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

Saturday, May 10, 2014

Missing virgin

Hello friends and fellow wanderers, you will have to read the entire blog before you get to the mystery for which this entry is named.  Ja-ja, the Haitians are teaching me some crafty tricks!

The finish of week three on the set; the thunder just rolled off the mountains down to the Pedernales seashore with such a resounding KABAMM that it set off a few car alarms down the road.  Probably the Red Cross vehicles whose drivers are loading up on beer and pollo frito at the restaurant a block away.  Rainy season is full on and it took us all week to get smart enough to make it to the beach on time after work before the customary 3 hours of persistent afternoon rain.  Everyone is thrilled despite the flooding and veneer of green is beginning to drape itself over the landscape of cactus and rubble. The air is 10 degrees cooler.

The three ring clinical circus I brought to Sant Santè Anse-a-Pitres has packed up and headed out - I'm super pleased with how the trainings have gone, and relieved that they are over.  I began last week with the didactic part of cervical screening, followed by 4 days of practical application.  The nurses were engaged and are on their way to becoming proficient.  Jeanne will supervise them in continued learning in my absence. 

The Speculators


The biggest feature was the captivating performance of Dr Mary Gratch, who dedicated a week's precious vacation, away from St Barnabas Hospital in the Bronx, to teach the docs and nurses here how to use the ultrasound machine that has been collecting a generous layer of red dust since it arrived here 3 years ago.  No one had any clue how to use it.  The word spread fast and the clinic has been packed with big bellied women for the last 4 days.  Mary taught staff how to judge dates, head and placental position, moms could see the little baby's heart beating, with directions ricochetting around a hot, crammed room in three languages.  She is a rockstar!!  This can give the providers and families here a chance to do advance planning for perinatal emergencies like breach, placenta previa, fetal non-viability, etc.  Just as a note, the first two births I saw here before Mary came produced dead babies, for a variety of reasons, most being total lack of prenatal care.

Dok Mary doin her thing

The UN Peacekeepers who were living next door to the clinic since the expulsion of Aristide in 2004 moved out about a year ago, so the land and the existing buildings have been lent to the clinic for the meantime.  Problem is, there is no power there so the resident handymen have had to jerry rig a series of generators, solar invertors, twisting bare wires into ridiculous contortions and risking electrocution and the destruction of the fragile sonography unit.  The machine is way tougher than we thought however, and behaved miraculously.  None of this drama was prepared for before Mary and dozens of large women were waiting as 9:00, 10:00, 10:30 drifted by.  Mary was a supa-troopa, Gras a bondye.

There's a little Haitian proverb that might be apt for anyone coming to volunteer here: Si ou renmen grenn anndan, ou dwe renmen po a tou.  "If you want the nut, you better like the shell too."

Using old UN trailer and my battery-powered projector for training


       When the UN packed up, they took the Virgin with them - they kept the nut and left the shell 
The Hispañola Health Partners team is meeting today in Pedernales to travel to Jacmel where we will further strengthen the collaboration with the Haitian Ministry of Health for our community health center in the mountain region of Marjofre.  Many of you have generously donated to this cause, thank-you, thank-you.  Along with the details of how this goes, my next chapter from deep inside Haiti will include a little more about the ethnobiology of witchcraft and various tetrodotoxins found here. 

This is highly toxic datura which grows up in the hills, the base for atropine and scopolamine

bye for now, Louise

Thursday, May 1, 2014

Goat on the road

     Welcome back dear friends, to my first entry since last November, accompanied by the first rainfall today since that date.  After a searingly hot afternoon, dragging my sweaty body back across the border, I sensed the unmistakeable ozone scent wafting through the windows as I was chowing down an enormous meal of la pechuga, chicken breast with salad, rice and beans. I realized it was pouring outside; the streets flooded with torrents of brown water, whirling plastic bottles, leaves and other detritus of life moving at breakneck speed.  And me without my umbrella!

