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

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: "A Tonton Macoute was a special operations unit within the Haitian paramilitary force created in 1959 by dictator François 'Papa Doc' Duvalier. Some 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