HIV in Haiti

Clarice sat in her chair on the side of the desk in my examination room, looking intently at the little test cartridge.  I was talking to her as the HIV rapid test result was developing.  I realized she probably wasn’t hearing much of what I said – she was concentrating on the test cartridge.  I think she already knew the result – most of our HIV positive patients have been tested before and come to us to confirm their fears.  “The test is positive,” I told Clarice.  “That means that you have the HIV germ in your blood.”  I watched her face as I gave her the bad news.  Her head jerked back as if she had been struck.  “It’s positive?” she asked.  “I don’t know how that could have happened.”  As it turned out both she, 52 years of age, and her 69 year old husband were HIV positive.  They had nine children together, and both denied having sexual partners outside their marriage.  We suspected that wasn’t quite the truth, but we’ll probably never know.

Fortunately for Clarice and her husband, there is a very comprehensive HIV treatment program here in Jérémie, funded by PEPFAR funds (President’s Emergency Plan for AIDS Relief).  Testing, consultation, medications and hospitalization are all free, and the program gives nutritional support and money for transportation when funds are available.  We have diagnosed and referred several patients to the program already, but we continue to follow them in our clinic for other medical problems.  They like the fact that they can continue to see us and stay in contact with “their clinic”.

Each Friday morning I make rounds at the government hospital in Jérémie with the physicians who are responsible for the HIV program.  They work at the hospital as hospitalists, responsible for all the patients admitted to the medical service, both those who are HIV positive and those who are not.  Rounding with them gives me a chance to get better acquainted with the way the hospital functions, allows me to act as a mentor to the younger physicians and gives me experience with the HIV program itself.  In our clinic in Gatineau, we offer testing to all our adult patients and find that most are very receptive to being tested.  We hope to be able to detect many who are in the early stages of the disease, so they can be enrolled in the HIV program and begin treatment when necessary; people like Clarice and her husband.

You Don’t Know Who Your Friends Are Until You Need Them

This past Thursday we went up to our clinic in Gatineau as usual, not knowing that a routine 8-10 hour work day was going to turn into a rugged 24 hour shift! We saw over 40 patients during the day, and at 4:30pm had the truck all packed up to start our drive home, feeling contented that we had been of service to so many people, but tired after what had been a busy day. I put the key in the ignition and turned it and the engine went chug-chug-chug, but didn’t turn over. So, I tried again. Chug-chug-chug, same result. I continued doing this over the course of the next 15-20 minutes, not believing that our pick-up truck, which has been so reliable for the past two and a half years, was failing us. But, alas, it was true. We weren’t going anywhere very soon.

We’re unable to get a cell phone signal at the clinic itself, so Cherlie and our co-worker Ti Jean climbed up a hill where they could get reception. She called our mechanic, and he said he’d get a motorcycle taxi and come up to help us out. But, the way he said it made Cherlie have her doubts. At the same time, Ti Jean’s son Jimmy, “just happened” to come riding up on a motorcycle, having given someone a ride to their home just up the road. So, we sent Jimmy off down the mountain to find a mechanic and bring him back to us. We, in turn, settled down to wait. We thought the problem with the car was a relatively simple one – I had just filled the gas tank at a local pump and we figured the gas had water in it, which is an unfortunately common event around here. Well, Jimmy and a mechanic we had never met before named Ernest, arrived just at dusk, around 7pm. After taking off the gas tank, Ernest decided he needed some more tools to remove the fuel pump. So, around 8:15pm, off went he and Jimmy, supposedly to check for tools at a mechanic’s house in Latiboliere, a community half way down the mountain.

As 9pm came and went, we came to the foregone conclusion that the guys had gone all the way into town; a conclusion that was verified when they showed up again at 10:30pm. But, they brought some food with them, so the lengthy delay was quickly forgiven. In the meantime, about six of our neighbors had wandered into the yard, wondering why they hadn’t yet heard us pass by their houses. We usually wave to people all along the road as we leave the clinic and head home for the day. So, when they didn’t see us, they knew something was wrong. One of them brought a wind-up flashlight and held it for Ernest as he worked on the car. The rest of us sat around together on the ground around the truck, alternately talking and sleeping as the night wore on. It took Ernest until 3am to fix the problem, which turned out to be a faulty connection on the fuel pump, but in removing it, some of the small metal pipes leading from the gas tank to the engine were broken. He patched them up as well as he could and the car finally started!

