Today was a good change: took a chance to clear rubble with Hands On Disaster Response (affectionately, "HODR"). Awesome organization that mobilizes general volunteers in projects designed in partnership with local government, OCHA, and average citizens. [They've been a HUGE help in the hospital, organizing our entire inventory. We owe much to our daily HODR "runners"]
HODR was by far the first to start clearing rubble in Leogane, and remains the dominant presence in this area(yep, slow response from others..) Individual Haitians come to ask for help clearing their homes, and often work with HODR to do it. While tackling 3 locations at a time, HODR has a waiting list of hundreds.
Our site today was on a side street off Rue LaCroix. Impassable by car because people have built makeshift homes on the road. Therefore, a big part of clearing involves moving all rubble to a "dump site" where it can later be picked up by heavy machinery.
So, I spent the time running wheelbarrows of the broken concrete (approx my weight?): as we took a 18inch strip bordered tightly by a tin house and a drainage ditch, and then zig-zagged through houses to the dump pile.
Best part of the work was our helpers. Six or so neighborhood kids joining to help shovel, pick, sledge, and wheel. They smile while they sweat. We smile too. I think I sweat more than my widest smile, however.
As we load the tools in our tap-tap to drive away, look back to see what we've done. Another dent, for sure. But much to go.
Much remains under the dekombe.
Friday, April 30, 2010
Thursday, April 29, 2010
Oh, BABY!
Introducing Emily Ann, born March 12, recently returned from a monthlong stay at Miami field hospital. Abbey went to PaP yesterday to bring her home, in 110-degree swelter. Abbey's birthday today spent in the hospital with significant dehydration. But even she thinks well worth it for the kiddo! More to come on this story..
The Real Leaders
More and more over the last few days, rapidly!, have felt a changing wind here. Our Haitian partners are leading en force, taking initiative to do more than we blan can. Major challenges still, but anyone reading this would rather get vignettes than gripes:
*For the first time...finally, brought Dr. Coles to a OCHA/UN health cluster meeting. [He's our field hospital administrator, a pediatric endocrinologist who returned to Haiti after practicing in Montreal, with vision to reduce maternal and child mortality.] After report from MSF-Swiss, Dr. Gerald (Frenchman, WHO cluster lead) looked to me to update from the other hospital in town. Instead, I motion to Dr. Coles to stand up. Pretty sure Gerald smiled and winked at me: probably seeing the kid finally cede authority to those who should have had it all along.
*Williamson, our 7yo orphan(?) patient, has made good friends with the hospital housekeeper's son, who was admitted for an abcess a few days ago. Today, Mme Beaucicot, "Manuska," reported that we didn't need to feed Williamson that morning, because she had personally already fed him twice. With what? Perhaps generosity has caloric value.
*Our longest term patient went home today: Janine, partially paralyzed when she came to us with sores and skin grafts, but now wielding her walker with upper body tone that must rival the U.S. First Lady's. As we were waiting for the car we'd arranged to take her to Archaie, Janine asked me to write in her Kreyol Bible.
*...And as I did so, our hardest-working employee sat beside me. Frantzy, the "trashman," who incinerates all our waste, has told me he aspires to be a preacher. So he takes the Bible, and reads us Psalm 91. Pausing each verse to explain with animated metaphors.
On Eagle's Wings: Anba Zel Bondye
Here's to hoping something will raise us up...
*For the first time...finally, brought Dr. Coles to a OCHA/UN health cluster meeting. [He's our field hospital administrator, a pediatric endocrinologist who returned to Haiti after practicing in Montreal, with vision to reduce maternal and child mortality.] After report from MSF-Swiss, Dr. Gerald (Frenchman, WHO cluster lead) looked to me to update from the other hospital in town. Instead, I motion to Dr. Coles to stand up. Pretty sure Gerald smiled and winked at me: probably seeing the kid finally cede authority to those who should have had it all along.
*Williamson, our 7yo orphan(?) patient, has made good friends with the hospital housekeeper's son, who was admitted for an abcess a few days ago. Today, Mme Beaucicot, "Manuska," reported that we didn't need to feed Williamson that morning, because she had personally already fed him twice. With what? Perhaps generosity has caloric value.
*Our longest term patient went home today: Janine, partially paralyzed when she came to us with sores and skin grafts, but now wielding her walker with upper body tone that must rival the U.S. First Lady's. As we were waiting for the car we'd arranged to take her to Archaie, Janine asked me to write in her Kreyol Bible.
*...And as I did so, our hardest-working employee sat beside me. Frantzy, the "trashman," who incinerates all our waste, has told me he aspires to be a preacher. So he takes the Bible, and reads us Psalm 91. Pausing each verse to explain with animated metaphors.
On Eagle's Wings: Anba Zel Bondye
Here's to hoping something will raise us up...
Tuesday, April 27, 2010
Global Medicine
"Remember you are a guest in this country. You are here to listen, to learn, and to possibly respond to the issues facing this nation if you feel so moved. You are not here to judge or to intentionally or unintentionally insult or disparage people whose lives you may never completely understand or identify with. You are not here to "fix" anything.
Please do not attempt to put what you will see and experience into an American context. You are no longer in the US and viewing Haiti through that lens will frustrate you and may insult your hosts, the people of Haiti. You are encouraged to ask questions and engage in active meaningful dialogue with the people you meet. That is one way--though not the only way--to learn about life in the villages, and slums.
