Two Nights in Ciudad Juarez, August, 2011

Luis, my host and guide, and I were out and about in his Jeep when, at about nine at night, we came upon the Festival of San Lorenzo at the San Lorenzo church in downtown Ciudad Juarez. San Lorenzo, a third century martyr supposedly grilled to death on orders of Roman Emperor Valerian, is the patron saint of Ciudad Juarez and this was his day. His festival had nothing of the grim circumstances of his demise, nor of Ciudad Juarez’s current reputation, about it.

Festival of San Lorenzo

All was frenetic action in the courtyard to the church’s left as well as in the plaza facing it. Groups of the faithful, dressed for some reason as if they belonged to various American Indian tribes, performed highly choreographed dances to the rhythm of pounding drums. In and among the Indians, fantastical masked characters ranging in appearance from satyrs to clowns to Father Time circulated. Each dance went on and on at an increasingly frantic rate until it ended in a spasm of ecstatic exhaustion.

Eventually, after Luis and I had been at the church for an hour or more, and still in the midst of the dancing, the San Lorenzo procession arrived. Led by a pickup with a small statue of the saint attached to the roof , the procession reportedly stretched several miles and consisted of thousands of believers. On this night at least, San Lorenzo seems to have trumped the cartels in downtown Ciudad Juarez.

Festival of San Lorenzo

We were relaxing at Luis’ house the following evening, digesting another excellent dinner prepared by Nanna Chalia, Luis’s nanny when he was growing up, when the call about the body in the empty lot came. It was nearing seven when we set out into the rapidly gathering dusk. By the time we arrived at the scene almost half an hour later, there was just enough light left for me to photograph without using flash.

The victim, a young man with close cropped hair wearing a white, now blood-stained, shirt and black pants lay on the bare dirt as Federal Police officers, some wearing ski-type masks to protect their identities, examined him. It was not an extensive evaluation. The cause of death, gunshots from an AK-47, was both obvious and no doubt very familiar. Within a few minutes of our arrival, the police finished writing up their report and began the process of removing the body.

Federal Police remove a murder victim

One of the officers stretched a black body bag out parallel to the victim and unzipped it. Then he took the body by the wrists while another officer grabbed the pants legs at the ankles and the two of them lifted him, sagging toward the ground as rigor mortis had not yet set in, and eased him into the body bag. The officer who had laid out the body bag then folded the victim’s arms across his chest and, with his partner holding it taut, zipped the bag shut. The two men then placed the body on a stretcher and loaded it into the coroner’s van which soon departed for the morgue.

Later that night as Luis and I continued driving around the city, we received a report of another murder victim. After much searching and consultation with Luis’s source, we finally arrived at the scene. By the time we got there a couple of TV crews and several other photographers were already in place. However, there wasn’t anything to see.

The press was restricted to an empty lot between two houses. Across the street was another empty lot containing a steep hill that loomed over the houses in the neighborhood. As we watched, Federal Police entered the lot and, using flashlights to light the way, disappeared from view around the hill. A short time later one or two returned, but that was the extent of the observable activity. After a half-hour or so Luis decided we should leave.

As we drove off we passed the other side of the hill and decided it might be worth trying to climb to the top to see what we could see. Starting up I saw figures at the top, probably forty or fifty feet above us, and I thought they were police. But they were other journalists instead and one of them shouted down that we had to climb up because the view was incredible. He didn’t exaggerate.

Federal Police examine a murder victim

The hill directly overlooked the murder scene in the courtyard of a house. As police examined the body of the victim, Ciudad Juarez glittered to the horizon. The perspective made it appear that the courtyard was below street level, as if in a cave. And this seemed appropriate, given the nature of the scene I stood photographing.

To view more photographs, see www.vichinterlang.com.

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Presidential Run-off, Port-au-Prince, March 20, 2011

Brillant and I got a relatively late start covering the presidential run-off between Michel Martelly and Leslie Manigat, setting out on foot from the Palm Inn at about 10:30. It being a national holiday, for the first few blocks of our trek in the general direction of downtown we saw only a handful of other pedestrians and the very occasional car or pickup. We arrived at our first polling station, a fairly large school, after about a ten minute stroll.

