The Gods Must be Crazy

December 3, 2014

Hola comrades:  Does anyone remember the South African film by this name released in 1980??  A french version of the film popped on when the power suddenly returned in a bedroom where I was staying in Port au Prince last week.  It cracked me up.  The film is described by Wikepedia:

Xi and his San tribe are "living well off the land" in the Kalahari Desert. They are happy because of their belief that the gods have provided plenty of everything, and no one among them has any wants. One day, a Coca-Cola bottle is thrown out of an airplane and falls to Earth unbroken. Initially, Xi's people suppose this strange artifact is another "present" from the gods and find many uses for it. (They employ it as a crafts tool, blow the top to make music, etc.) But unlike anything that they have had before, there is only one glass bottle to go around. With everyone wanting it at once, they soon find themselves experiencing envy, anger, and even violence. 

The film might seem trite now, but one can't avoid noticing the loss of innocence replaced by technology and commercialization when you travel in this part of the world.  We deplore the soot-spewing cars, trucks and motorbikes, mountains of Styrofoam and plastic, drab urban malls that we exported years ago to the likes of Santo Domingo or Port au Prince.  We come to a Caribbean island looking for charm and simplicity but are dismayed to see our own culture's dirty face in the mirror!! 

Luckily, the ingenuity of daily life here that continues to amaze and bewilder far outweighs the negative; the fabulous and funny things I see and love sharing with you, dear reader .

Am I too old to learn how to do this?

Fixing a flat on my moto in Thiotte

Lost tongs replaced by kitchen knives on a marimba used in the merengue tipico I danced to last weekend

I spent most of last week in a clinic run by Mennonites in the high mountains of Haiti, in a town

called Oriani.  I had been there before, and deeply admire the commitment of the people that established this haven for the sick and super underserved.  I was there to continue cervical screenings for cancer and follow up on some positive findings I had encountered there more than a year ago.  I was happy that I had time to spend with the nurses there, teaching them the technique, and making plans for a collaboration with Fonkoze, a large and well-respected microfinance NGO in Haiti, who will be sending their women members from the region there for screening in the upcoming months. 

teaching Sonia and Githane the didactic part of IVAA, screening for cervical cancer using acetic acid 

Oriani is at 5000 feet, cool and green as you can see, full of plenty of nutritious food that gets sold every week at market to merchants who sell it in Port au Prince

direct marketing - a soup made of beef and plantains

good green earth at 5000 feet

On the road to Oriani you transverse a 7000 acre reserve of pine forest

Each day at the clinic begins with a hymn and a prayer, led by a Haitian dok

The first night that I arrived there a woman in her 20s came in who had a frightening story; her husband had mysteriously and suddenly died a few days earlier and in her grief, she asked someone to get her a cup of a home remedy to calm her down.  The medicine was in an unmarked bottle, and the friend mistakenly gave her a swig of super-concentrated pesticide which was in an another unmarked bottle nearby.   She gravely damaged the mucous membranes of her upper digestive tract, looked very jaundiced and was desperately begging for an IV which everyone here thinks saves you from death.  She, the mother of 3 children under 4, had a terrified look in her eye and could not speak since the poison had burned her throat so badly.  After much ado, she was finally transported to Port au Prince, with a fate this is still left unknown, but her prognosis is not good. Its no wonder that such a tragedy would make a people believe in the power of vodou. Why else would one have such a coincidental run of bad luck? The sadness of this single event leaves me with a deep respect for Keith Towes and his staff who confront daily challenges like this as they serve the villagers at the Clinique Confiance en Dieu. 

Frere Keith with his peeps

I am writing this now in Santo Domingo where all week I have been training nurses, on the last leg of my travels.  I'll be in NYC on Sunday, God willing. Thanks as always for tuning in.

Love always, Easy Rider

Project Runway, Haitian school uniforms

Pre-K Pink

Modified sailor suits

It's blue in Thiotte

tangerine and melon are happening in Savanne Zombi

DO YOU WANT TO DONATE TO THE CAUSE???? hispanolahealthpartners.org, all donations go directly to Haitians in the struggle, foreign volunteers (like me) travel on their own dime.  thanks, always

Notorious

November 23, 2014

Hotel Oloffson

Its Sunday evening and the darkness slowly wraps itself around the hills surrounding Port au Prince, and from my balcony I can watch the bats swerving in and out of the palms as they bend in the breeze.  Choir voices waft upwards from the church on Avenue Christophe.  I am guiltily indulging myself in 2 days of hot water, internet, fine food and exhilarating company at this remarkable Victorian Gothic style hotel.  

