Se Therese

When I spent the summer in Cuba some five years ago, my finicky eating habits made meals difficult; I recall eating Nutella directly out of the jar in an attempt to obtain protein, though in general, I subsisted mainly on a healthy diet of fried plantains, rice and ice cream. College, and now medical school, have resulted in a great expansion of my food preferences, and I am now much less reluctant to try new things. During my first trip to Haiti, I found the food provided adequate, if limited. I was expecting more of the same this time around, and thus was pleasantly surprised with the quality (and amount) of food served at the guesthouse in Leogane. The nuns eat a mix of Haitian cuisine and more Americanized foodstuffs, and overall I feel I have been eating quite well (even overindulging at times). Which is why I find it rather amusing that one of the sisters, Se Therese, is consistently concerned with the amount of food Jackie and I are eating. She is convinced (despite evidence to the contrary) that we are not eating enough, constantly entreating us to take multiple helpings.

Se Therese actually speaks some English, though communication is often difficult secondary to my status as a "low-talker" as well as my current hearing deficit. She reminds me of a fairy godmother in both appearance and demeanor (or some other, similar character right out of a Disney story- http://media.bigoo.ws/content/top/cartoons/cartoons_53.gif: ok, so maybe sans wand and add a few more wrinkles... also substitute a habit for the cloak... but still): an older, somewhat portly women, wizened by age, with a persistently nurturing nature. From what I can gather, she is responsible for most things food-related at the convent/guesthouse. She makes her own ice cream (and occasionally cookies), and will place a heaping bowl of said dessert at your side before you even finish chewing your last bite of dinner. "No, mesi anpil" and a polite smile does not work --you cannot refuse her. This is never an option. You can explain that you do not like said food item or that really, you are BUSTING at the seams and yet she will still find a substitute foodstuff or will simply look at you as if you are going to KILL her with worry by your failure to eat a heaping plate of everything.

At this point, Jackie and I have given up. We have resorted to casually agreeing with Se Therese (trying to appease her), though in actuality, we just never go back for that sixth plate of rice and beans. As for the food items she keeps imploring we bring back to the kitchen/pantry in the guesthouse, we have simply stopped refusing and have now amassed a stockpile of food that could last us well into the next year.

Carnaval 2009

Dr. Merisier had not been to Carnaval in eight or so years, but was kind enough to drive us into Port-au-Prince to see the festivities (that or he was simply sick of hearing Jackie, Marisa and I talk about it). It didn’t take quite as long as I would have expected to reach the capital. We did hit slight traffic once we got a little closer (the highlight of which was the tap-tap Christ is the Answer nearly running us down). We parked near some relatives of Dr. Merisier and then headed out on foot (why I changed into flip-flops seriously eludes me… mystery water everywhere, not to mention the not-so mysterious piles of trash that dominate every corner).

We were there fairly early (around 6pm or so), so things weren’t too crazy. We walked the streets, making our way to the center of the celebration, the Champs de Mars. Along our route we saw various dance groups, people in costume and different bands. We also sampled some of the local treats, which were offered at every possible turn. It was like the Jersey shore, Haitian style, in that I had my choice of a wide array of fried anything. Our little group (which also included Dr. Merisier’s wife and two young, adorable children) shared some fried plantains, which had been slightly sweetened, as well as what I can only describe as (delicious) fried dough doused in sugar (it was a cross between a zeppole and funnel cake, and just as good).

The highlight of our adventure was most definitely Champs de Mars. I knew it was crowded, but did not realize the true extent of the people there…that is until I was able to climb up on one of the available trucks for a bird’s eye view. I had been enjoying myself before, but this was truly unbelievable. There were people everywhere, watching the various trucks/floats which slowly make their way through the masses, blasting music to the cheers and singing of the crowd. I broke out an occasional dance move (which I am sure was humorous to those surrounding me) but it was impossible not to move to the music. Although a lot of the trucks were HUGE, my favorite in the line-up was a little tap-tap complete with a mini painting of Obama. We left around 9PM, and it was clear that things were just getting started!

Chirugie

Got to see a C-section performed today in Hopital Cardinal Leger. The patient had prematurely ruptured her membranes a week ago, but began having contractions sometime yesterday. She was just short of 28 weeks, and as the baby was breech, a C-section was considered the best option. No anesthesiologists are on hand in Leogane, thus we had to wait for the arrival of one from Port-au-Prince before we could even begin.