At 3:30am, 11 hours after our first attempt, we thanked our neighbors, waved goodbye and said a prayer for safety as we made our way down the mountain. We were almost there when we lost power and couldn’t make it up the last few hills on our way into town. This time, the problem appeared to be a lack of transmission fluid. So, off went Jimmy and Ernest again on the motorcycle to go wake up someone to sell them some transmission fluid at 4:30 in the morning. A few cat naps later and they reappeared beside us. By this time the sun was up and people and other vehicles started to appear on the road. The addition of the transmission fluid allowed us to climb the last remaining hills to town, but gas was leaking profusely from the broken pipes by then and we could only inch along the rest of the way. We made it to another mechanic’s shop in the middle of town and stopped along the side of the road. By now, it was 6:30am, so we called a friend and he towed us the rest of the way home. Ernest, bless him heart, stayed on to fix the car, taking the fuel pump and pipes into town to get them soldered. By noon, the car was fixed and we were all tired, but grateful – grateful for safety throughout the night, the companionship and concern of neighbors up in Gatineau, the competence and dedication of a mechanic we had never met, the loyalty of our employees, Ti Jean and Annous, who stayed with us during the whole episode, and the faithfulness of the Lord, who’s hand was in it all. Praise Him!

Small Miracles

One of the most gratifying aspects of our work here in Haiti is when we see positive results of our medical treatment.  Each patient presents a challenge to the physician, both in terms of diagnosing their illness and in deciding the proper treatment for that illness or condition.  Obviously, the more experience and knowledge a physician has, the better they’ll be at making a diagnosis.  But, physicians also rely on laboratory tests and x-rays to help them determine the cause of an illness.  In a country where there are few diagnostic tests available, diagnosis is an even greater challenge.  So, when we “guess” correctly, there’s even greater joy here than when we’re in the US, with all the diagnostic resources at our disposal.  We like to think of these positive results as evidence of God working out his miracles through us.

Several months ago, an elderly woman came to the clinic with a rash on her lips and upper chest.  It had been there for months and had been getting worse.  Her lower lip was swollen and had some open areas and the chest rash was red and sore.  A visiting physician saw her initially and prescribed a steroid cream, and when she came back to see me a month later, there was very slight improvement in the appearance of the chest rash.  Her lip, however, was still sore and swollen.  I felt that she very likely had what is called a vasculitis, which is inflammation of the blood vessels and can occur in various parts of the body.  There are many different types of vasculitis, but they are generally treated with steroids, such as prednisone, given by mouth.  So, I decided to put her on prednisone for a month and see what would happen.

She came back to clinic last week, and I noticed her immediately as I spoke to the patients at the start of clinic.  There she was, sitting on a bench listening, and I was pleased to see that her lip looked much improved.  Later in the morning, when it was her turn for consultation, she was beaming.  “I’m talking to people about this clinic, you know,” she said.  “The medication you gave me has made me much better.”  She had obvious improvement in the rash on her lip and on her chest, with much less inflammation and swelling and healing of the open, ulcerated areas.  She was so pleased with the results of her treatment that she was telling everyone in her community about our clinic.  In fact, she had even brought her husband that day.  When I saw him next in consultation, I said to him, “What do you think of your wife now?  Isn’t she more beautiful?” he lowered his head and shyly grinned.  I could tell he was pleased with her appearance.  Later, his wife told Cherlie “I used to be embarrassed to talk with people, so I always covered my mouth as I spoke.  Now, I no longer feel ashamed and am able to hold my head up high.”

Positive results, small miracles!

