Thursday, May 14, 2015


Belle Anse

May 13, 2015  At first sight approaching from the sea or the high mountains above, you would think Belle Anse is a lovely place.  In fact Belle Anse does mean “ beautiful cove” and indeed there is a half moon pebble beach that crests around the town and is backed by a shelf of mountains.  It doesn’t quite all add up even though palm trees dot main street – the bucolic setting is ground down by the inevitability of Haiti’s hard luck and neglect.  The little houses are cute but grimey, dusty pebbly roads are spitting old shoes, plastic bottles, condom wrappers and donkey dung.  Despite the tempting turquoise sea, swimming is life threatening due to the surf and the current.  The seas are too rough to fish right now so there is little food, the rains haven’t come so there is little water.
The cutest (and only) hotel in town where I could be staying

I am working here for the week, doing my usual gig in the MSPP clinic here and living in the residence, enjoying the kindness of Dr. Cajou a dear doctor here who drives the only car in town, and the resident nurse, Miss Etienne, who cooks and takes care of me.  I can hear the surf roll in from my hot little cell block behind the clinic.  We have been seeing about 35 women a day, no one has ever had cervical screening. We work together without a break and finish by about 2:30  - just in time for lunch, or Haitian dinner. 

Haitians really just eat one big meal a day.  Breakfast is some strong coffee and bread or spaghetti, maybe some eggs, and an evening meal doesn’t really exist unless you want to eat leftovers or labui, which is very thin porridge.  It took me a while to realize that was how things were, cuz sometimes I’d pass on the midday meal because it’s so hot.  Then I’d hang around looking hungry at dinner and be ignored.  One evening I smelled the delicious fragrance of BBQ chicken, and when I came to the table there was a big plate of pitch-black charred bones.  Everyone dove into the dish with an "ummm" and "ahhh."  I tried one with a tiny bit of flesh on it but you couldn’t eat the meat without eating the bones that crunched in your mouth like a hard Cheeto.  When I asked what it was they said “wild bird,” with further questioning, ranmye.  Pidgeon!!
Instead I am here behind the kitchen where they throw waste but piglets 
and strays clean it up

Two cases of cholera rolled in last night, the quarantine is still up and running here after most of the cases elsewhere in the country have subsided.  Because of the lack of clean water this place is more vulnerable.  There are about 15 cases a month now, during the height of the epidemic there were 30-40 patients pouring in daily.  Luckily I use a lot of bleach in the work that I do…..

decontamination in the time of cholera

Dr Cajou, the sweetest flower of Belle Anse
Miss Etienne and the gals
Thanks so much for all you love and generosity

There is an optimism here, maybe its a belief in magic, that objects that are not functioning will one day become useful.  Or that their mere presence is enough.  On the wall there's a clock that always says 6:47 or 3:23.  One or two fridges are in a room with no electricity, their doors loose and dangling.  Rooms fully plumbed for a shower and sink have never felt a drop flow through its pipes, outlets everywhere with ne'er a pulse of current.  My toilet seat is but a small shard - broken long ago but still there to make you think you are not sitting on the cold bowl
Prestige is my best friend at the end of the day

a few last Haitian funnies:
krapo means frog
"Patience Shop"  is what they call an auto repair shop
Fè LaFrans or "act like you're French" means pompous

Tuesday, May 5, 2015

International Intrigue


Yes, on the road again.  But after 10 days on the trail I am taking a wee pause.

May 3rd, Port-au-Prince, half way up the hill to Petionville.  The breeze comes in long, deep, exhalations and I am on a shady rooftop with the mountain looming above me.  Music from various churches in the neighborhood pass their warm breath by me, and a penetrating drumbeat demands the ear.  Someone is frying garlic somewhere and the dog next to me is frantically licking his bottom.  Welcome to Haiti!

I got to Thiotte a week ago to begin a 4 day training of nurses on the procedure VIA/cryo, which most of you have heard of - sorry to be repetitive here - a simple but effective way to detect cancer of the cervix - a low resource alternative to the Pap smear.  With headlamp, speculum, white vinegar and a trained eye, you can see changes that indicate precancerous tissue. With this "see and treat" method, you can treat the women positive for precancer with cryotherapy during the same visit, with a cryo unit and tank of CO2 that you can fit on the back of a motorcycle, no electricity or running water necessary.

