The Diarrhea Iceberg?

     Diony is a community heath worker who works in our lab (see 10-30-13 blog post). Diony’s uncle died of diarrhea two days ago at the Hosanna clinic in Gressier. He was home for four days with diarrhea before going to the hospital. By then it was too late. We don’t know if it was cholera. They don’t test at the clinic. They just treat. His daughter also has diarrhea and is at the Doctors Without Borders clinic in Léogâne. She was caring for her father. Diony thinks his cousin will be all right. Diony told us he has another cousin who also has diarrhea. Meer and I decided we needed to go out to Diony’s neighborhood. It is not too far from Christianville so this afternoon we took out our mountain bikes and went up the road with Diony. We walked our bikes down a trail that runs between small houses, some just tents, some a little more solid, maybe a concrete block front and a tarp or a sheet metal roof. We met another one of Diony’s uncles. Diony gave him a sterile sample bottle and asked his uncle to fill it with water from their house. Diony gave his uncle four sachets of Pedialyte that I had brought with me from the U.S. and explained how to prepare it for his cousin who had diarrhea. We also collected water from two water sources near where Diony’s uncle lived. We took them back to the lab where Meer’s team will analyze them for fecal coliforms and test for the presence of Vibrio cholerae.

Diony points out a water source to test

     Meer and I are thinking that the cholera epidemic here is bigger than anyone realizes. We are looking at the tip of the diarrhea iceberg. Lots of cases are going unreported and people are probably dying from diarrhea out of sight of the public health eye. Haitians do not admit they have diarrhea. They find it is shameful, a stigma. So they stay home three, maybe four days with diarrhea and when they are too sick to do anything, they go to the hospital, maybe. And maybe they survive. Or maybe they die because it’s too late. They are too dehydrated from the persistent diarrhea that even intravenous fluid is not sufficient to save them. These are the hidden numbers of the cholera epidemic. We are not catching the number of Haitians with diarrhea who do not go to the cholera treatment centers or the local clinics. There is clearly a need for educational interventions in Haiti. First, to raise the level of awareness of diarrhea as a potentially life-threatening disease and to destigmatize the disease so that people are not ashamed to seek treatment. Second, people need to be taught how to prepare and use oral rehydration solution (ORS). It is simple and made with ingredients that are readily found in any home: salt, sugar and clean water. Use of the World Health Organization standard ORS has significantly reduced morbidity and mortality from diarrheal disease, particularly in developing countries. Simply put, use of ORS saves lives.

Kreyol patient ORS instructions

It’s Haiti v7 – A Door Knob and a Light Switch

   

View from outside the bathroom

View from inside the bathroom

     There is a doorknob on the door to our bathroom. It has a button lock just like the kind you probably have on the bathroom door in your house. You push in the button, and the door locks. On the other side of the doorknob is a keyhole so that you can unlock the door. We have no key. That is not the problem. The problem is that the doorknob is installed backwards. The button lock is on the outside of the bathroom. The keyhole is on the inside of the bathroom. Meer locked himself in the bathroom the other night. He could not get out. I was asleep and heard the banging on the door. I got up and opened the door for him. How long has this door been like this? What? No one ever noticed this before?
     Meer brought in Dale to fix it. Now we have a bathroom door with a doorknob in the right direction.

     There is a ceiling light in the entrance hallway to our house. I did not even know that there was a light since there was no bulb in the socket. Yesterday Meer came home with a couple of light bulbs. I screwed the bulb into the light socket and looked for the wall switch to turn it on. Meer chuckled. “Where do you think the light switch is?” he asked me. It took me a while to find the light switch. It is on the wall to the left of the front door as you come into the house. This less-than-brilliant (pardon the pun) wiring design means that the light switch for the entrance hall is behind the front door when you open the door from the outside. The logical design would be to have the light switch on the right hand side. You open the door, reach over on the wall on the right hand side, and turn on the light as you walk in. But not in our house. When you enter our house at night, you open the door in the dark, close the door in the dark, and reach around the door to turn on the light.

It’s Haiti. 

