I has been a while since I've last updated this blog. Things are going well here. The hospital program along with a visiting clinic group and trips to the villages have kept me pretty busy this month. I'm looking forward to vacation this coming Saturday!
Here are some highlights from July:
We lugged the grill from my house over to the Notre Dame Filariasis Program Residence to have a rooftop party with the Notre Dame, Duke, and Harvard students that are here in Leogane doing summer projects. Frank and Maria Elena also came to celebrate with us!
(Picture: hamburgers in Haiti)
(picture: Kara and Ming with Leogane market in distant background)
(Picture: Proof that I’m trying to learn salsa!)
The founder of the CNP, Dr. Mitch Mutter, came down with 14 people for a week of mobile clinics. The clinics went well, despite a couple of rainy days. On the second day we went to a village pretty high up in the mountains. The trucks were still able to get down the bumpy dirt road to get us there. Around 1pm in the afternoon it started to rain and we were told we had to pack up right then or walk back because the trucks had to leave. They would never make it back down in the mud. We decided to stay and finish seeing all the patients and hike back down the mountain. The only problem was we had a ton of stuff. The solution? Donkeys! We loaded all the stuff up onto donkeys and successfully make the muddy trek back to the main road.
On the third day we also had rain which caused the river that we had to cross to get to the village to swell. Luckily the cars were able to take the round about route to get us out and we only had to cross the river at one point. Water still came in the car though. After a week of this I was completely exhausted. 14 people are just too many to organize. It was great having them here, I learned a ton, but I was so happy to see everyone go.
(Picture: the large group)
(Picture: A consultation)
(Picture: Triage)
(Picture: people waiting to enter the clinic)
(Picture: donkeys!)
I took my first overnight trip to the village of Kampan from July 17-18th! We left the hospital at 6:30am and drove for about an hour to the Grande Riviere. The truck dropped Yva and me off by the river where the truck (or any other vehicle for that matter) could no longer go any further. We then waded up to our thighs through the river to the other side before starting the trek up the mountain. The hike took us 4 hours but was absolutely beautiful. Everyone we passed along the way took the time to say hello and a few people even stopped to chat.
(Picture: view of the river we crossed)
(Picture: Yva enjoying a flat part of the hike)
Kampan is literally at the top of a mountain. The last little bit up to the top was intense, but when we got there we were right in the middle of the vibrant kampan market. The nutrition program was being held right by the market so we were able to go check out the goods being sold. I bought couple of straw hats which ultimately came in handy for the hike down!
(Picture: kids eating the hearth meal)
When the nutrition program was over we were lead to a little house behind the church on the other side of the mountain where we would spend the night. While they were preparing the 2pm meal I fell fast asleep, most likely from utter exhaustion (I don’t remember the last time I hiked 4 hours up a mountain). Dinner consisted of rice and beans, vegetables, boiled plantains, boiled breadfruit, and lemonade. After dinner we just hung out, chatted, and read a bit. The house was really cute. It was a wooden house with mud floors and a tin roof. There were 4 rooms; the dining room, the kitchen, the bedroom (with 2 beds), and another bedroom/storage room. The main cooking area was in a little hut in the back of the house and the outhouse was up higher on the hill. Surrounding the house and down the mountainside were fields of corn. The family also had a few chickens and raised pigeons that made the most horrible scratching sounds with their claws on the tin roof.
(Picture: Kampan house that we stayed in)
(Picture: dining room)
(Picture: outdoor kitchen)
(Picture: Kampan)
There is no electricity in any of the mountain villages and so we went to bed when it got dark around 6:30pm. Yva and I squished into a little bed that was about 12 inches too short for me. Because we were high up it was actually quite cold and I had to sleep under a warm blanket. The coldness also helped keep away the mosquitoes which was nice because we had no mosquito net.
I didn’t sleep well at all and although I would love to blame it on the fact that I was sleeping on a non-existent mattress, I unfortunately think it was because my muscles were just too sore. We were up with the sun and had a breakfast of spaghetti with a slight tint of red sauce and some strong, super sweet black coffee. After saying by to the lovely family that had hosted us, we were on our way back down the mountain by 7:30am.