For those of you who like to talk and ask a lot of questions, we ask that you occasionally shut up and listen. For those of you who say little but may have valuable contributions to make to discussions, we encourage you to speak up. At all times, be respectful of our people, cultures, and ways of life.
Again, welcome to Haiti. We hope you enjoy your stay and that you come in right."
~Adapted from Kevin Winge's "Never Give Up"
[Written for South Africa, but I think generally applicable]
Please do not attempt to put what you will see and experience into an American context. You are no longer in the US and viewing Haiti through that lens will frustrate you and may insult your hosts, the people of Haiti. You are encouraged to ask questions and engage in active meaningful dialogue with the people you meet. That is one way--though not the only way--to learn about life in the villages, and slums.
For those of you who like to talk and ask a lot of questions, we ask that you occasionally shut up and listen. For those of you who say little but may have valuable contributions to make to discussions, we encourage you to speak up. At all times, be respectful of our people, cultures, and ways of life.
Again, welcome to Haiti. We hope you enjoy your stay and that you come in right."
~Adapted from Kevin Winge's "Never Give Up"
[Written for South Africa, but I think generally applicable]
Breaking
Today I broke two things: my first Haitian relationship and my computer. The latter was trustworthy for 5+ years, recently living with battery ducttaped in place. The former something I never took seriously.
Also am struggling with a few heavier things: the operations which can simultaneously seem to be going well, but then jolt from crisis to resource crisis. And also my place in the operation. What can be done hung in balance with what should be done... competing against what is starting to occur on its own anyway.
Here's the beginning of a good story, which I hope to continue telling: on March 12, I watched our great peds anesthesiologist rescucitate a 32 week old baby in respiratory distress. Mother abandoned her the next day. She teetered through that weekend, but made it. We transferred her to the University of Miami Medishare hospital in PaP for intubation / NICU care [see Steve Seidel's notes if you're reading this on facebook]. We learned later that she had heart surgery, was extubated, and is doing well. Today, Abbey called about getting her transported back to us for further action. I talked to Save the Children about gov't processes for child abandonment, to set her up for adoption, which Abbey is researching. Can't wait to see her again...
So in broken shells, there are pearls.
Also am struggling with a few heavier things: the operations which can simultaneously seem to be going well, but then jolt from crisis to resource crisis. And also my place in the operation. What can be done hung in balance with what should be done... competing against what is starting to occur on its own anyway.
Here's the beginning of a good story, which I hope to continue telling: on March 12, I watched our great peds anesthesiologist rescucitate a 32 week old baby in respiratory distress. Mother abandoned her the next day. She teetered through that weekend, but made it. We transferred her to the University of Miami Medishare hospital in PaP for intubation / NICU care [see Steve Seidel's notes if you're reading this on facebook]. We learned later that she had heart surgery, was extubated, and is doing well. Today, Abbey called about getting her transported back to us for further action. I talked to Save the Children about gov't processes for child abandonment, to set her up for adoption, which Abbey is researching. Can't wait to see her again...
So in broken shells, there are pearls.
Sunday, April 25, 2010
Men Anpil, Chay Pa Lou
Woke up very early this morning for a run, because then had to make Mass at 7 (-ish, was a bit late). Gary was singing in the choir, for his Boy Scout troop's festival. I haven't been going to church, and find it hard to practice any kind of spirituality here. But today, it hit me.
-The overflowing congregation standing on broken tiled floor and rubble, leaning on beams that make up the temporary church structure, crowding under the tarps to avoid heat.
-Pere Marat's homily in lively call&response style: "only strong with God... pray for his will..."
-Wilfrid gave me communion, as I remembered our conversation a couple weeks ago on a drive to PaP; when he spoke of his friends lost, and his hope for the world to help Haiti rebuild.
-At the end of Mass, a second collection was taken for the parish. Clapping & loud singing as nearly everyone processed up the aisle to give some of what precious little money they have, to something they believe in. I didn't know whether to smile or cry.
At home a few weeks ago, heard an Easter Vigil homily that seemed to be anonymously all about Haiti (or so it felt to me). The priest spoke of "Easter People" who "don't deny Good Friday... but acknowledge sadness while embracing joy" and then share that joy with others. That's what permeates here: little bits of joy being shared in much sadness.
Though usually cede all medical care to the real providers, today I helped with wound clinic because things were slow getting started in that area. Debriding large gashes that remain from when the "blok tonbe" (blocks fell) three months ago. People stoic, and somehow still both gracious and graceful.
Also visited today with a pastor who runs a little orphanage. Other than some food and supplies Sean has rounded up, they have received no aid. One of the boys, 8-year-old Williamson, is in the hospital now with bad sores that never heal because he lives in filthy debris. The pastor is desperate, has tried fruitlessly to get help through many NGOs, the Cellule d'Urgence committee, and the government. A former professor, he only wants to give a fighting chance to kids whose families can't care for them. More work on this tomorrow, so hope to update with better news soon.
Pere Marat ended church today with a call & response of my favorite Kreyòl proverb.
"Men anpil" he called [with many hands]
"CHAY PA LOU!" the people responded [the burden is light]
Men anpil, chay pa lou.
-The overflowing congregation standing on broken tiled floor and rubble, leaning on beams that make up the temporary church structure, crowding under the tarps to avoid heat.
-Pere Marat's homily in lively call&response style: "only strong with God... pray for his will..."
