I keep seeing Kenia's chubby 4-year-old face getting cross with me because I won't pick her up for what seems to me the zillionth time.l Now I wish I'd done it once more.

Kenia, I think I've mentioned before, came to the clinic in Grand Bois in February 2007. Her mother had a new baby, and apparently couldn't feed two kids. She came into the clinic too weak to cry, literally on her deathbed. Dr. M had to put the IV in her foot.

Now she bounces around the clinic like she owns the place. When amused -- and she's easily amused -- she laughs a deep belly laugh.

A couple in the US would love to adopt her. Michael had an appointment at the US embassy today to see what they could do to smooth the way. The appointment means standing on one side of a plastic window and, after a very long time and for a very short time, having someone not be very helpful. Frustration, here, is a way of life.

So, too, was Dave's mission to get wire to finish electrifying the school in Grand Bois. He found what he needed -- but they wanted $300 for $60 worth of wire. Overpaying for wire is a poor use of precious funds. So the next ServeHaiti group will have to carry the wire from the US.

Illustrating the Kafkaesque aspects of this city was a trip we made to the Presidential palace in the heart of the city. It's an immense white mansion. Just across the very broad avenue is a broken-down hovel. And in between is a monumental statue of a slave with a broken chain and a broken sword, blowing a chonch horn with all his breath. Freedom! Yet all around are homeless people sleeping on the concrete and boys, mothers with infants, and legless men begging for coins or food.

The main Cathedral has broken windows. Across the street from the cathedral gate, a homeless man sits in a hollow he's made in the dirt between the curb and a cement wall, picking nits from the hair of a frail little boy.

Geert was here when we got back to the hospice. He was supposed to have left today, but spent the day dealing with bureaucrats who were supposed to help him avoid customs costs on his boat. After a whole day of this, he had to pay anyway. When we saw him, I asked why he was still here.

"Have you ever read much Kafka?" he asked.

Yes, we have.

Labels: haiti adoption, haiti denoon, haiti grand bois, haiti kafka

Short blog tonight, as I sit in Port au Prince with having a beer with novelist Geert van der Kolk. He raises his eyebrow to the answer to his question: how many doctors are in Gran Bois, and how many people live there?

The answer: about 65,000 people. One doctor, and two residents.

Now the Dutch novelist and Dave, the Republican electrician, are debating the merits of publicly subsidized health care. That's a big issue. But here on the ground, there's no difference of opinion. We're all doing the best we can for the person in front of us. That doesn't mean scattering our few (or relatively many) dollars among everyone we meet. It means thinking, hard, about the long-term consequences of whatever you do for anyone. Give a local boy a dollar, and have you helped his family - or made him a beggar? What about the blind man with his hand out? What about the deserving but poor student who asks for nothing?

Lots of choices. Very few answers. I feel very, very humble.

Time to leave Grand Bois. The man with the filleted leg is in pain, but healing well. The two kids who had tungiasis -- burrowing fleas, which sounds better than it is -- are healing well, but still scream when Dr. L changes their dressings. Man who collapsed from malnutrition doing better, but needs more nourishment once he gets home. I don't know that will happen.

We've got the well running and doubled the voltage. We've surveyed a site for a new well in the next village down the road and are hoping, in the near future, to build a windmill to pump the water. Anyone with ideas of how this is done in the third world is welcome to contribute. Seems like a great idea to me.

As I type, two little girls are giggling and trying to punch the keyboard. Dr. L shows me a picture of them last summer. They were emaciated and barely able to stand. One of them, little K, was so feeble she couldn't stand. Now she's running everywhere, and won't let me alone until I pick her up and play. Of course, these are the orphaned or abandoned kids Dr. L and his staff are raising in the clinic.

Time to go. More later from PAP. Ah: little Silvio, the boy from the shack up the path, has come by. He is 7 and cares for little K like he was her dad. Bye for now, my new friends.