After about an hour of hiking down we arrived at the village of La Tournelle. The was also a nutrition program being held here so we took a little detour to go visit them. We played with the kids and observed the cooking for a while. The monitrice also taught the moms how to make “serum la kay” (oral rehydration solution) for when the kids get diarrhea. We were served some amazing hot chocolate. They didn’t know I was vegan and so I felt bad not drinking it since they went through the trouble of making it for us. It was so good. It would have been better if made with soy milk though. =)
The hike back down was a killer – almost harder than going up. We made it down in a total of 3 hours because it’s practically straight downhill. I fell about 4 times - twice in muddy spots (it rained the night before) and twice in really dry spots with slippery dirt and rocks. It was quite the scene because I was hiking in a mini skirt (pretty common thing to do here actually), but luckily there was nobody around.
We got back to the hospital at 2pm and I immediately took a shower and went straight to bed.
For the entire month of July there has been a band camp at the school next door to the hospital (and thus next door to my house). It is being run by a bunch of American musicians who are living in the hospital guest house (on the other side of my house) for the duration of the camp. The bands, orchestra, and choir are progressively getting better. Every morning at 8:30am the tone-deaf tenors practice “listening exercises” right below my window. They are not so bad anymore, but I’m looking forward to mornings without hearing “So Ni So Ni La” over and over and over.
I finally made it to the beach. It wasn’t so nice and there was no sand, but it was still the ocean. Haitians swim with their shoes (sandals or nice sneakers). There was lot so of compa playing and the rum was flowing. We decided it was time to leave when a group of rowdy drunk guys started having a soggy bread fight. We went to anicer beach in Jakmel last weekend that reminded me of Thailand. Much better than the first Haiti beach experience.
Here are some pictures of the children and their families that I’ve been working with in the hospital.
(Pictures by Susan Speraw)
(Family from Kret Loran)
(Madeleine and her mom)
(Evanson Wilmar, from Chaterly orphanage near Leogane)
(Kara and Evanson)
(Evans, also from Chaterly orphanage)
(Samantha and her mom)
(Jackson - has a congenital heart problem)
(Eating rice and beans!!)
(Child with Kwashiorkors – notice edema in her legs...she is much better now)
I found a baby lizard in the sink. I wish my mother had been here because she would have been just as excited as I was.
Mimi (formerly known as Pasha) loves crackers.
There is a woodpecker who pecks at the telephone pole across from my balcony!
A mobile clinic group just left this morning. They were here for the past week to do 4 days of clinic out in the villages. I’m sad to see them go because they were a great group and a lot of fun to hang out with. This group was led by the wife of a CNP board member and included 2 doctors, 2 nurses, plus 4 others to help with triage and pharmacy. I went to the clinic site with them on Monday and was able to take spend some time with them 2 other days as well in between other tasks.
On Monday we were in the village of L’Acul, about 20 mins from Leogane town. They set up the clinic in the Episcopal church – waiting area in the middle pews, triage at the altar, docs in a room outside the main church, eyeglasses set up on a table outside of the doctors’ room, and the pharmacy was at a window at the far end of the church. I mainly helped with odds and ends and when there was down time I sat with the doctors. The two docs, a pediatric neurologist and a surgeon, definitely were working outside of their specialties! They did great though. Most patients complained of GI problems and practically everyone was treated for worms. Fever (although not current), cough, and backache were also common. There was one little girl with kwashiorkors who ended up being admitted to the hospital the next day.
Overall the clinic days went well. There was a bit of a problem with a corrupt priest in Ste. Etienne, but other than that, things went smoothly.
