Something in the Water...

Adrenaline is a pretty awesome hormone. It kicks in with just enough of itself to carry me through the long work stretches, and it seems to know the exact moment to cease surging through my body. The only challenge with this scenario is that it takes me three days to recover back to a sort of chemical homeostasis. I only slightly exaggerate – today I am feeling almost back to myself, but I physically felt the disappearance of energy this past Friday morning. I woke up grateful for a weekend off, promptly got a call from one of our nurses who was with a little Ste. Anne kiddo at the hospital, went to be with them for the duration of their doctors' visit, came back and Skyped with friends for a brief while, feeling perfectly normal. Seconds after the phone call was over I suddenly wondered if I could even make it to my bed from the couch without collapsing from exhaustion. The body knows when the limit has been reached!

My working weekend consisted of our usual visit to the baby house on Saturday (the doctor has hours at St. Louis two afternoons a week, and visits Ste. Anne every Saturday) and updating vaccination records to include the most recent campaign. Sunday has turned into more of a planning day – I went to St. Louis in the morning and encountered five boys with high fevers, three positive for malaria, and four of the five from the same house. Pesky hungry mosquito! We have treatment for malaria, but the misery of suffering a fever of around 104 degrees is amplified by the heat in the containers. Add to that nausea and a headache, and these guys were suffering quite a bit! One of the temporary solutions subscribed to by the nurses here is to send kids to the cold showers as often as needed. It is a very short-term fix, but the kids come back a bit cooler. Tylenol and Ibuprofen only work so well in the presence of a malaria flare-up, but those are given as well. After a little bit of soup, a somewhat peaceful sleep arrived for the patients, and I continued delving into ideas for education sessions for staff and kids. There are many topics to choose from, but hand hygiene and basic first-aid are two that are foremost in my mind. A wonderful Sunday evening mass by candlelight ended the weekend with grace.

Monday morning the fevers were persistent, and the boys were exhausted from fighting illness. One little guy was concerning me, as his temperature continued to stay very high and he kept refusing food and water. The other guys were responsive, wanted their usual spaghetti instead of soup, and kept asking for water. Yay! Appetites on the rebound. At the end of the morning, another little girl came in with a headache. As I poured water for her, she looked in the cup for a long time, then handed it to me. Lo and behold, there was a little worm swimming away to his heart's content. After a gasp and a look into the container from which the water had come, there was yet more evidence that something was not right. A brief investigation and tracing of the water source revealed that for several days, water for the clinic and other “kays,” or houses, was being retrieved from an untreated spigot in the courtyard, instead of at the treated, filtered well located at the front of the property. The eternal challenge of good communication and the attention to directions continues to plague daily life, so staff was immediately informed (again) of the importance of obtaining water from the correct source. And my mind began racing as to what might be in the “bad” water. Parasites are endemic and dangerous, and the sudden increase in parasitic infections in the kids was now explained. Our concerns grew to include Typhoid, and then cholera, the ultimate enemy.

The directors and the doctor were quick to address the issue, and after a bit of research and chatting with Sr. Judy, the best of our resources for tropical medicine, we found that we had a plentiful supply of the right medications for Typhoid. Should cholera enter the picture, we are literally feet away from the cholera treatment center, St. Philomen.

Tuesday, Wednesday and Thursday, we watched our little group of boys grow by a few more – all from the same container, and were somewhat relieved to get another positive diagnosis of malaria confirmed for one of them. We decided to treat for both malaria and typhoid, just in case there was a typhoid presence in the water. It is an interesting experience to treat such a high fever here as opposed to the States. There is not the relief of air-conditioning, the ready availability of cold compresses, or the interest in the prompt administration of IV fluids for dehydration. (Note: we do have the fluids and equipment available to start IV's – but very rarely is that a step taken in the current clinic setting). We improvised with gauze and cold water from the refrigerator, sat the boys up for soup, kept encouraging water and oral rehydration salts, and located an additional fan. Panic and worry would get us nowhere – patience and faith was required. The Haitians are much better at this idea than we Americans. Move with deliberation, take the necessary steps to ensure the most comfort available, and then sit and allow ths illness to take its course. As of this weekend, to our relief, the kids and staff at FWAL have been protected from further water-borne illness.

The nurses continue to amaze me. They are trusting me more when I make suggestions to them, asking more questions about courses of treatment and medications, giving input more freely, and want to just be with me. They laugh and laugh, and I am grateful that our senses of humor seem to be similar in many ways. They love joking with me, and they love the look on my face when I attempt to eat a “pate,” or a fried, chicken-filled pastry, and I hit the “piklis,” or the spicy Haitian mixture of cabbage, carrots and spices. (I have a wimpy tongue with regards to tolerance of spiciness). They like sitting and just talking, are trying to convince me to stop such cosmetic practices as shaving legs and under-arms, and want me to dye my hair black! I have informed them that certain things will NOT happen, and I am thinking I have to bring back a photo of myself from “King and I” high-school musical days which clearly shows that I am not meant to have dark hair. They continue to express disbelief that I am not married and have no children, and gave me the Spanish Inquisition as to my list of essential attributes. “We will pray, but we will also start looking!” Yentas without borders...

