A tale of two families

The last two days have been busy in the clinics at both CONASPEH and Carrefour. Today amidst patient after patient, I saw a mother and daughter. They looked well fed, unlike many of the people who sat before me. The girl was well dressed, getting ready for school and had some questions about her changing body. Mom was educated, employed and nursing a sinus infection. It was almost like a clinic visit in the suburbs. The encounter contrasted starkly with another mother/daughter encounter I had a week ago. Dealing with their relatively normal and benign problems, I was reminded of prolems that are harder to solve.

Last Wednesday, one of my clinic encounters filled the tiny space where I do evaluations in the Carrefour clinic when a mother and her 4 daughters filed in, all with appointment paperwork. Beautiful faces ages 7 months, 5, 7 and 11 years looked back at me under the wings of a strong and sinewy mother who had each girl step forward and explain their ailments. The faces of children here, especially those who have had to endure a less-than-carefree childhood, often look back at me with a mix of suspicion, tolerance, and experience beyond their years. I saw such with the young ladies in front of me. All had stomach pain. Despite hunting for some easily curable malady, I couldn't find any reason to suspect infections or digestive issues. The hard fact was that these girls were hungry. One small meal a day leaves hunger pains that ache in growing bodies.

During my evaluation of the mother, we discovered she had a blood sugar of 400. She knew she was a diabetic, but hasn't been able to afford her diabetic medications, which previously included both oral meds and insulin. On top of it all, now she had high blood pressure. Her collarbones jutted through her skin and she flashed me a look of "but what can I do?" painted over her face. She had 4 children who had tummy pains because she couldn't find enough money to put bread in their mouths. Medication had to take a backseat among such priorities. I couldn’t help wondering where these children will be, who rely on the love of their mother and their one meal a day, when their mom suffers complications from her illness.

The oldest child emerged from the corner, last to be evaluated. She reported belly pains much like her sisters as well as a "vaginal infection." Such reports are common complaints among young girls in the throws of puberty. They usually offer a nice way for me to talk about the natural processes of the body. I opened first with my standard history gathering questions that I've learned to deliver unbiased. In medicine you quickly learn to not judge by the cover or the age when asking questions concerning drugs, alcohol, sexual activity and education. My rote question to the 11-year-old came out like a reflex. The "yes" answer equally as matter-of-face came back at me like a bullet. It took my best doctor skills to respond like I would to any "adult" with concerns related to sexual activity. Turns out she lived for a while with her father who apparently wasn't super protective when it came to his friends and their interest in little girls.

Today when I asked my patient the same question, her well-groomed mother looked at me like I was crazy. “She’s only a child!” she retorted in disbelief. Yes, a child. However not all children are allowed to just be.

Last week wasn't the time for shock. For nausea. For righteous anger. It was time to discuss how what I thought about my 11-year-old patient’s symptoms had now changed a bit given her history; we had to investigate further.

This is not a problem unique to Haiti. In fact, early sexual experimentation, teenage pregnancy and sexual abuse of children are problems that span all continents and cultures. I delivered a baby to a mother who was 12 years old during residency, and it wasn't the first time our hospital saw mothers barely used to buying Tampax, much less diapers. But evaluating my young patient’s problem within the complex web of her other issues left me angry, especially as the mother sat helplessly by. I bristled with the injustice that this 11-year-old girl has to face hunger pains, a mother with serious chronic illness, no education, sparse opportunity, and memories of sexual abuse under the "protection" of her father. Likely this girl will eventually be left to take care of her sisters if her mother falls ill. Her childhood is long over.

Our world has its share of wounds, of suffering, of injustice and crimes against humanity. We read about them, maybe get infuriated for a moment before we busy ourselves with the routine of our lives. Maybe we get inspired for a moment, write some letters, march in protest, volunteer or work for a better pocket of the world. But we have the luxury of choosing to get involved or not. And when it gets to be too much, we can turn away.

I think of this often, when looking into the faces of the people who live in the midst of one or many headlining problems of our world. Hunger. Abuse. Child Labor. Poverty. Sex and slave trade. Lack of education, healthcare, clean water, sanitation, opportunity.

