Reports from Haiti

Even though I’ve been back in the states for almost a week now, the events of last week are just too exciting not to blog about.

When BTB project coordinator Janet arrived in Thomonde last Wednesday to check up on our internship projects and transport us back to the U.S., Kelly and I were astonished to find out that Jeffrey Sachs, Sonia Sachs, and an entire UN delegation were planning to visit Project Medishare the next day!

I don’t think I’ve mentioned this in my previous blogs, but one of the villages where Project Medishare’s team works, Marmont, has been selected by the Earth Institute as a Millennium Village. It is the first Millennium Village in the Western Hemisphere. The goal of the Millennium Village Project is to improve the health, agriculture, economy, etc. in one impoverished village at a time in a developing country. The villages are designed to demonstrate how the Millennium Development Goals can be achieved through community-based development.

Early Thursday morning, about 30 conference attendees arrived at Project Medishare’s compound and we began a tour of Marmont’s various development projects.

Our first stop was at the construction site for the Akamil Production Facility and the Childhood Nutrition Treatment Center. Akamil is an oatmeal-like substance (we actually tried it at lunch—it’s good!) fortified with vitamins and minerals, which will be produced locally in order to decrease the prevalence of malnutrition in the area.

Next, we drove up Mourne Sourit to take in a view of Marmont. We could see Thomonde, Hinche, and the surrounding area.

We then met a group of farmers under a tall tree at the bottom of the hill, where we witnessed a dialogue between Jeffrey Sachs and local Haitian farmers. He asked the farmers what kind of crops they grew, where they obtained water, if they had enough water, what they thought the government and other non-governmental organizations could provide for them, etc. He also specifically asked the women, “Do you have enough food?”, and the women in the crowd quickly and in unison answered, “No.”

It was an incredible opportunity to observe this conversation between Jeffrey Sachs and the farmers. It’s one thing to hear such an important figure in international development speak, but to be able to listen in on a conversation between Jeffrey Sachs and everyday Haitian farmers, and really see Jeffrey Sachs in his element, is truly a one-in-a-lifetime opportunity.

The delegation then took a quick tour of the clinic in Marmont and the Maternity Ward construction site, which is expected to be completed in December. A dormitory-like building is also under construction directly behind the ward, which will house physicians and staff so that they can provide 24-hour care for women.

(Dr. Green, Dr. Fournier, Professor Jeffrey Sachs, Dr. Greig, Dr. Malou, and Dr. Sonia Sachs in front of the Maternity Ward site)

When we arrived back at Project Medishare headquarters, Kelly and I had hoped to demonstrate at least one of the backpacks to any of the conference attendees, but we knew that they were on a very tight schedule and understood that we might not get the opportunity due to time restraints. Dr. Arthur Fournier, co-founder of Project Medishare, was able to gather a few people to view the Diagnostic Lab-in-a-Backpack, however, and Kelly and I were thrilled to give a quick demo of the backpack. Dr. Fournier and Dr. Sonia Sachs were very impressed with the backpack and were able to provide us with valuable feedback as well.

(Dr. Fournier, the representative for the Haitian Prime Minister, and Dr. Sonia Sachs examining the user manual of the Diagnostic Lab-in-a-Backpack)

As quickly as they came, the delegation departed for Port-au-Prince, and it was hard to believe that all of the day’s events had actually happened. From schoolchildren, to medical students, to Jeffrey and Sonia Sachs, Kelly and I have certainly met a wide range of interesting and inspiring people in Haiti!

Since this is my last blog, I want to thank Beyond Traditional Borders, Bethlehem Ministries and the staff and students at St. Barthelemy, Project Medishare, Janet Wheeler, Kelly, and all of the incredible people I’ve worked with at Rice and in Haiti for providing me with this amazing opportunity.

A quick story on how the past year’s events have come full circle for me: just last summer, I happened to read a book about a doctor in Haiti, Mountains Beyond Mountains. I came across the name of a hospital that sounded familiar, and after talking to my mom, I realized that it was the same hospital she had worked at over ten years ago. Thus began my initial interest in global health. Soon after, I also happened to read The End of Poverty, by Jeffrey Sachs, which further spurred my interest. In the fall, I eagerly signed up for a Bioengineering and World Health course and took a subsequent course in the spring. Only one year later, I find myself living and working in the settings of these books, meeting the people I’ve read about and experiencing the country I’ve heard about for years, and even meeting one of the authors. I wouldn’t be exaggerating to say that this experience has been a dream come true.

