Notes From Leogane No. 20: Postscript

Dear Family and Friends:

This past Saturday I sent you No. 20 - Achte Pen - about lymphatic filariasis. Little did I know that two days later a team of American urological surgeons, anesthesiologists, and OR nurses would come to Hopital Sainte Croix to perform hydroceles surgeries. They performed four yesterday, and have five scheduled for today. They will be at HSC through Friday.

Most of the patients are men.  Genital swelling from LF primarily affects men, but female genitalia also can become enlarged. In hydroceles surgery, fluid is drained from the impacted area, followed by surgical repair/reduction of the enlarged anatomical area. By the end of this week, 13-15 patients will have a new lease on life.

When I was reading about filariasis to prepare NFL 20, one article commented that in various parts of Haiti the mass drug administration ("MDA") efforts were not accepted by some because they believed the grotesque attack on people's bodies was from voudu or voodoo.  (In Haiti, many don't even use this word to refer to this Haitian religious practice.  Rather, it is called "following the loa" or "serving the loa".)  

I thought it best not to include assertions about the "vodou" etiology of LF in the Note, because after all it was probably just the view of a few vodou followers. Then on Saturday we had three guests for dinner. One was the Haitian translator for the group. During dinner, I just happened to mention that on my way out of Haiti, as I did last year, I would be going next door to the LF clinic to get a six or seven pill anti-LF "super shot" to take the first day I arrived back in the States. This by the way is most probably an unnecessary precaution, because it would be a highly unlikely for a three months stay here to lead to LF infection.

One of the dinner guests was not familiar with filariasis, so I summarized for him the worms maturation process that causes the clogging of the lymphatic system. After my non-medical explanation, the translator guest spoke up. He said his younger twenty-eight year old sister had LF in her right leg. He indicated with his hands that the diameter of her leg was more than twice that of the other leg. He said it was vodou that got her when she walked out the front door one day and stepped on a piece of glass right foot. He said her leg ballooned up shortly after that. He was adamant that the slow, progressive development of microscopic filial larvae into adult worms had nothing to do with his sister's affliction. Now I have a better understanding for why some Haitians have not followed through with all 5-6 years of the MDA regimen.  I hope it has not been too many.

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

Peace,

David 

24 April 2012    

Notes From Leogane No. 20: Achte Pen

Bourik swe pou chwal dekone ak dentel.

(Haitian proverb : The donkey sweats so the horse can be decorated with lace.)

Si travay te be bagay, moun richla pran li lontan

(Haitian proverb : If work were a good thing the rich would have grabbed it a long time ago.)

Dear Family and Friends:

I’ve heard more one than one doctor down here say that lymphatic filariasis (“LF”) is a disease of poverty. My first note of this year mentioned a number of things that have not changed since my first stay at Hopital Sainte Croix (“HSC”):

“Some of the same street vendors walk past my window each morning. I have yet to hear last year’s bread lady, who I remember calling out “achte pen” (buy bread) about every 15 seconds. The parade of school children in ironed uniforms remains pretty much the same. Patients still arrive outside the locked entrance to the HSC outpatient clinic 1-1 ½ hours before it opens.”

I worry now that there is more going on with the bread vendor  than her finding more customers on a street other than Rue Pere Thevenot on the western edge of the hospital. I miss watching this 5‘10” regal woman walk by my office each day. She’s someone for whom carrying a metal basket on her head, selling a loaf of bread for 10-15 gourdes (25-30 cents) to feed her family, was easily matched with a showing of gracefully movement, almost.

This time last year she walked with a slight limp in the right leg. A year ago, you could tell she was afflicted with the early manifestations of LF. I fear this dreadful disease now has progressed to the point where it is extremely difficult for her to walk. The cause of lymphatic filariasis is not pleasant to contemplate. Lymphatic filariasis can result in an altered lymphatic system and the abnormal enlargement of body parts causing pain and severe disability.

*      *     *

Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease.  Infection occurs when filarial parasites are transmitted to humans through mosquitoes. When a mosquito with infective stage larvae bites a person, the parasites are deposited on the person’s skin from where they enter the body. The larvae then migrate to the lymphatic vessels where they develop into adult worms in the human lymphatic system. Infection is usually acquired in childhood, but the painful and profoundly disfiguring visible manifestations of the disease occur later in life. Whereas acute episodes of the disease cause temporary disability, lymphatic filariasis leads to permanent disability.

