Tremor

My body is shaking.  I hold my hands out and they show the slightest movement that remind me of those real dramatic scenes in Saving Private Ryan.  My whole body shivers.  My teeth clatter.  I'm cold.  It's the first time in about ten weeks that I am actually cold.  I'm finally home.  And this morning I'm in church.  A cold church, relatively.

I can't attribute my 'tremors' to the temperature.  It certainly was a factor, but just minutes before while we were 'passing the peace of Christ' my preacher asked if I would take a few moments and speak to the congregation about my experience.  How do you say no?  This is the church I grew up in.  The pews are (sorta) filled with the adults who have shaped my life - family, friends, neighbors, teachers, coaches, Sunday School teachers, and my pastor.  They have supported me with their prayers, with their voice, and some with their pocket books.  I am who I am today - for good or bad - because of the people I was asked to address.  I gotta let them get a look at their product.

I have no idea what I'm going to say.  I got back into the country nearly 48 hours earlier.  I arrived to my home less than 36 hours prior.  I had slept probably 8 hours split between each night and couple that with the 3-4 hours a night I was managing on my last two nights in Haiti and I could easily write a new post on insomnia.  I haven't even mentally debriefed.  I haven't reflected on my trip.  Hell, I haven't let go of Bedica yet.  But after the offering and before the children's sermon, I make my way to the podium.

My 'tremors' haven't abated.  Maybe it's an intention tremor.  They get worse when you try and perform an action.  These were definitely getting worse as I was ascending the pulpit.  I start. I ramble. I try and make a couple jokes. I offer thanks to everyone.  And I apologize for not knowing what else to say.  I apologize for my tremors.  And then I have to apologize for crying.  I'm not an emotional person.  I absolutely hate emotions.  But up there, I lost it.  It was frustrating.  Perhaps that was my reflection over my past two weeks working for Bedica.  Whatever it was I repeated my thanks and left the podium, straight out the sanctuary, and into the boys restroom by my old Sunday school rooms...


My hands were trembling.  It's my next to last day in Haiti and I got up early because I couldn't sleep.  I was excited.  Today was the day I was going to walk into the U.S. Embassy and secure Bedica's non-immigrant visa.  But right now I was trying to figure out why my hands were shaking as I was dipping my spoon in my oatmeal.  Am I having tremors?  Is there another earthquake?  Surely not.  Maybe it was just my excitement for the day.  Definitely was weird though.

Mike and I load up to head to Port-au-Prince.  We have to take him to the airport.  He's going home.  After a pair of exchanges we arrive near the tap tap station in PAP.  John is already on the phone with our driver trying to direct him to us.  It doesn't take long before we have a throng of Haitians surrounding us, waiting for us to give out whatever we must be giving out.  I get a phone call.  It's Dr. Buresh.  I pass off the child to Mike and step away from the crowd to talk.

"Are you guys okay?"  "Uh... yeah.  We're in PAP getting ready to take Mike to the airport."  "I got an email saying there was an earthquake this morning and just wanted to make sure you guys were okay."  Curious.  We knew it wasn't a huge earthquake, only a 4.6.  After reading subsequent reports it sounds like it was centered near Port-au-Prince and I had probably felt an aftershock.  Nobody was harmed.  But with the memory still fresh from the 7.0 magnitude quake of just over a year ago, people were reportedly running into the streets scared...


People were all around me.  I was in the backseat of a busted up Toyota being driven by a very knowledgeable driver with some sweet driving gloves.  The sidewalks were full.  Traffic was packed.  Bedica and her mom were sitting next to me.  I don't think they were aware that I had just failed to secure her visa.  She wasn't aware that everything that we had been working on was being put on hold.  I was.  It sucked.

But something else occupied the city.  As we headed back towards City Soleil the traffic got heavier and the foot-traffic even thicker.  Then the driver told us, "There are no buses at the bus station."  How do you know?  We're not anywhere near the bus station right now.  This is the last thing I wanted right now.  I just wanted to get home, to America.  And the first step to that was getting back to Arcahaie.

"The city is hot."  "John, that means nothing to me.  What is going on."  It was impossible to get a direct translation from him.  I think he often tries to sensor things so as not to scare me or give me a negative perception of Haiti.  Pretty annoying, but I understand why.  He finally opens up.  "They are shooting in City Soleil."  Awesome.  The same City Soleil that we were currently driving to the heart of.  The same City Soleil that the tap taps to Arcahaie usually drive through and park in.  The same City Soleil that the UN eventually gave up on trying to disarm because they were losing too many men.

It now became obvious why the traffic and people were behaving the way they were.  We were clearly going the wrong way.  An empty tap tap sped by us but then had to slam on its breaks as it came up to more traffic.  People flooded into the back of it, fighting and pushing their way on board.  Some hung on to the side of the vehicle.  They were doing anything they could to get away from the turbulence.  I was convinced.  Let's turn this car around.  I no longer feel like it is necessary to verify if the bus station is active or not.  If Haitians feel like it is important to leave in droves then it is probably the best idea for a white person.