We (Hispañola Health Partners) began 2 years ago and so far have screened 1000 women in the Arrondissement of Belle Anse (SE Haiti) where we estimate 30,000 women of appropriate age reside.
Please help us promote this cause by donating at our website: hispañ

This is the second training of three that I have done in this raggle-taggle corner of Haiti, a place by the coast with dusty, rocky roads and no system of transportation besides foot, donkey and motorcycle.  Less than 5% of the women have ever had cervical screening.  According to the GHESKIO Center here in PaP, the incidence of cervical cancer in Haiti is the highest in the world. Not a surprise, as Haiti always does things in superlatives!  It can destroy a woman in the prime of her life when she is the center of strength to her family, economy and community.  Yet it is a totally preventible cancer, slow growing and easy to treat.

This training was funded in part by a generous grant from WIL of Greater Philadelphia, a dynamite group of Philly women whose goal is to help empower women as leaders globally.  Cherish the ladies!

I and my Haitian nurse who supervises the program trained 5 nurses on the didactic and practice. Two of them are now being contracted by Hispañola Health Partners to provide full time cancer screening services in two of the three regional health centers.  After two rather tedious days of theory, we had 2 days of a sleek and seamless practical screening operatives; one room dedicated to registration and counseling, three exam tables set up with supplies for the 5 nurses taking turns doing the procedure, me checking each one, volunteer nursing students welcoming each woman, directing them once they got in and washing down the surfaces, decontaminating the speculums.

A chicken leg is perfect for learning how to use the cyro unit, you can even make soup with it afterwards 
The environment was at the same time a serious training environment as well as a tad raucous, with konpa and merenge on the ipod, sliding in a few dance steps across the tiled delivery room,  teasing one another about prior romantic adventures as we waited for patients to get ready.  The nurses affectionately call me antchoutchout, which means "little brat," because I stick to my demand for excellence like a spoiled child.  They also have christened me Madanm bouboun, which needs no translation if you are familiar with female anatomy.
My girls
We screened 93 women in two days, and treated 5 with cryo for positive findings.  These otherwise gentle ladies who shyly whisper bonjou as I walk by engage in a fair amount of pushing and shoving, since by early afternoon of the last day it was obvious we could not see everyone.  Despite our prep for crowd control, you could easily be roadkill it you weren't careful entering registration.  No worries, now that there is a permanent person doing cervical screening in the area, the women can come any morning and avoid a crush injury.
The women doubled by the second day once word got around

Watch your fingers, ladies!

Miss Vanessa, in charge of doing cervical screening now in Thiotte

cryotherapy in vivo
Last Saturday I took the 5 hour ride here with 14 passengers in a standard Land Rover, all day banging down the road in a dusty mid day rumble, a chicken picking at my ankles under the seat. Halfway through the journey, in the blazing sun that bleaches the rocks and some sonorous gospel choir on the radio, I feel a submission to gravity, the clumsy weight of the lady next to me who has fallen asleep and is listing heavily into my personal space.  A tight kind of togetherness.

jam packed
I have come to Port-au-Prince with a translator, guide and bodyguard, Naoul, who I recently met in Thiotte.  A young man of 26 who speaks fine english with a ghetto twang he learned from visiting relatives from NY,  Naoul has had no job or money for many months.  He just told me today that he had to borrow his younger brother's shoes to work with me, which means his brother can not go to school all this week while he is away.....He finished high school and some college a few years ago but could not go on as his family plunged deeper into poverty.   He jokingly calls himself my Tonton Macoute, named after the notorious brigade of security police who served during the Duvalier regime.

Yon ti istwa thanks to Wikipedia: "Tonton Macoute was a special operations unit within the Haitian paramilitary force created in 1959 by dictator François 'Papa Doc' DuvalierSome of the most important members of the Tonton Macoute were vodou leaders. This religious affiliation gave the Macoutes a kind of unearthly authority in the eyes of the public. From their methods to their choice of clothes, vodou always played an important role in their actions. The Tontons Macoutes wore straw hats, blue denim shirts and dark glasses, and were armed with machetes and guns. Both their allusions to the supernatural and their physical presentations were tools to instill fear."

