Posted Thursday, February 22, 2007 9:32 PM
It's 6:33pm and there's still so much to do! I began this week with a whiteboard full of tasks - all accompanied by little boxes, just waiting for that satisfied checkmark to show it had been dutifully completed. Less than 24 hours before the plane leaves the tarmac and how many of those boxes have been left unchecked! Just another familiar mantra of nursing school...
However, to put it into a little perspective on this otherwise petty concern, soon my clinical group and I will be in Jeremie, Haiti. As we've been preparing for this trip I've had several moments to briefly reflect on what this experience may be like - and how things may have changed since the last time I set foot on that small island.
Traveling to Haiti during my freshman summer of college in 1999 was the first time I had been outside of the continental United States. What a culture shock it was to set foot on the soil of Port-au-Prince, just outside of an airport thronging with unfamiliar faces and tongues, and gaze out onto the cityscape. This was my first encounter with a developing country - and it left a permanent impression. At the time I was traveling with a medical mission accompanied by nurses, medical specialists, and interestingly enough, my father. We witnessed great beauty - and great destruction - in the landscape we traveled during those brief weeks in 1999. I was amazed at how people could work so hard, in such challenging circumstances - with so little. I tentatively sampled a bit of goat meat offered by a generous hostess in a mountain village. I struggled to assimilate clumsy high school French into the richness of Creole - and failed - and I made many "small" friends along the way. The outstretched hand of a 5 year old and the sparkling smile that accompanied it became familiar - almost comforting - but I couldn't help but feel a bit uncomfortable about my role in this land so different from the one I had grown up in.
That trip served as a chief source of inspiration to pursue nursing practice and public health. The nurses I was with at the time and I theorized that the work we were doing there was only a band aid on a much greater need. I later came to understand that this kind of thinking has a name - in Peace Corps circles it is called "sustainable development" - in nursing, I have come to learn it is called "health promotion". In later years, once I became a volunteer, I often thought about Haiti and what I'd seen in Port-au-Prince, Cite Soleil, and the mountain villages that seemed so precariously perched atop the steep ridges that gate the island.
Now that our public health nursing clinical group is preparing to go back - this time to a different region with a slightly different mission - I wonder not only about what will have changed there, but also what will have changed within me.
Either way, I am so incredibly thankful for this opportunity, for my clinical group-mates (who are an awesome, accomplished, and inspiring bunch), for our instructors (an MPH student with previous experience in the Dominican Republic and a doctorally-prepared public health nurse who spent all of last year working in this Haitian community) and for the many generous donors and supporters of this trip who have made it - and the work we are about to do - possible.
Sorry for being so long-winded - but another checkmark down! Chat with you all in Haiti!
How Much for a Chicken Foot?
Posted Monday, February 26, 2007 12:56 AM
It has been a long but beautiful day. I was so heartened to see Haiti again – in fact, there were several of us, crammed hip to hip in the back of the Land Rover, who breathed a literal collective sigh of relief – perhaps release – upon finding ourselves in this incredible country (either back or for the first time) and doing the work that we love. Mostly I think we were high on laughter – and the intoxication only worsened with every pothole the vehicle struck. Perhaps I should say we had split-second lulls between the periodic launches from the benches upon which we were perched. We skipped right through Port-au-Prince and onto a “puddle-jumper” as my uncle would call it, and into the hilly but gorgeous region of the Grand Anse, where we landed on a white strip of runway in the city of Jeremie. This area is so – well, it appears thriving compared to what I last saw in Port-au-Prince. Perhaps it’s the greenery and the rural location, perhaps it’s my memory. Either way, it’s encouraging.
The people here are still beautiful – they smile and nod and greet you – “Bonjou!” upon encountering you on the street. This morning everyone was wearing their Sunday best in church and the way that they take care of their clothes they make the look GOOD, even if they really aren’t. Today was the first Sunday of Lent. We chose to visit l’eglise of the Sisters of Charity, a Catholic relief organization here in Jeremie, for their Sunday services. Little did we know that today would be an extra special fete for both the season and the third anniversary of their church choir. The inside of the snow white cement meeting house was bedecked in wedding decorations that had been converted into streamers for the celebration. The house was packed. The sermon was in French, mixed with Creole, and very focused on the holiday – particularly the fast. It was strange to hear this community leader speak about the importance of fasting, especially spiritual fasting, to an audience of men and women who probably had one to two small meals of rice or beans a day, if anything at all. There was a tiny little girl from the choir – she was maybe 8 – who stood at the church’s microphone and narrated along with the choir. She implored God to look out for those who are starving and suffering – not her community – but “others” of the world who are in need. They were praying for those who were truly suffering. I sat and watched in awe. It definitely gives you perspective - not only on one's own situation, but how the people of Haiti can also take real pride in themselves and their ability to help others as well.