Fried plantain vendor at polling place

In the courtyard beyond the open gate, voters were coming and going. There was an orderly line of twenty or thirty people standing in the sun waiting to enter the building. A fried plantain vendor circulated, carrying his stock in a wire basket balanced on his head. Going to the head of the line and peering inside, I saw two election workers sitting at a desk checking voter identification cards.

Brillant slipped in and asked them if I could come in to take pictures. They said I could if I had a press identification card, which, technically, I didn’t. Partly because of this, but more because the interior was so dark that it would have been impossible to photograph without using flash, I chose to move on and hope for better conditions.

Our next stop, just a few blocks down the road, wasn’t a polling place, but rather the Centre du Vote where voters went to locate their Delmas 31 polling places. Within another courtyard, six rows of eight and a half by eleven inch typewritten pages placed edge to edge stretched along a wall fifty yards long. Voters peered at the pages searching for their names. In the center of the courtyard, a poll worker surrounded by people sat holding what looked like the same information contained in a sheaf of paper. While I was photographing this scene, another poll worker challenged me.

Poll worker surrounded by voters looking for their polling places

Brillant told him that I’m a journalist from the U.S. covering the election and showed him my business card. This satisfied him and he gave me a thumbs-up to show his approval. Apparently, the bar for press credentials is pretty low here, which is a good thing for me. Of course, under the circumstances, there was really no reason to suspect that I was anything other than what I appeared to be.

From the Centre du Vote we walked to a fairly major artery that would take us further towards downtown. Here, we saw tap-taps running and hopped aboard one. Reaching the point where we needed to change, we found ourselves across the street from another school. We went upstairs to a classroom where people were actually voting and this time the light was sufficient to allow me to take pictures without using flash. Brillant did his card trick again and I was cleared to proceed.

Man voting at a school being used as a polling place

For the next half-hour or so we remained there and in an adjoining room that could be accessed through a hole in the wall. The activities to photograph were voters getting their ballots, marking them behind a cardboard screen about three feet tall and divided into four quadrants, placing them in the voting boxes and having their fingers marked to show that they had voted. Interestingly, for all their reluctance to be photographed generally, people by and large didn’t object to being photographed voting and a number of them seemed positively happy about it. I asked Brillant about this.

“I think it is because this is a public thing and everybody understands that. People are used to elections being photographed. When we go to the camps it is a personal thing and people are more suspicious.”

As we got closer to downtown, we came upon the first polling place we had seen with U.N. troops providing security. As we approached, an APC rumbled by and outside we found a small detachment of Brazilian troops, fully outfitted with weapons and blue helmets, flanking the entrance. Once inside we found much the same scene as the one we had just left. The only security issue we observed involved a voter who had lost his voter identification card, but was demanding to be allowed to vote anyway. This resulted in some raised voices, but finally the man left peacefully, accompanied by a couple of poll watchers, without voting. From here we continued towards the Champs de Mars and the Presidential Palace, shortly coming to a large, three story school very near them.

Brazilian U.N. troops providing security outside a polling place

Here we encountered the most significant U.N. presence of the day. In addition to numerous troops standing outside the entrance, there was an APC parked just down the street. The reason for this heightened security was probably related both to the size and the location of the school, being near the seat of the Haitian government and in an area known for its insecurity. However, inside the expansive courtyard calm prevailed as voting proceeded in an orderly fashion. Moving past the Champs de Mars tent camp and the Presidential Palace through streets largely empty except for U.N. peacekeepers, we reached our last stop, a small school, a little after four.

Outside, there were just a few U.N. soldiers standing guard as voters looked for their names on the courtyard wall in the declining afternoon light. Upon entering, I saw open air classrooms to my left and internal classrooms to my right. Given that the light was relatively good in the open air rooms, I spent my time photographing there. The polls were scheduled to close at five and business seemed to be dropping off. Many of the poll workers, with nothing else to do, stood around chatting. It was a quiet end to what appeared to be a quiet election day in the capital.

