Charmika’s Blog in Haiti 2012

Charmika’s Blog in Haiti 2012

February 18, 2012

Last night I arrived in Haiti.  It was a challenging endeavor getting to Haiti- thankful for safe travels.  I was blessed with an upgrade to first class which allowed me 3 free bags and I only paid $100 for extra bag.  What a faithful God we serve.  I spent all that time worrying about transport costs then got a great deal since He worked it out which was such a relief.  I was able to get all of the medications transported, both through my friend who brought a couple of bags earlier in the week and on this flight.  It was very welcoming to have Haitian men singing songs with big smiles as we got off of the bus that we caught from the plane.   However, it was disheartening on arrival after all of that work put into getting medications to have bags confiscated in customs which led to a lot of frustration and it was upsetting.  I did not have the necessary paperwork for getting medications in country.  They told me to get a letter from the health ministry to get all the medications approved.  I am working on that and realizing it is another test of my faith.  Above all things I must trust God in every aspect.  He led me to Haiti and He will see it through to ensure meds get to places needed for the people that they are intended to help.  I was exhausted, after about a 2-hour ride, from Port-au-Prince to guest house in Mariani, just past Carrefour.   The drivers took me on a ride to the store enroute to the guesthouse.  The roads were very rocky and after going up and down many unpaved and very bumpy hills we arrived.  We drove through Grace Village which is where my friend from Portland who brought two bags medications for me was staying at.  I later learned that there were two Grace Villages in two totally different locations which is why we were not able to connect initially.  I enjoyed staying at Hope Alive Guesthouse- that evening was spent connecting with some of the Haitian staff, Renaud and Wilio, and with Leslee and Katie.  We had dinner prepared by the cooks.  That night we sat on the porch of the guesthouse talking until late.  We later went to bed, some of the staff preferred to sleep on the roof and it was hot inside.  I slept okay, although hot with no AC or fan, in a room in the clinic area upstairs.  Being under a mosquito net was uncomfortable and stuffy, not something I’d done before in Haiti.  

February 19, 2012

We went to a Creole speaking church Sunday morning enjoying praise music in Creole and even though there was a language difference the positive energy in the church was evident.  The church was at an orphanage and we got to interact with the sweet children who sat around and with us playing throughout the service while some sat quietly listening. It made me feel even more connected to the culture and enhanced the desire to adopt a Haitian child as there are many who could use homes.   It was sad to leave them especially when one of the very friendly little girls through a tantrum when we said goodbye.  We spent the earlier part of afternoon at the Hope Alive Guesthouse and had plaintains with picklies for lunch.   Myself, Wilio and Katie went for a long walk around the neighborhood first to Grace Village at an attempt to get medications, when we couldn’t do that we decided to explore other areas.  We walked down to a beach hotel called the Lambi Hotel, about 20 or so minutes away by the main road.  It was a popular beach, but it was not the traditional sand and ocean I was used to at a beach.  The beach was in the south of Haiti where I heard the beaches aren’t as nice as those in the north.   We stopped and got some homemade pineapple icecream on the way there from a icecream stand which was tasty.  It was a small beach, we had to pay to get in.  There was loud Haitian music playing and an area for activities where people played sports and tables where people sat eating and drinking.   There was dancing and lots of Caribbean style music, locals were there and I did not see any people who looked liked visitors.  Seemed like a common place to go on the weekends, it was cool to get a taste of at least part of the authentic experience of living in Haiti.

I was eventually picked up later that day by a driver and Cary Roberts, one of the team leaders from the Haiti Outreach Ministries medical, construction and mental health team called Diakanos from Canada that I planned to work with that week in Port au Prince.  Cary wanted to make sure we made it back by dark as it was Carnival time when a lot of partying occurs.  Fights and other problems can erupt jeopardizing security and leading to unsafe conditions quickly.  We spent the evening getting acquinted at Walls Guesthouse with a team of providers, Pastor Leon (founder of Haiti Outreach Ministries) and his wife and others who would help with construction and building.  I even reunited with some old acquaintances a nurse from Seattle and Larry Roberts, (founder of Servants Gifts, an outreach organization with a group house in Haiti), friends who happened to be staying at the same place.    It was a refreshing start to prepare for the next week which will be spent in a clinic at Cite Soleil, an underserved, impoverished and historically unsafe community, known as a large slum.   The community has been victimized by crime, inequity and is vulnerable, I really anticipated serving there.

Trusting God for a fruitful, productive and meaningful week ahead covered by His protection.

February 20, 2012

Tough and restless prior night sleeping with so many people in a room, lots of noise with snoring and being awakened so early made it hard to feel rested for the clinic day ahead.  Topped off with a rough morning having taken Doxycycline 200mg on an empty stomach for malaria prophylaxis made me sick, learned not to do that again.  Morning quickly improved with fresh fruit for breakfast with mangos and watermelon and a cup of tasty strong Haitian coffee called Rebo.  Felt good with the warm sun shining, one of my favorite things about Haiti.  We boarded the tap-tap, a local Haitian mode of transport, a midsize truck with an open back, usually painted with vibrant colors and religious messages for designs, normally packed full with many people.  The team rented a few private tap-taps so we all got on and shared a cozy packed ride to Cite Soleil about 20 minutes away riding over many bumps on the rocky roads.   I quickly got used to riding tap-taps and liked the open exposure to the street life in Haiti where we drove past numerous people and vendors working hard creatively selling all kinds of items from bowls with toiletries to fruit and even medications.  I loved seeing school children in the early mornings from the smallest to older all in nicely dressed uniforms and young girls with ribbons in their hair.  It speaks to the values of education and determination via work ethics integral to the Haitian culture.  The streets of Haiti are filled in the mornings with the hustle and bustle of people selling what they can to make a living, stationary vendors often sell items varying from food to electronics and clothing.  There are mounds of garbage interspersed on the streets, especially causing profuse odors when they are in bodies of water combined with the heat so the smells are often profuse and malodorous most notable when large piles of disposed products are burned.  The putrid odors are short lasting though as the warm island climate and air blowing somehow seems to outweigh the offensive odors.   It’s sad to watch the children standing and walking amidst the piles of rubble and garbage and seeing animals, many emaciated dogs and cats, eating what scraps they can find.  Somehow the people seem to cope and are not, at least outwardly, phased by the visibly profound hardships in the environment.   It hurts to see so much hunger, stacks of garbage lining the streets and occasional pools of water filled with stacks of even more trash thinking on diseases of poverty born out of exposure to these elements.  Witnessing the massive needs it is easy to contemplate feelings of inadequacy, at a loss with resolutions to do much that would really make a difference.  Taking in the variety of colorful impoverished sites enroute to the clinic shakes and jolts one’s spirit.  Tin make shift shacks mixed among tented camps and boarded up sticks arranged with scraps to form houses, a shelter for what many call home in Haiti. Insight along the drive triggers doubts, raising questions on solutions while trying to remain pragmatic about the harsh reality of limitations.  Trying to avoid thoughts that clutter my mind on such seemingly insurmountable needs is a struggle.   Looking at the big picture in scenes like this must be avoided as it is self defeating and overwhelming, only casting doubts on the possibilities.  Still, off to the clinic it is, knowing that, at least for the patient’s encountered, I have a chance to make a difference, maybe help cure a disease and at least for a point in time, make someone’s load a little lighter.  In those individual potential differences resides the motivation to press on.

