The public market

On the weekend it’s hard to separate work from personal time. Cleaning my room involves starting on my accounting, as I try to get stray receipts out of my hand luggage and tidy up the space. I staple my receipts and convert my expenses from Haitian Gouds to US dollars for the accountant. But I do things I wouldn’t do in the US, like squeeze a little fresh orange juice from the inexpensive oranges I picked up in the market, which did not look attractive (mottled green, yellow with dark spots) but were incredibly sweet. The market is so off-putting, with its dirty looking vegetables and fruits and the genuine risk of cholera for anything uncooked. But the Haitian fruit, untended by strict breeding that we get in the US, has some of the most intense flavor. The white grapefruit was one of the sweetest I’d ever had.

I want to buy some limes and grapefruit, so I ask Wilfrid if I can go when he takes the car to be washed on Saturday. Most of the time when I shop for fruit, it is from my car, and Haitian fruit really looks the same when you are in a moving vehicle. Limes, oranges and grapefruits are all a yellow-green color and mainly distinguished by their size. Even passion fruit and mangos can look like citrus because their colors are the same. So I spend most time squinting at piles of fruit placed on the ground next to the road, straining to identify them.

I hop out of the car next to thirty live chickens in a pile. It’s hard to shop in the market comfortably. Even though it is not a hot day, the market is fully exposed to the sun. I quickly start sweating. It’s a dirt road with puddles of muddy water. It feels impossibly dirty, and motorbikes race through, very close to you. I can't believe that I eat food that sits in piles on this street. And then everyone is trying to convince you to buy their vegetables, and it’s a series of women with very similar selections of produce, piled. Some of the women are selling piles of chicken bouillion cubes. Haitians buy things in large fixed quantities. So it is difficult for me to purchase one grapefruit: they are piled in predetermined sets of 5.

I realize that I accidentally left my long hair down, which is something I try to avoid in the street. I don’t want to draw attention, and while I’m still obviously a blan (white), pinning my hair up definitely cuts down the staring. It’s almost impossible to put my hair in a ponytail while walking through the crowd without being knocked down, but I try. Also I’m sweating too much.

The market takes a lot of work, and I have to stare down at piles and piles of fruit and vegetables trying to determine which ones look the best, all while keeping an eye on the ground for mud puddles and trying not to be hit by a moto. Today I nearly collide with one. While I was evaluating some carrots, someone said, “Michelle!” I looked up. Right in front of me was Miss Delisca, the main pediatric nurse at Hopital Saint Antoine. “Oh!” She laughs at me and does an impression of me walking with my head down, shading her eyes. I laugh with her and ask her how she is. She replies that she is fine, but where have I been this week? It’s true, I was traveling for two weeks I tell her. I promise I will be at the public hospital on Monday.

“Good, we have a lot of kids who have been tested,” She says and I am deeply happy, both that she’s invested enough to stop me in the street and because Saint Antoine is my favorite of my sites, and I want them to perform better. I shamelessly play favorites at this point, I love their staff. “Have a good day!” I tell Miss Delisca.

I continue through the market with more confidence, feeling at home. Running into a familiar face while shopping solidifies that I am a member of the community. I refuse to be treated like an outsider here.

I select bunches of grapefruit, oranges, cherries, onions, and carrots. My purchases total $3 US. One of my plastic bags tears open, spilling everything but the cherries into the dirt, but a vendor gets up and helps collect all my purchases, placing them in my canvas bag for me. I thank her and buy a dozen of her limes, then make my way back out of the market into the safety of my bright blue SUV, still parked with the chickens.

The View from Here

Some photos to give everyone a better idea of what Haiti looks like. If you drive to the south from Jeremie - the route in the direction of Les Cayes you'll see one of the five rivers of the Grand Anse (photo 1),


Continue driving for four hours or so, and you reach Les Cayes. Turn west and continue and you'll see this (photo 2).


This bit of road has one of my favorite views. You climb uphill and can see greenery like that and the ocean not that far away.

Instead of heading south from Jeremie, you can also take a very narrow road to the west along the waterfront. It becomes a dirt road and if you are in a 4WD vehicle, a motorbike can just barely get past you when you intersect (and you will). At the end of this road is the tiny village of Anse du Clerc. Anse du Clerc wins as my second favorite beach in Haiti (photo 3).


You can't see it here, but if you walk down those rocks you will find some sand (not a lot though). You won't see many tourists here... it's mainly the local women, washing their clothes, the local children, shelling almonds (though the almonds here are small and shriveled looking, they are still nice to eat) and fishemen mending their nets.


