6-Months in Haiti: A Reflection

Yesterday marks 6 months in Haiti for me.  This fact is just crazy.  Some days it feels as though I've lived here 10 lifetimes while other days I feel like I just flew in and this is a completely foreign land.

The end of October, 2010 Sean and I packed up what was left of our stuff (we sold or gave away most of it...I gave my clothes to my sister knowing that I can always get them back.  Smart huh?) into our two cars and drove from Phoenix to Livermore, CA where Sean's parents Gary and Sheila live.  We then unloaded all our stuff, sorted it into "sell", "keep in the US" or "take to Haiti" piles and re-packed for Haiti.

I took off a few days early to fly to NC to spend a few days with my sister Lisa, brother-in-law Brian and nephew Carter.  (By the way Carter is the cutest, smartest child alive in case you were wondering). At that time there was a good chance Brian would be deploying soon so I wanted to spend time with him in case I couldn't say goodbye before he left (he didn't end up deploying which let us all breathe a sigh of relief).

Sean and I were supposed to meet in Ft. Lauderdale Halloween night to fly out to Haiti the next day, but my flight to Ft. Lauderdale was cancelled and there was no way I could make our flight to Haiti so I ended up staying at my sister's two extra days while Sean flew to Haiti by himself to get things going.

I'm not sure what we were all thinking but the plan was for us to arrive and then volunteers to start arriving the very next day.  Never again will we do something so crazy.  Not only was I unable to make it to Haiti with Sean, but his AT&T phone wouldn't work. Just wouldn't work despite the fact that he had called to ensure he was on the "Haiti Plan."

So he was here all alone shouldering all of the responsibilities trying to get the house set up and make sure the volunteers had a good experience, we couldn't contact each other 'til he got a Haitian phone, the house wasn't complete and wasn't liveable, plus we didn't have any supplies.  We had a woman who was supposed to cook, clean and do laundry and she didn't really know how to do any of the above let alone cook for a big group in an unstocked kitchen.  This is all in an unfurnished house with no electricity, no power and lots of openings to the outside for rats and other night-creepers to get in.  Yuck.

While Sean was in Haiti trying to get the ball rolling, I spent 48-hours freaking out, wondering if he was OK, if he had met up with the person who was supposed to get him at the airport, etc. When I arrived Sean was a crazy-person.  He was going on pure adrenaline, was sleeping like 4 hours/night, eating once/day and I became terrified about what Haiti was going to do to him, me and us.  The house was like a construction zone and was no more finished than when we had arrived in September.   For the first three weeks Sean slept on a dollar store pool floaty and I slept on a camping mat then for the next three weeks we slept on a twin air mattress together.  We took bucket showers (read: we hauled water up from a well with a rope then carried it upstairs and dumped water over ourselves) and managed to eat at least once/day.  In reflection I think if we can make it through those first few weeks, we can make it through anything.

As it turned out we survived and now .

• The house is now liveable, we have power most days and when we don't we have headlamps with an endless supply of re-chargeable AA batteries.
• We have Haitian cell phones plus Sean's US phone now works in Haiti.
• We have satellite internet that works if there are no clouds in the sky with a battery backup for emergencies.
• We can skype and have a google voice number for texts so we can keep in touch with our friends and family members who we miss desperately. Come visit! Yes you. Come visit!
• We have running water with a water heater.  This is especially amazing and rare in Haiti and so great for someone like me who will have to bundle up after a cold shower no matter how hot the air temperature is.  I WILL get goosebumps after a cold shower.
• We eat three times/day plus snacks and if anything we desperately need our cook Dieula to cut down the portion size...she thinks a huge plate of rice is normal for someone of my size to eat.  She also tells me at least 2 times/week that I need to get bigger.  For women in Haiti, much like 80's hair, the bigger the better.  Thanks Dieula for looking out for me.  She also likes to ask if I'm pregnant and when I'm going to become pregnant and don't Sean and I want to have a baby? :)
• We have more patients than we ever thought possible in our first 6 months (well 7 now) of practicing medicine: we've seen about 1250 patients as an organization since November.  Wow!
• I've realized that I love working with kids. Love, love, love.  I don't really like working with adults unless they're cute and elderly or pregnant.  I also am not a fan of delivering babies. While this is really ironic since I work at a birth center, I've realized that births are not where it's at for me.  Birth is a very beautiful thing and I sure do appreciate midwives and their dedication to making this beautiful thing safe and wonderful for all involved but it's not what lights me up.  With that said I love playing with the babies once they come out.
• Our busy birth center is now becoming a VERY busy birth center with at times multiple births/day and we've helped to deliver around 30 babies (4 at the St. Francois hospital in November and the rest here since mid-January) and have referred countless others to have a (hopefully) safe birth at the Justinian Hospital.
• I did my first intake in Creole without the help of a translator yesterday.  Sure I couldn't ask everything I wanted to but I was excited that when i found myself in a situation where a translator wasn't available, I could get the information I needed, make a diagnosis and formulate a treatment plan.  The perfectionist in me feels like I should have been doing this months ago, but given how busy we've been and how little time we've had for Creole-study and how great our translators are, I'm just glad it happened at all.
• We've become decent at diagnosing and treating many strange diseases.  These are things we were told in our pathology and other "ology" classes that we would never see.  Never ever so don't worry about studying them.  Too bad SCNM (our school) didn't have a tropical medicine class so we didn't have to teach ourselves many of these things.  Fortunately we can read about most of them in books. 
• We have made some good connections with many of the other aid groups working our area and consider two Haitian doctors friends of our organization.  We are also in with the Minister of Health and the head of the largest nursing school in Cap.  These are all good things.  
• We've been here through several political demonstrations (including one where we had to evacuate due to limited supplies) and while that was freaking terrifying, now it's no big deal. It's like growing up in Nebraska during football season with weekly parades.  Except there are burning tires and cars with men high on cocaine holding rocks and bottles.  Pretty similar.
• I have eaten at least 5 times my weight in rice and beans and while I haven't gotten sick of it yet, I do love getting to go to La Kay for cheeseburgers and fries (just found out the beef is imported from the US...probably not grass-fed, grass-finished but at least it's not from one of the poor emaciated Haitian cows).  I don't however love when our cook decides to make spaghetti with chopped up chicken liver in it.  Sick, sick, sick.  FYI we're not supposed to eat things like livers.  It's not natural.
• I have doctored patients through several medical emergencies now and while it's still terrifying I no longer feel like I will have a heart attack.  Patient with a headache and a BP of 230/120 likely having a stroke in our post-partum room? No problem, I know what to do! Unresponsive child with vomiting/diarrhea x 3 days which is most likely cholera. I've got it under control.  
• Sean and I have each lost 20 pounds and have battled countless bouts of diarrhea, headaches, sinus infections, dehydration, cholera (yes, and yes it was on my birthday as if that wasn't a kick in the face...), worms (that came in through our feet making it so we can no longer be barefoot hippies...yes Kim and Korina we've both had "the hook") leading to anemia and we're still going strong.  I liken it to a first-year school teacher who gets every child's sneeze and sniffle.  Except here the sneezes and sniffles are Dengue fever, Malaria and cholera.  Our immune systems will be able to handle anything after this.
• In the beginning we answered people here in Spanish instead of Creole (why is it that si and wi rhyme? For someone like me with dyslexic tendencies this is so not cool.) and got funny looks but now when we try to speak Spanish we answer in Creole.  Fortunately our guard Jason speaks Spanish and Creole so if we're confused we can just go talk to him and he will understand.
• I am now comfortable with the knowledge that there are cockroaches and spiders who live in our house.  BIG spiders too.  I would not have been able to sleep if a spider was in my house in the US but here I'm just glad they're (usually) downstairs.  By the way we're not super-dirty people who's filth attracts insects, this is just normal for most places outside the US.
• We have learned to garden.  By we I mean Sean, Zeenia, some of the staff and many of the volunteers.  The only credit I can take for our plants growing is that the things I planted didn't grow so there was room for someone who knew what they were doing to plant over my non-growing plants.  I am always happy to taste-test others' successes though.
• I have officially been over 6 months without coffee and have cut my migraines down to about once/month.  For those of you who know me well, you know this is a huge improvement.  I was off of chocolate too but have started having a little since Zeenia's mom sent down peanut butter M&Ms.  Peanut butter M&Ms and Reese's Peanut butter cups are like a drug to me. I can't resist them. Can't. Just can't.
• I am striving for a balanced life and am doing yoga and meditation so I can be a calm loving wife to my husband. Chocolate helps me to be this person too.
• I have a Haitian goddaughter names Sabina who is the second cutest child alive (after Carter).  She's 4 months, has a great appetite and is super cute.

