Haiti 2019

Typical street scene on our commute to work

Haiti is a confusing place. Yin and yang not only balance each other but they battle each other. It is a place filled with life (avg age 23, US 38) and a place filled with death, often of the very young (under 5 mortality in Haiti is 47/1000, US 6/1000). under 5 mortality  We have met some of the kindest, most gentle souls despite the petri dish of deep seated corruption that is brutal and pervasive. The conflict infects visitors. At one moment you think of selling it all and moving there to help those in need and a minute later you’re moving up your return flight to escape back to the comforts of home. These are not random thoughts. They grow from realty. Twice I phoned Dr. Mark, a dentist who had literally sold everything, including his practice to move to Haiti and build a hospital. You might think it may not last but that was 27 years ago. The team before ours had flown home a day early due to more planned riots protesting the price of gasoline. The price of gas had increased by order of the President to $4.75/gal, more than twice as much as most Haitian's daily income.  US issues warning about Haiti  I want to come more often and then I want never to return. The conflict is within me. Like many of the rampant tropical diseases, there is no vaccine for this infection.

St. Dominics Orphanage, goats near chicken house

Amplifying the dizziness was our movement between different worlds this visit. Our planned accommodations at the ALOM Clinic were not quite ready for its first visitors so we fell back on plan B, staying at a beachside resort.  Each night we returned to cold beers and a spectacular Caribbean sunset.  We enjoyed a full buffet dinner bathed in onshore sea breezes after a day of sweating at a dusty clinic site and a lunch of peanut butter sandwich washed down with room temperature water.  I did not want to stay at the resort because I thought it wouldn't seem right.  Wouldn't it feel indulgent, especially when so many have so little?  Then when we actually did spend the last night at the clinic, I longed for my cold beer and beautiful setting sun over the Caribbean Sea.   I don't think I'm strong enough to survive in Haiti.  It is a place only for the strongest.

Sunset at Kaliko Bay 

Returning from a mobile clinic site to the fixed clinic we entered into chaos.  A patient had just been brought in bleeding profusely from a knife wound.  He had allegedly been stabbed by his wife.  She was already in police custody and unfortunately for both of them, the good people at ALOM were unable to save him.  I was on the phone with Dr. Mark discussing options when I saw chest compressions begin.  He was too unstable for transport and an ambulance was nowhere in sight.  He had lost too much blood and units of available blood in Haiti are as likely as a snow storm.  Her assault charge was upgraded to murder.  A paper sheet was pulled up over the 25yo victim and the bloody floor was mopped.  The sterile smell of chlorox quickly masked the scent of death.  His parents came to collect his body.  The very next day Dr. Vlad was called to the women's prison to examine the wife.  She had apparently had entered a catatonic state upon learning of her husband's passing.  She refused to respond to Dr. Vlad.  The prison officials felt that she would be better cared for outside of prison so she was transported to the ALOM fixed site.  This is how we came to spend the night with her and her around the clock detail of guards as we inaugurated the conference room on our cots behind locked doors.  She and the guards were in a different room.  The morning of our departure she was once again speaking.  It is a very sad situation where everyone lost.  He lost his life.  She lost her freedom and their two month old baby lost both parents.  This event will not be reported in the paper or on the evening news.  If the AP picks it up it will be from my blog.

Kaliko Bay Resort -purple star  ALOM Clinic - yellow star

Amy saw a baby on Monday that had recently been found in a latrine.  The baby was now with an adoptive family providing care but was failing to gain weight. She prescribed higher caloric formula and recommended another weight on Friday but she didn't see the baby again.  What would the options be if there was no weight gain though? The odds are against that baby but at least it has found a supportive family.  The baby had been found by a 12yo boy.  The hero was rewarded with a year of school and a uniform by Dr. Vlad.  School is never free in Haiti.  The approximate cost for a year of school and the mandatory uniform is $70.  Hopefully the found baby will make it into one of those uniforms one day.

Amy seeing patients at Tapyo mobile clinic

I want our kids to go on these trips because I want them to have perspective.  A visit to Haiti provides perspective, especially inside healthcare delivery.  Abbey probably got more than she was expecting.  She saw a baby left for dead in a latrine.  She watched a man bleed to death.  She not only worked in triage at the mobile clinics, she was triage at one site when nurse Lucy got called back to the fixed site for a government inspection.  Abbey took blood pressures, temperatures and even did finger pricks to obtain blood sugar levels.  She recorded those vitals and passed the cards onto the waiting doctors.  This was all done without an interpreter since triage has no interpreter.  I was very proud of her and very pleased with her experience on this trip.