Not knowing what to expect in Cite Soleil was discomfiting as it was a historically dangerous, turbulent and often avoided section, others call a ‘slum’ on the outskirts of Port au Prince.  It was both intimidating and thrilling to look forward with anticipation on what was to come on the adventure there.  After previously trying to work in Cite Soleil on a former trip in Haiti, I was never able to as I could not get a local Haitian who’d agree to transport me to this region, even though I had a relief agency, Catholic Medical Missions board with a clinic there I was approved to work in.  That morning pleasant surprises awaited our crew as we drove into a what appeared to be newly renovated section of the town which was a cleaned up, nice segment of the Cite Soleil community with a large well-established church, a large school and a older clinic that was damaged in the quake and a newly built clinic shared with Samaritan’s Purse.  There were fresh almond and banana trees in the yard areas.  We set up our stuff in the clinic which consisted of a triage area, a separate air conditioned pharmacy, nice bathrooms and individual exam rooms.  It was refreshing to have a separate area to see patient’s in offering some privacy as previously this was limited in other places I’d worked in within Haiti.  It was obvious a lot of work had been put into this area.   We got our rooms set up with supplies, I wished I’d have brought a blood pressure cuff and thermometer to go along with the oximeter, otoscope/opthalmoscope and stethoscope to use but next time I’ll know to bring it all.   We met our translators, the young man who worked with me was named Jackson.   We began to see a steady flow of patients that morning.  Cases ranged from minor abrasions and rashes to more acute infectious conditions: probable malaria, pneumonia, upper respiratory infections, asthma, hypertension, diabetes, genitourinary, gastrointestinal conditions among others, the most difficult to treat were dermatologic.  Motivation came from hearing background live and recorded gospel music in the background at the church next door which ignited the perfect peace needed to get through the challenges.  After spending the day treating many patients, we wrapped up by 4pm and boarded the tap-tap (large truck w an open back to be filled w people a public transpo system, though this one was private).  We headed back to Walls Guest house.  We started the evening having a tasty dinner prepared by the hard working staff at Walls who are great cooks.  The night prior I bumped into a couple of people I knew from before, one a RN from Seattle and another man I knew, Larry Roberts, from the trauma hospital from a patient care encounter who started a organization called Servant’s Gift and had a group home in Haiti and who does mobile clinics.  It was the first of many serendipitous meetings, it was real cool to make new friends and see old ones.  We had Haitian food w an American twist, picklies that are coleslaw lie but delicious assortment of cabbage w Cajun flavor and vinegar, salad, fresh fruit and a mac n cheese mix w ham I picked out.  I loved the fresh hot Rebo (Haitian) café (coffee) available around the clock, mmm w crema (cream) e suc (sugar) a welcome treat after a long draining day to refresh.  Myself and two of the docs were taken out for a night time tour by the Pastor running the organization Haiti Outreach Ministries that we were volunteering though.  He took us up into the more exclusive wealthier part of Haiti.   He drove us up into the hills of Petionville where the houses are large and beautiful, he said they average around $200k US dollars.  We went to a couple of very fancy large hotels that stand on hills, one which had many guests perish in the earthquake.  The hotel grounds were exquisite and larger than any place I’d stayed in within the US with outdoor and indoor restaurants, pools and tennis courts.    I had previously seen this part of Haiti before, still it was nice to see the sharp contrast of what I’d been seeing with the fancier parts.   After a restless night prior w ~6 in a room, too loud to sleep right, I was able to move into a private tent which I really enjoyed sleeping in, snoozing by midnight to get ready for another day. 

February 21, 2012

Off to an early start after the routine breakfast, this morning oatmeal, fresh fruit and toast with hot coffee, and a mug to go before boarding a taptap, this time with my makeshift coffeemug halfway secured with a Ziploc bag. Confrontation with the street elements is a sobering reminder of the massive needs in Haiti.  The streets are bumpy and mostly unpaved, an analogy to life for many here.  In the congestion, people are busy hustling misc items in a quest to get paid, items for sale range from foods to electronics or whatever’s clever to make a living.  Shacks made of items found from tin to pieces of wood, tarp and metal make up the homes and vendor stands.  After about a 15 minutes ride through the urban neighborhoods we get to the clinic.  After braving the streets of Port au Prince in the taptap I had maybe a quarter cup of coffee left, enough to get me through the morning.   We set up in the Cite Soleil clinic, now routine as one quickly adjusts when being confronted with many complicated patients after a day of care rendered.  Most of the things used to set up the rooms are old and outdated, improvisation is the key to thriving and humbly making do with what’s available.  The morning was uneventful until about my 3^rd patient that is, a lil infant who was crying incessantly as I was holding him I felt my leg turn warm, I looked down and realized he peed all over my leg.  Didn’t think on the fact that diapers are expensive and many of the infants don’t wear them as a result.  One of the nurses Danielle was nice enough to arrange for me to get a pair of scrubs so I could change.  The day pressed on with many acutely ill patients who couldn’t afford to get to a hospital so it kind of felt like an urgent care center.  The one who stood out the most was a little boy sick with bad pneumonia and untreated asthma who required advanced care.   Reflecting on basic meds and access to care we take for granite in the US that prevent escalation of often simple diseases like asthma, but when unmanaged can result in death.  Many of the patients have basic care needs and a host of other health problems.  Running back and forth from the pharmacy all day to figure out meds available was tiring, but I was glad to have access to the variety of options.  We wrapped up the day by about 4 pm. Arrangements were made to take me and 3 of the guys to pick up some luggage with medications that a friend brought for me from Portland the week prior.  It was a relief to be able to finally connect with meds after a long drive and having to stop several times for directions, especially relieving after not being able to get other meds through customs.  On the way back we stopped at a Haitian restaurant and had spaghetti Haitian style which is served with veggies mayo and ketchup and crepes mine w cheese, all good served w fruity juice drinks. We headed back to the guest house and were able to enjoy bits of the Caribbean carnival with large groups of people parading the congested streets with music and dancing.  A police presence was noticed among the crowds.  Observing the different parts of town there seemed to be fewer people living in the tented camps than visible on previous visits, though this was only at a brief glance. Even though the poverty still appeared rampant, it was nice to see people happy and celebrating.  I heard from at least one Haitian that Christians do not usually take part in Carnival as it involves unwelcome activities like drinking and fighting. It was interesting to observe some of the festivities on the way back to the guest house. 

February 22, 2012

The day started as usual with fresh fruit for breakfast and coffee.  We headed to the clinic at about 7:30 am.  Set up was quicker as we had a routine developed.  We heard patients would be waiting in line as early as 4:30am, a humbling reminder that the Haitian people have something to teach us about patience.  Patients were triaged through the clinic through the EMS and medic volunteers to myself, one of the two ER docs or an RN Danielle.  After we saw patients we sent them for testing or treatment (i.e. blood or urine tests, nebulizers, or IV/IM medication treatments).  It felt good to have the unique benefit of seeing patients in individual exam rooms, in prior patient care in Haiti things had to be done much more openly with space constraints.  The pharmacy was usually the last stop where medications were picked up and instructions given by a Kreyol interpreter. We saw many acute and chronic cases.  The one that day which made one’s heart thump was an infant suffering bad from malnourishment.  One of the doctors had a 7 month old grossly undernourished baby come in whose mother had been reportedly feeding him some kind of mix of oil w flour n sugar. In her defense, she was working with what she had, the grim reality of a single mom raising 4 other kids and whose mom was helping her look after the infant as she was struggling for ends meat.  Without an academic education or financial resources no wonder so many moms could succumb to feeding their children whatever they could find, rumors of coffee creamer for formula, the truth of mud cookies that are made with sugar and look like sugar cookies.  Who could blame them, knowledge is power and a lack of it can be detrimental. So 7 months later this infant, who appeared lethargic so weak, barely able to move and frail with no muscle tone appeared as if fate may be better on the other side of the fence if reality meant continued consumption of homemade formula and the malnutrition that ensues.  The baby required an intrajugular intravenous line in her neck just to get IV fluids in her.  The mom declined taking her to a hospital, but she agreed to take her to a nutrition center the next day.   No human is in a position to judge and we had to be careful to question her decision, she had 4 other children to feed, probably at home alone.  When I walked in the room, sadness filled me as I stopped and looked at her, saw the hopelessness in her spirit, emptiness in her eyes, her other child stood by her side, he looked about 2 years old and he began urinating on the floor.  None of us had the heart or strength to even react, to busy taking in the cold realness of the case.  What hit me hard is this woman likely represents one of millions of mothers.  Mothers suffering, enduring nights and days of hunger, mothers longing to provide some stability, some nourishment and comfort for their children, with protection and shelter for their seeds, feeling perhaps alone and isolated maybe even agonizing in the process of daily grinding.  Thinking silently, intense realities are startling it is hard to imagine living in this tough environment.  I’m just coming in and out for a visit taking in a glimpse of the hardships I cannot even begin to fathom.  It is truly heartbreaking, I make a point to keep my cool and never get emotional in delivering patient care, this time my spirit was truly tested as I wanted to shed tears for her, for this little baby who’s future was questionable. Instead, I held back as usual, tried to think quickly how I could make just a little difference. Instinctively, I grabbed a small bag with granola bars given to be that morning and ran around the clinic to collect whatever food I could from the volunteers there on the ground.  The outpouring of love on the spot was inspiring, the small bag was replaced by a garbage bag filled with food.  The look on the moms face when giving her the bag was priceless.  For a moment in time, her face lit up a little smile shined through.  And for at least a point in time, just maybe she had a little hope and encouragement. One of the nurses bought her formula to take home.  After silent prayers and fluids given, the little baby called Shamella began to gain some energy, she shed a few tears, I think in each of us tears were silently shed as our spirits were shook.  This is why I came to Haiti. Perhaps I’ll never make a difference for the masses. Maybe not even for large groups of people, only God knows His plans, but all I know if for the moments I’m here and all we have is this moment, for the people I’ve been Blessed to touch I’ve made a difference.  At the end of an emotional day like this, I realize the one who is really Blessed by these trying endeavors is me, as I am vicariously strengthened by every patient encountered.  As a doc on the team said, you never know who is watching you and who you can bring hope to, in places consumed with hardships that hope can go along way.  I’ve seen opportunities for public health interventions are vast such as teaching community health workers to teach parents or guardians how to make formula for cheap, how to prevent worms by avoiding mud cookies, how to manage anemia cheaply with endemic products, prevention of reflux, management of blood pressure on a budget, preventing GI problems by cleaning water cheaply and a number of other issues.  Reduction in ailments with educational interventions in communities should not be underestimated.  In the fields and out I reflect on the statement by Mother Theresa of Calcutta which referenced how we feel like we are but a drop in the ocean, but without that drop the ocean would be less.  My dad, Daniel Schuster reminds me to make my drop a big splash. 