I was thrilled to know that one of the nurses, Jelita, wanted my company on Friday morning at the hospital. One of our kids was ill and needed to be seen by a doctor promptly. We nurses have been discussing autonomy and our authority to decide treatment courses for the kids, and I was glad she had decided to seek treatment for the child immediately versus waiting for the FWAL doctor's availability. One of the gifts of working where I do is the accessibility of St. Damien clinics and the triage area which is open every morning. If any of our children requires attention on dates when our doctor is not present on-site, or if an acute condition develops which is beyond our ability to manage, the hospital is literally yards away from St. Louis, right outside my door, and just a short 10-minute drive from the baby house. I arrived at the exam room to be greeted by the little girl, who just wanted me to hold her and talk to her. We practiced words for the different animals that are posted outside the rooms, looked at the cross and Jesus, reviewed all the parts of the face, and just snuggled. Daphnee has undergone a transformation since her arrival a month ago. She was very scared and angry when she first joined Ste. Anne, would sob uncontrollably when anyone left the home or when she needed to leave school, screamed and bit and fought, and had a very sad disposition. I have had the chance to be with her on several different occasions, to sit next to her, to play and talk with her, and wave at her as she sits in class at school. I have seen the return of her huge, laughing grin. Now, she runs to me and wants to hold my hand, if not to be held on my lap! There are countless moments like these at FWAL, when I am able to witness the joy of a child who knows he/she is safe, loved and secure. 

Daphnee

 Jelita, Daphnee and I, talked and talked, and I had an overwhelming feeling of gratitude and amazement at the graces present to me. We adults had an extensive conversation, and we understood each other the entire time. I was trusted by a Haitian nurse to be a source of support and a welcome presence for her, and I was trusted by another of the precious kiddos in my care. We saw the doctor, Jelita spoke appropriately and assertively with the doctor examining Daphnee, and she looked at me once the needed medications were prescribed. We have also been reviewing brand name versus generic ingredients of medications, a challenging concept here, as so many languages, names and spellings are involved. And, to her relief, I was able to help her realize that another several-hour wait at the pharmacy was not necessary, as we had all of the meds at our facility!

I leave you with pictures from our chapel. The building was damaged in the earthquake – part of the stone wall behind the altar fell, and it was replaced by wooden buttresses and panels. This past month, an American artist came and painted a spectacular mural to cover the dark wood, and blended it in with the stonework in the rest of the chapel. The mural is a beautiful representation of the progress of the country and its children since the earthquake, and a great gift which lightens the chapel immensely. Just imagine being able to enter in the evening with candles lighting every window, piercing the darkness and welcoming the hungry.

graves of nuns who died in the earthquake

buttresses holding up the walls

The chapel is always open.

Ubi Caritas et Amor, Deus Ibi Est

In my recent posts, I fear that I am not conveying enough gratitude. It is easy for me, a deep thinker, to be too concerned about portraying the painful and challenging details of this life in attempts to capture the realities of it. Yes, I am living in a broken country, caring for many wounded and traumatized children and witnessing desperation and tragedy and suffering. But for as many moments that could give cause for despair, there are infinitely more reminders of hope and of a Creator that cares for His little children. We are not always conscious of or willing to see these, but they are present nonetheless.

The priest talked at mass today about suffering, and how in suffering is evidence of great love. And we sang the words in the title of this post – where charity and love are found, God is there. So in suffering, God is present. In each heartbreak, there is still hope. In each child's eyes, hope shines. In the joy of a terrific sense of humor, there is hope. A coworker who has been here for many years told me just yesterday that when we as foreigners are able to laugh with the people of Haiti, we have entered a new level of intimacy with them. And this morning, the nurses and I spent literally hours laughing together, gaining new understandings of each other and flying through the cultural barriers that still stood between us. As I gain a better grasp of Creole, I am continually encouraged by the staff members at FWAL, and even teased by one of our drivers, who challenges me to learn more, but who paid me a very kind compliment when he said, “We will miss you when you leave, because we know you came to serve us and serve the children.” And so I wish to share a few of the things for which I am grateful, and because of which I was given pause many times today, sitting in disbelief that I have been given the undeserved favor of this experience.

Stanley, a bright light in my life every day.

 We completed HIV and Hepatitis B testing on all of the children in the FWAL program last week. Out of 182 children, none of them are HIV positive, and only two are positive for Hepatitis B. Those two are currently asymptomatic. This is a great blessing and protection for our children, in a country where HIV and Hepatitis B transmission is elevated. There is hope.

I was privileged yesterday to witness the first steps of an amputee as he walked with his new prosthesis. A group of American surgical volunteers was in the area at the time, along with a small contingent of NPH volunteers and employees. He walked tentatively, then looked up at his audience as we clapped and chanted our approval. There is hope.

