Mission Creep

     This morning at breakfast we learned of a new Christianville policy. Effective today, in addition to a prayer, each breakfast will be preceded by a reading from the Book of Psalms.

When Can I Start??

     All the approvals were issued, the equipment and material were in place, the money to pay my Haitian team was (will be?) advanced, my staff was trained and ready to be hired, I was all set to start the project next week.

     Or so I thought.

     On Thursday afternoon I asked the three people whom I planned to hire to come to Christianville. We all met with Herold, the Christianville Director, who explained the positions and how C’ville would be handling the hiring and salary. The contracts will be drawn up for their signatures next week. So we have begun. My staff is hired.

     Right after we met with Herold, Makendy drove me and my staff to the Gressier clinic to meet with Dr. Celestin, the clinic administrator. The meeting at the clinic did not go as well as I had hoped. Dr. Celestin does not want us to start until November 3. I had planned to start next week. He wants us to use his lab and lab technician for blood draws. I had planned for my staff to do their own blood draws. He wants me to hire a “Facilitator”. I had told him previously that we do not need one.  The rooms we will be using are not furnished. One room has only a desk. The other room has no furniture at all. I was frustrated and disappointed, but calm. We left the clinic and returned to C’ville.

Time to move to plan B.

And You Think You Can Start When?

     I arrived back in Haiti on Monday with renewed enthusiasm and high expectations to start my sexually transmitted infections study in Gressier. I finally received Human Subjects Research approval from my Institutional Review Board and another approval from the oversight committee that has to sign off on overseas projects. So everything was good to go as of September 12, 2014. It was only about 10 months later than I had hoped to start the project but I was very naïve and overly optimistic about how long it actually takes to get a study of this type underway.

     My equipment and supplies were all in place in the UF-EPI Haiti lab in Gressier and I brought down more supplies when I came back on Monday. So one of my goals was to hire my staff that I had trained in July. When I flew down here, I still did not have a contract in place between the Henry Jackson Foundation (HJF), the organization that manages my grant for the study, and Christianville Foundation, who will handle hiring and paying my staff as well as other in-country expenses such as housing, lodging, transportation, use of the UF lab, etc. Negotiations had begun in June and when I left my office in Bethesda on October 10, I still did not have a contract. I had been through several weeks of frustration trying to find out what was holding up the final contract. I cannot tell you how many emails I received that said the “final” contract was ready to be signed. Then something else would come up and nothing was signed. It was infuriating. I had already scheduled my trip with the expectation that the contract would be in place and that I would be free to hire my staff and start the project. I could not wait. My travel office required a 30 day advance to process the paperwork for a foreign trip. Don’t ask why. I would not be able to tell you. The forms are all filled out the same way as for my previous half dozen trips in the past year. Why should it take so long and require so much advance notice? I don’t understand. It is just one more frustration.

     So I arrived in Christianville on Monday and met with John, the person who is the Christianville contact for the contact negotiations. He could not understand why it was taking so long either. I apologized for the delay. I told him I would contact my Program Manager and see where we were on the contract. Tuesday, I contacted my Program Manager to get an update. Things were still a mess and no contract was ready. Tuesday night, John forwarded me an email he had received that afternoon from the person at HJF who was handling the contact. It said that she was no longer handling the contract and that someone else had been assigned to work on it.  John said he assumed that I had received the same email and that I was aware of the change. I was not. My Program Manager was not informed either. I was furious. It was embarrassing. I had dinner with John earlier that evening and he knew about the change while I was completely unaware of what was going on. Now what? This turn of events was very depressing and unexpected.

     The good news is that the person now handling the contract is very good and efficient. The better news is that on Wednesday the advance money was approved which means that I could hire my staff. We called them on Wednesday afternoon and told them to come to Christianville on Thursday. We hired them this afternoon! I have my Gressier team. We are ready to go.

     Or so I thought.

This Time, We start

     After a long hiatus, I am back to writing my blog. Please excuse the long absence. It was due in part to summer vacation and in part to not having much to report since my last trip to Haiti in July. Now I am back at Reagan National Airport (DCA) waiting to board my US Airways flight to Fort Lauderdale and then on down to Port-au-Prince (PAP). It was a little over a year ago that I sat in this same airport waiting for my American Airlines flight to Miami and then to PAP. It was the start of my sabbatical leave and the beginning of the long journey to set up a sexually transmitted diseases surveillance project in Haiti. A year has passed since that pre-dawn October morning when Pierre drove me down the GW Parkway to DCA. For probably the sixth or seventh time he has done so since last year, Pierre drove me to DCA again this morning. Pierre is now in graduate school at American University. Cecile and Odile are one year further along in their college education.

Last year, the Federal Government was shut down. Congress could not agree on a budget. Today it is closed for the Columbus Day holiday and operating on a continuing resolution. Nothing has changed in the Congress. Nothing gets done.

Last year they were two separate companies. Now American Airlines has merged with US Airways.

Last year the Washington NFL team was bad. This year they are maybe worse but now more people are refusing to call them the Redskins.

