Joey's Thoughts

Iquitos Reflection

2011-11-29T15:53:00.000-08:00

One year after returning from my time volunteering in pre and post-earthquake Haiti with the University of Notre Dame’s lymphatic filariasis elimination program, Dr. Reeves gave me the opportunity to complete an introductory rotation with the United State’s NAVY emerging infectious disease outpost in Peru. I am currently a second year osteopathic medical student at Lake Erie College of Osteopathic Medicine (LECOM) and considering a master’s in public health degree. This reflection is a compilation of my summer experiences and an analysis of their subjective value. My ultimate assessment is that moving to Iquitos to work alongside doctors and scientists with the Naval Medical Research Unit Six (NMRU-6) would be an invaluable exercise for any self motivated medical student considering specializing in tropical medicine, international public health, or infectious diseases.

My four week stay was split evenly between Dr. Morrison’s dengue fever project and the NMRU-6 disease surveillance initiative headed by Dr. Stalin and Dr. Siles. This division of time afforded me insights into the complexities of executing a research project in a resource poor setting as well as a general picture of the diseases that present daily in the largest hospital in Peru’s Loretto province. My first two weeks consisted mostly of short work days unloading, organizing, constructing, and distributing Aedes aegypti mosquito traps. On the surface it might have seemed like nothing more than manual labor, but to an opportunist these hours were a chance to practice Spanish with the Peruvian scientists, pick the brains of the University of Tulane Phd’s, to enter homes and witness the living conditions perpetuating diseases. With the internet connection at my Casa Callao residence I was able to access literature on dengue fever and other pertinent subjects. My hosts and accommodations at Casa Callao were superb, and included air conditioning, running water, a refrigerator, television, and wifi. These luxuries made reading up on dengue fever, malaria, leptospirosis, and several of the cases I witnessed while in the hospital easy. During the second half of my rotation I had several opportunities to participate in morning rounds in the emergency and infectious disease wings of Hospital Regional de Loretto. Here I witnessed dengue cases, a snake bite, late stage HIV, toxoplasmosis, miliiary tuberculosis, and diabetic neuropathy, to name a few of the more interesting cases. What I was unable to comprehend with my own intermediate level Spanish Dr. Stalin translated for me. Similarly, Dr. Siles, in an effort to broaden my horizons, allowed me to accompany him to several rural clinics for disease surveillance. Finger pricks, blood pressures, and temperatures in Nanay and Zangurococha were especially interesting. Blood and larvae collection efforts such as these were a great insight into the tedious and less glamorous side of research and health care in remote parts of the world. This perspective is particularly valuable to naïve first and second year medical students.

Medical work aside, my most fond memories of Iquitos came while exploring the community and befriending other medical students with similar interests. Playing soccer with the staff each Friday, attending the concerts surrounding the festival de San Juan, and being a guest in the homes of Dr. Stalin, Dr. Siles, and Dr. Morrison, were all unexpected experiences which made my rotation special. It should be noted that I always felt safe, had a Peruvian phone, and several emergency contacts. Most of my transportation was accomplished by walking or via inexpensive motor taxis. I purchased food most days but had access to a super market with bread and deli meat among other tourist items.

I approached my rotation with the same attitude that marks my independent learning curriculum at LECOM. Where some might flounder in a setting with little structure and fluid expectations, I thrived. This lack of commitment to any one specific project allowed me to taste several different aspects of tropical medicine and research and come away with the broad experience I hoped for, that being an introduction to tropical medicine and research. As a second year medical student I have been able to relate many of the basic sciences back to those sick patients I encountered in the Amazon. I am grateful to Dr. Reeves and all of the NMRU-6 staff for their patience, enthusiasm, and willingness to cultivate my burgeoning interest in their professions.

Almost to Thanksgiving Break!

2011-11-09T13:38:00.000-08:00

Yesterday afternoon around 4pm, in a fit of unproductivity, I slammed a five hour energy drink… and drove to school with all of my books. For seven straight hours I sat on the third floor looking at EKG’s, only rising during that time to do push-ups or use the restroom… I’m strangely fascinated by EKG’s and the heart’s mechanics, so this study session was not as difficult as kidney physiology or white blood cell pathology for instance. TIME FLEW by, and before I knew it the security guard doing his nightly rounds was knocking on the door and telling me I had to leave because the school closes at midnight. Amazed at my focus, and concerned by my amnesia-like loss of time, I wondered out to the car. On the three mile drive home I was particularly relaxed by the satisfaction of my late day rally… and thoughts of school, grades, plane tickets, rotation slots, residency programs, began to fade from the forefront. Usually mental relaxation is accompanied by sleep. Last night was different thanks to the excess of B vitamins still coursing through my system (5 hr energy)…

So there I was, alone outside my home in the street, relaxed, wide awake while the world slept, with the stage curtain of personal anxiety drawn to the side. I looked up at the full moon and took a deep breath…. Then I stood and looked at the airplane, no, a satellite, no, a star? I spent some time considering whether its seeming movement was an optical illusion cast by the slowly migrating clouds or some sort of orbit/propulsion. I agreed to disagree with myself and laughed inside at my own useless curiosity.

A few minutes later I strode down the street in my tennis shoes in search of nothing. What I found was a black cat puzzled by my hunting habits and two startled rabbits, irritated by disregard for their privacy. Energized by my own appreciation for the overlooked… I quickened my pace to a jog. My legs felt so strong and capable that I pushed it to a sprint… stopping abruptly for no reason to crouch in a sprinter’s stance. 3… 2… 1… crack…. I’ve never felt myself move as fast as last night as I raced to the next stop sign… The cool night air teased my face at the ridiculousness of the scene. I didn’t care though. I studied EKG’s for 7 straight hours. I felt like the freakin man.

Then I skipped home like a guy who had just counted his blessings and realized the insignificance of the four exams left before Thanksgiving break :)

(Andy, Dan, I in Athen's Ga together for a guy's reunion)

Soccer as a Language

2011-06-25T13:31:00.000-07:00

This is a picture of myself and Dr. Stalin who I did rounds with in the infectious disease ward last week. When he heard I liked soccer he invited me to play in "el estadio" with all of the doctors from Hospital Regional de Loretto. I scored all 3 of our teams goals in a 3-3 tie. I'm hoping that will open up some opportunities to work with a few of the other Peruvian specialists next week in the hospital :)

So I’ve been reading a book called “How Soccer Explains the World” by Franklin Foer. I’m finding it to be a bit scatterbrained but consistent with my past and present experiences playing pickup soccer with strangers in the states and abroad. What sport has captivated a more diverse audience for so long? They say that English is the accepted international business language, used as a sort of compromise amongst multilingual business groups. Where perhaps the English language is being forced upon the world, soccer’s spread seems to be welcomed and played adoringly. The point to be made, and what Foer’s book has yet to explain (and ironically an old friend and Notre Dame Soccer Player, Luke Boughen’s recently released documentary on international pickup soccer “Pelada” explains http://www.imdb.com/title/tt1530953/) is that soccer is more than just “common ground”. Soccer is a nonverbal language that nearly 2 billion individuals are at least “conversational” in.

I stumbled into soccer as a kid. My mom experimented with the Liberty Patriots soccer club when I was 6 years old likely for no other reason than to channel my excess energy that must have driven her crazy at times. For instance, she asked my kindergarten and first grade teacher to stop putting me in time out as a punishment. Since the excess inactivity in my day was causing problems, and my mischievousness seemed incurable, she asked my teachers to make me run laps around the school when I misbehaved. My first soccer team was made up almost entirely by classmates at my Saint James grade school in Liberty, Mo. It was in the nurturing “soccer mom” and classmate-filled environment that I fell in love with soccer. I still have the ball that my coach presented me with as a going away gift when I moved to Indiana in 1993. He asked all of my other 9 year old teammates to sign the ball, and gave it to me at an end of the year banquet. Football, baseball, basketball, and boxing individually have all occupied more of my life than most people choose to spend playing any kind of sport, yet these never suited my physicality or creativity like soccer has. Eighteen years after I began playing I often wonder if my energy and countless hours of practice might have been better used learning to play an instrument, studying foreign languages, or doing volunteer work (to throw out to some examples… of things I neglected as a kid and teenager) The honest answer is YES… and I take responsibility for this decision because the opportunities and encouragement to explore other hobbies were always there. Yet, I couldn’t have sat still long enough to study another language in addition to that required in school. I didn’t have the attention span for music, and volunteer work was never really introduced to me until college.

There’s a happy ending to my story. At age 19 when I first traveled outside the United States I realized that my soccer acumen, which I feared bore its last fruit in high school and intramural college soccer, would allow me to make friends with ease: Israelis, Palestinians, French, and Brits in Hyde Park, Hondurans in Trujillo, Mexicans in Tamaula, the Zoyo Gang in Rue la Sousse in Leogane, Haiti, and most recently the Tenorio brothers of San Juan in Iquitos, are just a few of the strangers soccer has introduced me to. How is this though?

In general when one comes across a soccer game in a public space it’s safe to assume that it’s a “pick up” game which means that anyone can play as long as they wait their turn. Seizing these opportunities is a perfect chance for an outsider to integrate. Once in the game it’s up to you to send the right messages with your play. This is where sports become languages. In soccer for instance a player can demonstrate a humble appreciation for being included by playing unselfishly and looking to pass immediately. Similarly a player can convey an arrogant sense of superiority by dribbling excessively and looking to shoot first. Body language is what it boils down to. When trying to make friends with your new teammates the message you send is crucial. Passing excessively and hustling on defense is always my strategy, especially amongst Latin American players who assume that gringo’s aren’t talented. Its also interesting to note that because of the egos involved in these sorts of encounters making a good first impression through this sort of defense and hustle is more important than actually winning a game. No one likes a show off and no one wants to be upstaged by a gringo from a country that treats their sport as an afterthought.

Last Monday I went to a place called Marumbi (an outdoor turf miniature soccer field with a bar and wooden viewing area where spectators can climb to) in hopes of meeting some locals and playing some soccer. When I arrived I encountered 10 guys sitting around outside the field chatting. It costs 30 soles (about 10 dollars) for an hour of play. It seemed these guys couldn’t afford more field time so I offered to pay for an hour if they’d let me play… and that’s all it took. I implemented my humble strategy for the first half hour, then took some liberty with the ball during the second half. After proving myself during the first hour, the Tenorio brothers decided to up the ante a bit and challenge the group of 5 who just showed up to 15 sole wager. The winners would take all. After the game I bought my teammates some beers using up my portion of the prize money (3 soles)and sat and spoke/practiced my Spanish for an hour. It was then that I discovered that all 4 of my teammates were cousins. They invited me back to play and offered to show me around the San Juan Festival. I know that I could learn quite a bit about life in Iquitos by hanging out with these guys. We’ll see if I have the time.

To Mazon on the Amazon

2011-06-14T19:21:00.000-07:00

Today I was able to skirt my duties building Aedes Egypti mosquito traps in order to shadow a Peruvian Infectious Disease doctor named Solomon. The day began with a, unique to Iquitos, moto taxi (see picture) to Puerto Productos where we (Solomon, Ashkan, Ellen, and I) climbed onto a passenger speedboat. I strapped my life jacket on as I pondered how alligators, anacondas, piranhas, and man eating catfish might react to a bobbing human in the amazon... We wouldn't have gotten on the boat if it weren't reputable... and sure enough we made it to Mazon (30 minute ride downstream) The city was actually 2 miles inland from the coast which required a second taxi ride through what I consider domesticated jungle terrain. Mazon's town center streatched along their only paved road for about 200 yards and included a medical clinic, laboratory, and school. Ashkan's mission was to collect the community's malaria prevalence records and enter them into an excel spreadsheet for the military. Ellen's mission was to meet the director of the clinic and scope out a monday through friday living space since she will be doing her filariasis in the region. While both of them accomplished their tasks I chatted up the ID doctor with my burgeoning Spanish. I was able to learn a great deal never the less about Peru's healthcare system which seems very organized despite the abundance of poverty.

Rainforest & Animals!

2011-06-12T14:44:00.000-07:00

Iquitos is in the center of the Peruvian Rainforest. Development and urbanization has gradually spread outward from the center of town, but one doesn't have to travel more than 15 minutes in any direction to find nearly impenetrable rainforest. Saturday we rode out to a Peruvian park called Quistococha which has a zoo, a lake, canoe access, and a small restaurant. The plants and animals did not dissapoint. The 7 feet long pre-historic looking fish called "paiche" were even more impressive to me than the 4 species of jungle cats and 7 different species of monkeys. These pictures are worth a thousand words. More pics to come!

Dengue Fever in Iquitos

2011-06-12T13:27:00.000-07:00

I've been in Iquitos for almost a week now. The second day I was here I was told that the Dengue project was going to be featured on NPR (http://www.npr.org/2011/06/09/137062165/in-heart-of-amazon-a-natural-lab-to-study-diseases)which turns out to give a very accurate summary of the study that I am assisting with. My role in the research is limited to the execution of what was conceived and funded (by the gates foundation) three years ago by several brilliant PHD's from Tulane and Berkeley. The jist of the study is that it is an experiment in mosquito control using specially designed mosquito traps. Over the next two weeks I'll be helping place what will amount to over 6,000 mosquito traps which are specifically designed to attract and kill Aedes egypti mosquitos (dengue vector). In addition to manual labor which is a large part of any research project, I'll be able to observe the living conditions that promote Dengue and ask the PHD's all the questions my curious heart desires :)

P.S. I am not puting myself at any serious risk of acquiring Dengue. This is the low transmission season, my living conditions don't expose me to Aedes Eqypti bites during the night, and I am living in a sanitary part of town.

Peru - Day 1

2011-06-05T20:22:00.000-07:00

Getting to Lima was an adventure that began with a greyhound and ended with a Taxi Verde. As anticipated the adventure lay in the journey rather than the destination... As I bounced from Miami to Quito, Ecuador to catch my second flight I sat next to two of the most friendly, dynamic, energetic girls, I've ever met: Soleen and Kelsey. Not suprisingly they were Canadians. But to my suprise they were medical students... heading to the ecuadorian amazon to build latrines and be awsome. I'm starting to think flying is the best way to meet chicas... While waiting for my second flight in Quito I had a chance to catch a sunset with the backdrop of the massive (active!?) volcano called Pachincha. I arrived in Lima around 11pm last night at a fantastic new airport that would remind you of O'hare or Midway. Erik and Jessica live on a cliff overlooking a Peruvian Naval Memorial Lighthouse Park and the pacific ocean. Miraflores reminds me of Madrid, Spain though I've never experienced such strange weather. Hundreds of surfers can be seen from their window braving the frigid water (its winter here)... and hang gliders can fly suspended indefinitly by the air currents rising up off of the hundred foor cliffs. Its a pretty magical place in my opinion. Off course the realities of Lima's poverty are just hidden here in this microcosm.

Off to Peru

2011-06-05T19:50:00.000-07:00

Life tossed me a wonderful opportunity while smoking a cigar on the roof of a fancy Dallas Hotel this past October. My cousin Charles was to be married the next day, and as we celebrated on the roof I was told I had to meet Charles' Navy friend Erik who is an Osteopathic Physician,Colonial, and Assistant Director of the Emerging Infectious Disease Outpost in Peru. After chatting about public health, Paul Farmer, and the Haiti Earthquake I had a new friend and an opportunity to work on a Dengue Fever Research Project in Iquitos, Peru (Iquitos sits at the beginning of the Amazon River and is surrounded by Rainforest. It is only accessable by plane. The show River Monsters was filmed here recently. Marine Biologists hang out at the fish market in hopes of identifing new fish species) Motivated by a need for adventure, a love of traveling, and the monotonous routine of medical school I decided to commit 1month of my final summer break to the Dengue project and a second month to exploring Peru's marvels.

Lessons From Leogane

2011-03-05T16:46:00.001-08:00

After a sleepless night, lying amid what remained of Hopital St. Croix, I arose to a scene as awful as anything Hollywood could have created. Imagine partially exposed dead bodies held captive by the weight of two stories of cement, doomed Haitians limping toward the wreckage of their only major medical facility, mournful wailing, and painful moaning. On January 13th, 2010, Leogane, Haiti, the city of approximately 60,000 which absorbed the epicenter of the widely publicized 7.3 scale earthquake, was about to become ground zero for one of the most hopeless inter-professional medical stands the world has scene. A ragtag team of grossly underequipped but well intentioned strangers, whose composition straddled three different nationalities, four languages, and every socioeconomic status, were united by a common desire to save lives. This immediate response began what would become an unprecedented billion dollar multinational relief effort that continues to this day. What I lived through during the six months leading up to the earthquake in Haiti and then participated in during the immediate aftermath left me with perspective uncommon for a first year osteopathic medical student.

