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 

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?. http://www.myriamchancy.com/apartheid-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

The work, the wandering, the widening lens

The Work

Salutations!  If you read my last entry, the second cryogun arrived in the capital a week after my other one gently exploded,  and after being held in customs for 3 days, either because of tariffs or due to the fact that it looks like some kind of space-age weapon of destruction, I personally escorted it on the 7 hour bus ride back to the border.  When I finally screwed it to the tank of CO2 as we were loading all our stuff on motorcycles for the hills, I pulled the trigger and some nice frost appeared on the tip, GOAL!!!!! I have to remind myself not to get too "clinical" with you all, or God forbid, descriptive, when I talk about the 197 gynecological exams I did on the women of the greater Anse-a-Pitres region over the last 2 weeks.  I will leave you instead with the facts; I screened 197 women between the ages of 30-55 for cancerous signs of the cervix, treated 6 of them with cryotherapy, checked all of their breasts for lumps and bumps, uteruses and ovaries for abnormalities.  In general the women of this region are in remarkable shape despite having up to 12 children, most of them born at home alone or with a local "untrained" midwife, no running water and challenging hygenic facilities.  Although I was without lab tests to check for sexually transmitted diseases,  I saw very few clinical signs of anything pathological, and luckily nothing I would judge suspicious for HIV infection.  I was told by several Haitian health care workers that the women loved getting a comprehensive GYN exam;  they are concerned about what is going on inside them, and have a very limited concept of their anatomy, disease processes, etc so fear reigns as the imagination soars.  A number of them we found had fibbed their age in order to be checked!  Alison Parker, a childhood friend who is a nurse practitioner from Vermont,  accompanied me on the last week of my journey, we had a great back and forth on clinical impressions, she was welcome company and a good road warrior.

I had the pleasure of working with Dr. Robert Peigne, a well-trained, young, bright, compassionate doctor from the region I have known for several years now who did hundreds (I lost the count) of primary care consultations at the same time as I did the cervical screenings; your generous donations helped pay his expenses as well as for the medication we brought with us to the boondocks.  He encountered the usual array of hypertensives (many), rashes, gastrointestinal problems.  No cholera cases, no malaria or dengue, although we hear it is around.  Presently the Ministry of Health is on a campaign with USAID to treat everyone for worms and filariasis, which is caused by a mosquito borne parasite that invades the lymphatic system mostly of the lower extremities and can cause elephantiasis.  I have seen pictures of infected men whose scrotums reach the floor!!  I took my dose.

                                           Women waiting for screening in the clinic in Ansapit

Alison doing screenings in Majofre with my beloved nurse, Jeanne

Health care promoter, Jean Robert, distributing pills for vemin ak filaryoz

Me and Alison loaded for an hours' ride up to Thiotte at the end of the day

Me checking for kinks in the cryosystem, testing with an orange, in Thiotte

The Wanderings

One of the places we worked, Banane, has the gorgeous Pedernales River running through it, girls carrying water home from there at the end of the day

I guess goat heads are sold separately in Thiotte

 Le Souvenir, the post-Sandy restored boat that took us through the starlit phosphorescence from Grand Gossier to Ansapit last fall got rammed to bits yet again, now maybe forever disabled


My dream retirement home


I'm glad that typos happen elsewhere than just in this bolg


The Widening Lens

When we got to Majofre to do the final three days of cervical screenings and primary care consultations, I was thrilled to see the scaffolding up on the half-finished clinic and a team of guys skimming a smooth surface of cement on the rough walls.  This is an ongoing project for a few of us gringos and locals who want to realize the dream of having a full time functioning clinic in this remote district.  It was started several years ago and now continues with the funds and moxie of Monsieur Fritz, a Majofre native who worked for 30 years in autobody repair in the Bronx and came back here to live.  We are making progress getting the Haitian Ministry of Health to sign on, as well as forming an NGO both here and in the States to help with supplies, meds and salaries.  Dr. Peigne, who I mentioned above,  is committed to coming back to this roughed out building to do monthly consults, bringing specialists like dentists and optholmologists from Port au Prince.  I plan to return in the fall, stay tuned and thanks for the love, Louise

Clinic entry way

This is the local team of health promoters, leaders and Mr. Fritz (top right)  sorry that my early model i-phone has no flash making it challenging for black facial features at night

Patients waiting in one of the freshly skimmed rooms

An attempt to do this from another site off my ipad, I think I remember last time itwas not so successful. Getting to quaisi reliable internet is hard now that they have gotten very strict with border passing, I can no long flow freely on my "white face" visa,  my passport has no more pages left from all the stamps that now the guys are stamping over old ones.  I am staying tonight at my nurse's house on the Dominican side, she is a Haitian who trained as a nurse in the DR.  She has been working at our clinic for free for the last 6 months; she would rather not loaf around doing nothing and keeps advancing herself, hoping she'll eventually land something.  She ismy right hand- kind, efficient, energetic.  We back and forth in spanish and kreyol as we greet the women, wipe down for the next patient, add in a few salsa steps as we go.

