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.