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EXPERIENCE IN HAITI:
THE CHILDREN OF SHADA I arrived in Cap Haitien in the early morning of September first, 2007 . After being picked up at the small airport in the second biggest city in Haiti , Cap Haitien , we traveled through the city to get to our destination. I was being hosted by SOIL, the non-profit organization (www.oursoil.org), who had invited me to come to visit Shada. I was invited by Sasha Kramer, co-founder of SOIL. Sasha lives most of the year in Cap Haitien . The other founders are Kevin and Sarah who live in Rochester , NY . They administer and live in a homeless shelter during the year and spend the summer in Cap Haitien . After breakfast we proceeded to go visit Madame Bwa in Shada, one of the poorest communities in Cap Haitien . In the truck with me were Sarah, her husband Kevin, my daughter Ashley, who had been there 7 weeks as an intern from UCSC, and two other male Haitians, Tony and Josepha. Denic, a 14 year old Haitien boy, who came every day to SOIL's apartment, was our constant companion. I was stunned at the poverty that I encountered. What I witnessed and saw over the next 10 days surpassed anything I have ever experienced in my 30 years as a Pediatric Nurse Practitioner. We traveled from downtown (our apartment was a seven minute walk from the center plaza and Cathedral) through cramped streets, universally with huge pot holes and trash accumulated in heaps at the end of blocks. I saw people sweeping the streets, not having a place to put the trash, it compiled at the end or middle of the streets. The city's sewage system was pouring green water out of the manhole covers, which were loosened due to the force of the contents pushing through. The city reeked of urine due to stagnated dirty water. The temperature was hot and humid, mosquitoes abound. What I saw was a naturally beautiful marine, filled with unnaturally ugly dark water, at times dark green or gray in color. At a spot where you would expect luxurious hotels, shops and restaurants, a housing area stood, of cinder blocks mostly covered with rusty, corrugated metal roofs. Most houses without windows or wood doors. Many times a curtain or sheet was makeshift for a door. This was a place of great activity and laughter, kids running around barefooted for the most part, many completely naked. They approached our truck which had to stop at Shada's entrance because no road is available to Madame Bwa's home. I was escorted to her home through narrow and curved passages, houses one next to the other, children running after us, men sitting playing cards or checkers, perhaps chess. Women were washing clothes in the small side walks (about 2.5 feet wide from their front doors) and water was stagnated on the canal that runs along the sidewalks throughout Shada. Women throw dirty water from washing and cooking in the canal, which is about 2 feet wide. Dogs, emaciated and many with old injuries, run on three legs, few had anything to eat. Women had large pots of aluminum on makeshift stoves lit with coal in front of their homes, two feet away from the smelly, putrid water in the canal. Even though I saw poverty, of which I had never encountered before, there was life and vitality in this community. I felt love and awe that I was there with these beautiful, resourceful and loving Haitians who need our help. Madame Bwa is the midwife and serves as a leader of this community. Her husband is also a midwife. I was escorted by Denic holding one of my hands and Tony the other through these narrow paths; they warned me to look down because I could fall in the canals, or in a pot hole. My large suit case full with medications was carried along with bags of supplies. As we turned into a more convoluted area, even more cramped and curved, all of sudden there was Madame Bwa, with an entourage of men and women and mostly children. We embraced, silently but strongly like if we had known each other for years…tears were flowing out of my eyes. My emotions were running rampant; however, later Ashley told me "never cry, Haitians, don't cry". I was not to keep this promise, because I did cry several other times during this amazing trip. Madame Bwa kissed me on both cheeks and looking intensely into my eyes, communicating all she wanted to say: love, acceptance and gratitude toward us for being there, in her community and with her people. Later she told me I was the first nurse or clinician ever to hold a free clinic in her community, Shada. We walked to her home, where promptly we were offered chairs, white plastic ones, made in Mexico . We sat and started to get to know each other. Madame Bwa told me, through Sarah, who speaks Creole fluently, who she was and what she did. Her birthday would be in two days, Tuesday; she was going to be 63 years old. She looked strong and beautiful, full of life and laughter in her honey colored eyes. She wanted to know how I could help Shada and her people. I answered I was there, mostly to learn about Haiti and Shada. I learned much from Madame Bwa, as it all turned out. We liked each other instantly and I couldn't wait to see what my work entailed. SOIL, my daughter Ashley and Madame Bwa had prepared an itinerary for me, which was very full for the next week. I would start on Monday, September 3, at their only school, an unfinished, and one room class near the shore. That was where I would be holding "my clinic". My itinerary: Monday: clinic in the morning and a seminar in the afternoon for the midwives of the surrounding areas. Madame Bwa and her husband planned to attend also. "Problems in Delivery and When to Transport the Mother to the Hospital" was the title of the seminar. Tuesday: Clinic in the morning and Lecture for mothers on "The Importance of Breastfeeding and How to Breast Feed Properly" in the afternoon. Wednesday: Clinic all day, half a day children and half a day adult consults Thursday: Clinic in the rural area of Milot and Borgne Friday: visit the hospital and local clinic Saturday: visit The Village for Homeless Boys, more commonly referred to as "street" boys. Also visit the Missionaries of the Poor (MOPS) Sunday: Mass at the Cathedral, day to relax at the beach. Monday: return home to Los Angeles . Shada does not have flushing toilets or plumbing. Children go in the piles of trash near the shore. Adults collect waste in containers and simply empty them on the heaps of trash. Pigs abound in the shore, consuming the waste and trash. Children play in the shore where water is contaminated. They take baths in this water. Because bathing water must be purchased, many children are forced to bathe in this filthy water, exposing them to parasites, fungal and bacterial infections of the skin. Also to ova and parasite problems, which cause severe diarrhea and malnutrition, including anemia and failure to grow and develop. Although we had a beautifully planned schedule, things don't always go as planned. Working in Haiti requires flexibility and compromise like had never been demanded by me before. After Monday's clinic where I saw 40 children and lectured to the Midwifes, I came down with severe dysentery and was ill with a high fever, vomiting and the common stomach problems one encounters when visiting a foreign country. I was in bed all of Tuesday with terrible stomach pain. Although somewhat weak, on Wednesday I had an all day clinic and saw 78 children and had several adult consultations. We conducted the clinic into the night, without electricity, and of course, no bathroom facilities. We finished clinic at 7:30 PM . I used Purell to disinfect my hands between patients. I drank two bottles Coca-Cola the entire day. I was dehydrated from the previous day's illness. This turned out to be a blessing since we had no bathroom facilities. SOIL hired a translator for me, Alex, who was my companion and link to the Moms, their infants and children. He was very helpful and a fantastic translator. Alex had never left Haiti and spoke flawless English, French and Spanish fluently. Haitians have a facility for language! That day, a 3 year old twin I had seen on Monday, was carried into the one-room, dark school, at seven PM . I was working with a couple of flash lights since there is no electricity in Shada. People normally use oil lamps to light their dwellings. The Mom hurried into the room, carrying the ill twin, with the other twin trailing behind her. This small boy, who looked 11 months old, was in respiratory distress, breathing at about 70 breaths per minute, and heart rate of 190-200. He was clearly very ill and I feared he was going to collapse and go into respiratory arrest. I had no oxygen, nothing that could help him. His Mom said that after he was examined on Monday and had taken his prescribed iron, he had gotten ill and couldn't breathe. I was very concerned and said "he needs to go to the hospital, now". Nothing happens immediately in Haiti . This was an emergency, but transportation is not available from Shada to the Hospital, and is twenty five minutes by car. Fortunately, after talking to the mother through Alex we figured out he had suffered a similar episode the previous year. I made a possible diagnosis of asthma or respiratory infection, although I couldn't hear any ronchii or rhales. It was a miracle Sarah, Kevin, and Sasha had just arrived to take us home. They proceeded instead to take the family, Mother and both twins to the hospital. Ashley carried the healthy twin, both completely naked. I finished the rest of the patients, about 25 more and walked with my Haitian male companions through Shada, to the street to catch a cab. That day and night were incredible; that experience will remain in my mind forever. I felt that my goal to go to Haiti had been fulfilled because a little boy's life had been saved. As I suspected, and later confirmed by the doctor at the hospital, he would not have survived another hour at the rate he was breathing. Thursday, the truck, our only way of transpiration to the countryside had had a broken motor part. Upon arrival to the hospital the night before, right after transporting the ill twin, our truck broke and had to be left at the hospital's parking area. We had no transportation to the country side. All 50 patients waiting for me needed to be cancelled. I was never able to go. The truck was broken for the rest of the time, until a couple of days before my departure. In Haiti they have very few car parts, they have to scramble to get a part from the capital, Port au Prince or fly to Miami to purchase it. Haitians, however, are very skillful and even though a part was not available, they fixed the car with an old part from a different model truck. For the time being, I was to travel in the tap taps or in a taxi. Therefore, that day Alex and I visited the La Fayette Clinic and had a wonderful tour by the director, Dr. Guy. I interviewed him and toured the clinic; I spent over two and a half hours observing the clinic. It was a delightful morning. I had the chance to see medicine practiced in Haiti . The clinic had several departments OB-GYN, Pediatrics and infant care, TB control (most TB is MDR) and HIV+AIDS. The services are run by two permanent physicians, nurses and doctors from Cuba . In the afternoon I visited the only hospital in Cap Haitien , Sacred Heart, where the little boy had been admitted the night before. I put my stethoscope to his chest and heard rhales and ronchii on the left upper lobe. He had pneumonia. He was with an oxygen canula given antibiotics and other medications. His mother didn't have any money to pay in advance for his medications or hospitalization, therefore, Kevin paid in advance for everything from SOIL funds. It is customary in Haiti to pay in advance, or they won't treat the patient. Kevin went outside the hospital, to several pharmacies to purchase and find the appropriate medications. The hospital pharmacy had run out of medications. When I entered the ward, the patient's Mom was lying on a sheet on the floor next to his crib. His twin brother next to her. Their cousin, a young girl, had joined them and was sitting on the floor, since no chairs or cots where available. The ward was full, babies of all ages in one cramped ward, even a preemie. All the relatives slept on the floor and had to be there to take care of their babies because the nurse to patient ratio was very high. I was impressed that even with the shortage of personnel, supplies and equipment the doctors and