Last year I had a plan but I had no idea how long it would take to implement. Today, I have all of the approvals to start my study. My equipment and supplies all are in place at the UF lab in Gressier. The people whom I plan to hire have been trained. This week I will hire my staff and visit the clinics to set up the space and work schedule to start the project. Now a year after boarding the plane for PAP, naively thinking that I would have the study up and going in three months, I am finally returning to Haiti to start enrolling participants in my study. This time for real.

Found!

     After three or four Denton flights that arrived in July-August, my instrument and cartridges for testing for chlamydia and gonorrhea were still missing. However, everything from the Operation Ukraine warehouse in Mississippi had shipped and the cargo should have arrived in Port-au-Prince on one of these Denton flights (see posts 07-21, 07-23 and 07-27). The only explanation that I could think of was that my cargo had gotten mixed up with Kathy’s shipments and that it was somewhere in their warehouse in Haiti. Meanwhile, I left Haiti on July 30 and returned to Bethesda. After a quick two days with my lab, I headed to France on August 3 with my daughter to join my other daughter and son for our annual summer vacation with my late wife’s parents and sister.

     I sent out emails from France to Kathy and Meer with a description of my cargo, the number of boxes, dimensions, and weight. While I waited anxiously 7000 km away in St. Jean de Monts, Kathy’s volunteers searched through the warehouse in Arcahaie, Haiti. On August 8, I received the email from Kathy: “Praise the Lord and thank goodness for a mission team that restacked all the boxes in the warehouse!” They found my cargo. I sent a quick email to Meer and asked him to contact Kathy to coordinate picking up the shipment. Four days later, Meer emailed me to report that he had my cargo safely in the lab at Christianville. However, not all the boxes were accounted for. The important piece, the test instrument, was there. So were the boxes of test cartridges. But the laptop computer needed to run the instrument was missing. I emailed Kathy and Meer to ask them to check again for the box with the laptop. That was three days ago. I’m still waiting to hear if they have found it. I think Kathy is back in the U.S. so I don’t know who might be at their warehouse in Haiti that we can contact. I fly back to the U.S. tomorrow.

     Stay tuned.

Running out of Plan B’s – The Denton Flight Arrives, but Not My Cargo

     Today we drove out to the PAP airport again to await the arrival of anther Denton flight. Last week’s flight had all of Meer’s cargo but none of mine (see July 23 post). Since the original load had been split, my cargo was supposed to be on this flight. Meer and I left C’ville in the Kia with Gesnier, a weekend driver for C’ville. An hour later as we turned onto the airport road, Meer pointed out the driver’s side window. The C-17 was in the air! It looked like it had just taken off. I quickly got on the phone with Ruben. Had we gotten the arrival time wrong. No, he assured me. The plane was just making a second approach. I was relieved but we were still stuck on the airport road for another 30 minutes before we finally broke through the lines of cars going to the terminal and the parking lot and we headed for gate #7. We pulled into the parking area alongside several of Kathy’s trucks and waited. I called Ruben to let him know we had made it. We waited. About 20 minutes later, the escort vehicle came and took us out alongside the runway to the unloading area. I remarked to Meer how security had changed since we came to the airport for the first Denton flight in March (see March 29 post). Back then our driver had to surrender his driver’s license for a vehicle pass. Before we could drive onto the tarmac, we stopped at a second checkpoint where our vehicle was inspected and we were wanded with a metal detector. Today, no vehicle pass, no second checkpoint; we just followed the escort vehicle onto the tarmac right up to the U.S. Air Force C-17 from Charleston, SC.

     Meer and I got out of the Kia and started looking around. Most of the cargo had already been off-loaded. There did not seem to be much food this time but a lot of furniture and boxes of clothes, a washing machine, blankets, chairs and desks. But no GeneXpert and no test cartridges. We walked around several times. My cargo was not on this flight. We talked with Kathy. She did not know why my stuff had not made it on this flight. She does have stuff on two more Denton flights coming in later this week. By then I will be back in the U.S. I was hoping that I would be here when my equipment arrived. Now, after two flights in one week, I still don’t have my equipment. I was very disappointed.

     We could not leave with an empty truck. Kathy asked us if we needed any desks or filing cabinets. Meer showed her a couple of nice four drawer filing cabinets we could use so we slide them into the Kia. Then someone found an incubator on one of the pallets. It did not belong to us. Kathy thought it might have arrived at her warehouse after she left for Haiti and they just shipped it without telling her. She asked Meer if he wanted it. Sure, he replied. So the old microbiological incubator went into the Kia. Maybe it works, maybe not. If it works, we’ll use it. If not, we’ll find someone to fix it.

     Soon the C-17 was revving its engines to taxi away from the unloading area. The plane was facing us and the noise was deafening. The pilot made a tight pivot and pulled away. The heat from the engines was indistinguishable from the late afternoon Haitian summer heat. It was time for us to go also. We will stay in touch with Kathy and Ruben. When the next flight arrives, they will let us know and Meer will work out a way to pick up my cargo. We thanked Kathy and Ruben, climbed into the Kia, and left the unloading area and followed the escort vehicle back to gate #7. We headed back to the airport terminal where one of Meer’s friends was waiting to pick him up. Meer will celebrate the end of Ramadan with his friends in PauP. I walked to the arrivals area and waited for Danette and two students from Texas A&M who came in on the American Airlines flight which arrived while our C-17 was unloading. I found them and brought them to the Kia. We loaded their bags and headed back to C’ville.