This beach also has a very wide green grassy area behind it, and then a sharp wall of green mountain rising to the back. I didn't get good photos of that, I was enjoying stretching out too much... also I wasn't sure I could even do it justice. There is also a decently organized little beach bar, rooms to rent, and a toilet. It's a rarity to find that on the beaches here. Although the toilet door doesn't close well, so I did walk in on a guy.

More in the tour of Haiti to follow soon.

Fatherless

Our social worker, Fedy, had tried to explain to me that many children in Haiti are "fatherless." But I learn best with data. I did not truly understand the problem until today.

No Time For Poverty conducted a household survey in the southern region of Haiti. Ninety percent of the households are female-headed households. Ninety percent. Just under ten percent of children are living with their father (or even a step-father) in their home.

I'm beginning to understand.

9/28/11

So, someone in the office noticed that there are two HIV positive children that shared the same last name. These children appeared at different hospitals. They were about the same age.

Odd. After some excellent sleuthing…

Well, they have the same father. Different mothers. He got two women pregnant at about the same time.

One of the women is still with him. And she got pregnant again. And now her second child has HIV as well.

One father, two moms, three children. All of them HIV positive.

Under one roof

When children reach the age of 24 months, they no longer qualify to receive free antiretroviral treatment. The reason for this is that they are less at risk of dying in the short-term. Very young infants are quite likely to die of HIV before they are diagnosed.

This is the entire idea behind our program, which seeks to identify children as quickly as possible after they are born so that they can have a chance to survive.

But for children who don’t get tested until HIV until they are older, they need to have a frequent CD4 count. The CD4 count is a measurement of your blood cells. With HIV, your CD4 count descends over time. The CD4 count determines whether you can receive medicine. A CD4 less than 350 makes someone eligible to begin treatment.

I had written a big note on my calendar for today. Kids should have their CD4 count checked every six months. One of my girls, Achelove, had not had her CD4 taken in nearly a year. I wanted to be there personally to be certain her blood was drawn for the test, so this didn't get delayed another month.

Of course I wrote that note before the electricity crashed.

Today I walked into the external clinic looking for Achelove, three years old. As I walked quickly through the room, a tiny hand wrapped around my pinky finger. A little girl with her hair groomed into a poof at the top of her head and in a dirty white party dress looked up at me with wide, hopeful eyes. I smiled at her and kept moving.

A health agent passed me. “Possible, is Achelove here?”

Possible pointed back at the girl in the party dress. Achelove had remembered me.

But when I found Dr. Narcisse, we hit a wall. There was no electricy (for nearly a week now) so they couldn’t perform a CD4 test. Achelove and her mom had to come back.

“Dr. Narcisse, when do you think the power will be back? When should she come back?” We stared at each other, uncertain. Achelove kept tugging on my hand. I turned to her mom.

“Do you have a phone?” She shook her head, no.

I turned to Dr. Narcisse. “I will give her a phone, and we can call her when there is electricity.”

“You are going to buy her a phone?” Dr. Narcisse laughed at me.

“No, we have phones we give to moms for when we need to contact them. For the program.”

“But Michelle, aren't you going to the HIV support group now?”

I looked at the mom, then at Dr. Narcisse. Taking care of Achelove was important. “I’ll go get the phone first.” I turned to the mother – “Wait for me. I’m going to get you a phone. I’ll be back in 30 minutes.”

I raced out the door, across the hospital, to my car. Wilfrid and I drove back up the broken road to my hotel, where I dashed out, grabbed the neon green Motorola phone and charger, and jumped back in the car. This is when I realized the phone wasn’t charged.

That’s ok, I can charge it at the hospital. Except no. No power. I grab Wilfrid’s car charger and plug the phone into the car. This is ridiculous.

So many of the families in town don’t have electricity, so they charge their phones at the hospital in the waiting room. What are they doing now that the generator is dead? I wonder.

When I get to the hospital, I can’t turn the phone on. “Charge it at the Red Cross” suggests Wilfrid. I doubt they have power, but I try. Asier is there, and I see computers plugged into the wall. “You have power?” I ask hopefully.

“We had power for 10 minutes. From a solar panel. But now that’s dead too.”
I go back to Wilfrid, ask him to charge the phone in the car, and go inside the external clinic to stall for time.

I have to ask Achelove’s mother to sign a contract – written in Kreol – asking her to keep the phone charged (ha) so I can reach her and to tell me if she loses it. I don’t like to give women money or phones in public. I decide to commandeer an office. Since there is no power, a lot of the hospital is abandoned. I wave for her to follow me and find an office with a window since the interior offices are nearly pitch black without light. I read part of the contract to her, since she is unable to read. I point to a line and ask her to make a little cross in place of her signature.

