We Drive to Baradères, Part I – Two Haitians, Two Browns, and Two Blans

     I awoke at 4:00 am on Wednesday morning. I had one more hour to sleep. We were driving up to Baradères today to inspect the site for the forward lab, to meet with Fr. Jacques (the pastor of St. Pierre de Baradères Church) and Sr. Denise (the administrator of the Baradères Hospital), and to interview candidates for lab techs. I had been planning the trip for a month. I recruited the people I needed for the trip and picked a time when everyone would be available. Now all the pieces were in place. I had a schedule of what we would do in the 24 h we would spend in Baradères. I had our vehicle and a driver (Makendy). The team was ready. We were to leave at 5:45 am.

Madsen and Meer

     The Science Crew – Madsen, Meer, and myself comprised the science crew. You already know Meer. Dr. Madsen flew in from the University of Florida, Gainesville on Tuesday afternoon. Madsen is a Haitian physician who in on the faculty at the UF-EPI. He helped set up UF-EPI Haiti Lab 1-Gressier and made the connections with the local clinics and hospitals for the diarrheal disease study. I needed
Madsen to talk with Sr. Denise and explain in more detail our plans for the sexually transmitted infections and diarrheal disease studies as well as UF’s long-term plans for the lab we will build in Baradères at Sr. Denise’s hospital (the “hospital” is really a clinic; it has one full-time doctor and only three beds). On a previous visit, Madsen and I had a long discussion about a sustained and expanded presence of UF-EPI in Haiti. That was when I started numbering the UF-EPI labs. Gressier is the first. Baradères will be the second. We hope there will be others in the years to come.

Solomon, Tony, Dale, Madsen, and Lamothe

     The Construction Crew – Solomon and Dale work for Christianville. Solomon is the construction boss. He is currently supervising construction of three buildings in C’ville and he has built many other structures in PAP. Solomon is an expert on foam core construction. I wanted Solomon to come along for two reasons: to inspect the lab site and to determine how additional usable space could be made on the adjacent roof area; and to introduce Fr. Jacques and Sr. Denise to the concept of foam core building construction. Watch this YouTube video that explains the concept (http://www.youtube.com/watch?v=YD5kqiDE53w). It is a remarkable technology that produces buildings that are highly wind and earthquake resistant (hurricane winds and earthquakes up to 9.5 on the Richter scale). It is also cheaper and faster than conventional concrete block construction which is very common in Haiti. I wanted Solomon to show Fr. Jacques and Sr. Denise what it was possible to do, especially in Baradères, with foam core modular panels. I asked Dale to come along because Dale is C’ville’s inside guy. He does the plumbing and fixtures. I needed Dale to measure the room that would become the lab and get me plans and a budget for how that empty room could be converted into a working microbiology lab.

     The Bonus – I asked my friend Lamothe Lormier to come along with us. Lamothe, who is Haitian, is the in-country liaison for Gift of Water (see post and GOW web site). Lamothe was already planning to visit Baradères to do some refresher training of the Water Technicians there and to deliver 50,000 Aquatabs for the Gift of Water units my church had distributed in the community last year. It would be a good opportunity to introduce Lamothe to Madsen and combine two tasks into one trip.

     The Truck – A Ford rented from Hertz. But that would change.

     The day before we left, I got a call from Sr. Denise. She wanted to confirm that we would have lunch with her when we arrived. More importantly, she warned me that the road from Cavaillon to Baradères was blocked and that we needed to take the road from Petit Trou de Nippes instead. I had never taken that road. It does not even appear on GoogleMaps. I asked Sr. Denise if that road was OK. She said yes. But be sure you have a four-wheel drive vehicle. It’s Haiti. Be flexible.

