I spent the morning in the usual routine getting up to breakfast and coffee at the guesthouse. I headed out with the large group I met from Duke University about 7:45 am to a large church Lharmonie (Cite Soleil) to do a mobile clinic. I was really looking forward to serving in this capacity knowing it was a chance to reach patients who likely did not get regular access to care. We set up at tables in the front of the inside of the very large church with one or two providers at each of the tables. There was a separate pharmacy set up that was managed by some of the Haitian staff and a pharmacist named Jonas from Duke. A room next to the pharmacy was available for patients who needed treatment or confidential exams. There was also a separate eye station where they did eye screening with charts and distributed eye glasses. I heard glasses were greatly appreciated and sought after as they were often needed and maybe even considered a status symbol or sign of wealth. A spinal surgeon available focused on seeing musculoskeletal cases. The interpreter who helped me was James. We saw patients of all ages, the youngest who was about 14 days old and had an impressive case of tinea capitis to the oldest who was 91 and impressively healthy not even using an assistive device to walk, her biggest problem was untreated blood pressure and somebody pain. When asked what her secret was to living her in her life her response was “God’s Grace.” She advises younger people that God helps. It was encouraging to hear that and continue to see His presence in the people of Haiti. The spectrum of conditions, some diseases very pronounced compared to mild un-worrisome cases was interesting, especially considering we were working in one of the notorious slums, Cite Soleil, that many won’t enter for safety concerns. Many of the conditions were exacerbated by anxiety, a recurrent theme. When asking around about the opportunities for counseling and resources in the area, I was happy to learn Pastor Luke (Pastor of this Lharmonie church) offers a weekly stress management workshop in the church so I encouraged patients to attend and asked him to make an announcement to remind people to come. I was thinking I would like to talk to more Pastors about implementing a similar initiative so people have some tools to deal with their stress. It was a start to learn about his program and it could be modeled after as there were not any community programs I knew of to refer people to for stress which was a major problem as mental health needs are important to manage. This is a major concern in Haiti considering all of the trauma people have endured. Word of mouth seems to be a very effective way to spread news in Haiti in a timely matter in it’d be great to be able to have programs to tell people they could go to for help. Word of mouth could increase activity in such programs.
Midway between patients and right on time cause I worked up an appetite, we were served a tasty hot meal with beans & rice, a meat n veggie mix that I shared and mmm it was good, stuff like this with harm hospitality makes me love working in Haiti. After the clinic was over, the lead translator, Eddy helped me get transportation to the ministry of health where one of the clinicians was helping me get approval for the meds brought from America to get them through customs. After a long and kinda intimidating motorcycle ride through Cite Soleil, Belair and other historically unsafe parts of town we made it through downtown to the Ministry of Health. I was wearing scrubs so felt like a stood out, but I imagine most people assumed I lived there as the average visitor wouldn’t be on a bike ridin through hoods. On the way back we went to one of my favorite eateries Epidor and got a light dinner and they have an inside ATM which I prefer so I could get cash. We arrived back to the guesthouse walls and I spent the evening socializing with others. I met a woman there selling creatively designed handbags made from recycled products such as plastics from Haiti. It was really nice to network with people from other organizations at the guesthouse.
The highlight and favorite part of evening was singing worship songs together as a big group. The leader, April Perry, NP, led an activity and we went around and said encouraging things to uplift each of the Haitian staff which I thought was cool. It was a Blessing to work with them as they were each helpful.

It was nice to have an air conditioned room to sleep in. I rested pretty well and got up early for church. A couple of my Haitian male friends, Jean and John came and meet me early to take me to Quisqueya for church in PAP. It was a pleasant start to a pretty sunny day to have fresh strong Rebo coffee with sugar, cream and clean water. We headed out for a short walk, got a ride to the bus stop from Bernard, one of the guys who works at the guest house. We then got on a large public bus which was my first experience on a bus in Haiti, it was spacious and much more comfortable then the congested taptaps. After about a 20 minute ride we arrived at the church. The place was all familiar as I attended services there on my last trip in Haiti and it was good to be back. The sermon was timely for me, Pastor John spoke on world missions with data showing increases in believers of the Christian faith worldwide with reference to places that had been visited by missionaries . He then said how missions are not enough as actions are needed. The Biblical themes of “seeing” and then responding were mentioned, such as when Jesus saw Lazarus and “Jesus wept.” The disciples saw the multitude when they were hungry and wanted to send them away to get food. Jesus saw them and instead acted by multiplying fish and bread from just a small number to 1000’s in order to feed the multitude. The message was about seeing as Jesus did and responding by taking actions. I reflected on my trip, the many ill patients I’ve seen and how I can respond in the future by maybe mobilizing others to help. The needs feel overwhelming at times, but I try to keep in mind that for the patients I see and am able to help it makes a difference in their lives. The service was concluded with the song that has the chorus shining in the light of your glory, Open the Eyes of My Heart Lord. It was such an uplifting service and just what I needed to boost my energy for a start to the week doing mobile clinics. I left feeling totally rejuvenated! I met with Pastor John after the service, it felt good that he recognized me from my previous trip and inquired on my whereabouts. We talked about my interest in mobile clinics and he gave me his card to contact him. I learned about the importance of making these connections in Haiti. After church we walked to my favorite bakery called Epidore which has delicious food and is one of the best eateries in Haiti. They even expanded since my prior visit and had such a large array of selections, they are known for their crepes which are so good. I ended up ordering rice and beans with picklies and veggies and a side of mac n cheese that I gave to my friend Jean after I saw the meat inside.

