It took me a while to figure it out. Something was different this stay in Christianville. I had been here for two weeks in October and before that my previous visit was in July. Now it is mid November. C’ville has changed since this summer.
I used to wake up at 6:00am to the sound of Ken riding past my bedroom window on his motorcycle to turn on the generator. Often I would hear some donkeys braying very loudly. I would always hear the egg laying chickens squawking in the chicken coop down by the fishponds. And depending on the wind, the smell of the chicken coops in the morning could be overwhelming. Breakfast (and all the meals) was in the old guesthouse and it was usually eggs. Now Ken is gone and the only generator that is still functioning is the 100 kV generator and when it is turned on at 6:00 am, it is very loud. The imposing drone of the generator dominates the soundscape all day long. I have no idea where the donkeys went. I have not seen any since the summer. The chickens are gone, too. Egg layers have a maximum productive life of about three years. The C’ville egg layers have aged. The old chickens are trying hard but egg production began dropping off in early summer. The “retired” chickens have not been replaced. I have no idea why. They know that they need new chickens. No chickens, no eggs. That explains why we have not had eggs for breakfast as often as before. I used to complain that we had eggs almost every day. Scrambled eggs or hard-boiled eggs for breakfast; egg salad sandwiches for lunch. Eggs, eggs, eggs. Breakfast this trip has been pancakes, corn flakes, or porridge. Over the last two trips, we have had eggs once or twice. I miss the eggs. But I don’t miss the smell of chicken poop in the morning.
Thursday, November 20, 2014
Saturday, November 15, 2014
The Road to Baradères in the Rain
The road to Baradères is worse. Yes, that is possible. Let me explain.
Both Sister Denise and Father Jacques had warned me the day before we left Gressier that it had been raining pretty hard in Baradères. So we should take the road to Baradères from Cavaillon, not the road from Petit Riviere de Nippes. Sister Denise told me to be careful. The road was bad and be sure the vehicle has four-wheel drive and that the driver knows how to «doublé » (drive in four-wheel mode). So we turned south at Miragoâne and headed over the mountains to the south coast. The sun was shining as we drove through Fonds des Negres, Vieux Bourg d’Aquin, Aquin, and past the beaches of Saint Louis de Sud. We arrived in Cavaillon and I directed Patrick to turn off the highway and zig-zag through the town. Turn right at the market, left toward the church and then right again. Keep going straight until the road ends. And that is where the road to Baradères starts. We had another 90 minutes of driving on the mountain road before we would arrive in Baradères. I hoped.
The clouds over the mountains ahead of us looked ominous. I began to worry. Rain was the second worst thing that I could imagine on this road. Rain and darkness was the worst thing. At least it was still mid-afternoon. Then it began to rain, only a little at first but soon the rain began to fall in torrents. The Patrol bounced along up the mountain road. And the rain continued to fall. We passed Bonne Fin and the Hôpital Lumiere. Normally the drive from this point to Baradères would take an hour. Not today, I thought. And the road gets worse from Bonne Fin.
Up ahead the road was cut deep with muddy ruts and a large pile of mud and dirt sat in the road. Patrick stopped the Patrol. It was time to «doublé ». Patrick got out and unlocked the front wheels, jumped back into the Patrol and threw it into four-wheel drive. Patrick inched the Patrol forward into the mud. We stuck. Then he pushed it again and we made our way out of the mud. Up the mountain we continued. And the rain kept falling. Meer pointed out the window. I looked over and I could barely see the next ridge of mountains through the falling rain. I looked out the window on my side of the Patrol. I could see the edge of the road and clouds in the valley beneath us.
On previous trips, I had seen many things on the road to Baradères: mototaxis, bicycles, tap taps, people, goats, cows, trucks, chickens, sheep, donkeys, and dogs. Today, I saw something new.
We came around a curve and there in front of us was a huge boulder that had slid down the mountain and was now sitting in the road. This one had split in two leaving barely enough room for Patrick to maneuver the Patrol around it to get past. Fortunately, there was a passage barely wide enough for a single vehicle to get around it. Another foot to either side and we would probably have had to turn back.
Further down the road, there was another boulder. Patrick drove the Patrol slowly and approached close to the edge of the road. I glanced down. Was it 40 feet or 400 feet? It really did not matter. If one wheel of the Patrol slipped over the edge, we would slide down the cliff and into the ravine. I tried not to picture the Patrol smashed up on the rocks at the bottom. Sister Denise told us later that a truck had gone off the road earlier in the week. She gave no details. I did not ask for any.
Both Sister Denise and Father Jacques had warned me the day before we left Gressier that it had been raining pretty hard in Baradères. So we should take the road to Baradères from Cavaillon, not the road from Petit Riviere de Nippes. Sister Denise told me to be careful. The road was bad and be sure the vehicle has four-wheel drive and that the driver knows how to «doublé » (drive in four-wheel mode). So we turned south at Miragoâne and headed over the mountains to the south coast. The sun was shining as we drove through Fonds des Negres, Vieux Bourg d’Aquin, Aquin, and past the beaches of Saint Louis de Sud. We arrived in Cavaillon and I directed Patrick to turn off the highway and zig-zag through the town. Turn right at the market, left toward the church and then right again. Keep going straight until the road ends. And that is where the road to Baradères starts. We had another 90 minutes of driving on the mountain road before we would arrive in Baradères. I hoped.
The clouds over the mountains ahead of us looked ominous. I began to worry. Rain was the second worst thing that I could imagine on this road. Rain and darkness was the worst thing. At least it was still mid-afternoon. Then it began to rain, only a little at first but soon the rain began to fall in torrents. The Patrol bounced along up the mountain road. And the rain continued to fall. We passed Bonne Fin and the Hôpital Lumiere. Normally the drive from this point to Baradères would take an hour. Not today, I thought. And the road gets worse from Bonne Fin.
Up ahead the road was cut deep with muddy ruts and a large pile of mud and dirt sat in the road. Patrick stopped the Patrol. It was time to «doublé ». Patrick got out and unlocked the front wheels, jumped back into the Patrol and threw it into four-wheel drive. Patrick inched the Patrol forward into the mud. We stuck. Then he pushed it again and we made our way out of the mud. Up the mountain we continued. And the rain kept falling. Meer pointed out the window. I looked over and I could barely see the next ridge of mountains through the falling rain. I looked out the window on my side of the Patrol. I could see the edge of the road and clouds in the valley beneath us.
On previous trips, I had seen many things on the road to Baradères: mototaxis, bicycles, tap taps, people, goats, cows, trucks, chickens, sheep, donkeys, and dogs. Today, I saw something new.
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| Boulder in the middle of the road to Baradères |
Further down the road, there was another boulder. Patrick drove the Patrol slowly and approached close to the edge of the road. I glanced down. Was it 40 feet or 400 feet? It really did not matter. If one wheel of the Patrol slipped over the edge, we would slide down the cliff and into the ravine. I tried not to picture the Patrol smashed up on the rocks at the bottom. Sister Denise told us later that a truck had gone off the road earlier in the week. She gave no details. I did not ask for any.
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| Water flooding across the road |
The rain kept falling and the road in front of us resembled a series of small brown lakes. Then I saw a muddy river, gushing across the road. Run-off from the mountains was pouring down into a stream that now overflowed across the road and then cascaded down into the ravine on the other side of the road. Patrick stopped the Patrol. The road beyond the flooded road pitched steeply upward. He gazed at the rushing water for a moment and then put the Patrol in gear. We edged forward toward the angry, muddy torrent. I suddenly thought about news stories I had heard about cars being swept away by floodwaters crossing a highway. How powerful was that stream of water in front of us? The front wheels entered the swirling water and the Patrol accelerated forward. We rolled through the water and sped up the slope on the other side. A veritable waterfall had formed at the side of the road funneling all the water across the road and down the mountain. But we had gotten safely across.
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| Water flooding across the road |
The Patrol slowly wound its way up the mountain. We passed a yellow Camion Mack (dump truck) grinding up the road. It had stopped before a particularly narrow part of the road. The driver motioned for us to go around his truck. We managed to get through the narrow passage. As we continued on up the mountain, we all wondered whether the Camion Mack would make it (it did; we saw the truck in Baradères the next day).
Over two hours after starting on the mountain road from Cavaillon, we pulled into Baradères. The rain had stopped. Sister Judith greeted us as we got out of the Patrol. I introduced Patrick and Madsen (she already had met Meer). We went inside the convent where Sister Denise was waiting. We hugged, everyone sat down to eat and Sister Judith brought out four bottles of Prestige. I had traveled eight hours across Haiti and up a treacherous mountain road. I was ready for a beer.
On the Road with Rain and Cholera
Madsen, Meer and I were making another trip to Baradères. We hired Lamothe’s (Gift of Water) driver and his Nissan Patrol. The driver, Patrick, arrived in C’ville at 7:30 am Wednesday. We had breakfast and started loading up the Patrol. It already had boxes with 98,000 Aquatabs that I had ordered for the Gift of Water program in Baradères. Meer gathered up some bottles to collect water samples and also some containers for stool samples in case we find any cases of cholera in Baradères. There was still some room in the Patrol so I asked if we could fit in the blood chair (for doing blood draws) that Kathy from Operation Ukraine had found and brought for us back in March. It fit nicely. So I felt better. I would not be going up to see Sister Denise empty-handed.
We never seem to make trips without multiple stops and this trip was no exception. First, we headed over to the Gressier clinic to look for Dr. Celestin, the Clinic Administrator. I still needed to resolve some concerns about the clinic before we could start my STI surveillance project there. Madsen had been trying to reach Dr. Celestin by phone for two days without success. Madsen walked into the clinic and came out less than a minute later. Dr. Celestin was gone. He had been transferred. There is a new person in charge. Madsen has the new person’s name and an appointment to meet with him. This change could be a good thing for my project. We can negotiate all over again and hopefully get what I need at the clinic. We’ll see after we get back from Baradères.
Our next stop was in Léogâne at Eva’s gas station to fill up the Patrol. As with almost all vehicles in Haiti, the Patrol runs on diesel. It cost 3680 gourdes, about US$85.00, to fill the tank. Madsen and I walked over to the Western Union office and I exchanged US$100 for gourdes and I paid for the fuel. Next stop, the Digicel store. I bought a cell phone for my Study Coordinator. When we get back, I will give the phone to Youseline and load it up with gourdes. This way she can compensate the participants in our study (250 gourdes each; US$5.00) by transferring the money directly to their cell phones instead of me trying to find phone cards to hand out. Next stop, Dr. Merisier, the regional director for the Ministry of Public Health and the Population (MSPP). Madsen had already sent him a copy of my protocol and the approval from the MSPP Bioethics Committee. He just wanted to stop in and introduce me. We spent five minutes at the clinic and were on the road again heading west toward Petit Goâve.