nurses were still able to take care of these severely ill patients. Even a tiny preemie who weighed 3 pounds! The clinicians are very dedicated and have excellent skills. The twins' mother was so grateful and hugged me when she saw me coming into the ward. Haitians are respectful, joyful and wonderful people who are very grateful for whatever little one can do for their children or their community. I loved working with the Moms and their precious children. How many people were helped directly as a result of my participation in this medical mission? I examined 178 children, several adults, probably 14, and gave classes to about 10 midwifes and 35 mothers. I visited the Missionaries of the Poor (MOPS) compound in Cap Haitien and brought needed supplies and medications to Brother James. He graciously gave me a tour of their home for the disabled and the aged. Their mission is to pick up from the streets children or elderly who are abandoned and who no one wants to take care due to severe disabilities both physical and mental. The MOPS invited me to come back to examine and treat their children. They have 35 infants with all kinds of severe physical problems, and house 120 elderly men and women. I know I need to come back. How would I apply this experience to any of the work that I do here in the barrios? The experiences that I had in Cap Haitien do not match any of my experiences here in the US , except to say that people are in need of health care and better nutrition. The ova and parasite infestation there in the population is great, particularly in children. The one thing that is similar is the asthma condition there and here. In Haiti , secondary to the pollution from using coal to cook; here from possibly environmental pollution, different sources. Dental problems and rampant cavities in the US , especially immigrant children, are devastating. This is my number one referral. In Haiti children have perfect teeth, no cavities. I only saw one child with a cavity the whole time there. In Haiti malnutrition is widely spread due to lack of good nutrional staples and resources such as vegetables, meats, milk and protein. Here in the US we have the contrary: we have obesity due to poor nutrition choices and not enough activity. In Haiti , I didn't see any obesity or even overweight children or adults. People there are on the move, trying to "live life, like Alex said to me, walking constantly from one place to another, selling food, gum, water, or going from place to place. The transportation system is poor; most walk or take a tap tap, looking to make a living and feed their families. Here we have TV in every household; I did not see any televisions in Haiti except for one in one of the best Hotels in Cap Haitien . How do I plan to share these experiences in the community? I have already made a presentation to a large group at my parish, St. John Fisher Catholic Church. My experiences there also have been chronicled by my daughter who's also giving lectures at University of California in Santa Cruz and my church as well. This weekend she will be presenting to a large, "Women's Spirituality Group." She was invited since her experience there was 8 weeks, although she always includes "our clinic" in Shada, as part of her lecture. I hope to be able to present some day in the near future to a group of managers and administrators at Little Company of Mary Hospital . I would have been able to see more children in the rural areas if our truck had not had engine problems. I will try to visit the rural area next time I visit there. I hope to return to see the "Village", Project Pierre Toussaint; where the homeless boys live a pleasant and productive life, go to school, learn farming and other traits, thanks to Doug Perlitz and Fr. Paul Carrier, SJ. At Project Pierre Toussaint, I examined teen boys, one who was infected with a severe STD's. I will again visit the Sacred Heart Hospital , where the twin infant was taken the night I examined him. How does the medical care differ here in US versus Haiti ? In US one can walk in a hospital with an ill child, like the twin boy who had respiratory distress, and get treated immediately, no questions asked or money exchange at admission. In Haiti (like in most of the world and the underdeveloped countries in Latin America ) one needs to pay, upfront, for all medications and even the hospitalization. In the case of the twin, Sarah and Kevin found the medications necessary around town, in two or more pharmacies, in order to have the patient treated. The parents need to take care of all the physical needs and act as nurses at the bedside, keeping vigil next to their children. Here, the parent has a choice and can leave the premises and go home. The nurses and doctors will take over. I was in shock to see that such an ill child had to wait for treatment until the medications where found and paid for. Thankfully, since a "blan" or white person carried with the child into the hospital, he was admitted immediately. Otherwise he might have died that night waiting to be seen. My visit to Haiti was the product of the generosity and donations of cash, supplies, medications and moral support, especially prayer. I feel that my mission was accomplished. I have nothing but gratitude for Providence Medical International Missions for their help, support and generous donations of medications and supplies. Over 300 pounds were collected and sent to Haiti or taken by me. These supplies will be given to the community in Shada, Milot, Borgne and others in need, including the prison. The hospital in Cap Haitien and Milot will also get some of the supplies and the clinics in the rural areas. Shada will get many supplies, which will be distributed through SOIL, by Sasha Kremer, the co-founder who resides in Haiti . Thank you for your help in making this trip possible for me. The check for $500.00 from the grant assigned to me was donated to SOIL as part of the $3,450 given in donations collected from our Divine Mercy Group at my church. I have great hope to be able to come back to this island where part of my heart stayed with its people. Sincerely, Pat Dahlberg, RN, MSN, CPNP. Partners for Healthy Kids Little Company of Mary, San Pedro , California 310-514-5465 |