And then there was one.

We completed our last day of lugging around makeshift measuring equipment around villages under the hot sun and torturing our interpreters last Thursday.  Transportation via hospital vehicles has been fickle; you could say that we waited three days for our ride to finally come and take us to where we needed to go to get the last of our data.  We then spent the weekend sitting on the porch from early morning to late night crunching data, designing charts and graphs, and building a preliminary report which we finally presented to the hospital’s Chief Medical Director on Monday evening.  We still have more data analysis to do back in Boston once we can get in the lab, but for now, we are proud of what we’ve been able to put together so far!  And for the first time, we have been able to analyze our very own collected data.  That is something.

We have continued to visit the post-surgery patient in town.  I got to see a doctor pull what seemed like a hundred staples out of her leg the other day.  And I have cleaned and redressed her wound twice.  There’s a first time for everything!  

Last Friday, Shelley, two visiting pediatric physical therapists, and I rode tap-taps into Cap-Haitien and walked across town to visit Missionaries of the Poor, a lovely, large, church-based compound, run by Catholic Brothers from around the world, that holds an orphanage for children and a nursing home for older adults.  The majority of the people that stay there have special needs and have nowhere else to turn.  It is amazing what the brothers are able to provide for these people.

So, now it is time to say my see-you-later’s.  Shelley left this morning to return to Boston and I’m the last remaining survivor of the Tufts gang!  I fly tomorrow morning to Turks and Caicos for 5 days for an indulgent island getaway and some intermediary reverse culture shock. 

Leaving Haiti is bittersweet… My time here has been very challenging and emotional at times, but also fun and inspiring.  The people and the landscape of this region are truly beautiful.  I suppose I won’t miss the constant itching and sweating, and sleeping in a tiny, rocky bed under a mosquito net.  But there are so many things that I will miss when I leave.  The warmth and hospitality of families in the villages.  The ability of the people to smile so often and keep a sense of humor despite their hardships.  The food, of course.  Wearing scrubs (pajamas) to work every day.  The stunningly beautiful children.  Meeting new friends.    Even the bluntness of the Haitians’ curiosity when they ask things like, “Why is your voice like that of a small child?” (This coming from one of the head administrators at the hospital.)

This has been an incredible learning experience.  We have only lightly scratched the surface in our 2 months, but I feel like I have seen and learned so much about what it is like to do field research and to work in Haiti.  I think I can speak Creole now about as well as a 4-year-old Haitian!

The poverty, malnutrition, and illness here never ceased to be overwhelming.  One of our faculty advisors told us once that we may often feel completely helpless, but we are here to bear witness.  For the first time in my overseas travels, I have been able to spend a large amount of time in the community and close to its people.  And for that reason, this blog has been much heavier than the others. 

I can understand how it might be difficult to not lose hope here.  The public health problems here can seem insurmountable.  But I have great appreciation for and take some comfort in the small, gradual, individual successes that we have seen.  I saw little Linda, behind in physical development by a year, stand up on her feet for the very first time on Monday.  She was being held by her foster mother and maybe took just a step or two, but we were ecstatic.  Sadly, beautiful little Rosie has not been thriving even with the formula and special bottles. However, we have been trying today to make arrangements for better care for her, and I’m hoping to hear soon after I leave that things are in place to guarantee her recovery.  And I couldn’t think of a better way to end our time here than one last visit to Children of the Promise to see the children and of course little J… who has gained plenty of weight!  He is healthy and plump and handsome again, likes to play, even gave us a couple sneaky smiles, and will be ready to go home in a month or so.  As his sponsor, I’ll fortunately get updates about his progress after I leave.  I couldn’t be happier or more grateful right now about how well he has recovered.  It is miraculous what proper care and treatment can do.

 

It can be hard to know whether you can really make a difference in Haiti as one person.  But I do know for sure that I will come back. 

Until then, n’a we pita, Ayiti.

See you later, Haiti.  Hopefully soon.

The Food Issue

Rice, beans, spicy meatballs, and cabbage

No travel blog of Elaine Siew would be complete without a rundown of the local cuisine!

Wednesday morning crepes!

Fiffy's pizza

We have been very lucky to have 3 square meals prepared for us every day by the talented cook on the compound, Fiffy, and her team of lovely ladies.  After just a few weeks, we had memorized the weekly food schedule that Fiffy prepares pretty consistently.  I know the best night for dinner is Monday – shepherd’s pie (pate chinoise - it's Chinese in Haiti, not Irish!) – or maybe Friday – Haitian pizza! (The crust is like flaky pie crust, mmm...) And everyone loves Wednesday breakfast – crepes!  Other delicious breakfasts include omelettes/fried eggs and toast, porridge (which tastes like dessert for breakfast), and Fiffy’s special caramelized French toast. Lunch is my absolute favorite meal of the day – huge and hearty Haitian comfort food stuff.  Maybe too heavy for people who enjoy light lunches or fresher foods in the heat, but I love it – lots of rice and beans, slow-cooked meats, veggies, and plenty of saturated fat :)  Other dinners include “fried night” (fried plantains, potatoes, yucca, with meat chili), pasta with spicy meat sauce, potato and hot dog stew – and always accompanied by salad with Fiffy’s secret-recipe salad dressing.  There really isn’t anything on the menu for any meals that I don’t like – everything is super flavorful, with lots of cloves and peppers.  And whoever in the group volunteered to dole out servings had to become very familiar with my “Elaine-size portions.” 

An Elaine-size portion of Shepherd's Pie

Rice & beans, chicken, spicy beets

So with all these wonderful prepaid meals, I’ve only had a few meals out.  The crazy-looking stew that looks like something out of a witch’s cauldron is called bouillon – with potatoes, boiled plantains, goat meat, and finger-like dumplings.  It’s quite tasty and filling, and a staple of the Haitian diet here.  And then there is the street food – ahh, my beloved street food.  Everywhere I go, there is nothing I love more than eating food on the street.  In the past few weeks, I’ve made a habit of eating something off the street every day.  You’ll find delicious fritage stands everywhere – ladies who sell a variety of fried foods, like pressed plantains, akra (little fry-shape dough), chicken, boulettes, and empanada-like patties filled with veggies and a bit of meat.  They serve them all with this great piklis – a cabbage and chili pepper slaw.  I’ve also just discovered bonbons at street vendors, which are sweet cookies or bars baked with coconut.  And then everywhere you go in the world, there’s always some kind of ubiquitous food for sale on every block, like the Fanmilk carts in Togo and Ghana, or chai tea in India.  Here, it’s packaged cookies of different varieties that cost about a quarter or less, and funny enough are all imported from India.  You are guaranteed to find cookies everywhere you look, so as you can imagine, I’ve been eating a lot of cookies.

