Haiti: Lessons and Conclusions

Today's view from the ground: New York, NY

If a person is affected at all by a place like Haiti, the return from it can be shocking. To have such a place so close to the United States (less than four hours' flight from New York and barely 80 minutes from Miami) is a distinction that illicits morbid curiosity. It is the only nation in the Caribbean that still rests on the edge of the naked past. It is also the only one that seems devoid of the English grandiosity, the Spanish zeal, or even the French stateliness that peppered other central American countries, as its early independence gave it new growth which continues away from the others. So it is the only such place where Americans can be enjoying their usual dinner directly after a morning of treating disease that should be extinct.

Haiti is continously speaking. The land and the people tell me new honorable and horrible stories that defy imagination every time I land and take off again. I have spent more time and certainly logged more visits to Haiti than most of the places I have been and, although I can lay claim to some expertise in limited fields, the place as a whole seems to slip farther away from my comprehension with each departure. It is a good idea, then, to wait to pass any sort of judgement on my experience until a few days after I have felt the arms of loved ones around me, clean food and water slip back into the commonplace, and the breathtaking sunsets of the Haitian hinterland have been replaced by the soft glowing chandelier atop the gorgeous Theater One of the Village East Cinema on Second Avenue.

I understand a few more things about Haiti and the struggles we all endure there, and many of these lessons are applicable to more than just that country or the plight of humanitarian aid. The reading several may find some help and hope in what came out of this remarkable journey.

There are many people to thank for this experience, although I know of some of them would prefer to remain anonymous (for reasons that will become clearer later). Danny McAtee's Haiti Medical Aid Project at dannymcateeinhaiti.com has long been the premier destination for dirty-boots coverage of the Haitian health care experience, and his Facebook group of the same name has become a Thorn-Tree-style bulletin board for getting and giving help in the best and worst of circumstances. Notable mentions of other writing and photography of this and other Haitian ventures will be forthcoming, once I can identify them and figure out if people want them listed.

1) You never own money. Money owns you.

It is generally a rule in life that the person who has the most also has the most to lose. Haiti is a place where that is especially true. History has shown that the people who ran the country, far from being immune to loss, were often targeted for dispossession and death. Anyone who currently has wealth to speak of must guard it very well, with walls and gates and broken bottles set in cement on top of them. On top of being unsightly, all of this protection is quite expensive. We often feel ridiculous to be spending large amounts of money on food, water, transport, and security in a place where many people are homeless and subsist on less than US$2 a day.

In January 2011, we were responsible for a base of operations (behind a wall and a gate), a broken-down van that caused more problems than it solved, and large quantities of food and water. By Haitian standards, we were very well-off - and spending astronomical amounts on all of it. In March 2011, we ate street food, rode tap-taps around the city, slept on stretchers and roofs, and we got ten times more done. The safety that all our earlier responsibilities assured us of was destroyed in a moment of violence that money could not guard from, and then we were free.

We made money, but not more than we needed. Once we were as poor as the people we worked with, or at least lived like it, the jangling choruses of children asking us for a dollar dulled out and vanished. None of the people I worked with are anti-capitalist; in fact, most of us seem to spend a lot of time figuring out where more money will be coming from. But money cannot always get you where you need to go. Money often picks its own path for you. There are too many people on that path who do not realize it, and there are too many people joining them.

2) Grant yourself the serenity.

Most people make lists of things they should carry. Mine is very short and consists mostly of multi-purpose objects that don't take up much space (the theft of my belay cord, hoisting winch, and equipment rack when it was serving as my clothesline in Joli Guibert was an unfortunate loss). However, above the need to carry adaptable objects, we must become adaptable objects.

Well before I ever studied medicine, I asked a doctor what stress is. She told me that it's a physical reaction to some pressure on ourselves that constricts our body systems and, if it persists, damages them. When I asked a rabbi the same question, his answer was not dissimilar. Essentially, stress is our reaction to conflict, competition, unreasonable demands - all the things not going our way. As someone used to nag me when I was upset, "in a fight between you and the world, bet on the world." Thank you, Franz Kafka, for coming up with the best way to get my goat. But the man was right. In most stress-inducing situations, the only way to keep our bodies from shredding themselves is to not pick a fight.

On this trip to Haiti, as well as many others and in different places, I have worked with people who end up frustrated and frenzied into a righteous rage. This type of anger is usually what institutes change over time when it is properly channeled. But in the moment, when nothing meaningful can change, the calmer among us rightly dissuade the others from such pique. Pique makes for excellent drama (another inflated currency among those who embark on this lifestyle, even for a week at a time) but little else except disillusionment, depression, and stress. The best difference between people who take despair and people who take wisdom from these places is that the latter do not crash into an oncoming system. They understand and accept the system, whether or not they agree with it or work inside it. The debate between religions teaches us that ideology and principles are the same thing viewed in a negative and positive light, respectively. Positive lights may shine false, but it saves our energy for the time to pick a fight we can win.

3) Keep your name to yourself.

Haiti is a place powered by voices. It is the cacophonous cry of ordinary people that has shaken its tree of liberty countless times, bringing rotten apples falling to earth. Whispers such as "ssst" and exclamations like "aba!" command Haitians' attention more than billboards and slogans. Kreyol, the Haitian language, suffers an awkward relationship with letters and spelling because it is a "spoken language" and has a written form because others demand it. In such a place, you are not your Facebook profile and you are not the letters after your name. You are what is said of you.

In most respects, this is a strength. The more permanent blans in Haiti that work on various development projects have good reputations that have been well-earned by fair treatment of many people, all of whom speak about them. The best way to find something or someone is to ask someone else, making relationships in Haiti feel more real than the ones that feed on computers and cell phones. Unfortunately, there is little of the evidence that the modern age has come to rely on about people; in my dumber time in Haiti, I shouted "give me names" in regard to a character accusation, which was (unlike the accusation) recorded. So it is also easy to be ill-defined as a dilettante, a braggart, and a fool.

Some of the pseudonyms used in THHL are used at the request of the people they refer to, as a name is a difficult thing to protect in such a vocal environment. But the lesson of self-imposed anonymity applies to more than a name and to a larger place than Haiti. The best reason people have for keeping to themselves is to counter the reaction to jump on board with every idea that sounds good but, as is often the case in Haiti, fails to stand up to reality. People are willing to help, but lies that say one is a fool are not as bad as truths that say one is a fool.

All of the projects I have been lucky enough to work on have been fueled by the thoughts and labors of the unknown and nameless, either by design or by chance. It is fitting that Haiti's grandest monument to its history is the Marron, the nameless slave who liberated himself and his people by sounding a horn made of conch. Those who demand their names shine on the pediment of their accomplishments are often unwise, and those who demand to be left alone to do their work are often the most trusted men and women of Haiti and elsewhere.