Selflessness is a privilege that the less fortunate often don’t possess. The most common gripes overheard when listening to foreign medical teams in Leogane pertain to frustration at having to bribe customs officials in order to avoid tariffs on medical cargo, disbelief in discovering locals stealing their supplies, and grumbling about less than enthusiastic welcomes from Haitian doctors. The proper perspective, which is near impossible to acquire during the average one week visit, would lend itself toward less criticism. Take a corrupt customs agent or a petty thief for example. One must ask the question, “How much money do these individuals make in a day?”, and then consider the different factors which might motivate such behavior. What might be considered greed or stupidity, a thoughtful person might recognize as opportunism of a sort no less human than that of a soldier who kills as opposed to being killed. The same scrutiny can explain the frustration and resentment often encountered from local doctors whose already small pool of paying customers is depleted by weekly ‘brigadas” who feel a moral obligation to treat for free. Belizians, Hondurans, and Mexicans refer to foreign medical teams by the abbreviated and sarcastic term “brigada”. Dr. Paul Farmer’s organization, Partners in Health, known worldwide for its social consciousness and founded to address the medical needs of Haiti’s poorest, even charges a minimal consultation fee. This self-preserving attitude amongst hard-pressed Haitians, like the cloud of concrete dust and humidity, clung to Leogane’s survivors following the destruction of 90% of the local buildings. Parents carrying maimed children jockeyed with the elderly for entrance into the fenced off field which had haphazardly been designated as an open air clinic. A mob surrounded the single functioning water well in the area, permitting only the most ferociously thirsty access to its flow. The dehydrated and dying didn’t have the privilege of waiting in line, lending a hand, or otherwise acting on behalf of others. These examples all stress the importance of visiting doctors recognizing the plights of their less affluent hosts. The term host being used to encompass all inhabitants of a community from the lowliest beggar to the local medical director. Viewing poor communities through this lens will foster cross-cultural good will and elevate their characteristic hospitality and friendliness, so often cited by those working in poor communities, to its proper level of admiration.

Recognizing professional limits is crucial in any inter-professional team, but especially so in an international medical setting far from the watchful eyes of lawyers and hospital administrators. When individuals with incongruous backgrounds, preconceived notions, and varying skill sets, unite for one week of forced collaboration, conflict often ensues. Disagreements about clinic locations, treatment hours, triage technique, and ethics, are just the beginning. However, this can be limited with sufficient prior planning and communication. This preparation includes designation of a group leader, creation of a formal agreement with a host institution, and intergroup adherence to pre-established roles. Problems arise when visitors decide to disregard their professional qualifications, question the validity of others’ medical training, or become arrogant and condescending toward patients and teammates. Take for example a guest pharmacist who wants to diagnose, a visiting medical student who tries to learn through trial and error, or a physical therapist who feels morally obligated to distribute anti-parasitic drugs. The consequences of these disputes can be greater than what might be expected. It only takes one disillusioned or mistreated patient to affect a hosting institution’s local reputation and thus sabotage future trips. Further, without allowing a host organization to take the lead, conflicts over potential patient consultation fees, liability, and accreditation can bring operations to a halt.

When operating in a foreign country the language barrier is an insidious and often overlooked threat to success. Open channels of communication between everyone involved in an international medical trip, from the patient on up, is crucial in order to maintain a high level of care. Communication prevents arguments, builds relationships, and avoids misdiagnoses. The most effective veteran medical teams frequenting Hospital St. Croix in Leogane held group meetings every night after that day’s clinic, providing a forum for each member to voice any thoughts and concerns from that day. Wisely, the local medical director of the hospital was invited to at least one of these sessions along with a translator if needed in a symbolic act of deference. Hiring such translators for the week is a cost that can’t be avoided. Ignoring this component is equivalent to cutting the patient history out of each clinical exam. Further, without a clinician’s ability to deliver flawless dosage instructions, patients are put at grave risk of under or over medicating. The quality of translator, though often treated as a secondary concern, is just as critical. Haitian Kreyol, which evolved as a hybrid of French and several African dialects, has very few phrases which translate word for word into English. Such incompatibility, found between many languages, requires translators who can recognize the context of questions in addition to mere words. The Hackett Hemwall Foundation which organizes medical trips to Honduras has developed a relationship with a language school in La Cieba and often receives the same student translators year after year. The FSIL nursing school in Leogane similarly would provide opportunities for its students to work alongside visiting doctors as translators. Bilingual local students such as these seem ideal, with a preference for those studying a health profession. With only two doctors to be found in the first twenty-four hours post-earthquake Leogane relief effort, one speaking French, and the other speaking Spanish, there were very few direct lines of communication. Arguably the next most qualified professionals included an English speaking American nurse practitioner, and several Kreyol, French, and English speaking Haitian nursing students from the FSIL school. Pairing of the bilingual nursing students with the doctors and nurse practitioner gradually evolved throughout the initial response, demonstrating a natural selective pressure favoring a physician-translator-patient relationship.

Judith Simone, a former Catholic nun and current motivational speaker, affiliated with Saint Joseph’s High School in South Bend, Indiana, coined the phrase, “don’t should on yourself, and don’t should on others”. This is intended as a universal caution towards telling peers what they should and should not do. This statement could be no more applicable than in instances of collaboration in third world medical clinics. Perhaps the most validating component of costly unsustainable primary care international medical mission trips, in light of the lost work time, medication expenses, transportation, food, and shelter, is the perspectives gained and the subsequent actions of those inspired by them. Just as in the United States one may struggle with a Jahova’s Witness who prohibits their child from receiving a life saving blood transfusion, a visitor to Haiti may encounter new scenarios such as the parent of several children who faces the dilemma of having to prioritize his or her resources. A medical team with black and white policies for handling such difficult moral and cultural instances robs its members of chances to consider a society filled with grey spaces. Hearing the reflection, “I feel like I benefited more from this week than the patients I came here to care for” countless times from veterans of aforementioned trips, suggests that perhaps the opportunity to treat patients in an impoverished setting is what Randy Pausch, (2008) author of The Last Lecture, would call a “head fake”; a head fake being a false prize or superficial meaning. The true value and transformative power of medical mission trips would then stem from those trip veterans who return home with reshaped worldviews and infiltrate their communities; communities with the resources necessary to address healthcare inequality’s fundamental cause. Dr. Paul Farmer, author of Infections and Inequalities, says this cause is structural violence such as lack of infrastructure, government corruption, and economic suppression. (Farmer, 1999) For instance, a truly healthy government would neither need nor tolerate foreigners doing its job.

These concepts of selflessness, limitations, communication, and ethics, do not uniquely pertain to international medical trips, but also to teamwork and cooperation in general. It’s no surprise that the distilled experiences of living in Haiti, organizing medical mission trips, surviving an earthquake, and responding to a medical crisis, offer insights into human nature and interprofessionalism. Similar enthusiasm amongst the medical community can be evidenced by the recent spread of global health curriculums to major physician producing undergraduate institutions such as Notre Dame, Duke, and Harvard. Considering the popularity of brief medical mission trips such as those discussed here, the role these trips play in exposing students to international medicine, and the growing national interest in global health as evidenced in recent surveys (Mcfarlane, 2008), ought to thrust the dynamics of such trips to the forefront of the global health discussion. Further, with international boundaries fading like the distinctions between osteopaths, allopaths, physician assistants, nurse practitioners, massage therapists, registered nurses, physical therapists, chiropractors, and others, thoughtful analysis of experiences such as those highlighted here are not only a step towards improved universal healthcare, but also towards more efficient use of philanthropic dollars.

Works Cited:

Farmer, Paul. Infections and Inequalities: the Modern Plagues. Berkeley: University of California, 1999. Print.

Macfarlane, Sarah B. Think Globally, Act Locally, and Collaborate. Academic Medicine 83.2 (2008): 173-79. Print

Pausch, Randy, and Jeffrey Zaslow. The Last Lecture. New York: Hyperion, 2008. Print.

One Year Later

2011-01-13T09:28:00.000-08:00

My friend from Leogane again got some nice press at USF:
http://www.usf.edu/index.aspA Survivor's Story

Haitian teacher Jean Francois Dujour survived the Jan. 12, 2010 Haiti earthquake; now forging new future at USF.

TAMPA, Fla. (Jan. 11, 2011) – Jean François Dujour first came to the University of South Florida in the summer of 2009 as one of a group of teachers from Haiti and the Dominican Republic in a special summer program to learn about teaching democracy in their home nations.

The program, funded by the U.S. State Department and carried out by the Patel Center for Global Solutions, had an eye on Haiti’s future. The investment in the teachers – through increasing their understanding of democratic principles and enhancing their English skills- had the potential to touch generations of Haitian and Dominican children to come.

But then came Jan. 12, 2010 and the earthquake which devastated Haiti, killed more than 200,000 people and shattering its schools. Dujour was teaching a class at his school in Léogâne, Haiti, when the earthquake struck. He narrowly escaped the collapsed building. “I thought it was the end of the world,” he later recounted.

This fall, Dujour returned to USF to pursue a master’s degree in French and told his story of surviving the earthquake to WUSF’s University Beat. Dujour now is playing an instrumental role in the Patel Center’s ongoing work with training teachers in Haiti as the nation attempts to rebuild its school system.

Dujour composed the following essay for USF News to mark the first anniversary of his homeland’s devastation. -Vickie Chachere

Earthquake Anniversary: A Day to Reclaim its Unity and Strength
By Jean François Dujour
As we remember Haiti today, we thank all the countries that responded and served in the humanitarian assistance effort. It seems strange that a year has passed already - the images of my nation’s terrible devastation are as fresh today as if it had happened just an hour ago.
January has always been a memorable month in the history of Haiti. It was on Jan. 1, 1804, Haiti became a nation. Then Haitian people did not profit from this victory, they could not afford to practice the very slogan that brought them independence, “L’Union Fait La Force” (translated: “Unity Makes Strength”). Since then, Haitian people have continued to struggle to redress their country and its constant ruin by leaders, misfortune, poverty and disunity. But out of pride, the Haitian people have worked for 205 years to become the world’s first free black nation, to create farms that produced food, cities that produced commerce and schools which produced educated young people – often for the benefit of the world, but rarely their home country.

Fate is unfamiliar to any human science. It was three minutes to 5 p.m. on that Tuesday, a nice day, when in 35 seconds much of Haiti was reduced to rubble and my city became a cemetery. The enemy was terribly harmful, completely invisible, truly unpredictable, and absolutely invulnerable. The adversary used our own shelters and shields to defeat us. Most of us thought that it was the end of the world. The victims were the children, the fathers, the mothers, the teachers, the workers, and government members, good ones and bad ones. The houses, the schools, the churches and the office buildings could not resist; even the Haitian palace collapsed.
The world responded and Haiti became the destination for soldiers, journalists, physicians and all sorts of technicians working to rescue victims and help Haitians survive. But in this year, misery has persisted – and yet the Haitian people press on.

Let us not expect someone to come and say, “Let there be light in Haiti” for the light to be. We want the Haitian society to be reunited with all its strength – the strength which allowed it to set free from slavery – and to draw on its integrity, dignity, courage, respect, responsibility and determination to fight against misery. In doing so, Haiti will be revaluing its motto: L’Union Fait La Force.
In the year to come, let us make the earthquake the event which shakes and wakes our sleeping solidarity and consciousness.

Jean François Dujour is earning his Master’s of Arts in French at USF.

1st Semester Recap

2010-12-19T19:37:00.000-08:00

(Notre Dame Haiti Program honored during the Pitt game)

(Dad found his way down onto the sidelines as well to share the moment)

If 3 million people in Haiti test positive for W. bancrofti antibodies, and 30% of those people have obvious (observable) disfigurement as a result of filiarial worm mediated damage to their lymphatic systems, how many of the 3 million have hidden (non-observable) lymphatic damage? A disease which destroys the negative interstitial fluid pressure in the extremities seems like it ought to be able to do the same in the thorax or abdomen? Could these hidden cases be responsible for increased susceptibility to Pericardial effusion? Pleural effusion? Ascites? tuberculosis? and a host of other diseases endemic to Haiti? What I’ve learned this first semester has provoked so many new questions. Anatomy, Embryology, Biochemistry, Physiology, Histology, Pharmacology, Pathology, were each central to our coursework.

I’m grateful for this unique curriculum provided at LECOM which integrates each of these disciplines and puts them in the context of real cases.
For instance I had to write a SOAP (subjective, objective, assessment, plan) note presentation on our most recent practice case (as we do for each case):

“An incoherent 37yr old white male, Billy Bob Ferner, arrived at the ED with two puncture wounds, one in his infrasternal angle between the median plane and the midclavicular plane approximately 7cm inferior to the xiphoid process and the other just inferior to the tip of his twelfth rib.

It was reported that Billy Bob was accidently shot with a titanium tipped arrow which penetrated his left abdomen and reemerged in his lower right back. It is presumed that this happened within the past two hours. It is reported by his friend who accompanied him to the ER that the arrow was extracted immediately after the injury. He reportedly was coughing up blood and urinated uncontrollably. It was noted that the urine was red. His friend reported that Billbob was fine this morning, was unsure if Billy was taking any medications or had allergies.

Physical Exam:
General: Billy arrived with little external bleeding. He is in some distress. He is lethargic but responsive to verbal stimulation. He is oriented to person but not to time or place.

Vitals 200lbs, 5’8, 99.4, pulse 112, resp, 24 shallow, BP 106/50

HEENT: pupuils are ERR. Extraocular movements not able to do bc of mental status. Nares had dried blood. The TM’s were pale. There is dried blood around the mouth. The neck is supple symmetric.

Thorax: is symmetrical. Recent tattoo above the left nipple. The area is slightly erythematous.

Lungs: Resonant to percussion bilaterally. Normal breath sounds bilaterally. No crackles, wheezes, or rubs.

Cardio: tachycardia with regular rhythm. No mummers gallops, rubs, radial pulses are +1.

Abdomen: Entry Wound, Exit Wound Location

Extremeties: Pale and clammy to the touch and mottled. Cap refill delayed.

Neuro: the patient is uncooperative. CN’s N/A, tendon reflexes are +2. The plantar reflex is flexion.

Tetnus shot was given.

Tests:

CBC/diff RBC’s low out of range, WBC high out of range, bands and segs high out of range, lymphocytes low out of range, platelets low out of range. PT INR both high out of range.

Arterial Blood Gas: Po2 low out of range, HCO3 Low out of range, O2 saturation low out of range.

Assessment: Our Patient is in the early phases of hemorrhagic shock. His lethargy could indicate mild hypoxia. His low radial pulses, pale tympanic membrane, low diastolic pressure (combined with his tachycardia) tell us that he is hypovolemic. This information combined with our knowledge of the nature of the trauma and the organs likely affected should have us suspecting considerable internal bleeding. We would also expect that his tissues are dehydrated from their attempt to compensate the lost plasma volume, and that his total circulating RBC count is low.

Plan: We ought to begin to immediately blood typing Billybob and give him 500ml lactated ringer solution followed by 1 Liter of whole blood. This ought to help with his hypoxia and dehydration. We should put him on 100 % oxygen to raise his 02 sat (P-exam indicates his lungs were not penetrated) We need a blood chem with clotting tests (PT, PTT, international) a urinalysis, a chest x ray, and CT immediately. We should consider methods for draining any accumulation of blood in the hepatorenal recess (most common collection location). Laproscopic surgery to evaluate the internal organs should be performed as soon as possible”

This was probably the most exciting case we delt with this semester. Others included a 1 month old with cystic fibrosis, a 3 year old with Gaucher’s disease, an anorexic teen with a spontaneous pneumothorax, a newborn with ambiguous genetalia, a 45 year old with Factor V leiden mutation, a child with sickle cell anemia.

These real life clinical correlations help the material come alive, and provide a kind of Christmas tree upon which to can hang the, otherwise random, pieces of medical information constantly stuffed down our chimneys.

I am writing this from Erie, PA where I’ll be spending X-mass with Mom, Dad, Carolyn, and Patrick. Jenna is on her honeymoon. Merry Christmas and Happy New Years!

Big Sister Getting Married!

2010-10-16T21:24:00.000-07:00

Jenna needed a bride's maid during this wedding rehearsal. Unfortunately at the time she only had a brother to work with. (Missouri, 1991)

So in less than a week my big sister will start a new phase of her life. After 6 years of courting, Jenna and Blaise will “seal the deal” and shove off into the uncharted and treacherous waters of marriage and FOREVER after…

I’m not typically very accepting of the boys that take likings to my sisters… My skepticism of their guy friends is not as much a product of my own familiarity with the male brain, as it is a product of my desire for Carolyn and Jenna to be happy. Blaise, in addition to being my brother in law, has become a close friend… which says it all…

well almost all…

Blaise showed up on the radar sometime during my sophomore year of high school. I was driving Jenna, a freshman at Notre Dame at the time, to a friend’s house when she mentioned that she kinda had a thing for a ND guy. Of course I told her to tell me about him and this is what I got: Well he’s really fun and friendly. He’s a really good soccer player. He loves to ski. He has dark curly hair and he plays the guitar. I remember thinking “wow… did Jenna just bring up (on her own without provocation!) a boy that she was into?” and “damn he sounds a lot like me...” If I recall correctly, that second thought was actually vocalized which got me an eye roll from Jenna.

I met Blaise later that year when we drove up to a F.C. Bayern Munich vs Real Madrid soccer game in Chicago together. Jenna somehow was tuned into the fact that both of us wanted to go but didn’t have any friends who were equally excited about Europe’s best soccer teams playing so close.

Two years later I found out that I was going to be a Freshman in Dillon Hall at Notre Dame, the same dorm that Blaise had spent the previous two years living in. He showed me around, made sure that I was on the Dillon Hall soccer team, invited me to senior parties (only with Jenna’s blessing of course), and gave me some pointers about pre-med at Notre Dame.