Entering our house

The light switch behind the door

The Dedicated Lab Staff of UF-EPI Haiti Lab 1-Gressier

     Yesterday was a very busy day. Our drivers brought in 28 samples from the various collection sites. Dozens of Petri dishes were prepared and the lab staff set to processing all the samples. At the clinics, a stool sample from each patient is placed in two types of transport medium (Cary-Blair and BGS) and also placed in a specimen cup (with or without formalin depending on transport time). When the samples arrive at the lab, material from the Cary-Blair tube is used to inoculate five Petri dishes of different kinds of culture medium (the sample is streaked out onto the surface of the Petri dish).  Two additional types of medium are inoculated from the BGS tube. Then one tube of enrichment broth is inoculated from Cary-Blair and one tube from BGS. Finally, the stool sample itself is processed for microscopy to look for parasite eggs and worms. So for each sample we receive, the technicians inoculate seven Petri dishes, two tubes of broth, and prepare a slide for microscopy. Yesterday they had 28 samples so that means they streaked almost 200 Petri dishes and inoculated 56 tubes of broth and examined 28 microscope slides.

     Meer trained the Haitian technicians who work in the lab. Benoit, Medjina, and Diony, Tabita (a community health worker), and Dickens (a trainee). They are good. They are dedicated. They worked diligently through the afternoon and into the early evening. At 5 pm, they were still here. At 6 pm, Meer and I went to the dining hall for dinner.  Meer had three plates of food prepared for his technicians, the ones who live in Port-au-Prince. He called over to the lab and told them to come over to eat when they were finished in the lab. After they ate, the technicians would then walk about 20 minutes (in the dark) out to the main road where they would catch a tap tap back to PAP. It’s a long day but the technicians are willing to work the extra hours to get the job done because they understand what we are doing and why it is important. We are doing good work here and Meer can be proud of the people he has trained.

Tabita, Dickens, Makendy (our driver), Diony, and Medjina

Tabita, Dickens, Benoit, Makendy, Medjina, and Diony

Meer at his desk in the lab

     Meer and I have talked about trying to organize a small workshop and invite the nurses and doctors who are collecting the samples for us. We could have them visit the lab and give them a short presentation of the project and the results so far. Maybe if we had some money, we could even provide a lunch. It would be good public relations and help raise the visibility of the lab.  There is so much potential here. Meer’s success with the lab and his technicians has shown us what can be accomplished. Now we need to expand our reach and do even more. UF-EPI Haiti Lab 1-Gressier is just the first step. Baradères will be UF-EPI Haiti Lab 2. I can’t wait to get that lab set up and working.

It’s Haiti v6 – We Get Our Bikes Fixed

     There are three mountain bikes in the front room of our house. The tires are all flat. There is also a bicycle pump. One morning I pumped up the tires on two of the bikes (did not have the right attachment for valve on the third bike). By afternoon, the front tires on the two bikes were both flat. So we had three bikes and four flat tires. I asked Meer if there was someplace we could get the tires fixed. Sure, he knew a place. So Sunday afternoon we piled the bikes into the back of the Dodge and Herold drove us down to the repair shop. Meer and I rode in the back with the bikes and after 10 minutes on the road, Meer banged on the cab to let Herold know to turn left. We had arrived. The “repair shop” was unmarked. Most places are like that. How do you even know that it’s here, I asked Meer. He shrugged, you just know.
     Behind a sheet metal door hanging rather precariously by who knows what, we pulled the bikes into a guy’s open air workshop where he repaired tires. Not just bikes but all kinds of tires. But, sure, he did bicycles, too. He quickly found the hole in one bike tire and then the second. He had two air compressors. One had a regulator, the other did not. He regulated the pressure on the second compressor by bending the hose over and using a string wound tightly around the hose to stop the airflow. We decided to get both tires changed on two bikes. They were worn out. So with the four new tires, inner tubes, a new seat on one bike, a set of pedals and new brake pads on two bikes, the total (labor included) came to 1500 gourdes, about $35.00 US. Not a bad price.
It’s Haiti.

Bicycle repairman with Herold and Meer

Herold calculates the total bill (on his hand)

Over the Rainbow, Under the Rainbow

     Another slow weekend in contrast to such a busy and crowded week. We had maybe 30 people in the guesthouse and the dorms and the dining hall was always packed with so many people here. Then people began leaving. Thursday morning, Friday morning, until by Saturday morning, there was just the Christianville family and three others. It was quiet; what a change. Meer and I got up early and were out of the house by 6 AM for an early morning hike with Lori and David (our eye doctor and her husband). We headed out before dawn, left the Christianville grounds and walked down the road. We turned off a little while later and started up a mountain trail. The air was cool. Haitians were coming down the trail on foot and on motorcycle. It seemed that most of the early morning movement was to gather water. People brought containers to the pumps which are found along the road at different places. It was a good hike, up a steep road and back down. We turned around after about 30 minutes and headed back to Christianville for breakfast.