(Pic – clinic group)
(Pic – Dr. Miller and patient)
(Pic – people waiting to see the docs)
(Pic – kids)
This is what I learned today:
3.5 hours in the Saturday market = migraine + nice tan + dehydration + very dirty feet
A mobile clinic group arrives this afternoon and so I went to help Janine buy food at the market this morning. It was market day which means the market is nuts and on top of that I didn’t realize we were going to buy food for the entire week. We ended up with more stuff than either of us could carry; too much even to take motorcycles back. We left all our stuff (including my bag of vegetables) with a lady who sells fruit and I came back to the hospital to try to find a car to go back and pick up the stuff while Janine went to the meat market (located in another part of town). Unfortunately all the cars had gone to Port-au-Prince to pick up the group at the airport and the one car that should have been around had to go pick up the ambulance that broke down on the side of the road. I had absolutely no food at home and was really looking forward to cooking lunch. I didn’t have the energy to walk all the way back to the market in the sun to get my bag. So, instead I just rehydrated and fell asleep on the couch while waiting for a driver to come back.
It all worked out in the end. The driver returned and went with me back to the market. I had a slight moment of panic when we got there because I thought I forgot where we left everything. You know me and directions! But I was able to find the fruit lady on the first try. Phew. Ender, a notoriously bad driver, insisted on driving the truck through the market (extremely crowded and tightly packed with people selling their goods on the ground) and straight up to the fruit lady’s little stall. Along the way he nicked the stall of someone selling electronics and broke a piece of wood off the side of the booth. Fortunately we made it to the fruit lady without any human casualties.
I’m now well stocked with fruits and vegetables! Here is what I bought:
ALL my underwear are now too small for me, although thankfully not due to the massive amounts of rice and beans I’ve been consuming. This morning I put a load of clothes in the washing machine, which among other things included all my underwear. I don’t dry my clothes for fear that they will shrink and so I specifically told the women working there not put them in the dryer. She forgot and when I went back down everything was hot and fluffy, straight out of the dryer. Luckily I can still wear everything. I guess it could be worse; I could have turned all my clothes an ugly grayish black color again. =0
The main objective of today was to buy a new mobile phone for our driver, Jean-Claude. His phone has not been working and I’m sure one of these days I’m going to lose him. He wanted a Digicel phone (apparently the best service in Haiti).
Surprisingly, there are 4 Digicel shops in this little town all located practically around the corner from each other. The first store was the largest and even had a nice little phone charging station on the front porch that consisted of about 12 outlets. (There is generally no electricity around here unless you have a generator.) The phone charging station was a big hit and the outlets were overflowing with chargers! The store had a nice display of phones, but unfortunately they only had 1 in stock. So we did some shopping around, but the same went for all the other shops as well. Jean-Claude was not happy with this and so we drove almost all the way to Port-au-Prince to find a shop that had a wider range of phone options. We ended up at a store in Carrfour. We were searched before entering, but the store was air-conditioned so that made it worth it. The Cubans came along because they wanted to go to an electronics store (known to give good deals to Cubans) to get some estimates on refrigerators to send back to their families in Cuba.
Despite doing relatively nothing today, I was exhausted. The last thing I wanted to do was data entry, but every afternoon until 5:30 that is what we do. Evelyne, one of the hospital program organizers, comes to help me and then we go together to check on all the kids at the hospital and give out the milk.
I can’t wait to switch to Plumpy’nut. The milk that we make is really starting to make me nauseated every time I get a whiff of it. I’m not sure how these kids stomach it.
There is a nation-wide transportation strike today and tomorrow protesting high gas prices. Transportation prices have nearly quadrupled so people are obviously not happy about this. Many places were closed because nobody could get to work.
Luckily we have our own driver so he was able to drive us out to the village to go supervise the nutrition program. When we finally arrived, nobody was there! All the mothers were there in the morning for the vaccine post (held once a month) and they didn’t want to stay until the afternoon for the nutrition program. So everyone just went home, including us.
On the ride back Felicia, who is 4 months pregnant, was complaining how the baby makes her hungry all the time. So we stopped to get some "friage" - fried plantains, breadfruit, and a plethora of fried meats that you can get at little stalls everywhere along the streets. It always comes with "piklis" (a spicy coleslaw) which I really like. I got a bag full of that since all the other stuff is fried with meat. The piklis goes great with any dish. I had it for dinner with couscous and sting beans. Yummy.
Here are some pics of our visit to the village of Haut Gerard:
(Picture: Volunteer mother cooling in the kitchen.)
(Picture: Eating!)
