Saturday, December 19, 2009

Concrete Improvements: Hope for Haiti

America is a wonderful place to live. I'm, just saying: oh, be thankful, folks. We have a lovely, clean, comfortable, prosperous place to live.
Now, I spend a lot of words in this blog talking about how rough it is in Haiti; it does astound me how close a neighboring country has such an enormous contrast to us; and I think Americans need to know (and care) about their neighbors.. And Haiti has had a couple centuries without any stable or beneficial government or investment in infrastructure. That makes that place so poor that it's really still in the 19th century.

But this blog entry is about hope for Haiti. I was there in March 09, and in December 09. There have been quite a few international initiatives implemented to help Haiti, and they are noticeable even over 9 months. The road to Hinche is almost done. In past years, our group only flew, never drove, from Port au Prince to Hinche, due to the crazy bad roads--- it took 4-6 hours, and cars break down,etc. Now, the road is graded, fairly even gravel, with drainage culverts in place, and paving will come soon. Our friend and translator Berry says that he can get on a bus ( "tap-tap", actually a truck with people sitting in the cargo area) in Hinche at 6 am, and be at class in PaP at 9am. Roads are key. Commerce can happen with roads. A farmer with extra mangoes on his tree can sell them, if there are roads. No roads; they rot. Women in labor can get help from a midwife with roads. No roads, moms and babies die. It's a big deal. Road work in Haiti was everywhere.

My favorite symbol of new hope for Haiti was right out of the "Narnia" series of children's books-(The Lion,the Witch, and the Wardrobe...rememer the lampost?) It's in the middle of the photo on this post...While driving out in very remote rural Haiti, several times, we came over a rise, and I thought I was seeing things, as in a tiny village crossroads, I saw a solitary lamppost and street light, with a solar panel on top. When dark has fallen in those villages, people are sitting under those new lights, reading the newspaper. Sewing, studying. Carving. Talking. Hoping. Let's Hold them in the Light.

Saturday, December 12, 2009

Do You Want Spaghetti or Bananas for Lunch?...or, Freaky Friday, again.

