Notes From Leogane No. 14: The Guesthouse

Dear Family and Friends:

For mobile clinics teams from the United States spending a week here, the HSC Guesthouse is a place to sleep after working all day in the field; with breakfast, a sack lunch "to go", and dinner to boot.  Mobile clinic teams, however, barely spend enough time here to know by name all of my co-workers, who I hope agree I can call them my new friends: Jeannine, Madame Bellevue, Tipanyol, Yvette, Lozina, Geralda and Djenie.  

In March 30, 2010, I arrived at my "temporary residence" will little idea of what it really meant to be the Guesthouse Manager at Hopital Sainte Croix.  After "shadowing" Dr. Robert Sloane and Robin Sloane for four days before they returned to Fort Worth, Texas, I knew better than to tell people that I was their "replacement."  Instead, I have said, "I was next."  In the span of four days, I got but a glimpse of how important the Sloanes have been to the success of the Guesthouse.  (Guesthouse entrance door shown in photo above.)

  

The past three months, I have kept in touch with the Sloanes by email and a few phone calls.  I'm indebted to Bob, along with Dr. Emilie Hitron and Rev. John Talbird, for talking me into coming to Leogane.  I'm grateful to Bob and Robin for all of the guidance they gave me during our meetings here before their departure on April 4, and since then.  The Guesthouse and Hopital Sainte Croix will again be enriched by their return again in January for three months.  

Bob and Robin were here this year from mid-January through April 4.  There were mobile clinic teams staying here just about every week.  They obviously were very busy managing the guesthouse.  My tenure here has been rather different.   
   
When I arrived March 30, a mobile clinics group, made up of Boston College Nursing College students and two instructors, were in the middle of their weeklong stay.  After Bob and Robin left the next Monday morning, I was here for the seven days stay of another mobile clinic group from the Boston area.

And then the dust, dirt, spattered concrete, pounding, hammering, chipping away all walls, and other construction work started on the guesthouse floor of the three story north wing of Sainte Croix.  When I first met Bob Sloane, Emilie Hitron and John Talbird last November in Miami, at a Haiti Episcopal Diocese Reconstruction conference, I made the mistake of mentioning that I had worked construction and later "acted" - more in the theatrical sense - as a City of Phoenix construction inspector of sorts before law school.  I warned them that I didn't know what the heck I was doing as a city inspector.  Somehow that experience translated into my becoming a somewhat "informal ad hoc" - and thankfully not "official"  - construction monitor for the hospital's project architect in North Carolina.

The seven weeks of construction from April 11 through May 29 were so extensive that we were not in a position to house visiting groups.  Construction continues to this day, but the necessary renovation of the large dormitory area was completed just in time to allow the nine member Duke University undergraduates, and mentor, to move into the guesthouse on May 30, for a two months stay.    

This is not a mobile medical group. Rather the "Dukies" are gathering information in Leogane for two surveys.  The first group is gathering information from survivors of the earthquake for use in a Post Traumatic Stress Disorder ("PTSD") study.  The other group is conducting Maternal Mortality interviews, to learn about the causes of death of women who either died in childbirth or shortly after a delivery.  It is my understanding that this information will be used to assist in the placement of clinics and midwives in the Leogane Commune.  Funding for the two projects is provided through the Bill and Melinda Gates Foundation. 

During construction, the "long term residents" of the guesthouse have remained here - Dr. Samuels, an ER physician at the hospital, Dr. Pierre, a public health administrator, Pernell Joseph, who works in the hospital's finance office ("Comptabilte"), and Carleigh Ghendt, the administrative assistant to Hospital Director, Dr. Gladys Memnon.

Carleigh originally came to Haiti last year with the All Hands volunteer group mentioned in Note #  8.  But this year she has been serving as Dr. Memnon's assistant at the hospital.  Carleigh has agreed to stay at Sainte Croix through the end of the year, if not longer.   She has been "drafted" to be the ad hoc guesthouse manager until the next formal Manager comes aboard.  (A photo of Carleigh, with me and Dr. Memnon from this evening is at right.  Dr. Memnon had just come from wedding.)

On several weekends during April, the guesthouse floor seemed a bit like the snowed in hotel in The Shining.  Dr. Samuels and Prenell would be in Port-au-Prince, Carleigh was on vacation in the States, and Dr. Pierre had yet to move into the guesthouse.  It was just me and Dr. L from Friday evening until late Sunday afternoon.  But instead of yelling "Here's Johnny" and chasing after Shelley Duvall with an axe, I'd sometimes find myself running down the hallways after Dr. Livingston with my camera.  He was as elusive as Danny and Wendy in the movie.  (There are no photographs of Dr. L for this note.  He's had his several weeks of fame, which is quite enough.  I know Dylan agrees.)

Seriously though, serving as the Guesthouse Manager at Hopital Sainte Croix has allowed me three months' time to get to know the staff here, each with unique personalities.

I start with Madame Bellevue, because she was the first person who took the time to teach me some Kreyol, and also because, well, there is only one Madame Bellevue. (Madame Bellevue in one of her many hats).  She is the strongest petite woman I have ever met.  When we would lose water to the guesthouse, it was Madame who would haul bucket after five gallon bucket of water up the stairs from a water source outside of the hospital lobby.  Madame Bellevue pesters me a few times each week to allow her to change the sheets on my bed more often; but I have won that battle most days !  When she has taught me a new word or phrase in Kreyol, and I finally use the proper pronunciation, she'll sometimes pat me on the face - with a giggle from the approving teacher to her student.  Madame Bellevue is in charge of housekeeping at the guesthouse.  She always is wearing a hat when she cleans up at the end of the work day, and changes into a dress for the walk home.  She has dropped by on Sundays a few times, to visit on her way home from church.  On Palm Sunday, she was wearing a long purple dress and a black hat  -  my favorite outfit for this remarkable woman who displays so much grace every day.

Tipanyol shown at right usually is the first to come to work each day, so I open for him the locked entrance door on the second floor.  He always greets me with a high pitched "Bonjou" and a soft crossing of one of our hands. (Haitians do not usually give you a firm handshake, which is a common American style. Rather hands are often brought together in more of a soft slap or a quick grasping.  Peterson, however, is a fan of firm handshakes.)  From Watson I learned that Tipanyol has been working at Sainte Croix since at least 1998.  Watson remembers seeing Tipanyol working at the hospital, when Watson, age 6, would be doing his homework waiting for his mother to finish work at Sainte Croix.  Tipanyol is a general handyman around the guesthouse and assists Madame Bellevue with housekeeping.  I think it is fair to say that he and I have developed a better working relationship as my Kreyol has improved, because Tipanyol speaks very little English.  He is a hard worker, and a good man.  

