Going Home

It's ten o'clock at night on my last night in Haiti. I am staying at a guesthouse in Port au Prince and I can't sleep. I can hear the soft breathing of a lady in a bed next to mine. From somewhere nearby I hear Josh Groban belting out You Raise Me Up. A baby goat is crying and a moto is passing in the street. A gentle breeze passes through the room. Two hours ago I "had sleep in my eyes," as the saying goes in Creole. Now sleep seems as far away as the States.

There are no words to describe the past three months, not even in Creole, the language even my dreams are speaking. There were so many moments when I was ready to be home. I was ready to be in my own space, to study without mosquitoes circling, and to feel a small sense of control over my life. Now all I can think about is how soon I can return. How I'll bring this but not that, more toothpaste, less conditioner. I'll plan my travel better. I'll see more friends before journeying west to Jérémie. I suppose this heartache at leaving is an indication of a time well spent.

Tonight has been a night of inquiry, both internal and external. People in guesthouses are quick with certain questions: what have you been doing here, where do you come from, how long have you been here, etcetera. Most questions are easily answered. It's that first question that continues to confound me. What have I been doing here? Beyond taking vitals, making friends, painting walls and scrubbing floors, I've been doing lots of listening. With that has come learning, and with that has been days, weeks and months of contemplation.

From this I know that I want to be a doctor. I know that I want to continue to be involved in Haiti. I know that these two things are not incongruous. The question is, how married are they? Do I want to return as Dr. Wolf has, for years and years on end? Do I feel it worthwhile to the country's long term development goals to come back on shorter terms?

I grew interested in medicine because previous time in Haiti exposed me to its practicality. The medical care of a physician is a precious commodity. It has no alternatives and in many areas, is difficult to find. It is my goal to be able to offer physician's services to those without access to them, both here in Haiti, back in the States, and all over the world.

I suppose before I can do that I have to go home.

Until next time Haiti,

Hannah

The 7 Senses

As many of you know, while here in Haiti I have been religiously studying for the MCAT. Part of my studies in biology focused on the senses we use to experience our environment. Most of you are familiar with the 5 senses we are taught in primary school: sight, smell, hearing, taste and touch. But did you know there are two more that are integral to our existence? They are proprioception (the ability to feel within our bodies) and equilibrium (the balance on which we rely to navigate our world).

Here in Haiti we live in a very sensory world.

Everywhere we go we are visually bombarded. We see the countless people walking along the sides of the road, carrying water in 5-gallon buckets on their heads and wearing the brightest of colors. We smile at the children in a dozen different school uniforms riding four to a motorcycle on their way to school. We pass miles of concrete block walls, each hand painted with the name of a business or an advertisement for cell service, beverages of all variety, or condoms. We are surrounded by the endless hills cutting into the horizon, the rich green leaves of the breadfruit trees and the cheery hibiscus flowers that line the fences.

All the while we are smelling the dust of the street, the charcoal fires beneath the banann peze (fried plantains) and the diesel exhaust of the cameon trucks that sustain economy here. Saturday morning we awoke to my favorite smell: fresh rain on warm dirt. My nose was in heaven as I remembered summer storms from my childhood. We breathe the scents of citronella candles and bug spray, fresh laundry, and the ocean breeze.

As I write this, I hear the passing of a rara band in the street outside our gate. Today is Carnival, a day for music and dancing, costumed revelry and drumming. The drumming carries the celebration across the city and the sound of people is nearly drowned out by the pulsing beats. Due to the holiday today, last night was also a time for congregational singing at the nearby church. I went to sleep around 11:00 with the hymns reverberating around my concrete-wall room. The chorus of a dozen songs were belted out by a congregation not afraid to sing off key. The few musical instruments they have are played by people inexperienced in playing them; nevertheless, it is a joyful noise. This morning when I awoke at 6:30 they had either kept singing or already started again. Silence is a rare commodity here!

The sensory overload continues in the taste department with no complaint from me! Haitian coffee with raw brown sugar, fresh mangoes straight from the tree, pikliz on rice and beans that will clear your sinuses in a second, and this morning- hot drinking chocolate made with Haitian cacao and spices destined to remain top secret.

The skin as a sense organ is a mixed blessing. Without it, I would never know the fresh relief of a plunge in the Caribbean, the strength of the wind in a storm or the joy of a kiss on the cheek from Marie-Marthe, my new adopted grandmother. However, I would also be free from the agony of bug bites on knuckles and feet!

