Bienvenue Madame Sara

On Monday, I had my first day as a teacher in the Rehabilitation Technician Training Program.  I was welcomed with a lovely chalk art drawing of a person climbing a tree, an elaborate bird, and lots of colorful fruits and vegetables covering the entire board. The six students were just finishing it up, writing “Bienvenue Mme. Sara.”  They call me Madame Sara, which I find very sweet.

I’m really glad I had met the students on my previous trip, had seen the classroom, and of course that I was familiar with HAS.  I had taken pictures of each of them, and took down their names from Janet, the teacher at the time.  I wanted to be able to recognize them and know their names when I returned.  I printed the pictures with their names at the bottom, along with the words “RTTP 2011.”  I showed them the pictures thinking we might put them up on the wall, but I quickly realized that they really wanted to have the prints for themselves.  I could see the pride in their faces when they looked at them, posing as they were, looking so self-assured.  I was pleased to be able to give them this inadvertent gift.

Even though I had read the material to present on the first day, I found it hard to think of enough things to say to them about the subject of balance apart from the notes I had.  Without a lot of experience, I don’t have a large well from which to draw examples and ideas.  So the first day was challenging.

Once I knew what to expect, though, I did much better.  I had a plan for the next morning, to be more engaging and demonstrative with the material, to ask more questions to draw them out, and to expand on their previous work.  Our afternoon balance lab was more structured, and I did a lot of demonstrating for them.  We got balance equipment from the hospital PT clinic, like a platform with a ball as its base, so that their balance could be challenged a bit.  They are so coordinated that they were practically doing gymnastics in the parallel bars, rather than trying to imitate a patient with balance problems!

There are certain things that seem to characterize these students. While they are unfailingly polite, often smiling, and clearly enthusiastic about becoming rehab technicians, they also don’t hide the fact that they may be tired, with glazed eyes, unstifled yawns, or heads on tables (which could not possibly have been due to my scintillating teaching!).  I don’t think this is rudeness, just reality.  One student rides his bike for an hour to get here.  It’s hot.  Didactic work is boring, yet is the system to which they are accustomed.  I therefore have a lot of motivation to find ways to be more engaging and keep them more active.  I’m not seeing much drooping now, but it is still clear when they need a break.  Another thing I noticed is how unhurried their pace is.  When we went over to the Hanger Clinic, they didn’t walk, they sauntered.  I kept turning around, wondering where they were! 

We started coordination today, and Silla, the Swiss PT who is my housemate, gave me some great ideas about using functional activities to work on improving coordination.  I was able to download some short videos to show them of coordination problems, and they seemed fascinated by these.  We also had two opportunities for real patient observation; one a stroke patient that they had seen last week, and the other a little boy just coming out of a body cast following a femur fracture, with weakness and decreased coordination in movement and gait from disuse (who will likely return to normal fairly soon).  For gaining experience, there is no substitute for the real thing!

Back Again

I got in to Deschapelles about 4 o’clock yesterday afternoon.  There was a pink and purple sky once again during my favorite time of day.  As soon as I got out of the Land Cruiser, I noticed familiar scents, a mix of heat, dust, wood smoke, and flora that I hadn’t remarked on before, but which immediately confirmed that I’m back in Haiti.

Last time I was here, Haiti time matched Eastern time, but this time it’s an hour earlier here than on the East Coast, even though Haiti is farther East.  That’s because Haiti doesn’t do Daylight Savings Time.  Can you imagine getting everyone in Haiti to change their clocks?  It would be ridiculous, in the grand scheme of things!

I had a flight glitch due to a fire at the Miami Airport, which caused several flight cancellations.  American Airlines kindly re-booked me on a flight the next day, which would have arrived in Miami several hours after my flight to Port-au-Prince had left, so I spent a long time on the phone working that out.  Instead of flying from Portland (where I was visiting my Mom) to Dallas/Fort Worth to Miami, where I would enjoy a good night’s sleep in a hotel before flying to Port-au-Prince, I flew from Portland to LAX , then took a red-eye to JFK, then on to PAP yesterday morning.