Yvette, Lozina, Geralda and Djenie are the staff members who have worked with Jeannine in the kitchen and dining room my entire time here.  Djenie is the youngest, and is Jeannine's niece.  (in green top) She has only worked here a few weeks, because she still attends secondary school.

During the seven weeks of construction when no groups were staying at the guesthouse, only Madame Bellevue, Tipanyol and Jeannine worked full time each week.  Jeannine and I agreed we would rotate in one additional cook to assist Jeannine each week, so that Yvette, Geralda and Lozina, and one week Djenie, would be able to work at least once every 3 - 4 weeks.  During the Dukies stay, Jeannine is being assisted in the kitchen and dining room by two additional staff members each week.  I hope the guesthouse will once again return to full capacity by September, so that full time employment is available to all of Jeannine's co-workers.  

Yvette (in brown top) is the most serious one in the group; and the best dresser.  Early in my time here, when Yvette was working, she made sure that promptly after 5 p.m. I had locked the metal door leading down from the roof, and all three doors accessing the second floor.  She was adamant that I secure the guesthouse immediately after the construction crew left for the day.  Because she doesn't speak much English, these "polite reminders" were done with hand signals.  Yvette must now think that I know what I'm doing, because for more than two months she has not found it necessary to get my attention after 5 p.m. by walking in front of me to point to the roof.  Now Yvette's "Bonjou Dave" greetings at the beginning of the day are quite friendly.  Yvette is like the co-worker who reserves judgment until a new employee proves he is not totally incompetent.  I think I have finally made the grade in Yvette's mind - of at least not being totally incompetent.  Next to Jeannine, I now am closest to Yvette among the kitchen and dining room staff. 

Lozina (in black top) is the oldest member of the staff.  Until two weeks ago, she had the most amazing braided hair I have seen in years.  She is very reserved and most quite kind.  When Lozina is working with Yvette and Jeannine, we most definitely have the "A Team” on board.

The first few weeks I worked with Geralda (purple top), I thought she was quite shy.  But during the past month or so, she has shown a different side.  She actually is quite outgoing once you get to know her.  As with Tipanyol,  improved communication between me and Geralda has been directly tied to my learning more Kreyol.  I now can make her laugh; which never happened in April. 

And then there is Jeannine (in blue stripes), the glue that holds together The Guesthouse at Hopital Sainte Croix. She's like an older sister, even though I have many years on her. People in Leogane, and mobile teams in the States, know of the reputation of the Guesthouse having the best meals in town. This is a reputation well deserved, in large part to Jeannine always trying to improve the cooking here. But Jeannine is much more than the person I meet with each week to decide how much "lajan" she needs to buy food supplies for next week's meals. She is the one person at the guesthouse who everyone looks to for guidance. She knows who to  call among the non-medical hospital staff to get something fixed. She takes great pride in her leadership role. I could not have survived the last three months without her counsel and polite shoves.  

Carleigh leaves tomorrow for three weeks of vacation with her family in the States.  It is just like Jeannine that for last two nights she has been surfing the Internet to find a few baking and dessert cookbooks she has asked Carleigh to bring back to the guesthouse.  

I have learned important life lessons from the grace and wisdom displayed by Madame Bellevue and Jeannine.  I hope that counsel stays with me long after I leave Leogane.  

The past few months, I have received a few emails asking me how I liked managing the staff at the guesthouse.  The answer is quite simple - I don't.  That is, I haven't been managing the people who were working here when I arrived in late March and who still will be here after I leave in two days.  This has truly been an experience where the patient veterans have brought the rookie along slowly but surely, so that he could eventually feel that he has made some small contribution to the goings-on of the Guesthouse at Hopital Sainte Croix.     

I hope this note finds you and your loved ones in the same good health and spirits. 

David

28 June 2011      

Notes From Leogane No. 13: The Hospital

Dear Family and Friends:

You can't spend three months at Hopital Sainte Croix and not recognize that it is a place with an important history, a different present, and a future with renewed promise. 

When you walk through the floors of the three story wing currently undergoing renovation, you get a glimpse of all of the medical specialties that once were available at the zenith of the hospital's service to the community.  In 1985, the Haitian Ministry of Health had designated Hopital Sainte Croix as the official health authority for the Leogane commune.

When walking the halls of the first floor under renovation, the now fading signage bears witness to grander days at Sainte Croix.  There once were separate departments or wards for OB/GYN and delivery, pediatrics, orthopedics and neurology.  There was an eye surgery center, a dental clinic, a surgical wing, and of course general medicine facilities.  There were 120 beds for hospitalized patients.  

Those days have been replaced with a scaled down hospital, with approximately 27 hospital beds.  But there is a vision for Sainte Croix's return to its place as a major hospital facility in the Leogane region and for that matter all of Haiti.

Before I arrived in Leogane, I had thought that the hospital was closed because of the earthquake.  I have learned that Sainte Croix had been closed for more than a year before January 12, 2010.  I have heard several versions of the reasons for the hospital's closing, none of which seem particularly important at this time, now that Sainte Croix is back in operation with a new Medical Director, Dr. Gladys Memnon, and with major financial support for a substantial expansion of the hospital.

I've attached a graphic diagram of the architect's rendering of the new hospital buildings, as well as the new school and church.  As reported in a newsletter by The Rivermont Presbyterian Church in July 2010:

"A plan to rebuild the entire hospital compound has been prepared by Jimmy Hite, the architect who designed the nursing school.  This program will cost about $12 million, funded by a group from the Pittsburgh area through Medical Benevolence Foundation (MBF)[, affiliated with Presbyterian Church USA,] and will rebuild the hospital, a guest house, and other hospital related buildings, as well as the school, the church, et cetera.

The most exciting news is the appointment of a hospital director, Dr. Gladys Memnon.  She is a Haitian American physician.  She has been working at the hospital for the last several months, and is a lady who is full of energy, determination, and grit.  After retiring from her practice of OB/GYN [, in Brooklyn, NY,] she returned to Haiti and for several months was sleeping in a tent in back of the chapel and providing leadership for outpatient clinics in that area."