     Saturday afternoon, the men got together to go to the beach. Solomon called it “gents day at the beach”.  It was another hot afternoon and the water was warm. Meer, Solomon, and I (the non-swimmers) stayed in the shallow waters while the others swam out to go snorkeling out by the reef. It was about 2:00 and there were not a lot of people at the beach. A bit latter, a mini-TapTap (like a mini-bus) pulled up on the beach and dropped off a whole bunch of people. It was like there was a bus stop right on the beach. I spent a long time conversing with a friend of Dale’s, René Duchèn, who spoke to me in English and French and Kreyol and I replied in Kreyol, English and French. I corrected his English and French and he corrected my Kreyol. He was having a great time. I think the bar opened before we got to the beach.

     Sunday morning, I pulled on my hiking boots and went out for walk on my own, just me and my thoughts. I said “Bonjou” to people I met on the road. I walked a while with a gentleman who had collected some milk from his cow. He spoke a little French so we chatted some in French and some in Kreyol. It was a good hike. I wandered down the road for about an hour and then headed back to Christianville.

Robenson and Eric

     I finished up the day with a visit to Robenson’s farm with Eric, our goat guy from North Carolina. Robenson leased a large parcel of land near Christianville where he plans to raise goats. Eric offered to visit the site to see how Robenson had it set up for grazing the goats and to give him advice. It was beautiful. The land is up on a hillside with a striking view of the countryside out to the coast. You can even see Post-au-Prince off in the distance. As we arrived, we saw a double rainbow over the mountain that was just stunning in the late afternoon light.  Haiti is such a beautiful country. What a great spot this would make for a bed and breakfast. We jokingly suggested that Robenson fix up the house and set it up for eco-tourists and offer people the opportunity to tend to his goats while on vacation here. He would get income from the tourists and free labor for his goat project. Maybe it’s not such a crazy idea. We should get somebody with expertise in the hotel and tourism industry down here to advise Robenson. 

Eric and me

Robenson and me

Double rainbow at sunset

Two Kids (goats), Two Kids (humans), and Two Shots

     Yesterday afternoon I went down to the pens to see the two new kids (baby goats) that were born earlier this week. Eric is down here from NC State to help with the goat breeding program. He suggested that I walk down there and take a look at them. The kids were cute, two of them, hiding under the branches hanging in the pen for feed. Mamma Goat watched over them very attentively as I moved closer to take some pictures. She stared at me. The kids started climbing over Mamma Goat. These kids looked healthy and ready to go out into the field. I asked Eric how much longer they need to stay in the pen before they can go out in the pasture with the rest of the herd. About a week. These kids were born out of the usual cycle so they are the only young ones right now. Eric is getting the rest of the females ready for the next breeding cycle and that is why he is down here now.

Two baby goats and Mamma Goat

     Late afternoon, about 5:30, Sue came to the lab looking for Meer. She needed help. A wild dog, a puppy really, bit two children at the orphanage. The men trapped the dog under a 55-gallon heavy plastic barrel. Dr. Jim at the clinic advised that the children be given rabies immune globulin and that the animal be killed and examined for rabies. We needed to preserve the head and transport it to Port-au-Prince to be examined for the rabies virus. We gathered around discussing the best way to put down the dog. The final idea was to cut a small hole in the top of the barrel, take a gun, aim and shoot the dog, preferably not in the head. Rob cut out a hole in the barrel. Ken got a gun. He peered down the hole, aimed, squeezed off two shots, and the dog was dead. Now, how do we remove the head? I suggested a machete (why not?). Someone went off to look for a machete. Believe it or not, there was not a machete to be found. It was late and all the Haitian workers had gone home. It was getting dark. Kirk and Rob managed to cut the head off. Kirk put on some lab gloves and placed the dog’s head in a double-bagged, biohazard bag that Meer had brought from the lab. Then Meer brought the dog’s head to the lab where he placed it in the -80C freezer to store until someone from PAP can come today to pick it up. They'll test it for rabies. Meanwhile the two kids got the first dose of rabies immune globulin. If the dog turns out not to be rabid, they can stop the treatment. If not, it's about seven weeks of treatment for the two kids, and the local clinic has no more immune globulin. They will have to get some more somewhere. What a way to finish off the week.