Thanks to a little sleep aid, I slept several hours on the LAX to JFK leg, snoozed for an hour or two at JFK, plus before and after the meal on the flight to PAP (interestingly, the flights to and from Haiti seem to be the only ones on AA that offer a free meal any more), and even in the car on the drive to Deschapelles.  It's pretty remarkable for me to be so relaxed!  But I was still with it, since I only took one pill.  (I Learned my lesson about taking two, as Bill can attest – he had to guide me for several hours after we landed in Boston last fall!)

I’m in a different house this time.  It is still generous in size and traditional in décor, with tile floors, dark wood bookcases, and ceiling fans.  It has colored lights draped for ambience at night.  I’ve got my own pop-up mosquito shelter, so I’m all self-contained for sleeping.  This also serves as protection from the house cat, Dino, who would probably be all over my bedding if I let him.  (I have antihistamines just in case.)

My house this time is close to where I stayed last time, but not within the gated area which also comprises Alumni House (where I had my meals before) and the pool.  I have a nice housemate, a physical therapist named Silla, from Switzerland (alas, she’s from the German part, so we don't speak French together, although her French, perhaps her fifth language, is better than mine).  She recently retired and decided to spend 3 months working here.  We have our own cook and security at our house.  The security, de rigueur in Haiti, is mostly for privacy, so that locals don’t come up to the houses selling things or asking for kados (gifts).  Silla told me that the night guard sits on the porch outside her window, and sometimes he gets cell phone calls in the wee hours and just chatters away!  She’s very tolerant, but I’m glad I’m in the back room!

Last night I heard live music out my window, and before long they played the song from the video I made, so I knew it was the Hanger band, “Prestige.”  They were doing a performance at the residential dorm for the prosthetics patients.  Silla and I went over to listen for a bit, and I met up with Yvener and Joel from the Clinic, Nick who runs the art and music program, and Oliancy, who runs the art program for children that I visited last time.  It was fun to be recognized and welcomed!

An Oasis of Hope

Hôpital Albert Schweitzer is a busy place.  Since family members stay with patients, it can be quite crowded.  The observation room is a ward with perhaps 20 beds squeezed into it with family gathered around, many patients with IV’s or casts or bandages, and there may be half a dozen more beds in the hallways.  People sit on wooden benches waiting for treatment or holding sick children.  Others lie down on the benches or the concrete floor to try to sleep while they wait.  In Haiti, people wait and wait and wait.

The lights are mostly kept off in the daytime, probably to save power and perhaps to make it seem cooler.  In the bit of natural light that makes its way to the hallways, people quietly tend to their loved ones.

Even with the crowding and relatively primitive conditions, the hospital smells clean.  Floors are constantly being mopped, and outside areas swept.  The operating rooms are being remodeled, and will soon be sparkling and modernized.  The library, lined with dark wood bookshelves and stone walls bearing Haitian artwork, is air-conditioned and equipped with wireless internet.

In the surgery ward, there are patients will all kinds of issues:  one young woman with burns, a man with external fixation on his leg and a foot that he might lose, a couple of new amputees.  These patients were all in the same room.  There is an isolation ward with a TB patient, and a medical ward with untold problems.  One family was praying around their loved one with chanting and holding of hands.

The cholera ward is in a separate building that, until the outbreak, housed the boutique that sells local art.  The rooms are dim but brightly painted, probably a remnant from their prior function.  There were 8 to 10 adults in one room, each on an army-style canvas cot, and a similar number of children with their mothers in another room.  The children all looked pretty good, since they were rehydrated and over the diarrhea, and had regained their appetites.  One tiny girl who looked about 6 months old but could have been twice that, was eating crackers from a big metal bowl she held in her lap.  I greeted each of them, but they couldn’t understand me and just looked at this strange apparition with wide eyes.

