Food for the soul

Today has been one of the best days I have had here in Haiti which is making it very hard to purchase my tickets home (I swear I am just waiting for a better price…)

I hope I was able to make her day as awesome as she made mine!

I have a few patients who I absolutely LOVE to treat. Oddly enough they are at the opposite end of the spectrum from the kiddos who capture my heart under normal circumstances. Today one women who I treat weekly for her back and leg pain came early this morning and Jason our guard came to get me to let me know she was waiting for me out on the patio. I light up when I see this woman as she is such a kind gentle soul. She is in her 70’s and always comes to appointments alone. Her children have died and her grandchildren are less than helpful. She walks with a cane, slowly and purposefully as she has intense low back pain that radiates down her leg making ambulation difficult. This morning she was her ever smiling self when I showed up dressed in my pj’s. She pointed at the bag I had lent her last week to carry her medications home in. I opened the bag and inside was 4 gorgeous coconuts and about 10 lbs of oranges and limes. She paid for a moto taxi to come this morning as she couldn’t carry everything but wanted me to have this beautiful gift. My eyes water just writing about it. There was nothing she wanted in return and there was no special occasion, she simply said, “as long as God allows me to walk I will bring you gifts.” Wow, talk about a way to start the morning! I accepted the fruit and gave her my breakfast in return.

My gifts that were made into the most delicious juice ever today!

sugar cane

I merrily went about my day (seriously it was the best adult day I have had here, as you all know I am not a fan of treating the adults but I have worked it out to basically see only the returning patients one week and I love to see how well they are doing so it makes it manageable) thinking how thoughtful it was for her to come and bring me those heavy fruits. At the end of the day a women who we see often, not as a patient but as a grandmother of a baby we treat, was waiting for me on the porch. Last week I helped facilitate an arrangement for her grandchild to stay in an infant care center called Children of the Promise as her mother is unable to care for her due to some cognitive issues. Grandma wanted to let me know how she was feeling about the situation and how she felt about the process and then took me out front to show me the four large sugar canes she brought me. Say what!?! Two sets of gifts in one day?? I really AM the luckiest girl alive J We chatted for a bit with Marie, Leonise (our translator) and Monise which was really fun, it was like girl talk mixed with match making as they were all plotting ways to get me to stay in Haiti. I had joked with Marie the night prior that if I met someone and got married I would have to stay. This pleased everyone as Marie relayed the story and they all discussed qualities I need in a man and how they were going to throw me a party and bring all of the eligible Haitian men for me to meet. I, in turn did my best, in Creole, to stay with the conversation while I pantomimed how Haitian men can dance and American men cannot…it was pure hilarity. They were laughing so hard and yelling “m’zanmi” with their hands in the air, I really wish I could have gotten a photo. Oh well, I have a mental snapshot that should last at least another 50 years.

I have been so blessed with such an amazing experience here which has transformed the way I not only practice as a doctor but how I see others and their daily struggles. There is so much love and beauty here in Haiti, how could I not come back for another round. This is like food for the soul and I am eating it up!

Patient yesterday who received a doll made by hand in the US because she was too cute not to, guess what goes around comes around.

Work hard, play hard

On Sunday night Sharon, Santo and I went out to the apartments where another friend of ours, Eyleen, lives. It was her birthday and coincidently there was a group of Haitian dancers that were coming to show off their skills that night at a small outdoor restaurant within the compound. The group was called a ‘traditional dance group’ but Santo told us that they were actually more of a specific form of dance group, one associated with the vodou culture which I have now come to realize that is very different than portrayed by the media. It is also different from the vodou religion which is a distinction that is not always made. The dancers were great and their costumes were amazing, especially the sequined red vests for the men…the drumming was awesome and we had a really great time. I am so thankful Sharon has been driving us around since we have no car, it is so very necessary to get out of this compound and I am grateful that she is so sweet.

I have been trying to get out and about more which has been good for the homesickness as well as the stress caused by running this clinic and being the only doctor here. I love my work and this job has afforded me many opportunities that I would never have been able to have otherwise but it is very demanding and stressful which I think is infinitely compounded by being here alone. On the other hand I am realizing that I will be home sooner than I think and it is freaking me out a bit. I miss the US and my friends and family terribly but I also worry about everything here…who will take care of the patients, who will make sure Dieula and Monise have a special piece of cake just because; who will buy Santo cheddar cheese Pringles and share Prestiges with Jason and le boss; who will get Marie treats from Croissant D’or? They keep telling me it will be ok because I will be back soon. I hope they are right.