The last two senses, proprioception and equilibrium are more difficult to share with you in text. I could try to describe the churn in my gut after I find a worm in my half-eaten mango (better than a half-eaten worm I suppose!) Instead, I would like to describe my experience with proprioception as the feeling inside of me that tells me I'm exactly where I am supposed to be right now and doing exactly what I should be doing. The sense that tells me at the end of the day, everything is going to be alright and the good of humanity will continue to conquer the evil. I could try to impart equilibrium as the way I tumble in the back of the Toyota as we slip and slide up and down the mountain after the recent rains. I would rather describe it in a more personal way. I enjoy my days spent in balance - both immersed in Haitian culture, speaking Creole, as well as spending time in my room or on the balcony, communicating with you and studying the wonders of all our senses. 

My Yellow Bandana

The bandana in all of its just-washed glory.

Whenever I find myself packing for an adventure, I am always sure to bring my yellow bandana. Purchased almost a decade ago in high school from the dollar store, it has become one of my absolute travel essentials. On numerous rock climbing excursions it has held hair out of my eyes. On freezing nights camping it has been one extra layer to keep my neck warm. The soundtrack to countless morning runs has been better heard with this bandana holding my headphones in. Here in Haiti it has served as: accessory, hand towel, face towel, bandage, sweatband, water-bottle-leak-mitigator and luggage identifier. This week it adds another title to its résumé: handkerchief.

Last Thursday in clinic it seemed like everyone had la grippe. Friday I began to sniffle and by Saturday it was all I could do to carry around this ever-helpful and increasingly gross bandana as the head cold made itself known. The weekend passed with no end to the mucus in sight. Dr. Wolf and Miss Cherlie graciously and adamantly insisted I stay home from clinic Monday and I sniffingly obliged. It was rough blowing my nose every three minutes and feeling like the quintessential mouth-breather, but sitting out on the balcony, eating mangos and chatting online with friends and family certainly improved morale.

Several hours in however, I decided to take a lesson from my utilitarian bandana and make myself useful. — I realize in rereading past blogs that I have discussed neither the Water Project, nor my involvement in it and it is now necessary to break from my bandana analogy briefly to discuss one of my primary occupations here.

The Water Project is an initiative to better the understanding of water, sanitation and public health in the areas surrounding the Centre de Sante de Gatineau. Communities chose men and women to be trained in public health promotion by Friends for Health in Haiti in partnership with Johns Hopkins University. These local “promoters” then teach their community members the importance of treating water, washing hands, and proper waste disposal, all in an effort to prevent the spread of cholera and other water-borne illnesses.

The Water Project promoters began working in their communities in October 2013. Each of the 12 promoters in 6 different localities kept a log of their activities. They recorded the date, where the encounter took place (in the street, marketplace, someone’s house, a church or a school), what subject was discussed or demonstrated (treating water, using a tippytap, hygiene, protecting water sources, germ theory, etc.), and how many people were present.

Gemy oversees these promoters and has been collecting these records. He comes over most weekends and for several hours at a time we sit, code data and enter it into Excel. This is Gemy’s first time working with a computer and he has taken to it rather well. Mango breaks and sugar-cane Coke make the work less tedious, but it has still been many weekends spent swatting mosquitoes and trying not to stick to the plastic table cloth on which we work.

We now return to my Head Cold Monday Morning…

I opened the monstrous Excel spreadsheet and began to sort, analyze and copy-paste. By the end of the day, I had an 8 page report with color-coded graphs, tables that summarize the promoters’ activities, and a discussion that made me think those days of data entry were really worthwhile.

I wound up staying home sick on Tuesday as well and happily polished the report, all the while wiping my nose with my trusty bandana, grateful for its reminder to always be useful, no matter the circumstances.

***Future aspects of the Water Project will hopefully include capping local springs to prevent contamination of these vital water sources. Just today Gemy and I walked into a local (only a 2 hour walk away) community to photograph and GPS water sources to aid in future grant proposals. I used my -now clean- bandana to prevent my water bottle from soaking my bag as it is thankfully no longer needed as a handkerchief.

The water source in Jean-Pierre. Gemy and a local inside the stunning source. The sign on the tree reads, "don't forget to treat water before you use it."

Yesterday's roof-pouring bucket brigade. Over 120 men came to heave cement in 5 gallon buckets up to the roof of the residence. It was quite a sight to behold!

Nearing completion of a 12 hour job. These guys left their homes at 0400 and were still singing away by 1800 as they piled into the back of the dump truck for the ride back down to Jeremie.