During my sophomore year I spent time with Jenna and Blaise in Washington D.C. where Blaise is now attending medical school (the first of three straight 4th of July’s with them in the city) During Christmas of my Junior year semester in Europe I spent 2 weeks with Jenna and Blaise in France. That subsequent summer I lived in Washington D.C. interning at WRIAR while both Jenna and Blaise were working in the city. Blaise and I played Thursday afternoon pick up soccer together in Tinley Town, and most Saturday mornings for the D.C. Notre Dame Alumni soccer team.

The experience which will forever highlight our friendship came this past year in Haiti. Blaise, a second year MPH student at Drexel University was my only visitor during the near 6 months I spent in Haiti. His trip, in addition to visiting me, was aimed at assessing the public health disaster in Leogane and finding information about his great uncle Cashmire Pellarin who disappeared in Port au Prince 30 years previously.

(Blaise’s extended family lives in Trois Rivye, Quebec. Cashmire, devoutly Catholic, mysteriously left Quebec in the 70’s in order to volunteer at an orphanage in Port au Prince. Unfortunately, due to the civil unrest and political violence at the time of his death, the Pellarin family never received news of the circumstances of the death, nor where he was ultimately buried. The only information available to the family was an old street address: 22 Rue Jean Brown)

Blaise arrived less than a month before disaster hit Leogane in the form of the Jan. 12th earthquake. Dec. 10th – 21st the two of us explored Leogane, Fondwa, and Port au Prince. With the help of Blaise’s fluency in French we were able to locate the orphanage that his Great Uncle Cashmire was last seen living in. The head Nun of the orphanage was so moved by our presence that she had her personal escort take us to his resting place in the National Cemetary (an unmarked square mile maze of above ground stone coffins)

To this day, Blaise is one of only a handful of friends who can appropriately appreciate what I experienced while living in Haiti. Momentously, the two of us were able to share this story this past summer together at the Pellarin family reunion in Quebec.

Anyhow, this next week Blaise will become my brother of a different mother and I couldn’t be more pleased. Jenna has picked a great guy to spend the rest of her life with… and I’m flattered that “on paper” he’s just like me ;)

First Month of Medical School

2010-08-29T20:23:00.000-07:00

Lots of new faces... Lots of studying... and preliminary results are indicating that I've got what it takes to make it through :)

I've joined several clubs: International Med Club, SOMA (student osteopathic medicine association, Student Research Club ...although I haven't had ANY time to divert toward those groups as of yet.

I'm especially excited about the International Medicine Club which sent a group of students to Haiti this past summer. Further, I discovered that there is an avenue at LECOM (via IM club) for arranging international rotations during third and fourth years. As a product of traveling and work with InterVol I have contacts at clinics or hospitals in Haiti, Mexico, Honduras, Belize, England, and Canada. Hopefully it will work out that I'll be able to return to one or several of these places as part of my training!

Last week a friend from Leogane (whose home collapsed) contacted me to say he was in Tampa Bay starting a graduate program at USF! I was able to meet Dijour for dinner and share stories from Jan. 12th. He was teaching that day at the Saint Croix school and was able to make it to the door before the floor above collapsed on him. He recalled the same heartwrenching encounters with mortally wounded individuals searching in vain for medical care. When he heard my story his jaw dropped and he told me that I have a very special gaurdian angel. He left Haiti several months ago in order to marry his american girlfriend. He is starting a master's in French program and intends to return to Leogane someday to start a school.

* 9/30/10 DIJOUR just made the local news!! ->http://www.tampabay.com/news/humaninterest/usf-graduate-student-plans-to-return-to-haiti-and-build-a-school/1124879

Four weeks ago I got an email from Michele Sare, the american nurse who I met (and worked alongside) in Leogane the day after the earthquake. In the chaos I never got her last name and had long ago accepted that I'd probably never see her again. She apparently contacted the Notre Dame Haiti Program to get my name and contact information. She is doing well and wanted to check on me :)

Anyhow, those are highlights from month 1!

Back on the Horse

2010-07-19T16:42:00.000-07:00

Classes start next week here in sunny Bradenton, FL. As my “year off”  comes to an end I have decided to recommence writing in this blog… for my family, friends, and self. Since I don’t journal I think this will be a good way to track my experiences in medical school and keep those who are interested informed about what’s going on in my life.

To bring some of you up to speed, here are some of the highlights of the last 5 months back in the US (in chronologic order):

- I moved into an apartment with my best friend Matt Story while working in Rochester for InterVol. Together we made a bunch of new friends and paved the way for my cousin Jordan Fort’s arrival in August. During my time with Intervol I organized Haiti Relief shipments, spoke about the organization’s mission, and helped identify sources of ongoing funding.

- My little sister Carolyn called to announce that she was safe in Santiago, Chile after an 8.8 earthquake struck her region of Chile. Fortunately this quake was significantly deeper in the earth’s crust and consequently did less damage than the Haitian quake. We have yet to have the “who’s quake was worse” argument. It will probably happen though.

- My mysterious and lingering cough (since Haiti), which didn’t respond to antibiotics, turned out to be harmless on chest X-ray despite fears of drug resistant TB. I’ve had several negative PPD tests since to confirm.

- Medical Mission Trip to Honduras with my dad. We travelled with a group known as the Hemwell Hacket Foundation. Their medical teams have been providing free prolotherapy to elderly Hondurans for the past 20 years. Unfortunately this trip was overshadowed by the death of my 27 year old cousin Thomas Leary. My dad flew home at a day’s notice to attend the funeral while I continued on as planned to Trujillo, Honduras to visit my best friend Francesca whose volunteering at Farm of the Child Orphanage.

- Several weeks after my return I went to a primary care doctor to have her examine my swollen lymph nodes. She suspected lymphoma (white blood cell cancer) and put me unintentionally through the second scariest experience of my life. The blood work results surprised her, prompting a cell phone call which began with the words, “it’s your lucky day… you’ve got mono”. This currently stands as the best phone call I’ve ever received.

- I was the keynote speaker in South Bend, IN for the Tom Dooley Society’s annual meeting. I spoke about the Notre Dame Alumni Response to the disaster in Haiti and shared some personal reflections. The gist of my speech was that, “selflessness is a privilege” in Haiti and that until we (in the broad sense) lift those people up to a level where their day to day basic needs are met, they don’t have the privilege of “helping themselves”. We/I have this privilege. The small group which showed up to hear me (including friends: Andy Masak, Caitlin Hildebrand, Matt Storey, Clair Northway) gave me a standing ovation. I wish I had more opportunities to share my experiences and thoughts.

- I took a road trip to Emenence, Missouri with my brother Patrick in order to meet up with my cousins Travis Fort and Charles Leary. We found an amazing campsite on the Jack’s Fork river where we all got a chance to catch up and have man time. Charles is now engaged and headed back to school to get an MBA while Travis is entering his second year working as an architectural engineer in Springfield, Mo. Our trip was cut short when my parents Black Toyota Highlander’s engine exploded. We were forced to “abandon ship” as repairs were more costly than the vehicle was worth. We sold the vehicle for 800$ (a real steal in actuality) to Bruce Wanger and flew home empty handed. Dad handled this like a real champ.

- I flew to Montreal, Quebec to meet my sister Jenna and her Fiancé Blaise (who visited me in Haiti just before the EQ) to participate in the Pellarin family reunion. I fell in love with French Canada that week , especially their fast food called, “poutine”. After Blaise and I ditched his obnoxious cat in the woods behind his great aunt’s barn, we drove together back to the United States to participate in the TWL (Thomas William Leary) annual family golf tournament at Firestone Country Club in Akron, Ohio.

- 5 days later I set sail for Florida in my new Toyota Camry with 900$ worth of textbooks, my special coffee table from college, and an infinite amount of miscellaneous items. I detoured to Washington, DC on the way down in order to help Jenna and Blaise move into their new apartment, and to see Andy and Amber who were both in town. Subsequent pit stops in Durham, NC and Atlanta, GA allowed me to see Dank, Laura, and Caitlin.

- I arrived the same day as my housemate Brett who is a ’10 Alabama grad. We get along remarkably well, and have furnished a great apartment. The past few days have been spent either at the beach (Siesta Key, Clearwater, Longboat Key, Holmes) or running errands.

Thanks to this “year off”, I fully appreciate the opportunity to study medicine, have a unique grasp of the need for doctors at home and abroad, and have successfully navigated some of life’s class 5 rapids. Medical school? I say bring it on.

My Account of the Jan 12, 2010 Earthquake

2010-01-25T19:23:00.000-08:00

I was fortunate to be among the first evacuated by the 82 Airborne Division late last Friday (Jan 15) morning after a long sojourn from Port au Prince to Leogane, and then back again. I am currently working at the InterVol headquarters in Rochester to get relief to my dear friends in Leogane. We already successfully deposited over 3,000 lbs of medical supplies and plan to continue sending shipments. (http://www.youtube.com/watch?v=SXV8C87XE3E) What I experienced in Port au Prince and in the improvised field hospitals of Leogane has given me new perspective on my life and is motivating me to continue the fight to bring basic food, clothing, shelter, and medicine to Haiti. I plan to embrace the proverb, “what doesn’t kill you makes you stronger” and draw upon this experience in the future. I believe that what happened to me last week deserves to be shared. It’s for this reason I have agreed to post this story.

God Bless,
Joey Leary

I arrived at Hotel Montana in Petionville (which collapsed almost entirely), Port au Prince around 9am on Tuesday Jan 12 for the 6 month bi-annual meeting of the partner organizations working to eradicate Lymphatic Filariasis in Haiti. This included IMA World Health, Zanmi Lesante, University of Notre Dame, Center for Disease Control, Haiti’s Ministry of Health, USAID, and RTI.

I was representing InterVol, a Rochester NY, NGO founded by a Notre Dame Alum and Plastic Surgeon, Dr. Ralph Pennino. I moved to Haiti in August 2009 after graduating with a Pre-Med degree and a minor in Anthropology. My Anthropology mentor, Prof. Karen Richman lived in Leogane, Haiti for 2 years studying Haitian Immigration & Vodou. Before I went to Haiti I deferred my medical school acceptance to Lake Erie College of Osteopathic Medicine so I wouldn’t have to re apply. While I was in Haiti I volunteered for InterVol and the Notre Dame Haiti Program simultaneously. I had been very active in Notre Dame’s Haiti Program to Eliminate Lymphatic Filariasis as an undergraduate at Notre Dame. Our most recent 2009 valedictorian, Brennan Bollman, was widely recognized for her work with the program in Haiti. I, in many ways, was following in her footsteps. The Notre Dame Haiti Program had me coordinating ND alumni doctor trips, guest visits, organizing mass hydrocele surgery camps, and collecting public health data on a GPS device, while InterVol had me setting up teleconferencing equipment, (InterVol donated this equipment to the Notre Dame Haiti Program) arranging shipments of medical supplies to Notre Dame’s two affiliate Hospitals (Hospital St. Croix & Hospital St. Francis de Sales) in Haiti. I spent my free time shadowing US doctors who came to visit, playing soccer in the streets with friends, playing basketball, dancing on the weekends at the disco’s, practicing my Haitian Kreyol, and exploring other cities whenever possible….

We (The Notre Dame Haiti Program) had a large group that day at the Hotel Montana despite the fact that several of the representatives from the CDC were not able to make it. Fr. Tom, Jean Marc Brissau, Dr Desir, Dr. Lantagnac, Dr. Feyette, Logan Anderson, Sarah Craig, Dr. Milord, Claudy Bertrand, Wilfred, Papiyon, and I, represented the Notre Dame contingent at the Hotel Montana from 9 am to 4:15 pm. The meeting was scheduled to last until 5 pm (after the earthquake) but because the presenters from the CDC couldn’t make it, the meeting concluded early.

Dr. Desir, Jean Marc, Dr. Latagnac, Papiyon, myself, and the representative from Zanmi Lasante, left the Montana at about 4:30 pm and headed to the Haitian Ministry of Health offices. We dropped off the official from Zanmi Lasante. Then we headed for Leogane on a route which took us through Port au Prince’s largest park, Champs de Mars, which sits adjacent to the National Palace and Parliament. Still back at the Montana, Fr. Tom and the rest of the Notre Dame group decided to relax. Apparently each of them ended up on top of one of the Montana’s many rooftop pavilions. After the earthquake they were trucked to the US embassy by the UN and evacuated to the Dominican Republic.

As we drove down a four lane street adjacent to the Haitian white house/national palace we were thrown into a panic when a mob of 50 – 75 men emerged at the upcoming intersection outside the Haitian palace/white house and began hurling rocks at the nearest cars, both stationary or attempting difficult maneuvers in order to escape. The moment that I realized that we were going to be attacked, the shaking began.

The initial earthquake at 4:52 pm was reported to be a 7.3 on the Richter scale. This earthquake allegedly lasted 30 seconds although I only remember the quick moment of confusion that overcame me when I watched at least five buildings, both in my direct line of vision and periphery, collapse simultaneously around the twenty acre or so park. I now realize that had the mob not caused us to come to a stop in the middle of the road we would have been two hundred yards further down the road and in between two, three story, buildings which collapsed. Similarly, had the earthquake not occurred I would have at least had to run from an angry stone throwing mob for my life.

When the shaking stopped my world was spinning in a way that I can only compare to the concussion I sustained several years ago, specifically the feeling I had as I regained consciousness. The feeling that something terrible has occurred and help needs to be called for; yet in both cases had no ability to execute with my body what my mind desired… I managed to get out of the car, carefully avoiding an abandoned jeep slowly rolling by in neutral. My thoughts immediately fixated on the fact that I was alive and lots of people around me were surely dead. My brain, as if in a frantic attempt to keep things this way, began to scheme of other impending threats; namely tsunamis, stampeding, starvation, dehydration, tropical diseases, violent theft, etc… When my brain finally retook control over my body I was able to successfully dial my mom’s number and call her. I spoke to her briefly but communicated the essentials: location, state of mind, and love for her. I left a message expressing the same sentiments on my dad’s phone. I texted Kara, Courtney, Meghan, and Marah, to see if they were alive. I only got a response from Marah. It was reassuring to hear from her because I knew she was in Port au Prince, but I was troubled to not hear from the others knowing that texting was possible. I was unable to communicate with anyone again until Thursday night after I reached the US embassy.

Jean Marc, Dr. Desir, Dr. Latagnac, Papiyon, Wilfred, and I, huddled together in a part of Champ de Mars park where nothing could fall on us. We made a pact to stay together. Papiyon was sent to drive the car to a more safe location after we placed our laptops under the back seats. We sat in the park together and weathered several more strong aftershocks while debating things like whether or not a tsunami would actually come, whether or not the president was inside the palace and consequently dead, whether or not it would be safe to spend the night in the park, whether or not we had enough food, water, and energy, to walk back to Leogane (40km), and whether or not we should move to higher ground at risk of exposing ourselves to falling objects. Basically the debate was: tsunami versus the possibility of more earthquakes. The discussion, jumping back and forth between Kreyol and English angrily, was interrupted by the sound of thousands of people standing up simultaneously around the park and starting to run into the surrounding city towards the mountains. Those who were fleeing were yelling, “the ocean is coming!” in Kreyol. We didn’t run. We hung together by a tree. Our decision was the right one in hind sight. The fact that the ocean never showed up, didn’t change the fact that I felt as though I might be trampled in the stampede. I remember watching the horizon, and listening, for the three story wall of water that must have been coming. In my mind it wasn’t just that I was going to die, it was that I was going to die standing idle and while ignoring my own sense of reason which was telling me that a tsunami was on its way and that I needed to climb to the mountains.

I was able to convince our little group that it would quickly become lawless and unsafe in Port au Prince and that we needed to leave as soon as possible under the cover of darkness and while people were not fixated on the obvious affluence amongst our group of dress suit clad professionals. An opportunistic street vendor nearby allowed us to store up some food for our immanent journey back to Leogane. I had to discard my book by Jeffry Sachs, “An End to Poverty” in order to make room for the chicken.

We set out from Champs de Mars around 9:30 pm in the direction of Hospital St. Francis de Sales, where the Notre Dame Haiti Program has offices and supplies, in order to get much needed water. We walked rapidly. Eighty percent of the people we encountered were walking into Champ de Mars while we were pushing to walk in the opposite direction. With so little information about the magnitude of the disaster, especially the epicenter, this sort of nonconformist behavior was, like not running during the tsunami scare, difficult. Two women from Leogane who were both friends of Jean Marc wanted to walk with us back to Leogane. We knew that there was no way they could make it based on their physiques. Convincing them to stay was difficult and ugly. None of the men wanted to be slowed up by these women’s needs.

We walked through streets of rubble, impassable wrecks composed of many cars, screaming women, shouting men, frantic people going in every direction. Fear was almost palpable. I tried to focus on Jean Marc’s back as we walked to Hospital St. Francis de Sales instead of the misery around me. Dr. Desir scolded me for speaking in English and told me that I needed to speak Kreyol only from now on. Dr. Latagnac grabbed me because he didn’t think I could see a pothole in the road because it was so dark. I could see it and was offended by his fatherly need to look out for me. I told him “m ka we… m genyen kje Ayitian… pause…pou fi tou” -> “I can see… I have Haitian eyes…pause… for girls too” Everyone laughed.