Bouillon

Then there’s the delicious island fruit in season.  There are beautiful fruit trees all over this region.  I’ve been eating mangoes all summer (and there are so many different kinds of mangoes), and it’s so wonderful to live in a place where you can eat fruits like avocadoes and starfruit that are grown locally instead of imported from far away.  I’ve also been able to try some new delicious fruits like kanep (a sweet a sour shelled berry that seems like a cousin of the longan), breadfruit (tastes like a potato when cooked), abrico (like a less sweet mix of mango and papaya), and soursop (a strang-looking but delicious fruit with white, squishy flesh that kind of reminds me of peach yogurt). 

Rice, mashed vegetables, and beef stew

Needless to say, I will really miss the food here.  Ironically enough, and shamefully, I’m here to do a malnutrition study yet I can’t stop stuffing my face.  I am happy about the fact that there are a lot of Haitian eateries in parts of Boston.  Now I just need to see how many mangoes I can fit in my suitcase…

:)

Dousman...

Meaning “slowly” or “gently” in Creole, which has become the word-of-the-day every day here in Milot.  It’s not only the rule for dancing Haitian-style, but also the theme for everything we do here. 

Speaking of dancing, we had to get just one more night at the roofless club yet again on Tuesday night, right before the med students left.  A friend had arranged an “American Night” as a send-off for the med students, where they said I could bring my Ipod with American music and they would play it for us.  However, our American classics are not quite dousman enough for the local regulars, so we settled on an American song after every two Haitian songs.  We could tell that the locals were cringing at the sound of Bon Jovi and Carly Rae Jensen – and couldn’t wait to return to the slow rhythm of their own music – but we were still able to squeeze them in (along with some Montel Jordan and Springsteen) and own the dance floor.  Before we headed out though, we announced our group superlatives, in which the guys decided the awards for the ladies and vice versa.  And the winners were: Rose – Best Techie Timekeeper, for fixing computers as only a MIT grad can and being extremely prompt to meals; Julian – The Poetic Justice Award for mastery of the English language; Shelley – The Blankest Award, so that she may choose her own superlative at will; Logan – Finest Undulation of Pelvic Girdle; Amelia – The Chick Magnet Award; Alec – The Shirt Monster Award, for meriting rights to toplessness; and me - #1 MOM :)

And then there were two.  The med students have flown away and things seem to have gotten much quieter around here.  We miss them, although on the plus side, I have since been mistaken less often for Rose, the other Asian.  We’re looking forward to reuniting the Tufts in Haiti family on the flipside!  They moved Shelley and I out of the chicken coop to make room for some incoming nursing students, so we are now in our own little room – I call it the honeymoon suite.  We have our own sink and a table to put some of our stuff! 

Shelley and I have since been focused on trying to get lots tiring data collection and field work done – going to surrounding villages, through Milot, and to the hospital’s peds clinic to make as many babies cry as possible.  Just a couple more days of aggressive field work before we wrap up the dirty work and move on to the other hard part this weekend – data analysis and report writing. 

The weekend was quite relaxing, mostly spent around Milot except for when Nadia, Shelley, and I ventured into Cap-Haitien on Sunday.  We took a tap-tap in to the city to take a stroll through the big, hectic, sensory-overload outdoor market.  I love going through outdoor markets everywhere I go. We then went to a hotel to send out emails (since we’ve had no internet on the compound or hospital grounds for almost a week – I’m borrowing a broadband key right now) and cool off in a pool after some long wandering around Cap to find the hotel.  To get home from Cap, you have to leave before 7 pm or so (when the tap-taps stop running), walk a mile or two to find a tap-tap going your way (where the first mate hanging off the back is yelling “Milot Milot Milot!!”), then wait a while in the truck sauna until the first mate is able to pile at least a dozen people in. 

  

Every day since the med students left, Shelley and I have been checking in on a patient that they were following, going by her home in Milot to see how well she is recovering and report back.  She had a massive surgery procedure on her entire leg, and the surgeon here says that Shelley and I get to help remove the staples on Friday! :-/ 

An orthopedic surgery team came over the weekend and brought some wonderful gifts – infant formula and a plethora of feeding bottles designed specifically for babies with cleft palates.  Shelley and I studied a DVD on how to feed cleft palate babies with different types of bottles on Sunday night, and then Monday morning we were able to bring the formula and a new bottle to Rosie at the nutrition center.  We went through the new instructions and the formula with the mother, and watched the baby happily chug down her first serving of formula (she must have been so hungry) using the specially designed bottle.  We’ll have to monitor her closely every day to make sure she is on the right road to recovery, but she has an enormous amount of catch-up ahead.  It makes me wish I could stay longer to watch her hopefully get better. 

Just about one week left in Haiti – and so much to do!

The Chicken Coop

New development in the ladies dorm this past week – one of the many chickens roaming the compound has been coming into our room and laying eggs next to Amelia’s bed.  When in Haiti!

So this past week, we went into the field for two days as usual.  The second day, Shelley and I got absolutely mobbed by a crowd of parents and children constantly shoving forward to try to get their child measured, plus other people in the village shoving closer to see what we were up to.  The curiosity is understandable, but trying to work in a square foot of space in the middle of a mob for an hour and a half gets overwhelming!  “Fè ba! (get back!)” works for about 3 seconds. 

Wednesday, Shelley and I went to Cap Haitien to meet with the director of Meds and Foods for Kids, an organization in Haiti that manufactures therapeutic nutritional foods for malnourished children.  We were so fortunate to meet the team at MFK soon after we arrived at the beginning of June and tour the factory, and now it was terrific to sit down with the director and just chat openly and honestly about child malnutrition in Haiti.  The organization is doing terrific work in an extremely challenging environment.

