MC and Aaron On The Radio For Haiti

Listen to our interview with Steve McIntosh on Issues 2010 airing Easter Morning.

In Wichita:

KNSS (1330 AM) Sunday 8:00 am

KFH (1240 AM, 98.7 FM) Sunday 6:00 am

KFBZ (105.3 FM) Sunday 7:00 am

KEYN (103.7 FM) Sunday 5:30 am

Online: Issues 2010

Download from iTunes

Download to your computer.

Namaste

Namaste is a sanskrit word. It translates literally to "I bow to you", but the meaning, at least within the yoga tradition, translates to "I honor the divinity in you which is also in me". It's a way of recognizing, and taking joy in, our sameness as human beings who share the breath of a divine life force. Recognizing we are sisters and brothers, no matter the color of our skin, the structure of our houses of worship, or the distance between our homelands.

This was an easy concept to reflect on in Haiti. It was self-evident in our everyday interactions. Smiles, laughter, tears, these are the things that have us instantly connect.

Aaron and I were blessed manifold during our medical mission to Haiti and have been since we've returned. Not the least of which is the overwhelming support we've received. It continues to humble us how widely our blog has reached, and how generous support has been.

I want to take this blog to send a special thanks to Brightwater Yoga Studio, in Hendersonville, NC.   The owner, Leigh Ann, held a special class with all proceeds donated towards our mission in Haiti. A group of generous yogis collected to do adho mukha svanasana (down dog), virasana (hero's pose), savasana (corpse pose), and many other asanas in support of the Haitian people.  I know their hamstrings took the hit of their generosity!

This gift from Brightwater Yoga holds a special place in my heart. Yoga has been a key part to my groundedness (or attempt at it) during medical training that offers anything but balance in it's rigorous scheduling and demands. I have been fortunate to practice yoga under Leigh Ann's direction a handful of times during my training. Her studio is near my sister's home.

Through her studio, her teaching, and her presence Leigh Ann creates an atmosphere that encourages yoga to do the work it's meant to do. On two separate occasions, I came to true peace and forgiveness over challenging life issues while in her class. This is an incredible gift, in and of itself.

That Leigh Ann, and the yoga community at Brightwater, have been part of another life-defining experience--Haiti--deeply touches my heart. To all of you:

"Thank you, and namaste."

~Maryclaire

Haiti's Invisible Elderly

A heart-wrenching story and photo essay from the Washington Post this week on the elderly who are being forgotten on the streets over these many weeks since the January earthquake.

Haiti's Invisible Elderly

Photo Essay

-Aaron

A Smaller World

Providing health care in Haiti was a team effort, not just between Aaron and me, but with the many others who committed to the Heart to Heart Clinics: translators, administrators, nurses, doctors, paramedics. 

My last blog post included an email from Calixte, one of our translators. This post, I'd like to share an email from Anita, an ER nurse from California. Anita joined us about halfway through our stay, and stayed on awhile after we left. She accompanied us on our first day of the then-experimental mobile (aka: taptap) clinic and on our house calls. 

She and I made an easy connection, sharing a room (and a tent when a smaller, but still alarming 4.7 earthquake on 2/24 shook us out of the modest seminary room), communal meals, and most importantly sharing the day to day of working in a medical and humanitarian disaster of a magnitude that still remains hard to fully comprehend.

Serving in Haiti was a life-changing experience for both of us. She has put some of her thoughts down in words, and given me permission to share them with you. She hits eloquently on our experiences, the issues that remain, and the uneasiness we all share having left a place, and a people, who remain in need of so much.

~ Maryclaire

..........

It has been a week since my return from Haiti, and I thought you would appreciate some reflective thoughts.  How quickly it was for me to fall back into my roll as "Mom" with swim practice, the start of baseball season, classes to attend, working day & night shifts, and yes, even a Bon Jovi concert with husband & son...  and that was just one week!
 

The difference is that this week I also shared my thoughts and experience with loved ones, co-workers, friends, acquaintances, and strangers who were interested in hearing my story; whether it was in the grocery store, work, school, on the sidewalk, etc.  It always began with the standard question, "How was it?", and my answer always began, "It was life changing... I don't ever want to forget". 

I think daily about Elyse, the beautiful Haitian woman, and her incredible meals.  Also, her ability to find joy in the simple tasks of daily living.  The lesson she taught me was the ability to rejoice in the act of serving others (sound familiar?).  I was a guest in her country, to serve those in need, and she relished in her ability to share her talents (and tent) to make our stay enjoyable.  She taught me that I did not have to travel to Haiti to experience the joys of volunteering and offering aide. 