Taking aim at the dog in the barrel

Meer prepares to take the sample
back to the lab

It’s Haiti v5 – Shots in the Dark

     As I was getting ready for bed last night (around 10:30 pm), I heard a shot. No mistaking. It was a shotgun blast. Five minutes later, another blast. Someone had told me that the guards sometimes shoot off their guns at night to scare away animals. This morning I heard a different explanation of last night’s action. Apparently the guards fired shots to scare away someone who was too close to the fence (trying to get in?). I live in a gated community, guarded by guys with shotguns who are ready to use them.
It’s Haiti.

Politics in PAP

     First, let me say that I am OK. Since no one asked, I assume it was because none of you heard about the riots in Port-au-Prince (PAP) Tuesday night. I guess news from Haiti tends not to make it on the evening news in the U.S. Anyway, I’m OK.

     One thing I like about being here in Haiti is that I am not constantly bombarded by the political news that fills the air in the Washington DC area. So I was vaguely aware of the non-progress on the “shutdown” and the final, temporary resolution. It was just not an omni-present news item. I won’t say that we work in a news bubble here, but I will say that the surroundings help keep things in perspective.

     Still, there is a need to know what is going on outside the bubble. Last week, the customs workers in PAP went on strike. I found out because I listen to RFI (Radio France International) (http://www.rfi.fr/) every morning. They have a correspondent in PAP and he files a story every day. I confirmed the news by checking the website of Le Nouvelliste, a Haitian newspaper (http://www.lenouvelliste.com/). I passed the news on to Meer. He rolled his eyes. It is not enough that getting any item through customs is slow and costly. Now the customs workers are on strike! I mentioned the news to some of the others in the Christianville family. No one knew. I do not think anyone follows very closely what is happening in PAP.

  Tuesday evening, the police arrested a lawyer who is a prominent opposition voice against the Martelly government. There were instant demonstrations in the streets of PAP. Roads were blocked, tire were burned. Anti-riot police used teargas and fired live rounds from automatic weapons in the air to break up the crowds. I heard all about it the next morning on RFI and I read about it in Le Nouvelliste. This time people here knew something about the riots but not the “why” behind the story. Today I heard on RFI that the police had released the lawyer and that calm was restored in PAP. That was good news since a mission team from central Pennsylvania was leaving today and needed to get to the airport in PAP. The roads were open and they left without a problem.

     These outside political battles affect us in more ways than just travel plans for Americans coming to and departing Christianville. Yesterday, someone from the CDC was in PAP and planned to visit the lab here to look at the BSL-3 TB lab as a possible surveillance site. She had to postpone yesterday’s visit because of the violence in PAP. The meeting was rescheduled for today. Late this afternoon, Madsen got a message from her stating that there was a shooting in PAP and her trip to Gressier had to be cancelled again. I think the American mission here is very conservative and protective (understandably so) about security. So with the political tensions running high, she was probably advised not to leave the embassy grounds. She returns to Atlanta tomorrow, so we lost an opportunity to showcase the lab to the CDC. I suggested that Madsen contact her and see if they can meet at the PAP airport since Madsen is also flying back to the States tomorrow. I sent Madsen pictures I took of the lab and now he can give her a virtual tour while they wait for their respective flights at the airport.

     The lab is a fantastic resource and we are only beginning to develop its full potential. We need to always be looking for ways to develop collaborations with people. I think I can help in that area. I am comfortable about exploring these collaborations. I even have a “30 second elevator pitch” for the lab and another “30 second elevator pitch” for the projects I am working on during my sabbatical (yes Pierre, Cécile, and Odile—even Papa has to have a pitch to sell people on his work). For the people here, it helps to speak French and deliver the pitch in French, if necessary. It also helps that I have been to Haiti before and that we (UF and I) are here long term. The Haitians (and Americans working in mission clinics) understand and appreciate that commitment. We are not “in and out”. We are here for the long term. That is also how we will make research collaborations work. The lab can provide a window into many areas of infectious diseases and epidemiology. Every day we think of new things we could do. I have a long list now and I am emailing people. We have a lot of work to do.

Meer with some papaya from
a tree next to the lab

Tony with some papaya from
a tree next to the lab

Norway, Quakes, and Coconuts

     It is only Wednesday and already it is a pretty eventful week. Monday morning I got up at 6 am and went for a walk. I met Dale who was here with a group of families who had brought their kids to Haiti for the experience (the kids ranged in age from 5 to 11, maybe?). Dale was wearing a Penn State T-shirt. He comes from a small town not far from State College, PA. Dale has been to Haiti before. As we talked, I learned that Dale had been to Hopital Lumiere at Bonne Fin which is a hospital on the mountain road between Cavaillon and Baradères. It is in the middle of nowhere. I’ve been there, too. Small world.