Decked with creepy statuary made from wood carvings and recycled doll extremities, skulls, hub caps, spray cans, the shady, the grassy grounds are a refuge from the insane traffic, open sewers and dust of the city.

Baby Jane

Tonton Macoute

Baron Samedi 

This place was built in 1896 by the Sam family and housed two of Haiti's presidents around the turn of the century.  It's up a hill,  providing cooler air and spacious views of the sea and city below.  It served as a military hospital in the 20s during the US Marine's occupation, then became a hotel in the 30s, a bohemian hang-out for artists, writers, actors.  Probably best known for the site of Graham Greene's The Comedians, all the rooms are named for the famous people who have stayed here: Jackie O, Edwidge Danticot, Mick Jagger, Katherine Dunham, John Barrymore, Amy Wilents, Barry Goldwater (?)  I think its stunning too! 

 Haiti Say You Will - my room

I know I am digressing and I promise to get back to the point of bringing you all to this blog very soon.  However, I feel like, as with many encounters of this trip so far,  it is a good karmic sign that I met and hung out for a second time with Richard Morse, the hotel's owner and cousin of Haiti's president, Michel Martelly.  Our link is a friend in common (Elizabeth Yoakum) from Lakeville, CT where he went to school (Indian Mt), and one September about 10 years ago he came up to Mt Riga one evening to a place Eliot and I were renting and we had a long talk about kids, music, politics. 

HHP's prez Phil Wolf, HHP's medical director Roberto Peigne, yrs truely, and Richard Morse.  Photo taken on the porch of the Oloffson by Daniel Morel, well known Haitian photographer who lives at the hotel   photomorel.com/

So I came down to sea level after being up in the mountains for a week of clinic services that Hispañola Health Partners and our local partner AMBUF provided for the community in Marjofre. We provided 5 days of gyn, 3 days of dental, optometry, and general medicine.  Final counts are not in but we probably serviced close to 300 people.  Except for me and Erin (last blog), all providers were Haitian and the 100 goude ($2.50) that AMBUF charged for the consultation and meds will be invested into the further construction and infrastructure of the project.  Trying from the start to incorporate locals in decision making, administrative duties, financial managing for the eventual soti po blan yo (foreign aid retreat), they are deciding how to best invest the near $1000 they raised.  By charging the residents of the community for the clinic services, they too are contributing to its future.  "May the circle be BROKEN" of eternal NGO handouts that unintentionally keep poverty entrenched.  

early morning dental demo for the waiting crowd

emergency tendon repair

It is pulling teeth

12 month old Jeudi's cheek abscess, as she calmly lies on her side on the table,
waiting for incision and drainage

Tomorrow I have a meeting with the director of Fonkoze, Haiti's well-known microfinance organization, that is interested in our cervical screening program for their women members in the SE region.  I am also meeting with the head of a cancer program in one of the local hospitals to help tighten up our referral system for women with findings too advanced to treat with cryotherapy. Tomorrow I am back in the boondocks to revisit the Mennonite clinic high up in the pine woods where I did screening 18 months ago to do follow up and help train a new nurse in the procedure.   

So, my dear friends, thanks for finding a little flash moment in your day for peeking under this circus tent.  It's fun to have you along, later, Louise

Mini Hostage Crisis in Haiti

November 14th, 2014

Set my specula free!!

Hello again friends and fellow wanderers:

I know there are a million things more important than 5 or 6 speculums stuck in police custody, but it was a rude awakening to come back to Haiti after 6 months and find that there had been a turf war between the Ministry of Police (UDMO) and the Ministry of Health (MSPP) in Anse-a-Pitres, and that my gear was caught in the middle.  Last May, the Ministry of Health was enjoying the extra rooms provided by the adjacent UN Peacekeepers' property after the UN had left town. That is where we were doing trainings, exams, and the everyday clinic goings on.  But sometime in July UDMO took over the property, waving high powered rifles around and confiscating all materials that were on the premises.  Sad for MSPP, who lost vaccines, birth control, records, the ultrasound and much more.  Our cervical screening program just lost some records, containers for decontamination, and the speculums we use for cryotherapy.  Luckily a clever nurse was able to liberate a few and I brought one from NY, so we are in business.  And gratefully, the cryo unit and C02 tank were somewhere else when the invasion occurred.  Apparently the standoff should be settled soon. 