-Wilfrid gave me communion, as I remembered our conversation a couple weeks ago on a drive to PaP; when he spoke of his friends lost, and his hope for the world to help Haiti rebuild.
-At the end of Mass, a second collection was taken for the parish. Clapping & loud singing as nearly everyone processed up the aisle to give some of what precious little money they have, to something they believe in. I didn't know whether to smile or cry.
At home a few weeks ago, heard an Easter Vigil homily that seemed to be anonymously all about Haiti (or so it felt to me). The priest spoke of "Easter People" who "don't deny Good Friday... but acknowledge sadness while embracing joy" and then share that joy with others. That's what permeates here: little bits of joy being shared in much sadness.
Though usually cede all medical care to the real providers, today I helped with wound clinic because things were slow getting started in that area. Debriding large gashes that remain from when the "blok tonbe" (blocks fell) three months ago. People stoic, and somehow still both gracious and graceful.
Also visited today with a pastor who runs a little orphanage. Other than some food and supplies Sean has rounded up, they have received no aid. One of the boys, 8-year-old Williamson, is in the hospital now with bad sores that never heal because he lives in filthy debris. The pastor is desperate, has tried fruitlessly to get help through many NGOs, the Cellule d'Urgence committee, and the government. A former professor, he only wants to give a fighting chance to kids whose families can't care for them. More work on this tomorrow, so hope to update with better news soon.
Pere Marat ended church today with a call & response of my favorite Kreyòl proverb.
"Men anpil" he called [with many hands]
"CHAY PA LOU!" the people responded [the burden is light]
Men anpil, chay pa lou.
Saturday, April 24, 2010
From the Rubble
Just walked back from the hospital, where I was talking with Charmant, one of the security guards. He described a meeting held today by Peter, our human resource manager & assistant administrator. [I'd happened to catch the tail end of Peter's meeting, not knowing it was planned, but highly impressed by the initiative.]
Charmant told me excitedly of his personal ideas on making this place better, saying the guards want good operation; they have pride in their job. I stood there, beat as a mule wanting nothing but sleep. He works day & night every chance he gets and remains animated.
Went to PaP today to pick up the new group, always a logistician's dream. 24 people and 60+ bags fit into 3 vehicles and the HSC's faithful Taihatsu truck. No bags, and even no bodies, were lost.
On the way there, rode with HSC driver Bellange and another fellow. We passed the country's single oil refinery where rows and rows of trucks are parked. [There has been an extreme gas & diesel shortage here for the last two weeks, countrywide. ND siphoned from its broken vehicles. We struggled to keep power 60% of time at hospital].
"Tèt charge," my two accompaniers said repeatedly [phrase expressing frustration & exasperation with understanding and some humor]. The problem is centralization. People don't have a way to live outside the city. How can we rebuild like that?
On the way home, I was odd man out and perched on luggage in back of the Taihatsu. I liked seeing from that angle. Things that flashed by previously keep catching me now, sometimes almost paralyzing. I worry I've become too accustomed to seeing rubble,. To seeing the camps with Canadian & US tarps, but little else. To signs still hanging that read "we need help," in English. To the slum streets of Martissant. To marchans selling their goods in slushy mud of markets. To the trash in Portail Leogane, which has been piling up for decades.
Where will it all go?
I think people like Charmant have ideas.
Charmant told me excitedly of his personal ideas on making this place better, saying the guards want good operation; they have pride in their job. I stood there, beat as a mule wanting nothing but sleep. He works day & night every chance he gets and remains animated.
Went to PaP today to pick up the new group, always a logistician's dream. 24 people and 60+ bags fit into 3 vehicles and the HSC's faithful Taihatsu truck. No bags, and even no bodies, were lost.
On the way there, rode with HSC driver Bellange and another fellow. We passed the country's single oil refinery where rows and rows of trucks are parked. [There has been an extreme gas & diesel shortage here for the last two weeks, countrywide. ND siphoned from its broken vehicles. We struggled to keep power 60% of time at hospital].
"Tèt charge," my two accompaniers said repeatedly [phrase expressing frustration & exasperation with understanding and some humor]. The problem is centralization. People don't have a way to live outside the city. How can we rebuild like that?
On the way home, I was odd man out and perched on luggage in back of the Taihatsu. I liked seeing from that angle. Things that flashed by previously keep catching me now, sometimes almost paralyzing. I worry I've become too accustomed to seeing rubble,. To seeing the camps with Canadian & US tarps, but little else. To signs still hanging that read "we need help," in English. To the slum streets of Martissant. To marchans selling their goods in slushy mud of markets. To the trash in Portail Leogane, which has been piling up for decades.
Where will it all go?
I think people like Charmant have ideas.
Thursday, April 22, 2010
Ayiti Demen
Child notes:
I returned today to be immediately greeted by Ludemilla and Oneilla, two girls who live in the camp right outside our fence. They greet me many times a day. Oneilla hugs me. Ludemilla asks for my cross necklace. She's an orphan. How do I tell her I can't because was given to me by my own parents?
Their friend, a 10-ish yr old boy, holds a rubber band on which is written "Je t'aime beaucoup." Thanked him and reciprocated.
Went for another beach run. This time danced on the sand with all the kids. As always, a crowd runs with us, but one 10yo girl stayed with me for a sold 2 miles. Barefoot. We made good conversation about how her family gets water from a drum built by an NGO, but that it ran dry yesterday. She was quite insightful about the process of drinking good water, so she and her friends don't get diarrhea.