After the church we returned to a paradisiacal villa to grab a quick breakfast before heading down to the Sisters of Charity, an orphanage and recovery house for impoverished infants whose parents can no longer care for them – either out of need or because of the child’s illness. Nuns care of many of these little ones – I can’t describe how their faces lit up as they greeted us at the door. We handed out crayons and coloring sheets and sat with the toddlers as they showed us their fine motor skills and played or explored with every pocket, hat, purse or pair of sunglasses they could find on us. After these ones were called to a hot lunch of rice and peanut sauce, we retired to a room of approximately 15 bassinets, flaked white paint outlining each one against the dimness. Inside each of these bassinets was a small child - they were in varying states of health and nutrition (or malnutrition). Many had obviously been kwashiorkor babies, others had apparent CP or MR – and many if not all seemed to have suspicious lesions, especially on their hands and extremities – congenital syphilis? Fungus? We weren’t exactly sure. But we fed them – or at least attempted to. The little one I chose to assist was unable to make eye contact me and his spasticity seemed to prevent any hope of his consuming the rice and sauce that I offered. It was very frustrating to see a little one such as this – so tiny and frail, and yet, so totally unable to benefit even from this small gesture we were attempting to provide. I can’t imagine how the nuns who worked there managed to see to the needs of all of these little lives every day. Apparently some of the parents come back to reclaim their children after they’ve recovered, and most of the staff are trained nurses or midwives. Nevertheless, the work they have is daunting. But the experience for us, even in its brevity, was very rewarding.
This experience also brought to mind some comments made by our host last night about the varying degree of sustainability in projects launched here in Haiti. It looks like Haitian Health Foundation is really interested in building the infrastructure of Haiti’s health care delivery system, and I’m excited to learn more about the organization and its health agents.
I won’t bother you all with a summary of the market we visited in the afternoon though it was fun to weave about the stalls, skipping over mud puddles and exploring the chicken feet section while steering well clear of the cleaver in the midst of separating them from the rest of the bodies. We had a good time, though the oranges are still bitter and one must definitely bargain for a deal.
The day ended with meeting one of our translators for tomorrow (another big day) and packing over 300 individualized hygiene packets for the young women we will be screening tomorrow. The work went quickly – probably because it was a lot of fun – and I know I learned a ton today that will help me both now, and I hope, in the future, though the word “humility” comes to mind.
Good night and thanks for reading the blog! Comments to us are welcome!
Roosters crow at all hours
Posted Tuesday, February 27, 2007 9:41 AM
Just a quick post before breakfast - yesterday was full but wonderful. We started off the day at HHF, hearing about the incredible project they've begun here - I can't go into all of the details but suffice to say this is the most impressed I've been with an NGO in a long long time. They have community buy-in and have made a tremendous dent in the cases of pediatric pneumonia, as well as several other illnesses, through their efforts. And most of the work in the field has been carried out by community health workers, which to me - having that continued active participation, monitoring and evaluation, is just astounding.
The hospital we toured afterwards was actually much more than I had expected, in spite of the obvious needs.
Then we headed off on another bumpy mountain road towards the village of Moron (pronounced, "moh-roahn") where we hosted the first of our health and hygiene fairs for a veritable mass of teenage women who had been recruited by their community health workers to participate. They laughed at our skit (thankfully - though not surprising considering how ridiculous, in some ways, our actions must seem to them given the language and cultural barriers), and they sat their stoically while I gave them their tetanus shots. The girls were screened for heights/weights, BP, hemoglobin level, and tetanus. Upon successful completion of the stations they each received a bag - full of donated supplies such as washcloths, soap, shampoo, and perhaps the errant bottle of toothpaste.
