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.

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?

Mission Creep

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

When Can I Start??

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

     Or so I thought.

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

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

Time to move to plan B.

And You Think You Can Start When?

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

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

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

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

     Or so I thought.

This Time, We start

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

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

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

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

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

Found!

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

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

     Stay tuned.