Hopital Sainte Croix reopened after the earthquake in September 2010.  Attached is a photograph at the hospital's re-dedication ceremony last September.  Dr. Memnon is shown with the Bishop of the Episcopal Diocese of Haiti, Jean Zache Duracin, and John Talbird, an Episcopal priest from Tennessee, who used to be the Chairman of the hospital's Board of Directors. (Rev. Talbird, along with Dr. Bob Sloane and Dr. Emilie Hitron are the reason I was asked to come to Sainte Croix for three months.)

At present, Hopital Sainte Croix operates an out-patient clinic that may see as many as 200 patients in a day.  Patients begin arriving around 6:00 a.m., in anticipation of the clinic's opening at 7:30 a.m. There also is an emergency room.  The ER physician, Dr. Samuels, resides at the Guesthouse Sunday nights (he's on call) through Friday afternoons, and then spends most weekends in Port-au-Prince.  He received his medical training in Havana, Cuba. 

Because my Spanish still is better than my Kreyol - though that may change - Dr. Samuels and I switch back and forth between Kreyol and Spanish, sometimes within a sentence, when we try to converse. 

Minor surgeries are performed at Sainte Croix, but major surgeries, such as orthopedic and neurological surgeries, are performed up the road at the Doctors Without Borders hospital.  Though there are plans to return to delivering babies at the hospital, high risk deliveries currently are performed by Medecins Sans Frontieres.  Regular deliveries, including C-Sections, are performed by Dr. Delson and another Haitian physician in Leogane.

Attached are some photographs of the hospital I took this morning: the Lobby, the main hallway leading to wards for in-hospital patients, and one of the surgery salons. The interior of the hospital looked a bit different the morning of May 1st.

The chocolate syrupy flood water residue you see in these photographs resulted from three days of rain that announced the beginning of the rainy season.  Photographs 0103 and 0107 were taken toward the end of the first of two days of an "all hands on deck" clean-up, with me, Madame Bellevue and Tipanyol lending a hand to doctors, nurses, and non-medical staff of the hospital.

During the two day clean-up, I had the opportunity to spend some time pushing flood waters along side of Dr. Belanger, the resident surgeon at Sainte Croix (shown in scrubs). He is one of the most sincere and personable professionals I have ever had the privilege to meet. 

The member of the hospital staff I will miss most, however, is Ty Ty, the head of security. We met the day I arrived at Sainte Croix, as Bob Sloane took me on a tour of the hospital.  Ty Ty has been my hospital guardian angel, so to speak.  He has helped me out of more than one bad spot.  And, on several occasions this month, he has arrived just in time to take over restoring electricity to the Guesthouse, after the circuit breakers started acting up and restoring power was no longer a simple matter of my throwing two switches, as had been the standard routine in April and May.

Two weeks ago I thought I might have electrocuted Ty Ty.  I think I have mentioned before that I'm a fan of the 35W generator not the 45W.  Cranking up the 35W is simple, so that even a mechanically challenged person such as I can start it at 2 a.m. in the morning.  The 45W seems more finicky.  It sometimes trips the circuit breakers when Ty Ty, Belove or Faisol switch it on, when the hospital and guesthouse both lose power from the Haitian Electrical Department ("EDH").  For three months, I have avoided the 45W like the plague. 

Two weeks ago, we lost power in the guesthouse.  (The hospital doesn't lose electricity when EDH power cuts out, because the hospital, unlike the guesthouse, is tied into a battery-backed storage system to provide uninterrupted power to the one story hospital wing.)  To make too long of a story shorter, I went down to the generator boxes and noticed that the switch was pointed to the 45W, so with my flashlight in my left hand, with my right I pulled the lever down to the 35W position.  Just then I heard a yell from the 45W shed that I was pretty sure was Ty Ty.  Then I heard the 45W generator kick in out back in the shed, followed by dead silence.  I waited 10 seconds or so, but didn't see Ty Ty coming out of the shed.  The security gate next to the generator switch boxes was locked, which meant that I had to take the long back way around a hospital building to check up on Ty Ty.  I thought he probably had been shocked real bad or worst when I threw the switch to 35W.  (Ty Ty knows I won't use the 45W). 

The 20 seconds or so it took me to get out back of the hospital was just enough time for me to try to remember how to do CPR.  Just as I thought, "No, only your kids are CPR certified" - because they have been Camp Mishawaka counselors - Ty Ty stepped out of the shadows.  I tried in Kreyol to explain that I thought I had made him "fe mal" or worse. In the dim light, I think he smiled.  He put his arm around my neck and walked with me back to the lobby.  Ty Ty gave me a big grin and a thumbs up as I crossed the lobby toward the stairs to the guesthouse floor.

I first learned that Ty Ty was the lead singer in a band when Carlos and I were out back of the hospital on April 29, loading sand bags on to a gurney as part of the sand bag brigade working late that Friday afternoon in anticipation of flooding in the area.  (Carlos definitely lifts weights) Photos 0103 and 0107 provide the answer to any question you may have about how successful the fifty or so sandbags were in holding back flood waters that weekend!

When they were practicing next to the 35W generator (which wasn't running of course), the band - Ty Ty on vocals, and keyboard and guitar players - and I'm not kidding about this, sounded somewhat like an unpolished version of Asleep At The Wheel, when I used to watch them on Austin City Limits.  Ty Ty's band had that same non-country Texas-style to the first two songs they rehearsed.  Then they switched to a song obviously intended for church.  Watson told me a few weeks ago that Ty Ty's band plays around town, including for churches such as Sainte Croix Episcopal Church.

Ty Ty is one of those rock solid people, serious but with good humor, who you always hope to meet when you find yourself in unfamiliar waters.  I have learned much from my friendship with him the past three months.  

  

There is a long and colorful list of people at the hospital who I have met the past three months.  I would be typing for hours were I to try and share even one story or impression about each of them. There is JoJo, the pharmacist; the nurse - whose name I don't know - who always greets me in English, and who is good friends with Jeannine;  Mr. Guey of course; and Belange, the best dressed driver in Leogane.  Dr. Memnon's assistant is Carleigh, who I will write about in the next note.  Prenell and Fontus are in the finance office.  I already have mentioned Faisol and Belove.  Zoe, who introduces himself though as Joseph, is the elder statesman of the non-medical staff of Sainte Croix.  Zoe loves the 45W.  Sammy is the equipment tech in the surgery department.