Back in the main hospital, I walked through the pediatric ward and saw naked little brown babies lying next to their mothers on cots, or older babies and children being nursed or fed, and others asleep with IV’s.  Many cots lined the hallway.  Nearby in the premie room there were 3 or 4 tiny, tiny babies in clear isolettes surrounded by family, some with NG tubes, one with a heat lamp, but none with telemetry.  One tiny baby weighing just 1 pound was off in a corner covered by a pink blanket.  These areas are not isolated, as the walls do not go all the way to the ceiling.  The doors to the outside are always open, and when I was looking at the premies with a nurse, a chicken wandered in!

As I walked through the halls of this third-world hospital, I wondered, why am I drawn to this place?  Why am I not horrified?  People are sick or injured, and may not have enough to eat.  Their families sleep on the floor.  They wait.  Yet people here are getting help, however slowly, and that, at least, is gratifying.

* * *

Hôpital Albert Schweitzer was founded in 1956 by Larimer Jr. and Gwen Grant Mellon, inspired by its namesake, Swiss physician, humanitarian, and theologian Albert Schweitzer.  Larry was a scion of the Mellon family of Mellon Bank, Gulf Oil, and Carnegie Mellon University.  After a year of college and a failed marriage, Larry decided he didn’t want to go into the family businesses and bought a cattle ranch in Arizona.  There he met Gwen Grant, also a divorcée.  They courted, and he spent time overseas in the OSS during World War II.  Larry and Gwen married in 1946, joined their families, and continued to live on the ranch.

One day in 1947, Larry saw an article in Life magazine¹ about Albert Schweitzer, who had founded a hospital in rural Africa and went on to win the Nobel Peace Prize in 1952².  Immediately captivated by Schweitzer’s philosophy of  “reverence for life,” Mellon struck up a correspondence with him.  The two men met, talked philosophy, and eventually thought of themselves as “brothers in spirit.”³

Larry Mellon decided that he, too, wanted to help those in need by becoming a doctor and building a hospital.  With Schweitzer’s encouragement, Larry returned to college at age 37 and completed his pre-med studies at Tulane.  “Don’t try to pass the exams with flying colors,” Schweitzer advised him regarding medical school.  “Content yourself with squeaking through honorably.”⁴  Larry received his M.D. from Tulane Medical School in 1954 at the age of 44, while Gwen earned a degree as a laboratory technician and scrub nurse.

The Mellons’ criteria for building a hospital was that it be in a place of need, with available land, in a rural setting where people could support themselves.⁵  Following a summer in Haiti, during which he did research in tropical medicine,⁶ Larry Mellon realized that there was an opportunity to build a hospital there.  The Haitian government offered the Standard Fruit Company’s abandoned banana plantation in Deschapelles, 60 miles from Port-au-Prince.  The company had left following a banana blight, but there were 60 acres and 42 houses on site built in the 1900’s.  Work was begun on the hospital while Larry was still in medical school.  Gwen supervised construction and continued to be the eyes and ears of the hospital throughout her life.

Larry felt that he could change the course of illnesses by bringing in potable water, educating new mothers about newborn tetanus, and developing community health programs.  Today, Hôpital Albert Schweitzer is still involved in a broad range of activities that contribute to the health and well-being of Haitians.  There is a water committee made up of Haitians that is building hundreds of latrines. There is the HAS Haiti Timber Re-Introduction Project (HTRIP), planting Mahogany, Spanish Cedar, and fruit trees in Haiti.  A malnutrition clinic serves to nourish and educate those in need.  The Hanger Clinic for amputee prosthetic fabrication and physical therapy and the Rehabilitation Technician Training Program have been established on site.  The hospital employs mostly Haitians, contributing to the economic independence of many in the area.