When I broke the news to the mother that her children looked relatively healthy and that I suspected their tummy aches were due to lack of food, the mother nodded in agreement. This was no surprise, no news flash. When I discussed what exams needed to be done and meds given to her eldest, she nodded with understanding. This was life as she new it, full of struggle and survival. Yet she smiled, thanked me for my time, kissed her youngest, tussled the hair of her other children and escorted them out the door to figure out how to make the best of another day of their life.

If you looked at that family, without gathering any information about their daily existence, you’d simply see a family relying on each other, loving each other. You’d see a family comprised of a protective mom and sisters who seem to look after each other well. You might even look at the 11-year-old and assumed she passed her time thinking about school lessons, her girlfriends and soccer. Often when looking one face at a time at the people here who are attempting to survive" the problems of our world,” we see less dramatics that one would expect. Then the stories come and carve an edge to the picture. The tales of trials endured make stoic warriors out of thin mothers and 11-year-olds with old eyes.

I remind myself to not allow their courage, their will to survive, their adaptability and patience lessen our my own anger at the causes of their suffering. I pray to not fall numb to the stories, or close my eyes to the injustices of our world when somedays it feels too much. And I have a new appreciation for the stories of children spared such trials. The benign and almost boring nature of my clinic visit today with mother and daughter was something worth celebrating.

Learning to Crawl

Last night, much to the joy and amazement of his parents, Solomon figured out how to crawl. (we tried to upload video, but the internet didn't like it) He has his own style, but it gets him from point A (usually a wide open space) to point B (usually something with potential danger i.e. electrical cord, unsteady chair, leafy plant, oven) quickly.

A new era has begun in parenthood.

Our child is officially mobile. ☺



I found celebrating Solomon’s new sweet skills fitting to thoughts as of late.

I don’t come by patience easily. I’m a task master, a see-a-problem-and-tackle-it kind of girl. The busier the better. So Haiti with her own pace, her own style of problem solving has provided me with a lot to learn. Over the last 9 months of language learning, cultural immersion, getting to know our co-workers and our community, Patrick and I at times feel like despite all our ideas and our energy, we are moving through the molasses of cross-cultural communication; we are in the infancy of our work. Often we feel ready to move but need first to learn the steps on how to go from sitting to motion. Like Solomon, we've been reliant on everyone around us to help us navigate our new world. And those friends and co-workers have been immensely important in teaching us how to put one knee, one hand in front of the other.

Recently I received news that Dr. Charcot accepted a job working with another organization. Let me clarify: a job that pays. So it’s a good for him, too bad for us situation. He’ll keep his toe in the loop with us and maybe volunteer with our mobile clinics every now and again, but our team has whittled back down to Miss Fano and I.

I have to admit, I was disappointed in Dr. Charcot’s news. I knew the day was coming, but I had hoped that we’d have him for a bit longer, maybe even find some funds to support him while we fed off of his energy and knowledge of the Haitian medical system. He is a great brainstormer, a hard worker, and one of those people who is ready to run with an idea the minute the meeting is over. He works fast. After he joined our "Central Committee for Health" things went from shuffling to a sprint. Our mobile clinics this summer were a bustling blur of patients and activity as we trucked and trekked from one location to another: some hidden in mountain neighborhoods, others on the plains, in barrios and in the center of the city. I really enjoyed working with him. Our pace complimented each other, and it was fun to tackle a waiting room full of people together, scratching our heads over interesting cases, offering advice back and forth, assisting each other on small procedures.

And after he left, mobile clinics slowed nearly to a stop as Miss Fano and I stepped back to re-evaluate.

The slow down has been good. We had been running all May and June, scattered all July, and now, before school starts and with new changes abound, it was time to step back and re-evaluate. Time to slow the running to more of a crawl.