I was humbled by the thousands of Haitians who woke every day to the never ending despair of their situation, yet maintained their activities of daily living with dignity & resilience; peace.  They returned to their churches and gave praise and thanks to the Lord with total ruins and loss surrounding them on all sides.  I felt like an intruder bearing witness to their powerful return of faith as I questioned my own on some levels.

You greet strangers with a smile and wave that was always returned.  The trust that was placed in our work was unyielding, and yet I/we could offer so little in comparison to the modern technologies of the 21st century United States.  Frustrated? Yes!  Every second of every day I was frustrated.  Frustrated that we could not offer patients proper surgical and medical attention that was a basic standard of care in my country.  I was embarrassed at my ignorance to this crisis that was clearly present long before the devastating quake.  

Will the young mother who lived with her husband, 2y/o son, and parents in an 10 x 10 shanty receive the surgical services to remove the external fixator?  

Will the elderly female with the  gangrenous finger receive the appropriate care before getting septic?  

Will anyone remember the 14 y/o boy who was so proud of his healing leg wound that initially presented with maggots?  

Did the infant child with the neck abscess / infection make it to the hospital, and was she received or rejected?  

What will happen to the people of Haiti when the rains begin?  

I question whether I remembered to report off all the "follow up" plans / ideas that were passed along to me when others departed.  I was mentally and physically exhausted, overwhelmed, worried, and I am sure that I did forget.  The comfort comes in knowing that I am a proud member of this wonderful society of humanitarianism.  Many will follow after me fresh with energy, skills, and ideas to make a change / difference in human lives.

On that same note, I could not be more proud of my community and hospital.  Yes, one person did make a difference.  Mendocino Coast District Hospital did make a difference.  The community of Fort Bragg, California did make a difference.  Thank you for your love, prayers, and support.  Thank you for making my world smaller. 

- Anita

Dear Doctor

"Dear Doctor,

It's a pleasure for me to [write you]. Ever[y]thing is ok for me by the grace of God. I hope that for you too. I miss you a lot...."

So began the surprise email Aaron and I received a few days ago. It was from Calixte, the young pastor of the Bel Aire Church, and one of the translators at our Heart to Heart clinic. We specifically chose him to be translator for the mobile taptap clinic because of his ability to size up the safety of a situation, control crowds and remain calm under pressure.

He is also a warm, gregarious person, with an easy smile and good sense of humor. We were thrilled to hear from him. He is someone I hope to have in our lives for years to come. While I'm not sure how it will come to pass, I envision sitting down to dinner with he and his wife in the future. (His girlfriend is getting a degree in Business Administration in Florida. When she retuns, they will marry.)

Just prior to receiving this unexpected note from Calixte, I had decided my next blog would be about Calixte, and the many other young men who arrived to the clinic each morning cheerful, in professional dress, and ready to translate hundreds of patient visits. Like Calixte, our translators were young men in their twenties, all personally affected by the earthquake, living in the tent cities. All were eager to help us help their people. I want you know a little of their stories.

Jean Baptiste was our taptap driver. He skillfully drove us each day in and out of Port-au-Prince. He also manned the wheel of the taptap when we transformed it into a mobile clinic. He was careful to park the truck so we could leave quickly if needed. He would jump out to perform crowd control from time to time, when the crowd pushed in too closely. People, especially children would press their bellies against the bumper of the taptap, to relieve hunger pangs. (Aaron had a young patient who wrapped part of a torn sheet tight around his belly to help relieve hunger pangs.)

Jean Baptiste has five children. He and his family stayed on the Nazarene grounds, but they did not have a tent. He, his wife, and five kids, slept on the ground, or on the floor of the taptap. Unaceptable. Towards the end of our stay we arranged for a Coleman tent, left by a previous volunteer, to be sent down from our base site in Leogone (the epicenter of earthquake) to the Nazarene Seminary. It arrived the day before we left. Aaron gave this tent and our remaining food to Jean Baptiste who was so overjoyed to have a 'home' for his family, that he kissed it.

Augustave was my clinic translator for two days. He had studied English at language school before the earthquake. He could say my name with the best American accent. He was studious in nature, keeping an English-Creole notebook of medical terms. He even had with him an English book on natural health for children published in the 1990's. He had picked it up for a few goud on the street.

"I like to know about different things, " he told me.

I encouraged him to go into medicine when the infrastructure returns. Haiti lost 60% or more of their medical personal in the earthquake.

