Note 22B

Notes From Leogane: 22A Worship Service Paroisse Ste. Croix

Dear Family and Friends:

Pere Kerwin allowed me the opportunity to video various parts of today's Sunday service at Pariosse Sainte Croix, the Episcopal Church next door.

Keep in mind, this service was held without any choirs is attendance.  All of the singing recorded today was by the congregation.  I think we have a lot to learn.  

I'll let the videos from today's 8:00 - 10:20 a.m. service speak, and sing for themselves as Notes From Leogane No. 22, with just brief commentary.  This video is from an early part of the service, before the Gospel reading.   

I hope this email and the later sent emails with videos attached find you and your loved ones in good health and spirits.

Peace,

David

Note 22L

The video of Pere Kerwin speaking during the community meeting / announcements also is too long for attachment, but then again he is not singing. 

     Please keep in mind this Sunday service did not have any of the choirs participating.  If they had been - Wow !

      I hope hits last part of Note No. 22 finds you and your loved ones in good health and spirits.

      Peace,

      David

      06 May 2012

Notes From Leogane No. 21: Street Beats and Rhythms and Leaving the Tourist Behind

“My eyes take in the view.

Poverty in all her glory . . .

   Burning tires and refuse,

       Piled trash along the roads,

          Garbage rivers running through the sewage bordered streets

But it’s not these sights that register; my heart is blind to this . . .  

My hand reaches out and I touch

     Dirt, grit and grime

     As I feel palpable humidity and sweat trickling down

     Creating muddy tracks

     That end in sticky pods on my skin

But these textures make no impression;

     My heart can’t feel these things

These things can’t touch and grasp the Haiti in my heart !  . . .

Instead . . .

My heart sees . . . Beauty . . .

     Lush vegetation and trees,

     on mountains with flowers by the sea

The sun’s blazing orb

     Casting light upon a darkened world

Reflecting the vivid colors of Haiti –

     Intense yellows, orange, blues, red, pink . . .

And . . . children

Being loved by their mothers

     or playing near streets

Children . . . in starched uniforms

(the colors of Haiti)

Walking to and from school  . . .

     Smiling . . .

        Laughing . . .

My heart also hears . . . Music

The music of street merchants selling their wares

“Pee-stoch”

“D’lo”

And bartering in rapid fire Kreyol . . .

Snorts, laughs, loud guffaws . . .

     And children singing is Haiti . . .

I sense an indomitable spirit

     Their pride

     Their joy . . .

(From Haiti in my Heart  by Cryssa C; an American who with her husband has adopted seven of their thirteen children from the Foyer de Simia orphanage in Haiti

I do not share this view of everyday life in Haiti. I’m not able to ignore the many problems and challenges here. I see where there is dirt and grime. There is nothing glorious, magical or uplifting about the abject poverty you can encounter every day when venturing off the beaten path or down the street a pace for that matter. I surely don’t subscribe to the notion that Haitians facing hard times will nonetheless be “happy and joyful people.”

There are many angry young men around Leogane, Port-au-Prince and elsewhere who internally, and sometimes outwardly, plead for a job. Profane, political graffiti on buildings underscores the anger.

For me, the death toll from cholera the past two years – most probably visited upon Haitians from a Nepalese UN troop source – should not stir someone to use this occasion to celebrate a people’s resilience.  I don’t see where there is beauty in someone experiencing heartache. It is one thing to admire the grit of others. But why elevate that admiration to a new level by suggesting that difficult times present well needed occasions for personal growth.  Such times often bring death, particularly among the young.

Last year, I found myself in the camp of those well-meaning folks, such as the author of the poem above, I now criticize. Their sentiments at times found their way into last year’s Notes. This year I continue in my admiration for many of the Haitians I have met in Leogane, but not because they suffer so well. No, it’s because they have reminded me of the importance of nurturing relationships, and about living. Life is teeming here.

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I do agree with at least one of the poem’s sentiments, that watching school children on their way to school is uplifting. I look forward to the parade of solids, stripes and checker-board patterns  outside my window every school day. (I’ve attached just a few photographs of student comings and goings from last week, 0695, 0700, 0702, 0717 and 0721)  I agree that the variety of uniform hues might suggest an alternative way of viewing “the national colors of Haiti”, rather than just the red and blue of the official flag.