At the entrance to Petit Goâve we pulled into the gas station and Madsen made a phone call. We were going to visit a Cholera Treatment Center (CTC). Cholera cases are on the upswing in the Petit Goâve area and the MSPP had re-opened a CTC outside Petit Goâve. Someone was going to meet us and guide us to the center. A pickup truck arrived and we followed our guide through Petit Goâve towards Miragoâne. We turned off the National Route #2 drove down a dirt side road and then turned onto another dirt road. Five bumpy minutes later, we arrived at the Dispensaire Madeleine. Madsen greeted the clinic doctor and introduced us. Then the doctor led us down a narrow path that ran alongside the concrete clinic building. The CTC was in the back.
It was a makeshift shack made of plywood with a sheet metal roof. At the entrance there was a bucket of clean water on a table and a flat box with a mat soaked with bleach on the ground.
We stepped into the box and then into the CTC. There were five patients, including one child, inside. Some were lying on the cholera cots, some were sitting up on the cots. We learned that at least two people had died of cholera recently in the Petit Goâve region. Over the past few months the world watched in horror as Ebola spread through West Africa and then began to decline. Meanwhile, the rainy season came late to Haiti and with it came cholera. The MSPP had closed many CTCs over the summer because there were so few cholera cases. Now the only two CTCs in the region were the one we were visiting and the one in Gressier. Cholera is back. It had never left. The microbe is established in the aquatic environment. It was lying in wait for the heavy seasonal rains to come and mix up the waterways with nutrients that flowed down from the mountains. The bacteria grow, the people drink the contaminated water and cholera is back. Meer shook his head, sadly. He knew all along that cholera would be back. His research published earlier this year showed how the bacterium was now part of the aquatic ecosystem. And now cholera is back.
We stepped out of the CTC, onto the bleach-soaked mat and washed our hands before heading back to the Patrol. The clinic’s truck was parked in front of the Patrol. Madsen pointed to it. I looked over. Piled in back of the pickup were buckets and hand-held pump sprayers. Buckets for the cholera cots and sprayers for bleach to decontaminate. The MSPP was preparing the CTC in anticipation of more cholera cases. Cholera is back.
We climbed into the Patrol. It was 11:30am. No more stops. We had another three hours of driving ahead of us before arriving in Baradères. I called Sister Denise and told her we would probably be in Baradères by 2:30pm. That estimate was going to be wrong, very wrong.
We never seem to make trips without multiple stops and this trip was no exception. First, we headed over to the Gressier clinic to look for Dr. Celestin, the Clinic Administrator. I still needed to resolve some concerns about the clinic before we could start my STI surveillance project there. Madsen had been trying to reach Dr. Celestin by phone for two days without success. Madsen walked into the clinic and came out less than a minute later. Dr. Celestin was gone. He had been transferred. There is a new person in charge. Madsen has the new person’s name and an appointment to meet with him. This change could be a good thing for my project. We can negotiate all over again and hopefully get what I need at the clinic. We’ll see after we get back from Baradères.
Our next stop was in Léogâne at Eva’s gas station to fill up the Patrol. As with almost all vehicles in Haiti, the Patrol runs on diesel. It cost 3680 gourdes, about US$85.00, to fill the tank. Madsen and I walked over to the Western Union office and I exchanged US$100 for gourdes and I paid for the fuel. Next stop, the Digicel store. I bought a cell phone for my Study Coordinator. When we get back, I will give the phone to Youseline and load it up with gourdes. This way she can compensate the participants in our study (250 gourdes each; US$5.00) by transferring the money directly to their cell phones instead of me trying to find phone cards to hand out. Next stop, Dr. Merisier, the regional director for the Ministry of Public Health and the Population (MSPP). Madsen had already sent him a copy of my protocol and the approval from the MSPP Bioethics Committee. He just wanted to stop in and introduce me. We spent five minutes at the clinic and were on the road again heading west toward Petit Goâve.
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| Meer and Dr. Madsen at the Petit Goâve Cholera Treatment Center |
It was a makeshift shack made of plywood with a sheet metal roof. At the entrance there was a bucket of clean water on a table and a flat box with a mat soaked with bleach on the ground.
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| Poster for the campaign against cholera |
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| Family with child who has cholera, Petit Goâve CTC |
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| Cholera patient lying on a cholera cot, Petit Goâve CTC |
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| Cholera patient lying on a cholera cot, Petit Goâve CTC |
We climbed into the Patrol. It was 11:30am. No more stops. We had another three hours of driving ahead of us before arriving in Baradères. I called Sister Denise and told her we would probably be in Baradères by 2:30pm. That estimate was going to be wrong, very wrong.
Thursday, November 13, 2014
Sexually Transmitted Infection Surveillance in Haiti – Day One
We started today, Tuesday, November 11, 2014. Well, we actually started over a year ago but today we enrolled our first participants. My staff had prepared all the material yesterday afternoon and we agreed on a time to start. Makendy came in early to drive us to the clinic, Haiti Health Ministries (HHM). It is only a 15 minute walk from the lab in Christianville but with all the materials we needed to bring along, we needed Makendy to drive us in the Everest. We left C’ville at 7:35 am and arrived at HHM five minutes later. Jenn, the OB-GYN nurse showed us the rooms we would be using today. We spent about 15 minutes getting our materials and laptops set up in both rooms. By 8:00 am, we were ready to wade into the crowd of people waiting to be seen at the clinic and start recruiting. But first, morning devotions. One of the clinic’s Haitian workers came out onto the porch waiting area and led the crowd in a song and prayer. Then Dr. Jim, an American doctor and the Medical Director, did a reading from the Bible, in Kreyol. Dr. Jim then gave a short sermon, still in Kreyol. He finished up with a prayer and I think he may even have asked for God’s blessing on our project. By 8:20 am we were ready to start recruiting participants for our project but it was also the time for the HHM staff to begin patient intake and measuring vital signs. It was not a good time to recruit. This was why Sandy, the Clinic Administrator, had advised me to have my team arrive early and start recruiting before devotions. In any event, Youseline, the Study Coordinator, began signing up people who expressed an interest in the project. We had set a modest goal of eight participants for our first day: four men and four women. By 8:40 am Dukens, a Research Assistant, took the first participant in our study (a man) through the informed consent process. I stood and watched as Dukens read the Informed Consent Document (ICD) while the gentleman followed along on another copy. Dukens answered the few questions that the man asked and then he signed the ICD. We had enrolled our first participant. Only 1,999 more to go.
In the meantime, Monise, the other Research Assistant, was conducting the same informed consent process with a woman in another room. Twenty minutes later, Monise had the women’s signature on the ICD and we had our second participant. The Research Assistant quickly started the specimen collection part of the protocol and then conducted the Behavioral Risk Survey. It was almost 10:00 am and things seemed to be going smoothly. There was nothing I needed to do. Well, there was one thing that I did not have time to do before we started. Buy telephone cards.
Part of the protocol is to give each participant a telephone card worth 250 gourdes (about $5.00) as a small compensation for their participation in the study. I had planned to buy the phone cards in Port-au-Prince on Monday after we picked up Madsen and two other people at the airport. But by the time we got to the Digicel store near Carrefour, the store was closed. I was stuck. Worse still, this morning Makendy had taken Madsen into Port-au-Prince and they would be gone for the day. I called Laura, the C’ville Guesthouse Coordinator. Sorry, she said, all the C’ville vehicles and drivers were out. No help there. I called Matt, a friend who lives at C’ville with his wife, Jessica. Matt has a truck. I asked Matt if he could do me a favor and drive me to the Digicel store in Gressier. Matt said sure. So I told my staff they were doing fine and that I was leaving to buy the phone cards for them to give to the participants. I started walking back to C’ville very worried that the Digicel store in Gressier might not have the cards. Then what? Matt and I drove out to the highway and down the road to the Digicel store. They had no telephone cards. The man at the counter said that Digicel was moving away from selling them anymore. Were there any available at the Digicel store in Léogâne, I asked. He did not know. I told Matt it was not worth driving to Léogâne and risk not finding cards there either. I was moving down the list and already was past plan B for plan B. Then Matt had an idea. Why not just transfer the money from my phone to the participant’s cell phone? It is easy enough to do. Although Matt did not know how to do it, every Haitian knows how because they do it often. And that is the solution that we found to my problem of phone cards for the participants.
Then I had my other problem. My staff and all of their materials were at HHM and there were no drivers or vehicles to bring them back. There was no way I wanted them to walk back carrying all that stuff. And it was not fair. When we planned the project, we knew that my staff would need a vehicle and driver at the beginning and end of each day. UF needs to hire another driver and we have told them that for months. But their attention has been consumed by the growing problem of electricity. There is only one generator operating in C’ville now and if that one goes down, there will be no power for the lab. In any event, my staff needed a ride back to C’ville now.
As Matt and I pulled into C’ville, I saw the other UF Everest parked next to the lab. Mille, who collects mosquitoes for the malaria project, had just returned from setting traps. I leaped at the chance and asked Meer if I could use Mille to pick up my team. Meer said yes and I was back at the clinic at 1:00 pm just as Dukens and Monise were finishing up with their last participant for the day. We were back at the UF-EPI Haiti Lab 1 Gressier at 1:15 and ready to start testing the specimens for Chlamydia, gonorrhea, syphilis and trichomoniasis. The lab work went smoothly but slowly. It was only our first day so I expected that. While we waited for the test results on the GeneXpert (a 90 minute test), I handed my cell phone to Youseline and instructed her to transfer the 250 gourdes to the cell phone accounts of our eight participants. By the time the results came off the GeneXpert, it was 5:15 pm; all eight participants had been tested. We had two positive tests for trichomoniasis. All the other tests were negative. One test for Chlamydia and gonorrhea (on the GeneXpert) was invalid and had to be repeated. It was negative.
So we had a good first day. I was very happy but exhausted. And tomorrow I leave for Baradères and my team will be on their own. I am confident they will do well.
In the meantime, Monise, the other Research Assistant, was conducting the same informed consent process with a woman in another room. Twenty minutes later, Monise had the women’s signature on the ICD and we had our second participant. The Research Assistant quickly started the specimen collection part of the protocol and then conducted the Behavioral Risk Survey. It was almost 10:00 am and things seemed to be going smoothly. There was nothing I needed to do. Well, there was one thing that I did not have time to do before we started. Buy telephone cards.
Part of the protocol is to give each participant a telephone card worth 250 gourdes (about $5.00) as a small compensation for their participation in the study. I had planned to buy the phone cards in Port-au-Prince on Monday after we picked up Madsen and two other people at the airport. But by the time we got to the Digicel store near Carrefour, the store was closed. I was stuck. Worse still, this morning Makendy had taken Madsen into Port-au-Prince and they would be gone for the day. I called Laura, the C’ville Guesthouse Coordinator. Sorry, she said, all the C’ville vehicles and drivers were out. No help there. I called Matt, a friend who lives at C’ville with his wife, Jessica. Matt has a truck. I asked Matt if he could do me a favor and drive me to the Digicel store in Gressier. Matt said sure. So I told my staff they were doing fine and that I was leaving to buy the phone cards for them to give to the participants. I started walking back to C’ville very worried that the Digicel store in Gressier might not have the cards. Then what? Matt and I drove out to the highway and down the road to the Digicel store. They had no telephone cards. The man at the counter said that Digicel was moving away from selling them anymore. Were there any available at the Digicel store in Léogâne, I asked. He did not know. I told Matt it was not worth driving to Léogâne and risk not finding cards there either. I was moving down the list and already was past plan B for plan B. Then Matt had an idea. Why not just transfer the money from my phone to the participant’s cell phone? It is easy enough to do. Although Matt did not know how to do it, every Haitian knows how because they do it often. And that is the solution that we found to my problem of phone cards for the participants.