SCHOOLS are starting again in Leogane! Uniforms everywhere (I'm trying to upload a picture, unsuccessfully). Anyway, let's support Haiti's future.
I returned today to be immediately greeted by Ludemilla and Oneilla, two girls who live in the camp right outside our fence. They greet me many times a day. Oneilla hugs me. Ludemilla asks for my cross necklace. She's an orphan. How do I tell her I can't because was given to me by my own parents?
Their friend, a 10-ish yr old boy, holds a rubber band on which is written "Je t'aime beaucoup." Thanked him and reciprocated.
Went for another beach run. This time danced on the sand with all the kids. As always, a crowd runs with us, but one 10yo girl stayed with me for a sold 2 miles. Barefoot. We made good conversation about how her family gets water from a drum built by an NGO, but that it ran dry yesterday. She was quite insightful about the process of drinking good water, so she and her friends don't get diarrhea.
SCHOOLS are starting again in Leogane! Uniforms everywhere (I'm trying to upload a picture, unsuccessfully). Anyway, let's support Haiti's future.
Ti & Gran Goave
Stayed in a hotel in Ti Goave last night, about an hour west of Leogane. I went there yesterday with ARC to tag along on another camp assessment, because ARC is trying to come into the region to do camp management, help people return home, and then work into community-based projects as they get a sense of the needs.
Interesting to experience the real humanitarian aid world. Things can move very, very quickly given willpower of sincere people leading the organizations. There's also a hoity-toity attitude of aid workers, with their badges and branded vehicles and fancy titles. I'm attracted to relief work, but not sure I want to ever assume that persona. One of the ARC folks spoke of that dilemma at lunch; she has lived in Rwanda for three years, only on a short-term stint here. "It's the difference between working and belonging."
Did the assessment in Ti Goave yesterday and Gran Goave today on the way back to Leogane. Met with the G Goave major, a friendly fellow. "Better rural schools, microenterprise with fairness, and environmental protection--with that you fix 80% of the problems here."
We found a lot of the camps have dispersed except for a couple dozen families. The camp committee leaders kept trying to tell us there were more...trying to get more help. Joe explained it well, "these people are just dirt poor, and are hoping for something, anything, before they leave." I suppose the people who left already just gave up sooner. Real help hasn't yet come to these places.
That is the disaster: acute insult on chronic misery.
I spent a good bit of time talking and playing with some kids. Told them I lived in Leogane, just visiting Ti Gwav. So one little girl said, "then come back tomorrow and make us a hospital."
"Why do you say that?" I answered (knowing the answer, of course)
"People are sick."
"What sickness do they have?"
"They eat dirt and it makes them sick."
Interesting to experience the real humanitarian aid world. Things can move very, very quickly given willpower of sincere people leading the organizations. There's also a hoity-toity attitude of aid workers, with their badges and branded vehicles and fancy titles. I'm attracted to relief work, but not sure I want to ever assume that persona. One of the ARC folks spoke of that dilemma at lunch; she has lived in Rwanda for three years, only on a short-term stint here. "It's the difference between working and belonging."
Did the assessment in Ti Goave yesterday and Gran Goave today on the way back to Leogane. Met with the G Goave major, a friendly fellow. "Better rural schools, microenterprise with fairness, and environmental protection--with that you fix 80% of the problems here."
We found a lot of the camps have dispersed except for a couple dozen families. The camp committee leaders kept trying to tell us there were more...trying to get more help. Joe explained it well, "these people are just dirt poor, and are hoping for something, anything, before they leave." I suppose the people who left already just gave up sooner. Real help hasn't yet come to these places.
That is the disaster: acute insult on chronic misery.
I spent a good bit of time talking and playing with some kids. Told them I lived in Leogane, just visiting Ti Gwav. So one little girl said, "then come back tomorrow and make us a hospital."
"Why do you say that?" I answered (knowing the answer, of course)
"People are sick."
"What sickness do they have?"
"They eat dirt and it makes them sick."
Monday, April 19, 2010
Resuscitating, Running, Remembering
All this passes too quickly for me to comprehend, or even feel. Being awakened, most often by stagnant heat, or sometimes by action--like this morning with both a late night C-section and then another early a.m. call about an older lady who died from some kind of metastatic cancer. And then work the day: talk, walk, carry, sweat. Computer at night. Pulling off my glasses for bed, I often can barely remember the day.
Wait, stop and remember:
A baby born Sunday morning, depressed. A team makes valiant efforts to resuscitate her, unsuccessful. Mother doesn't want the body, so we give them a box and 500 gds
Before that birth, a woman walks in our door in the midst of an abortion. Pills are cheap on the street. MSF is taking care of most complicated OB/GYN in the area, and reports fervently that dangerous street abortions are currently one of the most prevalent earthquake-related traumas.
But then, a couple weeks ago, I delivered two babies to happy mothers (under mentorship of a dynamic OB doc). Amazing how new life just slips out.
And rode up to Fondwa with a group in the back of John Parker's truck. Suzi packed lunch for the mountainside. [John & Suzi run the HSC guesthouse, wonderful people]. The mountains are deforested, yes. But also thick groves of banana and coffee trees. And plots of bean plants. And signs for farming cooperatives.
Ran to Plage St Luke, a fishing community, with Abbey today [she's a partner in this crazy job]. Followed by all from 4 year old boys to teenage girls. Stopped to talk with the village people once reached the beach. They know our names. I struggle to remember theirs.
