Oriani, Haiti is a village up in the mountains of southern Haiti. The economy of this area relies on produce from their gardens that they sell in the markets in Croix de Bouquets and Port au Prince. They use this money to buy rice, flour, oil, and other items they need and require. The economy here has been increasingly strained over the last several years by gangs imposing high “tolls” on trucks and other vehicles trying to access these markets. This has further depressed the already very poor people in this area. However, they continue to put in the hard manual labor required to grow gardens. Some of the gardens are on the side of very steep hills in very rocky soil. The effort put into farming this land and bringing their produce into the village to sell to merchants who arrange transport down the mountain is very impressive. However, in July, the gangs attacked Ganthier, a town on the road to Port au Prince and the road has been closed since. This was very bad timing as the first large harvest is in July and now they can’t access the markets to sell their produce. As a result, they lost their entire harvest! This area was already extremely poor with many people living on the edge of malnourishment. Now with the road being blocked, this has reduced the supply of food and driven up costs. At the same time, no one has money to buy food! The situation looks very grim. Now is the time to replant gardens in hopes of another harvest in November, but they lack the money for fertilizer and the ability to pay for the labor necessary to replant. At the same time refugees from Ganthier and the other towns affected by the gangs are coming up the mountain. This increases the demand for food and medical assistance. Many of these fled with only the clothes on their backs. The clinic has relied on a small fee for service to help supplement donations to cover the costs of operating. Due to the current crisis, we are often waiving this fee as fewer people are able to pay. We are asking for donations to help cover clinic costs and provide food and clothing for refugees in the area. We would also like to provide assistance to farmers as funds become available. The ability to replant gardens will be key in preventing a complete economic collapse up here on the mountain. Any assistance is greatly appreciated and will go much further here than you might think. Please mark funds as “Special Request” Thank you and God bless you.
UNCERTAINTY
Every morning when I am standing in front of the clinic during Paste Willy’s devotions, I enjoy the view. On market days there is a steady flow of traffic on foot, on moto, on donkeys, and some vehicles into town. The sky is a bright blue with a view of banana plants and gardens beyond the walls and in the back Pic la Selle. It truly is a beautiful setting. The clinic is busy on market days but our staff manage the patient flow smoothly. Our nurses are very comfortable in their roles and call me less often as they can manage care on their own. Sometimes I almost feel unnecessary because of how well the staff is managing. One big change you will notice on the monthly report is the section marked intestinal parasites. In the past the nurses only checked this box if the patient had noticeable worms. However, due to the high probability of intestinal parasites and the negative effects this has on a population already inclined toward malnutrition, we provide antiparasites to anyone with the slightest possibility of parasites. I decided we should mark for everyone we treat for parasites.
One of the reasons we can increase the treatment of parasites is due to a generous donation of mebendazole, an anti parasite, among other medications we received 2 weeks ago from L’eua de vie, a clinic in Fond Parisien. They had received a large donation of medications and were not sure they could use them all before they expired. So they loaded up the ambulance when it was in Fond Parisien with an eclamptic patient. I am happy to report the ambulance is finally working again.
It also made another trip Friday night successfully. This time with an older patient who seemed to have had a stroke. She had been fine the day before, but in the evening was not able to talk or react appropriately. Due to the sudden onset of the symptoms, I was quite certain of a stroke. However, the family wanted to take her and since I couldn’t be certain of my diagnosis, I didn’t have a good reason to say no. Here a stroke is not an emergency because we have no way to treat it. Even Port au Prince doesn’t have stroke care. Either way Port is not accessible. The patient was delivered to the hospital in Fond Parisien but they couldn’t do anything for her and she passed away. I was pretty certain of this outcome, but how do you tell a family no?
The situation in this part of Haiti took a dramatic turn for the worse last week. The gang in Croix de Bouquets attacked Ganthier, the town between them and Fond Parisien. The gang overran Ganthier and destroyed the police station and killed a lot of people. They made violent threats against Fond Parisien and promised a massacre. The police tried but couldn’t push them back. But a group of reinforcements were able to come up the road from Port and the police were able to reestablish a presence on the outskirts of Ganthier. Ganthier, from what I hear, is a ghost town, but for the moment Fond Parisien is safe. I was able to go there and buy medications, food, and fuel. So we are OK on supplies for a while. The reinforcements from Port went back to Port and the gangs blocked the bridge outside Ganthier so they will have a much harder time coming back. Produce from the gardens here in the mountains is carried by trucks to markets in Croix de Bouquets and Port au Prince. To pass through gang territory, they had to pay the gangs. I heard the gangs were collecting as much as $40,000 a day! Not sure how reliable this information is. After the gang attack, Fond Parisien blocked all truck traffic as they didn’t want the gang to collect this money. The gang is furious and blocked all traffic for any reason. So we are truly cut off from Port. We can still get medication from the Dominican and we have a good supply, but if this situation continues it will affect our level of care. Security in this area is still OK as the locals are blocking all the roads and checking all vehicles. When the ambulance last went they had to pass the checkpoint and pay some money. Since the people manning the checkpoints are volunteers, I don’t begrudge them the money.