Then I had my other problem. My staff and all of their materials were at HHM and there were no drivers or vehicles to bring them back. There was no way I wanted them to walk back carrying all that stuff. And it was not fair. When we planned the project, we knew that my staff would need a vehicle and driver at the beginning and end of each day. UF needs to hire another driver and we have told them that for months. But their attention has been consumed by the growing problem of electricity. There is only one generator operating in C’ville now and if that one goes down, there will be no power for the lab. In any event, my staff needed a ride back to C’ville now.
As Matt and I pulled into C’ville, I saw the other UF Everest parked next to the lab. Mille, who collects mosquitoes for the malaria project, had just returned from setting traps. I leaped at the chance and asked Meer if I could use Mille to pick up my team. Meer said yes and I was back at the clinic at 1:00 pm just as Dukens and Monise were finishing up with their last participant for the day. We were back at the UF-EPI Haiti Lab 1 Gressier at 1:15 and ready to start testing the specimens for Chlamydia, gonorrhea, syphilis and trichomoniasis. The lab work went smoothly but slowly. It was only our first day so I expected that. While we waited for the test results on the GeneXpert (a 90 minute test), I handed my cell phone to Youseline and instructed her to transfer the 250 gourdes to the cell phone accounts of our eight participants. By the time the results came off the GeneXpert, it was 5:15 pm; all eight participants had been tested. We had two positive tests for trichomoniasis. All the other tests were negative. One test for Chlamydia and gonorrhea (on the GeneXpert) was invalid and had to be repeated. It was negative.
So we had a good first day. I was very happy but exhausted. And tomorrow I leave for Baradères and my team will be on their own. I am confident they will do well.
Monday, November 10, 2014
Smoke
I smell like smoke. It’s Port-au-Prince (PauP). I just spent five hours driving through PauP. We left Christianville in the Kia at noon with Eugene at the wheel. Makendy was out collecting samples and was not available. Eugene is a C’ville driver. I had never ridden with him before. We drove to the PAP airport to drop off Char and Bill and Char’s daughter who were in C’ville over the weekend to artificially inseminate the goatherd. Then Eugene and I drove up to Epsilon Medical Supplies. I had a shopping list of supplies to pick up for the STI study. I had called Marc, the owner, to let him know we were coming and he started pulling some of the supplies out for me before we got there. Eugene had never been to the store so I called Makendy and had him give Eugene directions on how to get there. He did alright and we were soon in the store. I paid with my Jackson pre-paid credit card (what a relief!) and we loaded up what Marc had in the store. We then followed Marc over to his storeroom for the remaining boxes. The storeroom is over Gamma Medical Supplies, the store run by Marc’s parents. It’s all in the family. We moved down the dusty, unlit upstairs hallway past rooms marked off with numbers. Then Marc found the supplies I needed. As we walked out and back down the exterior stairway, Marc warned me not to step too close to the side wall which was topped off with a roll of razor wire. Then we were on the road back to the airport to pick up Madsen and two other people from UF who were arriving on American flight 1665 at 2:30. If you ever fly American into PAP, you are likely to be on flight 1665 in-bound or out-bound, or both. I think it is the same plane that just flies back and forth from Miami to PAP. Every day.
As we drive down Delmas 3, I stare out the cracked windshield of the Kia. The windows are rolled down. The Kia has no air-conditioning. Traffic is backed up, as usual. As the trucks and tap-taps in front of us inch along, a burst of the black diesel smoke of first gear fills the air. We drive through it. Traffic stops. We stop. Traffic starts up again and the air is filled with smoke again. And so it goes. There is smoke everywhere. From the endless line of cars and trucks and tap-taps belching black diesel fumes from their exhaust pipes to piles of trash burning on the side of the street. Things burn in Haiti. In late afternoon, it seems to be worse. People set their trash out to burn. There is some trash pickup now in PauP but even that trash is burned. Along the Route de Rails at the entrance to Carrefour, there is a large trash dump with a perpetual shroud of smoke hovering over it. At times the smoke coming from the burning trash dump drifts over the road obscuring all traffic in front of us. In addition to all that smoke, Haitians burn charcoal for cooking. Even in the cities like PauP. That is why you can see charcoal for sale in the markets in PauP. And out in the country, they burn wood to make charcoal. So tonight, I smell like smoke. I'm exhausted and I smell like smoke. I'm back in Haiti. Need some sleep. Big day tomorrow.
As we drive down Delmas 3, I stare out the cracked windshield of the Kia. The windows are rolled down. The Kia has no air-conditioning. Traffic is backed up, as usual. As the trucks and tap-taps in front of us inch along, a burst of the black diesel smoke of first gear fills the air. We drive through it. Traffic stops. We stop. Traffic starts up again and the air is filled with smoke again. And so it goes. There is smoke everywhere. From the endless line of cars and trucks and tap-taps belching black diesel fumes from their exhaust pipes to piles of trash burning on the side of the street. Things burn in Haiti. In late afternoon, it seems to be worse. People set their trash out to burn. There is some trash pickup now in PauP but even that trash is burned. Along the Route de Rails at the entrance to Carrefour, there is a large trash dump with a perpetual shroud of smoke hovering over it. At times the smoke coming from the burning trash dump drifts over the road obscuring all traffic in front of us. In addition to all that smoke, Haitians burn charcoal for cooking. Even in the cities like PauP. That is why you can see charcoal for sale in the markets in PauP. And out in the country, they burn wood to make charcoal. So tonight, I smell like smoke. I'm exhausted and I smell like smoke. I'm back in Haiti. Need some sleep. Big day tomorrow.
Now We Begin
Sunday, I flew back into Haiti with two suitcases full of material for the STI surveillance project. My flight out of Washington was late arriving in Miami; I had 10 minutes to get to the gate for my connecting flight to PAP. I made it in time. But would my bags make it? This flight was the last one out to Port-au-Prince for the day. My hopes sunk. But as I sat on the plane, the captain announced that they were waiting for the thunderstorms over Miami to clear before we could take off. That left enough time for connecting baggage (mine!) to get loaded on the plane. I found my bags on the Prestige beer carousel (the baggage claim carousel is covered with advertisements for the Haitian national lager beer) after customs and I grabbed them and walked out into the early evening heat and humidity. Meer was there to greet me. We waited for Maha, a student from UF who is working on malaria, to come out and then we loaded up the Everest and headed back to Christainville. It was the start of another stay in Haiti but this time we begin the STI project.
Over the past year I have felt squeezed on all sides with the difficulties of getting my STI surveillance study underway. I have frequently found myself spending so much time dealing with issues of a completely non-scientific nature. I am caught between two unyielding forces: unrelenting poverty (in Haiti) and inflexible bureaucracy (everywhere). It has been a succession of daunting tasks to overcome to get this far. Many times I have just felt that it was not worth all this effort for such a small project. Even today, I felt that way. Why am I still trying to do this? What good can we accomplish? How much data can we get? How useful will it be? Can we continue beyond the original funding period, that is, will the project be successful enough that my sponsor will agree to continue to support the surveillance long term?
But during this trip, we start. I am both excited and anxious. Excited to finally begin and anxious about what will happen when we actually begin the STI surveillance. What can go wrong? How well prepared is my staff? Do we have all the materials we need? What can go wrong?
Over the past year I have felt squeezed on all sides with the difficulties of getting my STI surveillance study underway. I have frequently found myself spending so much time dealing with issues of a completely non-scientific nature. I am caught between two unyielding forces: unrelenting poverty (in Haiti) and inflexible bureaucracy (everywhere). It has been a succession of daunting tasks to overcome to get this far. Many times I have just felt that it was not worth all this effort for such a small project. Even today, I felt that way. Why am I still trying to do this? What good can we accomplish? How much data can we get? How useful will it be? Can we continue beyond the original funding period, that is, will the project be successful enough that my sponsor will agree to continue to support the surveillance long term?
But during this trip, we start. I am both excited and anxious. Excited to finally begin and anxious about what will happen when we actually begin the STI surveillance. What can go wrong? How well prepared is my staff? Do we have all the materials we need? What can go wrong?
Monday, October 20, 2014
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.
Friday, October 17, 2014
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.
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.
Thursday, October 16, 2014
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.
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.
Monday, October 13, 2014
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.
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.
Sunday, August 17, 2014
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.
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.
Sunday, July 27, 2014
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 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.
Saturday, July 26, 2014
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.
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.
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 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.
 |
| 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 |
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) |
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.
Wednesday, July 23, 2014
A Plan B for Plan B – The Denton Flight Arrives
After the cancellation of the Denton flight on Saturday, we had to plan for a possible flight arriving on Sunday. Ruben, the military liaison from the Embassy, was going to contact us all on Sunday to let us know as soon as he heard when the flight would arrive. Meanwhile, Saturday night I explained our situation to Pastor Herold. We needed a truck and a driver again for Sunday. The Dodge was the only truck available. Herold called Juliome, a C’ville mechanic who also works as a weekend driver. Juliome would drive me to PauP in the Dodge where we would pick up Meer and then go to the airport and wait for the Denton flight again.
At 10:30 am Sunday, I received the email from Ruben. The flight was on and scheduled to arrive at 1:00 pm. Time to go. I called Juliome and Meer to let them know. In less than 10 minutes, Juliome was at the lab to pick me up. We headed out to the National Route #2 and drove to PauP. There was a lot less traffic than on Saturday and we made good time. We picked up Meer and went straight to the airport. We checked through the gate and Juliome backed the Dodge into a space next to the trucks from Lifeline Missions. As I stepped out of the Dodge, I heard the sound of military jet engines. I turned around in time to see our C-17 rolling slowly down the PAP runway to a stop. I checked my watch: 12:50 pm. The flight was exactly 24 hours late. I managed to pull out my cell phone and snap a few pictures as the C-17 turned and began to taxi down the runway to the unloading area.
We walked over and greeted Ruben who was getting ready to drive onto the runway area with the airport security escort. He gave Meer a great big hug and thanked him for the Indian food Meer had given him when we were here for the flight that was canceled on Saturday (see July 21 blog post). Then we all got back in our vehicles and waited for the escort vehicle to lead us onto the runway area. Soon we were driving on the tarmac and past a Delta Airlines and two American Airlines planes and then parked behind the C-17 that a forklift was busily unloading. We got out of the Dodge and looked around at the pallets that the forklift had already off-loaded. Soon we found two pallets with Meer’s petri dishes. Meer counted them: all 40 cases were there. I looked around, twice. My GeneXpert and test cartridges were not on this flight.