Achelove’s mom has been quiet this whole time. As we start to exit the office, she starts to speak: her mother and father had just died of cholera. I pause, horrified. I don’t know what to say to her.

know there are families here in Haiti that are not touched by cholera, or HIV. But I feel like the problems, the pregnant fifteen year olds, the young women getting HIV, the families hit by cholera – this problems are not arriving separately, at different doorsteps. They are all under the same roof.

Unfortunately, the only small thing I can do is to get this one little girl back to the hospital. Her mom is very quiet on the drive home, for good reason.

Mobbed by children at the beach, again.

Sorry for the silence... I picked up a new computer that has not let me submit blog posts. So much for upgrading.

But I went exploring on a new beach, with a town that stretches only three blocks. I believe every child in the area was at the beach, shelling nuts. Every now and then, one child would get up and bring a small handful of nuts to us.

Tet Chaje

Audrene is one of the housekeepers here at the hotel, I like her a lot. She works from early in the morning until quite late. We don’t talk that much, in part because I have a fear of speaking, not sure whether Creole or French will escape my mouth and worried about how badly I’m going to butcher a language. Today I was on the empty terrace (the restaurant) making tea when she stopped me. “Michelle, you work in the health domain?” She asked me in french.

“Yes.”

“On what exactly?”

I hesitated. “With children under the age of 18 months.” The word I used for child was the creole “timoun” – literally it means little man. Petit moun.

“But for everything, all children?”

“Well, some of the research is for children with HIV.” I’m careful because I don’t want anyone to assume that I am speaking to someone because they have HIV.

“And do you give medicine – is it available for everyone with HIV? Or do they have to be sick?”

“It’s available to everyone under the age of two years… so it’s important to diagnose and start them on treatment right away. After two years, it depends on the level of the illness, whether or not they will receive medicine”

“And they can live with HIV?”

“Yes, people can live like normal if they get medicine early.”

“But Michelle,” she pressed. “Even in the United States isn’t it possible for them to be cured of HIV?”

“No. It doesn’t exist.”

“Even for the richest people in the United states?”

“No! Even if you are rich, HIV cannot be cured.”

Audrene shook her head at me. “Tet chaje.” This phrase is an important one in creole… meaning “charged head” – when someone tells you something crazy and it is overwhelming to your brain. “Thank you. This is good information to have.”

I smiled at Audrene, picked up my tea and went back to work.

Cholera Continues

The report I heard states there have been 1,500 new cases of cholera within the past weeks in the northwestern town of Port de Paix. The hospital is overwhelmed as is turning away people who are arriving now, they have no more room.

There were twin children born to an HIV positive mother in our program at Port de Paix. They had been tested for HIV and both children were negative. Here at our headquarters, we received the news today that both children became ill with cholera in this latest outbreak, and they have both died.

The frustrating thing is that I am looking for news and information about this outbreak, but I can't find details online. Cholera cases are still underreported and even though I am here I still don't know what is really going on.

Port Salut

I don't want to give anyone the wrong impression, that I am spending all of my time at the hospital. This weekend, my girlfriends and I headed to the beach at Port Salut with Wilfrid (my wonderful driver). We were able to do this because I'm lucky enough to have a car.

Because Haiti is both an island and poor, there are very few cars in the country. This means even if you can afford one, there may not be a car available to buy. My organization spent months waiting for my rental car, a 2010 Ford truck. It's one of the few cars in Jeremie, and newer than most.

The drive takes about five hours or more on rough roads through the mountains and past Les Cayes (a town big enough to have a stoplight. We were shocked by this).

Port Salut has what is reputed to be one of the best beaches for a holiday. Pictured above is Jonathan. He was sitting in the water and doing small backwards flips into the waves. I complemented him on his gymnastics and he proceeded to fish about 20 tiny clams out of the sand for me.

After our day on the public beach, we headed to dinner at Dan's Creek, a hotel that is startlingly like a resort you might find anywhere else.

An Ordinary Day

My main responsibility here in the Grand Anse is to make sure that three hospitals in the region are testing children for HIV when they are four weeks old, and again when they stop breastfeeding. Any child who tests positive and is under the age of two years can automatically receive free antiretroviral treatment – as long as they have someone who can be trusted to bring them for monthly appointments and give them their medication regularly. Irregular use of ARV treatment would be dangerous for the child’s health as well as a waste of funds.