Like all of our translators, and patients, Augustave was well-groomed and professional. One morning he was interpreting the clinic visit of a pretty young Haitian woman. It wasn't until after she left to the pharmacy station, that he quietly shared that this young woman was his fiance. They had planned to marry in March, but had to postpone the wedding due to the earthquake.

John kept the clinic running smoothly. After our patients entered the church, they were ushered to the second floor to back rows of pews that functioned as our first waiting room. From there, they were called to the third floor where our clinic 'rooms' were located. A dozen people could wait here on a concrete bench while waiting for a room to open. John efficiently kept people moving to one of three rooms as they became available.

He also dispensed de-worming medication to everyone. All patients were given enough mebendazole for themselves and all family members. We had several patients return to say how well the medicine had worked in just 24 hours.

John also happens to play the drums quite well. He played at Sunday service. The following Monday he said to me, "I saw you sitting at service yesterday, did you like the drums?" I gave him an emphatic "yes!", because truly my favorite songs were the ones where he had played the drums.

Mark had lived in the States for ten years, but had returned due to visa restrictions. Just prior to the earthquake he had been standing in the street talking to his sister. He had been called across the street by another friend, when the earthquake struck. He looked over his shoulder a split-second later and his sister had been cut cleanly in two by falling debris--without even the chance to scream.

In the immediate aftermath he and others went through the rubble trying to free those pinned under concrete. One of the first people he pulled out was a young girl who was stuck under debris of a fallen apartment building. She had told him her godmother was holding onto her foot so she couldn't climb out. In reality, it was the dead weight of her godmother's body that was holding her down.

Mark shared this story with me at the end a clinic day, after which he thanked us for being there. Saying, if given the choice, he and other Haitians would choose to be in the States and not here in the aftermath of the earthquake. They were all so grateful we volunteered our time and our skills to Haiti.

Below is the closing message from Calixte's email. I pass it along to all of you who have supported the work we did with the Haitian people through your prayer and donations*.

"A friend of you[rs],

MAY GOD BLESS YOU and your family"

~ Maryclaire

...............................

*Several people have asked about donations received. To date we have received about 65% of our costs for medicines and travel. We are grateful for your support!

Chile

Most of you are aware that an 8.8 magnitude earthquake hit Chile over this past weekend.

Many people have asked me "are you guys getting ready to head down there?", and my reply is crisply, "no".

There is a fundamental difference between the 8.8 earthquake in Chile, and the 7.0 quake earthquake in Haiti, and it has little to do with the difference in magnitude between the earthquakes themselves.

Chile, an industrious 2nd to 1st world country with political and economical stability was the site of the largest earthquake in recorded history, which occured there in the middle of the 20th century (9.5 magnitude). Because of this, buildings were designed to withstand substantial earthquake damage. The major cities in Chile have well-developed emergency response teams and high quality hospitals available. And the nature of this quake itself is significant- it was of large magnitude but happened deep into the Earth, and it occurred in the early morning and on a weekend- when most businesses and large buildings were largely unoccupied.


The January 12th Haiti Earthquake occurred in the poorest country in the Western Hemisphere, one that has faced nearly a century of political upheaval, persistent aid embargoes, and other sources of instability and persistent poverty. The earthquake occurred during the peak of business hours on a weekday- when the markets, schools, hospitals, and streets were heavily populated. The epicenter was only 15km from the most populated city in Haiti, Port-au-Prince, with nearly 3 million people and it was a shallow quake. The buildings were poorly constructed, and from poor or improvised materials (there are actually no building codes in Port-au-Prince).

The loss of life in Concepcion and the surrounding areas in Chile is heart-breaking. As of this morning the death toll is just over 300. Crews from around the area risk their lives hourly to reach survivors trapped in rubble.

But consider that the apartment building across the street from our church clinic itself has a death toll nearly double that of the current death toll in Chile. When we left, the total in Haiti was 270,000+ in mass graves alone. That did not count bodies yet buried, or the thousands upon thousands that will be recovered from the rubble only en masse when the foundations are cleared over the coming years.

Consider that there was a 9,000 UN peacekeeping force on the ground already in Haiti due to instability. There are hundreds of thousands currently starving in Port-au-Prince right now, and it's 6 weeks after the event itself.

And the news will get only worse in Haiti. When we left, biosurveillance was detecting the initial cases of typhoid, malaria, H1N1 influenza, and cholera. All will explode as the rainy season begins now. Rabies, diarrheal illness, and other infectious diseases will multiply. The aggregation (mass collection of people) will continue to pass these and other illnesses throughout the tent cities and homeless masses sleeping directly on the street. Community acquired pneumonia will blossom throughout the masses.

