Last words for this round

I got home a week ago in time to celebrate Thanksgiving in New England with my family - sweet!  After loosing 10 pounds due to the scarcity of food and food choices, I am cramming myself full of a daunting amount of taste treats.  Yet this pleasant experience could not distract me from my recent experience - I am haunted day and night by dreams and desires to continue meaningful work in Haiti, elevating it to a more intense level as I toy with the possibility of starting a clinic in Majofre.  I stare myself in the face with the hows, whens, whats and whys of making it happen.  A giant Rubik's cube of logistical steps and potential pitfalls.  I have your encouragement and support to thank for this beautiful mess, as well as a team back in Haiti, doing their part to make it become a reality.  A group of us will continue to communicate by email in a variety of languages over the next few months, and God willing, I intend to touch back down with both the Haitians and you, my faithful followers, sometime in March.

to finish, a financial update:

2012 donations to date: $3025

2012 expenses to date: $1668
Meds and supplies: $1049
Patient assistance:  $192 (food, ambulance, tests)
Mobile clinic expenses (transport, food, stipends for assistants) $427

Therefore, I have $1357 to launch the next episode.

deye mon gen mon - beyond mountains there are mountains

Medicine Show continued

     OK, I´m back at it a week or so later, after another 4 days of clinics in the mountains and coast.  Before going any further I have to finish the story of Rene'l, the unfortunate fellow that fell from the avacado tree.  I went to the hospital in Barahona where he was sent last week and was able to locate the nurse who took care of him after he arrived from Pedernales.  He remained conscious until the end, but died at about 5 pm the next day, with her at the bedside.  She felt terribly sorry for him and thought maybe they could have saved him if someone had come with him and helped )$$$$$) transfer him to Santo Domingo.  His fever remained 105 and he had multiple internal injuries.   Eeek, I felt a little guilty hearing that.  Instead of saving his life, I was romping around with a clown.  But the obvious question is how would he have survived afterwards, paralyzed from the chest down?  As of today, no family has appeared in Ansapit to ask his whereabouts. His body is still in the morgue in Barahona.

Rene'l's nurse Ingrid in Barahona; too bad I can´t photoshop me out

     After leaving Grand Gosier last week we walked 8 km up to a place called Majofre to do a little clinic in a place where there is no health care at all for many miles.  Chris did more shows for waiting patients and I saw many people, lots of elderly who complained they couldn´t see.  My classic question is ¨Can you thread a needle¿¨ because the majority of them can not read.  I would lend them my glasses and magically they could see!!!  I have to bring a team of optometrists up here or at least a boatload of reading glasses.  I can´t imagine how lost in the world I would be without my $18 pair. I saw about 100 patients last week, and thanks to your dollars, people were provided with antibiotics, hypertension, pain meds, etc.

Chris ready to boogie in Majofre

This week I returned with Dr Demosthenes (Dr.Demo) from the clinic in Ansapit and the rest of the team, including Susan Koppenhaver, our practice manager from Hudson River Healthcare in Amenia.  I also brought along Patrick Howell, the director of an NGO in Barahona who was curious about Haiti and what I was doing.  We rambled for hours over the hills on motorcycles to return to Majofre, where we did another few days of clinics, this time seeing twice as many pts since we were 2 practitioners.

Susan, Patrick and driver ready to hit the hills

     With the help of local leaders, we have begun to hatch a plan to finish a clinic in Majofre that a Haitian American who grew up in the community has started.  He (Mr. Fritz) came back to his home town after retiring and, responding to a need for healthcare in the region, he began to build a clinic but ran out of money before it could be finished.  We stayed in his compound where he has the only electricity in town (2 hours), a bar, little general store and a bread bakery using a huge wood powered oven.  Dozens of children come over at night and watche TV, sitting on the ground of his dooryard.  We did a few days of clinics while Jean Paulin and Patrick interviewed the residents, met the local leaders and began to outline steps for finishing the clinic construction, brainstorming on how to get the Haitian Ministry of Health and an NGO to partner.  It is an ambitious plan, but if the Gods are on our side.......