And there's Phillipe, who seems to be able to find a way to fix most of the things that break around the hospital and the guesthouse.  I now have taken five round trips to Port-au-Prince with Phillipe.  It seems as if he can't drive more than a 1/2 a mile in PaP without someone waving at him.  Carleigh has observed the same thing several times.  

Hopital Sainte Croix is the only low income hospital in Leogane.  If a patient cannot afford prescription medications that are available at the hospital, they are dispensed free of charge.  The charge for an out-patient clinic visit is very modest.  Jeannine's nephew was hospitalized in May, I think for one or two nights.  The charge was 500 gourdes - $12.50 U.S.

Sainte Croix is centered in outreach efforts taking place away from the hospital.  It provides an office for the Children's Nutritional Program headquartered in Leogane.  Numerous off-site clinics and public health programs administered in Leogane Commune originate at Hopital Sainte Croix.  The hospital's vehicles are made available to medical and dental mobile clinics teams from the U.S. who stay at the Sainte Croix Guesthouse.

Nursing students from the Episcopal Nursing College up the road in Belval have come to the hospital for training rounds and lectures just about every week that I have been here.  

I think Hopital Sainte Croix serves a very important role in the lives of the people of the Leogane Commune.  It is a beacon of hope for the community. 

I hope this note finds you and your loved ones in good health and spirits.

David
23 June 2011

Notes From Leogane No. 12: The Mobile Clinics at Massanba and Belle'Air

Dear Family and Friends:

Jim said at one point the woman grabbed the handles on both sides and it seemed as if she lifted herself up out of the portable dentist’s chair a few inches so that her back was as straight as a board.  Jim said he could see the pain reflected in her eyes, but she didn’t make a sound.

This Haitian woman had come to the mobile clinic at the village of Massanba with four teeth broken off half way to the gum line.  Dr Bastien, a Haitian dentist, had to cut into the gums before he could extract the broken teeth.  In the States, I would expect most patients would be knocked out by general anesthesia before the gum cutting and extractions by an oral surgeon.  Dr. Bastien had administered a heavy dose of xylocaine, Novocain or an equivalent, but the patient was awake for the entire procedure.

To me, this woman is but one example of the amazing stoicism and heart of the many good people of Haiti who have faced obstacle after obstacle in their lives.  At Massanba, the mobile clinic team brought some light and relief to the many who came to the clinic. 

Infants speak a universal language when being examined by a nurse or doctor – they often cry or in some instances scream when their ears are scoped, or they otherwise are probed as part of a necessary examination.  Haitian babies and infants are no different.  But other than “pitit”, the patients at Massanba I observed kept to themselves any audible measure of the magnitude of their pain and suffering. 

      

At the mobile clinic in Massanba, Dr. Bastien extracted 17 teeth from 11 patients.  Even though I was often around the corner in another room, no more than 40 feet or so from Dr. Bastien,  I never heard a cry or moan from any of the patients in the chair.

Dr. Bastien, who has a dental clinic just one block from L’Hopital Sainte Croix, was the only member of the mobile clinic team that was not from the United States.  All but one of the members who flew into Port-au-Prince on June 11 were from the Atlanta area.   I think the other member was from North Carolina. 

Because construction continues at the HSC Guesthouse, limiting the number of guests beds available here to the group of undergraduates from Duke University staying with us, the sixteen members of the Georgia group stayed at Residence Filariose operated by the University of Notre Dame.  It is located in Belval, a Leogane neighborhood about 1 ½ miles from the hospital. 

But HSC vehicles were used to transport the group to the four days of mobile clinics from Monday, June 13, through Thursday, June 16. We also made all arrangements for eight translators to accompany the team to assist in communications between the Haitian patients and the American team members. 

I had the opportunity to spend the entire day last Monday with the team at the mobile clinic in Massanba, and also to travel with one of the drivers for the end of the day pick-up of the team in the village of Belle’air two days later.

Massanba and Belle’air are both in the country, but different from each other in many ways.  To get to Massanba, we traveled about eight miles on a main paved road to the town of Carrefour Dufort, which was bustling with market activity all along the highway as it passed through town.  We then turned to go another five miles or so on a good passable dirt road.  About 1 ½ miles from the village of Massanba, we came to a stream crossing, which I assume we would pass through and continue on the dirt road.  To my surprise, the drivers took hard rights into the stream and made their way up the stream bed for the last leg of the trip to the mobile clinic site.   

In Massanba, an elderly couple graciously offered the outside and first floor level of their beautiful two story house for the clinic site.  The house was on a hill above other more modest wood and metal houses, and in many instances, shacks, in lower farm land and stands of banana trees.  The “temporary clinic” house was painted a bright blue with white trim.  I’m still trying to figure out how all of the concrete for this two story edifice and the substantial concrete driveway and parking area adjoining the house was brought into the construction site.

 

Unfortunately, I had not expected to make the trip to Massanba and didn’t bring a camera with me, so I can’t share with you any photographs of the four wheel drive vehicles traveling up the stream, the “clinic house”, the team setting up all of the tarps for shade outside where most of the patients and team members would be stationed, or the team in action.

 

The team members from the States were a combination of medical professionals and those without a medical background.  The team leader, Priscilla, is a Certified Family Nurse Practitioner.  She is a take charge and get it done type, who has been to Haiti many times with mobile clinic teams.  She runs a tight ship.  I can say that, in respectful terms, from personal experience last week.

Priscilla’s husband, Ken, an engineer, provided oversight for site set-up and assisted other non-medical team members in the flow of patients from Point A to Point B so to speak.  Other non-medical members pitched in as needed to assist in the smooth operation of the clinic, so that the medical professionals could focus on what they do best – helping the sick.  Jim, a roofing contractor in the States, acted as Dr. Bastien’s assistant. 

Most of the medical professionals were nurses, including pediatric and general medicine nurses, some with neonatal ICU experience.  The group also had a pharmacist, Mike, who is Jim’s brother.  Mike was assisted by Briana, who is proficient in reading prescriptions, and is quite knowledgeable about the various prescription and non-prescription drugs that were on hand for dispensing to the patients.  Briana was another one of the team members who had been to Haiti with other mobile clinic teams.  