     Wednesday, 5:25 am, my cell phone is ringing. Damn, I slept later than I had wanted. I answered the phone. It was Lamothe. He was here already. I quickly washed up, grabbed my backpack, made sure Meer was awake, and walked over to the guesthouse where Lamothe was waiting. We talked while we waited for the rest of the team. At 5:37 am, I got a call from Fr. Jacques. He, too, warned me not to take the road from Cavaillon. The residents there were protesting something and had blocked the road. I mentioned this to Lamothe and asked if he was familiar with the road from Petit Trou de Nippes. Of course, he was. Lamothe has been everywhere in Haiti. In fact, Lamothe planned to take that route so that we could stop at the hospital in Petit Riverie de Nippes (more on that later). Lamothe offered to drive us in his truck to Baradères. He had a four-wheel drive Nissan Patrol, the best vehicle for the road.

Lamothe's Nissan Patrol

Lamothe at the wheel

We discussed this idea with Madsen who had rented a truck the day before in Port-au-Prince. It was decided. Makendy would take the rental truck back to PAP and return it. Lamothe was our driver, the Nissan was our truck. The last piece of the puzzle was in place.

     Dale and Solomon arrived. We loaded up Lamothe’s truck with our backpacks and climbed aboard: two Haitians (Madsen and Lamothe); two browns (Meer [Bangladeshi] and Solomon [Indian]) and two blans (me and Dale). We left at 6:25 am, about 45 minutes later than I had wanted, but it’s Haiti. We pulled out of C’ville and I knew we were in for a wild ride.

     The short road from C’ville to the main highway is unpaved, rocky, and rutted. Lamothe took it faster than any of our drivers. Lamothe pulled onto National Route 2, the coastal highway, and we were flying. Conversation in the Nissan was animated: Meer in the front seat talking with Lamothe. Me and Madsen and Dale in the second row, and Solomon napping on the bench seat in the third row cargo area. We passed Léogâne, Grand Goâve, and Petit Goâve and reached the outskirts of Miragoâne about 8:00 am. Route 2 turned south into the mountains but we continued along the coast on Departmentale 21. Miragoâne is the capital of the Nippes Department even though it is located at the extreme eastern edge of the department. Departmentale 21 took us around Miragoâne, the old port city. As we climbed up a hill and rounded a turn, the beauty of the Miragoâne Bay suddenly lay before us. And there was Reynolds Terminal.

Reynolds Terminal, Miragoâne

For about 20 years, Reynolds Aluminum operated a bauxite mine
and a port on the western shore of Miragoâne Bay a few miles outside of Miragoâne. Reynolds abandoned the operation in the 1980s during the “Baby Doc” Duvalier regime and left everything there. The terminal is the only operating port in Miragoâne, the docks in the city being blocked by sunken vessels. Meer and I had often discussed the possibility of shipping lab equipment and supplies into Reynolds instead of having everything come through Port-au-Prince. Customs is a nightmare in PAP. It takes months and costs lots of money to get things out of customs. The Reynolds Terminal looked like an attractive option. It is close (only about a 90 minute drive from Gressier) and the customs facility is small. The terminal accepts less than container size loads since big ships cannot come in. But Makendy bought a used Toyota Camry in the U.S. and had it shipped into Reynolds. He got it from customs in 10 days.

     Lamothe kept driving. The road ran right along the coast and the view in the early morning was beautiful. We passed Bezin, Charlier, and Madian where, the road ran practically on the beach. It was about 9:00 am and we were just outside Petite Rivière de Nippes. Lamothe turned left off the road and began climbing a steep, unpaved, rocky road that led to Klinik Vizitasyon (Visitation Clinic). The hospital is run by Visitation Hospital Foundation from Nashville, TN (http://www.visitationhospital.org/). Lamothe explained to us that Gift of Water had distributed 1500 units in Petite Rivière and had worked closely with the clinic. Gift of Water also stored their material in a warehouse on the clinic grounds and this was where Lamothe wanted to pick up the Aquatabs for Baradères. Lamothe also wanted to introduce us to Dr. Jean Francois who runs the clinic. We met Jean Francois in his house next to the clinic. Madsen and Jean Francois chatted in Kreyol and it started to become clear to me that they knew each other somehow. I interrupted and asked (in poor Kreyol) if they had already met. Yep. It turns out that they both attended medical school in PAP but a few years apart. Jean Francois recognized Madsen because he was in the same class as Madsen’s younger brother. Small world, again. It was like alumni weekend as Madsen and Jean Francois chatted about old times, former classmates, and teachers. Then Madsen explained what we were doing in Gressier and asked me to describe our plans for Baradères. Jean Francois was very excited. We will definitely work with him. We invited him to come visit Haiti Lab 1-Gressier the next time he drives to PAP. It was a very pleasant meeting and another very useful contact to add to my network. We picked up the Aquatabs for Baradères, piled back into the Nissan Patrol and headed back to the Departmentale 21. It was 9:45 am. I wanted to arrive in Baradères by noon. I was starting to wonder if we would make it by then.