February 23, 2012

We started the day out even earlier a shock to my system as I’m not a morning person, at all. The plan was to leave by 7am as we were headed to do a mobile clinic at a tent city by Cite Soleil.  After having coffee and fruit we left a lil later heading out through the busting streets pass by a different clinic called Blanchard where I had wanted to stay the following weekend. We stopped by to pick up supplies enroute to the camp. A group packed up medications that were used to set up clinic at the tented city not far away.  We arrived at the tented city, volunteers were oriented to different stations with areas designated for waiting areas for patients, a pharmacy, triage and a section in the open for clinicians.  Not much privacy available. We were welcomed with opened arms by loving children running up to us, a reassuring feeling in what at a brief glance looked like a destitute place. On a closer look, they were people , some working , some struggling to make a living like anyone else.  We were later told they had not had anyone provide healthcare for a year or more, they had to walk far for water and had little or no food, latrines were full which left few places to use the bathroom.   The culmination of a lack of sanitary facilities seemed to create the perfect breeding grounds for diseases.  What caught my attention were the scraps children put together for toys, looking oblivious to the poverty, a little boy pulled along a car on a string made out of an empty old oil can with wheels attached.  I’ve seen creativity like never before in Haitians which was uplifting.  Malnutrition, hunger and disease were seen in the camp, all balanced with a palpable resilience and determination in the community.   Diseases untreated had manifested into progressed cases and we had to just do the best we could with limited medications available. It felt like just putting small bandaids over deep rooted wounds.   Poor nutrition from lack of food was a magnified problem.  Women who had endured many hardships were forced to fend for themselves and their children.  It was not uncommon for children to come unattended by an adult.  One 14 year old girl who lived in the camp alone was an orphan, both of her parents were deceased and her brother lived in an orphanage. Her period was late and she had been sexually active. She didn’t appear to be phased at the thought of being pregnant. With scare resources and the need to treat an infection she had I couldn’t do a pregnancy test, just had to pick meds presumed okay in pregnancy just in case.  Her story is likely just one of many.  Earlier in the week  I worked with a young woman who had been severely beaten and raped left for dead, but she survived.  Now I was working in a tented camp where such actions, perhaps on a smaller scale were possibly commonplace.  Food was limited, I heard main staples if even options were beans, rice and bananas and of course the mud pies made with mud, sugar and oil.  There was not an outside source I knew about supplying food.  Walking through an unsafe neighborhood was required to fetch water.  No toilets created its own unique set of issues.  I’d read an article of women being attacked when seeking to use the bathroom on the camp outskirts. I even found it tough to find a private corner to do patient exams when needed.  At the end of the day I walked through some of the camp with translators and met community members. They shared with me that they live in the camps and have medical needs.  I watched children in the distance playing games without regard to scarcities.  Men stepped up from the community to serve as security.  I saw young women longing for attention, children and babies hungry, fatigue on the faces of the older tenants.  In the end of it all, one wonders how much good is really done. At best, perhaps the visits provide a glimmer of hope, maybe treating some conditions, still outcomes are all in God’s hands.  Many diseases will remain untreated, hunger may continue.  Striving to be His hands and feet is all one can do.   In the debriefing that night where we all seemingly selfishly retreated to the comforts of food and safety we talked and quietly reflected somber and still with all that had been seen.   We saw a total of about 200 patients that day, practicing what I call raw medicine, never enough, but for some patients hopefully it helped.  We talked on what had been a Blessing or surprised us- for me it was feeling the spirit of God and seeing Jesus so in the people of Cite Soleil , a place I could not even get a ride to in the past cause of its negative reputation.  We shared what challenged us the most- for me it’s now that I’ve witnessed the massive needs in the tented camp and other places , how will I respond to the call to help.  Lastly we shared our takeaway from Haiti- for me the lessons taught by the Haitian people 1) have faith 2) be patient 3) be grateful, always say thank you 4) love Jesus 5)work hard and 6) make the best with what you have.  We finished the night socializing on the rooftop talking and taking in the cool breezes.  My mom,  Rosetta Schuster, who always encourages me reminded me before I left that there would be times I’d be uncomfortable on this trip, but that everything will be allright as I’m doing God’s work here.  Reflecting on all the lessons in just a short time, I realize she right.  I’ve stepped out of my comfort zone, definitely tested in these circumstances, but it is all so rewarding and I’ll forever remain changed.  I’m thankful for being called to serve.  

February 24, 2012

Some of the team was leaving today so they took the morning off to site see.  The other group of us went to the Cite Soleil clinic to work.  There was a very long line of patients waiting in line for our arrival.  Since the group was smaller it impacted flow.  There were other volunteers there from the group Samaritans Purse which is an nongovernmental organization (NGO) which owns the clinic we were working in, it was nice to have other volunteers.  We had to be very patient with everything taking longer with fewer providers.  I was disappointed that we had to end the clinic early that day as we had to transport the other team to the airport. At the airport, Jackson, my friend who helped me translate, helped me go to customs to try and get medications out. Without the paperwork they required from the Ministry of Health saying it was okay to use the meds in country, it was too difficult to get them out of customs.  By now, I had contacted Americares the company who donated the $49,000 worth of medications and even the U.S. Embassy for assistance to help get the medications out of customs.  I had no idea how complicated it would be to get the medications out of customs and I would have just bought the medications in the country if I knew it would be so difficult.   Mike from the US Embassy was helpful as he gave me a contact at the Ministry of Health to let them know I was coming to the office.  Part of the Canadian volunteer group actually rode downtown with me to the Ministry of Health (MSPP).  Enroute we saw many of the buildings damaged in the earthquake including the Palace as we drove through some of the very unsafe and impoverished areas including the Belair neighborhood where I previously worked in a clinic within the Nazarene church.  Surrounding the areas around the Palace were areas with tents with people residing in them.  We drove by the Cathedral which is always interesting to see how the Crucifix appears unscathed from a distance while the Cathedral itself is extensively damaged.   It is a testament to me, to the Great Lord’s omnipresence.   We eventually got through the area and made it to the Ministry of Health which is right by General Hospital.  After going through security we eventually got to the pharmacy within MSPP where the contact was located.  I was so disappointed when I finally got to that point and learned he was gone for the day, I notified Americares again and they agreed to follow-up.  It was another test of my faith, knowing God’s in control and the medications will end up where he wills in His time.  It was a lesson learned about the need to get approval for meds before bringing them in country and navigating through a complex system to do so.  At least after this trip I’d have contacts for names and numbers.   We went driving after to Vista Lodge which was an elaborate hotel with a classy outdoor dining restaurant overlooking a pool and large hill with a view of parts of the city.  We decided to stay for dinner.  I had tasty drinks with vegetarian selections of pizza, picklies and some plantains.  Dinner was delicious and a nice way to spend the other teams last night.

I later learned that long term volunteer Americans was accosted by armed men on their way out of the same region I was working in within Cite Soleil while they were in a truck just a few days after the team I worked with left, although no one was injured and no shots were fired.   I reflected, thankful for the Lord’s hedge of protection over me, keeping me from unforeseen harm and having to encounter such an incident.  It could have been a traumatizing experience possibly tainting my visions for service in Haiti.  I also learned in a different section of Cite Soleil there were 3 homicides, reportedly of a school director, reporter and another person that next week after we left out.  It occurred the same morning that a youth group staying at the guest house I was at went to go visit a school in the area.  I was first upset when the Haiti outreach ministries organization that I volunteered with that first week told me I could not work with a team there the next week as they have a policy where they do not mix teams.  I was initially told it would be okay to volunteer the next week with the oncoming team.  This news of the change in plans came to me through word of mouth from the US based office through someone in Port au Prince.  I accepted it as God’s will and went ahead and proceeded with other plans to work with a different team in another location at the Hope Alive clinic in Mariani.  In retrospect, you never know what you are being protected against and I am so thankful looking back that I did work in a different location for that second week.