It's dusk and on the hills that seem empty countryside during the day one sees fires everywhere. They shine from the shacks in which each family cooks its meals over an open charcoal fire here in
Grand Bois (or Gran Bwa, in the local lingo), Haiti. Occasional families have built bread kilns from the rock that is everywhere, but most simply hang a pot over the fire for a one-pot meal.

I'm surrounded by the staff and friends and taken-in orphan children of the ServeHaiti clinic, all speaking rapid Creole. The kids had to fight off an aggressive chicken that jumped on their little table. A thin little dog and some ducks wait at the door for their chance. For dinner we're having rice and bean sauce (again) but today there is some turkey roasted over our own open fire. That explains the absence of the big bird that's been pecking in the yard all week.

It rained last night, turning the dust into an unbelievably sticky mud that clings to everything. It's sticky and gummy when wet, and dries into concrete. There's no getting it off your shoes, so we're tracked it all over, despite Donna's hours of sweeping (with all the orphan kids, who adore her, in tow).

Donna took me down to St. Pierre this morning, a hair-raising drive. Imagine the worst road you ever saw -- twice as bad as anything between the clinic and Port au Prince -- with deep, car-swallowing ruts in between bowling-ball-size rocks. At the end of the road is a small 100-year-old church and a much bigger community than at first is apparent.

We attended Ash-Wednesday Mass at the church, presided over by the athletic and strong-voiced Pere Reginald. He insisted we address the congregation, and my few words of greeting in broken Creole got a big laugh.

Donna, a professional photographer -- I'll post some of her shots when we get time -- and I took our cameras out into the village, to see the spring where everyone bathes and fills their water jugs. As Donna has been here dozens of times, she introduced me to some of the friends she'd made. Life in this place -- without running water, without sanitation, without any economy other than the fields and the market, with no health care other than that provided by our clinic way, way up the hill -- is joyful.

As yesterday's post no doubt showed, there is also pain and despair. After I'd posted last night, we saw a man who'd collapsed from malnutrition and a woman who looked pregnant due to bloody fluid that filled her abdomen. A Cuba-trained resident studying here under Dr. Leo told us it was the third time since January the woman had such fluid drained. Dr. Michael and I looked at him: So what did the lab tests show? As it turns out, it's too costly to send such samples all the way to Port au Prince, just to get unreliable or unhelpful results. Does the woman have parasites? Has she got liver failure? We just drained off the fluid and hoped for the best.

The rains that made the road to St. Pierre so dreadful cut down the flow of people to the clinic. Just a trickle today; nothing more dramatic than a very old man dying in pain with prostate cancer. If it doesn't rain again, I wonder what tomorrow will bring.

Ooops. Just as I wrote that sentence, the steel roof began ringing with a furious rainstorm. Everyone is shouting to be heard. The plan now is to make our way through the mud to Port-au-Prince, where we will order some supplies for the clinic and get a sense of what is happening in the capital city of this beautiful, crowded, and troubled land.

I was going to sign off, but two things just happened. One is that the wife of the man who collapsed from malnutrition -- who was sobbing inconsolably last night -- just walked in the kitchen door. She's part of the maintenance staff, as it turns out. As she came in, dripping with rainwater, she recognized me and laughed out loud at her predicament.

The other thing is that the power just went off in a flash of lightning. So I'll log off. The reward of serving others, to paraphrase Paul Farmer in Mountains Beyond Mountains, is getting the chance to do it again. I didn't understand that the first time I read it. That has changed.

Shortly after dawn this morning I stumbled downstairs and out onto the front porch of the ServeHAITI clinic in Grand-Bois, Haiti. I was looking for Dr. Michael, whose 18-year-old patient had been in labor all night. I'd been looking forward to assisting at the birth of her first child.

An elderly woman approached, half carried by a man. I rushed down the stairs to help; she collapsed at my feet.

With fear in her eyes she half raised herself on one arm and cried out for help. Dr. Leo and Dr. M appeared and we carried her into the clinic. As we eased her into a cot, she cried out to God and gasped the kind of gasp you may never have heard but would instantly recognize. She was dying.