In the above picture, the little baby being fed (on the left) is 9 months old and has signs of kwashiorkors. She had a great appetite and no other signs of illness though. I’ll see how she’s doing when we go back to Haut Gerard next week, but unfortunately I think she will need to come into the hospital to be rehabilitated with the therapeutic milk.
(Picture: waiting patiently)
My boss was in town the past few days for a meeting we had in Port-au-Prince. We stayed at a really nice hotel with a pool and great drinks...all on the CNP! The food left a lot to be desired from a vegan’s standpoint, but since there was a pool it didn’t really matter.
We had an all day meeting on Friday with Save the Children, Concern, UNICEF, and the Haiti Ministry of Health to get the Plumpy’nut project underway. Plumpy’nut is a peanut butter based ready-to-use therapeutic food used to rehabilitate malnourished children that has been shown to work better than the therapeutic milk (F100) which we currently use in the hospital. Plumpy’nut is already being used by some organizations in Haiti but with very different treatment protocol so we're hoping to standardize it's use for the treatment of severe acute malnutrition and use the data collected over the 6-month trial to inform policy chance in the national protocols (currently undergoing revision) for treatment of malnutrition in Haiti. I'm pretty excited to be a part of the project. I was so hungry during the meeting due to the lack of vegetables at lunch that all the talk about Plumpy’nut was making me salivate!!
I forgot to mention – Cathy told me that the cat is actually named Mimi and has been around for about 10 years!! Apparently Pasha was a very similar looking cat that died. The women in the guesthouse who call her Pasha haven’t realized this I guess. I like the name Pasha better and I think I may stick with it. It’s hard to change names after a month.
This past Thursday night (May 31st) I went with Cathy (woman who had my job for 6 years) and her friend (former Haiti Peace Corps volunteer), Leah, to see a voodoo inspired band called RAM at the Oloffson hotel in
The band didn’t start until around 11:30pm and since we were all pretty tired (partly due to the killer fruit punch) we didn’t stay to hear them play for very long. They were interesting though and had a very different sound from the usual Compa music that you hear here.
(Picture: RAM)
We spent the night in the very unfurnished apartment that Cathy and her fellow law school classmates are renting for the summer. There were no pillows, sheets, fans, dishes…nothing. We didn’t even think to buy clean water to drink!
The CNP driver picked us up on Friday morning and Cathy came back to Leogane with me to visit her old friends. It was fun to have her here. She showed me all around and introduced me to everyone. In the evening we went with a group of guys who work for the filariasis project down to the beach. It was great to be by the ocean, but the beach was covered in garbage. I won’t be swimming there.
Last night we went to the disco with some of Cathy’s really good guy friends. The disco is a large room with tables and chairs surrounding the dance floor which is marked by a large rectangle of colored flashing tile lights. Before 10pm they have salsa dancing and after the lights are dimmed and it turns into a proper disco that plays a mix of American top 40 and Haitian Compa. It was fun. All the girls sit around and wait for guys to ask them to dance. Dancing to Compa is fun and a lot more formal than what I’m used to. During the salsa part there were some amazing dancers! I can’t salsa to save my life. One of Cathy’s friends is a salsa teacher, so I’m going to start salsa lessons next Saturday!
This week so far has been spent dealing with one very bitter little man, Monsieur D, who writes the bills that a patient needs for all diagnostic exams in the hospital. He has been refusing to do so unless patients pay upfront (i.e. bribe him). This has been causing problems for the nutrition program. The hospital director was supposed to have talked with Monsieur D at the beginning of the week, but today it was still the same old story. I can sympathize with him a little. The hospital is having financial difficulties which has resulted in many people, including Monsieur D, not being paid for several months. But if he’s still going to show up to work, he needs to do his job. He told me that the hospital director never talked to him. We argued and I told him I was going right then to talk with the hospital director, again. This scared him enough to write a bill “for today ONLY” for the little boy’s blood work. He gave me the bill for the labs, but today only is just not going to cut it. I went back to the director and little Monsieur D got in big trouble. I’m sure he’s not too happy with me, but he better be writing bills for us from now on. The former manager of the program told me that she had the same problem with this guy when she first got here. Guess he's trying to see what he can get away with.