Foster

I wanted to write a piece about the verb ‘to foster.’ I wanted to contrast NGOs that foster dependency with those that foster relationships. I was motivated by two groups of short term volunteers working in the area and the stark contrast between their work and that of Friends for Health in Haiti. I had clever lines about Foster Farms and Australian beer but in the end the entire piece turned into a big chunk of cynicism. In brief, and with minimal sarcasm, here are the salient points:

1) Orphanages are awful endeavors that should be the last resort only when extended family cannot foster the children. The “three meals and two juices a day” you may think you are providing are likely not there when you are not.

2) Short term mission groups should learn A) how to pronounce the name of where they’re working and B) what it is they can reasonably accomplish that doesn’t just foster dependency. For example, if a patient comes to your LPN-only clinic and states they are only there because they can’t afford the $1 consultation fee to be seen at the doctor’s clinic, you offering to pay their fee guarantees only one thing: that all of our patients will now be coming to you first.

3) Long term commitments that are requested by, supported by, and accomplished with local people are the best way to bring about positive change in any setting – especially resource-limited places like Haiti. The only way to do this is by first slowly and patiently fostering relationships with the very people you’re trying to serve.

Development takes time. People who wake up at 0200 to walk for miles to sit outside a little hut for hours and patiently wait for their 10 minutes with the doctor don’t want a clinic that is built overnight. Rome wasn’t built in a day and if it had been who would have cared if it fell down the next? Easy come, easy go.
Very little about establishing the Centre de Sante de Gatineau has been easy. The journey to the clinic –both literally and figuratively – is littered with more than its fair share of pot holes. But this journey also brings greetings from friends, waves from smiling children and random gifts of fresh fruit and bread. It’s enough to make even the biggest cynic smile. 

Part of the road as viewed from the back of a pickup at sunset

More of the road as viewed from the front of the Jeep in the afternoon

Pharmacy Tech Guy-John, EMT Hannah, and Medical Records Adrien

Miss Cherlie counseling a patient and her friend on med admin

The Middle

Yesterday marked the halfway point of my time here in Jeremie. I have now spent more time here than I have left. It got me thinking about things in terms of middle ground, mediation and being the go-between.

We have two visitors with us currently and just as two weeks earlier when we had seven, I feel as though I am in the middle. I’m not quite a visitor as they are, but I’m not quite a host or resident. Not having a set task here I get to float between the permanent clinic and the visitors’ activities. Two weeks ago I helped the lady volunteers paint and served as the gopher translator for the carpenters. This week I am working with an eye clinic, translating for the nurse on the team and bringing patients between the Sant de Sante and the “Haiti Hut” where we are holding the eye clinic. I love serving as the middle woman, translating across languages and cultures as best I can.

A perfect example of the go-between I get to serve was with one particular visitor, Angela, who hoped to visit a local school. Dr. Wolf had arranged with Genezye, a friend/groundskeeper of the clinic who runs a nearby primary school, for her to spend a morning observing. The morning she was supposed to go visit, Genezye was nowhere to be found. Not to let a visitor be disappointed, Dr. Wolf quickly improvised a new escort: namely myself and Gemy (the water project coordinator). This proved to be a blessing in disguise. Gemy knew the teachers at the school and I was able to translate our presence into Creole for the school kids to understand. In exchange, I got to sit in on 6 different “classrooms” (all in one building, with three classes meeting outside in the most refreshing of breezes). The littlest of children sang us a song of welcome and the older groups stared and smiled as whispers flew. We spent an hour in their presence before heading back down the hill towards the clinic. Shortly after we left the schoolhouse we ran into Genezye on his way up to meet us. Satisfied that we had had a successful visit he escorted us down to his house. We sat in the yard and drank coconut milk fresh from the tree, brought to the ground by a perfectly hoisted 25 foot 2 x 4 and hacked open by an expertly wielded machete. It pays to be the mediator sometimes!

Kendy, Richard and an 83 y.o. patient getting her first pair of glasses

This week I am again a sort of mediator. Two folks from Milwaukee are here to run an eye clinic. It’s a limited service as we do not have an ophthalmologist* on the team and are only able to provide reader glasses and eye drops. Nevertheless, in the nearly 70 people we’ve seen so far this week, we’ve had quite a few giant smiles emerge as people are able to see again. I’m helping the nurse on the team fit people with glasses once their prescription has been determined. We ask if certain glasses are clear, if they can read (or count) things off the bottom of charts and if they fit their faces to their satisfaction. It’s terribly enjoyable and my Creole vocabulary is growing ever more eclectic. I can only imagine what the second half of this adventure will bring. But for now, I’m quite happy to be right here, in the middle.