4) Find a line between the shadows and the sun.

When I was growing up, it seemed that there was no greater aspiration than to live in a massive empty house on a tiny piece of land and drive a fancy bright-colored car. In the generation before mine, the ideal was an expansive Tuscan-inspired estate with the first initial of a family's last name pressed on the gates to give the image of permanence. Both are versions of braggadocio that don't often go over well, especially in places like Haiti (see Point 1).

People seeing someone being useful is always a good thing. It inspires respect, the lubricant of all human interactions, and encourages further usefulness among others. It is, however, very easy to have this usefulness misunderstood. One of the issues I had when I began working in humanitarian fields on my own (without the flag of the U.N. or some other organization over me) was how to identify myself. I had long since faced the fact that I "glow in the dark" in Asia, Africa, and most parts of the Americas. I obviously don't belong. So I went whole-hog and made myself look like what I am: a medic. The problem was that medics look different all over the world. Most of the uniforms selected for medic duty, with their tough fabrics and multiple pockets, look like military uniforms; the police in Haiti and the dreaded army before them wore the same types and colors of pants and boots that most U.S. medics wear, leading to confusion and fear among Haitians when they encountered large numbers of uniformed aid workers in 2010. The loss of insignia makes it all the more strange. In most cases now, I wear a T-shirt and jeans with a practical khaki shirt emblazoned with a red cross, the universal symbol of medical care.

This leads to its own problems. I am now easy to pick out for help, and there are many situations in which I cannot help (when there are too many patients, when my own safety is in danger, etc.). But my intentions and role in places where I don't belong become clear. One of my most trusted and least identifiable colleagues travels around Port-au-Prince with no medical insignia other than a stethoscope around his neck, an idea I then adopted later in my trip. But the lesson was clear: there is a big difference between showing and showiness, a difference that can lead to theft, injury, and death when it is mishandled. All over the world, humility and self-restraint are respected values, if not honored practices, and one can luxuriate in the sun and take cover in the shadows when one has come to peace with the surroundings and the surroundings have dictated their allowance for a person.

5) Stethoscope tanlines.

They look bad-ass for a day or two, but then they just look like you were pulling a plow. Try to avoid them.

That's the view from the ground.

Haiti: The Big Finish

Today's view from the ground: Cite Soleil and Jacmel, Haiti - Thursday to Saturday

"Cite Soleil is like nowhere else. You look and you think you know, and then you look up, down, away for a moment, and it is something different."

- Marie Estimable, Cite Soleil resident, 2010

"Tried my hand at the Bible, tried my hand at prayer - But now nothing but the water is gonna bring my soul to bare."

- Grace Potter and the Nocturnals, "Nothing But the Water (Part 1)"

When I woke up on Thursday in my hammock under the mango tree at Communitere, I discovered that layrngitis had all but silenced me. I tried to take it easy for the day. In Haiti, that entailed a morning venture to the fabled "worst neighborhood in the Western Hemisphere."

I have no particular love for Cite Soleil, although I will admit a certain cavalier fondness for the citizens and even the gangs who war over the shantytown district. They always respected the red cross I have borne in their midst and never gave me any trouble, while other areas of Port-au-Prince have given me more grief. Cite Soleil is a place that is neither safe nor dangerous for me. At the moment, some friends and colleagues of mine are taking part in a renaissance for the infamous neighborhood, creating community empowerment projects to harness the raw energy and camaraderie of the Haitians who live there. In the Communitere workshop, a half-finished model of the Eiffel Tower stands ready to grace the part of Soleil called "Paris." 2012 is hopefully the year to be proud of Sun City.

I like that my contribution is to prepare a few choice buildings to use the sun for light and safety. Although my project is missing three of the original sixteen solar panels, we were able to assign three to St. Catherine's Hospital, a dingy clinic near the sea. I had not been there since a year ago, when I was abandoned by a U.N. team for breaking protocol and treating a Haitian with a gruesome gunshot wound (we resolved the issue later and I admitted my fault). A year had not been kind: the place still smells of death and remains stained with blood.

In the morning reports, the U.N. mission had warned us of a gang war brewing in parts of Soleil. This had been perceived the same day as a state visit from the president of Brazil, which had all but shut down major thoroughfares throughout the city. Haitian police trucks and U.N. vehicles clogged the single entrance to Soleil, as well as many of the alleyways through the complex grid pattern. Brazilian troops leaned against their vehicles and tried to stand clear of others. They usually appear relaxed to me, but they were tense and silent on this day. I shouted a cheerful "bom dia" to a platoon and received a curt series of nods in place of the usual waves and grins that their native greeting illicits.

The raised security reduced any harm for my team and myself, although it soon became clear that no solar panels would be installed that day or the day after. Cite Soleil was not going to become another incident like Cite Solidarite. The Haitian contractors were not interested in walking through the neighborhood, which instilled fear in some of them despite their local knowledge, and being the center of another debate. The asthmatic electrician seemed to be struggling to breathe before we started climbing.

I calculated the sightlines and we measured for our special theft-proof "well cover" blocks, and that was it for the day. The Brazilian state delegation was on the ground and we were not interested in remaining in such a restive place. Once our numbers were written down, the job was preserved for a later time. The contractors are certainly skilled and devoted enough to do the job and bring some needed relief to one of the neediest hospitals in the world.

I did manage to relax for most of the rest of the day. Howard and I shared another drink at MediShare. I checked on my previous installations in Fontamarra and Solidarite; all was well. Laura and Genevieve were cleaning and sorting supplies at General Hospital and I joined in for a bit. In the mess, I recovered a 38 French, a hard flexible spike designed to aid a tube's entry into the abdominal cavity. Since there was no use for the ruined thing, I ended up carrying it around all day. Some of the Haitian children I encountered may still think it was a magic wand.

It was the last night for one of Communitere's friendly faces and we had a dessert party planned. Some people got ice cream at nearby gas stations and Stacey made a great deal of cake. It was just before dessert that we got the news. Big Dave had died in Florida. We rose our glasses and bottles to him and continued on with the party. Haiti is no place to linger on such things.

I awoke before dawn on my last full day in Haiti. I collected the last of my things at Communitere - my filthy clothes, the coffee and cigars for the Californians, the remaining medical gear that would not stay in Haiti - and left the rest with Jimmy and Sam. I went back out to Cite Soleil, only to find the situation had worsened. My friends there had spent most of the night indoors in whatever safety they could arrange, as gunfire had erupted in the very early hours and was still being pursued and silenced by the police. As I left the tattered St. Catherine's, the dark call of machine gun fire spat into the distant wind.