A few words about this project - cervical screening for signs of precancer is rarelydone in places like this, in fact if you have the ways and means to get a Pap done, or even know what the hell it is, the next challenge is getting the results back, not to mention treatment for people who test positive.  I just read statistics from WHO that said cervical cancer is the number one cancer in women in poor countries; and the death is long and painful, you literally rot from the inside out.  "See and treat" was begun in the 1990s in Asia and Africa, where by using simple white vinegar and a decent light, a trained health care worker could diagnose precancerous lesions on the cervix and treat with cryotherapy.  A John's Hopkins set of very detailed manuals, at a site called jhpiego.com,  is a great resource and has been my bible leading up to this trip.  Many of the women here have never been screened, so I decided to begin on the first leg of the journey, improving my skills first and then supplying the clinic with the tools and training to do it themselves.  It has been overwhelmingly popular here, the clinic is crawling with women between 30 and 55 all day long, some waiting for hours.  This is a testimony to a band of health promoters who having been educating and recruting around the neighborhoods of Ansapit since last week.

Everything was perfectly in its place after the 80# tank of co2 arrived tied to the back of a guagua (ramshackel bus), which is what I use to do the cryo.  But the moment I hooked it up with the regulator attached to the cryogun, a torrent of freezing gas shot out accompanied with a undeniable pop and I knew things were changing course - voodoo in a bottle¿¿¿. The new unit the company in CT is sending me has been held up in customs for 3 days for reasons unknown, but i have faith that I'll have it in my hands soon.  The great thing here is that everyone here expects things to screw up so they are totally flexible and forgiving when it happens to you.


This guy came into the clinic yesterday spewing blood from a laceration about an inch long, right through the entire depth of his left nostril.  Talk about body piercing¡ He was sobbing and rather hysterical while I was sewing him up, and I felt sorry for him when he told me between heaves that someone came right up and stabbed him with a branch.  I told Peter, the guy at whose house I live in, about it later and he said, " Oh yeah, I saw that happen, he is a very bad boy.  He was trying to steal pepe (second hand clothes that had just arrived in a big fresh bundle off a truck container) from my mother so my cousin hit him with a rock.  Everyone knows he is a thief."

Spring is Cervical Screening in Ansapit

• Bonjou enko everyone who might bend their ears my way for a little while.  If you have been following this blog since its creation in February of 2011, you will know that is about the work (I´m a nurse practitioner) and play I have been involved in the twin towns, Ansapit in Haiti and Pedernales in the DR.  I arrived here about 2 weeks ago, this time with a mission to do cervical screenings on the women in Ansapit at the clinic where i have been working, as well as up in the hills.  I arrived in Pedernales after the sweaty bus ride, sticking to dirty naugahide for 7 hours, only to find that my private chaufeur, Meris (below right) had dropped dead of a heart attack 26 days before.  Apparently he had worked all day giving people rides as usual, was relaxing before going to wash up, stood up from a chair, said he felt bad and whap!!!  He had taken me and many of my friends (even Nicolette) on long moto trips to the beach and the mountains,surviving flat tires and other calamities.  He was also gentlemanly and would accompany me and friends to "La Mecca" to dance, the only "pista" that didn´t employ prostitutes.  He was a smooth and easy dancer.  I did catch him swigging from his flask now and then though he never acted smashed and never smelled like alcohol, however now people tell me he drank all day and smoking, well you could tell from his grater quality voice he was a puffer.  Anyway, this first entry is dedicated to him.

TEam of health promoters getting ready to spread the word to the community about the availability of cervical screenings, using simple vinegar and then cryotherapy for postives.

 Me in my usual position for the last 4 days, where I have done about 125 screenings so far.

 Last sunday dinner at my Haitian family´s house, so delicious, better than many restaurants in the States, all made over a little charcoal stove on the ground - beef, beet salad, rice and beans with sauce and salad

 Nasty road rash, motorcycle accidents are our specialty-  luckily people are not going so fast, just skimming the pavement

 I finally have a use for some old curtains I made from African fabric, the women feel relaxed in the exam room where we have colorful drapes and lots of good music off my ipod.

Suddenly half a dozen "washing stations" have appeared in Ansapit, apparently donated by the owner of Taco Bell who came to Ansapit and thought the people needed them when he saw them washin and bathing in the little canals that run through town.  No one is using them yet, there is no water, but someone sitill managed to christen with a little graffitti.

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!