I returned to the Haitian/Dominican border a week ago - the first part of my month here involves teaching my colleagues at the health center in the little town of Anse-a-Pitres how to do cervical screening for cancer using a simple technique involving vinegar, a headlamp and cryotherapy for positives.

Community health promoters identifying my reproductive organs!!

This week I am doing three didactic workshops for promoters, doctors and nurses and next week will be doing practical training with patients coming to the clinic for screening.  Dr. Mary Gratch, a friend and OB/GYN from NYC is joining me to do a training on pelvic ultrasound at the same time. Cluster-teach Haitian style!!  It has been an arduous job translating Spanish PowerPoint presentations (175 slides), courtesy of an American organization that does similar trainings in Central America called Grounds for Health,  as well as other training materials into kreyol with the help of my Haitian nurse, Jeanne. My search for an organization that does similar work to partner with has been in vain.  Few non-profits access this far corner of SE Haiti, so the lone wolf continues to roam the hills.....

Last week I was joined by Lydia Marden and her daughter Sadie from my beloved old stomping ground, the State of Maine.  Lydia is a nurse practitioner (we've been best friends since nursing school in the 70s) and Sadie is in her 3rd year of medical school. We did some cervical screenings in a remote fishing village about an hour by moto from Anse-a-Pitres.  The "president" of the town owns the only recognizable business there, a bar of course, so we did the gyn exams on tables on the dance floor between the giant speakers, with a gorgeous cliffside view of the sea.

Sadie doing her exam between the Marshall stacks!!

our seaside clinic from out back

     Things continue to improve from my perspective here, granted I am an optimist, but you can't argue when you seen the decommissioned cholera beds, plenty of staff running around and new construction underway at the health center.  The addition is being built by a Spanish NGO, Arquitectos sin Fronteras, and will include labor, delivery, exam rooms and an operating room (can't imagine where the surgeon will come from) for C-sections, etc.   We thought it would be done by now but there has been a little hold up in the funding.  Solar panels now bring enough current to run a computer and the light for the microscope as well as a dull nighttime bulb in the little ER and a light trickle of water runs from some sinks.  
Off the job and hopefully not to come back during the rainy season

Arquitectos sin finanzas

goat on the road

more later, much love, Louise

Sunday, November 24, 2013

Moto mundo

Dear Friends: the patient load was light this week because it started with a Haitian holiday on Monday, celebrating the Battle of Vertieres, which was Haiti`s final defeat of the French forces in their fight for independence on November 18th, 1803.  The hero of the revolution, Toussaint Loverture, was deported to France by Napoleon the year before and died the next year in a French prison.  His lieutenant, Jean Jacques Dessalines continued the fight.  The Haitians heavily outnumbered the French, 27,000 to 2,000 on this day and made Haiti the second independent nation in the new world, and the first black republic.  Dessalines went on to be Haiti`s first ruler, naming himself Governor General for Life.  He was assasinated 3 years later by disaffected members of his administration.

end of history lesson

As an amature blogger, I struggle with trying to make these reports interesting to my readers.  My days recently are so filled with cervixes that I wish to spare you much of the descriptive details, although it is a gorgeous universo in there.  Therefore, I try to choose a different topic that you might be interested as a blog feature for each entry.  This time the world of small motorcycles wins the nomination.

Nothing feels better than turning the corner and seeing this vast expanse of sea at 30 mph
As you might have already gathered, I spend a lot of time for a more-than-middle-aged white woman on motorcycles.  It is the only form of transportation unless you are so poor and have to use a donkey or are lucky, rich, or work for a non-profit and drive a car.  Therefore, I am going to try to celebrate the two wheeler in this edition.  There is so much I do not know, and never will, so I am only prepared to give you the perspective from the back end.  Generally I feel very safe on the bikes, now that my former interpreter doesn`t interpret for me, one of his most important roles is getting me, my associates, and all our gear from Anse a Pitres to our destination safely.  To do this, he chooses our drivers with elite discrimination.