Friday morning, Shelley and I led a workshop on Child Nutrition for the community health workers that work for the hospital here in Milot.  This was the last of a five-part series of workshops that the med student organized on different health topics.  We had a lot of fun putting on the workshop, even though there is always so much to talk about when it comes to nutrition – our favorite topic of course – and so little time.  Promoting public health through community health worker education – check!

We’ve been checking in on the Nutrition Center as usual in between field visits and meetings.  Not surprisingly, once one severe case is resolved (temporarily, at least), there are always more to follow.  Just the week after little J went to the infant care center, we discovered two more difficult cases of malnutrition at the nutrition center.  And the more you talk to their parents, the more you unravel layers of their story that brought them to this severe state.  In the first case, we have an adorable little baby – we’ll call her Linda – who you can usually find sitting on a mat, looking around taking the world in, smiling once in a while.  She loves to be picked up, and she’ll just lay her head on your shoulder.  If she didn’t have the reddish hair and the infections on her skin, you might think she was a pretty good size 6-month-old baby.  But she’s actually 19 months old and a year behind in development. And if you didn’t talk to her mother (who appeared unusually old to have such a young child at 50+ years old), you wouldn’t know that she was actually a foster mother who rescued Linda when her own mother threw her in a dumpster at 5 months old.  Linda has had a very difficult health history since, and has been in and out of the hospital with different illnesses.  I had a visiting pediatrician come to take a look at her, who also realized that in addition to multiple nutrient deficiencies she had pneumonia and potentially scabies.  She went into inpatient treatment for a few days and was released early last week, but the last I heard was that her mother could not afford her medicines.  It is hard to predict how Linda’s childhood will pan out in the next few years.  It would be a triumph if we could get her to attempt crawling before we leave, but that may be hoping for too much.

In the second case, a mother started coming in to the nutrition center two weeks ago with a beautiful tiny baby - we’ll call her Rosie.  At 7 months, she is almost the size of a newborn, weighing just 9 lb.  She has a cleft lip and cleft palate, which causes milk to come out of her nose when she drinks.  A craniofacial surgery team came earlier this year and operated on her lip, but it is not clear when they or another team will return for follow-up surgery, and she may still be too young to receive surgery for her palate.  At first, we assumed that she is severely malnourished because she cannot eat and drink properly, so we have requested that a volunteer team coming this weekend bring special bottles designed for cleft palate babies.  This is definitely a large part of the problem, but another looming issue is food insecurity at home.  We realized last week that sometimes she can drink properly from a regular bottle if sitting upright, but also that she is the youngest of seven children and hardly eats anything after noon and on the weekends when she’s not at the nutrition center.  She needs to be on a diet of concentrated infant formula to build back her energy, but infant formula costs the same price here as it is in the US – which is expensive by US standards and thus completely unaffordable for most people here.  I’ve been in contact with the pediatrician who was visiting, and we are trying to figure out how best to help this baby.  In the meantime, it’s hard to come up with effective, sustainable solutions when I’m leaving in 2 weeks.  When I went by the nutrition center on Friday, Rosie wasn’t there, but her mom had heard that I was looking for the baby, so she actually came by our residence compound on Saturday to see me.  I had told her that the baby needs to go to the clinic because she is also sick with a fever and needs medicine, and that the baby ultimately needs infant formula to regain her strength, which was of course in vain because I know the mother cannot afford to buy it.  I said that I would keep trying to help her.  I don’t yet know how.

This past weekend was the last in Haiti for the med students, who leave Wednesday.  I spent most of Saturday on the compound, except for when I went for a walk with another visiting volunteer to visit a family that she knows in the village with a bunch of cute little children.  I tried to give out some nutrition advice in my broken Creole to the mothers with young children.  In the afternoon, after a fruitless quest to find affordable infant formula in town, I went to visit a post-surgery patient in Milot that a couple of the med students have been monitoring, since I’ll be checking in on her after they leave.  Sunday, we went to the coast for one last trip to lovely Cormier Beach.  And then at night, one last night out at the roofless dance club before the med students take off.

Just a couple more weeks now for Shelley and I to furiously collect the last of our data, write up our report, and wrap things up here in Haiti!

The Haitian Float

 As demonstrated by Logan at a pool in Cap Haitien today…

We have noticed that many Haitians at the beach enjoy floating face down in the ocean to relax in the water. Meanwhile, foreigners like me start to panic because this is also the universal ‘drowned and unconscious’ look.

So little J was already doing a bit better last weekend when I went to visit him, which was great to see.  He’s in great hands and should make a good recovery in a few months.  On Sunday morning, I went to the big Catholic church in Milot for the first time, as a cultural experience – it’s intersting to see everyone in town fill the churches in their finest clothing, and I love the singing.

Last weekend, a big group of vets came to Milot – including Haitians, Americans, and some of my people (Canadians, the best veterinarians in the world) – to run a great spay and neuter clinic for all the dogs and cats in town for the first time.  What a fun change to have some non-human doctors around!  We had a lot of fun with them this week, including a 4^th of July celebration on Wednesday night for Americans and non-Americans on the compound.  We had a bbq again with the fresh chickens, rocked out to American classics, and then headed to the club to dance the night away.  Pretty unbelievable – we have found at least 4 night clubs in little Milot! “Club” is a bit of a loose term.  This new one we walked to on Wednesday night was basically a room on the bottom floor of a building with a bar and maybe 1 green light bulb, but we all just danced in the outside alley all night while a bunch of locals sat around us and watched us make fools of ourselves. 

Needless to say, getting up early the next morning for a hot day out in the field was a little tough.  We again spent two days in the communities collecting data, walking house to house, and Shelley and I spent one day at the pediatric clinic at the hospital to collect data there.  We've been in and out of the nutrition center as well all week - playing with kids as usual and also trying to find extra help for the few kids that are in very difficult shape, like a little girl that - while totally adorable - has the size and development of a 6-month-old when she will actually be turning 2 later this year, or another beautiful baby who is wasting away because she has a cleft palate and cannot feed properly.  Yesterday, Shelley and I ran a lesson for the moms at the nutrition center on nutrition and food safety basics.  It was of course a little difficult, since it’s never ideal when we can’t communicate in Creole and need to rely on a translator (who may turn your 5-word sentence into a 5-minute monologue and leave you a little confused) and have other nurses chiming in all the time.  But, overall, it went alright, and we got our ‘caregiver education’ in!  Look at us public health professionals. 