On the job training

In other news, I watched Shannon, a certified nurse midwifery student and 6 year OB/GYN nurse veteran show Marie how to insert a feeding tube into a pretty listless little girl who was delivered here 10 days ago. Mom came in today for a check in and said she had not been feeding the baby, “because she sleeps all the time” and that the last time she fed well was when she was born-yikes! We were concerned about the care the baby would get at the local hospital as the most likely would have given some fluids and sent mom home, it is clear what the baby needed was to be fed and the mom needed to understand the severity of the situation. We chose to keep the baby here and work on getting her to feed while Marie talked to mom about feeding in general. Baby was unable to muster the strength to suck from the breast so Marie and Shannon helped mom pump and tried via a bottle which was not effective either. We luckily found a NG tube and Shannon gave us a little one on one tutorial! The baby by this time had her eyes open and was becoming feistier which was a huge relief. Mom is going to hang here for a few hours form some ‘inpatient care’ while they continue to educate her and get the baby some more breast milk. This just goes to show how easily education goes over the heads of patients. Marie is phenomenal about educating moms before the leave, making sure to watch for breast feeding difficulties, talking extensively about solely breastfeeding and making sure the baby feeds frequently. We also make sure we are here for the moms if they need anything and ask that they come back in 3 days for the first consult after birth. This mom failed to come back. This is one of the main pushes for a community health worker to be involved with car. Thankfully Santo will be done with his class at the end of August and we can send him out on his motorcycle to check on moms and other patients! We know that the most crucial time for the babies is the first week or two after birth and this is one great example of what happens when there is follow up on the mothers’ part. With a community health worker we will be able to track the family down and make sure things are going well…I can’t wait, it will step up our ability to care for the women immensely.

Revitalized by some community education!

Yesterday Sharon (my friend and nurse at the local Hospital St. Fraciose) made the rounds to talk about STI's. First we spoke at a clinic within walking distance from here to a group of 20 or so medical students, nursing students and auxiliary community health workers. They had many questions and seemed to find the information valuable. The doctor in charge asked us to come back next week to speak on Malnutrition signs and symptoms. They even had a some light refreshments for us and the group afterwards which was very sweet!

Making food for all the children

Afterwards we headed to Shada which is a place Sharon has kindly taken under her wing. This is not small under taking as it is an area of about 4000 who live in severe poverty and despair. They are unable to feed themselves and their children and most are unable to attain any amount of medical care. I always invite them to come here but it is about 35 minutes away and it is hard to come when most families have many children to take care of. We showed up and Madanm Bwa who is our main contact there and a traditional birth attendant greeted us, she is also one of the most amazing people around. She was getting ready to complete her second day of 'free cooked lunch' for the children of the area. With the help of donations from Food for the Poor (rice and beans) and with money from friends and family of Sharon's they were able to purchase vegetables, stoves to cook the food and fruit for the children. Some of the local women cooked and viola! food for 250+ kids. It was awesome and heartbreaking to watch the children line up for what was probably their first meal of the day and most certainly the most complete meal they have had in a long while. Not a drop of bean sauce or grain of rice went to waste. I would love to be able to help Madam Bwa do a meal like this at least once per week for these kiddos.

So many kids so much love.

After the meal we gathered some women and spoke about STI's. It was completely different from the group of students we spoke with earlier in the day as many of these women have never been to school and don't have access to testing and other medical resources. They had many questions which Sharon and I did our best to answer. I also offered to come back in two weeks and bring medications to treat certain STI's if the women would go and get tested. They seemed very happy to have this option and maybe this is another incentive to get everyone tested for HIV and Syphilis, both are free tests. HIV meds are given free by the local hospitals though many people have still never been tested. I really hope this starts a movement of women getting tested for things like Chlamydia, Gonorrhea, Syphilis, HIV and Trich.

The talk turned to the use of condoms and they all began to laugh and talked about how the men refused to wear them. They also talked about lack of access to contraception due to financial constraints and how the med were unwilling to help out. It seemed par for the course that the men would use force if they wanted to have intercourse and the women didn't as well as the fact that the men were providing food for the women and if they tried to make the man wear a condom or get tested or abstain, they would not be able to eat. In one woman's own words, "if I don't do it, he beats me and my children don't eat." This is not a situation of a woman staying with an abusive significant other because she can't leave physically, this is a story of survival in which women must rely on these 'men' to eat and to be able to feed their already malnourished children. Many want contraception as they know they cannot afford another child however there are no programs offering these services for free and in Shada which is considered the slums of Cap, if it is not free it is not affordable.

Kids love photo ops!