In summary this has been a time of growth in every single way imaginable and I'm so glad we took a leap and did it.  I wonder how much more evolved and settled we will be at our 1-year mark?  I hope I haven't lost another 20 pounds and had another myriad of diseases by then.

Thanks for reading,

Dokte Sarah

Pigs are Flying

A strange thing happened this weekend.  My family (mom Teri, Stepdad Tim, and maternal Grandparents Gene and Elaine) in North Dakota had a huge blizzard with 67mph wind gusts and 10 inches of snow and they lost power.  While this was happening, Sean and I were in Haiti enjoying near-constant power at the birth center.  Pigs somewhere must be flying because not only is it strange for us to have power this much but it's even more strange when people in the US lose power.  It's big news. Here it's a daily occurrence and is completely normal.  Many of our neighbors never have power.  Ever.  The fact that our house is hooked up to power is a big deal.  The fact that our house is painted on the outside means we pretty much live in a palace.  My grandparents spent their time without power sitting in front of their fireplace roasting hot dogs on sticks.  Grandma said is was very romantic. :)  They were invited to their neighbors' house who has a generator but they declined because the family has 5 kids and certainly didn't need two more people, she said.  I remember blizzards as a kid being so bad the entire car would be buried in our driveway.  Fortunately this storm wasn't that bad and the temperatures did not get below zero so they were lucky.

My Grandpa Gene having his morning coffee amidst the snow.

  I'm thanking my lucky stars I don't have to put up with snow and that when we lose power, it's if anything too hot rather than too cold.

Thanks for reading,

Dokte Sarah



Yesterday was my Goddaughter Sabina's baptism.  Her mother stopped over a couple of days ago and said that it was my job to dress her so they would be stopping by and then we would go to the ceremony together.  I really had no idea what to expect but when I saw her, she was dressed up like a cupcake.

Sabina (didn't get a good shot of her face), her godfather and I.

When we walked in to the ceremony, I discovered that a wedding was going on at the same time.  Not just a wedding but a mass wedding for 27 couples!  Apparently an American pastor pays for a wedding once/year for couples in Haiti who can't afford a wedding of their own.  He pays for everything from suits, to dresses, to bouquets, to veils, to gloves!  It was really a beautiful thing to witness though i can't imagine getting married with so many other people around.  Somewhere in the middle of the ceremony they had three babies come up front (including Sabina), held them up and spoke words of blessing over them.  Apparently it wasn't an actual baptism but a dedication.

The couples sat in chairs directly across from each other and the wedding guests sat or stood wherever they could.

I love the 80's wedding dresses. :)

After the ceremony, Sabina's parents invited myself and Santo (who had accompanied me to translate) to a celebration.  They fed us maccaroni salad, chicken and soda. Unfortunatley we couldn't stay long because it was getting dark and there aren't street lights or anything where we live so when it's dark it's pitch black.  After we got home, Sabina's mom came by to give me my godmother's gifts: two slices of pizza (I have no clue where they found pizza in Haiti), two huge pieces of cake, and two bottles of soda.  It was a very sweet day and I felt so honored to be included.

Sabina's parents.

Parents and godparents with the special little lady. Doesn't she look sweet? Her dress was really hot though, poor thing.

Today Zeenia and I ventured into Cap by ourselves for the first time.  We were so proud of ourselves for getting onto a tap-tap, finding our way to the Justinian hospital, finding our meeting location and then finding a copy shop to pick up some documents we had dropped off on Wednesday.  We met with Eyleen from Meds and Food for Kids who showed us around the Medika Mamba program in the Pediatric ward of the Justinian.  We got to observe how kids are weighed, measured and she walked us through the forms we'll need to use in order to have a program at our clinic.  While we were sitting outside two mangos fell from a tree so Zeenia and Eyleen got to eat them.  Nothing like fresh mangos!  After the tour, we hitched a ride with two of Eyleen's co-workers and got a tour of the MFK factory!  It's really cool to see how they turn Haitian peanuts into medicine for Haitian babies. :)  After the tour she gave us all the materials we'll need to get started with our own Medika Mamba program.  Thanks so much to those of you who donated towards this program.  I'll keep you posted with progress.

Peanuts drying in the sun to avoid aflatoxin.

Peanut sorting machine.

I'm also going to post some pictures of the shade house pics up close for you to see.  I just can't believe how fast things have grown!

That's all for now.  Thanks for reading!

Dokte Sarah

Plants, Motorcycles and Paintings, Oh My!!

It's Easter Sunday and since Haitian traditions are vastly different from American ones (mostly because American traditions typically involve spending a lot of money on food and other things that won't be enjoyed past that day), it doesn't feel like a holiday the way Christmas didn't feel like a holiday.  I don't know what time of year it feels like but with no seasons and no real holiday celebrations to mark the time I often get confused as to which month and especially which day it is.  I made brownies since the power was on and I hear we're having fish to eat which everyone but me is excited about.  The staff members are excited because they could choose to either take the day off or to work and get time and a half pay.  Most of them are working and eating brownies.

We've had a few exciting things happen this week aside from Easter so here are some pictures with explanations

Our garden is growing like crazy! Not just the plants which have been in the ground a couple of months but the ones in the shade houses too!

View of the right half of the garden.

The view of the left half of the garden.

This is one of the new shadehouses Joe, Jaime and Ron built for us. Seriously folks, these plants were put in the ground a little over a week ago!  Things grow so well down here. 

Sean bought himself a brand-new motorcycle which he is learning to ride.  He is taking lessons from  a Haitian mototaxi driver which he said is like learning to swim from a Navy SEAL.  He took me out for a ride out in the country last night and did a great job!  We are in the market for a second helmet for me as well as knee and elbow pads which he absolutely must wear each time he goes out (my orders) because drivers in Haiti are crazy.  Like legit crazy.  I'm really happy for him as this has been a dream of his for a long time and am happy for me because I get to ride along and get to actually leave the birth center once in a while.  After not having a car for over 3 months, it's been feeling a bit like a jail.