The "road" ahead

     We drove through Petit Rivière de Nippes. On the right side of the road almost on the beach was a beautiful white edifice, St. Anthony of Padua Church. It was brilliant in the morning sunlight. We crossed Grande Rivière de Nippes. We drove through Anse-a-Veau. Then we pulled into Petit Trou de Nippes. Up to this point, the road was paved and we had made good time. But we still had the worst part of the road ahead of us.

Goats, Anyone?

Doe ready for insemination

     Last week, Char Farin and her colleague Bill Knox, came down from Raleigh, NC with a box of dry ice and a bunch of “straws” filled with goat semen. Char is a reproductive physiologist and professor at North Carolina State. She and Bill came to Christianville to artificially inseminate the goats. A few weeks ago, Eric (see 10-28-13 post) had come down from NC to inject the does with hormones to synchronize them for the breeding. Now the does were ready and Char and Bill were here with the tools for artificial insemination. They are breeding crosses of Nubian and Boer. The cross is for fast growth, tolerance to hot weather climate, and carcass quality. The plan is to breed a good goat for meat in Haiti. It’s genetics!

Char inseminates a doe

     I wanted to see how artificial insemination was done so I wandered down to the goat pen in back of the guesthouse one Saturday morning and found Char and Bill already at work. Bill had a Dunkin Donuts thermos full of hot water and all the instruments they needed laid out on a table in the space between two pens. A doe is brought in from one pen, a “straw” is taken from the box of dry ice, warmed, and connected to a pediatric catheter. They inseminate the doe and move the doe to the opposite pen. Then the next doe is brought in and the process is repeated. It takes about 10 minutes per doe. Char and Bill are good at artificial insemination of goats. They even teach a short course in it at NC State: Goat Artificial Insemination & Breeding Management Short Course. (http://www.cals.ncsu.edu/ncsugoatAI/CourseInfo2.html). It is a three-day course and is next offered in August 2014. Register now!

Char inseminates a doe

Bill prepares a "straw"

     After they finished inseminating the does, Char asked Meer if she could use a microscope in the lab to check her goat semen. They looked fine she told us. Char always packs a few extras, so before leaving she asked, “Do you guys want a few straws of goat semen?” Eh, no.




     With so many goats in Haiti, why is there no goat milk or cheese? Char had a simple answer: refrigeration. A dairy “industry” larger than a single household requires refrigeration. And refrigeration requires electricity. So there are lots of goats in Haiti but no fromage de chevre.

Bill inseminates a doe

The PA Team

     A mission team from central Pennsylvania left this morning. They arrived in Christianville last Saturday. They were a terrific group of people: seven women (four nurses) and two men (pastors). The people in the mission teams are volunteers. They take off from work (or school), they pay their own way to Haiti, and they pay for their meals, lodging and transportation while at Christianville. Don’t let the term “mission” mislead you. These folks are not here to preach or convert. They come here to help Haitians.

     Sunday, the day after their arrival, we all got on the C’ville school bus and drove to Grand Goâve for an afternoon at the beach. It was a beautiful day: hot sun, warm, calm sea, and a cold Prestige. One of the PA team waded out into the water to bring us our beers (I knew then that this was a great team). So I had a Prestige while relaxing in the water at the beach. I think somebody took a picture but I did not have my smartphone with me to get one myself. This was the beach where I ate the lambi that did me in for three days (see 11-11-13 post).

