The guest house we stayed in was the same place we would see patients in so it was nice and convenient. After breakfast with good Rebo coffee, we went upstairs to see patients who arrived early waiting patiently for our arrival. Myself, an ER doc and a nurse from the states with Haitian staff saw patients that day, I also had a young aspiring nurse Katie working with me. After being trained, she helped take histories and do some of the physical exams on patients. It was nice to have staff helping out in the pharmacy. The pharmacy was fairly well stocked with medications. In contrast to places we did mobile clinics at, this clinic seemed to have patients who were relatively healthier, perhaps because they live in the surrounding area and can get regular follow-up care at the clinic, sort of a haven. The need for mobile clinics is vast as many patients do not have access to health care or money. The Christian based clinic has a Mom-tot program for moms w limited resources who can be sponsored w food, classes and parenting techniques from pregnancy until children are 3. My favorite thing about working at this clinic was being able to start the day with devotions and pray for individual patients. This helped in the deliverance of compassionate care. We finished the patient care mid afternoon. The cooks made a delicious lunch (with picklies, plantains and sweet potatoes) and dinner (vegetarian mix of vegetables with rice and peas served with mangos). I slept upstairs in the same clinic room I’d be working in which was much better rest after I removed a large spider from the room.

I got up early and met with Larry Roberts at the guest house, a man I previously knew from working at the Bernard Mevs trauma hospital when he was seeking medical treatment for one of the children he was caring for in his group home. He runs an organization called Servant’s Gift which takes care of Haitian children. I planned on helping out at a mobile clinic at a remote school in a town about an hour away from the capital of Port au Prince called Carrefour. He has worked with the school for awhile. A man who is an FNP from Portland, Doug Brown joined us as he specializes in alternative medicine and would be offering these services to the group. We packed all of our meds and headed out in a rental Larry had which was similar to our jeep. He had to negotiate very narrow and sometimes scary roads up steep and rocky hills. Along the way I saw women selling mud pies in big bowls, which were reportedly made of sugar and mud and really did resemble sugar cookies. These were the same pies many of the patients I treated obtained their worms from, and they seemed to be a common snack, perhaps because of limited access to foods. One of the many public health educational opportunities I saw to teach about the seemingly unknown problems associated with consumption of such items. Once we arrived and got briefly acquainted we set up mobile clinics in a couple of the classrooms. Patients were given the option of having more conventional medicine with what I had available or alternative medicines with Doug Brown. Larry helped me see patients and we did our own vital signs, and gave out meds. Between both of the supplies we had there was a substantial amount which was great. The most interesting case I saw was a young woman who we were told had “AIDS’ but we were not supposed to tell her which was disturbing as she’d been labeled as having this disease. She appeared to have a bad case of pneumonia and possibly tuberculosis with hemoptysis and other symptoms, plus she was tachycardic and had a high fever. I did what I could to treat her with meds available and advised her to get to a hospital when or if she could for HIV and TB testing, at least that way she could be informed of her health status. There apparently was no hospital in the area and we were somewhat isolated on a remote hill so unknown if she’ll get any follow-up care. With mobile clinics you aim to maintain an array of meds but for bigger problems like HIV and TB it requires a whole different arsenal of long-term treatment options. Maybe in the future I can add some of these options. The one med I had an ample supply of for TB, Rifampin, was stuck in customs at the airport and due to expire so it wouldn’t have done a lot of good as it has to be taken for many months. More items I need to add for mobile clinics which are much more easily accessible in stationary clinics are nebulizers for airway issues and IV fluids. Again I had a station set up for worm treatment and Gentian violet. Being closer in the country areas there seemed to be more of a prevalene of voodoo. I had one infant who was wearing a tooth around his neck and a small shell on a necklace. When I inquired about the meaning and asked if it were voodoo related I was told by one of the translators it was a Haitian thing I wouldn’t understand. Someone said it was for antibiotic purposes when the teeth are pulled. There are unique cultural practices that are hard to understand in Haiti. At the end of the clinic day the mom of the school administrator had cooked us a tasty homemade scrumptious meal. The view from the top of the school where we ate in a classroom was gorgeous as it overlooked the fabulous large ocean and green lush trees off in the distance. This picturesque Caribbean seen with the warm sun and comfortable climate was so inviting. It was also such a sharp contrast to the immediate neighborhoods in the area we were working within. It is admirable to see the resilience and endurance of the Haitian people. The work ethic and willingness to extend love to visitors is much appreciated. After leaving the clinic I had planned to return to the Hope Alive Clinic in a neighboring town called Mariani. Larry the driver did not want to drive the opposite direction of the capitol though. I was so happy to find out when I called the woman Leslie who manages the