HAS sees a constant stream of thinkers dedicated to improving the situation in Haiti.  Just while I was there, a professor and some doctoral students from the School of Public Health and the School of Forestry at Yale arrived to make plans for bringing a class of 20 students back during their spring break to address issues in agronomy, water, and cholera.  We had doctoral students in global health and malaria studies from Tulane, and pediatricians and internists serving at the hospital.  There was a 4-day malnutrition seminar for nurses in the hospital library.  Every morning there is a conference in the library where current cases are presented by and for the doctors and nurses, and then a presentation is made on a relevant medical topic.

A brief history of the hospital on the Friends of HAS web site states, ⁷ “The hospital opened as a 100-bed facility with diagnostic, clinical and surgical services. Over the years, it has expanded to include outreach and prevention programs, as well as services to strengthen household economies. From the hospital’s earliest days, the Mellons established the values and principles which led to its founding. These include Dr. Schweitzer’s philosophy of reverence for all living things; a sense of humility; respect for the dignity of the Haitian people; and a dedication to assisting those who are less fortunate improve their lives.”

Hôpital Albert Schweitzer continues to admirably follow this precept.  That is why I see it as an oasis of hope in the heart of Haiti.

1      http://books.google.com/books?id=MEgEAAAAMBAJ&pg=PA95&source=gbs_toc_r&cad=2#v=onepage&q&f=false

2      http://home.pcisys.net/~jnf/nobelsp.html

3      http://home.pcisys.net/~jnf/schauth/rq32.html

4      http://www.people.com/people/archive/article/0,,20076339,00.html

5      Jenny Mellon Grant, personal communication

6      http://www.hashaiti.org/History

7      http://www.friendsofhas.org/hospital/hospital_history.php3

Animals

One of the first things I noticed about animals in Haiti is that all of the dogs are the same:  slender, medium sized, short-haired, usually light brown, sometimes with white collar or feet markings.  It occurred to me that creating different dog breeds for the pleasure of humans is a concept that has not reached this part of the world.

The dogs don’t seem to belong to anyone.  Sometimes during the night, I hear awful-sounding dog fights, and I have to remind myself that this is a normal dog’s life here.  People don’t feed them, for obvious reasons.  I was told that if a culturally insensitive visitor were to feed a dog off of a plate, the Haitian cook would destroy the plate.

There are chickens all over the place. They wander in and out of yards and buildings and cluck around anywhere they please.  Some chickens are marked with paint to indicate possession, but I don’t know how anyone keeps track of them.  However, Rose told me that someone brings a rooster to the cholera clinic and ties it by its leg to a tree root, where it crows all day. I suspect its owner doesn’t want to lose a future meal.

There are goats wandering all over, too.  Some are tiny babies and are really cute.  A lot of them have a wooden triangular frame around their necks that apparently keeps them from passing through narrow spaces, like the fences here made of tall, slender cactus.  On our first day, we saw a pig tied to a tree, and she had several babies, too.  I’ve seen a couple of small horses (young or underfed?  I don’t know) tied in different places around the campus.  One day they were tied to a tree near the pool.  One had broken free and was galloping around and around the pool area, dragging its long rope and seemingly having a blast.

A Typical Day

My day starts around 6 am, when the water comes on for an hour.  While it’s a bit early for a cool shower then, I might wash out some clothes and hang them up for the day.  Even though Maude will wash and iron our clothes within a day or two, mine dry so quickly that I prefer to do them myself so that I can wear them again right away.  One of the guys staying in Alumni House said that Maude got a stain out of a shirt that had been there for about 3 years, but Rose told me that there are only so many Haitian scrubbings that fragile clothes can endure!

Breakfast is served at 6:30 in the Alumni House next door, with the other guests staying there.  We have been served some yummy egg dishes, freshly baked white bread, and occasional dry cereal.  The peanut butter is a bit granular, a little sweet, and delicious.  There is “confiture,” a kind of jam that is so sweet that you can’t tell if it’s guava or grapefruit, even thought the label identifies it as one or the other.  There is often a bowl of watermelon and papaya, and perhaps pineapple, and coffee, powdered milk, fresh juice, and filtered water. Friday seems to be pancake day.  They are a little chewy, but really good with peanut butter and confiture.  Sometimes I eat my own instant oatmeal to cut back on the refined carbs. 