View from the road to Majofre

Partially finished clinic

Dr. Demo with a cutie

Waiting room

getting stoked for some hot bread

     Haitians continue to be, at least in this part of the country, the most gentle, surprising, kind hearted people I have ever encountered.  It sounds like ridiculous hyperbole, but I have hundreds of simple examples =  we were taking off from Grand Gosier in a vessel last night resembling a hollowed out 40 foot pirate ship without mast and sails.  This boat had broken loose in Ansapit during hurricaine Sandy and floated 40 miles down the coast  to Grand Gosier, getting severely beat up in the process.  Chris and I saw it being repaired on the beach last week, they were jamming felt in the spaces between the planks that made up the side of the boat and painting the hull with tar bubbling over a little fire in the sand.   I was surprised yesterday when doing one more clinic on a cliff I heard a roar of cheering down on the beach.  They had finally launched Le Souvenir after 2 weeks of repairs!  We embarked last night to return to Ansapit on its maiden voyage.  About 10 minutes into the trip the 40 hp engine sputtered and died.  For 30 minutes the captain kept yanking the cord, sweating, groaning, huff'puffing, but not a swear word was uttered!  This grease stained sailor still kept calling his deck mates mache, ´¨ my dear¨¨ and saying his please and thanks yous even after repeated coughs, chokes, gurgles.  When we finally got going, much to my disbelief, under the stars and above the phosphorescence in the waves, all hands on deck started singing thanks to Agoueh, the god of the sea.  The chanting went on for two hours, along with the captain blowing a conch shell every time we saw some candle or lamplight on the shore.

Le Souvenir is launched

    I must mention that at the same time Haitians can be extremely annoying, ruthlessly pushing you aside on the narrow footbridge with their motorbikes loaded with cargo 6 feet wide, standing in the doorway of the consulting room listening to everything privately said between doctor and pt, despite repeated chiding. You can not eat anything in front of anyone without sharing it, or open your wallet in public without pleading eyes watching you.  It as if we are all a teaming mass of people struggling through life´s tortures and pleasures all together, no such thing as privacy, no being alone.

A few of my dream Haitian houses

secluded bungalow

for immediate occupancy

fixer upper

                                                   Fellow travelers on the road to Majofre

A 9 inch tarantula I found one night in my bedroom watching me undress!

sweet victory

November 9th, Friday

Hello friends, first of all I want to congradulate all of us for the great news of Obama´s second term.  We found out when we woke up on Wednesday at our clinic high on a cliff facing the sea, from a Jacmel radio station.  Jean Paulin and Peter taught me this little song in creole from the last election which we sing and dance to in the attached video segment:

Ann nou rele, vive Obama

Sa sel Obama kap fe la plis e le bon tan (repeat)

Obama  Obama kap fe la plis e le bon tan

We all call out, long live Obama
Only Obama can do the most in good time

loading the boat in Ansapit

We took off for our "medicine show" on a small boat loaded up to the gills with 100 pound blocks of ice to be delivered to the fishermen along the coast to pack their fish to sell in the market in Jacmel.  Our captain, "Blan" (they call him that, "white" because he is lighter skinned and gets sunburned), and his deck hands show incredible strength, their bodies rigid with muscles hauling heavy loads, including us,  on and off the boat, constantly jumping in and out of the water for deliveries.  We putt-putted along the coast with his 15 HP motor, dropping off loads at fishing villages dotted along the coast, until we finally reached Grand Gosier 7 hours later, only slightly sunburned.

loading Chris in Ansapit

Approaching Grand Gosier, our clinic was that yellow building on the right

Ta-Ta who cooked for us and our view from the center where we worked and stayed

Jean Paulin giving a little talk to waiting patients

We set up shop in a center recently built by some NGO for conferences, visitors, town matters, etc.  Although it had no electricity or running water, it did have a big tank of rainwater we could douse ourselves with and flush down the rancid potty.  I saw 70 people (nothing earth shattering to report, no new cases of kout manga) in 2 days while Chris did tricks for people waiting to be seen and some evening shows in the town square.  After 3 days I felt like I lived there, people asking after us and looking out for us.  Eating red snapper, swimming at noontime break, all this and being able to sleep in a tent under a sky jammed with stars was exquisite, even without cold beer!