Hope Alive Clinic that they were already in the area so I was able to meet up with them as fate would have it, felt like it was God’s plan for me to connect with them. It was reassuring to have a sign that there was somewhere else I was supposed to be since the plans I was hoping for with the Cite Soleil clinic didn’t work out. It reminded me how we have our plans which often are not consistent with God’s ultimate plans. This trip is Haiti is giving me a lot of time to be introspective and let Him move. Larry reminded me on one of our talks that when we step away from trying to do things on such a rigid time structured path it allows God to operate. That’s a lesson I’ll carry with me. Once I connected with the new team in Mariani we got to know each other over dinner with spaghetti at the Hope Alive clinic/ guesthouse where I spent the first night in Haiti. I spent time visitng with the local staff later. I tried to sleep in the room with the other guests later, but many people in one room with lots of snoring made it hard to sleep. Instead I headed up to the rooftop and dragged some mats out to sleep where some of the other local staff were sleeping Libertan and Wilio. I tried not to worry about the possible tarantulas that lived around the guest house crawling up on the mats, but it made for a restless night. We laid up in the late night hours chatting and they taught me about Haitian culture. We laid out under the stars enjoying the breathtaking views of the sky. We could hear what sounded like voodoo ceremonies off in the distance which was a little unsettling with the music off in the mountainous areas. They tried to scare me with stories of bad things that happen at night. We chatted until falling asleep. Funny we were awakened by rain drops pouring down a couple of hours later and I eventually ended up on the porch trying to stay dry, it was a restless night, but I managed to get enough sleep to still wake up and start a clinical day.

The morning started off right with 4 peops coming to meet me at 7a to help get a mobile clinic started.  It was divine intervention with the encouragement that helped me press on.  We boarded a private tap-tap and headed to several pharmacies to stock up on a range of medications trying to anticipate the variety of diseases and make sure there is adequate coverage for potential diseases is always a challenge.  I take for granite the preparation it takes to adequately stalk a stationary clinic.  Clinicians were generalists with experience in internal medicine and a love for pediatric populations so it was an ideal group.  We headed down to general hospital to get equipment.  We drove by the areas I worked in before in a neighborhood called Belair notorious for being dangerous and riddled with problems.   We were driving through the areas around the Presidential palace which sustained a lot of damage from the earthquake.  Reminds me of the impoverishment and homelessness I used to see when living in DC around the white house.  The areas by the Palace are surrounded by people living in tented camps.  The area is covered with poverty but somehow there’s a palpable strength on the faces of people.  It’s always impressive to drive past the Cathedral which was badly damaged and the Crucifix in front of it which appears unscathed.  I see it as a message of Christ’s omnipresence.  After we finished up at the neighboring pharmacy across from General Hospital and I did a little browsing from the vendors on the street we headed to a area not far  where we set up a mobile clinic in the back of the church.  Many people of seemingly all ages were waiting in line seated in the different pews patiently anticipating our arrival.  I had to make a trip to another pharmacy to get some meds we were missing so one of the clinicians got it started which was great.  There were a bunch of meds for peds in liquid form so he focused on seeing the children until I could get back.  Trying to get meds to cover chronic and acute conditions was no small task.  There were infectious diseases that needed treatment on top of many chronic issues I’m used to seeing in the U.S.  After I returned I worked with a Haitian nurse who was doing a good job working in our made up pharmacy.  We set up a station that the translators helped out at to treat fungal infections with Gentian violet and a worm station to treat the many cases seen.  It helped better manage the distribution of meds to a large group of people.  It was hot and stuffy and tough not to grow tired from the long lines and lack of privacy even though I was in the corner of the church.  There was no running water and no fan or AC with a hot climate things one quickly gets used to with mobile clinics.  Just on time, in the middle of the afternoon we were surprised by the church moms with homemade Haitian food.  The homecooked food was tasty enough to make me forget about the worries of typhoid or hep A that can be contracted from unclean inner city areas.  The meal included green lettuce and salad with potatoes a tasty sauce plantains and a meat (that I gave away) with a really tasty sweet and frosty tomato juice.  The warm hospitality is always present and just one more reason I appreciate working in Haiti and long to return when away.  We finished up the clinic about 5:30pm and headed back to the guest house on a taptap after dark.  It was a tiring, but productive day, lessons learned and a good feeling of helping many people who just maybe wouldn’t have received the care as we worked in a disenfranchised part of town.  Patients have consistently been grateful for services, I love that and they always say merci (thank you).  Mobile clinics, although tricky to manage when it comes to setting up, stocking and never being able to fully plan what ailments may come about are very rewarding as it is a means of delivering care to meet people where they are at, closer to their residence.