After, we left and got back on the bus for another adventure on the public transportation system and we made it back to the guest house. I decided to walk to the Creole church to visit with Pastor Luc to detail plans some other mobile clinics. He welcomed me and we talked to plan arrangements for the mobile clinics at his urban and centrally located large church in PAP and if time permits on this trip possibly one of his remote locations. He is the Pastor over 43 churches in the mountainous rural areas as has done mobile clinics before. Medical care and access to services is lacking or unavailable in many of these places. It sounds like a great opportunity to connect and plan for future mobile clinics, beyond this trip. I look forward to building on these friendships and possibly developing outreach initiatives.

The rest of the afternoon was spent relaxing in the sun, much of it on the rooftop of guesthouse. One of my favorite meals was served for dinner, this time a different flavored beans, rice, plantains and picklies with salad and other sides. I spend the night sleeping in the private tent which I really enjoyed and this time there was an even larger twin bed in the tent which was very comfortable.

I went to the kitchen early to try and make coffee I developed a new appreciation for the hard work the Haitian staff endure cooking with no coffee maker. I learned to make it from scratch with a makeshift filter and boiling water. It seemed like such a huge task when trying to do it for a large group of people. After a short day in the clinic seeing patient’s we saw fewer than before and ended early. I had planned on returning to PAP on Friday to arrange mobile clinics with Haitian staff. Since I had another delay in getting meds out of customs and want to use them for mobile clinics I decided to wait until Monday. Pastor Luc who I had met before came to the guest house to meet with me in PAP on Friday, as we were supposed to connect to plan for the mobile clinics. I did not realize he would just come early and I was sorry I missed him so we had to plan for another time. I learned how important it is to build relationships over time in Haiti. He wanted to sit down to meet to get acquinted before carrying on the business of mobile clinic planning. It was a lesson for me on putting people first over time even if it meant, as it often did, taking more time to get things accomplished. I learned to value this approach of building relationships first as it feels like it is something we lack in American culture.

I wanted to use the time after the clinic to go explore the neighborhood and a group of translators were going to head out with us. The clinic owners didn’t want us to go out so we stayed in instead. I was hungry and the Haitian cooks made me a snack with fried potatoes which were so good.

I called for my ride, a taptap from a driver named Bertrand and he came to get me. We drove through Carrefour and other cities on the was on the way back to Port au Prince where the Walls guest house was that I wanted to stay at that night. I wanted to get back to PAP for church in the morning at an English speaking service at a church called Quisqueya or Port au Prince Fellowship that I enjoyed before. I also wanted to make plans for the mobile clinic.

En’route to the guest house he took me to a market where I bought foods and some gifts for an old friend of mine. I was able to connect w him and drop off the gifts in PAP.

After arriving at the Walls Guest house I quickly met a large new group. Many of the translators/ staff recognized with the group recognized me and came to greet me with smiles. It was a nice welcome and pleasant surprise. I learned they were working with a large group from North Carolina – Duke University lead by a nurse practitioner to do mobile clinics which was really exciting. I enjoyed listening to the group sing Christian songs with a devotional led by Frantz, one of the translators. He spoke from topics taken from Matthew 25:14-18, and he gave a sermon and said prayers. I felt God’s presence in the midst of all of it and it was so moving and reassuring. It seemed this is exactly where He wanted me to be and I had no idea why I was wanting to come back to the Walls Guest house, just felt compelled to come back. I met with the group leader, learned about their plight for the mobile clinics which was consistent with what I was seeking to start so I was happy to make this serendipitous connection. They invited me to work with them and go to church the next day. The Lord knows how hard this trip has been and it was such a Blessing to cross paths and have this encounter, all by His design in my view. I even was given my own room by the hotel manager Veniel which was nice with AC. They’d move me into my own private tent the next night which was perfect. After chatting with several of the people and taking time out for prayer and reflections I returned to the dining area. The group was singing worship songs out of a book with a guitar, one of my favorites caught my attention, “You’re all I want.” Felt like confirmation for me that this is where I was supposed to be at this moment.