The good thing that came out of this, other than the fact that I hope to not have any more problems with Monsieur D, is that I now know the process of getting laboratory tests done. This was my first time up to the 3rd floor. Located up there is the laboratory, dental clinic, the filariasis project lab, and the hospital radio station (that I didn’t even know existed and is apparently one of the most popular stations in Leogane!). I was rather impressed with the lab. There are 2 refrigerators, an incubator (that may or may not be working), 2 microscopes, and a centrifuge. (There was also a pile of old dusty broken microscopes and a centrifuge in the corder). There were a million people in the room, most of whom were students observing. Parked almost right in the middle of the room was one chair for the patient to sit in. I found the lack of privacy for the patient rather awkward, but I don’t think privacy is all that much of an issue here.
I’m essentially taking off the rest of the afternoon and all day tomorrow (Friday) to go hang out in
Today is Mother’s Day in Haiti. Janine, one of the women who cooks for the guesthouse, invited us to her house for lunch. She lives in a village not too far from the hospital. We arrived around 9:30am just as everyone was starting to prepare all the food for lunch and decorate the house with balloons.
(Picture: Janine’s house)
Janine’s house is cute. It consists of a bunch of concrete/wooden rooms (each with a bed or two) and a small living room. The backyard housed 2 pigs – each with their own mud piles, a bunch of chickens, the outhouse, and a section with old rusted weight lifting equipment. The outhouse did not have a squatting toilet like I had hoped. Instead it had a normal toilet seat over the hole. The seat was almost too high to squat over (and not physically sit on), but I managed. Until now I haven’t had the opportunity to use an outhouse in the village. We’ve been peeing in the bushes!!
I hung out with the women while they cooked for a while. There was a separate little building that functions as the kitchen. It had a little table and three coal stoves. (Most people use coal to cook and I’ve occasionally seen open fires.)
(Picture: Jolina, the other woman who works in the guesthouse, in the kitchen preparing a spicy tomato sauce for the meat dish)
(Picture: The rest of the women preparing food outside)
(Picture: The food waiting to go out to the table)
While we waited for the feast we all enjoyed some Haitian beer and an appetizer of “croquette lam”. Lam (short for lamveritab) is a breadfruitl. This was actually my first time ever eating it. The croquettes are made of pureed breadfruit, spices, and usually meat and cheese (but these were left out for me), shaped into little balls, and deep-fried. They were really good despite the lack of meat and cheese (although I do think they would have been great with the cheese).
(Picture: Frank and Sylvestre, Janine’s son, hanging out before lunch)
Lunch was incredible and there was so much food - rice with beans, two kinds of fried plantains, more lam croquettes, avocado, salad, pasta salad, a vegetable platter with broccoli, carrots, beets, string beans, and potatoes, goat meat, fried fish, mango, papaya, oranges, bananas, pineapple…and champagne to wash it all down!
After lunch we hung out for a bit. I worked on my Spanish comprehension while the Cubans chatted a mile a minute. Little bits and pieces from the year of Spanish I took in college are coming back!
After taking a bunch of photos we hopped in the truck to head back to the hospital.
(Picture: Janine and her mother – Happy Mother’s Day!)
(Picture: right to left – Maria Elena, Kara, Janine’s mother, Frank, Dania, Sylvestre, Janine)
The rest of the day has been relaxing. I napped for 2 hours, there were no major problems at the hospital, and it’s now raining and cooling everything off. The frogs that sound like ducks are out, but I think I’ll sleep right through their quacking tonight.
It’s the weekend. I slept in until 8am which was refreshing (but yet not refreshing enough). I didn’t do anything but work at the hospital and go to the market with the Cubans. It was market day and very busy. I bought enough brown rice to last the next 6 months. I didn’t realize I had asked for so much!
I’ve been preparing the milk and checking on the kids on week nights and the weekends. The women who normally run the program aren’t here at these times and I’m just beginning to really realize how big a problem this is. I think it will be great when I can finally set up a schedule with the nursing students to help out. The other thing though is that the CNP covers all hospital costs for the children in the nutrition program. Unfortunately it’s not as easy as just paying the bill at the end of the patient’s hospital stay. There is definitely a bill at the end, but there are also many little expenses on a day to day basis because families have to purchase all medicines, IVs, etc. themselves.