  

The attached photograph of a woman in Leogane, with bilateral lower extremity LF, provides but one example of the grotesque ballooning of the limbs and genitals associated with this dreadful disease. For males, the disease often manifests itself with enlarged testicles/scrotum. Soon after I arrived in Leogane last year, I was walking to Belval with an American who had been living in Leogane for more than a year. When the subject of filariasis somehow came up, I was asked if I had seen “the wheelbarrow man.” I had not. I’m now told that he received hydroceles surgery, to drain fluid and dramatically reduce the size of his genitals.

It is not my purpose here to overwhelm your thoughts with images of the victims of LF. But, you cannot fully appreciate the challenges of life in Haiti, and other impoverished tropical environments, without a candid discussion of the ravages of lymphatic filariasis. The images you may be contemplating right now may be tempered somewhat by a brief report on the progress being made in the fight against LF, particularly in Leogane.

     

In Leogane, “the percentage of residents testing positive for the young [LF] parasites plunged from 30% in 1995 to 5% in 2005.” (ND Newswire, The priest and the parasite, University of Notre Dame, June 06, 2005). The ND Newswire article acquaints the reader with Father Tom Streit, a Catholic Holy Cross priest who now has been living in Haiti for more than fifteen years. (Photo of Fr. Streit attached)

The Filariasis Clinic he founded is supported by various organizations, primarily the University of Notre Dame, the Centers for Disease Control (“CDC”), Hopital Sainte Croix and the Haitian Health Ministry with grant funds from the Bill and Belinda Gates Foundation. The clinic is next door.

The importance of this clinic was first brought home to me last year, the day before I left Leogane to return to Arizona. I went next door to say goodbye to an American volunteer at the clinic. During my visit, I was told that the 20-25 men in the waiting room were there for follow-up visits after they all had undergone successful hydroceles surgery.

The dramatic drop in the rates of LF infection among the citizens of Leogane Communale (“Leogane Region”) is attributable to an aggressive mass drug administration (“MDA”) program initiated by Notre Dame/CDC/Ste. Croix  under the auspices of the Filariasis Clinic. Studies here and at the World Health Organization (“WHO”) have determined that “MDA should be continued for 4-6 years to fully interrupt transmission of the infection.”

By 2010, worldwide “thirty-seven endemic countries had already completed five or more rounds of MDA in at least some of the endemic areas. From 2000-2010, more than 3.4 billion treatments were delivered to a targeted population of about 900 million individuals in 53 countries, considerably reducing transmission in many places.” (Lymphatic filariasis , WHO Media Centre Fact Sheet No. 102, January 2012.)

While it is much harder to reverse the damage from advance stage LF, it is preventable. “[I]n 1997, . . . the World Health Organization named filariasis among several diseases able to be eradicated. WHO’s target date to complete eradication is 2022.” (ND Newswire)  Until its worldwide defeat, LF will remain a disease of the poor; unquestionably so in Haiti.

“The majority of the worst cases are among poor Haitians, who are unlikely to visit a doctor. Others are too ashamed to appear in public.” Father Steit is blunt in his assessment:

“I challenge people to come up with another disease so tied to poverty. You look at the world where it exists and there is always horrible poverty.”  (ND Newswire)

I have a more basic take on the tie between poverty and lymphatic filariasis. When Watson and I, and the moto driver, hopped on one moto this past Tuesday, we took a short cut, rather than the paved highway back toward Santo, which would then have required another two miles on a dirt road.

The short cut took us by many temporary shelters and tents in Santo. Many of these tents were vacated by the new homeowners who moved into the Habitat and Haven built houses in January 2012. There had been an absolute downpour for about two hours Monday night. Tuesday morning there was standing water everywhere. I could see where people had shoved water out the door of their shelters and tents. I was reminded of another trip to a tent city, last April 2011. Then, I walked up to the largest open air market in Leogane City Center looking for a used tie to wear at the Easter service next door. The half circle road, along which tarps and blankets were placed on the ground for the display of items for sale, served as a border for the largest tent city I have yet to see in Leogane City Center. The tents were located in a depression below the grade of the road. The berm of the road would keep water from flowing away from the tents during and after a downpour.

I returned by moto to the guesthouse with my used tie in hand. A few hours later, the skies open up. As I enjoyed the sights and sounds of this cleansing rain, I stopped to think about the families in the tent city next to the market, and other tents in Leogane, because I already had been told that during major downpours many parents have to pick up and hold infants to keep them out of the standing water.

