have the backdrop of the  caribbean blue ocean, and a little breeze even, while we worked under the palm trees.
Unfortunately, our Paramedic Extraordinaire, Matt, was cut down by a bad case of heat illness vs. Traveler's Diarrhea (or some combo of both) early in the day. He went from triaging patients to being a patient, poor guy. While we worked and enjoyed the company and food the locals brought to our clinic, he was splattered on a concrete bench under a tree, probably wishing he was elsewhere...
To the unfamiliar observer it may have looked like he was relaxing at the beach. But he was miserable. We felt so bad for him. But he would not let us get a car to send him back to camp. We drugged him up, mixed him some oral rehydration solution, and checked on him periodically until clinic was over.

Then when we got back to Leogane camp we hooked him up with an IV bolus while we waited for the new docs to arrive and our ride to take us back to PauP. He's doing better tonight, and I'm so glad. He flies home in the morning. It's going to be a much needed rest after his last 10 days.

Coming back in to town this eve, I was reminded of just how much of a wreck Port au Prince really is. I can't even go into it right now, but I said before that I saw progress, and that is still true. It's just so very bad here.The sheer density of buildings and people are what boggle the mind and are why the loss of life was so great.  I can't even imagine having been here on Day One of the earthquake. How to even decide which of all the collapsed buildings everywhere you look to go into first to try to rescue people?
You would have to have been pulled in every direction at once -- and whatever you chose, you would know that someone else who needed just as much help wasn't going to get it.

Tomorrow, clinic at the Port au Prince city site, which is now in a dark, humid church building somehwhere in BelAire. It will be a contrast in many ways to the sunny outdoor clinics in the more rural place we just left behind. Then Thursday, Tricia, Viv and Cyndy head home to CA.
I'm going to miss everyone, and especially my little country team of Tricia and Matt. Nothing makes a fast family like an experience such as this.

I love you guys!

I am really too tired to write more tonight, or to post pictures. So, time to catch up on some sleep (in a bed, indoors, with fans) and recharge the brain and heart for tomorrow.

Jen

The lost blog, found!: Leogane Saturday March 13 2010 and the long and windy road to Fondwa

Today was clinic at the church in Leogane. A good day.
Got to do a little suturing when a boy fell playing out in front of the clinic and lacerated his forehead.
Ups, does that count as an iatrogenic problem?
Morning went by fast, and today, we took time out for lunch and I think it was worthwhile to have a little energy influx about midday. My super trooper team mates, Matt and Trish, took up the challenge of holding clinic by themselves after lunch. And they rocked it!

In the afternoon, Gary Morsch (President) and Jon North (CEO) from Heart to Heart International Headquarters came out to Leogane with about 15 people, many of whom were representing gracious donor companies such as FedEx, BD, and others. They were all very nice people and interested in what they saw. I hope they feel that their contributions of medicines, supplies, shipping and money were going to good use. We could not do any of this without them! I went with them all to Fondwa, a little town up the mountain from here, where there is an orphanage that is tirelessly run by a Father Joseph and Sister Carmella.

There had been a school here that was destroyed in the earthquake. Luckily that day no kids were in the school by the hour of the event. But 2 maintenance workers were killed in the collpased building, as were a nun and one of the orphans who were in the lodging quarters at the time.

Now, the children and sisters sleep in the makeshift tent/houses on dirt floors, with sheets or tarps for walls. This is where they sleep, they cook, they iron, they eat, they live. It is dark and hot, though outside the elevation makes for a nice breezy locale that is occasionally covered in the mist of surrounding clouds. They have begun to have school again, in a new spot, but without a building, of course. As everywhere in Haiti, the people here are just lovely. They have really almost nothing. They smile, they invite you to share what little they have.

 They are surviving. HTH is trying to help connect them to people who can help them rebuild this school and orphanage properly. The school serves not just Fondwa, but 700 children from kindergarten through 14th grade from within a 28 square mile area. Some kids would walk FOUR HOURS each way to school. And this is in the mountains, too!

We had a delicious dinner at a restaurant in the town proper, prepared by one of the sisters and some of Father Joseph's students from Fondwa University, a very small but important school for educating the local young adults in Agronomy, Veterinary medicine and Business management. Got to hear a lot about the history of this town, and the unending efforts of Father Joseph to create a working and sustainable community and business, agriculture and educational system for the people of this remote part of Haiti.

The school: paper doves hang from broken ceiling

School half flattened

This man has a vision, and it is big. He will see it through, I have no doubt.

A note about orhpans: not all of them are in orphanages. Most that lost their parents in the earthquake are not. They are taken in by other family members, friends of parents, or random strangers it seems. When a child comes to clinic with an adult, you cannot assume that this adult is their mother or father. We are surprised when we ask and find that 'oh no, I am not the mother'. You can't tell by watching them. They take care of these kids as if they were their own. They often don't know much of the history of the child. They are just there helping look out for the little children who have no one else.

