Monday, January 29, 2018

Why do we do this?

We had a long, long wait at the under-construction Port Au Prince airport, so many discussions arose about why we're doing this project, are these efforts worth it... why do we go to Haiti? I'm glad these talks came after the week, as I felt more knowledgable about what I'd seen and experienced. Here's my attempt at sorting through it all:

Why Haiti? And why Cange?

The simple answer to this question is that Bishop Beckham of the Upper SC Diocese made a commitment in 1979 that we would take care of the people of Cange. And we did. The diocese sent money, volunteers and resources to Cange for years. With these gifts, the town grew from a single, simple church and scattered, desperate people to having a clean, reliable water source, a fully functioning hospital equipped enough for surgery, a TB clinic, an eye clinic, a beautiful church, a successful primary and secondary school, gardens and residences. As such, the town itself grew, and now has homes and markets and even a paved road leading to it.

It takes regular, systemic, long-term investment to make this kind of change. You can't build a new town with one or two donations. You can't completely change the life expectancy of a people with one or two medical visits. It's easy to give money to the latest cause, the latest place you read about that has a great need. Yes, there are great needs all over the world and in our own backyards--but we made a committment to Cange, Haiti. By staying there, by continuing to invest there, we Episcoplians are not only fulfulling a long-ago made promise, but we are investing in a community where we feel we can do the most good and effect the most change.

Partners in Health/Zanmi Lasante has shifted their focus to Mirebalais. They received a lot of money after the earthquake and focused on a newer hospital, one that could grow (Cange is restricted), and chose Mireabalais, a larger city located at a highway crossroads. That hospital and its related TB lab are important and are meeting health needs in the Central Plateau -- but that doesn't mean Cange needs to be left behind. We have supported this community for 40 years; it wouldn't seem right to leave now (even with political issues in the church, which I won't go into here).

Why treat hypertension?

Due to the work on water systems and health care, led by Partners in Health/Zanmi Lastante and the Upper Diocese, infectious diseases have been nearly eradicated in the Central Plateau. Unlike 40 years ago, there are few cases of cholera, TB, malaria and HIV, as well as fewer cases of malnutrition. So once you have cured people of the threat of these deadly diseases, they are now living long enough to have chronic illness, and the most common illness here is hypertension (high blood pressure). The going theory is that the genetics of the people from the original African countries where they were brought from causes their kidneys to hold onto too much salt. So hyptension and the strokes it leads to when untreated are significant problems and cause of death here now.

We saw about 450 patients in our four clinics. I would guess that 60-70% had high blood pressure. Many had symptoms that were due to hypertension: headache, body aches, nausea, trouble sleeping, dizzyness, fatigue. After visiting our clinics, they received a 30-day supply of an effective, inexpensive (for us; they don't pay) medicine that will immediately make them feel better and extend their lives. Unfortunately, we also saw stroke victims who hadn't been treated in time, and heard many stories of family members having died of stroke.

Now the challenge is that hypertension has to be treated by taking a pill every day for the rest of your life. We are now relying on the patients to come to the community health meetings each month to pick up their free medications for the month. And we are relying on the community health workers, Maneus, Margaritte, Emmanuel, and others, to hold the meetings, reach out to those who don't attend, and oversee the ongoing health of their villagers. But this is how it has to work -- they can't rely on a once-a-year visiting medical team for all their needs. The people get a prescription from us, but they are part of a system involving community health workers and local hospitals (Cange and Mirebalais) that can treat them as needed. We are part of a larger health organization that is based in and operates fully in Haiti.

And what's the story with supporting students?

In addition to the medical ministry, Holy Trinity Clemson supports several university students as well as the Cange school, Bon Saveur. From my understanding, we help pay the teachers at the school, and we directly pay for 12 or so students to attend university. Earl Burch and two others personally help fund more primary, secondary and university students. Some others have bought textbooks for university students over the past years. Many of our current and former students were the translators and helpers on this trip.