Across from our compound, there’s a big, lovely ridge, and a group of us climbed up a treacherous jungle path to the top on Monday afternoon.  Here’s a view from the top!

Last night, we went out in the “party bus” (i.e. a giant truck with benches in the back that were used to haul dogs and cats around this past week for the vet clinic) into Cap Haitien to hang out at a restaurant/bar by the ocean for the evening.  We returned to Cap today – this time riding in tap-taps, speakers blaring Haitian hiphop and flat tire stops included, as well as some nutso teenagers hitching a ride on the back of the tap-taps, holding onto the truck while on rollerblades at 40+ MPH.  Yikes.  We got to treat ourselves with a stop at a bakery before we walked to a hotel with a swimming pool so that we could lounge and swim for the afternoon. 

Time to project a movie now on the white wall outside, for more relaxing time on the porch!

:)

Midpoint

We finally got our IRB approval for our community projects a week ago (hurrah!) so – at the midpoint of 9 weeks in Haiti – we finally began our field work and data collection this past week!

We travelled to one of the surrounding villages on Tuesday and Wednesday to measure children and ask mothers/guardians about feeding practices and their children’s health.  Tuesday we walked to this spot in the village under a big tree where women had gathered with their children for a monthly weigh-in (a hanging scale hung from a tree) with the community health worker.  We joined in to do our study, and it was chaos for 4 hours straight – measuring screaming babies (who don’t like crazy-looking light-skinned people making their baby limbs stay flat on a measuring mat, or making them hang from a tree in a wedgie sling to measure their weight), scribbling down data, and at times doing some crowd control.  No water, food, or breathing breaks – data collection in a crowd can be exhausting.  By the time we had to leave with the other med students who were already finished up collecting data for their projects, we still hadn’t gotten to all the moms with their kids and had to escape.  Wednesday was calmer – a few of us went from house to house in the same village, spending a good amount of time with each family to take measurements and provide some nutrition guidance.  The families were all very welcoming to us as we barged into their yard with our clipboards and equipment – the grandmother in one family told us how honored she as that we came to her home, that no “white” people ever came to visit her home when she was young. 

We went to another dance spot in town twice this past week (yes – in this tiny rural town, there is more than one night club!), once to celebrate a couple birthdays and the second time to see a local band perform.  I've never been to a club like this, that’s for sure!  Not only did we again have to walk a while into town in the dark, but then we turned down an alley between buildings and through a gate to enter what looks like an empty concrete house that is missing half a roof.  The band or DJ plays in the corner and the only light in the club comes from a few black light bulbs, a light-up Santa Claus ornament, and the stars above, since there’s no roof.  Everyone dances and enjoys $1 beers or $2 8-oz bottles of rum.  I’ve been told I dance like a Haitian!

Yesterday, my old pal, President Clinton, came through little Milot!  Sadly I didn’t see him or know he was here during his quick visit, but some of the board members and staff here got to snap some photos with him by the old palace.  I think he was just coming through for a quick hello on a little tour of different areas of Haiti, as he’s often here as the UN Special Envoy.  Alas, he and I will have to coordinate a little better so don’t miss each other next time.

Here’s my pile of 36 mangoes that I bought for $2!  My translator picked them up for me – they’re a labor of love to peel and cut, but ooh they’re good.  If I were buying, my pitiful haggling skills might get me about 8 mangoes for that price.  But, the interesting thing about haggling for basic things like food or soap here is that vendors might give you a high price at first because you’re a foreigner, but if you suggest half of that price (or the real price for Haitians if you know it), they just say “OK” and give it to you – they don’t try to exhaust you with negotiation. 

This afternoon, I head to the orphanage to visit little J!  

Island Time

Where everything moves a little slower and being ‘on time’ is a very flexible term…

So to recap the past week…

It was very interesting to visit Children of the Promise, an orphanage/infant care center 20 minutes from here, although our timing was completely off – all of the babies were taking a nap!  We’ll have to go back some time to have plenty of baby fun time.

Besides a visit to the village on Thursday morning, where Shelley and I talked to families in the community about their perceptions of malnutrition, I spent the weekdays in Milot, going to the Nutrition Center, and mostly trying to figure out how to help little Jamesley.  I’ve been enlisting the help of different visiting doctors to figure out how to treat this little boy – going back and forth between the lab and clinic and nutrition center to run different tests and figure out what treatment he needs.  To complicate things, apparently his mother did have her new baby a few weeks ago, and his parents dropped Jamesley off at his grandparents’ home because they could no longer take care of a sick child and a new baby.  The grandparents themselves have tiny children of their own, and both do not work – the grandfather has been out of work for a few years since he went blind.  On Friday, the docs that I had been working with decided to put Jamesley on a regimen of deworming/antibacterial medication to get rid of any parasites in his body that may be contributing to his malnutrition.  The grandparents let us know where they live (just down the street) and preferred that we come by to give Jamesley the medication, so since Friday evening I’ve been going by their house three times a day to check in on Jamesley and give him his medicine.  The grandparents are incredibly humble and welcoming, but they too have very little food for their own children, let alone Jamesley.  To make matters worse, the father came by over the weekend and took a day’s worth of his PlumpyNut (therapeutic food) and left with it while the grandmother wasn’t home and unbeknownst to his blind father. This is not only dangerous for Jamesley, but if it was taken for the new baby, it is very dangerous for the baby as well since this product is not for babies that young.  I’ve been bringing by mashed banana and biscuits (plus bananas and biscuits for the other children to hopefully ensure that Jamesley gets his share to himself), but I am quite sure he is not getting the amount of food that he needs… It looks like the parasites might be clearing up, but he still refuses to eat anytime I’ve observed him (medicine can disrupt the appetite as well) and there clearly isn’t much food for them at home.