My simple lesson learned is that the more resources one has  the higher one’s home, both in terms of locating a house above low lying areas and being able to afford an elevated foundation that sits above expected flood levels such as the new houses in Santo. Pockets of standing water provide breeding grounds and living quarters for moustik.

I fear that today you may feel I’m painting too gloomy of a picture. That is not my intent. The efforts of Father Streit, Notre Dame, CDC and Hopital Sainte Croix are good works of hope and promise.

Another story of improvement is being played out today at the hospital clinic downstairs while I type this note. The clinic usually is closed on Saturdays. But today 1-5 year-olds from all over the Leogane Communale are here to receive their vaccinations from the Haitian Ministry of Health.

  

“The wealth of the rich is their fortress; the poverty of the poor is their ruin.”  Proverbs 10:15

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

Peace,

David

21 April 2012

May 12 Second Postscript

 About fifteen minutes ago, I heard a familiar voice say "achte pen" outside my window for this first time since I arrived in Leogane on March 30, 2012.

You can't see the right leg of my favorite bread vendor in the attached photograph (0801). 

 I'm happy to report that while madame still has a slight limb, I didn't see any increase in the size of her right leg since I last saw this woman in late June 2011.

I may have been mistaken last year when I assumed this woman was in the early manifestation stages of lower extremity lymphatic filariasis.  I hope so.

Peace,

David 

12 May 2012 

Notes From Leogane No. 19: Holy Week and Cange

Dear Family and Friends:

The martyred Salvadoran Catholic bishop Oscar Romero once said:

“This is what we are about. We plant the seeds that one day will grow. We water seeds already planted, knowing that they hold future promise.  We lay foundations that will need further development.  We provide yeast that produces effects beyond our capabilities. We cannot do everything and there is a sense of liberation in realizing that. This enables us to do something and to do it very well. It may be incomplete, but it is a beginning, a step along the way, and opportunity for the Lord’s grace to enter and do the rest.”

In this Note, I’d like to work backwards during the days of Holy Week, to arrive at Cange on Palm Sunday, where seeds of promise were planted almost thirty years ago.

Easter Sunday Service at Paroisse Sainte Croix - Eglise Episcopale D'Haiti

I attended Easter Sunday service next door at the Episcopal church.  The new church remains the same – a concrete pad, a corrugated metal roof supported by wood cross beams and vertical wood support posts.  The church remains an open air meeting place. The ruins of the old church are about 100 feet back of the altar.  As you sit in a pew, the remnants of the vertical and horizontal concrete beams of the destroyed church invite your mind to wander, to see unintended massive crosses as backdrop for the service. Easter service this year was but two hours and forty minutes long, a bit of a reprieve from last year’s three hours marathon.

Pere Kerwin Delicat still is the Rector. I met with him this past Thursday, to discuss a commitment by St. Anthony on the Desert Episcopal Church in Scottsdale to assist the Episcopal school.  (I’m proud of my church’s support of Paroisse Ste. Croix.)  During our meeting, I learned from Pere Kerwin that all of the church service presented through him and other religious,  from the opening prayer through communion, is said in French.  Hymns alternate between French and Kreyol. Pere Kerwin and the Deacon switch entirely to Kreyol during  announcements and the community meeting - about forty-five minutes long - at the end of the service, followed lastly by the benediction in French.

The “communal soul” of the people of this church, described last April in Note No. 3, was ever present last Sunday. Sunday strikes me as a day for the congregation, individually and as church body, to leave behind for a few hours the hard life for many of the past week and the week to come in Leogane, Port-au-Prince and elsewhere, to share a common bond with all of their brothers and sisters, whatever his or her station in life. They offer up their faith and look to receive spiritual nourishment.

In last year’s note about Episcopal Paroisse Sainte Croix, I acquainted you with all of the choirs that give such uplifting character to Sunday services.  The adult choir (“Chorale des adultes”) still performs as does the children’s choir (“Chorale des enfants”).  The “twenty-somethings” choir of last year – four women and a man accompanied by a single acoustical guitar  – was replaced, at least on this Easter Sunday, by “Groupe Phylantrope.”  The four men, all in their twenties, were dressed in black from head to foot.  The electric guitarist also was the lead singer.  The congregation seemed to enjoy this singing group; there was polite applause after each of their songs.  But it is obvious that “Groupe Choeur des Anges” continue from last year as the musical stars at this parish.