There were 21 abandoned children living in the hospital, several significantly disabled, but several healthy. They have been left by mothers for unknown reasons. The challenge of raising a child with disabilities is greatly multiplied here, and many impoverished parents simply cannot face the difficulty. (Several do, and those little ones are the grateful recipients of one of NPFS's ministries here, where they attend classes and physical therapy). One little guy, Yvens, whose mother died of AIDS and tuberculosis many months ago, was the smiliest little man, verbal and trying his utmost to meet the developmental milestones for his age. He was a buddy of Dani's, and she was dedicated to helping him learn to walk during her daily visits to the room. The children, once declared officially abandoned, wait and wait and wait for placement in a home or orphanage. Many programs, including ours, are filled to capacity, so this is a very long and difficult process. However, much to our surprise last weekend, Yvens was placed in a home and was finally able to leave the hospital! One less child living alone. There is hope.

I am blessed to serve with some extraordinary people. This past Tuesday, we held a goodbye party for my roommate Sr. Kathleen, a religious sister who has lived and worked here for the last 14 months. A vocational decision prompted her return to the States earlier than she anticipated, and it was an emotional several days as she packed up her Haitian life. Sr. Kathleen was a living example of God's heart for the children here. She is a clinical social worker, and she worked tirelessly with the children at Ste. Anne, coordinating activity groups, educating the staff, being a daily presence at the home and loving the kids with a gentle firmness. She was active in the school during the last year as well, bringing characters and a therapeutic eye to her work. Whenever I would ride with her to Ste. Anne, a chorus of voices would arise from the porch yelling her name as we arrived. Tuesday was a very special day, as the children she loved so much showed their love for her by singing special songs, dancing and admiring her with hugs and kisses. The staff honored her as well, sharing their hearts and gratitude for her mentorship. There was much to celebrate, as she has brought light and grace to Haiti, telling the children it's ok to cry and express emotions. (Emotional expression is frowned upon in this culture). She met regularly with a few children with significant histories, assisting them in embracing the challenges they have been given. She lives in hope.

Sr. Kathleen sitting with some of her beloved babies at her goodbye.

One of her perfect parting gifts for the kids - a new playhouse!

 I noticed ti Erline my first day here. I have talked of her many times. She lived for months with chronic watery diarrhea, in sadness, with significant malnutrition and fatigue. I have been praying for her and reaching out to her during each visit, hoping for answers, which as we know do not come quickly. In the past month, we have gotten small glimpses of happiness from her, and she has demonstrated increased energy and started laughing more! She loves the daily glass of Pediasure, and now refuses regular milk! (Uh oh...). She is sometimes still not so sure about me, but we spent a precious afternoon together at Sr. Kathleen's party. I showed her a picture of herself on my camera, and that was it! Smart little one that she is, she figured out how to look back at all of the previous pictures, and pointed at herself and me, then sighed happily as she viewed photos of her housemates. I wore my hair down, and she stroked and played with it. She shreiked in happiness as we sat watching the festivities. There is hope.

Precious ti Erline - the smiles come more quickly now!

The staff at St. Louis and Ste. Anne care deeply for the children in their charge. They sacrifice hugely, working 11-day shifts, living day and night with the kids, essentially raising them and being their accessible parental figures. The children are happy, active and engaged with life, and the quiet and challenged children are noticed just as well as the loud and well-adjusted ones. The madames and mettres have embraced me, with one of them asking if she could be my mother! (Don't worry, mom.) They patiently sit with me and talk as I ask questions with my incorrect words and grammar. They smile when I remember their names and remember the names of the children. (I'm determined to know all 182 names soon – I'm getting there!) I am continually amazed at the patience and tenderness I observe, and the enthusiastic energy which is present in the faces and words of the staff. Just today I ate for the first time at St. Louis instead of returning here to the hospital for lunch, and I am kicking myself for waiting so long! The beans and rice were absolutely delicious and spice-free. The cook anxiously asked if I am planning to eat on-site Monday - She loves to serve hope.

Four of the children at St. Louis were diagnosed with heart murmurs on their initial admission physicals. With no training in cardiac anomalies, the physicians here (and even visiting pediatric physicians) panic and refer for immediate follow-up. As I have learned in my few short months here, many children are on unnecessary heart medications due to poor diagnostic capabilities, lack of training and inaccurate echo readings. So I jumped at the opportunity for all of the St. Louis kids to be seen by a visiting American pediatric cardiologist and echo tech this week! All four of them were seen, and they are all completely normal! What a relief! And, perhaps equally as important, they behaved perfectly for the doctor and were very cooperative. There is hope.

I was able to meet and sit with a 10-year-old end-stage cardiac patient yesterday. She has spent two months in the ICU at St. Damien, and has not attended school for four years due to her heart problem. Tuesday evening's echo confirmed that there is no surgical intervention possible for her condition, and her disease has progressed to the point of significant compromise. She was clearly frightened yesterday, and as we sat and talked I thought of the interventions I would be doing were she in the States. But there is an acceptance of God's will here which I pray to have, and she and her mother sat peacefully, resting in the good moments and bravely attempting a walk around the hospital. She smiled as she talked about her favorite things and asked me to bring her notebooks for her brothers so they could attend school. In her physical weakness, she thought of others. There is definite sadness in this story, but there is still good to report. She has a mother who has been at her bedside the entirety of her hospital stay, and the visiting cardiologist determined that she does not benefit enough from the added oxygen to merit her staying in the hospital any longer. And, miraculously, a terminal care nurse has been found who will be able to visit her at home. So my sadness at the brevity of our time together pales in comparison to the gratitude I feel in knowing that she will be able to live her final days with her family. She will soon know the complete healing that only heaven can bring, resting in the hands of Hope.