Today in my CONASPEH clinic, I had a happy stream of patients all morning long. Week after week through the summer I’ve been there despite school being out, seeing one, maybe three patients in a morning. But today I enjoyed the fruits of a slow crawl summer thanks to our consistent presence. I saw a woman who I had visited in her home, who had been too sick to come in to the clinic. Today she looked strong and spirited, breathing like a champ and only concerned that she wasn’t feeling quite as strong as she did before the onset of malaria. I saw several follow-ups from our mobile clinics to re-check rashes and blood pressures. A little girl sat bravely as I cleaned out her ears, another wailed as I inspected an infected scalp. I inspected a man with typhoid and lots of the sinewy, tuff elders of the community in for blood pressure and blood sugar tests as well as Tylenol for their aches and pains.

I was smiling all day. Like my little boy, our little clinic has been growing. It certainly hasn’t been the big bang and one-day rush that mobile clinics feel like some times, with a waiting rooms full of people anxious for attention. But it’s a community clinic I’m proud of because it has grown slow and steady, full of faces of people whose trust I’m slowly earning.

This afternoon in a meeting with Francois and Miss Fano, we set out plans for our clinic re-design and laboratory. Thanks to all who helped make donations to the mobile lab. We are using part of it now, utilizing tests that can be done quickly and within the context of an office visit, putting off a few of the more technical tests until we can find an open day to set aside just for labs or better yet, a lab technician. However the lab will not only be used for medical care and outreach; it will serve as a great teaching tool for the students of the nursing school. I have my own dream of enlisting their help in our clinic outreach, manning the microscope and the urine samples. ☺

So plans continue to evolve and take shape no mater how the group changes. The work and the ideas move on.

Despite my best intentions, I tend to hit things running with a mind full of ideas, energy for projects, goals and expectations for how things will evolve. But as one friend often reminds me, life is not a sprint, its a marathon. After landing in Haiti, we've learned a language, a new culture, the context of our work and our community. We've gone from complete dependence and grown into a "crawling phase" where we are now at a place where we can speak, we can move, we can add reasonable ideas and see how they work thanks to a lot of help and insight from everyone around us. I'm thankful for the crawl. It has given me the chance take stock, to evaluate and plan anew, but most of all, to sit back and simply enjoy the work I have the honor of taking part in.


"No Mom, don't, its toooo funny. I can't stand it!"

House Call

Today one of my students approached me at CONASPEH. She wanted her mom to have a consultation, but thought she was too weak to make the long trip by tap-tap in to see me. "She is coughing hard, has had 4 days of fever, and is very weak. What medicine should I give her?" she had asked me. Instead of playing a guessing game and diagnosing based on hypotheticals, we decided to drive together to make a house call.

M lead me through a neighborhood labrynth of concrete, past houses for the employed and barely employed. We drove down roads lined by walled in homes complete with mango trees and yards, cars in the garage and heavy gates. Next door, skeletons of homes-that-once-were or never-could-be stood like crumbling lego-block structures. Often, even in these remenants of homes, a line of laundry colorfully swung in the breeze, a cooking fire glowed, and children played.

M's home was modest, but clean. The two-room home had a roof, walls on all sides, a front porch and modest furniture. No great wall separated their home from their neighbors whose accommodations were a bit more sparce, but the wall-lessness created a warm neighborhood feel: women lounging in the shade of a tree, children playing all around with balls or empty cans, running with or without clothes in the sun. We parked the car in front of the house. I had Solomon with me as Patrick was traveling to a seminary in Leogan. M promptly handed the baby to the neighbor woman who was glad to entertain him while we went and checked in on her mom.

I had to smile. There aren't many places in the world where you'd let your baby be handed to strangers and trust completely that he was in good hands. He was.

We entered a dark home and found M's mom lying on a simple cot. She was tiny, thin, and shivering with fever. But despite obviously feeling horrible, she sat up and greeted me, welcoming me into her home. A history and exam made it clear she was likely suffering from a pretty big pneumonia at the least. With M there, we examined her mother together so she could hear how the lungs didn't fill with air in the right base, but rather sounded like bubbles underwater.

Glad to have one of my best students as the caretaker of this very sick woman, we went through instructions for the antibiotics, the tylenol, the breathing medication.