In many ways, this internship has felt like the culmination of months of preparation and work, and it has been, but I also know that this is just the end of a beginning. As a rising senior who’s still unsure about life after graduation, I went into this internship expecting to figure out which post-grad road to take, but I’m surprisingly as uncertain as ever. I’ve experienced the hope in teaching children who otherwise would not receive an education, witnessed the joy in providing sight to the blind, felt the excitement in building devices that improve the health of those most in need, and enjoyed the adventure of traveling and experiencing a new culture. A year ago, I never would have expected to be where I am now, so I’m not too worried about the future—I know it will work out even better than I can imagine.

Thanks for reading! I hope you enjoyed reading about my adventures in Haiti as much as I enjoyed writing about them.

This week, our last in Haiti, has been as amazing and unforgettable as our entire experience here. What follows is a Reader’s Digest version of our crazy week!

On Monday, Jocelyn and I worked at Project Medishare’s clinic in Marmont. We counted out thousands of multi-vitamins and iron pills. While working the pharmacist Nanette played English songs off of her phone – Celine Dion, Elton John, and some other fun classics, over and over. (I am not sure I will be able to hear Shania Twain’s “You’re Still the One” and not think of fun-loving Nanette’s big smile.) The work was very relaxing and it was nice to be doing something that was clearly needed.

Tuesday was an educational day. Jocelyn and I shadowed a Project Medishare Community Health Worker (CHW) while she made her rounds in Marmont. She asked to see children’s vaccination cards and instructed people to see the doctor if they were sick. We gained valuable insight into the role of the Haitian CHW that we can use to help improve the CHW pack, which is, if you remember, one of the three packs we brought with us to Haiti.

Wednesday was very quiet as we spent the majority of the day in preparation for the arrival of our mentor Janet and a demonstration of the Diagnostic Lab-in-a-Backpack to physicians, nurses, and technicians from Project Medishare. The backpack was well-received, with one physician even declaring how the backpack would help him in conduct his mobile clinics.

Thursday was almost indescribable it was so surreal and amazing. Project Medishare invited many influential people to visit the Marmont Millennium Village Project and conduct a conversation with the Haitians about what they want for themselves and their families – and what they need to get there. In all of my time here in Haiti, working with various organizations, it is the first time I have heard anyone actually ask the Haitians what they want. I was honored to be present at this important event.

We were fortunate to be able to demonstrate the backpack to Dr. Arthur Fournier, co-founder of Project Medishare, and Professor Jeffrey and Dr. Sonia Sachs. Dr. Fournier and Dr. Sachs provided us with some valuable suggestions for additions to the backpack.

Jocelyn and I just finished writing a blog for Project Medishare detailing the time we spent there demonstrating the backpack. It should be up soon. Check it out at http://projectmedishare.wordpress.com.

This morning (Friday) Janet, Jocelyn, and I made our way to Port-au-Prince in preparation for our early flight tomorrow morning. The drive from the Central Plateau down through the mountains was beautiful. The varied scenery –mountains, a lake, a dam, and the sea- makes for a ride full of sights well worth seeing. We are staying in a lovely apartment owned by Project Medishare. From our porch we have an excellent view of the city.

Our last week here in Haiti has been a fast-paced, exciting blur. At the beginning of this week I was sitting in Medishare’s clinic counting pills to Celine Dion’s sultry tones, yesterday we demonstrated the backpack to Jeffrey and Sonia Sachs and many other interesting people, and today I am sitting in a comfy red armchair in a beautiful home in Port-au-Prince.

I cannot believe I am going home tomorrow. I am going to miss Haiti so much, especially the wonderful people I have met here and the bananas; the bananas are divine. This has truly been the experience of a lifetime. The knowledge I have gained here has left me better prepared to understand the challenges we face in improving global health and to work toward improving the quality of life for all of the world’s people.

I would like to thank everyone who made this internship possible, including the Beyond Traditional Borders Initiative, the Howard Hughes Medical Institute, St. Barthelemy School, and Project Medishare. Janet, your company and insight have been invaluable. Jocelyn, my other half, I wouldn’t have wanted to be here with anyone else, even if we jokingly argue like an old married couple! Thank you everyone!

This post’s title pretty much sums up the past week in Thomonde. Kelly and I had the opportunity to tag along with the medical team from Morehouse School of Medicine on their mobile clinics, which was very interesting and enjoyable (sidenote: approximately 99% of the Americans I’ve met in Haiti are from Georgia, including Kelly, so I’ve come to the conclusion that Georgians are slowly taking over Haiti. Don’t be fooled by their innocent Southern accents; they’re definitely up to something). Our daily commutes to the clinic sites were an experience themselves, as we had to drive for up to 2 hours through the hills, valleys, and streams of the Central Plateau to reach our various destinations.

But let me backtrack a little: last Monday, we left Terrier Rouge (a bittersweet goodbye) and flew from Cap Haitien to Port-au-Prince. After spending six weeks in Northern Haiti and visiting Cap Haitien several times, I actually felt some reverse cultural shock when we arrived in Port-au-Prince. While I’m sure the area that we drove through was a nicer part of the city, Kelly and I were both surprised at the relative cleanliness and consideration for traffic laws. We even saw several traffic lights.