After breakfast, I have time to go to the library to get online, or back to my room to read or review, before heading to the clinic a little before 9 am.  The walk is about 5 minutes, on a typically rocky, uneven Haitian road.  If Haiti’s problems can be represented by "Mountains Beyond Mountains," their roads and paths can be described as “rocks beyond rocks.”

We see patients until about 12:30, when we return to Alumni house for lunch.  There is always the bread and peanut butter, but usually there’s something hot, as well.  My favorite lunch is rice with a brown bean sauce, which happens to be the Haitian national dish.  Some dishes are spicier than others, but most are tolerable for me.  There is usually fruit again for lunch, and sometimes a plate of iceberg lettuce and sliced tomatoes and carrots.  On a few occasions there has been a delicious dense yellow cake for dessert.

The water is on again from 12 to 1 pm, but I’m usually not at the house during that time.  In the shower is a big barrel for collecting water while it’s on to use while it’s off.  I think that the incoming water is chlorinated, but it’s not potable, so we filter the water before we drink it.  The bucket in the barrel is handy for pouring over your head to cool off, or for taking a “bucket shower”, and all you have to do to flush the toilet is to pour a gallon or two of water into the bowl, and down it goes.  Who knew?

I usually take a half-hour nap after lunch, because the heat, while not unbearable, does wear you out.  We see patients again from 2 to 4 or so, when a man on a motorcycle comes to transport the patients back over to the group home across campus for the night.

After work, my first stop is usually the swimming pool.  It feels great to jump in and cool off.  After that, it’s lovely to sit in my room where I'm finally the right temperature.

I take my cool shower in the evening before dinner, when the water is on once again between 6 and 7 pm.  The electricity goes off for a few minutes in the morning and evening as the diesel generators are switched to a fresh supply of fuel, but the brief blackout is no surprise.

At 6:30 I head to dinner with my new friends at Alumni House.  This week, Jake and I have gotten to know Dr. Bob Love and his wife Rose, a nurse, both of whom are working in the cholera ward.  There are 3 graduate students from Tulane working on global health (Adam) and mosquito/malaria studies (Mark), and Mark’s brother Eric is a premed student along for the adventure.

Last week there was a photographer and journalist from a big magazine in Switzerland doing a story on the Swiss Man of the Year, Rolf Maibach, who was honored for his many years of work at HAS.  We also had an internist, a pediatrician and his girlfriend who is a nurse, and a gastroenterologist here to teach the Haitian doctors how to do endoscopies.

There is a tennis court nearby, and very accomplished local players have matches some afternoons, complete with umpire, line judges, and cheering crowds.  It’s fun to stop by and watch, or just listen to the thwop of tennis balls and cheers of the crowd from my room.

Dinners are usually some kind of soup or stew, usually made with chicken or goat, along with potatoes and carrots in a flavorful broth.  Dismayed when I found a weird bone, I decided to minimize my meat intake, as there is plenty to eat without it.  There are mounds of mashed potatoes or piles of rice, or spaghetti with a red sauce with some carrots or peas or tomatoes and perhaps a little meat.  We’ve had a dense pizza and an equally dense quiche, both different from what we’re used to, but still quite tasty.  Overall, the food is voluminous and starchy.  It would be unseemly to gain weight in Haiti, but it would not be hard to do here at Alumni House.

After dinner, I usually check the internet back in the air conditioned library, one of the few air conditioned rooms far and wide.  Then I retire to my room to read or write before bed.

I’ve become accustomed to my little routes and routines.  I’ve learned to recognize some faces of the security staff that I see often.  I enjoy the familiarity and coziness of my bed with its net canopy, and my little fan and little lantern and my books on Haiti.