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Street Beats and Rhythms

There are definite patterns and sounds to living in Leogane; some man-made, others not. Weather fluctuates between bright sun and high humidity, and cool air that follows a thumping rain. I don’t think the rain brings the same level of noise one-half mile away in the sugar fields. But here, it beats down on the corrugated metal roof of a ramada that was placed below my office window during the renovation project. (Rain photo from yesterday – 0727)  This roof, half a story down, serves as somewhat of a safety net Dr. Livingston, who continues to go out on to the 5” wide ledge outside my window. (Dr. L. on the ledge 

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yesterday, photo 0729)  I guess he has forgotten falling from the second floor to the ground when he was six months old, while stretching out on the same ledge. He’s lucky though, he only has to survive the dangers of his street-watching roost until August when Missy Owen is moving back to North Carolina after being here for more than two years. She’s taking Dr. L with her.

It’s good that he won’t be here next Christmas or Easter. Missy told me a few weeks ago that these are cat-eating holidays. Poor Jackson. He owns a pharmacie across the street and is one of Missy’s next door neighbors. In January, Missy helped Jackson by de-worming his cat. Jackson thanked her; maybe the cat didn’t. He went missing Easter weekend; the cat, not Jackson. I wonder how attractive a worm-invested cat would have been to Haitian feline carnivores.   

                

Motos infuse the streets with tinny noises. Their beeps can be a warning that the moto is turning a corner or that it is approaching from behind – so keep walking a straight line or just stop in place. But doing the latter will surely delay the arrival at your destination, because motos are ubiquitous to the streets of Leogane.

Sometimes the annoying sound signals a non-verbal tirade directed to a truck or tap-tap that is hogging the road. Whatever the purpose, these beeps ebb and flow during the day. They fill the morning around 7:30 a.m., as many motos are driven by parents or older brothers ferrying students to school. Last week, I saw five on a moto – father driving, the youngest child in front sitting on the fuel tank, and three children on the back. I don’t see many five occupant motos drive by, but plenty with three or four. Moto sounds again dominate the street around 1:00 p.m., as the work day is at full throttle and children are returning from school. Traffic picks up again after 5:00 p.m.

Moto horn symphonies reach full crescendo on Saturdays - market day. On Samdi, ferried school children are replaced by adults sitting behind the driver, holding on to large bags of rice, beans, charcoal, and other assorted items bought at market. Cargo may also be placed in front of the driver. Only the laws of physics seem to control the size of a load. Lumber or rebar may be toted, adding 2-3 feet of clearance that people on foot must cede to an approaching moto driver. Many times, the passenger is using the moto as a taxi. It usually costs 25 Gourdes (about 60 cents U.S.) to catch a moto for a one-way in-town ride.

On Saturdays, open markets are filled with a wide assortment of wares, clothing, shoes, CD’s, DVD’s,  hair and beauty products and mangoes, mangoes and more mangoes. (I’m told that there are more than twenty kinds of mangoes.)

Every day tap taps and buses hit the road from early morning through evening. On Friday afternoon, starting around 3 p.m., people leave the “bus depot” in Leogane for Port-au-Prince where many who work in Leogane Monday through Friday spend the weekend with their families in the capital city. Monday morning brings a reverse migration from PaP back to Leogane. Dr. Samuels, the ER doctor at the hospital, is one of the many Leoagne – PaP roundtrip weekend travelers.

Last year, the “bus depot” in Leogane City Center was where Grand Rue (one block north of the hospital) meets the main highway going to PaP. I walked by it several times last year. It always was busy. The first weekend I was back this year, there were only a few tap taps there at a time when I expected at least ten vehicles in formation to be filled with passengers paying 50 Gourdes to get to PaP, Jacmel, Les Cayes or elsewhere. The next day I happened to mention the scarcity of vehicles to Mario. He told me that the Leogane City officials had moved the bus depot to another location about two miles away, out at the junction of the main highway and the Leogane bypass road. The relocation was made a number of months ago after a bus at the old depot backed into a wooden power, and ten people were electrocuted when a power line that fell across the bus. Among the twenty or so of the others who survived, some had legs and arms amputated because of the severity of their burns or they suffered “electrical amputations” at the scene.