On my first trip to Haiti, the final day of the trip, Friday, was a crazy adventure in understanding Haiti healthcare, by delivering a baby in a Haitian hospital (‘A Haitian Birthday” post). Well, it must be something about the Friday thing, as this Friday Dec 11 offered Stephen and me yet another Grand Finale of the trip experience.
One of my main tasks for the week was to go out with the CARITAS mobile clinic team, with our 2 newly graduated midwives who will be adding prenatal care to the services this charity provides on a monthly basis in several remote rural villages. We learned only 2 days in advance that it was a “go” to do this, but I got the message to Magdala and Thelamaque, and they showed up at the orphanage at 5 am Friday…our last full day in Haiti. Soon thereafter, the midwives, Stephen and I, with a big bag of supplies and prenatal charts, and piled into the Toyota Land Cruiser, with the CARITAS team, 2 Haitian nurses and a driver. Being a driver in Haiti is a REAL job, really a profession. The roads are so terrible- rutted, with blind curves, and the traffic on them so heavy and diversified that driving is more like a rally road race than a “ride in the country”. We were a little behind schedule after waiting for our tardy interpreter, so the driver put on the gas whenever he could. Random donkeys, other trucks, chickens, goats, and deep potholes of course interfered, but he was valiant. We rumbled along in our Land Cruiser as the sun came up and the road got rougher after we left the paved part in Los Cohobas. We stopped to pick up, or drop off items or messages on the way, and the journey lengthened into a 3 hour adventure that included both Magdala and me getting carsick from the crazy turbulence, dust, and heat.
THEN we arrived at our destination; the itsy bitsy village of Rosec, with its tiny church and parish house compound. As we parked in the dusty courtyard and folks began to bring pieces of broken furniture, benches, and tarps which would build our “clinic”, the driver asked us “Do you want bananas or spaghetti for lunch?”..It was 9am, 90 degrees, and I’d been vomiting. Gee Whiz….decisions, decisions! Neither Stephen nor I had any clue how to reply to such a random question, and not much interest in lunch at that point, though we did find it intriguing that it was going to be obtained from a “restaurant”…one of which I really hadn’t seen yet that day…but anyway. Based on the status of the village, I didn’t want to expect more than anybody else would be eating that day, and if the menu was bananas or spaghetti, I’d eat it and be grateful. I said whatever they wanted to get was fine and passed over some cash.
We set to work, opening our bags on an ancient table that once had 3 planks, but now had 2, the middle one missing. We also had a small table for our desk, a couple chairs, and they got a bench from the church for our patients to recline upon for exams. Tarps were stretched to define our space, and one for shade, as the sun was getting higher. Meanwhile our patients were filling the “waiting room”—a bunch of other benches out in the middle of the courtyard. I am proud of our new midwives. Magdala and Thelamque are new at midwifery, and I am pretty new to practicing in Haiti, but we made a good team. I provided an organizing element, monitoring and assisting the giving of meds, physical assessments and plans of care, using faithful Manno as interpreter. The Haitian midwives had good ideas about practical Haiti things, like putting the bench so that the head was “uphill”, and discarding the urine samples in a gravel pile nearby. They were diligent and competent, recording each pregnant woman’s history and not shocked at the standard answers, which often involved 6-10 pregnancies, histories of prematurity, hemorrhage, and infants who died of unknown causes. Most women had no idea what their diagnoses or problems had been—there is very little discussion, education, or explanation given during Haitian health care, when the people to receive it. The women we saw had no previous prenatal care, and ranged from 16-35 weeks gestation. This also involved a lot of guesswork, as most women also had no idea how far along they were. Hopefully the “new Haitian midwives” we’re training will be communicators and educators with Haiti’s women.
Stephen took great photos and film of all of this, and reported to me several times that ”they just keep waddling in!”, lining up on the benches. Well, sun got higher, the day got hotter, and lunch came from the restaurant in styro boxes. We paused to eat. It was fried chicken, a couple very scrawny but tasty wings, actually, and boiled plaintains—aha! that was the “bananas” part of the lunch order!! Apparently it was a “choose your starch” question; we could have had “spaghetti”!! Darn it. This was the Haitian equivalent of “fries or baked potato?” Oh well. It was something to eat, and it was brief, as we had a message from the CARITAS nurse, who was working across the courtyard, asking us to “move it along, the ladies are complaining about waiting." In Haiti?? Tired of waiting? It seems all these folks have to do is wait! Some of their friends even came to wait with them, for entertainment! Do they have other appointments? We’re doing our best, lady! But we tried to speed up.
In my USA practice, a “New OB” appointment is the longest one. Even with nurses to help, it takes a good 30 minutes to start a woman’s pregnancy care and have a handle on her situation. Our Midwives for Haiti mobile clinic was new to Rosec, and the women had never seen anybody for care, so we had nothing but “new OB”s” all day. But we saw 18 women, provided Prenatal vitamins, iron, and administered worm medicine to everyone. Some we treated for other problems, including a terrible case of pneumonia that I would have sent directly to the hospital if we had been in the States. As it was, I put her on oral Amoxicillin and Zithromax, with the advice to GO to the hospital if she felt worse or not better in 1 or 2 days. I hope she gets well—it’s a long, hard journey from there to “the hospital”, and not much reliable help even when she gets to one.
After lunch, Stephen had shot most of his film and battery. He disappeared for a while… Then he came around the tarp while I was working on my lab desk/broken table,…looking a little… disoriented?...astonished? and said “Mom, I just attended a Haitian funeral.” This stopped me in my tracks, just for a minute, as I was seeing the pneumonia lady and was also running out of vitamins…I looked at him, and said;”Yeah? I bet that was different?!”…Oh, you will never believe it, he said—and gave me some details, only a few, until later—but it included a procession singing and dancing,
Drumming on buckets and drums
Banging machetes
Drinking alcohol and spitting it on the coffin…
But then, the coffin did not fit in the mausoleum,
So they hacked it up with machetes until it fit.
The widow seemed to like Stephen’s presence, and stood with him a minute, then basically signaled that he should leave. Which he did….so he came back to the compound with that funny look, and a wild story to tell later.
By then I had run out of vitamins and iron, but the CARITAS nurse said I could send the ladies over to her nurse who would give them some, but I had to “write a prescription”. I asked Manno: how in the world I do that, in Creole? On what form? But we just punted…I pulled out my little notepad, and he helped me spell out “Name” (Nom), “date” (Dat) etc., and we wrote a Rx template in Creole. I had a dog wandering under my half a table as I wrote these, and I have no idea where these “documents’ will go… but I wrote Creole prescriptions and the ladies got vitamins. And iron. Oh, what a day. It only took 2 and a half hours back, and no one lost their lunch—the lunch of “bananas” and chicken. It was the Freaky Friday, final-day-in-Haiti, all over again.

