A bit late...

So I finally finished posting my Haiti diary.  The trip was in the spring of 2011, so it's only 4 1/2 years late.  School got in the way (I took a quarter off to make the trip).  I guess I could make other excuses:

• The sun was in my eyes;
• There were locusts;
• I had a doctor's appointment;
• I was washing my hair;
• I was dry cleaning my dogs;
• I was washing the squirrels in the backyard;
• I overslept;
• I was trying to find a word that rhymes with 'orange';
• The dogs ate my homework;
• I got stuck on Level 10 of Angry Birds;
• I wasn't allowed to leave the table until I finished eating the broccoli; 
• I've been having flare-ups of my Cotard's Syndrome and think I'm dead.

So choose the one you like, it doesn't matter.

Haiti Reflections: Epilogue

“Is this worth it?”

I can’t tell you the number of times I heard this question.  THE question.  I heard it in the Barracks and over meals, and an awful lot on the porch during our moonlit debriefing sessions over our Prestige beer.  My answer was always yes, but I rarely said it out loud.  This was because, at the time, I couldn’t clearly articulate why I felt it was, but also because most of the time it was asked by somebody who was clearly leaning towards an answer of no, and I wanted to hear why.  Overall, these negative perceptions were born from a sense of frustration and futility.

Not too long after coming back, Shelagh and I were in Tampa.  We got together with Rich and Ginny Salkowe for dinner one night.  We got along pretty well and I wanted Shelagh to meet them, and them to meet Shelagh (“See? I told you I married Mary Poppins!”).  One new thing about Chantal came up while we ate.  We were talking about the hypertension we encountered.  Why would so many people who are malnourished or starving have such spectacularly high blood pressures?  Rich, who has an interest in geology, has a friend who is a geologist at the University of South Florida, and he asked him if there were any geologic clues.  In looking at the hydrogeology of the region, it was clear that the source of the problem was probably the drinking water.  The aquifer around Chantal has extremely high levels of sodium that will leech into the water.  The aquifer around Canon also has high levels but somewhat less than Chantal.  This would explain a lot of the B/Ps we saw and the differences between the two areas.  It also follows Haitian luck: their sources of “safe” drinking water are poisoning them.  Slowly, but surely.

The Question came up here, too, over dinner.  Was it worth it?  The Salkowes didn’t feel that it was, at least, not for them.  But from my perspective, if they hadn’t gone, the aquifer might not have been identified as the problem.  Will it get fixed any time soon?  No.  But a problem can never be fixed until its cause is found.  Rich, with his geological affinity, likely completed Step 1.  The chances that anyone else with his combination of interests will happen by Chantal are so slim as to be unimaginable.  So if his discovery of the correlation between rocks and blood pressure is remembered, then in my estimation their trip was worth it.  At the very least, his was.

Many times during our stay, Father Yves told us, “We are not here to save Haiti.  We are here to do what we can to help.”  Clearly, he was trying to temper some expectations.  And I think expectations are the source of the sense of frustration, and the sense of futility.  These expectations have both individual and cultural origins.

In listening to all those who said no in answer to The Question, I found that some of the individuals clearly went to Haiti with an idea that they were going to effect some great change.  Some clearly had the idea that, even though it was 15 months later, we were going to be providing more earthquake-related relief.  But while there was a population surge because of the quake, it was made clear to us from the outset that we were there to provide primary care.  These individuals with great change or possibly even heroics on their minds were going to be disappointed from the get go, and as a result, got frustrated.

But the origin of the sense of futility comes, I believe, from our culture.  We are Americans, and when we get sick we have a reasonable expectation that when we go to our primary care physician, we will be cured.  In the subculture of American clinicians, we are used to being part of the team that provides cures for everyone we see, or at least a fighting chance at being cured.  And therein lies the source of the overwhelming sense of futility: the lack of a cure.