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Bon Retour J.B. Aristide

Welcome home march in Aristide's Tabarre neighborhood

On Saturday, March 12, one week and one day before the Haitian Presidential run-off election between Leslie Manigat and Michel Martelli, there was an article on page two of the Austin American Statesman announcing that Jean Bertrand Aristide’s return to Haiti from exile in South Africa was “imminent.” The article went on to note that President Barack Obama was sufficiently concerned about the potentially destabilizing effect of such an occurrence that he had telephoned President Jacob Zuma of South Africa and President Rene Preval of Haiti to personally ask them to do what they could to prevent it.  For me, the destabilization was immediate, forcing a reconsideration of my decision not to return to Haiti for the run-off.

That decision was based on evidence that with the two most popular candidates from the first round of voting in the run-off, and Jude Celestin, the hand-picked candidate of President Preval, out of the picture, the final round would be an orderly affair. However, if Aristide, who remains hugely popular among Haiti’s poor, returned at some point in the week leading up to the election with mischief in mind, all bets were off.

I had little doubt that I should go if Aristide went back. But, despite the declaration in the article that his return was imminent, there was no guarantee that it would actually happen prior to the run-off. It occurred to me that Aristide might be trying to influence the election simply by saying he was going back. Then, there was the question of whether the government of South Africa, or of Haiti, would yield to President Obama’s blandishments and somehow prevent Aristide’s return.

So, given the uncertainty of the situation, I decided to take a wait and see attitude. Rather than going and hoping Aristide would show up, I waited and hoped that if he did, I would have enough notice to get to Haiti ahead of him. It almost worked out.

Throughout the week, I diligently scanned the news online several times a day, but there was nothing. By early Thursday afternoon, I had pretty much decided that the announcement of Aristide’s return had been a feint. Then, at about three, as I was getting ready to go to a St. Patrick’s Day celebration at the Dog and Duck Pub, I decided to do one more check before I left, and there it was. The AP story stated that Aristide was on his way to the airport in Johannesburg and was expected to arrive in Port-au-Prince Friday around noon.

After discussing the situation with Sharla and weighing in my own mind the odds of Aristide’s return actually being disruptive, I decided that I should assume the worst regarding his motives and get to Haiti as soon as I could. Sharla, though considerably less than enthusiastic, particularly regarding the price of a flight leaving the next morning, consented to indulge me.

I booked an American Airlines flight leaving Austin at 6:50 a.m. and arriving in Port-au-Prince at 3 p.m. and hoped that Aristide would be somehow delayed. Unfortunately for me, he was on a charter flight and actually arrived earlier than expected, at about 9:15 a.m., while I was still in mid-journey. By the time I got to town at about 4:30, my flight from Miami being late departing, Aristide was already ensconced in his villa in the Tabarre neighborhood of Port-au-Prince, the initial flush of excitement at his return already fading.

When Brillant’s next door neighbor Jean drove us by on the way to the Palm Inn Hotel, there were just two Haitian policemen standing in front of the locked gate and a small crowd of curious onlookers mingling across the street. Nevertheless, the possibility of auxiliary excitement, perhaps in the form of a demonstration in front of Aristide’s home the next day, remained. Consequently, at about nine the next morning, Brillant and I set out by tap-tap for Tabarre.

Even as we were climbing down, Brillant said “There is something happening” and pointed up the street. I didn’t see it, but unhesitatingly followed along, matching Brillant’s brisk pace. Within a half block or so of turning the corner, we could see, and hear, the tail end of the march, which consisted of some sort of a band, a block and a half or two blocks ahead. Increasing our gait to a jog, we overtook the march a block or so later.

La Kove Rara sets the tempo for the march

It was a small, probably no more than 150 people, but enthusiastic pro-Aristide organization called Asosyasyon Baz Solide an Aksyon Tet Ansanm (roughly, Association Based in Solidarity of Action to Move Forward), abbreviated to ABA Satan, which gave me the false impression that it was a religious group. As the march proceeded, the band, La Kove Rara, consisting of a dozen or so musicians playing what looked like oversized vuvuzuelas, a variety of drums and cymbals, beat out a lively rhythm. I had hoped that the march was going to Aristide’s place, but as it turned out it was heading to the group’s headquarters. This was simply a large tent under which about 50 chairs were set up in four or five rows.