With our lovely group of ladies in Shada

A view of the water from Shada

I left feeling like I needed to come up with a plan for these women and that we need to invest time in education throughout the community, including the men. The women laughed when we proposed this but Sharon and I said we would seek them out and talk to them one by one if need be, that this behavior is unacceptable and that these women are strong and have each other to rely on if need be. They are beautiful women who can say 'no' and have their words respected. Though at the end of the day, we get to go home to our comfortable beds in our safe houses while these women live in a world full of desperation, abuse and hunger.

Look who made it to the Dominican Republic after all...

After all was said and done with the car (well, after they took it and we came home and went to a BBQ to lift our spirits) I decided that I wanted to make the trip to the DR without the car and so we set out the next day via Caribe tours bus to the DR. The bus is very nice, air conditioned (a little too efficiently) with nice comfy seats and complete with a little snack to tide you over. The bus ride is significantly longer than driving as you have to stop at the border and everyone gets off and has their things rifled through which put the ride at about 5 hours. We lost an hour heading in the DR but I was not going to let that bring me down, we took a taxi to the hotel (oh wow, talk about culture shock-hotel was super nice and really all I wanted to do was lie in the comfy bed with the blankets pulled up around me with the air conditioning and television on...you can see where my priorities lie). We decided to head out to dinner and chose a rice little "steak house".  Now keep in mind this was Santo's first time out of Haiti...he was like a little kid and I was so happy to be able to experience it with him. When you live your whole life in a country like Haiti with only stories about other places in your mind, I can only imagine what it is like to travel-even if it is just across the border. 

My favorite moment came when we were in the hotel and we were about to get into the elevator and Santo was looking at it and it did not even occur to me that he had NO idea what these large steel doors and enclosed area were. He politely asked me to show him how it worked and to explain what it was. I realized that there is just simply so much we take for granted and I am thankful that I had the opportunity to grow up in the U.S. with all its luxuries.

What is this thing!?!

 It is hard to imagine but here people that have not traveled outside of Haiti really have no idea about what things are like since TV and movies are mostly filmed here in Haiti. It is no like you can easily search the internet for things either as power and internet are scarce so what you get is really limited to stories from others. As someone who has traveled quite a bit I have a hard time imagining knowing only one way of life. E

Enjoying a wonderful dinner, Santo's first non Haitian meal.

I am a foodie. I love different types of food and trying new restaurants. This has been a problem for me here in Haiti as most of the food I have come in contact with is made with the same 10ish ingredients. Don't get me wrong, it is delicious but it is all the same. As someone who can't even set her alarm clock for the same time each morning, this 'food situation' has been the hardest part of being in Haiti for 6 months. What I wouldn't give for some fat chubby Thai noodles.

I was so proud of Santo for trying this seafood and rice dish that was full of wonderful spices like cilantro ...a totally different taste from the typical Haitian fare.

All in all the trip was a success, even if it was only 24 hours and we didn't get the solar panels. I witnessed what it was like for someone to travel outside of their home country for the first time and I was able to get a few of the luxuries which made the homesickness I have been feeling a little bit better.

Customs schmustoms

Last week Santo and I embarked on a trip to the Dominican Republic for the purchase of some solar panels (yay solar!) however we only made it about an hour and a half out when we were stopped by a customs agent in Terrier Rouge, outside of Limonade. He waived me in politely, asked for our paperwork for the car and then came back out to ask us to come inside. He told us that the tax we paid on the car was incorrect due to the fact that the base price of the car was incorrect, or something like that. He said he would keep the car and that we needed to drive to a town called Ouanaminthe which is the border town, to find out how much we owed-pay it, then come back and get the car. I wondered out loud how I could do this with no vehicle and he calmly replied that he thought most people called their friends but that he was unsure as he spent most of his time in the office. He then left us to find a ride home. Thank goodness for Sharon Barefoot our good friend and nurse at St. Franciose who came to the rescue (in the ambulance and all.)

Fast forward to a week later and hiring a new translator who happens to have a friend at the police station who said he would look into things for us. He is a wonderful man who traveled with me out to Terrier Rouge today to see about getting the car back but sadly we made no progress. I am still unsure if there was really an issue with the paperwork or if this is a way to create revenue for certain people but it is frustrating and annoying to say the least. I miss the car (that we finally had fixed so I didn’t have to jump it each time I turned it on) and I miss being able to go places (like helping the ladies to the market or hiding out at the Christophe to get some emailing done). Besides letting out a string of words that would make most people blush after finding out we wouldn’t be making it to the DR, I wished for the first time since I have been here, that I was back at home where at least I know what to expect.

Please don’t feel too sorry for me though, there are still people who can’t eat daily and I am healthy and well.  

