Konten

This last trip a volunteer asked me how many times I’ve traveled to Haiti.  I couldn’t answer them.  I ballparked the answer as somewhere between eight and twelve.  Some trips longer than others.  My comfort with Creole also variable.  My destinations change.  I’ve visited during my various stages of education.  There have been trips where I’m so far removed from my faith I might’ve spontaneously combusted walking into a church.  More recently, that has flipped to where I lean on my faith because I have learned that so much healing is beyond my control.  You know how frustrating that is for someone with as big of an ego as me?!?!?!  No matter the settings or situations I’ve felt like Haiti “helped me” much more than I helped the people I went to “serve”. 

I typically use this blog space to discuss clinical care for a patient encounter, but truthfully this most recent trip had very little of that.  And it may have been my most rewarding trip yet.  And I don’t say that to discount my other experiences, but my mentality was so different this time.  First, I was leading a bunch of other blan for the first time.  Second, I really separated myself (some) from the clinical and focused on the people.  And I was filled with joy.

One of the unique aspects of the St. Vincent de Paul clinic in Gran Bois where I was working is that it is basically one game of “Red Light… Green Light” away from the Dominican border.  No passport needed.  If anyone follows my other social media efforts you may have seen pictures of the stone marker denoting where Haiti transitions into the D.R., or even the photo of my phone getting confused and welcoming me to Vietnam.  #TrueStory  #GoHomeSiriYoureDrunk

Naturally, it’s a neat group activity to take a team of newbies on a hike and go to the “border”.  Then we get to take the standard photos of people “straddling the border” or waiving to each other from “different countries”.  Yes, everyone who travels to Haiti is a nerd, or at least they must pretend to be one when they travel with me.  #DealWithIt 

It was Sunday and we had a pretty eventful day - a two-hour church service (more on that experience on a later date), a walk through a bustling market, a sampling of fresh sugar cane, a soccer game, and so on and so on.  But, later in the afternoon and after our 3 pm “dinner” was settled I rounded up the crew to “hike to Dominica”.  Everyone put on their Dri-Fit tops, athletic shorts or gore-tex hiking pants, and Merrill hiking footwear to get ready for the trek.  Needless to stay, our (my) pasty-white skin and fresh, name-brand threads stood in stark contrast to the collection of kiddos that decided to follow us on our hike.  #ThisIsNotACallToDonateClothing

It was going great.  We had one good incline that made you kind of feel like Rocky when you got to the top.  But of course the kids dominated it like it was nothing.  #AltitudeTraining #HaitiFit  The climb was early in the hike, at least, so the rest of the time we could enjoy the amazing views from a relative highpoint. 

Some stumbles.  No falls.  Some poop dodging.  “Oooh’s” and “Ahhhh’s”.  And arrived at the marker.  There’s a peace at the top of a mountain in Haiti that is impossible to put into words, even when you’re surrounded by a thunderous herd of little boys.  Come with me some time and I’ll prove it.  Then you can try and put pen to paper.  Photo after photo after photo snapped trying to capture the majesty of the setting sun over mountain tops with lakes in the valleys.  Bob Ross would stay and paint for days.  But, days we did not have.

Haiti is on the CDC travel advisory warning list.  Recommendations are not to be out after dark for safety reasons.  Security in the country is sparse.  As a foreigner you are warned that you could be targeted.  Well, objective numero uno for this boss was to keep everyone on the trip safe (unless you count letting them ride on motos).  So, as I could see the sun was setting I had to break up the four hundredth photo “straddling” the border to encourage us to head back. 

We took a slightly longer way back, but one without as many steep climbs or descents.  Still copious amount of fecal material on the trails though, don’t worry #NameThatPoop #FunGame.  As the sun sank further several of the community boys ran ahead of us heading back home.  And then it struck me, they probably had a curfew.  How silly is that of a “eureka” moment?  Oh yeah, these little children are probably not supposed to be out after dark - especially with a bunch of foreigners.  I wonder if their parents are gonna ground them for being home late.  Is it weird that I, for some reason, figured those cultural things were exclusive to our over-protective suburban, “Wonder Years” families? 

As we sauntered on we all became engrossed in our steps.  It was dark.  The paths were made of rocks and dirt and poop, so no step was to be taken for granted.  The moon was coming up but by this time we were between peaks.  We were passing people, likely on their way home from a day of work or even a late Sunday church service.  The path narrowed and was flanked on either side by tall, thick bushes.  And my worst fear became a reality. 

The screams were reminiscent of a ferocious charge during a military battle and they seemed to surround our little party.  Panic was immediate as eyes quickly darted and tried to adjust.  Fight or flight causes your pupils to dilate so more light gets to the retina.  And what did we discover?  That those little shits had set up an ambush!  They hadn’t run home to beat curfew!  They just wanted to scare us!  And scare us they did!!!  I think one of the volunteers might’ve peed a little.  Terror turned to pure hilarity as they laughed and laughed and laughed at the jumpy blan. 

They were so proud.  And so much like little boys in the states.  Ornery little devils that were just up to mischief.  Oh, and they weren’t done.  They performed the same trick TWO MORE TIMES to us as we finished up our hike.  But, I wasn’t about to let them have the last laugh.  I caught a glimpse of a rock sliding and then a shirt trying to hide behind a mound of dirt.  They had laid their next trip… I made my move.  I swung around to the left to try and outflank them.  My long strides were lucky that they found true footing as I quickly ascended the large dirt and rock pile. 