It doesn’t matter what day of the week it is – the sun rises about the same time during any given week – everyday roosters crow about thirty minutes before the first ray of light hits the street. There are two roosters that call the day to order near my window. One is a very large white bird. I showed him to Mario yesterday.   He took one look and said “He’s not a native Haitian rooster, he’s too big.” Whatever his lineage, it’s always a hoot to watch this ambulatory wake up caller plant himself in front of Madame Carmen’s house, and start crowing at her door about every thirty seconds until she chases him away. (He’s in attached photo  0712, at Madame Carmen’s front door.)

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Speaking of Madame Carmen, as you can see, the lime-green house of last year is now pink – at least the front half. The painted on Christmas tree and ornaments are gone. One thing remains though. Just like last year, every so often Madame Carmen sits in her doorway, on her low riding chair, butt naked; like yesterday.  (No photos attached.)

Dogs provide the evening sound bites, while the roosters rest up for morning. I have yet to see an overweight dog in Haiti. They all look like they would rule any U.S. or Canadian neighborhood, should  they somehow get transported to North America. The expression “street-wise” comes to mind when I watch Frankie’s dog across the street.

Should you come to Leogane, and take at least a fifteen minute walk around City Center or Belval, I promise you will hear a number of children call out “Hey You !” Children and adults also may shout “blan” at you. As a general rule, “blan” – which is Kreyol for “white” or “whitie” when called out to a pale foreigner – is not intended as a pleasant greeting. It’s more like, “I see you in my neighborhood white person.”  “Hey you” on the other hand can cut one of two ways; as a friendly greeting of “Hey you, what’s up” or “Hey you, what are you doing here.”  I have learned ways to respond to these shout outs. It doesn’t hurt to know a fair amount of Kreyol. I’m getting there.

A description of common street happenings in Leogane would not be complete without a mention of “Ti Malice” – which has at least three levels of meaning in Haiti. First, and foremost, “Ti Malice” is a brand name for various cooking oils and food products. You can’t walk more than two blocks in Leogane without seeing someone who is wearing a bright yellow t-shirt with “Ti Malice” in blue on the front. I scored one during Ra Ra. (Photo 0696)

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Frankie, who owns a street level shop across the street, and lives upstairs, wears his Ti Malice t-shirt and shorts 2-3 times a week. That’s him across the street in attached photo no. 0695, taken during a school day uniform parade. Ti Malice was a major sponsor of this year’s Ra Ra. One of the photographs I sent you with this year’s Note about Ra Ra was of a number of men on horseback with straw hats. They all are wearing yellow Ti Malice t-shirts under their blue sport coats.

Ti-Malice also is a popular Haitian rock/reggae type band. And, Ti Malice is a noted Haitian folklore character:

“Probably the most popular of the [folklore] characters are Uncle Bouki and his perpetual antagonist, Ti Malice. Bouki is ineffective, boastful, sometimes greedy, continually hungry, foolish, and often gently touching. Ti Malice is quick, conniving and ready to deceive either for an advantage or a joke.  Together, Uncle Bouki and Ti Malice form a combination for plot and counterplot, usually funny, sometimes with a moral humor....As for Ti Malice, Haitians would roughly translate the name as meaning “mischief.”  But the Ti in the name could well have come from “tio”, meaning “uncle” in Spanish.” Woody Woodpecker, Bugs Bunny and Roadrunner have nothing of you Ti Malice. Here, you win hands down the imaginary battle of the per capita t-shirts headcount.

RANDOM SIGHTINGS 

In no particular order, I leave you with a list of some things that caught my attention when I worked around Leogane City Center, then up north of the Belval neighborhood where the Nursing College is located, out to the main Leogane – PaP highway, back down to Rue Lavandiere then west to Rue Pere Thevenot in front of the hospital, for about seventy-five minutes on Saturday one week past. Other sightings were made this past week.