     Later at breakfast, I was introduced to Signe Prøis. Signe is a Norwegian freelance journalist living in Port-au-Prince. She was visiting Christianville for the day for a story she is writing for a Norwegian magazine on faith-based organizations and their activities in Haiti. Signe was accompanied by Marie, an American freelance photojournalist who also lives in PAP. I had a long chat first with Signe and then Marie telling them about the lab and what we were doing here and also about my project for surveillance of sexually transmitted infections. I called Meer over and introduced him to the two women. Meer explained more about the projects and especially the BSL-3 tuberculosis lab. He invited them to come over after lunch to visit the lab. Monday is a quiet day as we wait for samples to come in from the clinics and hospitals. Signe and Marie came over to the lab and Marie took lots of pictures. She was particularly interested in getting pictures of real Vibrio cholerae growing on plates. Just imagine, that little dot (we call it a colony) is made up of over a billion Vibrio bacteria!

     Yesterday I got up at 6 am and went out for a run. The sun was barely peaking up over the mountains and the moon was still bright and high up in the western sky. I thought it would be just me and the sounds of early morning. But then Ken rode by on his motorcycle. He was coming back from the generator room after turning on the generator for the early power cycle. As I ran past the container pad where the generators are located, I heard the drone of electricity being made. Further down the trail, I could hear the roosters, near and far. It seems like they are talking to each other as first one crows and then another one in the distance responds. I heard the donkey braying on the road below before I saw its dark shadow pass by. Pretty soon the chickens would be clucking but there were no sounds coming from the chicken pens. No smells either. I must be upwind this morning.

Early morning haze in the mountains

     This afternoon around 1430, the lab shook for about five seconds. It was as if a large truck passed close by. But there are no roads next to the lab and no large trucks. It was a small earthquake. Meer and I walked outside. Everything looked normal. It was just a small tremor, less than the 4.0 minimum to register on the Seismic Monitor website http://www.iris.edu/seismon/.

     Later in the afternoon I wandered over to our house to see how the workers were doing on trimming the trees in the yard. The workers had taken a break and were drinking from coconuts from the tree above us.  The coconuts did not look too mature so I guess someone had climbed up the tree to cut some down. One of the men asked me if I wanted a coconut. “Oui, pourquoi pas”. A guy opened up a coconut with a machete (of course). Four or five well-placed slices to remove the top and one last cut to open a hole for drinking the coconut milk. He handed it to me. Delicious and refreshing! We stood around drinking while two small boys used a spoon to carve out and eat the fleshy inside of the empty coconuts.

Leftover coconuts a few hours after we drank from them;
they have oxidized in the afternoon heat  

Coconut tree in our yard

     Madsen arrived this afternoon. He is a Haitian doctor who is a faculty member in the Emerging Pathogens Institute at the University of Florida. Madsen is well-connected in Haiti and he helped set up the network of hospitals and clinics that are providing us samples. I was anxious to meet Madsen. I have a lot to learn from him. Madsen was delighted to hear that I speak French. It is another thing we share that connects us. Madsen will be here three days. I’m actually staying in Madsen’s room in the house I share with Meer. The idea was that Madsen would stay in this house whenever he visited Christianville. This trip, Madsen will stay in the guesthouse so I can stay in his room. The three of us sat in the lab and talked until 10:30 pm. Still lots to do but it will have to wait until tomorrow. I am exhausted. A good day!

My Day Off

Sunday – Got up early this morning to try running. I was always a bit hesitant about trying to run while in Haiti. I was wary about the heat and humidity. But how much worse could it be than a July morning in the Washington, DC area? So I put on my Chuck Taylor All Stars (not a very good running shoe, but that’s all I brought), stretched bit, and set out on my run. The air is humid but cool. I soon find that there is really no place to run. The paths and trails are “paved” with stone and gravel. It hurts to run on them. I can feel the stones and rocks through my sneakers.  So I run along the grass where I can. Soon, another problem. The paths only go so far. I run up to the new dorm/guesthouse (being built)

New dorm/guesthouse under construction

New dorm/guesthouse under construction

and then down past Dale and Ingram’s house to the chicken processing plant (still being finished up). Then I have to turn around and run back up the hill to the dorm site. I decide to stop, stretch, do some Yoga, and then just run in place on the steps overlooking the countryside. These are the same steps where I sat on my first Sunday morning and read a book. Occasionally, the sound of a passing motorcycle on the road below or the screaming of a group of large birds (crows?) in the trees breaks the morning calm. I run in place. The sun begins to peak out over the mountain range to the east. The mountains to the south are shrouded in the early morning haze. It is a beautiful “tableau” but I did not bring my smartphone to take a picture. I’ll get it another day.

