December 1, 2008--a Monday

I’ve rediscovered the jump rope. I don’t think I’ve taken a jump rope seriously since Elementary school and the brief chapter in my life that included Jump Rope For Heart. I believe we even had a routine, to “Thank God I’m A Country Boy,” and performed it at a half-time performance for one of the high-school basketball games. Oh my lucky-lucky parents.

Exercise, primarily running, has long since been my most healthy form of stress-relief. It kept me from quitting med school and maintained sanity through residency. My residency friends and I joke it is a poor-man's Prozac. But exercise has also always been an easy route for meditation allowing my mind to slip happily into the quiet that breathlessness brings. Since the streets of Port-au-Prince are not welcoming playgrounds for a long, unwinding run to process the intensity of the days, I’ve had to come up with other alternatives. The aerobic tapes haven't been cutting it. I end up wanting to throw things at the puffed up guy in spandex coaching me to contort myself a little further, or squeeze out one more push-up. So over the last few days, I’ve pulled out a jump rope we happened to pack, and headed up on the roof. I certainly get breathless fast! Long gone are the days of Jump Rope For Heart and the endless energy of youth. However, despite the burning in my lungs and the insta-cramp in my calves, I have started to experience that exercise-induced calm once again. Thoughts dissolve into the rhythm of breathing, my mind clears. Tonight I jumped under stars in the velvety night air. The day had had its ups and downs, but the sound of my heart pounding in my ears brought me back to center. I am spoiled that I can have a cool-down night swim afterwards; treading in the inky black water under the dark sky, letting the tension in my muscles relax in the buoyancy of the water. I found my release.

This morning we met our Creole tutor, a man referred by Patrick Villier. Speaking with an American accent, he shared his story of a youth largely spent in America raised by his Haitian father, deported in his early twenties for “being in the wrong place at the wrong time”, and now raising a family of two in Haiti for the last 10 years working as an English and Creole teacher. We liked him instantly, and after an hour working with him, felt a new shining hope that we may actually have a fighting chance at learning the language well.

At school, we met Pastor Milfort, the President of the Central Organization of Haitian Protestant Churches newly formed. He was a lovely man, and described his own organization very similarly to the goals and philosophy of CONASPEH. He seemed interested in Patrick teaching in his own seminary once in a while. We look forward to getting to know him over the next 4 years, and learning even more about how, together, we can accomplish bigger things for the Haitian people using a unified approach.

At the end of the day, we took a teacher in the school home because he wasn’t feeling well. The house he lives in with his family is one of the 16 small, cider-block homes that were built by CONASPEH. I remember visiting them before, on our first interview trip to Haiti, and struggling with the simplicity, with the lack of the key elements of a house I’ve never lived without: a kitchen, a bathroom, electricity and running water. The cooking is done outside as is the washing and bathing. The houses are built close together, so being a neighbor means bumping into people all the day, sharing the intimacies of life. Today, though, I was interested in a subtle change in my perspective since my first visit. Today I saw a simple but beautiful little community with hope.

The young teacher invited us in to meet his mother and his brothers who are students at the CONASPEH school. When we arrived, his mother had been washing the family’s laundry by hand in a large washbowl outside her front door. Drying her hands on her apron, she quickly rose to greet us and to welcome us into her two-bedroom home. One room had a double bed mattress on one side, and twin bunk beds on the other with just enough space in-between to stand. The other room had another twin bed and a table wedged between the bed and the wall. A shelf held cups, plates and pictures of family. The house was tidy, small, and spoke of many lives that slept in its shelter.

Most of the domestic activity happened outside the walls of the house as was clear by the congregation of women and children in the tiny walkways separating the stone buildings. Other women were doing washing, some were stoking the charcoal fires for dinner, and children were running about in the dirt. Despite the simplicity of it all, it felt warm and welcoming. All the women there greeted us, and the children came to stare in curiosity. Where as my initial reaction months ago was shock at the inadequacy of the place by American standards, today I saw it as a community of sturdy shelters, simple but well-built homes that housed so much life within. Compared to the masses living in Port au Prince, these tiny houses were suburban dream homes: sturdy, clean, community-organized and safe. Neighbors were living together, working together, sharing the load and their lives. Patrick and I felt honored to stand in their midst, to be invited in with hospitality and pride..

My shock of the day came when the mother of the house showed me a piece of paper with my signature on it. It was an order for labs I had written for one of her sons; by the list of orders I had written, I had been worried about significant disease. She explained to me apologetically that she had gone with her son to the lab, but they hadn’t understood my orders, didn’t comprehend the language I had used. I stood in her tiny living room and felt anger and frustration collapse around my shoulders, my worst fears seemingly coming true as I stared at the unfilled request. How many people did she represent? Everyone I had seen??? I had previously reassured myself that at LEAST I had offered recommendations for a next step; but the truth was not only could I not council those recommendations to my patients, but my own Haitian medical colleagues couldn't understand me either. I had asked whether my English orders would be understood, and 2 nurses and a Haitian doctor said, "pa gen pwoblem." (there is no problem) But the realization hit hard that they must have been mistaken, that there was a BIG problem, that the hundreds of people for which I had recommended labs, x-rays, work-ups or referrals were stuck with a piece of paper no one here can interpret. I stood horrified that this women likely represented so many more in her same circumstance and all were too busy? too scared? too apathetic? too sick? too distrustful? to come back to the clinic and tell me sooner. The mystery of why not a single lab result has fallen into my hands became all the more clear.

