Hartely Video

Final day countdown:



Get up – 4:30 a.m.


Record the sounds of Haitian dawn. Check.


Photo walk through town and tent city. Check.


Write. Check.


Interview Sterling. Check.


Interview Archange. Check.


Photo walk with Brian to goat farm community. Check.


Visit Orphanage, video, photos. Check.


Bonus interview with Ronald. Check.


Purchase items for auction. Check.


Run to beach, demonstrate mad water ballet skills, smash face into ocean floor. Check.






It wasn’t supposed to go this way. That last bit was to be a refreshing unwind with friends before we bid them orevwe. The best part was the way each of them, all nurses and doctors mind you, recoiled and gasped as they swam up to me. “Good Lord!” What happened?!” Um, nice bedside manner guys.


I already knew from the force of impact that it was bad and I was hearing the ponderous strains of cello and having a Peter Benchley moment as the blood flowing from my face created a gauzy bloom in the celadon water. However, with each expression of shock and disgust, I knew that I had truly blown it. “I am not an animal!” was the lament that started surge through my mind with each gushing (overflowing) pulse of my heart. This refrain actually continued through the night as everyone I encountered back at the mission offered the same succession of utterances of horror. The Haitian guards at the gate gave me the same disconcerted, somewhat apoplectic, stares that they gave me when I went for a run. The look that seemed to say, “That is one crazy white woman.”


Anyway, the point of this story really is that bad things happen when we least expect it. I cannot tell you how foolish I feel to have injured myself because of a lapse of judgment in a moment of frivolity


Worse yet, is that as I fly home bandaged and unglamorous, this warped moment of frivolity, occupies a space of jarring contrast in my mind, caught in juxtaposition to the fresh images of the frightened, wounded and despairing survivors of the earthquake.


The earthquake, happened out of the blue, plucking them from their plans and their routines and deposited them in a place that is tenuous, uncertain and seemingly infinite.

My pathetic schnoz will heal. I have some fervent prayers going up against infection and scarring but soon I will be home. I will work, I will hug, I will resume my routine and I will heal.


Gito may or may not. A bureaucratic glitch might eclipse his hope of being able to go to Chile for open-heart surgery. Sherlyn may or may not. She seems like mere flotsam in an overcrowded, understaffed tent hospital and possible solution and many answers are miles away in the fractured capital city. Cassandre, Archange, and all the others suffering from Post Traumatic Stress Symptoms probably will, though it will take a long time.


And what happens in the meantime, to the nation waiting for restoration? How does she rise with strength and purpose when her people, her leaders are confused and tentative, living in tents, living in fear.

The work started by the doctors and our mental health specialists will help. The approach of taking the promising Haitian nurses and training them in these recovery skills is a momentous step. Aimee has returned to the states and in order not to overburden Mary with the PTSD workshop responsibilities the staff has the brilliant idea of assigning Myrto, a local nurse, to help. She now teaches alongside and learns from Mary, demonstrating the relaxation techniques and helping the people to understand that there experiences of seemingly enduring fear are not abnormal – and not forever.


The plans and the commitment that Dr. Bob has brought for an on-site, staffed medical clinic will help. Again, this will offer progressive health care in the Grand Goave area so that basic diagnosis and treatment does not need to be found via an expensive trip to Port au Prince or elsewhere. This will provide jobs for local nurses and eventually doctors. The groundbreaking for the clinic could be this very summer.

The eager desire of people like Sterling, the technical school administrator, to see the school open again and to see students financially equipped to attend also helps. Sterling has already started setting up the computer lab again and desks will soon fill the great tent donated by City church in Kirkland WA. Jobs will be created when construction on the technical school and medical clinic are commenced and families will earn money to eat, rebuild their lives and attend school.

Marc and Lisa Honorat and their vision for Haiti ARISE, their devotion and faith, and others like them will help. Their confidence in God’s love and mercy and the joy that they themselves bring to their community is unequivocally essential to the sustenance of hope.