     The PA team started work at the clinic on Monday. That evening the nurses told us that a patient died at the clinic that afternoon. The patient had an abscess and went into cardiac arrest at the clinic. So what do you do when a patient “codes”? You are a well-trained nurse who instantly swings into action to stabilize the patient until the code team with the “crash cart” arrives. But you are in a clinic in Haiti. You are the code team. The crash cart at the clinic was ill equipped. The ambu bag, the self-reinflating bag used during resuscitation, was dirty and moldy. And the patient was also HIV positive. Despite their best efforts, the patient could not be revived. The death was particularly hard on one of the younger nurses. She was upset that the kinds of things she would instinctively have done to try and save this patient she could not do, some of the material was just not available. It’s only their first day at the clinic and the PA team was getting their first personal experience with the frustrations of working in Haiti.

     The PA team was a really fun group. They were friendly and joked and laughed (loudly) all the time. So they pulled together, supported each other and went back to work the next morning with energy and joy. All week long they worked at the clinic, played with the children at the orphanage, tutored children, and distributed rice and other items that they bought. At meals we talked about what we did during the day, and shared stories about family, Philly, and PA. It was a pleasure talking with them. We were becoming family. The ladies made chicken salad one day for lunch and shared it with us. Teams sometimes bring in “goodies” that they share with the C’ville folks. So one afternoon I had some pretzel sticks dipped in Trader Joes chocolate. In Haiti! They also brought in several boxes of Pringles (Meer’s favorite), a box of Cheerios (Raymond’s favorite), and boxes of cake mix. It’s funny how you forget about these everyday food items when you are down here and so they become special treats. Thursday night, we all got back on the C‘ville school bus and drove to the Ocean Grille for dinner. My appetite was back so I enjoyed the meal. Almost everyone, including myself, ordered the charcoal grilled red snapper (but Georgie ordered lambi; he just can’t get enough). It was a fun night out and a welcome break from the dining hall menu.

     So this morning at breakfast, I found the PA team in the dining hall with all their bags packed and ready to leave. Some of the orphanage kids came to say goodbye. Pictures were taken, email addresses were exchanged, and there were hugs all around. The PA team boarded the C’ville school bus and headed into PAP for their flight back to the U.S. All was quiet at C'ville this afternoon.

     Another mission team came in this evening.

It’s Haiti v10 – Two Guys, Two Saws, and a Concrete Post

     Remember I told you that the concrete post right next to the emergency exit from the BSL-3 lab needed to be removed? (see October 6, 2013 post “Back to Work? - Did We Ever Stop?”). One Friday morning, two guys with two saws started work on the concrete post. They chipped away the concrete to get to the steel reinforcing bars and then started sawing away the bars. By midmorning, the post was down and a guy with a pick set to breaking up the stump of concrete remaining in the ground. They started pouring concrete (by hand) for the sidewalk after lunch and that was done by dinnertime. Things like this small project could sometimes take months to get done here. But with the right word to the right person at the right time, things get done. Of course, back home the job would have used one guy with a mechanical saw (and protective goggles) to cut through the concrete and the post and it would have been down in less than 15 minutes. But two guys with two saws managed to do the same thing in less than two hours.
It’s Haiti.

Cutting down a concrete post

Cutting down a concrete post

Breaking up the post stump

Building the sidewalk

Oral Rehydration Solution Saves Lives

     But it does not taste so good.

     I have mentioned oral rehydration solution (ORS) as an important treatment for diarrheal diseases, particularly cholera. When we visited Diony’s neighborhood after we learned of his uncle’s death from diarrhea, I gave Diony my box of Pedialyte. He gave them to his family and explained how to use them and what the treatment was for (see 10-31-13 post). A week later Diony told me how his cousin used the Pedialyte and was “cured”. “A miracle”, they said. No, I explained to Diony. Be sure to tell them that Pedialyte is ORS. It is not a cure for cholera or any other diarrheal disease. It replaces the fluid and salts that the sick patient loses from the diarrhea. It treats the symptoms, but does not cure the illness. But the patient usually gets better, as did Diony’s cousin.