Etienne Getro dancing in the lead

In a brief interview, Etienne Getro, the group’s leader, said that ABA Satan, banned during Aristide’s exile, (and, technically, probably still so) is a political and social organization dedicated to fighting for education, health and economic progress for the Haitian people. He added that its activities include operating training programs for young people who want to become plumbers and electricians. Now that Aristide has returned, he said the group’s primary objectives are to welcome him back, organize meetings and rebuild its base. “People said we were crazy to think that President Aristide would come back, but now the dream has come true.”

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Haitian SOIL

The need for soil in Haiti is as great as perhaps anywhere in the world. Given its long history of deforestation caused by its people’s need to cut down trees for firewood, Haiti suffers from an epidemic of erosion. In 2006, Sasha Kramer and Sarah Brownell founded Sustainable Organic Integrated Livelihoods (SOIL, www.oursoil.org) in part to address this situation. SOIL is a non-profit organization whose mission is to protect the remaining Haitian soil, empower communities and transform wastes into resources. It is the transformation of wastes into resources, however, that provides the foundation on which SOIL’s mission is based.

Sasha Kramer

Initially located only in Cap Haitien and its surrounding communities, SOIL began by focusing on providing public ecological sanitation, or Ecosan, toilets that would drain urine, which is sterile, into the ground, while collecting feces to be composted. The decision to concentrate on public toilets was based on a desire to provide as much sanitation, as well as to produce as much compost, as quickly as possible. Initially, the members of the community where the toilets were located would maintain them, but a basic problem with this system soon manifested itself.

“It’s very difficult to make public toilets work, because people don’t want to clean up other people’s poop,” Sasha told me.

There was also a design flaw in the early toilets that exacerbated the situation. Originally, the toilets had large chambers that took six months or more to fill. When it came time to empty them, it turned out that the feces had not dried out as expected. So the community members emptying the toilets were essentially faced with the task of manhandling a huge vat of semi-liquid feces, clearly an unappealing proposition.

Nevertheless, in spite of these difficulties, SOIL proceeded to establish a pilot composting project in Limonade, near Cap Haitien. There, the human waste from the public Ecosan toilets, together with rum processing wastes, garden wastes and market scraps, are aerobically composted into a high quality agricultural fertilizer. Such naturally produced fertilizer could become a critical asset to Haitian farmers, given the generally poor quality of Haitian topsoil and the cost, more than most farmers can afford, of commercial fertilizers. However, first it must be shown to be safe and effective.

A Haitian SOIL employee checks the temperature of compost

A recent study by John Strutner of Notre Dame University found the SOIL compost to be free of fecal pathogens, including cholera, clearing the way for the compost to be tested on SOIL’s pilot garden in Shada. Even though Sasha is very encouraged by this result, further testing needs to be done before the compost can be put into widespread use. Meanwhile, after the January, 2010 earthquake, SOIL expanded its operations to Port-au-Prince, applying the lessons learned in Cap Haitien.

The first change SOIL made was to switch to smaller plastic drums to collect waste. This was followed by a change in the way SOIL manages its public toilets. Due to the logistics of the situation in Port-au-Prince, SOIL realized it would need to hire someone to maintain the toilets it installed in 23 tent camps and 8 schools around the city. While this is more efficient than having the communities maintain the toilets, funding is an issue.

It currently costs about one dollar per drum, or $300 a week, to collect the waste and transport it to the composting center not far from the U.S. Embassy. In the wake of the earthquake, SOIL has been able to acquire sufficient emergency funding to pay for the maintenance service. But with the earthquake now a year in the past, that funding is fading out and Sasha is investigating alternative strategies. One possibility, for the smaller camps at least, is communal toilets.

A Haitian SOIL employee carries plastic drums to be cleaned

These would be shared by four or five families, with each family having a key allowing access. SOIL would pick up and transport the drums, covering the cost out of its budget. While additional funding sources will eventually need to be found, the cost of maintaining the communal toilets should remain less than hiring someone to provide the service. Eventually, however, SOIL’s goal is to move away from public toilets.

“As an organization, we would like to move to household toilets,” Sasha told me.

Although the design has not yet been completed, what Sasha has in mind is basically a wood box that can somehow be sealed to contain odors, with two five gallon buckets, one for solid waste and one for urine. “It would be good if it looked like a piece of furniture, so it wouldn’t be obvious it was a toilet.”