We have the radio on some sort of public station.  People are yelling.  I have no idea what's being said.  We're speeding down the road past people running on the sidewalk.  John points out a sign of President Martelly that has been painted over his face.  The people have turned against him.  A report just came out that he might in fact be a dual citizen #GodForbid #Sarcasm.  The man shouting on the radio is one of the Senators.  John translates for me.  "I did not know that he was a dual citizen.  But, if the people want to remove him then they should remove him."  Very supportive.  Exactly what Haiti needs to heal.

We drive through the city.  Traffic thins out and the number of people on the sidewalk normalizes. The sun is setting.  The driver wants to take me by a market.  It's huge, and empty.  The large stone buildings are charred and there are charred remains of what was probably the usual wood tents that make up a majority of markets.  "Why was it burned down?"  "Someone wanted to make it look bad for President Martelly."

The city was hot, like John said.  The excitement had nothing to do with the small earthquake.  It was a reminder that this country has a long way to go before the word 'stability' can enter the conversation.  Even beyond the dual citizen scandal there is another one brewing that involves hundreds of millions of dollars in foreign aid being stolen by people in power.  Already one high-profile person was assassinated in the wake of this scandal.  We can only hope that it is the last and the truth comes to light quickly...


I'm back in the United States.  My tremors haven't recurred since church.  My mind is still pre-occupied with the Haiti that I left Friday morning.  The scandals.  The turmoil.  The patients.  It's not something that I will shake easily.  Although it seems to make me shake easily.  The time will come when I will make my return to Haiti.  I can't predict when and I can't predict what the circumstances will be.  But I know I need to take the time to properly reflect on this experience.  I'm happy to talk about my time even if it appears to make me sad.  Some stories end well, some end poorly, and some do not yet have a conclusion.  I guess that's what keeps us coming back for more.

Anal Atresia: Hope

Hope isn't a disease, nor a number as far as I know, but it's the best term to discuss the near-conclusion to our story.  I emerged from the Ministry of Immigration on Tuesday with Bedica's passport in hand (notice the name change from how I had previously - Begika -  spelled it as this will be important to our story).  My final posting or contact with the outside world was a photo I was able to upload to facebook showing her passport.  That would be the last instant that we had power inside the compound for quite some time.  No power.  No internet.  #AsPrimitiveAsCanBe #IsMerryAnnSingle?  The lack of power/internet I believe was ultimately my undoing.

The steps I needed to complete before securing the VISA were muddy to say the least.  I knew I should secure a better "letter" from a Haitian physician as the one I was currently rocking was a google.translate job that I bs'ed one day by writing in cursive.  It had certainly worked up until this point, but I wanted to be as legit as possible when approaching the embassy.  I also needed to fill out the online application for the VISA.  And not only did I have to fill out this 10 page application that asked such gems of questions as, "have you ever been involved in any attempts to engage in human trafficking?" and "Have you ever enlisted child soldiers?"  But I also had to have the mom physically click the submit button.  No idea why.  And I have no idea how they expect anyone from Haiti to jump through these hoops.  The questions are absurd and not contextually appropriate.  What is her address?  Let me think, the stick and tin lean-to off the road leading from Carrefou Poy?  The only number is the one spray-painted by the post-earthquake inspection team that gave it the okay.

Okay, I'm venting.  But it is kind of a ridiculous questionnaire.  Again, I had to have the mom to click the submit button.  This is also impossible to do without power.  And for those of you wondering why I hadn't worked on this earlier it's because the second page of questions request the passport number. So, handcuffed until last Tuesday.  And then powerless.

The last things I needed were various documents from the U.S. including a letter from the medical team that would take care of her, notes from the host family stating that they will provide for her, and then some sort of confirmation from CHI that we wouldn't be expecting Haiti to pay for anything or using tax dollars.  Dr. Buresh had sent me most of this stuff the previous week.  For those of you waiting for the foreshadowing to come back, this is the time.  The previous week when we had all been operating under the understanding that the little girl's name was "Begika Emilise."  That's how my interpreter had spelled it to me during the first interview.  The parents had nodded when I showed it to them.  But when I finally took the time to look at the birth certificate and then the passport, to the people of Haiti her name was not "Begika" but "Bedica".


I was torn.  My phone batter was nearly dead.  It had few minutes.  I had no internet.  Do I find a way to get in touch with Dr. Buresh to get him to change the papers?  Or do I use the remaining charge on my computer to see if I can change the baby's name?  I opted for the latter.  You'd be surprised what you can do with a screen "snipping tool", Paint, and Microsoft Word.  After about an hour I had some fresh new documents with the baby's correct name and legit looking signatures and letterhead.  So that was settled, but I still had no way to print them and now my computer was about dead.