This beauty is yet-to-be named but we anticipate many hours of fun and freedom in our future.

This week we had our friend Lucien (not our former employee for those of you in the know) come to visit us with things to sell as he does every week or two.  He is a very talented artist and told us his wife is in the hospital and her meds are really expensive so he was wondering if we could do something to help him raise more money.  So Sean had the idea to have him paint a painting here at the birth center so we could photograph the process and then have the painting taken to the US to be auctioned off at the Benefit Cruise our organization is holding May 13th!  He did a MamaBaby theme and it turned out really well.  We really don't want to send it to the US but I suppose he can probably paint us another one to have in our birth center.  I was really amazed that he painted the whole thing in just a few hours!

Isn't this beautiful? Lucien is the guy on the left and the guy on the right is his assistant (he mumbled his name when he said it all three times I asked so I didn't catch it) who is about 15 and is very talented. Both are self-taught artists.

Tomorrow were are hoping to go to the beach which will consist of a 1 hour ride in a taxi each way with fresh seafood, fruity drinks, white sand and clear blue water.  I'll try to post pictures in the next few days.

Thanks for reading!

Dokte Sarah

Where There Is No Diaper

Caution: This post isn't for the faint of heart.  If bodily fluids gross you out, stop reading.  Continue readingat your own risk.

Being a doctor who works with kids, it's inevitable that you will get peed on, pooped on, slobbered on, snotted on and vomited on at some point in your career.  In school when Dr. Mitchell my attending physician on several of my pediatrics rotations informed me of this, I noted it but since it never once happened to me during school I admit, I didn't really believe her.

Since living in Haiti there has been an ABUNDANCE of bodily fluids landing on our floor.  Fortunately the entire house has a tile floor so it's easy to clean up but still shocking each time it happens.  At least once a week a baby will pee while it's here for a visit and it's not wearing a diaper so it goes all over our floor.

I learned long ago not to judge a book by it's cover and since moving to Haiti I've learned that just because a baby has a super-frilly dress complete with a headband and frilly socks on does NOT mean that child has a diaper on and so I should NOT just pick up the child unless I want to get peed on.  This is an important lesson all of you should learn if you ever come to Haiti.

Also about once a week a child vomits all over our floor too.  Just out of nowhere we're doing an intake and "bhhhlllaaaatttt" there it is.  I wish the parents would tell us right away the child's been vomiting so we can get a trash can ready.

We also have some women who pee in our showers instead of the toilet when we send them to the bathroom for a urine sample because they're not used to using a toilet.  This makes me sad as it brings the realities of Haiti to the forefront: there are no decent places to do your business (you're lucky if you find even a latrine) so grown women are to scared of our toilets and opt for squatting in the shower instead.  I wonder how we can get them more comfortable with the toilets because nobody likes pee in the shower.  Please let me know if you have any ideas.

The other night we were hanging out upstairs after dinner when Santo came up and said there was an "emergency visit" here to see us.  Sean, Zeenia and I must have been bored because all three of us went down to investigate.  We found a young mom and her 6 month old, afebrile son who presented with several bouts diarrhea and vomiting over the past 24 hours.

We knew we needed to rule out cholera so we asked the mother what the diarrhea looked like and she couldn't really give us an answer since she hadn't been caring for the child that day but she told us he was having diarrhea every 15 minutes or so.  So we thought, "great we'll wait 'til it happens and then we'll see what it looks like and then we can decide whether we need to refer him to the cholera treatment center or not".

This baby was super cute, cooing and talking to us and chewing on everything in sight.  After a few minutes we heard him fill his diaper so we asked the mom if she had another diaper with her.  She said yes and took the first diaper off.  The stool was yellow in color and loose but not super-watery with no mucous (cholera stool is sort of a dark tan color, is very watery and profuse with whitish mucous) so we knew it wasn't cholera and could just treat the child for generalized gastroenteritis.  Plus he was playing so much that we knew he wasn't so sick that he was in danger.

We said "OK you can put the new diaper on" but she just sat there with the child standing between her legs on the floor and didn't make a motion to get the new diaper.  We were all starting to get worried as this was a 6 month old with diarrhea and this is a situation where a diaper is ABSOLUTELY necessary but she was not making a motion to get a new diaper on.

I looked around her and saw she didn't have so much as a purse or a diaper bag in the treatment room and I couldn't figure out where this mysterious diaper was and why she wasn't reaching for it.  So I decided to take action and left the room to go grab her one of our cloth diapers when I heard a splat hit the floor and sure enough, this sweet little baby was having diarrhea all over our floor.  I just started shrieking "where is the diaper!?!?!" and Santo was translating this to her, and the mom still just sat there as if her child wasn't having diarrhea all over our floor.  Most moms I know will jump at the knowledge that their child is having diarrhea all over someone else's floor but not this lady.  She just sat there.

By this time it was getting dark and since the power was out and it was hard to see what was going on I knew I had to grab my headlamp as well as the diaper so this allowed for even more diarrhea to get on the floor.  By the time I got back to the room with said items, a man (must have been the baby's father) came in from the porch, with a diaper bag containing the diaper this woman had claimed to have all along.  She got the diaper onto the child's bottom and we bleached the floor like it's never been bleached before (read I put gloves on and bleached the floor...yuck) and all was well.

We still can't figure out why this woman just sat there and wasn't running for the new diaper or asking us to get it for her if she knew it was on the porch all along.  Apparently there isn't a sense of urgency relating to bodily fluids in this culture that we so obviously have in our own culture.  We ended up giving the mother some instructions on how to keep him properly hydrated and gave her warning signs of dehydration and sent them on their way.

As I say so often here in Haiti, life is NEVER dull.

Thanks for reading,

Dokte Sarah

3 Ways MamaBaby Haiti is Working to Combat Hunger

I promised you I would update you with Joe's answer to the question "Why are people in Haiti are always asking us for more money?".  He replied that it's because they live for today, don't usually plan for more than a week in advance at a time and because of this, they want to ensure that they will get as much from us as they can because they don't know when we might pick up and leave.  It made me stop to think that it's not a bad way of living.  In the US we are taught from a young age to save for a car, save for college, save for a wedding, save for kids, save for kids' college, work hard, work harder and it goes on and on.  It's exhausting and we so often forget to just live in the moment.  I'm not saying don't save your money for a rainy day or retirement but there is something to living each day to its fullest and know that tomorrow will take care of itself.

I have been so impressed and inspired by these three guys, Joe, Jamie and Ron.  They are some of the most humble human beings I have ever met.  They have been getting up at 5AM each day, working until breakfast, going back to work until lunch, taking a siesta in the hottest part of the day and then working until dinner.  This is the result of their hard work:

From Left to Right: Nancy, Ron, Jamie & Joe put the finishing touches on one of two shade houses they've built for us.

Thanks to their hard work, we now have two shade houses in our yard which provide a climate 15 degrees cooler than the outside air where we can grow delicate things like lettuce and other greens!  The cover for the shade houses allows 40% sunlight through and has holes big enough to let the rain in.  We are so excited to see what we can get to grow in them and I'll do my best to keep you updated with pictures.  The next step is to have classes with some folks in our area to teach them how to take what we are doing home with them to grow their own food for their families.  We envision providing them with seeds and tools and offering our help as problems arise.  This is one way we are working to combat hunger in our patients.