As I packed up my stethescope and med bag to leave, I told the sick woman that her daughter was a good student, one of the best, and she was going to make a fine nurse. Through her feverish haze, the woman flashed a beaming smile. Clearly she was proud of her daughter, a daughter who despite it all was getting an education and would work for people in need.

I found Solomon outside the house, surrounded by the neighborhood children who were dancing and tickling him, delighting in his reaction. The woman tending to him asked me if I would give Solomon to her as a gift. "No, I love him too much." She seemed very pleased with such a response, and handed him back after two kisses on his chubby cheeks.

Driving home at the end of day, tired Solomon crashed out in his car seat after entertaining an entire neighborhood for some time, I was struck with what an amazing adventure we are on, what an incredible opportunity we are afforded.

The evening traffic was slow but steady as the tropical sun made its sleepy way toward the horizon. The golden light of evening illuminated the silhouettes of women and children on the banks of the river, washing clothes, washing bodies and splashing in the water. Along the banks of the river, lush bushes and trees rose up out of the dust, creating a cool, green oasis in the heart of the city of concrete and cars. The streets and sidewalks were filled with people heading home at the end of day, roaming through markets for an evening meal, playing dominos under an awning of a barber shop, closing up food stands and chasing away stray dogs. I became amazed all over again at the variety of things that can be carried on the head; I can imagine a great version of "I spy" to be played with Solomon when he's a little older. "I spy utensils! I spy mangos! I spy milk/fish/bread/charcoal/spaghetti/milk/water jugs/car parts!"

Over the last few months, as the newness of our placement in Haiti has worn off, we have struggled to define the work we are here to do and our place in the community we live in. We've struggled with finding a common ground in the expectations of our partners and our own expectations. We've had to readjust goals and plans and realities.

But from time to time, like driving home tonight, I am struck with awe at the adventure we are on, the incredible place we have the good fortune to get to know. Career aspirations, humanitarian efforts and spiritual growth aside, the here and now puts it all in perspective.

A blogger I follow wrote something that really spoke to me. He wrote, "“This whole thing is my own creation, and it is because of me that I am here. If I ever feel scared, I just kind of smile and take the jump. I would rather take risks and live my life in a way that’s worth protecting than to spend all my time safeguarding something that I can't enjoy.”—www.ryanrunseurope.blogspot.com.

When I remind myself that we are here because we chose to be here, that we are taking some risks for this experience, whatever it may hold, I am able to once again take ownership of the here and now, putting plans aside, goals and expectations in the future where they belong. Because life is about what we see, who we meet, the moments we spend, the spirit that catches us on a drive home and reminds us of the incredible beauty of life all around us.

Itchy irritations

I just did something that I'd NEVER do in the States: stand in line for 2 hours at the bank, only to wait for 40 minutes more at the window to PAY ONE BILL. Seriously. I want to unibomb our phone carrier, but the hard fact is that 90% of their customers buy cards, not a monthly plan... so we aren't their priority. :) Its no wonder we are always late in paying our bill. What a DAY WASTER! My walking meditation has climbed to a whole new level that I was able to do that without being an antsy, twitchy mess. And I was happy to find out that my fellow line-standers were just as roll-their-eyes annoyed as I was about throwing away two hours of their day in a line. The difference between Haitians and Americans in this instance, however, is that Haitians don't wear their annoyance all over their face, in every body movement. No toe tapping, no heavy sighs, no growling expressions. We chatted about how many people were ahead of us, how few bankers were working, and how achy our feet were, laughing about it instead. So I ponied up and tried to get rid of my "I'm American and you aren't making me happy" non-verbal communication and tried to emulate my fellow Haitian's adapt-to-the-situation persona.

I came home with a new appreciation for the automatic bill pay option from my bank, wishing there were ways I could stretch it to all parts of my life. :) "Oh, you are boring and pointless? Let me put you on autopilot!"