The late afternoon and early evening is my favorite time of the day.  I’ve accomplished some work, gotten hot and tired, cooled off, and rested under my canopy undulating in the breeze.  I have time to write, read, and listen to the sounds of the evening.  There are cawing birds, hooting owls, and roosters that crow at all hours.  There are goats bleating and dogs barking, romping through dried leaves the size of dinner plates outside my window.  I hear the occasional sounds of motorbikes, and voices of people passing by.  There are often drums from voodoo ceremonies in the distance, and the sounds of singing in a nearby church on the Corridor.  In a house nearby, someone practices the trombone, with scales and études and doleful melodies drifting over the gathering dusk.

The Hanger Clinic

We had a slow start to physical therapy because most of the patients are brought by van from Port-au-Prince or Gonaive or other outlying areas.  The transportation from Port-au-Prince is handled by the Catholic Medical Mission Board, and they decide if it is safe to travel.  Patients are usually transported on Mondays and Thursdays, but on the Thursday that we arrived, the resolution of the election runoff controversy (for the election now scheduled for March 20) had been announced, and there were worries of unrest, roadblocks, etc.  Then on Monday, there were rumors that President Preval would step down that day, and again unrest was anticipated and transportation cancelled.

The slow start was good for me because I am so rusty, but Jake was raring to go.  I was able to follow him and learn, and I even suggested that I act as his intern because of the disparity in our current skills.  With our small number of patients, I didn’t feel guilty about not carrying my load, and instead welcomed the learning experience.

David Charles, the one and only staff physical therapist at HAS, is a Haitian who trained in the Dominican Republic (since there are no PT schools in Haiti), and is one of only a few PT graduates to return to Haiti to practice.  He was at the APTA’s National Combined Sections meeting the US during our stay.  Read about him here, on page 4: http://www.apta.org/AM/Template.cfm?Section=Home&CONTENTID=80142&TEMPLATE=/CM/ContentDisplay.cfm. 

A young man named Verna, a graduate of the Rehabilitation Technician Training Program here, was ably carrying the inpatient load at HAS on his own, but Jake went over to the hospital ward to help him, and I tagged along.  Jake continues to help out at the hospital in the afternoons after the clinic closes.

Jake has two patients who are bilateral above-knee amputees. One is a woman who first lost her legs in 1992, got prostheses, and then lost those in a hurricane in 1994!  How much bad luck can one person endure?  She has not had limbs since then.  Bilateral AK patients start on “stubbies”, sockets with feet attached directly to them, so that they can start low to the ground to get used to weight bearing and walking without having to work so much on balance.  Little by little, the height is raised and knee joints are added until the person reaches a functional, if perhaps shorter than original, height.

Jake’s other bilateral AK amputee is Oscar, who had a motorcycle accident about 8 years ago and was getting prostheses for the first time.  He had been here for a week or two before we arrived, and was walking with full height, jointed prostheses and forearm crutches.  It takes an incredible amount of strength and endurance to manage the weight of the prostheses, especially with relatively short residual femurs as Oscar has, but he is progressing slowly but surely.  In one of the most impressive feats any of us has ever seen, Oscar managed to get up from the floor (fall recovery) by getting up to his prosthetic knees, supported by the forearm crutches, then extend first one leg and then the other into a wide triangle stance, then just power himself up to standing with sheer determination and upper body strength.  It was unbelievable.

One of my patients is a 55 year-old woman named Meromise who lost her left leg below the knee in the earthquake, and another is an older lady named Jacqueline who has a left above knee amputation from a car accident 7 or 8 years ago.  One day they spent a lot of time waiting in the PT department for adjustments to their limbs.  They’d sit for a while, lie down on the wooden benches for a while, then sit some more.  When Jake was busy with our only other two patients, I asked the ladies if they would like a little massage.  I took Meromise into a treatment room, had her lie down, and began massaging her shoulders and back.  As she relaxed, I thought:  Now I’ve arrived.  I am in Haiti, giving some love to someone who suffered in the earthquake.