February 25, 2012

The morning started with plans to do a mobile clinic at one of the orphanages in Croiz des Bouquets where I previously worked.  There were a number of Haitian staff working with me including a Haitian internist, there were last minute changes in who could go but it worked out with those available.  Our first stop was the 4C pharmacy to stock up on medications and another store for misc supplies and additional medications.  Many lessons learned on all the various items needed for a successful mobile clinic beyond the assortment of meds which in itself is a huge task, items like gloves, hand sanitizer, blood pressure cuffs, thermometers w covers, among others help bring it all together.  Doing a child focused clinic verses adult emphasis requires different meds and they should be available in liquid form to ease swallowing.  It helps to have a scale or good ability to gauge weights as meds are supposed to be given based on weight, in many cases guessing estimated weight is necessary.  It’s tough to pick meds based on potential diseases that may be encountered.  We arrived at the orphanage in a tap-tap.  We were greeted by the Pastor his wife and the children and toured the facility.  They were thankful to have received the food shipment that day w beans/rice, oil, spaghetti, seasoning, dry milk , sugar and cereal which was purchased from the T shirt campaign.     The orphanage had rooms filled with bunks, a kitchen, a bathroom and the backyard had latrines.  We passed out donations (i.e. candy, educational goods, toothbrushes, toothpaste,, Vitamins) while setting up the mobile clinic.  I set up a worm treatment station and another area for treatment of skin infections with Gentian violet.  I had the driver get involved with that part and he helped treat each of the children who lined up waiting for their turn.  It was a good day- we saw many children until nightfall.  We had them line up to do a quick head to toe assessment and evaluate who needed further treatment.  We saw worms, scabies, malnutrition, various skin infections among other problems.   We stayed until after it was dark, did not get to treat all of the children.  It is hard to end a clinic day without seeing everyone, but that is a reality in managing high volume clinics.    We headed back to Port au Prince after a tiring day.

February 26, 2012

I connected with a couple of women at the guest house and we went to a Creole speaking church down the street.  I enjoyed singing and praising in Creole.  The service lasted for a few hours with a few different pastors giving sermons.  One of the main Pastors, Pastor Luc noticed us sitting up front which was welcoming as he had us stand up and introduce ourselves.  He translated and we received an applause from the audience.  It felt good to be welcomed.    After the service the Pastor came to talk with me and I was so excited to learn that he has done work with mobile clinics and he has 43 churches in the mountain areas.  I feel like God has laid it on my heart to do mobile clinics so it was perfect timing to have an affirmation of this idea from a well known man so connected in the Haitian communities.  We exchanged information with plans to connect.  After walking back to the guest house, I walked around the neighborhood with a friend Bernard to try and get something to eat.  I changed my mind after the food spot we went to didn’t have the food ready yet and it did not look to clean or safe to eat.  We headed back and I connected with a friend John who arranged a ride for us on a motorcycle (my first time riding since I was a kid), a main mode of transportation in Haiti.  We headed to Petionville, stopped by some shops to look at shoes and then over his Dads.  I hung out with his sister and her friend and enjoyed some Mango juice and hospitality.  His friend came by and we all headed out to a real nice outdoor gospel concert.   It was at Place Boyer a mayoral center on large grounds with a concert stage.  The place was clean and spacious. We enjoyed an array of Haitian gospel music and my friend surprised me with snacks and a tasty Haitian meal as they were serving food in the back.  It was the perfect refreshing way to get rejuvenated and start the week off right.  We walked around the grounds and stayed until evening.   That night we headed back to the guest house.  We made plans for the next day for folks to meet me at 7a to get the day started for mobile clinics, it was so motivating to have such love and support.

February 27, 2012

The morning started off right with 4 peops coming to meet me at 7a to help get a mobile clinic started.  It was divine intervention with the encouragement that helped me press on.  We boarded a private tap-tap and headed to several pharmacies to stock up on a range of medications trying to anticipate the variety of diseases and make sure there is adequate coverage for potential diseases is always a challenge.  I take for granite the preparation it takes to adequately stalk a stationary clinic.  Clinicians were generalists with experience in internal medicine and a love for pediatric populations so it was an ideal group.  We headed down to general hospital to get equipment.  We drove by the areas I worked in before in a neighborhood called Belair notorious for being dangerous and riddled with problems.   We were driving through the areas around the Presidential palace which sustained a lot of damage from the earthquake.  Reminds me of the impoverishment and homelessness I used to see when living in DC around the white house.  The areas by the Palace are surrounded by people living in tented camps.  The area is covered with poverty but somehow there’s a palpable strength on the faces of people.  It’s always impressive to drive past the Cathedral which was badly damaged and the Crucifix in front of it which appears unscathed.  I see it as a message of Christ’s omnipresence.  After we finished up at the neighboring pharmacy across from General Hospital and I did a little browsing from the vendors on the street we headed to a area not far  where we set up a mobile clinic in the back of the church.  Many people of seemingly all ages were waiting in line seated in the different pews patiently anticipating our arrival.  I had to make a trip to another pharmacy to get some meds we were missing so one of the clinicians got it started which was great.  There were a bunch of meds for peds in liquid form so he focused on seeing the children until I could get back.  Trying to get meds to cover chronic and acute conditions was no small task.  There were infectious diseases that needed treatment on top of many chronic issues I’m used to seeing in the U.S.  After I returned I worked with a Haitian nurse who was doing a good job working in our made up pharmacy.  We set up a station that the translators helped out at to treat fungal infections with Gentian violet and a worm station to treat the many cases seen.  It helped better manage the distribution of meds to a large group of people.  It was hot and stuffy and tough not to grow tired from the long lines and lack of privacy even though I was in the corner of the church.  There was no running water and no fan or AC with a hot climate things one quickly gets used to with mobile clinics.  Just on time, in the middle of the afternoon we were surprised by the church moms with homemade Haitian food.  The homecooked food was tasty enough to make me forget about the worries of typhoid or hep A that can be contracted from unclean inner city areas.  The meal included green lettuce and salad with potatoes a tasty sauce plantains and a meat (that I gave away) with a really tasty sweet and frosty tomato juice.  The warm hospitality is always present and just one more reason I appreciate working in Haiti and long to return when away.  We finished up the clinic about 5:30pm and headed back to the guest house on a taptap after dark.  It was a tiring, but productive day, lessons learned and a good feeling of helping many people who just maybe wouldn’t have received the care as we worked in a disenfranchised part of town.  Patients have consistently been grateful for services, I love that and they always say merci (thank you).  Mobile clinics, although tricky to manage when it comes to setting up, stocking and never being able to fully plan what ailments may come about are very rewarding as it is a means of delivering care to meet people where they are at, closer to their residence. 