Though there are free, public schools in Haiti (well, free as in no tuition, but families must still buy supplies, uniforms and food), most schools are parochial and private. Bon Saveur has a required tuition and is the only school in Cange. Holy Trinity has helped pay for students to attend, but then when the students are ready to go to college, they need money for that too. But there are complications in wiring individual people money, and there are challenges in arranging for middlemen (many known to skim a lot off the top) to administer the funds. The church and related donors are still sorting out the best way to do this, but it's clear that the need is strong (we have a temporary arrangement with Summits Education, hence our visit there). Students want to go to school and many want to study to be doctors and nurses (which are very, very needed in Haiti), so funding them is helping to improve and shape the future of Haiti.

Saturday, January 27, 2018

Leisure/Connections Day

Today was the day for packing up, mentally decompressing, and making connections with important people.

We drove from Cange for about 45 minutes to Corporant, to the campus of CFFL (Centre de Formation Fritz Lafontante). Gillane Williams, a native Australian and current Greenville resident who spends much of the year in Haiti, gave us a tour.


CFFL was developed as a trade school to teach three disciplines: agriculture, woodworking, and construction. The focus now is mainly on agriculture, as the other two disciplines closed because the students couldn't find enough jobs after graduation, and also because teaching farming  techniques is the school's most important mission. The school opened in 2010 with major funding from the Upper SC Diocese, Zanmi Lasante/Zanmi Agricol, and Rotary Greenville.

The building is light, lets in a constant breeze, and is clean and nicely decorated. There's a fully updated computer lab and plenty of classrooms, and beyond the building are about 40 lush acres of fruit trees and crops. 

Gillane (she later told me) got involved in Haiti after she was asked to translate for Pere Lafontante when he visited Greenville (she is fluent in French). She first came to Cange in 1999 as an English teacher, but was struck by the malnutrition she saw. She asked people why they weren't growing certain foods, and they said they just couldn't. Experienced in agriculture herself, she asked for room in Cange for a garden, and was given an area below what became the external clinic. Gillane used it to teach people how to grow various plants. 

In 2004, a person showed her the land in Corporant and asked, "Do you want this?" She got the 40 acres and planted 14,000 bananas by hand the first year. Her team went on to grow food to give local people by inviting villagers to collect the harvest. In 2010, the earthquake struck, and they started growing and producing on all the land that had never been plowed. One key task CFFL does is grow and shell the peanuts for Nouramanba, a healthy, calorie-dense peanut butter for kids. CFFL students grow the peanuts, then it is sent elsewhere for added vitamins and minerals. The end product has a long shelf life for mothers to take home to their children. It's so effective, it is prescribed by doctors.


During our tour, we were met by Marie-Flore, Pere Lafontante's daughter who is carrying out his legacy of helping Central Haiti. She took us to her new compound in Ledier. She and her crew left Cange when the new priest replaced her father in 2015. Her work was previously part of Zanmi de Education but became Summits Education in 2015 upon leaving Cange (Summits is based in Boston). The group went to Corporant for two years but didn't like the small space. Last year, an employee suggested she look at an abandoned compound that an Italian group had built in Ledier to house workers who were building Highway 3. The Italians had left it for families to use, but it was destroyed. Marie-Flore moved in in December and started renovations. We were therefore visiting a very nice, clean, bright and lovely conference-center type place that has been operational for only a few weeks.

This place houses Summits Education, and Abel gave us the full tour. Summits (Sommits in Creole) oversees the operation of 40 primary schools (some are a 6-hour walk away, others are nearby), all K-6th grade. They work with about 300 teachers and 4,000 students. They hire the teachers, train teachers, arrange teacher transportation, and send student snacks, among other jobs. So their compound acts like a conference center, a superintendent's office, an administrative office, and a dorm. There are also a few houses here, where the Lafontantes and Gillane and her husband, Charles, stay.

Tourism and Leisure

We arrived at the Summits compound around 10:45 a.m. and settled into our rooms. Compared to Cange, it felt like a luxury hotel, as we all got our own rooms and bathrooms (though we're still sleeping under mosquito nets, taking cold showers and drinking only bottled water). Abel gave us a tour, and we met several members of the administration. We also saw workers tilling a field with hoes and picks, and workers installing an iron-bar fence where a wall had been in order to create a view of the river from the patio.