Indeed, the cover of the program distributed before Easter service noted that the Easter Sunday service was commemorating the anniversary of the Choir of Angels. Last year in Note 3, I called this group of seven young women the “purples/whites” – because I was unaided by a program to see their proper name: “Each wore a white suit top with purple stripes and a matching white skirt, also with purples stripes.” This description came from a regular service I attended a few weeks before Easter.

At Sunday’s Easter service, the Choir of Angels wore the same light beige dresses, with green and blue trim on the neckline and short sleeves, they wore at last year’s Easter service.  The same stellar voices rose high last Sunday, but this year there was a new lead singer who shared lead vocalist responsibilities last year’s veteran.   I observed a bit of polite friction between the seasoned veteran and her younger colleague when they engaged in a “private discussion” outside the church during the offertory, before their last hymn during communion.  (My ease dropping was aided by the open air sides of the church.)

I now have attended three services at Paroisse Ste. Croix.  At each, right before anouncements, Pere Kerwin has motioned for everyone to stand, look up, wave toward the sky, and say loudly, in Kreyol, “Bonjou Seye.”  Each time, Pere has asked for the greeting to God be repeated and to be louder.  After success on the second or third try, he moves on to the next wave and shout out, “Mesi Seye.”

I wonder how I would react were I to attend a religious service in Arizona and, rather than ending with a demurred closing prayer or benediction, the priest, minister, rabbi or other religious told us to jump to our feet and shout toward the sky:  “Hello God” followed by “Thank You God”, two or three times each until we got it right.  I must confess, my effort this past Sunday failed to meet Pere Kerwin’s standards.  

A Good Friday Procession Revisited

I will not dwell on last Friday’s Good Friday procession, from the Catholic church Sainte Rose de Lima, which passed by the hospital on Rue Pere Thevernot heading for Rue La Croix. It already has been the subject on a brief note, No. 17.  But, the photographs I sent you last Friday do not do justice to that religious observance, because those photos were taken at ground level. For that reason, I’m including a few of the procession photos from last year’s Catholic Good Friday procession.

Offerings at Palm Sunday Service in Cagne

On Palm Sunday, half of the Michigan mobile clinic group staying at the HSC Guesthouse attended the Episcopal service next door. They missed falling into the back of the procession as it passed underneath my office window – one laggard was still combing hair - but they all were in the wooden pews before Pere Kerwin, the Deacon, acolytes, and about fifty parishioners arrived at the church. Michigan John told me after the service that an usher showed him a good seat up front. But, he no sooner had settled in for the 150+ minutes service when the usher returned with a well-dressed elderly woman, in an Easter hat. With hand signals, the usher directed John to squeeze in next to his friend Tom a few rows back. Age and church tenure does have its advantages, particularly when the interloper in your usual spot is only in town for a week.

The other half of the Michigan crowd traveled to Cagne in a van driven by the Dean of the Episcopal Nursing College, Hilda Alcindor.They started a bit late, but made the 2 ½ hour drive northeast of Port-au-Prince, arriving in time for the beginning of the 10 a.m. service. They arrived back her about 3:00 p.m.

Original Church

Upon his return, Michigan Fred, who is in his seventies, said that the Palm Sunday service in Cange was one of the ten most memorable experiences of his life;  because of the offering. He and his colleagues had learned from Dean Hilda during the drive up that this event has been repeated for several years on Palm Sunday at the church in Cagne.

The Palm Sunday service does not have your ordinary collection. Ushers do not pass a wooden plate, for the offering of weekly tithing envelopes, checks, currency or coins. No, the offering is a lengthy processional down the aisle, with music, starting with the youngest members in attendance. First came rolls of toilet paper, balanced on the heads of young boys and girls. Next, mangoes, papaya, other fruits and various vegetables.  Loaves of pen (bread) were included. Men carried over their shoulders sacks of beans and diri (rice).

This was not a somber walk down the aisle. Music accompanied all of the offerings. Women were the most active dancers as they carried their gifts to the foot of the altar. One of the Michigan worshipers began laughing as she talked about the woman carrying some food stuffs, who stopped dancing down the aisle when the music stopped. She glared back at the band, and waited for more music before continuing her samba steps to the altar. Beer and wine, and various fruit drinks and sodas were brought forth.

I’m not sure, but I think someone told me that the offering included various linens, towels and cloth napkins, but I’m not sure. But I’m positive what I heard about the last part of offering. A number of the Michigan folks said tears welled up about this time. Live chickens, goats, pigs and cows were brought down the aisle to the front of the church. A sight that none of the Michigan folks had ever seen, and may never see again.  I sure haven’t been fortunate enough to witness this kind of outpouring of giving during a church service in Haiti.