The largest grey hair hog I have ever seen, half submerged in a big mud pit. I thought it was dead until I saw a few bubbles come out of the snout. Three little drummer boys along the side of a house – sharing a coffee can and plastic container to make street beats.

Walking back with Watson from Belval, after meeting with two of the nurses who were part of the hydroceles surgery team operating at HSC last week. We were passing a huge public works ditch project near the old, now demolished city hall, and approaching where the new Catholic Church will soon be built.  Watson said, “Leogane is building.” Indeed it is.

Walking by the tent city next to the large open air market in Belval. There are about half the number of tents I remember from this time last year. I think this is a good sign. Perhaps some have moved into the new homes in Santo.

The crowd watching the UEFA Champions League soccer game between Barcelona and Chelsea, across the street at Jackson’s. Leogane is a Futbol Club of Barcelona town. Here the team is simply called “Barsa” (as in “bar sah”). Chelsea knocked Barsa out of the semi-final round. Jackson’s was packed (photo 0714), as it also had been a few days earlier for “El Classico”; which is the name given to any match

 between Spanish La Liga rivals Barsa and Real Madrid.  Barsa also lost that game. It was not a good week for the crowds at Jackson’s. On top of the two loses within a span of a few days, I don’t think more than 5 – 7 of the fans could actually see the T.V. inside Jackson’s store.

Buying a grilled ear of corn for 10 gourdes from a woman vendor on the main Leogane-PaP highway.  I’m not hesitant to eat local fare, within reason.

Trash. Though it pales in comparison to the life and death challenges some face, and I hesitate even to mention them, there are mundane, small things around here that drive me nuts; for example the ubiquitous litter of small plastic packets that once held about four ounces of drinking water and discarded Styrofoam food containers.

Watching the hardest working men in Leogane; those who pull huge wooden carts to tote at sorts of heavy items for their customers. These are Haitian “teamsters” so to speak, but without a Jimmy Hoffa legacy union or a decent wage to compensate for the wear and tear endured by their bodies. (Photos 0724 and 0725)

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At the beginning of my Saturday walkabout, I was walking up Rue Pere Thevenot, and watched a barefoot man, who couldn’t have weighed more than 110 lbs., struggle to pull a wooden cart loaded with at least fifteen bags of cement and a few other bags. He was bent forward so much that his chin couldn’t have been more than two feet from the ground. Amazing strength, and lots of sweat.

I again visited the mass grave where many unidentified Leogane citizens are buried.  he mass grave is located within the white wooden fence line between the established cemetery at the end of Rue La Croix and the main Leogane to PaP highway. (Photos 0705, 0706, and 0707)

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The sobering visit to the grave site was followed immediately by a turn west on to Rue Lavandiere, where I came upon the third of three Kleren stills I passed during the Saturday hike. (Photo  0708)  Some Americans here refer to Kleren as “Haitian sugar cane moonshine.” I think that’s a misnomer. When I think of moonshine, I think of a still hidden from “Revenuers” far back in an Appalachian “holler.” Here, Kleren stills are along well traveled roads, including one that is two blocks from the hospital over on Rue Lavandiere. 

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(Photo 0708)  I’m tried Kleren.  It has such high alcohol content that it starts evaporating as soon as it hits your tongue. I’ll stick with Prestige Beer if you don’t mind. But, I’ll ask my wife Jeanne to give Kleren a try when she visits in a few weeks; so she can have yet another memorable Haiti experience.

       

HOW IS YOUR FAMILY ?

When you are greeted by people you know, and even when meeting some strangers for the first time, it is not uncommon to be asked, “How is your family?” Most asking this question are sincerely interested in your answer. When I see Dr. Bastien, the local dentist – as I did yesterday - he always asks me, “How is your wife?”

Madame Bellevue and I start the morning by asking each other how we slept last night. Last week, I also asked her about the soreness in her right wrist. She no longer is “fe mal,” which is good. I learned Monday that over the weekend she had stopped the Advil I had given her.