No beach or getaway this weekend, but I did take one field trip – Shelley, Nadia, and I went to go meet people who work with SOIL – a very cool organization in Haiti that has been constructing composting toilets for household, communal, or public use here.  I had looked up their work before since I heard about it in class.  Sanitation and waste management is largely non-existent in Haiti, with trash or burning trash everywhere and rivers of sewage, so natural innovations such as waste compost could make a great difference here.  Saturday morning, the three of us went on what we thought would be a half-hour walk to an intersection to meet up with the SOIL folks but is more like a 12-kilometer walk – so thankfully they picked us up along the way before we passed out in the heat.  They took us to see their farm where they process the compost and have developed a nursery, planted different crops for sale, and experimented with different natural fertilizers (corn without compost, corn with pee vs. corn with pee + poo!).  We also got to check out their new compost storage location and then run a few errands with them here and there, which included a nice little conch stew lunch at a tiny restaurant in a nearby town.  We got dropped off at the same intersection on the way back and while trying to hail a tap-tap to take us back to the hospital, we got a ride with a rice truck for part of the way, and then as we started on the last few kilometers in the scorching heat, we again luckily got picked up by one of the doctors for the rest of the way.  We were not made for long walks in this heat!

I couldn’t sleep for hours on Saturday night trying to figure out how to help Jamesley recover without creating enormous costs for his family or crossing the boundaries of my role here.  I would take care of him 24/7 myself if that wouldn’t cause a mess of other ethical problems.  He seemed a tiny, tiny bit better this morning when we came by to give him his dose of meds, and I’ve been communicating since Friday with the fine people at Children of the Promise to see if it would be a good idea to have him go to their care center for a few weeks until he recovers, so he can get the food and monitoring that he needs in an appropriate setting.  They came by Milot today to meet the family at their home, evaluate Jamesley’s condition, and explain their services.  When I came by the house to give Jamesley’s his noontime medication, they were just coming back from a stop at the hospital in their car to pick up Jamesley and actually his 19-month-old aunt, who is also showing signs of malnutrition.  They will take care of Jamesley for 3 months to get him back on his feet… sigh of relief.  I held myself together as I watched them drive away.

Adventures of the tap-tap

It was a fun and adventurous weekend! 

Friday night, we started out with our usual cards and beers on the porch.  Then around 10 pm, a couple other Americans on campus were heading into town to go to a bar, so half of us students decided to tag along.  “Going into town” on a Friday night in Milot really means walking down dirt roads for a half mile in pitch black night (no street lights), past people hanging out outside their houses in the dark, trying not to fall into a side ditch or get hit by the occasional motorcycle whipping by.  We reached the bar, which was a big dark room with a raised dance floor in the middle, and empty of people except for the two guys behind the bar.  Perfect!  A couple of us took the dance floor right away and I didn’t leave it much all night – they played some Haitian music and made an obvious effort to give us some Justin Bieber and other such American classics.  About a half hour after we arrived, a dozen or so local people started trickling in, potentially to observe this curious foreign bunch dancing so strangely.  After a couple hours of wowing the locals with my killer moves in our semi-private nightclub, we headed home to get some sleep before beach day part deux.

The next morning, we again piled into a tap-tap (again, a pick-up truck converted to public transportation), but as a much bigger group this time.  We piled 6 of us students, our translator/guide to all things Haiti - Lumarc, another American dancing queen Nadia, and 6 brawny electricians, plus the driver and 3 of his wingmen into this tap-tap.  Needless to say, we were a little heavy going up those mountain dirt roads from Cap Haitien to get ourselves over to the beach.  After some tough speed bumps to the undercarriage and puffs of black smoke coming out the back of the truck, we slowed to a halt mid-hill.  I felt very sorry for that truck.  We all climbed out and started walking uphill for a while until it was allegedly safe to climb back in for a couple hundred feet of downhill.  This repeated a few times until we finally made it to the beach.  It was all worth it for another lovely day relaxing on Cormier Beach.  I showed off my beach volleyball prowess (not), got in some reading and sun, and ate a cheeseburger and fries (I know, I know – if I didn’t eat Haitian food for every meal every day here at the compound, I would give myself the stink-eye… In the end, we all realized that the burgers were the most reasonably priced and filling items on the menu at the beach).  The water was a little less lovely than the first time, since it was dotted with floating trash that day that flows in from who-knows-where.  Come 5:30 pm, I’m not surprised that our originally faithful tap-tap driver didn’t feel like picking up a good 3,000 lbs of human cargo for a second time. So Lumarc called another tap-tap in Milot to drive the hour to the beach to pick us up.  We finally left the beach at 7 pm, again piling an absurd amount of people into this refurbished pick-up truck, and again having to jump out and walk uphill when we reached the slopes.  When we finally hit flat ground, we had 3 men standing on the back of the truck, the wingman on the roof, a couple in the front, and a dozen in the bed of the truck.  About halfway home, it started raining to make it extra refreshing for the guys hanging off the back.  We made it home a little after 8 and I passed out before 10.

Yesterday (Sunday) was another quiet day on the porch, except for a quick trip down into the market in town to attract lots of local attention as we haggled for mangoes.  The mangoes and pineapples here are delicious!  The compound is covered with mango trees, but when the mangoes are ripe they fall and split on the ground – which makes them not so safe to eat anymore.  I keep pitching my ideas of a giant fish net around the compound, or covering the ground with pillows to save these precious mangoes.  No bites yet.

Speaking of ideas, I feel like we are finally starting to form some ideas on some recommendations for nutrition prevention and treatment here.  It’s a better feeling than the first two weeks where I just felt a little lost and overwhelmed as to where to start and how to contribute to solving the very difficult problem of widespread malnutrition.  But, with ideas, there still comes frustration and sadness because there will always be things that you cannot change.  Today was an especially sad day at the Nutrition Center.  Little 16-month-old, 15-pound Jamesley that I mentioned last week, was in terrible shape this morning.  Not only has he not improved since he started coming to the nutrition center a month ago, but he has actually lost weight, often refuses to eat, and just let out what seemed like a couple litres of diarrhea this morning.  I ran back to the compound to grab some oral rehydration salts and bring them back, but when the diarrhea continued, we (his father, a translator, and I) brought him to the emergency room.  I was skeptical, since his visit to the hospital the previous week didn’t seem to be very helpful.  I returned to the nutrition center once he was firmly in line to be seen, and continued to chat with the ladies who work there to learn more about how things work – or don’t work – at the center.  An hour later, Jamesley returned, only to unleash more out of his weak, tiny body as we scrambled to clean it up (still to an improvised, mediocre degree) before all of the other crawling babies got sick.  He really needs to be hospitalized and put on inpatient therapeutic feeding, but unfortunately it doesn't seem like that's available here.  My only relief before finally leaving was that he started taking bites of his lunch.  But with a new list of prescriptions from the ER doc that his parents likely can’t afford because they don’t work and have no money, I just sit – stunned – wondering how this boy will ever recover, and not knowing what we can do to see that he does.