When we arrived at Hopital St. Francis de Sales the courtyard was already filled with injured men and women. They were lying everywhere. They fixated on me as I entered the compound since more often than not white men in Haiti are doctors. Unfortunately for them I was not a doctor, and the real doctors with me were only focused on one thing: getting back to Leogane to see families. I can’t express how uncomfortable it was to enter that compound of suffering and ignore it all completely while walking business-like to the offices that we went to every week, stand there while someone jingled keys, and unlocked the door as if nothing had changed.

Entering Hopital St. Francis de Sales was scary. It was the first time I had entered a building since the earthquake. Water was a priority. We had one, 5 gallon, drum. I opened it and poured as much as I could into my Nalgene bottle. I drank it all and refilled it. I recognized that it could have been a long time until I drank clean water again. I urged the others in the group to drink heavily. I selfishly went outside and peed on the wall hoping to make room for more water as I thought of the twenty mile walk ahead.
When we had finished drinking and provisioning we gave the two overweight women an ultimatum. Eventually they listened. Maybe they didn’t… but anyhow we left and they weren’t with us. We walked like mad men from that time on. It was so dark that I couldn’t see the pavement in many places. This was hazardous because there were large potholes, sometimes two feet deep, in the road. The adrenalin was finally getting some action.

The guys stopped after about one hour to buy sodas from a street vendor. I couldn’t believe that the man was still selling his supply and not storing it up for the impending crisis. It was as if he didn’t realize that Haitians like him would be starving and without water in less than a week.

I was still worried about a tsunami and secretly wished we were walking parallel to this street but about one mile further inland. I wouldn’t have had a problem with this, but couldn’t get my group to agree. I seriously thought about ditching them to go up into the mountains above the road on several occasions. I did insist that we all stop at the UN base for a few minutes as we walked by to ask for information. We had no idea at the time how widespread the damage was in Haiti. When I asked the guards they indicated that they didn’t speak English. They were Brazilian. Finally one English speaking guard told me that they hadn’t heard anything and that they didn’t have any way to communicate.

It was also about this time that Jean Marc was able to get news, via his phone, of Fr. Tom, Sarah, Logan, Dr. Milord, and Claudy. It was relieving to know that this bunch was more or less ok. Claudy was transported to a hospital in Petionville on helicopter for a broken leg and is now recovering I am told without a cast.

After the UN base, we came upon an unusually large crowd for as far away from Port au Prince as we had gotten. We had probably gotten to Carrefour. We began asking bystanders what was going on. All the people were saying that, “the road is out.” At this point nothing was going to stop us, or at the least prevent us, from investigating for ourselves. The road was definitely out, with a thirty yard in diameter circular piece of road missing. For strong men and women it was not impassable. We decided that we would follow the lead of several others and climb around the sink hole using the prison-like widow bars of the adjacent buildings to cling to.

After the sinkhole excitement, fatigue started to hit our group hard. Every time a car or truck passed by we had to rush to the side of the street so as not to be hit. We would wave at them to indicate we needed a ride in the direction they were going. I wasn’t very optimistic about our chances of having someone stop for us, but I was wrong. A truck with a flatbed in the back stopped and we all climbed on gratefully. Suddenly a new fear of driving during an aftershock arose in me. I had seen plenty of crashed cars on the seven mile walk leading up to this point to know that it could be a problem. I held on extra tight as I stood up on the back of the truck. We raced down the road between Carrefour and Leogane, swerving for fallen rocks, hitting bumps that were actually deep cracks. In retrospect these could have been fault lines. As we approached Gressier the driver slowed and turned off of the main road. He told us he needed to handle something. We figured we would just have to wait for him. While we were standing up in the back of his now stationary truck a strong aftershock ripped through the ground. No one fell off, but I we were fortunate to have been parked again. I remember glancing out at the ocean, only one hundred feet away, to see if the boats in the bay were rocking in a manner indicative of a tsunami. I was thinking that if I saw a dramatic fluctuation in the water level out there I might have five minutes to scramble up a hillside or at least climb something.

No Tsunami arrived. This had to have been about 10:45 pm because when we got a flat tire twenty or thirty minutes later on the road I remember thinking about the 11:30 pm rumor that people on the streets had been talking about. The rumor, who knows how it began, was that at 11:30 pm a second huge earthquake would hit. This rumor didn’t make any sense to me because I didn’t think there was any way to predict earthquakes, and in my opinion the aftershocks were earthquakes themselves. I remember thinking at that time that, “No you can’t predict earthquakes but you can predict tsunami’s…” and perhaps someone with a radio heard an international announcement and got the facts confused.

As we stood on the road, parked, changing the car’s tire it was 11:15 pm. I again considered ditching the group and running up into the mountains nearby. I had enough chicken from the vendor and water from Hospital St. Francis de Sales to last at least a day. I really thought that each of these aftershocks, not to mention the 7.0 earthquake, could have triggered a tidal surge capable of wiping out the coastal regions. I again chose to stay with the group for practical reasons and longer term considerations. The bottom line was that I was very scared.

As we stood there in the middle of the road we decided to try to catch another ride. After ten minutes had passed only two additional vehicles passed us. Both slowed to investigate but continued on toward Leogane without us. Our group suggested that I stand in the front because they all agreed that drivers would be more likely to stop for a “blanc” = “white foreigner”. The next car stopped and its driver agreed to drive us in his van to Leogane. We thanked our first driver and left him to his tire and sped off toward Leogane. 11:30 had passed which provided a strange sense of relief.

Remarkably all of the bridges between Carrefour and Leogane were still intact. We drove in past the Sri Lankan UN base, a pancacked UNPH school, a mostly collapsed Anacauna High School, and more. Remarkably the Union of Voudisants three story building still stood towering over the roundabout that indicates one’s arrival in Leogane. The van took us to the soccer field which was being used as a refuge for the displaced (80 -90% of people) and wounded. I jumped out and ran through the pitch black to Hospital St. Croix to look for my best friends Kara and Courtney from the Children’s Nutrition Program who lived in second story apartments inside the hospital compound, and Suzie and John Parker who ran the Hospital’s guesthouse and lived on the first floor below them. On the way to Leogane in the van, the radio had broadcast that the hospital had “te crazay net” – “crashed completely.”

I yelled for them as I entered the compound. The whole town was spookily quiet. I heard the voice of Suzie Parker. I wanted to cry. I asked about John, Kara, and Courtney in one explosion of noise. She said that she had not heard from Kara and Courtney because they had similarly gone to meetings in Port au Prince for the day, but that her husband John was all right. I had been preparing myself the whole trip home for the news that Kara and Courtney were dead, and this seemed to indicate that there was a good chance of that. I realized that I might not know definitively for weeks about Kara, Courtney, or Meghan. She went on explained to me how when the earthquake started she was able to run outside but John wasn’t fast enough. He was trapped under a tremendous amount of concrete but, miraculously, was only scratched. Suzie said that two of the Haitian hospital translators who were with her worked for three hours tirelessly with a sledgehammer breaking open a hole in the concrete to drag him out. The picture of his escape hole is amazing and terrifying. Realizing that he passed several subsequent 5.0 aftershocks in that state without Kara’s apartment further collapsing on him is remarkable.

It was 12:30 am when I looked at my phone again and tried, in vain, to call the states. I tried about every one hour and then turned it off to conserve charge. I wasn’t anticipating seeing electricity for weeks. John and Suzie gladly shared in eating some of my chicken from Champs de Mars. They let me fill up my canteen at their rapidly leaking water pump. They told me to get some rest because tomorrow was going to be a big day. They offered to let me snuggle in with them in the courtyard between the collapsed guesthouse, the collapsed apartments, and still standing, but vacant, hospital. I laid down, but had no hope of falling asleep. My mind was on fire with thoughts of survival, escape, foreign aid, all of my friends in Haiti, family, malaria, clean water, food, and more earthquakes.

I sat up most of the night. Life felt like a dream. The stars were so beautiful. I saw tons of shooting stars. I wondered why people weren’t screaming in the streets anymore, because I knew that there were still hundreds of people trapped in rubble within five hundred yards of me. I wondered why I wasn’t out looking for my friends in the streets and was sitting looking up at the sky pathetically. It was so dark, and I was so afraid for everyone I knew. They say fear is paralyzing, but I never experienced it until that night of mental confusion and shock.

The next day I made up for those four hours of inactivity with a vengeance. At 5:30 am the screams and yelling began again. The sun is completely up at 6am and completely down at 6pm in Haiti.
I seriously doubt that “the morning after” or any of the details of the entire day of Jan 13 will ever fade from my memory. I stood up and I walked out into the street. It was my first daylight view of the destruction in Leogane. Reports now are saying 80 - 90% of the buildings were destroyed. I looked out at “Masaje”, the bar across the street from the hospital that was the center of nightlife in the town. I realized I might never see Dominic, Lady, Mckenzie, Ti Frere, or any of the “regulars” there again. I headed for my home (the Notre Dame compound) known to the locals as the CDC and foreigners as The Residence Filarose, on the same route, between the hospital and the Residence Filarose , that I had taken five hundred times before. Today I had to climb over rubble that had poured into the streets. There were no shouts of “blanc” or “Joey” or friendly smiles that morning. Everyone was going somewhere. The streets were swarming. I was almost running toward the Residence Filarose. We had heard from Jean Marc the night before that it had not collapsed so I wasn’t expecting to find any destruction. I walked past my buddies in the Zoe Club standing listlessly in the street. The expressions on their faces were incomprehensible. I gave some of the guys hugs, but had to keep walking. By this point I had seen many terrible scenes of people stuck in collapsed buildings, so my eyes focused straight ahead. I didn’t want to see any more. The faces in Port au Prince were strange faces. The men and women suffering in Leogane were familiar strangers; girls I had danced with at Eve Andre’s house, guys I had played basketball with at Suren School, English club, Saturday morning soccer, Saturday nights at Praktik, the nursing school, etc…

I arrived at Belval Plaza and entered the gate. Nearly two hundred people had already congregated in the huge open field surrounding the FISL Nursing School Compound. I saw some of the nursing students I knew sitting around the entrance to their school. Men and women were starting to be being lain out on the ground in front of the front gate. I waived to all of the Residence Filarose inhabitants: Precene, Gary, Wesley, Jo Anne, Akila, Nicole, Jean Marc, Michelle, Sebastion, and Mitch, making note that they were all ok. I was amazed to see that the Residence Filarose didn’t have any visible damage, although parts of the cement walls around the compound had fallen. I remembered Fr. Tom telling me that Leogane was on a fault line and that the Residence Filarose was designed to withstand earthquakes. I ran inside to collect my most important things. I was factoring in looters, food provision, possible evacuation, and the immediate need for my first aid kit and scissors.

I put together a small bag with the essentials. The essentials included my wallet, passport, contact information, my US phone and charger, my Haitian phone and charger, two flashlights, my canteen, and some power bars. I was hurrying franticly because I knew that there could be another tremor and I didn’t want to be inside, because I needed to get my meds to the nursing students, and because I needed to bring medicines from Hospital St Croix to the nursing school where all the seriously injured were congregating. When I emerged from the Residence Filarose lots of the refugees outside were looking at me. I was the only white person in one thousand. Precene shouted, “are you leaving us?” I responded, “No! I Need this bag to go get the medicine at the Hospital and take it to the nursing school.” I set out on my bike with my huge Osprey hiking bag on my back and my smaller “essentials” bag inside of that. I gave Parnice and Big Mama, two of the nursing students who are my friends, the first AID kit that my dad had sent me down with to get them started. I kept the Tamiflu since I knew that I might have problems when I returned to the US and I figured Swine Flu was the least of their concerns. Maybe I will turn out to be wrong since the flu thrives in refugee settings. As I rode past all of the refugees I knew that they believed I was abandoning them. This was tough, but compelled me to ride even faster to the hospital for supplies. On the way I bumped into one of only three Haitian doctors working in Leogane that day, Dr. Desir. I told him what was going on at the nursing school. He wasn’t aware of any medications available at the hospital so I shared with him my news of the guest house pharmacy.

When I arrived back at the hospital courtyard, fifteen minutes later, John and Suzie Parker had a group pulling medicines out of the collapsed mini-pharmacy. The building could have collapsed at anytime, but the need for those medications was too great not to take the risk. Twenty or thirty men women and children had gathered around the courtyard, some frantic, some stunned, some unconscious, while Lorenz and some of the hospital translators attempted to organize the medications that were being pulled out of the rubble. Guesley looked frantic and asked me about Kara when he first saw me. I had a tough face on and told him that I had no idea and that I heard the Children’s Nutrition Program group went to Port au Prince. I assured him that they were alive to make him feel better even though I sensed there was a good chance they were not. He told me that he was leaving to go to Port au Prince to look for her. I told him to take the road closest to the coast that goes through the oil refinery because the sinkhole is blocking the old route. He thanked me and left. Dr. Desir, the Notre Dame Haiti Program Medical Director, showed up with a truck shortly after to help transport even more of the medications to the two improvised field clinics/refugee camps that were forming rapidly in town: the Cavaly soccer stadium and the FISL nursing school. I helped him for a bit sort supplies but was distracted by the horrendous wounds that were coming in.

The Cuban doctor from Hospital St. Croix was holding six inches of a screaming boy’s scalp away from his skull so that he could scrub the bone with butadiene. I recognized one of the best basketball players from Suren school sitting on a bench waiting for attention. He was insanely good at basketball and was in amazing shape. I wasn’t planning to try to help patients then because of my limited knowledge of how to handle compound fractures, head trauma, internal bleeding, deep lacerations, etc… but someone came over to me and tugged on my arm and said, “doctor please help him.” I told her that I was not a doctor but she was almost screaming at me and I remembered him from basketball. He looked pretty fine from my vantage point so I was expecting to just see some cuts or bruises. The look on his face was one of fear, confusion, and utter helplessness. He turned his head when I asked him what was wrong with him. “Ki pwoblem ou genyen?” He turned his head and exposed a piece of his scalp and skull hanging away from his head exposing a large chunk of brain that was pushing out through his opened up head and leaking cerebral fluid down his neck. I wanted to cry, vomit, and scream for help all at the same time. I kept my composure and interrupted the Cuban doctor, now suturing the boy’s entire scalp back over his freshly scrubbed cranium, to tell him that we had an awful head injury waiting. He shrugged. I left to continue my job organizing meds to transport back to the nursing school, but walked past a little boy with two sharp gashes in his head that penetrated his skull and allowed for a glimpse of his brain, and several others with broken bones, some compound fractures, laying on the ground.

I took my bag ahead on my back pack to the nursing school since a bike is faster than a car in Leogane. I was feeling good about the new impression I was leaving on the people as I rode by; one of, “I’m not leaving and help is on its way”. When I made it to the nursing school again the number of refugees and injured seemed to have doubled. The gate leading to the inside of the nursing school was swarming with all sorts of urgent and terrible injuries. Several students were manning the gates to keep people from forcing themselves inside. There was a group with a stretcher going around and identifying the worst and most urgent to be let through the gate where Michelle, a visiting US nurse practitioner, was waiting along with fifteen to thirty nursing students to do whatever they could to help. With the arrival of my supplies and Dr. Desir’s truck, the makeshift clinic came alive with activity. I decided to find a simple job for myself to do in order to be most helpful. I decided that I would stock up a supply of water for the makeshift hospital. They didn’t have any at that moment, so I grabbed two, five gallon, buckets and went in search of clean water. I was optimistic about this because I knew that Leogane has had quite a few wells drilled around its community over the recent years. I was happy to find some running water only two hundred yards down the road from the Belval Compound. It apparently is tied into a network of pipes in the surrounding mountains which create the pressure differential necessary to make it work. What types of bacteria and parasites were in the water I’m not sure of. I waited about thirty minutes to fill up ten gallons of water. I struggled back to the compound. On my way back from outside struggling with two, fifty pound, buckets of water I saw Marah! I still don’t know how she got back to Leogane from Port au Prince, but I gave her a hug. She was my best friend at the nursing school who I had passed the time between Christmas and New Year with in Le Cayes at her family’s house. She had a tough stoic look on her face like she almost always did. She didn’t hug back with much enthusiasm. She said her family was okay as we walked to the compound together. I didn’t ask about her aunt and cousins Fera and Rachel who she passes the weekends with in Port au Prince because I had seen their home and knew that it didn’t stand a good chance. We both had lots of work to do and parted ways. I had to fight my way through the nearly rioting mob of horribly injured and maimed people in order to get my water in the gate. I was exhausted and realized that I would need some help, if not someone completely different to do this job. I spent the next hour walking around giving water to all of the most seriously injured folks inside the compound. By 8am there were probably forty people laying inside the nursing school gates. I found a bottle of 1,000 Ibuprofin in the mound of medical supplies in the center of the lawn which I decided would compliment my water bucket nicely. I made one complete sweep of all the patients, giving all those who needed it water and some very mild pain-reliever. It probably made people feel better regardless, like a placebo might. By 10am things were getting out of control. Word apparently had travelled all over town that patients were being treated here and we had medications. The number of people at the gate yelling to get in doubled and the number inside probably went up to sixty. Only about ten at any one time were receiving attention from one of the nursing students. It was at this point that I felt I could no longer spend my time distributing water and Ibuprofin. People had urgent needs that I could tend to: bones to be splinted, splints to be made, wounds to be scrubbed, bandages to be changed, etc… I began by working at Michele’s side doing whatever she instructed me to do. The next thing I knew I was prescribing amoxicillin (by this I mean digging through a big cardboard box of miscellaneous meds we had dug out of the already makeshift pharmacy in the collapsed part of the hospital until I found something useful to hand out) and cutting off the mangled remains of an old woman’s pinky finger with scissors while she looked away. The bone, muscle, and 50% of the skin had been cut. The finger was obviously dead as it hung awkwardly by a tendon and some skin. Instead of letting it be ravaged by maggots and cause gangrene of her hand I got the nod from Michele to cut it off. I tried to wash the wound with betadine before I did anything. There was a piece of string that had gotten stuck in the wound. I knew that it had to be moved to prevent infection so I reached into the flayed finger and pulled the string. It wouldn’t come out so I yanked harder. I got it out but it splattered little bits of blood all over my face. In the meantime the woman wasn’t even moaning. She had a foot swollen three times the size of her other one, but it wasn’t broken when I checked. I tested the scissors on some cloth nearby because they didn’t seem very sharp and if I was going to do this I wanted to do it fast; hopefully two quick cuts. Her finger obviously needed to come off, but in good conscience I could not cut someone’s finger off without explaining the situation and asking permission. After all, many Haitians don’t believe in Western medicine, let alone something as invasive as this. I said, “Si mwen pa koupe sa, ou pral komanse trey malad! Sa se mouri déjà Wi ak mwen bezwin koupe. Eske sa OK?” She nodded and tried to look away. I removed the drawstring from a little bag laying around with my pocket knife. I tied it around the nub even though there was almost no bleeding at this point despite the wound. I was committed now. Other nursing students, some in shock, some helping, paused in amazement or horror at what it seemed I was about to do. Family members of other patients who were screaming at me to help their mother or brother etc… even for just one moment, realized that I WAS FUCKING BUSY and couldn’t help them right now! I was committed now. Even Michele looked over from the bone she was scrubbing. Snip… tendon, snip… flap of skin. It hit the grass. The woman stared at her finger. I covered it up with some trash so she couldn’t anymore. I poured some more betadine on the wound and went looking for antibiotic ointment. One of the nursing students gave me a little container which I squeezed onto a piece of gauze which was all I had at this point to bandage. I cupped the nub into the gauze and cream and used the rest of the string to tie it in position. I later found out that the cream the nurse gave me was antifungal cream and not antibacterial cream, and that we actually had sutures on the other side of the nursing school. I did the best that I could, and this one was very lucky to get a five day course of amoxicillin.