Michael sent me running for a piece of plywood board that he'd been planning to use in building beds and shelves. We set it behind her back, and I began CPR compressions while the staff scrambled to find some atropine (we're set up as a public health clinic, not an ER -- but there's nowhere else to go around here). Eventually someone found some epinephrine and the Michael injected her. The oxygen machine was broken, but Michael gave her air with a mechanical ventilator while I pushed down hard on her chest, arms locked, one hand on the other, forcing blood through her heart, over and over. Through her thin skin, it felt exactly like what it was: holding her heart in my hands.

We kept working for a long time, perhaps a half hour or more. Dr. Leo hooked up an EKG and we got a faint reading -- but when I stopped doing chest compressions, the line on the graph flattened out. At last, Michael put his hand on my shoulder. "Let's give her some peace," he said.

A little later, Michael and I decided to run some wiring at the dilapidated school a couple of miles down the road. It's where 400 local kids get primary and secondary education. We were planning on setting up some outlets for a few donated computers (even though there is no Internet access. Or, for that matter, much of anything except chalk and a few blackboards).

That's when a dusty truck pulled up with men carrying a stretcher. On it was a man, age 60 or so, screaming in pain. Janvier, our interpreter (and a skilled nurse, as it turns out) relayed the story. The man had been running to jump onto the back of the truck but slipped and fell under the truck on the rock-strewn road. And then the truck ran over him.

His leg was torn open in a 14-inch wound that exposed the muscle beneath in a wide, jagged cut. There were a couple of smaller, equally deep wounds as well as a serious 3-inch cut on the sole of the foot, from which muscle protruded. All the wounds were deeply impregnated with dust and rock and bits of the filthy fabric that had been used to staunch the blood.

And by now, his foot and lower leg was extremely swollen. Given the emaciated state of his other leg, the swelling was alarming but totally irrelevant to what Michael determined was his first need: pain control, wound cleaning and a lot of stitches.

Given the nature of the injury, Michael and I both thought his shin had been crushed. If that had happened, he'd have to go to Port au Prince for care -- a 5- or 6-hour drive. We began making preparation for this, but Dr. L happily determined that the bone was somehow not broken, and that we could treat him in the clinic.

Michael pulled on sterile gloves. He gave the man what pain medication we had, which was not particularly effective. I held the man down while Michael injected the wound with xylocaine anesthetic and cleaned the wound, first with water, then with peroxide, and finally with antiseptic. The man was very brave, but could not help crying out. It took two of us -- one of his coworkers and me -- to hold him down. It was a scene from a civil war movie, I kept thinking.

Then I scrubbed down gloved up. While Michael painstakingly ran a curved needle and suture through the edges of the wound, my job was to push the tissues back under the skin and hold the wound closed while he pulled the stitches tight. We illuminated the procedure with camper's headlamps we'd fortunately packed for the trip.

Michael ran two series of stitches down the wound. Every time I pulled the wound shut, the man cried out in agony. After about an hour of this, my head got very light and a cold sweat broke out on my neck. Michael noticed the symptoms, and we agreed I should take a break. Luckily, I got better after a few minutes and we resumed work.

None of this fazed Michael, who under brutal conditions worked steadily and with great skill. His sewing was sure and true, often making little circular stitches that almost miraculously pulled the wound shut in places it seemed there was far too little tissue for coverage. Several times, his work made me cheer.

At last the job was done, and Michael put a cast on the leg. Finally we could elevate the foot and bring in the man's family. They rejoiced to see how much better he looked, and immediately fed him a bowl of rice and beans, which he ate with great gusto.

And at about this time, Dr. L came in and jokingly chastised Michael for forgetting his other patient. Then he broke into a wide grin. "It's a boy," he said. Despite being in labor for over 14 hours, the mother and child almost immediately set out for home.

By now it was about 2pm, and there was a lunch of corn mash on the table. Just time to eat, when Dr. Leo said it was time to treat the kids with tungiasis.