I paid MediShare one last visit. Howard and I discussed life and matters arising until it was time to go. I said goodbye to Rachel, the current administrator of MediShare, who I had met a year earlier. We commiserated on the fate of Big Dave and each returned quickly to our day's errands. Again, this was no place to grieve.

I took a tap-tap down Boulevard L'Ouverture to the U.N. base, where I was supposed to meet Captain. He was held up by another meeting and then in traffic, as the consequences of the Brazilian state visit was still stalling the city's roads. He graciously offered to meet me quickly on Saturday before I left the country, which freed me up for one final adventure.

Jimmy was planning a weekend getaway to Jacmel. My friends Emma and Chad, who I met at Communitere ten months earlier, were also going. In addition, Tara, one of the muses of my development work and a dear friend, was flying in that day and leaving promptly with them. I had not seen Jacmel since the post-earthquake horror and had desperately wanted to see the resurrected town. Despite the warnings that I could not return to Port-au-Prince for my flight the next day, I waited to leave with them.

Tara had just arrived; I embraced her as if I had not seen her in a year, although we had met less than a month earlier in New York. I had expected her arrival earlier and from London; I brought lox spread in two weeks earlier but she could have gotten it herself in New York that morning. The gesture was appreciated, especially by Jimmy, who already had some. The driver of the rented tap-tap van continued to negotiate the price for the drive to Jacmel, which increased for the silliest of reasons. After we saw the van, we wanted a discount: the rusted hulk had holes in the floor dropping to the road below, and the windshield had been shattered, held together now by a decal of the face of Jesus over the epicenter. Once we were all assembled, we resigned ourselves to the lackluster chariot and headed out of town.

Jimmy got me a Yaquiba cigar, one of my Haiticentric vices, at a rest stop (I was the only one in the quintet who is not an inveterate smoker) so I felt more part of the group. I was worried that I'd be the fifth wheel amid two couples, but friendship won the day. We reached Leogane quickly and began our sinewy ascent of the Massif de la Hotte, the same mountain range that bisected our journey from Grande-Anse to Sud four days earlier. With the pall of smog gone from around us, we all breathed easier and smiled through the thin clear air. The sun was beginning to fall and the colors on the mountains, from patchwork terrace farms to rich green undergrowth, stunned us into silence. Tara had fallen asleep in the front bench.

At the apex, we saw the magnificent Caribbean, blue fading quickly into grey. Jacmel, a tiny line of white dots spreading into a curve at a gulf, appeared at a great distance. Before long, the schizophrenic road became a gentle ramp onto the miniscule coastal plain. We passed the creek bed, full of laundry and cars all being cleaned, and the airport, which I remember from our landing shortly after the earthquake hit. We passed gently through town, where a number of construction projects were employing the same method I had seen in Cap the week before. Shapes of elegant bannisters and verandas were being cast in concrete on the spot and then painted in bright Caribbean colors. Jacmel was back to normal and getting better.

We turned off the main road and down an alley to the Cyvadier Plage Hotel. Chad knew the concierge, who welcomed us and worked out our lodging. While he tapped away on his computer, Jimmy and I walked to the edge of the cliff upon which the hotel was built. The grounds exemplified faded glory, with 60s-era furniture and structures lining around a patio and peanut-shaped pool. I noticed none of this then, as the sunset was closing to its typical dramatic finish over Haiti. As I followed the heartbeat-like sound of the sea, I peered down into a rippling cove of sea that opened a few hundred meters before us into the grand Caribbean. I could have jumped into the sea from that very spot. I gasped and Jimmy smiled. We both needed this.

We settled into our rooms and met for dinner. We order "spiny lobster," which is really giant prawn, and the local salad. Our table was right next to the shrouded sea, and we could hear the waves but barely see them. The moon, which had widened from a crescent to a bulging half since I had first marked it with Clancy in Milot, danced upon the wild waves as they brushed over the jagged rocks at the cove's mouth. After dinner, we asked the concierge to open the gates to the beach, which he did. I made one last pot of popcorn on the sands as we all faded into drowsiness, held comfortably by the sound of the ocean. It was not even 11 o'clock, but we were all ready to sleep.

I awoke at 5 A.M. As I went outside, I was surprised to see Emma waiting. I made us tea as we sat in the oversized hammock on the edge of the cliff and waited for the breakfast crew to come and unlock the gate again. We talked about Haiti in a way neither of us often do. We both love the promise of the place but also know its shortcomings, as well as our own. We do our best to help but rarely succeed and, when we do, cannot be sure if our goal was the right one for Haiti. We both love adventure, a craving that is sated by the mystical land, and we both love humanity, which we hope we are serving. In a place where so many are bound by faith, our covenant is not so ludicrous. We can believe we are meant to be there.

Once the gates were opened, I stripped and stepping into the sea. It is a rare place in Haiti that does not punish a blan for walking into the water, but we were in one now. I quickly swam to the center of the cove and, struggling under the lightening sky, took off south for the sea. I ducked under waves and past the rocks on either side of me until only the ancient battlements of Hispanola were in view. Even Emma, patiently watching from shore, was gone. I looked eastward down the coast to see the dark sky gilded for a moment by the sun's emergence. There was a massive bank of clouds, thick as stardust, hovering right over the disk, leaving only the sea beneath the glow with the fire of its light.

I was treading water and began to laugh. This grew into a fit as I splashed and floundered in the heavy waves. I laughed out all the ash and blood still on and in me from two weeks' travel in Haiti. I thrilled at the fizzle of salt water in my numerous cuts and gashes. I coughed out a mouthful of sea water, and my larynx spasmed into rest. I shed a tear or two for those we have lost and it slipped into the greedy sea. Eventually, I steadied myself and took a placid moment bobbing the waves to face the blue sky and the red ocean, brilliant and clear as the colors on the Haitian flag.

Tara and Jimmy were now on the beach with Emma. I bade them all a quick farewell, as I knew I'd be overcome if it lasted any longer, and took a shower in my room. Other than at the Visa Lodge, it was the only real shower I had taken in Haiti. I marched up to the main road as the sun finally appeared above the fading clouds. I gave my popcorn pot to a woman who remarked on it and took a moto to the tap-tap stop. This was a better view of the cheerful Jacmel. The town was already awake, with open businesses and smells of food wafting out invitingly into the road. Unlike Port-au-Prince, there is no sign of the horrors I witnessed there two years ago.