The last blog showed me and Yunior, one of my favorite drivers.  He loves me too because we listen to my iPod, one ear bud in his the other in mine, as we roll along.  Everything from Y0Y0 Ma to the Joint Chiefs!  He straps my CO2 tank on to the back of the bike with old strips of inner tubing, they grip really well and seem to trump bungie cords.  There are no gas stations in the region where I work, so along the roadsides everywhere people sell gas in beer, rum or water bottles, all you need is one shot and you're ready to roll.

Fixing a flat by melting some rubber with a pot of fire on the hole, then putting the whole thing in a press
It isn't too fitting for an older woman to ask a pack of young men in deep concentration exactly what they are doing or how precisely it is done, so many questions remain unanswered about flat tire repair.  There is really nobody or nothing you can not carry on a moto under 180 ccs.  My favorite sensation, which I hear before I see, is the guy on the back dragging a dozen or so 20 foot pieces of rebar along the concrete

guess he just came from a big box store

Returning briefly to the reason that I am here in Haiti:  Jeanne and I have done 108 cervical screenings and 8 cryotherapy treatments.  The cost to you, dear donors, has amounted to $5.21/patient.  Both the women we treat and the communities and health centers where we are received are happy to see us and very grateful for the service.  Jeanne has now done over 100 visual inspections and 6 cryo treatments, well on her way to working independently.  We will be doing a training of doctors, nurses and community health workers in the spring in Anse a Pitres, in the newly constructed maternal-child wing, financed by Arquitectos sin Fronteras.

42 year old mom with dysplasia too severe to be treated with cryotherapy.  We had to send her to the new University Hospital of Mirbalais, built and run by Zanmi Lasante/Partners in Health which has a wonderful cancer center.  Your donations paid for her transportation, a 5 hour bus ride.   

As I finish this entry, I am back home in the cold north.  Thank you, faithful readers, and will reenter this wonderful web again next spring, si bondye vle (God willing).  Much love, Louise

Friday, November 15, 2013

from Jacmel to Jehovah

                                        Any Jungians out there willing to interpret???

A salute to my beloved friends and family back home with an intelligence (?) report and mission update.  Due to who-knows-what snafus in the techno infrastructure, I´ve had a ·$%& of a time trying to get the pictures up and this off to you. I wrote the text last week.

November 8th, 2013
It´s been a wonderfully productive week working towards getting the clinic up and running in Marjofre. Last Sunday Phil and Patrick appeared in Pedernales, president and vice prez of the non-profit we have started to help move the clinic along, Hispañola Health Partners. We had a meeting with the department head of the Ministry of Health of Haiti (MSPP) of the SE province which was surprisingly positive.  After 3 hours on motorcycle and 6 hours in car to get to Jacmel, we agreed we would be happy if he were just THERE and didn´`t blow us off.  Instead Dr Ted Lazarre was enthusiastic and supportive and after we abide by a few not-to-impossible-to-fulfill requirements, we can expect them to partner with us in the upcoming year or so.  That would help enormously in making the clinic eventually self-sufficient; MSPP would provide a doctor and nurse, a network of trained community health workers and the usual services (or lack thereof) of family planning, maternal child health, vaccines, TB, HIV and cholera prevention.  We would continue with salary incentives to keep good staff, as well as supply the clinic with meds, equipment and a functional lab.

From left to right, Fritz Regis (founder of clinic in Marjofre), Phil Wolf, president of Hispañola Health Partners, me, Patrick Howell, Vice President of HHP after a victorious meeting with MSPP

Passing through Port Au Prince for the first time, we buzzed along the outskirts as fast as possible en route to Jacmel. Both hammered by the earthquake, i can´t say either place looks any worse than many other metropoli in the developing world, the usual piles of rubble seem like nothing out of the ordinary.  Jacmel however is a seaside town of distressed majesty, gorgeous colonial buildings in various stages of crumble with salt air and intoxicating breezes/stenches coming off the freckled light blue bay.


