Reports from Haiti

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.

Bonswa!  Sunday was a very good day.   It was Jocelyn’s twenty-first birthday.  I gave her a card I made back in the states and a bag of Skittles I picked up in the Miami airport.  Not much, but I think she really liked it.  Also, it was nice to surprise someone who I spend every moment of every day with; it sort of felt like the feeling you get when the vending machine gives you two of what you wanted.  It felt great to give her a gift, even a simple one, and the bonus was that it was a surprise.  

We started off the day with breakfast at seven.  Then we went back to our room to pack our bags for the journey to church.  We shared a bag with the necessary items: camera, water bottles, money, granola bars, and sunglasses.  Bags packed and ready to go, we left the school headed for Milot.  We took the highway we know so well until we came to the so-called Intersection of Death.  It sounds so ominous, but I really have no idea why they call it this; there is nothing really out of the ordinary about it.  It is like a T.  The long side is the road from Terrier Rouge.  If you turn right at the Intersection of Death, you go towards Cap, the second largest city in Haiti after Port-au-Prince.  If you turn left the road ends at Milot, where we were going.  For those of you who are more directionally minded than myself, Milot is south of Cap along the coast.  Also, a turn to the right allows you to travel on comfy asphalt, but turn to the left and you are in for a bumpy ride.  

Dominique wanted to go to church in Milot because her friend Fabian was getting ordained.  It was his first service.  We got there late, as is usual for us and church.  Church seems to be the only exception to Haitian time, meaning it actually starts when they say it is going to start. (I am starting to like this aspect of Haiti; they are much more easygoing.)  It was so hot in the church, but it was very beautiful.  Driving into the town, it was like you were in a little rain forest and then all of a sudden this big beautiful dome with a cross on top appeared out of nowhere.  

That dome is the church.  King Henri Christophe built the church and a beautiful palace in the early 1800’s.  (Haiti became the first modern black republic in 1804.)  The palace is now in ruins, but one can imagine what it must have looked like and the sheer size of the ruins is impressive.  It was lovely.

After the service, we went to a party for the newly ordained priest.  It was in this lovely courtyard. To get there you had to cross a little creek and climb up these really steep stone stairs and under palm fronds.  I felt as if I could be discovering a long lost kingdom in an Indiana Jones movie.

On the way back from the church, we went to Cap to have lunch.  We ended up going to a small fast food-like place.  Next, we stopped at a bakery to get some goodies for Jocelyn’s birthday. As I opened the door, I noticed there was a man standing behind it.  I quickly began to search my mental Creole dictionary for some type of polite apology when I noticed he had a gun.  I stood there frozen in the door for a moment before I realized he was an armed guard paid to “protect” the cakes, creams, and croissants from the beggars standing outside.  And that is when we saw them. The cakes were all different colors, pale pinks, sea foam greens, and lovely yellows with beautiful white flowers, hearts, and crosses.  We each got to pick out our own slice.  Jocelyn chose a yellow cake with icing that looked more sugary than sugar itself.  Later she would tell me that she only chose it because the icing looked the best.  I chose a marble cake with pale green icing and pink designs.  It was the most beautiful cake I have ever seen, and one of the best I have ever tasted.  

Yesterday we taught one second grade class and both third grade classes the water purification lesson and a brief introduction to cells.  Once we explained what cells were, we asked the kids how many cells they thought we had.  The answers included one, six, twenty-seven, two hundred fifty-six and one thousand.  They were shocked when we told them it was millions.  

Today Jocelyn and I taught our favorite lessons so far.  It was very rewarding to see the kids engaged and interested in what we were teaching.  We taught the older grades -4^th, 5^th, and 6^th– about cells.  We first talked about cell basics and then described five cells in detail, specifically red blood cells, white blood cells, neurons, muscle cells, and skin cells.  We made each cell out of paper and held it up as we talked about them.  We also used a diagram to explain what happens to cells when we are sick and how the white blood cells protect our bodies.  Then we held up all the cell types and played a matching game.  We would ask a question and the students would have to point to what kind of cell we described.  Then we asked the class for a volunteer.  We had a boy use a check swab so that they could see their own cells using the microscope Jocelyn described below.  I think it really brought the message of the lesson home. 

We are also teaching an English lesson later on today.  Today we will cover seasons and weather.  The teachers are such enthusiastic learners and very encouraging teachers!  I am learning that I really like teaching and my Creole is definitely improving. 

On Tuesday, Kelly and I began teaching English to the teachers! We’ve covered basic greetings, numbers, and the family so far. After we taught the vocabulary in English, the teachers taught us the vocabulary in Creole. It’s been a great way for us to interact and bond with the teachers. The teachers’ enthusiasm inspires me to learn Creole as well.