This blockade could not have come at a worse time for the mountain people. Their gardens were just starting to produce and now they have lost everything. All roads are blocked and their produce they rely on selling is rotting. I don’t know what the future holds or how they will have money to replant. Truly dark times for Haiti. What this all means for the clinic and for us remains to be seen. We are still safe enough, but it is a fragile situation. We help in whatever small way we can, but the amount of people begging for help is increasing. Pray for us and this poor country. They desperately need help, but the rest of the world seems uninterested.
Border Troubles
Hello again from Oriani! The month of June did not go according to plan for us. Heidi, my niece, who has been here for 6 months to teach Sebastian, was to go home for the summer. The plan was for us to go to Santo Domingo to pick up her family and bring them here for a week before they went home. We made it across the border without trouble and enjoyed a couple of days shopping and spending time with friends , before picking them up at the airport. When we got back to the border, the Dominican officials refused to let us across. They said since the American missionary couple was killed in Port au Prince we need a letter of permission from the head of immigrations in Santo Domingo before they would let us enter Haiti. Why this is up to them baffles me. I called the American embassy in Santo Domingo and Port au Prince. Neither had heard of this requirement and assured us that we had the right to enter Haiti. Well, we decided to spend the week in the Dominican with our visitors instead, then after they went home, we would try to get back to Oriani. It was disappointing not to be able to show them Haiti, but we enjoyed our time with them exploring different beaches. Carlos and I went to the immigration office to see about getting the letter of permission. They said we would have to submit a request then would get a reply in 45 days. We submitted the request, but we weren’t going to wait 45 days to see if we might get this letter. So Carlos called his contact at the border and we were able to cross, but they didn’t stamp our passports. I guess we’ll see if this causes us trouble in the future.
In the meantime, the Haitian staff did a fine job of keeping the clinic open in our absence. They even sent a woman with an OB emergency to Fond Parisien with the ambulance. However the ambulance didn’t quite make it back to Oriani. It had to be towed the last few miles. We found a crack in the fuel line and I hope it’s finally operational again. But the woman did get the help she needed. I was very concerned for the older gentleman who I did a thoracentesis on the day before I left. I didn’t know if he would be alive when I came back. Thankfully he was, but I have had to repeat the procedure twice. Every time we drained off 1.5 liters of fluid. Despite our best care he is failing and I fear he may not have long left. I told them we were doing everything we could here, but if they thought they could make it to a hospital in Port or Mirebalias they should consider it. It is very hard to know what to tell these people. I don’t know what the state of other hospitals is or if they can provide the help people need. Considering the expenses, difficulties, and dangers of travel here, I hate the idea of sending them on a wild goose chase looking for something they might not find. But, I felt I needed to let them make that decision.
Friday, June 28 we had a 4 year old girl brought in with 2nd degree burns to her torso. They said her clothes had caught fire. I didn’t understand what they said about how it happened. The burns covered exactly what a T-shirt would have covered. It had happened 5 days before. They said they were from a long way away. I don’t know why it took so long for them to get here. I could tell she needed more than we could give her. I messaged the surgeon in Fond Parisien and he said to send her to the Doctors without border hospital in Port that has a burn center. We covered the burns with a dressing and gave her IM antibiotics. I couldn’t find a spot for a peripheral IV because of the old infected burns. She was awake enough to drink so we gave her oral fluids. I tried to contact Haiti Air but they were out of service. Mom and dad were with her and I told them they needed to go to Port immediately. They didn’t have money and I didn’t want them to spend time looking for some, so I gave them enough to get them to Port plus a little. The dad exchanged phone numbers with Fre Willy and they headed off. Unfortunately, the next day the father messaged Fre Willy that she had died on the road. It was one of those situations that makes me feel like I should have done more, but I don’t know what else we could do.