After meeting up with the team of med students, MPH students, doctors, and nurses from Morehouse, we headed to Thomonde, via the most winding, edge-of-the-cliff road I’ve ever driven on (and considering I grew up in Pittsburgh, the capital of ridiculous road systems, that’s definitely saying something). I can’t even begin to describe the amazing view along the way, so I’ll try to upload some photos in a later post.

Even though I’ve read Mountains Beyond Mountains (like many global health enthusiasts) and tried to imagine the bumpy Rue Nationale 3, the beautiful Lac du Peligre, and other features of the Central Plateau, nothing can compare to seeing it in person. It was like seeing a movie version of one of your favorite books, but in real life and ten times better!

The first night in Thomonde, Kelly and I got to know the medical team, realized just how much we missed conversations in English, and tried to help out with some basic Creole translations. While I really haven’t learned as much Creole as I probably should have after spending six weeks in Haiti, Kelly and I are pretty adept at Creole pronunciation, so we did our best to write out some phonetic Creole (i.e., “M’rele” became “mmm ray-lay”). If all else fails, Kelly and I can start our own phonetic Creole translation business after graduation.

Tuesday through Friday, we drove to four different villages and watched the team quickly transform various churches/schoolhouses/shaded trees into functioning triage, pediatric, ophthalmologic, OB/GYN, and internal medicine stations. Because the team treated hundreds of patients each day and had to make quick, gut-reaction diagnoses, the diagnostic backpacks Kelly and I brought were not applicable to their work, but we were able to observe how a mass-scale mobile clinic works and understand both the challenging and rewarding aspects of such work.

A patient being fitted for glasses

While many patients received medical care that they would otherwise have never received, and some critical patients were referred to the closest hospital for life-saving treatment, there were some obvious limitations to the mobile clinic as well. Patients with end-stage cancer, ectopic pregnancies, Turner’s syndrome, or other difficult/life-threatening/genetic conditions were given their diagnosis, but treatment was out of the scope of the clinic.

Lines of patients waiting to see the ophthalmologist and internist

Observing the mobile clinic work also gave me a whole new appreciation for health prevention and the health and hygiene lessons we taught in Terrier Rouge. I can only hope that our lessons on hand washing, teeth brushing, malaria and typhoid transmission, etc. at St. Barthelemy will prevent at least a handful of clinic visits in the future.

Kelly and I probably spent the most amount of time at the pediatric station, where we measured kids’ arm circumference, height, and weight. Many of the patients suffered from malnutrition, and several times I did a double-take when I read a child’s age on their chart after taking their weight—I might not have a medical degree, but I do know that a 3-year-old should never weigh 18 lbs.

We also tried to help translate at the triage station by asking patients, “Ki kote ou fe mal”?,” which means, “Where does it hurt?,” so that they could be referred to the proper station for further diagnosis and treatment. It was rather shocking how many patients, after saying that their stomach hurt, subsequently said, “M’grangou,” which means, “I’m hungry.”

It reminded me of a quote in Mountains Beyond Mountains that giving medicine but not food is like “washing your hands and drying them in the dirt.” Not that I advocate handing out food necessarily, but the fact that many patients needed the simple treatment of “food” surprised and saddened me. The food shortage in Haiti struck me even more during our drive to Hinche. We saw street vendors selling bagged dirt, and one of Medishare’s doctors explained that Haitians use the dirt to make “dirt pies” that they actually eat. I don’t think I’ll ever look at dirt, or pie, the same way again.

I actually felt the most useful when Kelly and I were given a portable photo printer that the team had brought in lieu of the no-longer manufactured Polaroid camera and film. Throughout the clinic on Thursday and Friday, we took photos of mothers with their children at the pediatric station and gave them a print to keep. It put a smile on my face to see the mothers’ smiles when they saw the photo of them with their children. In a country where many people do not even know what they look like because they can’t afford a mirror, something as simple as a photograph can mean so much to someone.

The portable photo printer.... a nice mobile clinic novelty

My favorite mom-child photo 🙂

Overall, I really enjoyed our time at the mobile clinics, and being able to observe and work with such a gracious and fun team of students and doctors made the past five days some of my most memorable and enjoyable in Haiti.

Today was the dedication of the third and final floor of the school and the graduation ceremonies.  Everything, including the kids’ outfits, was St. Barthelemy colors, red and white. The decorations were beautiful.  There were red and white tissue paper chains and white doves lining the walls. The kids graduating from preschool were so adorable.   The girls wore frilly white dresses with red satin sashes.  The boys looked like little men, uncomfortable in their white long-sleeved button-ups and khaki pants.  Some boys had a piece of red cloth pinned to their shirts like a tie.  The graduates from the sixth grade wore their red St. Barthelemy shirts with khaki pants.  Lots of dancing and singing later, the kids graduated from preschool and sixth grade.  This year’s graduation was especially important because the sixth grade class is the first class to complete its education at the primary school. 