These household toilets would be placed, at least initially, in urban slums. SOIL would probably start with Cite Soleil, in Port-au-Prince, where it already has a foothold with 19 toilets, although not of the household kind, and a pilot neighborhood composting project. The rationale for such a strategic shift has both a personal and a commercial aspect.

From a personal viewpoint, private toilets are more dignified. No one, or very few people anyway, enjoy being in a situation where friends and neighbors can watch one’s toilet going routine as a matter of course. Also, having a toilet inside one’s house conveys a certain social status that most people aspire to, and can therefore be a boon to a person’s self esteem. As can operating a small business, which is central to the commercial aspect of the rationale.

What Sasha envisions is a situation where, ultimately, members of the community start businesses to deal with all aspects of the process, from collecting the drums and delivering them to the local composting center, to composting the waste, to selling and delivering the compost to local farmers. “I’d like to eventually see a market chain develop.”

SOIL’s role in the development of this chain would be to lead each phase, facing its risks and problems first. “I’d want to see SOIL continue to pilot until all the initial mistakes have been made and the system is working.” Sasha’s dream is to ultimately be able to turn the entire enterprise over to Haitians.

Although she has no plans to move from Haiti, at that point she would basically shift to a consulting role. She would also have time to travel to other countries to spread SOIL’s message of sustainability. This is a long term goal, however. There is still much work to be done in Haiti, and Sasha remains in it for the duration.

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Megan Coffee, M.D.

Early on the afternoon of January 12, 2010, Dr. Megan Coffee, 33, was working at a computer on the University of California, Berkeley campus modeling the spread of infectious diseases, research she does for that university and the U. S. Veterans Administration. In the midst of her work, she received an email from a friend in Haiti before the news even broke, informing her that a huge earthquake had struck Port-au-Prince. An infectious disease Fellow at the University of San Francisco Medical School, Dr. Coffee had studied infectious disease in Haiti and intended to come to the country, using her saved vacation time, in May. The earthquake changed her plans.

Megan Coffee talks with a TB patient being sent home from the hospital.

Cat Laine, who works with the Appropriate Infrastructure Development Group (AIDG) (www.aidg.org) , an NGO in Haiti, contacted Dr. Coffee not long after the earthquake and asked her if she could come down to help with the infectious disease situation. Almost all of the local infectious disease specialists were missing for one reason or another, and very few foreign doctors with this specialty had come, as initially the need was for surgeons and other trauma care specialists. Dr. Coffee arrived in Haiti, via the Dominican Republic and bringing as much medication as she could manage, two weeks after the earthquake struck.

Once on the ground, Dr. Coffee was approached by a relative of a Haitian-American doctor and asked to work at the Hopital l’Universite d’Etat d’Haiti, the General Hospital in downtown Port-au-Prince. She met with one of the few Haitian infectious disease specialists remaining there and realized immediately that tuberculosis, TB, was the most significant infectious disease affecting the post-earthquake population. However, in many cases the TB was complicated by the patient also being HIV positive. Together with Mulhouse Charles, a Haitian nurse who recruited other nurses to come to work at the hospital, Dr. Coffee established an approach for addressing this dual threat.

“Actually, living and working in San Francisco was excellent training for Haiti. It’s probably the only place in the U.S. with a higher HIV infection rate, among men anyway, than here.”

Megan Coffee studies a TB patient's x-ray.

Due to their weakened immune systems, HIV positive individuals tend to get worse cases of TB than those who are HIV negative. They are also more likely to contract new strains of TB from other patients in the hospital. TB, for its part, further stresses the already weakened immune system, making the development of AIDS more likely. To break this vicious circle, Dr. Coffee decided to simply treat all HIV positive TB patients for both conditions.

HIV treatment has now developed to the point that a patient only requires one pill a day. For TB, the regime is a bit more onerous. TB treatment requires the patient, depending on weight, to take between two and five pills, each of which contains four medicines, each day. The patient should also take one multivitamin each day to prevent nerve damage that causes foot pain.

“People taking their meds makes a huge difference. It not only helps the individual, but reduces illness in the general population as well.”

