Haiti (April 11: first clinic day in Bien Amie)

We were up and out by 7:45 am on our way to the small mountain community of Bien Amie. We ran right into horrendous Port-Au-Prince rush hour traffic. It took our four 4x4s two hours just to get out of the city. Mostly stand still. With no traffic direction and no traffic lights, it’s a free -for-all. You don’t flinch, you just keep driving. It’s truly a game of inches.

 We finally got to the church about 11:30 and started to set up. Now by church, I mean a flat 25×25 foot area on a hillside shaded by torn tarps suspended by rough hewn poles. Our ears popped, so I’m guessing we were up about 3,000 feet. There were about 300 people waiting, many moms and kids.

We set up places for 3 providers, a pharmacy, treatment, and to see most of the children. After I presented the gospel to all the moms gathered there, I had a translator and got to talk to everyone who needed to see a doctor after they registered. I asked if the were Christian, and how I could pray for them. These were great conversations. Prayer requests ranged from deliverance to children to a stronger faith. I had two conversations that actually led to first time faith. One was a man who had heard a lot about Jesus and wanted to take the next step. The other was a woman who had miscarried, she believed, because of her involvement with voodoo. I led her through the whole wordless book and prayed as she told God of her faith and asked for forgiveness. I then connected her with a local pastor for more conversation.

We wrapped up about 4 and got home by 6. Yes, we took a different way home!

Haiti (Worship and prep day: April 10)

  

Worship at Good Shepherd Lutheran Church

 
After an interesting breakfast, we loaded up and went to worship at Good Shepherd Lutheran Church. Oh, you were wondering what I meant by interesting? A spicy bean soup, fresh mango and pineapple and croissants. I usually don’t have soup for breakfast, but I’m glad I tried it. Very tasty. Worship was spirited, a familiar liturgy (though in Haitian Creole) and very well attended. One of our translators sat next to me to tell me the scripture readings so I could follow along in my bible. It was fun to try.

After worship we headed out to an orphanage that housed 14 teen boys. It was in great disrepair, but our doc said the boys were fairly healthy. A sad place to be but one that could come alive with a few seeds to plant and some chickens in the yard. Mission:Haiti is exploring the best way to help. 

The orphanage

 From there we got to stop by Lophane’s new guest house, still under construction. It just needs some floors, electrical and plumbing. The roof and stairways were poured concrete. I’m not sure how they do that, but it looked great.

 

Lophane’s guest house

 
Back at Walls guest house, we are a quick lunch and started to prepare our supplies for the week. We counted out hundreds of bags of vitamins and medications, birthing kits, baby kits and hygiene kits. The kits would be used in the education we will present this week. I know you’re wondering: a birthing kit consists of a pad to sit on, gloves, gauze pads, a washcloth, some strings, a razor to cut the umbilical and some instructions. A little teaching goes a long way in helping the people care for themselves. 

 

Some of our supplies

 
Our team brought so much along, including diapers, washcloths, baby clothes, and medication. We’ll be in some remote areas where there ‘s no where to go to buy anything. I wonder how they live off the land there. I guess I’ll find out tomorrow. The pastor of the church there is so excited that we’re coming. We will help him connect with many families for future ministry.

Haiti (day 1: arrival)

  After an uneventful (but very early) flight to Port-au-Prince, we got a ride to Walls Guest House, our home base for the week. After a quick unload of twenty -something fifty pound duffles full of supplies, we rode over to Good Shepherd Lutheran Church to attend the Saturday program, which members from our church support.

It was so good to see our friend Lophane, Pastor Josie and his wife Elise, and listen to the voices of over 160 children in attendance. We also helped serve lunch, then we headed out to a small pizza/burger place for lunch. 

Back at Walls, we were able to catch a nap and relax a little. After a supper of noodles and sauce, we met to go over our plan for the week.

Our team comes from all over the U. S. from teens to retired, some medical providers, some not. Some wide-eyed first timers in Haiti; others have been here eight times or more. 

When we stepped out of the airport today, Lisa and I both thought, “This feels like Haiti.” What’s that mean? It’s hard to say. The air is filled with a smoky, musty, diesel-exhaust smell, Bougenvillas in full bloom are tumbling over every wall and fence, and the ever present sound of car horns fills the air. It’s been five years since my last trip, but it feels familiar. 

The streets are lined with a strange mix of new construction, buildings in disrepair and make shift home in every nook and cranny. We were told that  ecause of inflation, things are actually worse here. Last year’s twenty-dollar bag of rice for the Saturday program now costs $35. 