These are Days

I have hit the two-month mark, a fact that is both easy and hard to grasp. In many ways, it seems as if time has been crawling by, as each moment is so full and there is so much to observe, process and translate as I live it. Yet, in other ways, each day passes quickly. Moments with the children are precious and genuine, and I am still adjusting to the change in routine that school brings. I now know the weekly menu by heart, and I have my basic schedule set. Laundry and the remedial tasks of this life are never thought of that way – I appreciate them just as I did in the States. Today, a “day off” after a whirlwind stretch to be detailed shortly, I found myself craving the therapy that a clean home brings, and could not relax until the bathroom and the floor were shining! My living situation is changing – I will be moving into a house with Dani tomorrow. I have relished my corner of the living room but am ecstatic to have a more permanent place, with a door that I can close, a space I can make my own.

Last Monday began “Project Immunize.” I had no notice of this little adventure, but it turned out to be a huge undertaking upon which I can look back and breathe a sigh of relief. NPFS has been looking for money with which to supplement the vaccines that the government of Haiti gives. There is a regular vaccination schedule set by the Ministry of Health, and the government provides regular vaccinations to the children of the country. These are limited, however, and can vary depending on what is available at the time of scheduled vaccination appointments. (Example: one month the DTP, or diptheria-tetanus-pertussis, vaccine may be available, the next month only the Td, or tetanus-diptheria, vaccine may be the only option). Another problem is that the government does not offer catch-up vaccines for any children. Enter our program and the orphanage in Kenscoff, where many children are admitted with an unknown vaccination history. So, as a responsible organization, we are obligated to provide each vaccine that the child should have had up to their current age. And this takes a great deal of money.

A donor family recently came forward to generously cover thousands of dollars in vaccines for the children of NPFS. This family tragically lost a child to a vaccination reaction, so their gift was felt deeply by all of us. I was told at the beginning of my year that this project would come eventually, but had not expected the suddenness of what happened next...The money for “Project I” came through last weekend, and Monday morning, I found myself in a tiny NPFS sedan with Jan, regional health coordinator, the driver and another gentleman, making the trek up the mountain to Petionville with a large cooler in the trunk. Upon our arrival at the company offices, the men at the counter immediately began chuckling at our cooler, stating that we did not have nearly enough space for what we had purchased. Our eyes widened, then a realization came to me...vaccinations do not come in multi-dose vials anymore – they come in single-dose vials! A nice box with a pre-filled syringe, vial with the vaccine in it and needles. And each box is individually packaged. And we had purchased enough vaccine to immunize 600 kids against several diseases. And we had a little tiny sedan with which to make an hour-plus drive with a HUGE box containing all of these vaccines. A box which would not fit into the car at any attempted angle. Thanks to Haitian resourcefulness, we found some twine at the corner of the property and tied the box into the trunk...and started down the mountain home. We condensed all of the vaccine as much as possible and stuffed it into three fridges in the basement of the hospital. And then the next day, we got the other half of the shipment...12 styrofoam coolers worth. Another afternoon of condensing and compacting, and we moved to the next step.

What I thought I would have weeks to plan, involving the clinic nurses and taking time to educate them about all of the vaccines, I now had three days to coordinate. But this is my kind of crisis, and the nurses were all about digging in and helping me. We talked through out ideas, we got the vaccine information in French and Creole, the nurses avidly read the info, and we came up with a game plan. The doctor was excited too, and teamwork at its finest was exemplified. Friday, we vaccinated the 32 babies against Hib, meningitis, MMR, and Hepatitis B. The hardest part of the whole afternoon was preparing the individual vaccines, and that fell to yours truly. As much as I would like to educate the nurses about their injection technique, they have one that works and I gladly relenquished “picky” duties in favor of facilitation and prep. The day went well, with lollipops for each kiddo after the pain, and a doctor and nurses with great senses of humor.

Yesterday, it was the big kids' turn. All 150 of them. All of the prayers I asked for were felt! There was so much peace present, and the kids actually skipped to me when their names were called! This, as my supervisor told me later last night, was a perfect example of a trusting relationship. We did the vaccines in a separate room, which is a major difference from how the Ministry of Health does them. They have long lines, where everyone can see the poor victim as he/she is poked and cries accordingly. Imagine being the kid at the back of the line, having to witness everyone before you! Oh, the agony! (I did witness this on one of my first days in Haiti...and vowed to change it). I was able to call each kid up, have them wait outside the room, explain to them why we were giving the pickys, and they looked at me and said it was ok. They willingly walked in, sat and were so brave – the little guys took it as a challenge to be macho! I was proud of every single kiddo – to be trusted and see the smiles after the few seconds of pain was heartwarming. Hugs and lollipops, and laughter and immunity. What a great combination.