February 28, 2012

I got up early and met with Larry Roberts at the guest house, a man I previously knew from working at the Bernard Mevs trauma hospital when he was seeking medical treatment for one of the children he was caring for in his group home.  He runs an organization called Servant’s Gift which takes care of Haitian children.  I planned on helping out at a mobile clinic at a remote school in a town about an hour away from the capital of Port au Prince called Carrefour.  He has worked with the school for awhile.  A man who is an FNP from Portland, Doug Brown joined us as he specializes in alternative medicine and would be offering these services to the group.  We packed all of our meds and headed out in a rental Larry had which was similar to our jeep.  He had to negotiate very narrow and sometimes scary roads up steep and rocky hills.  Along the way I saw women selling mud pies in big bowls, which were reportedly made of sugar and mud and really did resemble sugar cookies.  These were the same pies many of the patients I treated obtained their worms from, and they seemed to be a common snack, perhaps because of limited access to foods.  One of the many public health educational opportunities I saw to teach about the seemingly unknown problems associated with consumption of such items.   Once we arrived and got briefly acquainted we set up mobile clinics in a couple of the classrooms.  Patients were given the option of having more conventional medicine with what I had available or alternative medicines with Doug Brown.  Larry helped me see patients and we did our own vital signs, and gave out meds.  Between both of the supplies we had there was a substantial amount which was great.  The most interesting case I saw was a young woman who we were told had “AIDS’ but we were not supposed to tell her which was disturbing as she’d been labeled as having this disease.  She appeared to have a bad case of pneumonia and possibly tuberculosis with hemoptysis and other symptoms, plus she was tachycardic and had a high fever.  I did what I could to treat her with meds available and advised her to get to a hospital when or if she could for HIV and TB testing, at least that way she could be informed of her health status.  There apparently was no hospital in the area and we were somewhat isolated on a remote hill so unknown if she’ll get any follow-up care.  With mobile clinics you aim to maintain an array of meds but for bigger problems like HIV and TB it requires a whole different arsenal of long-term treatment options.  Maybe in the future I can add some of these options.  The one med I had an ample supply of for TB, Rifampin, was stuck in customs at the airport and due to expire so it wouldn’t have done a lot of good as it has to be taken for many months.   More items I need to add for mobile clinics which are much more easily accessible in stationary clinics are nebulizers for airway issues and IV fluids.  Again I had a station set up for worm treatment and Gentian violet.  Being closer in the country areas there seemed to be more of a prevalene of voodoo.  I had one infant who was wearing a tooth around his neck and a small shell on a necklace.  When I inquired about the meaning and asked if it were voodoo related I was told by one of the translators it was a Haitian thing I wouldn’t understand.  Someone said it was for antibiotic purposes when the teeth are pulled.  There are unique cultural practices that are hard to understand in Haiti. At the end of the clinic day the mom of the school administrator had cooked us a tasty homemade scrumptious meal.  The view from the top of the school where we ate in a classroom was gorgeous as it overlooked the fabulous large ocean and green lush trees off in the distance.  This picturesque Caribbean seen with the warm sun and comfortable climate was so inviting.  It was also such a sharp contrast to the immediate neighborhoods in the area we were working within.  It is admirable to see the resilience and endurance of the Haitian people.  The work ethic and willingness to extend love to visitors is much appreciated.  After leaving the clinic I had planned to return to the Hope Alive Clinic in a neighboring town called Mariani.  Larry the driver did not want to drive the opposite direction of the capitol though.  I was so happy to find out when I called the woman Leslie who manages the Hope Alive Clinic that they were already in the area so I was able to meet up with them as fate would have it, felt like it was God’s plan for me to connect with them.  It was reassuring to have a sign that there was somewhere else I was supposed to be since the plans I was hoping for with the Cite Soleil clinic didn’t work out.  It reminded me how we have our plans which often are not consistent with God’s ultimate plans.  This trip is Haiti is giving me a lot of time to be introspective and let Him move.  Larry reminded me on one of our talks that when we step away from trying to do things on such a rigid time structured path it allows God to operate.  That’s a lesson I’ll carry with me.  Once I connected with the new team in Mariani we got to know each other over dinner with spaghetti at the Hope Alive clinic/ guesthouse where I spent the first night in Haiti.  I spent time visitng with the local staff later.  I tried to sleep in the room with the other guests later, but many people in one room with lots of snoring made it hard to sleep.  Instead I headed up to the rooftop and dragged some mats out to sleep where some of the other local staff were sleeping Libertan and Wilio.  I tried not to worry about the possible tarantulas that lived around the guest house crawling up on the mats, but it made for a restless night.  We laid up in the late night hours chatting and they taught me about Haitian culture.  We laid out under the stars enjoying the breathtaking views of the sky.  We could hear what sounded like voodoo ceremonies off in the distance which was a little unsettling with the music off in the mountainous areas.  They tried to scare me with stories of bad things that happen at night.  We chatted until falling asleep.  Funny we were awakened by rain drops pouring down a couple of hours later and I eventually ended up on the porch trying to stay dry, it was a restless night, but I managed to get enough sleep to still wake up and start a clinical day.

February 29, 2012

The guest house we stayed in was the same place we would see patients in so it was nice and convenient.  After breakfast with good Rebo coffee, we went upstairs to see patients who arrived early waiting patiently for our arrival.   Myself, an ER doc and a nurse from the states with Haitian staff saw patients that day, I also had a young aspiring nurse Katie working with me.  After being trained, she helped take histories and do some of the physical exams on patients.  It was nice to have staff helping out in the pharmacy.  The pharmacy was fairly well stocked with medications.  In contrast to places we did mobile clinics at, this clinic seemed to have patients who were relatively healthier, perhaps because they live in the surrounding area and can get regular follow-up care at the clinic, sort of a haven.  The need for mobile clinics is vast as many patients do not have access to health care or money.  The Christian based clinic has a Mom-tot program for moms w limited resources who can be sponsored w food, classes and parenting techniques from pregnancy until children are 3.  My favorite thing about working at this clinic was being able to start the day with devotions and pray for individual patients.  This helped in the deliverance of compassionate care.  We finished the patient care mid afternoon.  The cooks made a delicious lunch (with picklies, plantains and sweet potatoes) and dinner (vegetarian mix of vegetables with rice and peas served with mangos).  I slept upstairs in the same clinic room I’d be working in which was much better rest after I removed a large spider from the room. 

March 1, 2012

After a good night sleep, I got up around 7, slept much better having quiet quarters.  After breakfast and devotions we headed upstairs to see patients.  The room I slept in was converted to an exam room.  We saw ill patients, but seemingly conditions were much less advanced then other cases I’d seen.  There were many gastrointestinal, genitourinary and various dermatologic issues mixed in with a lot of chronic problems like HTN.  Diseases seemed to not be as progressed as they were in say the tented camp or Cite Soleil or other mobile sites.  Not having labs, as usual in these environments, treatment is empirical based on presentation.  Patients’ often wont follow-up if sent away and asked to return. I’ve found it’s best to just treat what you an while they are available.  Mid-day we had lunch made by the Haitian staff who were incredibly good cooks.  They worked so hard preparing tasty Haitian meals.  Lunch was one of my favorites with Haitian plantains with picklies, I seasoned with hotsauce.  After eating we returned to patient care.  The most memorable patient I had that day was a malnourished, underweight 4 month old whose mom couldn’t breast feed.  It was a welcome change to be able to connect them with community resources like Hope Alive’s mom tot program compared to other cases where I have scarce options.  It was nice to send her away with formula and having the baby’s energy increase after feeding him formula even if he did pee on my scrubs.  Basic items can  go such a long way in patient care in Haiti.  Trying to include a little public health education about these not to feed for formula, food and many other topics is always helpful.   Training patients to be community health workers and teach their relatives or friends lessons learned helps spread the knowledge and ideally change patterns that cause negative health outcomes.   Common issues are cheap ways to treat water, consuming natural products in environment to promote health preventing common issues like anemia, avoiding mud pies that are often eaten and cause worms, managing reflux, high blood pressure and a number of infectious diseases.  I’d like to bring more Creole handouts to share in the future with pictures for those who don’t read to help illustrate concepts.   The day was filled with a lot of teaching around these topics.  We concluded the dinner with a delicious mix of vegetarian food (for me, others had a meat dish) combo of flavorful vegetables and rice and hot sauce.   After dinner a group of us walked down the street and hung out with some of the locals for awhile as they played soccer, one of the docs gave them a new soccer ball that they loved.  It was impressive to see many of them playing without shoes but sad to think of how basic things like shoes are even hard to come by.  We spent the evening hanging out on the guest house roof, joined by a stray cute little kitten that found its new home.  

March 2, 2012

We got up early to breakfast and Rebo coffee and started the clinic as usual.  The patient flow was a little lighter.  We finished up earlier so we could head out to the beach, myself some of the volunteers and Haitian staff loaded up in two trucks and headed to the beach.  These were the south beaches we went to, I heard the beaches in the north that I had visited on a previous trip were nicer. This beach we stopped at had music (much American R&B and hip hop).  There was a really nice hotel which had food available for purchase, although from the menu it was all seafood and meat.  The view of the ocean and the variable blue colors was pretty, but there was no sand, just small rocks. I walked around a bit and dipped my toes in the warm ocean.  I didn’t get in like before at Kaliko beach in the north where I went snorkeling.  Most of the team played soccer.  I sat by the ocean and chatted with local Haitians while enjoying the captivating scenery with the ocean surrounded by gorgeous trees and mountains in the background.   A scene that was so inviting and calming, I could have stayed for many hours just relaxing.  I especially loved the hot sunshine, one of my favorite parts of the island.  When all was quiet there was a school of yellow/black fish that swam that swam up by the shore by which was a pleasant surprise. There were a lot of small crabs that crawled up on the stairs I was sitting on.  I was wishing I had a swimsuit but didn’t bring that gear.  After we drove around by some of the road vendors to see if I could find a swimsuit I wanted, but none really appealed.  We headed back to the guest house for dinner which was scrumptious again with a veggie combo for me – everyone else had meat- and served with rice.  I wanted to spend more time after the clinic hours to check out different parts of town.  Later that night it was sad to see hungry and frail cows grazing in the open yard next door, I tried to feed them a little without success.  The very large house on the other side of that was damaged in the earthquake and I was told two children perished in it, felt odd to see people just in the bottom of it at night with the top seemingly abandoned.  As I was going to bed later that night I came across huge spider in the dark in looked like a tarantula which sent me running and screaming through the guest house only to see big roaches scattering on the ground in the room I was sleeping in.  That was unsettling and the staff helped me out.  Felt like I needed to stay alert all night long and when the electricity was working for at least part of the night I slept with the light on.  Funny the night prior I was awakened with the new kitten running across my bed with a big roach on the divider/ screen not far away.  Seemed I was in for another restless night as there were some things I just couldn’t get used to, though I imagine if I encountered enough I’d learn to cope, well with all except the big spiders.  I eventually fell asleep that night and woke up the the next day to a new start. 

