Our Breakfast with Ian

Dr. Ian Rawson, the director of Hôpital Albert Schweitzer, greeted us at the entrance of his lovely home overlooking a lush hillside.  Open to the outside through wide, louvered doors, the stone-floored living room offered a cool oasis in the warm Haitian morning.  Near the home is a garden preserve containing specimen plants from all over Haiti.  “This is what Haiti could be with irrigation and compost,” he said.  He led us to an outdoor dining area set simply with small plates, tiny coffee mugs, a plate of what looked like crèpes, and a tray with small dishes of condiments:  papaya conserve, blueberry yogurt, and some kind of hot green pepper.  He also brought out a small omelette cut into bite-sized pieces.

Ian had prepared a meal in the manner of an Indian guest who had cooked for him.  She told him that the way to eat was to have “lots of flavors in small amounts,” and that is just what the 6 of us enjoyed.  The crèpes were called dosa (pronounced “dosha”), and are customarily torn into small pieces, dipped in the condiments, and eaten with the fingers.  Along with a few pieces of the egg dish, this small amount of food seemed to grow like the loaves and the fishes to be a very satisfying meal.

While talking about food, Ian brought out 2 small, chalky discs, hand-formed, with the thumb impressions inviting continued rubbing as they were handled.  He asked us to guess what they were.  There have been many stories in the media of Haitians being “so poor that they eat mud cakes.”  Well, these were those cakes, but Ian did not believe that they served as a last-ditch effort of starving people to put something in their stomachs.  So he went to a vendor of these discs and started asking him questions.  Do people have to eat these?  No.  Do they eat them often?  No. Who buys these?  Only women.  How many do they buy?  One or two.  When to they buy them?  About once a month.  Or when they are pregnant.  Any ideas, readers?  Ian believes that these mud cakes serve as sources of minerals that the body craves when it needs them.  What a brilliant and reassuring assessment!  Ian is determined to dispel the myth of the starving people’s mud cakes, so he sent the two samples with one of the doctors at our meal to take to the US to have them assayed.  If their nutrient value is confirmed, the doctors plan to write an article with the results.

Ian told us about the first cases of Cholera coming into HAS, as the disease originated not far away in the St. Marc region of the Artibonite Valley.  One of the doctors asked him about the controversy about how Cholera arrived in Haiti, and he replied that it does not matter how it got here.  “I only care about where this patient got it,” he said, because the important thing is to eliminate the sources of contamination.

Dr. Rawson has been involved in the building of latrines in critical areas.  In the mountains, people with whom he spoke didn’t even know what a latrine was.  After eliminating, they wash their hands with dust.  The solution to avoiding contamination is to separate water for consumption from waste, and the latrines serve this purpose.  The latrine project is driven by a water committee made up of Haitian stakeholders.  They started with tens of latrines, progressed to hundreds, and hope soon to have thousands.  The goal is to have one latrine in every “court”, or extended family living area.

Education is improving in these mountain areas.  Most people know about basic sanitation.  The problem with sanitation now, Ian told us, is the gap between knowledge and resources.  These people are very intelligent, but, “The inability to read and write is what keeps Haiti down,” Ian said.

Empowering Haitians is one of Ian Rawson’s primary goals.  That is why there are only 10 non-Haitians on permanent staff at HAS.  Therefore, it was primarily Haitian health professionals who handled the 1,000 patients admitted to the hospital following the earthquake.  It was so crowded that rooms normally holding 4 beds held 7, and the hallways were packed with more injured patients.  In Haiti, family members take care of the patient’s non-medical needs, feeding them, bathing them, and providing linens.  Family members, therefore, stayed under the beds!  There was simply no other physical space for them.  The Haitian staff’s management of the earthquake aftermath is something of which they can always be proud.

Serving the goal of making Haitians economically independent, HAS has begun to develop teaching programs to educate Haitians in the health professions.  Through Friends of HAS Haiti and Health Volunteers Overseas, the Rehabilitation Technician Training Program was established here.  It is a 9-month program serving 6 students at a time, is in its third year, and previous graduates have been hired at HAS.  Rawson also has goals of establishing programs for full physical therapists, nurse anesthetists, and nurse midwives.

Hôpital Albert Schweitzer is home to the Hanger Clinic, providing prosthetic legs to everyone who needs them.  The clinic has fitted some 750 limbs in the past year, and has been described as the busiest prosthetic clinic in the western hemisphere.  Ian tells of the day an angel flew in on a helicopter shortly after the earthquake.  As Ian put it, the man said, “Hi, I’m Ivan Sabel.  I just started a foundation and I don’t know what to do with the money.”  He is the head of Hanger Orthopedic Group in the US, and through the Ivan R. Sabel Foundation, and in partnership with the Haitian Amputee Coalition, the Hanger Clinic was born at HAS.  Ian reported that they have blown through the foundation money and that the clinic is running off of company profits, but he declares that both men see the clinic as continuing indefinitely.

Hanger provides the prosthetists that handle prosthetic fabrication and fitting on site, and Physicians for Peace sponsors the physical therapists.  The knee components are donated by the German company Medi, which also supplies a new pair of shoes for each client.  Upon fitting early patients with prostheses, it was soon discovered that the combination of the vigor of the Haitian clients and the roughness of the terrain caused standard knee components to break.  Medi therefore developed the Haiti Knee, which has a stiffer return to slow down the forward swing of the lower leg, because Haitians use more force during this phase of gait than typical clients.  It also has Teflon surfaces for increased smoothness and greater strength to handle the additional stresses placed on the knee.  Ian told us that the poorest country in the western hemisphere has the most sophisticated knee prostheses in the world.  The Haitians don’t know this, though; nor do they care.  He said they just know that they couldn’t walk before, and now they can.