Kindergarten Graduates

This post has nothing to do with medicine.  There, you have been forewarned.

What it does have to do with is the two and half hours I spent on Sunday at a promotion ceremony for the school one of the children here attends.  A promotion ceremony for kindergartners.  Now, to be fair, kindergarten here is three years long. But still.  Two and half hours?  The ceremony was held in a church nearby, which was packed to the gills with families in their best.  The kids were also all dressed up, with the graduates themselves in flashy matching suits and white dresses with green sashes and ribbons.  There were ten of them.

We started the whole shebang off with a song and prayer and introduced the master of ceremonies.  To my surprise, the whole production was in French.  Now, I know that the parents of the child we were going with don't speak French, although the mother understands a lot of it (very helpfully for us volunteers with bad Creole).  So I'm left to wonder how many of the parents really knew what was going on.  The children performed various songs, dances, and poems - all also in french with occasional verse of English (and once, Spanish).  Every single one of them was adorable, of course, but a couple of things struck me as a bit bizarre.  Firstly, the MC was quite talkative, repeatedly exhorting us to applaud the children saying "it's good to clap for children" or "another round of applause for that please, louder, louder!" the response to these commands was not as enthusiastic as might be supposed.  Instead of clapping on demand, the Haitian audience often failed to even half-heartedly applaud in the way American audiences usually do when feeling polite but not particularly impressed.  The second oddball thing, from my perspective, was the way in which increasingly toward the end of the program, the MC started some hardball recruiting. All throughout he had been mentioning the name of the school with an odd frequency, almost like you would a sponsor of a sporting event.  Then as we moved to the second half, in which the graduates (red-robed and crowned with mini mortar boards no less) stood on stages and sang their thanks, received gifts and diplomas (bigger, by the way, than my four-year liberal arts diploma), and very variously feted more directly; the MC moved to explicitly extolling the virtues of the school: "If you want your child to learn English well, French well, really get a good education" enroll in our school.

The recruitment push brings to the fore the fact that here, schools are businesses.  So they charge money to make money, and compete for students to fill their classes.  The whole ceremony was a surprisingly money-visible situation, with an official videographer, custom outfits the students had to buy for the occasion, gifts given, and parents and siblings all parading their best.  I felt truly dumpy in my flip-flops, skirt and polo (the most "dress-up" clothing I had).  It was a striking illustration of how Haiti continually refuses to fit into my boxes.  Yes, the children I'm working with now are desperately poor and their bodies and minds all show signs of that neglect.  But just across the way two and three story houses with manicured gardens, beautifully tiled flooring, new cars, and eight foot high rock walls topped with razor wire.  Just down the hill is Petionville - a wealthy suburb with a store accepting US dollars, several quite nice restaurants and a lovely supermarket with basically anything you'd want.  But then just up the hill in Kenscoff is a tiny shack that used to belong to the mother of three of our kids.  The other volunteer showed me pictures she took when they drove up to move her out and into a small but substantially nicer house we're renting for her.  Having lived in Africa, I suppose I expected things to be more visibly cultural.  More clearly other, more clearly poor.  I'll let you know if I find that Haiti.

Looking down towards Port-au-Prince

I'm too tired to put together much of a post about things, but here's a picture of the view looking down on Port-au-Prince from our hillside: 

Stolen Chickens, Kidney Stones

Dissection posts on hiatus until I come back from Haiti.  Sorry for the bizarre lack of continuity in this medium, but that's how things role.  

So I'm in Haiti.  I have been for about three days now, which have been hectic, tiring, at times awkward days in which I've learned an immense amount of Kreyol (but still nowhere near enough), the day to day schedule of the six children I'm working with here, and mostly that I know next to nothing about Haiti  - even with the reading I've already done.  But let's rewind a little bit: The project is called Haiti Circle of Friends and it’s an orphanage.  Sort of.  The project manager, Barb, is trying to work family by family with the poorest families in this area, just outside the capital city, and get them back on their feet.  She does this in a variety of ways – by taking in children whose families cannot afford to take good care of them, by working with those families to teach them how to better care for their children, and by employing Haitians (often, the families of the children) to work for the orphanage, giving them a small source of income and hopefully preparing them to be self-sufficient.  Right now HaitiCOF consists of a house where I’m staying with another volunteer, five children, Barb herself and another one or two women who help take care of the kids; a small house that the project rents for the mother of three of the kids, one of whom lives with her now; a small plot of land that same woman is learning to farm – from which the house will gain vegetables and the woman will gain income, and two goats.  There were chickens, too, until last night. 

Sometime in the middle of the night last night someone came into the yard and took every single chicken.  No one heard but me, and I didn’t recognize the noises for what they were: distressed chickens here means theft.  It’s a nasty loss to the project, because it means replacing them at a cost of around $50, and it means until we do we have to buy the eggs we were getting from them.  Mostly, it’s a loss coming nastily on top of a much heavier financial burden: an unexpected hospitalization. 