It is great to move all over the city with him, on tap-tap, motorcycle, by foot.  Although I never feel uncomfortable or unwelcome here,  Naoul makes it smooth as satin.  He is a gentle and pensive soul, who lets me proceed in kreyol until I am eventually trapped by either party's incomprehension.  As I have a week full of meetings, taxis can be expensive and the streets a tangle of markets, garbage, traffic and cul-de-sacs, he is precious to me.

Security Agent Naoul Senat with spagetti, the Haitian breakfast staple

love and gratitude to you all, next chapter an update on the clinic in Marjofre.  Bye, Louise

Getting better all the time - clinic in Marjofre

Friday, December 5, 2014

The Gods Must be Crazy

December 3, 2014

Hola comrades:  Does anyone remember the South African film by this name released in 1980??  A french version of the film popped on when the power suddenly returned in a bedroom where I was staying in Port au Prince last week.  It cracked me up.  The film is described by Wikepedia:

Xi and his San tribe are "living well off the land" in the Kalahari Desert. They are happy because of their belief that the gods have provided plenty of everything, and no one among them has any wants. One day, a Coca-Cola bottle is thrown out of an airplane and falls to Earth unbroken. Initially, Xi's people suppose this strange artifact is another "present" from the gods and find many uses for it. (They employ it as a crafts tool, blow the top to make music, etc.) But unlike anything that they have had before, there is only one glass bottle to go around. With everyone wanting it at once, they soon find themselves experiencing envy, anger, and even violence. 

The film might seem trite now, but one can't avoid noticing the loss of innocence replaced by technology and commercialization when you travel in this part of the world.  We deplore the soot-spewing cars, trucks and motorbikes, mountains of Styrofoam and plastic, drab urban malls that we exported years ago to the likes of Santo Domingo or Port au Prince.  We come to a Caribbean island looking for charm and simplicity but are dismayed to see our own culture's dirty face in the mirror!! 

Luckily, the ingenuity of daily life here that continues to amaze and bewilder far outweighs the negative; the fabulous and funny things I see and love sharing with you, dear reader .
Am I too old to learn how to do this?

Fixing a flat on my moto in Thiotte
Lost tongs replaced by kitchen knives on a marimba used in the merengue tipico I danced to last weekend

I spent most of last week in a clinic run by Mennonites in the high mountains of Haiti, in a town
called Oriani.  I had been there before, and deeply admire the commitment of the people that established this haven for the sick and super underserved.  I was there to continue cervical screenings for cancer and follow up on some positive findings I had encountered there more than a year ago.  I was happy that I had time to spend with the nurses there, teaching them the technique, and making plans for a collaboration with Fonkoze, a large and well-respected microfinance NGO in Haiti, who will be sending their women members from the region there for screening in the upcoming months. 

teaching Sonia and Githane the didactic part of IVAA, screening for cervical cancer using acetic acid 
Oriani is at 5000 feet, cool and green as you can see, full of plenty of nutritious food that gets sold every week at market to merchants who sell it in Port au Prince

direct marketing - a soup made of beef and plantains
good green earth at 5000 feet
On the road to Oriani you transverse a 7000 acre reserve of pine forest

Each day at the clinic begins with a hymn and a prayer, led by a Haitian dok
The first night that I arrived there a woman in her 20s came in who had a frightening story; her husband had mysteriously and suddenly died a few days earlier and in her grief, she asked someone to get her a cup of a home remedy to calm her down.  The medicine was in an unmarked bottle, and the friend mistakenly gave her a swig of super-concentrated pesticide which was in an another unmarked bottle nearby.   She gravely damaged the mucous membranes of her upper digestive tract, looked very jaundiced and was desperately begging for an IV which everyone here thinks saves you from death.  She, the mother of 3 children under 4, had a terrified look in her eye and could not speak since the poison had burned her throat so badly.  After much ado, she was finally transported to Port au Prince, with a fate this is still left unknown, but her prognosis is not good. Its no wonder that such a tragedy would make a people believe in the power of vodou. Why else would one have such a coincidental run of bad luck? The sadness of this single event leaves me with a deep respect for Keith Towes and his staff who confront daily challenges like this as they serve the villagers at the Clinique Confiance en Dieu. 

