The Weeks from Hell: Part 1

**This is going to be a pretty long post and I don't have any pictures to break it up - just to warn you.

The next few weeks (which puts us into February) passed with much excitement, both good and bad.  We had routine days going to school, working on art and environmental lessons, working with the women in the loan program, and organizing everything on our end for two groups of high school girls to come on week-long immersion trips.  In the midst of all of this, we had three tragedies within two and a half weeks.  To put these on top of all of the work that we were doing on our projects and these school groups, Beth and I, (Frankie went home to be there when her sister gave birth to her new nephew), had a hard time, physically, mentally and emotionally.

When we first arrived, a little girl came to our house with her mother looking for medical assistance. She had gone to Fon Ibo and Camp Claudine in the summer, so the sisters and Beth knew her.  She had a huge growth on her elbow - the size of a small basket ball.  The sisters pulled some strings and paid for her to get into the best children's hospital in PAP.  It was decided that the only thing that they could do for her was to amputate.  They weren't sure if it was cancerous, but they knew that her arm had to come off if she was going to live.  It's important to understand that despite the fact that this girl could live a normal and productive life with only one arm, amputees are less accepted here and regarded as "sick."  The father, who was living abroad, was consulted by telephone about the prognosis and told the mother, knowing full well that his daughter was going to die without the surgery, to not do it because there were risks with the surgery and they could always have another child.  I just want to say that this may not be the full story - it is what we heard from someone and we have no way of really knowing whether or not this was the reasoning behind the final decision.  While I'm not excusing the reasoning of the father, and the mother's submission to the man's decision (this follows along cultural lines), I just want to acknowledge the fact that we may have a very skewed perspective of what happened.

Anyway, the girl came back from the hospital and then the waiting game started.  In February, Beth and I decided that we should stop by and see the little girl because she wasn't going to school or really doing much of anything.  One day we told her uncle we were going to come, something came up and we didn't go.  A few days later, when we decided that we were actually going to go, Beth saw the uncle and asked if it was alright and he replied that she had died that morning.  When I met up with Beth later in the morning and she told me that, my jaw literally dropped.  I couldn't believe it.  What strange forces were working that on the very day we were going to see her, she died?  It's hard to say exactly what I felt when I first found out.  Shock, definitely.  Sadness, of course, because this was a life that didn't need to end so soon.  Anger, yes - at the father for his decision not to take action and at the mother to not stand up for her daughter's life.  Despite all the reading I've done about Haiti, the questions I've asked, the people I've met and the things I've seen, there are still some things that I don't understand.  This is one of them.  Why didn't anyone fight for this girl's life?  Is the death of a child so common here, that a life is considered almost replaceable?

Because Beth had worked with the little girl in camp and Sr. Pat had paid for their trip to the hospital, we decided that we should attend the funeral.  I had heard a little bit about Haitian funerals, from the sisters and knew that I needed to prepare for an intense experience.  The service itself was similar to other services I've been to.  The casket was open in the front and the preacher spoke for a while about the girl and various other subjects.  I don't remember the specifics of what he said, but at one point, I remember thinking that the fact that the preacher was literally shouting down at the family and friends did not seem like an appropriate tone given the circumstances.  In fact, I remember thinking that after the first 20 minutes of being yelled at, if it continued any longer, I would politely excuse myself because it just seemed disrespectful.  But that's just my opinion - I have no idea if that style of talking is accepted at funerals here.

I had heard that at funerals here, women will wail.  Let me tell you, that is a sound like no other.  Overcome with grief, women will wail.  It can't be likened to crying or screaming.  It's more like a long, high pitched noise that reverberates in you like no other sound I've ever experienced.  Words can not explain it, but upon hearing it, my mind jumped to the Siren calls told of in Greek mythology.  It had an eerie quality that just rips into you.  It was amazing, and a little scary, to see how open these women were in expressing their sorrow.  One woman passed out and had to be carried out of the church.  As one who avoids crying or talking about my feelings, it was pretty incredible to see how much these women were feeling.