Infectious disease is only one thing that will be brought by the rain. The mudslides that will be generated will pull down the tens of thousands of shanty homes on the hill and mountain sides that have already been shaken from their lose foundations.

And then there is the ever-present danger of secondary collapse of buildings, and of course- the damage another earthquake itself could bring.

Both Maryclaire and I can personally attest the people are starving and have no water. The people will become cold, frustrated, further despondent.

My concern, and the reason for even writing this post, is that I don't want people to either forget Haiti or become preoccupied with the event in Chile that the news is relentlessly portraying at this moment because it's interesting. Aid and attention should not be diverted from the continuing crisis of the Haitian people. The Chilean government actually specifically asked for no foreign aid initially. Later they allowed aid from neighboring countries, and even from the United States. Heart to Heart International has contributed a team and supplies to the area as appropriate for the level of emergency and continues to assess the situation.

Keep Haiti in your minds and hearts as you also reach out with your prayers and donations to Chile. Please remember the millions who have been hurting, grieving, and starving- even as the news hasn't been paying attention.

-Aaron

Some Useful[ness]

She was one of hundreds who came to the clinic for burning, stinging, watering eyes, with decreased vision. But hers were the worst I had seen. Her eyes were glassy, red, teared, with the look a pterygium forming. A pterygium is a non-cancerous growth of clear, thin tissue that lays over the white part of the eye. Risk factors are exposure to sunny, dusty, sandy, or windblown areas. The air in Haiti is thick with contaminates: concrete dust, diesel, burning trash of all kinds, burning charcoal for cooking. Everyday we drove in and out of the city, we wore sunglasses and respirator masks (the kind you use to keep tuberculosis, and other infectious irritants out of the body). But she she had access to neither of these. She lived in the tent city next to the ruins of the National Cathedral.

I told her I would give her eye drops to take home, and cautioned her against sitting close to smoke. I also told her I needed to flush her eyes. I tucked a drape under her shirt collar, and had her carefully lean her head outside the taptap window. She stayed perfectly still as as a stream of flushing solution cleaned each eye. When the flush was finished, I used a sterile gauze to wipe away the water streaming down her cheeks. It felt like I was wiping away her tears.

On our last day of mobile clinic, the taptap pulled away from the curb after we had sent the septic two-month-old baby to the hospital. Over a dozen people were still waiting to be seen. I knew they would be seen by my colleagues the following day. But still, I couldn't keep from having to wipe away my own tears, as these beautiful people became smaller in the distance.

Since I've been home, the tears still come easily when I read the news of Haiti, or see commercials on TV for the many aid agencies working in Haiti.

Yesterday I watched a short clip from the Dalai Lama's recent visit to Nova Southeastern. We first saw news of his trip to NSE on the front page of the newspaper while awaiting our connecting flight in the Miami airport. I am always inspired by the Dalai Lama's words. But those that struck me from this talk were this: "The nature of compassion is taking care of others, of their well-being.....My only interest, so long that I have life, is that my life be meaningful, [have] some useful[ness]".

When colleagues at work ask me how my trip to Haiti was, my response has been: "It was beautiful and devastating, and truly the most meaningful thing I've done".

Thank you again for your part in all this. Thank you for your support, your prayers, and for following our blog, so we can tell our story, and the story of the Haitian people.

~Maryclaire

..............................

We will continue to post blogs and stories. We have updated more photos to previous blogs. If you go to "little hands" you'll see many pictures of the beautiful children.

Mesi (Thank you)

A father brought his four month old baby boy to the clinic for persistent diarrhea. The next day as we were loading up the taptap to go home this father found me and grabbed the interpreter. His baby was better, he wanted to say "Mesi" ("Thank you" in Creole).

A young woman who had given birth to a baby girl just days after the earthquake, came in for some of the "usual" post-earthquake complaints. Among other things, she was anemic. Her one month-old baby girl was beautiful, but did have thrush, like so many of the children here. As I sent the mother away to pick up multivitamins to strengthen her and her baby through 'fortified' breast milk, she flashed me a big smile and said "Mesi, Mesi".

We sat in the taptap mobile clinic as Aaron patiently explained the next steps (which hospital to go to, how to administer antibiotics) to the family with the septic two-month-old baby, as I dressed the wound with antibiotic ointment. The father, who had been turned away at the national hospital looked to us both and said "Mesi, Mesi, Mesi".