Phil, Patrick ad I stayed there for an extra day and Fritz and his jeep returned to PAP to pick up a team of Haitian dentists who were packing themselves, folding dental chairs and all their equipment to do 3 days of consults in Marjofre.  We 3 had to deal with the devil to get to Marjofre by sea, which looks painfully close on the map, but the roads are barely donkey worthy.  So at 7:30 pm in the drizzle we sought a ride to the dilapidated port of Marigo, where we would take a 6 hour open boat ride up the coast to Grand Gosier. (I have taken you there before a few times).  The only wheels we could secure were motos just a hair above mo-peds, my and Patrick´s driver had to use my headlamp for a headlight. When we got to the boat, which is a hollow hulled wooden structure resembling the Nina or Pinta without any sails, I expected to see it cargoed up to the gunwales with charcoal and plantains but instead the hull was lined with bodies stem to stern, eerily reminiscent of those slave ship drawings. Chuckles ripped along the curled up bodies as they watched the blans stumble their way on board with their enormous backpacks and clumsy feet. When it started to pour, the mates covered us all with a huge tarp under which you could hear a symphony of snoring, gurgling, wheezing, coughing an whistling of passengers in different stages of sleep.  I stood up (there was no more lying room unless I wanted to get really friendly) with my umbrella sheltering me from the storm and watched the sky change from passing clouds to a packed house of stars, then a second light-show below as the phosphorescence was showing off as the wake broke off the side of the boat.  The captain sang as he steered the boat in full darkness, creeping along the shoreline, never more than 40 feet away from the white rocks, cacti and thornebush scrub that was emitting this warm fragrance of butterflies, herb, woodsmoke and dried fish.  A mystery mix of life unknown.
                                        The fleet waiting for nightfall in Marigot

                                                 Agwe, voodoo god of the sea, watched over us
We eventually reached the long wharf of Grand Gosier at 3 am and were greeted by our moto taxis who we presumed were going to bring us up the steep 8 km road to Marjofre where some comfy beds awaited us.  But alas the road was too wet and we would have to wait, and anyway, a young woman in town was having a hard time giving birth to her first baby and they had decided I was going to help with that before I realized I´d dropped my flipflop into the deep water while trying to get off the boat.  The mariners fished out my flop expertly and I was on my way up the cliff to the village.   The 17 year old girl´s water had broken 24 hours before and her labor was ¨piddly´¨ as I think they used to say, 35 years ago when I worked as a midwife.  Yet she was well dilated and almost ready to push, so I told her to walk outside for a while, meanwhile we hung our hammocks on nearby porches and tried to catch a few zzzzs.  The baby´s heartbeat was great, so there wasn´t much for me to do, but ¨let God.¨ We left at dawn and her labor had picked up, I later found out she had the baby at 5 pm, in the company of an ancient matron or lay midwife. 

We only stayed in Marjofre long enough to meet with the local clinic committee and see the dental and medical clinics going full swing, using a roaring generator for electricity and lugging water from the cistern.

Thanks to many of you, hundreds (don´t have the count yet) of dental and medical visits were done Nov                                                   7, 8, 9th in our rustic clinic in Marjofre

Over the weekend I went to visit some old friends in Las Matas de Farfan and Elias Piña, along the Haitian/Dominican border, where I worked years ago.  I visited the priest from St Teresa de Jesus, a jolly soul from Wisconsin who has been there for years.  Just like a Dominican, he rips out his spanish in spitfire speed, all full of jokes and colloquialisms.  In the same way he is supernaturally in touch with the community´s needs, and among thousands of other amazing things he has organized in the community during the last 25 years he has been there, his parish recently finished a vocational school for 432 high school students, in a former mansion of Trujillo, the notorious dictator, mowed down in the early 60s.
El Jefe was more prone to violating than educating young girls
On the 20 mile ride back to Las Matas de Farfan, our ¨carrito,¨or jalopy crammed with passengers, first got retained for 30 minutes because we were carrying some contraband garlic.  I saw a few 100 peso notes pass hands with la guardia and we were on our way.  Suddenly, at 50 mph the hood of our car flies up and hits the windshield, already worse for wear, now cracking it into a dizzying roadmap of crooked lines, brakes squealing, zero visibility.