Within a few days, Meromise had progressed well to walking without a cane up and down hills on the rough outdoor terrain.  The final task was to have her carry a load.  We have a bucket full of cement chunks that weighs about 20 pounds.  I brought it to her, and while I was trying to decide which hand she should use, she just hefted it up and started walking, no big deal!  I asked if there was anything else she needed to do, and she indicated that she wanted to carry it on her head!  This she did, walking around the department as gracefully as you please!

By Thursday we had several new patients.  I did my first evaluation on Jean-Carlot, a big, jolly man who lost his left leg above the knee along with part of his right foot in the earthquake.  He speaks French, so I could do most of the communicating on my own.  The evals are quick:  when/how did the injury occur, any pain or sensitivity, any other significant medical issues, manual muscle tests and range of motion.  The prosthetists fit the limbs and adjust them as the patient gets up and starts walking, so I can do lots of observing and questioning before I start gait training.

Another patient, Logista, arrived on Friday.  She is 21 and has a left below-knee amputation and a nearly fused and heavily scarred right ankle from the quake.  As soon as her limb was donned, she walked off with a cane, using a beautiful gait.  She was allowed to take her prosthesis with her back to the group home, and I told her I would visit her there on Saturday.  I did so, and we walked, with no cane, down a steep ramp, around the house on a rough stone sidewalk, and then out and about across rocky, rutted, terrain, over tangled tree roots and up and down inclines.  She just marched on, with a smooth, even gait, “pas de problèm” – no problem at all.  “C’est facile!” she exclaimed, “It’s easy!”  She was just delighted, and kept giggling and hugging me as we walked, as if I was the one who gave her this gift.  It wasn’t me, though, it was HAS, the Hanger program, and her own fortitude that made it happen.

Giving

Although I brought items with me to donate, there is not really a mechanism here for distributing them.  We were told that shortly before we arrived, someone attempted to hand out hand sanitizer in the hospital, and there was such a run on it that they had to call security.  Evidently, handing out dozens of toothbrushes in the wards is not going to work.

The PT patients staying here live in a humble house just outside the hospital campus.  It has water and power, and small rooms with separate entrances from wide outside porches, but is very sparse otherwise. I visited to take them the 6 sets of sheets I had brought from home, because there 6 were people staying there at the time.

Ulna, the wife of one of the patients, had asked me if I could “help her with her children.”  She has two daughters, 12 and 14, and speaks some French. I thought I’d take the comb and colorful hair elastics that I had brought as well as the sheets, so I told her I had something “tout petit” – really small – for her.

When I arrived with my suitcase with sheets she was thrilled, thinking that everything in the bag was for her, so she immediately took me into her room.  There was nothing but a cot and a mattress on the floor.  But I told her the things were for everyone, so she reluctantly took me back out onto the porch.

The other residents were happy to receive sets of clean white sheets and new toothbrushes, but when I gave Ulna her sheets along with the hair things, and her husband Oscar the playground ball he had said he wanted (and will probably sell), Ulna seemed unimpressed.  I felt terrible, as if I had raised her expectations, and then disappointed her.

It’s hard to know how to help.  HAS reminds us that our gift to the Haitian people is our being here, but it is up to us to decide if we want to do more.  If I give Ulna $10 or $20 before I leave, is that a good thing?  Is it enough to make a difference?  And what about the other patients who have just as much need?  They all know that we are so wealthy that it must seem stingy that we don’t give more.  Yet Haiti is so dependent on handouts that one wonders how helpful it really is.  After I left the patients’ residence, I realized that I had several hundred dollars in contingency cash hidden in the very suitcase I’d taken to their house, and felt even worse.