I got to Pedernales, at the farthest western edge of the Dominican Republic 4 days ago and did 3 days of cervical screenings up in the hills along the frontier, at the house of a community leader and health promoter, Nansi Calbajal, on her kitchen table. Although she is Dominican, all the people that she serves in her community are undocumented Haitians and she welcomes them with a big warm heart. Considering the decades of hostility between Haitians and Dominicans, this is particularly uplifting.

Nansi at home with the world

The first day I arrived, the men of the community were shaving the hair off a 150# pig they had just slaughtered about 15 feet outside her kitchen door, and during the course of the morning I checked in on the butchering process, which was surprisingly neat and clean.  The women didn't pay it any mind and marched right by into the kitchen one by one.  They have some amazing first names: Macdounize, Kleumanta, Wislet.  Privacy (HIPAA for those in the biz) just DOES NOT EXIST in this culture.  As often as I ask my assistants to register people in private, it never happens - everything personal is a spectator sport in this land.  We are asking them delicate things like how many partners they've had in a lifetime, and when the first time was that they had sexual relations - both have relevance to their risk of human papilloma virus, the precursor to cervical cancer.  Today a 52 year old woman who had 9 children told the crowd she was 42 when she had relations for the first time! When I asked her again when we were alone, she told me she was 12.  Some of us are better with the chronology of our lives than others; one woman yesterday had no idea how old she was when she first had relations, but knew it was during the time of Jean Claude Duvalier ('71-'86)!

Patient Registration - "Sans Souci"

November 22nd, 2014

Meanwhile I was waiting for my soul sister and fellow NP Erin Quinn to meet me in Pedernales before getting swallowed into the throat of Haiti.  She had made a 28 hour Herculean trip from San Diego - red eye to JFK, JFK to Santo Domingo, was grabbed at the airport and whisked off to meet the 8 hour bus to Pedernales.  The next day we were facing the "twisted horseshoe roll" (roller coaster vernacular)  4 hour motorcycle ride with bags upon bags of stuff; we had lots to accomplish in the short time she could dedicate to coming.  Magically, Jeanne, our Haitian nurse who knows everyone but the Pope, found a minister to take us the whole way in Climbing for Christ's comfy Toyota Hilux, someone who also stayed with us and helped out with 3 days of clinical events in Marjofre.  Gracias, Minister Miguel.

Erin with Jesus and his ride

Erin had come to teach Matron yo, or home birth attendants, how to judge a baby's respiratory status the first minute after birth and when the use of a tiny Ambu bag might be needed.  All births in the region are done at home with the help of matron yo, elderly wise men and women who most often blend folk medicine and gently serve the spirits of  the loa (Vodou). The 3 hour course was held in our yet unfinished health center that our organization, Hispañola Health Partners, is helping local Haitians complete and get up and running.  We also made 200 clean birth kits with the help of the matron yo and members of AMBUF (our local committee).  This simple kit, with plastic for the woman to lie on, a clean razor blade to cut the cord, clean twine to tie off the cord, gloves, soap for handwashing, and cute little cap for the baby to keep itself warm, are essential ingredients to help prevent maternal-infant infections with severe consequences. 

To help you get your bearings, we are are located in the Southeast corner of Haiti (Sud-Est), between                                                          Thiotte and Belle Anse

workshop underway

Faktori for clean birth kits

Proud matron with his clean birth kit, Ambu bag and suction bulb

That's it for now, please check in later today or tomorrow for further installations, since I am sitting pretty in Port au Prince with great wifi until Tuesday and will catch up on all the news that's fit to print.  Love to you all, Louise

Weeds and deeds

Bon nwit, zanmi yo.  As promised in my last blog, I will write a little about datura stratmonium, also known as jimson weed, and other neurotoxins called tetrodotoxins, used in the process of zombification.  Wade Davis, in his book The Serpent and the Rainbow, cites the case of the famous zombie, Clairius Narcisse.  