A 39 year-old carpenter came in with complaint of back and sciatic pain. He had palpable muscle tightness in his lower back and hip muscles. I told him I'd prescribe ibuprofen, but I let him know the true solution for this problem was stretching out those tight muscles. I taught him modified yoga stretches. As he demonstrated the chair twist, a big smile broke out on his face. He could feel how this stretch was working on his aching back muscles.  "Mesi!" he exclaimed as he left.

While 'touring' the devastated cathedral grounds, two young girls living in the nearby tent city asked us if we had anything to eat. We split the only remaining food we had on us at day's end, a lone granola bar. "Mesi" they said in unison, with a big smile on their faces.

As we gathered supplies out of the storeroom on our last day, we gave bouncy balls and jelly bracelets to the children living on the Nazarene grounds. As I placed a purple jelly bracelet on the small wrist of a five year-old girl she said to me, in English, "Thank you, Thank you", and blew me kisses saying "mwah, mwah".

These stories are just a few of the many expressing our patients' gratitude. All of this thanks, I pass along to you--our family and friends, friends of family and friends. Your generous support of us and the Haitians has changed lives. Mesi, Merci, Thank you.

~ Maryclaire

......

We returned from Haiti late Wednesday night. We are well, though exhausted. We have both joy and sadness in our hearts. It was simultaneously wonderful and devastating to work with the Haitian people, and hard to leave with so much work left to do. My dreams are filled with the people of Haiti, and the need that we left behind.

We will continue to post remaining blogs and photos. Please see our previous blog posts that have now been updated with photos.

The Things That Remain

We're home now. Safe in the US and with some degree of culture shock.

I know for me it's hard to talk about this whole story, as we're still kind of there, in Haiti. It's hard to go from despair and hope and death and all of it to TV's and water you can drink straight out of the sink and people's day to day conversations.

We have some stories for all of you to finish out. There are more things to say, more things to pass on. We have other people's stories to tell, as well as our own.

We'll finish out the remaining posts, and hit on those other topics. We have some multimedia slide shows we have to create, that will narrate some of the story.

Stay tuned over the next few weeks for the end of our adventure.



-Aaron

P.S. We are still in need of donations. Anyone you can pass this information on to who may want to donate, please do so. We borrowed all of the money to head on our mission, and still need to pay down those debts. We were actually doing well until Pay Pal discontinued our ability to receive donations.

Any donations in surplus of our debts will be directly donated to Heart to Heart International, and will go to mission critical meds like we brought, that we will send directly with future team members heading into the field- vs. those sitting in port with all of the other aid agencies. Thank you for your continued support!

Emergency Medicine

We worked very hard to get heatstroke on Monday, our final day of clinical work in Haiti.

The taptap needed a repair, so we were unable to start out right away with mobile clinic. Instead we made a housecall that was needed. At the start of the earthquake, the medical aid response was huge. Doctors, nurses, surgeons, paramedics- rushed into Haiti providing life-saving care. Many operations were performed. A popular procedure was reduction of fractures and stablization with external fixators- large medical devices that keep the bone straight and in place on the outside of the body. The problem is that all of the surgeons left. Nobody is here to take out the external fixators. Now there are thousands in Haiti with devices in their bodies unable to move or walk, and getting secondary infections because of the permanent wounds. We are working hard with agencies right now to address this. The pediatric hospital, St. Damiens (which was a regular hospital comandeered by international pediatricians and neonatologists) has agreed to even see adult patients on a limited basis, and will remove the fixators when appropriate. We are responsible for maintaining care until then.

A lovely woman who has been kindly taken in to an actual house (one room) up the street from our clinic receives regular house calls from us for wound care on her external fixator. Things had been fine until Monday. On our visit on Monday, we found the wounds to be pussing, hot to the touch, and with other signs of infection. We immediately prepared the woman for transport. We could not find our only doses of our first choice of antibiotics, so were forced to compromise with an injection of an appropriate med, and oral follow up with a very less than ideal med. We wish we could tell you this was the first time we did this, but it is what it is in Haiti. We sent her immediately to the children's hospital.

While we were out, a large aftershock hit the church, and many ran out from the building. There was no damage, but many were scared. Eventually we were able to load up to the taptap. On our way down to the street we ran into many who had been scared out of the building- mostly amputees- who would go no further. They were unable to be seen by the others upstairs in the clinic, so we set up there and saw them all. Eventually we were able to finally hit the street, and again we set up in front of the Cathedral.

We saw many that day, and Bel Aire most certainly set us out in clinical style. These were the sickest patients we had seen during our entire stay in Haiti, and we were more like an emergency room than a clinic. We admitted or referred 6 in the last hour alone.