We enjoyed a very tasty lunch (veggies, creamy potato salad, and flavorful chicken thighs) and then headed out for the only real tourism part of this trip: a drive to Saut D'eau (Sodo in Creole) to see a sacred waterfall. We drove about 30 minutes though the busy, colorful and urban town of Mirebalais (and by the amazing hospital we'd seen on arrival day) and into Sodo. At the gate to the site, Haitians entered for free, but blancs had to pay $5. We learned the waterfall is considered a sacred place in Voodoo because the Virgin Mary of Mount Carmel  (Voodoo version Erzulie) had been seen once on a palm tree there. Haitians now visit to wash in the falls for luck/healing, and they burn candles and make small shrines (mostly out of repurposed bottles) around it. On the Virgin Mary's day, July 16, we were told the falls are so packed you can't get near them, and the town is completely overrun by thousands of people making a pilgrimage.

The falls themselves were beautiful: very steep and powerful, surrounded by tropical plants. It was almost a scene you'd expect from deep in a rainforest. And yet...this is Haiti. There were steps to the falls inlaid with tile, but they were crumbling in places, and trash lined the sides (there is a LOT of litter in Haiti). Boys and some men aggressively descended on us and tried to make conversation and help us with the steps in an effort to get tips. Several women were bathing in the falls, so it felt uncomfortable to appear to have paid money to see naked women. The old burned bottle candles were tucked into every rock and tree around the falls. It was jarring to see a site that is sacred and important look trashed and chaotic. I suspect those $5 tolls go right into a pocket and do not pay for upkeep. 

We returned to Summits for a bit of rest and showers, then joined a lively cocktail hour Marie-Flore had arranged on the newly built patio with a view. We had beers and Haitian rum with Cokes, and everyone seemed to relax and smile in a way we hadn't all week. Soon, a live band started up, playing banjo, drums and guitars, often involving several of the male guests in singing/repeating lyrics. We talked more with Gillane, with Kathy (a retired English professor from Vermont who is helping to write a strategic plan for CFFL) and with Marie-Flore, who was clearly proud of her new home base. A wonderful meal of shrimp in a cream sauce and purple cabbage was served, and we got to try carrasol juice for dessert (a frothy fruit juice, maybe soursop in English?, that Fritzlene had raved about. It was tasty!). Soon the staff and all our crew were up and dancing, and the night was just perfect.

A few of us left to stargaze (stars without light pollution are always worth admiring), which made for a lovely and positive end to this big adventure we just had.

Friday, January 26, 2018

Leaving Cange

Several of us started this morning with Morning Prayer on a beautiful landing at the top of all the stairs, above Jackie's house. The sun was already up, but it wasn't yet hot, and a nice breeze carried music up to us. It was just beautiful: a perfect spot to take in the view. Mother Suz led the service, and the reading for the day was assigned to be Jesus and the Loaves and Fishes. After a week of trying to help people, giving medicines and hoping they come for  more, yet knowing there was also so much more to do, the passage felt meaningful and intended just for our ears to hear that day.

We are now packing up and getting ready to leave Cange for Corporant. The people here know it's their last chance to be with us.

Samuel must have told his uncle to bring his wares here, as he's outside with a blanket full of souvenirs (many of us bought a few things). The hallways are full of young people waiting to talk to Earl and make their pleas for money. Some of us think Earl's illness may be caused by taking on all these peoples' burdens (it's more likely flu, but the point stands). Eager, desperate students with no other idea of how to get to school are lined up, holding manila envelopes, undeterred by the long lines or our insistance that Earl can't see everyone (probably because he's still "taking meetings").

It's hard to leave.

Thursday, January 25, 2018

A new clinic: Anana

Pardon me if this blog isn't my best. I've succumbed to the GI bug (virus? cholera?) that is sweeping the group. Earl has a really bad case of it and had to spend the day in the compound. Betsy may have it. After a night and day of feeling bad myself (though I was okay for the clinic), I'm going on Cipro per doctor's orders (it's very handy to travel with a medical team and a full pharmacy). For the record, that makes five, possibly six of us, getting whatever this illness is.