Another way we plan to combat hunger is by fundraising to buy Medika Mamba, a fortified peanut butter made by Meds and Food for Kids here in Cap-Haitien (www.mfkhaiti.org) designed to provide adequate nutrition for kids suffering from Kwashiorkor, Marasmus and other malnutrition diseases.  Currently we are able to send kids to the Justinian Hospital in Cap, but it's difficult for some of our patients to make the 90minute round trip trek once a week, especially if they can't afford the tap-tap fare (about 75 cents).  So to solve that problem we're going to receive training next week from Eyleen, a woman who works for MFK in proper re-feeding protocols and procedures.  Then we'll be able to take care of our patients right here without having to send them away.  We have the vision, we'll be receiving the training but we can still use some more money so if you'd like to make a donation towards this project, please do so here and earmark it for Medika Mamba.  Each container is 1.1kg and costs $2.50US.  We will most-likely be buying 20kg at a time for $100US.  Here are some facts from the MFK website:

What's in Medika Mamba? Medika Mamba is a RUTF (Ready-to-Use Therapeutic Food) made of ground roasted peanuts, powdered milk, cooking oil, sugar, vitamins and minerals.

How long does treatment take? A typical treatment program for one child lasts 6-8 weeks and takes 25 pounds of Medika Mamba.

How effective is Medika Mamba? Within six weeks of starting treatment, 85% of children on Medika Mamba recover, far better than the 25% survival rate with older milk-based treatments.

How much does treatment cost? $65 covers the cost of a full Medika Mamba treatment, saving the life of one child.

No amount is too great or too small to get some nourishment inside the bellies of some of our most vulnerable patients.  Please consider giving what you can today.

The third way we are trying to combat hunger among our patients is through Operation "Happy Meal" or "Manje Kontan" in Creole.  This idea was born when MBH volunteers Nancy Becker and Susan Moray saw how awful it was for our patients to sit and wait for appointments all day without having a nutritious meal.  The obvious answer was for us to provide them with food but as we have learned free food often causes riots in Haiti or at a minimum patients with fake symptoms just wanting to be fed so their solution was to provide the seed money for a woman from the community to sell healthy food inside our yard while patients are waiting so they can get healthy, safe, reasonably-priced, protein-rich food instead of eating cookies and sugary juice.  They hired Santo to be the manager and Jason (our guard)'s girlfriend (I don't know her name yet) to make and sell the food.  Yesterday was our pilot day and she sold out of everything by mid-day!  She offered rice, saucepois (bean sauce), chicken, salad, juice with NO sugar added (a very rare thing in Haiti) and bags of potable water.  We are so excited for this because it provides more money for Santo, a job for Jason's girlfriend and a good opportunity for our patients to get nutritious meals while they wait to see us.

Thanks for reading!

Dokte Sarah

Navigators in a Foreign Land

This week we are fortunate to have Joe, Jamie and Ron here with us in Haiti.  These guys have spent lots of time traveling around the world and have been to Haiti a few times.  They are good ol' boys from Missouri and have lots of great stories.  They work with an organization that takes people around the world to serve others by helping to build churches, schools, gardens and homes for people.

Joe works on sustainable food projects (he's going to teach classes to interested patients who want to learn about gardening), Ron works with clean water (we're hoping he'll consult with us on our well and how we can help get clean water to our neighbors), and Jamie likes to build.

They have come to stay with us to build us two shade houses for our garden and we are SOO excited.  This will mean we can grow plants about 15degrees cooler than the outside temperature and these plants will have a cover which will allow 40% sun and rain water to soak through.  Apparently they have built these all over Haiti and several other countries and the recipients of these shade houses have had a lot of success.

Here's a photo of Ron, Jamie and the appropriately-named Redheads Without Borders members Nancy, Eve and Susan prepping the ground for the shade houses.

Joe is sort of the ring-leader and has came to Haiti three months at a time 6 different times.  He speaks a bit of Kreole and has so many great stories to tell.  I have a feeling these guys are going to give us a lot of insight into some of the cultural things about Haiti that continue to stump me.  Sort of navigators in a foreign land if you will.

Yesterday I was talking to Joe about how much people want to be paid in Haiti since we almost always have an employee dissatisfied with their salary.  When we first came to Haiti we were advised that $100 USD/month was adequate since the average person in Haiti makes $600/year.  We have paid our employees well above that and we also provide room, board and free health care.  Yet some are still unhappy.

Joe said they will always be unhappy with what we pay.  We were cut off after he said this last statement but I plan to pick his brain to try to understand why.  Is it a cultural thing to try to get as much as you can?  Are they worried we'll pick up and leave and they'll be out of a job so they better get what they can?  Do they see our extravagant lifestyle in comparison with theirs and think they can probably get more pay?  I'll let you know what I find out when I get a chance to talk to him.

I am looking forward to this week not only so we can learn more about gardening from this trio, but so we can also have some help navigating our way through this foreign land.

Haiti is Hot and Humid

I lived in Phoenix for 4 years and tolerated temps up to and above 120 degrees.  I also have a thyroid condition which makes me colder than the average person in most situations.  When we decided to move to Haiti, I wasn't worried about the heat because of these reasons.  I failed to calculate the humidity factor and what that can do when it's over 90 degrees in the cement house where you are trying to sleep and the power is off so you can't use the AC or a fan.  It's hot here.  Really really hot.  It's only going to get worse too.  Fortunately we found a nice little (well, big really) diamond in the rough where we will be spending many afternoons this summer, I'm sure.

For just $5/person we can swim all day at this pool while enjoying cold beverages with ice made from purified water and listening to music on their great sound system to which we can hook up our ipods.  Life will be much cooler than we had anticipated while we try to help our patients without sweating all over them.

Happenings as of Late

This blog turned out to be more a weather report but it's all I can come up with now so here we go:

This week we were fortunate to have 12 students from Naturopaths Without Borders - Bastyr Chapter with us in Haiti!  Their arrival was delayed a day due to the roads being closed in Haiti the day of the elections so they missed out on a clinic day but we still managed to see about 150 patients in 4 days!

Tuesday we went to a local baptist church run by Pastor Laurore and saw over 60 patients including men, women and children.

Wednesday we were at a new site, an orphanage which houses 12 kids and feeds over 100 kids every day!  This is the orphanage that received a bag of rice a week or so ago because they struggle to feed their kids more than once per day.

When we arrived the kids sang us two songs, one in Creole and one in English.  I stood there crying, looking at their malnourished bodies thinking how is it possible that these kids can sing when they have no parents and maybe get some white rice each day with beans 2-3 times a week?  I think if I was in their shoes I wouldn't be singing and am baffled with how strong they are.

After working for a while, the pastor brought us fresh coconuts as a thank you for coming to see the kids there.  After drinking the coconut water out of a hole in the top, he broke them open for us so we could eat the yummy meat inside.  What a treat!

At the end of the day, we discussed coming back later in the week to plant a garden for them.  All in all we saw over 40 kids.  The pastor showed us a spot in his yard that would work well and we promised to return Friday or Saturday.