As soon as I stood up I was hit with the same angry man who spoke broken English. His wife had a single broken leg and it had not yet been splinted. There was no bleeding, which put him almost at the bottom of the list of urgent patients. I thought he was going to hit me. He was right in my face yelling, “what you gonna do for my wife? You walk by and never see her! you help everyone but me! You can’t do that man!”… I tried to ignore him but he was a big guy and was at his wits end. I don’t remember why he stopped hassling me, but someone must have gone to check on his wife.
The sequence of events of this day are blurry. From this point on there wasn’t anything I could say to people to convince them that I wasn’t a doctor. They didn’t care. They saw me cut off that woman’s finger and wrap it up. During this interim period I saw four compound fractures (no other scrapes etc…) where the tip of the tibia and fibia both tear through the skin of the ankle where it should meet the foot. In all four cases the foot was at an awful ninety degree angle bent inward. It makes me hypothesis that perhaps the sheer tork of the 7.3 earthquake was enough to break these, presumably walking or standing still, people’s ankles in this way. THEY WERE ALL THE SAME. Michele explained that all that we could do was scrub the bone, keep it moist, and try to wrap the foot and ankle. She said we would need a doctor or orthopedic surgeon to put the bone back inside the skin. It was so awful seeing these patients and knowing immediately that what they needed was so far from being available. Michele tried to teach me how to recognize a pulmonary embolism on a man who’s chest and stomach had been crushed. He appeared to have internal bleeding and Michele could hear a scratching noise in his stomach between lub dubs. There was nothing we could do for him. I had to tell him in Kreyol for Michele. I watched a girl with the side of her face swollen to four times its normal size sieze on the ground. Ironically not far away a perfectly unharmed Haitian women was screaming at the sky and shaking her body as if seizing. A Red Cross transport plane flew overhead in the distance which was the first sign of help any of us had seen or heard of. We didn’t know where it was headed. There was another girl with an obvious head injury. Michele was examining her pupils. She explained that there was nothing we could do for this girl, not even Ibuprofin because that alters the presentation of head injuries and sometimes increases the hemorrhaging. The mother was desperate and wanted some of the Ibuprofin which she saw that we were giving to almost everyone. I told her, “Nou pa ka fe anyen pou li paske li gen yon pwoblem avek tet li. Malady tet yo se lot de malady lot kote yo. Li pa ka pran medicama la paske lap domi.” – “We can’t do anything for her because she has an injury to her head. Head problems are different from injuries in other places. She can’t take medicine because she is sleeping.”

The mother insisted that “Li Kapbab… Li Kapbab” – “she is able… she is able…” but Michele insisted that she would throw up. We asked the father if the girl had been throwing up and he said yes while the mother said no. We had to recommend that they keep her comfortable and still. Someone showed up with a neck brace from nowhere and put it on her almost as consolation, and her parents carried her off on her board to undoubtedly die.

Next I was interrupted by a man who had goo oozing from his left swollen eye. I think something may have penetrated it. He spoke perfect English as some Haitians who have immigrated to the US and returned do. He seemed so resigned, but asked me if he could have some Ibuprofin. I gave it to him.
Michele and I began assessing a screaming six year old girl with a broken femur and a tibia-fibula fracture of the same leg. Her father spoke English and was remarkably calm and appreciative of our attention. Together Michele and I splinted both parts. Michele explained that in order for the femur fractures we were seeing to heal properly the patients needed to be in traction. Since the father spoke English she was able to tell him that because there was no traction available his daughter would be crippled for the rest of her life. I believe that is exactly how she said it. He just nodded and started to look for a place to move her out of harm’s way.

I think it was about this time that I bumped into the patient who I really connected with/felt the most sorry for. It was sometime in the afternoon now and I was finally feeling a little fatigued and disoriented. For the immediate no one was yelling for me or grabbing my arms and trying to pull me to their loved one. As I stood there wiping my head and thinking oh my God, I got my next call. A frantic young man came over. I somehow could tell that this wasn’t the usual degree of panic and that whomever he was caring for had something especially awful. I went to see and my mouth dropped. In actuality this girl was better off than those bleeding internally or with compound fractures. She had just been pulled from the rubble (approximately 20 hours trapped). She had what I can only compare to a shark bite on her right calf. It was a gaping 1 ½ foot slash. Part of her gastroc muscle was flayed and the entirety of her calf was laying exposed, practically hanging out of her leg. The skin, usually taunt around the muscle, was recoiled leaving all the muscle exposed. Her hands were crushed and horrendously cut. The muscle in her right hand was hanging out of the laceration. None of her cuts were bleeding at the moment, whether it be dehydration, clotting, or the nature of the injury. I was surprised to note that her left hand had already been stitched up? This puzzled me? Who had stitched up one hand but left the other two worse wounds gaping open. (It turns out that my friend would soon recognize her as the girl who they had to turn away from the hospital because there wasn’t anything more they could do for her there.) She was moaning but conscious. She was obviously dehydrated which was the first thing I told her friend to handle. It turns out she was starving too. Her friend gave her some rabbit meat that he had bought from a vendor who obviously didn’t realize he should be storing up his food for his family and not selling it. I was completely unprepared at this point in the day to handle any of these problems. I searched for someone to help me. Michele was occupied with an internal stomach bleed. The chief 4th year nursing student said he would be right there but never showed up. I realized that if anything was to be done for this beautiful girl that I might have to do it. I started by rolling her onto her stomach, which was difficult with the state of both hands. I poured water and betadine onto her leg wound which was starting to dry out a bit. Then, as I began to get desperate for what to do next, a REAL DOCTOR showed up out of nowhere. He said he would be back. He had sutures, gloves, lidocaine, and disinfectant. I have no idea where that stuff came from. There was a late day infusion of supplies, namely sutures, bandages, and lidocaine, that arrived late that afternoon which must have come from some stash in the old closed hospital or one of the pharmacies around town. He used his gloved hand to reach down inside her leg and pull out dried chunks of blood. He snipped away dead pieces of muscle that were starting to get black. He used a damp piece of gauze to rub up and down on the exposed calf muscle. The girl was in agonizing pain. He cut away dead tissue and picked debri out of the inside of her leg. During this time I was holding her down and giving him whatever he asked for. Next he used oversized needles to inject lidocaine into some of the skin around the wounds… probably a little late to do any good… and began to sew up some of the muscle which had torn and recoiled down to her ankle. He did a beautiful job. One continuous stitch that connected to the muscle in a number of locations all pulled together to reconnect the muscle. When he was done with that he cut the finger off of a rubber glove and then opened both ends he put that into the wound to create a drainage opening. He began to sew the skin back around the gastroc. He worked rapidly, starting at the ankle, (low stress area) and working his way up to the center of the calf. Unfortunately three sutures in a row broke and he said he couldn’t close the leg up without steel wire sutures. The skin was too taunt in this location. He had me grip the bare muscle (I had just found my first pair of rubber gloves of the day) and try to force it down under the skin. The suture broke anyway. He started again at the top and worked his way down from the other direction until the sutures started breaking again. Then he stopped and said that was all he could do and disappeared. I began re-sterilizing and wrapping the still exposed small envelope sized area where the skin was unable to meet over the muscle. I got it covered to the best of my ability and then turned my focus to the un-sutured hand. The doctor had looked at the hand and concluded that the tendons in her wrist had torn and that she would need microscopic surgery to reattach the tendons. The muscles of her hand were flaccid and had expanded which was why they were bulging through the five inch gash. I was about to attempt to sew the hand wound up based on all of the times I had watched it done, when a nursing student came over and said that she had learned how to suture. (It was about this time that I looked up and saw my two best friends from the Childrens Nutrition Program! Kara and Courtney… standing there behind me alive! We all had a 2 second teary moment and then it was back to work. They told me to come to the hospital tonight and left) The nursing student was far from experienced but was able to close up the wound while I used some forceps to push the hand muscle back down while she closed the skin over them. The sutures took an hour and the girl was moaning that she just wanted us to stop. It was as if she didn’t care anymore. She just wanted us to stop fiddling with her. When we were done I remembered the nondescript bag in the mountain of meds, both useful and not, where I had found the amoxicillin for the woman whose finger I had cut off. Sure enough there was some left. I selfishly grabbed three bags which equated to about 2 weeks of antibiotics and gave it to her friend with strict instructions. That was the last I saw from her.

It was starting to get dark now and the guards had stopped letting people into the FISL nursing school compound. I helped move the girl with a broken femur and tibia/fibula from earlier outside into the tent village with her father. After that I decided I was done for the day and walked the one hundred yards to the Notre Dame building while fighting off tears. There was no time to be sad yet. There was too much still to be done. I got some food and clean water at the Residence Filarose. My food was still the chicken from the night before and the water from some melting ice in the, now turned off, freezer. I then hitched a ride on the truck with Jean Marc and Wesley who were driving to the soccer field. I saw Marah on the way out and waved thinking that I would get to catch up later tonight when I returned. It was pitch black now at 6pm and I got off and told Jean Marc that I would either see him at the RF or would sleep with my friends at the Hospital.

I walked five blocks from the soccer stadium to Hospital St. Croix. My hamstrings and ankles were painful from such strain the night before. As I entered the compound and shouted the names of my friends I caught them exiting the back of the compound on their way to the open field inside the St. Croix hospital compound. I would never have found them had I a come any later. Cell phones were still not working and visibility was almost zero at night time. Kara, Courtney, Ashley, Lara, Suzie, John were all together. They had just finished taking turns washing with some of the water John was able to pump using the generator. He had switched the circuits to connect the generator, which was still working, solely to the leaky water reservoir. They had left it on for just enough time to fill a few buckets in order to wash. They stood by and waited while I took off my clothes and poured water onto my head. I’m not sure how effective I was in cleaning my body with those scoops of water, but it felt good. I decided not to put my dirty socks back on. My shoes still smell as a result of that decision. Suzie and John had salvaged some blankets from the remains of the guesthouse which we were planning to lay out on in the field next to the other refugees. Big hugs were exchanged. Courtney was excited to catch up and exchange stories with me, but Kara was distracted by her boyfriend Guesley who she was contemplating seeing for the last time.

Ashley is the stateside director of the Children’s Nutrition Program. Lara is a nutritionist on the tenure track at the University of Washington St. Louis who was visiting to assess the program. They had both flown in the night before for annual meetings. Kara, Courtney, Ashley, and Lara were all together in Port au Prince eating at an open air restaurant in Petionville when the earthquake struck. Courtney shared with me quickly that they were all contemplating leaving very early the next morning in a Hospital St. Croix truck that still had gas in it to attempt to get to the airport and be evacuated

The horrible decision of “to stay” or “to go” began in my mind as it had in Courtney’s and Kara’s already. I had all night to lay awake thinking about it. In my mind, when I walked and hitchhiked twenty miles away from the airport and the US Embassy, I had made the decision to bunker down in Leogane until international aid arrived. As I laid there and hashed out the pro’s and con’s of attempting to drive to Port au Prince with Courtney, the other refugees broke out into Christian song. Suzie shared that this was a group from the nearby Episcopal Church.

The decision to drive BACK to Port au Prince was based on the following factors: empathy and love for my worried parents, concern for my needy friends in Haiti, my usefulness in the medical clinic in Haiti, usefulness organizing relief efforts in the US, the amount of money in my pocket, safe water availability, infectious disease, the probability of further earthquakes, possibility of tsunamis, potential civil unrest, chances of foreign aid reaching Leogane, the odds of being robbed on the trip through Port au Prince, chances of roads being out and getting stranded in the city, and various emotions which I can’t re-create.

The night was a relatively sleepless one, punctuated by early and late aftershocks. We tried to “eve’s drop” and listen in on one of the neighboring family’s radios which was getting poor reception all night. We heard that the international community was sending aid and that nearly 100,000 were feared dead. Little other remarkable information was communicated.

Kara, Courtney, and I, also had a very difficult decision to make with regard to our good friend Meghan who was still missing. No one had heard from her or Dr. Mersier whose home she was living in since the earthquake. We had reason to suspect that she was in the mountains up at a town called Fondwa. She ran the vitamin program for the elementary school in the town, and travelled there every Tuesday afternoon by herself. We figured that eventually when she had the opportunity she would make it back down to Hospital St. Croix where she would find Suzie and John, (ultimately this did happen) but none of us felt good about leaving Leogane with one of our best friends still missing.

Ultimately after the night in the St. Croix school soccer field (I played soccer here every Saturday morning at 6am for the past six months) I decided that I would ride along with Ashley, Lara, and Courtney, and make an attempt at getting evacuated. Kara was the last to confirm that she would be coming with us. I can’t imagine the emotions Kara would have been feeling as she had to say goodbye to her boyfriend of over a year. John and Suzie decided that they wanted to stay and direct the relief efforts in Leogane which they felt strongly would be quick to arrive. They were correct after all in their gamble, but we thought they were making a dangerous mistake to expect foreign aid to reach Leogane as rapidly as it did.

I considered walking the one mile across town early that Thursday morning from Hospital St. Croix to my home to grab a few more items out of my room and to say goodbye to Jean Marc, Wesley, Michele, Jo Anne, Precene, Ti Gary, Evens, Marah, Anderson, Carl Henry, Gethro, Bitten, Naldi, Sebastion, Mitch, etc... I decided that I couldn’t walk through the refugee camp of neighbors without being forced to attend to sick patients, couldn’t non-verbally announce my departure by emerging from the Residence Filarose covered in luggage, couldn’t say goodbye to everyone I grew to love in Haiti quickly enough to make it back to the Hospital in time to leave… So I didn’t tell anyone and left with only the diaper bag Sr. Mary Spano had given me months before which contained my water bottle, my wallet, my passport, my Haiti cell and charger, my US cell and charger, and three additional street vendor purchased bags of purified water.

The Cuban doctor, who I had worked with the day before while treating the girl with the calf wound, wanted to look for a friend in Port au Prince. He agreed to drive our entourage to the airport in the Hospital St. Croix vehicle. Before we left we took a few pictures on Lara’s camera of Kara and Courtney’s crushed apartments, the hole that John used to escape from the rubble, and several other destroyed buildings. Ironically, Courtney’s laptop computer, passport, and money were all sitting and visible inside the remains of her apartment. The precarious nature of the damaged concrete ceiling above her valuables prevented anyone from daring to attempt to salvage them. Even I didn’t want to risk it at this point. We knew that, as a result though, Courtney would have a difficult time being evacuated.

We set off anxiously to Port au Prince with a full truck. It was surreal leaving the town we all knew so well. There were not many vehicles driving around at this point and especially not ones filled to the brim with “Blancs” – “white foreigners”. We got lots of stares. Because we had each hitchhiked through the first stretch we were not concerned about the road being out. Because of an incident the day before which Kara, Courtney, Lara, and Ashley had experienced with a road-block and a demanding guard we were more concerned about theft and the necessity of walking to the airport in the midst of miserable poverty, suffering, and death, than we were of impassable roads.