I leave Haiti with crowded impressions of people in my mind. Mackenzie and Mary and the other little children from the tent cities, who walked through town with me holding my hand and bubbling Creole, have followed me home and, quite honestly, resonate with painful longing in my heart. I yearn for a way to deliver them from so much need.

Yet, I have returned home with gratitude for what we have, and a renewed determination to fulfill my role with Haiti ARISE by trying to keep Haiti in the minds of compassionate people. She simply must not be abandoned. There are ways to help by offering a hand up and not just hand outs. Communication between agencies and the government is an essential change that must occur. Comprehensive assessments of what are available in terms of health care and housing and education across the country is essential. Money must continue to pour in to help rebuild the infrastructure and to bring food and shelter during restoration. Decentralizing the government, education, health care and industry could make a dramatic difference. The collapse of Port au Prince crippled the entire country.

So I return home with this truly unmaskable injury, and whether or not it was divinely allowed, it offers me the perspective that I could not just slip in and out of the place fortified by a warm fuzzy feeling of altruistic satisfaction with myself. I am, instead, reminded that there is big wound in our hemisphere that needs to be healed. Each time I asked a medical professional how long it would take my unsightly nose to heal they dodged an answer altogether or shook their head sadly. I was assured that it would get better, however, though it would take a long time.

Haiti is suffering and her healing will take a long, long time.

Tuesday morning

Today Lisa was talking about how she wants to stay.  She is seriously thinking about coming back in June.  Marc would love for her to be here.  But the tremors make him hesitate.  We had one last night and again while I was typing this morning.  The ladies in the kitchen want to see the Honorat children but they say to Lisa that if she brings them down they absolutely can not sleep in the house.  All of us think of this while we are lying in bed at night.  It is difficult to avoid these thoughts.  I pray myself to sleep, thinking of my family and I do not let the images of the earthquake take purchase. But what a dilemma for the Honorats.  Their hearts are here, though the treasures of their heart, their children, are safest there in Canada.  I am certain that they wait until it seems clear to them, and if they are sent, God will shelter them.  His very timing, that he kept Lisa and the children safe in Canada when the quake struck, is made clear in how Marc struggles with PTSD symptoms following the quake.  She points out how terrible it would have been if they were both struggling.

The allure of this place is so evident when you stroll through the countryside.  It is verdant and fragrant and languid.  The shore is warm and gentle.  The people are beautiful, creative and sweet.  Last night we watched as our dinner was drawn from the sea. (Poor Brian had hoped to go out in one of the dugout canoes and that was a comedic disappointment but that is a story for another time.)  The men cooked the lobster and crab and conch over coals in our campus yard.  It was such a feast! 

I can't get over the children.  I confess, though I am so anxious to get home to my babies (big and small) and my sweet husband, I am on the verge of tears and my throat closes when I think of leaving. A little girl named Mary followed us through the market yesterday.  She was about Maggie's age, seven or so, but it is hard to tell because malnutrition stunts their growth.  All she wore was a black t-shirt worn to a charcoal smudge of color.  She held our hands and glanced shyly up to us, chirping things in Creole.  Mostly, she watched us with tentative sideways glances, traveling down to the shore and then all the way back up to the busy main thorough fare.  No one called after her, no one stopped her.  She was hungry but we are not allowed to give food or money because it can create a dangerous situation.  It truly breaks your heart.  As we drove away she watched us, her face leaping in brightness as I caught sight of her and waved.

I see Barbie being effected much in the same way that I was on my first trip here.  You rise and fall with the joy and sorrow of the place.  Though the joy is less frequent these days.  At times you are caught up in the deeply evocative nuances of this place and then plunged into a desperate longing for home.  I look so forward to hearing her reflections on this adventure when we return home.

I will be sad to leave the new friends we have made on the medical team.  It has also been good to spend time with Jessie.  I have always connected with her but in this place you are forced to be your truest "real."  I love the conversations we have all shared. Last night Kathleen (team coordinator) who had been sleeping in a room all by herself, moved into ours after spending two sleepless nights plagued with thoughts of what was outside the walls and what would happen if another quake hit.  She has a very upbeat personality and does not seem at all timid or prone to emotionalism.  I know from my previous visit that any isolation here is a ponderous feeling. The strangeness of the place is very visceral and profound.  She admits that she slept better being in with all of us.  We understand, we all agree we are better together.