  

The translators working this past week with this group have been with many medical clinic groups from the United States.  Last week’s group was given high praise by several of the translators, who remarked that this group not only had a well organized operation, but that all of the team members brought to the clinics that invaluable combination of superior professionalism and sincere compassion for their patients. 

At the end of the week, I was advised by Priscilla that in four days of mobile clinics they had seen more than 500 patients.  The dentist performed extractions on more than 40 patients.

I’m pretty sure the mobile clinic process in Massanba was generally the same for all four days. The first wave of patients assembled as a group around the lead translator, Peter, who held up the initial intake form and explained how it needed to be filled out before the patient could go to the next stage – “triage”.   At triage, the intake form was reviewed by a team member, preliminary questions were asked, and vital signs, such as blood pressure and pulse, were taken.

New groups of patients arrived at the clinic throughout the day. A translator assisted in having the patient describe the reason for coming to the clinic.  After triage, patients were sent to a medical professional who conducted a more detailed medical assessment specific to the reported ailment(s) or condition(s), again with the assistance of a translator.  Most often a medication was prescribed; in many instances multiple medications.

After the assessment and diagnosis stage, many patients who were to receive medications were shown to the bench in a hallway on the first floor, to wait in line for Mike and Briana to review the prescriptions sheet and gather the prescribed medications.  To ensure that each patient fully understood how to use their medications, including when and how often to take pills, or how to apply an ointment, each patient would meet with “Mario”, the oldest of the eight translators (in picture at left). Mario celebrated his 58^th birthday while Jeanne was visiting Leogane a few weeks ago.

After watching Mario in action for several hours in the pharmacy, I understood why a number of months ago Priscilla made a special request that Mario be one of the translators.  Before Mario handed medications to a patient, he assumed a tone and demeanor that was one-half Marcus Welby and one-half sage Haitian neighbor, father or grandfather, depending on the gender and age of the patient.  Even though I understood little of his Kreyol instructions, I could tell Mario took all the time necessary to make sure each patient fully understood his use instructions.  He spiced up his directions from time to time with a little humor, most often for children and young adults.

In certain instances, medical treatment was given by the consulting medical professional before the pharmacy stage.  On several occasions, I watched the NICU nurse administer a vaporizer treatment to a “pitit”, while the child’s mother held the infant in her lap.  The group had come prepared with an ingenious “vaporizer pump system”, which is my fancy way of saying that some of the non-medical team members – I think under the direction of John who I think may have “invented the pump system” at a previous clinic in Haiti - hand operated the tire pump to have the therapeutic vapor come out of the plastic mouthpiece for insertion into the infant’s mouth or to dispense vapors near the mouth and nose.  

This vaporizer system is but one example of the resourcefulness exhibited by the mobile clinic team during its four days in the field.

 

Their day didn’t end with the trip back to Leogane.  The team spent most of the evening preparing supplies, instruments, and prescription carrying cases for the next day’s clinic.  I hope they all at least had time for a Prestige or Coke after dinner.  

  

At the end of the day, more than 140 patients had been seen at the Massanba clinic.  There is no telling how many people had received relief from a condition that would have been left untreated had a mobile clinic not come to Massanba that day, to Petit Harpont on Tuesday, Belle’air on Wednesday, and Grande Savane on Thursday. 

Not all patients however could be treated at the clinics.  One of the medical team members  mentioned how difficult it was to diagnosis a condition that required more intensive medical intervention, such as children who needed lifesaving surgery for a heart defect, or the eight year old boy whose preliminary assessment was Type I diabetes.  All such patients were referred to a medical facility where hopefully they would receive necessary care.

Usually, the drivers of the transport vehicles remain at a mobile clinic site the entire day.  This is done in part to allow for a quick exit from a village when heavy rains start and the outgoing road becomes flooded, preventing a scheduled return to Leogane.  Last Wednesday, however, one of the three vehicles was needed in Leogane at mid-day, which gave me the opportunity to take the return trip to Belle’air at 3 p.m.  The drive into the high mountains, half way between Leogane and Jacmel, lasted almost an hour. This time I had my camera with me.

Belle’air is about twenty-five miles from Leogane.  The main highway from Leogane and Jacmel is totally paved, and there are many large trucks on the highway hauling a variety of building materials.  Large passenger buses and tap-taps make day trips back and forth on this main road.

Once off this highway however travel was on a narrow and winding dirt road, which required three four-wheel drive vehicles.  The lush vegetation, and the modest houses, huts and shacks dotting the mountainside, announce the transition to a very different way of life for the people who look down into the valley of the much more “urban” city of Leogane. 

The site of the Belle’air mobile clinic was quite different from the modern two story home in Massanba.  In Massanba, Dr. Bastien’s “office” was on concrete porch protected from the sun.  In Belle’air, Dr. Bastien’s patients sat in the brown portable dental chair under a tree and tarp alongside of the dirt road, about 30 yards from the main clinic area at a modest wooden house.     

In Massanba, the pharmacy was indoors, as was the hallway waiting area.  In Bell’air, medications were assembled in a modest hut, and then dispensed just outside the door on a wooden table of sorts.  In Massanba, patients sat on a bench waiting for Mario, and remained seated to receive his instructions.  In Bell’air, they stood outside across the table from Mario. 

I’m attaching several photographs taken at the mobile clinic in Belle’air.  I’ll also forward to you by separate email photographs of the mountain region around Belle’air and lower valley areas outside of Leogane the city.  While the clinic setting in Belle’air was more spartan than Massanba, the care in Bell’air was of course as excellent as in Massanba.

I didn’t travel with the mobile clinic team on their last trip, but I sure heard about the return trip on Thursday; about how one of the HSC drivers, Mr. Guey, kept the Nissan pick-up from rolling off a cliff.   I first heard about this while I was on a moto, on my way to Belval to check with Priscilla about how the day went in Grande Savane.  About 1/3 of a mile from Residence Filariose, Dr. Bastien flagged me down and told me that he and others in the pick-up had barely avoided a serious accident.  He didn’t describe what had happened.

At Residence Filariose, I spoke to a few members of the team who described how Mr. Guey remained cool and collected as the Nissan came around a corner in the dirt road, and somehow started to drift backwards toward the cliff.  There were several people riding in the back of the pick-up, and others in the cab with Mr. Guey.