Frere Keith with his peeps
I am writing this now in Santo Domingo where all week I have been training nurses, on the last leg of my travels.  I'll be in NYC on Sunday, God willing. Thanks as always for tuning in.

Love always, Easy Rider
Project Runway, Haitian school uniforms

Pre-K Pink

Modified sailor suits

It's blue in Thiotte

tangerine and melon are happening in Savanne Zombi
DO YOU WANT TO DONATE TO THE CAUSE????, all donations go directly to Haitians in the struggle, foreign volunteers (like me) travel on their own dime.  thanks, always

Monday, November 24, 2014


November 23, 2014

Hotel Oloffson

Its Sunday evening and the darkness slowly wraps itself around the hills surrounding Port au Prince, and from my balcony I can watch the bats swerving in and out of the palms as they bend in the breeze.  Choir voices waft upwards from the church on Avenue Christophe.  I am guiltily indulging myself in 2 days of hot water, internet, fine food and exhilarating company at this remarkable Victorian Gothic style hotel.  

Decked with creepy statuary made from wood carvings and recycled doll extremities, skulls, hub caps, spray cans, the shady, the grassy grounds are a refuge from the insane traffic, open sewers and dust of the city.
Baby Jane
Tonton Macoute
Baron Samedi 

This place was built in 1896 by the Sam family and housed two of Haiti's presidents around the turn of the century.  It's up a hill,  providing cooler air and spacious views of the sea and city below.  It served as a military hospital in the 20s during the US Marine's occupation, then became a hotel in the 30s, a bohemian hang-out for artists, writers, actors.  Probably best known for the site of Graham Greene's The Comedians, all the rooms are named for the famous people who have stayed here: Jackie O, Edwidge Danticot, Mick Jagger, Katherine Dunham, John Barrymore, Amy Wilents, Barry Goldwater (?)  I think its stunning too! 

 Haiti Say You Will - my room

I know I am digressing and I promise to get back to the point of bringing you all to this blog very soon.  However, I feel like, as with many encounters of this trip so far,  it is a good karmic sign that I met and hung out for a second time with Richard Morse, the hotel's owner and cousin of Haiti's president, Michel Martelly.  Our link is a friend in common (Elizabeth Yoakum) from Lakeville, CT where he went to school (Indian Mt), and one September about 10 years ago he came up to Mt Riga one evening to a place Eliot and I were renting and we had a long talk about kids, music, politics. 

HHP's prez Phil Wolf, HHP's medical director Roberto Peigne, yrs truely, and Richard Morse.  Photo taken on the porch of the Oloffson by Daniel Morel, well known Haitian photographer who lives at the hotel

So I came down to sea level after being up in the mountains for a week of clinic services that Hispañola Health Partners and our local partner AMBUF provided for the community in Marjofre. We provided 5 days of gyn, 3 days of dental, optometry, and general medicine.  Final counts are not in but we probably serviced close to 300 people.  Except for me and Erin (last blog), all providers were Haitian and the 100 goude ($2.50) that AMBUF charged for the consultation and meds will be invested into the further construction and infrastructure of the project.  Trying from the start to incorporate locals in decision making, administrative duties, financial managing for the eventual soti po blan yo (foreign aid retreat), they are deciding how to best invest the near $1000 they raised.  By charging the residents of the community for the clinic services, they too are contributing to its future.  "May the circle be BROKEN" of eternal NGO handouts that unintentionally keep poverty entrenched.  
early morning dental demo for the waiting crowd

emergency tendon repair
It is pulling teeth
12 month old Jeudi's cheek abscess, as she calmly lies on her side on the table,
waiting for incision and drainage
Tomorrow I have a meeting with the director of Fonkoze, Haiti's well-known microfinance organization, that is interested in our cervical screening program for their women members in the SE region.  I am also meeting with the head of a cancer program in one of the local hospitals to help tighten up our referral system for women with findings too advanced to treat with cryotherapy. Tomorrow I am back in the boondocks to revisit the Mennonite clinic high up in the pine woods where I did screening 18 months ago to do follow up and help train a new nurse in the procedure.   