I connected with a couple of women at the guest house and we went to a Creole speaking church down the street.  I enjoyed singing and praising in Creole.  The service lasted for a few hours with a few different pastors giving sermons.  One of the main Pastors, Pastor Luc noticed us sitting up front which was welcoming as he had us stand up and introduce ourselves.  He translated and we received an applause from the audience.  It felt good to be welcomed.    After the service the Pastor came to talk with me and I was so excited to learn that he has done work with mobile clinics and he has 43 churches in the mountain areas.  I feel like God has laid it on my heart to do mobile clinics so it was perfect timing to have an affirmation of this idea from a well known man so connected in the Haitian communities.  We exchanged information with plans to connect.  After walking back to the guest house, I walked around the neighborhood with a friend Bernard to try and get something to eat.  I changed my mind after the food spot we went to didn’t have the food ready yet and it did not look to clean or safe to eat.  We headed back and I connected with a friend John who arranged a ride for us on a motorcycle (my first time riding since I was a kid), a main mode of transportation in Haiti.  We headed to Petionville, stopped by some shops to look at shoes and then over his Dads.  I hung out with his sister and her friend and enjoyed some Mango juice and hospitality.  His friend came by and we all headed out to a real nice outdoor gospel concert.   It was at Place Boyer a mayoral center on large grounds with a concert stage.  The place was clean and spacious. We enjoyed an array of Haitian gospel music and my friend surprised me with snacks and a tasty Haitian meal as they were serving food in the back.  It was the perfect refreshing way to get rejuvenated and start the week off right.  We walked around the grounds and stayed until evening.   That night we headed back to the guest house.  We made plans for the next day for folks to meet me at 7a to get the day started for mobile clinics, it was so motivating to have such love and support.

The morning started with plans to do a mobile clinic at one of the orphanages in Croiz des Bouquets where I previously worked. There were a number of Haitian staff working with me including a Haitian internist, there were last minute changes in who could go but it worked out with those available. Our first stop was the 4C pharmacy to stock up on medications and another store for misc supplies and additional medications. Many lessons learned on all the various items needed for a successful mobile clinic beyond the assortment of meds which in itself is a huge task, items like gloves, hand sanitizer, blood pressure cuffs, thermometers w covers, among others help bring it all together. Doing a child focused clinic verses adult emphasis requires different meds and they should be available in liquid form to ease swallowing. It helps to have a scale or good ability to gauge weights as meds are supposed to be given based on weight, in many cases guessing estimated weight is necessary. It’s tough to pick meds based on potential diseases that may be encountered. We arrived at the orphanage in a tap-tap. We were greeted by the Pastor his wife and the children and toured the facility. They were thankful to have received the food shipment that day w beans/rice, oil, spaghetti, seasoning, dry milk , sugar and cereal which was purchased from the T shirt campaign. The orphanage had rooms filled with bunks, a kitchen, a bathroom and the backyard had latrines. We passed out donations (i.e. candy, educational goods, toothbrushes, toothpaste,, Vitamins) while setting up the mobile clinic. I set up a worm treatment station and another area for treatment of skin infections with Gentian violet. I had the driver get involved with that part and he helped treat each of the children who lined up waiting for their turn. It was a good day- we saw many children until nightfall. We had them line up to do a quick head to toe assessment and evaluate who needed further treatment. We saw worms, scabies, malnutrition, various skin infections among other problems. We stayed until after it was dark, did not get to treat all of the children. It is hard to end a clinic day without seeing everyone, but that is a reality in managing high volume clinics. We headed back to Port au Prince after a tiring day.