When the service ended, everyone gathered outside the church where the marching band (a typical component of Haitian funerals) and the hearse were waiting to begin the march to the cemetery.  Beth and I tried to stay out of the way and towards the back, but it turned out that the path the coffin had chosen to take was right in front of us.  So, there it went - a beautiful white lacquered coffin, about 4 ft long, carried literally under my nose.  I remember my breath catching in my chest and thinking about how small it looked and the little girl laying inside.  I knew, that as the fanfare started and the little girl was put into the car, the sounds of the wails would haunt me for a long time.


A few days later, Beth and I went to the Village to play with the kids.  While we were there, a woman approached me and said that a young man was very sick and needed medicine.  I told her that we only had medicine for minor injuries and ailments.  If he was that bad, he needed to go to the hospital.  But, she insisted on showing me the man.  She brought me (and a whole troop of little followers) into a small, dimly lit room that had nothing in it except a bed on one side and a young man laying on a few blankets in a corner.  I could see right off the bat that he was incredibly thin and that one of his eyes was a bright, opaque blue.  Beth joined me and we tried to figure out more information about this man's symptoms.  None of our questions were answered beyond the fact that he was sick, he couldn't eat, he was thirsty and there was no money to send him to the hospital.  They did show us his legs and feet, however, which were pretty swollen.  We did our best to explain that he really needed to go to the hospital but that if his sister came to our house Tuesday or Wednesday (we were closed to visitors Monday because of the parish feast celebration), they may be able to give a little support.  We advised trying to have him eat a little rice or bread and we emptied our water bottles so he would have at least some clean water.  We also asked why he was on the floor and not in the bed and tried to get two young men to lift him into the bed, but no one wanted to touch him.  After that, we went home, told Sr. Pat what we had done and that his sister was coming.  We then went about our business.  Wednesday morning rolled around, the sister arrived bright and early and Sr. Pat gave her a slip for the hospital that said we would cover the costs for tests and being seen by the doctor.  She came back in the afternoon and said that the young man had died that morning, before he ever made it to the hospital.  We still have no idea what killed him and to be completely honest, I was a little nervous to go back to the Village for a while because we weren't sure if we were going to be blamed for his death (something that does happen relatively frequently here).

It's said that bad things come in threes and we didn't have to wait long until the third one presented itself.  We had two groups of high school girls come for week-long service immersion trips and Beth and I (and Frankie when she came back from the States) worked pretty closely with them making sure things were set up before the trip and then showing them around while they were here.  We were at the hospital trying to coordinate an information session with the nurses working in the malnutrition clinic.  One of the head doctors/administrators generously helped us set up the session and then gave us a brief tour of the hospital.  Maybe two days later, we heard that he and another doctor had been in PAP and had been shot at and the other doctor had actually been killed.  Apparently, there was an armed robbery nearby and the doctor was answering his phone but the robber thought he was trying to call the police - so he shot him.  Our series of unfortunate events ended up in four, not three, because a few days after that, the little boy Beth is really close with told us that his baby step-sister who was only a few months old had died.  We had met the baby as a newborn and we both got to hold and cuddle her.  She had a cough for a while and I believe had gone to the hospital, but she ended up dying.

Needless to say, it was a pretty difficult few weeks.  It was hard for me to know what to do, think, feel or react to these situations.  I'm not sure if I learned any huge life lessons or morals from them, but it did show me a new aspect of life here.  It gave me a better idea of how hard life is, the consequences poverty as well as cultural norms can have, how many parents bury a child and how Death's presence seems nearer in a place like Haiti.

Pictures.

A few more pictures that get you caught up to present day!  These are in no particular order.

(Beth took this one.)

Art lessons - working on mixing white and black paint into a color to change the tint and shade. 

The girl in the shiny pink dress - her face is priceless. 

So cute!

All of Beth's market purchases.  And there were even more, because this picture was taken in February.  Needless to say, she has a problem.  But it's hard to resist when you can get quality clothing for super cheap!

My first running-related injury.  Just in time for Valentine's Day too!

The empty market.

Beth and I getting freshly cut sugar cane.

Happy Mardi Gras!

One of the projects Beth has been working on was building a library.  It now has over 200 books donated from groups and individuals all over.  It's so wonderful to see children explore the world of literature!!

Showing off the "guns"!  These tough guys definitely had me beat with all their karate moves, cartwheels and gymnastics.