Friday, December 11, 2009

NO Fast Food in Haiti

It is just too overwhelming—and possibly tedious, both to read, or write, a list of what we’ve been doing in Haiti this week (besides sweating heavily, giving away scrubs, riding around in the truck!) Sharon and I plan to sit together on the flight back to Miami, Saturday, and compose an email to the M4H Board with that kind of laundry list. So for now, here are just some descriptions of little pieces of the lovely, crazy quilt that make up this week in Haiti:
A bigger classroom in the Ministry of Health was open for us to use for our “Out of Hospital Birth” presentation. All of Class 2, (mostly graduated) and Class 3—(beginners) attended, and Sharon and I had a blast, sharing with them our philosophy of woman-centered midwifery and the concepts of risk assessment; what’s ok to do at home, what’s not, and tips on assisting a labor without much intervention. Stephen and Chris improvised a “Haitian boom” microphone --- ( mic duct-taped to a broomstick) and got good audio and video of the whole event. Stephen said he had a proud moment with me and Sharon role-playing, demonstrating back labor, side-lying, and hand-and-knees delivery, with me crawling around on the conference table, moaning loudly. Meanwhile, Sharon played the midwife role, showed how to do these labors and deliveries and validated that mobility in labor and different positions are not only normal but helpful.
We’ve been available to whatever pregnant women wanted any care, so that has meant a prenatal visit each day with somebody—our translator Theard’s wife, and then each of the 2 cooks, wanted to See the Midwife and made an “appointment” when we could check them out in our bedroom at the orphanage. It has been so sweet to sit with these women, give them information about what is normal, when their due date will be, discuss what their plan may be for birth. They have generally seen somebody at the local clinic, but it seems there is no teaching or sharing of information…nobody knows why they should take iron, or vitamins, whether their urine test, blood pressure, or size of their belly was normal, so they just wonder and worry. We will change that with more midwifery care!
The lunch each day on the porch at Maison du Fortune Orphanage has given me happiness. In past trips, we’ve often not been able to arrange to bring our staff- drivers, translators, etc, into the places where we ate our noon meal. They just fended for themselves, or even (we kind of figured out over time)… went hungry. There is no Fast Food in Hinche! Actually, nothing is fast. Not the traffic, the most of which is on foot or human or otherwise. Not the pace of business—“Maybe Tomorrow” is a motto these folks live by. I went to a Haitian bank, and while a mob waited forever in line for the teller, cell phones were plugged into the wall, charging, by the potted plants—free power!
On this trip, at this new “home”, however, all The Guys Eat with us, served by the cooks of this house of Xavieran Brothers who host us. Each day at noon, we come back here, and rest on the shady, tiled upper porch, pray, and share our meal—(Any blog reader already KNOWS the menu!) And it is so pleasant.
In Haiti, hunger is not an abstract concept or a growling stomach due to poor time managment. People struggle, worry, and exert great effort each day to find a way to make some money, grow some crops, make some deals, to find food. Then they find charcoal with which to cook it. They get water from a tap, often not a tap at their house, but down the street. They go to market on a donkey or a bike or walk, to buy the food, and then, finally, if all goes well…there is lunch. It is a happy time. A big plate of beans and rice, a little bit of meat cooked, with raw onions on top… makes a Haitian happy. It’s made me happy too—to share provide work that makes someone able feed their get to live this day, and eat lunch with my family and friends. Messi Bon Dieu—Thanks be to God.

Wednesday, December 9, 2009

Pressure Cooker: Which are Thicker: the Mosquitos or the Stars?

Food cooks faster when you cook it under pressure. I’m feeling about cooked myself, now, from the heat, humidity, combined with pressure of what I hope or need to accomplish vs.the obstacle-ridden chain of events that can make up a day in Haiti. We can make plans, but they will change daily, if not hourly.