Back to square one. And I just pray its not square negative one since I'm sure the patients I have seen think I'm no good if I can't even communicate what I need them to do. So its just more fuel to the fire that I need more orientation and a medical translator; it all validates the concerns I raised last week. Of course I've put my proposals and concerns on the table, and they were graciously approved. Just need patience for it all to unfold.

Patrick reminds me that these are all stepping-stones--that the upside of this is that I gained valuable information today by chance. He reassured me that we could use what we learned in that tiny living room to reinforce my proposal, to solve one problem at a time. I think I can, I think I can, I think I can. I just hate that people have to suffer while I figure this all out.

And maybe I have to stop being as careful as I've been to assure a diagnosis before treating. It makes me feel so uncomfortable to go off assumption, especially when a fever could mean about 500 different things, as could abdominal pain, etc. Everything I was trained tells me not to just go doling out antibiotics... then again, maybe i just start knocking off infections one by one? But if I can't verbalize precautions, signs of allergic reactions, etc, is it really safe to be handing out meds willy-nilly hoping for the best??? Tell me to be less anal. I just don't want to do harm. I don't want to turn people away from one meager medical resource, don’t want to inspire further distrust in a system that has failed them for years.

So I'll go back to work tomorrow and try to once again explain my concerns, hoping for a little insight and progress. If I survive these next 4 years without a exorcist-spinning head, and if I actually help one person here, I will have accomplished something.

Dear God Help.

The defeat I wore like a cloud tonight contrasted sharply with the attitudes of the members of the latest group to stay in the guesthouse. A huge team of people have arrived for a 8-day praise and worship rally on some soccer field in Port-au-Prince. They sing praise and worship songs late into the night fulfilling their mission to spread the word of the gospel. Their cheerfulness felt odd to me today.

And in fairness to the group at large, I think I was largely turned off by a few who certainly don't represent their well-meaning colleagues. One turned up his nose at the beautiful meal Mdm Rosalina put forth, proclaiming in a loud American drawl, "What IS this? I just CAN'T figure it OUT? Anyone want to order a pizza?" while my friend watched from the kitchen. If you don't like it or don't trust it, don't put it on your plate. But don't insult the chef, don't make a scene of rejecting food that so many people don't have the privilege to enjoy. The other yelled out, "T-shirts here! I thought I'd give you first pick since Haitian's don't care about the size of their clothes." Oh right. That's it. Nice insight. Once again, we privileged get first pick while the poor get our leftovers.

In my opinion, Haiti’s problem isn’t that they don’t know Jesus. In fact, Christianity pervades everything; churches are on every other block. Prayers are sent up fervently every day. I see the people praying harder than I've ever seen anyone pray. Yet children are starving to death; people are dying of easily preventable disease while people sit in churches looking to the sky for food and help to rain down on them. They are praying, where is the bounty? My personal hope is for Christianity to empower people, to inspire courage in the use of God-given hands, God-given brains, and God-given voices to take a stand and make some changes for themselves. I would like to know if the Jesus I love and respect, the one who WORKED for political change, WORKED for a change in attitude, worked to make the sick well and the lowly feel included would sit by and just ask people to worship him harder. Is he really waiting for some frequency or volume of praise before waving his hand and turning the whole world right? I choose to believe that God is always with us and gives us strength to do the things we need to do to make the world better, to make REAL a kingdom on earth. THAT's the miracle of God. At least that is my understanding. And my faith unfortunately doesn't keep me skipping everywhere I go. Not tonight. I get tired and frustrated and heart broken, but I think it is my faith that allows me to take the next step, to wake up and try again. I can't imagine that Jesus isn't weeping for the suffering that exists in Haiti. I imagine he uses the fierce spirit of the Haitian people who seem to take it all as it comes to help ease their plight. And he uses the power of the impact on the relatively privileged folk who visit this place to inspire change and plant a call to help make things right.

So I try to take a little of the positive energy these new folks bring and translate it into something I can use, despite our difference in opinion of what Haiti needs.

The roof-top jump fest and the night swimming did a number for my attitude. Some new ideas came out of the sweat and tears, and my mind feels quiet enough to sleep. Tomorrow I wake up and start again, hoping for another brave step forward into this massive project of acclamation, orientation and intervention. One day at a time. I’m thankful for the will to get up and try again, whatever the source may come from.