Last night Sol had a tossing/turning/moaning/crying-all-night night. If I had to guess, I would say it was from the heat. Even the fan didn't help much, and we only had it on for half the night because the city power is once again refusing to do its job and provide even periodic power for the city. The hum of generators all over the neighborhood is a constant. So I'm tired from my own tossing and turning, trying to find a comfy spot, trying to usher my son back to sleep, trying to focus on something other than the itchy GIANT mosquito bites that have cropped up on the inside of my thighs. It looks like I had some cross between an animal and a mosquito pinched between my legs at some point, and as it fought for its life, it apparently tried to bite its way through on either side. Of course whatever it was, it was still no match for my Mary Lou Retton hams, but still... he gave it a fair fight because I'm now toting giant raised, red, intensely itchy mountainous bumps the size of thumb prints the very place where my thighs kiss, and there is even some bruising!!! Seriously. Makes for an itchy day in the sun in a place a little uncouth to scratch. Also makes standing still in a line that inches forward at a snail's pace all the more heroic.

Ah the glamor of it all. :)

Driving Lesson

Oh what a day.

Remember those blogs about the pastor who had a horribly disabling stroke? Well he is the only administrator for the nursing school and the seminary. I.E. all files are in his office, all records, etc. Now that he is no longer in his office, we've had to try to find things in it. And omygosh what a feat it has turned out to be. First of all, I think that the pastor was having a lot of little mini strokes before the big one, given the state of his office. Being an expert organizer, I volunteered to try to make sense of the chaos... felt like a challenge that might be fun... meditative, instantly gratifying and one that could let my OCD nature soar. But today I realized that I need to clone myself about 15 times in order to get through maybe the biggest mess I've ever seen. Makes my parent's basement look like an add for the Organizer store. Keep in mind its a small office with three floor to ceiling bookshelves/file cabinets full to the brim of file folders packed with papers of no certain organization all in french, creole, or a mix of both. In fact, I think he used the file folders to more HOLD papers rather than SORT them. I spent 4 hours in the dark, dusty office, and I got through 1/2 of a shelf. I have a stack of "what the heck is this" going, and I've started a file system that myself and the director of the nursing school at least understand... so it will be slow going. I'm not sure why I made it my job except that I get twitchy around disorganization and that so many of my student's are waiting for grades because their tests, their grades (that I handed to the pastor very well organized) are all buried and jumbled in the black hole of his office.

After some meetings and a few erands, I dropped P off at home and then took off for my act of volunteerism for the day: to give my teenage translator a driving lesson. Let me just scratch that off of my list of things I'd like to do when I grow up. It was an exercise in sphincter control, Tourettes control, and faith in the afterlife. son of ah.

I guess I take it for granted that I started driving at the age of 10, sitting on my dad's lap. Hello overcorrection. Dear God, please don't hit the girl, the pot hole, the old man pushing 3 x's his weight in scrap metal, the child--oh God the little child-- the pile of rocks, the very big and very unyielding mac truck. There's a wall, and THERE's a wall, and THERE's a wall... bing bing bing like a pin ball zigg-zagging through the machine.

I finally made Frenaud show me a field we could practice in, and I aligned some rocks to help teach him to drive straight without overcorrecting... taught him a 3-point turn that we'll have to work on tightening up a bit since it took him the entire football field to get 'er done, and starting from stop on a hill. I remembered my lesson with a friend in KC who took it upon herself to teach me to drive stick, and decided to recommend her straight away for saint hood. I also remember my terror behind the wheel the first time with a car I couldn't quite figure out... so that kept most of the shriek out of my voice.

Truth-be-told and dramatics aside, F did an amazing job. He won the Most-Improved award on day one. He's a smart guy and is excited about learning, so after an hour, he could drive a straight line, turn a tight 3 point turn, and get a car up a hill with only a few spun-out rocks. I am proud of him. He's already better than some of the drivers on the streets of Port-au-Prince.

Side note, I had to learn how to go from stop to start up a hill in PaP by myself, driving out of necessity for the first time, the shear terror of hitting the space-crampers 1 inch off of each of my bumpers teaching me how to hold the clutch/accelerator in balance. Fear teaches, I tell you.

So anyway, I am home, safe, in one piece, and the Galloper is no more crappy than it was this morning. ;)

I think I deserve a very very stiff drink.