I´ll give 3000 pesos to anyone who finds an intact windshield in a public vehicle in this country

a hip shot from the moto of the high rise tombs here in Haiti

Pretty grateful to Jehovah when I arrive alive, tank and all

November 15th : I just finished doing a whole bunch of cervical screenings in the mountain town of Thiotte, more later, much love and HAPPY BIRTHDAY ROSIE !!!!!

Thursday, October 31, 2013

washday and other activities

Laundry day in center Anse-a Pitres
Last Sunday I decided to stop being a princess and do my own laundry.  This created quite a spectacle as you might imagine, as everyone in this town assumes blans yo (white people) have maids at home to do everything for them.  But I was surprised by the complexity of the routine.  You head down to one of the raging canals that run off the mountain above town and zig-zag through every neighborhood.  People wash themselves there, kids play, and that is our source of water for the house (I drink from a sand filtered vat).  You bring 3 big pans, your kids and a little chair to sit in.  You step into one of the chilly canals, being careful because its slimy and slippery underfoot.  What a rush during the heat of midday!  You fill the pan with water, being careful it doesn't pull you and itself down the canal with the force, and then you scrub each piece of clothing with a yellow bar of soap.  Rinse each piece one by one in the canal.  Sometimes you have to run after a escaped pair of undies, catching it 30 feet down the street.  By now most of the kids in the neighborhood are watching you, rippling with giggles.  You fill another big pan with fab and repeat the process.  For white items you use the third pan, mixing fab and bleach, letting it sit for 20 minutes.  Then rinse and soak for a few seconds in indigo, a blueing that apparently really gets those whites bright.  You gather up your stuff and your little chair, and head home to hang the load.


The beach of the maleconcito of Pedernales
There isn't much good to remember about Hurricane Sandy which ripped through here a year ago, but I was amazed this year to go down to the beach in the Dominican border town where I enjoy the luxuries of running water, TV and internet, to also find the beach that had always been covered with impossible stones for barefoot walking, was covered with a lovely, thick layer of sand for as long as the eye can see.  These fishermen bring in red snapper, eel, conch, lobster, crab and plenty more.  The maleconcito is dotted with trailers that put out their own tables, chairs and domino boards and play a version of "battle of the bands" as they blast music from their own sets of megaspeakers.  Fantasic way to end the day: cold beer, soft breeze, brilliant sunset, ka-ka phony....
Haitian fishing nets made with floaters from old pieces of flip-flops

He WAS born yesterday

I'm enjoying working back at the clinic this week, picking up where I left off 6 months ago and seeing a usual mix of pregnant women and runny noses, anxiety reactions, dizzy spells and a few VIA (cervical screenings) in between.  There is no doctor here for the next week or so - we are an army of sisters holding the fort.  Yesterday a typical Haitian country girl went into labor and was groaning the usual "mezami,"  "manman mwen," "bondye" (wow, mama, good God) when I heard her clearly say "shit, man!" several times over.  Who says America is not a great exporter??  Her water broke early and it was stained with meconium, or baby poop, which is not a great sign.  We could not hear the baby's heartbeat as she labored along, although with no 02, incubator or possible chance to have a caesarian, you truly just "let God."  The baby came out not breathing and we sucked gobs of brown-stained secretions from its little nose and mouth, feet and hands looking liked they'd been dipped in "indigo."  Miss Leana, the nurse with most experience (over 20 years, I guess), gently took the helm and began pumping its tiny chest a few times with her fingers and then flexing its little body back and forth as if making it do sit ups. 5 minutes of this, as well as the upside down hanging and tapping its feet, and you see the results!

