Health assessments

I had promised myself to see more of Haiti this summer, since I was going to be here for three months this time. Jacmel is pretty small and after six weeks of driving along the same main road every day, back and forth, I was ready for a change. So when I heard of a couple of health assessments that needed to be down in nearby towns, I jumped at the chance.

We went to Bainet a couple of weeks ago. This is the next town west of Jacmel, right along the southern coast. It’s only about 40 kms away, but I was told to prepare for a long journey. They weren’t kidding. It took us three hours to get there, driving on the bumpiest road I have ever been on, up into the mountains. It would have been a beautiful drive had my head not been bouncing around crazily. But as we crested the mountain, we could see Bainet below us, bright and colourful, with the ocean just beyond. Gorgeous!

Bainet itself is an old town, like Jacmel, with interesting architecture and old narrow roads (so narrow, in fact, that we had to do practically an 8-point turn to get into the street housing the town clinic), with a population of 70, 000 people. I had already heard that there was a hospital here, but that it was not fully functioning due to staffing issues. We found a few more problems than we bargained for. The clinic is named The Bainet 10 Bed Clinic. It is, in fact, Bainet’s only medical facility, and it only has 10 beds. This place has one operating room that is currently being used as a storage space. There is a dentist’s office, but no one knows if the equipment still works, since they haven’t had a dentist in 4 years. There is one labour and delivery room, but as a woman, I would never have used that room – a small cramped space, with two half beds with stirrups (so women have to sit up, there is no other half of the bed to lie down on) and a non-functioning bathroom. In fact, none of the bathrooms at the clinic are functioning. The facility has a small generator for electricity, but they don’t always have money to keep it running on gas - they have been known to deliver or suture people up in the dark. Pregnant woman tend to stay at home for deliveries and children rarely come here to receive care. If there are any urgent cases, or complicated deliveries, patients are referred to Jacmel’s St. Michel hospital. Bainet does not have an ambulance.This means that patients requiring surgery, women in labour that need a c-section, or patients that cannot be covered in Bainet, have to travel that bumpy road for 3 hours by moto to get to Jacmel. 3 HOURS. On a motorcycle. Unbelievable.

A few days after, we went to do an assessment at Anse-a-Pitres, a town right at the Haiti-Dominican Republic border. It is a smaller town, only 27, 000 people, but, as a bordering town, there is quite a bit of human trafficking, mostly in the form of prostitution. There is quite a bit of gender-based violence here. While we were there, we were told of several cases of rape involving young girls, including one girl who who was pregnant at 14 years old with her second child. She had her first child when she was 11. Anse-a-Pitres is about 80 kms or so from Jacmel, but it takes anywhere from 7-9 hours to get there because of the roads. In fact, if one decided to do this journey by car, it is preferable to go up to PAP and back down east, rather than head directly east along the southern coast from Jacmel. This clinic does not have an operating room and again, most women deliver at their homes. They have one vehicle to offer their urgent cases – a moto, of course. And it takes so long to get to the nearest Haitian hospital, that urgent or complicated cases are always sent across the border to the DR. This is not good.

The worst thing about these two towns is that neither was really damaged by the earthquake. This is the standard of care that has always been offered here. No standard at all. Happily, however, we should be able to help with the staffing.

Oh, by the way, I did not drive the 7 hours to and from Anse-a-Pitres. This was my ride!

An emotional week

It has been a tough few days here. There is a tropical storm sitting over Haiti right now. For awhile, it looked like it was going to turn into a hurricane, but thankfully it stayed nice and calm. I say calm, but it has rained heavily here the last few days, flooding roads so badly. In fact, my trip to Port-au-Prince the other day was delayed for several hours due to road blockage from rains and landslides. Last night, the wind from tropical storm Bonnie kicked up several notches…..it was pretty fierce. I lay awake most of the night, thinking of the camps and praying everyone was ok. We spoke to Charlotte this morning, and she said several tents fell during the night, right on top of people. Sigh.