Stories and Tears

There are times when our patients’ life stories bring tears to the eyes of both Cherlie and me.  One such episode occurred recently and I’d like to tell you about it.  A man and his wife had come to the clinic a few weeks ago with their infant daughter.  She had a large growth on her right upper arm and one day it started to bleed spontaneously.  They managed to stop the bleeding but over the next few days she became weak and pale, so they brought her to see us.  After hearing their story, I examined the little girl in her mother’s arms, her listless eyes looking up at me without a sound coming from her throat.  She was, quite literally, as pale as a ghost and when I checked her hemoglobin, it was 2.9 (normal being more than 12).  It was evident that she had bled a lot and I thought it was a wonder she was even alive!  She had a large, firm growth on her right shoulder and arm that looked to me to be a congenital vascular lesion called a hemangioma.  Her parents were convinced it had developed as a result of a vaccine she had received when she was a few months of age.  Whether that was true or not, the important thing was to get her admitted to the hospital in Jérémie so she could receive a blood transfusion.  So, we suggested that her parents take her down to the hospital immediately.  They said they weren’t prepared to go that day, but would take her down the following day.

We reluctantly watched them leave with their little girl, not knowing if we would actually see them again.  But, true to their word, when we stopped by the hospital the next day, there was the mother with her anemic daughter.  The hospital physicians had repeated the hemoglobin and it was slightly higher, so they decided not to give her any blood, but they placed her on iron and vitamins.  They also felt that the arm lesion represented a hemangioma, but wanted to do some further testing.  So they planned to keep her for several days, until her anemia was better, and then she could follow up with us at our clinic.  They actually kept her for two weeks and we checked on her frequently, always finding one or both of her parents by her side.  Little did we realize that her siblings were paying a price for her illness.

This past Thursday we saw the little girl again in the clinic and both parents were with her.  However, they also brought one of their other children, a seven-year-old daughter.  They said she had lost a lot of weight lately, had abdominal pain and weakness.  They thought some of her symptoms were related to their being away at the hospital with the other child.  She apparently hadn’t been eating well and had been sad without her parents.  I asked how many children the couple had and they said five.  Then I asked who did the cooking for the children while the parents were away and they said “the oldest child”.  Well, it turns out the oldest child is only ten years old and she had responsibility for herself and the other children, aged 8, 7 and 5.  There was a woman who came to the house to sleep each evening, but otherwise, the children were on their own.  The father went back and forth from home to the hospital (which is a 4-5 hour walk away), checking on them periodically.  I almost cried just thinking about that poor little 10 year old girl, with all the household responsibilities for herself and three siblings, while her parents were busy trying to save the life of her precious little sister.  What a difficult choice for parents to make and what heavy burdens are put on small children in this country.  It makes me realize again how important it is to have a personal relationship with Jesus Christ, who helps bear these burdens and gives wisdom in difficult circumstances.  How the Lord loved children such as these!  “Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these.  I tell you the truth, anyone who will not receive the kingdom of God like a little child will never enter it.”  And he took the children in his arms, and put his hands on them and blessed them (Mark 10:14-16).

Cultural Adjustments

I recently spent a few weeks in the US, and my activities included a wonderful fund-raising banquet that was held in Milwaukee on April 4^th.  We’re thankful to Fund Development Corporation, who helped with the planning of it, in collaboration with a great group of volunteers and our administrative assistant Tracy Bernhardt.  Over 230 people attended the event, which was held at the beautiful Wisconsin Club, and I think everyone had an enjoyable evening.  It was a wonderful chance to share what Friends for Health in Haiti is doing here in the Jérémie area and what our vision is for the future.

I realized, after getting back to Haiti, how much I became accustomed to the luxuries of life in the US when I felt surprised that:

• I turned on the light switch in my room and the ceiling light didn’t come on (we only have electricity when we turn on a generator or inverter/batteries).
• I stopped at one of the local gas pumps and they were out of gas.
• I put on my seat belt and realized that no one else in the pick-up was wearing theirs.
• I turned on the hot water faucet in the shower and no hot water came out.  In fact, no water came out because the pipe bringing running water to our house was broken and took a day and a half to fix.
• There were 30 people in front of me in the line at the bank and no one seemed to care that they would be standing there for an hour or more.

This just goes to show that the daily activities of life are much more difficult in Haiti than they are in the US.  So, don’t take 24/7 running water and electricity for granted!  They are a luxury to people in many parts of the world, including Haiti.

Haiti life has both surprise and tragedy

Last Thursday, we had a surprise visit at our clinic from several Haitian Public Health Department personnel from Port-au-Prince. They were there to inspect our present facility (our little tin-roofed house), evaluate the future clinic site and assess the need for medical care in the area. It represented the final step in a process that began two years ago with our application for approval for construction of a new medical facility. During those two years, we submitted a 59-page dossier with 7 copies, including the initial application and supporting documents, three subsequent sets of additional documents, all with 7 copies, detailed engineering and site plans, survey information, etc. Finally came this site visit and, hopefully, soon after we’ll have our official approval. It just goes to show that things are never easy in Haiti!