The days will accelerate as we near departure for home. I must leave this office and get out into the soft Haitian air.  It is raining a great deal now but I love it and I feel the need to keep moving to capture the images that will convey this place.

Monday, Monday

Yesterday afternoon we held a PTSD workshop for our leaders and Staff. Aimee and Mary expanded on what they shared in the public workshop, explaining how important it is for the leaders to take care of themselves in order to take care of the people in their community. Many members of the community of Grand Goave look to Haiti Arise for answers and security.



I was troubled when I saw how many of our staff and board responded to the assessment questions. These are not people looking for attention or free meds. In fact, they are slow to admit it at first but eventually, partly encouraged by Marc’s own testimony of his struggles since the quake, they began to confess their experiences.


Archange, who is on our Haitian board and directs our education program, truly illuminated the expanse of the lingering psychological stress when he asked,” Why is it that the majority of people are more aggressive and the majority are more greedy?”


I experienced a sinking feeling. I had struggled with horrible melancholy and a sense of uselessness all day, questioning my abilities altogether without realizing that I was simply responding to the incomprehensible magnitude of the situation. The dawning realization that if these people, our leaders and staff who are educated and strong in faith, were still suffering, then how much more so are those without hope? I confess I had believed there was something to the post Traumatic Stress but I had some skepticism as to the profundity and breadth of the disorder.


Aimee answered Archange in her customary fashion, ballerina hands, dancing expressively with her words, “When the limbic system takes over people can become more selfish, they don’t think through problems very well. They react to things in front of them quickly and do not think them through.” She explains further, “People are trying to survive and they are thinking that it is survival of the strongest. But that is contrary to how we think as Christians. We need to respond with grace and understand that they are afraid and stressed and that is why they are behaving that way. You must fight aggression and greed in the power of the opposite spirit.”


Fortunately, Aimee and Mary bring solutions. They teach relaxation exercises, explain the physiology of the disorder and stress the importance of good health habits.

Even so, I left the workshop with a heavy heart. Haiti has long had a troubled soul. How much more can they take?


Later, I asked Barbie, Aimee, and Jessie to pray with me and as I laid my efforts and determination at God’s feet, I understood that just as He would give me the words when the time was right to communicate what needed to be shared, He would guide our efforts.

Today we went to Petit Goave to the hospital. There we checked on Sherlyn. She seemed slightly but that is probably partly due to receiving attention, minimal though it is, she has yet to be diagnosed and treated. Again, our appearance seems to prime the pump and she is being scheduled to got to Port au Prince for further testing. The doctors talk and agree that yes, it seems to be a renal issue but could possibly be caused by tuberculosis.


We met with David, the Canadian Nurse, again and he gave us a tour of the hospital. We wanted to see what they were doing there, what they were capable of doing so we could know what to rely on for the future. However, nothing is certain. The facility is under administrative change once more. They have x-ray. But no paper. They have buildings. But they may or may not be structurally sound so they utilize numerous tents for their wards. They have a lab. But one microscope. One technician. They have a fully equipped new ambulance. But no insurance and no gas. The Canadian nurse shakes his head and smiles apologetically and shrugs. It is clear that even he is bewildered. There are some hopeful aspects to the visit; we talk about monthly meetings between some of the facilities. Perhaps we will attend. We leave with a list of contacts for practitioners on the island. Sheryl is one step closer to getting the help she needs. We know that the clinic we are planning will offer care that will be an excellent option.