The boy was about 5 and his sister about 8. Both had painful black bumps on their toes and soles. The boy went first. A nurse held his leg fast as Leo took a curved surgical scissors and carefully probed under the bump, about a quarter of an inch under the skin. He pried the hardened skin off the edges of the bump, and when the skin came off, it came with a soft white ball the size of a baby pea.

A close look at the pea revealed a tiny head on the end going into the foot, and a tiny orifice on the end going out of the skin. The animal is the variously named jigger flea -- a flea with limited jumping ability that burrows into the skin and becomes bloated from feeding on blood. When removed from the host, it looks like a spherical maggot. Each child had dozens of the fleas embedded in their feet. They were extremely brave, but for two hours their screams rang through the halls of the clinic.

When it was over, I gave them each a Tootsie-Roll Pop (I had a few with me). They laughed. I cried. They will fully recover with some antibiotics and bandages (though their house and grounds must be treated with insecticide to prevent reinfestation -- each flea leaves about 100 eggs in the environment).

For dinner we had rice with a bean sauce, whole roasted plantains, and a little piece of roast goat. Dave, who during all this finished wiring the well and burying the cable, shared a beer with me as we watched the sun set.

I really mean it -- it was a good day. Maybe a great day. Yes, there is terrible suffering. But: There is grace.

Labels: cpr, first aid, haiti denoon, servehaiti, tungiasis

A most amazing day. We left Port-au-Prince in a Nissan Patrol and soon were free of the city -- and paved roads. Most of the way, we made about 5 miles an hour over huge rocks and ruts and seas of dust. We wove between pedestrians, mules, donkeys, goats, bicycles, and a few hardy and hard-used trucks filled to the overflowing with people.

The scenery is stunning. There are a few trees here and there, but mostly thorny cactus and rocks. As we got higher into the hills, water became more and more scarce. Springs, separated by miles of shoe-destroying road, were miles apart. Finally we reached an area where cattle and donkeys and people shared a muddy trickle on either side of the road.

Dr. Leo suggested that we stop. Donna and I asked a pretty teen girl (and her mother) if she would pose for us, and her broad smile revealed that she'd already lost most of her adult teeth -- the ravages of sugar cane, which is chewed not only for its sweetness but also for thirst.

We hiked up the stream about 50 yards to the source: a small spring at the feet of an immense tree, whose roots apparently created an artesan well (or at least that's the local lore). A concrete form about 10 feet square was carved into the rock to create a wellhead, into which people crowded to dip their buckets.

Our interpreter, Janvier, asked people how long they had walked to get there. Some said they'd walked a couple of hours with all their families' buckets -- and of course, on the way home the buckets and jugs and bottles would be full, and the path would be steeply uphill. Next month, when the dry season begins, the spring will dwindle to a trickle. People will sleep all night at the spring, hoping their bottles will fill by morning. Then they'll trudge home -- most with just a single bottle for their families.

Some of the children at the spring had their heads shaved, and bore patterns of little scars on their scalp. Ringworm, Dr. Leo said. If you hardly have enough water to drink, bathing is not a priority.

Of course, cattle share the stream, and people bathe along with them. They also bring their families clothes to wash, and dry them on the bushes high up the side of the hill.

All this being said, the people we met were in high spirits. They laughed at our pathetic efforts at Creole, and joyfully helped hand us across the slippery rocks to look into the wellhead. Eyes were bright with intelligence, humor was everywhere, and despair was nowhere evident. If you don't believe that resilience is a human quality, you haven't been to Haiti.

And now we're at the clinic. Dave, the electrician, and I installed a series of new car batteries and an inverter to boost the clinic's voltage to power the new well.

Right now, a woman is in labor. The baby is in the occipital posterior position, so the doctor has her on her hands and knees to help the baby's head to turn -- an old obstetrician's trick, he says. If the delivery is tonight, I'll be there to assist.

Tomorrow, Dr. Leo will treat a couple of kids who've come from distant parts to be treated for tungiasis -- infestation of the feet by egg-bearing female "jigger" fleas, which swell to the size of peas, causing intense pain and secondary infection. Each flea and each egg must be removed by scalpel and forceps. I'll get to observe, so stay tuned and you'll hear how the kids came out. Of course, if the kid hadn't been barefoot, the fleas (which don't jump very high) couldn't get in.