Thursday we stayed at our clinic to work and saw about 25 kids.  It seems as though we might be getting to a point where we won't have 100 people outside our gate each day which is something we're happy about.  It's very difficult for us to turn people away and it's no fun for our patients either.  Pastor Laurore came to translate so we had three groups of students and were able to work quickly.  Each student got to take turns being primary (under our supervision of course) even though some of them had never taken a case and reported that they had learned a great deal in doing so.

Friday the students wanted to go to the Citadelle so Sean took them since he was sick the last time we went.  I was happy to have a nice calm day to get things done and rest up a bit.  It's hard work to supervise students in a clinic. :)

Saturday was our adult clinic and since adults typically have more complaints and since the students wanted to garden at the orphanage Saturday afternoon, we kept the number to 15 patients (of course two more managed to sneak their way in so it was really 17).

After the clinic everybody changed clothes, got their gardening tools together and headed over to the orphanage.  I wasn't able to go along because I had to go pick up a new group of volunteers from the bus but they had a great time and now the pastor and the kids who live and eat there will have some fresh veggies along with their rice and beans.

The new volunteers are two students from Bastyr (5 more will come today due to some lost baggage) and midwife Kelly who comes to us from Oregon with 8 years of midwifery experience.

This morning we woke up and had breakfast and the students shared the pluses and minuses from their week here so Sean and I can make it better for the students here this week and next.  After breakfast they got in two tap-taps and drove away for the bus station.  We will pick up the other 5 students today and will have a similar schedule this week.

Thanks for reading!

Dokte Sarah

The Bigger Person

I find it hard to be the bigger person when:

...a woman brings her child to see us but her child is obviously not sick, she just wants free medicine. So we give vitamins and probiotics and gently try to reassure her that she can bring her child to us when he's really sick and we'll take good care of him.

...when a patient has symptoms of a UTI but silly you, you forgot to bring UA strips to the village clinic so you ask her to meet you at the clinic at the end of the day for a quick UA.  You then take the rest of her case and when the UA is done, you find that she DOES have a UTI.  Whens he finds out she's only getting 3 different forms of treatment, she pretends to have really severe knee pain and then a rash and then a headache and then a belly ache so that you will give her more and more medicine.

...when you try to hire a pastor to help you translate to give him some extra cash to feed his six kids and he's insulted by the $20 bill you try to hand him and tells you "if you're going to pay me, you have to pay me $30." You pay him the $30 but the next day you don't bring up the issue of payment and he leaves at the end of the day without saying a word.

...when a child is obviously reacting to the dairy in her formula because she's getting a rash, is so congested she can hardly breathe and has an ear infection.  You tell her mom that breast milk is enough but the mothers response is that you don't know what you're talking about and that SHE was fed formula when she was a baby by HER mother and she turned out alright.

...when a woman is cursing at your translator so much that he refuses to translate for her, you try to calm both of them down but she storms out yelling back at you the whole way.

...when you find out during one of your busiest days that two of your employees are possibly stealing from you.  Sure they're just sheets and sure they're taking them to family members who don't have enough sheets but couldn't they ask?  Who do you believe: the guard who wants his girlfriend to have the job of one of the women he accused or the two women, one of whom you know has stolen your treasured Ghiradelli chocolate bars in the past because you found the wrapper outside of the gate and you know your husband wouldn't littler like that.  Plus, he doesn't even like chocolate.

Recipients of Rice

As some of you remember, we have been given bags of rice (from Food for the Poor) to give to hungry patients so I thought I would write to tell you about some of the recipients.   In just a little more than 1 week, it has provided meals for over 150 people.  One family came in with their twin 2-year-old girls and it wasn’t until the end of the visit that I noticed that one of them had the faintest dusting of copper tips on her hair.  I took a closer look and yep, it was definitely one of the tell-tale signs of malnutrition so I asked the parents how things were going at home and if everyone was getting enough to eat.  The father gestured to his bandaged left hand and said he had been injured in an accident at work and had been unable to provide for his family of 10 for more than three months.  He said they didn't have enough food to go around but they were doing the best they could.  I immediately thought of the rice we had been given and knew I had to give this family as much as they could carry so they could spend any money that they did have on more nutritious things like beans and vegetables.  We also invited the father to come back to be seen at our adult clinic this Saturday so we could have a look at his hand and we gave him more rice.

A few months ago we were visited by a local pastor who told us he runs an orphanage.  He said he only has beds for 12 children but that he feeds between 100-150 kids each day and has a small school room on his property so kids in his area can have an education.  He came to ask if we would do a village clinic at his orphanage and brought us a few of the kids living at his orphanage to examine.  At that time we had several clinics scheduled with other churches and schools but I told him I would call him soon.  I was struck by how small the boys were for their age and asked him if they had enough to eat.  He said they usually can give the children rice twice a day but beans were only a couple of times per week.  Unfortunately I misplaced his phone number and had been trying to locate him all this time but then he stopped by on Wednesday of this week!   We were able to go and see his orphanage, to meet some more of the kids living there and set up a time to do a village clinic next week with the visiting ND students from Bastyr!  We also gave him a 100lb bag of rice so that maybe he can buy a few more beans for a while.

On our way home from the orphanage, we walked by Rosenaka’s house to check in and see how she and her family were doing.  Rosenaka is the sweet little 2-year-old girl that some of you may recall we thought had been a burn victim but really just had a raging case of impetigo.  Her mom, just like every time we see her praised god for what we had done for her daughter and told us how happy she was to see us.  This woman has a smile the size of Texas and the two of them are two of our favorite patients.  She told us that little Rosenaka had gotten a new kind of rash in the last few days but when she put our Ringwerbs formula on it, it seemed to be clearing up.  We asked her to come in to our clinic the next day so we could examine her and give her some more immune support.  This poor little thing just doesn’t seem to have the immune defenses she should have and seems to get really sick with every little bug that comes along.  When she came into the clinic we could tell that the rash was healing but that she had scratched at it quite a bit and that it was likely something like chicken pox or another viral exanthem (rash that comes with a virus).  I gave her a month’s worth of vitamins instead of the usual week's worth, re-dosed her vitamin A, got her on some more vitamin C, re-dosed probiotics and gave homeopathic sulphur because of the intense itching she was experiencing.   We asked her mom how many children she has and she said 6 children, 3 grandchildren and she and her husband.  That’s 11 mouths to feed.  She said they usually have white rice once per day and rarely get anything else.  So we sent them home with two Ziploc bags of rice for now since she had to carry them and her daughter and promised to deliver more soon.  I asked if she would then be able to buy beans and vegetables and she wasn’t sure but that they were grateful for the gift of rice anyway.  I’m really hoping we can get some beans with the next food shipment, especially for this family. 

If 1.5 bags of rice can feed more than 150 people, imagine what we could do with your donations.  Any amount whether $5 or $5,000 will get us closer to one day ensuring that all our patients always have enough to eat.  www.mamababyhaiti.org/donate

Thanks for reading!

