Haiti Letter #3

A few more thoughts on Haiti as my time here winds down. Awful things still occur here, but I don’t feel like I want to dwell on them today:

• There is a shock and awe aspect to cold showers that doesn’t seem to get better with time.

• The weapon of choice for tarantulas remains the broom.

• It is delightful to prescribe milk, eggs, and beans to people who don’t eat well.

Some upbeat ideas about the electronics on the compound:

The compound gets most of it’s electricity from solar panels. At night they use a diesel powered generator. Late at night the generator is shut off to save on fuel and the panels have needed some motherboards to work properly, so all is not always well. Still, it is better than the rolling, irregular, expensive power outside the compound. The solar guy came by yesterday to throw up his hands and say the new parts don’t work so the power will be less, but not gone. He was telling us how in his part of Haiti they were having power only after midnight for a few hours, so everyone would get up and do the laundry and ironing during that time. That seems like a hassle. I like the security of having the panels and am giving some thought to having a small, RV style unit at the house in case the grid has problems.

Ultrasound is the coming thing in medicine and it really helps at this clinic. Haitians just are terrible at giving a good history of their illnesses for lots of reasons. Many answer yes to every question I ask them on a clinic visit. “Do you have fever? Yes. Do you have cough and runny nose? Yes. Do you have stomach pain? Yes.” And on and on. So a quick answer to something like tummy pain is to get this cool, laptop-like machine, use some sound waves and look inside. Dr. Jim does these for me and you can check their kidneys, liver, spleen, stomach, intestines, all the other things and feel like you are on firm ground when all those things look okay. No radiation. No risk. Very cool.

Other things:

Early last week I had a 25 year old young man come in with some long term chest pain with painful breathing. He took off his shirt and for want of a better term, there was this mushroom like tumor about the size of a quarter, growing in the right upper chest, sitting in a shallow crater. I showed one of the Haitian docs and we both gave it a somewhat sophisticated version of “geewhazzat?” We discussed various labs and x-rays to start the workup, then pulled in Dr. Jim.

“Ah yes. Dermatofibrosarcomaprotuberans. It’s rare in the states, but common here.”

That would have been my next guess.

I was asked to do the biopsy and one of the nurses stood by to coach me on it. Some have suggested that cancer will never be cured because it is so genetically close to the healthy stuff. Just one little mutation in a long string of genes that work just fine and it becomes disease. Somewhere in that haystack there is one small needle that is like a light switch. When flipped the other way, it would turn this thin bubble filled with soft, mushy, cottage cheese back into healthy, taut skin. The weird thing is that a precious few of these switches have been found and those cancers can now be simply turned off. No chemo. No surgery. Won’t happen this week in Haiti of course, but the man’s chance of living a long life is way up there. That’s the good news. Still, since being here I am getting to see the enemy way up close.

I mentioned in a previous letter meeting this skinny, older, white lady with this chocolate brown 15 month old boy with pneumonia. They came in a few days later for a check up and he was fine. It turns out here “thing” is to rescue starving babies at less than half their normal weight and coax them back from death. Some take a year or two of round the clock mothering by her and her staff to get to a normal weight. She has 39 such kids and her oldest is 16. That’s quite a hobby.

I am getting to see a bunch of newborns and it is a fun part of the job. My young, male translator worked with a pediatric nurse practitioner at the clinic for several years and is the clinic expert on breast feeding. Despite what you might expect, he is good at it and the benefits of breast feeding in a poor country are staggering.

Since most of the brand new babies I see are pretty healthy, the most important part is giving young moms some short, easy to remember bits of advice that applies to them where they live. I think of this when I see a family of three or four passing me on their motorcycle with a baby in mom’s arms, I know that telling them to get a car seat is out. Here is my list of things to tell moms in Haiti so far:

Breast feed your baby for at least a year. Even if you start to give your baby some table food at 4-6 months you should still breast feed. Even if you are sick you should still breast feed. The milk will not hurt your baby.

Table foods to give your baby should be things like bananas, other fruits and crushed beans, not just white rice and those crackers made with white flour.

An egg a day is a good rule of to go by when they start to eat table food.

Don’t hit your child in the head. Never shake your baby.

Bring your child in every 6 months to have them treated for worms.

Make sure they get their shots at the government clinic.

If your baby’s tummy starts to swell up (from malnutrition) don’t give them tea. (It is a voodoo thing.)

If the mom starts to swell up and have shortness of breath she needs to come to the clinic right away.

I also came across this bit of insight from someone named Robert Heilbroner:

Imagine doing the following, and you will see how daily life is for as many as a billion people in the world.

• Take out all the furniture in your home except for one table and a couple of chairs. Use blanket and pads for beds.

• Take away all of your clothing except for your oldest dress or suit, shirt or blouse. Leave only one pair of shoes.

• Empty the pantry and the refrigerator except for a small bag of flour, some sugar and salt, a few potatoes, some onions, and a dish of dried beans.

• Dismantle the bathroom, shut off the running water, and remove all the electrical wiring in your house.

• Take away the house itself and move the family into the tool shed.

• Place your "house' in a shantytown.

• Cancel all subscriptions to newspapers, magazines, and book clubs. This is no great loss because now none of you can read anyway.

• Leave only one radio for the whole shantytown.

• Move the nearest hospital or clinic ten miles away and put a midwife in charge instead of a doctor.

• Throw away your bankbooks, stock certificates, pension plans, and insurance policies. Leave the family a cash hoard of ten dollars.

• Give the head of the family a few acres to cultivate on which he can raise a few hundred dollars of cash crops, of which one third will go to the landlord and one tenth to the money lenders.

• Lop off twenty-five or more years in life expectancy

Heading back to the land of $4 lattes this weekend. Counting my many, many blessings. What a life we enjoy back home. Thanks for letting me ventilate on the internet. Love you all.

Jeff Smith