I cast that aside and took mama and baby to another clinic by my translator's house.  The local physician with whom we've established strong ties repeatedly rejected his ability to write a letter in support of our cause.  I do now know why.  He is a recent graduate of their medical school in Haiti, so perhaps he felt that he didn't have enough seniority.  It clearly states "A letter from a Haitian physician...".  It doesn't need to be the Grand Chief of Pediatric Butt Surgery.  But I certainly can't force the issue.

The other clinic is very nice.  Small, but appropriate.  John says they usually work from 6 am till 6 pm.  They had one physician there, a general medicine physician, but they also claimed to provide Ob/Gyn and Peds consultations.  Granted, there aren't residencies that I'm aware of in Haiti, so it's basically a person saying they specialized in a field.  The general med physician saw our patient.  He agreed with my assessment.  But once again I found a physician who did not want to write the letter.  I still can't understand why.  He punted to the clinic's "Medical Director" perhaps because he was an older, more respected physician.  Only problem, the medical director wasn't in yet.  We would have to return.

And we did.  We came back and sat down in the waiting room.  It was filled.  However, I think that most of the people were there because the tv was playing the Barcelona soccer game.  Cheers would erupt when Messi would score his goal and the doctors would come sprinting out of the exam rooms to catch the replay.  I guess I can say I'm no better as I was watching the Cardinals playoff games while I was doing ER shifts #12in12.

Finally he took us back.  He sat down behind his desk and asked what we needed.  I explained the situation.  "We need a letter from a Haitian doctor describing the baby's condition.  We need their declaration that she is healthy enough to travel to the U.S., but that she needs to rather urgently to get the surgery performed because it cannot be performed in Haiti."  The word "cannot" is used rather loosely.  The surgery can be performed.  Heck, I can "do" it.  But if you want the kid to have a good outcome, heck, if you want the child to survive, you need to take her to the U.S.  We tried Zanmi Lasante.  We tried the Italians or Spaniards that have the hospital in PAP.  We were told that the General Hospital was trying to achieve 100% mortality rates for this procedure.  So all of our local options were drying up quicker than a goat hide in the Arcahaie sun.  We needed a letter, and since I was leaving in two days, I needed it stat.

"Come back tomorrow so the pediatrician can see her."  "I DON'T NEED A LETTER FROM THE PEDIATRICIAN.  A FOUR-YEAR-OLD GIRL CAN MAKE THIS DIAGNOSIS."  I explained to him in a much more watered-down tone that he couldn't understand anyways.  The other doctor had already seen her.  All I need is a letter.  He discussed with the other physician...  "We'll get it to you first thing tomorrow morning."

FML.  So much of this journey has been spent walking away from an office at the end of the day with the 'promise' of having what I need be there "first thing tomorrow morning."  It hasn't been the case yet, and on Thursday (today) it would keep its hitting streak alive.  I had yet to find that single person who was a problem solver.  A person who would look at a pile of nails in their path, and instead of turning around (like I'm convinced most Haitians would) he/she would lay a tarp over it, or build a bridge, or make wooden shoes.  I don't know what, but they would do something.  Everyone seems very content to just sit back and let everything happen.

I went home.  Still no power.  Maybe there would be some tomorrow.  People were coming to fix the generator at some point #HaitiTime.  I was left with my thoughts.  At this point my thoughts are pretty sparse, so I fell asleep at approximately 9pm #GoodOrBad #BrainDrain.  Unfortunately, Mike was sick and probably could have used an IV.  Apparently I'm a bad roommate and slept through all of his cries for help #StillAlive  #BackInTheUs#BackInTheUS#BackInTheUSofA.

The next morning John was supposed to pick up the letter at the clinic and then grab the mama and baby on the way to the compound.  Both are on his way.  I call him at 8am.  It doesn't ring.  I call him at 9am.  No answer.  He calls back.  "I'm still waiting for them at the clinic."  So much for them working from 6am till 6pm.  He finally gets the paper and calls to ask what he should do.  "Like I said ten times before, bring the paper and the patient to the compound."  Why, you might ask.  Well, late in the morning the people finally came to work on the generator.  It fired up about 10am.  I went to work on the application.

Ten pages, at least.  I finished just before John arrived with the mama and baby.  "John, can you tell her to push the submit button?"  He stutters.  She doesn't move.  I take her hand, put it on the left mouse key and say, "Presse."  You better believe I bloggie'ed the crap out of that action.  I wasn't going to let them tell me she didn't submit the application.  I loaded everything onto my flash drive and we took off as quick as we could.  Mike said his goodbyes and came with since he was heading to the airport.