So, my dear friends, thanks for finding a little flash moment in your day for peeking under this circus tent.  It's fun to have you along, later, Louise

Sunday, November 23, 2014

Mini Hostage Crisis in Haiti

November 14th, 2014
Set my specula free!!

Hello again friends and fellow wanderers:

I know there are a million things more important than 5 or 6 speculums stuck in police custody, but it was a rude awakening to come back to Haiti after 6 months and find that there had been a turf war between the Ministry of Police (UDMO) and the Ministry of Health (MSPP) in Anse-a-Pitres, and that my gear was caught in the middle.  Last May, the Ministry of Health was enjoying the extra rooms provided by the adjacent UN Peacekeepers' property after the UN had left town. That is where we were doing trainings, exams, and the everyday clinic goings on.  But sometime in July UDMO took over the property, waving high powered rifles around and confiscating all materials that were on the premises.  Sad for MSPP, who lost vaccines, birth control, records, the ultrasound and much more.  Our cervical screening program just lost some records, containers for decontamination, and the speculums we use for cryotherapy.  Luckily a clever nurse was able to liberate a few and I brought one from NY, so we are in business.  And gratefully, the cryo unit and C02 tank were somewhere else when the invasion occurred.  Apparently the standoff should be settled soon. 

I got to Pedernales, at the farthest western edge of the Dominican Republic 4 days ago and did 3 days of cervical screenings up in the hills along the frontier, at the house of a community leader and health promoter, Nansi Calbajal, on her kitchen table. Although she is Dominican, all the people that she serves in her community are undocumented Haitians and she welcomes them with a big warm heart. Considering the decades of hostility between Haitians and Dominicans, this is particularly uplifting.

Nansi at home with the world

The first day I arrived, the men of the community were shaving the hair off a 150# pig they had just slaughtered about 15 feet outside her kitchen door, and during the course of the morning I checked in on the butchering process, which was surprisingly neat and clean.  The women didn't pay it any mind and marched right by into the kitchen one by one.  They have some amazing first names: Macdounize, Kleumanta, Wislet.  Privacy (HIPAA for those in the biz) just DOES NOT EXIST in this culture.  As often as I ask my assistants to register people in private, it never happens - everything personal is a spectator sport in this land.  We are asking them delicate things like how many partners they've had in a lifetime, and when the first time was that they had sexual relations - both have relevance to their risk of human papilloma virus, the precursor to cervical cancer.  Today a 52 year old woman who had 9 children told the crowd she was 42 when she had relations for the first time! When I asked her again when we were alone, she told me she was 12.  Some of us are better with the chronology of our lives than others; one woman yesterday had no idea how old she was when she first had relations, but knew it was during the time of Jean Claude Duvalier ('71-'86)!

Patient Registration - "Sans Souci"
November 22nd, 2014

Meanwhile I was waiting for my soul sister and fellow NP Erin Quinn to meet me in Pedernales before getting swallowed into the throat of Haiti.  She had made a 28 hour Herculean trip from San Diego - red eye to JFK, JFK to Santo Domingo, was grabbed at the airport and whisked off to meet the 8 hour bus to Pedernales.  The next day we were facing the "twisted horseshoe roll" (roller coaster vernacular)  4 hour motorcycle ride with bags upon bags of stuff; we had lots to accomplish in the short time she could dedicate to coming.  Magically, Jeanne, our Haitian nurse who knows everyone but the Pope, found a minister to take us the whole way in Climbing for Christ's comfy Toyota Hilux, someone who also stayed with us and helped out with 3 days of clinical events in Marjofre.  Gracias, Minister Miguel.