Their smiles were also beautiful, and I marveled at how well they composed themselves in the face of uncertainty (many had never had a BP cuff around their arm before and tetanus shot does not translate too well in any language to girls of 15 years). We were exhausted by the end but having screened between 120-180 girls, we were very happy. The health workers who work with the women also looked on - it was nice to know that when we referred the girls for low blood iron or blood pressure, they'd be there to follow up. All in all a terrific day - plus we got to tour the hospital, a bush sugar distillery, and Sant Lespwa!
Now off for another trip!
Quick post
Posted Wednesday, February 28, 2007 9:35 AM
Quick post before we head out - my body aches from the bumpy car rides but its better than walking those roads all the way home!
Yesterday was another amazing day. It started out with a demonstration of the "KOMBIT" home-based life-saving skills - we watched Haitian animators act out normal deliveries - and when something goes wrong - and how they and their villages mobilize to save the lives of women in distress without the help of emergency medical services like we have in the States. Their testimonials about times when women in their villages were actually hemorrhaging and they acted quickly to save their lives were really moving - and it gives one a sense that the project here is really working.
After that we headed back over to the orphanage to play with the children and do a skit on hand-washing. Imagine us singing (best we could) in Creole about the way we wash our hands with dozens of toddlers - all ages. They were adorable and seemed to get into it (at least the older ones who are in that "pleasing" stage). The younger ones were just happy to get to play around with some balls and pipe cleaners we brought and I'm sure we were once again an amusing site for all.
A few of us (me included) then got to hop across the street to a hospice run by nuns that caters to women who are terminally ill or otherwise ostracized from their families. We came armed with stickers and nail polish and before you knew it we were having a "spa day" - cutting their fingernails (badly needed in many cases), painting their toenails and adorning their fingers, faces, arms, and pretty much anyplace else they wanted with stickers. They seemed truly happy to have us there - and the nun was a bit relieved herself as she had recently arrived from India and - in response to our fledgling greetings in Creole and French - asked, "Um, do any of you speak English???"
The day wrapped up with another health fair - this time in Marfranc. We were a bit more organized this time - things went smoothly - and seeing as how we identified several girls with very abnormally high BPs and low Hgb (6.1 in one case), I think we did something valuable - of course this was all possible thanks to the health workers who set it all up and without them and the infrastructure of HHF we might simply be on a tourist journey. Its really been brought home to me how important it is for those who wish to help here to partner with agencies like HHF - so you're building the services rather than reinventing the wheel and then picking up and leaving after a couple weeks.
On the way back into Jeremie we stopped by the wharf just in time to watch an over laden boat with Haitians literally hanging off the sides of it begin to pull away from the pier. The thing didn't really look seaworthy for a swimming pool, much less the 12-19 hour journey to Port-au-Prince, but that's okay. They seemed content to ride the waves on what could only be described as a tin circus afloat (so many colors and people and animals and packages, etc)...apparently our host (who is also an anthropologist) has made the same journey so I guess it’s possible.
OK others are waiting so I'll go - thanks for checking out the blog and please comment if you wish!
a really bad road
Posted Thursday, March 01, 2007 12:28 AM
So today we took a really really bad road up a really really really steep hill (like my English major skills?). This road led to Laferme (or perhaps Ferme - we were never quite clear on the name of the village). Anyways the trip renewed my faith in development work. We accompanied an American doctor who is in the process of completing her MPH and starting a clinic in a very remote region of the mountains to a series of focus groups and interviews she is conducting as part of her capstone project in the School of Public Health at Johns Hopkins. Got to practice my translation skills as we struggled to keep up with the Creole. I couldn't blame the men and women she interviewed when they responded to her favorite question - "What would you do if you were the president of Haiti to improve the country?" - with "ROADS!".
The roads here are truly unique - much much worse than anything I ever saw in West Africa - partially I think because all of the villages are perched on the sides of steep mountainsides and when it rains I can imagine the rivers that form down in these natural gullies. The Land Rovers we've been using seem to be able to negotiate just about anything - from washed out bridges to gulfs in the pavement that look like bomb blowout sites from old black and white pics of WWII. It’s not uncommon to view the skeleton of an old rusted Kia truck and other vehicles that couldn't cut it and now find themselves part of the flora and fauna that accompanies these miniature riverbeds.
Before leaving the village they sent a child of about 8 scurrying up a 20+ meter tree to cut down fresh coconuts for us. We drank the milk and used a natural spoon to scoop out the tasty white interior. Then - miracle of miracles - they produced boiled eggs with sea salt! I had hardly touched my own packed lunch and my stomach was already full. I would say I was surprised by the generosity but so far it has been the norm here.