Abbey checks blood pressure at Arcahaie mobile clinic

One case in which all three of us participated I suspect will haunt us for sometime.  It is a 15yo boy that looks like he was just liberated from a concentration camp.  He is the thinnest person I've ever seen.  By ultrasound I detected a massively dilated stomach and no other abnormality.  What could be the cause of such a finding? Chronic gastric ulcer, post inflammatory stenosis, lymphoma, bezoar, parasite? He had actually been seen a week earlier in the clinic and had appropriately received a dose of worm medicine and a course of antibiotics.  In the US this kid would be admitted to the hospital.  A PICC line would be placed for nutrition.  A gastroenterologist would be consulted and an endoscopy with biopsies would be performed.  A pediatric surgeon would also be consulted.  I suspect a gastric bypass would be performed.  It's not that easy in Haiti though.  There is no free healthcare or free hospital.  This case is the second time that I had called Dr. Mark for advice.  He recommended a few hospitals, including Paul Farmer's in Mirebalais but said we would need to travel with the patient and to bring at least US$2000 to get the boy admitted.  We were leaving the next morning so this was impossible.  Admission often takes paying a series of bribes from guards to doctors over a series of days.  Nurses hoard supplies and then sell them to patients.  Families are required to care for their own family members inside of the hospital.  We heard many stories firsthand from people who had experienced the system from the inside.  One particularly revealing example was the US$1,000 that was needed to retrieve the body of someone's father who had passed after a short admittance to the government hospital in Port Au Prince.  I suspect he will be gone soon as he is weak and already very anemic.

Basile putting the finishing touches on another busy day at ALOM

A parallel system "providing" healthcare in Haiti is the Witchdoctor.  Witchdoctors can be found in every town and village.  If the witchdoctor recommends something, the family does it.  No questions.  These are mysterious men with feared powers.  Many times the treatments involve potions or foul smelling poultices.  Some witchdoctors though are more inventive.  We heard of a family that was dealing with a daughter with severe typhoid.  She needed inpatient care but the hospital wanted $10,000 up front.  They couldn't afford it so they sought the witchdoctor.  He said that he needed $20,000 and they needed to leave her with him for 10 days!  They raised the money.  Sometimes families sell a vehicle or a home to raise these funds.  The witchdoctor then took the woman to the hospital and paid the $10,000 but made certain that the staff knew that they only had ten days for the cure.  When the family returned, they were very pleased to find their daughter cured as promised.

Traffic circle might help this intersection

I am thankful for our wonderful hosts in Haiti, Drs.  Vlad and Merline. We bonded with the thoughtful and kind staff at the Alpha Omega Clinic, especially Junior, Sony, Mackenson, Lucy, Dr. Francise and Jude. We are grateful for the Sisters of Mercy that organize these trips.  In particular, none of this would be possible without Dr. Ellen Lawson.  We are fortunate to know her.  Her example is humbling.  She can best be described by one of our long distance cycling mantras, "relentless forward motion."  Her life experiences could fill a book or two but I expect that she'll never have the time to sit down and write one since she is always "doing." 

I suspect it will take a while to recover from this visit.  Haiti is a state of constant heightened awareness.  It pushes on you and pulls on you.  You never know quite what to expect but you're definitely getting something, a new perspective. 

Naway pita Haiti.

Thriller

We had completed the difficult task of the day. Nine people had arrived from 5 separate locations on 4 different flights and were now piling into a rented Dodge Caravan in San Juan, Puerto Rico. We loaded up google maps on multiple phones and battled our way through traffic and unmarked lanes to Vega Baja on the North Shore about an hour west of the capital. We had completed a most comprehensive tour of our rental house, which was conducted in Spanish. A few things were lost in translation which became evident as we found that we did not possess the keys to the upstairs portion of the tour, which was simply advertising for next time. Anyway, we were past all that because we were hungry! We needed food. We reloaded google maps with a target, the closest one of the two restaurants which our hostess had provided as a recommendation. We asked for four recommendations since we would have four dinners at Vega Baja but alas only two places could be suggested as suitable for us.

Our intended destination was La Casa del Pescador. Vamanos! Did I mention that we were hungry? As we approached La Casa my crew began to salivate. Pavlov would have been proud. One small problemo though. No casa. Vacant lot with a few stray dogs sí, but casa, no. We were more likely to find a missing person than to score some mofongo. I locked the doors and redirected the caravan. Perhaps it was further down the dead end. It was not. Fortunately for our Donner party, an oasis appeared, Villa Pesquera Cibuco!