We left the compound at 1130.  Boarded a bus/tap tap at about 12 and stood waiting in City Soleil for about half an hour for my go-to driver to come pick us up.  Mike's flight was at 5, so he opted not to make the trip to the embassy.  We drop him off at the airport and the guys in red shirts pounce on his luggage.  We arrive at the embassy at around 2pm.  The sign says they operate until 3:30pm.  I know heading into this visit that I do not have an appointment, which you are supposed to take the time to schedule for a non-immigrant visa.  I did not have that luxury.  You are also supposed to print out the application confirmation.  I had it on my flash drive, but did not have available printing #NoKinkos.

I talk to the Haitians guarding the front and explain the situation.  She guides me back to the more formal security gate.  Fortunately the workers I talk to are bilingual as John had went with the driver to find food for everyone.  I carefully explain the situation and hand over the doctor's letter.  He reads it, and he clearly cannot understand it all, but it obviously strikes a cord with him.  He realizes the serious nature of the child's condition.  I mean, as soon as you hear that someone doesn't have a butthole, you probably freak out #WhatWouldYouDoWithNoButthole?  He starts making phone calls.  Dial tone.  Answering machine.  Endless ringing.  No voices.  He re-iterates that I'm supposed to schedule an appointment.  I re-iterate that I was only able to submit the application this morning and my flight leaves at 0930 tomorrow morning.  Again, he realizes my relatively desperate position.

The phones still go unanswered.  I decide to try my one and only trump card that I have access to, my hosts.  I call Mahalia who readily offers up a personal friend of hers that works in the Embassy.    The clock clicks past 2:30.  I walk to the other end of the building along the outside wall.  He meets me outside the gate.  We exchange pleasantries and then he starts up with, "You need to schedule an appointment."  #BeenThroughThis.  "I can't."  He says there is no way around this, you have to schedule the appointment and then email the lady to request an urgent meeting.  "You mean I can't call her?  I can't show up and try to speak with her face to face instead of dancing around the internet?"  Is it just me or is that kind of ridiculous?  That would be like going to the police station to file a complaint and them saying, "I'm sorry we only handle that business by phone."  WTF.  I'm trying to eliminate a few steps in the process here.  I only need enough of her time and energy as it takes to pick up a rubber stamp and place it down on this little girl's passport.  Or hell, if she's pissed off she can slam it like it's Wile E. Coyote's head under the mallet.  I don't care.  Just stamp the damn passport.

He couldn't help.  I thank him for his kindness of coming to see me and quickly brush past him.  I had limited time and I had to try something else #WhoYaGonnaCall.  Unfortunately there were no ghosts to be had nor do I have Bill Murray on speed dial #HowAwesomeWouldThatBe.  So I called the next best thing, my mom.  "Mom, are you by a computer?"  She's actually in a car dealership where they have a public computer #WhatADeal.  I have her log into my email and send a message to the PAP embassy.  Subject: Medical Visa Bedica Ermilus.  Content: Need appointment today. Medical emergency.  Signed -Me.  Dramatic?  I think not.  Then, she is able to find my submission confirmation and in the email are links to follow that eventually lead to a scheduling page.  I tell her to schedule one for the first available.  It's Monday, March 12th.  Whatever.  Get it on the books.  #ThanksLoveYaMommy.

I run back to the other entrance with the scheduling confirmation scribbled on my hand.  It's about 3:15 at this point.  Keep in mind that I walk when I talk, so I had actually crossed the street at one point, entered into a bank, got frisked and wanded by a security guard, contemplated bribing a bank teller to print off everything off my flash drive, but then walked out dejected before having even tried to speak Creole all in the midst of having my mom pull off the epic Toyota Showroom Scheduling Spectacular.

I rush past the first security guards praying I don't get tasered in the back.  I enter the main security doors and tell the very helpful guard that I have a appointment code now and have sent the lady an email.  He gets a look of absolute "Oh shit."  The person that you have to talk to...just left.

Foxtrot.  Uniform.  Charlie.  Kilo.  He tried.  To his credit, he tried.  Hell, he might've got himself in trouble by trying so hard.  And I certainly hope that wasn't the case.  From the look on his face he felt like a failure too.  I felt bad for him.  But I also felt bad for Bedica and Carole (the mom).  Not because this would have been the might success for them, that will come with the surgery, but I have been pushing and pulling them back and forth across Haiti for nearly two weeks and I fell one step short of securing the child's trip to the U.S.

It won't be difficult to complete the process.  It will just take somebody to bring the baby with them to the embassy with the paperwork that we have assembled and with a pre-arranged appointment (piece of excrement) to get the rubber stamp go-ahead.  Then the 'Blan' Knight can come down and whisk Bedica away to the land of germ theory and post-operative nursing care where she can safely have her surgery performed with expectations of a great outcome.  And honestly, I've had so much of this kid's shit on me that the surgeon better do a damn good job so that never has to happen to anybody else #BabyPoopIsNotTheNewAxeBodyFragrance.