An earlier view from my "quiet space"

  After brunch, a group of us pile into the Christianville school bus and head for an afternoon at the beach. There are 10 of us “blan” and five Haitians. We are going to a real Haitian beach, where Haitians go and where there are no tourists or “blan” from other organizations working here. The beach is next to the compound of the Episcopal organization where Dale and Ingram used to work. We park in the compound and walk a short distance to the beach. There are about 20 Haitians on the beach and in the water. They are swimming and kids are splashing around. Dale introduces us to the guy who seems to be in charge of the commercial activity on this beach. There is an improvised bar under a thatched roof held up by tree branches. There are coolers with beer (Prestige, of course) and juice drinks. Music is blaring from a pickup truck parked on the beach with both doors open. People are cooking. A woman is covering fish with cooking oil and laying them over a fire. We watch as a guy cooks “lambi” (conch) in their shells over a small fire. After the water boils off from the meat in the shell, he turns the shells over. The conch cook for about five minutes and then the guy removes them from the fire, using only a leaf to protect his fingers from the hot shell. Another guy takes a rock (the second most common tool, after the machete, in Haiti) and breaks open the conch shell. He pulls out the meat and drops it onto a bucket. Another person takes the meat and cuts it into slices and mixes in the spices. We taste the conch. Delicious!

     The beach is made up of dark, coarse sand, more like gravel. The air is hot, maybe 90F. The sea is calm and flat today. The water is beautiful and incredibly clear! Some of our group move off with their snorkel gear and swim toward a coral reef. I can’t swim so I wade out into the water up to my neck. The water is warm, warmer than my cold morning showers. We stand in the calm water and talk. It is totally relaxing. No work today. Well, maybe after dinner.

Our House

     After living here for two weeks, I thought it was time to show some pictures of the house where Meer and I live.

South side of house

The main road on the Christianville campus runs past the house. In this photo, you can see the road in front of the house and a row of cactus growing along side the road.

Closer view of south side of house

The closer view shows the path that leads from the road around the east side of the house towards the north side of the house. The window is a room that is mostly used for storage.

East side of house

The door on the east side of the house is not used because it is so close to the road. It also leads into the room which is where we store the bicycles. The window to the right of the door is the kitchen. The path from the road leads around this side of the house, in front of the kitchen window and to the back door of the house, which is the door that we use. This same path turns right, away from the house, toward the dining hall. Everyone from the guest house uses this path to get from the road to the dining hall which is next to our house. So it gets a lot of traffic.

North side of house

The door shown here on the north side of the house is the one we use. The window is Meer's room. The path continues to the left toward the dining hall.

Our kitchen

My bedroom

Bedroom window, facing west

     My bedroom is a good size. It has a queen size bed, a table, a chair and a plastic table and kitchen chair I borrowed from the dining hall. The small window on the wall next to the bed is a south facing window. There is a ceiling fan which is useful to cool things down a bit. We have electricity 24/7.

     There is no closet. I hang what I can (not a lot of hangers) and put the folded clothes on the shelf. The bathroom is between my room and Meer's room.

A rack and shelf to put some of my clothes

It’s Haiti v4 – A Man, a Machete, and the Lawn in Front of the Lab

     We needed to have some landscaping done around the lab. The building is nice and Meer and I both believe that the surrounding area must be kept neat in order to preserve the professional appearance. So we asked Herold to have the landscaping guys come by to cut the grass, trim back the palm trees next to the entrance, and remove a small tree that had grown high enough to hide the sign. This last task was important since the tree was obscuring the list of donors and agencies who contributed to building and furnishing the lab.

     So they came yesterday morning and set to work. It was not the kind of landscaping crew I would see back home in Silver Spring. A guy with a machete (of course) was cutting the grass and edging the lawn along the concrete path. Another guy with cutting shears set about trimming the trees next to the entrance. I think a lawn mower came by later but the guy with the machete did a really nice job edging the lawn. I just hope my son, Pierre, doesn’t ask me to bring him back a machete so that he can trim our lawn in Silver Spring. The machete: the Swiss army knife of the people.
It’s Haiti.