We'll keep running, but hope to see more of what flashes by on the way.
Wait, stop and remember:
A baby born Sunday morning, depressed. A team makes valiant efforts to resuscitate her, unsuccessful. Mother doesn't want the body, so we give them a box and 500 gds
Before that birth, a woman walks in our door in the midst of an abortion. Pills are cheap on the street. MSF is taking care of most complicated OB/GYN in the area, and reports fervently that dangerous street abortions are currently one of the most prevalent earthquake-related traumas.
But then, a couple weeks ago, I delivered two babies to happy mothers (under mentorship of a dynamic OB doc). Amazing how new life just slips out.
And rode up to Fondwa with a group in the back of John Parker's truck. Suzi packed lunch for the mountainside. [John & Suzi run the HSC guesthouse, wonderful people]. The mountains are deforested, yes. But also thick groves of banana and coffee trees. And plots of bean plants. And signs for farming cooperatives.
Ran to Plage St Luke, a fishing community, with Abbey today [she's a partner in this crazy job]. Followed by all from 4 year old boys to teenage girls. Stopped to talk with the village people once reached the beach. They know our names. I struggle to remember theirs.
We'll keep running, but hope to see more of what flashes by on the way.
Tuesday, April 13, 2010
God gives us this
Shucks, missed Michelle Obama! But good of her to drop by.
Today, I went to a meeting for the Cellule d'Urgence et de Reconstruction de Leogane (CURL), the committee I mentioned in my last post that formed to bring local voices to this effort. I strained to use my Kreyòl to understand the French; not perfect, but am almost sure I understood this message "It is Easter, the season of rebirth. We are grateful to the blan who understand that."
We also stood for a moment of remembrance. April 12 had passed, the 3 month mark.
In the hospital later, I told a woman she had advanced breast cancer. I didn't realize I was the one to break the news, for one of the docs had passed her to me to work on referral options. In discussing these, I just mentioned it, "because you have cancer, you would need medicine after surgery." Her eyes sharpened, "O, m gen kansè?"
Apologizing, trying to be present, explained the rest: she doesn't have many options. Go home, or mastectomy with no adjuvant chemo, or find a private oncology clinic she can't afford. She explained, "I don't have money since the movement January 12. I can't know what I will have now. God gives us this."
A large tarped wooden structure went up last week, the first major building to be rebuilt in Leogane (many more trucks & heavy equipment around now, exciting!). What was it? The church, built new around the altar that survived.
I can't even imagine the faith of people around me right now. I'll never have it, but I'm glad they do.
Today, I went to a meeting for the Cellule d'Urgence et de Reconstruction de Leogane (CURL), the committee I mentioned in my last post that formed to bring local voices to this effort. I strained to use my Kreyòl to understand the French; not perfect, but am almost sure I understood this message "It is Easter, the season of rebirth. We are grateful to the blan who understand that."
We also stood for a moment of remembrance. April 12 had passed, the 3 month mark.
In the hospital later, I told a woman she had advanced breast cancer. I didn't realize I was the one to break the news, for one of the docs had passed her to me to work on referral options. In discussing these, I just mentioned it, "because you have cancer, you would need medicine after surgery." Her eyes sharpened, "O, m gen kansè?"
Apologizing, trying to be present, explained the rest: she doesn't have many options. Go home, or mastectomy with no adjuvant chemo, or find a private oncology clinic she can't afford. She explained, "I don't have money since the movement January 12. I can't know what I will have now. God gives us this."
A large tarped wooden structure went up last week, the first major building to be rebuilt in Leogane (many more trucks & heavy equipment around now, exciting!). What was it? The church, built new around the altar that survived.
I can't even imagine the faith of people around me right now. I'll never have it, but I'm glad they do.
Not by the Book
The Delco broke down Saturday, so our 24/7 climatized field hospital was without power for a longer period than the usual couple hour lapse while gas is being purchased each day. We moved all temp-sensitive meds to one room, essentially dismantled the OR, made a huge mess in the ICU (clean-up is tomorrow's project!). Our guys worked very hard in steaming heat to diagnose the problem, with the best tech in town consulting the best in the country. Heck if I know how it works; they do.
But a foreign vol approached me with better ideas, "They don't really do things by the book here, do they?" I could only glare and dash off to one of the other 5 pressing tasks.
Later this morning, had a meeting with Dr. Desir. Got to talking about the committee founded by his brother, on January 13. Since that day after, a group of local professionals have been liaising between the government, UN OCHA, and all humanitarian organizations to orient the response toward what the people here want. Desir showed me maps, described some of the forthcoming detailed plan--the vision for Leogane. Continuously, since the day after... working for their comrades struggling to survive. I sat back, in quiet awe.
Listen to us, he was emphatic. It is for us to decide.
When I accompanied Joe and American Refugee Committee on a IDP camp assessment last week, we quickly realized the aid groups in charge knew little: directing us to "priority" camps that no longer exist. The complex excel matrices, updated as of last week, are inaccurate and inefficient. In contrast, met up with a young Haitian member of a civil society organization who had handwritten reports of 110 camps in the area and guided us directly to them. Spot on.
The temptation to label Haiti as chaotic and backward is admittedly there. Sometimes things just don't work, and that's frustrating to us bleeding hearts. So I have to catch myself often: be patient, it is not for me to decide.
Let Haiti write its own book.
But a foreign vol approached me with better ideas, "They don't really do things by the book here, do they?" I could only glare and dash off to one of the other 5 pressing tasks.