At the end of the graduation ceremonies, gifts were handed out, gifts that Jocelyn and I wrapped in the weeks leading up to the event.  Some of the gifts were oddly shaped, which made them hard to wrap.  Their odd shapes and a shortage of wrapping paper led to some interesting creations.  One particularly memorable gift was a calico beanie baby on top of a sack of jacks.  I wrapped the gift carefully, but did not have enough paper for the head, so I had to cut a scrap and wrap it around the head.  It looked like a green, red, and grey striped Egyptian sphinx.  Jocelyn and I watched to see the kid that would get this special gift.

Music for the ceremony included Britney Spears (the old stuff), the Backstreet Boys, and, of course, Celine Dion.  I am convinced that if Haiti had a Top40, Celine would be all over it.  The Haitians love her!

After the ceremonies we were sitting on our porch enjoying the cool (by Haitian standards) night air.  Joseph, our translator, came over to say good-bye.  While exchanging wishes for good health and hopes for long lives, it hit me that we are really leaving. I am very sad, but Jocelyn and I hope to come back together someday.  Hopefully we will be that fortunate!

Tonight is our last night here in Terrier Rouge, and I have to say it is a bittersweet ending.  We are excited to get started on our projects in Thomonde, but we will miss our friends here in TR.  We will never forget all the people we met here, the things we have seen, and, most importantly, what we have learned about the world and ourselves.  

This is our last weekend in Terrier Rouge and I’m finding it hard to believe that our time in Haiti is coming to a close so quickly. I’m really looking forward to the next two weeks at Project Medishare in Thomonde, but St. Barthelemy has grown on me more and more over the past six weeks and it’ll be hard to say goodbye to the amazing students, teachers, and staff here.

I know that most of my posts so far have focused on my outward experiences and observations in Haiti, and I’ve avoided delving into a lot of my own personal thoughts and emotions. It’s easy for me to describe what I’ve seen and heard, but to describe what I’ve felt seems nearly impossible. Every conversation, interaction, and experience I’ve had in Haiti elicits more thoughts and emotions than I could even begin to describe. It’s almost as if I would need some sort of stock exchange-like live update attached to my blog: Jocelyn is hopeful… Jocelyn is nervous…. Jocelyn is thrilled…. etc. to show my “thought of the minute.” Even though I’ve been in Haiti for six weeks, I feel like I’m just beginning to process my time here.

Thursday’s adventures, however, allowed me to gain a new perspective on Haiti, literally and metaphorically, so I’ll do my best to tie together a narrative of the day and how it represents one of the overarching themes of my experience so far:

At the crack of dawn, Kelly, our translator, and I packed into one of the school’s SUVs and made our way to Milot, via Cap Haitien and a few other modes of transportation (for the sake of my parents’ blood pressure, I’ll leave it at that). When we arrived in Milot, we made our way to the center of town to begin our ascent up the mountain, on top of which the Citadelle, the largest fortress in the Western Hemisphere and one of Haiti’s most famous landmarks, is located.

(the Citadelle is the square-shaped structure in the center of the photo)

After some tough monetary negotiations with a rather questionable “official” tour guide (at times, the Haitian gourde-Haitian dollar-American dollar conversion has required some long division!), we made our way up the mountain via another mode of transportation and on foot. At one point, I began to wonder why we thought climbing one of the highest mountains in Northern Haiti in July was a good idea, but once we arrived at the Citadelle and took in the spectacular view, I realized it was more than worth the climb.

I felt like we were on top of the world—I could see in every direction for miles, from the bay of Cap, to the Grand Rivière in the valley, to the mountains in the South. It was truly one of the most incredible sights I’ve ever seen.

According to a plaque we read inside the fort, the Citadelle was built by King Christophe to defend Haiti against French invasion. In 1820, the king committed suicide after a mutiny arose, and although his body was returned to the Citadelle, to this day, no one knows where his remains lie in the fortress (future Pirates of the Caribbean/Indiana Jones movie plot? I think so).

On our way back down the mountain, we also explored the ruins of Sans Souci, King Christophe’s palace.

The completely different views from the base and the top of the mountain reminded me of the different perspectives I’ve had during my work at the school and clinic. Many times, I’ve had a “base of the mountain” view of my work, but seeing my work from a larger, “top of the mountain” perspective is so much more rewarding.