The rest of the day was more of the same - a large community meeting with 150 pairs of young eyes peering on (the children refused to leave) and then back down the road we came... 2 hours of rocky bumpy crevices. The other former Peace Corps volunteers and I agree - kudos to anyone who could get a Trek up those things! I probably would've walked.
Haitian medicine
Posted Friday, March 02, 2007 8:51 PM
First allow me to apologize for being a day behind - but hey, its Haitian time, right?
Anyways yesterday was another exciting adventure into the mountains - this time to Bigarade where there was another "poste". This was something similar to the prenatal screenings/vaccination campaigns we used to do in Peace Corps out in West Africa, except that HHF seems to take a more comprehensive approach. Once we arrived at the village we scaled a steep hill where a hastily-constructed (or so it appeared) thatch-covered pavilion awaited just above the cemetery. (Cemeteries here are above ground, much as you see in places like New Orleans where concrete tombs encase the caskets and one can easily see the reasons for such superstition surrounding the dead as it looks like many could simply pop the top off of their tombs and greet you as you walked by). Our guide assured us that having the clinic on the grounds of the cemetery was only a problem at night when Haiti's zombies and other spirits are known to roam the forests.
There were already scores of women and babies awaiting us patiently on the hill - in spite of the chaos each seemed to know his or her place in line. We started out with BPs and weights until the rest of the Haitian team arrived, and then it was prenatal checks, pediatric evaluations, syphilis and anemia tests, and baby-weighing. Many of the women are hard to get a good stick on - their hands are already so callused from years of rough labor. One of the Haitian health workers pulled me aside because I speak French and sat me down at the pediatric assessment table. Pretty soon I was filling out comprehensive assessment forms as mothers presented their babies - some just a few months - others already a couple of years old, and sought guidance. The health workers have been trained to recognize signs and symptoms of certain pediatric ailments common to this area - pneumonia, anemia, malaria, typhoid, etc. Upon finding a probable case they'll consult a standardized book of treatments and then refer the woman to a nearby pharmacist (set up on a rickety card table under the shade of some trees), who'll give them enough medicine to tide them over until they can seek primary care at the clinic or hospital.
We were having a grand old time assessing these children - some with common colds, others with what appeared to be more serious cases of pneumonia or malaria - when the health worker handed me a pad of white paper. His question was simple, "So what do you want to write for this?” "Whoa!” I said, snapping back into Nurse Practice Act mode (not to mention student nurse mode) - "We can't write prescriptions. That you'll have to get one of your people to do". It took me back to the days in Mali when people assumed that because I was a foreigner and had some schooling I was obviously capable of diagnosing and prescribing just as you would see a family nurse practitioner or general specialist do. Not that it isn't one of my goals, someday, but still.
Luckily there were others who were able to step up to that task and in the end I'd like to think our assessments (really, the assessments of these lay health workers), were able to catch some of the more serious but treatable cases of pediatric illness which otherwise might have gone untreated until much graver circumstances intervened. With people so isolated and high up into the mountains, it’s easy to see how a case of pneumonia might not necessarily warrant a trip all the way down to the city if you didn't have a bona fide health worker giving you the official okay to make that investment. It’s really quite a system they have - and the people, as always, were terribly gracious and kind.
Today was spent at the actual Haitian Health Foundation - we observed as one of their doctors - a man who actually came from the city of Jeremie before getting his medical degree - treated the endless streams of people young and old who arrived on the doorstep of HHF seeking what they knew to be some of the best medical care available in this region of the country. Patients were treated with respect - it was quite heartening to actually watch the doctor lock the door to the office when performing an exam or asking sensitive questions - and the people had infinite patience. He's a diabetes specialist, and I was surprised not only by the number of cases of diabetes and hypertension he treated today, but the fact that in a country with such poverty where electricity is a luxury - much less refrigeration - Diabetes Type I patients manage to survive and even thrive! We saw a broad range of conditions - his office actually reminded me of something akin to an American community hospital ER - and those who couldn't pay were often sponsored or taken care of in other ways. All in all, I think I'm going to leave with a better impression of Haitian medicine (at least the medicine and nursing practiced by this project) that I ever had coming in.
Well its dark now - the sun is setting and the ocean is growing mistier in the distance - so I think I'll go for now. But keep checking for more updates!