I was rather excited to get to see a surgical procedure here in Haiti. I went in without any concrete expectations, though with a considerable certainty that things were likely different. This was not entirely true, however. The OR appeared slightly antiquated: minimal equipment (no ventilator, for one) and one large, OR lamp on a fixed track. The generator was specifically turned on to provide electricity for the procedure, and to conserve this precious power, suction was only turned on once the uterus had been opened (and subsequently turned off when it was no longer needed). The suction machine, itself, was quite noisy, but when not in use, the OR was noticeably devoid of any beeps, buzzes or whirring. Blood pressure was taken at sporadic intervals manually . And while I am used to being somewhat overheated in the OR, I was downright hot, as the majority of the operation occurred in the absence of any air-conditioning. As a med student I relish the few times I get to feel useful in the OR (or anywhere, really), but it was clear our patient would not likely benefit from the immediate procurement of warm blankets at the conclusion of her surgery. And to think I was not even in full garb: a gown placed over my board shorts and t-shirt, together with mask, bonnet and booties and I was ready to go.

Otherwise, however, the C-section was like any other I had seen in the States. Though I did not actually scrub in, I was able to see the entirety of the procedure easily. Our patient delivered a very tiny baby boy, her second child. Interestingly, I don’t recall the time of birth being recorded (though I may have been too engrossed in his arrival to take note of this event, which likely occurred in Kreyol, anyway). He was quickly whisked away by the waiting pediatrician. I could hear him crying from inside the OR, which was obviously a good sign, though his prematurity (and the lack of a ventilator or any previous administration of steroids, which can help mature the lungs) leaves him in a somewhat precarious condition. At last glance, he was working hard to breathe, but managing to cry, nonetheless... so only time will tell!

Lagrip

So, since my arrival in Haiti, I have basically been sniffling/snorting on a regular basis (attractive, I know), battling a runny nose that just never seems to run dry. For the most part, I was convinced I was being fairly discrete, casually sniffling everything up when no one was in close proximity. But apparently this has not been the case, as I now have been asked on three separate occasions whether I have lagrip, the flu, etc. I think one of the nuns was sufficiently annoyed with all the sniffling; after her inquiry as to the state of my health, she promptly offered me several tissues; too embarrassed to blow my nose right then and there, I tried to stifle my subsequent sniffs, though I think I failed miserably, as evidenced by several side-long glances directed my way.

In all actuality, I think it is just persistent allergies; I experienced similar congestion back in October, which quickly resolved upon my return to North Carolina. Nonetheless, I have since been more mindful of my snorting activities and am blowing my nose constantly (or at least it seems that way). My newest predicament: all this sniffling/nose blowing/congestion has left me with clogged ears such that I cannot actually hear much out of my left ear. This is particularly problematic when one is already having communication problems. Whereas before Kreyol was my primary barrier to understanding, I am now also plagued by partial deafness-- understanding English is even a battle now!

Actually made it into Port-au-Prince yesterday evening for Carnaval (courtesy of Dr. Merisier and his wife); more on that (hopefully with pictures), later!

Klinik

Monday clinic was not crowded; similar to Friday, we managed to test some 15 or so women for HPV. It is likely that the persistent low number of patients is due to the holiday (Carnaval) this week (in fact, we will be closed today and tomorrow). Nonetheless, most are certain it will pick up in the next week or so.

Upon arriving, each woman is required to sign a consent form, which explains the purpose of the test and our research; this form (which is actually written in English) is described entirely in Kreyol by a translator, with multiple opportunities for patients to ask questions. The women are provided a number when they arrive (to ensure that they are seen on a first come, first serve basis) and following the testing, they receive a card with information (their unique ID number, as well as a telephone contact for any lingering concerns) necessary to obtain their results, which are generally available in three week's time. Women who are shown to be negative for the virus, do not need any further follow-up, while those who test positive will return for further analysis and treatment. During our time here, Jackie and I are planning to go out into the community to contact those women (tested over the last year and a half) who have yet to return for the necessary follow-up.

As promised, here are some pictures of the clinic. It is far from complete, but has come quite a long way (trust me)!