Later this morning, had a meeting with Dr. Desir. Got to talking about the committee founded by his brother, on January 13. Since that day after, a group of local professionals have been liaising between the government, UN OCHA, and all humanitarian organizations to orient the response toward what the people here want. Desir showed me maps, described some of the forthcoming detailed plan--the vision for Leogane. Continuously, since the day after... working for their comrades struggling to survive. I sat back, in quiet awe.
Listen to us, he was emphatic. It is for us to decide.
When I accompanied Joe and American Refugee Committee on a IDP camp assessment last week, we quickly realized the aid groups in charge knew little: directing us to "priority" camps that no longer exist. The complex excel matrices, updated as of last week, are inaccurate and inefficient. In contrast, met up with a young Haitian member of a civil society organization who had handwritten reports of 110 camps in the area and guided us directly to them. Spot on.
The temptation to label Haiti as chaotic and backward is admittedly there. Sometimes things just don't work, and that's frustrating to us bleeding hearts. So I have to catch myself often: be patient, it is not for me to decide.
Let Haiti write its own book.
Thursday, April 8, 2010
Flooding
The ND house just flooded. Survived a 7.0 earthquake to have clogged drainage pipes. Torrent, a good foot of water on second floor, inches on first. Kristina came to get me as just starting to doze in downpour. all hands on deck: pails, brooms,
towels, mops. Sean started to rig a FEMA tarp for future runoff. Back in tent, only minor seepage.
G'night.
towels, mops. Sean started to rig a FEMA tarp for future runoff. Back in tent, only minor seepage.
G'night.
Raining, pouring
Just dashed to my tent in a downpour. Hard hard rain, feel it above, around, and below. Am dry, unlike almost everyone here. How many ways to rock and beat people?
Monday, April 5, 2010
A Longer Story
Roselin traveled 80 km to reach us, in the back of a furniture truck. A connection at a hospital in Pierre Payan asked to refer her and another patient to our hospital, saying the patients needed surgical and wound care they could not offer. I accepted.
Several men had to carry Roselin inside on an improvised plank stretcher. We learned this 30-year-old woman had been crushed in the earthquake, and paralyzed from mid-back. At some point in the horrible aftermath, she had lain for a long period without being turned, and so developed a very large sacral decubitus ulcer. Just before the transfer, her previous hospital had attempted to surgically repair her raw sore with a skin flap.
But upon first examination, our two lead surgeons found that solution hadn’t worked. Her flap was highly infected, necrotizing. So they took her straight to the OR, removed the flap, de-brided the sore. And with great creativity, they jimmy-rigged a “wound vac” using tegaderm and a suction canister. The negative pressure would keep her wound clean & drained, and potentially encourage some natural shrinkage until they could attempt another closure. An absolute best effort in a complicated situation. Still, her first days with us were precarious as she battled fever and confusion, teetering on the edge of sepsis, possibly death. “She would have died if we hadn’t gotten to her when we did,” one of the surgeons remarked.
Roselin pulled through. Her mother stayed with her most of the time, “nou pa gen lakay.” We don’t have a home. Roselin’s brother, Fezen, was also often present—clearly devoted to his ailing sibling.
And so, for more than two weeks, our nurses turned her every four hours. Cleaned around her bandaging when the vacuum seal became soiled and started to break. Propped as many pillows and blankets as we had to offer comfort. Sat with her family. Easily our most challenging patient to care for, literally back-breaking sometimes. “But she’s been my favorite patient. I love her,” one nurse said. Roselin felt the care, came to know all the nurses by name, and often tried to communicate even without an interpreter. She knew me, and I usually couldn’t pass her bed without catching her eye’s subtle beckon—must stop to talk.
But things were becoming difficult. The ulcer was getting bigger, not better: 2-cubic feet across and through her back—gaping, raw. We couldn’t offer what she needed, lifetime 24/7 care. I started making calls to all referral contacts I could find: Handicap International, Hopital Paix, Adventiste. One became promising, requesting details on her case, saying “we just need to line some things up, give you a definitive answer tomorrow.” This hospital, in Port-au-Prince, was offering to take her for wound care, and then send her all the way north to Sacra Couer in Milot, where there supposedly exists a long-term rehab program.
Several tomorrow’s past, and I gave a quick pestering call on each. Until finally a tomorrow that said “we got hit hard with urgent care last night; we just can’t take her…”
Of course, we were facing the same: more acutely ill and injured people, constantly. Perhaps the anticipated infectious disease boom has arrived, from a homeless country living in squalid camps? Perhaps we’re simply now treating the baseline injuries, burns, and ailments—things that in pre-January Haiti would likely have gone ignored? I believe it’s all still disaster relief: acute insult reveals chronic suffering.
The staff doctors conferred: Roselin’s prognosis was terminal. Even in the States, her wound might beat our best-in-the-world care. And here in Haiti, even if she survived this acute insult, what is the chronic? More bedsores, surely. More infection and suffering. No rehabilitation.
Following clinical consensus, we sat with Roeslin, mother Julienne, and brother Fezen. We explained, slowly. To the questions of what could be done, we answered that even in the “Ozetazini,” long life was probably not possible. Stopping antibiotics and aggressive treatment would be most comfortable. All pain medicine she needed. All comfort possible. I offered two options, “We can keep you here, and care for you until the end, or we can send you home.”
It was a hard moment… probably don’t need to describe.