We took pictures covertly as we drove. We saw crushed buildings everywhere. There was an occasional body in the road with a sheet over it. We drove by a funeral procession. The streets were increasingly filling with people the closer we got to Port au Prince. We drove by many skeptical looking folks but no one tried anything to stop our car. Courtney and Ashley noticed a Tap Tap (Haiti’s form of public transportation) with machine gun wielding pedestrians riding on the roof. They were driving the opposite direction. This drive was anything but relaxing. I had a sense that from here on out what happened was out of my control.

We made it through the oil refinery and into the Western coastal side of the city in good time. The crowds and traffic prevented us from moving rapidly though. At several points people around us were making better time walking. We had all been desensitized to the destruction at this point, having walked through it, touched it, smelt it, cried about it, feared it, so we weren’t dwelling on the sights this time around. I don’t think people whose experience of Port au Prince is limited to the recent television coverage can appreciate the level of EXTREME poverty that was found in that city BEFORE the earthquake.

Imagine crushed plastic bottles, wrappers, bones, rotting fish, fruit peels, feces, urine, 3 inches deep covering the ground. You might think that the trash was melting with the amount of water draining through it down out of the mountains in the horizon. The canals that were constructed were clogged with trash. Pigs grazed freely in these rivers of waste. An occasional starving man or woman would be passed out amidst the hustle and bustle of shoppers. Because this particular space was the only public area in that region of the city it served as the market. Produce of every conceivable variety was sold on top of, and in the midst of, this squalor.
On this particular drive through the market there was the addition of broken cement, wailing, and dead bodies.

Because of blocked roads and detours we ended up driving through Champ de Mars where I, not even 48 hours previously, sat in a truck with Jean Marc, Dr. Desir, Dr. Latagnac, and Papiyon while the first earthquake wrecked its havoc. We snapped pictures as we drove by the parliament and national palace. It seemed at one point in the odyssey that we were going to be stuck. Two of the three roads at the intersection were blocked with debris. The third option was a standstill traffic jam of vehicles angrily trying to back up unsuccessfully. Fortunately, perhaps remarkably, one Haitian passerby saw our predicament and started to move the wreckage out of one of the streets. He moved two pieces of steel rebar just enough to let our car squeek by, and then smiled and waved to us as we headed down an unknown road, previously blocked, which was packed with people. I was sure that we were just getting ourselves more stuck, but surprisingly we hit a thoroughfare. From this point on it was smooth sailing to the airport. When we arrived, 10pm Thursday morning, we expected to see the United Nations and perhaps the US military. What we saw was one hundred, predominantly Caucasian folks, squawking around the airport door.

I think it’s fair to say that we pre-maturely started envisioning our arrivals back in the United States. The next seven hours outside the airport (the building was damaged and unsafe to enter) out in the sun seemed to bring out the worst in the people around us. All day at the airport I witnessed ugly fear, self-centeredness, racism, and anger. Additionally the authorities demanded that Courtney travel to the US Embassy to have them process her missing passport before they would allow her to be evacuated. It was as if they thought we could just jump on the metro and be back in a few. By the time the sun started to go down our group had resigned to try again tomorrow. Finding a safe place to spend the night then became the issue.

Fortunately a Brazilian woman who worked for the United Nations agreed to give the five of us a ride to the US Embassy which was about three miles down the same road. We were very grateful since our other options for passing the night were starting to look like the field across the road or the parking lot. We arrived at the US Embassy around sunset. We were all allowed inside the massive compound which seemed to have been designed to handle crises like these. When I exited the metal detector and walked through the second security gate I finally felt as though I could begin to relax.

Remarkably I bumped into Fr. Tom Striet inside the US Embassy cafeteria watching CNN. Anderson Cooper, or one of the other celebrity disaster reporters, was broadcasting live from the side of a trapped young girl in the city. It was surreal watching the world press dramatize the sorrow and unfathomable losses that broken families and injured men and women, sitting next to us in that cafeteria, were really experiencing.

That night we were fed MRE military rations. We shared stories with other survivors. We called our families using my US cell phone. I could hear my mom almost break into tears as I announced cheerfully and a bit triumphantly, “Hi Mom this is Joey. I’m at the embassy in Port au Prince…”

That night I was woken from a sleep in the courtyard by woman from the state department. She told me that if I had a passport and didn’t have any luggage that there was a spot for me on the next military transport. Fifteen minutes later (1 am) I was racing through the streets of Port au Prince in a fifteen van caravan of government bulletproof SUV’s. They drove us onto the tarmac where the 82 airborne division had just arrived, checked our passports, and helped us get situated in the C130 which was to take us to Maguire Air Force base in New Jersey.
An aftershock shook our plane violently as the engines turned on.

Pictures from My, Courtney, Lara, Ashley, and Kara’s journey Thursday to the embassy can be seen by clicking this link: http://flickr.com/gp/34925215@N07/D0JH57

Details!

2009-12-10T11:38:00.000-08:00

I apologize for neglecting my blog for so long. I have been consumed with the present more than ever it seems. It is SO easy here to lose track of the big pictures here when the minor details of life consume so much mental energy:

Acquiring money – A little bit of money goes a long way here… (that is if you’re not sharing). To get some money in Leogane, I first need to ride my bike 1 mile across town to Hospital St. Croix which is two blocks from SogeBank. I leave my bike here and walk the rest of the way to the bank. I usually wait in line for an hour, then present my passport & debit card to a tenant who helps me acquire a sum of money. It is a poor idea to carry a lot of cash on you, but also a real hassle to acquire more. It is actually pretty unusual for a bank to offer an ATM “cash advance” service so I am lucky. Otherwise Port au Prince or carrying money into the country ahead of time, would be my only option. Whatever I request is then given to me in Goudes (bills that look like monopoly money). If I am lucky they will give me some small bills (50, 100, 250 gd bills) but normally I am given money in 500gd & 1000gd bills (which becomes a problem when trying to spend my newly acquired money) I don’t know my numbers well enough to make this request yet and am always so embarrassed by the number of bills that 50 usd dollars amounts to that I just gratefully accept and leave. The exchange rate is 1usd = 40 gd
This means that 500 gd = 12.50 usd
Annoyingly all businesses etc display prices in “Haitian Dollars”… 1 hd = 5gd (5hd = 25gd & 8hd = 1usd)
You won’t survive here without being able to do simple long division and multiplication in your head. Even then you are screwed if you can’t pronounce all of the numbers correctly (I need to practice my French/kreyol numbers!)

Making a phone call – There are three major cell phone providers in Haiti. Digicel, Itel, & Voila. They all compete with each other. Each has their own army of employees around the country selling phone cards with minutes on them. Westly recently hooked me up with a special Itel “international plan” month by month plan for 500gd. I was under the impression that I had unlimited international minutes for the month based on my misinterpretation of the French text message announcing my plan to me. Yesterday I was urgently trying to explain to a Haiti Program worker who was on the Isle of Gonave how to properly use the GPS device (in kreyol to make it even more frustrating!) when my phone shut off b/c I had used all of my minutes. In order to call him back I needed to get on my bike, ride out to compound gate, ask the security guard there if he had any friends who were dealing Itel cards, ride my bike to the place he said, ask some strangers sitting around talking if they had any Itel cards to sell, buy 350gds worth of cards b/c I only had a 500gd bill to work with and they don’t have any kind of change, scratch off the lottery ticket-like gloss to reveal the numbers, dial them into my phone, wait 10 minutes, then call him back, and continue the struggle to communicate.

Going dancing- dancing, “going out” on the weekends is a hassle for me. Because I live at the Residence Filarose, and the RF is inside the nursing school compound, I am forced to abide by their 9pm curfew. This is fine, unless I want to hang out with Kara, Courtney, Meghan, Guessley, or a whole slew of other Haitian friends on the weekends. Thankfully Kara and Courtney are amazing and let Meghan and I spend the night on their extra beds inside their apartments at Hospital St. Croix when we want to go out with them. (Meghan is in the same kind of situation) Every Saturday, as I mentioned in a previous blog, we go to Praktik (8pm – 10pm) at a swanky dance club down the street from the hospital (has a tree growing through one of the walls) called Kay Dance. We always have a good time together, and usually stop at another bar adjacent to the hospital on the way home called Masaje. I play basketball with Ralph who is their DJ, and he seems to be in love with Courtney and Meghan, so we have special influence over what music is played.

Email Communication- The Residence Filarose has a basic internet connection. (160 kb/s upload, 500 kb/s download) It works when there are not heavy clouds overhead and the generator is turned on. I am able to do lots of emailing out of the RF. When I need to upload large documents (such as the 66MB file containing all of the hydrocele patients’ photographs and information) and send them (to the surgeons) I must go to Port au Prince where the program has offices and a stronger internet connection. Instead of 6 hours, the files will upload in maybe 2. The power is more consistent here as well.

Collaborating with Haitian Professionals- In Haiti, the professionals (doctors, lawyers, government officials, etc…) speak French to each other despite the fact that they all know kreyol. Haitian kreyol is indisputably the language of Haiti. (95% of the population fluent) Yet the important transactions, textbooks, and communication is always done in French. Think of it as a special handshake that only the “important” people know… It is a way of distinguishing superiority & education here. Americans utilize expensive 500$ Jolsten’s “college class rings” to accomplish this same sort of educational identity. The consequences of this language barrier is great and far reaching in Haiti. One of the effects is furthered marginalization of the poor. As soon as one opens their mouth he/she can announce their socio-economic status. In this regard I am a sort of enigma -> being white but speaking Kreyol and no French. In meetings with Hospital Director’s etc… I am unable to understand because they speak French to each other. I have by no means mastered kreyol at this point, but I recognize, whether I like it or not, that to make a real difference in Haiti I will need to learn French. Has anyone seen the movie “My Fair Lady”?

Eating/drinking- I eat much healthier here than I ever did in the United States. I am fortunate enough to have at least one meal a day prepared for me by Nicole, the cook at the Residence Filarose. She prepares vegetables, some of which I do not even recognize, in ways that are very appealing. She always gives me some variety of freshly squeezed citrus juice to go along with her dish. Additionally my closest friends here include a vegan and a vegetarian. All of this, in addition to lots of daily exercise, has contributed to my increasingly sexy physique… “sexy” is used synonymous for “skinny” here I wouldn’t want to be gaining weight in a country that was so underfed anyhow.

Transportation- I ride my bike everywhere I need to go in Leogane. Regular stops are Souren School where I play basketball, Hospital St. Croix where I work, ZOE club where I play soccer and my friends hang out, and the Residence FIlarose where I live. When I need to use the offices in Port au Prince I arrange this in advance and ride with the program staff. Other cities and villages I have visited outside of Leogane thus far include Port au Prince, Miraguan, Jacmel, Fondwa, and Cabaret. Visiting Cange, Le Cay, and Cap Haitian are on my to do list. I am always looking out for people headed those ways.

Anyhow, I hope that you appreciate reading about some of the more subtle complexities of my life here in Haiti. As my dear friend Sister Josepha would say, “I’m not complaining… I’m explaining…” 

Pictures

2009-11-19T10:41:00.000-08:00

This is a picture of me shadowing Dr. Miller , pediatric neurologist, on a mobile clinic in the mountains which surround Leogane. I learn quite a bit each time I go out with the medical teams who frequent Hospital St. Croix.

Carl Henry works at the Residence Filarose and has become a friend of mine. He first introduced me to his friends in the Zoyo Club who have since become my own. He asked me to take some pictures of him so that he could make a facebook profile picture. This was one of them.

This is a picture taken of the Leogane DEC distribution checkpoint GPS map that I am creating on google earth. As you can see this is Leogane and it is not a very big city.

These pictures were taken at Giliu Beach, a private beach and bar about 6 miles from Leogane, on the Toussaint Louverture Holiday. We swam, ate grilled conch, drank some beer, and danced to bachata and compa music. It was a great day. Ti Frere & Guessley are two of the friends in the top picture. Courtney Latta is the gal in the bottom picture.

This is a picture I took while hanging out with the Zoyo Club guys. They are a group of ~18 - 24 year old guys who all hang out in an open lot between two houses and under a tree by a well. The board game they are playing is "Wedo" or "lido" and is a game that requires two dice, simple addition and subtraction, and lots of strategy. There is always a tournement going on between the guys. I am not very good, but am learning all of the nuances and exceptions as they periodically arise at crucial points to make me lose. I also play a lot of soccer with these guys in the street next to their lot. I am really thankful for their friendship.

Ti Bouchan is a Zoyo Club friend. He is a jewler. In addition to repairing bracelets, necklaces, and rings, he makes his own out of any precious metals he can get his hands on. His work is beautiful. This is a picture of him working with a delicate gas smelting/welding device. Ti Bouchan is also a great latin dancer. He is a regular at Kay Dance (swanky dance club by the hospital) and a coveted dance partner.

Back in Leogane

2009-11-15T19:32:00.000-08:00

I made it home! And yes I am referring to Leogane and all of its familiar strangeness! I had a fantastic visit in South Bend and Chicago which I had been anticipating since I purchased my flight 2 months ago… and like the rest of grade school, middle school, and college I have emerged wondering what happened and wishing life didn’t move so quickly!? Dancing cha cha cha in the Walsh hallway with Carolyn, the Linebacker with Carolyn and Matt… Dorm parties with Patrick… med school lectures in Chicago with my organic chem. study buddy and future president of the American College of Medicine -> Greg (team “stick it in your phenol” what? what?), drinking my first bruski in the Hesburgh Library with Amber (better late then never right?), tailgating with my mom and dad, speaking in front of the Haiti Working Group as a graduate who moved to Haiti, being introduced to a visiting lecturer as “Prof. Richman’s” protégé, speaking Kreyol to my Haitian ND undergrad friend Fera whose hair and differentness always used to intimidate me, visiting sister Josepha at SMC, Rogelio and company at Saint A’s, Mrs. Dombrowski, the Mcdonald family… It was all good… and in each case too brief.

Time Flies... can you dig it slash fly wit it?

That thought brings me back to the present (which is the roof, the stars. the shooting stars, my scraped arm, the bacterial load I subjected it to when I fell flat on my back in the sewer water today, my teammate who insisted on me coming into his back yard where his wife was completely naked and bathing so that she could wash my shirt for me, and what I need to accomplish tomorrow) AND the Haitian word for Crazy which is “foo”.

I don’t know when I will be back in the United States next, but I have decided that when it happens I won’t tell many people. The gifts that I brought back were mostly favors which I ultimately didn’t ask payment for. It seemed as though everyone knew that I was leaving and had spent time deciding exactly what they wanted me to buy for them. I came through in most of the cases, but was unable to find what was requested in several. I am not sure if Anderson was really upset, certainly disappointed though, until he saw me give some specially requested fruit juice to a different friend. I think he will get over it. Some of the larger items like 25$ worth of muscle building protein powder I demanded payment for. My friends (<1 dollar/day) need to understand that I am not the typical blanc who is 300 times more wealthy then them, but rather a special “volunteer” blah who is only 30 times more wealthy than them…

Coming Home Briefly

2009-10-29T18:55:00.001-07:00

I brought my favorite puppy, Jasper, up to the roof of the Residence Filarose to chill with me. I think he is afraid of heights. I can’t do any of my work that requires internet access right now. The clouds are blocking the connection. There always seems to be lightning somewhere in the distance, and tonight it is lighting up the northern sky out over the ocean. I’m listening to “se pa pou dat”, my favorite Haitian compa song. It means, “It has been a long time since I’ve seen you”
This past Sunday wrapped up the mass drug administration(MDA) of DEC and albendazole in Leogane. Over 4 days they distributed medicine to 100,000 people. I am using a GPS device to mark the locations of the 160 distribution sites, and will be assisting Montiluse with the statistical analysis. The hope is to have a google earth map with all of the distribution checkpoints marked to indicate the number of drugs they distributed each day. With this information we can discover trends that might influence next year’s distribution in Leogane and the upcoming MDAs in Gonieve and Port au Prince.

There is a group of American doctors at the hospital this week who seem to be very appreciative of my assistance in their mobile clinics. Yesterday I took blood pressures, pulses, temps, analyzed urine for abnormalities, and administered malaria and pregnancy quick diagnostic tests. I had dinner with their team at night, after playing pickup basketball near the hospital, and gave them a 15 minute presentation on Lymphatic Filariasis and the ND Haiti Program. I really love teaching in those kinds of settings. I get better each time I explain it/come up with better analogies… I like to compare the mass drug administration strategy for elimination/extermination of LF in Haiti to a nuclear war, and the fortified salt strategy to a covert poisoning of the food supply. On the way home from the hospital, riding my bike I met a bunch of the students at the nursing school (next door to where I live) and was able to hold my best conversations yet. The girls were laughing at my straw hat as I rode by, and didn’t know that I understood what they were saying. I gave the criticism right back to them playfully in kreyole, and made some witty comments. Then to make the day even more complete, I got a skype video call from 3 good friends (Jenna, Alicia, Amber) of mine who are seniors back at Notre Dame… (who I will get to see next week when I come home briefly!) I learned that since I last saw each of them, Alicia learned the
“tornado”, jenna learned the “booty shake”, and Amber learned to dance bachata ;)

Next week I will be staying a night in Chicago at UIC medical school with my friend Greg (he arranged for me to give an informal talk to some of his classmates about my experience in Haiti with Neglected Tropical Diseases/Lymphatic Filariasis during their lunch break!) then heading to South Bend for meetings with InterVol and the ND Haiti Program. During the weekend I hope to make it to the Bengal Bouts boxing reunion and film premier and the Notre Dame vs. Navy football game in addition to catching up with one of my best friends (St. Joe Highschool & ND together) Matt, my freshman brother Patrick (in Keogh), my junior sister Carolyn (in Walsh), and my mom and dad who are making the trip in from Erie, Pa. It will be a fantastic blurr of 7 days…a continuation of the fantastic blurr that has been my 23 yrs thus far. I plan to savor each bit… just as I do when I’m drinking an ice cold soda in 90 degree heat. I will reflect when I get back to Haiti and its slower paced lifestyle. Maybe I’ll even blog about it/immortalize the experience on the world wide web?