At the end of the day on Thursday, the team gave me the customary tips for the HSC drivers.  But Priscilla also gave me an additional, special tip for Mr. Guey to thank him for saving members of her group from what could have been a fatal accident but for Mr. Guey’s quick reactions and skilled driving.

As I reported to Priscilla in an email the next day (with a request she distribute it to all team members), Friday morning I ran into Mr. Guey sitting alone out back of the hospital.  I sat down next to him, handed him the special tip, and said: “Gwoup klinik la vle ou fe yon vwayaj espesyal paske ou sove yo de yon aksidan ye.” He got a nice smile on his face – which is history making in itself – a little gleam in his eye, and replied, “Thank you.”

Thanks to the online English to Haitian Creole “Bing Translator” I have been using the last 2 ½ months, I think (but the Bing translator does make mistakes from time to time) I had delivered this message: “The clinic group wanted to give you a special tip for saving them from an accident yesterday.”

When I arrived in Port-au-Prince on March 30, 2011, I was greeted in the airport parking lot by Bob and Robin Sloane, the Guesthouse Managers I would follow.  Mr. Guey was the driver who drove us back to Leogane.  He didn’t say anything the next two hours.  Regardless of the traffic conditions, he never changed the expression on his face.  He was all business.

I’m glad for many people that last Thursday Mr. Guey again was his consummate serious self, and all business.  He has helped ensure that many good people in last week’s mobile team will be back again to help many good people in Haiti.

I hope this note finds you and your loved ones in good health and spirits.

David
20 June 2011   

Notes From Leogane No. 11: School Colors, the Haitian Education System and Watson

Dear Family and Friends:


Each morning from Monday through Friday, there are processions of school children past my window and on other streets near here.  But unlike many neighborhoods in the United States, the students are not wearing an individualized outfit from J. Crew, Guess, Banana Republic, Target or Walmart. 

No student here would be allowed out on the street wearing the short shorts I have noticed some young ladies in my neighborhood wearing as I have driven by a school bus stop on Mountain View on my way to Starbucks. (There is no Starbucks in Leogane, but I'm doing just fine.)


Students in Leogane, and in the rest of Haiti, wear uniforms to school whether they are attending a private or public school. Each school has a distinct uniform style and colors. And, within a school, the colors of uniforms may sometimes vary depending on the grade level of students.

Over the course of the last two months, a veritable rainbow of uniform colors have passed by here in the morning and again later in the day when students return from school.  Next door, at the Episcopal Church's L'Ecole Sainte Croix, girls wear dark blue jumpers with light brown short sleeved blouses. Boys wear dark blue pants and light brown short sleeve shirts. Students attending L'Ecole Sainte Rose de Lima wear the trademark all blue in two shades, uniforms of that school. Everyone here knows their school colors because as reported after the earthquake "the centerpiece of the City [Leogane] was the Sainte Rose de Lima School." Because of its Port-au-Prince, the solid brown pants and skirts, with brown checked blouses and shirts, colors of College St. Pierre ("CSP") (elementary and high school levels) are well known in Port-au-Prince.  The attached "CPS students back in school" photograph shows students at this school in one of the one of the temporary buildings erected but a few months after the earthquake. A photograph of some of earthquake damage to CSP also is shown.

  

Other uniform color combinations passing by my window since I arrived on March 30th have been grey skirts and pants and yellow blouses and shirts, dark and light green combinations, and a red and pink tartan pattern shirt and long brown shorts for very young boy students.  Some of those uniforms are shown in other of the photographs attached here, along with a few downloaded from websites.


Watson attends L'Ecole Anacaona. I think the school is named after the Taino queen Anacaona. Most of the time my Kreyol lessons with him are in late afternoon so that he has changed his duds. One day though he came by in his uniform--dark blue pants, white shirt and a matching dark blue tie.  Very crisp lines I might say.

You also can see students in brown colored uniforms in photographs of the funeral procession included with Note From Leogane No. 7.  In that note, I mistakenly said that "[t]he large contingent of girls toward the front, in light brown outfits, are Girl Scouts."  In the note, I mentioned that Peterson was walking toward the back of the funeral procession.  In a conversation a few weeks ago, Peterson said that the girls in the front were students who attended the same school as Peterson's deceased friend. 

Though I was mistaken about Girls Scouts being in the funeral photos, there is no mistaking the fact that one of Leogane's Girl Scouts, Joanie Estin, whose photograph is attached, and other Girl Scouts here gained some notoriety within a few days after the earthquake. As reported in a CARE International publication on 24 January 2010:

" ' I can't describe how frightened I was,' recalls Joanie  Estin, remembering that terrible day barely a week ago when her world fell apart. ' We've lived through a lot in Haiti, but this is the first time anything like this ever happened.' But Joanie doesn't look scared.  Sad, yes -- but resolute, confident and committed. Every inch the Girl Scout. 'I always keep a cool head because otherwise you won't be able to help other people,' she says calmly. The 22-year-old wears her uniform with pride, the sky-blue kerchief of the Ste. Rose de Lima Scouts of Leogane tied neatly over her beige dress. Today that uniform means more to her than most people can imagine.

Joanie was enjoying the early evening socializing with neighbors outside, as was the custom on the Rue de la Liberte in Leogane, when the unthinkable happened. Her father was the only one inside the house when it collapsed. They never saw him again. The surviving family members -- Joanie, her mother, and six siblings -- have been living at a local school, the Ecole des Freres, ever since.  

'I was so overwhelmed at first. My mother and I stood still in the middle of the road or about 15 minutes until the earth calmed. Then we went home, and our house had been completely destroyed.' Joanie coped the way she always has--by getting down to work. As soon as she could, she found her way back to Ste. Rose de Lima and, with 50 boys and girls who had survived the earthquake, started rallying.

As many of the local Scouts and Girls Guides who could find each other in the aftermath -- 94 in all -- began volunteering their services to humanitarian groups, including CARE, that bring critical supplies to survivors in central Leogane. 'We try to advise the people on how to stay calm, and we help the international agencies with the distributions. For me, it's a good deed done.  It helps me feel better.'

On Wednesday a group of Scouts served as security and emotional support as CARE delivered soap, sanitary napkins and other hygiene supplies to women of Leogane. The boys stood guard to help control the anxious throngs outside the site -- a telecommunications office laid idle by the quake. The girls provided gentle guidance, walking alongside the tired and frightened women as they braved the crowds and noonday heat.