The vast majority of people we saw had maladies that we weren’t going to be able to cure.  There were profound numbers of people who had chronic musculoskeletal pain, mainly because they are subsistence farmers and for them “backbreaking work” is not a cliché, it is literal.  There were people with heart failure, cancer and a host of disorders caused by malnourishment.  We weren’t going to cure any of them.  This reality was emotionally insurmountable for a few of the team because the inability to cure is considered a failure here at home.  Those who had this mindset were of the opinion that if we don’t have even a remote chance of curing, what we were doing is futile.

Most people could see past this inability to cure, knowing it wasn’t going to happen.  But the culture of American clinicians tripped some of them up with the sense of futility when they realized what help we were providing was so very limited.  They had expectations of being able to provide care based on American standards, not the harsh reality of the third world.

For those who may go to Haiti or another third world country to provide help, but haven’t been to the third world before, I would like to engage you in an empathetic exercise.  It may help you understand.

You are a Haitian, living in a remote area outside Chantal.  You are a subsistence farmer, growing the only thing that is marginally viable: rice.  To produce enough rice for you and your family to live on through the year, you must plant several acres.  It requires you to work all day, every day, bent at the waist, whether you are planting or harvesting.  The very nature of rice farming means that you will, with 100% certainty, develop chronic lower back and hip pain, probably at a very early age.  As you get older, the pain will get worse.  There is no relief and you will live with this pain.  You will also work with this pain, which will make it worse still.  There are no drug stores and you can’t afford any medicine anyway.  And there is no welfare, so if you stop working, you will starve. 

I am willing to come to you and help you as best I can, even if it’s just to provide you with a few weeks of reduced pain.  If I cannot cure you, or treat you to normal American standards of care, I will still provide you with some relief, some respite.  It is the kind thing to do.  It is the compassionate thing to do.  It is merciful.

So my answer to The Question remains yes. 

Mercy is always worth it.

Haiti Reflections: Day 8 - March 22

Sunrise from the Francois' rooftop patio

Up and fed at 0600.  Out the door to the airport at 0630.  Getting into the airport was not nearly as harrowing as getting out of it.  In fact, there was no chaos at all.  I hung out for a while with Bill, Woody and Juliet in the waiting area.  Bill and Woody were taking a different route back to Harrisburg than Juliet, so they left earlier.  Juliet and I flew to Miami on the same flight but weren’t seated near each other.  The flight was smooth and comfortable.

Juliet and I had a long lunch together as we both had long layovers.  We continued to decompress – something made easier by being on American soil, even if it was in an airport.  We had a lot of pleasant conversation that even included some trauma system shop talk.  After a couple of hours, we hugged and went to our respective gates.

The flight from Miami to Columbus was uneventful.  Since my flight time was changed and Shelagh was working, she arranged for our friends Alan and Louise picked me up at the airport.

As I was exiting the terminal, I caught a head-to-toe view of myself in the reflection of the glass doors.  I was quite a sight.  If you’re reading this, you know me and that I’ve never given a hoot about my appearance, but boy, was I rough around the edges!  Beard untrimmed for over a week, dirty hiking boots, uncoordinated shorts and t-shirt (which were only clean-ish), with my duffel bag and backpack, I was looking like a cross between ‘mountain man’ and ‘homeless.’  Alan and Louise let me get in their car anyway and mercifully took me home.

Haiti Reflections: Day 7 - March 21

The day started very early.  At 12:05 a.m., Pierre Francois came into the Barracks to wake us for the trip back to PAP.  It was now Monday and the travel restriction had been lifted.

Our luggage, now lightened significantly by the off-loading of all the supplies we brought, was loaded into the back of Father Yves’ Hilux.  I went from the Hilux back to the Barracks for one last check to be sure what I was leaving behind (sheets, scrubs, assorted t-shirts, empty duffel bag) was what I intended to leave behind.  As I was headed back, two things happened.

First, I passed a hen who was sheltering two small chicks under her.  This is her earlier in the week:

She started as I passed, and I said to her, “HA!  Doesn’t feel so great when somebody wakes YOU in the middle of your sleep cycle, does it?”  Never mind that hens don’t crow...she was barnyard fowl and fair game.