Nasty breast infection we were fighting hard; double antibiotics, topicals and salt water compresses

More magic, not the nice kind

This is Grand Gossier as you approach by sea

I wrote a long blog yesterday but it got devoured by the strange forces that inhabit my surroundings before I could send it off, so I am trying again.  I hope by now most of you have restored your lives to its more normal pace, post Sandy. I was traveling this week to pick up meds in the capital which I will be using for my last two weeks while we do some mobile clinics in the remote areas surrounding Ansapit.  We are leaving on Monday by boat down the coast towards Jacmel to Grand Gossier, where we will make headquarters in a clinic that has no meds, doctor or electricity; just one nurse who wings it by candlelight.  I am joined by clown-mime-magician Chris Yerlig, sponsored by Project Troubador, who will help me do our style of "medicine show," where we will travel by foot with a local health promoter and my trusty sidekick, Peter.  Chris, who goes on to Port au Prince next Friday for a few weeks of teaching and performing, will entertain the waiting pts and their families while I do my thing and the health promoter holds information sessions about sanitation, disease prevention, nutrition.  The area is completely cut off from health care access, so this ought to be quite an experience!

When I returned to the clinic from Santo Domingo yesterday morning I was told it was a holiday (Day of the Dead), so no one was around - they were all back in the residence cooking, washing, hanging out.  I looked in our little ER and saw this most distressed pt lying awkwardly on the stretcher, IV long ago finished and tubing disconnected, scraped up and dirty and, mezami!!!! he had ants crawling all over him!!!!  It appears the night before some people had brought him in after he fell from a tree, or the tree fell on him while he was trying to get some avocados.  Rumor had it he was stealing the avocados and the accident was another koute manga, or negative force imposed on him from a zombie that keeps watch over people's gardens.  I know it sounds outlandish, but in addition to these kind of beliefs, it was the Day of the Dead, so people, even those who work with me, did not want to touch him for their superstitious beliefs.  Compounded by the fact that this 27 yo boy was from far away and had no family to advocate for him.  My dear Dr Demo shared this mix of apathy, embarrassment and frustration as he thought he had fractured his pelvis and had him in a holding pattern until he could somehow get him across the border.  I soon realized that his legs were 

beginning to swell, and that he could not move from his chest down, no sensation, nothing.  This was a spinal cord injury for sure!!  I washed him off (dead weight) trying to keep him as immobilized as possible, and shooed off the ants and covered him with the filthy sheet and pillow that someone had provided. I got him some food and water  and sent people to look for someone who knows him to clean him, feed him, advocate for him.   I had to keep hassling  my coworkers back in the residence about what should be done, saying I could pay for someone to get him on a stretcher, over the border, into the back of a truck and to the hospital in Pedernales.  They all looked at me with the most indifferent look, as if this person had a mere stubbed toe.  Because Chris was here and we had a show back in Pedernales, I left later in the afternoon thinking that the nurse on call was going to get the wheels rolling.  I gave her $30 to cover the expenses of getting him to Pedernales, which is hardly a trauma center.

I came back this morning and he was worse, no progress made in getting care for him, still in the same postition but his abdomen was rigid as a floorboard.  I realized he hadn´t peed since the accident and catheterized him. Got lots of urine but the belly was still rock hard.  His skin was burning hot, temp 40.5, which I think is almost 105.  I decided today I would stay with him until he got moved and with a little more $$$ incentive I got 5 of us to carry him across the bridge in a stretcher and onto the back of a pickup in the blazing sun, dust and chaos of the border.  When we got to the hospital I was relieved to see the face of a doctor I already knew who gracefully got the wheels turning.  It happens that along with an acute abdomen (obstruction from lying in the same postition for so long), xrays showed fractures of T9, 11 and L1.After a couple hours I negotiated $170 for a nurse and ambulance to take him to Barahona, 3 hours away where his care will be covered, if he lives long enough to get there.  I am so disturbed and disheartened by the neglect of my coworkers¡¡¡¡ Yet I know this hardened attitude comes from years of working where there are so little resources,  plastered on a backdrop of mistrust and superstition. This painful realization of mine was softened by the compassion and cooperation of the Dominican doctors and nurses, who are often maligned as mega-haitian hater racists.