In the midst of the vaccine project, we celebrated the dedication of St. Philomene, a wing of St. Luke hospital, on Sunday. Brief history: after the earthquake, St. Luke was opened out of necessity as an adult hospital. Then cholera hit, and yet another facility was opened emergently to accommodate the cholera patients. During the course of the last year, Fr. Rick and the St. Luke staff determined that it would be wise to have a standby wing that could be dedicated to care of a large number of people in the case of another disaster or medical outbreak. This is now St. Philomene. Cholera patients are still treated at St. Philomene, and there is a large space available for use should it be needed. An unfortunate reality of this country is that it is very likely that space will be filled soon. Sr. Philomena, from the Adrian Dominican Sisters (go Michigan!!), was present at the mass. She worked for NPH for fifteen years, caring for babies. The new hospital was dedicated in her honor. And yet, as Fr. Rick pointed out during his homily, the ground for the hospital was already christened by the playing of children, the dancing of little feet and the young singing voices which echoed here after the earthquake. Where the hospital now stands, children were initially cared for in the days after the quake when the FWAL program was started. Meals were given, spirits were lifted, joy permeated the chaos-filled air and young lives were transformed, even as some in the world-wide audience spoke of the presumed demise of the country.

I have been challenged in every way this past week. The raw emotion that fills me has at times been difficult to bear. The suffering present on faces begging outside the hospital and on the street is heart-wrenching. The intensity of the vaccination marathon exhausted every ounce of energy I had left. Sunday evening we had at least half a dozen tiny bodies lined up on one stretcher at mass, ten bodies total. Criticism and misunderstanding acompany many situations here, as a group of imperfect humans from many different cultures work together. Passion pervades the hearts of new and experienced volunteers alike, and anger is often justifiable. I hear of milestones from home – new life, engagements, deaths, job changes – and the pain of separation presents itself with each new notice. I yearn to be present to those I love, I fear being forgotten, I read news headlines and am puzzled at the vanity and shallowness of some realities. I wonder what would cross the minds of the majority of my fellow Americans were they to be transported here and see the resilience and strength of a people for whom a tax return or retirement account or health insurance is completely foreign, a people for whom 80% unemployment and perhaps one meal a day is the reality, where the goal is to survive until tomorrow. And I am grateful to re-learn every day a lesson which the poor have taught me for the past eleven years, and yet which never ceases to strike me in new ways. The less material distraction we have, the less obsession with self, the less ability to isolate behind computer or Smartphone or closed-door or supposed reality television show, the more we look at the people right in front of us and realize their importance. I will never tire of the little fingers running through my hair, the precious touches and the trust that I saw in the eyes I met yesterday, the loving hands that reach out during the Kiss of Peace at mass, the excited voices calling out my name, the smiles that rest on faces I greet each morning. I will forever cherish the voices of the laboring women outside my window, as new life makes its way into this world. This life is not meant to be lived in isolation or ingratitude or ignorance. It is meant to be lived in Relationships, in being present to others in the fleeting moments we are given with them. Opportunities to learn are constant; chances to lift spirits, to truly listen, to serve, to honor thoughts and actions, to put another person before ourselves, are countless. As many times as we are tempted to assume conclusions and judge others about whom we know a little, or even perhaps a lot, let us pause and examine our motives. And may we all strive to be present in the little moments we are so blessed to cherish. May they not pass us by unnoticed. That would be the ultimate tragedy.

School's In

The weather has radically changed this past two days – it's a “cool front” of sorts, with high winds and temperatures in the 80's, a drastic difference from our regular blanket of high heat and humidity. Very refreshing, the air and the breeze!

The kids survived their first week of school. I admire them for their diligence and attention to class in a very challenging situation. They, of course, are used to the noise and distractions and the outdoor classrooms. When the FWAL program was started, this is how they attended school – tents were set up all over the property and they sat on benches together, looking collectively at a large white pad of paper or at a chalkboard propped up by sandbags. The school on the property is almost finished, and as classrooms are completed, the students will move into them, starting with the oldest classes. But for now, it is the old system. About 600 children from outside the residence also come and attend school here, so it is a big crowd. And the adorable kindergartners, as young as three years old, sit in different groups around the courtyard within the St. Louis home itself. Everything is taught in French, and they are learning counting songs, greeting songs, drawing, a different version of the Hokey-Pokey – and they are just precious! I have walked around and snapped pictures, trying to be discreet. But there is just no way a tall “blan” with a camera is ever discreet with these kids. They stare, laugh, run up to me and just touch my arm or hand, then run away squealing. So my pictures are a mixture of smiles and blank, awed stares. It is easy to forget that most of these these kids don't know me as being here for the past two months! They are not used to me. The teachers, or professors, are amazing. The order they keep with 200 little ones is astounding. We get occasional little stragglers who wander into the clinic, needing a better look at me, or who simply don't want to sit any longer, and we have to coax them back to class. But otherwise, the environment is pretty calm and organized!