By the way, Carnival is in full swing even here in Grand-Bois. Dr. L and the PEPFAR funded people hosted a huge party that drew about 200 people, who got HIV tests in return for free T shirts. The music plays as I write.

Labels: denoon, haiti

From the hilltop porch of a guest house, every light in Port au Prince glows eerily through the haze of bonfires burning here and there across the city. An evening breeze carries music and whistles and the singsong voices of people filling the street. It's Carnival in Haiti.

Our party arrived with 11 duffel bags stuffed with medical supplies and electrical equipment for rewiring the pump for the clinic's well. Customs was a bit of a problem when we were tagged for inspection and a duffel full of pills was opened. After a brief discussion, the inspector agreed to allow us to pass in return for a couple of baby acetaminophen. Although she didn't say so, it seemed to us that she was worried about a sick child at home.

On the road from the airport, people hung from the backs of the tiny colorful tap-tap buses you've seen portrayed in those painted tin cutouts. The real thing hardly seems any bigger.

By accident, the clinic's Dr. Leo was returning to Haiti from Canada on the same flight we were on. He and Michael, our obstetrician, both knew our driver, who will be taking us up the road on the six- to 10-hour trip to the clinic. Michael asked about the health of the driver's wife, who, as it turns out, is quite ill and requires a complex operation too risky to perform in Haiti. Leo and Michael are working to get her a travel visa to the U.S. As we discussed the case, we passed any number of people on the street in obvious need.

I asked Michael how he manages to prioritize: how can he expend so much energy on one person, when so many must do without. He looked into my eyes and said, "You just help the person in front of you."

It's a lesson I'll try to learn.

Labels: denoon, haiti

The person writing this post will be changing over the course of the coming week.

It will still be written by me, Dan DeNoon, senior writer for WebMD. But the only thing I'm sure about is that guy is going to change. And you're invited to watch it happen, and, more importantly, see why.

On Sunday 22 February I'll be going to Haiti on a one-week service mission with the nonprofit organization ServeHaiti, on whose board I've agreed to serve (without pay, of course, and paying expenses out of my own pocket).

ServeHaiti has built and maintains a medical clinic in Grand-Bois, an impoverished area in the mountains outside Port au Prince (almost to the Dominican border, about 35 as-the-crow-flies miles east-northeast of the city but a very long way by tortuous roads). I've seen the pictures and film from the area, and have met the heroic doctor who works at the clinic.

But I really don't know what to expect. I've been assured only of one thing: It will be a life-changing experience.

That having been said, this blog is not going to be about me. Yes, I'll be sharing my feelings, thoughts, and experiences. But my focus will be on the welfare of the people of Haiti -- on their resilience as well as on their struggles. And I'll be sharing with you what happens when someone from outside that world tries to make himself useful.

I've been to places where people struggle to survive before -- but only as a tourist wandering without a clue in city slums or hard-luck countrysides.

I'm still pretty clueless, but this time I'll be arriving carrying 90 pounds of medical supplies and ready to go to work. I very much hope to do some good.

My three traveling companions have made multiple trips to the area. One, Donna Williams, is a talented photographer. Another, Michael Grady, is an obstetrician. The third, Dave Schumaker, is an electrician.

This blog will carry a Twitter badge so you can follow my adventures more closely. And you can follow me on Twitter as ddenoon.

Many readers of this blog will have made service missions themselves to various places of the world. I invite you all to weigh in, and to keep this first-timer on his toes.

The plane leaves first thing Sunday morning. Good or bad, I'll be filing reports. You're invited to come along.

Follow the Entire Series

• Service Mission to Haiti
• In Another World
• People Everywhere, Water Not
• A Death anda Life
• Rain, Mud, and Water
• Time to Leave Grand Bois
• Big Country, One Doctor
• Kenia & Kafka
• Catching Up
• Images of Haiti
  

Labels: denoon, haiti