I went for it.  “Ahhhhhhhhhhhhhhhhhhhh” as I wildly swung my arms in the air and closed the remaining steps to their secret location.  And they erupted in shrieking giggles as they scattered.  They scurried every which way, their smiles nearly glowing in the waning daylight. 

But the final word would not belong to the blan… A few of the boys set up one final trap for us as we were getting ready to turn back towards the clinic.  It was a fantastic cap for an eventful day.  A day disengaged from the clinic.  A day where we just went into the community to be among the people.  We attended church.  We participated in commerce.  We played Sunday futbol.  And we were the source of entertainment for a gang of mischievous boys.  I felt a sense of contentment and belonging that I can’t say I had ever felt just working in the clinic. 

Grief (The Story of Mirlande)

On an earlier visit to Haiti, I was fortunate enough to be invited to an “English Club”.  No, it was not an elitist club created for and by the blan, but rather a group of Haitians that would meet and practice their English.  It was fun!  They’d propose a topic and have philosophical discussion, in English, about it.  I quickly found that I wasn’t necessarily there to participate in the conversation, but more to help their pronunciations #StillAnOutsider

One such meeting took a turn I would have never predicted.  The topic was depression or, more specifically, “Who was more depressed – Haitians or Americans?”  Wow.  Let that sink in.  It seems so trivial, but then it starts hitting on so many different levels.  To me, at first, it was a no brainer.  I offered than in my brief (especially at that time) medical service in Haiti I very rarely came across patients whom I thought would meet criteria for depression using any sort of scoring system.  However, in the U.S. I feel like MDD is one of the more common diagnosis codes that end up in my notes.  Diabetes Mellitus Type II. Morbid Obesity. Major Depressive Disorder #TrendMuch?  I was hooked to the conversation.

In the group, the overwhelming response was that Haitians were more depressed.  I mean, they would HAVE to be, right?  Half of the morning in rural Haiti is spent getting water.  Most don’t have steady employment.  Food insecurity is common.  Infectious disease and trauma are daily occurrences.  This conversation was just two years removed from the Earthquake that claimed hundreds of thousands of lives and unquestionably impacted every single person in Haiti.  Plus, it was hot as hell where I was and there were no AC units to be found #FirstWorldProblems.  How could you disagree with their argument?!?

It stuck with me.  Mental health is a wholly under-represented field in low-resource countries.  Somehow, my friends at Respire are accomplishing the impossible by offering mental health counseling to their students.  The results and stories are both sad and amazing.  But it wasn’t until I was on this most recent trip to Gran Bois with ServeHaiti that I realized how vital this service is to community wellness.  (I hyperlinked to both organizations' websites if you want to see more about the awesome work each are doing or are interested in donating time / money / goods).

The story was sad.  A 6-month-old was brought in by her father because he couldn’t get her to eat anything.  She was laying in our hospital crib covered by a tattered blanky.  The kind of tattered you’d expect next to a toddler that just didn’t want to let go of their baby blanky.  Her brown eyes wide open and just piercing through me.  No smile.  No tears. 

The dad didn’t offer much for nonverbal cues as I began my infant exam.  That’s when we went from sad to tragic… “The mother had been working in the garden when a rock fell and hit her head and she died.”  Hold up.  Imagine, real quick, that you’re hunched over a 6-month-old auscultating her heart and trying to get any kind of reaction out of her with silly faces.  Then your interpreter drops this bombshell on you.  A monotone, run-on sentence that punches you right in the gut. 

“Wait…. What??”  “That’s what he said.  The mother was working in the garden when a rock fell and hit her head.”  “When did it happen?”  “Last Friday.”  It was Wednesday.  The girl hadn’t eaten anything in six days.  The staff at the clinic had started her on Plumpy Nut RUTF and Oral Rehydration Syrup as well as a vitamin regimen and some antibiotics for kicks. 

Powerless is seeing a problem and not being able to provide a solution to it.  And boy did I ever feel powerless.  Her problem extended well beyond any physical ailment.  She was grieving.  I imagine she was confused.  She needed to be nurtured.  Held.  Breastfed by her mom because that’s all she knew.  The father needed counseling.  How the hell does he deal with this?  Single parenthood is tough in the states (speaking not with personal experience), but I can’t even try and relate it to rural Haiti.    

It was a heavy reminder to me that mental health is more than just depression and “feeling the weight of sadness” as it was once characterized in a Zoloft commercial.  It’s about grieving.  It’s about coping.  Addressing PTSD.  It’s about the mind working through problems that modern medicine struggles to define let alone treat.  It’s about a community that doesn’t isolate a patient struggling with bipolar disorder or schizophrenia like they’re a crazy demon.  It’s about a healthcare provider who realizes that alcoholism and addiction can’t be treated with a pill or incarceration.  These treatments often require deep, interpersonal relationships, trust and a spiritual healing.

The first photo is her on admission and the Facebook image gives a little more background into some family dynamics from a couple of other volunteers.  This picture is her after ten days in the clinic.  Thank you to Liz McDermott and Sarah Stafford for the updates.

I don’t yet have a conclusion for the little girl’s story.  I hope the ending is far away and happy, but I fear the worst.  Even in the U.S. a tragedy like this would be very difficult to recover from.  They were the last patients I said goodbye to on my way out.  Her eyes still wide and vacant.  His eyes confused and full of fear.  I think I speak for the whole team that saw them when I say their faces will never leave my mind.