I visited with Haiti veteran/Indiana native Missy Owen a few days later about the Cagne service. (You’ll recall mention of Missy in Note No. 15 last year.)  She explained that the Palm Sunday service in Cagne comes during a harvest period in Haiti. The offering is made to support  the religious and church staff.  But, what is left after the church’s share is taken is given back to the community; after a luncheon (manje midi) celebration is held after the service where parts of the offering are eaten.

Paul Farmer and Partners in Health

Before I returned to Haiti last year for my first three months stay in Leogane, had you mentioned “Cagne” to me, I would have never thought about the Palm Sunday service there. I only heard about this intriguing event from the descriptions of two weeks ago.

    

After reading a few years ago “Mountains Beyond Mountains,” I only associated Cagne with Dr. Paul Farmer and the non-profit medical organization Zanmi Lasante (Partners In Health / PIH). There is not enough space here to properly cover how much Dr. Farmer and PIH have meant, and still mean, to the delivery of much needed medical care in Cagne and other villages in the Central Plateau region of Haiti. I would start by saying that Paul Farmer is recognized worldwide as an authority on infectious diseases, and a learned anthropologist. He is Harvard Medical School trained. His work has included the treatment of Multi-Drug Resistant (“MDR”) tuberculosis, not only in Haiti but in the slums of Peru and prisons of Russia.

Dr. Paul Farmer

“Mountains Beyond Mountains” provides an excellent first read for anyone who is interested in learning more about this amazing doctor and humanitarian.

The Introduction to the book explains that the title is based on a Haitian metaphor for life’s challenges:  “Once you have scaled one mountain, you reach a place where you can see that there are always more mountains farther away; you will never stop climbing, never be finished.”

Those associated with the original church and first clinic in Cange undoubtedly were challenged both physical and metaphorical mountains beyond mountains, before they arrived at a point where their vision beyond many difficult climbs became one of the premier social, economic, educational and medical complexes in a third world country. They succeeded in following Bishop’s Romero’s ideal of laying foundations for further development, to produce effects far beyond what others may have expected.

Modest Beginnings Leading to Dramatic Impacts        

Cange is one of the poorest regions in Haiti, because of the hydroelectric dam built on the Artibonite River in 1956.   After this power project flooded the main fertile area of the valley, the people of Cange were pushed up onto rocky hillsides with very little farm able land.

In 1962, Father Lafontant and his wife, Yolande, established a primary school in Cange. Many of the students didn’t reach adulthood – infectious diseases killed almost one-quarter of all of their students

Father LaFontant

In 1983, just after being accepted to Harvard Medical School, Paul Farmer came to Cange for the first time.  With the support of Father Lafontant, the Episcopal Church in Haiti and the U.S., and Boston businessman Tom White, the Clinique Bon Sauveur was established in Cange in 1985.

Zanmi Lasante/PIH was founded in 1987 by Paul Farmer, its founding director, Tom White,  Harvard medical student Jim Yong Kim–then a Harvard medical student, and others. (I include here now Dr. Jim Yong Kim not only because of his role in the founding of PIH,  but also because, of interest, recently President Barak Obama nominated Dr. Kim as President of the World Bank.)

Twenty-four years later, Partners In Health has reported on its work in Haiti during FY2011:

• 2.8 million patient encounters
• 13,784 children received educational assistance
• 6,268 HIV-positive on treatment
• 98,735 pregnant women seen in antenatal clinics
• 53 houses constructed or repaired
• 482 TB patients treated
• 75,000 cholera patients treated.

Partners In Health also recently reported that in the two years after the January 12, 2010 massive earthquake, PIH registered 4.6 million patient encounters. These statistics unquestionable underscore the incredible work of Zanmi Lasante for the people of the Central Plateau.  But this recounting of the importance of PIH to the delivery of essential health care in and around Cange serves as a grave reminder that Haitian public health services and private Haitian hospitals and clinics are ill prepared at this time to go it alone and meet the health needs of its more impoverished citizens.

In the Central Plateau, the PIH clinic in Cange now has is a sliding scale fee clinic.The less money you have, the less you pay for medical services. Elsewhere in Haiti, for example at various hospitals and clinics in Port-au-Prince and Cap Hatien in the north, medical care may be denied to patients unable to pay the medical provider’s usual charges.