I will leave Haiti tomorrow morning, bright and early.  A week ago I was nearly in tears with all the struggles I was facing in trying to power through this process #TearDuctsSurgicallyRemoved.  But now, I can leave with the comfort of knowing that I did what I could and she is way closer than Vegas odds-makers would have placed her.  I didn't know what my chances of success were when Chris told me to focus on this.  In rereading the emails we received from others who have been involved in Haiti, they said that they usually take 7-10 days to get everything lined up.  Some steps can take up to a couple months.  The quickest they've been able to do it is 5 days, but that was before many of the regulations were in place and it was a medical emergency.  I've used up the last two weeks of my trip trying to make this happen.  I've dealt with public transportation, a well-intentioned but under-equipped translator, extortion, bribery, a lost birth certificate, 2 hour lunch breaks, week-long karnival celebrations, work days ending at 1:30 pm, and my own frustrations and limitations and still managed to come to the front gates of the final goal.  My grail.  My El Dorado.  But unlike the explorers of the past, I have faith that my quest will come to fruition and Bedica will get her surgery.

Anal Atresia: Cashed

Physically.  Mentally.  And Emotionally.  Cashed.  The term hasn't quite made it to Haiti.  In fact, I'm not so sure that this use of cashed has spread much further than my Southern Illinois routes.  But when something is done, or empty, we say it is cashed.  And that's how I feel.

Last Friday seemed successful.  On Thursday we were told that the paper was lost and that we'd have to restart the process.  We did.  We went to Arcahaie and had to pay $20 to get them to make a new birth certificate.  Pretty sure that was extortion, but when you're pressed against a hard time line there really isn't much negotiating.  However, this time they did what we asked them.  They actually gave us the copy so that we could deliver it to our next step.  The constant promises of "the paper is coming" or "we just sent it to the next place" were in fact all lies.  I'm assuming they were lies.  I can't verify that anyone knew where the copies of paper were last week.  So, we started over on Friday.  With the hand-written birth certificate in hand, John and I made for Port-au-Prince where we went to the Public Archives.  There, we walked up, handed over the sheet of paper, and waited till they brought it back out with a little slip saying they "verified" it.  Really important step apparently.

So that was it, we were told.  That was what was needed to move forward towards procuring a passport.  And I was happy to head into the weekend with some positive news.  It all seemed so easy when they just let us take care of transport...  Oh, what could have been.

Last night I passed out at 8pm.  I had went on a three hour hike up the mountains and then moto-ed back to the compound.  Then I went to English Club and basically gave a lecture about health and medicine.  It was a long, exhausting, but also rejuvenating day.

I woke up at 2 am feeling awful.  My stomach wasn't rejuvenated and for some reason I picked the last week to catch some sort of cold.  #NotHelpful.  My sleep was shot.  My breathing was labored.  My stomach was, well I'll spare you the details.  Let's just say I wasn't feeling good when 6 am rolled around.

The troops were rallied.  Water bottles were filled.  The wallet was replenished.  I was off to secure the passport.

We hopped on the truck.  I opted to stand because no matter what position you're in on those things you're going to be uncomfortable.  At least this way I wouldn't be bouncing my tailbone on a hard plank.  The ride was jerky.  Swerving left to right with sudden stops and starts.  Pretty standard.  Not great when you feel like crap.  Speaking of crap.  The other day I was on a moto when the driver pointed out a woman on another moto and said, "She has cholera."  How did he know, you ask?  I wasn't paying attention, but he said you can tell because she was laying down on the back of the moto.  Makes a lot of sense.  With cholera you don't have a lot of bowel control, so you want to put yourself in the best position possible to prevent leakage.  Therefore, you lay down on the back of the moto.  Wonder what the sensitivity and specificity of that observation is?  

As if the poop stories weren't enough.  My luck just wasn't great today.  The tap tap was packed full.  A woman in a yellow dress came a stood next to me.  She didn't last long.  She certainly looked uncomfortable.  She sat down and it became more evident; this woman was sick with something.  A man behind me opened up some sort of cooler and she splashed the water on her face.  With every bump or twist of the truck she would grab my ankle for support.  And then the gates opened up.  I glanced down and see her vomiting all over the floor, into her hands, and then into her coat.  Like I said, she looked sick.  I certainly couldn't diagnose her with anything other than diaphoresis, emesis, and pregnancy.  Her traveling companions kept offering her water to splash on her face.  The emesis didn't seem to stop. 

It did.  The girl sitting behind her was nice enough to not complain when the woman laid back against her legs.  We were almost to PAP.  I checked her pulse.  Quick, but not scary quick.  When we got off I made sure they were on their way to the hospital.  I bought 6 things of ice water to pack with them and sent them on their way.  I had other fish to fry and the family was tending to her.

We left by moto to the Ministry of Justice.  The motos are ten times more expensive in PAP than everywhere else.  I would guess that is because they know we aren't familiar with the layout of the community.  We don't know how far everything is away from each other.  It seems like they won't even start their engines for anything less than twenty dollars Haitian.  I'm tired of arguing at this point.  I know I'm getting ripped off, but it's exhausting to argue for a fair price.  