The morning had to be scheduled to the minute, which usually does not go well in Haiti. Once I got to the tap-taps, I had two choices. One was an overcrowded Transit van, in which I was assigned a rickety stool in the back aisle. I tired of this, as we were not moving, so I went across the park to a truck painted like a circus wagon and bearing no windows. I was given an equally unattractive seat and realized I would be dizzy within an hour. As the Transit van pulled out of the lot, I leapt onto the road and into its open door. The conductor grabbed me and everyone cheered; apparently, they had all been betting on whether the blan would choose the van or not. In Kreyol, I told them "the truck looked good, but your ride is better."

I got a rickety stool but it was farther up. The hills were brightening but the road was sickening. I turned on my iPod and vanished into a book. Despite some delays near Port-au-Prince, it took precisely three hours to get to Portail, the massive transit hub near Centre Ville. I was ahead of schedule. Unfortunately, two tap-taps going in a different direction than the drivers said they did took care of my lead in time and, after farewells to the crew at General Hospital, I was just in time to meet Captain at the U.N. base for some final words of encouragement and a ride to Communitere. Howard picked me up there with his moto and gave me the last exam of a GAI student, who had missed our session two weeks earlier, before he hugged me goodbye. His was the last familiar face I saw as I entered the airport.

That's the view from the ground. Next stop: Lessons and conclusions.

Haiti: The Good, The Weird, and The Tasty

Today's view from the ground: Port-au-Prince, Haiti - Wednesday

"Haiti is a prison. . .In that prison, there are rules you must abide by or suffer the pain of death, no matter how those rules seem strange or senseless."

- Jean-Bertrand Aristide, 1989

Haiti is a land of outliers. Its people rest on edges. Resources come from an unlikely confluence of natural and artificial forces. Doctors are shocked at pathologies which make no sense, furthering a belief in the supernatural and the medical hunt for "zebras." Even the improbable geography of the place - a crude horseshoe of mountains dotted with a pair of islands - adds to its strangeness and charm.

Events are odd and often contrary to their causes. A colonist in the 18th century would have no idea that the rich wooded Saint Domingue would teeter on barrenness barely more than a century later. Dozens of leaders have fallen to disgrace and death at the hands of those who supported their rise. When Jean-Claude "Baby Doc" Duvalier led a multi-million-dollar effort to dazzle Pope John Paul II for his visit to Haiti in 1983, he was shocked to hear His Holiness shaming his excesses in public - and in Kreyol.

After a while, one gets used to the absurdity of Haiti. This happens by realizing that Haiti is not absurd. It is simply a different species of country. That is one of the reasons I feel comfortable there. So it should not be surprising or even disquieting that my last few days there contradicted normalcy and seemed to circumvent reality.

Sugar, Clam, Snakebite, Chapati, Bridget, Kate, and I left the Visa Lodge early on Wednesday morning with Nez, who drove us to the airport. I could not enter, but I said farewell to them all before they trundled through security into the new terminal building. The airport had not gotten a facelift for quite a few years, and it was good to see that the departure hall had finally begun to recover from the earthquake.

I dropped off my bag at the nearby Communitere, switched out my equipment, and went back to Cite Solidarite. The place used to be a comfortable neighborhood for me, as I had worked night shift in it and practically lived there for a month. I knew all the vendors and the local soda salesman trusted me enough to let me have a glass bottle without a deposit, as I would always return it. Now, things are different. After Big Dave was shot nearby the previous week, several of us were on edge in the labyrinthe side streets and MediShare on Rue Solidarite, an bottleneck avenue with no exits, was warning its staff more than ever.

I was above all this, literally if not realistically. I was on the roof of a school with a small band of electricians and construction workers, trying to figure out the best of installing a tilting solar panel and make sure it would not get stolen. In grand Haitian style, the men figured it out: a piece of steel welded to the back of the panel and set in raised blocks of concrete, acting as an axis for the panel as the sun travels across the sky. One man even suggested a massive turntable to act as a sundial as the sun moves on its ecliptic, but we had to reject that development out of expense.

A group of children amassed at our last two projects, and we were expecting another on Wednesday. They did come, although the crowd also included grown men, most of which did not look happy. I thought some of them were waiting for work, as the team had been inundated with questions about employment from bystanders at other sites. They were there to shut us down.

One would think that a school having free electricity would not be a major point of contention. But the arguments began. Why this school, which has Canadian funding, over other "more Haitian" ones? Why a school over people's homes? Who cares about a school where half the children are sick and may die? The list continues, enumerating all the things that are wrong with what appeared to be an undisputed good deed.

Our initial joy at working out the problem turned to desperation as we rushed to get the job done and leave. One of the electricians, converted to laborer by the need to get the concrete on the roof, began a vociferous engagement with one of the more forward protesters and ended up with a fit of the dry heaves. He seemed to be overexcited by the argument (it often appears to the blans that Haitians are arguing when they are just discussing in an animated way) but then exhibited symptoms of asthma. Two stories about the flat filthy Cite Solidarite, we were still well in the grip of Port-au-Prince's terrible smog problem. I cracked two ampules of albuterol sulfate into a bit of water and boiled it under his nose with my small burner, as the nebulizer I carried earlier had been stolen in Grande-Anse.

An hour later, the crowd had wearied and we had finished the installation of two 130-watt panels, a 20-amp controller, and the inverter necessary to hook the output up to the school's existing crude wiring. I gave the crew the next day's assignment - a hospital in Cite Soleil - and bid them goodbye for the day. I had lunch with Jean-Francois, a military man turned cockfighter, who had a special treat for us. One of his cocks had been killed in one of the small arenas in Delmas, where I had met him a year earlier. It is always a shame for him when he loses a bird, but he had bet money against it as the fight turned ill and was able to recoup some of the losses. Now was the time to eat the bird, a ritual that adds sweetness and sadness to the life of a cockfighter. The adrenaline that rests in the chicken's system after a fight ends its life adds a dark richness to the meat that comes out in stew.

In most cases, the treatment of farm animals in Haiti would shock an American. I have killed chickens at an organic farm in my native Pennsylvania, and it was designed to be quite painless in comparison to other methods. Flanders taunting the goat in Grande-Anse had upset me a bit, although I dismissed it as a quirk of behavior that often happens in such situations. I should have bristled at the taste of a chicken that had been killed by the spurs of another in a man-made fight to the death for sport and money. I did not. It was delicious, especially in the company of Jean-Francois.

For him, this was a ritual as sacred as the ancient rites of Vodou or Catholicism. The violence and adversarial nature of humanity, wrapped into the form of two cocks in the gladiatorial ring, had come to an abrupt end. The bird had fought honorably and died in its own defense, and it was our turn to honor that life. It is not an experience I hope or expect to repeat, but I am in no position to deny or rebuke Jean-Francois for his trade. He seems to possess the respect that the strange sport of cockfighting is supposed to engender.

