Girl with jaundice, eyes as yellow as her dress but you can´t tell in the photo, she probably has sickle cell anemia.

Life has started to feel somewhat routine as I settle into a rhythm of walking along the dry road to the border every morning and back every evening, craving a shower, a beer and a cigarette.  I read or watch spanish telenovelas at night.  I am staying up on the second floor of a building that surrounds a very green, luscious courtyard in a pension run buy a family who have now become friends.  They always have the coffee, strong dominican brew that needs sugar to cut the bite, and they have great taste in music which wafts through the thick air of the morning.

This weekend was slow, all I really did was sew up a few lacerations, a knife wound from a young guy who smelled distinctly of kleren, Haitian moonshine, and someone else that managed to mangle his hand on some bamboo.  I hang my hammock outside the clinic under some fig trees )no figs) and study kreyol or just listen to the clucking of the hens, waiting for some action.  Breezes make it pretty bearable in the shade.  Alex and I or Peter, my translator often go to La Belle Anse a Pitroise, the only restaurant in town which is about a mile through the humble village from the clinic.  There a pleasant buxom lady with a magnificent smile who serves you a mountain of rice under a shaded tent, the kitchen is outside too, under a grove of guayaba trees.  Each time you are served a small piece of meat of some sort and a bowl of brown ¨pwa¨which are supposed to be beans but is really more like a brown soup that tastes a lot like cinnamon.  I actually dont like it at all, so my choices are limited.  The ¨sos¨that you get for your meat is red, rich and and delicious, they serve it separately in a big bowl with a piece of raw onion in it but it is only about a tablespoon, just a tease. 

Lydia and I saw this little girl in the yellow dress a few days ago and we were shocked to see such a little person with such yellow eyes and a very palpable liver peeking out from under her right rib cage.  Her dad was very caring and intelligent, she had apparently been in Santo Domingo for the same thing last year and from what we could surmise she was supposed to get a test for Sickle Cell and never did.  She had vbeen fine up until a few days before. LaMatine, one of the doctors I work with sat down with him and tried to convince him to bring her to Port au Prince.  You would think that with all the organizations there, there would be some great resources for her.  But when I saw her dad yesterday, he told me she is much better, less jaundiced, because a family friend came with some tea made from a leaf that made her poop a lot and she´s been improving ever since! 

In everything I do here, I have to weigh what makes clinical sense, common sense, cultural sense and so on.  For instance, although we do not give children in the US zinc, they have a ton of it here in the pharmacy.  Neither of the doctors seem to be using it, but when I read about it, it seems the perfect thing for everybody around here  pregnant women, lactating moms, etc. helps boost the immune system, growth of bones and muscles, prevention for diarrhea, on and on.  When I ask them why they don´t use it they just say, Öh, you can go ahead !¨ So I plan to gently begin using it, although you have to be careful with the dose, parents could make their kids toxic with too much.  And there is no tetanus vaccine here for adults here, so when you sew up a laceration, you just hope that vaccine they received in childhood is still hangin in there.

I´m trying to memorize some useful expressions in kreyol to make my conversation a little more colorful

Ala gason antchoutchout!       What a nasty boy!!

Se touye máp touye ou!       You´re killing me, you´´re really killing me!!

Ala traka pou yon malere!  What tribulations unfortunate people have to bear!!