In the case of one orphan, the person responsible for his treatment is me. It surprised me that we were going so far to make sure each child gets treated. But Samuel lives with a charitable mission, and the hospital did not think the nuns would be able to bring him regularly. So Friday, I went to take Samuel to the pediatrician.

Samuel goes to the public hospital in Jeremie, a place where “it doesn’t seem possible anyone could get better there.” Rickety, rusting beds are jammed together in the pediatric ward, files are kept in gigantic paper registries, confidentiality is questionable. Folding chairs are spray painted on the back “PEPFAR” – gifts from the U.S. government.

Despite the fact that the physical appearance of the hospital is depressing, I really enjoy being there. Many of the staff are sharp, competent, and warm, which is a miracle. In particular, the health agents (you can identify them because they wear kelly green pants or skirts), are very cheerful when I arrive and shout hello to me across the waiting room. The social worker is particularly insightful, and he is very invested in the well being of the patients. And the pediatricians.

The pediatricians fascinate me: two very pretty, very professional young women. In this drab setting they seem glamorous. One of them entered the room with a red flower neatly arranged in her hair. The new pediatrician was wearing a low cut red floral dress with a black ruffled shirt unbuttoned over it. They speak to me in French and to their patients in Creole. (Except once when Dr. Saint Fleur said softly, in English: “Michelle. You are very quiet!”)

Like everywhere in the world, people wait patiently for the doctors to appear. There are just fewer of them here. They sweep in, do their job, and exit.

“Bonjour Michelle.” Dr. Narcisse Nadege greets me. “Is his infection any better?” Samuel has a bad ear infection, and she uses cotton to swab goo out of his ear with a worried expression. In the middle of Samuel’s appointment, her mobile phone rings. She speaks in fast Creole. “Did you put him on oxygen?” she asks. When she hangs up, she pauses. “Michelle, excuse me. I will be back in ten minutes.”

I bounce Samuel on my knee but he always keeps the same serious expression on his face, as if he knows what’s going on.

Ten minutes later, Dr. Nadege returns. “Is everything ok?” I ask. She shakes her head.

The child had died. “It’s sad.” she says to me.

I watch her calmly continue her work. I realize that there is nothing unusual about this day for her. I can’t imagine what it’s like to be her.

A Haitian Orphanage

There are three orphans who live at the hospital. By “live,” I mean that they have tiny cribs in the corner of the pediatric ward, and I assume they get some kind of food. One of them is a six year old girl who sleeps in a crib that is barely long enough for her body.

I don’t know how long they have been there. They are wards of the city. My NGO identified an orphanage near Port-au-Prince that would accept them if we can get permission from the city of Jeremie to release them.

I was asking for help from the hospital social worker when I suddenly realized that my concept of “orphanage” was not the Haitian concept. To me, an orphanage should be a place that tries to find families that will adopt its wards.

“Fedy, we would like to move the orphans to an orphanage, near Port-au-Prince.” I explained in French.

“Ahh!” he smiled gently. “A place where they would be able to give the children better attention, more care?” he asked happily.

I shook my head. A place where they might get to live in a home with a family, I explained to him. My head was a mess of creole and French, so I tried to remember the word in English: “ADOPTION.”

Adoption does not exist here. There are not enough parents for children. “So, in the United States, a woman can choose to adopt a child instead of having her own child?” Fedy asked me. Exactly. It wasn’t until that moment that I understood why those three children were just living in the hospital. No one liked it. No one believed it was good for them. The pediatricians wanted to help the children. But people do not adopt other children here -- my idea of an orphanage didn't exist.

In Haiti, Fedy explained to me, many children are said to be “without fathers.” I've met numerous women have children from different boyfriends. Abandonment of their children is widespread, commonplace. To the extent that parliament is trying to pass a “responsible father” law.

“What are they going to DO!” I asked Fedy. “Make them pay a fine??” I raised my eyebrows at him. “It’s in parliament, they are still working on the law.” He reassured me. “Mmm, Fedy, and who is going to go find these fathers and enforce it?”

We’ll see what happens, if this law gets written and passed.

Anyway, before the hospital will write me a letter allowing me to leave with the three orphans, I need permission from the UN military. I have been waiting for someone from the UN to arrive at the hospital so I can get the kids released.

“Michelle, MINUSTAH.... they are never going to show up. You have to go to the office of the UN Military. To get permission.”

“And I just walk into the UN office and ask who is responsible for these kids? Who do I ask for?”

Fedy shook his head at me. “Just go.”

Trying to find someone from the UN who will admit to having any responsibility for these children is going to be a nightmare. I am going to be shuffled from desk to desk, until I am unable to continue speaking French. I just know it.