 Poor Rene´l being transported by truck with fractured vertebrae

 They had to do the xray on the floor because they wanted to keep him immobilized

photos and update

Haitian snake oil

HI EVERYONE I am having a frustrating time with blogging, please bear with me, I don´t now whether you have received multiple copies of an entry that I can´t seem to brighten the print on so it is basically illegible.  Please excuse the nuisance.  I am going to carry on because now I am over a week behind in entries and I have wasted hours trying to fix the last one.

I am so heartbroken to hear bits and pieces about the storm, aching for NYC.  Our few days of flooding is nothing iin comparison to this blitz.

Oven

finished product, great when warm with some strong sweet black coffee

My notes in kreyol, sorry can´t turn them around

Last night I slept in the clinic residence and was awakened at 6 am for another birth.  This one, although another first baby, went quickly, I am watching and helping, learning the routine.  The next episiotomy will be mine.  Most women get pitocin to hussle the contractions, speed up the birth.  The nurses act as midwives, confident, skilled, compassionate and joking away as we slide on the mix of blood, betadine and amniotic fluid that misses the big bucket.
The clinic was bustling this morning, several wounds to sew, a crazy girl came in, another case of kout wanga or being possessed by a spell someone cast, as I explained in my last entry that you most likely could not read. Her family had tied her hands in front of her so she couldn´t hurt herself or anyone else.  We had run out of IV valium, so I gave her promethazine to help her sleep and my translator, an ardent evangelist, advised her to go to church.

Psycho photo from my bike, shot by mistake

A bit difficult to get a history on this woman who was a deaf mute that nobody  knew

Me and Jeramy studying kreyol and english, respectively

baskets for catching fish

Fresh catch drying in the sun on conch shells

Love truck

several days lost in el ciclon

Hello  all yee faithful how are you???  Hopefully weathering the storm ok now that it is your turn.  I am posting my meanderings over the last week while out of contact, starting 10/25.  Thanks for the love, Louise

A woman came in yesterday who had been beaten up by her husband (he's in jail).  She was wet and covered with sand and dirt, hair totally wild and she was super bug-eyed, "Night of the Living Dead," each eye going in a different direction while having the closest thing to a real seizure as I have ever seen.  She was contorting her neck in a scary bizarre position, people were holding her down and the little emergency room was packed with family and rubberneckers.  Pulse normal, pupils equal and responsive, moving all extremities, a few nasty bumps and bruises, maybe a fractured arm.... Dr Demonsthenes, a 30 yo intern from Port au Prince who is working with me, sharp as a whip and a face of a 15 year old mumbles humbly to me, "um, you know, the Haitian people (pause), she is having anxiety.  We will let her stay here for a while and see if she calms down."  But others explained that she 

must have been cheating on her husband and he put a kout wanga, or spell on her.  She ended up staying for several hours and still did not calm down after getting hosed off in the tub for cholera pts (see photo) and IV Valium.  Her parents decided to take her across the border to get checked by dominican docs.  Demosthenes later explained that Haitians frequently don't trust their own doctors or hospitals and often seek something beyond their border, if they have the means. 

Woman with the kout wanga getting washed off in the cholera tub

Today it was raining for the 3rd day in a row, the sideshow of the hurricaine that passed between Cuba and Jamaica.  I've been drenched repeatedly riding around by bike and motorcycle.  Few people come to the clinic because they are deathly afraid of going out in the rain and getting sick.  "Cholera will come back with this weather" they cluck.  But today we had a birth which took many hours, the mother's first.  Since 6 am she lay naked and splayed out on the sickly pink colored plastic birthing table in 90 degree humidity as we fanned her madly with an old medical file and tpped on her belly like telegraph messengers gone mad, to help promote contractions.  "Mezanmi!!!" she would hollar.  The cranky nurse who used to sleep on her desk started slapping her inner thighs to get her to open up and bear down with all her might.  We're all cheering "puse, puse, l'ap vini," (push, push, its coming) and sure enought she did after 7 hours of pushing.  In the States she would have had a C-section before the morning coffee break.