Fezen spoke on behalf of family, needing to think and talk to each other. Of course, all the time you need. “We don’t have a home,” he reminded. I told him that if he wanted to go, we’d make them a home.
Left them over the next couple days. Roselin was quiet, sometimes murmuring to herself. Fezen stood in the entrance corridor, reading a small Bible. He then came to me: home, as soon as possible.
Found 2 tents, gave them to him the night before departure, showing how to pitch them. And called Maltesser, an NGO that has an ambulance, pleaded for its use to drive the 2 - 3 hours it’d likely take to reach Tabarre in traffic. Found a cot, pillows, sheets, kerlex and dressing coverage, pain medicine. Sent them off. In the last moment of eye contact before I stepped out of the ambulance, Roselin looked calm, but also blank.
Nothing is predictable here, and this day no different. When the Maltesser ambulance driver returned, he said “the brother told me to take her to a hospital, so I did.”
Were they trying for a hospital closer to home for her comfort care, for her dying? Perhaps. More likely the decision was hope for better treatment. And now, what? Is she being turned every four hours, and kept clean? Is she comfortable? Or is she just receiving antibiotics to keep sepsis at bay? What now?
What should have been done for her? The docs & nurses did their job, offered their very best care. So then, what should I have done?
That was a week ago. I intended to write this story on Good Friday. Now it’s a day after Easter, and I don’t see Roselin’s resurrection. I guess I just hope she somehow finds it.
Several men had to carry Roselin inside on an improvised plank stretcher. We learned this 30-year-old woman had been crushed in the earthquake, and paralyzed from mid-back. At some point in the horrible aftermath, she had lain for a long period without being turned, and so developed a very large sacral decubitus ulcer. Just before the transfer, her previous hospital had attempted to surgically repair her raw sore with a skin flap.
But upon first examination, our two lead surgeons found that solution hadn’t worked. Her flap was highly infected, necrotizing. So they took her straight to the OR, removed the flap, de-brided the sore. And with great creativity, they jimmy-rigged a “wound vac” using tegaderm and a suction canister. The negative pressure would keep her wound clean & drained, and potentially encourage some natural shrinkage until they could attempt another closure. An absolute best effort in a complicated situation. Still, her first days with us were precarious as she battled fever and confusion, teetering on the edge of sepsis, possibly death. “She would have died if we hadn’t gotten to her when we did,” one of the surgeons remarked.
Roselin pulled through. Her mother stayed with her most of the time, “nou pa gen lakay.” We don’t have a home. Roselin’s brother, Fezen, was also often present—clearly devoted to his ailing sibling.
And so, for more than two weeks, our nurses turned her every four hours. Cleaned around her bandaging when the vacuum seal became soiled and started to break. Propped as many pillows and blankets as we had to offer comfort. Sat with her family. Easily our most challenging patient to care for, literally back-breaking sometimes. “But she’s been my favorite patient. I love her,” one nurse said. Roselin felt the care, came to know all the nurses by name, and often tried to communicate even without an interpreter. She knew me, and I usually couldn’t pass her bed without catching her eye’s subtle beckon—must stop to talk.
But things were becoming difficult. The ulcer was getting bigger, not better: 2-cubic feet across and through her back—gaping, raw. We couldn’t offer what she needed, lifetime 24/7 care. I started making calls to all referral contacts I could find: Handicap International, Hopital Paix, Adventiste. One became promising, requesting details on her case, saying “we just need to line some things up, give you a definitive answer tomorrow.” This hospital, in Port-au-Prince, was offering to take her for wound care, and then send her all the way north to Sacra Couer in Milot, where there supposedly exists a long-term rehab program.
Several tomorrow’s past, and I gave a quick pestering call on each. Until finally a tomorrow that said “we got hit hard with urgent care last night; we just can’t take her…”
Of course, we were facing the same: more acutely ill and injured people, constantly. Perhaps the anticipated infectious disease boom has arrived, from a homeless country living in squalid camps? Perhaps we’re simply now treating the baseline injuries, burns, and ailments—things that in pre-January Haiti would likely have gone ignored? I believe it’s all still disaster relief: acute insult reveals chronic suffering.
The staff doctors conferred: Roselin’s prognosis was terminal. Even in the States, her wound might beat our best-in-the-world care. And here in Haiti, even if she survived this acute insult, what is the chronic? More bedsores, surely. More infection and suffering. No rehabilitation.
Following clinical consensus, we sat with Roeslin, mother Julienne, and brother Fezen. We explained, slowly. To the questions of what could be done, we answered that even in the “Ozetazini,” long life was probably not possible. Stopping antibiotics and aggressive treatment would be most comfortable. All pain medicine she needed. All comfort possible. I offered two options, “We can keep you here, and care for you until the end, or we can send you home.”
It was a hard moment… probably don’t need to describe.
Fezen spoke on behalf of family, needing to think and talk to each other. Of course, all the time you need. “We don’t have a home,” he reminded. I told him that if he wanted to go, we’d make them a home.
Left them over the next couple days. Roselin was quiet, sometimes murmuring to herself. Fezen stood in the entrance corridor, reading a small Bible. He then came to me: home, as soon as possible.
Found 2 tents, gave them to him the night before departure, showing how to pitch them. And called Maltesser, an NGO that has an ambulance, pleaded for its use to drive the 2 - 3 hours it’d likely take to reach Tabarre in traffic. Found a cot, pillows, sheets, kerlex and dressing coverage, pain medicine. Sent them off. In the last moment of eye contact before I stepped out of the ambulance, Roselin looked calm, but also blank.