Church tomorrow, then we sort and organize all our supplies for Monday’s clinic.

Haiti (prequel)

We are headed out to Haiti tomorrow morning with a Mission:Haiti team to a small community not too far from Port-au-Prince called Bien Amie. Google Maps and Earth doesn’t show much out there. Helen, our trip leader, reports that no mission teams have yet been to this area. This will be their first exposure to the medical care and education we can bring to them. Bien Amie 1

It’s been five years since my last trip to Haiti. Where did that time go? The last time we took a group from our church and did a lot of work with Lutheran Schools in the Port-au-Prince area. It will be interesting to see what has been repaired and rebuilt since my last time there and since the earthquake six year ago.

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Madagascar (part 6 – clinic day four in Ambohimponana)

Photo Oct 14, 7 06 33 PMSo many people were quietly waiting when we arrived at the fourth clinic site on Thursday, October 15. It felt calmer and less rushed, but we still saw more than 400 patients.

After clinic, we went to see the oldest Lutheran Chuch in Madagascar, established in 1867. They were in a sanctuary build in 1950. The front of the pulpit was a beautiful carved Luther rose. Every church has a Bible verse arching above the chancel.

Pulpit with Luther Rose

Pulpit with Luther Rose

Oldest Lutheran church in Madagascar

Oldest Lutheran church in Madagascar

 

 

 

 

 

 

 

 

 

We then traveled to a community that housed and cared for 140 mentally-ill, addicted and demon possessed people called Toby (TWO-by). Yes, demon-possessed, as described Pastor Bob Bennett’s book I Am Not Afraid. Some were in chains, to keep them from hurting themselves and others. We went in part to give them some rice and oil, but also to experience this unique situation supported by a number of churches. It was clean and well-kept, but not a place where you really wanted to spend time if you didn’t have to. The Church there was beautiful.

Church at Toby

Church at Toby

Our guides next took us to a small candy making shop where the owners mixed up some Bon Bon Gasy (“Madagascar candy”) for us. We brought home eight flavors.

Upon returning home, Dr. Harison provided a delicious barbecue for all, to say thanks and good-bye. Tomorrow we leave Antsirabe. Altogether we’ve seen over 2,000 patients over four clinic days!

Jane with her interpreter

Jane with her interpreter

Lydia giving a breathing treatment

Lydia giving a breathing treatment

 

Madagascar (part 4 – second clinic day in Ambano)

Waiting for the clinic to open

Waiting for the clinic to open

Tuesday’s clinic ( October 13) was at a Lutheran church in Ambano, only 30 minutes away, a location where a team hadn’t gone before. About 100 people were waiting for us. After a devotion by Pastor Andy, the local pastor, we opened the doors.

We saw 425 patients on day two. Janelle helped us set up a highly-efficient, high volume, assembly-line pharmacy, and we were able to keep up and fill every prescription, finishing up by 3 pm. On this day I had the chance to interact with some of the patients, especially children. Dr. Harison was amazed at how many patients with goiters came through his makeshift office, a concern he would communicate to the local health ministry. Molly had a chance to teach both tooth brushing and hand washing, giving out lots of tooth brushes, toothpaste and soap.

High volume super-efficient pharmacy

High volume super-efficient pharmacy

Since we got done a little earlier, we went to a Jewel market, a long row of little outdoor shops, all selling semi-precious gems. We really didn’t see anything we wanted to buy at this location.

Our next stop was a place where artisans made everything and anything you can imagine from the horns of zebu. We bought a few souvenirs here.

We then went to a little shop where a woman made her own paper which she then crafted into postcards and notecards. She also made silk thread and wove beautiful scarves. We did buy some items here.

Supper was a very well done pork tenderloin, noodles, rice and French fries, along with some watermelon and mango.

After supper, it was more pill packing then off to bed.

Donna at a triage station

Donna at a triage station

Molly at a triage station

Molly at a triage station

Dr Harison at work

Dr Harison at work

The facilities

The facilities

A demonstration of how to make just about anything from a zebu horn

A demonstration of how to make just about anything from a zebu horn

 

 

Madagascar (part three – clinic day one in Antsiriribe)

Photo Oct 11, 8 33 00 PM

Waiting for the clinic to open

Monday (October 12) was our first clinic day in Antsirirabe (not to be confused with Antsirabe, where the Lutheran Hospital is located). After a two-hour drive on OK roads, we went off-road for the last hilly and bumpy final 7 km that took us to a Lutheran Church where the local pastor said 800 people were waiting for us. A team had supplied a clinic here in September, so word must have gotten around. They were gracious and patient as we set up and began to see patients.

