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.