Nothing is predictable here, and this day no different. When the Maltesser ambulance driver returned, he said “the brother told me to take her to a hospital, so I did.”
Were they trying for a hospital closer to home for her comfort care, for her dying? Perhaps. More likely the decision was hope for better treatment. And now, what? Is she being turned every four hours, and kept clean? Is she comfortable? Or is she just receiving antibiotics to keep sepsis at bay? What now?
What should have been done for her? The docs & nurses did their job, offered their very best care. So then, what should I have done?
That was a week ago. I intended to write this story on Good Friday. Now it’s a day after Easter, and I don’t see Roselin’s resurrection. I guess I just hope she somehow finds it.
Sunday, April 4, 2010
Mad Farmer Liberation Front
Beyond just the obvious final two words, I think this poem is a profound Easter message...:
THE MAD FARMER LIBERATION FRONT
by Wendell Berry - 1991
Love the quick profit, the annual raise,
vacation with pay. Want more
of everything ready-made. Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more. Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you. When they want you
to die for profit they will let you know.
So, friends, every day do something
that won't compute. Love the Lord.
Love the world. Work for nothing.
Take all that you have and be poor.
Love someone who does not deserve it.
Denounce the government and embrace
the flag. Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand. Praise ignorance, for what man
has not encountered he has not destroyed.
Ask the questions that have no answers.
Invest in the millenium. Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit. Prophesy such returns.
Put your faith in the two inches of humus
that will build under the trees
every thousand years.
Listen to carrion - put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world. Laugh.
Laughter is immeasurable. Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep
of a woman near to giving birth?
Go with your love to the fields.
Lie down in the shade. Rest your head
in her lap. Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it. Leave it as a sign
to mark the false trail, the way
you didn't go. Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.
THE MAD FARMER LIBERATION FRONT
by Wendell Berry - 1991
Love the quick profit, the annual raise,
vacation with pay. Want more
of everything ready-made. Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more. Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you. When they want you
to die for profit they will let you know.
So, friends, every day do something
that won't compute. Love the Lord.
Love the world. Work for nothing.
Take all that you have and be poor.
Love someone who does not deserve it.
Denounce the government and embrace
the flag. Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand. Praise ignorance, for what man
has not encountered he has not destroyed.
Ask the questions that have no answers.
Invest in the millenium. Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit. Prophesy such returns.
Put your faith in the two inches of humus
that will build under the trees
every thousand years.
Listen to carrion - put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world. Laugh.
Laughter is immeasurable. Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep
of a woman near to giving birth?
Go with your love to the fields.
Lie down in the shade. Rest your head
in her lap. Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it. Leave it as a sign
to mark the false trail, the way
you didn't go. Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.
Friday, April 2, 2010
Tout moun ap soufri grangou
[All people are suffering hunger]
Hating to follow an uplifting post with one much less so, but after just watching this video, can't but share it. Produced by Partners in Health and the Institute for Justice & Democracy in Haiti. Need to learn more, but is what I started to hear at camps a couple days ago:
Hating to follow an uplifting post with one much less so, but after just watching this video, can't but share it. Produced by Partners in Health and the Institute for Justice & Democracy in Haiti. Need to learn more, but is what I started to hear at camps a couple days ago:
Haiti IDP Camps video 2 from Adam Stofsky on Vimeo.
Thursday, April 1, 2010
Anthem: We are the World
Back in that between space, home in good ol' St. Joe. On my out, I had an early morning meeting with the MercyCorps head (courtesy of a ND connection). So Wilfrid and I hit rush hour on our way into Port au Prince, making 90 minutes into 3 hours. Conversation was pleasant, but per usual, also had the radio on.
News update turned to the opening statements of the UN conference for Haiti, during which donor countries pledged $5.3 billion immediate-term aid to a total of $9 billion. [to the skeptics: yes, there is a government plan for reconstruction available online, if you read French, and a committee co-chaired by Bill Clinton and PM Jean Max Bellerive to monitor use of disbursed funds...]
Wilfrid immediately cranked up the volume. "Our country is kraze nèt [totally destroyed]. We need to build it again." Shortly after the UN report, Radio Caribe played the remake of "We are the World." I asked Wilfrid if he knew the song. "Yes," he replied, "I heard it was made for Haiti."
Most poignant to me was when we had hit a particularly congested spot in Portail Leogane, stopped by packed lines of people on their way to a food distribution. 8 AM on the dot, every morning, the country listens to its national anthem, "La Dessalines"... remembering how they once won freedom.
News update turned to the opening statements of the UN conference for Haiti, during which donor countries pledged $5.3 billion immediate-term aid to a total of $9 billion. [to the skeptics: yes, there is a government plan for reconstruction available online, if you read French, and a committee co-chaired by Bill Clinton and PM Jean Max Bellerive to monitor use of disbursed funds...]
Wilfrid immediately cranked up the volume. "Our country is kraze nèt [totally destroyed]. We need to build it again." Shortly after the UN report, Radio Caribe played the remake of "We are the World." I asked Wilfrid if he knew the song. "Yes," he replied, "I heard it was made for Haiti."
Most poignant to me was when we had hit a particularly congested spot in Portail Leogane, stopped by packed lines of people on their way to a food distribution. 8 AM on the dot, every morning, the country listens to its national anthem, "La Dessalines"... remembering how they once won freedom.
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