Clairius on his way to his not so final resting place

Mr. Narcisse, born in 1922, was not well-loved in his community; along with being a womanizer, having children with at least 5 different women, he also was involved in a nasty land ownership dispute with his brother.  He quickly and mysteriously took sick and was declared dead by 3 well-respected doctors from the Albert Schweitzer Hospital here, and buried on May 2, 1962.  He appeared back in his village 18 years later, much to the surprise of his family and neighbors, who all recognized him at once.  Apparently someone (his brother?) had hired a bokor, or vodou priest, to make a mixture of human bones, plants with stinging spines and the bacteria that is commonly found on a pufferfish (watch out, sushi lovers). This mixture was secretly applied to a skin abrasion of his, inducing a coma which mimicked death.  A few days later he was exhumed and force fed a mixture of datura, cane syrup and sweet potato which made him loose his memory and hallucinate.  The regular ingestion of this formula kept him compliant while he worked in the cane fields.  When his master suddenly died after 2 years, Clairius was free to roam the countryside, which he did for 16 years, until the effects of datura faded enough for him discover that his brother had died and eventually find his way home.

Now and then I pass a group of blank-faced field workers in black rubber boots and hoes in hand, all working robotically in a row under the blazing hot sun.

meetings, meetings, meetings

My final week here in Haiti found me transversing the country - I should work for the highway dept here and file a report - 5 of us took motos and a jeep for 11 hours from Anse-a-Pitres to Jacmel to meet with the head of the Ministry of Health for a meeting that never came to be. However, we powered on and spent 4 productive days in Marjofre, gathering with the local folks, discussing administrative issues with our Haitian partners, talking over the final floor plans for how we will divide up the space - patient waiting area outside on the porch and under a palm shaded front yard, 2 consultation rooms, a little ER, pharmacy, lab, maternity, a bathroom and administration.  All in about 800 square feet.

Jeanne talking about cervical screening on our clinic porch

This month we did 105 cervical screenings in 4 different towns, making our total count in the last year 575.  Jeanne is now in charge of continuing the screenings and teaching staff.  Many thanks to the donors for this project.  We will be bringing the trainings to the southeastern towns of Belle Anse and Thiotte in the next year.

Our team - Hispañola Health Partners - Patnè Sante Ispanyola

We have raised about a third of the $12,000 we need to finish the clinic, as we wait for 501 (c) 3 status, please write me at llindenmeyr@gmail.com to find out how you can make a tax-deductible donation now.  Our new, improved website will be up and running in a few weeks - I'll be in touch.  Our motto, created by the founder of the clinic, Fritz Regis (last guy on the left) is:

                                                         LOVE PEOPLE

Cascade Pichon - we had a cool swim on the way back from Belle Anse

Tap-tap gallery - the flora of Port au Prince

Samson and Dalila on bottom, caption "a friend in need is a friend indeed" on top

Missing virgin

Hello friends and fellow wanderers, you will have to read the entire blog before you get to the mystery for which this entry is named.  Ja-ja, the Haitians are teaching me some crafty tricks!

The finish of week three on the set; the thunder just rolled off the mountains down to the Pedernales seashore with such a resounding KABAMM that it set off a few car alarms down the road.  Probably the Red Cross vehicles whose drivers are loading up on beer and pollo frito at the restaurant a block away.  Rainy season is full on and it took us all week to get smart enough to make it to the beach on time after work before the customary 3 hours of persistent afternoon rain.  Everyone is thrilled despite the flooding and veneer of green is beginning to drape itself over the landscape of cactus and rubble. The air is 10 degrees cooler.

The three ring clinical circus I brought to Sant Santè Anse-a-Pitres has packed up and headed out - I'm super pleased with how the trainings have gone, and relieved that they are over.  I began last week with the didactic part of cervical screening, followed by 4 days of practical application.  The nurses were engaged and are on their way to becoming proficient.  Jeanne will supervise them in continued learning in my absence. 

The Speculators

                                      

The biggest feature was the captivating performance of Dr Mary Gratch, who dedicated a week's precious vacation, away from St Barnabas Hospital in the Bronx, to teach the docs and nurses here how to use the ultrasound machine that has been collecting a generous layer of red dust since it arrived here 3 years ago.  No one had any clue how to use it.  The word spread fast and the clinic has been packed with big bellied women for the last 4 days.  Mary taught staff how to judge dates, head and placental position, moms could see the little baby's heart beating, with directions ricochetting around a hot, crammed room in three languages.  She is a rockstar!!  This can give the providers and families here a chance to do advance planning for perinatal emergencies like breach, placenta previa, fetal non-viability, etc.  Just as a note, the first two births I saw here before Mary came produced dead babies, for a variety of reasons, most being total lack of prenatal care.