March 3, 2012

I went to the kitchen early to try and make coffee I developed a new appreciation for the hard work the Haitian staff endure cooking with no coffee maker.  I learned to make it from scratch with a makeshift filter and boiling water.  It seemed like such a huge task when trying to do it for a large group of people.  After a short day in the clinic seeing patient’s we saw fewer than before and ended early.  I had planned on returning to PAP on Friday to arrange mobile clinics with Haitian staff.  Since I had another delay in getting meds out of customs and want to use them for mobile clinics I decided to wait until Monday.  Pastor Luc who I had met before came to the guest house to meet with me in PAP on Friday, as we were supposed to connect to plan for the mobile clinics.  I did not realize he would just come early and I was sorry I missed him so we had to plan for another time.  I learned how important it is to build relationships over time in Haiti.  He wanted to sit down to meet to get acquinted before carrying on the business of mobile clinic planning.   It was a lesson for me on putting people first over time even if it meant, as it often did, taking more time to get things accomplished.  I learned to value this approach of building relationships first as it feels like it is something we lack in American culture.   

I wanted to use the time after the clinic to go explore the neighborhood and a group of translators were going to head out with us.  The clinic owners didn’t want us to go out so we stayed in instead.  I was hungry and the Haitian cooks made me a snack with fried potatoes which were so good.   

I called for my ride, a taptap from a driver named Bertrand and he came to get me.  We drove through Carrefour and other cities on the was on the way back to Port au Prince where the Walls guest house was that I wanted to stay at that night.  I wanted to get back to PAP for church in the morning  at an English speaking service at a church called Quisqueya or Port au Prince Fellowship that I enjoyed before.  I also wanted to make plans for the mobile clinic. 

En’route to the guest house he took me to a market where I bought foods and some gifts for an old friend of mine.  I was able to connect w him and drop off the gifts in PAP.

After arriving at the Walls Guest house I quickly met a large new group.  Many of the translators/ staff recognized with the group recognized me and came to greet me with smiles.  It was a nice welcome and pleasant surprise.  I learned they were working with a large group from North Carolina – Duke University lead by a nurse practitioner to do mobile clinics which was really exciting.  I enjoyed listening to the group sing Christian songs with a devotional led by Frantz, one of the translators.  He spoke from topics taken from Matthew 25:14-18, and he gave a sermon and said prayers.    I felt God’s presence in the midst of all of it and it was so moving and reassuring.  It seemed this is exactly where He wanted me to be and I had no idea why I was wanting to come back to the Walls Guest house, just felt compelled to come back.  I met with the group leader, learned about their plight for the mobile clinics which was consistent with what I was seeking to start so I was happy to make this serendipitous connection.  They invited me to work with them and go to church the next day.  The Lord knows how hard this trip has been and it was such a Blessing to cross paths and have this encounter, all by His design in my view.   I even was given my own room by the hotel manager Veniel which was nice with AC.  They’d move me into my own private tent the next night which was perfect.  After chatting with several of the people and taking time out for prayer and reflections I returned to the dining area.  The group was singing worship songs out of a book with a guitar, one of my favorites caught my attention, “You’re all I want.”  Felt like confirmation for me that this is where I was supposed to be at this moment.    

March 4, 2012

It was nice to have an air conditioned room to sleep in.  I rested pretty well and got up early for church.  A couple of my Haitian male friends, Jean and John  came and meet me early to take me to Quisqueya for church in PAP.  It was a pleasant start to a pretty sunny day to have fresh strong Rebo coffee with sugar, cream and clean water.  We headed out for a short walk, got a ride to the bus stop from Bernard, one of the guys who works at the guest house.  We then got on a large public bus which was my first experience on a bus in Haiti, it was spacious and much more comfortable then the congested taptaps.  After about a 20 minute ride we arrived at the church.  The place was all familiar as I attended services there on my last trip in Haiti and it was good to be back.  The sermon was timely for me, Pastor John spoke on world missions with data showing increases in believers of the Christian faith worldwide with reference to places that had been visited by missionaries .  He then said how missions are not enough as actions are needed.  The Biblical themes of “seeing” and then responding were mentioned, such as when Jesus saw Lazarus and “Jesus wept.”  The disciples saw the multitude when they were hungry and wanted to send them away to get food.  Jesus saw them and instead acted by multiplying fish and bread from just a small number to 1000’s in order to feed the multitude.  The message was about seeing as Jesus did and responding by taking actions.   I reflected on my trip, the many ill patients I’ve seen and how I can respond in the future by maybe mobilizing others to help.  The needs feel overwhelming at times, but I try to keep in mind that for the patients I see and am able to help it makes a difference in their lives.  The service was concluded with the song that has the chorus shining in the light of your glory, Open the Eyes of My Heart Lord.   It was such an uplifting service and just what I needed to boost my energy for a start to the week doing mobile clinics.   I left feeling totally rejuvenated!  I met with Pastor John after the service, it felt good that he recognized me from my previous trip and inquired on my whereabouts.  We talked about my interest in mobile clinics and he gave me his card to contact him.  I learned about the importance of making these connections in Haiti.  After church we walked to my favorite bakery called Epidore which has delicious food and is one of the best eateries in Haiti.   They even expanded since my prior visit and had such a large array of selections, they are known for their crepes which are so good.  I ended up ordering rice and beans with picklies and veggies and a side of mac n cheese that I gave to my friend Jean after I saw the meat inside. 

After, we left and got back on the bus for another adventure on the public transportation system and we made it back to the guest house.  I decided to walk to the Creole church to visit with Pastor Luc to detail plans some other mobile clinics.   He welcomed me and we talked to plan arrangements for the mobile clinics at his urban and centrally located large church in PAP and if time permits on this trip possibly one of his remote locations.  He is the Pastor over 43 churches in the mountainous rural areas as has done mobile clinics before.  Medical care and access to services is lacking or unavailable in many of these places.  It sounds like a great opportunity to connect and plan for future mobile clinics, beyond this trip.  I look forward to building on these friendships and possibly developing outreach initiatives. 

The rest of the afternoon was spent relaxing in the sun, much of it on the rooftop of guesthouse.  One of my favorite meals was served for dinner, this time a different flavored beans, rice, plantains and picklies with salad and other sides.   I spend the night sleeping in the private tent which I really enjoyed and this time there was an even larger twin bed in the tent which was very comfortable. 

March 5, 2012

I spent the morning in the usual routine getting up to breakfast and coffee at the guesthouse.  I headed out with the large group I met from Duke University about 7:45 am to a large church Lharmonie (Cite Soleil) to do a mobile clinic.  I was really looking forward to serving in this capacity knowing it was a chance to reach patients who likely did not get regular access to care.   We set up at tables in the front of the inside of the very large church with one or two providers at each of the tables.  There was a separate pharmacy set up that was managed by some of the Haitian staff and a pharmacist named Jonas from Duke.   A room next to the pharmacy was available for patients who needed treatment or confidential exams.  There was also a separate eye station where they did eye screening with charts and distributed eye glasses.  I heard glasses were greatly appreciated and sought after as they were often needed and maybe even considered a status symbol or sign of wealth.   A spinal surgeon available focused on seeing musculoskeletal cases.  The interpreter who helped me was James.  We saw patients of all ages, the youngest who was about 14 days old and had an impressive case of tinea capitis to the oldest who was 91 and impressively healthy not even using an assistive device to walk, her biggest problem was untreated blood pressure and somebody pain.   When asked what her secret was to living her in her life her response was “God’s Grace.”  She advises younger people that God helps.  It was encouraging to hear that and continue to see His presence in the people of Haiti.  The spectrum of conditions, some diseases very pronounced compared to mild un-worrisome cases was interesting, especially considering we were working in one of the notorious slums, Cite Soleil, that many won’t enter for safety concerns.  Many of the conditions were exacerbated by anxiety, a recurrent theme.  When asking around about the opportunities for counseling and resources in the area, I was happy to learn Pastor Luke (Pastor of this Lharmonie church) offers a weekly stress management workshop in the church so I encouraged patients to attend and asked him to make an announcement to remind people to come.  I was thinking I would like to talk to more Pastors about implementing a similar initiative so people have some tools to deal with their stress.  It was a start to learn about his program and it could be modeled after as there were not any community programs I knew of to refer people to for stress which was a major problem as mental health needs are important to manage.  This is a major concern in Haiti considering all of the trauma people have endured.  Word of mouth seems to be a very effective way to spread news in Haiti in a timely matter in it’d be great to be able to have programs to tell people they could go to for help.   Word of mouth could increase activity in such programs.