I saw a baby in the gutter that was being rocked by a teenager with a foot. He stated the baby was fine but we demanded he be brought into the truck. The baby was a double-orphan because of the quake, and had non-stop diarrhea for one month now. Not uncommon, the people drink any water they can find, and boiling is almost never an option.

Maryclaire saw a pregnant woman who has had vaginal bleeding since the earthquake. She would pass a handful of clots nearly every day.

I was called out of the taptap urgently because there was an older man, who could barely breathe, and could not stand or walk. When I found him in the filthy room, he was working hard to breathe and was in obvious pulmonary edema and heart failure. We did not have the medicine of choice, but a similar medicine was available to start to take the fluid out of his lungs. I brought it back but it is a blood-pressure lowering medicine and we had to check his pressure first. Of course it was extremely low. With my penlight I could now see the signs of extreme dehydration. He was dehydrated, yet his lungs and legs were filled with fluid. I rehydrated this man right there so I could take the fluid right out of his body again. I admitted him urgently to the General Hospital.

On the way to the taptap, I was expecting to tell the driver we were leaving immediately. A man ran up to me with a baby wrapped in a towel. I looked at a light bandage over the neck, and found a gaping wound. We examined the baby on the taptap. Two month old with signs of extreme sepsis. We aadmitted the baby to MSF (Doctors Without Borders) as the child had already been turned away elsewhere.

The afternoon continued to be a challenge. It was hot. We were dehydrated and could barely stand by the middle of the day. It would take all night to put the fluids back into us, and earlier both Maryclaire and I had to be rehydrated in the clinic (image to the right is crusted salt on my shirt at the end of the day. The streets of Bel Aire certainly did not hold back on our last day of work.

-Aaron

Bearing witness

We no longer have clinic on Sunday afternoons. Initially the medical need was so critical that clinics, ours and those run by other relief organizations, ran seven days a week from dusk to dawn.  Though our staff attends church service with our translators and our patients Sunday mornings, the clinic is now closed on Sunday afternoon. The founder of the Heart to Heart International (the humanitarian organization we are working with), Dr. Gary Morsch, joked with our clinic director,

"Who decided we weren't working on Sundays anymore?".

"God",  Dr. Spaulding responded. "He wanted all of us to have a day of rest".

We are fortunate to have the founder of Heart to Heart back in Haiti for a few days during our time here. Dr. Morsch was initially to Haiti three days after the earthquake assessing need and planning operations to meet that need. Sunday after church, he offered to take us around Port-au-Prince, to share with us what he knew of Haitian culture, and to allow us to witness the full magnitude of the earthquake's destruction. While we could see the ruins of the National Cathedral outside our clinic windows, Sunday was the first time we saw the devestation of the Palace, the courts, the nursing school, the national hospital and pharmacy, and countless other cultural landmarks.

We walked the two blocks from the clinic to the Cathedral. Our first stop was at the ruins of a building next to the clinic. Scattered amongst the rubble were clothes, plastic flowers, and human bones. It was jarring. All streets are lined with fallen debris that has been pushed into seemingly monotonous piles of concrete. But if you look closely, you see personal affects, the materials of everyday living, and the remains of those who perished.

We walked on in near silence to the National Cathedral*, which was a notable and beautiful landmark. (About 80% of Haitians practice Catholism.) Dr. Morsch, who is a retired marine, took us perhaps a little farther into the rubble than common sense might allow, but this site drew us in. As I dusted underneath my feet, a beautiful marble floor emerged. To my left, a baptismal basin sat askew. Priest's vestments, one in black, one in white, laid amongst the twisted metal, chunks of concrete, and shattered stained glass. The archbishop was killed in the cathedral the day of the quake.

From this sobering site, we took the Tap-tap (so named bc you "tap" it when you want it to go or stop) downtown to the Palace and National Hospital. On our way there, we stopped at the nursing school. The quake happened during class session. Many, many died. It was chilling to see medical supplies, notebooks, shoes, and other affects. Though like before, most chilling was to see the scattered bones of those who died just six weeks ago. The devastation is so great, with 90% of structures in rubble, that there is not the man power to remove rubble and retrieve remains in a timely fashion. Approximately 240,000 of those who perished are already in mass graves. The death count from the quake is surely double, triple this, when you consider the many whose bones remain amidst the debris. The downed school across from our clinic holds the bodies of 200 children. We said a prayer for the nurses, and all of Haiti's people, and moved on.