Erin with Jesus and his ride

Erin had come to teach Matron yo, or home birth attendants, how to judge a baby's respiratory status the first minute after birth and when the use of a tiny Ambu bag might be needed.  All births in the region are done at home with the help of matron yo, elderly wise men and women who most often blend folk medicine and gently serve the spirits of  the loa (Vodou). The 3 hour course was held in our yet unfinished health center that our organization, Hispañola Health Partners, is helping local Haitians complete and get up and running.  We also made 200 clean birth kits with the help of the matron yo and members of AMBUF (our local committee).  This simple kit, with plastic for the woman to lie on, a clean razor blade to cut the cord, clean twine to tie off the cord, gloves, soap for handwashing, and cute little cap for the baby to keep itself warm, are essential ingredients to help prevent maternal-infant infections with severe consequences. 

To help you get your bearings, we are are located in the Southeast corner of Haiti (Sud-Est), between                                                          Thiotte and Belle Anse
workshop underway
Faktori for clean birth kits

Proud matron with his clean birth kit, Ambu bag and suction bulb

That's it for now, please check in later today or tomorrow for further installations, since I am sitting pretty in Port au Prince with great wifi until Tuesday and will catch up on all the news that's fit to print.  Love to you all, Louise

Sunday, May 18, 2014

Weeds and deeds

Bon nwit, zanmi yo.  As promised in my last blog, I will write a little about datura stratmonium, also known as jimson weed, and other neurotoxins called tetrodotoxins, used in the process of zombification.  Wade Davis, in his book The Serpent and the Rainbow, cites the case of the famous zombie, Clairius Narcisse.  
Clairius on his way to his not so final resting place
Mr. Narcisse, born in 1922, was not well-loved in his community; along with being a womanizer, having children with at least 5 different women, he also was involved in a nasty land ownership dispute with his brother.  He quickly and mysteriously took sick and was declared dead by 3 well-respected doctors from the Albert Schweitzer Hospital here, and buried on May 2, 1962.  He appeared back in his village 18 years later, much to the surprise of his family and neighbors, who all recognized him at once.  Apparently someone (his brother?) had hired a bokor, or vodou priest, to make a mixture of human bones, plants with stinging spines and the bacteria that is commonly found on a pufferfish (watch out, sushi lovers). This mixture was secretly applied to a skin abrasion of his, inducing a coma which mimicked death.  A few days later he was exhumed and force fed a mixture of datura, cane syrup and sweet potato which made him loose his memory and hallucinate.  The regular ingestion of this formula kept him compliant while he worked in the cane fields.  When his master suddenly died after 2 years, Clairius was free to roam the countryside, which he did for 16 years, until the effects of datura faded enough for him discover that his brother had died and eventually find his way home.

Now and then I pass a group of blank-faced field workers in black rubber boots and hoes in hand, all working robotically in a row under the blazing hot sun.

meetings, meetings, meetings
My final week here in Haiti found me transversing the country - I should work for the highway dept here and file a report - 5 of us took motos and a jeep for 11 hours from Anse-a-Pitres to Jacmel to meet with the head of the Ministry of Health for a meeting that never came to be. However, we powered on and spent 4 productive days in Marjofre, gathering with the local folks, discussing administrative issues with our Haitian partners, talking over the final floor plans for how we will divide up the space - patient waiting area outside on the porch and under a palm shaded front yard, 2 consultation rooms, a little ER, pharmacy, lab, maternity, a bathroom and administration.  All in about 800 square feet.
Jeanne talking about cervical screening on our clinic porch
This month we did 105 cervical screenings in 4 different towns, making our total count in the last year 575.  Jeanne is now in charge of continuing the screenings and teaching staff.  Many thanks to the donors for this project.  We will be bringing the trainings to the southeastern towns of Belle Anse and Thiotte in the next year.
Our team - Hispañola Health Partners - Patnè Sante Ispanyola
We have raised about a third of the $12,000 we need to finish the clinic, as we wait for 501 (c) 3 status, please write me at to find out how you can make a tax-deductible donation now.  Our new, improved website will be up and running in a few weeks - I'll be in touch.  Our motto, created by the founder of the clinic, Fritz Regis (last guy on the left) is:
                                                         LOVE PEOPLE
Cascade Pichon - we had a cool swim on the way back from Belle Anse

Tap-tap gallery - the flora of Port au Prince
Samson and Dalila on bottom, caption "a friend in need is a friend indeed" on top