'These young people are the future of Haiti. They are the ones who are going to pick up the pieces and help rebuild this country,' said Sophie Perez, CARE Haiti country director.  'It gives me great hope to see that they have already started that task.'

For Joanie, there was really no other choice.  It's who she is. When the dust settled on the ruins of her house, Joanie was able to crawl in a back door to retrieve a few things.  'I don't know what came over me -- I just did it,' she says. She managed to save just a few clothes, a cosmetics case--and one more thing, the most important of all. Her uniform. "
("Haiti : Scout's Honour Part 2 : Profile in Courage," www.care.international.org.uk/news-and-pres (24 Jan. 2010)

In Note #2, I reported on my first walk around Leogane on April 1, 2011, and how Bob Sloane - who had been in Leogane several times as a volunteer surgeon before the  quake - remarked that it brought tears to your eyes to see what had happened to the church and school at Ste. Rose de Lima.  He said it was the most beautiful site in Leogane.

 I didn't fully appreciate the deep hole in the heart of Leogane from the complete loss of Ste. Rose de Lima until I spoke to Watson and did some reading recently. Photographs of the church before and after the quake are attached as well as a photograph of the bells from the church's demolished bell tower.

I don't think you can overstate the devastation the earthquake caused the delivery of education in Haiti, which questionably was in need of significant reform before January 12, 2010.  But one example of the magnitude of the loss of life of students and educators in Haiti from the earthquake is captured by this January 19, 2010 report from Leogane by the Washington Post:

"Townspeople say as many as 500 nuns, priests and students were crushed to death when the cream-colored walls of Sainte Rose de Lima School collapsed in last Tuesday's earthquake, a disaster that destroyed the emotional and physical centerpiece of this city."

I expect that the emotional hold the church and school had/has on the people of Leogane, regardless of their faith tradition, can be traced in part to the fact that the church was one of the oldest in Haiti. Jean Jacques Dessalines was married in the church. Indeed all of the city of Leogane is a historic place. In 2013, it will be 350 years old. Leogane is the birthplace of the Taino queen Anacaona, though at that time it was called Yaguana. I have been told that in some circles, Anacaona is frequently mentioned alongside other Haitians of great historical significance, such as Toussaint l'Overture and Jean Jacques Dessalines, the principal leaders of the fight for Haiti independence that officially was declared on January 1, 1804. Anacaona was executed by the Spanish three centuries earlier, reportedly in 1504, at the age of thirty-nine.

At the Episcopal Diocese of Haiti's renowned College of St. Pierre in Port-au-Prince, which has instruction through the secondary level, 800 students were enrolled before January 12, 2010.  Three hundred students were entombed in quake rubble.

    
This Note cannot possibly serve as a vehicle for a meaningful discussion of the failings of the Haitian education system before January 12, 2010, though undoubtedly there were many, which unquestionably have been aggravated by the earthquake and its aftermath.  Here I report but a few statistics that I have learned of from various web searches.

Haiti's literacy rate is 53%; 55% males/51% females; well below the average literacy rates for Latin American and Caribbean countries. The rural population is underrepresented in the country's classrooms. Most Haitian schools are private rather than state-funded. While the enrollment rate for primary school is 67%, less than 30% reach 6th grade. Secondary schools only enroll 20% of eligible-age children. Before the earthquake, one source reported that less than 40% of schools were accredited.

The extent of the damage to educational facilities is hard to fathom. "About half of the nation's 15,000 primary schools and 1,500 secondary schools were affected by the earthquake and the three main universities in Port-au-Prince were also almost totally destroyed. The earthquake also destroyed a nursing school in the capital, one of the three such schools in the country.  .  .  ."  (ReliefWeb/UN reports dated 18 Jan. and 22 Jan. 2010.)

The Episcopal University of Haiti was one of the universities in Port-au-Prince that was completely destroyed. A Diocese of Haiti reconstruction report estimates that $18.1 million (U.S.) will be needed to rebuild the university. The rebuilding costs estimate for College Ste. Pierre is $13. million (U.S.). I was able to better appreciate the standing of CSP among educational institutions in Haiti after I read the following from a "History Of College St. Pierre":

"[In 1956], the school began offering courses for the 6th, 7th and 8th grades. On May 11, 1958 Monsignor Charles Alfred Voegli laid the first stone for the construction of the College Saint Pierre's new location at 53 Capois Street, Champ de Mars, Port-au-Prince, Haiti. At the end of 1958, the college moved into the new building where all the secondary classes were held.

The College Saint-Pierre is a secondary school that accepts all categories of students. It is one of the oldest institutions of the Episcopal Church of Haiti and offers a Christian and educational formation. It is known as a center for sports and recreation for many people living in Port-au-Prince. The school has formed many executives during its 53 years of existence not only for Haiti but for foreign countries as well. Roger Jean, father of Madame Michaelle Jean, current Governor of Canada, was a director of the College of Saint Pierre. It is also one of the best schools in the Republic of Haiti recognized by the Ministry of National Education and of Professional Formation.

In 2004, during the episcopacy of Monsignor Jean Zache Duracin, the college was enlarged by the construction of a new computer lab, a chemistry lab, an infirmary, an auditorium, several administrative rooms, a soccer field, a basketball court, a volleyball court and cafeteria.   .  .  ."
(2011 Friends of College of St. Pierre submitted by Pere Rigal Lucas , College St. Pierre)

    
Before the earthquake, the Episcopal University of Haiti and College Ste. Pierre were more than  educational institutions. They also were cultural centers for all Haitians. As noted on a web page for the Children's Medical Mission of Haiti, both the Musee d'Art Haitian and the National Art Museum were located at College Saint Pierre. The Holy Trinity Music School was operated by the Episcopal Diocese in cooperation with the College. The Episcopal Holy Trinity Philharmonic Orchestra has served as Haiti's unofficial state orchestra.

All of the homes for these important cultural institutions were destroyed in the earthquake along with but three of the Murals of Holy Trinity the Episcopal Cathedral. In Leogane, students who were two years old and attended classes next to the historic Saint Ste. Rose de Lima Church now go to a make-shift facility three or four blocks to the east, across the street from l'Hopital Sainte Croix, though plans already have been prepared for a new school. Similarly, students at L'Ecole Ste. Croix now receive instruction primarily in open air plywood constructed classrooms. I have reviewed the impressive plans for new school buildings and recreation areas at L'Ecole Ste. Croix, and for a new Episcopal Church and hospital buildings, subject of course to there being all necessary funding in place as needed.