We began loading the petri dish boxes into the Dodge. They were all going to fit. Then Kathy started showing me stuff and asking if we could use them: a desk, filing cabinets, buckets. We took them all. At least we took what we could fit in the Dodge. I reminded Meer that we still had to pick up Nancy, the graduate student from UF, and her bags. Her flight was arriving in another 40 minutes. Ruben helped us tie down the load on the Dodge while the C-17 revved up its engines and taxied to the runway for takeoff. The C-17 was quickly in the air and on its way back to Charleston, SC. It was 2:15 pm. The entire unloading operation had taken less then 90 minutes.
We said good-bye to Ruben and Kathy. We’ll be back next week for the next Denton flight. Kathy has 85,000 pounds of rice and 42,500 pounds of beans in the system. Her group always brings several trucks and school buses that they fill up with all the food and stuff that Kathy brings into Haiti. We will come back with the Dodge again next Sunday. My stuff should easily fit in it.
At 10:30 am Sunday, I received the email from Ruben. The flight was on and scheduled to arrive at 1:00 pm. Time to go. I called Juliome and Meer to let them know. In less than 10 minutes, Juliome was at the lab to pick me up. We headed out to the National Route #2 and drove to PauP. There was a lot less traffic than on Saturday and we made good time. We picked up Meer and went straight to the airport. We checked through the gate and Juliome backed the Dodge into a space next to the trucks from Lifeline Missions. As I stepped out of the Dodge, I heard the sound of military jet engines. I turned around in time to see our C-17 rolling slowly down the PAP runway to a stop. I checked my watch: 12:50 pm. The flight was exactly 24 hours late. I managed to pull out my cell phone and snap a few pictures as the C-17 turned and began to taxi down the runway to the unloading area.
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| The C-17 Globemaster III from Charleston, SC |
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| Kathy, Ozmy, and Meer with Meer's petri dishes |
We began loading the petri dish boxes into the Dodge. They were all going to fit. Then Kathy started showing me stuff and asking if we could use them: a desk, filing cabinets, buckets. We took them all. At least we took what we could fit in the Dodge. I reminded Meer that we still had to pick up Nancy, the graduate student from UF, and her bags. Her flight was arriving in another 40 minutes. Ruben helped us tie down the load on the Dodge while the C-17 revved up its engines and taxied to the runway for takeoff. The C-17 was quickly in the air and on its way back to Charleston, SC. It was 2:15 pm. The entire unloading operation had taken less then 90 minutes.
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| Some of the pallets of humanitarian cargo from the Denton flight |
Monday, July 21, 2014
A Plan B for Plan B – and No Denton Flight
A rule. My Rule #2 for working in Haiti is: Have a plan B and a plan B for your plan B. Meer and I put the rule to the test this week. After a lapse of three months, we have more cargo coming in on a Denton flight. The last flight (our first) that we had was back in March (see blog entry March 29) and we have been anxious to get another shipment of material for the lab on another Denton flight. Meer ordered 40 cases of petri dishes and I purchased a GeneXpert plus several cases of test cartridges. All of these orders were shipped to the Operation Ukraine warehouse where Kathy Cadden included them in her load of humanitarian aid for shipment to Haiti. And then we waited. No flights came in April or May. One flight came in June but it did not have any of Kathy’s cargo. Meer and I waited impatiently for a date for our shipment.
A date. Early July, Kathy emailed me and said a flight was coming in on July 16. She would arrive in Haiti on July 16 to be there when the flight arrived. I emailed Meer, who was back in Haiti, and made my arrangements to return to Haiti in time for the shipment (and also to be present for training the personnel I planned to hire). Before I left, Kathy emailed me again to say that the flight was arriving on July 20, not July 16. I flew out on July 14 as planned and waited in C’ville for Kathy to call. A few days after my arrival, I received a call from Kathy. Good new, bad news. The good news is that there will be two Denton flights arriving this month – one on Saturday, July 19 and the other on Sunday, July 27. The bad news is that her cargo was split up and she does not know which flight our cargo will be on. We need to be at the airport Saturday with a truck in case our stuff is on that flight.
A truck. Meer and I talked about getting a driver and a truck to transport our supplies. No C’ville weekend drivers were available. So we had to call on Makendy to work on Saturday, his day off. We talked to Pastor Herold, the C’ville director about getting a truck. The large red flatbed Daihatsu will do nicely. Not available, it was leaving on Saturday morning to bring chickens up to Gonaives. I have no idea where the Kia is. The other pick up trucks are too small. Then there is the Dodge. Herold said we could use the Dodge. It is large but not large enough to carry 40 cases of petri dishes plus my instrument and supplies. We would have to rent a truck. Meer thought that maybe we could fill out the paperwork to rent a truck and wait until the flight arrived to sign the rental contract or cancel. I guess that may work. We needed a Plan B for Plan B. I called Kathy and explained our problem with the truck. She told me that her logistics guy knows how to get a truck on short notice and not to worry. He’ll take care of us. Meer and I left it at that. We decided to see what would happen next.
The Dodge. We piled into the Dodge at 10:15 am Saturday and Makendy headed for the PAP airport. Traffic was bad around Mariani (it usually is) and it took us about a hour and a half to get to the airport. We dropped off Amanda, a graduate student from Johns Hopkins who worked with Meer on a cholera project for the past couple of weeks. Then we drove to gate #7 and into the parking area to wait for the Denton flight. It was 11:45 am, one hour before the flight was scheduled to arrive. Kathy arrived with the trucks from Lifeline Mission shortly after 12 noon and Ruben arrived 15 minutes later. Meer had prepared some Indian food for Ruben and his fiancé (who was visiting this week). We originally had planned to have a big Indian dinner with Kathy and Ruben and his fiancé and one of Meer’s friends in Port-au-Prince but it is the middle of Ramadan and it would be too hard to set something up. So Meer made the meal and froze it for Ruben. We all stood around in the bright mid-day sun and talked about things: the situation in Ukraine, the state of orphanages in Haiti, sexual violence against women in Haiti and other countries (Ruben’s fiancé works in that field), Indian food, how Kathy manages to raise money for her organization and how she gets people to donate things. There was a constant breeze so we did not feel the July heat so much but it was better to stand in the shade.
12:45 pm. We all squinted up to the sky as Ruben pointed out an approaching aircraft. Then he shook his head. It’s not our C-17 transport. Even at this distance he could tell by how the wings were bent. Sure enough, the plane that landed was a Delta flight. We waited again. Then another aircraft began its final approach. Still not our C-17. This time it was an American Airlines 757. 1:45 pm and still no Denton flight. Meanwhile, another American Airlines 757 landed. At 2:00 pm, Ruben contacted flight control. Where is our flight? Bad news. The aircraft had taken off from Charleston, SC but encountered some mechanical problems and turned back. They were not sure how long it would take to fix the problem but they were hoping to get the flight out today. We all shook our heads as Ruben read the email. No way. It was too late. By the time the plane gets to PAP, unloads and gets turned around, it would be too late to take off. The PAP airport has no runway lights. All air traffic stops around 6 pm. We did not think there would be a flight today. But flight control told Ruben to stand by and they would do their best to get the flight out. At 2:45 pm. Ruben got the word. No flight today. They will let us know what time they plan to fly out tomorrow. We all got in our empty vehicles for the long return ride home. We’ll be back tomorrow, maybe?
3:00 pm. We drive up to Petionville and drop Meer off at his friend’s house. Meer will spend the night with them and we’ll come back Sunday to pick him up and meet the Denton flight, if it comes. Makendy and I get back in the Dodge and start down the mountain into PauP and the National Route #2 to drive back to C’ville. Traffic started to slow down and then stop just before Mariani, always a bottleneck. We managed to drive past the curtain of smoke that continually blows across the highway from the trash dump next to the road. And then traffic stopped completely. For almost two solid hours, we barely moved. All told it took us more than three hours to cover the 12 km from Mariani to C’ville. We finally pulled into C’ville at 7:15 pm over four hours after we left Petionville. A long day and we returned home empty-handed.
A date. Early July, Kathy emailed me and said a flight was coming in on July 16. She would arrive in Haiti on July 16 to be there when the flight arrived. I emailed Meer, who was back in Haiti, and made my arrangements to return to Haiti in time for the shipment (and also to be present for training the personnel I planned to hire). Before I left, Kathy emailed me again to say that the flight was arriving on July 20, not July 16. I flew out on July 14 as planned and waited in C’ville for Kathy to call. A few days after my arrival, I received a call from Kathy. Good new, bad news. The good news is that there will be two Denton flights arriving this month – one on Saturday, July 19 and the other on Sunday, July 27. The bad news is that her cargo was split up and she does not know which flight our cargo will be on. We need to be at the airport Saturday with a truck in case our stuff is on that flight.
A truck. Meer and I talked about getting a driver and a truck to transport our supplies. No C’ville weekend drivers were available. So we had to call on Makendy to work on Saturday, his day off. We talked to Pastor Herold, the C’ville director about getting a truck. The large red flatbed Daihatsu will do nicely. Not available, it was leaving on Saturday morning to bring chickens up to Gonaives. I have no idea where the Kia is. The other pick up trucks are too small. Then there is the Dodge. Herold said we could use the Dodge. It is large but not large enough to carry 40 cases of petri dishes plus my instrument and supplies. We would have to rent a truck. Meer thought that maybe we could fill out the paperwork to rent a truck and wait until the flight arrived to sign the rental contract or cancel. I guess that may work. We needed a Plan B for Plan B. I called Kathy and explained our problem with the truck. She told me that her logistics guy knows how to get a truck on short notice and not to worry. He’ll take care of us. Meer and I left it at that. We decided to see what would happen next.
The Dodge. We piled into the Dodge at 10:15 am Saturday and Makendy headed for the PAP airport. Traffic was bad around Mariani (it usually is) and it took us about a hour and a half to get to the airport. We dropped off Amanda, a graduate student from Johns Hopkins who worked with Meer on a cholera project for the past couple of weeks. Then we drove to gate #7 and into the parking area to wait for the Denton flight. It was 11:45 am, one hour before the flight was scheduled to arrive. Kathy arrived with the trucks from Lifeline Mission shortly after 12 noon and Ruben arrived 15 minutes later. Meer had prepared some Indian food for Ruben and his fiancé (who was visiting this week). We originally had planned to have a big Indian dinner with Kathy and Ruben and his fiancé and one of Meer’s friends in Port-au-Prince but it is the middle of Ramadan and it would be too hard to set something up. So Meer made the meal and froze it for Ruben. We all stood around in the bright mid-day sun and talked about things: the situation in Ukraine, the state of orphanages in Haiti, sexual violence against women in Haiti and other countries (Ruben’s fiancé works in that field), Indian food, how Kathy manages to raise money for her organization and how she gets people to donate things. There was a constant breeze so we did not feel the July heat so much but it was better to stand in the shade.