This is not the case at Hopital Sainte Croix in Leogane. Only modest fees are paid. And, depending on the needs of the patient and availability, medications are provided at little or no cost. HSC is the indigent care hospital in the Leogane Region.

From my experiences here last year and this past month, I would venture to say that Hopital Sainte Croix is moving forward to significantly expand the scope of health services in the Leogane Region.  In 2011,  a number of additional medical specialties are returning or are planned for return in the near future: OB/GYN, ophthalmology, urology, sonography, endoscopy, colonoscopy, an eye clinic and a dental clinic. I sincerely believe that eventually, in the not too distant future, this hospital will return to its position as a state of the art and point of reference in Haiti for both its out-patient clinic and in-patient hospital.

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

Peace,

David

14 April 2012

Notes From Leogane No. 18: Ra Ra Photos Part A-1

Dear Family and Friends:

After experiencing Ra Ra for two years now, I have come to recognize that it need only be be seen and heard, and surely not explained by someone from Arizona, except to note that the Queen of Leogane Ra Ra is shown in photo 0752.

Queen of Leogane Ra Ra

There are yellow banners with red lettering hung around the Leogane City Center today, which essentially say that "With Ra Ra Leogane Will Become More Beautiful."  Some of the photos and videos you will see are from Watson. Watson dropped by about 30 minutes ago to load my computer with the photos I am sending you from the last two days of Ra Ra.  

Watson said I should expect 20 or so Ra Ra bands to pass by the hospital tonight and into the early morning hours. 

Some of the videos I'm sending you are broken up by 5-10 seconfs delays, so that they would attach to my emails.  

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

Peace,

David

Notes From Leogane No. 17

Dear Fellow Vestry Members of St. Anthony, and Family and Friends: 

It's Good Friday in Haiti. The outpatient clinic is closed today, because it is a high holy day. A skeleton staff remains on duty at the hospital for emergencies, such as to attend to the elderly gentleman who was carried into the hospital around 8.30 a.m. by a neighbor. Jean Claude, the driver, has to work today. He is driving the hospital Land Cruiser to transport into Port-au-Prince all of the luggage of the fourteen members of a dental and medical group that stayed at the Guesthouse the past seven days.

Life presents us at times with a lesson that flows from the most mundane of things. Three of the fourteen departing HSC guests are flying back to the U.S. today. They were very anxious to get on the road to the airport this morning by 9:30 a.m. (As an aside, a 11 a.m. departure still would have allowed them to make their flight back to Miami.)

At 9:35 a.m., I told all of the travelers that I had just received a cell phone call and was advised that it was taking awhile for the flat tire to be fixed on the van - being provided by the nursing college - that everyone would ride in for the trip into PaP. The Land Cruiser would follow with all of the luggage. A number of the travelers seemed a bit nervous after receiving "the tire isn't fixed yet" status report.  

We still were waiting for the van at 10:15 a.m. when the Good Friday Stations of the Cross procession from Rose de Lima Catholic Church stopped in front of the hospital main gate for the next station of the cross.  About ten minutes later, one of the travelers pointed to the north and came over to tell me that she could see the van parked up the street unable to reach the hospital gate.  

As several of travelers were looking up the street at the parked van, I commented that it was interesting that the delay in fixing a flat tire this morning allowed everyone in the group to experience a Catholic Rosary and the Lord's Prayer in Kreyol, as well as listening to other prayers and a hymn in Kreyol.  Some smiled.

The Rose de Lima procession stayed in front of the hospital gate for another ten minutes or so before moving on to the next station of the cross, making way for the van to pull into the hospital driveway. The travelers departed for the airport (3) and Hotel Karibe (11). 


I was reminded yet again this morning that there just are times when our "itineraries" need to take a back seat to other needs, not only ours but of others.

The photo shows what a flat tire allowed some nervous travelers to experience this morning.


Happy Easter Weekend and other faith tradition wishes to you all.

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

Peace,

David

Notes from Leogane Part II: No. 16--Returning to Leogane

Dear Family and Friends:

(I have numbered this first 2012 Note as No. 16, to follow on the heels of the first fifteen Notes From Leogane (“NFL”) I sent you last year during my first three months stay at Hopital Sainte Croix (“HSC”) in Leogane.

I arrived back at HSC this past Friday after the quite common 25 miles but two-hour drive from the airport in Port-au-Prince (“PaP”).  I think it was good karma that Madame Bellevue was the first person to greet me as I walked into the HSC Guesthouse on the second floor of the renovated three-story north hospital wing. On the plane from Miami, I had been practicing my Kreyol greeting for Madame: “Mwen byen kontan we ou anko.” Accent marks omitted. (“I am very happy to see you again.”)