Some of the team was leaving today so they took the morning off to site see. The other group of us went to the Cite Soleil clinic to work. There was a very long line of patients waiting in line for our arrival. Since the group was smaller it impacted flow. There were other volunteers there from the group Samaritans Purse which is an nongovernmental organization (NGO) which owns the clinic we were working in, it was nice to have other volunteers. We had to be very patient with everything taking longer with fewer providers. I was disappointed that we had to end the clinic early that day as we had to transport the other team to the airport. At the airport, Jackson, my friend who helped me translate, helped me go to customs to try and get medications out. Without the paperwork they required from the Ministry of Health saying it was okay to use the meds in country, it was too difficult to get them out of customs. By now, I had contacted Americares the company who donated the $49,000 worth of medications and even the U.S. Embassy for assistance to help get the medications out of customs. I had no idea how complicated it would be to get the medications out of customs and I would have just bought the medications in the country if I knew it would be so difficult. Mike from the US Embassy was helpful as he gave me a contact at the Ministry of Health to let them know I was coming to the office. Part of the Canadian volunteer group actually rode downtown with me to the Ministry of Health (MSPP). Enroute we saw many of the buildings damaged in the earthquake including the Palace as we drove through some of the very unsafe and impoverished areas including the Belair neighborhood where I previously worked in a clinic within the Nazarene church. Surrounding the areas around the Palace were areas with tents with people residing in them. We drove by the Cathedral which is always interesting to see how the Crucifix appears unscathed from a distance while the Cathedral itself is extensively damaged. It is a testament to me, to the Great Lord’s omnipresence. We eventually got through the area and made it to the Ministry of Health which is right by General Hospital. After going through security we eventually got to the pharmacy within MSPP where the contact was located. I was so disappointed when I finally got to that point and learned he was gone for the day, I notified Americares again and they agreed to follow-up. It was another test of my faith, knowing God’s in control and the medications will end up where he wills in His time. It was a lesson learned about the need to get approval for meds before bringing them in country and navigating through a complex system to do so. At least after this trip I’d have contacts for names and numbers. We went driving after to Vista Lodge which was an elaborate hotel with a classy outdoor dining restaurant overlooking a pool and large hill with a view of parts of the city. We decided to stay for dinner. I had tasty drinks with vegetarian selections of pizza, picklies and some plantains. Dinner was delicious and a nice way to spend the other teams last night.

I later learned that long term volunteer Americans was accosted by armed men on their way out of the same region I was working in within Cite Soleil while they were in a truck just a few days after the team I worked with left, although no one was injured and no shots were fired. I reflected, thankful for the Lord’s hedge of protection over me, keeping me from unforeseen harm and having to encounter such an incident. It could have been a traumatizing experience possibly tainting my visions for service in Haiti. I also learned in a different section of Cite Soleil there were 3 homicides, reportedly of a school director, reporter and another person that next week after we left out. It occurred the same morning that a youth group staying at the guest house I was at went to go visit a school in the area. I was first upset when the Haiti outreach ministries organization that I volunteered with that first week told me I could not work with a team there the next week as they have a policy where they do not mix teams. I was initially told it would be okay to volunteer the next week with the oncoming team. This news of the change in plans came to me through word of mouth from the US based office through someone in Port au Prince. I accepted it as God’s will and went ahead and proceeded with other plans to work with a different team in another location at the Hope Alive clinic in Mariani. In retrospect, you never know what you are being protected against and I am so thankful looking back that I did work in a different location for that second week.

