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.