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