Rose, a nurse working in the cholera ward with her physician husband Bob, told me about one of her patients, a little boy who had been brought in by his grandmother.  He was feeling better, but the two of them hadn’t had anything to eat for 2 days.  The boys’ mother was away in St. Marc and didn’t even know he was sick, and the grandmother had no money for food.  Workers are discouraged from taking food to patients because there is no equitable way of distribution in this setting, and there would never be enough.  But Rose couldn’t stand by and let these two, the young and the old, continue to be hungry.  She took leftover food, snuck them into a dark room, and fed them, saying, “don’t tell anyone about this.”  They were extremely grateful.

The gate to our compound is guarded all the time, mainly, I understand, for the privacy of the residents and to keep locals from approaching and asking for handouts.  One guard, named Berthoud, is there most afternoons and evenings and I’ve become a little familiar with her.  One day her young son Michi was with her, doing his schoolwork.  He proudly showed me his book on hygiene, opened to a page with line drawings of teeth and how to brush.  The next night when she was there, I gave her two new toothbrushes for Michi and his brother, one decorated with dinosaurs and the other with stars and moons.  A few nights later, Michi was with her again, and he approached me with a huge smile, thanking me for the toothbrush.  He was so sweet.  This night, he showed me his book on the history of his country, and I told him that I was studying the history of Haiti, too.  I’ve learned that small gifts are more appreciated when they are not expected.

* * *

At the end of our workday on Friday, a young man approached me in the clinic and started telling me, in English, about his art program for children.  He had small papers to hand out showing his web site and email addresses, and invited me to come see his program the next morning.  I asked him where it was, and he said he’d come get me at my house in the morning and walk me there, but I didn’t want to do that.  It was close by, so I said, “why don’t you show me now?”

So off I went, with this young Haitian man named Oliancy, through a grassy field dotted with trash and goats, past tiny painted cinder block hovels, and on to the continuation of the Corridor that runs by the HAS campus.  We passed lots of curious children, some of whom wanted me to take their picture, which I happily obliged, while Oliancy continued to tell me in heavily accented English about all of his efforts.

We turned into an enclosure with a large yellow building that appeared closed, then passed between that and another small white building with blue trim, where students were packed inside a tiny, dark room finishing their days’ lessons.  Oliancy told me that these were secondary school students.

Beyond that building was a cinder-block structure with 4 rooms and no light, with wooden benches, chairs, and desks that you would imagine seeing in a Colonial era American schoolroom.  This is where he held his “club,” from 8:30 to 10:30 on Saturday mornings. I told him I would come back at 9 the next morning.

That evening, Ian Rawson was visiting Alumni House, where we take our meals, so I asked him if this guy was for real.  Ian replied, “they all are,” but I’m not sure what he meant, because he went on to tell us that Haitians are very creative and sophisticated in their methods of extracting money from sympathetic foreigners.  I then asked if he thought it was safe for me to return the next morning, and he said, “Oh, yes, it’s very safe, because they all know that there are so many people looking out for you.”

So the next day I walked up the Corridor, probably only 100 yards, but it had seemed further when I went the other way with Oliancy.  I saw a little girl in a red shirt go into the little building and followed her in.  Darned if there wasn’t Oliancy with about 30 children packed into a little classroom, teaching them a song, the words to which one of them was diligently writing on the chalkboard.  They all snapped to their feet and greeted me when he introduced me, saying brightly in unison, “Bonjou, Madam!”  Then they sang me their song.  In the adjacent room, 4 other children were working on drawings, with an older boy at the chalkboard drawing the design they were to copy.

Oliancy showed me some of his supplies:  paper, scissors, crayons, colored pencils, glue, and twine.  They also use coconut shells and paint for various art projects and jewelry.  I gave him one of my playground balls and $20, and he said he would use the donation for more supplies.  He also promised to bring me some art created by the children before I leave.  As far as I can tell, this 24-year-old man is doing what he says he is doing, and I was very impressed.