In the past couple of weeks, there have been two adolescent school boys killed in Jérémie in motor vehicle collisions. They were both very tragic deaths and show us that life is certainly not something to be taken for granted. Unfortunately, after each of the accidents it was said that someone else had caused the student’s death; in other words, putting a curse on them that resulted in death. This type of thinking is very typical of the superstitious thought processes that are at play in a country that is steeped in Voudou like Haiti. It is also an example of why we are so much in need of prayer in our daily lives here – for safety and wisdom as we go about our work and interact with those around us. Thanks for your continued prayers.

Hope for Haiti Banquet update

Hope for Haiti - our first ever FHH banquet – is fast approaching!  The banquet will be held on Saturday, April 4th at the Wisconsin Club in Milwaukee, WI.  For tickets, please email Tracy at friendsforhealth@gmail.com.

Plans are well underway and all signs point to a very fun event!    In support and celebration, please join Dr. Catherine Wolf, founder and executive director, and the Board of Directors in supporting the mission of Friends for Health in Haiti.

A cocktail reception begins at 6pm, where we will be entertained by members of the Ko-Thi Dance Company,  performing music from Haiti and the Caribbean.  If you’re not familiar with Ko-Thi, I encourage you to visit their website.  They are celebrating 40 years in 2009.

Dinner will follow at 7:30.  There will also be a silent auction, which is shaping up to be quite exciting with wonderful donations from area business and organizations.  There will also be a large number of Haitian arts and crafts.

Tickets can be obtained by emailing friendsforhealth@gmail.com.  Other opportunities are still available as well.  We are still accepting auction item donations and advertising for our program.  Email us if interested in these opportunities.

Happy New Year!

Happy belated New Year! I trust that you all had a happy holiday season. I spent ten days in Milwaukee helping out in two Emergency Departments over the holidays, so I was able to experience the snow and cold of the Midwest once again. I was glad to return to the warmth of Haiti again last week!

Our clinic is off to a good start after all the holidays. Each time we talk with patients, they tell us how grateful they are that we are there and how much they consider this “their” clinic. This sense of ownership is something we are glad to see. It shows us that our relationship with the surrounding communities is growing as is our reputation. I asked a young man this week what they say about our clinic in his community. He said people who have been here tell everyone what good results they’ve gotten from their treatment. And another patient said “people say you have good medications here”. We give glory to God for providing the experience and wisdom that allows us to make good decisions about the medications we give! We appreciate your prayers with us in this regard.

As we look ahead to the future, our most immediate goal is to continue to develop the clinic, and through it to deepen our relationships with the surrounding communities. It is through these relationships that behaviors can change, allowing people to use the resources around them to improve their health themselves and to positively influence the health of those around them. We use “teachable moments” during patient consultations to begin the process of community education. Everyone in the clinic listens closely as we give instructions to patients regarding their own specific illnesses. They even enter into the discussion as Cherlie explains to others how to take their medications. “She said to take it twice a day. Didn’t you listen?” they’ll say to the patient having difficulty understanding Cherlie’s instructions. Then, when their turn comes, others listen closely to see if they “get it”. Community participation, community education, all occurring in a small little clinic in a house!

Little Did I Know!

This past weekend I had to make a quick trip into the capital city of Port-au-Prince. We periodically ship supplies to Haiti through a mission organization in Grand Rapids, Michigan called Rays of Hope for Haiti. They pack up containers, ship them to Haiti, clear them through customs and put them in a warehouse in Port-au-Prince. Since space in the warehouse is limited, they like for us to pick them up as quickly as possible once they get there. Last Monday, I got a call that a container with some of our supplies had been cleared and was in the warehouse. So, on Friday, I flew to Port-au-Prince and some Haitian friends and I loaded the supplies on a 28 foot box truck we have there. We re-arranged everything in the truck on Saturday, planning to leave early on Sunday for the 12 hour drive to Jérémie.