I quickly strolled through the market, a frightening labyrinth of shanty and tarp full of squatting vendors peddling fruits and vegetables fish and rice; soaps and sandals, hair extensions and sparkly tee shirts. Pigs heads, mud cookies, unidentifiable greens and gourds. It is surreal. Aimee commented on the layers of smell: delicious food, garbage, fish, fruit and urine. We wended our way to the waterfront where a tent town huddles on the shore. They say that the help organizations come but they do not reach them. It is hard to sort out the truth. I learned tonight about how some people have taken to placing tents near their homes to solicit the attention of the aid workers. They do not need them or use them. They are called Zombie tents. Oh, the elaborate masquerade that is Haiti. She tips her mask, as we dance, for a moment you see who she is and then she flips the disguise to portray another face and then back again and you are not even sure what you have seen.

This evening, Aimee and Mary held another PTSD workshop, this one was open to the whole community and the word had spread. Those who had attended the clinic workshops knew what to expect and had invited others. The church was nearly full. Johane helped with the workshop by sharing his knowledge of Geology.


He had just finished a geology class when the earthquake hit and he knew what was happening and tried to warn everyone to run to the mountains because he knew to anticipate a tsunami. In the workshop, he explained to them about the earth’s crust and what happens during an earthquake. Many people had believed that it was the end of the world and that they were suffering a judgment from God.


Following this portion, Aimee and Mary did their routine, which had gained dimension over the week. Aimee reported that the majority of people were responding to the questions. They shared there complaints and their collective experience covered the gamut of symptoms. Even now, they are suffering from heart palpitations, headaches, pain, memory changes, sleeplessness, nightmares etc.


Something different occurred as Aimee proceeded through her list of dos and don’ts. When she told the crowd that they needed to make sure to pay attention to their diet and to eat good things. Someone called out. “We have to have money to eat.” This gave her pause for a brief moment but she pointed out that there were many things to avoid and plenty of fruit and vegetables available in the country. It did not solve the problem but it pointed them in the right direction.


Aimee, also told me that one man shared his story. His past had been terrible, he confessed, he said that he had committed horrible crimes, including murder. Just before the earthquake, he was trying to get inside a tap tap but they would not let him in so he clung to the back as they careened through the streets of Port au Prince. When the earthquake hit he was flung from the tap tap, a building collapsed on the transport killing all the others. Only his foot was caught in the rubble. When he pulled free, he thanked God for his life but wondered desperately why someone like him had been spared. Since that moment he had been attending the church at Haiti ARISE, looking for solace and wondering if he would ever be truly free from his past. Aimee assured him that indeed he had new life.

As the workshop progressed everyone joined in practicing relaxation exercises and they laughed with each effort. Marc then came and spoke with them. Sharing his earthquake experiences and post quake struggles. When I came upon them it sounded as though I was stepping into a comedy club. Marc, if you have never had the opportunity to hear him speak, is an amazingly charismatic man. Last night he was pulling out the stops, flailing his arms and jumping and waving his hands and laughing, the squeal and fall of his voice booming beneath the tin roof and sending the crowd into fits of laughter. I cannot tell you how good it was to see so much laughter. That has been very, glaringly absent this trip. The joy we have seen only in tiny flashes - children playing, girls braiding hair and singing.

Aimee eventually just stepped aside and let Marc finish his show. I watched her and she was beaming watching the laughing crowd, she clasped her hands under her chin, it was as if she was drawing a blanket of comfort up around her. The laughter filled the space and filled our hearts. Fear fled into the dusk and the deep shadows of the mangoes and relief and healing infused a brightness in its place.


Aimee said later, “Tonight, was the reason I came.” Jessie smiled her beatific smile and gently corrected her, “No, you have days left. It builds, and there is more to do.”


She is right. Each day has been a progressive revelation. We felt a little small and uncertain at first. Then we saw the beginnings of the effects of stress, then we saw the magnitude, then we saw the people reach out and respond and then, what joy, we see them healing!

In church on Sunday we sang the worship song Trading My Sorrows in Creole, well they did, I sang along in English. As I think of the gathering last night, rocking with laughter and clutching at each other with joy, I hear those words, my heart rises and the tears come, again.