I came to Haiti hoping to get to learn something about its health care system – but knowing that wasn’t my express purpose in coming so I might not see a lot of it.  Far sooner than I’d thought possible I got to experience it from the point of view of one of the COF children.  Barb told me on my first day the laundry list of ailments: malnourishment for all of them, developmental delays as well (probably related), skin diseases, anemia, and, in one case, kidney stones with a urinary tract infection.  This particular boy, Julio, had had kidney stones for some time, but had been passing one the other day.  Then he stopped peeing.  Because of the UTI, he had been drinking lots of water and cranberry juice – so dehydration wasn’t likely.   After the problem didn’t resolve in a day, Barb asked me to take him to the local clinic to see the doctor. 

The process of getting to see the doctor is a lot of waiting and more waiting.  We arrived around 11, and sat and waited.  There was lots of getting up and talking to people then sitting down again.  Finally the doctor actually arrived and the clinic staff arranged everyone into a line to see him – the line order must have been determined by something more complex than first come first serve, because we were first, but exactly what the order was I wasn’t sure.  We went in to see the doctor and it was painful for me to stumble through explaining things in French, then have Julio explain again in Kreyol, which I don't understand well, so I couldn't be sure if he was leaving things out.  He'd been so quiet, and so reluctant to go to the clinic.  The verdict, unfortunately, was a kidney stone blocking urination.  The doctor said maybe diuretics would work,  but without knowing for sure where the blockage was, they could also do more harm.  His first plan was to insert a catheter right then and there, see if that worked.  But apparently, the clinic had no catheters that day.  So instead he wrote out a full page, hand written referral for us to take to the hospital at Fermat for imaging, and impressed on me the urgency of the situation.  

There followed a harried hour or so in which I had to make contact with Barb and she had to come find us with the COF car so we could drive up to Fermat.  Fermat, it turns out, is a Baptist mission complex with a several clinics, a hospital, a place for mission groups to stay, a garden, cafeteria, and gift shop.  By this point we had both both Barb and Micalange, a Haitian woman who works at the house, with us so I was mostly superfluous – or so I thought until later.  We then began a strange process of first, finding someone to staff the clinic’s front desk area, then talking with them, going in to see the doctor (who tried to send us away, but Barb wouldn’t let him), trooping to the pharmacy to buy not just medications, but required equipment for injecting them, back to the doctor, back to the pharmacy where Barb bought a IV kit and several doses of intravenous antibiotics, to the hospital where they told us that the boy would have to be checked in for three nights.  This was an unpleasant surprise, since the doctor at the local clinic had implied everything could be done in an outpatient setting.  So we trooped back to the clinic, Barb shanghaied the doctor (there was a lot of Barb being pushy to get what she wanted out of people, I’m confident that if she hadn’t been, we would have at the very least been there twice as long, if not been completely refused) and he explained that since he was only a general practitioner, he wanted  to both treat Julio immediately and to keep tabs on him a few days until the urologist would be around.  

Now, to stay at a hospital in Haiti you have to bring your own food, drink, clothes, sheets, entertainment, everything.  And since Julio is only 12 we’d have to have someone stay with him. How COF was going to manage this with five other kids to watch over at home was a little bit of a struggle.   It was around this point we took a much needed lunch break - to anyone keeping track of the day, that was around 2:30/3:00. 

The final conclusion was that I would stay with him while Barb and Mica went back to the house to get everything needed.  So I spent about an hour sitting in the hospital corridor with a silent, sick, twelve year old who dosen’t speak my language and who hardly knew me.  He was extremely quiet, even when they put the IV drip into the back of his hand.  We did math problems on a sheet of paper the nurses gave us (when I asked really nicely and because they were so pleased I spoke French).  We stayed in the hall the whole time on a rickety bench that tipped when I stood up or sat down – because until the others came back there were no sheets for the bed.  The hospital is probably not that much bigger than my primary care doctor’s office back at home.  It was clean and decently staffed and painted bright green - but there were no doors on the wards, and the wiring was clearly not finished in some places.  Still, Julio seemed content enough once he was fully settled in and we'll just have to wait and see how the rest of his story plays out.  

Throughout the day I was struck by the contrasts in people's behavior: often polite, and seemingly helpful -yet things happen at a crawl.  The nurses at first glowered at me when Barb said I was staying with Marc, but then once they learned I spoke French I was welcomed.  One of them actually said to me "Welcome to Haiti" it was hard no to laugh, under those circumstances.  I hope to be able to write more as my time here goes on, but I'll leave you with the links to the project's website here and ask that if you can spare anything to help offset the costs of some of these unexpected expenditures, you look through it and give what you can.