Best. Purchase. Ever.  I first saw these months ago, but hesitated because they are in pretty rough shape.  After researching the re-webbing possibilities online, I decided that I should get them.  Trouble was, I couldn't find them.  The woman selling them was never out and I couldn't find her anywhere else in the market.  One day, Beth and I were walking and I said we should go the way where this woman had been selling.  She was joking that I would never find the sandals and as soon as she finished, there they were!  They cost me 150 gourdes or just over $3.

Malnutrition and Miracles

As surprising at it seems to those of you who know my reaction to anything medical, one of the most interesting and exciting things I have done here has been working with the handful of medical teams that have come to Gros Morne.  It has been a fascinating way to learn more about the daily struggles Haitians live with and how, despite the many efforts put into healthcare in Haiti, medical attention is still not accessible to many people.

Early in the new year, a team of pediatric medical students from Johns Hopkins came to provide a mobile clinic.  They performed regular check-ups for all kids aged new-born to 17 in some of the areas in and around Gros Morne.  One of the main goals of the clinic was to identify children in need of umbilical hernia surgeries, circumcisions and general pediatric surgeries.  The team of students and surgeons was headed by Dr. Sr. Karen (a Sister of Mercy), who is just an incredible lady.

Here's a little kid with a pretty large hernia.
They are measured by how many fingers you can
fit into the hole.  For example, it may be
a "two finger" hernia, which means that it's relatively
small.  A grown man could fit four
fingers into this baby's hernia.
(Beth took this photo.)

For this team, we did some of the pre-organizing - making sure they had tables and benches and coordinating with a local priest/village leader that we could use their space.  Then the three of us, (Beth, Frankie and I), translated during the consultations.  We saw many of the same things that we had seen in other clinics -- fevers, colds, coughs, stomach pain, etc.  In addition to this, we identified several children that were referred to the free malnutrition clinic at the hospital.  Many children had varying degrees of umbilical hernias.  I had never seen one until I came here and now I see them everywhere.  It looks like a child has a small (or large) bubble in their belly button.  There is a ring of muscle and tissue around where the umbilical cord enters the fetus that usually closes before a baby is born.  But occasionally, this ring doesn't close and it creates a weak spot/hole in the abdomen.  Intestine, fat or fluid can push into this weak spot causing a bulge.  Sometimes the hernia corrects itself, but if it doesn't by the time a child turns 4 or 5, an operation is needed to correct it.  If left untreated in girls, it can cause complications during pregnancy.  While the pediatricians were here, they saw a little over 300 children and performed 17 surgeries.

We did have several interesting and heartbreaking cases, all on the last day.  Immediately after we had arrived at the site and surveyed the children that were waiting to be seen, Dr. Sr. Karen told Beth and I that one of the little girls there was going to die.  This particular little girl looked like she was about 6 years old, but she was actually 8 or 9.  Her legs, arms and face were all swollen.  Her hair was clumpy and she had dark spots all over her face.  The skin on her legs and feet looked like it was peeling off leaving open sores.  She said that the girl was suffering from Kwashiorkor, a type of severe acute malnutrition caused from lack of protein in the diet, although in some cases, it may be caused by an underlying disorder that makes it difficult for cells to absorb the protein.

(Zaas' photo)

I did some research on Kwashiorkor.  According to UNICEF, this little girl was probably suffering from severe Kwashiorkor.  Instead of the typical malnutrition you think of, where a child is literally skin and bones, children with Kwashiorkor are characterized by edema (accumulation of fluid in tissue) which can result in heart and kidney failure.  It was suspected that this little girl was so far along in the disease that her organs were already starting to shut down.  She had "severe edema" – her feet, legs and arms were swollen and swelling was beginning in her face.  Another sign of Kwashiorkor is dermatosis -- patches of lighter or darker skin and peeling of skin.  This little girl's skin was discolored, had many patches of peeling/flaking skin on her feet and legs exposing raw skin.  Because of all of this, it put her in the "severe" category.

Dr. Sr. Karen told Beth and I not to tell the students what the girl had because she knew that they had never seen anything like it, (it is uncommon in the States), and she wanted them to try and deduce, based on the symptoms, to guess.  One of the coolest parts of working with students was that they too were in the learning process and were so willing to explain different things to us, what the causes were and why it was treated a certain way.  I never thought I would enjoy learning about medicine so much - but I guess I have to add it to the list of things I never thought I would like or do since coming to Haiti!