Many joys in the past days, and many frustrations and griefs. Hugging my son Stephen at the airstrip this morning was a big one. It’s so great that he’s willing and able to share even a a part of this work, and experience this piece of global reality, and my heart. Frustration over the lack of internet: it’s broken at our host building, and not one cyber cafĂ© open in the whole town due to the Feast Day. So blog posts go out very intermittently as the opportunity arises. This afternoon, a long, dusty, rugged ride in the back of Ronel’s truck to the Medical Missionaries clinic in Tomassique, where one of our star graduates, Merlinda, is working. Great scenery! Great to see her and her clinic. She and a partner midwife attend 30-40 births a month out there, using 3 labor beds all in one room, and a table and a sink at the end of the room, behind a screen. That was the joy….the more difficult part of the scenery is the many, many people on the road, who live in these rugged hills, scraping out the meagerest living on bare agriculture and random pieces of work they can find. As we rounded one bend in a massively rutted road, I looked up the big wooded bank above the road, and saw a man at a treadle sewing machine, in the front yard of a little wooden Haitian house. What’s he sewing up there? How far will he walk, or ride a donkey or a bike, to get some food or some money for it?
In Merlinda’s clinic, she had a lady who she had attended 2 hours prior to our arrival. It had been a long labor but all was well. The woman, Jacline, had had one prenatal visit, and had traveled 2 hours to get there and have safe midwifery care for her baby’s birth. I gave her a gift pack of onesies and diapers. I want to give her and her baby a better life, but this is for now, the best we can do.
Long after dark, we got “home” to the orphanage. I broke the shower nozzle when I took a shower. I’m wracked with painful guilt over breaking anything in Haiti—it’s so hard to fix! So much other stuff is broken. It’s not easy to live a day here, even when everything works. I prepared for tomorrow’s plan, only to get a cell phone call at 9 pm that scrambled the day and week….again. The mobile clinic truck is going out on Friday and I need to take our 2 newly-hired gradutes and go help them get oriented. So other planned activites have to be fit in some other day, but we’re running out of days…and oh yes, we’re trying to take film while we do all this. I’m worried I can’t fit it all in. I’m worried I’ll forget things I promised to do, or that I will drop the ball on these peole we are trying to help. I’m afraid to let them down. These are real people with real lives, and they try so hard, and they count on us to help them. It’s hot, the mosquitos are thick tonight, the humidity is high, and the pressure is on. I’ve got to get in my mosquito net before I’m eaten alive! But I look up from my porch, and, because there is no municipal electricity, there’s no light pollution, and the stars are spectacularly thick and brilliant. It’s the glass-half-empty-or-half-full riddle of Haiti: Which are thicker? The mosquitos or the stars?

Monday, December 7, 2009

A Day in Haiti Lasts Three Days

At 4pm today, I was hiking down a rugged dirt path, gazing at dry blue mountains rising above bright green sugar cane fields. We had just viewed a rural school that our interpreters started this year, partly with funding from US donors like us and volunteers from their own community.. The school consists of blackboard, benches, a latrine and a thatched roof. At the 4pm moment, I dodged a cow coming down a path, with a kid following her on a string, not exactly in charge, but hanging on…. I looked at my watch, turned to my travel partner midwife Sharon Ryan and said “We’ve almost been in Haiti 24 hours.” Her eyes widened; she sighed, and she agreed…in regular time, we have only been here one day. It feels like 3. Maybe 4. But they have been 3 really good days, and we should sleep great tonight.
Our arrival in Port au Prince was a brief, intense overnight stay. The short drive through the city was almost as disturbing as my first time; the gigantic potholes! The dusty, hot streets! The minimal sanitation! and lots of pedestrians trying to avoid motorbikes and trucks. Our hostess, BethMcHoul fed us a lovely dinner, and showed us her women’s center and birth center, which is saving the lives of the poorest women in Port au Prince. Her program teaches women sewing skills to foster financial independence, provides basic education (reading, writing, math), prenatal and classes on health care, breast feeding. They even feed these severely malnourished women high protein meals by raising their own tilapia! Then Beth and other volunteer midwives attend these women’s births with dignity and kindness in a place where very little of that exists. And as a bonus, they give Midwives for Haiti volunteers a safe overnight when we’re coming into the country. God Bless them!~ We donated some baby clothes medical supplies salvaged from the US hospitals, meds that she can’t get in Haiti, and she gave us advice and wisdom on working with Haitian women and culture.
Today has been a day of gladness and pieces falling into place. I had such joy to reconnect with the friends I made last March…our interpreters, Theard and Manno, and Ronel, our driver., Danise, our Haitian nurse-midwife teacher. After the 20 minute lflight in a 4- seater plane, we landed with no plan at all, other than to start making phone cell phone calls to all the people that we need to meet with. But, then the sun, moon , and stars all lined up… Father Jacques , our primary Haitian contact and advisor, said “come on over, I will be happy to see you now!” Within an hour of landing, we were sitting on his balcony with our group and both the M4H teachers, Danise, and Marthone, talking over many of the issues we current issues for the program and goals for the week. Then things just kept moving—we got to the orphanage where we will stay in the guesthouse. Ate dinner (Beans! Rice! Goat stew! Surprise!) with all staff and Brother Harry and Mike. We visited the homes of Theard and Manno, saw their kids and wives…I am getting re-accustomed to kissing on both cheeks as a greeting. We examined a friends’ wife and will try to find the right meds to help her severe abdominal pain. (We think she has an ulcer.) We saw the rural school (ie, paragraph 1!) that Theard and Manno have built simply on believing that they should, and friends have funded in random and generous manners when they can. As a result, since this past October, 72 children in Naral are learning to read and write who have never been to school before.
We looked at the house that MH could consider renting to have a “permanent space” that’s ours. I don’t think that particular house will work, but it’s an idea. This little non-proft currently lives out of closets in about 4 builidngs and pays room and board for 2 Haitian teachers in 2 different places. A “home of our own” in Hinche could save money and logistical energy. But for now, we’re “home”—the Maison du Fortune Orphange. A soccer game of about 30 kids was going in the courtyard when we returned at dusk. The boys are sweet and shy, but love it when we speak English with them—or join in their games. We brought them shoes, clothes, and medicines. Wait ‘til they see we brought them a soccer ball and a basketball.
I think I’m in an emotional honeymoon phase…I do find that as a “second voyager”, I’m now less traumatized by the poverty, and can really cope better and feel more normal than the first time. (I have high hopes that I won’t wake up crying at all!—we’ll see.) The bigger and harder issues of the week have not yet even begun. We need to spend some special teaching time with our students, have some meetings about getting the new graduates jobs, travel out to see some former grads at their practice sites, and oh yeah, Stephen lands Tuesday and we’ll start to make a film! But tonight, I’m just happy.
Happy to be in Haiti. The mountains and fields are spectacular. The people are incredible. They just keep trying, and they show that it’s true—we should never, ever, give up. You never know when things will go exactly right. Like today…these 3 days that we just lived in one.