I didn’t tell Madame Bellevue that it took me at least one hour on the plane from Miami – quietly in seat 13G – to be able to speak just six Kreyol words without a 3 x 5 note card translation crutch. I had to reacquaint myself with the “nasal” way of speaking Kreyol. I like to think that the laugh by my first Kreyol teacher and friend revealed some measure of approval for my effort. After all, she did kiss me on the cheek and said, “Byen David.”

After I mentioned that I would be returning to Leogane for another three-month stint at the Guesthouse, a few of my family members and friends asked me whether I thought there has been meaningful improvement in Haiti since my Leogane stay ended last year on June 30, 2011. I cannot speak about Haiti on a nationwide basis; that is too daunting of a task. But as for Leogane in general, and HSC in particular, I can most definitely say that there are exciting signs of improvement here.

This past Saturday, I jumped on the back of Watson’s moto. A moto trip is almost always an adventure, weaving back and forth among the road hog tap-taps and larger buses headed to PaP, Jacmel, and places beyond.

I asked Watson to come with me to Santo to translate, should we be fortunate enough to find at home the two women owners of the houses I worked on for five days in November, 2011, with the other Habitat team members for houses 311 and 312. In addition to hoping to visit with the homeowners, I also was carrying a leather carpenter’s belt, hammer, two screw drivers and pliers, to give to Sheeklay (ph), the son of the 311 homeowner. Sheeklay was the tireless teenage worker who contributed “sweat equity” all week of the Habitat build on behalf of his mother. Watson and I were able to visit with Sheeklay’s mother and her neighbor, but Sheeklay wasn’t home. We left his tools with his mother. Watson and I plan to go back to Santo in a week or so to see Sheeklay and, with permission, take photographs of these houses and the surrounding neighborhood.

The Santo Community is part of the Leogane Region as is the Leogane City Center. Within this region, the City Center absorbed much of the brunt of the January 12, 2010, earthquake - with 20,000 people dying in this region, along with the devastating loss of life in Port-au-Prince. Each city was but 10 miles from the epicenter, in opposite directions along the coastline from the epicenter.

The New Santo Neighborhood and HSC Renovations  

As I noted in a previous November 2011 supplement to one of last year’s Notes, the Habitat build in Santo by more than four hundred volunteers resulted in 100 new homes being at least 90% completed for move-in.  Another 50 houses had been built the week before by two hundred volunteers from Haven, an Irish volunteer organization. Most of the volunteers were from County Cork.

After the departure of the November, 2011 volunteers from Haven and Habitat, a final wave of finish builders came to Santo to get all houses ready for move in. I’m happy to report that this past January 150 families moved into their new homes. Many had spent the last two years after the quake living in tent cities in the region.

Last Saturday Watson and I enjoyed the sight of how the new homeowners have been going about the pride -driven task of giving individual touches to their new abodes. Grass and landscaping is taking root in this neighborhood, and more growth is on the horizon. The Habitat International Jimmy Carter Working Project (“CWP”) will be returning to the same Santo neighborhood the Monday after Thanksgiving, 2012.  Overall, 500 new houses will be built in this new neighborhood. I should know in a few weeks whether I’ll have the opportunity to return for this additional Habitat build.

The three-story north wing at HSC has undergone a chameleon-like transformation. Perhaps the best way to underscore the changes on the Guesthouse floor is to review some “before and after” photographs.

Photo 0089

0595

Photo 0089 was taken in the main hallway in April, 2011. Photo 0595 was taken a few days ago. Photo 0134 shows a dormitory renovation in progress last year. The post-renovation dormitory condition of the same area is shown in photos 0600 and 0601, taken a few days ago.

Photo 0134

Photo 600

Photo 601

The last two days around 5:30 p.m., I have walked through every room on the three renovated floors of the north wing, to lock down any unlocked doors and windows. This evening tour has brought home how the hospital has shed its past and stands ready to move forward with a significant expansion of the medical services to be made available to those in need of low cost medical care in the Leogane region and perhaps beyond this region. For example, a new dental clinic is scheduled for reopening in the near future. The renovated wing has improved clinic and operating facilities.

After the operating hospital moves into the renovated three-story north wing, there are future plans in place to demolish the existing one-story buildings where the hospital now operates, and to then build new hospital buildings in their place; hopefully in the next few years or so.