Although this progress encouraging, it is still sometimes difficult to adjust to the healthcare setting here. In the US, frequent emphasis on HIPAA and patient privacy (http://www.hhs.gov/ocr/privacy/index.html), has made most US healthcare professionals hypervigilant with regard to protecting patient information. Although attempts are made to do so here, it is sometimes difficult to ensure a private setting in which to take a medical history. Furthermore, the frequent use of translators and nonmedical personnel complicates the picture.

Even more concerning, however, are the stories I have heard about other healthcare institutions (or lack thereof) within the community: patients refused services (including palliative care/comfort measures) secondary to a lack of sufficient money, individuals having to travel to several locations (often over great distances) just to access any care at all... and people dying, from preventable causes, simply because they don't have this access/funds. While it is true that these issues are neither new nor exclusive to Haiti, it is sometimes difficult not to become disheartened!

Bon weekend!

Weekends in Leogane are somewhat slow. I did manage to sleep in, though foot and automobile traffic increases considerably around seven or eight, making continued slumber a slight struggle, even for me. All in all, Saturday consisted primarily of a random pattern of dozing, reading and eating. As the power is generally off from noon until six (unless of course, the government is supplying electricity; from what I have heard, this supply is sporadic at best... the longest span of time without government power can be up to a week!), there is little else to do.

Nonetheless, Saturday evening was considerably more exciting. Jackie frequently travels between NC and Haiti, and during this time, has built a little social network of various individuals working in Leogane and Port-au-Prince. The group currently residing in Leogane (at the nearby Hopital St. Croix) consists of three public health workers, as well as one fourth year medical student spending a two month elective in Haiti. We had a delicious, home-made dinner courtesy of these new friends, after which we went to the local disco for some salsa and compas. Even with some liquid courage (in the form of red wine and then some Presitge, a Haitian lager), I was most reluctant to embarrass myself on the dance floor, where my spasticity was readily augmented by the superior dancing of the locals. I was dragged out on a handful of occasions, but in general, was more content just observing!


Sunday also proved to be fairly laid back. We managed to get to the beach for a few hours, which required taking a canoe-like vessel to a small island just off the shore. Apparently, there are plans for a new hotel and various amenities within the area. Some Haitians (the self-described planners of said hotel) were having a barbecue and were eager to provide some authentic cuisine (which I politely declined... I still cannot get past my seafood phobia, though my fellow travelers raved about how good the conch was); they also offered us a brief boat ride, showing us the amazing coral reefs on the other side of the island... not a bad ploy in terms of advertisement, as we were all quite impressed.

Nuns on the Run

Although it was rather nice to sleep in and relax yesterday, I awoke from a rather long nap with the need to get out and explore a little. Marisa, an OB/Gyn resident spending the next three weeks in Haiti (she is staying with Dr. Merisier) had come by earlier in the day to introduce herself and see how things were going. We parted at lunchtime, but not before she explained how I could get to Dr. Merisier's house and the new clinic. At around three in the afternoon I set out, a regular blan (general Haitian word for foreigner), with sunglasses and water in tow. I was maybe seven minutes from the front of Cardinal Leger, when I heard a slight commotion behind me. Two of the nuns (dressed in their habits) were in pursuit, calling my name and waving while a whole bunch of townspeople just laughed. I tried to explain (in sign language, really) that I was just on my way to Dr. Merisier's, that I knew where I was going, etc., but to no avail. Instead, I decided to return with them, completely mortified. The tale was recounted at dinner last evening AND again tonight... hilarious. I remain quite embarrassed, though they all seem to think it is just humorous (granted, I am not entirely sure what they are saying... but I get the gist).

In other news, Dr. Merisier's clinic officially opened today. When I had first seen it back in October, it consisted of only one floor, without any doors, floors, furniture or plumbing. Today, however, it looked absolutely transformed: the inside was finished, painted and quite spacious, while the second floor had been added (though has yet to be completed). We set to organizing one of the exam rooms and were subsequently able to screen approximately 30 women for the HPV virus. I am told this daily number will likely increase dramatically, as more women learn about the screening and the clinic's new location. (Eventually, I will try to post some pictures of the clinic - before and after).

A quick note on the name of my blog. It is a Haitian proverb that (I think) means: "Little by little the bird builds his nest." Not entirely sure why I picked it, but overall it just seemed to fit. I'm still trying to find by place in medicine and on a smaller scale, to determine my role while in Haiti. It also seemed appropriate with regards to FHM (Family Health Ministries...the nonprofit founded by my mentor and his wife): little by little they are trying to make things better in Haiti.

