photographic evidence

The waterfall at Saut d´eau. It´s a welcome sight after working at the clinic in the country and sweating for 40 hours straight.

Bonny and his sister trying to get the donkey out of the mud. On the way from their house to the main road so we coulod catch a tap-tap back to Croix-des-Bouquets.
Loading up the donkey with avocados and sugar cane to sell in Croix-des-Bouquets.

The whole clan at the rural clinic: Jorge, Leo, me, Bonny´s sister and brother, Bonny in the front row, and Fernando next to him.

Leo and me doing consultations. That you see on the desk behind the patient is the pharmacy for the day. These people are so far away from any medicine or doctors, this is all they can get.

another story

I don´t want to tell the whole story of what happened here last Tuesday, since I don´t know how much of this story I am permitted to recount. But I will give the basics and the occurrences after the event.

Eight days ago, during triage, we let a woman into the clinic and, while we were finishing triage, (which typically takes 45 minutes to an hour to do a brief once-over of all the children and adults) someone came outside and said one of the patients died inside. The doctors and I, of course, ran inside and found that, indeed, a woman had died. We all agree that she most likely had some serious health problems already; she was 26, but could have passed for 14, which is a major indicator of a long-standing illness. She may have had AIDS, she may have had a congenital problem, she may have had developmental delays. Whatever the problem, she died inside the walls of the clinic, without a doctor present. This is where the problems started for us.

The doctors are here with America Solidaria and this organization wanted to take this opportunity to readjust how it was operating at the clinic, so they pulled the doctors out of the clinic for the rest of the week, and so far all of this week. Last week, I also had two days off, since I find it very difficult to do my job without the doctors around. Friday, I let in patients for wound cleaning and blood pressure checks, since I can do that, for the vast majority, without the necessity of doctors or medications. This week, only one day with patients, and yesterday and today, we did inventory (which, I feel compelled to say, is probably the best thing we could have done with this obligatory ´free time´. We are finding medications that expired two, three, four years ago and I laughed when I found SteriStrips that had an expiration date of 1983. Where they came from, we can only imagine. The clinic opened in 1998, FYI). Tomorrow, if all goes as planned, the doctors will be back and can do consultations with patients again.

I don´t want this to be the only story for this post, since it seems so dreary to me. Last weekend was a welcome break, with the clinic being re-shuffled. I was invited by Carlos, one of the seminarians living here, to go to the beach with Father Edison and the rest of the students here on the compound. It is a public beach very near Port-au-Prince, only about an hour drive away (it´s probably only two or three miles, but the roads are indescribable, except to say that you never want to go more than 30 or 40 miles an hour, the potholes are sometimes hard to see. Once we got up to 65 and I felt like I was in a stowaway in a NASCAR race). It was a beautiful beach, with the expected palm trees and salty water (something which stupidly surprised me, since all oceans are salty. But in Oregon, I don´t often get wet above my knees, thus forget the taste of salty seas.), but also scrawny chickens, empty bottles floating from the beach, Bob Marley blaring from pathetic speakers, and gawking passers-by. Not many blans visit this beach, I assume. And here´s Carlos, Father Edison, and me in our swimsuits. We kind of stand out. We swim for a while, eat the rice, chicken, sandwiches, coleslaw-sort-of-thing, and King Cola, I play a very poor game of checkers with Telo, read a few pages of our chosen books, try to nap in the shade (although it´s tough, there isn´t sand, just big smooth rocks, and the sun still finds its way through the pam fronds), and generally relax and enjoy the beautiful holiday at the beach. After a few hours, we drive home, with all of us trying to sleep without bashing our heads on the ceiling or the windows when we go over the massive bumps in the road. When I get back to my room, I discover I have managed to get another sunburn (on my legs this time, not as bad as the shoulders and face like last weekend), and I take a much-needed nap.

I ended with a happy story and I am satisfied. I will write again when something else happens. Or when I manage to make fried plantains.