12:45 pm. We all squinted up to the sky as Ruben pointed out an approaching aircraft. Then he shook his head. It’s not our C-17 transport. Even at this distance he could tell by how the wings were bent. Sure enough, the plane that landed was a Delta flight. We waited again. Then another aircraft began its final approach. Still not our C-17. This time it was an American Airlines 757. 1:45 pm and still no Denton flight. Meanwhile, another American Airlines 757 landed. At 2:00 pm, Ruben contacted flight control. Where is our flight? Bad news. The aircraft had taken off from Charleston, SC but encountered some mechanical problems and turned back. They were not sure how long it would take to fix the problem but they were hoping to get the flight out today. We all shook our heads as Ruben read the email. No way. It was too late. By the time the plane gets to PAP, unloads and gets turned around, it would be too late to take off. The PAP airport has no runway lights. All air traffic stops around 6 pm. We did not think there would be a flight today. But flight control told Ruben to stand by and they would do their best to get the flight out. At 2:45 pm. Ruben got the word. No flight today. They will let us know what time they plan to fly out tomorrow. We all got in our empty vehicles for the long return ride home. We’ll be back tomorrow, maybe?
3:00 pm. We drive up to Petionville and drop Meer off at his friend’s house. Meer will spend the night with them and we’ll come back Sunday to pick him up and meet the Denton flight, if it comes. Makendy and I get back in the Dodge and start down the mountain into PauP and the National Route #2 to drive back to C’ville. Traffic started to slow down and then stop just before Mariani, always a bottleneck. We managed to drive past the curtain of smoke that continually blows across the highway from the trash dump next to the road. And then traffic stopped completely. For almost two solid hours, we barely moved. All told it took us more than three hours to cover the 12 km from Mariani to C’ville. We finally pulled into C’ville at 7:15 pm over four hours after we left Petionville. A long day and we returned home empty-handed.
Wednesday, July 16, 2014
Cholera, Chikungunya, and (Pay)checks
Meer tells me that the lab has been receiving fewer cases of severe diarrhea from the clinics. There are fewer cases of cholera also. The incidence of cholera seems to ebb and flow with the seasons, peaking in the rainy season. Now is the rainy reason in Haiti but, curiously, there is not a lot of rain. I arrived in Haiti two days ago and there hasn’t been any rain since my arrival. The last time it rained was a week ago. As we drove in from Port-au-Prince, I could see that the drainage ditches were dry and the rivers and streams had very little water flowing through them. Amanda, a graduate student from Johns Hopkins, went out with Meer yesterday to collect water samples and they told me that they saw the same thing: rivers and streams are drier than usual for a rainy season. Where is the rain? Maybe the unseasonable lack of rain is keeping the incidence of cholera down. Good for Haitians; not so good for Meer’s project.
One of my biggest concerns about returning to Haiti was the risk of getting Chikungunya. Before I left last month, I heard about many people I knew who had Chik or someone they knew had Chik. Sue told me that all of her kids at the C’ville orphanage had it. Ken, our former chief mechanic, got Chik just as he left Haiti. He was so sick on the flight home that he could hardly walk. I was a little worried. The epidemic is sweeping through Haiti and catching everyone. I’m wearing jeans despite the heat just to keep my legs covered and using Deet on my arms, neck, and face every day. And I’m careful to be sure my mosquito net is closed around my bed at night (against the mosquitoes that carry malaria; the mosquitoes with Chik and dengue are day biters). Today I read in Le Nouvelliste, the Haitian newspaper, that Dr Paul Adrien, Director of Epidemiology, Laboratory and Research at the Ministry of Public Health and the Population (and a collaborator on my STI surveillance project), confirmed that the number of Chik cases reported for the first week of July declined throughout the country. Maybe the efforts to eliminate mosquito breeding grounds are succeeding. Maybe the epidemic is burning out. Maybe the virus is evolving into a less virulent form and fewer victims feel sick enough to seek medical attention and, thus, are not counted. The cases are all classified by symptoms anyway since there are no diagnostic tests for the Chik virus. We just don’t know and the surveillance studies proposed by UF-EPI to study the epidemic may not be reviewed or funded before the epidemic dies out. Both the reduced cases of cholera and the declining cases of Chik fit a maxim of Amanda’s Ph.D. director, Dr. David Sacks. Basically he said that if you want to cure cholera (or insert your favorite infectious disease here), start a surveillance study. It is an exaggeration to be sure and more a reflection of our slow response to studying epidemics and how long it takes to set up these projects. However, I doubt that sexually transmitted infections will go away before my surveillance begins.
This afternoon, Meer and Amanda and I drove out to Petit-Goâve. Meer’s diarrheal disease surveillance project receives specimens from a hospital there: l’hôpital Notre-Dame de Petit-Goâve. I had been in contact with the administrative director of the Henri Gerard Degranges Foundation, which operates another clinic in Petit-Goâve. Earlier this year, a team from UCLA published a small study on STIs they carried out at the Degranges clinic last year. In addition to the STI work, I thought the clinic could be another possible source of diarrhea specimens for Meer’s project. I had planned to meet the director in March when she was in Haiti but our schedules never matched. I contacted her on my return to Haiti on Monday and asked if it was possible to visit the clinic since Meer planned to go to Petit-Goâve to visit Notre Dame Hospital. No problem. She gave me the clinic director’s cellphone number and I called him last night to set up the meeting.
This morning Makendy dropped off Khan at the airport for his return to Gainesville but traffic in Carrefour made his return to C’ville over an hour and a half later than we planned. We got on the road to Petit-Goâve and when the clinic director called to ask me where we were, I explained the reason for our delay and told him we would arrive about 3 pm. The clinic closes at 3 pm but he assured me that someone would be there to show us around. We arrived in Petit-Goâve shortly after 3 pm and were greeted by Mr. Georges, the accountant at Clinique de Henri Gerard Desgranges. I told him about the UF-EPI lab at C’ville and Meer’s project, avoiding the scientific details since I was talking to the accountant and not the medical staff. He seemed to understand what Meer was looking for in the collaboration (diarrhea stools) and then we talked numbers (he is an accountant, after all). How many patients do they see at the clinic per day? About 20-30, a lot less than a few weeks ago when they were seeing over 60 patients a day, mostly Chikungunya cases. How many cases of severe diarrhea? Not many at all. Any cholera cases? None. Is there a Cholera Treatment Center in Petit-Goâve? No, there was one but it closed down. So here, too, it sounded like cholera and Chik were on the decline. Then the surprise came from a chance remark. Do all the cases of severe cholera go to the Notre Dame Hospital? No, that hospital is closed. Stunned silence. I asked him again to be sure my French was not fooling me. Mr. Georges said that the Notre Dame Hospital in Petit-Goâve was closed. There was no money to pay the staff salaries so the 80 employees of the hospital went on strike last Tuesday. The employees are demanding 18 month back pay they claim that they have not received (see http://www.haitilibre.com/article-11561-haiti-sante-l-hopital-notre-dame-de-petit-goave-de-nouveau-paralyse-par-la-greve.html). I turned to Makendy. He shook his head; he didn’t know and Makendy said that he had picked up samples there last week. So maybe with the strike at the larger Notre Dame Hospital, the Clinique de Henri Gerard Desgranges will get the diarrhea patients and Meer can get his samples after all. It may be that our visit today was more fortuitous than any of us expected when we drove out to Petit-Goâve. It seems that I experience a lot of these chance events in Haiti. Maybe it happens more, maybe I just see the chances more readily here. In any case, I think our timing today may prove to be impeccable.
One of my biggest concerns about returning to Haiti was the risk of getting Chikungunya. Before I left last month, I heard about many people I knew who had Chik or someone they knew had Chik. Sue told me that all of her kids at the C’ville orphanage had it. Ken, our former chief mechanic, got Chik just as he left Haiti. He was so sick on the flight home that he could hardly walk. I was a little worried. The epidemic is sweeping through Haiti and catching everyone. I’m wearing jeans despite the heat just to keep my legs covered and using Deet on my arms, neck, and face every day. And I’m careful to be sure my mosquito net is closed around my bed at night (against the mosquitoes that carry malaria; the mosquitoes with Chik and dengue are day biters). Today I read in Le Nouvelliste, the Haitian newspaper, that Dr Paul Adrien, Director of Epidemiology, Laboratory and Research at the Ministry of Public Health and the Population (and a collaborator on my STI surveillance project), confirmed that the number of Chik cases reported for the first week of July declined throughout the country. Maybe the efforts to eliminate mosquito breeding grounds are succeeding. Maybe the epidemic is burning out. Maybe the virus is evolving into a less virulent form and fewer victims feel sick enough to seek medical attention and, thus, are not counted. The cases are all classified by symptoms anyway since there are no diagnostic tests for the Chik virus. We just don’t know and the surveillance studies proposed by UF-EPI to study the epidemic may not be reviewed or funded before the epidemic dies out. Both the reduced cases of cholera and the declining cases of Chik fit a maxim of Amanda’s Ph.D. director, Dr. David Sacks. Basically he said that if you want to cure cholera (or insert your favorite infectious disease here), start a surveillance study. It is an exaggeration to be sure and more a reflection of our slow response to studying epidemics and how long it takes to set up these projects. However, I doubt that sexually transmitted infections will go away before my surveillance begins.
This afternoon, Meer and Amanda and I drove out to Petit-Goâve. Meer’s diarrheal disease surveillance project receives specimens from a hospital there: l’hôpital Notre-Dame de Petit-Goâve. I had been in contact with the administrative director of the Henri Gerard Degranges Foundation, which operates another clinic in Petit-Goâve. Earlier this year, a team from UCLA published a small study on STIs they carried out at the Degranges clinic last year. In addition to the STI work, I thought the clinic could be another possible source of diarrhea specimens for Meer’s project. I had planned to meet the director in March when she was in Haiti but our schedules never matched. I contacted her on my return to Haiti on Monday and asked if it was possible to visit the clinic since Meer planned to go to Petit-Goâve to visit Notre Dame Hospital. No problem. She gave me the clinic director’s cellphone number and I called him last night to set up the meeting.