I'm trading my sorrow


I'm trading my shame


I'm laying it down for the joy of the Lord

I'm trading my sickness


I'm trading my pain


I'm laying it down for the joy of the Lord

And we say yes Lord yes Lord yes yes Lord


Yes Lord yes Lord yes yes Lord


Yes Lord yes Lord yes yes Lord Amen

I'm pressed but not crushed, persecuted not abandoned


Struck down but not destroyed


I'm blessed beyond the curse for his promise will endure


And his joy's gonna be my strength

Though the sorrow may last for the night


His joy comes with the morning!

Sunday

She is out here again, the old woman in her blue kerchief, stooping and gathering. The sound of her harvest snicking, like grass cropped by a horse. Pull and break, pull and break. In fact, it looks like grass, thick blades of it and she fills her arms and then moves down the red path to the next hunch of foliage, drops her bundle of leaves and begins again. This time I see great roots come up with the leaves, like potato or yam. I need to find out – but I do not speak Creole and I am way up here on my roof and she is already disappearing along the path in that steady Haitian tempo.



A swaybacked donkey with white brows and watery dark eyes, croaks in the field below. He has seen me on the roof or he is talking to the two goats tethered nearby or he his lamenting the meager shrubbery he is forced to graze. In the distance, men are yelling at each other and I cannot tell if it is an argument or just lively conversation. Next time…next time, I will have learned some Creole!


Today we go to church, which is a long affair here. Prayer begins at eight and the service begins at nine. I am loathe to leave.


All around me roosters crow, birds offer their melodies, squeak and talk as though in competition. This air is unbelievably still and humid but the mango leaves on the ground are always rustling.


Because it is Sunday, the women do not sweep the dirt in the campus. They arrive at church in their very best clothes and you would not know how poor they are except for an odd assemblage of their apparel or the worn evidence on their outdated shoes. Most of the young men and women are stylishly dressed in what was may be just last year’s style. I still cannot get over how they do this in their dirty environment. I look woefully at my smudgy trousers and bespattered blouse. I am down right atrocious in comparison.


I have yet to go for a run here. I did not really think that I would be able to but hope springs eternal. It is very hot and there is little time, however. I have entertained the idea of running up and down the path from the back of the property to the front but the security guards and the men working on the wall would think me daft. They already do I fear, stopping their work to watch me quizzically as I take pictures of the nails in their buckets, a hammer on a bench, a dilapidated desk holding rain water in the bowl of it’s warped laminate.


Later I did finally succumb to the desire to run, because it was Sunday we were blessed with free time but mine was only filled with melancholy. I felt so discouraged that I would never be able to convey the magnitude of the situation here. I convinced Jessie that we should run down to the beach where some of the medical team was swimming. It was quite hot but she agreed. I cannot tell you the surprise that flashed across the faces of those we came upon. They shouted many things and I found I could run faster. Suddenly we were going past our goat farm property where some very poor families live and where we also host a tent city, and yelling and laughing children surrounded us. They grabbed at us and jeered at us, I think Jessie was quite anxious, but I assured her that they just wanted to play, they wanted to run with us. Therefore, I motioned for them and they did, laughing and grabbing. I wanted to draw them all into my arms and make promises about tomorrow but I just wooped and giggled with them and gave them the thumbs up for their lively, athletic effort.


It was so fabulous to run. Heavenly. Up until then I had had to satisfy the need to exercise with sit-ups, push-ups and running repeats on the stairs to the roof. Once on the roof I did squats and lifts with a cinder block. I can only imagine what the passing Haitians thought of the crazy white woman on the roof.


Right now, I have only early morning critters as company. A massive hunched up rat is scuttling and leaping in the thin light around the cinder blocks below me. I hate rats. The spider the size of my hand that we found in our room last night does not bother me the way this rat does. I am trying to remember exactly where it was that the shotguns we purchased after the earthquake for security (and have not had to use) are stored. 


That is another issue that I have not been able to sort out yet. Security does not seem worse in that we have more freedom to go into town than last time I was here but the general sense inside the walls holds uncertainty. Not that I feel I am in danger but perhaps it’s the lingering disarray since the earthquake, that nothing seems linear or certain and that something “mal” could happen at any moment. Walking through the town, through the penetrating eyes, you are never really certain who hates us, who sees our presence as good and who are just indifferent.