*This word was properly spelled on first attempt. Thank you former scribe job!

Walking up above the clinic on the road to Previle

A view through the clinic before the day begins

A street scene in downtown Jeremie

Some Pictures for your Perusal

Hi folks! Here are some (possibly low quality) pictures for your enjoyment. The first picture is the view from the balcony here. It's where I've spent many an afternoon packing medications and studying for the MCAT. Oh, I've also relaxed a bit up there too!

 This is the clinic's current home. Dr. Wolf's consultation room is on the left and the waiting room/admin/pharmacy/triage is to the right. Patients wait on the benches outside on the far right. You can also see the back end of the Toyota we use to get here!

 Clifton (on left) and Gemy (on right) as we walk into neighboring communities to meet with promoters of the Water Project that Gemy oversees. It took us 2 hours to walk here and many of our patients come from further distances.

Yours Truly on a hilltop above the new clinic. The day had been spent painting the ceilings in the new pharmacy/lab - hence the paint in the hair. (Shout out to my LCC EMT friends! I sacrificed the T-shirt knowing I had the same exact one waiting for me at home.)

Some local flora above the new clinic.

The stages of construction - on bottom is a corner of the laboratory. On the top, in the roof-framing stage is what will be the residence. Yes, that's bamboo!

A Day in the Life

Greetings friends! We just had a group from New Jersey and the week absolutely flew by! Dr. Wolf had asked me to write a little article for the Friends for Health in Haiti newsletter and this is what I've thrown together. I'll try to write more about the past week soon, but we had a little incident with tiny ants moving into the laptop for a few days and now it's touch-and-go with this poor little Dell.  Anyway, enjoy the article!

When I met with my friends Drs. Garry and Mitzi Barker in April 2013 and asked if they had any suggestions for medical experiences in Haiti, I didn’t realize how fortunate I was that they knew Dr. Wolf. Now that I’m here I realize I’m even more fortunate that Dr. Wolf and Cherlie agreed to let me come and stay for 11 weeks this winter. Not only am I being given an invaluable opportunity to improve my Creole and my EMT skills, I’m fortunate enough to bear witness to the incredible amount of work that these ladies do each and every waking moment – which, for Dr. Wolf, is quite a few moments!

Mornings here start shortly after dawn with a simple breakfast and a strong cup of coffee. By the time we have arrived 12 miles up into the mountains and grown an hour older, the caffeine is fully circulating and we are set to open clinic. Despite drinking the same coffee, Cherlie seems to have an extra source of energy. She always arrives ready to give her invigorating morning message to the waiting patients. People laugh, they nod amen, and best of all they come away with an understanding of the heart of the clinic.

What follows can be anyone’s guess. Patients arrive for follow up visits and treatment plans are altered as needed. The day continues in this fashion, with patients varying from chronic hypertension to acute synovitis, along with a plethora of adorable, occasionally febrile children. People often arrive on stretchers made of wood and banana leaves, the bearers sweating beads in the cool of the morning. It’s a testament to the difficulty of the terrain, the distances people are willing to travel, and the incredible respect the Centre de Sante de Gatineau has earned. The day up at the little clinic ends when the last patient has been given careful instruction from Cherlie on how to take their meds, return precautions and loving reprimands on whatever each person needs to hear – somehow she always seems to know exactly what that is.

We next spend time at the new clinic site, the magnitude of which is heightened by a comparison to the amenities currently available in the area – no electricity, no running water, no two story buildings, few roofs made of anything but tin or thatch and certainly no other health facilities of this caliber. It is a testimony to the power of belief and perseverance. Construction continues on at an encouraging pace. The roof is being framed with a maze of bamboo supports and the masons continue to smooth and beautify the seemingly endless concrete structures. Through it all, Dr. Wolf documents and compares the physical clinic with the architect’s plans, patiently keeping everything progressing.

The workers clean up around four o’clock and we tend to leave Gatineau by 4:30. The day is far from over, with many more moments to work. We are home and setting the table for dinner by 6:00. Cherlie is an excellent cook and her enthusiasm for produce has us all eating well. Once the table is cleared, it’s time to pack medications for the next day, record the finances and double check the log books. My day’s work has ended and I often retreat to the balcony to study and relax. From there, I see the light of Dr. Wolf’s office on until the wee hours of the morning, taking advantage of the quiet and what seem like endless waking moments.