I have to remember we are not the level 1 trauma and burn center I am used to but a clinic. I feel we do as good a job as we can within that role. Basic primary care such as wound care, prenatal care, antibiotics, and some level of control for hypertension and diabetes. Thursday I sutured a man’s finger that was almost severed at the middle knuckle. I placed a finger splint and told him to go to a bigger hospital that could fix the bone. Then I had a woman come in that had been bit on the leg by a pig. I cleaned it up, gave her a tetanus booster and antibiotics, and sutured the wounds. This is what we can do that is something they don’t have without us and can stop little problems turning into big problems. Thank you again for your support! It allows us to keep helping in whatever way we can.
Births, burns, and bad spirits
Hello, again. I hope God is blessing you wherever you are. We are doing well here. Our numbers in the clinic are trending up. I think the change in price along with word getting out that we will help regardless of ability to pay is making a difference. Speaking of numbers going up, our nurses delivered 7 babies in April. I forgot to mention it in the update for April, but I’ll give them a shout out now. The nurses are doing a great job and have grown into their role here. Sometimes I feel the staff here is doing well enough, they are almost working me out of a job. However, I will claim credit in delivering one of the babies here at the clinic in May. To be fair, the mom did all the hard work!
One of my biggest frustrations here is the difficulty in getting people to keep their appointments. For example, the girl with the burns that I mentioned last month. I told the mom to try to keep her burns covered and come back if the dressing came off. But she did a very poor job of this. On return visits the dressing would have been off for a day or 2. The burn was not healing well, so I told her she needed to come back in 2 days, but she quit coming. I don’t think they live far from the clinic, but we don’t know where, so I can’t go find her. Hopefully she will heal ok. We had a 2 year old come with burns on his left arm from dumping hot porridge on it. They come from much further away. Almost an hour by moto. They have been faithfully keeping their appointments, and he is healing well. I thought Friday might be his last visit, but they didn’t come back. Hopefully that is a good sign. Last week we had a man brought to the clinic for scattered burns on his left arm. He is fou (crazy) and had been trying to get into someone’s house and they threw hot water on him. He had some minor second degree burns, so I did a simple dressing. I talked to the man who came with him and tried to understand the situation. We don’t have much to help, but I gave him some valium pills and told him to give the man one if he needed to calm down. We don’t see many true psych patients here, thankfully. There isn’t much we can do for them. Around the end of February, if I remember correctly, we had another “fou” man brought to the clinic. The story was he had been in sendoming (the DR) and had been fighting with people there so his parents went to get him. He had only been back a day or so, but was causing trouble and they wanted me to give him a shot to calm him down. This seemed a little unnecessary to me as he was sitting quietly watching me. I tried to ask if it was possible he had taken any drugs in the DR. They didn’t seem to understand. I told them to go home and I hoped whatever he might have taken would wear off. Apparently normally he isn’t crazy? Anyway I forgot him until 3 weeks ago when Roosevelt and a couple other youth boys came to our gate. This man lived behind Fre Berlin’s house (Fre Berlin’s wife is one of our nurse aids) and he was causing trouble fighting with people. I got my moto, stopped by the clinic for a syringe and some valium, and followed them over to Berlin’s house. This man was up a path behind the house outside a little building. His hands and feet were tied together and another man was holding a leash. He was hopping around and yelling incoherently. His actions and incoherent speech reminded me of the psych/drug patients we see in the US. I asked if he had taken anything and they were certain he hadn’t. What could have caused this? They all said he was a good boy before. Did he fry his brain on bad drugs in the DR? Or some concoction from a witch doctor? Or an evil spirit? He was hopping around trying to hit people. They held him down while I gave him the valium. That didn’t even slow him down so I had to go back to the clinic for ketamine. After he was asleep, I gave them some valium pills to try to give him in the morning. The next day they said he was up and just as feisty as the night before. They didn’t ask me to come back, so I haven’t. Honestly a very sad situation, but there are no psychiatric hospitals in Haiti that I know of.
The situation in Port is very tense, but the gangs are letting people travel around again. They are hoping to get on the people’s good side before the Kenyan force comes to Haiti. After all their violence and destruction that seems very unlikely. However this does give us the opportunity to buy medicine in Port and for MFI to make a couple of flights and bring some supplies from the US and get our vehicle papers updated. Our agents in Port are working on this and hopefully we will see results in the next week or so. Thank you for your support and prayers. God bless you all!