Market day

Today was market day. Saturday. We did not make it to market but almost. Aimee, Barbie and I joined Pat and Dr. Ilona, at six in the morning, for a little jaunt through Grand Goave. We were obtrusive, five white women wandering in the early light, gingerly stepping over garbage and rubble and the silty seepage from public wells, trying to memorize intersections by the graffiti on walls that were still standing.



We walked for an hour, reaching, at the apex of our walk, the crowded main street where market was being set up. Mopeds and dilapidated trucks rushed past honking and like frightened ducklings we stirred and milled in confusion on our corner before opting to return the way we came to breakfast. It has been great getting to know some of the medical team a little better. Dr. Ilona is quite engaging and down to earth. She recently spent two years with her husband and two small children practicing medicine in Malawi. She has a great sense of adventure and seems pretty fearless and content with life. Pat is similar in that respect. Though much softer spoken and quite possibly one of the sweetest people I’ve ever met. She is a nurse and joined the team with her youngest daughter, who is also a nurse. Aimee and I have had a few adventures and misadventures over time already and those are all tremendous stories for another day. Barbie, is yet another story and because I have not mentioned her much yet, and because she is becoming less of a mystery to me, I invite you for a closer look. (Much to her chagrin, I’m sure)

If you spend any time around Barbie, you know her as a woman who chooses her words carefully. There aren’t many but they are choice. For a few years, I thought she did not care for me but I concluded that her face is in repose most of the time and her far away gaze, which is so steady as to be unnerving, is the result of lofty thinking. All those choice words are running through several filters. She’s sharp. I would love to hear the unrefined product or merely glimpse the sub thoughts that hit the cutting room floor.

Her method for processing information seems to be fine-tuned by queries. She will ask questions before she speaks. Here you see her processing furtively. Her jaw is set and her eyes travel slowly to regard the breadth of her circumstance. She is such an honest and humble servant. Willing to set herself aside to serve where she is needed even though it feels way outside her comfort zone. She is compassionate and gracious in her giving of skills and self. However, she has been looking at life here from the corners of her eyes, uncertain, because it so dramatically culturally different, raw and exposed. Day by day, Barbie is processing Haiti. The first morning she rose and intimidation hung, unconfessed tears at the hem of her eyes. This morning somewhere between praise and supplication, she thanked God to be in such an amazing place.

At the other end of the day, we took Brian and Johane (an interpreter – really sweet young man) and we revisited these places with our cameras. We also visited the tent cities located on our adjoining property. It was good to see our land being used to house people out of the streets. However, it was just heart wrenching to see these children playing half clad in this flimsy environment, knowing that the rainy season and hurricane season are nearly upon them.

Tonight Marc arrived and he is meeting with the Haitian board. They are gathered beneath the mango tree and they are excited because they are discussing how we are going to start to help our leaders, staff and community rebuild their homes. They are discussing ways to help. Getting the school up and running will be key to helping restore a sense of normalcy and forward motion. Sessions will begin in the large tent donated by City Church of Kirkland, WA. For two reasons: 1) It is an ample structure to keep out weather and accommodate many students. 2) Many students are still just too afraid to spend any time inside buildings.


The doctors and nurses noticed with many of the patients, as they came into the exam rooms in the residence building, that they cast anxious glances repeatedly at the walls and ceiling.

We saw over 120 patients yesterday. Today we saw a few less probably because of Market. We held our vision clinic, essentially, an opportunity for those who appeared to need glasses to read a chart and try on reading glasses until they found the best correction. This was a rather delightful station to observe, as the end result was that they were provided such a small thing, a pair of reading glasses, which could significantly impact the individual. To boot, they are considered rather stylish and bit of a status item. The smiles were just brilliant.