Friday, December 4, 2009


"Embargo": possibly Latin for "Tear your Hair Out"!
I was on call for 5 of the 7 days before I left for Haiti. Full moon, lots of labors and births. I knew the schedule, and that this was coming, so I packed carefully in advance-- my friend Brett even came over, gave us dinner, and helped do the final pack. We had SO many generous donations of all sorts, but were sure I had all in order. Except-- the day before my departure, I learned from Sharon, my travel-partner midwife from Ohio, that between Thanksgiving and Christmas, the airline has an embargo on any luggage over 75 lbs, and NO third bag allowed....hence, "Tear your Hair out!!"

I attended 3 births on Wednesday, then between deliveries on Thursday, I raced home, said hi to Greg who had not seen me for a day or so, and frantically re-arranged, ruthlessly and rapidly prioritized the "Must Go Now Stuff" in 2 Bags vs. the "Stuff to Go in March". This time, medical supplies, meds, cell phones and laptop, scrubs for the students, some baby and kids' clothing, books, portable food. A lot of the baby stuff, diapers, and some kids clothes will go in March when I go back for trip #3.

When my plane took off from Dulles on Friday at 6 am, I had 2 bags that were exactly 75 lbs; (after I re-arranged them at the baggage counter again with the whole world looking on..!) It's all ok--only a reminder and a taste of third-world life that I'm headed for. In places like Haiti, plans are made, but every day is generally a series of emergencies, small, medium, or large, that folks navigate as best they can. So my crises in packing are exhausting but oh, so small.

On the map, Florida sticks its nose out into the Atlantic and Caribbean, and Miami sits on the tip of the nose. I write this in the Miami airport, with the sensation of bouncing on the end of the diving board, the jumping-off point of the USA and into the third world. We land in Port-au-Prince, and nothing is quite so simple after that; not internet, power, water. Not even birth is safe.

But Midwives for Haiti has a mission that is inching forward, trying to help. This trip, I will look at a house that the Board may consider renting, so that we have a "home" in Hinche and not just random rooms and closets in several different buildings. I'll meet with teachers, students, our Haiti friends and advisers, and help organize a new mobile clinic. I'll talk about a Durango SUV that is being donated to the cause from the US, and how to get it to Hinche (that should be interesting for sure: we can't even send a package UPS, let's see how we get a truck there!) And my son Stephen will arrive on Tuesday and work on filming for future PR projects.

I don't need to ask for prayers or good wishes. Gifts, notes, hugs, help, donations, and phone calls have convinced me many times over that I only do this with the love and support of a very large tribe. Thank you for reading this. Thank you for being part of it with me. OK.... jump off the diving board!!!