En route we encounter a police road block.  Just a few policemen with really big guns.  They were checking papers from the drivers and giving people pat downs.  Now, I speak a little Creole at this point.  But I sure wasn't going to let them think that I understood a lick.  He started asking about my papers.  "M pa konprann."  I didn't have my passport and I don't know why he would need it.  The questions kept coming.  I really don't think he believed me when I said I didn't speak Creole.  And for good reason I guess.  He came close and put his hand on my shoulder.  He walked around to the back of the bike and told me to "descendre."  That much I do know, so I started getting off.  Before I could even start to truly worry what was going to happen, he started laughing, said something about me understanding Creole, and let us go on our ways.  Crisis averted.

We arrived at the Ministry of Justice.  As always, the guards at the gate start asking John a bunch of questions.  They inquire about me.  They inquire about the mom.  And they inquire about what kind of "malade" the baby has.  It doesn't help that the baby doesn't look sick.  She looks very peaceful and the mom doesn't seem to be at all concerned about the image she portrays when she breastfeeds her child in the waiting rooms.  Maybe you'd want to hide that.  Maybe we don't want them thinking that the baby has no problem eating.  If the baby has no problem eating, then why wouldn't they assume that they baby can actually poop okay?  And often times they do.  IMO they shouldn't even be told what's going on, but this is Haiti and judging by my abundance of photos there is no HIPAA here.  

And now it starts getting frustrating.  My understanding of the process from here forward was that I would need to pay the Ministry of Justice for some sort of authorization and then take that paper to the Ministry of Immigration where they would complete a passport for the child.  Piece of cake.  Nothing in Haiti, or on this journey, has been a piece of cake. 

We needed more paper.  They told us we had to go to get a notary to "authorize" the travel.  No amount of questioning could ever get them or my translator - never truly know who is to blame in these situations - to articulate what this paper was or why I needed it.  Just that, "we have to do it." So John got directions, sort of, and we were off.  By directions I mean he was told a name to tell the moto drivers.  In case you haven't figured this out yet by my writing, I hate dealing with less than a full deck of cards.  And throughout this entire journey we've been playing with a deck that was a little "light."  Maybe smaller than a euchre deck.  

We wandered around.  If I pushed him to then he would ask for directions.  But a natural problem solver he is not.  

The office is not well labeled.  There is a small print of the official's name on the window, but other than that no identifying marks can be found.  We enter.  Mom is quiet, like always.  She finds a place to sit and tends to her baby.  John goes to work trying to figure out what paper we need and how much it's going to cost.  "Twa mille Gourdes."  I was dumbfounded.  I didn't know what this paper was.  I didn't know where else we could get it.  And I definitely didn't know how much it should cost.  Although, I would wager a bet that it shouldn't cost 3000 Gourdes.  

Over the course of our visit in the notary's office I was asked to hand over my passport, give them my address, give them the address where the baby will be taken in the U.S. just to name a few.  I tried to have some language put into the document that would place medical decision making into the hands of Dr. Buresh and his wife.  No one could translate between English and French including my translator.  So we have English mixed in with the French of this "very official" paper.

It cost $500 Gourdes.  Discount for some reason.  But we were told that we would have to come back and get more papers before we took the child out of the country.  Whatever it takes.  We hop on a pair of motos and head back to the Ministry of Justice.

Before we even get through the front gate, the security guards start telling us we need another piece of paper.  Now, these men do not know where we've been.  They do not know what papers we have.  And they shouldn't really bother themselves to know what we're trying to do.  But they do, and they have, and they were right.  We did need to go somewhere else to get yet another paper that I had not been told about until I was already trying to move on to the next step.  Remember what I said about operating with less than half a deck of cards?

It's walking distance from the Ministry.  After John gets us lost again by walking in the complete opposite direction as they told us, we finally get on the right path.  Before we even get to the front door a couple well dressed gentleman standing outside flag us down.  John explains the situation.  One of them says for 500 Gourdes he will get the paper we need.  Again, "What paper are we getting?  Why do we need it?  Where else can we get it?"  John is clueless.  He doesn't answer any of my questions.  I'm tired of pulling teeth.  I hand over the money.  He disappears inside the building. 

Twenty minutes later he emerges with a sheet of paper.  I guess it's what we need.  At the bottom it has a "cost."  "9.5 Gds."  Great.  Really glad I paid so much extra for that.  We get a copy made of each document before heading back to the Ministry of Justice.  We make it past the guards this time back to the original office.  She said something about us having the other paper and all I could think was, "Oh, very good you went and got the paper that I knew you would need but thought it more fun not to tell you to get it before coming back here."  She and another lady signed our papers and sent us on our way.  And as opposed to going to the Ministry of Immigration like I thought we would be, they sent us back to our second stop where the guys were still hanging out front.  We had to purchase a "temp passport."  