We finished up the day at a missionary school that was having debris cleared by 120 college students, mostly from the University of Miami, who came in for a weekend to help clean up. The man who coordinated the students' efforts, was a friend to Dr. Morsch's brother, Paul Till. While there we spoke with a woman from Vermont who has been teaching at the school for 11 years. Her apartment was on the upper floor, towards the back of the building. It came down in the earthquake. We asked her about the quake, what she had experienced. So many talk about how loud it was. The first thing you heard was the noise, they all say. But this woman added another dimension to our understanding of the quake. While the noise of the earth rumbled for 35 seconds, the wailing of the people lasted for hours:  There was an incessant loud wail of unimaginable human anguish throughout the streets for two to three hours after the earthquake struck.

From this conversation, I now know that the memory of this wailing, the participation in this wailing, is part of what my patients bear. Part of what spurs their headaches, their stomachaches, their inability to sleep at night.

~Maryclaire

p.s.  More to come tomorrow from Aaron on our second day of Mobile Clinic.

*p.s.s.  To see pictures of the Cathedral, the palace and other landmarks pre and post earthquake, please go here.

The thousand words a picture is worth

I bought a painting today. On the way home from clinic we drove through the downtown, just past the destroyed Palace (Haitian White House) and sprawling tent city in front of it, is a small market place with a dozen vendors.  It is surely a fraction of the tourist trade that used to line the capitol city streets. These few vendors vied for the attention of American doctors. My attention was drawn to a stylistic and nearly monochromatic painting of Haitian women dressed in white, gathering bags of  rice into baskets headed for the marketplace.

Many of our patients arrive to clinic in clean white clothes. All arrive well-dressed, the men in pants and button-down shirts, the women in dresses, skirts. The children, too, are dressed well. This despite the fact that they are living in the street. Just outside the clinic a shoe shine has set up 'shop' along the dusty streets that are lined with fallen debris. Men are lined up throughout the day having shoes, even tennis shoes, cleaned and shined. The people here have a quiet, reserved dignity that is at once startling and humbling.

There are signs throughout the city that say: "Revive, live life. Haiti has not perished". There are t-shirts with this same message seen on the backs of paraders walking through the streets, with music and singing. The music is starting to come back in parades, in church, in the streets. The streets were eerily silent of music for weeks after the earthquake. Partly from lack of electricity and music makers, and I imagine, from overwhelming sorrow.

Sunday morning we attended service at the church that is home to our clinic on it's top floor. This was the second Sunday service held after the earthquake. People were too afraid to enter buildings before that. This Sunday, however, several hundred people filled the pews. Again, all impeccably dressed, even though they have been living on the streets for 5 weeks.  Men and boys in ties, and suit pants, women and girls in beautiful dresses, with hats and bows in their hair. I sat next to a woman dressed in a white linen dress and held her six-month old baby for part of the service, so she could fully participate without being distracted by a squirmy, cute-as-a button, big-eyed, baby boy. (Yes, of course, there was also my selfish motivation of receiving rejuvenation from this little spirit).

The service was over two hours long and filled with praise, singing, dancing. It was powerful and humbling (I am continually humbled by the Haitians) to see these people who have lost so much,  able to offer such joyful praise. This culture knows what it is to live in gratitude...and dignity. I witnessed this at the church service, and every day I work at the clinic. 

And so now I have this painting of women in white to remind me...of the Haitian people, of my experiences here, of the calling we all have to live in gratitude and dignity.

~Maryclaire

House Calls

She spoke no English, no French, and we speak incomprehensible Creole. Her message was clear though through her eyes, her face, and her gesture- "I'm not going up there- I've tried, but there is no way".

Our mobile street clinic was an incredible success. On the street we have found so many people who as expected were too afraid of entering buildings- much less going to the fourth floor of one- to enter the church that is the home of our clinic. Maryclaire and I took our Taptap and driver, our best translator Calixt, and drove to the massive ruins of the National Cathedral which lies in front of a massive tent city.

We weren't sure exactly what was going to happen but it pretty much solved itself. We brought a case of meds and supplies, and between Maryclaire and I, we acted as physician, nurse, and pharmacist. Calixt would bring one person at a time into the Taptap and we conducted ourselves as we would in the clinic. Later we brought Anita back to the site so we could have an RN with us to help out.

We saw 50 patients in a short time, and transported 34 to the clinic in between. When we left we had a crowd of 30-40 begging us not to leave, but so happy when they heard we would be coming back on Monday. We saw a lot of the general complaints we've been caring for (eye irritation, gastritis, muscle pains, parasitic infestations), but also sicker issues that we were able to refer or transport not only to our clinic but to the outlying field hospitals we have relationships with. We were able to ask what we had planned: 'do you know where someone is who is very sick, and unable to reach medical care?" We'll continue the mobile street clinic today, moving into other areas of downtown.