Diony, Benoit and Dr. Taina explaining the dangers of
diarrhea and the importance of ORS treatment
to a meeting of the Christianville school PTA

     The British medical journal, The Lancet, described ORS as "potentially the most important medical advance of this (20th) century." ORS contains glucose and that is the key to helping your body absorb the salts that are in ORS. Common sports drinks use the same principle as ORS to replace lost fluids and electrolytes when you sweat. But sports drinks have more sugar and less sodium. The extra sweetness makes the sports drink more palatable. ORS is saltier and less sweet than sports drinks. I know. I am drinking some ORS right now and it does not taste like your standard sports drink. It is saltier and not sweet at all. 

     So why am I drinking ORS? We went to the beach at Grand Goâve yesterday afternoon. We had some beers and fruit drinks and someone ordered lambi (conche) with plantains. I love lambi. So I ate some. That was the source of my problem today. I will spare you the details but this morning after I woke up I just felt tired and weak. I ate some breakfast and worked in the lab. I still felt tired. I had a little rice for lunch and went back to the house to take a nap. I slept for about an hour. I got up and still felt tired and sweaty. I had a bout of diarrhea and felt really weak after that. I laid down again for a while to get my strength back. I walked over to the lab. I saw Meer and another person who had shared the lambi with us yesterday. When I asked how they felt, that’s when they admitted that they both had diarrhea last night or today (I guess it’s not just Haitians who are shy about admitting they have diarrhea). Meer sent someone to the clinic for some ORS packets. I made a liter and here I am drinking my ORS. And I feel a whole lot better. I am not eating any more lambi at that beach again. That was a rookie mistake.

ORS packets from Hind Pharma

My Day

     Now that I have been here over a month, I thought it might be a good time to talk about my daily routine. There isn’t really a routine but some things are fairy consistent. I wake up about 6 am. The sun is already up and there is movement on the road outside the house. Workers and vehicles arrive for the day’s work. The chickens are making a lot of noise. You get used to it. Did I mention the smells yet? Christianville is a working farm. In addition to the chickens, there is a herd of goats here. The herd moves between pastures next to the lab to down back of the guesthouse. Some mornings I hear the goats, too. Some mornings I’m not sure if what I smell is the chickens or the goats, or both. It doesn’t matter. You get used to that, too.

Sunrise

     I take a shower. I’ve gotten used to taking cold showers. After I shower, I do some pushups, some stretching, some yoga. Some mornings I get up earlier and go for a run. I have not done that too much lately. The road is too rocky and the circuit is basically a boring path back and forth. I take my doxycycline (anti-malaria), hang my bath towel on the line in the yard to dry and walk over to the dining hall for breakfast. We drink coffee while we wait for breakfast to be ready at 7:15 am. Everyone who is present joins hands and someone volunteers to say a prayer. That person gets to be first in line to eat.  There is a long table with the food. We pass along both sides of the table to serve ourselves. Later I will do another post on the meals (with photos) at Christianville. People wander in and serve themselves. We talk about our plans for the day. If there is a mission group present, we’ll talk with them, ask where they are from, what they are doing in Haiti, just get to know them a bit and make them feel welcome. Mission groups come and go. They stay at the guesthouse (also known as the Fish House or Hotel West Virginia) for a week or 10 days. There may be five people or 15 people. As we finish eating, everyone helps collect the dishes and bring them into the kitchen where the ladies wash the dishes.