Dr. Sr. Karen said that this little girl needed to be treated immediately and even with treatment, it was likely that she was going to die.  I helped her and one of the residents translate while they asked the father basic questions, told him how serious the situation was and how a car was coming to bring them to the hospital.  The little girl was eventually transported to the State hospital in St. Marc.  This was an incredible surreal experience.  Here was a little girl, right in front me, that was going to die because her parents couldn't afford to take her to the hospital when she first started getting sick.  It was hard to know what to feel.  Part of me was horrified that death was so near, part of me was terribly sad because this little girl was suffering so much, and part of me was reminded that this is what life is like in Haiti.

(Zaas took this one.)

There were two other interesting children who came into the clinic that will actually lead to another post, but I'll introduce them now.  One was a little boy, about 5 years old, who came in with osteomyelitis, a bone infection.  He actually came to be seen by the student I was translating for and it looked like he had a hole in his shin and pus was sort of oozing out of it.  He could barely walk and hobbled around on tiptoe.  He looked so sad and scared and when his mom found out how severe it was, she was terrified.  He was given specific antibiotics and was instructed to return in 3 weeks when Dr. Sr. Karen returned with more medication.  Karen stressed how important it was to take the medicine because if he didn't take them, he was at an even greater risk of losing his leg.

The other young man who came in, who's story will continue later, came in with an elbow that didn't work.  He had broken his elbow in November, nothing was ever done about it and now his arm just hung uselessly at his side.

Our first adventure!!  Climbing Stellenbosh Mountain in
Stellenbosch, South Africa, January 2013.

One of the coolest parts of this particular team, was that one of my friends I met studying abroad was able to hook on to the pediatric team's transportation and come visit.  He was on his way home from Ecuador, found a cheap ticket to PAP and thought he would "stop by."  He too was an International Relations major (at Ohio State) and is interested in community development/non-profit work.  It was so fun to have Zaas come and see what we were doing here.  There is really only so much that I can share via the written word and images.  But to really be here, take in the sounds, the smells and the sites all at the same time is something totally different.  I was happy that I was able to share some of the experience with him.  He was put to work as soon as he got here, trying to keep children and their parents in line while waiting to see the doctor, giving every kid worm medicine and fluoride and snapping wonderful photos -- all without speaking any Creole.

Another adventure - two years later, almost exactly.

It has been such a privilege to work with teams like the one from Johns Hopkins.  I know I take my good health (knock on wood), health insurance and doctor/nurse friends for granted.  In other areas of work here, we see the daily struggle with education, drought, poor soil quality and lack of infrastructure.  But these opportunities have given us a close-up picture of what children and adults of Haiti suffer, the difficult choices they face between health care and feeding their family and how poverty truly impacts all areas of life.  I know I cannot thank the various groups that have come not only for the care they are providing the people here, but for allowing me to be a part of it.

Update as of April 2015:
Since the little girl with Kwashiorkor was diagnosed, she was sent from our hospital to the larger one in St. Marc.  There, she was slowly introduced to food, beginning to increase calories (carbohydrates, sugars and fats) and then protein.  We heard only a little news while she was in St. Marc, basically that she had good and bad days.  But a few weeks ago, Sr. Jackie told us that the mother had approached her in church and told her that the little girl was home and feeling much better.  We're not sure what the long term ramifications are, but it's a miracle that she's still alive!!

Some more of Zaas' photography!

Met these kids at the top of the mountain!  They were so fun to play with and such hams for the camera!

(Beth took this one)

TOMorrow’s Shoes

I am a huge fan of TOMS shoes.  My mom bought me my first pair years ago, when they were much less well known.  Since then my collection has grown and I have been an admirer of their business model and the work that they do.  I had always thought that it would be wonderful to be able to go on one of their shoe drops and help them distribute the shoes to kids that really needed a pair.  I never thought that would be something that I would have the chance to do while I was here.  I also never thought that it would be so difficult.

There is an organization here in Haiti called Food for The Poor that has partnered with TOMS to help distribute shoes throughout the country.  Gros Morne received a shipment of 11,000 pairs of Haiti-made TOMS (because they now have a factory here) that were to be distributed to a handful of schools in town as well as the schools other RJM sisters work at in Jean Rebel.  I was away for Christmas when the trucks with the boxes got delivered and the initial distribution started to happen (shows you how far behind I really am), so I really only witnessed the tail end of everything.