Well, I never got to send the above entries because the internet has been down for a few days now due to the storm.  The dominican phone I have is not working either, but the Haitian cell provider is, kudos to something working better here than in the DR!  The howling wind and sheets of rain come in paroxysms, about 30 minutes apart, giving you hope that things might clear, but WRONG, back it comes.   Its so odd to be in a big storm without knowing anything about it - its strength, where it is headed,  its name - no persistent weather channel updates 'round here beyond just looking outside; its raining, it stopped, sky is deep gray, now its getting brighter, wind is slamming doors and window around, things are quiet and calm.  waves in the sea today are super high, you can hear the surf a mile away; We went down to the beach this morning to see for ourselves.  They needed to pull ashore this tremendous wooden ship that they use to transport people and cargo from Ansapit to Jacmel, so they placed seaweed under it and raised it up on some pathetic looking logs.  With the help of 40  men and women who pulled ropes  tied to the boat's bow with a series of rhythmic heave-hos, sure enough they advanced it tug by tug to higher ground.

Boats ready to go the 7 hours to Jacmel in happier times, several were ruined in the storm

More kreyol - grate tet - to wonder,  ponder, literally to scratch your head
Fwod - fraud
Pa chat  - to sneak around (to act like a cat)

fotos and more stories

Jeanne giving a talk about HIV prevention in the clinic.  There is no testing available, we have to send people to Pedernales -$$$.  The latest infection rate according to the UN is 1.9% of the population between 15 and 49

Beds are empty in the cholera tent.

Rode and Muscadin in the nurses office.  Now there 6 capable nurses with organized schedules and the obligatory whites.  When I was here before there were only 2 nurses, one who mostly napped at her desk,even though there was a cholera epidemic outside

My examining room.  We are using body bags from the cholera epidemic to cover the examining tables, which I didn´t realize until I turned it over and noticed the big long zipper!!!  I am writing my notes in kreyol now, thank God I have been seeing only 5-10 a day this week.

The door to my bedroom at Peter´s house

The outdoor shower feels great on a day when temps reach the high 90s.  The neighbors 15 feet away put on great music - boleros, salsa, bachata, merengue - to add rhythm to scrubbing

Here´s the squatter, brand new and clean as a whistle

Natalie and Rosmaris, Peter´s sister and stepdaughter that live with us.  They share the same bed.  Rosmaris, who is three, feeds herself as delicately as the Queen mother.  I have a book of kreyol children´s stories that I read to her.

Natalie getting coiffed by a neighbor in our jarden

Ezrameyel, Peter and Sylphan´s 14 month old antchoutechoute or wild little monkey who gets into absolutely everything

Rosmaris waiting for dinner last Sunday - rice, beans, fried chicken, yucca, "sauce."  Very special because of my arrival.



Let´s talk about food.  This morning for breakfast I had some spaghetti floating in a thin red sauce with a few light green peppers.  Good enough, especially with strong sweet black coffee, served on the porch of my domicile.  I bought 5 little bags of home roasted peanuts on the street on my way to work that tasted great with my second cup of sweet mud when I got to the clinic (another upgrade from last time).  Then around 1:30 Sylphan delivered my lunch - yanm, which is more like a fibrous potato, again with the light red sauce, this time accompanied by a fish skeleton for flavor, decoration maybe? Tasty enough but I was done after a few bites because it is hard to have an appetite when it is a breezeless 98 degrees.  However the sweetened, watered down natural orange juice she brought me is a godsend.  Tonight on my way home I bought some pen or white hamburger looking rolls, fresh baked in a home oven, still hot.  For dinner we shared 3 of the rolls between 7 of us, with labouyi or porridge, made from cornmeal, milk, cloves and vanilla.  Eating is a family free-for-all with no one having their own specific plate, however I play defense in hopes that Ezramael´s grubby mitt (haha gotcha Romney) won´t approach mine.

