Tuesday, July 12, 2016

Piece of Cake

Birthday cake delivery boy in matching Tee
Dear readers:
I am already digressing to the delightful minutiae of my travels.  But I think if you were there with me, you would do the same.  And in that vein, I will turn over the recall of our recent visit to my companion for the week, Peter Halle:
Community ambulance and the crew ready to start mobile clinics - left to right, outgoing administrator Cleeford Pierre, AMBUF member Jean Baptiste Altès, HHP Medical Director Dr. Roberto Peigne, Marjofre Clinic doctor Dr. Daniel Antoine, me, Peter Halle, clinic nurse/new administrator, Miss Florette


Travels with Louise

Louise and I flew into Port-au-Prince near the end of June, with four duffle bags filled with 200 lbs of free medicines, courtesy of AmeriCares.  The meds were destined for the burgeoning, but needy Centre de Santé Communautaire de Marre-Joffrey, a health clinic located deep in the Southeast.

Louise Lindenmeyr is a nurse practitioner and the executive director of Hispañola Health Partners, the NGO that helps support the Marre-Joffrey clinic.  You may know her as the mandolin-playing band member of the Joint Chiefs, along with her husband Eliot Osborn.  She is multi-talented and a force of nature.  I am a retired Wall Street finance guy who can build Excel spreadsheets, speak French, and withstand hours on bumpy jeep roads.

Hispañola Health Partners (HHP) was incorporated in 2013.  With the generous support of St. John’s Episcopal Church, the Salisbury Congregational Church, as well as private donors in our community, HHP has begun to realize its mission to provide integrative primary health care to rural Haiti.

After our first day in the capital converting currency and making arrangements, we headed to the bus terminal, a beaten down gas station, where we were packed like sardines into a rugged and worn 4WD bus for the five-hour drive up 3000 feet.  Now nighttime, we transferred to motorcycles for the remaining roller coaster ride down to Marre-Joffrey.

The Marre-Joffrey clinic opened for patients six months ago, amid local fanfare. The handful of Haitian nurses and doctors serve a surrounding population of 25,000.  The clinic struggles with neither electricity nor proper running water – both solvable problems in time.  But the staff is well trained and motivated to care for their community.  The clinic is dependent on the NGO’s expertise and money, and the plan is for it to become self-sustaining.

Beginning just a few miles outside Port-au-Prince, the road was unpaved with sharp scree, deeply rutted, crossing streams and flocks of goats and chickens.   It was the main highway.  But the crude roads are also a place for social interaction.  The people we met, and there were hundreds due to the mobile clinics, were friendly and, for the most part, content if not happy (after all, they were seeing a doctor).  The mobile clinics, a new initiative of the Marre-Joffrey clinic, consisted of hiring a stripped down 4WD “ambulance” to take us further into the hinterland to treat patients who could not easily get to the clinic.  While Louise and the other professionals saw to patient care, I acted as novice “farmasyen” counting pills, distributing meds, and fitting the far-sighted with free magnifier spectacles. 

Back at the clinic, the doctors and nurses tended to a regular stream of patients, organizing the inventory of drugs, and planning the necessary building improvements.  I trained the new nurse/administrator in Excel and how to track   the clinic’s finances.  But it was not all work.      

The rough and tumble roads were central to our adventures, providing a window into the dramatic landscapes and to the gorgeous unspoiled seashore.  Due to Haiti’s appalling infrastructure (water, sewage, electricity, roads), some of the most pristine beaches are unknown to all but a few.   Grand-Gosier on the southern coast possesses such a beach, where we swam one afternoon in the clear aquamarine waters.

From Marre-Joffrey we traveled six hours through the Belle-Anse arrondissement and over switchback roads to Jacmel, the regional capital, for a meeting with the health minister.   The politics of running a health clinic are every bit as important as the economics.  Jacmel has its charms, including a lovely waterfront and an old town with 19th century colonial architecture.

Our final leg was back to Port-au-Prince during rush hour.  Traffic lights have not functioned since the earthquake in 2010, and traffic rules are, well, flexible.  Coming from the ease and prosperity of our lovely corner of the state and the world, it is jarring to see the plight of Haiti.  But it is not depressing.  These are a people who have withstood the hardest knocks, and have kept their dignity and good humor.  With a little help, they may yet prosper.

Ribbon cutting of clinic on inauguration day, February 21st, 2016
We began full time clinic operations in January, providing primary care to a community that had poor or no access to services in the past.  However, it is not easy in a culture of poverty and deprivation to convince people to take care of themselves regularly.  When you are poor, I theorize, you are so consumed with fighting the enormous challenges of food, water, safety and shelter, that taking care of yourself only becomes necessary when the salivating jaws of the monster of death are about to devour you.
This woman delayed treatment for a deep neck ulcer, showing up on our doorstep with her problem hidden under a scarf

Our mobile clinics, which take place once a week, are designed to reach people who have not heard of our services, living farther than a long walk or an affordable moto ride.   For 50 goude, less than one dollar, they receive a registration card for our clinic, a consultation and free medication, appropriate for their problem.  We have started a Go Fund Me campaign to help cover the costs of the ambulance, driver, and medication.  PLEASE MAKE A TAX-DEDUCTIBLE DONATION TO HHP AT:  gofundme.com/25rbfe8e 

Baron Samedi, a raunchy bad boy, usually seen with cigar in mouth and rum in hand, imposes his diabolical power at the crossroads between the worlds of the living and the dead.