We started the day out even earlier a shock to my system as I’m not a morning person, at all. The plan was to leave by 7am as we were headed to do a mobile clinic at a tent city by Cite Soleil.  After having coffee and fruit we left a lil later heading out through the busting streets pass by a different clinic called Blanchard where I had wanted to stay the following weekend. We stopped by to pick up supplies enroute to the camp. A group packed up medications that were used to set up clinic at the tented city not far away.  We arrived at the tented city, volunteers were oriented to different stations with areas designated for waiting areas for patients, a pharmacy, triage and a section in the open for clinicians.  Not much privacy available. We were welcomed with opened arms by loving children running up to us, a reassuring feeling in what at a brief glance looked like a destitute place. On a closer look, they were people , some working , some struggling to make a living like anyone else.  We were later told they had not had anyone provide healthcare for a year or more, they had to walk far for water and had little or no food, latrines were full which left few places to use the bathroom.   The culmination of a lack of sanitary facilities seemed to create the perfect breeding grounds for diseases.  What caught my attention were the scraps children put together for toys, looking oblivious to the poverty, a little boy pulled along a car on a string made out of an empty old oil can with wheels attached.  I’ve seen creativity like never before in Haitians which was uplifting.  Malnutrition, hunger and disease were seen in the camp, all balanced with a palpable resilience and determination in the community.   Diseases untreated had manifested into progressed cases and we had to just do the best we could with limited medications available. It felt like just putting small bandaids over deep rooted wounds.   Poor nutrition from lack of food was a magnified problem.  Women who had endured many hardships were forced to fend for themselves and their children.  It was not uncommon for children to come unattended by an adult.  One 14 year old girl who lived in the camp alone was an orphan, both of her parents were deceased and her brother lived in an orphanage. Her period was late and she had been sexually active. She didn’t appear to be phased at the thought of being pregnant. With scare resources and the need to treat an infection she had I couldn’t do a pregnancy test, just had to pick meds presumed okay in pregnancy just in case.  Her story is likely just one of many.  Earlier in the week  I worked with a young woman who had been severely beaten and raped left for dead, but she survived.  Now I was working in a tented camp where such actions, perhaps on a smaller scale were possibly commonplace.  Food was limited, I heard main staples if even options were beans, rice and bananas and of course the mud pies made with mud, sugar and oil.  There was not an outside source I knew about supplying food.  Walking through an unsafe neighborhood was required to fetch water.  No toilets created its own unique set of issues.  I’d read an article of women being attacked when seeking to use the bathroom on the camp outskirts. I even found it tough to find a private corner to do patient exams when needed.  At the end of the day I walked through some of the camp with translators and met community members. They shared with me that they live in the camps and have medical needs.  I watched children in the distance playing games without regard to scarcities.  Men stepped up from the community to serve as security.  I saw young women longing for attention, children and babies hungry, fatigue on the faces of the older tenants.  In the end of it all, one wonders how much good is really done. At best, perhaps the visits provide a glimmer of hope, maybe treating some conditions, still outcomes are all in God’s hands.  Many diseases will remain untreated, hunger may continue.  Striving to be His hands and feet is all one can do.   In the debriefing that night where we all seemingly selfishly retreated to the comforts of food and safety we talked and quietly reflected somber and still with all that had been seen.   We saw a total of about 200 patients that day, practicing what I call raw medicine, never enough, but for some patients hopefully it helped.  We talked on what had been a Blessing or surprised us- for me it was feeling the spirit of God and seeing Jesus so in the people of Cite Soleil , a place I could not even get a ride to in the past cause of its negative reputation.  We shared what challenged us the most- for me it’s now that I’ve witnessed the massive needs in the tented camp and other places , how will I respond to the call to help.  Lastly we shared our takeaway from Haiti- for me the lessons taught by the Haitian people 1) have faith 2) be patient 3) be grateful, always say thank you 4) love Jesus 5)work hard and 6) make the best with what you have.  We finished the night socializing on the rooftop talking and taking in the cool breezes. My mom,  Rosetta Schuster, who always encourages me reminded me before I left that there would be times I’d be uncomfortable on this trip, but that everything will be allright as I’m doing God’s work here.  Reflecting on all the lessons in just a short time, I realize she right.  I’ve stepped out of my comfort zone, definitely tested in these circumstances, but it is all so rewarding and I’ll forever remain changed.  I’m thankful for being called to serve.

