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.