The afternoon is playtime for the younger kids at St. Louis, study time for the older kids. It's a strange thing not to see them so much in the morning, as school starts for them at 7 am. I miss the morning greetings – I had gotten used to bear hugs and handshakes every morning, and the “Bonjou Brigitte!” said in little voices as I entered the clinic. I miss it! But these mornings will become a great work time for us  – there are vaccination days and inservices to plan, ideas to exchange, chances to really sit and talk with my Haitian colleagues and gain an understanding of what is important to them, and many things for me to learn from them! I want them to feel included in all of the planning and improvements we are making, and I believe that is the only way to induce true change – people must feel validated, important, and that there is a mutual commitment to long-term relationship before any sort of change is suggested. In countless failed attempts, the approach of NGO's and mission groups has been, change first, then responsibility, then relationship, then trust. How is this productive? The approach must be trust, relationship, then responsibility, then change. How will anyone trust someone who comes in, tells them that what they are doing is wrong, and insists that sweeping changes occur before anything else can be done? (And then leaves?)

An absolute highlight of my week this week was working with the nurses. One nurse with no computer experience before I came, now insists on helping me with everything computer-related. (So wonderful!!) I was near tears when she sat with the other nurse with no previous experience, and taught her how to enter information on the Excel spreadsheet we had created. (She taught her correctly!) They were both excited, and told me how easy it was! (I don't even like Excel that much!) Another conversation was had about the color of my hair. I would call it a dark blond – they don't have a word for “blond” in Creole – so they asked me, “what color is your hair?” I asked them, “what color do you think it is?” They pointed to a cardboard box! I exclaimed, “You think I have box-colored hair?” They laughed hysterically, then responded, “No, no! Just that color!” So, naturally, I asked, “What color is the box, then?” They were gracious and called it, cafe-au-lait. (Coffee with milk.) I commented on how this was a drastic improvement over “box-hair,” and begged them to please not tell the kids, otherwise that would be my nickname for the year! They still greet me in the morning now with, “Bonjou cheveux boite!” (Good morning, box-hair!) But they promise not to say it in front of the kids. Don't know how long that promise will be kept...

The nurses and kids have been asking for pictures of my family and friends. Because of the generous gift of a dear friend, I brought many pictures with me. (My old computer died a few weeks before I came to Haiti, and took all of my pictures and media files with it). At first, most of my audience did not recognize me in the pictures. Then, when I pointed myself out, they stated, “Is that really you? You are beautiful!” This was a little disconcerting, as I accepted the compliment but also wondered, what the heck do I look like every day here? I know – sweaty, red-faced, without any make-up, with all of my flaws visible and crazy frizzy hair. It is certainly humbling to get dirty so quickly, offer myself as an unmasked and exposed servant, and accept that physically I will look different doing this work. The kids are always fascinated by my many freckles and love to trace my veins. I explained that when I am in the sun, I get more and more freckles, and this amazed them. They question the hair on my arms, and before they saw my pictures, they asked if my family was the same color as me. (Never to worry, family and friends! They were completely complimentary!) One of the kids asked me my age, and he guessed that I was 19 years old! I don't think I will get that guess in the States, folks. It is a strange thing to think about age here. Where so many births and deaths are not recorded, many children do not know their exact birthday or even how old they are. So true age is very rarely known among the poor.

I am happy to report that all of the kids at Ste. Anne (and the staff) are finally getting parasite medication. This may not seem terribly exciting to you, but after a seven-week adventure, it is a thrill to me! We are planning an inservice for the staff and one aimed at teaching the kids too. Parasites are endemic here, so the medication is only a temporary fix. Hand-washing, food preparation basics, teaching and massive reinforcement regarding cleanliness will be recurring themes for the year. Ti Erline is smiling and laughing more – we had a precious morning last weekend, as we talked and sang and played, and yesterday morning we sat together and laughed a little bit more. She is improving on the Pediasure plan, and she was also positive for parasitic infection. So with medication, continued calories and a lot of love, I am very hopeful for her. She has a gentle touch and moves deliberately and thoughtfully – and she has a wonderful belly laugh! I want to hear many more!

I love my little entourage of boys at St. Louis. The walk to the clinic passes two houses of boys, ages 5 through 8 or 9 years old. They stop in their tracks when I approach, even in the midst of a soccer game, and run to me with hugs, high-fives and greetings. Just a quick hand squeeze is enough for some, others want to hold onto me for a while longer. The smiles are radiant, warm and welcoming. A few of them request a photo every time they see me – one of them now wants a picture of me to put by his bed! Several times throughout the day, and now delayed a bit due to school, they run to the door of the clinic and just say my name just to see me look up, and smile. They ask for a glass of “d'lo glase,” or cold water, from the fridge, because they know I will give it to them. Cold water is a pretty special thing here – even one of the nurses believes that medication given with cold water has no effect! It is a rare thing to have a glass of nice, refreshing cold water. Cold storage of anything here is unheard of in the slums and the poor neighborhoods. Ice? Forget it! Think about that one as you turn on the kitchen sink, grab your Brita filter out of your refrigerators, or as you enjoy your morning glass of milk or your afternoon Diet Coke, and be grateful.