The day started as usual with fresh fruit for breakfast and coffee.  We headed to the clinic at about 7:30 am.  Set up was quicker as we had a routine developed.  We heard patients would be waiting in line as early as 4:30am, a humbling reminder that the Haitian people have something to teach us about patience.  Patients were triaged through the clinic through the EMS and medic volunteers to myself, one of the two ER docs or an RN Danielle.  After we saw patients we sent them for testing or treatment (i.e. blood or urine tests, nebulizers, or IV/IM medication treatments).  It felt good to have the unique benefit of seeing patients in individual exam rooms, in prior patient care in Haiti things had to be done much more openly with space constraints.  The pharmacy was usually the last stop where medications were picked up and instructions given by a Kreyol interpreter. We saw many acute and chronic cases.  The one that day which made one’s heart thump was an infant suffering bad from malnourishment.  One of the doctors had a 7 month old grossly undernourished baby come in whose mother had been reportedly feeding him some kind of mix of oil w flour n sugar. In her defense, she was working with what she had, the grim reality of a single mom raising 4 other kids and whose mom was helping her look after the infant as she was struggling for ends meat.  Without an academic education or financial resources no wonder so many moms could succumb to feeding their children whatever they could find, rumors of coffee creamer for formula, the truth of mud cookies that are made with sugar and look like sugar cookies.  Who could blame them, knowledge is power and a lack of it can be detrimental. So 7 months later this infant, who appeared lethargic so weak, barely able to move and frail with no muscle tone appeared as if fate may be better on the other side of the fence if reality meant continued consumption of homemade formula and the malnutrition that ensues.  The baby required an intrajugular intravenous line in her neck just to get IV fluids in her.  The mom declined taking her to a hospital, but she agreed to take her to a nutrition center the next day.   No human is in a position to judge and we had to be careful to question her decision, she had 4 other children to feed, probably at home alone.  When I walked in the room, sadness filled me as I stopped and looked at her, saw the hopelessness in her spirit, emptiness in her eyes, her other child stood by her side, he looked about 2 years old and he began urinating on the floor.  None of us had the heart or strength to even react, to busy taking in the cold realness of the case.  What hit me hard is this woman likely represents one of millions of mothers.  Mothers suffering, enduring nights and days of hunger, mothers longing to provide some stability, some nourishment and comfort for their children, with protection and shelter for their seeds, feeling perhaps alone and isolated maybe even agonizing in the process of daily grinding. Thinking silently, intense realities are startling it is hard to imagine living in this tough environment.  I’m just coming in and out for a visit taking in a glimpse of the hardships I cannot even begin to fathom.  It is truly heartbreaking, I make a point to keep my cool and never get emotional in delivering patient care, this time my spirit was truly tested as I wanted to shed tears for her, for this little baby who’s future was questionable. Instead, I held back as usual, tried to think quickly how I could make just a little difference. Instinctively, I grabbed a small bag with granola bars given to be that morning and ran around the clinic to collect whatever food I could from the volunteers there on the ground.  The outpouring of love on the spot was inspiring, the small bag was replaced by a garbage bag filled with food.  The look on the moms face when giving her the bag was priceless.  For a moment in time, her face lit up a little smile shined through.  And for at least a point in time, just maybe she had a little hope and encouragement. One of the nurses bought her formula to take home.  After silent prayers and fluids given, the little baby called Shamella began to gain some energy, she shed a few tears, I think in each of us tears were silently shed as our spirits were shook.  This is why I came to Haiti. Perhaps I’ll never make a difference for the masses. Maybe not even for large groups of people, only God knows His plans, but all I know if for the moments I’m here and all we have is this moment, for the people I’ve been Blessed to touch I’ve made a difference.  At the end of an emotional day like this, I realize the one who is really Blessed by these trying endeavors is me, as I am vicariously strengthened by every patient encountered.  As a doc on the team said, you never know who is watching you and who you can bring hope to, in places consumed with hardships that hope can go along way. I’ve seen opportunities for public health interventions are vast such as teaching community health workers to teach parents or guardians how to make formula for cheap, how to prevent worms by avoiding mud cookies, how to manage anemia cheaply with endemic products, prevention of reflux, management of blood pressure on a budget, preventing GI problems by cleaning water cheaply and a number of other issues.  Reduction in ailments with educational interventions in communities should not be underestimated.  In the fields and out I reflect on the statement by Mother Theresa of Calcutta which referenced how we feel like we are but a drop in the ocean, but without that drop the ocean would be less.  My dad, Daniel Schuster reminds me to make my drop a big splash.