In the afternoon we took the long route home to take a translator home, around areas of downtown we haven't yet seen- including the Palace, the national nursing school (with 500+ nursing students and teachers lost), and other devastated areas. We stopped by the stadium so our departing paramedic Jim, who was finishing a 3 week tour and had been here early in the disaster, could say goodbye to the place he had seen so much pain and chaos. The stadium was transformed, and a palpable feeling of peace and calm was the dominating feeling, over the

smells of human aggragation, filth, and the obvious disrepair of a tent city within the structure. It was moving to see the look on his face, to see the results of his work. Maryclaire and I walked along separate from our group, talking to the children and families. We were asked to urgently come see a woman, and we made a house call to her. She was 8 months pregnant, and was dehydrated, and having abdominal pain. This was her first pregnancy. We assessed her, Maryclaire calmed her and her family, and they asked if we could come back and see her one day. We said we would.

The Palace looks like a scene from the movie Independence Day or Armageddon. The entire roof of all sections is slid down, the pillars crushed, the front caved in. Imagine the white house crushed and sloped, with a multi-thousand person tent camp in front of it. It was shocking. In sharp contrast there was a parade of the people in front, led by a truck blaring songs of praise. The people were singing and dancing, all wearing some bit of yellow. Their song was of joy, not of grief.

At the end of the parade near the end of the tent city, we dropped off one of our interpretors. This was the first time one of our new nurses had realized the fate or our translators- our colleagues. They were just as homeless as all of our patients. She didn't realize this because like our patients, they are always dressed in the best clothes they can find, and well groomed. With nothing, they make sure they always look their very best. We passed a graffiti sign after leaving the palace that said 'Haiti has not perished!'. With so much emotion in the air, and with such respect for the peoples imaginable loss, deep tragedy, and persistent love and defiance it was impossible for us all not to cry.

We were all so grateful to the people of Haiti for giving us so much in that hour, and in this experience.

-Aaron

little hands

A small hand slipped into mine at the end of the day, while we were walking a path on the Nazarene grounds. It belonged to one of the parishioner's children. Many of the Nazarene parishoners, like so many Haitians, lost everything. They are living in tents on the five acres of the church grounds (our base camp). Every evening we come home, and every morning as we load up the truck, children flock to us. They have bright eyes, beautiful smiles, and eager helping hands. They are happy to be made busy boxing up the day's medicines from the store room.

We are surrounded by vibrant children everywhere. And it is wonderful. As we load up clinic supplies outside the Bel Aire clinic at the end of the day, the street is filled with children. Playing ball, flying kites made out of plastic bags and sticks, giggling and laughing. As we load up, they make their way to us, saying "bon soir, ca va" (good afternoon, how's it going), and asking us to take their picture. They love having their pictures taken, and laugh with delight when we show them the image. Adults have asked to have their pictures taken too.

On our drive home today, we stopped by the stadium. "The stadium" is the soccer field that was made into tent city grounds immediately after the earthquake, where much of the initial medical aid in Port-au-Prince was stationed. You likely saw footage from this at the beginning of the news coverage. It was a chaotic place. Today, there was a sense of palpable calm. The medical clinics have left the grounds, and relocated as ours has, but the stadium grounds provide a safe space for hundreds of tents, and food and water is distributed.

As we walked around the stadium grounds, a little two year old asked me to take his picture. His mother then asked me to take hers. She is not the only adult to ask. In my mind, I think of this request as asking me to 'bear witness'...to who they are, to what they have been through.

At the end of each clinic visit, I ask my patients if they have any questions. The other day I had a woman say "No, but I want to tell you about my sister". She then told me about how she had lost her sister in the earthquake. I feel empty handed as I hear these stories of grief. "How can I even begin to offer a "cure" for this hurt? For this woman, I simply placed my hand on her knee, looked into her eyes, and said "I am so sorry". She then went to our pharmacy station to pick up her medicines for trouble sleeping, headaches, stomachaches.

My last patient of today was a 19 year-old man. He had one complaint: "I wake up in the night, and I am screaming, and I don't know why." My heart breaks again, and through the interpretor, I talk about post traumatic stress in layman's terms and offer him breathing exercises and benadryl to help him get back to sleep after he wakes from these night terrors.

After hearing these stories throughout the day, my heart is rejuvenated by the smiles and unending joy of the children. I held tight onto that little hand that slipped into mine at day's end.

~Maryclaire