I still can't get over how despite the situation, the dirt floors, the flapping walls and the dust everywhere, these people are always in their Sunday best and looking clean and sharp and well put together when they come to clinic, or when they are just out doing business on the street. Women come in their nice hats, men in their trousers and belts. Shirts are tucked in, hair is done. People are proud.
This is who they are. They don't surrender.

"Knowledge Is Power"-sign over school door

On the drive home it was dark, but people were out and about on the street. We actually passed a night club of sorts (says 'Disco' on the sign) where lots of people were hanging out front and lights were flashing inside and the music was loud and lively.Well, wait-it is Saturday night!

March 15, 2010 A FULL DAY!

Today started out damp and mushy and humid after the rain last night, but finished off hot (and humid) and scorchingly sunny! It was a great day, though. Clinic was busy and we did some interesting things. Met more delightful people. We have one little old man that Trish is following for hypertension and afib. He said he came and slept here out by the church last night in order to be here at 9am 'fasting' for a BG like we asked Saturday. If only we'd known he had to go to such lengths! people just don't tell you that they walked 5 miles to get here. We know only such a little glimpse of the lives we come into contact with. And what you don't think to ask might be something you really wanted or needed to know. Lunch was again a welcome rest that allowed us to re-energize just enough to finish the rest of the clinic with smiles and laughter. Our translators, Innocent and George kept us plenty entertained with their comedic interactions while we made another scouting trip around the edges of Leogane at the end of the day.George took us to two orphanages that had been destroyed in the quake, both of which said they could use medical care. One has 85 kids here in Darbonne, and the other, located about 40 km away in the mountains, is a school with 250 kids,none of whom have had medical care in ages. The entirety of the first one was leveled by the earthquake, and they had cleared the rubble from the lot to hopefully rebuild. Meanwhile, they live in tents and huts out back, a now familiar sight that is the norm rather than the exception.

Then we stopped at the Darbonne market to look around. This is the area from which my translator, Innocent, comes from. He showed us the school churchyard where he used to play basketball, which was next to the market. The area is lively, but one of the most disheveled and poverty-stricken in appearance than any I've seen so far. Raw meat in open 5pm air and sun, with flies coating it like blackened pepper crust.

The sewage ran right through in gutters that criss-crossed the marketplace, and the tent city that rests behind it. Goats, cachetic cows, and the universal world dog all over among it.

Kids flying their plastic stripe sac kites (and very well, I might add!) seemed oblivious to their surroundings,happily. And as always, everyone greets you cheerfully, little kids and old ladies wave cutely, and yell out "Blanc!" (white!) as you go by, trying to get your attention. We tried to figure out what the appropriate response to 'blanc!' is, but not really sure except to smile and wave back. I don't speak Creole, but i understood when as we passed one lady in the market and everyone in turn greeted her with a "Bon Soir!", she says to the translator "Bon Soir is the only thing they know how to say, eh?" It was funny, and mostly true.

But we are trying! We have picked up a lot in the last few days, though mostly best applied in the context of the focused medical interview--so not exactly usable in the marketplace.

'Kijan ou rele?' - what are you called?

'Como ye?' - how are you?

'Sac passe~?" -what's happening? (we use that with friends, not pts)

'No pi mal!' - I'm not too bad

'Mwen bien' - I'm good.

'Quil age ou?' - what is your age?

'Ou fait mal?'- what part (body) is bothering you?

and several others that you don't need to know concerning private things...

Whenever we do have to examine something of a private nature, we are challenged since our clinic is basically in the front yard of a church. So, we take a headlamp and a chaperone/translator into the church building, back to the storage closet by the pulpit. There, we have them strip whatever garment is required, shine the light on the problem, put clothing back in place and march back out. No room to sit, lie or turn around in there. Kind of awkward but the people accept it like it's nothing out of the ordinary.

Now, after dinner at the compound of chicken tacos with homemade tortillas and pico de gallo, FOLLOWED BY homeade ice cream and chocolate syrup (!), we sit on the bench under the light bulb to write our updates, make nightly chats on facebook (Matt with his wife), and just let the day replay in our heads --or out loud if it was a funny moment we like to recall.

In the background is the sound of the neighboring church at service, singing, singing, singing. Even after 8pm. We walk past this church (chapel? very small) every morning and afternoon to and from our church clinic on the other block. I'll post a picture so you can see. It's basically a tiny room stuck into a narrow passage from one street block to the other, where people's homes were destroyed and in place are tents and tin, and the entirety of the daily living occurs in the corridor. There's a little boy that runs at large and is always ready to slap someone on the behind as they walk by. Matt has aptly named him the' Butt-slapper'. They have come to be comfortable with us, needless to say--and like to chase us from time to time also. Until we chase back, of course. :)