The Dichotomy

I have been silent since May because I didn't know how to write what was going on or what I was feeling. As most of you probably know by now, Sean and I made the decision in May to leave our work in Haiti to come back to the US, regroup, get healthier, and meet each other once again as husband and wife. See when you are giving all the time, when you are someone's one opportunity for a better life and they ask you for clothes/food/laptop/trip to the US/money, it wears on you and sometimes you forget why you signed up to sell everything you own and take a gigantic leap into the abyss with the one you love.

Since we've been back things have been lovely. We have gained back all the weight we lost in Haiti (plus a little extra), we've spent much-needed time with our American loved ones, we've re-connected with each other, we've rented movies, gone to concerts and slept on our cushy bed in our climate-controlled bug-free bedroom and we've eaten Thai food no less than once every two weeks (and chocolate every day...you don't know how every cell in my body missed Thai food and good chocolate when we were in Haiti and I fear I may have over-indulged). We've taken trips to spend special time with loved ones (nephew Carter's 3rd birthday, Grandpa Preston's 90th birthday/Preston family reunion, Grandpa Gene's 80th birthday/family cruise to the Caribbean (so close to Haiti...), trip to Carmel for our anniversary, trip to ND for Thanksgiving and many other special events.  Yet not a day goes by that my heart doesn't ache for Haiti and our loved ones there.

We have turned the student group Naturopaths Without Borders into a non-profit organization which has been a full-time gig and we are in talks with MamaBaby Haiti (the organization we worked for in Haiti) to see how the two can best coordinate to best-serve our Haitian brothers and sisters.  It's been a time of paperwork, meetings, learning about fundraising, marketing, taxes, the government, more meetings, running a business and it's been a blast. I've also started running, have practiced cooking (here and there), have practiced the piano (my generous, spectacular in-laws rented one for me to use while we're at their house) and have had time to catch up with and bask in the glow of loving my husband.  We even have a plan for how to keep our marriage a (huge) priority when someone needs us all the time. This is probably a great lesson for future (hopefully) parenting.

The United States and Haiti are so incredibly different it is such a shock to go from one to the other, especially when you've been in one for a few months. In Haiti it's chaotic and unpredictable. It helps me live in the moment and to realize that it's OK to dwell in ambiguity because planning ahead won't get you very far. It will get you frustrated. In the US it's not so chaotic and it's quite predictable. For example, I can put 5 things on my to-do list and 90% of the time, I'll get them all completed. In Haiti if I put 5 things on my to-do list, 10% of the time, I'll get them all completed. Haitian roads have goats, pigs, chickens, children, motorcycles, tap-taps, pot holes the size of a smart car and noise. The US has clearly divided lanes and you can be certain that people will (usually) stay in them, speed limits are marked, and the pavement is so smooth you could almost ice skate on it.

Now that we have made the decision to go (we'll be there so soon...Feb 8th!) back I struggle to find balance in this life while preparing for that life. Here I have reliable internet that's so fast you can even skype on it, I don't have to run out to the street to pay a man on the corner to recharge my cellphone with minutes so I can hear my mom's voice and if I crave any kind of food I can either go to a restaurant that makes it or cook it in the kitchen on a gas burning stove that lights itself. If my sister needs to talk, she can just call. We don't have to coordinate the time and worry about how much money we're spending in international cell phone fees.  There's no need to find a flashlight, buy some charcoal and rip bits of paper up to start a fire in order to make dinner because both the modern (electric) stove and the (backup) propane stove won't work. On to plan C. Yet somehow, when you've worked that hard for your dinner, it tastes better.

I still have so many unanswered questions and unresolved issues trying to live between these two very different worlds.  We just bought a house in AZ (designed to be our oasis when we need a break from working abroad) and we're supposed to decorate it. As a new home-owner I'm told I need to care about things like granite countertops, stainless steel appliances and paint colors to not only appear stylish, with it and modern; but to also increase the resale value of the home. Yet when I think of decorating and picking out paint colors in the context of Haiti I remember how only the very rich in Haiti have paint on their houses. The rest are the color of what they're made of.  Cement.  Or of scrap metal, old doors and tree branches.  It is unheard of for people to have a fridge but Americans wouldn't dream of going without one. Yet in Haiti we did just fine with a Coleman cooler and ice from the ice factory next door. For 7 months straight. Maybe it's OK if our appliances aren't all the same brand and if we use the same paint colors that the previous owners had. After all the paint is perfectly fine.  It's even a little trendy.  Repainting in Haiti would feel indulgent and wasteful. Repainting in the US is normal. I still have no idea what we will end up doing. Maybe something in between. Maybe we'll save our money and paint one room at a time just so some sort of sacrifice is involved.  On the one hand we've worked hard, we deserve to have a beautiful oasis to go home to when we need a break and if that means repainting, that's OK. Then I think about how the money saved from NOT repainting could save lives. Human lives. Human lives that have suffered more than you and I can imagine.

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