Five o-clock Sunday morning saw us on the road heading out of Port-au-Prince. I was looking forward to the trip because I didn’t have to do the driving, it’s a great way to see life in the Haitian countryside and I figured I could take a lot of “people” photos as we drove. Little did I know what was in store for us!

The first 120 miles to the town of Cayes is on mostly paved road. When we were an hour outside of Cayes, near the town of Aquin, we had a flat tire – a blowout, in fact. Fortunately, we were near the center of town where there was a tire repair person, so we pulled over and began the process of changing the tire. It just so happens that a very good Haitian friend of mine lives in Aquin, so I was able to have a short visit with her and meet her six-week-old first grandson. A fortunate set of circumstances, I thought, despite the fact that we lost two hours in the process.

When we got to Cayes, we had to buy a new tire to replace the one that blew out, since we always travel with two spares. So, we lost another couple of hours there. At 3pm, we started out for Jérémie, only 60 miles from Cayes, but on the opposite coast, requiring travel over multiple mountains, on rocky, narrow roads. In a jeep it usually takes 6 hours, so we knew we wouldn’t be arriving home until after dark.

There are three really treacherous, difficult areas on the way to Jérémie, where the mountains are steep, and the roads are rocky and too narrow for vehicles to pass. Whenever Cherlie and I drive through these areas, we pray extra hard that we don’t come face to face with a big truck and that we don’t wreck our vehicle on the rough terrain! The first of these areas is called The Ramp and when we got to it late that afternoon, a light rain had started to fall. As we came to the first steep climb, Michlet, the driver, shifted down into low gear and we lurched forward. But, we were going too slowly to get up enough momentum to climb and he had to put on the brakes. As he did so, we started to slip down the hill and every time he took his foot off the brake to back down to a less steep area, the back of the truck slid closer and closer to the edge of what was a very deep ravine. It also happened to be the passenger side of the truck! The thought suddenly flashed through my mind – if we don’t stop sliding, we could go right over the edge!

Fortunately, he backed the truck down to the bottom of the hill and brought it to a stop. Our load was heavy, our traction poor and we wondered what was in store for us in the next few hours! After a collective deep breath, we made another attempt to climb, this time successfully, but all the while slipping and lurching over the large rocks. We continued on for several miles, slipping and sliding on the narrow road, coming close to the edge several more times as the rain poured down harder. Each time, I gripped the roof handhold tighter and tighter. Normally, I am not one to scare easily, but I have to admit that I was a little afraid during that stretch, realizing that if the truck went over the edge, I would be the one to hit the ground first. Not a pleasant thought! Thank the Lord, the road further ahead was dry and we made it through the next two dangerous areas without further mishap, getting to Jérémie around 11:30pm that night, 18 hours after we started. It never felt so great to be home! So, if you felt led to pray for us here on Sunday afternoon and evening, now you know why! We are grateful for the prayers and thankful for the Lord’s protection! Neither is easily taken for granted.

The Little Things in Life

Sometimes it’s the little things in life that we take for granted, like electricity and running water. In our little “house clinic” in Gatineau, we had neither electricity nor water. On cloudy days or in the late afternoon, it was difficult to see our patients or write on their charts due to lack of light in the clinic. So, we were especially thrilled this week when John Ohlinger, an engineer who is visiting from the US, installed a battery system with 4 ceiling lights for us. As the clouds came over and the rain fell in the afternoon, we thought we were in heaven with our little lights illuminating each room! His next project is to set up an inverter so we can have fans running on those sweltering summer days.

Engineer John will be supervising the future clinic construction project and we’re very grateful to have him on board with us. He’s also been helping us this week with our house/guest house construction in Jeremie. The first floor of the house was partially built when we bought the land and we finished it up enough to move into it last year. It took months to complete construction on a kitchen and storage area on that first level, because the house was built on solid rock that had to be chipped away with hammer and chisel to give enough clearance to pour the floor. Now, we’re in the process of putting up another two floors, replete with balconies overlooking the Caribbean Sea. We’ve learned a lot about construction in the process, and are convinced that it is only by the Lord’s grace that we’ve accomplished what we have thus far! Pray with us for rapid completion of the house, which will enable us to accommodate visitors more easily.

Rock floor of the future kitchen

View of the first floor roof when we first bought the house and land

Same view now with garage and front porch