Always an adventure in Haiti

Well, I´ll start from Friday.

Another day at the clinic, crying children, infected wounds, etc. but it was better, because I was going, after work, to the house of the doctors I work with. We were going to eat pizza (Leo-style) and relax before heading out to one of their friend´s house, out in the country. Now, when I say out in the country, I mean it in every sense of the word.

Saturday morning, we woke up with the sun (which means about 5am here), ate a meager breakfast, got all our stuff packed for hiking and a day at a rural clinic, and walked toward Route Tabarre, the main road near the doctors´ house. We waited for a tap-tap to take all six of us: me, Dr. Leo, Dr. Jorge, Dr. Fernando, Natella (a Haitian wmoan who lives with the Chilean doctors and has been the cook and tour guide for the house for the last four years...she is marvelous), and Bonny, whose house we were going to stay at and who ran the rural clinic. He is not yet a doctor, but will be starting medical school in the Dominican Repubic in January.

We waited for a tap-tap to take all six of us, which didn´t happen, but the doctors saw a friend driving his moving van down the street, he stopped, and drove us to the tap-tap depot on the other side of town. We were bombarded with tap-tap drivers who all wanted the "blans" to take their tap-tap, because they all think that they can trick us into paying more than the fair share for a tap-tap ride. We´re blan, that´s true, but we´re not stupid.

One of the tap-tap drivers took one of our bags and threw it into his tap-tap, which was already mostly full and could maybe fit all six of us into the covered bed of the pick-up. Stuffed in, we made our way up into the hills above Port-au-Prince. I don´t know how we got up those hills, with about twenty people in the back of the unkempt car, but we made it somehow. Probably just with prayers and not much gasoline. Being jostled around for two or three hours is not much fun, but with beautiful scenery, such as the mountains in a tropical country, it is easy to forget how miserable the cities are.

Stopped finally at a widening of the road, which was the start of our trek into the jungle, as it were. At the trailhead were children dragging donkeys with spindly legs, heavy-laden with bags of charcoal or sugar cane, as well as women trying to sell mangoes and coconuts from their small farms. All six of us started walking, only Bonny knowing which way to go to reach his house. If I ever complained about hiking in the States (which I know I have...), I was getting serious pay-back for it. The roads got narrower and narrower the further we got from the road, and since it is a tropical country, there is plenty of rain and more than the fair share of mud. Leo slipped crossing one of the half-dozen swollen creek beds and his shoe was then covered with the clay-mud mixture. Natella and myself were fortunate to get a piggy-back ride from one of the men from the village (God bless him), and we continued on until we finally reached Bonny´s house, maybe a two hour hike from the road. A gorgeous hike, full of friendly people who are quick to smile and children who have never before seen a white person. It´s an eerie feeling to be gawked at by children, but they are like their parents, polite and curious and all smiles.

Bonny´s house is a small shack, made of concrete walls (quite sophisticated compared with the neighboring huts) and 2x6´s bolted together and hinged for a door. Thank goodness none of us are gaining weight, we couldn´t have fit through the door. Inside was a table with a lace cloth and bread and coffee and cheese. In his neighborhood, we were eating like royalty. We rested just long enough to eat something, then headed out again for the clinic. The clinic was just about the size of a decent size living room, with benches for the patients. We were on one side of the room, separated from the patients with a bedsheet hung from one of the cross beams, and that rectangular room separated into two rooms by another sheet. This made two exam rooms that were private enough for the patients to feel comfortable. (As a sidenote, most Haitians are not the least bit modest...they aren´t rich enough to be. When you hardly have enough money to buy materials to build a shack, let alone a place to go to the bathroom, and you have to pee in the same place as all your neighbors and bathe in the same stream as the rest of the village, you come to be very comfortable with the human body. Comfortable or indifferent.) I worked with Leo in one room and Jorge and Fernando worked in the next room. We saw patients with the flu, parasites, back pain (probably from osteoporosis or herniated discs or other preventable illnesses), consultations for birth control, and one man who I will never forget who came to see us because he had high blood pressure. I noticed he had a bulge in his mouth, like he had chew stuffed into the pocket of his gums. But he obviously did not have access to that sort of thing, so I asked him what it was, He opened his mouth and a tumor the size of his tongue engulfed the rest of his mouth. Leo told him he had to go to the hospital right away, since it may be a benign tumor or it may be cancer, we didn´t know. He seemed more concerned with the blood pressure, maybe because that was more uncomfortable than the golfball in his mouth, and he knew what would happen at the hospital...he would have to pay to get there, pay to see a doctor, pay for x-rays, pay for lab tests, and pay to come back home, without ever receiving treatment.