When I came back to the guesthouse at the end of my Saturday hike a week past, Madame Bellevue opened the second floor door for me. She was visiting with one of her sons. Man was he tall – “wo” in Kreyol. Madame stopped her conversation with her oldest child to introduce him to me and to engage in several minutes of conversation with me and her son even though she knew I wasn’t following everything in Kreyol. It was more important to take the time to chat than to have all words understood. How typical of Madame Bellevue, from whom I have learned so much about nurturing relationships. My lessons from her began on my first day in Leogane last year, March 30, 2011.

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Those of you who read last year’s Notes have already seen the attached photo of Madame Bellevue (Photo 0294). I attach it again for the newcomers, and to show all but one of the eight or so hats she has worn the past month. Madame is a person of very modest means. But, she is rich in grace and every day radiates an infectious zest for life.

In the early evening, after 7:00 p.m. when moto traffic has subsided a bit, the pace on Rue Pere Thevenot changes. Madame Carmen holds court with passersby. Frankie and Jackson are out front sweeping their porches but stopping often to talk with friends on foot, bicycles and motos. Jackson’s grandson is on his plastic tricycle, laughing quite a bit as he plays in front with one of his parents or one of his 4 -6 years old neighborhood friends.They sometimes taunt dogs roaming the street until a growl ends that mischievous play.

Evenings on Rue Pere Thevenot give me a taste of what it would have been like to have grown up in a small town, spending summer and fall evenings on the porch for an hour or two. Here, chickens and some goats roam the neighborhood. No need for cages or animal pens. Everyone knows who owns each animal.  But I guess this “hands off” courtesy doesn’t always extend to cats.

During evenings at the hospital, Ty Ty and Beelove are around. They both live out back. They sit on the concrete bench area outside the lobby and chat with friends, and with those bringing a meal to a patient in the hospital. (There is no cafeteria at Hopital Sainte Croix as is the case with most hospitals in Haiti.)

Last night I was outside under an overhang next to the hospital main gate while it rained talking to one of the translators about an American mobile clinic team due to arrive in 10 days. There was no rush to finish our conversation. Cells phones were not allowed to intrude.

When I’m in Leogane, I’m reminded once again of the importance of talking to family and friends often and for more than a few off-handed exchanges. To me, the need to cement relationship bonds increases in direct proportion to the ever accelerating pace of life in the United States. My conversational skills improve when I’m here, because people expect you to ask about them and their families, and for you to talk about yourself and your loved ones.

When he comes upstairs to see what meds we might have in the guesthouse auxiliary pharmacy depot, I talk to Sammy -  the one who works in the O.R., not Sammy the translator - about how Barsa in its last game. (I think this Sammy is a closet Real Madrid fan.) I often talk politics with Mario. We most recently discussed when the UN troops might be leaving Haiti. When I see Jo Jo each Monday and Wednesday for our “You teach me Kreyol, I’ll teach you English” lessons, I ask about his three month old daughter, Betsy, and his wife. He asks about Jeanne, and when she’s coming to visit. It is not enough to ask, “How are you today,” but that’s always a good start.

Most Thursdays or Fridays, I ask Ty Ty about the church his band will be playing at the next  Sunday/Dimanch service. Jeannine and I talk about her weekend business. Last week, we printed up business cards for Jeannine’s thriving catering business. In front of Jeannine about two hours ago, I was singing the praises of her chocolate cake with a hint of coconut to the volunteer manager of the Filariasis Guesthouse in Belval. I’m hoping that compliment will bring some of Jeannine’s homemade cookies to the dinner table by the end of the week.

Mario and I have a running rock trivia challenge carried over from last year. Just yesterday he came by to visit, and for some reason we drifted into conversation about British soccer hooligans. Mario started laughing, and reminded me that last year he stumped me when I couldn’t tell him which British rock band had cut the “Hooligans” compilation album. It was The Who!

Greeting someone is not a perfunctory experience in Haiti, if you let the give and take of initial dialogue come to you and let it grab your undivided attention. Life slows down here for many reasons, some good, some not so good. To me, the best reason is the most refreshing – relationships truly matter. 

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

Peace,

David

02 May 2012

    

    

  

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