Just a few steps beyond the hen, just as I passed the women’s dorm, a colossal group-shriek came from the dorm’s open windows.  I knew instinctively that Derek’s eight-legged friend had reappeared, even before the first “SPIDER!!!  KILL IT!  KILL IT!! KILL IT!!!” was howled.  And that was howled many times over the next couple of minutes.  There was screaming, wailing and the thudding of things being thrown.  Then there was a CRACK followed by sudden silence.  Somebody had found a broom or mop and used the handle to end the excitement.  Too bad, too.  The spider wasn’t out to hurt anyone, and the noise was keeping the roosters awake.

We said adieu to the nuns who were so very good to us during our stay, climbed aboard the bus and rolled out of Chantal.  I strained to see everything of it that I could through the windows in the dark of night.  I wanted to miss nothing.

As we rolled through the darkness, most of us tried to get some extra sleep.  It wasn’t easy.  The roads wind through hills and mountains, making positioning for sleep difficult.  And when the bus had to climb a very steep hill, the driver had to turn off the air conditioner for the extra horsepower.  It didn’t get overly hot, but the sudden increase in temperature and humidity will cause you to stir from a mild slumber.

Somewhere during the trip there was a very loud bang.  We had blown one of the rear tires and the cabin began to fill with the smell of burning rubber.  We pulled over at the entrance to a heavily fortified UN compound.  The driveway was flat and well lit.  The driver got out to check the tire and many of us got out to stretch our legs.  The compound walls were formidable, clearly purpose built for defense, and topped with dense coils of razor wire.  Two guard towers were strategically positioned to cover the entry gate.

The bus had dual rear wheels and it was the inside tire that had blown.  Replacing it would take hours, which was time we didn’t have to spare for those with early flights.

Suddenly, Father Yves came flying back up the road in the Hilux.  He was in the lead when the blowout happened and, on the winding roads, it took him a couple of minutes to figure out we had been separated.  He was very agitated that we needed to get back on the bus and get out of there.  We were to just drive on the remaining five wheels.  Go!  Go!  Get back on the bus now!  We must leave!

It took a while to figure out this emphatic behavior.  When you have mechanical problems with your car in a bad neighborhood, pulling in to the parking lot of a police precinct is generally the wise thing to do.  But these aren’t law enforcement officers in a police precinct, they’re soldiers in a forward-deployed base.  They see things very differently from cops.  Our presence in their entryway could easily have been a decoy or the opening gambit of an attack.  What were in reality bleary Americans taking snapshots could have been construed as people performing reconnaissance.  It’s how soldiers think – it’s how they must think – in order to stay alive.

So on we drove for another two hours, bathed in the perfume of burning flat tire.  Even with the brief stop for the flat, the trip took 5 ½ hours.

We arrived back in PAP and went straight to the airport.  About half the team was headed out now.  There were many hugs, tears and well wishes.  As our friends disappeared into the terminal, we got on the bus and went to the Francois residence.

The home of Father Yves’ parents was really big and well appointed.  Father Yves’ father (his Dad, not another priest) was apparently a career soldier and was able to make a comfortable upper-middle class life for his family.

Front Courtyard

Living Room

Dining Room

Kitchen

Those of us staying overnight for a flight out tomorrow morning brought in our bags.  We were fed the standard Haitian breakfast, this one without PBJs.  Afterwards, we sat back and relaxed and caught up on some sleep.

Bill, Alex, Juliet and Woody demonstrating the concept of "a good kind of tired."

After our naps, we had lunch then took half of the remaining team to the airport.  Before we got there, we stopped at a local supermarket.  This is where I got my Rebo coffee.  Sadly, I didn’t get nearly enough.

Universel [sic] Super Market, a very nice grocery.

There were more tears and hugs as we said good-bye to more friends at the airport.