Tomorrow, we head back into the communities in the morning for field work, and then we’re heading to a nearby orphanage in the afternoon to learn about the work that they are doing and spend time with the kiddies.  We’re really looking forward to it – will report on it soon!

Pig on a leash

We’re now just past 2 weeks in to our time in Haiti!

We are still waiting for final approval from the IRB back home to begin our surveys in the community, but we have still gone into the villages twice this week to meet the people who work at the health posts and walk around to collect water samples from wells and other water sources for testing.  The guys were giving out smiley face stickers which was super exciting for kids in the neighborhoods and really drew a crowd.  In between days in the community, we’ve been continuing to visit the nutrition center in the mornings.  I absolutely love playing with the children, but everyday gets a little more disheartening – it’s hard to feel like we can make a great difference when the largest problems I see are that children are unnecessarily ill because their parents cannot afford their medicines, and are hungry because there is no food to eat at home.  There is one child who is severely malnourished and so very sick – he stares around the room blankly with big eyes, his head seems as big as his body, and he weighs only 15 pounds at a year old.  He needs to be eating special therapeutic food, which he receives (though in insufficient quantity because he was prescribed less than half of the amount that he actually needs), but it’s hard to tell whether he is eating it all  - especially since both his parents are unemployed (apparently there is little work here) and are hungry themselves.  His mother is also pregnant.  Yesterday, he refused to eat and then threw up all his food from the previous day, so I said that he had to go to the hospital.  It doesn’t seem that there is an inpatient therapeutic feeding center, so he was sent back to the nutrition center with a short list of medications to buy, which his parents likely cannot afford.  One of them was oral rehydration salts, which we were able to bring him later because one of the other students brought some to give away.  But I’m really concerned and will watch him very closely in the coming days. 

We’ve continued to have our nightly lectures with the visiting doctors.  Some medical information is way over my head, but I enjoy the discussions.  Last night, we had a discussion about the ethical dilemmas that we face every day in health care in developing countries.  So many people every day have treatable illnesses that are fatal if they cannot pay the $100, $20, or $5 to get the medications they need.  One boy who visits our compound – an orphan of the storms from a few years ago – was bitten by a dog a few weeks ago.  He is completely fine and playful now, but rabies symptoms can take up to a few months to appear and by the time they do, there is absolutely no treatment – it is 100% fatal.  However, the rabies vaccine is rarely available and if it can be sent over from the US, it costs almost $1,000 (which would lead me to the enormous issue of the completely absurd price of life-saving drugs – but that is a much longer conversation).  So what do we do – us foreigners here who can afford to forego $50 to save a life?  Or if we had more, do we put $1,000 towards saving the life of one boy, or put it towards saving 50 lives with antibiotics?  Or put it towards food packages for the children at the nutrition center, if we were forced to choose?  Sure enough, other residents staying here from Port-au-Prince asked us last night right after this lecture (and on their 3^rd day at this hospital) to donate to a cash collection for a patient at the hospital who needs antibiotics to recover from a terrible illness but cannot afford them.  The medical students also know that the woman in the bed right next to this patient is also suffering from a fatal illness and also cannot pay for antibiotics.  And likely several other patients in the hospital are in the same position, and more will come every day.  The hospital has a policy that we are not to provide any cash to patients to purchase their medicines, because while us visitors will leave in a couple months, a couple weeks, or tomorrow, the rest of the hospital must face the precedent that we have laid and that they cannot sustain for every needy patient that comes after us.  It’s these dilemmas between personal and institutional choices that make work in developing countries very difficult, and often depressing.

To end this entry on a lighter note:

1. We had our first torrential downpour on Tuesday!  It hadn’t rained since we arrived, and the rain miraculously brought the temperature way down (to maybe a brisk 80 degrees or so!) so that I actually wore pants and a jacket, and put a sheet over me while I slept for the first time! 
2. We did communal girls laundry last week, and today I realized that I couldn’t find a shirt I had washed.  We know we emptied the dryer completely, so it was very puzzling and I asked the others this morning if they had seen it.  A little while later, lo and behold, I saw one of the cleaning ladies here wearing my blue button shirt – or an identical shirt.  After spying on her all morning, I awkwardly confronted her (I normally might not confront her, but I packed so light I really need those clothes for the next 7 weeks! She can have them when I go!) in my broken Creole, and then I couldn’t understand her response but figured it was something like – no, someone gave this to me, or something like that.  So I gave up.  But alas, we thought it was funny.
3. In the village on Tuesday, I saw someone walking a pig on a leash!

You have to enjoy the little things :)

Sleepy weekend in Hispaniola

I learned a few days ago that cruise ships will dock on the lovely beaches of Northern Haiti, but the stop will be labeled as “Hispaniola” (the island that combines Haiti and the Dominican Republic) instead of Haiti – possibly as a way to make you feel like you’re not vacationing in the poorest country in the Western Hemisphere?

The theme of sleepiness began on Friday morning.  Shelley and I spent the morning at the nutrition center, as we have been doing, but the atmosphere seemed different.  The center was much more quiet than usual partly because there were less children as there were earlier in the week (potentially because their mothers cannot taken them to the center because they have to work, or do not have the energy to make the often very long walk in the heat). The other reason was that many of the children had fevers.  Many had visited the hospital the day before, where they are able to be seen by a doctor free of charge if they are under age 5.  However, the medication that they need is not free, and parents often cannot pay for the drugs.  So some of the children at the center on Friday had no choice but to be sick – unmoving, burning up, especially in this summer heat.  It was a bit of a frustrating morning for me – standing around in my scrubs, not being able to help these kids, not knowing how to have a real conversation with the mothers. 