Some days, I felt so overwhelmed by all of the kids and their bottomless energy in the mid-day heat. I sometimes wondered how we would manage to teach and encourage healthy behaviors in children who are surrounded by anything and everything that inhibits good health. But then I see kids like 6 year-old Didi, who has a smile that could stop an army, and 12 year-old Francisca, who asks such thought-provoking questions, and their smiles and questions remind me why we’re teaching and how fortunate I am to play a role in their education. This experience is not about the insignificant, day-to-day frustrations I may complain about; it’s about passing on some of the knowledge that I’ve been so blessed to receive in my life to the kids whose lives can be changed with such knowledge.

During our work in the clinic, it can be so easy to fall into the negativity trap when a patient’s file has two different reference numbers, or when the language barrier between you and the technician seems momentarily insurmountable. But no matter how confusing the filing system and conversations may be, I try to remember that these patients are so fortunate to even have medical records at all, and the fact that I am participating in their medical care, even in the smallest way, is a huge privilege and valuable learning experience.

So I’m trying to view every obstacle and challenge as part of the overall picture, and to not get caught up in the smaller, momentary frustrations that come with living and working in an unfamiliar place. I think it’s important to gain both perspectives, but the view from the top, while a lot more difficult to reach, allows you to fully appreciate and understand the view from the bottom.

St. Barthelemy’s kindergarten and 6^th grade graduation is tomorrow, and then Kelly and I leave for Thomonde Monday morning, so my next blog will most likely be from Thomonde. This weekend will definitely be our busiest yet.

Happy Fourth of July!

The mobile clinic last Saturday was definitely one of the highlights of my time in Haiti so far.

Setting up the mobile clinic in Phaeton

I know Kelly described the clinic in detail already, so I’ll just add a few of my own observations while working with Dr. Lucien.

Kelly and Josenide examining a hematocrit sample

A majority of Dr. Lucien’s patients, about 25 total, received post-op care after having cataract surgery over a month ago. She performed surgeries in only one eye per patient in order to minimize risk of infection and complications (I think this is the standard procedure for all cataract surgeries).

While Dr. Lucien brought several of her own supplies on the trip, she was also able to use the equipment in the diagnostic eye pack as well. Our main goal in bringing all of the backpacks to Haiti is to observe their use by physicians and receive feedback in order to improve upon the designs.

The exam protocol was similar for each patient. Dr. Lucien’s assistant first checked patients’ visual acuity with a vision chart in the front of the building, and then Dr. Lucien examined patients in a room away from sunlight. She examined the patients’ treated and untreated eyes with a direct ophthalmoscope, slit lamp, headlight, and penlight. I was able to view a few of the patient’s intraocular lenses that were implanted after the removal of the cataract with the slit lamp, as well as the patients’ clouded cataracts in the untreated eyes.

Paul, Dr. Lucien's assistant, performing vision tests

After visually examining the eyes, Dr. Lucien numbed some of the patients’ eyes with medication and used a tonometer to measure the intraocular pressure of the eye. In one case, the patients’ pressure was very high, which indicated glaucoma. Dr. Lucien explained that this was why the patient’s surgery was not nearly as successful as it could have been because of his underlying glaucoma condition.

Dr. Lucien examining a patient with the portable slit lamp

Another particularly interesting case involved a non-cataract patient. A middle-aged gentleman had difficulty seeing in his right eye, but the reason for his poor vision was not immediately obvious. Dr. Lucien applied drops to dilate his pupil, and after examining him again she noticed that he had scarring on his retina and prescribed him with medication.

While post-op complications seemed to be minimal, the joy of regained sight was infectious. When Dr. Lucien asked one woman how she was doing since her surgery, she replied, “M’ap danse!,” which means “I’m dancing!” in Creole. Another woman said “Grace à Dieu, grace à Dieu” several times, meaning “thanks be to God,” for her restored sight. There were many other comments made by the patients, but I could only translate the relieved and grateful looks on their faces.

I cannot imagine how it must feel to have sight restored after months or even years of blindness. While working on my project during the school year, I learned that in places like Haiti and other developing countries where surgical eye care is not readily available, a vast majority of people with cataract accept their blindness as a permanent condition and learn to live with it. Dr. Lucien’s work in Haiti is a testament to the fact that Haitians should not and do not have to learn to live with treatable blindness.

I could not ask to observe and work with a more respectable and adaptable physician. Dr. Lucien managed to see 25 patients in less than 4 hours while dealing with sweltering heat, chickens strolling through the exam room, equipment malfunctions, and other interruptions and distractions. It was certainly a sight to behold (and thanks to her skillful work, her patients could!).

Kelly and I sporting the backpacks. Huge hit on the medical fashion runway 🙂

Since the mobile clinic last week and the end of school, Kelly and I have been working on various small projects to prepare for the graduation next Sunday. We’ve also been assisting one of the technicians at the clinic with the entry of electronic medical records.