Father Yves took the rest of us on a wide-ranging tour of PAP so that we could visit several of the local art markets.  I bought a wooden vase at the first one, while Elena and Connie went nuts at all three of our stops.  Clearly, they both wanted to maximize all the room now available in their baggage allowance for the flight home.

At the first art market, seen below, I had an interesting encounter with the large gentleman in the blue shirt in the center of the picture.

 After I took this picture of the market, I chose to cross the street pretty much right across from him.  I noticed that he was sort of eyeing me as I crossed.  His arms were folded, as they are here, and his posture tense.  Just before I stepped onto the curb, I looked right at him, smiled, and said, “Bon jour.”  He immediately relaxed, smiled back and returned the greeting.  I got the feeling that an international incident was avoided by simply speaking half my French vocabulary.

We got to see a lot of PAP.  Here are slums being overlooked by massive walled compounds on top of the hill. 

Garbage lined the streets everywhere, a result of the debris removal policies of the government I mentioned on the first day.

After hitting the third and final art market, Father Yves took us back home.  But it took forever.  Rush hour had set in and it was a long way.  Those of us in the bed of the pickup – Juliet, Bill, Woody, Elena and I – were treated to a ride we won’t soon forget.  The potholes are bad, but there was a lot of noise and dust and exhaust from thousands of vehicles on the roads.  And the garbage...ugh!  A lot of it was being burned right at the side of the road, sometimes in barrels or dumpsters, sometimes just open in the gutter.  The smells varied from fire to fire but were uniformly repugnant.  At one point, traffic lurched to a stop and left us in a cloud of trash smoke for a minute that seemed like an eternity.  I don’t even want to begin to contemplate what we were inhaling.  The hell of it is that we were all having a great time!  We laughed and joked the whole time.

Some collapsed buildings were still there.

When we got back, I took a shower before I went to sleep.  I am not exaggerating in the slightest when I report that the soap lather in my hair was charcoal gray.

Haiti Reflections: Day 6 - March 20

Today is Sunday and National Election Day here in Haiti.  This is the first post-earthquake election that will decide the path the country will take in its recovery.  There were signs before the earthquake that Haiti was, if not recovering, at least hitting a plateau and stabilizing.  Not only did the quake devastate the country, it killed 17% of the bureaucrats who were running the programs responsible for that change.  This election is a huge deal.

Our original plan was to return to PAP today, lodge at the Francois residence there, and maybe find someplace to go for a swim.  This would allow a safe margin for the large number of team members with an early Monday morning return flight.  But we can’t go to PAP because, in the chaos that is Haiti on a good day, interdepartmental (interstate) travel has been prohibited by the government on Election Day.

We still slept in – sort of.  The frigging roosters still started at 0300 and then got really boisterous an hour later.  But I lolled comfortably on my mattress on the floor until around 0600.

I went for the excellent-as-always breakfast and the back to the Barracks for a potty stop.  Glad I did.  As I got onto the porch, I heard Fred saying, in a small voice, very plaintively, “Would you guys just kill it?  Please!  Just kill it!”  I entered the Barracks to find Fred in bed, in his sleeping bag, curled in a fetal position with his head inside the sleeping bag.  About three feet from Fred was Derek.  Derek was trying to get a picture of the object instilling such forlornness in his normally jocular friend.  It was a spider, about 5 inches across at the legs, grey and furry.  Because it was on a plain wall, there was no perspective and Derek wanted to get his hand in the picture to show that this was a really, really, big arachnid.  But every time Derek got close, the spider would scramble away.  Derek was determined to get the shot and Fred was suffering from a near-lethal attack of the willies.  I had to laugh as I passed through.

“Aww, Tim!  Please!  Can’t you kill it?” asked the melancholic med student clamped in his fetal position.

“Are you kidding?  I’m a nature photographer, Fred.  You know I can’t do that,” I replied.

Greg, Derek and Rich laughed as Fred let out something between a wail and a groan.