We didn’t take any excursions are go on any lengthy hikes this weekend, just spent a lot of time on the porch here on the compound!  Exciting weekend nights consist of cards and beer and music playing on our iPods J  During the days, none of us have to go to clinic, we don’t have any more IRB paperwork to do, and we don’t have any research data to analyze yet, so we have the weekends to relax for now.  I do remember previous Tufts volunteers who came to Milot talking about how you could get a little stir-crazy from the down time around here.  Milot is a very small, quiet town, and we end up spending a lot of time on the compound, basically on the relatively cool porch.  Some of the others are already getting a bit of cabin fever, but I’ve kind of been enjoying the peace and quiet.  I’ve spent a lot of time reading (just finished Little Bee), and while I have that instinctive guilt that I’m not being productive, I remember that I always crave the chance to sit outside on a nice long, warm days and read all those books that I’ve been putting off forever.  The other nice thing about having the porch and the free time is that we’ve been working out every day!  This is something that I NEVER do when I’m overseas.  I’ll work out once every two weeks MAX, because I’m hot and lazy. But here, we’re waking up at 6:30 am to go running (excluding me, I am not down with that) or do some strength training on the porch.   I brought a set of Yoga DVDs and have been organizing afternoon hot yoga sessions (since it’s 95 degrees outside anyway) on the porch.  Our participants have been growing every session!

We’ve been here 12 days now, and we’ve already seen many people come and go.  There are the volunteers from the US, UK, or elsewhere that come for 7-10 days at a time, and we’ve also already had 3 faculty supervisors come and go to supervise the med students at the hospital.  We’ll see like old birds as the weeks go by.  We just got two more ladies in our bunker, medical residents from Port-au-Prince, so we’ll be getting a little more crowded!  Especially since there’s only 2 bathrooms for 30+ people. 

We’re supposed to have a barbecue this evening for one of the volunteers’ birthday.  So when they say they’re getting fresh chicken for the grill, that means they’re bringing in live chickens to be slaughtered here on the compound for dinner.  The guys persuaded me to watch while one of the med students did the honors of cutting the throat of one of the chickens with a blunt knife.  I watched from 40 feet away, reluctantly, and had to shield my eyes at times, especially when I caught a glimpse of headless chickens flapping around in circles on the ground.  I guess if I’m going to eat it, I should see this part of the food preparation as well.

Well, time to feast and get ready for another big week ahead!

:)

Plan your next beach getaway in Haiti!

Time to catch up on the last few days! 

So Sunday, after I posted my last blog, we heard a marching band going down the street by our compound, and realized it was two soccer teams making their way to the nearby soccer stadium – it was a match between the local high school team and the alumni.  Tons of people from the town filed into the walled-in dirt field to watch the game. We all had to pay $1 each (the foreigner price, surely) to watch the game, but of course by bringing out my wallet, I suddenly get a swarm of kids asking me for money.  The most persistent will stay by you for a half hour, telling you that they need $1 to go to school.  It puts you in a weird position to have to say no over and over again.  Even though a dollar isn’t much, there are not enough dollars for all of the children in town, and since we’re new to town, we would expect to see children everyday if we started to hand out money.

We are still waiting for the ethics review board to approve our field research before we start, but in the meantime, we went to a couple villages on Monday to explore the health posts there and see what the areas look like.  Every night this week, we have also been having evening lectures, outdoor on the porch, with this week’s visiting doctor/supervisor or the Tufts group, learning about different tropical diseases in this area.

Tuesday and Wednesday morning, Shelley and I have been hanging out at the nutrition center at the hospital here, where malnourished children arrive, sometimes with their mothers, to get breakfast and lunch, and otherwise play with toys all morning or take naps, similar to a daycare center.  We'll likely be hanging out here at least twice a week to observe and help out when we can.  Carrying around and playing with babies and toddlers – that’s right in my wheelhouse.  Using my French, I’ve also been able to chat a lot with the ladies who operate the Nutrition Center, figuring out their routines and multiple needs to better run the center and help the children recover.  The mothers come sometimes from very far away, on foot, in the heat, to come to the center and get meals for their children – sometimes the only meals that they will get that day.  One simple fix that I noticed right away was the lack of soap in the center; posters were up regarding the importance of washing hands with soap and water, yet there was no soap so the mothers and children were just rinsing their hands in the sink before eating (and we’ve seen these kids crawling on the floor, swishing around puddles of pee, and touching all kinds of unclean things).  One of the other American visitors to the compound luckily gave us a box of hotel soap that he had been collecting to donate, and we were able to bring that over. 

We noticed after the first day, with 2-year-olds drooling and coughing all over us, that we need to start wearing scrubs – which are provided for all volunteers here to use in the hospital.  Sure enough, while wearing scrubs, Shelley got peed on by a baby yesterday.  The children rarely wear diapers here (too expensive, and not typical in this area), so the babies and toddlers wear maybe just underwear, or sometimes don’t wear any bottoms at all in the nutrition center.  So I’m sure I’ll get my first pee soiling one of these days – just a matter of time!

I went from carrying around a severely wasted child yesterday falling asleep in my arms, to going to a luxurious beach resort today.  Talk about switching between totally different dimensions.  I guess that it can't hurt to promote Haiti's tourist economy.  Today the nutrition center and many non-emergency services were closed for “Fête de Dieu” (God’s Day, or Corpus Christi I believe), so we all rented a tap-tap (a pick-up truck with benches in the bed that can carry an unreasonable amount of people) for the day and made our way to a beach resort close to Cap Haitien via a hour-long bumpy ride through hilly dirt roads.  This resort was pretty amazing – it took us all a little while to adjust to its luxury.  There was a big, lovely restaurant with a bar, and a super clean and beautiful beach where we could lay on beach chairs.  The northern coast is just stunning, with green hills cascading down towards the sea, and the water is so clear, sparkling, and calm – I could just sit in the water all day.  The restaurant and bar charge US prices, so it was not cheap, but I took advantage of the opportunity to get myself a bloody mary and some grilled local conch!  We all got pretty roasted under the intense sun.  There wasn’t a cloud in the sky to shield us from the 95* heat.  Still, we all look like pink and bronze gods. 