I had a cold Coke with Howard and smoked the last of the Yaquiba cigar at the U.N. base. I ended up speaking to a group that included the woman who is taking over the psychological trauma team. I was listening obediently to a contracts specialist about the similarities of Chernobyl and Fukushima (although he did not pronounce either correctly) when I was tapped by Captain, a gentleman who teaches Haitian police officers how to respond to emergencies. I have natural interest in what he does, and I greatly respect how he has been able to do it thus far. Our 28 students are well-trained and motivated, while he has overseen the training of more than one thousand.

Captain told me a lot of valuable things about the Haitian emergency management system, which we had largely assumed did not exist or function. It all rests in the Department of the Interior and not Health, which we had been pursuing for nearly a year. In this way, Haitian sensibilities are the same as American ones, as the U.S. Department of Transportation regulates the national curricula for emergency responders as part of the Highway Safety Act (although most states run their registries out of their Departments of Health). After a week of feeling top of the heap, I was rightly back in a neophyte position. This is nothing bad; it is just another reality.

The throat infection that Chapati, Bridget, and I all contracted had finally stolen my voice. As my neck throbbed and my larynx tightened, I excused myself for the evening and got a ride back to Communitere courtesy of a pair of American U.N. police officers. I felt a bit silly being escorted the 200 meters from one gate to the other, but I also accepted that most blans don't walk around Port-au-Prince at night, even near the U.N. base. Haitian reality can find you in the darkness.

That's the view from the ground. Next stop: Jacmel.

Haiti: Walking Among Ghosts

Today's view from the ground: Port-au-Prince, Haiti - Tuesday

"Oh, city, seat of this dark isle, born as a ghost and matured a full-grown spirit."

- Victor-Therese Charpentier d'Ennery, regarding Port-au-Prince, late 18th century

Tuesday was everyone's last day in Haiti except mine. The Californians were on different missions for keepsakes and cultural experiences, and we spent most of the day wandering central Port-au-Prince. We paid homage to the ruins of the National Cathedral, now far less strewn with rubble than it was ten months ago. The once-great structures' few remaining walls and stairwells are home to some of the unfortunate Haitians with nowhere else to go. The crevices and hideaways of the cathedral, once grand and spiced with incense, are moldering in rotting garbage and human excrement.

We walked briskly along Rue Monsignor Guilloux and around the Presidential Palace, also cleaner in appearance from its embarrassing collapse. Two of the three great cornered cupolas have been demolished and taken away, making the great white structure look less ready to fall over yet again. The gates around the palace are still peppered with the same characters as always: art dealers with rolls of garish canvasses, seated women roasting peanuts, lively children trying to cadge a coin or two from the blans, and a stern police officer or two.

Many of the group had not seen General Hospital for more than a year, if at all. We came through the gates and up the walk to the tuberculosis ward, where Dr. Coffee, Nurses Ben and Laura, and Alain and Genevieve did their daily unenviable task: fighting one of the worst diseases in Haiti. Tuberculosis is nearly part of Haitian mythology: it stole the life of the hero Toussaint L'Ouverture, it is thought to be the result of several Vodou curses, and it swallows up

lives by the hundred in Port-au-Prince and the surrounding countryside. Dr. Coffee is usually a flurry of activity, especially in the morning when most Haitians seek care. Ben, still recovering from a stomach bug, was in good humor although obviously had better days.

Everyone finally got to meet everyone else. Sugar and Snakebite got a few minutes' medical talk in with Dr. Coffee while Clam and I talked to Ben, who had not seen me since the morning I left for Grande-Anse. He seemed bemused and expectant of my tale of fail, although I had succeeded in reaching Pestel. He has seen enough of Haiti's obvious and hidden problems to realize that such a venture would ultimately be a disappointment.

We proceeded down Guilloux to the National Cemetery, which is now graced by a chaotic semi-circular monument to the lives lost in the earthquake. We pondered the yellow and brown spectacle under the midday sun as we chewed on sugar cane and sought the way into the vast necropolis. We found it locked, but a small man eagerly opened it for us and asked our business. As a deflection, I said I was looking for someone I knew who was buried there (it was not a total fabrication, as one of the police officers I met in 2009 who died a year later had

a family plot there). This bought us some time to look around, but it eventually came down to the group's respect for the locals and willingness to pay.

Sugar (the man, not the cane) became lost in the spirit of the place, with its two-story graves and colorful panels, much like the remote ones that dot country roads elsewhere in Haiti. Here, they are packed in like miniature apartment buildings, some vacant and even sporting sales information. A few had crumbled out of neglect or seismic shock, leaving eerie prisms of white where coffins had been (and, sometimes, still were, exposed now to the light of the living). A few had become homes, just like the remains of the great cathedral. Frail forms of people appeared in and on tombs, betrayed by the wisps of smoke from their pipes. One woman roused to beg us for "tabak" and, upon receiving a cigarette, tore it to shreds and shoved it into her pipe.

Raoul, a muscular man with a thin smile, also had a pipe rolling between his lips. He invited some of the crew into a memorial for a demonstration of Vodou. I had seen enough, with the circular symbols of religious astrology scrawled in front of graves with ash and charcoal. Sugar went in while some of us lazed about outside. I saw the name of the police officer I knew, slightly altered. I bought a memorial card of Saint Michael, patron of lawmen, for fifty goud from a woman seated in the shade nearby and placed it inside the grave. As it turns out, the name was different because the deceased next to me was a woman. I hope the dead are not too choosy about where their remembrance is celebrated.

Sugar and the others emerged from Raoul's lair, slightly dazed. The pipe-smoking houngan also saw fit to show us a skull sitting in the darkness behind a large catacomb, which was strangely fascinating to me yet also a grim reminder that life in Haiti is cheap. On the way, we passed a squarish platform which Snakebite had posed for a photo on. Raoul told us that Francois Duvalier, Baby Doc himself, rested below. The platform held a grander memorial but the quake had broken it and it had been cleared away, leaving only the stark pedestal. "How kind," I thought, "for the cemetery to have such an excellent bathroom."

We moved back towards Champ de Mars, the shantytown-covered park that used to be the national gardens, still feeling woozy and overcome with the spirits of the place. Later, a dog began barking maniacally at us, advancing and shrinking away in a manner very uncharacteristic among the submissive emaciated beasts that wander the city. Everyone except me thought the same thing: we still had a little Vodou trailing us from the cemetery.