Fortunately, the Faculte des Sciences Infirmieres de l'Universite Episcopale d'Haiti in Leogane ("FSIL"), which is about one mile from l'Hopital Ste. Croix, survived the earthquake without any significant damage. The nursing college was built recently enough to have been designed to withstand an earthquake. I think I may have previously mentioned that the buildings and outside grounds of FSIL were converted into an emergency ward and trauma center on the day of the earthquake. Nursing students assisted in the delivery of babies for several weeks. From January 12 through the end of May 2010, 5,000 surgeries were performed on the grounds of FSIL.

Unquestionably, rebuilding the schools and colleges is only part of the challenge of improving education in Haiti. Some aspects of systemic reform have been summarized in "Rand Review," a publication of the Rand Corporation, which has been involved in the publications of numerous Haiti-related analyses and position papers before and after the earthquake:

"There are three needs for the education system in Haiti: substantially expanding access to education (which requires the government to spend many times more than it now does on education over and above the costs of rebuilding the roughly 5,000 schools destroyed in the earthquake); improving the quality of education (which means recruiting, educating, and training teachers; establishing a national curriculum; providing textbooks that align with content standards; and ensuring that students attend elementary school without dropping out for extended periods of time); and exerting oversight to guarantee access and to enforce quality controls, such as the establishment of a regulatory system to accredit and inspect schools and of teacher-training programs.

Only a third of Haitian children reach the fifth grade, and only 4 percent enter high school. In a nation that lacks a middle class which would normally supply teachers, it is not surprising that teacher quality is extremely low. Tests administered to a representative sample of 1,200 private and public school teachers in 1996 showed that one in three teachers did not know how to sequence words alphabetically; eight in ten could not use the passive verb form in French; and fewer than one in ten performed satisfactorily on fourth-grade mathematics.   .  .  ."
(Rand Review / Winter 2010 - 2011)

 One of the students who has beaten the low high school attendance odds is my friend Watson, who I previously mentioned is one of the mobile clinic translators and also is my Kreyol teacher. As I have complained to him on more than one occasion, Watson is all business when teaching me Kreyol, in spite of my attempts to crack jokes from time to time. This is surprising to me because he is both witty and sarcastic with a great sense of humor which he displayed quite well when Jeanne came to visit me less than two weeks ago. Watson has "friended" Jeanne on Facebook. I think that's what you call it though I really wouldn't know. I told Watson that I'll keep in touch by email.

I've already apologized to Watson for not being able to come to his July 1, 2011, graduation, the day after I end this trip to Haiti. Watson is Vice President of his class. He is graduating from the 13th grade of secondary school. He is fluent in English and French and of course Kreyol.  His Spanish is pretty good, but he says it needs a lot of work. After graduation in mid-July he will still need to take the national exam administered to all 13th grade students. National exams also are administered to students at the 6th, 9th and 12th grade levels. I expect that the requirement to pass a proficiency exam at the 6th grade level is a factor in only 4-20% (statistics vary) of age eligible students entering secondary school as well as the costs for private schools - the dominant providers of education in Haiti.

Last Friday Watson and I traveled together to Port-au-Prince. On our way back as we were talking in the bed of a pickup truck while holding down a large crate, he mentioned that a year or so ago he had been offered a full ride scholarship by a private high school in North Carolina.  He couldn't accept it because the U.S. State Department had not issued a student travel visa.  

Learning about his frustration in not being able to improve the quality of his secondary education in North Carolina was a bit ironic, considering the fact that just four days before our trip to the big city a group of nine undergraduate students from Duke University in Durham, North Carolina arrived here with their coordinator for a two month stay at the HSC Guesthouse. Their volunteer work through the "Duke Engaged" program will undoubtedly provide them with lasting impressions about Haiti and important life lessons.

It is not my purpose here to get involved in a discussion of U.S. immigration policies. I will reserve that for a different time and setting and private conversations. I mention Watson's inability to go to high school in North Carolina as just one example of how some of the best and brightest students in Haiti will not necessarily receive the highest level of education they are well capable of pursuing for a variety of reasons and circumstances.

From Watson I learned that there is only one state run university in Haiti--Universite d'Etat d'Haiti ("the State University of Haiti'). As a beneficiary of a public university education at Arizona State University and the U of A and the G.I. Bill, I know firsthand how access to a government financed education allows someone to obtain a college education that would not be possible were a private college or university the only available institution of learning. (As previously noted for a few of you, or maybe more than a few, my alma mater is Arizona State University. The U of A was my trade school, though the best trade school of its kind in Arizona.)

I'm a big fan of Watson, but please don't tell him I said that. While he is not known in Leogane in the same manner as Joanie Estin, I know he is a born leader. He is of good character. Watson is held in high regard by members of mobile clinic teams he has worked for over the past year even though he was only 18 years old when he started working as a translator. During the past two months, several teams who will return to Leogane during the next twelve months have made special requests to have Watson included in the team of translators for their next trip to Leogane.

Time will only tell which future path or roads to higher education my friend, and Jeanne's friend, Watson will be able to take.

I hope this Note finds you and your loved ones in good health and spirits.

David

08 June 2011

Dear Family and Friends:

I hope you will allow the comments below forwarded with permission from the Rev. Dorian Mulvey, the Rector at St. Anthony on the Desert, the church where Jeanne and I belong -  to serve as an Addendum to Notes From Leogane No. 11.  Many thanks to Dorian.

It was an interesting contrast to read your notes on the schools in Haiti, especially the inadequate training of the teachers and the story of Watson succeeding despite all the odds against him and then to read an article in the NY Times about private tutoring. Apparently parents who send their children to the most exclusive private schools in New York (tuition in excess of $35,000 annually) also pay for private tutoring to insure that their children receive A's in their advance placement courses and high SAT scores. The range was from $35,000 to over $100,000 a year in tutoring. The tutors themselves receive anywhere from $100 to over $700 for a 100 minute session (clearly a lucrative profession!). One might question how as a society we can reconcile such exorbitant spending on a few while denying so many children in the world with even a basic education.

Blessings,

Dorian+