Anyway, today was a good day to finish on. We set out on what felt like a real adventure, because no one had been to Anana before. Glen even had trouble finding it on a map. After some issues finding a second car, we drove about 45 minutes, where the first 15 were on paved highway and the rest was on a rocky road. We passed cisterns installed by World Vision and a Baptist Church we were told was built by a professor from Virginia Tech. We also saw some rings for cockfights.

The hike seemed easy at only 1.5 miles/1 hour, and only the occasional steep incline or descent. The thrill of the walk was a rickety suspension bridge we had to use to cross a river. It had rusty metal rope-like rails, chain-link sides, and a wooden plank floor (with a few holes). Someone spoke with a woman who lived there and said she'd never crossed it; she was too scared. Our group took it in stride, and even the interpreters and helpers were laughing and taking photos.

The Anana clinic was set up in a church that was decorated with plastic flower vines and paper mache balls hanging from the ceiling. We had one big room, which we used for triage, and a smaller stage-like area, where we put the three doctors and Audrey. (Audrey is a Family NP, joined us today. She's part of a dental clinic group from the Highlands, N.C., area that just arrived, and she asked to join us. We were glad for the help, and she did great work.) The pharmacy was a table facing the church's front door that patients accessed from outside.

Though we had less space, the clinic ran well. Blood pressures were taken outside, and Suz did a wonderful job with this task again (I hate that I didn't get a photo of her in action!). She was at a small table in the shade, surrounded by waiting people, for almost the whole day. She told me she enjoyed how the job allowed her to literally touch every person we were seeing, and do her best to comfort them. She said she prays for them often too.

Again, Fritz-Raul, Becca (with Sonel translating) and Fritzlene ran triage, and I entered every person's data into our hypertension database. We saw more children this time, which actually made the end of the clinic a bit emotional. A few children had maladies that couldn't be treated with any of our medications, including one young boy who had had siezures and brain damage. The doctors felt the most compassionate response was to tell the mothers: "Stop going to rural clinics. There's nothing here that can cure your child. You need to go the hospital in Cange or Mirebalais and ask for help." I just hope the mothers follow through.

Glen wrapped up the clinic with an uplifting speech thanking the community health workers for coordinating the clinics and providing health care services for all of these people year-round. Mother Suz blessed them all, and then we took group photos. I felt like we all finished up in good spirits knowing that good work was done.

I thank Glen (and Harry, from afar) for successfully coordinating a brand new clinic, which ended up running really well. 

We've all struck up relationships with different interpreters, and we've seen the hard work the community health workers have done to set up these clinics in their areas. So even though everyone was volunteering their time, our group pooled together money to tip them all (and the staff at Cange who have been cooking and cleaning for us). Fritzlene made goody bags of snacks, and Becca brought some New Testaments in Creole to pass out as well. I hope they know how much we appreciated their work. These clinics would not work without their time and talents.

We're done with clinics! As I type in bed, the rest of the group is taking inventory of all the medications so we can return them to the Cange pharmacy. We've done our work for now, and we pass the baton to the March team.

Wednesday, January 24, 2018

Through the Jungle to Bel Aire

9,500 steps
4.5 miles
2 hours 30 minutes
 -- the one-way hike to Bel Aire

We were originally told by Glen that Bois Joli (Monday's hike) would be the most difficult, but it turns out today's was longer and occasionally steeper. That said, most of us found today's hike to be easier because it was less rocky, often shady, and took us through gorgeous jungle and mountains.

We walked narrow cow trails (as we call them in Texas) that wove up, around and through the mountains. Twenty-foot tall blooming orange century plants lined the first part of the mountain trail. We walked through rows of banana trees and by a small farm of tobacco. We spotted a red-headed woodpecker on top of a royal palm and picked up fossilized shells from the rocky parts of the trail. The landscape was lush and green, dotted with cows and chickens and small huts.

The clinic was again in a converted school, and the folks who had been there before were excited that the roof was now aluminum and no longer thatched banana leaves. School children in uniforms came out to greet us. We set up the BP station outside, triage in the big school room, pharmacy in a smaller room, and the doctors in rooms that looked like stalls. 