Midway between patients and right on time cause I worked up an appetite, we were served a tasty hot meal with beans & rice,  a meat n veggie mix that I shared and mmm it was good, stuff like this with harm hospitality makes me love working in Haiti.  After the clinic was over, the lead translator, Eddy helped me get transportation to the ministry of  health where one of the clinicians was helping me get approval for the meds brought from America to get them through customs.  After a long and kinda intimidating motorcycle ride through Cite Soleil, Belair and other historically unsafe parts of town we made it through downtown to the Ministry of Health.  I was wearing scrubs so felt like a stood out, but I imagine most people assumed I lived there as the average visitor wouldn’t be on a bike ridin through hoods. On the way back we went to one of my favorite eateries Epidor and got a light dinner and they have an inside ATM which I prefer so I could get cash.  We arrived back to the guesthouse walls and I spent the evening socializing with others.  I met a woman there selling creatively designed handbags made from recycled products such as plastics from Haiti.  It was really nice to network with people from other organizations at the guesthouse.

The highlight and favorite part of evening was singing worship songs together as a big group.  The leader, April Perry, NP, led an activity and we went around and said encouraging things to uplift each of the Haitian staff which I thought was cool.  It was a Blessing to work with them as they were each helpful.

March 6, 2012

We got off to an early start I actually made it to the dining room dressed in scrubs at 6:30AM, motivated to start the day.  People normally start days really early in Haiti, I have a hard time adjusting to the hours.  We had breakfast with fresh fruit, toast and coffee.  A morning devotion was the perfect way we started the day with a prayer focusing on letting Jesus serve us through others.  We then loaded up in 3 tap taps and headed out to clinic in Croix Des Bouquet about an hour away from Port au Prince driving through dusty and bumpy roads.  There’s never a dull moment on the streets of PAP.  Lots of stimulation with the sites, sounds, people, activity, animals and whatever random things pop up whether it’s the UN big armed trucks, misc accidents from lack of traffic regulation, buses turned over on the side of the road and vendors running up to cars hustling everything from fresh fruit to shampoo and medications, it’s always a thrill.  After awhile , we arrived to a hidden gem, a pleasant surprise next to the grounds of a seminary, a clinic run by Haiti Medical Missions of Memphis. I had previously read about this organization and was interested in working with them before so was very excited to make this connection.  It was a very large Catholic based clinic with many services and speciality care called the Clinque Saint E'Sprit (Holy Spirit Clinic).  There were even prosthetics, occupational & physical therapy, a large kitchen, guest house a gym and very nice clean facilities with private patient rooms.   Volunteers were welcome.  I noticed Sisters were present as well.  I somehow ended up in the pediatrician/ midwife section so by default was mostly seeing children with ailments through the day, occasionally I’d treat women with genitourinary problems and children has mostly GI and derm issues.  It was sad to see such advanced manifestations of simple ear infections that went untreated.  We were served a tasty meal for lunch, chicken for those who like it, a bean sauce w rice & beans and fruit.  It was comical that we were told to wash our own plates after eating considering there was a tiny kitchen with a sink and like 3 tables of us.  This was a custom we’d never heard of, fortunately some folks did it for us so we could keep seeing patients.  I bought some souvenirs before leaving (flags, paintings and a necklace) from a man on the translator team and bargained for a good deal.  We took group pictures before leaving for the day.  We were stuck with a flat tire and after it was changed, stopped by a store called DeliMart in PAP to stock up on goodies like Rebo coffee and other treats. 

We spent the evening at the guest house hanging out.  I fell asleep early after being tired from a long day and was awakened around 9pm with my bed shaking from an earthquake.  I quickly sat up and was on the verge of going right back to sleep til I though about being in Haiti- I ran out of the tent so quick I was the first one out of the guesthouse.  Recalling that people had perished in the same guesthouse just two yeats prior from the quake and knowing that I was sleeping under slabs of concrete was unsettling.  I was shocked to see people straggling out 10 minutes latter carrying personal belongings.  I could see how priorities misplaced could lead to such tragedies in catastrophic events.  Poor Haitians I could see standing on the roofs of their houses, who could blame them considering the history.  It was a restless night, I went back in but came running out when I’d hear loud sounds fearing aftershocks.  I later learned it was around a 4.6 earthquake , but thinking on the damage done from the large one of around 7.0 in 2010 with ~200,000 people perished that was not comforting.  I heard there wasn’t damage from this nights quake though. 

March 7, 2012

I got up early and Bernard took me to the airport in another attempt to pick up the medications out of customs.  We arrived around 730 and after going through the process of talking to multiple people still had no success.  Patience is very necessary and something that doesn’t come easy.  I had several clinicians waiting on me at the clinic and people waiting for medical care at Pastor Lucs church as we had planned on doing a mobile clinic there that day.  After stopping at a clinic, We finally made it to the guest house and picked up the clinicians then headed to the church.  We made do with meds I stopped by a pharmacy to get after going to an ATM in a bank.  I saw a huge line of people when stopping by the bank and learned it was people seeking work.  Humbling and a reminder of my good fortune.  Haitians are hard working people and it’d be a hard country to live in unemployed I imagine.  At the church, the members were so attentive to helping us set up the clinic.  The people were waiting patiently, a lesson I needed to adopt and practice more.  With 3 clinicians and myself we worked through the patients.  I learned lessons about organization to have triage, vital signs taken and ideally someone to manage the pharmacy to keep everything in order and flowing,  will take it all into future preparations in developing solid mobile clinics.  I can look back on this trip and see how the variety if experiences have been instrumental in preparing me for the mobile clinics that I’m managing with God’s guidance.  Having these things arranged at other clinics in advance made things work out more efficiently so lessons learned for the future. This basis enables providers to focus on spending time with and moving through the high patient volumes.   Though it started off rough, with teamwork, we all pulled together and all the patietn’s were seen.  We walked back to the guesthouse and the others enjoyed soda and Prestige Haitian beer while waiting for me to change. Bertrand came with his tap tap and we all headed out to go to dinner. We ended up at a really nice restaurant called LaMaison, it was delicious.  Everyone ordered tasty Haitian food, I enjoyed my usual beans, rice with a sauce, salad, plantains and picklies.  They shared stories with me about life in Haiti, some really sad and it was good to get more acquainted.  One of the clinicians lost his mom and siblings in the quake and you never would have known it with the quiet strength he carried on with and he was always willing to help out.  The painful stories people endure are palpable and hard to fathom.  It helps put things in perspective about what matters in life.  It amazes me how those who have been through some of the worst trials have the most calming and comforting spirits.  The determination and resilience Haitians carry, maybe is in part what gives so many people a desire to come serve here as Haiti is a very special place.  Somehow exposure to the culture strengthens and Blesses us beyond measure.  I cant contemplate how I would carry on in the face of a magnitude of similar obstacles.  In the end of it all as my trip nears its final days, it only deepens my desire to come back and serve more.  It makes me want to dedicate part of my life from now until I can no longer serve in Haiti to help make a difference. Perhaps, in part I’ve found my calling, medical mission trips abroad, it’s what makes me thrive.  I especially love the idea of mobile clinics and meeting people where they are at.  I was touched more in this day, which was no doubt one of the hardest, but most emotionally moving and somehow uplifting days I’d had in Haiti. I had a renewed energy to carry on even after the challenges of not getting the meds out of customs and other issues.  After dinner we stopped by a couple of different pharmacies to get more meds  on the way back to the guesthouse to no avail.  Things were really expensive to buy in bulk at the place that was open, and Delmas 2000 the main market I wanted to go to was closed.  Most shops close early in PAP, especially on the weekends in the early afternoon by ~2pm most stores are closed. 