Despite Baron Samedi's taunting presence in Haiti, we carry on with the youthful optimism of these delightful carnival sprites.  Please help us win the battle at: hispanolahealthpartners.org or send a donation to HHP  374 Taconic Rd. Salisbury, CT 06068


Carnival sprites

In the loving memory of Joe Rinaldi, our dedicated board member who suddenly passed away on May 6th of this year, I lay down these words and continue the struggle.  Joe, a financial wizard with a generous heart and many years of NGO chops, helped us develop into a better board of directors over the last year of his involvement with HHP.  He visited Marre Joffrey for the first time in February for the inauguration and with a little touch of the Baron in him, he handed out cigars and Barboncourt (great Haitian rum) to the local committee.  Cheers, Joe!


Many thanks and stay tuned for more about our cervical screening program next time, Louise






Friday, December 11, 2015

Talkin 'bout good news

 December 11th, 2015
home sweet ougan
Hello friends and comrades - I have been in Haiti for the last 2 weeks but, unplugged, unintentionally "off the grid." It's hard to even keep a charge on your cell phone.  Lots of fine things have happened in this land of the unexpected which included today, while riding on a motorcycle taxi, when my driver decided to take a shortcut to the border and drove right though a little vodou compound as they were in the midst of a ceremony.  The dark hut was warbling with their prayers and intermittent taps of a tamborine.  My driver was embarrassed when I asked him to stop, with a warning chuckle of "ougan," or vodou priest.  This is what had caught my eye, as we buzzed by.
An image to Erzulie Freda, the goddess of femininity and compassion, not without her darker side
I started with a journey back to Belle Anse, a coastal town where I had come 6 months ago to begin teaching cervical cancer screening.  This is the third location where Hispañola Health Partners helps train and equip Haitian government clinics in the Arrondissement de Belle Anse, a neglected corner in the southeast of the country.  Every woman we screen here has never had a pap test, as there has never been the capability.  “See and treat” is a simple procedure using white vinegar and the naked eye with a good headlamp to detect changes that indicate pre-cancer.  The affected area can be treated on the spot by freezing with a cryo gun attached to a small tank of CO2.  Everything has to come by motorcycle, over crazy rocky roads.  


This time I was accompanied by Anne Griffin, an ER nurse from Lewisburg, PA who I hadn't spent time with since we worked together in a Cambodian refugee camp more than 30 years ago. 
She makes the perfect companion for the job. She has lived in the desert of Niger, worked in refugee camps in Sudan, projects in Malawi, and jumped out of a tuk-tuk in Thailand to escape being kidnapped.  We trained a doctor and a nurse to become proficient in the "see and treat" procedure, screening 100 women.  The greatest news is that our efforts are finally being recognized, after seeing and treating 1500 women in the last two + years, one of our participating doctors presented the project to the Haitian Ministry of Health and they are finally developing a way to incorporate this into their routine services.  Ah, the sweet breeze of victory!!


Me at 63 on a pile of conch shells while Anne trolls for her favorite
I spent my birthday in the little fishing village of Cap Pierre. Banging down the mountain in a pick-up to eat conch, crab and snapper in the rocks by the shore, grilled by the guys who caught it. Plenty of Prestige beer, bobbing in the waves and taking a few spins on the rustic dance floor made a perfect celebration of time passed on the planet.


one of my birthday guests
I also came to Haiti this time to check out the finishing touches on the clinic we are building with the locals in Marre-Joffrey, located in the same Belle Anse region.  Not without its challenges, we are poised to open for daily services with a doctor and administrator by the beginning of the new year. This week, Hispañola Health Partners hosted a Haitian team of 3 dentists, 1 ophthalmologist,  a surgeon and a family med doctor, accompanied by me doing gyn, HHP board member Dr. Hank Schmidt assisting in everything, and Anne playing pharmacist. We saw about 500 people in 3 days.


HHP Medical Director Dr. Roberto Peigne distributing toothbrushes while the dentist does fluoride treatments with school kids in the clinic dooryard


*******CONSIDER GIVING US A TAX-DEDUCTIBLE DONATION!!!  VISIT hispanolahealthpartners.org OR SEND A CHECK TO Hispañola Health Partners, 374 Taconic Rd, Salisbury CT 06068  THANK-YOU !!!!!!!!!

Cholera is back due to the flow of refugees crossing the border in Anse-a-Pitres to escape persecution from the Dominicans they have lived with for decades.  Hispañola Health Partners just donated money for IVs and bleach which was desperately needed at our sister clinic in Anse-a-Pitres. Hundreds of them are living in raggle-taggle camps just outside of town. For more information, read recent article from another aid organization:  http://www.hearttoheart.org/refugee-crisis-builds-in-haiti/   Here's a few images shot today from the back of the bike.  


Thanks to all and goodnight, Louise

Thursday, May 14, 2015

Shards

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
MIGHT YOU WANT TO DONATE?? PLEASE GO TO HISPAÑOLAHEALTHPARTNERS.ORG.
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



Crusaders!

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: hispañolahealthpartners.org

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