Things I have learned to do:

Ride sidesaddle on a motorcycle when I am wearing a dress

Drink a 40 oz beer, a Dominican fria grande, freezing cold by myself in less than 30 minutes, still on my feet and ready to roll onward.

More witchcraft:

    The other day a neighbor brought her 2 yo child over to be checked by me because he had a little scar on the left side of his neck.  I was trying to understand what the problem could be because it just looked like a well healed wound from long ago.  Sure enough, I later found out that when the chuild was only a few days old his mom found him one morning in a little pool of coming from a neck wound.  Outside the bed she found drops of blood leading out the door.  Do you believe in vampires?

      Peter started talking about zombies again when he took me to his cornfield.  When i asked him if he is worried that people will steal his corn which is ready to harvest, he said that often you see zombies standing in cornfields, watching them for their owners.  It seems they are most used for the boring-ist of jobs.  Pete also said you always see zombies in Haitian factories, and also for some reason in the drugstore.  You can tell they are zombies because their voices are always very nasal, sort of like a snorting.

Some new favorites in the kreyol lexicon: 

Blofe  liar

Twompe  deceive

Zengzeng  bother

Gaga  simpleton

Fizi  firearm

These Haitians are tricksters by nature.  HOllywood should do some recruiting here.  Yesterday evening I happened to drop by the clinic and this teenage boy came panting in, totally out of breath, looking just like he was having an asthma attack, being held up by 2 family members.  I asked his sister if he had asthma and she said yes.  So I immediately gave him a nebulizer treatment and even though he was still heaving heavily his lungs were perfectly clear.  I thought hummm, he was burning hot, 104.5 degrees.  20 minutes later he´s in bed with an IV, positive for malaria, resting quietly.  I wasted time and a nebulizer treatment because I did not recognize his dramatization of the fear he was feeling - my bad!

N'ap ale anko ( here we go again)

Bonjou tout moun anko - Hi from Haiti to everyone that is interested in continuing the ride or jumping on the bus while it¨´s smoking up the hill!  I got to Pedernales, in the Dominican Republic on the border of Haiti, about one week ago.  Although I had done my best to prepare by word of mouth that I was coming, and was told last February while making a brief visit back that I was most welcome, what appears is often not at all what is, especially veiled by the cultural smokescreen.  I was received politely last Thursday, but told by the chief doctor of the clinic (LaMartine) that he would have to meet with his staff to see how they feel about me starting.  He said he would get back to me the next week!!!!!  Wow, enough fire to hard boil an egg in this gringa´s boiling blood!!!  Wait in this dusty cowboy town for who knows how long for who knows what?????  I took a few deep breaths and nodded in agreement, circled around the health center to meet everyone.

 Things have changed considerably since I left mid-March of 2011.  The non profit organization, Batey Relief  Alliance (BRA), with which I was allied last time I was here, had not succeeded to take over operations of the then woebegone clinic.  Although contracts had been signed between BRA and the Haitian Ministry of Health, hands shaken, press releases sent here and there; in the end there was some kind of power struggle and BRA was sent packing.  Today things look considerably cleaner, better organized, more manpower, everyone dressed in startched white, including me, the only person sweating bullets in this uniform in 90 degree heat with a ceiling fan that only reaches 1 on the scale up to 5.  I got the greenlight to work the next day, after meeting with the head nurse who knew me well and couldn't understand why I wasn't starting right away.  So she got the wheels rolling andhere I am back in the knack, sewing up lacerations, seeing babies with high fevers, funny rashes, pregnant women, people possessed by spirits and writhing in paroxysms of pain like in an old fashioned grade B horror movie.  However I am feeling content with a little more kreyol under my belt and understanding the routine much better than last time.  By the way, although the cholera tent is still standing out in the backyard, there are no patients now and haven't been for some time.

I am staying in Haiti with my translator and his family- no light or running water, but it is kind of like camping in luxury.  His wife does everything for me - she cooks cleans, washes my clothes, she even followed me into their rustic shower to help me bathe until I told her it was not really necessary.

I'm sorry if this blog is a little helter-skelter, I have to reenter the DR in order to have wifi and I am attempting this on a i-pad, so the curve is a little high.  I am going to try to post some photos