I ran into a problem with this today. One of the mother’s of a little boy who was admitted on Thursday has absolutely no money. (We actually met them at the Ti Foye visit in the mountains that we did on the 23rd and told them they needed to come to the hospital.) When I went to go see how they were today, the baby’s IV had run out and he had a prescription for an antibiotic and a thermometer (patients even need to buy their own thermometers!) that needed to be filled. The mom hadn’t gone to the pharmacie to buy more saline soln or get the meds because she couldn’t afford it. She was also supposed to be taking antibiotics herself (which I know she had because I gave them to her), but hadn’t taken them because she didn’t have any clean water or food to take it with. I was able to get everything for the baby because I have access to the CNP pharmacy and I have a stash of money to buy what we don’t have from the hospital pharmacy. Otherwise she would have had to wait until Monday! I guess I’m just going to have to ask the pediatrician on try to predict what the children may need over the weekend and get it for them on Friday because I won’t be here every weekend (and it’ll be nice not to have to work everyday).
I almost had to deliver a baby last night. There was a woman screaming her lungs out and about to give birth in the middle of the dark corridor leading to the pediatric ward. The family was trying to get her to the labor and delivery room, but she wasn’t having it. There were no doctors or nurses to be seen anywhere. I went to go find someone and the two docs that were on the roof in the doctors’ residence (one of whom was the doctor on call!!!) wouldn’t come help because they were “not obstetricians”. They would rather let this woman’s family, or worse yet, me, deliver the baby. I was shocked and later really upset with them. I ran home to get gloves to prepare for the worse case scenario (my helping out) and by the time I returned one of the lazy nurses finally decided to come out of her hiding place and investigate what was going on. She still wasn’t doing anything, but I decided she was good enough and I carried on with what I had come to do – feed Vincent (a little boy in the hospital whose mother was also recently admitted for TB and severe malnutrition).
I am not a fan of the nurses here. The nursing students are great, but the actual nurses are horrible. They are not friendly and hardly ever work. Tonight one of the kid’s IVs came undone and was dripping everywhere. There was one nurse around and so I went to ask if she could help fix the IV and her response was, “I’m not a pediatric nurse”. Well, she was the only nurse there and it didn’t take any special pediatric skills to fix the IV. I ended up doing it. Luckily, on my way out I ran into a (very flirty) doctor who covers the ED on Thursday nights and I had him come check the baby’s IV. He ended up scolding the nurse that wouldn’t help me and made her go check on the child. Haha. Serves her right. I think she hates me now though!
Apart from frustrating evenings at the hospital, I had an enjoyable dinner on Wednesday night with the Cubans. We had spaghetti with tomato sauce, fried plantains, and bananas. Apparently it’s a very Cuban thing to eat a banana with spaghetti! It was bizarrely good. The salty tomato sauce and ripe banana actually compliment each other quite well. I suggest everyone try it.
Today’s Ti Foye visit included another “little walk”. I knew better than to wear my slippery Jcrew flip flops, but I wasn’t prepared for this! We hiked down there:
Luckily it was a nice day and not too sunny, but I’m definitely out of shape.
(Picture: Yva and Kara taking a photo break)
The kids has a snack of peanut butter on bread while the monitrices reviewed the material they had covered. This particular Ti Foye was nearing the end of its 10-day course. The mothers eagerly shared all the information that they had learned such as how to prepare a balanced and high calorie meal for their kids, what causes diarrhea and how to prevent it, how to make oral rehydration solution at home, and the signs, symptoms, and prevention of malaria.
(Picture: Mere voluntaire’s little boy standing outside the kitchen - He doesn't look too happy in this picture, but in fact he happily played and tormented a rather healthy looking stray dog the entire time we were there.)
Just as the kids were about to eat the lunch of rice, black bean sauce, and vegetables, a big black rain cloud appeared and it started to thunder. Yva and I decided we did not want to hike in the rain so we booked it back up the mountain and made it to the truck just as the first drops began to fall! Phew!