The basic flow: (1) sign in, with weight and age; (2) see a nurse for BP and triage (what’s your main concern today?); (3) see a doctor, or Joanna, the NP working here for the year; (4) pick up your prescription at the “pharmacy.” “Pharmacy” is a table with all of our meds spread out, waiting to be put into bags as prescribed. I think we had three triage stations, three providers, and seven of us working in the pharmacy. The other two pastors with us directed traffic from one station to another.

We saw 607 patients that day before we closed up shop at 4:30. I worked as a runner in the pharmacy, taking filled pill bags to Jeanelle, our pharmacist, for a final check, who handed them off to an interpreter to deliver to the patient. I helped restock all the stations where prescriptions were filled. We gave out antibiotics, antifungal cream, analgesics, and many, many, many vitamins.

I thought we were doing very well, until at the end of the day we still had a stack of unfilled prescriptions! Where did they come from? We would need a better system for the next few days. No worries – Jeanelle had a plan for tomorrow. Also, a team would come back next week to fulfill all those prescriptions.

The doctors and Joanna didn’t need interpreters, so we were able to see many patients in a short time. Plus, there weren’t too many severe cases. Mostly headaches, hypertension, asthma (all that dust we were breathing) and infections. A few were referred for further hospital care, but the hospital is several days walk away and fairly expensive. I’m not sure what happened to them.

We had some very well done zebu of supper that night, along with some Three Horses Beer, a native brew of Madagascar. After supper and devotions, we filled hundreds of bags with vitamins and other medications to help facilitate a speedier pharmacy in the morning.

The "pharmacy"

The “pharmacy”

Waiting to pick up medications at the pharamacy

Waiting to pick up medications at the pharmacy

Madagascar (part two – driving to Antsirabe)

It was not, however, so easy getting up at 6 am Sunday morning.

The Hotel Ivato, where we spent our first (short) night.

The Hotel Ivato, where we spent our first (short) night.

There was a little restaurant at the hotel so Lisa and I stopped in for some coffee. The table menu said a cup of coffee was 3,000. Three-thousand what? Ariary, the currency of Madagascar. The exchange rate is about 1 to 3150, so roughly a buck. Tasted like instant to me, but it was OK.

We loaded into the vans and drove about five minutes to a little breakfast place where we had juice, coffe, rolls and omlettes. Not too bad.

A Lutheran church in Antananarivo

A Lutheran church in Antananarivo

Muffler shop

Muffler shop

Because of the drive ahead of us, we weren’t able to attend church. We did stop to peek into the back of a service to hear some of the singing at a Lutheran church. But only for a minute; we had to be on our way.

We headed out through the city and stopped at a service station close to the edge of town, where we discovered a clutch problem with one of the vans. Car repairs are typically done by the side of the road, by a guy with a couple of ramps, a few tools and a propane torch. They could have fixed it, but they didn’t have the right hose. No problem. Just squeeze everyone into two vans rather than three, and we’re on our way.

For the next few hours we drove through rural areas and small towns, filled with sights that reminded me of Kenya. But there were two noticeable differences. Every valley and hillside was terraced with rice paddies. The Asian influence is strong and everyone grows rice. Or, they make bricks. The landscape was lined with rows of bricks drying in the sun and stacks of bricks being fired over charcoal embers. A smoky haze hung in the air everywhere went went in the course of a week. Eventually we got used to breathing the mix of dust, smoke and diesel exhaust.
Bricks being dried and fired

Bricks being dried and fired

We stopped for lunch at a restaurant out in the middle of nowhere surrounded by a field full of pineapple plants. There was no sign out front, so I don’t know the name. We started with plates of foie gras (from ducks, not geese.) I tried some. Eh. Lisa chose to save room for some chicken fried rice. Much better.

The unnamed restaurant

The unnamed restaurant

Foie gras

Foie gras

On the road again

On the road again

It took another two hours to get to the Lutheran Hospital in Antsirabe. Lisa and I sat in the front of th van with the driver for this leg of the trip, and it was terrifying. We passed eighteen-wheel truck both ways on curvy roads barely big enough for two cars. We held on tight; the driver didn’t ven break a sweat. He’d driven this road dozens of times. He knew when to slow down for every pothole. The basic rule for driving here: no brake, lots of horn. We arrived safely and unloaded all our bags into the guest house, cleaned up and gathered in the common room for a supper of some very well done skinny chicken, rice, French fries and ziti. The prepared a ton of food for us. After supper, Dr. Harison took us on a tour of the hospital.