Despite sleeping under a mosquito net in my tiny bed (which feels like sleeping on a wobble board – I think the frame is on its last legs) and dousing myself with backwoods deet, I am still getting pretty heavily lit up by mosquito bites.  To be expected – it seems to happen anywhere I go, and I better get used to it for the next 8 weeks!

We’ve been spending all of our nights on the porch working on our laptops after lectures, feverishly trying to complete seemingly never-ending IRB revisions and papers.  It seems like some reprieve is in sight though, and a day at the beach today was definitely an amazing treat.  We might actually finally have our outdoor movie night for the first time tonight that we’ve been planning for days!

:)

"Give me one dolla"

That hike was pretty extreme.

 We set out at 6 am on an 8-mile, 5-hour hike from the volunteer compound to the mountaintop Citadel.  The way up was a whole lot of incline, although at that time in the morning at that altitude, there was a lovely breeze (though we were still drenched in sweat).  We had clear skies and the views were spectacular – lush green hills and valleys.  At the bottom of the hill, the ruins of the Palais Sans Souci (“Worry-free Palace”) of the Haitian monarchy in the early 19^th century are stunning.  We spent some time at the Citadel at the top of our steep hike, touring the old fortress and enjoying the cool air.  The heat really started to beat down on us on the way down once the breeze vanished and we were left in full sun, going through some challenging, narrow, steep trails through the jungle.  Drenched in sweat with aching legs, we finally made it back to the hospital compound around noon, feeling very accomplished!

That afternoon, I went with a few other visiting guests at the hospital to tour another RUTF nutrition supplement factory in progress between Milot and Cap Haitien to replace the older factory that we visited the day before.  It is such a treat to get to meet other people working on nutrition issues in Haiti that are right in my academic/professional wheelhouse.

Most of the kids we pass by around here just smile and say “Bonjour” (even a butt naked boy ran up to us to say hi on our hike today) or stare curiously.  They are painfully adorable.  Some do yell “give me one dolla” (potentially the only English words they know) which is a tiny bit less adorable, but still cute and harmless.  And no, I don’t go around the town handing out dollar bills.  That might send the wrong message.

I’m slightly terrified because the boys dorm next door (separated by a curtain) has got an invasion of bed bugs, and it’s likely just a matter of time that they come our way.  From experience, I do not do well with bed bugs – those bites itch like crazy.

Looks like a chill work day today – which means sitting on the veranda at the computer, working on some papers, maybe a little yoga on the porch later and a movie tonight!  Forecast today - 95 degrees and humid. Nice.

:)

Taking the good with the bad

(from Friday, June 1)

Day 3 in Haiti!

First of all, the meals here are delicious!  We’ve had spicy rice, squash, chicken stew, beans – all slow cooked with some chili heat!  It smells like hot paprika around the volunteer grounds for a couple hours before each meal.  We even had the cook’s spin on French toast this morning and pizza tonight! 

After two nights in our double room – Fort Rollet-Siew – we have moved to a new location on the grounds – the four ladies from Tufts are now bunking in an 8-bed dorm, slumber party-style.  I’m glad for the ceiling fans, because it felt like a sauna in there during the day, complete with a plethora of mosquitoes.  There are chickens hanging out around the grounds, with confused roosters coo-ing at all times of the day.  There is also one single menace bird that chirps very loudly at 5 am and wakes us up. 

Yesterday, Shelley and I visited the Nutrition Center at the hospital in the morning, filled with adorable toddlers, and we were able to ask the ladies there about how things work in the center.  I speak French, and the ladies respond in a Creole French mix.  We also watched a demonstration of a new water purification system from other visiting Americans, then met some other administrative staff in the hospital.  We had a “birthday party” for our Tufts mate, Amelia, with Prestige beers (the Haitian beer of choice in our lodgings) and card games on the porch.

This morning, we went to a workshop with community cholera workers, which was all in Creole.  Hence, we did not learn too much.  But it was interesting to see the workers all together.  I am learning some Creole phrases here and there though from my Creole Made Easy book – I think I’m getting the hang of some words and will hopefully learn a lot over the next 8 weeks!

After lunch, we all (13 of us) hopped back into a van and headed to Cap Haitien through some tough traffic to visit the town’s public hospital and meet a woman who is working with a great organization that has been running capacity building programs in hospitals in Haiti.  Cap Haitien is on the coast (so we did get a quick glimpse of the ocean) with large hills, with houses built on the slopes.  The heat is quite oppressive for most of the day, as expected, so it was an extremely sweaty day.  After the hospital, we journeyed over to Meds and Foods for Kids, which was super exciting.  This is an organization manufacturing and distributing ready-to-use therapeutic foods called PlumpyNut – a nutrient-dense peanut butter paste given to severely malnourished children for quick recovery.  This is the same type of product that I worked with last summer in India.  This organization here in Haiti also works with local peanut farmers to promote high-quality local production of raw ingredients.  It was fascinating to chat with the staff there and tour their facility.  I hope to go back soon and find out more about their work!

Afterwards, we swung by the airport to pick up another American visitor to the hospital.  While parked there, I took some pictures of the airport and a tiny Hertz Rent-a-car.  We have been told to be very prudent about taking pictures of people around here, as many people may not like it or will ask for money.  That’s totally understandable.  Well, apparently my Hertz glamor shots were in the direction of a man walking by (but who didn’t actually end up in any of my pictures), who proceeded to approach the car and ream me out because I did not have the right to take his picture.  Alas, I was flustered and in retrospect could have tried to reason with him and explain.  Oh well… lesson learned?

An eventful couple of days!  Taking the good with the bad - intense heat, a little taste of hostility, but delicious food, terrific field trips, and mostly super friendly people. I’m a little concerned about having the energy to do all the computer desk work in the evenings that I need to do this summer after mornings and afternoons going into the field in the heat… All I want to do after 4 pm is take cold showers and lay down! 

Tomorrow morning, we set out at 6 am to hike to the Citadel – hilltop ruins for which Milot is famous.  It should take a few hours, so I’m hoping we survive the heat!  

:)