Overheated, we went to the Plaza Hotel. Bridget and Snakebite know it well, as it was the epicenter of the press reaction to the quake. They showed us the CNN Deck, where Anderson Cooper and others had broadcasted from, and we had lunch before heading out for some

shopping. Back in front of the crumbled palace, the art dealers swarmed us, convincing Clam and I to take up vantage points on the fence to counter surrounding. Once each man had bargained for and acquired his favorite canvasses, we walked away, still pursued by some children and dealers. Just as we passed the vacant guardhouse, the children took off into the labyrinth of the camps, pursued by a pair of men, just as a transport carrying policemen showed up. We kept walking, not wanting to know why.

The Pantheon, the underground disk housing the small national museum, survived the quake nearly without incident. We saw the anchor of the Santa Maria, a rusting hook beckoning up with pride at its discovery. Faustin's bejeweled crown sat as empty as the coffers that used to be flush with money from sugar, coffee, and tobacco in the palace nearby. Baby Doc's stethoscope bears an unfortunately resemblance to my modern model. A panel of photos from right after the earthquake was too much for me to take after an emotional morning; instead, I received a catalog of them to see later. We returned to the Plaza after a few minutes' shopping in the souvenir stands next to it. Michael, a tall sickly tour guide, hounded our every step until Chapati finally gave him the task of finding a map of Haiti painted on a canvas. He vanished after that, as the job couldn't be done before we left.

We split our evening between the Plaza and the Visa Lodge. Exhausted, I eventually retired to finish Edwidge Danticat's first novel. I had read her collection of short stories in my first class in college. It was the text we were supposed to discuss on a bright Tuesday morning in September 2001, but something happened right before class to supplant the subject. No longer an assignment, her book was my shroud for a few troubled days after that, and her description of Haitian hope and horror has fascinated me ever since.

Later in the evening, the disagreement between our cadre and some of the others involved in the Pestel mission came to a head. We discussed it at length and came to a reasonable conclusion, allowing Snakebite to speak for us all. In the frustration, coming after a long and hot day of honoring the fractured past of Haiti, we soon fell asleep.

That's the view from the ground. Next stop: Cite Solidarite.

Haiti: Sugar, Saints, and Shenandoah

Today's view from the ground: Grande-Anse, Sud, and Ouest Provinces, Haiti - Monday

". . .For, as God be praised, this land belongs to all Christians, the remembrance of it must be preserved to all time."

- Christopher Columbus (zafa), regarding Hispanola, 1493

"Sugar is our bones, as ancient as the rocks."

- Francois "Papa Doc" Duvalier, President for Life of Haiti, 1963

"Oh, Shenandoah, I long to hear ya; look away, you rolling river."

- Oh, Shenandoah, a popular song among sailors of the early 19th century

Clam, Sugar, Dole, and I woke up at dawn to climb the ridge behind the warehouse again. We made it to the first point where we could see the sun climb over the ridge opposite us and paused to watch the stark colors unfold. With our clinic duty behind us, we were starting to unwind. As we descended, we heard the school building, where we had our first clinic, erupt into choral song. Flanders was inside, raising the parishioners' voices high up the jagged cliffs and down the lonely valley.

After breakfast, we blitzed the warehouse, straightening up the disordered supplies to a meticulous degree in order to be released in time to catch the flight back to Port-au-Prince. We were done early and we issued the call to mount up: "Shenandoah," a go word from an old unit of mine. Although it used to mean it was time to high-tail it immediately, it took 45 minutes to negotiate through the remaining needs of the mission's head. We finally left with Sugar, Clam, Snakebite, Kate, Dole, Vero (still suffering abdominal pain), Chapati and Bridget (both under the weather with fluish symptoms). Dilazo was driving and I was riding on the back of the Land Cruiser. Flanders had left just before us by moto for a church in a hidden southern pocket of Grande-Anse.

It was a beautiful drive south to Cayes. We wove around the majestic mountains of the Massif de la Hotte, which dominates Grande-Anse and Sud provinces. The bald caps of deforested peaks trailed down into crude terrace farms and block houses. The more open stretches (meaning relatively flat land for twenty meters of the mountains' descent) held tiny towns close to the slopes, each with its own homes, churches, and schools. It was mid-morning on a Monday, and each school was surrounded by its children, all in matching uniforms. As we passed them, they would stare and yell "blan," and we would cheerily wave back.

In three towns, we passed Flanders and he passed us. The man's good humor, as well as that of our respective drivers, kept it a jolly and relatively safe game. I do not hold the same covenant as such men but I cannot help but respect them. In a country ruled by gods, one may teach the love and forgiveness of one without reproach. He seemed a selfless and dedicated man who had nothing to gain by his spreading the word of God, except some deserved pride of accomplishment, and we were sad when our game ended and he found his destination, a small white church perched under a cliff and over another one.

We saw a waterfall several hundred feet below us and dramatic white rock many levels above us. The road improved as we entered Sud province. A Canadian-funded project was underway to smooth the winding road to Cayes. We passed effortlessly through the charming town of Camp Perrin, a famous hub for coffee plantations, and into the flatlands of Sud, where rice and sugar are grown.

In my solitude on the back of the Land Cruiser, I began to think about sugar's hold on Haiti. Its workforce lives and dies among the sharp stalks of sugar that pop up effortlessly all over Hispanola. The Taino, the native inhabitants of the place at the time of the European landing in 1492, had pled for an end to the gold-mining horror by offering to grow sugar. The offer came too late to save them from near-extinction, but Europe soon fell in love with the crop. Since then, slaves and then free Haitians grew, cut, and ate massive amounts of sugar. We have treated as many sugar-filled cuts and impalements as we have machete wounds. The country's fortunes rose and fell with the world price of sugar. Now, very little Haitian sugar makes it to the international market. Like so many other things here, we used it and threw it away.

We arrived at the airport with time to spare. Sugar (not the crop) and the crew said farewell to Dilazo, who suffers from diabetes. We got some fried chicken at a local stand, where a kid gnawing on a piece of sugar cane offered to go down the road and gets us each a Coke, made a true guilty pleasure by its use of Haitian sugar cane instead of the crude American corn syrup. It is truly delicious.

The small plane landed and I met Michael, the pilot. He is a bald man with a Texas smile and a ragged captain's uniform topping near-destroyed blue jeans. He packed our bags into the belly and checked us all in. He also offered a pre-flight prayer, praising our work in Haiti and entreating the Lord for safe travels and friendly TSA agents. It was a hit.

We took off and saw Sud shrink below us. The intimidating mountains became wrinkles of green and brown past the edge of the rice paddies and the sea to the south vanished into a wisp. As we continued east, I saw the road that had borne me to Titwo three days earlier, shrunk to a thread clinging to the north coast of the peninsula. The Massif de la Hotte looked like it could be crossed by foot in a day. We could see clear across the Gulf of Gonave to the northern fork of Haiti, equally resplendent in its impenetrable geography.