Landscaping with a machete

Landscaping with a machete

Planting new bushes along the lawn in front of the lab

Lab entrance - before

Lab entrance - after

Peaks and Valleys

I often tell my graduate students and post-docs that science is a series of peaks and valleys. Some days you eat the bear; some days the bear eats you. You know what I mean. Wednesday afternoon I received an email from Pfizer. Back in July I had applied to them through their Investigator Initiated Research (IIR) program to request antibiotics to treat the subjects who test positive in our sexually transmitted infections (STI) surveillance project. The email was bad news. Pfizer turned down my request. I told myself that this was not a show-stopper. We can still do the study and treat the patients, it will just cost us more to do it. Since the beginning, I have been looking for ways to find money and save money for the project. So it was a setback, a big disappointment. Everything seemed to be falling into place up to now. I left the lab to take a walk over to the old university section of Christianville. Here is where a new guesthouse is going up next to the remains of the building that collapsed in the 2010 earthquake. I leaned on the fence and looked out over the countryside towards the mountains to the south. This country really is like the Haitian proverb, “Dye mon, gen mon.”  Beyond the mountains, more mountains. Bill and Donna walked up the path and stopped to chat. I told them about the Pfizer email. They encouraged me not to give up. There would be another way to do it. They are right. The project will still get done, somehow. I felt better.

Looking south from Christianville Missions, Gressier

A few hours later after dinner, I returned to the lab. I woke up my laptop. There was another email from Pfizer. Since my IIR proposal had been turned down they suggested that I submit the request for antibiotics via the Corporate Affairs Department where it would be considered as a donation and not a research protocol. Suddenly the future looked bright again. I quickly replied, thanked them and asked for details on how to proceed through Corporate Affairs. By early Thursday morning, I had connected with Pfizer Corporate Affairs in Costa Rica and received instructions on how to submit my request. I’m moving forward. Hopefully this time, we will be able to get the medications.

This afternoon I received an email announcing that the proposal I had submitted to AFHSC-GEIS (Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance and Response System) for the STI surveillance project is going to be funded! This is really exciting news. I had been waiting and hoping for this funding since the spring. Now I can do what I came down here to do. And now that I have the money, we can seriously start plans for the forward lab in Baradères. I have already christened the lab with a new name. I call the Baradères lab UF-EPI Haiti Lab 2-Baradères. The existing lab in Gressier will be UF-EPI Haiti Lab 1-Gressier. I already started using the names in my emails to all the UF people. If it catches on, fine. If they don’t like it, maybe they can come up with a better name. I just thought was time to give the Baradères lab some credibility and get it in people's minds as a real, soon-to-happen entity. Because it will happen now.

 

“Bonjou, Baradères, Mwen ap vini.” 

“Baradères, here I come.”

Mountains near Baradères

A Guy, a Tree, and a Machete

     This afternoon I heard some noises coming from the roof of the lab. I went outside to take a look. There was a guy on the roof of the lab with a machete. The guy is Jean-Robert. He was doing what I hired Bartholomew Tree Service to do at my house in Silver Spring earlier this week: he is trimming back branches on a tree that are hanging over the roof of the lab. He is hacking away at the branches with his machete. Jean-Robert works quickly; he is ambidextrous. He climbs up the trunk of the tree in his bare feet. As I watch, I think about how the work was done back in Silver Spring. Those workers probably used ropes and chain saws and were wearing boots and safety goggles. Not Jean-Robert.

Jean-Robert on the roof of the lab

     When Jean-Robert finished trimming the branches of that tree, he climbed up into another tree and did the same thing. Hack, slash, crash, the machete flashed and the branches tumbled to the ground. Jean-Robert climbed down and I thanked him in Kreyol, “Mesi anpil”. I asked him if I could take a picture. He told me that his machete was old. At least that’s what I translated from the Kreyol. What he actually said was that the machete was “old” in the sense that it needed to be sharpened. So someone took it around the other side of the lab and soon we heard the sound of a grinding wheel sharpening Jean-Robert’s machete.

Jean-Robert and his machete trim another tree

Jean-Robert starts on the almond tree

Machete vs. almond tree

Axe vs. almond tree

     A young man came around with an axe. There is an almond tree growing too close to the lab. The roots might crack the foundation in a few years time. Right now its upper trunk is pushing up against the sheet metal roofing of the lab. The tree has to come down.           The axe starts swinging. This is a tough tree. The young man pauses. Jean-Robert takes over. He starts to swing the axe, alternating left-hand and right hand. There is a thick knot in the tree trunk that the axe is bouncing off.