The creepiest thing about this isn't that it's a 5" spider,

but that it's a 5" spider with one eye.

The show was continuing as I came out of the bathroom, but our furry friend had moved into the area where my bed was, Derek close in tow.  I double-checked that my gear was all zipped up, twice, and then headed out to church (where I prayed that my permethrin-treated sheets would effectively repel Haitian mega fauna). 

Derek reported that he eventually lost track of the spider as it headed into the area between the top of the wall and the roof.  Nobody knew what happened to it after that.

Investigation on return to the States determined it to be a Huntsman spider.  It’s non-venomous.  It doesn’t spin a web, but instead takes down its prey with its speed and agility.  And when you think of it, this also describes a Doberman.  Apparently, some people welcome them in their homes because they eat vermin, such as roaches and silverfish.  Derek could easily have wound up grappling with the thing and losing a digit in the process.  And like a Doberman, it doesn’t need venom if its bite causes you to bleed to death.

---

The Mass at Ste. Jeanne was wonderful.  I’ve been to several Catholic masses and they differ little from the Lutheran services of my upbringing.  But this was special because even though I didn’t speak a word I could feel the love through the music.

One man with a pair of bongos accompanied a children’s choir and the congregation as they sang what were likely traditional Haitian hymns.  The natural richness and beauty of the sound was moving.  It was so beautiful that I was tempted to use my camera to record some of it, violating one of my personal rules of not using my camera to intrude too far into a person’s life, which especially includes a person’s relationship with their God.  I resisted, but live with their songs in my heart.

Ste. Jeanne after the Mass

Exiting Ste. Jeanne

During the Mass, Father Yves was lavish in his praise of our work.  He spoke of how much we sacrificed to come and give them so much.  The congregation gave us a standing ovation, which none of us felt we deserved.  We had the ability to help, so we did.

Immediately after Mass, Father Yves bundled us onto the bus.  We couldn’t go to PAP today, so we were going to the beach!  Port Salut is in the same Department as Chantal, so even though it was a ways away, we could go still go there.

The trip itself was instructional.  We got to see a lot of the Haitian countryside.  Rice paddies were abundant, but the hillsides were denuded of trees, especially hardwoods.  This is one of Haiti’s critical infrastructure problems: people need to cook food to eat and the only fuel for that, especially in the countryside, is wood.  So most of the trees that don’t produce fruit are gone, chopped down years ago.  “Sustainability” is a relatively recent (and annoying) buzzword here in the US, but a concept sorely lacking, and far too late, in Haiti.

Grazing Cattle

Rice Paddies (with my mortal photographic enemy, a utility line)

This is what remains of Haiti's once-lush tropical jungles.

And then we got to Port Salut.  It is a true Caribbean beach.  Blue water – impossibly blue water – wide white sandy beach, palm trees.  The crystal clear sky was dotted with a few bright white clouds, the breezes were warm, the water was cool.  It was a truly glorious, unplanned, unintended perk of the elections.

Despite what we have seen during our time here, there is still much splendor in Haiti.

It took a few minutes...but only a few... for us to realize that this was a public beach and that we were free to be carefree beachgoers!

 

Juliet on a contemplative walk

 

Greg Ellsworth starring in Baywatch: Port Salut

Speaking of equanimity, Dr. Reeshard takes his relaxation pretty seriously.

Father Yves went out and bought us lunch.  Local catch of the day (in the most literal sense of the term) that was grilled perfectly, fried plantain, cole slaw and tomatoes.  It was a hefty plateful and was tasty as all get out.  We apparently overpaid Father Yves when we gave him 3 bucks a plate.

I actually ate one piece of fish and a slice of plantain before I took this picture.

 According to Sondi, you can get this kind of meal daily on or near any Haitian beach.

We alternately frolicked and lounged for hours on the beach (I never looked at my watch, but we were there a long time) and before sunset, we bundled back onto the bus and returned to Chantal.

Back in the Barracks, we packed and then bedded down for a few hours of shuteye.