The highlight of the day for me was the children. Everywhere, children in the street, between tents, playing in the smears of standing water, playing soccer on rutted roads. Their smiles and obvious desire to engage with us was so infectious. They do not seem to see their circumstances to be as forsaken as we see them; sadly, life is not that different for many of them, than what they have always known. Children are pure hope. They gravitate to life and motion, a place where running fast or playing tag are enough to fill you up again for a time. And laughter is good medicine. Their laughter, their smiles were good medicine for me today. Two children whirred past us in the dusk as we returned to the campus tonight; they dipped past and through our configuration like barn swallows. Their cries of delight in the game of chase that pulled them along, rose between the rustling of the palm fronds and the slow turn of banana tree leaves and filtered back upon me with the withering light of day. Their laughter, like the small shifting motion of that shadow and light through foliage, took up residence in my heart. Even now, it rustles and soars in vibrant tones of delight, percolating hope and joy.

Friday

About 64 patients were seen yesterday. It was only a half day. Aimee and Mary conducted their PTSD workshops and then Barbie and Kim (actually his name is Brian - I dunno – maybe it’s a Canadian thing) shuttled the groups of 20 from the old tin church where the workshops were held to the Residence building where the clinic stations are set up. With the help of interpreters, they located old paperwork and filled out new. Then the patients lined up against the wall, seated in neat white folding chairs, waiting their turn to see the nurses, who weigh them and check vitals, then on to the docs. Following the doctor, they visited the pharmacy if necessary. I was impressed by the efficiency of the process and in the evening the team gathered to debrief and the observation was the same. They all agreed that it had been the smoothest 1st day of any of the preceding years.

The team gathered at the humid-sticky, plastic covered tables to debrief and assess how to proceed for the remaining days of clinics.


“We could do more procedures,” said Dr. Bob. “Things like dental extractions.” He has a wry sense of humor. They discuss the front end of the exam and ways to expedite the flow. The discussion ranged from the possible distribution of candy for young patients to how feeding symptoms in the PTSD workshop might be complicating assessment of other symptoms for the doctors. Apparently, the patients came to the doctors from the PTSD clinic complaining of pwoblem memwa (trouble with short term memory), pwoblem domi, (difficulty falling to sleep) fatige (exhaustion) etc. They had a litany of symptoms that could easily mean something else but proved to be confusing for the doctors because it seemed that they may have just adopted the PTSD symptoms recently discussed. The medical staff decided with the mental health team that communication at the end of the workshop should emphasize that the original complaint for the visit was brought to the doctors’ attention first but if they had identified symptoms of PTSD that they could return to the workshop after the clinic and receive more counseling and prayer.

Dr. Bob also offered up a scenario that would create stress for a hypothetical patient: she lost her husband, a child died, she is raising her sister’s three children along with her own and her house was destroyed in the quake. Her symptoms are not necessarily typical of post traumatic stress or directly attributable to the earthquake. He asks Aimee and Mary would they have the time and willingness to counsel these individuals. Naturally, the response was yes.

It seems though that there is never enough time or man power to meet the vast needs of this country. In the wake of the earthquake, despite the enormously increased North American presence, the situation i.e., Haiti’s poverty, malnutrition, hygiene, corruption etc. seems to be exacerbated. Part of the problem is a lack of communication between agencies.

For example, no one even knows what sort of medical care one can receive at the “hospital” and that is a very generous term for the building in Grand Gaove. No one here can seem to answer whether or not there is even a facility standing in the neighboring town of Petit Goave.

Today a young woman came to the clinic with a severally distended abdomen, swollen ankles, heart palpitations, weakness, she could barely walk and then only with help. Her hair was matted and infested. She had had a baby in February but the father stole the baby from her and took it to the country, leaving her in Port au Prince. How she made her way here is unclear but the poor woman was not at all well. The doctors examined her and felt that she was experiencing congestive heart failure.

They were certain that they were dealing with Postpartum Cardiomyopathy, which is very rare occurring in about 1 in 2,500 women. In Haiti, apparently it is a much higher incidence. The cause is unknown but contributing factors can be stress and malnutrition. Haiti’s flavors du jour.