Jeanne doing "depistage," or visual inspection of the cervix with acetic acid (VIA)

I'm encouraged about the progress of my grand plan to teach VIA to several of the clinic staff in Anse-a-Pitres when I return next spring.  With the help of other sister organizations that are doing this around the world like Grounds for Health and Basic Health International, I have begun to collect some materials in kreyol, French and Spanish and think about a curriculum that will work here.  The people here are excited to learn and now Jeanne has done almost 50 herself.  She will be the supervisor of the project once people are trained and the equipment is provided, and will make sure that at least 1000 women will be screened each yera at each site.  My goal is to teach it in three major posts in this rough, remote rural district; Anse-a-Pitres, Thiote and Belle Anse over the next two years.  Many of you have helped make this a reality - avek lanmou, Louise 

Saturday, October 26, 2013

Making contact

The open air Pedernales cinema has known better days

Bonjou mwen zanmi yo ,or 'hi friends' I returned to this foresaken bordertown a few days ago, feeling stragely at home, far less stunned by the heat, noise, absurdity etc that hits an innocent where it hurts when he first arrives. Many old friends and familiar places, and always, the delicious 'fria' or ice crested Presidente beer at the end of the day to help me study war no more!
My Hunter Thompson imitation

I still feel a little 'pants down' when I am in the heat of the battle, trying to speak in both spanish and kreyol, mixing them up incomprehensibly - except to my Darling nurse Jeanne who understands me in any language except english - at the same time that I am trying to be an efficient, sympathetic and competent health care provider. Sweating piggishly! I went up to the mountains with Jeanne to do some cervical screenings for the last 2 days, as we had been invited there the last time I was in the región. We caught a ride up there in a CARE vehicle, and the driver, a friend of Jeanne )who knows everyone), floored the thing, 50 MPH over the road of heavy rock, a nice new jeep getting beaten like a criminal, spitting stones the size of cantelopes in its wake.
Your CARE dollars going to a good cause
We made it there in good time but the clinic there is under construction so we had to set up in a little community center across the Street. Apparently the community health worker did not really do her job alerting the women, because no one knew we were coming, so we had to scramble to find someone to walk around town with a megaphone, which had no batteries. So after paying a guy for the batteries and sending him on his way with incentive pay, we were in business. We saw 15 women up there and I had plenty of time to spend teaching the technique to Jeanne, who will eventually be the supervisor of the cervical screening Project when I hand it over to the Haitians after the trainings over the next year. Banane is a funky, grimey town. The only thing I really like about it is its river and surrounding canyon which is gorgeous, a 5 minute walk out of town. I took a dip in the super swift current at dusk. I needed to get ready for a klonapin night, where I was sharing a lopsided matress with gray sheets in a tiny filthy house with 8 other people. One of them was this 11 year old boy with Down's who walked around butt naked and was fascinated by everything I did and had. He mumbled incomprehensibly and danced provocatively with the pole on the front porch. Thank God I had a headlamp to stumble my way over the mounds of broken cement block in the front yard. No electricity anywhere. Anyway, I slept like a baby. The next day the ding-dong that I paid to walk around with the megaphone apparently left town without finishing the job, so only 5 women came yesterday.

I get frustrated and disheartened when people do nothing to help themselves as a community. The lack of that spirit here comes in painful pulses, interspersed with inspirational, tireless giving. My friend Peter, with whom I live thinks that all Haitians need to find God, because otherwise they are not good people by nature. Hummmmm. Right now there is a lot of unrest between the borders. Apparently the constitutional tribunal of the DR just finalized a case that strips citizenship from offspring of non'residents, even if they were born here, or their ancestors were born here, trickling all the way down to when their original relatives entered illegally. This brings back ugly images of the time of Trujillo. laws from 1929, when thousands of Haitians or those dark enough to look like one, were slaughtered. There's a great article that Vali just sent me, Aparteid in the Americas. Are you Haitian?. I understand of course that you can not let rivers of poor, needy, unemployed, illiterate people with their 10 children flow freely across the border and get free services from the DR that suffers from its own poverty. That's why Peter and I have these philosophical conversations about how Haití can help itself become a better place to stay. We and the rest of the international community, my my My camera charge quit before I got to Banane. I hope to send a bunch of photos in my next chapter. Many, many thanks for all the help and interest you have offered. I always tell my women patients that their sisters in the US sent the service. bye bye, Louise