Dr. Sarah

Education in Haiti

This morning as Santo and I were riding in the taxi to run errands in Cap and then to pick up Christine, our newest volunteer and American midwife, the first thing I noticed was that Haitian children go to school on Saturday even though they only go half days all week.  Santo was shocked when I told him that American kids HAVE to go to school 5 days a week, all day long from age 5 until they're old enough to drop out of high school or until they graduate at age 18.  The second thing I noticed was that a man who had to have been in his 50's was wearing the same impossibly, impeccably pressed uniform as all the school-aged children around him.  I say "impossibly, impeccably pressed" because Haiti has a ridiculous amount of dust and dirt around yet their whites are SO WHITE and everything is ironed so well they could give the US military a run for their money.  I usually feel like a slob when I pull a shirt out of my drawer and throw it on knowing full well I have wrinkles all over and my patients who eat just once a day come to see me in their Sunday best with not a wrinkle or speck of dust on them.  Anyway, back to the man going to school: He stood on the side of the road with kids 1/5 of his age waiting for a tap-tap to take him to school and it hit me that he is probably finally at a point in his life where he can afford to get an education! Maybe he came from a poor family with several children and was never able to go to school or at least not able to complete his education.  Many of our staff members have an elementary education because for whatever reason their families couldn't afford to send them to school.  From what I'm told, the cost of education goes up depending on which school you're in (Kindergarten, Primary or Secondary school) so this could be part of it, but Lucien told me it would be about 300-500 Haitian dollars per year for a student to go to school.  This amounts to between $38-$63 US dollars per year.  Our education system in the US, though it definitely has its faults, along with so many things I see here in Haiti, make me so glad that in the US we HAVE to go to school.  It also makes me so glad that we HAVE to pay taxes so we don't have craters in our roads the size of Texas and trash in our oceans and streams and on our roadways like they do in Haiti.  I know we all complain about paying our taxes, especially with April 15th looming, but maybe the next time you catch yourself complaining about it you'll remember this man and realize that if he had been born in the US, he most-likely wouldn't be going to school on this sunny Saturday.

Thanks for reading,

-Dokte Sarah

Making Headway in Combating Hunger or The Evils of Coffee

One of the biggest complaints we see in the MamaBaby Haiti clinic is belly pain.  Most of the time the root cause of this is some inappropriate food the patient is eating or simply a lack of food altogether.  We've seen babies two months of age being fed coffee and milk and it's very common for babies who's moms have plenty of milk to be fed other foods like flour and water, formula, and even rice, beans and other adult foods.  Most of the moms we see do a fabulous job of breast feeding with most babies breastfed well over the 1 year mark, but for some reason they think breast milk is not enough so they try to feed their kids other things.  We are slowly trying to change these happenings by holding education classes and of course educating individuals as they come into the clinic but at this rate it could take years to spread the knowledge to everyone.  When a child comes in with belly pain we try to find out first if it's something serious like an intestinal blockage or appendicitis (usually it is not), second if they're eating enough (usually they're not most of our patients eat 1-2 times per day) and third if the foods they are given are appropriate for their age (often they're not).  Once we determine the offending agents, we try to educate the parents (or whomever the parents asked to bring their child to the doctor that day - it's funny how often the accompanying adult is a neighbor who has NO CLUE what is going on with the child) about the changes that should be made.  Sometimes they fight us on it: "My child is ONLY drinking a cup of coffee each day."  We then tell them all of the negative effects coffee can have on their child's body including appetite suppression, poor absorption of minerals, and insomnia just to name a few they usually agree to at least give the changes a try.  9 times out of 10 those who come back say the pains went away when they removed the offending agents.  Now if we could afford to put billboards all over Haiti telling of the evils of coffee in Kreole, we'd be set.  Since we can't do that we'll just keep educating, one family at a time.

In a previous blog, I've mentioned the high prevalence of malnutrition syndromes, Kwashiorkor and Marasmus.  Yesterday we saw one of those cases:

Midwife Edie Wells with a tiny little angel.

She was 7 months old but weighed just 11lbs.  Her mom had died giving birth to her, her father didn't want her so her older sister was caring for her.  She had been surviving on flour mixed with water, cookies mashed up in milk and a sugary orange drink called Tampico.  We had received a formula donation (thanks Sue Osborne of www.nostalgic-nana.blogspot.com and friends) and were so happy to be able to give this family a whole lot of it to try to get this poor little girl out of danger.  I always have trouble sleeping after seeing a case like this struggling with the dilemma of knowing the treatment they need is more food but knowing that it's not that simple.  See, when you first come to a place like Haiti, you think that the answer is to throw money and food at every problem and don't realize that you have to go about things strategically.  When a malnourished child comes in, I could go to our well-stocked kitchen and give them some food, but then what happens when the child's mother tells others what I've done and we have riots outside our gates because other families have kids who are just as hungry?  Or when we're on the streets and a street kid comes up saying "Blan (Kreole for foreigner), give me one dollar" if I give him a dollar, a very insignificant amount of money, all his friends will be right there crowding around me grabbing at my hands and pockets wanting a dollar too and the problem will soon become a much larger one.  Riots happen all the time when aid groups such as the UN try to hand out food because it's so desperate here so we've all learned to work systematically and carefully.

I am so happy to report that we have recently been connected with Food For the Poor (www.foodforthepoor.org) a group who provides rations of food in developing countries like Haiti for hungry people and Meds and Foods for Kids (www.mfkhaiti.org), a group who makes "Medika Mamba" a fortified peanut butter made in Haiti designed for malnourished kids ages 6months - 5 years.  We received 5, 100lb bags of rice from Food for the Poor which will allow the families of our hungriest kids to use the money they would have spent on rice to buy more nutritious foods such as beans, vegetables and fruits.  In the future we are hoping to get rations of beans from this organization as well, but are so happy to have something to give.  We have not figured out yet how to dole out this food without causing a riot but we will try to do it on non-clinic days so other patients who are not so bad off won't feel jealous.  I'll try to post a blog in the next few weeks to update you on how things are going.  In the meantime, your positive thoughts, prayers, and donations (www.mamababyhaiti.org/donate) are greatly appreciated as we try to improve the lives of those who need it most

Mesi davans (Thanks in Advance),

Dokte Sarah

The Harsh Realities of Haiti: Patients Who've Tugged At My Heart Strings

I've had many questions about the types of patients we are seeing in Haiti, so I thought I'd write a blog about some of the ones who have really tugged at my heart strings.

My first week working as a licensed doctor was spent in Haiti and on my very first day a group of volunteers from MamaBaby Haiti (including a group of midwives) were volunteering at the nearby Hopital St. Francois, a catholic hospital run by our friend Father Geordani.  I felt completely unprepared for what I saw that day without my safety net that I got used to in school of a whole group of students a a doctor working on each case.  One of my first patients that day was a young pregnant mother who resembled a skeleton.  She was brought in because she was having contractions at 34 weeks.  Her eyes were sunken into her head and she didn't have an extra ounce of flesh anywhere on her body.  After questioning her, we discovered that she had been starving herself since she found out she was pregnant because she didn't have a way to feed yet another mouth.  It was finally determined that this woman was not in true labor but was likely contracting due to dehydration.  The nurses gave her an IV and we spoke to her about the possibility of putting her baby up for adoption when the time came.  Eventually the contractions stopped but we have no way of knowing what ended up happening to this suffering mama and her poor baby.