The TB/HIV ward, a large tent on the grounds of the hospital, opened January 1, 2011. Dr. Coffee now has a staff of sixteen Haitian and one American nurses. She depends on a variety of NGO’s, International Medical Corps (www.internationalmedicalcorps.org), (See International Medical Corps), Partners in Health (PIH) (www.pih.org), (See Guerrier Carmen and Kerline Jean Louis, June, 2010) and Operation Blessing International (www.ob.org) among them, as well as the Haitian government and the kindness of strangers, to supply the means to continue her work.

A patient in the TB/HIV ward

“It’s amazing. People just show up with stuff. A woman came by the other day with a carload of diapers. I don’t question it.”

As for the future, Dr. Coffee plans to stay in Haiti at least until July. Her one year leave of absence from her UCSF infectious disease fellowship is up July 11. Nevertheless, she’s frankly undecided about what she will do. Obviously, it’s not easy to leave possibly the most rewarding job you’ll ever have.

Postscript

Using the phone number Brillant got from her sister Rosemante, International Medical Corps located the woman in the Acra Sur tent camp who had been wasting away from an undiagnosed illness for a year or more  (See Acra Sur Tent Camp).  An International Medical Corps team transported her to the Hopital l’Universite d’Etat d’Haiti (General Hospital), where Dr. Coffee examined her and determined that she is suffering from TB.  The woman is now receiving treatment at the hospital and her condition is improving.

To see more pictures, go to  www.vichinterlang.com.

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Eating Crow in Carrefour

When Brillant and I arrived at the Route des Rails median tent camp for the third time (See Route des Rails Median Tent Camp, Carrefour and Route des Rails Moving Day for accounts of our previous visits), it was immediately obvious that major changes had occurred, but whether for good or ill remained to be seen. Whereas before, there had been almost a solid row of tents running down the median for half a mile or so, now only a relatively few remained, separated by long stretches of empty ground littered with rubble and the detritus of the residents who had departed. The question was, where had they gone, and did they go willingly?

Empty median where tents once stood

We approached a couple of guys sitting in front of their still standing home and Brillant inquired. They responded that all of the residents who had left had moved to the new USAID and ACRA sponsored housing by the sea. There were still eleven families on the median, but they expected to move soon. Apparently, the residents’ fears, expressed to us on our last visit, that only ten families would be allowed to move and that everyone else would be evicted with no place to go, were unfounded. Given this, we set out for the new beachfront subdivision.

Out and about in the new neighborhood

As we entered, the roll of barbed wire that had blocked the entrance on our last visit now tossed aside, the first thing that caught my eye was a row of laundry hanging to dry off the back of an orange house. Once among the houses, we immediately saw people going about their lives, children playing, a young woman combing out another’s hair while a friend sat nearby with a tray full of candy, gum and cigarettes for sale, a man shining his shoes and people walking to and from their neighbors’ homes to visit. After a few minutes, one of the young men who had intercepted us summoned an official of some sort, who arrived shortly thereafter.

Once Brillant explained, yet again, who I am and what I was doing there, the supervisor escorted us through the neighborhood facilitating my asking questions and taking pictures. As we meandered along, we ran into a number of the same people we had met on the median. Without exception, they said that they were happy with their new homes, and indeed, it was obvious even without them saying anything. Their manner and activities clearly expressed their joy and excitement. The old woman I photographed in her home on the median with her grand-daughter beamed at us from her new doorway, before going inside to pose on her relocated bed.

Old woman in her new home

Because closing the wood door and windows the houses come with isn’t really a viable option due to the heat, everyone had hung curtains, usually white or pink, and sometimes a little sheer, to provide some privacy and decoration. Inside, peoples’ belongings, regardless of how many or few they possessed, were neatly arranged around the walls. We came upon one woman busily painting a metal frame that appeared to be intended to hold shelves as a string of laundry hung between two houses behind her. All in all, it was a beautiful day in the neighborhood, but not a perfect one.

Short term, the buildings that will house the toilets are still not completed, leaving the residents to continue to fend for themselves in this regard. Longer term, there are at least two matters that should be of serious concern. One is the question of what chemicals have leached from the adjacent refinery into the soil the houses are built on and the water that embraces that soil, and the effects those chemicals may have on the residents. And the second, and most obvious, is the question of what happens to these houses built at sea level when the next hurricane hits.