Latter that night after I was back at the guest house hanging out I was reading through and singing from a worship song book and gave an extra copy I had to one of the stoic guards.  Not long after I saw him walking around and singing out of book as well, many songs were in Creole and English.  He later came to join me and even though we spoke different languages he sang in Creole and I sang in English, both praising the same God.  It was these serendipitous, spiritual moments that left a lasting impression in my heart for Haiti and the people and what an awesome God we serve.  He helped me with the Creole verses and I helped him with the English and we sang songs until late in the night.  The spiritual unity of believers is a powerful thing and transcends races, languages and all other divisions.  Its what reminds me of Christ’s omniscience and a gentle affirmation that he’s always there.  That night was a reminder that I’m where He wants me at this point in time.    Those moments spent singing had me thinking we never know how we can impact someone’s life.

March 8, 2012

I started the day early in customs at the airport in another attempt to get meds up in the directors office.  The morning grew long after spending hours going back and forth between people and offices which was so frustrating.  I even had all of the paperwork I needed from the ministry of health and everything, I still couldn’t get through with nothing but delays to get meds out of customs.  There was a line of patient’s waiting at the church for a mobile clinic, this time with the other clinicians there prepared to see them, but I was hoping to get the meds to bring to use in the clinic.  Instead I spent hours, with several people, including even a police officer who was a cousin of my friend Bertrand, all trying to help me persuade people to release the meds.   They let me obtain the bags to go through them and it was even more disappointing to see that a bag had been damaged and opened with items missing.  We had to verify the list of meds with what was in the bags, but they still would not release them.  We stayed all day until about 3pm when they insisted on wanting money or that I would have to come back the next day.  I decided at that point I was done with the process and would not return and instead let Americares reps, the company that donated the meds deal with the rest of the process to retrieve the medications.  It was a lesson learned and in the future I’d focus on getting medications in country rather than trying to bring them in to go through customs.  Fortunately the clinicians waiting at the church went ahead and saw all of the patients which was such a relief and reminded me that God works things out on His time.  Around 3 pm we were warned that there was a lot of commotion going on and we needed to get to a safe place as loud sirens could be heard and traffic came to gridlocked standstills.   Businesses, including airport staff and schools were shutting down now and everyone was rushing to get home.  It was all political issues and reminded me of the time I was working in a clinic in 2011 and when BabyDoc arrived in town we had to shut down the clinic and rush back to the guesthouse to avoid trouble.  I convinced some of the others to go out to eat since it was the end of my trip and we went to a nice lounge called Eclipse at Delmas 31.  There was a broadcast of the political state and it had to do with the President Martinelli not relinquishing his passport to prove his Haitian citizenship reportedly.  They were accusing him of being American and wanting him out of the country, at least that was the rumor.  After we were watching the news he eventually surrendered his passport to prove he is Haitian . Then it was all good and people were celebrating. He was also a popstar and had songs and they began playing his songs in the lounge we were in and many folks were celebrating.  We enjoyed food and drinks and spent some hours chatting.  The ambience was really relaxing with the dim lights.  I had my usual tasty dish, beans, rice, plantains and picklies but somehow it tasted different and good everytime.  The plan was to spend the afternoon at the beach, but we had to change that since the upheaval occurred. I was supposed to be leaving the next day to return to the states, but didn’t want to go so was going to call the airlines.  That night I met some missionaries from Texas at the guesthouse hosted by Haitians who had an NGO and we had a nice long chat reflecting on purposes of mission trips and the need to respond with actions to what is witnessed.  We exchanged contact info to keep in touch.

March 9, 2012

I slept in til around 7ish and woke up to one of my fav meals with pancakes and fresh fruit.   I caught up with one of the Texans before they headed out to the north about 7 hours away.  Haiti is such a big place in ways and there are so many placed to serve.  I then called United airlines and explained that I was supposed to leave that afternoon, but wanted to change til the next day.  I was so thankful and pleasantly surprised when they changed my ticket for no fee.  What a Blessing that was and I was looking forward to a stress free last day in Haiti. My friend Renulus came to meet me and we headed to the store for some drinks and then set out on a moto (motorcycle) to check out the Mother Theresa Home for Sick and Dying children at Delmas 31. I guess there is another large orphanage in same neighborhood so we were brought there first unknowingly and ended up touring the place as there was not a name on it. The woman who worked there showed us around and it was a nice well kept, but crowded orphanage and I found it that it was actually an adoption center.  It was so sad to see so many children needing homes, one as young as 14 days old whose mom died when he was 3 days old.  I got the women’s card for the place as I planned to keep in touch with them.  I believe divine providence led me to the place.  We eventually arrived at the Mother Theresa home and the Sisters there taught us about the place and how they try and refer to children with other co-morbid conditions to hospitals when there is availabilty.  They took in very malnourished children off of the streets regularly and even had a community feeding program.  We toured the place and saw the heartbreaking cases of the worst hunger and malnourishment and all the physical components that manifest like edema, altered skin texture, big bellies, changes in skin texture and hair color and of course an emaciated thin appearance.  I learned to recognize subtle signs of malnourishment during this trip as I never had before from just textbooks as I saw more of it this time around than I ever had. Some children were so bad they had to be started on just fluids and carefully titrated up to foods or they could die.  They had different levels with the sickest children at the bottom who could not tolerate food and we did not get to see them.  It was heart wrenching to walk through this place and see so many ill and hungry babies.  It was encouraging to see their feeding program and volunteers feeding the babies, some who were on IV fluids, even with IVs in their necks.   I had wanted to use some of the funds from the T shirt campaign to do a food delivery and was considering this place and the orphanage/ adoption center as recipients.  The staff gave me contacts for places to order bulk food from in Haiti.  They invited me to a dispensary called St. Josephs the next day where patients would be seen for healthcare services and medications.  This is somewhere I’d like to volunteer at on

After our visits we decided to go out to dinner and went to this nice authentic Haitian restaurant which was crowded and popular.  I liked the dim red and green lights and enjoyed the food, my usual beans 7 rice with plantains for dinner and fruity smoothies with papaya we ordered.  The Haitian music was a plus and there was even an attached dance room.  We headed back to the guesthouse on a moto and spent the evening hanging out there and on the rooftop. 

March 10, 2012

This was my last morning in Haiti and I was pleasantly surprised that a few of the clinicians and Haitian staff came to visit and give me a sweet send off.  I was sad to leave, but knew in my heart I’d return.  We made plans for them to carry on mobile medical clinics in my absence and I would help support their efforts with fundraising and getting the NGO, Global Mustard Seed missions up and running.  They would continue to arrange mobile medical clinics in the urban and rural areas and as I can work out connections help provide them with medications, materials and volunteers to assist when feasible.   I left them with medical books they could use for future clinics which they were so grateful to receive.  We walked to a pharmacy that morning to try and get them some meds to carry on.  After seeing the prices I reached out o Leslie from the Hope Alive clinic and had some unexpected Blessings that morning as she agreed to provide some medication.  The clinicians planned to do the first clinic after I left on March 14, 2012.  I was in touch with Pastor Luc who has the 43 churches in the provinces so it was so exciting to be able to make this connection.  There is no way this was anything other than the hand of God putting me in all of these places, making all of these connections and keeping me safe through it all.  It was such a wonderful gift to have them continue on as I envisioned hope for sustainable efforts but never imagined it would come to fruition so soon.  Dreams do come true with hard work and perseverance and of course faith and above all else keeping Christ central as He is still in control.  There are many lessons learned on this trip in Haiti, but I think that summarizes the most important ones.  The Americares rep, Brian who I’d been working with agreed to follow-up on getting the meds out of customs and he’d already sent someone there to handle it.  They would then connect with the clinicians there to provide them the meds so they could continue to render care.  I think of the importance of having faith when we cannot see the outcome and it seems hard to envision anything good coming out of trials.  But now I see, all along, God had His plans for those medications to be delivered on His time and where He wanted them to be.  I am only a vessel here to help as are we all and have to learn to give things to Him and trust in His sovereignty.  These plans for the clinics to carry on were so meaningful and such a fabulous way to end my trip in Haiti.  Until I can return, I will continue to work hard to fundraise and do what I can to make, what my dad says, my splash a big drop in the ocean.  I had been Blessed with so many people to help with the process like the rep from Unitransfer who agreed to continue food deliveries from the warehouse in Haiti.  I’m so thankful that things worked out as they did and the dreams I have of mobile clinics are becoming a reality.  I ended the trip with picking up some souvenirs the guys helped me negotiate on around the streets of the Walls guesthouse. Bertrand came and picked me up and we headed to the airport.  This trip I left with a sense of accomplishment, knowing there is much more work to be done.  Check in at the Port au Prince airport went smoothly.  Feeling like we all served as Christ’s hands and feet made the load a little lighter and the weight less heavy for the patient’s we touched and who touched our hearts.  And that in itself is a reward beyond measure.   The strength gleaned from working with such resilient people makes me feel even stronger.