I breezed past them this time.  I wanted to see the process inside.  One followed us and even showed us the way.  It was a long line.  I was smart enough to ask the lady at the previous office how much this temp passport would cost.  "320 Haitian Dollars."  That's about $40 U.S.  I asked the man who walked us back to the line.  "They cost about 320 Haitian, so if you give me 400 I can go have it made for you."  Honesty.  I was impressed.  I agreed and got out the money.  He took it, a couple of our papers, and headed towards the front of the line.  I saw him pass by an older gentleman and hand off the money with a few quiet words in his ear.  He came back and got the mom and placed her at the front of the line.  It's that easy.  

We had it.  The man asked for a small tip since he got none of the extra money.  I handed over a couple bucks.  We finally had everything in hand that we would need to get the passport.  Another moto ride brought us to the Ministry of Immigration.  

The building is poorly labeled.  In fact, we had to walk around the back and through a gate to get where we were supposed to go.  We stop and talk to a security guard sitting behind a desk.  John volunteers our papers for further direction.  He pauses at our ID cards.  "You're going to need a NIF number."  "She has a NIF number."  "She needs a better one."  Again, I ask why, how, how long, when and where.  The answers I get are, "It'll make it easier.  There is a man nearby."  Turns out there was a guy right behind us who said for the low low price of 1000 Gourdes he could make it for us.  I counter with $20 US (just over half).  He accepts.  He takes our papers and my $20 and heads off.  I send John to fetch our food as it was nearly 2 pm and we hadn't eaten other than the protein bars I had given to each of them.

The gentelman returns with a piece of paper with the same NIF number on it as the photo ID's I had made and this paper didn't have a photo on it.  He said we'd need to attach one.  I didn't feel like messing with it, so we went on into the building.

We didn't get questioned about the IDs once.  In the first office they directed us upstairs.  In the second office they said that we were too late for today and we'd need to come back tomorrow.  They stop at 1pm.  I toyed with the $40 U.S. in my pocket looking for the right person to try and encourage to help us make this happen today.  We convinced this office to direct us to the office where they handle the passports.  The door is open.  The guard lets us pass.  A half dozen people are still sitting in the waiting room.  John speaks up, surprisingly, to talk with the receptionist.  She states that we are too late.  I implore her to let us speak to the director in charge.  She asks.  He comes out.  He's a very tall, young man who greets me in English.  He examines our papers and confirms that we have all the necessary documents.  No reference to the photo ID cards.  But he still tells us to come back tomorrow.

I'm awkward.  I've never actually bribed someone before. But I wanted to do it without everyone else seeing it.  So I palmed a couple twenties in my hand and just asked the man, "Are you sure there isn't anything else we can do to make this happen today?"  All the while my eyes keep glancing down towards my hand.  He probably thought I had a nervous tic.  He didn't see it or he wasn't impressed.  We're going back tomorrow.

Another long day has passed.  I still feel sick as I type and I hope that I wake up feeling much better tomorrow.  We have to make yet another trip to Port-au-Prince to get the passport.  After that it will be the visa.  The way our progress has been thus far I do not hold great confidence in my getting this done before I leave this Friday.  But I do know that John and I will continue to move forward and that she will get her surgery.

Headache Revisited

The smell was awful.  Some combination of rotten fish, spoiled fruits and vegetables, burning trash and the general musk of the dominant cooking oil seeping out through the pores.  The latter was probably me as my body has pretty much acclimated to the local cuisine.  Still.  Everything was nauseating.  The exhaust was wafting in front of my eyes.  The horns blazed around me and the driver had never seen a brake light he didn't want to accelerate into.  My head was throbbing #Thunderclap.

Couple this with my hypertensive crisis that I had created a mere half hour earlier when I nearly got myself arrested out of frustration with everything about Haiti.  Over the past week we have made four trips to Port au Prince only to be told that the "paper" isn't there, "Someone else has it," and it will be here tomorrow.  We've gone to the city of Arcahaie and heard the same story.  Everyone wants to pass the buck.  I've offered bribes.  I've applied guilt.  I've tried intimidation with wild gestures, loud noises and curse words that mean absolutely nothing to anyone, including my translator.  I've considered threatening to take $1000 U.S. to a voodoo priest and cursing their penis, but I don't want my behavior to reflect too poorly on my organization #StillNotABadIdea.

My blood pressure reflects my frustration #CaptainObvious.  My frustration at John for not getting all the appropriate information, for not being able to function without me holding his hand, and for not having a good enough vocabulary to copy my outlandish tirades (Okay, the latter is probably for the best); My frustration at my patients for continually making us late in getting to Port-au-Prince; And worst of all my frustration with everything about Haiti.  It's rough.  The constant, unnecessary bureaucracy that impedes every step.  The lack of accountability that makes it impossible to figure out where we are in the process and what needs to be done.  The lack of accountability that makes it so easy for them to say "someone else has the paper.  They'll bring it tomorrow."  Knowing full well that they don't have a freaking (#Censored) clue where the paper is or when it will arrive.  The mentality in every passerby that I'm a cash cow just ready to hand out money to everyone who asks for it.  The same thought from all of the modes of transportation, shop keepers, and even my translators who expect me to pay premium prices for everything because I'm white and I have infinite money.  Sorry guys, no cheat codes in this game.