When we taught the 6^th grade class, Kelly and I noticed that the students have misconceptions about malaria. They seemed to believe that diseases like typhoid, the common cold, and malaria came from microbes in water. When our translator showed us the water pumps around Terrier Rouge, even he said that you can get typhoid or malaria from the water. I think we’ve found another topic to cover, to say the least!

Yesterday, we had a busy morning with the preschoolers and kindergarteners. We tried our best to teach them the hand-washing song, but to be honest, they were really distracted by our presence—as Kelly and I walked around the classroom, singing the song and showing the hand motions, they stopped singing and just stared at us as we came closer. It seems as if the 3-year-olds have a 3-second attention span, the 4-year-olds have a 4-second attention span, etc…. Next week, we’ll have to find some activities that are a little more engaging.

In the afternoon, we demonstrated the Diagnostic Backpack to Dr. Gustave, who was very impressed with the backpack as well.

Best news of the week—there will be a mobile clinic tentatively on Saturday, June 20^th, with Dr. Lucien and Dr. Gustave, in which we will participate and see the backpacks in action! It’s great that the doctors are willing to take time out of their weekend to run a mobile clinic and test the prototypes.

We also briefly heard about the clinic’s community health workers who go door-to-door administering basic treatments and medications. They may even follow the DOT system (Directly-Observed Therapy), which is used for TB, HIV, and other types of patients on strict medication regimens in order to prevent drug resistance. Kelly and I hope to observe their work at some point and see if we could make any contributions or improvements to their work in Terrier Rouge.

Today was thought-provoking day for Kelly and I, as well as the kids. Our next round of lessons focuses (ha ha) on the microscope and how to view microbes in the microscope. In the first 1^st grade class, we had a few technical difficulties (even your basic microscope can stump a couple of college students…. after much head scratching, we decided to pull out the directions!), but we quickly fixed the problem and showed the class the “meekwobes,” as they pronounce it. They watched the microbes swim across my computer screen (we had a small camera attached to the eyepiece so they could view the microbes on a larger screen) and were fascinated by their movement. I think it was especially interesting to them because the water containing the microbes looked very clean.

After all of the students saw the swimming microbes, we added Clorox to the water sample, and the students then observed the immobile microbes.

In the 2^nd grade class, we also had time to introduce the concept of cells, explain what they are, and how we have millions and millions of cells in our body (we figured that the word “trillion” might be confusing). We ran out of time to swab our own cheek cells and show them in the microscope, but we hope to try it on Monday with the upper grades.

Here are a few photos taken over the past two weeks:

Yesterday we taught the second and third graders the hand-washing lesson. I think they got something out of it, and the third grade teacher offered us some advice that we were able to incorporate into our lesson. This is what we have been hoping for all along; we want the teachers to engage in meaningful dialogue with us about what we can do to help them and teach the kids well. Dominique, the founder of the school’s daughter, asked us to take on another project and we are very happy to oblige. We have been asked to teach English lessons to the teachers after their computer lessons. We think it will be a great opportunity for us to do something useful and improve our rapport with the teachers.

After school Joseph, our translator, showed us around Terrier Rouge with the explicit purpose of taking us to many different water pumps across the village. It was very interesting to see where the people get their water. It is gross, but the situation could be much worse. They use pumps. On our drive yesterday we passed through towns where people got their water from rivers, which is also where they and their animals relieved themselves, where they washed their clothes, and where they bathed. However, it was still appalling. Some people here use chlorine to purify their water, but not everyone can afford it. Water pools around the pumps. Typhoid and malaria are common.

On our walk, we passed the funeral home and morgue, noticeably the nicest buildings in town. It would seem that business is good. We also went by the cemetery. The Haitians bury their dead above ground in brightly painted cement buildings. While there, I noticed a recently dead dog partially concealed by a black plastic bag, covered in a swarm of flies.

We will be able to incorporate the information we learned into our lesson plans on water purification and disease transmission.

Today we taught the first and sixth grade classes. The first grade was very fun to teach. They were very cute and listened well. At the end of the lesson when we are leaving the classroom, we always ask the teachers for suggestions/comments. The first grade teacher thanked us for helping to improve the health of the children.

The sixth grade lesson was a little more challenging, as we purposely designed it to be. We added in skits about how you get germs and what germs do to your body. They did not understand the one about what germs do to your body; Jocelyn and I realized that they do not understand abstract concepts. They take everything very literally. We will have to keep this in mind while designing our future lessons. While there were a few miscommunications, the sixth graders asked very good questions at the end of the lesson and we feel like they learned a lot. They asked things like “can you get germs from wearing dirty clothes?” and “can you get germs from going to the bathroom close to your house?” The teachers also did not know the answers to these questions, so we think we cleared up a lot of lingering questions. Also, we really enjoyed hearing them form questions. Students here are taught by repetition; they hear something, repeat it, and that is that. By asking them to ask questions, they had no choice but to process the information we gave them.