Clearly, she needed further testing to be definitively diagnosed and she is ill beyond the clinic’s treatment capabilities. Suddenly there is a faltering in the seamless progression of the day. Where does she go? No one seems to know what to do with Sherlyn. No one seems to know what kind of care is provided where and who is still alive to practice? Eventually we learn that the hospital in Petit Goave is open. The Norwegian Red Cross is running it now. So Brian, the photo journalist from Canada and I jump in the truck with Sherlyn, her aunt, and our two Haitian translators to take yet another careening ride though the Haitian countryside. The looming hillsides plush with vegetation rise and fall from view, lightly held in a veil of cloud. We speed past vendors and tent cities and idle nationals waiting for something, perhaps change, in the oddest places: guardrails, gravel heaps, ditches and gutted car bodies. Suddenly we plunge into the chaos of Petit Goave and weave our way to the hospital. I am in the back seat with Sherlyn. I take her picture once and touch her arm, gesturing for her to look at the picture in playback. “Belle.” I say. She smiles weakly and looks back out the window. Every now and then, she grunts as we hit the areas of road crevassed by the earthquake. Her breathing is erratic and her hair is alive. But she is beautiful. It is heartbreaking.

Once we get to the hospital, she seems to receive quicker attention by the presence of her North American companions. I tell Brian that we have been good for something, even if we seem to be the butt of everyone’s joke. The laughter and Creole moves around us, like taunting children, in the tarped over waiting area. We have been asked, ever so politely, not to take any more pictures so we watch and wait following Sherlyn as she shuffles, escorted by her aunt, from one exam station to another. Finally, they admit her. I quickly ascertain that admittance is not what we understand it to mean in North American terms. She has secured a bed in a tent.

These tents are scattered around the buildings of the hospital, which are unsound. The tents are filled with cots. The sick and wounded are treated together, undifferentiated by ailment or sex. A nurse comes to us and tells us that Sherlyn awaits an EKG and that we can leave. The aunt stays and we say goodbye to Sherlyn and return over the rutted roads with few answers. We do not know what the final diagnosis is. We do not know when she will return. I, personally, am no closer to sorting Haiti of the past from Haiti post earthquake. It is different but nothing seems quanifiabe or certain. The story keeps changing. “There are more injuries,” said the Canadian nurse at the hospital in Petit Goave. “But strangely they are restoration related. People are coming to us with all manner of physical injuries…because the labor is so hard and so much to do by hand.”

However, I walked though the hospital tents there and they were full of people who were so malnourished and ill that they could barely move. I thought of Sherlyn and wonder how, if at all, her situation was exacerbated by the earthquake. Postpartum Cardiomyopathy sets in one month prior to delivery to five months postpartum. The baby was delivered in Port au Prince shortly after the earthquake. Imagine the stress of those conditions.

The world has largely lost interest in Haiti but Haiti still suffers from the earthquake. The Canadian Nurse in Petit Goave was supposed to stay until December. He does not think he can do so. I could see in his eyes that it was too much here.

When I return to the clinic at Haiti ARISE, I am confronted all over again with my admiration for this Doctor and his team. Every little bit counts. Yesterday an elderly woman came to us with a head injury from when part of her house collapsed. We learn that while she lay there in her shattered home, men came in and took her things. They also kicked her and beat her, breaking several of her teeth. Still here she was, broken and beaming, sweet beyond words. She was so grateful for the little bit that was done for her here. When I came to take her picture, she hugged and kissed me. Dr. Bob will see her again early next week and remove the tooth that is so damaged that she cannot eat. She is slowly starving to death. Yet you would not know it by the smile on her face and the love she gave us.

At the end of the day we walked to the beach and rested in the soft Carribean water. Floating and laughing in cool proximity with each other, sipping sodas and drinking from coconuts. It looks like a vacation for a moment. Barbie, who has worked so hard all day, managing the patient flow from the PTSD workshop to the clinic and helping with intakes, is grinning from ear to ear. She is finding this side of Haiti quite to her liking. We all sample some conch cooked in butter and lime and purchase some items from beach vendors. Then clamber into the bus, a few of us on top, and sway homeward in the breezes cooling before the rain clouds.