New construction is ongoing at the four-year nursing college of the Episcopal University of Haiti in Belval, a Leogane neighborhood about a mile from HSC.

As I have traveled on foot and by moto around the City Center to and from Belval the last two days, I have seen several lots where new concrete foundations are being poured for commercial buildings and  residences. A new 10–12 rooms lodging business opened about a year ago three blocks from here. Hand demolition work continues in various parts of City Center to clear lots for new structures.

Various waves of determined efforts and cautious optimism are palpable and observable in Leogane.  I hope this continues. Leogane deserves these kinds of infections.

Some Things Have Not Changed
There are many things that remain as I remember them. The day unfolds outside my office and bedroom window much as it did last April -June. But a few examples come to mind as I type this Note. Rooster crows come from two or three spots across and down the street, at least one hour before sunrise. The ice truck still pulls up to make an ice block delivery next door. The driver still leans on his horn, even when the customer is waiting on the street in front of his/her dwelling; though the horn now blares around 6:15 a.m., not at 5:30.

Some of the same street vendors walk past my window each morning. I have yet to hear last year’s bread lady, who I remember calling out “achte pen” (buy bread) about every 15 seconds. The parade of school children in ironed uniforms remains pretty much the same. Patients still arrive outside the locked entrance to the HSC outpatient clinic 1–1 ½ hours before it opens.

At the HSC Guesthouse, Jeannine still leads the kitchen/dining staff. Yvette, Lozina and Geralda continue to work with her. Lozina and Geralda remain quiet, but smile from time to time. My ability to joke with Yvette has resurfaced in just a few days. Perhaps that flows from my improved Kreyol, as compared with my first month on the job last year.
 

Soup joumou– it’s pumpkin based – already has been served by the staff. It still knocks my socks off.  Jeannine had it served Sunday because two of her brothers and two nephews were visiting from Orlando, Florida.

There have been some changes. Jeannine has stepped up the pace of her cooking and baking classes. (She’s off all day tomorrow for a class.)  She has a thriving weekend catering business. On Saturday afternoon, she catered a wedding event for 100 guests.

Madame Bellevue still is the strongest 90 lb. woman I have yet to meet. Her grace and dignity remains true. 

Typanol will always be kind and shy. As before, he is the valued utility player at the Guesthouse. In the hospital, Ty Ty continues to serve an invaluable role for non-medical support. Bob and Robin Sloane confirmed during our “transition meeting” on Saturday that Philip still works his magic getting the HSC vehicles up and running to and from mobile clinic sites. Zoe still prefers the 45W generator for back-up electricity when we lose Haitian Public Power, but its out of commission. Perhaps he’ll shift his loyalty to the 100W generator we now use for back-up until the new and more powerful generators go on line.

Dr. Gladys Memnon contines as Hospital Director and Dr. Belanger as chief surgeon. I have been in email contact with the pharmacist JoJo (Vladimir Gestine) since last August and made a point of visiting with him first thing Monday morning. He and Ty Ty are as solid as ever.

Ra Ra bands are in full force as is the case every year during Holy Week. (More on Ra Ra next week.) And, yes, Dr. Livingston still roams and rules the Guesthouse. For newcomers, Dr. L is a most unusual cat.  He is extremely long in torso; so much so that he can stand on my office cabinet and stretch his head out the window for 5 minutes or so watching street traffic. We have a medical and dental clinic group from southwest Michigan staying here this week. Dr. L is upholding his tradition of greeting visitors by pawing their legs under the dining room table at breakfast and dinner.

Lastly, I would be remiss were I not to thank again my mentors, Bob and Robin Sloane, who returned to Ft. Worth yesterday, after serving as Guesthouse Managers since mid-January, as they did last year. The Sloanes mean so much to the success of the Guesthouse and the hospital. Last year,  they  joined with John and Suzie Parker–who were the Guesthouse Managers when the earthquake struck–to form a non-profit organization in the U.S. to assist in bringing a dental clinic back to HSC. That clinic should be operating within a matter of weeks. (John Parker was under Guesthouse rubble for five hours after the quake. Not deterred, the Parkers stayed at HSC for another 8–9 months to help get the hospital running and to reopen the Guesthouse at its current location.)

As I finish this Note, I continue in my admiration of the grit and reserved dignity of quiet dignity of the good folks at Hopital Sainte and Leogane I have had the privilege of meeting during my three trips so far to this area. Haiti has a way of pulling on your heart.

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

Peace,

David

3 April 2012