We were greeted with smiles and a warm welcome.  The two largest tables were pushed together and surrounded by white plastic chairs. Sure, our table was directly in front of the DJ and the music was deafeningly loud, but that didn’t matter because we had menus. The menus were the single page laminated kind with a few sparse pictures and many words which were new to us. Our waitress only spoke Spanish but it didn’t really matter because with the volume of the music, our only chance at communicating was through sign language. In a break between songs we found out that her favorite fish was grillo (red snapper). I don’t recall everyone’s order but the overwhelming majority of our food would visit the depths of a deep fryer before arriving to satisfy our hunger. Just as poplar trees herald the comeback after a forest fire, deep fryers dominate food preparation after natural disasters. Medalla light, the cerveza of Puerto Rico, arrived along with conch fritters. The fritters were a flop. They were not the deep fried balls with little bits of conch and vegetables. They were more like a puffy empanada with soup inside but the beer was ice cold and just 77 calories per 10 oz can. The bottles of beer came with napkins stuffed into their mouths.

The kitchen was open air and directly in front of us. We saw all the happenings. Five ladies in hair nets bustled about preparing our order. To make up for the unsatisfying “fritters” we broke down and ordered fries and mozzarella sticks. They were disposed of with great efficiency. Although this was hardly embracing the local cuisine, we still had fish orders to come. Turns out there was a whole lot more to come besides our fish!

The DJ had finally recognized that our crowd was less than 75,000 and had turned the volume down to a point where we could nearly hear the person beside us. Perhaps "VJ" is a better term for this evening's maestro since he was not just playing music but was showing the accompanying music videos on a flat screen tv, behind which he was hidden.

Our food trickled in a plate at a time. By the time my whole fish snapper arrived I was hungry enough to eat it whole! The grillo exceeded my wildest expectations. It was beyond fabulous. When our waitress came by to check on my meal I gushed as enthusiastically as our language barrier and the pumping bass would allow. She pulled out her phone to show me pictures of the snapper just hours before hanging from a line held by her husband. Her husband had caught my dinner! This more than made up for the fries and mozzarella sticks.

I surveyed the table over the pile of fish bones in front of me.  I was feeling quite satisfied and by the looks of things so was my crew.  Next would come that tricky task of obtaining the check.  I figured this would take some time but it seemed that our waitress had disappeared.  I called over another waitress who had served us a few beers and she noted my request. She walked into the kitchen and the calculations commenced.  Two women worked together surveying our table and pecking away on a calculator.  It was about this time that the "clown" who had arrived earlier began his performance.  He was not in fact a clown.  He was the king of pop, Michael Jackson! 

We noticed him earlier but had no inkling of his intentions.  We had seen the chubby MJ milling about the VJ setup with pancake makeup, red lipstick and a dark suit.  My guess was that we were in for an animal balloon demonstration.  I was wrong.  We were in for the second coming of the Man in the Mirror. He now sported a fedora and was dancing to "Smooth Criminal" with a microphone.  It was not long before he was sweating more than a sinner in church.  He definitely showed off some unexpected moves for a big guy. 

It looked like he needed an iv as "Smooth Criminal" was finishing but he then launched directly into "Billie Jean"! He knew the steps.  He even showed off the moon walk! He attempted to engage our table but Abbey was having none of it.  She was not dancing with the King of Pop.  Emma, however, stepped into the humid night air and became his dance partner for a few magical moments.  After "Billie Jean" he disappeared around a corner into the dark and I thought that the show was over.  Again, I was wrong, because when he re-emerged in a red leather jacket we all knew what we were in for..."Thriller"! He did the whole zombie intro and everything.  His stamina was impressive.  The 1983 Thriller video was 13 minutes in length and this performance was true to the original. Eventually though it did end and that was the finale...at least of the Michael Jackson performance.  There was still Karaoke to come.  While MJ's fedora was passed for tips, a patron from the back took the microphone and launched into a soaring anthem.  She did not need the words scrolling on the tv screen.  People appeared to be lining up for their turns and our check was nowhere in sight.  Our original waitress then reappeared and with hair net in one hand and a microphone in the other I knew that our check would be a little bit longer in arriving at our table. She also moved about the room, having no need for the scrolling words and bouncing dot.  During a pause in the lyrics she was standing at our table and she asked Anna if we would like to go next.  Anna respectfully declined, telling the waitress that we needed to get to the grocery store before 9pm and it was already 8:30!  The check did eventually arrive and we settled up.  Anna laughed on our way to the grocery store about how lame it must have sounded as we excused ourselves from our turn at stardom.  Let's face it though, no one in their right mind was going to take the mic after those two songs and a night of reincarnated Michael Jackson!