The Bittersweet

It has been a weekend full of the bittersweet. Such strange juxtapositions and situations which should be joyful...but are marked with the sharp pain of tragedy.

The journey continued last week, as I again introduced the nurses to the idea that soooo many books with so many lists was not efficient, and that documentation is absolutely critical. They have worked out a system in the year plus that FWAL has been in existence, and I admire and appreciate their work. But as we continue to delve into organizing the charts, there are unfortunately many flaws in the system, and numerous issues have been missed. So, enter computer and Excel spreadsheets. This is very much the opposite of what all of the nurses are familiar with, and two of them have no knowledge at all of computers. Therein lies a massive challenge for all of us! I was able to create a spreadsheet with all of the admission labs needed for each child, and who still needs what. (Yes, these are labs that are meant to be completed on admission of the child to the program). After our work with heights and weights, the nurses were not completely terrified about the next step, and bravely assisted me with entering information. I can understand the terror of a new system with tools totally unfamiliar, and they are not able to see the efficiency of what a computer can provide. But anyhow – as of this morning, we have four out of 182 children who have a complete set of labs! (Not a great stat, I know). So we march forward, slowly working our way down the list and through the kinks, to get everyone up to date. Each time we can fill in a blank box with the word, “gen,” or “have,” we are excited. Now we begin with collecting statistics for the clinic – a gracious and immediate move by one nurse was to purchase three new notebooks “to write the lists.” Again, unfamiliarity with the computer.

Another challenge, as I mentioned previously, is documentation. Children with scheduled medications, meaning those kids undergoing treatment for a particular issue, are most often followed well, with each medication administration documented in the chart. But the numerous children who come into the clinic with bumps, bruises, headaches, tummyaches, fevers, et cetera receive treatment as well. Those treatments are very rarely documented in charts – the infamous Book is taken out for such things. We have now had three conversations about how critical documentation of EVERYTHING in the chart is. It's a slow process, changing behaviors. I am hoping if I continue to lead by example, the reminders may perhaps be slightly diminished in number. We shall see. So many things to do!! I continue to observe and ask questions, and the nurses are understanding my Creole!! I had a wonderful Eureka moment on Thursday afternoon, when I was able to speak through an entire 15-minute reporting session and they understood me. I am sure I still sound a bit ridiculous, as I continue to mix French and Creole words, with a little Spanish thrown in unintentionally. But they are gracious and complimentary. One nurse has been a bit more challenging to read and reach – she has been here since the beginning of the program and has the most routine established, not terribly appreciative of change and an increased workload. But we make small strides forward – win her over with humor, was Joanne's advice. The nurse does have a great sense of humor. And I love to anticipate needs and questions. I can work from that approach too.

NOTHING happens quickly here. I have bitten my tongue as I wait patiently for medications and tests that we need, as I learn week to week that the process of purchases takes time, as communication continues to be a burden to bear. The effort is diligent, and the intentions are good. But intentions do not kill parasites! So I must continue to be patient as we search. The program for kiddos who need extra nutrition should begin within the next week. We have enough protein- and calorie-rich meals to serve them for two plus months. That should, Lord willing, provide enough time for me to find a replacement supplement once our supply is depleted! The two children who tested positive for TB and had a positive chest x-ray were able to enter the TB program through St. Damien last week. Such a relief it was to send them, and the work of Joanne and the staff at the hospital has been a great gift. We are still working through the process of obtaining medications through them, and numerous protocols continue to be reviewed.

I was in the mist of my three-day weekend but made the trip to St. Louis for my first “Visitors Day” experience. A large population of the children at St. Louis and Ste. Anne has family in or near the city, and the first Saturday of each month is Visiting Day. The children from Ste. Anne are brought over, as there are many siblings split between the two locations due to age. Extended family signs in, there is the greeting, and then there is time for just being together. Food and gifts are brought by several visitors. Some children appear anxious to see the family that comes, some are clearly happy to embrace the time. It is a strange day – families which ideally should be reunited are brought together for a few short hours each month, because the means are not present to be together in one home. These children came from the poorest areas of the city, and they lost one or both parents in the earthquake or were rescued from horribly dire situations. The strain is visible on the faces of some “parents” (any family that is now caring for a child, regardless of actual relationship, i.e. aunt, sister, cousin, is called “parent”), the children are guardedly excited, and then when the family members leave, devastation is seen in the youngest children. Sobs ensue for some, quiet and reserved silence for others. Some children receive no visitors at all. Many children in this case had no one come to see them. Some children never do. Those who have been abandoned, those whose family is indifferent or too impoverished or ill to travel, sit and watch the sweetness of short reunions. We try to entertain them, we play and draw, we walk around and hold the babies, we laugh and tickle, we comfort and listen.