I'm whining.  Just venting my frustrations for no other reason other than to tell myself I'm not an alcoholic for truly feeling like booze is what I need to calm my mind tonight.  And then my story could be about my morning headache #CAGEPositive.  But neither of these are my title's inspiration.

While I had John trying to figure something out with the Archived Birth Certificate (total waste of time sending him by himself) I was across town at St. Damien's hospital with Julmis, my new translator, and the hydrocephalus girl trying to get her in to see a neurosurgeon.  We got to the gates at about 1230 pm after spending 20 minutes haggling with a taxi driver to bring us there and return us to the tap tap station #JustAnotherRipOff.  After dropping off my camera at the security booth (top secret stuff inside, ya know) we made our way towards the pediatric clinic.  The sign out front said that clinics shut down at 1pm, so I knew we would be pushing it.  Turns out we were 'too late'.  It was a quarter till and the woman out front said the doctor would be leaving soon so we'd have to come back tomorrow.

If you can't tell, I'm tired of the 'coming back tomorrow'.  I certainly don't feel entitled to exemplary treatment.  When it comes down to it do I push more because I'm white?  Absolutely.  I don't expect it to work all the time, and I pick and choose my moments.  When I'm facing a hard deadline and need to get all the steps accomplished so these two little girls can receive the treatment they need you can bet I'm going to push to the brink of arrest.  And I also don't have a problem name dropping Rigan, who is going to be CHI's first full time employee if he can step aside from his role at St. Damien's.  Name dropping only helps if the person is knowledgeable enough.  This lady wasn't.

Rigan wasn't around and he wasn't answering his phone.  I was stranded.  I continued to push and the time ticked past 1 o'clock.  I knew my odds of getting the girl seen were sliding away from 'slim' towards 'none'.  I could only hope that John was having better luck across town (he wasn't).

I went to the front desk and explained the situation.  And then I did the usual 'loud with wild gestures' to hammer home the point.  She said someone would see us if we went to the clinic.  Yet another person trying to pass the buck.  I didn't fall for it.  I called her out for sending us to a clinic she knew wouldn't see us.  She wasn't impressed.  Probably because my tone didn't translate well.  Then I tried a completely different tactic.  I tried pleading.  I calmly apologized if she was offended by my previous tone.  I explained that all I want was for this girl to get into the system.  I know she can't get the surgery today.  I don't even know if the neurosurgeon will want to attempt anything given her age.  But I just want a doctor to evaluate her, schedule her for an appointment with a surgeon, and go from there.

She understood.  But it still didn't look like it was going to help us today.  Maybe she just didn't have enough clout.

And then it hit me.  The girl has a huge head.  This is not something you see every day, even at a hospital.  I know what it is, but I've also had medicine drilled into my head for the past 3 and a half years #TalkAboutHeadache.  The women I've been talking to have zero medical training.  I play the trump card.  "Julmis, I need you to talk to the mom for me.  I need you to tell the mom that her child has a headache.  We're going to go to the emergency room, we're going to tell them that the girl has a headache, and we're going to get seen."  He explained it to the mom and we walked towards the emergency room.  The lady at the front desk tried to call us out.  Again, she referred us to the clinic.  I pushed back.  "The baby has a bad headache.  Look at her head.  There is something wrong.  Are you a doctor?  Can you evaluate her and say this isn't an emergency?  Didn't think so."  #Asshole  #YouBetcha.

It worked.  She wasn't pleased with my tone.  But she sent us to the ER.  Julmis went with her.  The triage nurse there sent us to the clinic where we finally sat in a line to be evaluated.  Success.  She was posted up next to a couple of kids on IVs, so I knew there was some level of care being administered here.

At this point I left to tend to John and our paper work.  Julmis worked the St. Damien's task.  It wasn't until I had suffered through the two mile stretch of rotting and burning trash in a densely populated area of PAP that I finally met back up with Julmis and got the update.  The girl was seen.  She has to return tomorrow, but she was evaluated.  They think they can help her.  It may not lead to a ventriculostomy, but she will be seen by a skilled physician.

It wasn't an Excedrin.  And it wasn't an Anheuser product.  But knowing that with a little more effort this girl was going to be evaluated by a trained physician provided a little redemption to a crappy day.  It's exhausting.  I've said it before, the lows can take you low, but hold on to the highs as best as you can.  And sometimes you'll be fortunate enough to catch a glimpse of innocence that can help refill your tank.  Even if it's a few extra fumes, that's something to help you get out of bed the next day for another headache.