This morning Makendy dropped off Khan at the airport for his return to Gainesville but traffic in Carrefour made his return to C’ville over an hour and a half later than we planned. We got on the road to Petit-Goâve and when the clinic director called to ask me where we were, I explained the reason for our delay and told him we would arrive about 3 pm. The clinic closes at 3 pm but he assured me that someone would be there to show us around. We arrived in Petit-Goâve shortly after 3 pm and were greeted by Mr. Georges, the accountant at Clinique de Henri Gerard Desgranges. I told him about the UF-EPI lab at C’ville and Meer’s project, avoiding the scientific details since I was talking to the accountant and not the medical staff. He seemed to understand what Meer was looking for in the collaboration (diarrhea stools) and then we talked numbers (he is an accountant, after all). How many patients do they see at the clinic per day? About 20-30, a lot less than a few weeks ago when they were seeing over 60 patients a day, mostly Chikungunya cases. How many cases of severe diarrhea? Not many at all. Any cholera cases? None. Is there a Cholera Treatment Center in Petit-Goâve? No, there was one but it closed down. So here, too, it sounded like cholera and Chik were on the decline. Then the surprise came from a chance remark. Do all the cases of severe cholera go to the Notre Dame Hospital? No, that hospital is closed. Stunned silence. I asked him again to be sure my French was not fooling me. Mr. Georges said that the Notre Dame Hospital in Petit-Goâve was closed. There was no money to pay the staff salaries so the 80 employees of the hospital went on strike last Tuesday. The employees are demanding 18 month back pay they claim that they have not received (see http://www.haitilibre.com/article-11561-haiti-sante-l-hopital-notre-dame-de-petit-goave-de-nouveau-paralyse-par-la-greve.html). I turned to Makendy. He shook his head; he didn’t know and Makendy said that he had picked up samples there last week. So maybe with the strike at the larger Notre Dame Hospital, the Clinique de Henri Gerard Desgranges will get the diarrhea patients and Meer can get his samples after all. It may be that our visit today was more fortuitous than any of us expected when we drove out to Petit-Goâve. It seems that I experience a lot of these chance events in Haiti. Maybe it happens more, maybe I just see the chances more readily here. In any case, I think our timing today may prove to be impeccable.
Chik is Chic
May 6. I’m sitting on the porch of the priest’s house in Baradères while I type out my blog. There is a steady stream of people and animals on the road making their way to the Saturday morning market. Young men, women and children lead donkeys laden with bananas. They balance containers with dry goods on their heads as they walk. It is not yet 10 am and the day is sunny and hot.
After lunch, Father Jacques came to tell me that a girl came to the house with Chikungunya. Could he give her some acetaminophen? Sure. We brought dozens of large bottles of acetaminophen to Baradères for this reason. How much should she take? I told Father Jacques to check her age and read the label on the bottle. Twenty minutes later, a man greeted me on the porch. I didn’t recognize him though he seemed to know me. He said he was happy to see me again. We exchanged a few words, in Kreyol, and then I ran out of things I could say. He said good-bye but before he left the porch he turned and asked me if I could give him some acetaminophen. I told him to ask Father Jacques. Later this afternoon I translated for Cynthia as she spoke with the graduating students of the Philo class. The girl whom Father Jacques told me about earlier was there. She looked a little tired but clearly was able to move. From what I heard about the symptoms of Chik, the joint and muscle pain is so severe that it is incapacitating. Does she really have Chik?
There is no doubt that Chik is really here. The Ministry of Public Health and the Population (MSPP) declared its arrival earlier this month. Mille is in the mosquito room every day preparing his traps to take out. I asked him what he has found so far. Chik. Now all the Haitians believe Chik is here. The Haitians all think they have it, too, and they all want acetaminophen. Back in C’ville Pastor Raymond said that it is “chique” to have Chik. Everyone says they have it. And no one is really sure, not until we can start doing some surveillance testing for it.
June 14, 2014 – I spent the weekend in Baradères to attend the graduation ceremony for the “Philo” class of le College St. Jean Baptiste, the school that my church in Silver Spring supports. We again hear stories of people suffering from Chik in Baradères. The epidemic continues. After my return to C’ville from Baraderes, I learn that a good friend of mine who works at an orphanage near here came down with Chik. Matt is a big guy but Chik laid him out with fever and muscle pain so bad he could barely walk. Three days later, he was back in the dining hall looking and feeling much better. Chik is making the rounds. I’ve lost track of who has had it.
July 5, 2014 – I received an email from Sister Denise. One of the sisters in her community died of complications from Chikungunya. I had heard about many cases but no fatalities until now. Chik is not “chique”; it is for real. Sister Denise’s email went on to say that one of the candidates whom we had interviewed for the lab tech position in Baradères died. Malaria. Yes, I remind myself. These diseases are real and real people are dying.
After lunch, Father Jacques came to tell me that a girl came to the house with Chikungunya. Could he give her some acetaminophen? Sure. We brought dozens of large bottles of acetaminophen to Baradères for this reason. How much should she take? I told Father Jacques to check her age and read the label on the bottle. Twenty minutes later, a man greeted me on the porch. I didn’t recognize him though he seemed to know me. He said he was happy to see me again. We exchanged a few words, in Kreyol, and then I ran out of things I could say. He said good-bye but before he left the porch he turned and asked me if I could give him some acetaminophen. I told him to ask Father Jacques. Later this afternoon I translated for Cynthia as she spoke with the graduating students of the Philo class. The girl whom Father Jacques told me about earlier was there. She looked a little tired but clearly was able to move. From what I heard about the symptoms of Chik, the joint and muscle pain is so severe that it is incapacitating. Does she really have Chik?
There is no doubt that Chik is really here. The Ministry of Public Health and the Population (MSPP) declared its arrival earlier this month. Mille is in the mosquito room every day preparing his traps to take out. I asked him what he has found so far. Chik. Now all the Haitians believe Chik is here. The Haitians all think they have it, too, and they all want acetaminophen. Back in C’ville Pastor Raymond said that it is “chique” to have Chik. Everyone says they have it. And no one is really sure, not until we can start doing some surveillance testing for it.
June 14, 2014 – I spent the weekend in Baradères to attend the graduation ceremony for the “Philo” class of le College St. Jean Baptiste, the school that my church in Silver Spring supports. We again hear stories of people suffering from Chik in Baradères. The epidemic continues. After my return to C’ville from Baraderes, I learn that a good friend of mine who works at an orphanage near here came down with Chik. Matt is a big guy but Chik laid him out with fever and muscle pain so bad he could barely walk. Three days later, he was back in the dining hall looking and feeling much better. Chik is making the rounds. I’ve lost track of who has had it.
July 5, 2014 – I received an email from Sister Denise. One of the sisters in her community died of complications from Chikungunya. I had heard about many cases but no fatalities until now. Chik is not “chique”; it is for real. Sister Denise’s email went on to say that one of the candidates whom we had interviewed for the lab tech position in Baradères died. Malaria. Yes, I remind myself. These diseases are real and real people are dying.
Wednesday, June 18, 2014
Route Nationale #2 – Medicine, Mangoes and a Mangled Machine
So once again I found myself sitting in the back of the sisters’ Land Cruiser speeding west down the National Route 2, headed for Baradères. Father Jacques had come to Port-au-Prince the day before to pick up our team from the airport. Three parishioners flew in for the graduation ceremony for the Philo class from our school, the College St. Jean Baptiste in Baradères. The trip had turned into a mini-medical mission because of the chikungunya epidemic that had gripped the island. Our team was bringing down large three bags each of acetaminophen to treat the symptoms of Chik fever. Their flight was arriving at 12:40 pm. Father Jacques and Kendol, Sister Denise’s driver, would get them at the airport and then pick me up at Christianville on the way to Baradères. At 2:45pm I received a phone call from Father Jacques. He had picked up the team and they were stuck in Carrefour. Traffic. Maybe another hour. At 4:00pm, another call. They were here. I gathered my backpack and the extra eight giant bottles of acetaminophen that I had brought down (part of our church’s generous donations) for treating the Chik fever and headed out the door. We got on the road at 4:15pm. I figured about a five-hour drive so we would be on the mountain road up to Baradères after dark. Just like my first trip there.
It is World Cup time and as we drove up to Baradères, Kenol had the Land Cruiser’s radio dialed into the Holland – Spain match. The announcer gave the play-by-play in French in the typically animated fashion that is football broadcasting. When a goal was scored, the classic “GOOOOOOOOOOOOOOOOOOOOOOOOOOOAL”filled the inside of the Land Cruiser. Holland crushed Spain 5-1 so we heard plenty of, well I’m not going to type it again.
We stopped at Eva’s for gas, bread, and drinks. Father Jacques picked up eight loaves of sliced bread. The inside of the Land Cruiser was already filled with our team’s bags and food that Father Jacques has bought in PauP. Supplies were also lashed onto the Land Cruiser’s roof. Cynthia sat in front next to Kenol, the driver. Jacques, Stephanie and I sat on the bench seats in back. Two cases of Prestige were stored under the benches.
The traffic got heavier and slowed down as we entered Carrefour du Fort. More than a dozen vendors lined both sides of the Route National #2 in front of the Total gas station. They were all selling mangoes. We came to a stop and as we did, about six vendors (all women; I don’t recall ever seeing a man selling fruit or vegetables on the road or in the market) raced up to the Land Cruiser carrying their mangoes neatly piled in pyramids in shallow wicker baskets. Jacques carefully opened up the rear door of the Land Cruiser and examined the mangoes of the first (lucky) woman who presented her basket. Jacques picked out two bruised mangoes and told the woman that he did not want those but would take the rest. She quickly agreed but said that she had other, nicer looking mangoes she would give him in place of the two bruised ones. Jacques placed the mangoes he wanted in a black plastic bag that the woman had given him and the woman returned to her stand to find the nicer ones. A second woman took her place in front the Land Cruiser's rear door. Jacques examined another basket of mangoes and bought them. The first woman returned with the new mangoes and Jacques paid her the 100 gourdes for all six large beautiful fruits. Mangoes always seem to be in season somewhere in Haiti and the country is full of them. Mangoes fall out of the trees in C’ville when I walk to the lab. They lie on the ground waiting for someone to collect them or they start rotting in the hot sun. I wonder, as I often do during these trips, why there is no mango export industry. The fruit appears plentiful and it is not possible that Haitians are consuming all the mangoes produced on the island. Father Jacques told me later that Haiti does export mangoes. Nevertheless, between 4 and 5 million tons of mangoes go uncollected, unsold, uneaten (all of the above?) and rot on the ground every year. Why can’t they do better? It is a plentiful natural resource and another paradox of Haiti. A bountiful fruit yet so much waste.
We slowed down as we drove through Miragoâne. Jacques was on his cell phone. We stopped momentarily. Then we drove on. We stopped, again. Jacques threw open the rear door of the Land Cruiser and Father Castille climbed in with his backpack. He was returning from a wedding and had spent the night at his mother’s house. As usual, vehicles always fill up on any trip. We drove on and a few minutes later we slowed down again and Father Castille told Kendol where to stop. He opened the rear door and a tall man handed Father Castille his clothes. Jackets, shirts and pants cleaned and pressed and on hangers covered with a clear plastic bag. It was just like picking up your dry cleaning back in Silver Spring.