We got up early to breakfast and Rebo coffee and started the clinic as usual. The patient flow was a little lighter. We finished up earlier so we could head out to the beach, myself some of the volunteers and Haitian staff loaded up in two trucks and headed to the beach. These were the south beaches we went to, I heard the beaches in the north that I had visited on a previous trip were nicer. This beach we stopped at had music (much American R&B and hip hop). There was a really nice hotel which had food available for purchase, although from the menu it was all seafood and meat. The view of the ocean and the variable blue colors was pretty, but there was no sand, just small rocks. I walked around a bit and dipped my toes in the warm ocean. I didn’t get in like before at Kaliko beach in the north where I went snorkeling. Most of the team played soccer. I sat by the ocean and chatted with local Haitians while enjoying the captivating scenery with the ocean surrounded by gorgeous trees and mountains in the background. A scene that was so inviting and calming, I could have stayed for many hours just relaxing. I especially loved the hot sunshine, one of my favorite parts of the island. When all was quiet there was a school of yellow/black fish that swam that swam up by the shore by which was a pleasant surprise. There were a lot of small crabs that crawled up on the stairs I was sitting on. I was wishing I had a swimsuit but didn’t bring that gear. After we drove around by some of the road vendors to see if I could find a swimsuit I wanted, but none really appealed. We headed back to the guest house for dinner which was scrumptious again with a veggie combo for me – everyone else had meat- and served with rice. I wanted to spend more time after the clinic hours to check out different parts of town. Later that night it was sad to see hungry and frail cows grazing in the open yard next door, I tried to feed them a little without success. The very large house on the other side of that was damaged in the earthquake and I was told two children perished in it, felt odd to see people just in the bottom of it at night with the top seemingly abandoned. As I was going to bed later that night I came across huge spider in the dark in looked like a tarantula which sent me running and screaming through the guest house only to see big roaches scattering on the ground in the room I was sleeping in. That was unsettling and the staff helped me out. Felt like I needed to stay alert all night long and when the electricity was working for at least part of the night I slept with the light on. Funny the night prior I was awakened with the new kitten running across my bed with a big roach on the divider/ screen not far away. Seemed I was in for another restless night as there were some things I just couldn’t get used to, though I imagine if I encountered enough I’d learn to cope, well with all except the big spiders. I eventually fell asleep that night and woke up the the next day to a new start.

After a good night sleep, I got up around 7, slept much better having quiet quarters. After breakfast and devotions we headed upstairs to see patients. The room I slept in was converted to an exam room. We saw ill patients, but seemingly conditions were much less advanced then other cases I’d seen. There were many gastrointestinal, genitourinary and various dermatologic issues mixed in with a lot of chronic problems like HTN. Diseases seemed to not be as progressed as they were in say the tented camp or Cite Soleil or other mobile sites. Not having labs, as usual in these environments, treatment is empirical based on presentation. Patients’ often wont follow-up if sent away and asked to return. I’ve found it’s best to just treat what you an while they are available. Mid-day we had lunch made by the Haitian staff who were incredibly good cooks. They worked so hard preparing tasty Haitian meals. Lunch was one of my favorites with Haitian plantains with picklies, I seasoned with hotsauce. After eating we returned to patient care. The most memorable patient I had that day was a malnourished, underweight 4 month old whose mom couldn’t breast feed. It was a welcome change to be able to connect them with community resources like Hope Alive’s mom tot program compared to other cases where I have scarce options. It was nice to send her away with formula and having the baby’s energy increase after feeding him formula even if he did pee on my scrubs. Basic items can go such a long way in patient care in Haiti. Trying to include a little public health education about these not to feed for formula, food and many other topics is always helpful. Training patients to be community health workers and teach their relatives or friends lessons learned helps spread the knowledge and ideally change patterns that cause negative health outcomes. Common issues are cheap ways to treat water, consuming natural products in environment to promote health preventing common issues like anemia, avoiding mud pies that are often eaten and cause worms, managing reflux, high blood pressure and a number of infectious diseases. I’d like to bring more Creole handouts to share in the future with pictures for those who don’t read to help illustrate concepts. The day was filled with a lot of teaching around these topics. We concluded the dinner with a delicious mix of vegetarian food (for me, others had a meat dish) combo of flavorful vegetables and rice and hot sauce. After dinner a group of us walked down the street and hung out with some of the locals for awhile as they played soccer, one of the docs gave them a new soccer ball that they loved. It was impressive to see many of them playing without shoes but sad to think of how basic things like shoes are even hard to come by. We spent the evening hanging out on the guest house roof, joined by a stray cute little kitten that found its new home.

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.