     After breakfast, Meer and I head over to the lab. The lab techs come in about 8 am. Meer checks to see which clinics called in and where he needs to send Makendy to pick up samples. We get specimens from Léogâne, Petit Goâve, Grand Goâve, and Jacmel. I don’t do anything with the samples. The Haitian techs do all the work. I turn on my laptop and check my email. I pull up the list of emails for which I am awaiting a response. If it is taking too long, I’ll send out another email. I check with Meer to see if we going to meet anyone today. Some days Meer and I drive out to meet people. We drive out to introduce ourselves to the staff at the clinics that we work with. We want to establish a personal relationship with our partners. Sometimes we will drive out to meet someone new to establish a partnership, to learn what they are doing, to explain to them what we are doing, to see if there are ways we can work together. Basically we are getting the word out to the community that the UF-EPI Haiti Lab 1 is here and explaining what we do. It really does help to cultivate that personal connection.  

     Back in the lab, I work at my laptop. I write protocols for our surveillance projects. I review research progress from people in my lab in Bethesda. I write proposals for funding. I write emails to collaborators. I write to my colleagues in Florida and in Haiti. I send out requests to meet with different people and organizations in Haiti as I try to build up my network. I also spend a lot of time setting up projects, developing ideas of things to do. It is crazy and fun!!! Meer and I just toss around ideas of what a microbiology laboratory can do in Haiti. What about parasites? I didn’t think I’d get into parasites but now I’m learning about schistosomiasis and reading up on it. I spent most of the day one Saturday writing a pilot protocol to test for schistosomiasis. I'm not a parasitologist so I need to bring in some people I know at USU and the University of Georgia as collaborators. Why not food studies? Meer and I talked about looking for Campylobacter and Salmonella in chickens. They raise lots of chickens and produce lots of eggs in Christianville.  Maybe we should look and see if the chickens are colonized with Campylobacter or Salmonella. But how do you get cloacal swabs from a chicken? I don’t know but I know a guy who knows chickens – my Ph.D. mentor, Roy Curtiss III. So I sent Roy an email and he told me how (there is a YouTube video). 

     There is so much that can be done here. The limiting factors are personnel (getting the right people to work on the project), material (it's not easy to get equipment and supplies into Haiti), and money. At times I almost feel like I’m back in Bethesda writing grants. I spend a lot of time sending out emails begging companies for donations or reduced pricing for material and supplies. We are doing things on a shoestring and the work here really needs a much larger investment. But I love it down here. We're going to get a lot of good stuff done.

     Lunch is at 12:00 noon. Same routine as at breakfast. On my way to lunch I go into our yard to fold up my bath towel and bring it back into the house. After lunch, it’s back to the lab. Sometimes during the day, one of my kids will jump in on Google Chat and we exchange messages for a while. I really enjoy that. It keeps me connected with them and what they are doing. We also Skype. That is great (except when the Internet connection is poor and keeps dropping the call). But I still miss them.

     Dinner is at 5:30 pm. After dinner, I grab a flashlight from the house and head back to the lab and continue working on my laptop. It usually rains. We are in the last month of the rainy season. I work until about 10:00 pm and then pack up the laptop, say goodnight to Meer (he works until after midnight) and walk back home in the dark. The nights have gotten noticeably cooler this week. I brush my teeth and rinse with bottled water from our Gift of Water household water treatment system. I have not used the tap water since I got here. I have not been using the bed net. I think we have our mosquito problem under control since Meer and I spent a whole day taping around all of the window screens with duct tape and did a thorough house cleaning. I am sleeping a lot better.

     Time for bed. 

     Bonne nuit, les enfants. Dormez bien.

Sunset

Post Script to Two Kids (goats), Two Kids (humans), and Two Shots (10-26-13 post)

     About 10 days after the incident, someone came from Port to pick up the dog’s head. Yesterday (Nov. 9) we learned that the dog was rabid. Another wild dog from our area who had bitten someone also tested positive for rabies. It was suggested that the guards be told to shoot any stray dogs that they find on the Christianville grounds.

     I’m not worried about tarantulas, or malaria, or cholera. I can take precautions to avoid them. I worry about rabies and I am more aware now of stray dogs. I stay away.