We sped along the National Route 2 as it turned south into the mountains towards the opposite coast. Suddenly Kenol slowed down and came to a full stop. A truck was stopped in our lane facing us. There was an accident. A crowd of Haitians was gathered on the right side of the road around a blue pickup truck that had run off the road into a drainage ditch. The truck’s driver gestured to Kenol to back up and he climbed into his vehicle. I could see that the truck was not part of the accident as I first thought but that it had a towline attached to the pickup that was in the ditch. We backed up and the truck driver slowly put his truck in gear and moved forward. The towline grew taut and the crushed pickup truck slowly rolled backwards out of the ditch. The truck stopped and the driver undid the towline. It looked like an old fire hose that was just tied from one vehicle to the other. The truck moved away and Kendol slowly advanced the Land Cruiser past the accident scene. The crowd grew more animated. As we drove past, I saw a shirtless young man swinging a sledgehammer on the passenger side of the crushed pickup. A woman was trapped inside and this was their only means of extricating her. Kendol was talking almost non-stop now on his cell phone. He was telling his friends about how this pickup truck had sped past us earlier on the road. It was driving much too fast, he said and now the pickup was smashed up on the side of the road. I wondered how many times a day this same scene plays out in Haiti, on this same road and on other roads in the country. I have seen it before but usually the twisted remains of the accident. I had never arrived on the scene so soon after an accident. We all witnessed the response. There were Haitians helping Haitians. Regular people. There were no police to direct traffic and coordinate a rescue response. No fire trucks, no EMTs or rescue vehicles. No “jaws-of-life” to extricate the trapped woman; just a man with a sledgehammer. I saw an ambulance drive away shortly after we arrived but it appeared to be carrying passengers, not accident victims. I could not be sure. As we drove down the road past the accident scene, a man was placing large leafy branches he had cut down from a tree in the middle of the road. This was the Haitian highway equivalent of safety flares or orange cones. It was to warn drivers of an accident ahead. We drove on. Kendol had one hand on the steering wheel and the other on his cell phone complaining about bad drivers and bad outcomes.
It is World Cup time and as we drove up to Baradères, Kenol had the Land Cruiser’s radio dialed into the Holland – Spain match. The announcer gave the play-by-play in French in the typically animated fashion that is football broadcasting. When a goal was scored, the classic “GOOOOOOOOOOOOOOOOOOOOOOOOOOOAL”filled the inside of the Land Cruiser. Holland crushed Spain 5-1 so we heard plenty of, well I’m not going to type it again.
We stopped at Eva’s for gas, bread, and drinks. Father Jacques picked up eight loaves of sliced bread. The inside of the Land Cruiser was already filled with our team’s bags and food that Father Jacques has bought in PauP. Supplies were also lashed onto the Land Cruiser’s roof. Cynthia sat in front next to Kenol, the driver. Jacques, Stephanie and I sat on the bench seats in back. Two cases of Prestige were stored under the benches.
The traffic got heavier and slowed down as we entered Carrefour du Fort. More than a dozen vendors lined both sides of the Route National #2 in front of the Total gas station. They were all selling mangoes. We came to a stop and as we did, about six vendors (all women; I don’t recall ever seeing a man selling fruit or vegetables on the road or in the market) raced up to the Land Cruiser carrying their mangoes neatly piled in pyramids in shallow wicker baskets. Jacques carefully opened up the rear door of the Land Cruiser and examined the mangoes of the first (lucky) woman who presented her basket. Jacques picked out two bruised mangoes and told the woman that he did not want those but would take the rest. She quickly agreed but said that she had other, nicer looking mangoes she would give him in place of the two bruised ones. Jacques placed the mangoes he wanted in a black plastic bag that the woman had given him and the woman returned to her stand to find the nicer ones. A second woman took her place in front the Land Cruiser's rear door. Jacques examined another basket of mangoes and bought them. The first woman returned with the new mangoes and Jacques paid her the 100 gourdes for all six large beautiful fruits. Mangoes always seem to be in season somewhere in Haiti and the country is full of them. Mangoes fall out of the trees in C’ville when I walk to the lab. They lie on the ground waiting for someone to collect them or they start rotting in the hot sun. I wonder, as I often do during these trips, why there is no mango export industry. The fruit appears plentiful and it is not possible that Haitians are consuming all the mangoes produced on the island. Father Jacques told me later that Haiti does export mangoes. Nevertheless, between 4 and 5 million tons of mangoes go uncollected, unsold, uneaten (all of the above?) and rot on the ground every year. Why can’t they do better? It is a plentiful natural resource and another paradox of Haiti. A bountiful fruit yet so much waste.
We slowed down as we drove through Miragoâne. Jacques was on his cell phone. We stopped momentarily. Then we drove on. We stopped, again. Jacques threw open the rear door of the Land Cruiser and Father Castille climbed in with his backpack. He was returning from a wedding and had spent the night at his mother’s house. As usual, vehicles always fill up on any trip. We drove on and a few minutes later we slowed down again and Father Castille told Kendol where to stop. He opened the rear door and a tall man handed Father Castille his clothes. Jackets, shirts and pants cleaned and pressed and on hangers covered with a clear plastic bag. It was just like picking up your dry cleaning back in Silver Spring.
We sped along the National Route 2 as it turned south into the mountains towards the opposite coast. Suddenly Kenol slowed down and came to a full stop. A truck was stopped in our lane facing us. There was an accident. A crowd of Haitians was gathered on the right side of the road around a blue pickup truck that had run off the road into a drainage ditch. The truck’s driver gestured to Kenol to back up and he climbed into his vehicle. I could see that the truck was not part of the accident as I first thought but that it had a towline attached to the pickup that was in the ditch. We backed up and the truck driver slowly put his truck in gear and moved forward. The towline grew taut and the crushed pickup truck slowly rolled backwards out of the ditch. The truck stopped and the driver undid the towline. It looked like an old fire hose that was just tied from one vehicle to the other. The truck moved away and Kendol slowly advanced the Land Cruiser past the accident scene. The crowd grew more animated. As we drove past, I saw a shirtless young man swinging a sledgehammer on the passenger side of the crushed pickup. A woman was trapped inside and this was their only means of extricating her. Kendol was talking almost non-stop now on his cell phone. He was telling his friends about how this pickup truck had sped past us earlier on the road. It was driving much too fast, he said and now the pickup was smashed up on the side of the road. I wondered how many times a day this same scene plays out in Haiti, on this same road and on other roads in the country. I have seen it before but usually the twisted remains of the accident. I had never arrived on the scene so soon after an accident. We all witnessed the response. There were Haitians helping Haitians. Regular people. There were no police to direct traffic and coordinate a rescue response. No fire trucks, no EMTs or rescue vehicles. No “jaws-of-life” to extricate the trapped woman; just a man with a sledgehammer. I saw an ambulance drive away shortly after we arrived but it appeared to be carrying passengers, not accident victims. I could not be sure. As we drove down the road past the accident scene, a man was placing large leafy branches he had cut down from a tree in the middle of the road. This was the Haitian highway equivalent of safety flares or orange cones. It was to warn drivers of an accident ahead. We drove on. Kendol had one hand on the steering wheel and the other on his cell phone complaining about bad drivers and bad outcomes.
Tuesday, June 17, 2014
Chilling with Customs in PAP
I planned to fly back to Haiti for a week in mid-June to meet with some people about my project and also to attend a graduation ceremony at the school that my church supports in Baradères. The beast arrived in my lab in Bethesda three days before my departure. The beast is the GeneXpert IV, a real-time PCR machine that I was going to use for rapid diagnosis of Chlamydia and gonorrhea. The GeneXpert is a loaner from Cepheid, the manufacturer, who agreed to lend me the instrument for one year for my STI surveillance study. The instrument itself is not large but with its shipping case, it was a beast. The wheeled shipping case is a heavy black plastic cube about 18 x 20 x 24 and weighing 67 lbs. Perfect for safely shipping the instrument but it proved to be a red flag for Haitian customs.
As is our tradition, early Thursday morning Pierre drove me to DCA for my flight to Miami. I had no problem checking the beast at Reagan National. Overweight? No problem. You just pay extra, which I did. During the flight, I tried to think about what might happen at customs in PAP. I had never been stopped there before and I was almost certain that the beast would be my ticket to a special interview with a customs agent. It was.
I collected my suitcase and the beast in baggage claim and got in the line that moved slowly past a customs agent who collected our papers and then directed people (seemingly at random) to another room for bag inspection. I was selected. While I waited for a customs agent to appear, I watched a family of five being questioned about what they were bringing into Haiti. Acetaminophen, the father explained as the rest of the family looked on anxiously. The customs agent pulled out a Costco-size bottle of acetaminophen from their open suitcase. I had eight of the exact same bottle in my suitcase. And I had the beast. This could be bad. The customs agent asked a few more questions and let the family go.
Soon a young man appeared. It was my turn. He asked me in English to open my suitcase. I did and he was soon looking intently at the top layer of 30 boxes of rapid diagnostic test kits for syphilis. What are these he asked? Test kits for syphilis, I answered. He directed me to open a box. I did and he looked curiously at the individual packets and then pulled one out and inspected it. He returned it to the box and asked if I was a doctor. Yes (why not? Otherwise it gets too complicated). Okay. He told me to close the suitcase and turned his attention to the beast. He told me to open the case. I carefully undid the latches and soon the customs agent was staring down at the beast.
I told him what it was and explained that it was on loan from the manufacturer and that it was for medical purposes. He looked at the laptop that comes with the beast and informed me that I needed to declare the beast and pay customs duty. How much? I asked. It depends on how much the beast is worth, he replied. I have no idea, I said; it is on loan. I showed him the contract with the manufacturer that explained that the beast was on loan to me. It was not enough. The young man wanted to know how much the instrument cost so that he could calculate the customs duty. He pulled out a smart phone and asked me how to spell the beast’s name, GeneXpert-IV. The customs agent typed it in his search engine. He had an app for searching prices, very smart for getting an item’s value. But I knew, and the young agent soon found out, that no amount of searching would yield the actual price of the beast. Medical and scientific instruments that are this expensive do not have their prices listed on any web site. The young agent searched and searched and re-typed the name and searched again but he came up empty. Now the room was empty, too. The last passengers who had been selected for inspection had long since left. The young agent sighed. You can go, he finally said. I carefully re-fastened the latches on the shipping crate, pulled out the handle, thanked the customs agent and left the room. It was not until I exited the airport building into the hot sun that I realized that I had gone toe-to-toe with Haitian customs. I had stared them down and won.
Outside in the reception area, I found my Christianville driver and we loaded the beast and my suitcase into the Land Cruiser. Danette was already waiting in the Land Cruiser (her flight had come in at about the same time as mine but my detour through customs delayed me almost 20 minutes). What’s in the big box, Danette asked. One of my instruments for the STI surveillance project, I said. In reality, it was a small victory and a big step forward in actually getting the project underway. Welcome to Haiti, beast!
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| GeneXpert IVV shown here with desktop computer |
As is our tradition, early Thursday morning Pierre drove me to DCA for my flight to Miami. I had no problem checking the beast at Reagan National. Overweight? No problem. You just pay extra, which I did. During the flight, I tried to think about what might happen at customs in PAP. I had never been stopped there before and I was almost certain that the beast would be my ticket to a special interview with a customs agent. It was.