Dok Mary doin her thing

The UN Peacekeepers who were living next door to the clinic since the expulsion of Aristide in 2004 moved out about a year ago, so the land and the existing buildings have been lent to the clinic for the meantime.  Problem is, there is no power there so the resident handymen have had to jerry rig a series of generators, solar invertors, twisting bare wires into ridiculous contortions and risking electrocution and the destruction of the fragile sonography unit.  The machine is way tougher than we thought however, and behaved miraculously.  None of this drama was prepared for before Mary and dozens of large women were waiting as 9:00, 10:00, 10:30 drifted by.  Mary was a supa-troopa, Gras a bondye.

There's a little Haitian proverb that might be apt for anyone coming to volunteer here: Si ou renmen grenn anndan, ou dwe renmen po a tou.  "If you want the nut, you better like the shell too."

Using old UN trailer and my battery-powered projector for training

                                      

       When the UN packed up, they took the Virgin with them - they kept the nut and left the shell 

The Hispañola Health Partners team is meeting today in Pedernales to travel to Jacmel where we will further strengthen the collaboration with the Haitian Ministry of Health for our community health center in the mountain region of Marjofre.  Many of you have generously donated to this cause, thank-you, thank-you.  Along with the details of how this goes, my next chapter from deep inside Haiti will include a little more about the ethnobiology of witchcraft and various tetrodotoxins found here. 

This is highly toxic datura which grows up in the hills, the base for atropine and scopolamine

bye for now, Louise

Goat on the road

     Welcome back dear friends, to my first entry since last November, accompanied by the first rainfall today since that date.  After a searingly hot afternoon, dragging my sweaty body back across the border, I sensed the unmistakeable ozone scent wafting through the windows as I was chowing down an enormous meal of la pechuga, chicken breast with salad, rice and beans. I realized it was pouring outside; the streets flooded with torrents of brown water, whirling plastic bottles, leaves and other detritus of life moving at breakneck speed.  And me without my umbrella!

I returned to the Haitian/Dominican border a week ago - the first part of my month here involves teaching my colleagues at the health center in the little town of Anse-a-Pitres how to do cervical screening for cancer using a simple technique involving vinegar, a headlamp and cryotherapy for positives.

Community health promoters identifying my reproductive organs!!

This week I am doing three didactic workshops for promoters, doctors and nurses and next week will be doing practical training with patients coming to the clinic for screening.  Dr. Mary Gratch, a friend and OB/GYN from NYC is joining me to do a training on pelvic ultrasound at the same time. Cluster-teach Haitian style!!  It has been an arduous job translating Spanish PowerPoint presentations (175 slides), courtesy of an American organization that does similar trainings in Central America called Grounds for Health,  as well as other training materials into kreyol with the help of my Haitian nurse, Jeanne. My search for an organization that does similar work to partner with has been in vain.  Few non-profits access this far corner of SE Haiti, so the lone wolf continues to roam the hills.....

Last week I was joined by Lydia Marden and her daughter Sadie from my beloved old stomping ground, the State of Maine.  Lydia is a nurse practitioner (we've been best friends since nursing school in the 70s) and Sadie is in her 3rd year of medical school. We did some cervical screenings in a remote fishing village about an hour by moto from Anse-a-Pitres.  The "president" of the town owns the only recognizable business there, a bar of course, so we did the gyn exams on tables on the dance floor between the giant speakers, with a gorgeous cliffside view of the sea.

Sadie doing her exam between the Marshall stacks!!

our seaside clinic from out back

     Things continue to improve from my perspective here, granted I am an optimist, but you can't argue when you seen the decommissioned cholera beds, plenty of staff running around and new construction underway at the health center.  The addition is being built by a Spanish NGO, Arquitectos sin Fronteras, and will include labor, delivery, exam rooms and an operating room (can't imagine where the surgeon will come from) for C-sections, etc.   We thought it would be done by now but there has been a little hold up in the funding.  Solar panels now bring enough current to run a computer and the light for the microscope as well as a dull nighttime bulb in the little ER and a light trickle of water runs from some sinks.  

Off the job and hopefully not to come back during the rainy season

Arquitectos sin finanzas

goat on the road

more later, much love, Louise