I think I can speak for Kelly, too, when I say that we miss the kids dearly. We’ve still got our rooster, donkey, and cow neighbors to keep our little Haitian countryside symphony going, but it’s oddly quiet at 8 in the morning without 600 kids outside of our window.

Also, I was a little under the weather after the clinic, but I’m feeling 100% better now thanks to Kelly and the school staff’s attentive care. I’m pretty sure the entire town of Terrier Rouge knew I was sick. No, really: I saw our translator on Tuesday, after not seeing him since last Friday, and he knew I had been sick, and another preschool teacher asked me if I was feeling better too. Word travels fast around here!

A few visitors and relatives of the Brunos are in town this weekend for the St. Pierre (Terrier Rouge’s patron saint) festival, so it should be an exciting and busy weekend.

On Saturday Jocelyn and I went along with the clinic staff on the long anticipated mobile clinic.  We set it up with them a few weeks ago to test out the backpacks we brought with us –the Diagnostic, Community Health Worker and Ophthalmology packs- and get feedback. 

Phaeton, the town we conducted the mobile clinic in, was about a thirty-minute drive away on unpaved roads.  Ever wonder how many people and how much medical supplies can fit in a Land Cruiser?  One driver, two doctors, three technicians, two interns, three backpacks, countless bags, and a puppy on the way back. 

Once we got to Phaeton, we stopped at the local clinic and set up camp for the day.  There were already people waiting.  Jocelyn worked with Dr. Lucien the ophthalmologist and I worked with the technicians.  Dr. Lucien had performed surgery on many of the patients last month and the day’s clinic would serve as their post-op appointment.  It was truly wonderful to see the patients express their joy over regaining their sight.  Jocelyn said one lady even talked about how she was dancing now that she could see.  The technicians and I used the equipment in the Diagnostic and Community Health Worker backpacks to perform tests and conduct routine check-ups.  The most interesting moment of the day for me was when we performed a malaria test and (unfortunately for the patient) got to see the malaria parasite under the microscope.  The day was very productive and we got lots of feedback from the clinic staff on how to further improve the packs. 

While we were at the clinic there were two cute puppies playing in the yard.  Dr. Lucien decided to bring one of the puppies, a cute little girl, back with her.  She was a tiny, adorable thing and we got asked to name her!  We chose to name her Malou.  I think Dr. Lucien liked it because when we told her our choice, she smiled and said, “Malou-lou” to her new puppy.  

Sunday was a strange day because it was my first day doing things on my own.  Jocelyn was not feeling well.  Pere Bruno conducted a small church service at the school, and Doug and I went.  Then, Doug asked me to see if I could “drive” the Capteur Soleil.  He wanted to test out the set of instructions he had written.  We identified a few things that could be improved, and, a few hours later, we enjoyed some yummy steam-cooked vegetables.    Doug and Jean left yesterday, and Jocelyn and I were sad to see them go.  We really enjoyed their visit – from the card games and conversations to the shared understandings.  

Today was the last day of school, and we couldn’t have asked for a better way to finish off the year than by demonstrating the Capteur Soleil to the 6^th grade class.

Jean, Dr. Schuler, Richard (who works at the school), Josef (our translator), Kelly and I all visited the 6^th grade class, and Dr. Schuler and Richard explained how the Capteur works.

It was especially exciting to see Richard up in front of the class, drawing diagrams on the board and asking the students questions. Jean told us that Richard assembled a lot of the Capteur himself, so it’s really great to see a school employee take ownership of the device and share his knowledge with the students. It’s one thing if we, as the out-of-place foreigners, are excited about the project, but it’s even better if students, teachers, and staff at the school show interest in it as well.

After a brief lecture in the classroom, we all made our way down behind the school to see the Capteur in action. The kids seemed quite amazed by the UFO-like device that “landed” behind their school just this past week.

Some of the students put their hands near the top of the device, where the sun’s rays, bouncing off the mirrors, are concentrated, and they could feel the increased temperature. This seemed like a great way for them to conceptualize the idea of light being converted to heat.

Richard poured some water into a tube, which traveled up to the “concentrator” part of the device. The sun’s rays, focused at the “concentrator,” converted the water to steam, the steam entered a cooking pot, and food in the pot was cooked. We actually ate some potatoes that were cooked in the Capteur the other day (“pommes de terre du soleil”, as Jean called them), and they tasted even better than usual.

I’m just amazed that, in only 5 days, Jean and Dr. Schuler have been able to transport, assemble, and complete a functioning device as complicated as the Capteur Soleil. I feel so lucky to be present for such a momentous occasion.