After half an hour, the great amphitheater of Port-au-Prince, facing the rounded gulf where Gonave Island points into it, expanded below us. The epicenter of the earthquake, a flattened bowl of earth between Leogane and Carrefour, was cast in an eerie shadow as Chapati pointed it out to us. We crossed the massive shantytowns of Fontamarra and Martissant, the crumpled central district, and the orderly rows of Cite Soleil's tin shacks. Touchdown was flawless and we applauded Michael's efforts. Once we landed, Vero vanished towards the orphanage where the crew had stayed before leaving the previous week and we tried our luck at a hotel.

The crew found the Visa Lodge, a nice modern place tucked behind the Prestige brewery not far from MediShare. We got a suite and enjoyed a pizza lunch with beer and cocktails. During the meal, I got a call from Nurse Jeannie, a hardcore veteran of cholera and tuberculosis treatment, who was hiking through Nippes. She had come across Titwo, where she heard tales of a Canadian doctor trying to get to Pestel by boat. That "Canadian doctor" was me.

I directed (errantly, at first) our driver, Nez, to one of the Syrian-run grocery stores in Delmas, where we got some luxury supplies: toothpaste, drinks, potato chips, and Yaquiba cigars from Jacmel. We were back in the high life again.

That's the view from the ground. Next stop: Downtown Port-au-Prince

Haiti: Thank you, David Bompart

Today's view from the ground: Port-au-Prince, Haiti

I interrupt my travelogue to pay a small tribute to the memory of "Big Dave" Bompart, who ended his struggle last night. He was shot last week during a robbery near Hopital Bernard Mevs. After being hit, he maintained the strength to walk to the hospital gate, where his friends and colleagues stood ready to fight for and with him.

Big Dave was logistics coordinator for MediShare, which staffs and supplies Bernard Mevs in Cite Solidarite, a rough neighborhood of central Port-au-Prince. The hospital is now the premier trauma center in Haiti's capital. Big Dave rallied supplies and personnel to keep the operation running through countless changes in staff. When I met him, I was just beginning to teach GAI. He supplied our project with the trauma gear we needed to simulate scenarios for our students in the first weeks. Without Big Dave, we would never have made it through the first week of the now-successful program.

Thank you, Big Dave. Thank you, Nicolle, his loving wife, for sharing him with the people who needed him. Thank you, MediShare, for continuing your work and working to save Big Dave's life. Thank you to all the people who wished him well and donated money and time to keep him among us. Although he is now gone, we must remember that he fell during a life of service and his example is one to follow and respect.

That's the view from the ground.

Haiti: At Play in the Hills of the Lord

Today's view from the ground: Northeast Grande-Anse Province, Haiti - Saturday and Sunday

To protect the innocent and the annoying, this entry of THHL includes code names for all those involved except Bridget and Kate, who have already been introduced to the reading several. Once again, the lack of photos is due to the theft of my camera last week, so I suppose I will have to make the writing even better.

As usual for Haiti, I woke up before dawn. The porch of the storeroom had a few local kids on it. After a day of travel and being called blan or croix rouge, it was relieving to earn a new appelation from the locals: Mickey Douce. The president of Haiti, with whom I share a first name and last initial, ran with the nickname Tet Kale - Baldie. Since I am also bald, I am often called Tet Kale here. Mickey Douce, or Sweet Mickey, was the president's nickname when he was still merely a celebrated pop musician. Since Danny (or Sugarwalls in code) already calls me Mikey, it made sense and felt strangely comforting.

I met the whole crew at breakfast. Snakebite is an E.R. physician from California with a quick wit and a friendly way about him. Clamslayer is a nurse turned filmmaker who was never seen without his camera, which is fortunate because he is a gifted photographer. Chapati (yes, his kin hails from Mumbai) is a pilot and rescue specialist who immediately seemed to be the emotional anchor of the quartet of Californians. And Sugarwalls, the only one I had spoken to before, is exactly as I pictured him: an imposing man with an Irish face and a combination of good humor and good old-fashioned git-'er-done mentality. Vero Beach, a first-year med student who had considerable finances behind his mission in Haiti, was as excited as first-year med students usually are to get clinical experience in the bush. Chattanooga, the supply chief, is a grisled ex-nurse with a shadowy history and a great way with the local kids (at least to speakers of English). I liked them all instantly.

The group also included Flanders, a mustachioed southern American pastor with the optimistic timbre of speech that one would expect from such a man in such a place. His only vice was taunting the goat who was tied up outside the kitchen, who was about to be prepared for dinner. Jersey, the gynecologist, was as animated and passionate about the trip as I had expected. There was also Happy, a woman who had the look of someone who was preparing to visit an amusement park, and another woman who seemed interested in giving orders but did not communicate with me enough for me to even gauge her medical credentials. And then there was the chief of the outfit, who has more than three decades' experience in rural Haiti and had created a miniature empire of local workers, some of who had been orphans in her organization's care. Everyone in this paragraph is blond and over 40.

Kate woke up while I was bucket-bathing myself and Bridget brought her out to see me, where I could only wave in modesty. She was pleasantly shocked to see me, as the trip thus far had been boring. Much like during her recent trip to India, Kate had been crammed in the backs of all-terrain vehicles on bad roads talking to people about health problems. Neither woman had seen a patient and, contrary to the exigent circumstances that surrounded Bridget's and my previous cholera response (see THHL from November 2010), the entire group had only seen five cholera patients. It was a relief that the horrid disease had not made major gains in the region of late, but it also made me question what any of us were doing there.

The mission runs much like MediShare, where volunteers pay the exorbitant cost of flying to Cayes and driving overland for a couple of hours (or drive from Port-au-Prince in six hours) to work village health clinics, gain experience, and see the sites. The first day of the trip, which I had missed by getting to Pestel (costing me more time but far less money), had been a tour of local medical curiosities and some of the nearly-vacant cholera treatment centers. The crew had spent most of that time talking up weekend health clinics to the indigenous people for whatever medical problems they may have. Saturday's was planned for the school building next to the warehouse. By 7 A.M., the outdoor benches were lined with more than a hundred patients. The clinic did not start for nearly three hours after that, when that number had nearly doubled.

I volunteered to run the pharmacy, as everyone else seemed to be itching to see patients. Vero Beach had brought two hanging shoe racks to act as a dispensary, and we hung them behind a tiny table in the far room of the building next to the exit. Vero, Snake, Chapati, and Sugar saw patients in one room while Happy ran the deworming station and Clam saw patients through from the waiting room. Kate and Bridget helped with the pharmacy for a while before Kate set off on a one-woman mission to rid the world of scabies. Intestinal worms and scabies are two of the most prevalent health problems in Haiti, and both are easily treated (at least initially) by a cheap pill.