The next little patient is a sweet little baby girl named Sabina Mae. Before she was born her mother had come to see me for a couple of prenatal appointments since we didn't yet have a midwife on staff.  I taught myself how to use a doppler and learned what information I needed to get from these women by looking back at my notes from Obstetrics class and making frantic calls to the midwives on our board.  The day Sabina Mae was to come into this world, was the first anniversary of the earthquake, January 12, 2011.  Her parents showed up at our gate in the morning asking if she could be born at our clinic.  We had a midwife coming in just two days but since neither Sean nor I had ever delivered a baby, we told her we would drive them to the hospital.  Her mother looked so frightened, with blood staining the back of her nightgown, holding onto her husband's arm with each contraction and they were worried about the cost of going to the hospital.  We assured them that we would be able to assist them and that all they had to worry about was getting the baby out safely.  We got them to the hospital and I was planning to stay with them but the staff at the hospital didn't want us to be in the delivery room. So we asked Sabina's parents to call us when they were finished for a ride back to our clinic so she could recover.  After just a few hours we got the call that a new baby had been born safely and that both mom and baby were doing well!  It was a wonderful surprise to me to find out later that her parents wanted me to be her godmother!  This not only meant that I got to choose her name, but would also  be responsible for Sabina if anything was to happen to her parents.  I felt so honored that I started to cry.  I chose Sabina which means "peace" to honor the day she was born and Mae to honor my Great-Aunt Della Mae who had recently passed away.

Marc was about 1.5 years when his mother brought him in to us.  She complained that he was irritable, not walking, had a poor appetite and was losing his hair.  At first glance I would have guessed he was about 8-9 months of age but was shocked to find out he was actually as old as he was.  It turned out he had marasmus which is a condition of gross malnutrition.  He had not been breastfed and had instead been given a mixture of flour and water along with Gerber baby food from 3-4 months of age until the day of his visit.  I had to excuse myself and go have a little cry when his mother told me all of this wondering why someone couldn't have intervened sooner?  Why is it that in Haiti mothers don't have access to good lactation consultants and education about what to feed their children?  After a few minutes of feeling upset and frustrated, I realized that this is exactly why we are in Haiti.  It is still often hard to know that no matter when we arrived here we would have been too late for some but I try to focus on those for whom we've made and will make a difference.  After pulling myself together I went back into the exam room and tried my best to educate his mom about what was going on and how she needed to slowly change his diet to one more appropriate for a 1.5 year old.  We have not see this little guy since this visit but I think of him almost every day and hope he's gaining weight and getting some more balanced nutrition.

Rosenaka on her first visit.

Rosenaka is a 2 year old female who was brought to us by her mother.  At first glance I thought she had been the victim of a burn accident but upon further questioning, we realized that she was suffering from a serious case of Impetigo.  Her mother said they had been to several doctors and she had not had any improvement.  This staph infection covered the majority of her head and face as well as her genitals and it was obvious this child was seriously suffering and had been suffering for a few months.  We prescribed an antibiotic and after 5 visits now, she looks completely normal.  Our next goal with her is to help her to gain some weight and to eat a more balanced diet.

Rosenaka at her most recent visit last week with her mother and Dr. Sean.

Another patient I saw while volunteering at the Hopital Saint Francois was a 12-year old boy was brought in with severe watery, tan-colored diarrhea with mucous, vomiting, leg pain, and lethargy. His eyes were sunken and rolling into the back of his head and all he could do was to lie on the bed.  All of these symptoms pointed to a diagnosis of cholera and we knew we had to act fast.  It's become commonplace to simply diagnose cholera clinically because of the serious lack of access to stool testing, not to mention the lack of time.  It's not unheard of for a patient with cholera to pass away within just 12 hours of the onset of symptoms so if it looks like cholera we treat it like cholera and ask questions later.  For this little guy, he was so dehydrated that we were unable to get an IV into his veins so we decided to rehydrate him rectally and orally.  After watching him for a while we also decided to give him homeopathic aconite because of his shock-like presentation.  The aconite really perked him up and he seemed to get that spark back into his eyes after just a few minutes.  This gave us a lot of comfort but we decided to try to get an IV into his arm again because we knew we weren't out of the woods yet.  Unfortunately it was late in the day and the hospital said we had to send him home (seriously????) so we asked if they would transport him to the cholera ward in Cap in their ambulance.  The response was that the ambulance is not for patients with communicable diseases and he would need to take a taptap. Again seriously???  We knew that we were unable to bring him home with us because at that time we didn't have any resources so we decided to drive him to the cholera ward in our own car where he would receive overnight observation.  I was unable to ride along due to lack of space but I'm told the ward was really a gymnasium with lines strung across the length of the building on which IV lines were hanging.  Connected to the IV lines were 200+ patients, mostly lying on the floor receiving treatment from a completely overwhelmed medical team.  Some of the patients had clearly passed away but the medical staff did not apparently have time to deal with them, they just had to move on and try to help as many people as they could.  I don't know what happened to this little guy but I have hope that he made it.  Cholera in Haiti has been a seriously scary situation, but I'm happy to report that we saw this patient in early November when cholera was relatively new and still on the rise and fortunately the situation has gotten much better in Haiti: daily infections and deaths are considerably lower and many more medical professionals, especially Medecines Sans Frontieres (MSF, better known in the US as Doctors Without Borders) have since arrived to focus primarily on combating this disease.

These are just a few of the several hundred cases we've seen since starting our work in Haiti.  Those several hundred are just several hundred in the pool of millions of Haitians of whom only 1 in 10,000 has access to a doctor.  Please take some time to reflect on this and consider what you can do to change these lives and this country.

Mesi,
Dokte Sarah

Trip to Cap

We spend the majority of our time at the birth center, especially since we are without a car right now so yesterday all of the girls living here decided to make a getaway.  Originally Sean was invited but he decided to stay home and fix his computer.  The mission was to acquire junk food and fabric to make skirts and maybe have lunch in Cap-Haitien.  It would have been a day JUST for the girls except we decided to bring Santo to help us translate and for some protection from the guaranteed cat calls you will get if a group of ladies are out on their own in Haiti.  We walked across the street to the tap-tap station and miraculously were able to fit all seven of us (Edie, Ashlin, Zeenia, Charles Marie, Rida, Santo & me) in the same tap-tap.  For those of you who don't know, a tap-tap is the main form of transportation in Haiti.  This picture gives you an idea of what it's like to drive around Cap and a tap-tap is pictured to the right.

A tap-tap is made from a small pickup truck with a cover on the back, some benches are installed for people to sit down and usually very loud and chaotic music is blaring.  Standing on the back of the tap-tap (as in this picture) is the manager who is responsible for tapping on the side of the vehicle to tell the driver when to stop and start. He also collects 10 goudes (about 25 cents) each way from each person who wants a ride.  Since this is usually the only source of income for both the driver and the manager, they try to cram as many people into the tap-tap as possible.  For example yesterday our tap-tap had 24 people at one time riding along (4 in the front seat, 4 standing on the back bumper and 16 in the bed of the truck).  Once the benches are crammed to the max with 7-8 people on each one, people stand in the middle sort of bent in half resting their hands on people's knees or they will just sit on the laps of those seated on the bench.  It's quite an experience especially with the loud music and the lack of deodorant that's a noticeable scent in the air.  After about 45 minutes we finally arrived at our destination in Cap and decided to head for the market.  After about a 20 minute walk and a couple of close calls with a motorcycle and a car (the rule in Haiti is the bigger your vehicle the more right-of-way you have with pedestrians being at the absolute bottom of the barrel) we arrived at the Americanized market where I bought a few munchies for Sean, myself and our Haitian staff to enjoy with some birthday money I had been given.  I felt like a 12 year old spending my birthday money on treats but this is the first time we've really indulged since being in Haiti and it felt good to know I didn't have to feel guilty since I eat a pretty clean diet here.  Edie one of our midwives was thrilled to get her two-liter of diet coke even though we keep trying to convince her that she will do much better on water.