Weather aside, it’s been emotional here lately. I work closely with my Haitian colleague, Mona. She and I became very close during my last trip here, and have only gotten closer since my return. We spend all day, everyday together, going from meeting to meeting, planning the community centre (updates in a later entry) and medical clinic (also another update!), and giggling and talking. She is like a sister to me. She is amazing. She was born and brought up in PAP, the middle child in a family of 7 children. Her mother died when she was 15, and her father died when she was 17. With her siblings’ help, she got through medical school and after graduating, she starting working in the north of Haiti, raising her son at the same time while her husband completed medical school. To reach this clinic, she used to ride a moto for two hours each way. All her siblings have moved to north America, but, despite their insistence that she join them, she wants to stay in Haiti. When she came to Jacmel with Haiti Village Health after the earthquake, it represented a new phase of life for her – she and her husband are finally together (well, on weekends….he travels in the countryside during the week with a mobile clinic), her son is in school and she is sharing her house with her two best friends. Last Saturday, she called me in the morning asking for the day off to spend with one of her housemates (Daphnee) and this housemate’s husband, since he was visiting (he also works in another town). Apparently they all had an amazing day together. As Daphnee, Daphnee’s husband and sister were driving towards Leogane, they got in a car accident. Daphnee’s sister fractured her arm badly and after a day in the local hospital, she was flown back to her home in the States for surgery. Daphnee and her husband both died. They are survived their 6 month old baby girl.

Mona is devastated. She manages to keep distracted during the days while we work, and I am happy I can be there with her and for her, distracting her and making her laugh. But that first day back to work was hard. We were in the car, quiet as I held her hand, and then she started to talk. As we drove through the streets, she talked about her friend, who was like a sister to her. She talked about her parents, she talked about the tough times she had in her life. As she spoke, we both cried. We went to Pinchinat and I felt so discouraged and so so sad for everyone there. We kept crying and talking as we went to the orphanage to drop of our vitamins for our malnourished girl (see “Updates and more!” entry). As we neared the orphanage, I saw the lineup of people, waiting for food, as I had seen them in March. There were so many children, hands clasped with siblings that weren’t much older. I was feeling like everywhere I looked, there was suffering and my heart completely broke for everyone. For camp residents, for the kids waiting for a meal, for Mona who has lost so many important people. I went in search for our girl with a runny nose and puffy eyes.

I saw her sitting up, her tiny body being supported by the side of her crib. She looked the same and as I approached her, I was about to burst into loud sobs. But before I had the chance, the best thing happened…. She reached out her arm to me and she smiled! Oh, it was like the sun burst out and I started crying and laughing. I was so happy for my girl, who had strength enough to recognize me and lift her arm right out. I held her hand and tickled her and yes, she ended up flopping down, but that’s ok. Baby steps. She will be ok.

There are days here when it feels like for every two steps forward, you take four back. But that’s ok. There were still two steps forward.

A little bit of Hollywood in Haiti.....kind of

In case it wasn’t obvious already, one of the things that brought me back to Haiti is the IDP camps. I have become really interested in everything to do with camps: site planning, camp management and camp coordination. While here in March, I read a lot about the work that the International Organization for Migration (IOM) does and really liked it. So while working for my NGO here, I am also trying to volunteer with the IOM as much as possible to learn how they function. I mentioned briefly in a previous entry that I did a food distribution with the IOM, which was interesting (especially as it was given to me to supervise!), but the most interesting thing I have done so far with them is camp assessments. These assessments are done to identify the true residents of the camp, as opposed to those people who don’t really live there, but come for the distributions/to take advantages of the services offered (I am of two minds about this – I certainly understand the need to identify the “truly vulnerable”, but if a person’s situation is so bad, or their access to resources so limited, that they voluntarily spend their days in these camps, then I say let them have the extra ration of food, or whatever. But anyways.). The only way to do an accurate assessment is to check the tents at night to see if anyone is sleeping there. We already know the names and number of people who are supposedly living in the tent – if they are not there at the dead of night, it means they are not true residents and down the tent goes.