Poignant Experiences

2009-10-12T12:23:00.000-07:00

Yesterday Fr. Tom, myself, Jim Sylivant, and Leslie Roberts from "Science" magazine, were driving back to Leogane from Cabaret, the city where they were just finishing distributing Dyethlycarbamazine and Albendozole to 60,000 people. In the distance we saw a huge truck lying overturned on the side of the road. It had been carrying construction supplies and 4 women in the back carrying space. (typically you see about 30 people on these trucks...) We stopped along with a car behind us. We were the first on the scene. For the first 5 minutes until a crowd of pedestrians started arriving it was just us. No one was crushed/trapped miraculously but the people had been tossed all over. We searched the bushes around the road but didn't find anyone. The worst woman was dripping blood out of her mouth and looked to have at least a broken jaw, maybe cheek, and possibly some other cranio-facial problems. She was moaning awfully which, along with the flies, was the worst part. The most sobering thing about the situation was that for the time being there was no one with medical skills coming, and no one reliable to call. Fr. Tom was able to get a phone number from the woman with the head injury, hold her hand, and keep the flies off her blood on her face for about 20 minutes until her brother came to pick her up. I focused on making a splint out of cardboard and a torn shirt for another woman, who's only problem seemed to be an absolutely shattered forearm, so that she could be gotten into a truck and driven back to Port au Prince. I've never seen a more floppy broken arm. The other two women seemed to be dazed and confused, but didn't have any terrible bleeding... We did not know what might have been going on internally. By about 45 minutes everyone had been loaded into vehicles and taken away. There were no stretchers, no neck braces, no paramedics, just concerned people working together... This whole memory seems like a dream.

Some other worthwhile encounters:

4 days ago I had the opportunity to help monitor a malnourished, dehydrated, HIV positive, infant named Mckinley (he had pnemonia as well) for several hours. He ended up dying despite the best efforts of the pediatrician and nutrition program staff. He weighed 6 pounds and was spasming throughout time I was with him. His twin brother had already died from similar HIV, respiratory, malnourshed, problems...

Today I washed the feet of 2 women with "gwopie" in the LF outpatient clinic at Hopital St. Croix. I have begun doing this on Monday mornings. In order to halt the growth of a damaged leg the patient needs to thoroughly wash their leg two times a day with special soaps (who can afford to do this in Haiti? CDC/ND HP donate these supplies, but patient compliance is estimated at 30%...) A bacterial or fungal infection in the damaged sight could trigger an "acute attack" at any time which in turn causes a mass influx of lymph fluid to the swollen leg (typical of an immune response, but an LF damaged system can't pump the fluid back into cirulation) causing greater disfigurement. The lymphatic systems of their disfigured legs have largly lost their ability to pump lymphatic fluid against gravity. The result is tremendous swelling and the loss of much of the legs lymph facilitated immune response in those areas.

The cycle of growth looks kind of like this:

Leg grows slightly bigger b/c adult worms are causing a detrimental immune response in the lymph ducts (Not Blockage) -> small increase in foot size and decrease in local immune system -> a foot infection caused by poor hygiene creates entry lesions for more severe bacteria to enter the foot and cause an "acute attack" of the immune system. (I would blow up like a balloon with the rate I acquire foot fungal infections for instance...) -> increase in foot size to the point of possible folding of engorged tissue -> this creates fissures and crevices (see picture above) for bacteria and fungi to better escape cleaning and cause infection -> cycle of growth and infection amplifies and can occur indefinitely... This disfigurement is irreversable (except for hydrocele) and disgusting both visually and nasally. I would take leprosy over "big foot"... any day. (there are about 20,000 with leprosy here too)

Mobile Clinic

2009-10-06T20:35:00.000-07:00

This past Saturday (while Notre Dame apparently played the football game of the century back home against Washington) I had a chance to travel into the mountains with a group of American doctors to set up a mobile clinic. I made myself useful sorting medicines and moving equipment when I could, but spent most of the day with a primary care doctor seeing patients. It was an awesome day from the ride up into the mountains (standing on the back of a truck) in the morning to the walk home from the latin dance club that night. The group of doctors, nurses, and dentists from Boston were very well organized/prepared for what they were going to encounter. The team was made up of mostly veterans who had traveled to Haiti before which was key. The group probably saw about 150 patients that day and dispensed a tremendous amount of medicine, vitamins, toothbrushes, and bifocals… The group was made up of about 12. American Airlines agreed in advance of their flight to allow each member of the group to bring 3 checked bags as long as they were under 50lbs for free b/c they were a humanitarian aid trip. The group each packed all of their personal belongings into their carry on bags which left room for (50 x 3 x 12)1800 lbs of supplies. ( I did that calculation in my head…thanks MCAT?) That is almost 1 ton of supplies. They brought vitamins, medicine, bifocals, toothbrushes, toothpaste, and more. There are plenty of arguments for why brief visits from foreign doctors should be frowned upon, but if all medical mission trips were organized like this there would be nothing to debate. I took plenty of notes since I will be leading identical groups of ND doctors to similar locations in the upcoming months. Some highlights from the clinic included watching a rotten tooth get pulled, seeing a huge salivary gland tumor, explaining in kreyol to a mother why she needed to immediately was her son’s scabies infested shirt, watching a dumptruck tip over down in the valley, and watching the most beautiful sunset I’ve ever seen materialize while cruising down through the mountains on the back of a pickup. The day was capped off with news of an ND overtime win vs Washington, beer, and cha cha cha dancing at “Kay Dance”…

Real World?

2009-09-30T19:22:00.000-07:00

It is storming! The lightning is spectacular. It is 9:30 pm and it has already been dark for 3 hours…

I heard a car accident, on my way home from the Cavaley soccer game this afternoon. It was a new experience, hearing the sounds of the accident but not actually witnessing the event. It happened right outside of Hopital St. Croix (the closed hospital) and just across the street from “Belle Negras” the 1 real restaurant in Leogane. It sounded bad. When I went to look I couldn’t deduce anything because a crowd of about 100 people had already mobbed the scene. I wanted more than anything to have been able to jump through the crowd and asses the victims, give everyone specific orders, and whisk them off to a hospital. Someday I will be good at this. I can already visualize myself barking out instructions and checking for vital signs. For now I am fairly useless in these situations... which is frustratingly ironic after 4 years of preparing to become a doctor at Notre Dame. (struggling through the pre-med requirements, MCAT, AMCAS, etc… was like boxing for me -> an uncomfortable experience tolerated in order to achieve a greater goal which is ultimately worth the struggle) I have no idea how badly hurt the drivers were or if they ended up receiving medical attention… I went and told the director of the hospital, but all he could do was phone a doctor and tell him that there was a car accident in Leogane by the hospital. I think he was just humoring me (the idealistic blan) I got the vibe that this was nothing to get too worked up about, and that there was no expectation that a local doctor would drop what he was doing to get to the hospital without more specifics. This is the “real world”.

Speaking of “real world” I think it is interesting to examine different people’s interpretations… (I came to Haiti excited to enter what I believed was the “real world”)

My friend Matt says he’s entered the real world, which he described to me as when parties become networking opportunities, dress socks become normal attire, weekends are for shopping at Lows and Kohls, and shotgunning beers becomes socially unacceptable…

Senior year friends would sometimes preface their post graduate plans with, “well when I get out there into the real world I’ll probably have to…” (I’ve said this too) I am beginning to think that there might not be any American college graduates living in the real “real world”. Our educations, and thus our mindsets, would prevent it… despite some people’s best efforts to forgo that rich materialistic lifestyle. The difference is that for Americans it is a choice, not an imposition, to go without. I wonder what some of the rockstars of this ilk, like Gandhi, would say to the question of “can a rich educated man truly ever move to the ‘real world’?” (I wish my buddy Michael Mcdonald were around snap out the answer…He probably took a philosophy class on this stuff while I was taking a Kaplan course to improve my MCAT score… FYI He is busy working with severely handicapped adults in a L’arche community in France)

Disclaimer: I am not classifying myself as someone who is currently forgoing the rich American lifestyle. For now I have everything I need and only a few minor inconveniences. This picture was taken the other day in the HSC guest house while we (Kara, Courtney, and Suzie) were making dough for homemade pizza…!

The Brissau Family

2009-09-25T14:07:00.000-07:00

The family that I am living with, Jean Marc, Michelle, and their two boys Sebastion and Mitch are wonderful. I met them all last fall at Notre Dame when they came to one of the events that I helped to plan in the "Hands and Hope for Haiti Lecture Series". Michelle cooked delicious Haitian Food for about 50 people and Jean Marc spoke during the event. I had never met Jean Marc's family prior to this, so when I saw "Fera" (a 19yr old Notre Dame student who is Haitian) I went up to her and thanked her for making the food for us. We were all embarressed...except for maybe Jean Marc who might have found this a sort of compliment. I don't think he did though. I did find the real Michelle Brissau who was standing right behind me and aplogized and met her two boys. At the time I hadn't the slightest idea that I would be living in Haiti with them. During September and October of last year I was 100% headed to LECOM for medical school after graduation. (actually it was only about 3 weeks before graduation that I found out about this opportunity, and well into the summer before I got permission to defer my acceptance) Even then I remember thinking to myself, "wow those boys are soo well behaved to sit through this 2 hour talk in a foreign language..." (I later found out that they both picked up English during their 1 year in the US... which is very impressive) Anyhow my point is that life is CRAZY and I had no idea that I was meeting a future "2nd family". It seems that I have 5 surrogate families now... The Mcdonalds, The Dombrowski's, The Coynes, The Penninos, The Brissaus.

Birthday Bash

2009-09-16T18:49:00.000-07:00

So I decided to throw a party for all of my new friends and hosts here in Leogane in honor of my birthday. I figured that this would be a great occasion to treat all of the wonderful people I have met in my first month and kick off the year…and it felt so good seeing everyone indulging and having fun lemme tell ya. I rode into the wealthy sector of Port au Prince on Monday with some of the Hopital St. Croix volunteers to a grocery store. It was on par with any in the United States. The party supplies: 24 burger patties and 28 buns, 6 cans of baked beans, 3 cans of black beans, 2 cans of corn, cheese, ketchup, mustard, pickles, onions, a bag of cookies, 4 bags of chips, a case of beer, a case of coke, a bottle of Haitian Barbaincourt rum, plantains, guacamole, a huge slab of ice, and some hotdogs I found in the Residence fridge. When I came back from the store on Monday and brought all of this stuff into my room little Mitch Brissau saw me and almost killed me with a high pitched squeal of excitement when he heard that we were going to have a party. He and Sebastion couldn’t sit still for the rest of the night and followed me around the entire next morning asking me when people were coming. They are both way too cute. I fixed the bake beans, made my favorite black bean and corn dip, set up some speakers, moved all the tables and chairs to the roof. I made sure that everyone who I have worked with, or has worked with/for me was invited. I think it was the first time I’ve ever thrown a party where everyone I invited showed up and where 100% of the food and drink were consumed. This was by far the most fun and memorable party I’ve ever thrown… Everyone there seemed to set aside their immediate troubles and just have fun together.

5 Days Until I'm 23...yikes

2009-09-10T21:09:00.001-07:00

My second cousin, Logan Anderson, was recently hired as the ND Haiti Program’s CFO and was in Leogane the past couple of days working on the budget. Logan and I were just on the roof chatting about life. He graduated from IU business school, worked for four years at JP Morgan in Chicago, quit his job to go to World Cup 2006, travelled Europe for 6 months…..then while on the Isle of Mallorca in Spain got a job working on a yacht which lasted for 2 years taking him thoroughly around the world. I LOVED this story 1. because I happened to find myself on the isle of Mallorca (Palma is possibly my favorite city in Europe) around the same time in 2007 while on fall break from my study abroad in London… (not knowing of Logan’s European adventures) 2. Because Logan’s story is a story of someone who refused to let life take him where he didn’t want to go (this takes nerve and a certain amount of faith/self-confidence) 3. Because it makes me feel good about where I am right now… I saw a shooting star as I told Logan, “man I wanna do that…” so look out…haha I’m not kidding about the shooting star…But I want to do EVERYTHING so me saying that is nothing special…

So regardless of whether I sail around the world on a yacht I have decided that over the next four or five years I’m going to take to take to the water in some form or another. I’d like to become a good enough swimmer to compete in the Presque Isle triathlons, to buy a life-long canoe that can take me on a month long cross country canoe/camping trip down the Mississippi River from Minnesota to Louisiana, and to learn to sail / manage a sailboat. We’ll see if medical school allows me the flexibility/time for any of this… but why shouldn’t it right? Getting an M.D. or D.O after your name ought to be an “enabler” not a “disabler”

Soccer, Cows, Gardening, Diplomats, Kreyol

2009-09-06T19:14:00.000-07:00

Highlights from this week included playing in the Haitian street soccer championship, going to a Cavaly soccer game, the cow destroying my experimental garden, having lunch with David Lindwall (Deputy Chief of Mission at the US Embassy), scheduling a medical mission trip for a group from Northwestern Medical School, and beginning daily Kreyol lessons with my new teacher Jean Claud.

The championship soccer game this past Friday evening was an experience that neither my pictures or writing ability can really do justice. I played in the most unique/trecherous venue of my life, with most talented and passionate teammates I’ve ever had, in front of the largest and rowdiest crowd of my career. I couldn’t help but feel like I was in a movie. My team was called Simitare (means cemetery in kreyol and fit with our team’s zombie theme). It was sponsored by the Filarose program which was why I got on the team. The field was the mainstreet in Leogane so the field was 5 times narrower than it was long. Out of bounds was constituted by contact with a spectator surrounding the playing area. Bouncing the ball off the steps of the church, signs, adjacent buildings, was in play. The playing area extended up over the curb in some areas which created a dangerous change of plane and obstacle for the ball. The best players used all of these surfaces to their advantage just as indoor soccer players do in the US. The dirt on the street and the drainage grade were additional challenges. During the semifinal I made my first appearance, while apparently breaking the color barrier. The crowd went wild when I entered the ring/field. No one could believe that a Blan was going to try to play soccer with their best street players. They let me play for the first 20 minutes despite lots of skepticism amongst my own team. I made a few good passes, managed not to break my ankles, and got the crowd excited with a shot from distance that the keeper just nicked over the crossbar. Jean Marc who was in the audience said that there was a distinct change in opinion amongst the people around him at that moment. “I think that blan might be able to play?” “He moves like he knows what he is doing…” were some of the post-shot comments that got back to me…haha We won that semi game 4-1. The opposing team had three players red carded and removed from the playing surface by police. The championship this past Friday was even more attended than the semi. Our coach acquired some really nice jersies and soccer socks for each of us. One fan brought all of us white candles. Another fan went around putting baby powder on our cheeks to make us look pale. I’m not sure I needed it but went along with the antics. A local DJ showed up with some huge amplifiers so when we walked out of the nearby home that we had been prepping in out into the street the crowd was rocking to “Smack That” by Akon. Everyone was pumped up, bobbing to the music, shouting. The crowd parted to let us enter the field with our candles. No one had any matches so they weren’t lit. Everyone huddled together and one of the guys said a prayer in Kreyol and then everyone took their unlit candles and pushed their way through the crowd standing on the church steps and placed them in front of the entrance. We took a team picture and then the game started. (I hope to get a copy) The game was wild. The six players who started the game for our team were all new additions since the semifinals but no one seemed to care. The game ended with us loosing 2-0. I never saw any action, but didn’t mind sense I had a feeling my playing time would have caused some mutiny on the team. (although I definitely would have been an offensive threat of a different style had they decided to play me…the street style is very dribbling oriented where my game is all about making quick passes and seizing the rare opportunities to shoot) The starters from the week before were all on the bench and livid…constantly trying to convince each other that we would be winning if they were in and the coach hadn’t picked up these new guys. (last week I was one of these new guys…) Further, these teams are made up of player from specific neighborhoods, (mine was a group of guys who play together daily on the north end of town) and I wouldn’t have wanted to become any kind of a scapegoat. This game was easily the most important game of the year for some of these diehard soccer players. I can’t say that I was really disappointed in the outcome. I was just pleased to have been part of such a cultural spectacle. Further, I was happy that I had the courage to play. That soccer field and those fans were INTIMIDATING. After some chaos surrounding the ejected players in the semi-final I was considering skipping the final. (for the same reasons that I listed above about feeling ok about not getting any playing time) Here are some pictures from the beginning of the Semifinal game:

Starting a garden was the idea of my friend Charlie who recently left the Residence Filarose. He had met someone who felt very passionately about the need for poor families to start vegetable gardens to improve nutrition. We both agreed that there was a ton of wasted land surrounding the Residence Filarose, so we acted on the idea. He acquired some seeds (beet root, swiss chard, tomato, ochre, spinach) from Dr. Desir’s brother who is an agronomist. I used plastic cups filled with soil in my room to nurture the seeds through the early seedling phase and then planted them in a space of land that we cleared in the back yard. I had been watering them regularly for about three weeks before the cow wrecked the fence I built and stomped around in my little plants. It didn’t appear as though he ate anything, but he still managed to crush about half of what I had planted. After this, a dog invasion, and ant infestation, I have about 15% of my initial crop. I’m going to have to do some more strategizing/reading up before I give gardening another whorl. Here is a picture of my garden though:

My Mom’s brother, Mike Mans, is a US Drug Enforcement Agent who just returned from 5 years of work in Guatemala. One of his colleagues there was recently named the #2 at the US embassy in Haiti. He put the two of us in contact, which resulted in lunch yesterday at the Residence. His security team sat outside in his armored SUV while Jean Marc (Haiti Program Director) and I chatted about Haiti etc.. He struck me as a really genuine and optimistic guy. His work with the US State Department has taken him to Martinique, Panama, Honduras, Colombia, and loads of other countries. He played college soccer in the US, and speaks a bunch of languages. I hope that I can get to know him a bit this year. He was very interested in the filariasis program which is great for ND.