I suppose that is more than enough for one evenings; it currently appears the mosquitoes are out in full force...I best head back to my room/bug spray.

Arrival in Haiti

My official arrival in Port-au-Prince, Haiti, occurred around noon on Tuesday and was accompanied by the sounds of joyous clapping, and even some tears. Having spent a brief period of time in this country back in October, I was fairly well prepared for the heat that immediately embraced me when I stepped onto the runway and the general chaos that is Haiti’s international airport. While on my previous trip I had been absolutely overwhelmed, this time around I navigated through customs (breaking out one of my five Creole phrases: Bonswa!) and managed to successfully secure a cart for my luggage. It took quite a bit of time to actually locate my two, ginormous 50 pound bags amidst the sea of luggage rolling off the baggage claim, not to mention the countless passengers engaged in the same task as myself.

Next stop: the Digicell counter, where I purchased a cell phone ready for immediate use. Upon entering the appropriate code, I was then informed that I had 100 gourdes (Haitian currency) worth of minutes. A quick call to Dr. Delson Merisier and I was on my way!

Dr. Merisier informed me that he was already outside the airport. I put on my no-nonsense look and inexpertly pushed my overloaded cart through the doors. Within seconds, at least 3 different luggage handlers, readily identified by their red caps, eagerly offered to take care of my bags. Creole Phrase Number 2 was subsequently employed repeatedly: No, mesi. Once seated in Dr. Merisier's car, I breathed a slight sigh of relief: that wasn’t so bad —expectations are, indeed, everything.

We had two quick stops before making our way from the capital of Port-au-Prince to Leogane, a town some 20 miles west, situated in the coastal plains. Dr. Merisier is an OB/Gyn by training, though as he explained during our ride, in Haiti, it was more or less necessary for him to “know everything.” After dropping off a handful of Pap smears and cervical biopsies (to be sent to a local lab), I accompanied him in a visit to his niece, who had been home from school the past two days with complaint of nausea/vomiting and diarrhea. He provided her with a quick injection of antibiotics and some further instruction, before we were again on our way.

I consider myself a city girl at heart, which may explain why I am enthralled by Port-au-Prince. While initially there is a period of “sensory overload,” during which one feels continually assaulted by an endless barrage of sights, sounds and smells, one quickly learns to take the city one piece at a time, breaking it down into manageable and enjoyable chunks of everyday life. The colorful buildings and frequent markets. School children, immaculately dressed in their uniforms, casually strolling in groups of three or four. The innumerable, elaborately painted tap-taps and the constant honking of horns. The smoke of charcoal fires and the haze of exhaust. People everywhere- selling, laughing, talking, moving, rushing, bargaining. It is both overwhelming and invigorating.

Dr. Merisier slowly worked his car through the winding streets filled with traffic and people, offering me an impromptu tour as we traveled along. He also provided some interesting insight into the training of physicians in Haiti. While medical school in the States is far from easy, I have never had to travel well over an hour in order to have electricity by which to study.

At approximately four thirty, I arrived at what is to be my home for the next seven weeks, the Hopital Cardinal Leger. My lodgings are quite comfortable, complete with a common TV and what appears to be a lava lamp. That evening, I dined with the eight sisters (as in religious sisters) and one physician who reside here. I speak not a word of French and basically no Creole, yet these individuals managed to welcome me warmly and make me feel at ease. I enjoyed their company, despite being entirely clueless as to their discussions. My main words of the evening were Mesi (for the wonderful meal and for their assistance) and Wi (as in Wi, I had enough and Wi, I enjoyed my meal very much). Not surprisingly, they quickly discovered that I am “tee-mead,” which I eventually discerned was “timid” (I suppose my persistent blushing served as a fairly obvious clue). Nonetheless, they have provided adequate motivation for my learning Creole; while there are obvious benefits in having some command of this language, I would also love to talk to these wonderful women using more than just my blushing, “tee-mead” smile and sign language!

My first night I slept soundly, grateful for the delightful breeze coursing through the window right above my bed. Today I mostly relaxed, awaiting the arrival of Jackie, the research coordinator at Family Health Ministries (www.familyhm.org) with whom I will be working. I did attempt to take one brief foray out into the city, but more on that later!