We did two “night raids” on consecutive nights last week. I already knew the gist of what it was going to be like: At around 10pm, teams of 2-3 people would knock on each tent and confirm the information of the people inside. Any empty tents would be removed immediately. It sounds easy enough, except walking into these camps in the pitch black and waking unsuspecting, sleeping residents can be kind of dangerous. I knew we were going to have security agents. What I didn’t expect was how Hollywood movie-like it was going to be!

On the first night, we all met at the UN base for a final debriefing before heading out to the cars that were going to take us to the first camp. In the parking lot were 8 trucks waiting for us, with UN security guards, police officers and OCHA security all armed and ready to go. We pulled out of the base one truck at a time, in a long silent convoy. I have to say, it felt pretty cool! (I had called my sister just before leaving, to find out whether my parents had safely reached New Jersey. She very reasonably pointed out that my parents were driving on a smooth highway from Mtl to NJ in the daylight, while I was about to take off with a good percentage of the military personnel in Jacmel to do a night raid, and that maybe they had more reason to worry about me. I thought that was funny.)

We moved through the city, which was already mostly deserted, the trucks making sure to stick together, until we came up silently to the camp, where the trucks fanned out and quickly shut off their lights so that we wouldn’t alert residents that we were there (so that they wouldn’t call their friends to come sneak into the tents). I had 4 teams to supervise that night, so I was busy walking (and sometimes tripping) from section to section, making sure everything was going smoothly, with my little flashlight lighting my way. Generally teams had one member checking information while the other would be keeping guard. I was alone but had two very nice Sri Lankan UN officers staying near me and helping light my way. None of my teams found empty tents.

The second night was essentially the same except that everyone was exhausted...we had finished the night before around midnight...about three hours after everyone’s usual bedtime. But we met again at 9pm, headed out in that same cool Hollywood convoy and snuck up on the other camp. This time I had only two teams to supervise, so I stayed with them as they knocked on each tent. This is when I really realized what it must be like for the residents. Voices from inside the tents called out, sometimes sleepily, sometimes in fear, asking who had come to wake them in the middle of the night. They had to come to the door to show their ID cards, only to see their normally pitch-black and silent camp teeming with strangers walking around with flashlights everywhere and armed police surrounding the perimeter. One young man came to me and asked if he could just ask me one thing. “Why do you have to come like this to do this to us?”

We found and removed 10 tents that night. I know it was the right thing to do and could only be done this way. But I felt bad anyway.

Not much like Hollywood after all.

Updates and more!

I have to start by saying a big thank you to so many of my friends who have responded so generously to my last post. Each pledge has touched me and if I didn't know it before, I certainly know now how generous my friends are. I have to say a special thank you to my parents for going the extra mile - carrying printed copies of my blog with them and telling everyone they meet about my experiences here. Mom and Dad, you're the best!

The baby I wrote about in the last entry is doing great! We were able to buy them several days worth of food, as well as baby clothes and bathing stuff that she will need. We also dropped off a giant gallon of water to keep Mama hydrated and thus Baby breastfed. Right now, there are two ladies ready to give birth at any moment. We advised them to get to the hospital now, but they don't have money for a taxi. Thanks again to the money everyone raised on my behalf, we were able to assure them that we can help them. It's a good feeling!




I had a friend here who was working as an occupational therapist at the big hospital in Jacmel. For some reason, a little girl was referred to her for therapy. This was a little girl of 3, who looked like she was 1. She was unable to walk or talk, looked malnourished and was extremely fatigued. This baby didn't need therapy (and psychology - the other part of the referral), she needed to be hospitalized. The mother of this child lives far away in the mountains and felt like she could no longer care for her properly, so she left her baby girl in an orphanage. When we found out about the baby, we were able to override the referrals, and get her immediately hospitalized. Phew!