This is the most infuriating thing for me to see. People who have treatble diseases whose only obstacle is payment. Their lives could be saved if they could get to a hospital who would do x-rays, sonograms, consultations, diagnoses, and treatments for free. It seems like a lot, and it is, but that is for a major case. At the clinic, jsut today I saw a man who sliced open the bottom of his foot as well as the top of his big toe. It had swollen to about twice it´s normal size. He said it had been like this since September 7th, and he went to the hospital and got x-rays and medications, but he couldn´t go again because it cost too much. I don´t know if he had an infection or if he had broken any bones, and since the doctors aren´t at the clinic today, I can do very little. I can clean and bandage and say "come back on Monday to talk with a doctor". Most likely, he will have this wound on his foot for a very long time. It´s incredible the lack of medical treatment here.

But I digress. I was talking about the clinic... At around 2pm, we finished our work at the clinic. Went back to Bonny´s house, changed into our swmsuits, and took a very short walk to a stream where we swam and cooled off and enjoyed cleaning ourselves in the not-so-clean-but-oh-so-delightful water. Went back to the house for dinner and to listen to the small radio to the Colombia v. Chile soccer game. I could not understand anyof it, but by Jorge and Fernando´s reaction, I knew Chile was winning. I think the neighbors probably thought they were crazy (which they are, when it comes to Chile being in the world cup playoffs). Then to sleep on the concrete floor, all five of us side by side in a room maybe 8´wide and 10´long. Very cozy. And a bucket in the corner for a bathroom during the night.

The next morning, we headed out very early because Fernando had a fever all night and the next morning and he felt horrible. We hiked all the way back to the road, with less mud than the previous day, although we had a donkey carrying some coconuts and mangoes that Bonny´s sister was going to sell in Croix-des-Bouquets. That donkey almost didn´t make it all the way to the road, he got stuck in the mud up to his belly at one crossing, and had to be unpacked and pulled and pushed by Bonny and three assistants. Got to the road, took a moto to Sodo to play in the waterfall. On the way there, I managed to forget Leo´s advice about being careful about the exhaust pipe and I got second degree burn on my calf. Also, being stupid, I forgot to put on sunscreen and I got plenty burned, mostly on my forehead and shoulders. I look silly with a sunglasses tanline.

Enjoyed the waterfall, Fernando slpt and still felt terrible, so we took the motos to a nearby town to transfer to a tap-tap for 10 goudes (roughly 25 cents US). Then we began a new adventure. The tap-tap carried us about a mile up the winding road, the stopped because it had no water left in the engine. They can´t use radiator fluid, it´s to scarce, so they use water instead. When they opened the gasket, boiling water cam shooting in through the grate separating the cab from the bed of the moving truck. Nobody was hurt, just surprised and furious at the driver. And Fernando was trying to sleep and did not appreciate it as a wake-up call. This happened twice more as we were trying to get back to Croix-des-Bouquets, as well as a flat tire. So, three hours and 50 goudes later (they raised the price to pay for all the repairs the tap-tap needed), we were in Croix-des-Bouquets. Took another moto back to the doctor´s home, slept very well, although painfully due to the sunburn, and welt to work the next morning.

The week that followed will be in the next post, since I have already written a lot for this update. The next one will be just as interesting, I hope.