After filling our backpacks and arms with as many treats as we could hold, we headed for the restaurant (one of 3 or 4 in Cap that's safe for American tummies) for lunch.  I was SO excited to find that this restaurant sells "Bon" ice cream which is a treat we enjoyed when we were in the Dominican Republic!  This is the first time we've seen ice cream in Haiti so we'll have to remember it for future reference.  The sign outside said one of their specials was a lobster salad and being right across from the ocean, Zeenia and I knew we had to give it a try.  We were also craving hamburgers and french fries so we decided to split both with pineapple juice to top it off.  At one point our waitress even brought out french baguettes with REAL butter, not the margarine we have to use at the birth center due to no available refrigeration.  This restaurant is a nice little diamond-in-the-rough from the absolutely insanity that is Cap-Haitien.  It's an outdoor restaurant owned by a French woman, the food is delicious, the service is great and at night they have live music and dancing.  We often see other aid workers from MSF and the UN there.  If all is quiet you can hear parrots and other creatures in the trees and like yesterday, there are often white caps out on the ocean to watch.  I think this will be one of our getaway spots when we need to have some time away.

After lunch it looked like it might rain so we decided to put the fabric shopping off for another day and to find a taxi home.  We found two for a decent price and piled in.  Ours was a relatively calm ride, but Edie reported that she had to close her eyes and pray because apparently their driver took great pleasure in freaking her out with near-collisions.  We had such a great time and now feel recharged to continue our work.

Power Struggle

As in most developing countries, and Haiti is no exception, electricity is almost never a consistent thing.  In the 3.5 months we’ve been here, we’ve had maybe two days where we had power for an entire 24 hour period.  We’ve had several days with NO power in a 24 hour period or power at completely erroneous times such as from 11PM to 3AM.  Sean and I have theories that the power is controlled by a little hamster on a wheel and when it gets tired the lights go off.  It’s always funny to me to watch the transition people make during their stay in Haiti.  On their first day they say things like: “wow, there isn’t any power how do you survive?” or “I’d love to have a shower but there’s no power…” or “How can I check my email with no power” or “Am I really supposed to deliver a baby in the dark?”  By the end of their stay most people will cheer when the power runs on, stop whatever it is they’re doing to plug their electronics in and after taking a shower will check their email and update their Facebook status; even if it’s 3AM and they’ve been asleep since 9PM.  Martin for example, one of our current volunteers who has spent his month in Haiti making us laugh and tirelessly working on fixer-upper projects has been trying to build gates for us for the better part of a week now.  Whenever the power is on he runs down to the garage and welds furiously, coming back inside frustrated saying “I was 15 minutes away from finishing before the power went out”.  So he decided to adapt to his circumstances.  The night before last when the power came on well after midnight, he rigged up a work light and spent a few hours working on the gates.  I think he’s almost finished so let’s hope the power cooperates today.  We’ve noticed a really interesting phenomenon about foreigners coming to live in Haiti: Everyone gets really sleepy right after dinner and will usually go to bed within a few hours of the meal.  We eat around 5:30 or 6PM and it’s not uncommon for most to be fast asleep by 8 or 9PM.  Everyone also naturally gets up around the time the sun rises which is usually about 6 or 6:30AM.  It’s amazing how your body will adjust to be in rhythm with the sun when give then chance.  Sean and I are really loving sleeping this way and as any good naturopath knows, good sleep is the key to good success so we must be well on our way. J

Introduction and Krapos

My name is Sarah Preston Hesler and I am a Naturopathic Physician (ND) who recently located to work in northern Haiti along with my husband Sean Hesler, who is also a naturopath.  Why Haiti you ask?  Why not?  Haiti is the poorest nation in the Western Hemisphere and that was before the terrible earthquake in 2010.  Add on top of that the cholera epidemic and political unrest that have been plaguing Haiti as it tries to recover.  Then consider the rising food prices and the fact that 1 in 10,000 Haitians has access to a doctor and you can see why we are here.  Haiti needs help so badly and as time goes by I will be sharing much much more on that later, I'm sure.  More on what we are doing here: Sean and I are employed by the organization, MamaBaby Haiti (www.mamababyhaiti.org) a 501c3 who's mission is to reduce the maternal, fetal and neonatal death rates in Haiti and we are the medical directors for the birth center/clinic.  Our center is located in Morne Rouge just west of Cap-Haitien.  On staff we also have a lovely Haitian nurse midwife, Charles Marie who is extremely competent and very sweet with the women who come to our facility to have their babies.  We also have frequent volunteers from doctors, to midwives, to students to community volunteers who just want to help Haiti.  It's a pretty great life but it's just amazing how different things are here.  Yes we're all just people trying to survive in this world and some of us are having an easier time of it than others but honestly sometimes it's so shocking how different things are here.  

Take the Krapo ("frog") Incident for example:  Before I can tell you this story I have to give you some background: On our property we have a swimming pool.  This pool is not filled and is ridiculously big and deep.  We as an organization don’t know what should be done with it.  We could fill it but when you consider that most of our patients don’t have access to clean water, how can we justify swimming around in it for fun?  We've considered the idea of filling it with dirt for extra garden space, filling it with fish to provide more sources of protein for our patients or just leaving it as is.  The matter has yet to be resolved so for now, it collects rain water and as of today has a fence around it to prevent any small children from falling in.  Many creatures have taken advantage of the collecting rain water including mosquitoes, dragon flies and krapos.  We have tadpoles and krapos who like to make a LOT of noise at night.  As the tadpoles were growing, we realized that most Haitians are TERRIFIED of krapos and claim they will “pee in your eye and you will go blind!!”  This of course makes all the Americans laugh hysterically.  The Haitians however, don't seem to have a fear of the same things we Americans fear like spiders, snakes, or mice.  When we are shreaking and running away from a mouse or a spider they are laughing at us so I guess it all works out.  

Anyway, back to the story: One day someone brought a full-grown frog into the pool as a joke and Sean, our friend Zeenia and I decided it would be a good idea to catch it.  Santo, our translator who lives and works with us started throwing pebbles at the poor thing and was yelling emphatically for us to leave it alone and that we would surely lose our vision if we picked it up.  Sean eventually caught the poor thing and started chasing Santo around the yard with it.  Santo ran out of the gate and down the road and one of us decided it would be hilarious if the frog was in his bedroom when he came back.  Yes this is what we do for entertainment with slow, spotty internet and no TV.  We went about our business as usual until Santo came upstairs saying “You put the frog in my room!”   We took the frog out of his room and then started getting threats from Santo that he would put a snake or a spider or a mouse in our rooms.  He would walk by us and say “I have three mice for the three of you…”  We hope this will be the first of many practical jokes that are played in Haiti.  Alright the power's off and the battery backup may die very soon so I better sign off for today.  Thanks for reading!

-Dr. Sarah