One little boy, Maxuel, is a precious little one whose eyes speak of hidden trauma. He recently came from Ste. Anne to Ste. Louis, and crowds are overwhelming for him. He moans and cries, unable to keep eye contact, but so affectionate and playful when he is not scared. His behavior changes on a dime; a momentary flash can trigger fear. He stayed close to Sr. Kathleen or myself throughout the morning, anxious with the new and different people present at “his house.” He had no visitors, and has not had visitors since his admission. So he was one we watched carefully, listening and with an ever-present hand holding his.

Another little girl, Fabienne, stayed very quiet and walked right next to Dani for the morning. At one point, when I saw her and approached her, she started to cry as she looked around. She said her mother was ill and was too far away to visit, and the sadness was in her body language as she held her head down. She is a beautiful artist, and she colored a picture and finally decided, after several minutes, that her favorite color was red. The tears were never far away, and when I asked if Dani and myself could be her family for the day, she cried again as she nodded her head. Bittersweet. Emotional. So difficult for young children to observe, experience and process. So joyful for those who are able to reconnect with family. But they continuously kept watchful eyes on the staff and volunteers, as if to say, “Don't go too far away. Stay where I can see you.” They live and are cared for here, and will be indefinitely. At the same time, it is crucial to maintain relationships with family who want to eventually take these children back into their homes. One father, who broke my heart two weeks ago when he dropped his children off at the program, decided he could not bear being without them. This was a man whose emotions showed clearly on his face. It was a rare thing to witness, as the men are so often stoic and restrained. This father loved his kids. They were very healthy and well cared for when they arrived, and the tears fell both from father and children when they were separated. He came back on Visiting Day and took them home. He was noble and determined, and I know they will be loved and secure with him.

Sunday we took a trip to the mountains! The glorious change in the air and the temperature was a wonderful and welcome respite from the constant blanket of heat. The drive is absolutely gorgeous, and the scenery is breathtaking. It is hard to believe that the same country houses such contrasts in climate and culture. As the elevation increased, so did the evident wealth of the population. The sizes of properties increased greatly, and though the ever-present poverty continues to follow us wherever in Haiti we go, the rich bourgeois stake their claim as well. There are mansions behind heavily secured gates, built into the mountains. There are also tiny homes literally stacked onto each other, looking precarious especially given recent history. But it is beautiful. The orphanage at Kay Ste. Helene houses over 400 children, and is a series of houses intermixed with two large schools. The volunteer house there is a quiet stone building with an amazing view of the mountains and the countryside. We had just a few hours there, but it was a mini-retreat. We hiked straight up to the top of the mountain, (and I mean straight!) and we searched for the stunning view of Port-au-Prince that we know is present...but the rising fog spoiled our plans. We had a wonderful lunch, a delightful change from the standard menu here in Tabarre, and we just breathed for a while. My legs are protesting a little bit today, but it's a good pain!!

Security continues to be an issue for us, as the climate of the surrounding areas changes. The walks I so enjoyed every morning, midday and evening are on hold for now, as we are driven back and forth from work site to home site. So that is a bit of a negative for now. I so loved walking through the pasture, having a few minutes to myself, getting exercise and greeting the cows as they ate! A lot of tiny little ones are being born – the cuteness factor! I try not to think about why they are really eating so well...gulp. But I am grateful each day for the prudence and care of the staff and employees here. As in any developing country, we must act cautiously, but at the same time approach our mission with the knowledge that it is not our mission at all, and that we are in the care of Someone much greater than ourselves. There is grace and so much peace present in that realization.

School started today! We entered St. Louis this morning to find hundreds of children lined up and being separated into classes, after a brief prayer led by a local priest. The kids looked nervous but oh so handsomely dressed! The number and differing colors of ribbons in the girls' hair was amazing. The sun was unforgiving, as usual, and the kids waited patiently as they were divided. I was excited to learn that the kindergarten class will be meeting just down the walk from the clinic for now! (The construction of the school is very close to completion, but will take at least another month. So the kids are spead out throughout the St. Louis complex, in tents and under roofs and in a few classrooms that were used last year). The kids are adorable! Even with the crying that was present through the entire morning, the singing and playing was fun to watch. Most of the children did very well, and I was thrilled as I encountered our Ste. Anne kids in the midst of the 200 kindergartners. The smiles as I greeted them were so heartwarming – as they recognize me and know I am here, I hope that they sit just a little more at ease.

I met Jan and Dr. Pilar this midday. Jan is the regional health coordinator for Haiti and the DR, and Dr. Pilar is the international medical director. It was wonderful to put names with faces and emails, and to talk through many issues with them. We then had an extensive meeting this afternoon with the clinic doctor and nurse, where my list of duties grew ever longer. So much job security is given to me every day! The work continues, and as long as it takes it will take. But we are determined to better the lives of the children in our charge, and to better ourselves for it.

Pictures...

Words to follow soon!

The view from Kay St. Helene, the orphanage in Kenscoff

hallway at the volunteer house, Kenscoff

Painting on the side of a building, Kenscoff

chapel at Kenscoff

another view from Kenscoff

ruins of the National Cathedral. The stained glass and doors have all been removed.

All of the rubble has been cleared.

Palais Nacional. Demolishing of the building has started.

Palais Nacional. The tent city right in front of this landmark is the most dangerous.