The clinic ran smoothly, and we were able to see all 140 patients (our biggest one yet). I ran the database again, and this time entered every patient, not just those with high BP (so yes, I came all the way to Haiti to type in my phone all day). So I saw every triage sheet and every patient. This is my database:

It was frustrating to see so many patients who had once been treated for BP but had stopped taking their medications. It was sad to see people who were presenting with symptoms most likely caused by not having enough food. It was reassuring to see patients with high blood pressure come in with complaints like headache and dizziness, knowing that the pills we would prescribe that day would truly help them.

Our group

I need to take a moment to showcase two members of our group: Reg and Earl.

Dr. Reg Brooker is 76 and completes all these hikes without complaint (and sometimes near the lead). He has been to Haiti 50+ times. His first visit was in 1981 with John Page and Pierre Williams, the original builders of the water system. At that point, Cange wasn't even really a town. An oncologist in Greenville who attends Christ Church, he started working in Cange even before Paul Farmer got here and alongside of Paul when he was still a student. Dr. Brooker has also traveled all over the world, as an Army doctor, a volunteer, and for fun. His stories are amazing and his attitude and enthusiasm are inspiring. I advised him to write his memoirs; I hope he does.

Earl Burch is like a king here. Everywhere we go around Cange, young people ask in broken French or English for Earl Burch. He personally (or combined with Summits Education) funds 15 or so young and university students to go to school, and he coordinates Holy Trinity's support of 12 university students (I need to check these numbers.) The kids know Earl is the point person to ask for help, so they constantly approach him for money, laptops, and his contact information. He takes it in stride, kindly talking to each one, taking meetings and hearing their pleas. He understands well how things work in Cange and has a long history of coming here.

Every member of this group, and the kind folks translating and helping us, is valuable, interesting and caring. I feel blessed to be a part of this. 

Tuesday, January 23, 2018

Party at Jackie's

We had a lovely "petit soiree" at Jackie Williams' house this evening. She is from Greenville but now lives in Haiti full-time. Her husband, Pierce Williams, worked with John Page as one of the original builders of Cange's water system. A plaque honors them at the cistern's location:
From my understanding, Jackie started visiting Cange occasionally with her husband, than more reguarly, until his death about 20 year ago. She chose to bury him there and move there full time. She is Fritz-Raul's godmother, runs Sant Art (the artisan center), teaches English, and knows everyone.

She lives in a house whose name translates to "The little house above the cistern." It was small but bright, covered in Haitian art, a few photos, and her wide-brimmed hats hanging on pegs along the wall. She gave us cheese, snacks, wine and beer, and shared wonderful stories of her time there. She also helped catch me up on some of the recent political shifts, told with an understanding of how things have changed often during her decades of work there.

I also spoke more with Earl Burch as he was sorting through all the mail that Jackie gave him to take back to the states. Among the letters was the most recent accounting of students who needed their tuitions paid. I was surprised at how inexpensive it was to send a student to school for a year. If you're interested in funding any of these kids, you can donate here:

Also, we saw tarantulas on the way home. They live in the many holes of the stone walls that are throughout the Cange compound. You spot them at night if you carry a flashnight. Sweet dreams!

Clinic Two: Peligre

This morning started with the good news that all three of our sick group members have recovered (Becca became sick last night, but a dose of Cipro and 11.5 hours of sleep made her right as rain.)

We were excited for an easier day -- in that we only needed to do a short ride in the packed van to get to the town of Peligre, which is located near the Peligre Dam. We parked our van in an area surrounded by rusty but decorated abandoned construction equipment from the dam project.

We set up the clinic in a series of three rooms off a long outdoor corridor. Crowd management worked much better today. Patients waited on the side of the building, then saw Earl and Suz for blood pressure readings. Becca (with translator Sonel), Fritzlene and Fritz-Raul ran triage, while I entered data on a cell phone for those patients with high blood pressure. Our room was hot and stuffy, but ran efficiently. The middle room was for all three doctors and their translators, and the final room was the pharmacy, again staffed by nurse Betsy and Samuel, the Haitian pharmacist.

Again, most patients had high blood pressure, but they were often there for other complaints too. We saw a surprisingly large number of patients (like about half the women) with complaints like yeast infections and UTIs. Overall, we saw 128 patients in about 4 hours, and we didn't have to turn anyone away.