     I was hot, tired, sweaty, and dusty. I had spent the afternoon breathing diesel fumes while stuck in the PauP traffic (remember, the Kia is not air-conditioned so the windows were open) and aviation fuel fumes while waiting under the unrelenting sun in the parking area. I was disappointed that my cargo was not on this flight. Very disappointed. I hope my cargo will come on the flight next Saturday. If it does, we have another plan to pick it up. If not… I don’t want to think about that right now. Stay tuned.

Meer, Me, and the Mountain Loop

     Meer and I have been taking early morning hikes up into the mountain. We get up a little after 6 am, get dressed and head out the door. Meer leads the way through the C’ville gate and along the road behind the C’ville school. We turn left up the road that leads to Haiti Health Ministries (HHM), one of the sites where my STI study will take place. We go past the site of another mission called Shepherd’s House. Their compound is very large and they have a soccer field. We continue up the road and then it begins a steep climb. It is rough and the going is slow. The road is rutted and there is nothing but rock and stone. There are generally a few people on the road and several moto taxis but otherwise it is quiet. The view from the ridge opens up on the plain that extends down to the coast and the Bay of Port-au-Prince. We walk along the ridgeline and then down the hill until we reach the main road that brings us past the Marechal soccer field and finally along the back of the C’ville school. All told, the loop is a brisk 45 minutes.

Marechal

     Saturday morning, I head out alone on Meer’s mountain trail loop. The end of Ramadan is approaching and Meer is still fasting. Meer worked late last night so he wants to sleep in this morning. It is about 8:15 am and the temperature is near 90F. The sun is up above the mountains to the east. I greet the guard at the gate and let myself out of the C’ville compound. As I walk along the road behind the C’ville school, the women at the food stand are already cooking the food that they will be selling during the day. I greet them and they greet me in return (they recognize me by now) and I walk along the road that is quickly filling with moto taxis. There are a lot of them this morning. I try to walk along the edge of the road to stay out of their way. Several young people are at the corner filling up buckets of water from a faucet that is hooked to the C’ville water system.

Haiti Health Ministries

     I turn left and walk up the road toward the HHM campus. HHM is closed now for two weeks for vacation. Everything is quiet there. Twice earlier in the week, I saw things on Meer’s mountain loop that I had never seen in Haiti. One morning near the HHM compound we saw a young blan woman walking a dog on a leash. I had never seen a dog on a leash here before. As if that wasn’t strange enough, the dog was a German shepherd. I don’t know how the poor puppy can stand the heat. The only other time I had seen a dog on a leash here was a drug-sniffing German shepherd at the PAP airport. At least that dog was working in an air-conditioned building. The second unusual thing we saw was a group of five Haitian teenager boys jogging down the mountain road. Yes, they were clearly runners in training.

     Along the road there are goats and cows and a few people. I reach the ridgeline and turn right along the road. I look back over the coastal plain. There are fields under cultivation, pastures with cows and goats, and the two large mission compounds. As is true throughput Haiti, the mission compounds are fenced in communities. HHM is large and encircled with a cyclone fence. They had recently completed an expansion of their campus and moved out of the tents that had served as their clinic into very nice facilities with tiled floors, windows, lights, and a cool natural ventilating breeze circulating throughout.

Shepherd's House Ministry (foreground) and
Haiti Health Ministries (background)

Shepherd’s House Ministry is further up the mountains and partly built into it. A tall concrete block wall partially encloses the compound and obscures it from view from the road. From the ridge, the size of the compound is evident. I did not realize it was that large. A group of young men are playing soccer. I can also see a basketball backboard and hoop and what appeared to be either a gazebo or a moon bounce. A few solar panels dot the roofs. The large mission buildings are in contrast to the varied construction of the homes along the loop trail. Haitians live in homes made of concrete block, sheet metal, thatched vegetation, or tarps such as the popular sky blue tent material from Samaritans Purse. Such is Haiti, a country of contrasts.

     The air is hot and the sun is beating down on the large, bare rocks that litter the road. Even though it had rained quite a bit last night, the road is mostly dry with only a few scattered puddles of water. In spite of the heat, I am wearing my jeans. They are my protection against mosquitoes. I had also sprayed my arms with Off Deep Woods for protection on my bare skin. I am wearing an Under Armour heat shirt but I am soon sweating right through it. I pass an old man walking along the road. He looks at me and says, “Ou mouye”. I nod. Yes, I am wet. “Fa cho,” (it’s hot), I reply. He laughs.

     I continue my walk along the main road through Marechal heading back toward the C’ville school. I greet a pair of young girls who are walking in the opposite direction. They stop and ask me if I am Haitian. I laugh. “Non. Je suis americain. Mwen se amerikan", I reply. They giggle and walk on. Sometimes I think I’ve been down here too long.