The hospital was rougher than anything I’ve seen for a while. The wards were filled with old beds, some without mattresses, and equipment. There were plenty of patients, many with family there to care for them. Lisa said that the hospital in Haiti was better than this one.

Private room at the hospital - for those who can afford it

Private room at the hospital – for those who can afford it

Nursery at the hospital

Nursery at the hospital

Pediatrics ward

Pediatrics ward

Lisa and I got to room together in the guest house. Our mattress was a simple piece of foam rubber that made you roll towards the center. Screens in the windows and relatively dry conditions made mosquito nets unnecessary. G’night.

 

Antananarivo to Antsirabe

Madagascar (part one – leaving on a jet plane)

All of our bags at DAB. Nice Delta agent photobomb.

All of our bags at DAB. Nice Delta agent photobomb!

The first leg of our flight to Madagascar departed from Daytona Beach for Atlanta at 11:30 am Friday, October 9. We checked six large rolling duffle so of supplies and carried on all our own personal items. The duffle so weighed less than forty pounds each, much less than I expected. No line at the ticket counter and no line at security, so we had plenty of time to wait before boarding. Time for a little snack and some people watching. While I prefer to travel comfortably, some opt for tight skinny jeans, stiletto heels and revealing tops. To each his own.

We had a two hour layover in Atlanta, enough time to grab a Greek salad with chicken in the terminal E courtyard listening to a live alto sax player accompanied by his iPad. Sweet gig. A salad on the way out is pretty important since we probably won’t be eating many vegetables in Madagascar. Anything irrigated with or washed in the local water would be off limits for the next week.

Our next flight, from Atlanta to Paris, would take 8-1/2 hours aboard a full 767. We took off on time at 3:30 pm. The in-flight food of chicken or pasta was average. The complimentary wine was very good. I slept a little, did some reading, and watched the the second Hobbit movie, The Desolation of Smaug. Wifi on board? Though every advertisement said yes, the reality was no. I did catch a glimpse of the business class section, with its little pods where you could lay flat and sleep. Maybe someday.

We're in France...aren't they all "French pastries?"

We’re in France…aren’t they all “French pastries?”

We landed in Paris about 5:45 am and found ourselves in a mostly empty airport. We would eventual rendezvous with the other members of our team, but their flights didn’t begin arriving until 8 am. We walked to what we thought was our connecting gate, and then took a little shuttle to our actual connecting gate. A little coffee shop was open. We had some so-so coffee and croissant, and dozed a little in the gate area.

About 9 am, other people began showing up at the gate, including the members of our team:

  • Pastor Jeff Kuddes, team leader from MO, who had been to Madagascar several times
  • Diane, a nurse from Napa, CA
  • Molly, a nurse from Iowa
  • Tammi, Molly’s mom from Iowa
  • Jane, a nurse practitioner from Wisconsin
  • Samantha, a hopeful mad school student from Wisconsin
  • Christie, a forensic science teacher from Glendale, AZ
  • Jeanelle, a pharmacist fro Phoenix, AZ
  • Peter and Donna fro Oregon. Donna is a nurse and Peter’s a pastor
  • Lydia, a nurse from the Washington DC area

We all had a chance to chat while waiting to board the 777 to Madagascar. (Who knew so many people wanted to travel to Madagascar?) while chatting, we learned that the government had changed some laws, which might prevent some of our nurse practitioners from acting as providers in Madagascar. One rule of trips like this is that you must be flexible.

We departed at 11:30 am and the flight was uneventful. Flying with Delta (Atlanta to Paris) was much nicer than Air France (Paris to Madagascar). Upon reaching 10,000 ft, the flight attendants immediately brought out some iffy-looking food. Then they disappeared and we didn’t see them again until we we began our descent into Antananarivo, when they brought out some iffy-looking breakfast. I do not like them in a plane…I do not like them in the rain…I do not like green eggs and ham.

We touched down in Antananarivo, Madagascar about 11:30 am local time. We had been warned about the long wait at immigration, which indeed took about two hours. All of the three hundred passengers on the plane were funneled to a small glass cubicle containing eight government immigration workers. One took your passport, handed it to one of four people working at computers, who scanned your information and handed it to a third, who stamped it and handed it off to a fourth who signed it and called your name to pick it up. Not efficient, but it provided jobs for eight people.

The blessing of the night: all of our bags arrived with us. As you know, that’s a victory no matter where you are traveling. We loaded up in three vans and drove about 10 minutes to the hotel where we spent the night. It was easy to fall asleep at 2:30 am after about thirty hours of travel.