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.