Beth - getting all artsy!

I was under the impression that when schools received TOMS, every student would receive a pair that fit them perfectly, or at least close enough.  This is not the case.  Before the shipment came in, information about each school enrollment was collected.  I believe that the first few schools that came to pick up shoes received enough for every student to receive a pair, but there was no guarantee that they would actually fit.  The schools that came last only received maybe a hundred pairs of assorted sizes and were left to figure out which kids/classes would get shoes.

Food for the Poor wanted us to pick two schools that were going to be “highlighted.”  In other words, they were going to come and actually distribute some of the shoes, take pictures and do some interviews for their website.  Fon Ibo was one of the schools that was chosen because we could help facilitate everything.  So, Beth and I, (but especially Beth), spent tons of time at school measuring every child’s foot from a chart given to us by Food for the Poor and recording the data.  Beth and Frankie then made sure that the school received exactly the number of each size that we needed.

One of the first problems that we faced was the fact that the shipment did not include every size.  Kids who were measured to have a size 35 (European sizes) were getting 37s because we had tons of 37s, but no 35s.  Although this wasn’t ideal, the sizes weren’t too off, so we figured that some of the kids would just have to squeeze and others would have to grow a little bit, but it was something that we could work with.

Although some kids were mad

because they got shoes that didn't fit and

some didn't even take a pair, 

some of the kids were happy and 

thankful for their new shoes.

(Beth took this)

We had gone through all the shoes, divided them into classes, wrote down what each child was getting (with the corrected size) and waited for Food for the Poor to arrive.  When they finally did, we gave them the boxes, the charts and watched as they started to give out the shoes.  But we noticed that many of the shoes were too big.  They distributed two classes worth of shoes and left us with the rest.  So Beth and I got to work.  As we gave out shoes in the first few classes, we noticed that every pair of shoes was way too big for every student.  We were so confused.  If a couple of the pairs had been a little off, it would have been understandable because of the mix-ups with the sizes that they sent and potential errors on our part, but every kid?  Finally, I suggested checking on the sizing chart that we used.  It turns out that the chart that we used to measure every kids foot did not correspond with the sizing of the TOMS – it was about 3 sizes off.  This meant that in addition to having to adjust some of the pairs to fit with what we got from Food for the Poor and TOMS, they were adjusted even more because of the mess up on the chart.

I had been really looking forward to giving out shoes.  Many kids here either do not have shoes or have shoes that are falling apart or are way too small.  You can buy decent shoes, (used ones from Goodwill), in the market but they are incredibly expensive.  Most people have rubber sandals or some kind of plastic shoe.  We’ve had tons of kids ask us for shoes or tell us that they can’t go to school because they don’t have school shoes.  While giving out TOMS at Fon Ibo didn’t necessarily help the kids that couldn’t go to school because they didn’t have shoes, I knew that many of the kids at the school could use a new pair.

But giving out the shoes was an absolute nightmare!  We had to explain to every kid that things got messed up and that the shoes were too big, but that we didn’t have anything else.  Kids got mad at us because the shoes weren’t good and couldn’t understand why we couldn’t give them a different pair.  It was frustrating to deal with the kids but even more frustrating because in my mind, it seemed like TOMS was failing.  Although some of the kids got pairs that fit and others were able to share with family members or are holding on to them for when their feet grow, we’ve seen tons of TOMS in the market.  It was sad to see how something that sounds so good on paper can be so dysfunctional in real life and it really got me thinking about what happens on their other shoe drops.  How much good are they actually doing if kids don’t even get a pair of shoes that fits?  I appreciated that the shoes themselves were made in Haiti, but there is always a concern about just bringing things, whether they be shoes or food or anything else, into a country instead of doing everything “in-country.”  In other countries where TOMS gives, they are not providing people with jobs, they are not boosting local economies or really doing anything that will, in the long-term, resolve poverty.  This idea has become more and more evident since I’ve been here, but seeing it with an organization that I loved and admired was sad.  It’s sent by brain abuzzing as to what are the best methods and solutions in countries like Haiti that need so much.

Distribution.

(Beth's photo)