Jean Claud works for the Children’s Nutrition Program at Hopital St. Croix. He is giving one of the other year long volunteers Kreyol lessons each morning at 9. He has agreed to meet with me at 8. I think that this will be tremendous. I can do the independent learning thing, but I definitely am more responsive to the give and take that comes with having a teacher. He used to be a Rastafarian so I’m sure I will learn lots of interesting stuff in addition to Kreyol from him. Also, there are a couple of younger female volunteers at the Hopital St. Croix guesthouse working for the nutrition program that I mentioned They both seem pretty adventuresome, so I’m sure we will have some good times over the upcoming year together. It is good to know that I’m not the only Blan in Leogane!

Night of the Critters

2009-09-03T13:20:00.000-07:00

So this actually happened about a week ago...but I didn't have the ability to share these until today... So here is the story:

I was heading to bed at about 11:30. I walked tiredly into my room (I had left the light on most of the evening by accident which is key to this story) brushed my teeth, scratched, contemplated showering ;), used the bathroom, drank some water, and then went to turn out the light...and by the grace of God caught a glimpse of a beetle out of the corner of my eye which caused me to hesitate long enough to notice that my bed and bed net was covered with little insects! Not just mosquitoes. This time there were ants, chiggers, bedbugs, beetles, and probably more. The ones that were small enough had made it to the interior and were hanging out on my sheets waiting for me. It was at this point in the night...shocked, tired, and unsure of my next move, that I got out the camera and filmed this clip in hopes of sharing this funny situation with my friends and family :
http://www.youtube.com/watch?v=fXNtSqTRhmI

Lucky for me the door accross the hallway was unlocked and had a bed with a bednet. I decided to sleep there for the night and deal with the bugs if they were still there in the morning. Finally I felt comfortable enough, with the bednet secured on all sides to the edges of my bed, to go to sleep...but before I fell asleep I gave in to the desire for some more water. This required me to walk down the hallway to the water dispensor. While walking there in the dark I noticed, and barely at that, a perfectly white tree frog on the wall. It didn't try to escape when I reached out to touch it, probably overconfident in its camouflaging ability, so I grabbed it! I continued down the hallway got a drink with my free hand and started back to my room. And then to my suprise int on the other wall there was an alien-like lizard/gecko (I don't know which yet) looking at me. I managed to catch it as well. It was at this point that "Night of the Critters 2" was filmed:
http://www.youtube.com/watch?v=EOxT63g8hKo

all of America needs to watch this simple lecture!

2009-08-27T07:15:00.000-07:00

http://www.storyofstuff.com/

This lecture hits the nail exactly on the head. I am with this woman 100%. I would vote for her if she ran for president... not necessarily because she has a solution to all of this, but at least she is acknowledging the BIG PICTURE. People need to WAKE UP. Our appliances, computers, etc... are not cheap...they are just being paid for in human and environmental costs in the third world. As I sit here I am smelling burnt plastic wafting in from the streets. I am seeing this stuff first hand. The people have nothing, the country has been deforested to 2% of its original level, and I am told presidents, no matter their platform coming in, here can't do anything without first pandering to Haiti's big corporations; Big corporations which have a financial incentive to keep 90% of Haitians poor. The only thing Haiti has going for it is the liesure time she speaks of. (there is a 60% unemployment rate here) Haitians have next to nothing, but at least they have time to enjoy the little they do have...?(I am not trying to glorify their poverty in any way) Quality of life -> vs wealth and power?

Settling In

2009-08-22T16:00:00.000-07:00

Last night I got owned by 6 anopheles mosquitoes. It serves me right too since I was bragging to some of the others at the residence about how I haven’t been bitten once in two weeks… When I woke up I noticed I had little red dots all over my shoulder. As I further examined myself I noticed that I had bites everywhere…probably 40 little dots all over my body, and they weren’t random either. I could almost trace the insect’s progression via red welts up my left ring finger to my wrist. The same was true with my left bicep and shoulder. I was sleeping under a bednet though, and hadn’t had any confirmed mosquito bites in almost two weeks of sleeping under it so I was trying to think of a different culprit. Mites? Fleas? Bedbugs? Ants? Who/what could have done this to me? After 5 minutes of examining my body in the shower I came out thinking that I would check my sheets to see if anything was still there….and then I saw them… It was like a horror film… 6 especially fat anopheles mosquitoes dangling upside down on the INSIDE of my bednet! Those little bastards I thought! I laid there all night sound asleep feeling completely safe, while they completely took advantage of me. And then to make it worse they didn’t bother to leave! They were too fat with my blood to relocate the tiny hole at the bottom of the net that they used to come in. I really enjoyed blasting each one individually with a full spray canister of 100% DEET. The scientist in me wanted to confirm that these bugs had in fact taken a blood meal (my blood!) so I smashed the belly of one of them and watched a remarkable amount of uncoagulated red blood smear onto the floor… ughh I was told by some of the researchers staying here that the Haitians sometimes get 150 bites a night while they are sleeping! And that it is for precisely this reason that diseases like Malaria and Lympahtic Filariasis continue to cause nightmares in this country. We don’t see these diseases in the US, not because of pharmaceuticals, but because we don’t have the stagnant water for them to breed in. These diseases are as much about infrastructure (i.e. stagnant water=mosquito breeding sites) as they are about mosquitos, bednets, and meds… Anyhow I patched up my bed net and should not have this problem again.

Today I went on a little adventure with a guy Fr. Tom and Brennan recommended to me as a translator/guide. His name is Robinson. He was born in Haiti, but moved to Daytona to live with his dad when he was 16. He lived there for 10 years and was then deported. He is a pretty big guy, and seems to know everyone in Leogane, which made me feel a lot better about being a riding spectacle…”Blanc Blanc” yell the children when they see me. There is NO way for me to lay low in the community…maybe at night time (everyone is dark then…right?) but I don’t intend to be caught out at night by myself anyhow. Karen Richman’s godson, from her time in Ti Rivye (suburb of Leogane), is named Charlie. He heard from her that I was coming to live at the Residence Filarose and has come to see me twice. He has a great smile, but seems to be very frustrated about his situation in Haiti. He wanted me to meet his family and show me his home so I arranged to ride a bike with Robinson out to his place. I had no idea how long and difficult of a bike-ride it was going to be. It was only three miles, but my terrible bike, the 95 degree heat, and the mid-day sun, destroyed me. When I got back I took an extra cold shower and then slept for 3 hrs. It was great to see the farming part of town though, to meet Charlie’s brothers, to get a snapshot of his life…but it was ultimately a sad snapshot though and he seemed to be trying to impress this upon me. I don’t see how I am going to escape the preconceived notion on the Haitians part, that I am a walking bank…(I mean they are right sort of? Comparatively?) I am really grappling with how to react to the constant encounters with beggars and malnourished kids. As I sit here typing at the Residence Filarose one of cooks’ children came over and whispered “ou Kompba ban mwe manje?” which means “are you able to give me some food?” OF COURSE I am able to give you some food you cute underfed little guy! I thought, I almost blurted… but instead I smiled and asked him in Kreyol (hurray I am able to communicate things like this now!) “Does your mom give you food?” He looked at me with such a blank face and said something I didn’t understand in Kreyol…(comprehending is a whole different game ) Anyhow, it was obvious to me from his whispering/secretive attitude that this boy, his name is Duda and he is 9yrs old, knows that he is not supposed to ask guests here for food and money, but that he was hungry enough to risk punishment. I gave him one of probably 20 packs of salted planters peanuts that I had in my room, and if there was a way to subtly make him take one of my “Centrum for men” multi-vitimins I would have done that as well. I have no solution to my problem of having finite resources and wanting to give food to every sad hungry face that asks me for it. This boy was just one of roughly 7 million underfed Haitians I have read.

My First Tarantula

2009-08-20T17:27:00.001-07:00

http://www.youtube.com/watch?v=PRDuTIUmB4g

Video Update 2

2009-08-20T15:57:00.000-07:00

http://www.youtube.com/watch?v=-7yW5ZWuXag

Living Situation

2009-08-15T19:44:00.000-07:00

The Residence Filarose is the name of the building where I am living. It is about 2 miles from the ocean. From what I understand it is an “international reference center” for the study of lymphatic filariasis. It was built with Notre Dame’s Gates Foundation grant money on land owned by an Episcopal Church in Texas. (All land in Haiti is officially “rented” with tax dollars from the government) This same church has built a nursing school and a hospital (Hopital St. Croix) on nearby property. The Hopital St. Croix group is affiliated with the Notre Dame Haiti Program, hence a Notre Dame building on their land, and a Notre Dame office in their Hospital. This relationship seems to be very sensitive… I am discovering a whole new world of NGO turf wars stemming from government and funding issues. (Currently the Hopital St. Croix, which used to be one of the top 4 hospitals in all of Haiti, is closed because of tax issues with the Haitian government) At this point, from my outsider vantage point, it is all difficult to understand with so many people claiming to be acting on the Haitian people’s best interests.

The Residence Filarose is operated by Jean Marc Brissau (Haiti Program Director) and managers Max and Precene and their staff composed of several cooks, drivers, etc... There are two generators for power, an artesian well that provides clean running water, and a satellite that provides direct TV and reasonable internet. The real surprise was to find an exercise room, built by two previous volunteers, complete with a boxing heavy bag, gloves, weights etc…Recently, because the volume of guests there has been three meals a day (wonderful food!) but I am told that this might change when it is only Jean Marc, his family, and I living there. The roof and various balconies provide a nice view of the countryside and surrounding town. I was given one of the nicer rooms in the building. It has a closet, a bathroom, a shower, a desk, a chair, a ceiling fan, and a bed net. Last night when it rained a considerable amount of water leaked into my room but that slight inconvenience hardly compares to the luxury of the Residence.

Video Update 1

2009-08-13T06:38:00.000-07:00

http://www.youtube.com/watch?v=EHJcnKn-EkE

Back from Mexico and Off to Haiti

2009-08-04T20:03:00.000-07:00

I returned to the United States feeling lucky, as I ought to have… lucky for having been the recipient of a completely financed and organized trip to Mexico, lucky for not getting caught when I ducked in front of fifty people at security, and lucky that I was allowed onto the plane five minutes after its scheduled departure time. As I walked out the arrival gate I was greeted by both of my parents, smiling and excited to see me, who were waiting to pick me up and take me home. The drive allowed me time to reflect and share highlights from the previous weeks; farming with my host family, sparring in front of the entire community, grilling chorizo on wood fueled grills, catching poisonous animals, dancing in Guanajuato, and making new friends from Chicago and Mexico. Our conversation did make it past the “when”’s and “what”’s and eventually we had a disagreement about how the United States should handle Mexican Immigration. It was obvious to my parents that my recent experience had created a new distance between our stances.

Getting a chance to be part of the trip to Tamaula is just another blessing/opportunity to throw on top of a mountain of others that have accumulated in my life. Being in Mexico, rooming with Mario from Teatro Americana, and sharing meals with the Laguna family served as further confirmation of my status in the “1% club” of extreme privilege. My trip to Mexico could best be compared, in typical rich kid from Notre Dame fashion, to jumping in and out of a hot tub during the middle of a snow storm. The initial transition from Adrianna’s luxery in Irapuato to Tamaula’s subsistence provided a real shock to the system, yet it was great fun at the same time. These uncomfortable, and even awkward, leaps back and forth from primitive to developed gave me an opportunity to evaluate on a deeper level my decision to leave my comfort zone and live in Haiti during this upcoming year. It makes me wonder how long it will take my being out of the hot tub to adjust to the snow, and simultaneously if this sort of behavior is healthy? There are indigenous healers in Iceland for example who recommend hot-cold therapy, while the majority of doctors in the United States agree that it weakens the immune system and allows for opportunistic infections like the flu. In this analogy I hope that the Western medical tradition is wrong and that these experiences, Mexico and Haiti, inspire me to give back at the same rate that I continue to receive.

I love the freedom and certainty of action that I feel when I don't map out my days. Planning for the unplanned, leaving room for improvisation, is my philosophy when travelling. I felt that our coordinators were wise to create a framework for the two weeks while allowing Chicago Youth Boxing and Teatro Americana to fill in the details and specifics. For instance this flexibility helped us to position boxing practices at times when our target youth were most available, explore those parts of Guadalajara that we found most captivating, and, in my case, learn how to herd goats. With that being said I think that future trips comprised of multiple organizations would benefit from a more self-evident chain of command.

The Fundacion’s goal of combating immigration through community development in Mexico is the logical way to address the problem, though difficult to achieve. Getting to know Nacho Laguna, a twenty eight year old farmer who returned two years ago from his illegal job in Athens, Georgia, impressed upon me some of the realities of immigration which I hadn’t previously considered. If young men like Nacho, from rural farming communities, are going to forgo working in the United States it will be the result of their communities providing them with a chance to improve their quality of life. A boy born into Tamaula’s current status quo doesn't have a chance of surpassing his parents financially unless he leaves. Tamaulans know that there is more available in the United States. Popular media along with the stories they hear from deportees and visitors make sure of this. It was very clear to me as chatted with Nacho that If I lived in Tamaula, wanted to get married, build a new home, and start my own goat business, I would have snuck across the border with no more hesitation than when I ducked the rope at airport security. He explained that he could make 300 dollars a week in the US, and that in Tamaula he is lucky to make 300 Pesos. Working to make the Tamaula community more cohesive, to educate its youth, and to provide extracurricular activities, though not unrelated, is still a far cry from improving the economy which I believe is causing the problem.

The antiquated farming equipment, rocky soil, and small market for surpluses, strike me as Tamaula’s biggest barriers to economic development. All corn is planted by hand. There is no fertilizer other than goat feces which requires the beans and corn to be planted together, beans being nitrogen fixers and corn being nitrogen consumers. This makes harvesting by hand a necessity. The corn they grow is surely not the most fruitful breed, as giant agriculture companies such as Monsanto sell this breed at high premiums, patent the DNA sequences, and genetically modify the plants to be sterile. With tractors, pesticides, and synthetic fertilizer Tamaula could conceivably double or even triple its corn and bean output. Nacho explained that the corollary would be using the extra corn for goat feed and ending the daily seven hour grazing hikes demanded of him.

I felt uncomfortable telling Nacho about the forty acres of land that I grew up on in Missouri. The soil was rich and rock free, a plot of land unimaginable for Nacho and his father. When the goats are taken care of and the corn has been harvested, Nacho spends his days loading boulders onto a donkey sled and pulling them to the side. Before my day in the fields, I wouldn’t have believed anything could grow in soil with so many rocks. He plows the land with a horse team and a steel frame plow, both expensive and coveted, which he likely could afford with the money he saved while in the US. “I prefer this to what I was doing in the United States,” said Nacho; words that ought to be encouraging to organizations like the Fundacion. Mexicans like Nacho who immigrate are not aspiring to be millionaires. They seem to merely want to provide their children with, and expand on, the opportunities and lifestyle that their parents provided them with. Nacho found it necessary to work in the United States to achieve this.

The fact that Tamaula is a traveler’s dead end, being on the top of a mountain, makes commercial enterprises difficult. The Laguna’s goat cheese business, with a maximum output of about four wheels of cheese per day, does not have a very big market in Tamaula. The family will occasionally sell cheese and butchered lamb to stores at the bottom of the mountain but Nacho made it clear that the prices were not great enough to make any considerable profit. There were only two stores, run out of homes, in Tamaula, and no indoor public spaces other than the school.

Conversing with Nacho also made me aware of many of the serious issues that we as Americans need to address at home with regard to Mexican immigration. Naivety is something which I think needs to be changed amongst the wealthy movers and shakers of our nation. I wished, as I debated the immigration issue on the way home, that my parents knew a Mexican immigrant. Until hard working Americans like my parents look Mexican immigrants in the eye and realize that they are working equally hard day to day for the same reasons, they will never be able to fully appreciate the situation of Mexicans working in the United States. I am thankful for having had the opportunity to confront my own misconceptions about Mexicans, Mexican immigrants, and Mexican Americans.