Off to an early start after the routine breakfast, this morning oatmeal, fresh fruit and toast with hot coffee, and a mug to go before boarding a taptap, this time with my makeshift coffeemug halfway secured with a Ziploc bag. Confrontation with the street elements is a sobering reminder of the massive needs in Haiti.  The streets are bumpy and mostly unpaved, an analogy to life for many here.  In the congestion, people are busy hustling misc items in a quest to get paid, items for sale range from foods to electronics or whatever’s clever to make a living.  Shacks made of items found from tin to pieces of wood, tarp and metal make up the homes and vendor stands.  After about a 15 minutes ride through the urban neighborhoods we get to the clinic.  After braving the streets of Port au Prince in the taptap I had maybe a quarter cup of coffee left, enough to get me through the morning.  We set up in the Cite Soleil clinic, now routine as one quickly adjusts when being confronted with many complicated patients after a day of care rendered.  Most of the things used to set up the rooms are old and outdated, improvisation is the key to thriving and humbly making do with what’s available.  The morning was uneventful until about my 3^rd patient that is, a lil infant who was crying incessantly as I was holding him I felt my leg turn warm, I looked down and realized he peed all over my leg. Didn’t think on the fact that diapers are expensive and many of the infants don’t wear them as a result.  One of the nurses Danielle was nice enough to arrange for me to get a pair of scrubs so I could change.  The day pressed on with many acutely ill patients who couldn’t afford to get to a hospital so it kind of felt like an urgent care center.  The one who stood out the most was a little boy sick with bad pneumonia and untreated asthma who required advanced care.   Reflecting on basic meds and access to care we take for granite in the US that prevent escalation of often simple diseases like asthma, but when unmanaged can result in death.  Many of the patients have basic care needs and a host of other health problems.  Running back and forth from the pharmacy all day to figure out meds available was tiring, but I was glad to have access to the variety of options.  We wrapped up the day by about 4 pm. Arrangements were made to take me and 3 of the guys to pick up some luggage with medications that a friend brought for me from Portland the week prior.  It was a relief to be able to finally connect with meds after a long drive and having to stop several times for directions, especially relieving after not being able to get other meds through customs.  On the way back we stopped at a Haitian restaurant and had spaghetti Haitian style which is served with veggies mayo and ketchup and crepes mine w cheese, all good served w fruity juice drinks. We headed back to the guest house and were able to enjoy bits of the Caribbean carnival with large groups of people parading the congested streets with music and dancing.  A police presence was noticed among the crowds.  Observing the different parts of town there seemed to be fewer people living in the tented camps than visible on previous visits, though this was only at a brief glance. Even though the poverty still appeared rampant, it was nice to see people happy and celebrating.  I heard from at least one Haitian that Christians do not usually take part in Carnival as it involves unwelcome activities like drinking and fighting. It was interesting to observe some of the festivities on the way back to the guest house.

Tough and restless prior night sleeping with so many people in a room, lots of noise with snoring and being awakened so early made it hard to feel rested for the clinic day ahead.  Topped off with a rough morning having taken Doxycycline 200mg on an empty stomach for malaria prophylaxis made me sick, learned not to do that again.  Morning quickly improved with fresh fruit for breakfast with mangos and watermelon and a cup of tasty strong Haitian coffee called Rebo.  Felt good with the warm sun shining, one of my favorite things about Haiti.  We boarded the tap-tap, a local Haitian mode of transport, a midsize truck with an open back, usually painted with vibrant colors and religious messages for designs, normally packed full with many people.  The team rented a few private tap-taps so we all got on and shared a cozy packed ride to Cite Soleil about 20 minutes away riding over many bumps on the rocky roads. I quickly got used to riding tap-taps and liked the open exposure to the street life in Haiti where we drove past numerous people and vendors working hard creatively selling all kinds of items from bowls with toiletries to fruit and even medications.  I loved seeing school children in the early mornings from the smallest to older all in nicely dressed uniforms and young girls with ribbons in their hair.  It speaks to the values of education and determination via work ethics integral to the Haitian culture.  The streets of Haiti are filled in the mornings with the hustle and bustle of people selling what they can to make a living, stationary vendors often sell items varying from food to electronics and clothing.  There are mounds of garbage interspersed on the streets, especially causing profuse odors when they are in bodies of water combined with the heat so the smells are often profuse and malodorous most notable when large piles of disposed products are burned. The putrid odors are short lasting though as the warm island climate and air blowing somehow seems to outweigh the offensive odors.   It’s sad to watch the children standing and walking amidst the piles of rubble and garbage and seeing animals, many emaciated dogs and cats, eating what scraps they can find.  Somehow the people seem to cope and are not, at least outwardly, phased by the visibly profound hardships in the environment.   It hurts to see so much hunger, stacks of garbage lining the streets and occasional pools of water filled with stacks of even more trash thinking on diseases of poverty born out of exposure to these elements.  Witnessing the massive needs it is easy to contemplate feelings of inadequacy, at a loss with resolutions to do much that would really make a difference.  Taking in the variety of colorful impoverished sites enroute to the clinic shakes and jolts one’s spirit.  Tin make shift shacks mixed among tented camps and boarded up sticks arranged with scraps to form houses, a shelter for what many call home in Haiti. Insight along the drive triggers doubts, raising questions on solutions while trying to remain pragmatic about the harsh reality of limitations.  Trying to avoid thoughts that clutter my mind on such seemingly insurmountable needs is a struggle.   Looking at the big picture in scenes like this must be avoided as it is self defeating and overwhelming, only casting doubts on the possibilities.  Still, off to the clinic it is, knowing that, at least for the patient’s encountered, I have a chance to make a difference, maybe help cure a disease and at least for a point in time, make someone’s load a little lighter.  In those individual potential differences resides the motivation to press on.