Speaking of momentous occasions, we will be participating in the mobile clinic with Dr. Lucien, Dr. Gustave, and the whole traveling medical team tomorrow! I can hardly wait to see the backpacks in action. After nearly a year of planning, discussing, and designing the diagnostic eye pack, with many bumps in the road and changing directions, it will be a dream come true to see the pack used for its intended purpose. I only wish it were possible for everyone who has contributed to the Diagnostic Lab-in-a-Backpack, Community Health Worker Backpack, and Diagnostic Eye Pack to see the results of their work as well, although there are probably too many people to count.

Our work at the clinic has begun to pick up this past week. On Thursday, we helped the technicians organize medical records. Patients’ files are ordered numerically and the number is matched to the patient’s name in a spreadsheet. We had some initial confusion about the record system because some numbers were accidentally used for multiple patients, and a lot of the names sounded very similar (for example, there were files for twins named “Josenide” and “Josemide”… as a twin myself, I would just like to thank my parents for giving my sister and I very different names!).

Kelly and I also observed that the techs were not using the Excel program as optimally as they could have, so we’re hoping to show them a few pointers if time allows. The techs were really friendly and interested in learning English, and I’m excited to continue working with them.

I also spoke to Dr. Lucien and Dr. Gustave about the lab protocols (Gram staining, hematocrit, urinalysis, etc.) that can be performed with the Diagnostic Backpack. They were interested in having the technicians read and become familiar with the protocols, but because the directions are only in English, I suggested that Kelly and I could translate the directions to French. Between the two of us and our translator, we hope to translate as much as possible before the mobile clinic on Saturday (5 days! I can’t wait!).

On Friday, we taught a bone and dental hygiene lesson to the lower grades and a malaria and typhoid transmission lesson to the upper grades.

We discussed how we have 206 bones in our body, where the main bones in our body are located (cue Kelly’s amazing skeleton poster), how our teeth are a type of bone, and how and why we brush our teeth. When we asked them how long we should brush our teeth, we got some really funny answers, like 52 minutes, 2 hours, and other rather lengthy amounts of time. Kelly and I realized that the hand washing song is ~30 seconds, so if you brush your teeth while singing the hand washing song 4 times, it’s a pretty good teeth-brushing timer (4X in 3 classes + teaching the song 2 weeks ago = we are now singing the song in our sleep. That, on top of chloroquine, makes for some very interesting dreams).

We had other amusing replies to the question, “What do we put on our toothbrush?” We were hoping to hear “clean water” and maybe a few “toothpaste” answers, but the entire class replied, in unison, “COLGAT.” Apparently Colgate has strong branding strategies in Haiti.
The 6^th grade lesson was really interesting and fun, as always. Kelly and I intended to tie together the germ transmission lesson and cell lesson into a disease transmission on a cellular level lesson. We used sheets of paper to depict the sequence of both typhoid and malaria transmission, with purple glitter representing the typhoid bacteria and silver glitter to representing the malaria parasite (as you can tell, glitter might be our most popular teaching tool). After we explained each step in the transmission process for each disease, we asked several students to hold the papers in front of the class, put the transmission steps in order, and explain the events of each step.

As a visual learner with nonexistent artistic ability, I think it’s been helpful to show a few images on my computer of whatever cell/bacteria/parasite we’re discussing so that the students have a better mental picture of the concept as well.

The students asked a lot of really great questions, like “what kind of mosquito carries the malaria parasite?,” “can you get malaria from eating from the same spoon as someone who has malaria?” and, “can you get malaria if blood from an infected person gets into a cut in your skin?” (which led me to ponder their knowledge of HIV, but that’s a whole other summer’s worth of material…). I love the question/answer part of our lesson; it’s almost like I can see the wheels turning in the students’ heads.

For me, this lesson was one of the most rewarding parts of our teaching experience so far. To hear the students explaining the function of red and white blood cells, the importance of hand washing, the affect of germs on our body, all in one class period, was like seeing pieces of a puzzle finally fit together. It’s still a work in progress, and we might have lost a few pieces and jammed a few pieces into the wrong place, but I can start to see the overall picture.

We had a fairly uneventful weekend, with the exception of Dr. Schuler, a Rice professor at the Jones School, and his father-in-law, Jean Boubour, arriving on Sunday to begin their Capteur Soleil project, which is a type of solar device used for cooking, medical instrument sterilization, and other heating applications. Kelly and I were particularly excited about a potential soap-making application as well, as we’ve noticed the lack of soap in the school’s bathrooms, and we’ve considered initiating a soap-making project with some of the older students once school is out.