The doctor that made those ridiculous referrals comes from one of the NGOs here. We know of another case where he put a cast on a 10-year-old girl's arm that was so tight, within two weeks, she lost complete sensation in her hand. She will likely have to get this hand amputated, for no reason whatsoever. This is a big problem at the moment - there is no standard of care here. The worst part is that you can't do anything about it. You can talk to the WHO, who will in turn make recommendations that certain people or groups be stopped from working here, but that is the extent of it. It is up to the Haitian government to take the actual step of removing them, which then becomes a political problem.

As ever, take the dire example of Pinchinat. There is a military group from one country that is installed as official leader of the camp. But they are failing to provide adequate care and it is largely because of them that Pinchinat is in the state it is in. The WHO has recommended their removal, but the Haitian government won't remove them because they have an understanding at the federal level with the government of that country. But who suffers for that political understanding? It's the 8-year-old girl who was raped and her friend who was blinded in one eye when she tried to stop the rape, because there isn't adequate security here. It is the 11-year-old girl who was raped and is now 3 months pregnant, because there is a massive gap in the medical care here. It is the woman who gave birth on a mud floor in the rain with a male volunteer by her side and a razor as a surgical tool. It is the 16-year-old girl who is now a prostitute so that she can get (the free) food for her family, because there is an underground trade system in place here.

Of course, Pinchinat is not the only camp that is suffering. There is another camp in Jacmel located at the edge of a river. They only need one hurricane to hit for this entire camp to be wiped out. This camp is lacking proper latrines, so residents have been defecating into the river - the same river they wash themselves and their clothes in. They are also lacking drinking water and drink from the same river. Of course, conditions don't need to be so bad to make camp living intolerable. 6 months of hot days, hot tents, boredom, and lack of any change for 1.3 million people is more than enough to make life unbearable.

The current strategy is to encourage people to get out of camps and return home. Many camp residents are landowners and don’t need to be living in camps, but they do it to capitalize on the free services. In order to encourage them to leave, there are incentive programs in place, including several weeks worth of free food, hygiene kits and NGOs funding and building new homes for them. In fact, last week, I helped with a food distribution that the IOM organized, giving 3 months worth of food to 65 families who have already moved home. It was an interesting experience, at once satisfying, serving people who are returning to what will surely be a better situation for them, but at the same time, it was hard knowing that so few families are this lucky.

For Pinchinat, 203 families are without such luck. They are not landowners, and have nowhere else to go, but because their current situation is so desperate, they are being moved to a new camp. This new camp has been under construction for the last several months. Because there are site planners and engineers and experienced NGOs involved, this new camp will certainly address some of Pinchinat's problems - the latrines are in the middle of the camp, so there is less of a security issue for women and children. There are roads running through the camps, with proper ditches for drainage. There are already more security guards at this new camp though no one has moved there yet. A new hospital is being built on the camp grounds. But, as with many other relocations taking place around the country, these residents will leave the tents of Pinchinat only to move into tents at Mayard. While this is certainly not ideal, at least each family will have their own tent (instead of several families squished together at Pinchinat), and these tents will eventually be replaced by transitional shelters and then, hopefully, real homes. Construction for a child-friendly space has already begun and there is a big space allotted for the community. It is this space which especially interests me.

Since it looks like residents will be here for the next three years, we are proposing that an actual community centre be built here. We recognize that though the current philosophy is to get people out of camps (and the strategy to accomplish this is to make camp life unappealing....as if it wasn’t already), we are also looking at how to make life better for 203 families that have no other choice. We want to use this centre to run community-based programs and thus help to combat the lack of education here. Along with many partnering NGOs, we would like to start courses on health (for example, nutrition, STDs, reproductive health), gender-based violence (teaching people what it is and what resources are available), education (literacy classes, vocational classes, language classes), and cultural programs (showing documentaries, etc). We want to give residents something to do, while giving them a way to better there lives. This won’t be easy to do and, of course, we are waiting for the go-ahead so that we can start building.

This is a project near and dear to me. I so badly want to make life better for people who have had suffering heaped upon suffering. If my donors are in agreement, I would like to use part of the funds raised towards getting this centre built and getting the classes started. Hopefully the next time I write, it will be with an update that we got the go-ahead. Fingers crossed!