We returned to the compound and split up. Glen, Mark, Fritzlene and Suz went to see a patient at the Cange hospital with heart problems who is under Dr. Morse’s care. The rest of us had a pill-counting party, then went to Sant Art to shop in Jackie Williams’s store for art and gifts. The artists work there and learn English there. We are going to a soiree at Jackie's house tonight, and I'm looking forward to hearing more of her story. She is from Greenville but lives here full-time. Her husband constructed the first water system.

Overall, we had a good day: no hard hike, efficient clinic, low-key afternoon. I'm told tomorrow's hike to Bel Aire will be more strenuous than the Bois Joli hike, so again, please send prayers.

I enjoyed getting to know our translators a bit better today. Joseph (goes by JBM) is fluent in Creole, French, Spanish and English. He's in school and wants to study international relations. He is personable and friendly and seems to really enjoy being with us. He translates for Glen. Robinson helps in the clinic by directing patients where to go. He approached me to give him money to go to medical school in the Dominican Republic. Fritz-Raul is a second-year medical student who has Jackie as a godmother and Harry Morse as a godfather. All of the translators and helpers have been indispensable in our ability to get around and run the clinics. 

It's worth noting that these translators, educared and volunteering their time, don't have access to regular meals. Some brought no clean water. We have shared our snacks with them each day, and started having waters added to our supplies. So even connected, educated folks here have food insecurity.

First Clinic: Bois Joli

Today was our first medical clinic. The clinics focus on hypertension, so while we brought (on a horse) a wide variety of medicines, most of them were for high blood pressure, aches and pains, and stomach issues. Anyone with a critical problem is told to go to the hospital in Cange.

We set up in the school, which was one of two buildings on the top of the hill (the other is a church). One room was for blood-pressure readings, one for triage, three for doctors, and a pharmacy. First photo is the church, the rest show the school/clinic.

People were crowded together to see us. I'd estimate 150 came, including about 20 children. Many were dressed nicely. During the year, they get medicines and general check-ins from Maneus, a community health worker, nicknamed the Mayor of Cange.

Earl and I took the blood-pressure job, which was the patients' first stop. I had to quickly learn how to set the cuff, but thankfully an electric machine did the reading. All readings higher than 150/90 I wrote out on a red index card, along with their pulse. Lower readings went on a yellow card. I liked the work: seeing people, doing a simple but necessary job, and feeling like part of the process. The patients spoke only Creole (my French did little) and in general seemed a bit nervous but eager to be there. We saw all ages. Sadly, at least 75% got red cards.

The patients then went to see nurses Fritzlene and Becca (with an interpreter, Sonel) for triage. The nurses filled out a simple form of name and age, medications, history of hypertension, and symptoms/complaints. Raul (and later me) recorded the forms onto a phone-based database to start collecting data on hypertension treatment.

Patients then went to see a doctor, either Dr. Quattlebaum, Dr. Meyer, or Dr. Brooker, all paired with translators. The doctors listened to their hearts and lungs, briefly examined necks and bellies, and wrote out a prescription. I'm told it was mostly hypertension, complaints of stomach pains or body aches, and some infections. 

The patients then took their prescription sheets to the pharmacy, which was run today by nurse Betsy and a Haitian pharmacist named Samuel. Betsy fetched our pre-packaged pills and Samuel ensured that the patients understood how to take them.

We worked from about 10:30 a.m. - 2 p.m., with a brief stop for lunch. After lunch, it became clear that the doctors couldn't see everyone, so they prioritized those with high blood pressure. It was hard to leave when people were still waiting, but we were concerned about rain or darkness affecting our long trip back (later we learned how sick Glen and Suz were, so it was important to go).

Feelings were mixed at the end of the day. It was disappointing to see so many patients with high blood pressure in a place where this program ran clinics many times before. There was a great feeling of excitement at completing the hike, mixed with sheer exhaustion. And the two sick folks were just going through motions by the end. But we did it. At least 100 people have medicines they need. The people of Bois Joli know that someone cared enough to care for them.