While helping with some of the assembly of the device this afternoon, we’ve discovered an addition to the list of “Things Kelly and Jocelyn Do That the Haitians Find Hilarious” (eating mangoes being first on the list): using screwdrivers, hammers, or any other tool. One of the kitchen ladies watched us struggle with a bolt for a few minutes, laughing to herself at the phenomenon of women using tools. For our next act, maybe we’ll play soccer with the boys. While wearing pants 😉

No, it’s not actually snowing in Haiti: we learned weather and seasons in our English/Creole class yesterday, and Kelly and I were surprised to find out that there is, in fact, a word for snow in the Creole language. But I bet the title made you want to keep reading 😉

As I finish my second full week of teaching here at St. Barthelemy, I thought I’d reflect on some of the challenges Kelly and I have faced and how we’ve tried to overcome them. I’m optimistic about our work at the school, and I hope that my blogs so far have conveyed this outlook, but I definitely don’t want to give the impression that teaching kids is all fun and games. It’s been really enjoyable at times, but also very difficult at times. A few lessons I’ve learned so far:

Teaching is hard.

I feel like I have a whole new appreciation for every teacher I’ve ever had. Standing in front of a room full of students and trying to get across an idea verbally or visually is quite daunting, especially for someone like me who’s more of a behind-the-scenes kind of person. It’s one thing to understand a concept that you’ve known for years, but to explain it to a room full of kids who’ve never heard of the concept is completely different.

Teaching in a different language is even harder.

Not only do we have to teach health and science concepts to the students, but our translator, who is a native Terrier Rougian (not quite sure how to say that?), is not familiar with a lot of the concepts either. Before class, we have to make sure that he understands the concepts well enough to translate the ideas and related vocabulary. I’ve learned to avoid jargon-y phrases like “made up of cells” and use more easily translatable phrases like “composed of cells,” or use “eliminate germs” instead of “get rid of germs.”
I’m also learning that many words just don’t translate from English to Creole. In the 3^rd grade class the other day, we discussed red blood cells and their ability to transport oxygen. The teacher asked a question about “glob rouge,” and my college-educated mind jumped to the word “hemoglobin,” and for a minute I was really excited to talk about heme groups and iron and all of that nerdy stuff… and then I realized that he probably just meant “red blood cells.” I don’t think the term “hemoglobin” actually exists in the Creole language.

Teaching requires a level of energy that is nearly impossible at 8 am.

(For those of you who’ve dealt with me in the morning, you can imagine how particularly difficult this is for me!)
Even though we’re speaking in English and the students have no idea what we’re saying, we still have to sound enthusiastic about the lesson. And one thing that all kids have in common, regardless of nationality or age, is that monotone lecturing will lose their attention in less than 5 seconds. So we try to sound as excited as humanly possible about water purification and hand washing.
By the way, Kelly is a saint for being so chipper during the English lessons. After several hours with hundreds of kids, I just don’t have it in me to get as excited about greetings and numbers as I do about cells.

Students tend to take things very literally.

When we tried to explain how germs take water and nutrients from our body, we used a water bottle and mango to represent the body’s water and nutrients. The 6^th graders, however, only saw a water bottle and mango, and they thought we were trying to show how to wash fruit before eating it. The next time we taught the 6^th grade, we made a diagram (see below) showing a microbe taking a cell’s water (drawn as a water drop) and nutrients (drawn as green dots). I considered drawing a banana or bread inside the cell to represent nutrients, but Kelly pointed out that we’d then have a bunch of 6^th graders who think there are bananas and bread in cells…. bad idea.

Basic science concepts are fun!

By far, our best lesson yet was the cell lesson we taught the 4^th, 5^th, and 6^th graders this week. When we explained the different kinds of cells (see Kelly’s post for details), it was kind of like describing different characters in a story, each with their own roles and personalities. When we explained how white blood cells attack invading microbes, it was very convenient that leukocytes really do eat foreign bodies (see my Pac man-like drawing above). When we explained that some neurons in our body can be up to one meter long, our translator told the class that we exaggerate a little, but we corrected him and emphatically said that it’s true. Forget fairy tales and monsters—cells are just as cool! So I’m learning that science topics, especially concerning the human body, can be really interesting if taught in a narrative fashion.

Limited resources make not only teaching, but learning, even more difficult.

As a product of American education, I’m beginning to realize just how spoiled I’ve been for the past 18 years. I learned with play-doh, coloring books, educational CD-ROMs, and Sesame Street. Kids in Haiti learn with… chalk, one notebook, and a few posters around their classrooms. The fact that St. Barthelemy teachers are able to teach their lessons with such limited resources, and that the students try so hard to learn with only a chalkboard and their own imagination, absolutely amazes me.
The weekend before I came to Haiti, I was visiting family in Nashville, and my aunt showed us around the exhibits in the Nashville Science Center to which she contributed (hi Aunt Tina!). One of exhibits, Body World, had a huge, beating heart to show how the circulatory system works, and a larger-than-life set of lungs to show how the respiratory system works. I can’t even imagine how much the kids at St. Barthelemy would love to see such an exhibit and how much it would improve our health lessons.