     Suddenly, the axe head falls off the handle. The young man takes the axe head and the handle to the shop to fix it. Jean-Robert picks up his “new” machete. There is a rope tied to the top of the tree so that it can be guided to fall away from the lab. Jean-Robert starts clashing at the tree trunk with his machete. He picks his spots carefully. He makes his cuts around the knot and then slides over to the other side. A few more carefully places slashes and he backs away. The young man with the rope gives a tentative tug to see if the tree is ready. Then he pulls hard, several times. And the tree is down on the ground. The axe is still in the shop. Jean-Robert's machete finished the job of the axe. It all took less than 20 minutes. I go over to measure. The tree trunk was a little over three feet in diameter.

Machete wins, almond tree falls

     I asked Benice what kind of a tree it was. He said it was an almond tree. Edible? (“Ou mange ca?”), I asked. "Oui". He took a nut, chose a nice, large, flat rock and set the nut on it. Then he took a smaller one that fit nicely in his hand and used it to break open the shell. There was a tiny almond, about one-fifth the size of the kind you find in the stores back home. We sat around while Benice broke open almonds for us and we ate them. Not your California almonds, but still tasty. Meanwhile, Jean-Robert was hacking away at the tree limbs to make them easier to haul away. To Jean-Robert and his machete, “Bon travail”. Time for me to go back to the lab.

Jean-Robert and Meer

Jean-Robert with his machete

“Ki kote twalet publik la, souple?”

     Last week, Meer and I went out looking for public toilets or more accurately places where people poop. Here is why:

Phages attached to a bacterium

One of the projects that I would like to do is to look for bacteriophages in different water sources in Haiti. Bacteriophages, or phages, are viruses that attack bacteria. They are everywhere in the environment and every species of bacteria has groups of phages that attack those bacteria. Most phages kill the bacteria that they attack.
A phage injects its DNA (or RNA) into the bacterium and takes over the biosynthetic machinery of the bacterium. Then the phage directs the bacterium to make more copies of the phage genome and the parts that go into making the phage capsid, its head and tail particles. At the end of this period of synthesis, the phage genomes are packaged into the head, and the head and tail are assembled into the phage capsids. In the final step, the phage produces an enzyme that breaks open (lyses) the bacterium, releasing the newly manufactured phages that go on to infect new bacteria. However, bacteriophages are specific for the bacteria that they attack. Phages that attack Escherichia coli will generally not attack Vibrio cholerae. Phages that attack Shigella will not attack Yersinia. This specificity is useful for classifying bacteria and also for doing genetics.

So why are we in pursuit of poop? We are studying the bacteria, like Vibrio cholerae, E. coli, Shigella, and Salmonella, that cause diarrheal diseases. These bacteria are found in large numbers in the feces of people who have diarrhea. Thus the risk of diseases like cholera increases when human waste is not treated but is dumped directly into the environment potentially contaminating water supplies on which people depend. Since I am interested in looking for the phages that attack these bacteria, the best place to start foraging for phages is in places where people, with or without diarrhea, defecate. That’s why we were out looking for “twalet publik”.

Small tent city in Gressier

Remember, don't poop in the river

We drove down a side road to an area where people are living in tents. Makende asked someone, “Ki kote twalet publik la, souple?” Then Makende explained to the person that he wasn’t looking for himself but that the “blan” (Haitian word for anyone who is not Haitian) in the truck were scientists who were looking for “kaka”, poop. That got a good laugh, a really good laugh. Oh, the Haitians were willing to show us where they go to defecate, they just thought it was funny that we wanted to see the poop (kaka).

I kept telling Makende that we were not interested in the poop itself. We just wanted to see where the water runs off the poop into whatever water source is near by. If the bacteria are there, there will be phages. Nancy and Rey back in my lab in Bethesda sent us the chemicals we need to isolate the phage. We should get the material we need in another two weeks. Then Meer and I can start hunting for phage. When we find the phages we are looking for, we can start studying how the presence of certain phages in the aquatic environment may correlate with the ebb and flow of diarrheal disease. That is, the phage might be a good indicator of the disease potential in the environment. The second project is another hunt for a certain phage that attacks Shigella. I will have more to report about that one after we find it. In the meantime, Meer and I are just a couple of “blan” looking for poop.

Animals (and people) living next to
stream running through tent city

Meer standing next to stream running in a channel
through a tent city