Although I did not need one for the simple prescriptions I was giving, I was given a Haitian translator from the mission staff. I named her Grabby, as I often spotted her lifting drugs and other things she shouldn't be taking. When we told the empress, she laughed it off, saying she expected 15% of the supplies to be stolen. Chattanooga took umbrage at that suggestion, saying the head of a mission should maybe instill some of the basic commandments in her flock. Grabby spent most of the day annoying me, seizing things out of my hand and repeating my acceptable Kreyol (often incorrectly) to the patients. She also blocked me into my tiny square of standing room, not moving even as I climbed over her with a dodgy knee, a bit sore from Friday's moto accident and the acrobatics it took to keep her in line.

In order to reduce the confusion of our patients, who seemed bewildered by so much blan activity and shoddy translation, I adopted a symbology that medics and pharmacists learn for places where they don't know the language or work with illiterate people. I would draw capsules on the tiny plastic bags I was dispensing pills in, with a rising sun or a crescent moon to show when they should be taken. Everyone also got a pack of multivitamins, which helped rein in the usual Haitian outrage at being told there was no drug for the malady they complained of. Some people were convinced that a vitamin supplement was enough to ward off headaches and stomachaches, when the real prescription would have been better food and cleaner water. That is a prescription no pharmacist can fill for Grande-Anse Province.

My stamp came in handy as well, as it added to the placebo of officiousness that Haitians are used to. The examiners would write on slips of paper I had cut out of a 72-page village health protocol I had intended to leave for the mission (absurdly, no one else had paper, and Chattanooga assured me there was only one book that anyone read around there anyway). At first, the scraps showed names and ages as well as complaints and prescriptions, but that eventually got reduced to "Grandma" or "Girl in Yellow" as it became clear that most people would not reveal personal information and most had the same medical problems: headache, stomachache, vaginal infections, diarrhea, arthritis. Bridget clashed with Vero once or twice on prescriptions and Kate eventually got sick of cleaning scabies all over people's bodies. The other women had gone off somewhere out of the village. Since I was the only one legally qualified to fill prescriptions in Haiti (not that it mattered in any way), I would stamp the prescriptions as they were filled to make the patients feel better and avoid confusion, as I was often mobbed by patients who tried to grab their scrip back for a double dip and Grabby was grabbing whatever she wanted in front of me unless I slapped her hand away.

We closed up at 5 P.M. after seeing 300 patients. None had been emergent cases and only one was a mystery, which turned out to be a pediatric case of giardia. A pregnant woman had to wait with her family on the steps of the warehouse until well after dark for Jersey to return. After she did, there was a cursory examination and the woman elected to go to a friend's house to give birth. I was surprised that three blond women staring up her birth canal and speaking in tongues wasn't enough to send her into eclampsia.

The day ended with a sour taste in our mouths. No one had done what they expected to do and many of us did not feel good about what we had done. I arrived with no expectations except to find cholera; since they were dashed, I had no disappointment to revert to. But it did seem like a lousy, inefficient, and completely unsustainable way to run village health care.

The Californians and I cleared our heads by walking about the road under moonlight, smoking cigarillos and allowing Clam to try different camera tricks. Sugar was seeking the drums of a voudou ceremony, which we never found. We came back for dinner, which included one of the best goat barbecues I had ever tasted; I did not intend to eat the poor tortured animal but I could not help follow the smell after such a long day. The men stayed up late in the warehouse drinking cold Coke and telling stories.

We discovered that the previous clinic had drained our supplies of pain killers, the most common prescription. I called Fero, the moto driver from Pestel, who offered to bring me a fat sack of acetaminophen from the clinic there in the morning. I walked two towns over to meet him. The stroll led to a entourage of local children and many confused hellos from townspeople. I caught a ride back with Fero, on his way to church and clad in a smart black suit with a tie around his neck (he was not wearing a collared shirt).

Before this, Clam and I climbed the inviting ridge behind the warehouse at dawn in order to see the sunrise from the highest nearby point. The climb was quite difficult, as there were large igneous rocks with sharp edges and unpredictable points amid the ruddy dirt that had covered my boots over the previous 36 hours. The seemingly infertile ground held an orange tree, sugar cane, and sweet potatoes planted with care amid the stone and long vines. Halfway up the ridge, we encountered several bound goats, indicating that the land was certainly being used well.

The view from the top was spectacular, especially as the rosy dawn had filled the sky just as we reached the summit. We sat and talked as the sun crept over Pestel and the sea to the north, burning off the mist that lingered in pools over the deep valleys to the west and the south. It was one of those moments that makes a long trip worth the effort.

We drove two Land Cruisers to a neighboring village, while Kate, Bridget, and the Californians intended to walk. Savior insisted on bringing everyone by vehicle and wasted at least half an hour rounding everyone up and stacking them dangerously on the back while she sped over terrible roads. Runner cackled in delight at the further absurdity that she was creating. We picked up an old woman on the way; her knee was swollen and she wailed in pain. Once we finally arrived at the makeshift clinic, a one-room schoolhouse rigged with palm-leaf walls, a crowd of at least a hundred had gathered outside. They were far less orderly that Saturday's patients. Chapati and Vero spent nearly the whole day screaming at them and trying to keep them from overrunning us. Sugar, Bridget, Kate, and Happy ran a hurried clinic with Dole, a Haitian med student who had come from Port-au-Prince with them to gain some experience. He kept many of the fake translators away from me (they would try to translate for patients and then ask for money for the useless favor) and also escorted Grabby away to translate for the doctors, where there was less for her to steal.

The Haitian clinicians were writing conditions on whatever paper there was, and their prescription was always Tylenol. I had to reassess many cases at my embattled pharmacy desk to give a real effective prescription. The clinic was shorter that Saturday's, only five hours or so, but we saw more than 400 patients. I had again run out of pain killers, even though I was cutting them in half with a razor.

After walking part of the way back, the evening became a party. Clam took photos of the crew waving lit incense sticks in the thin moist air and a drum circle began among some of us and the Haitians who loitered near the warehouse. I made popcorn, which inspired a simple rhythmic song that then demanded more. Clam recorded it for posterity.

Bridget had the beginnings of a painful head cold. Just before I went to sleep, Vero reported a sharp abdominal pain and Snakebite asked me to give him some ondansetron to settle his turmoil. We finally went to sleep before midnight so we would be ready to clear out in the morning and begin the craggy drive to the airport at Cayes and the flight back to Port-au-Prince.

That's the view from the ground. Next stop: Cayes.