I collected my suitcase and the beast in baggage claim and got in the line that moved slowly past a customs agent who collected our papers and then directed people (seemingly at random) to another room for bag inspection. I was selected. While I waited for a customs agent to appear, I watched a family of five being questioned about what they were bringing into Haiti. Acetaminophen, the father explained as the rest of the family looked on anxiously. The customs agent pulled out a Costco-size bottle of acetaminophen from their open suitcase. I had eight of the exact same bottle in my suitcase. And I had the beast. This could be bad. The customs agent asked a few more questions and let the family go.Soon a young man appeared. It was my turn. He asked me in English to open my suitcase. I did and he was soon looking intently at the top layer of 30 boxes of rapid diagnostic test kits for syphilis. What are these he asked? Test kits for syphilis, I answered. He directed me to open a box. I did and he looked curiously at the individual packets and then pulled one out and inspected it. He returned it to the box and asked if I was a doctor. Yes (why not? Otherwise it gets too complicated). Okay. He told me to close the suitcase and turned his attention to the beast. He told me to open the case. I carefully undid the latches and soon the customs agent was staring down at the beast.
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| The beast in its box |
Outside in the reception area, I found my Christianville driver and we loaded the beast and my suitcase into the Land Cruiser. Danette was already waiting in the Land Cruiser (her flight had come in at about the same time as mine but my detour through customs delayed me almost 20 minutes). What’s in the big box, Danette asked. One of my instruments for the STI surveillance project, I said. In reality, it was a small victory and a big step forward in actually getting the project underway. Welcome to Haiti, beast!
Monday, May 26, 2014
Memorial Day
I am back in the U.S. and this post has nothing to do with Haiti.
Today is Memorial Day. This morning I drove up to Yeadon, a suburb of Philadelphia, to visit the cemetery where Mom and Dad are buried. I had not been back to the cemetery since Mom’s funeral in November 2012. Dad died in November 2010 a few weeks before my wife, Bedou, died. Today I wanted to go to the cemetery to see Mom and Dad. The sky was blue and bright with sunlight. I pulled into Fernwood Cemetery and drove slowly down the narrow roads that separate the sections. I parked along the side of the road and walked down the gentle slope toward the bottom of the section where the gravesite was. I stopped and scanned the rows of headstones trying to find Mom and Dad. The cemetery had placed American flags at the gravesite of each veteran buried here so I looked for a flag. Dad had served in the Seabees in the Pacific during World War II. I found the gravesite. I had only seen a picture of the newly carved headstone that now included Mom’s name and dates. It fit nicely on Dad’s official military headstone. They were together again as they had always been.
I thought for a long time about what Mom and Dad had done for us, for their family, friends and neighbors. They gave so much, loved so much, and shared so much with everyone around them. They showed me how to be a good parent, not directly, but by the way they were parents to my brothers and I. If I did well raising my kids, it is due in part to the way my parents raised me.
Today is Memorial Day. Thank you, Dad, for your service. Thank you Mom and Dad for being my parents.
Today is Memorial Day. This morning I drove up to Yeadon, a suburb of Philadelphia, to visit the cemetery where Mom and Dad are buried. I had not been back to the cemetery since Mom’s funeral in November 2012. Dad died in November 2010 a few weeks before my wife, Bedou, died. Today I wanted to go to the cemetery to see Mom and Dad. The sky was blue and bright with sunlight. I pulled into Fernwood Cemetery and drove slowly down the narrow roads that separate the sections. I parked along the side of the road and walked down the gentle slope toward the bottom of the section where the gravesite was. I stopped and scanned the rows of headstones trying to find Mom and Dad. The cemetery had placed American flags at the gravesite of each veteran buried here so I looked for a flag. Dad had served in the Seabees in the Pacific during World War II. I found the gravesite. I had only seen a picture of the newly carved headstone that now included Mom’s name and dates. It fit nicely on Dad’s official military headstone. They were together again as they had always been.
I thought for a long time about what Mom and Dad had done for us, for their family, friends and neighbors. They gave so much, loved so much, and shared so much with everyone around them. They showed me how to be a good parent, not directly, but by the way they were parents to my brothers and I. If I did well raising my kids, it is due in part to the way my parents raised me.
Today is Memorial Day. Thank you, Dad, for your service. Thank you Mom and Dad for being my parents.
Friday, May 16, 2014
Life, and Death
I am sitting in the boarding area at the PAP airport, waiting for my 9:40 flight, American Airlines 377 to Miami. I am on my way back home. We left C'ville on the yellow school bus this morning at 5 am and arrived at the airport at a little past 6. On our way through the central market, I saw my most disturbing sight yet. Our driver pointed to his left. There was the body of a man lying in the middle of the road, crushed and broken, arms extended above his head, his lower body splashed open. It looked like the man had been run over. From our seats in the bus, we were higher than we would be in a car or in the Everest. My first thought was that it was a large animal. But even in the early dawn light, we could see the body all too clearly. It was a dead human being. Traffic slowed down to maneuver around the body. We drove around the body, too, just like everyone else. How long had the man been lying dead in the road? Minutes? Hours? I have no idea. No one was there to stop or direct traffic around the body. There were no police. Two UN trucks drove past in the opposite lane on our left. We drove on. To the right of us, the market was coming alive with activity as people unloaded their goods from trucks and tap taps. Less than 20 feet from the bustling outdoor market, there was a dead man lying in the street.
I have heard people say that life is cheap in Haiti. I did not want to believe it. Today, I think I do.
I have heard people say that life is cheap in Haiti. I did not want to believe it. Today, I think I do.
Wednesday, May 14, 2014
Why the Pastor was Angry
Someone just asked a simple question: how was the wedding reception? That question triggered a reaction that I never expected. The Pastor was clearly offended by something that happened to him. He had presided at the wedding ceremony but at the reception, he felt that he was not treated as he should have been treated, as he deserved to be treated. He gave few details, but one got the sense that he was not treated as a very special guest. He grumbled that Catholic priests are paid when they do weddings but that Protestant ministers do it for free. It’s not fair. We should charge them, he cried. So he proclaimed to all of us that in the future he will only agree to preside at weddings under certain conditions. He will insist on being treated royally. They should send a car, a limousine, to pick him up. He should be seated at the table with the other officials (I don’t know who they are) so that he would be sure to be served first in case there is not enough food for everyone else in attendance. I did not ask what other conditions he would demand. I was too disgusted by his arrogance and hubris. And this attitude was coming from someone who is a Pastor, a minister, someone who professes to follow the example of Jesus Christ. I wonder what Jesus would think of the Pastor’s attitude toward his people.
Another wedding took place the same day in a town about 30 minutes west of the Angry Pastor’s wedding. The pastor who presided at this wedding did not arrive in a limousine. No one sent a car for him. He took a tap tap. This pastor did not ask for money. In fact, he helped bring the musical instruments to the wedding reception. He did not sit at the official table. He ate with the other guests. And he did not demand that he be treated royally. Angry Pastor should take a lesson from his brother pastor. He can learn a little about humility and service to God and his people. It is a wedding. It is not about the Pastor.
Did the bride and groom err in not giving recognition at the reception to the man who married them? Certainly. But that is not an excuse for Angry Pastor to act in such an unchristian-like manner. To my mind, it is a petty issue, not worth ranting about to everyone.
Another wedding took place the same day in a town about 30 minutes west of the Angry Pastor’s wedding. The pastor who presided at this wedding did not arrive in a limousine. No one sent a car for him. He took a tap tap. This pastor did not ask for money. In fact, he helped bring the musical instruments to the wedding reception. He did not sit at the official table. He ate with the other guests. And he did not demand that he be treated royally. Angry Pastor should take a lesson from his brother pastor. He can learn a little about humility and service to God and his people. It is a wedding. It is not about the Pastor.
Did the bride and groom err in not giving recognition at the reception to the man who married them? Certainly. But that is not an excuse for Angry Pastor to act in such an unchristian-like manner. To my mind, it is a petty issue, not worth ranting about to everyone.
Chik is Here
Chikungunya fever is here. Florence Duperval, the Minister of Public Health and Population, made it official on May7. It was only a matter of time. Chik was already in the Caribbean and cases have been reported in the Dominican Republic so we were waiting for the last couple of months for the first cases to be reported in Haiti. Now it is official.
The chikungunya virus is spread by Aedes aegypti and Aedes albopictus mosquitoes, the same mosquitoes that transmit dengue virus. According to the CDC (http://www.cdc.gov/chikungunya/), symptoms may include headache, muscle pain, joint swelling, or rash. People at increased risk for severe disease include people with diabetes or high blood pressure, two conditions that are very prevalent among Haitians.
UF-EPI Haiti Lab 1-Gressier is ramping up for Chik surveillance. This week Millé, one of the Haitian technicians who works in the arthropod lab here, came in and pulled out all the mosquito traps. He spent most of a day just hooking up and re-charging the batteries needed for the equipment.
We have been getting many anecdotal reports of Chik. Makendy told us that there are “lots of people” with really bad fever. Some people have muscle pains so bad that they cannot walk. Others complain that it feels like they are carrying a large weight on their shoulders. Several members of the family of one of the C’ville workers have the fever. The clinic at the C’ville school has reported at least 25 children with fever. Millé is trying to get the addresses of where the students live so that he can go out to their neighborhoods and set traps. Some of the students live as far away as Mariani (a suburb of PauP) and Carrefour Dufort (west of Léogâne). Chik is not likely to be a local disease.
I think people are worried. Maybe not scared, but worried. This disease is new. The population is naïve and has never been exposed to this virus before. People will get sick.
I had stopped using Deet a long time ago. Now I’m spraying it on every morning to try and protect myself from the mosquitoes. Just trying to be as safe as possible.
The chikungunya virus is spread by Aedes aegypti and Aedes albopictus mosquitoes, the same mosquitoes that transmit dengue virus. According to the CDC (http://www.cdc.gov/chikungunya/), symptoms may include headache, muscle pain, joint swelling, or rash. People at increased risk for severe disease include people with diabetes or high blood pressure, two conditions that are very prevalent among Haitians.
UF-EPI Haiti Lab 1-Gressier is ramping up for Chik surveillance. This week Millé, one of the Haitian technicians who works in the arthropod lab here, came in and pulled out all the mosquito traps. He spent most of a day just hooking up and re-charging the batteries needed for the equipment.
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| Mosquito traps |
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| Mosquito trapping equipment |
We have been getting many anecdotal reports of Chik. Makendy told us that there are “lots of people” with really bad fever. Some people have muscle pains so bad that they cannot walk. Others complain that it feels like they are carrying a large weight on their shoulders. Several members of the family of one of the C’ville workers have the fever. The clinic at the C’ville school has reported at least 25 children with fever. Millé is trying to get the addresses of where the students live so that he can go out to their neighborhoods and set traps. Some of the students live as far away as Mariani (a suburb of PauP) and Carrefour Dufort (west of Léogâne). Chik is not likely to be a local disease.
I think people are worried. Maybe not scared, but worried. This disease is new. The population is naïve and has never been exposed to this virus before. People will get sick.
I had stopped using Deet a long time ago. Now I’m spraying it on every morning to try and protect myself from the mosquitoes. Just trying to be as safe as possible.
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