The foregoing notwithstanding, however, I must admit that my initial impression of the neighborhood, and of the local authorities, was unfairly critical. The Caribbean colored houses are a huge improvement over the Route des Rails tent camp. And the authorities do seem to intend to move, at their own pace, all of the residents of that camp to the new housing. Clearly, attempting to impose U.S. standards of health, safety and efficiency on Haiti is not only unrealistic, but unfair. Pass the crow.

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International Medical Corps

The International Medical Corps health clinic in the Tabarre tent camp on the outskirts of Port-au-Prince, a well developed camp on its way to being dominated by actual structures rather than tents, provides primary care to the camp residents, and anyone else who finds their way to it. According to Crystal Wells, International Medical Corp’s Communications Officer in Haiti, these primary health care clinics, there are two others in the Port-au-Prince area, one at the Petionville Club Camp, also known as JPHRO, or Sean Penn’s Camp, and another at St. Bernadette’s Church in Martissant, deal primarily with common Haitian health issues, such as malaria and diarrhea, as well as chronic issues like hypertension.

Initial patient waiting area

The clinics, staffed almost entirely by Haitians, also act as an entry point to the cholera treatment system. They are set up to diagnose the disease and immediately provide hydration fluids, in the form of an iv, if necessary, before transferring the patient to a site that can provide higher level care.

The local staffing is a hallmark of  International Medical Corps (www.internationalmedicalcorps.org), whose mission statement is “From Relief to Self-Reliance”. Dr. Robert Simon founded International Medical Corps in 1984 as a response to the destruction of Afghan medical care by the 1979 Soviet invasion. Having established medic training centers in Pakistan’s Northwest Frontier Province, International Medical Corps recruited Afghan medic trainees from the remotest areas of Afghanistan. After a nine month course of training, these medics then returned to their communities with a stock of equipment, supplies and medications to set up clinics. International Medical Corps has now established this model of self-reliant health care in more than fifty countries across the world.

A local International Medical Corps staff member checks a patient's blood pressure

The care procedure at the clinics is a well oiled machine. Patients, with the exception of emergency cases, are seen in the order of their arrival. Their first stop is with a nurse, who takes their blood pressure and temperature, weighs them and asks them why they have come to the clinic. Once the reason for the visit is established, the patient goes to a second waiting area consisting of a row of benches. The patient then waits their turn to get a vaccination, see a doctor, or see a mental health worker. The last stop is the pharmacy, where the patient picks up any drugs that have been prescribed. There is no charge for the care provided.

A local International Medical Corps staff member vaccinates a child

During the hour or so I spent at Tabarre, about 30 or 40 patients were in the process of being seen. A number of children received vaccinations. Two doctors each saw several patients reporting a variety of ailments. And there was one young woman who had given birth the previous day receiving fluids through an iv. A steady stream of patients also stopped at the pharmacy to pick up medicines.
One service I didn’t witness was International Medical Corp’s safe spaces for children tent, where teachers educate mothers and caretakers about the importance of play and affection in a child’s development. For that, I had to go to the Petionville Club Camp.

A local International Medical Corps staff member teaches parenting skills

The teacher sat at the far end of a large tent set up within the clinic building displaying a page on a flip-chart showing pictures of child, and parent-child, activities. With a very animated manner, she discussed the activities, among which were a child rolling a hoop with a stick and a mother teaching her child to walk, with the seven women and one man who, with their children, sat barefoot in a circle on the straw colored mat covering the floor. From time to time, a woman would ask a question and the teacher would enthusiastically respond, encouraging self-reliance beginning with the most fundamental of human relationships.

Postscript

Using the phone number Brillant got from her sister Rosemante, International Medical Corps located the woman in the Acra Sur tent camp who had been wasting away from an undiagnosed illness for a year or more  (See Acra Sur Tent Camp).  An International Medical Corps team transported her to the Hopital l’Universite d’Etat d’Haiti (General Hospital), where Dr. Megan Coffee examined her and determined that she is suffering from tuberculosis (TB) (See Megan Coffee, M.D.).  The woman is now receiving treatment at the hospital and her condition is improving.

To see more pictures, go to www.vichinterlang.com.

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