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.

We went to a Creole speaking church Sunday morning enjoying praise music in Creole and even though there was a language difference the positive energy in the church was evident.  The church was at an orphanage and we got to interact with the sweet children who sat around and with us playing throughout the service while some sat quietly listening. It made me feel even more connected to the culture and enhanced the desire to adopt a Haitian child as there are many who could use homes.   It was sad to leave them especially when one of the very friendly little girls through a tantrum when we said goodbye.  We spent the earlier part of afternoon at the Hope Alive Guesthouse and had plaintains with picklies for lunch.   Myself, Wilio and Katie went for a long walk around the neighborhood first to Grace Village at an attempt to get medications, when we couldn’t do that we decided to explore other areas.  We walked down to a beach hotel called the Lambi Hotel, about 20 or so minutes away by the main road. It was a popular beach, but it was not the traditional sand and ocean I was used to at a beach.  The beach was in the south of Haiti where I heard the beaches aren’t as nice as those in the north.   We stopped and got some homemade pineapple icecream on the way there from a icecream stand which was tasty.  It was a small beach, we had to pay to get in.  There was loud Haitian music playing and an area for activities where people played sports and tables where people sat eating and drinking.   There was dancing and lots of Caribbean style music, locals were there and I did not see any people who looked liked visitors.  Seemed like a common place to go on the weekends, it was cool to get a taste of at least part of the authentic experience of living in Haiti.

I was eventually picked up later that day by a driver and Cary Roberts, one of the team leaders from the Haiti Outreach Ministries medical, construction and mental health team called Diakanos from Canada that I planned to work with that week in Port au Prince.  Cary wanted to make sure we made it back by dark as it was Carnival time when a lot of partying occurs.  Fights and other problems can erupt jeopardizing security and leading to unsafe conditions quickly.  We spent the evening getting acquinted at Walls Guesthouse with a team of providers, Pastor Leon (founder of Haiti Outreach Ministries) and his wife and others who would help with construction and building.  I even reunited with some old acquaintances a nurse from Seattle and Larry Roberts, (founder of Servants Gifts, an outreach organization with a group house in Haiti), friends who happened to be staying at the same place.    It was a refreshing start to prepare for the next week which will be spent in a clinic at Cite Soleil, an underserved, impoverished and historically unsafe community, known as a large slum.   The community has been victimized by crime, inequity and is vulnerable, I really anticipated serving there.

Last night I arrived in Haiti.  It was a challenging endeavor getting to Haiti- thankful for safe travels.  I was blessed with an upgrade to first class which allowed me 3 free bags and I only paid $100 for extra bag.  What a faithful God we serve.  I spent all that time worrying about transport costs then got a great deal since He worked it out which was such a relief.  I was able to get all of the medications transported, both through my friend who brought a couple of bags earlier in the week and on this flight.  It was very welcoming to have Haitian men singing songs with big smiles as we got off of the bus that we caught from the plane.  However, it was disheartening on arrival after all of that work put into getting medications to have bags confiscated in customs which led to a lot of frustration and it was upsetting.  I did not have the necessary paperwork for getting medications in country. They told me to get a letter from the health ministry to get all the medications approved.  I am working on that and realizing it is another test of my faith.  Above all things I must trust God in every aspect.  He led me to Haiti and He will see it through to ensure meds get to places needed for the people that they are intended to help.  I was exhausted, after about a 2-hour ride, from Port-au-Prince to guest house in Mariani, just past Carrefour.   The drivers took me on a ride to the store enroute to the guesthouse.  The roads were very rocky and after going up and down many unpaved and very bumpy hills we arrived.  We drove through Grace Village which is where my friend from Portland who brought two bags medications for me was staying at.  I later learned that there were two Grace Villages in two totally different locations which is why we were not able to connect initially.  I enjoyed staying at Hope Alive Guesthouse- that evening was spent connecting with some of the Haitian staff, Renaud and Wilio, and with Leslee and Katie.  We had dinner prepared by the cooks.  That night we sat on the porch of the guesthouse talking until late.  We later went to bed, some of the staff preferred to sleep on the roof and it was hot inside.  I slept okay, although hot with no AC or fan, in a room in the clinic area upstairs.  Being under a mosquito net was uncomfortable and stuffy, not something I’d done before in Haiti.

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.