A delivery is a delivery wherever it happens..

 Last night around 6:30pm Jason came up and told us there was a woman downstairs, “li gen trache” which means she is having contractions. Marie heads downstairs and Melissa follows…usually when I woman comes in there is a good 30 minutes before anything starts happening which is usually filled with asking questions about whether the woman has been to our clinic for care or whether or not she has had HIV and Syphilis testing as well as any other pertinent history. I hung back, while I am a HUGE fan of the work we do here in the clinic I am not always intensely interested in birth-in all honesty it usually goes too slow for my ADD. As I am finishing dinner Melissa calls up after a few minutes have passes and asks if I can grab a syringe for the Pitocin which I thought was odd as that is part of the protocol laid out by the ministry of health here in regards to active management of the third stage (which is after the baby is actually coming out). I head downstairs to see the woman on a birth stool in the arms of her friend on the front porch actively laboring like a champ. Wow. How cool I thought, talk about perfect timing, although I am sure the motorcycle ride over was of no help in keeping the labor at bay. So we hung a sheet, grabbed our headlamps and flashlights and she delivered a healthy 7.4lb baby boy within 50 minutes. It was really cool too because Monise who is another non medical staff member of ours was really into the birth and gloved up and helped out like a pro, I was so proud of her and the other woman on the patio for using the resources available and making this birth as gentle and wonderful as the rest even without a bed, pillows, mats etc. I am trying to convince Monise to be trained as a midwife and that we can help train her but she doesn’t seem too interested which I am hoping will change if she sees more births and recognizes what an asset to the process she is.

Overall it was a great day and another nod to the amazing work that is being done here in Haiti by our staff. I am so happy to be part of this organization and more and more I see how our work here is impacting the community in more ways that just keeping them healthy and decreasing maternal, neonatal and childhood mortality rates. The way everyone comes together to help when they see the need is so encouraging in a world where I too often see people’s only concern being their own well being with little concern for others. This used to make me angry as I see the world in a different light I guess, however now I am learning that most people are doing the best they can. Whether it is helping someone find the correct gate at the airport or giving an extra moment to smile at someone who is having a bad day I believe most of us doing something nice for others on a daily basis. Either that or the lack of inundation by media and all outside sources has taken its toll on my brain and I am suddenly living in a make believe world. I am ok either way. I will continue to see the best in people because I believe people live up the expectations you have for them. I will also continue to lead by example not because I feel I must but because I love the work I do and I know how many people are benefiting from it. Even if one person passes on the information they have learned from us my time here is worthwhile. 

Kerosene inhalation causes health problems...be warned.

After being in Haiti for 5 months you don’t really think you are going to see many ‘firsts’ but today I did. A woman came in and sat down and began to give us her information. Her voice was very hoarse and I figured she had pharyngitis or layrnigitis. Then she begins to tell me about how when she was pregnant she really enjoyed the smell of gasoline and kerosene. I didn’t think much about it as I know that pregnancy does strange things to you but I was a little concerned that maybe it had impacted the baby. Upon further investigation that was 5 years ago when she was pregnant and she is currently ‘smelling’ or as we call it, ‘huffing’, kerosene 6-7 times per day. She is very worried as her voice has changed, she cannot eat and she cannot stop. Trying to quit for 3 days caused her massive headaches, irritability and sickness…yeah, I imagine it would. 

I felt so incredibly bad for this woman as she had no idea about addiction and that basically she had become physically, emotionally and mentally dependent on this substance. It is unlike drug addiction in the US where people understand what is happening but are too far removed to be able to do anything about it. She had absolutely no idea what was happening, she just knew she liked the smell of this product. My heart ached for her knowing that there are no ‘rehab’ programs here and that without serious intervention she would likely die from this habit. I told her I want to see her weekly which is all the time I can give to her, though part of me wants to house her here and try to get her weaned from this addiction. She has 3 children at home who need a mother who can care for them. I tried to tell her all the health risks which she seemed to really be affected by but without the knowledge of what is happening she really cannot fathom what it will be like to try and stop. I told her without any sugar coating that it was going to be one of the most if not the most difficult things she has ever done and that I would be there to help her but I am acutely aware of the drug rehabilitation rates in the US where we have facilities on every corner so sadly I fear that beating this may not be feasible. However, as long as she comes back and wants help I will work with her and do everything I can to help her get her life back. I think she was just thankful that someone finally told her about “addiction” and that she can release the self reproach she has been feeling about how she can’t just ‘stop’ doing this even though everyone else tells her she can.

 Empowerment comes in all forms I guess.