Not knowing what to expect in Cite Soleil was discomfiting as it was a historically dangerous, turbulent and often avoided section, others call a ‘slum’ on the outskirts of Port au Prince.  It was both intimidating and thrilling to look forward with anticipation on what was to come on the adventure there.  After previously trying to work in Cite Soleil on a former trip in Haiti, I was never able to as I could not get a local Haitian who’d agree to transport me to this region, even though I had a relief agency, Catholic Medical Missions board with a clinic there I was approved to work in.  That morning pleasant surprises awaited our crew as we drove into a what appeared to be newly renovated section of the town which was a cleaned up, nice segment of the Cite Soleil community with a large well-established church, a large school and a older clinic that was damaged in the quake and a newly built clinic shared with Samaritan’s Purse.  There were fresh almond and banana trees in the yard areas.  We set up our stuff in the clinic which consisted of a triage area, a separate air conditioned pharmacy, nice bathrooms and individual exam rooms.  It was refreshing to have a separate area to see patient’s in offering some privacy as previously this was limited in other places I’d worked in within Haiti.  It was obvious a lot of work had been put into this area.   We got our rooms set up with supplies, I wished I’d have brought a blood pressure cuff and thermometer to go along with the oximeter, otoscope/opthalmoscope and stethoscope to use but next time I’ll know to bring it all.   We met our translators, the young man who worked with me was named Jackson.   We began to see a steady flow of patients that morning.  Cases ranged from minor abrasions and rashes to more acute infectious conditions: probable malaria, pneumonia, upper respiratory infections, asthma, hypertension, diabetes, genitourinary, gastrointestinal conditions among others, the most difficult to treat were dermatologic. Motivation came from hearing background live and recorded gospel music in the background at the church next door which ignited the perfect peace needed to get through the challenges.  After spending the day treating many patients, we wrapped up by 4pm and boarded the tap-tap (large truck w an open back to be filled w people a public transpo system, though this one was private).  We headed back to Walls Guest house.  We started the evening having a tasty dinner prepared by the hard working staff at Walls who are great cooks.  The night prior I bumped into a couple of people I knew from before, one a RN from Seattle and another man I knew, Larry Roberts, from the trauma hospital from a patient care encounter who started a organization called Servant’s Gift and had a group home in Haiti and who does mobile clinics.  It was the first of many serendipitous meetings, it was real cool to make new friends and see old ones.  We had Haitian food w an American twist, picklies that are coleslaw lie but delicious assortment of cabbage w Cajun flavor and vinegar, salad, fresh fruit and a mac n cheese mix w ham I picked out.  I loved the fresh hot Rebo (Haitian) café (coffee) available around the clock, mmm w crema (cream) e suc (sugar) a welcome treat after a long draining day to refresh.  Myself and two of the docs were taken out for a night time tour by the Pastor running the organization Haiti Outreach Ministries that we were volunteering though.  He took us up into the more exclusive wealthier part of Haiti.   He drove us up into the hills of Petionville where the houses are large and beautiful, he said they average around $200k US dollars.  We went to a couple of very fancy large hotels that stand on hills, one which had many guests perish in the earthquake. The hotel grounds were exquisite and larger than any place I’d stayed in within the US with outdoor and indoor restaurants, pools and tennis courts.    I had previously seen this part of Haiti before, still it was nice to see the sharp contrast of what I’d been seeing with the fancier parts.   After a restless night prior w ~6 in a room, too loud to sleep right, I was able to move into a private tent which I really enjoyed sleeping in, snoozing by midnight to get ready for another day.